|
PR PARTIAL EXCISION DISTAL PHALANX FINGER
|
Professional
|
Both
|
$1,272.00
|
|
|
Service Code
|
HCPCS 26236
|
| Min. Negotiated Rate |
$428.45 |
| Max. Negotiated Rate |
$826.80 |
| Rate for Payer: Aetna Commercial |
$574.12
|
| Rate for Payer: Aetna Medicare |
$445.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$574.12
|
| Rate for Payer: BCBS Complete |
$508.80
|
| Rate for Payer: BCBS MAPPO |
$428.45
|
| Rate for Payer: BCN Medicare Advantage |
$428.45
|
| Rate for Payer: Cash Price |
$1,017.60
|
| Rate for Payer: Cash Price |
$1,017.60
|
| Rate for Payer: Cofinity Commercial |
$616.97
|
| Rate for Payer: Cofinity Commercial |
$574.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$428.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$449.87
|
| Rate for Payer: Nomi Health Commercial |
$514.14
|
| Rate for Payer: PACE SWMI |
$428.45
|
| Rate for Payer: PHP Commercial |
$599.83
|
| Rate for Payer: PHP Medicare Advantage |
$428.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$826.80
|
| Rate for Payer: Priority Health Medicare |
$428.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$428.45
|
| Rate for Payer: UHC Medicare Advantage |
$428.45
|
| Rate for Payer: UMR Bronson Commercial |
$585.12
|
|
|
PR PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 26235
|
| Min. Negotiated Rate |
$477.52 |
| Max. Negotiated Rate |
$885.95 |
| Rate for Payer: Aetna Commercial |
$639.88
|
| Rate for Payer: Aetna Medicare |
$496.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$687.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.88
|
| Rate for Payer: BCBS Complete |
$545.20
|
| Rate for Payer: BCBS MAPPO |
$477.52
|
| Rate for Payer: BCN Medicare Advantage |
$477.52
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$687.63
|
| Rate for Payer: Cofinity Commercial |
$639.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$477.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$501.40
|
| Rate for Payer: Nomi Health Commercial |
$573.02
|
| Rate for Payer: PACE SWMI |
$477.52
|
| Rate for Payer: PHP Commercial |
$668.53
|
| Rate for Payer: PHP Medicare Advantage |
$477.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health Medicare |
$477.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$477.52
|
| Rate for Payer: UHC Medicare Advantage |
$477.52
|
| Rate for Payer: UMR Bronson Commercial |
$626.98
|
|
|
PR PARTIAL EXCISION SUPERFICIAL PELVIS
|
Professional
|
Both
|
$1,528.00
|
|
|
Service Code
|
HCPCS 27070
|
| Min. Negotiated Rate |
$611.20 |
| Max. Negotiated Rate |
$1,205.38 |
| Rate for Payer: Aetna Commercial |
$1,121.67
|
| Rate for Payer: Aetna Medicare |
$870.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,205.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,121.67
|
| Rate for Payer: BCBS Complete |
$611.20
|
| Rate for Payer: BCBS MAPPO |
$837.07
|
| Rate for Payer: BCN Medicare Advantage |
$837.07
|
| Rate for Payer: Cash Price |
$1,222.40
|
| Rate for Payer: Cash Price |
$1,222.40
|
| Rate for Payer: Cofinity Commercial |
$1,205.38
|
| Rate for Payer: Cofinity Commercial |
$1,121.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$837.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$878.92
|
| Rate for Payer: Nomi Health Commercial |
$1,004.48
|
| Rate for Payer: PACE SWMI |
$837.07
|
| Rate for Payer: PHP Commercial |
$1,171.90
|
| Rate for Payer: PHP Medicare Advantage |
$837.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$993.20
|
| Rate for Payer: Priority Health Medicare |
$837.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$837.07
|
| Rate for Payer: UHC Medicare Advantage |
$837.07
|
| Rate for Payer: UMR Bronson Commercial |
$702.88
|
|
|
PR PARTIAL HYMENECTOMY OR REVISION HYMENAL RING
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 56700
|
| Min. Negotiated Rate |
$193.26 |
| Max. Negotiated Rate |
$427.05 |
| Rate for Payer: Aetna Commercial |
$258.97
|
| Rate for Payer: Aetna Medicare |
$200.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.97
|
| Rate for Payer: BCBS Complete |
$262.80
|
| Rate for Payer: BCBS MAPPO |
$193.26
|
| Rate for Payer: BCN Medicare Advantage |
$193.26
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$278.29
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.92
|
| Rate for Payer: Nomi Health Commercial |
$231.91
|
| Rate for Payer: PACE SWMI |
$193.26
|
| Rate for Payer: PHP Commercial |
$270.56
|
| Rate for Payer: PHP Medicare Advantage |
$193.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$427.05
|
| Rate for Payer: Priority Health Medicare |
$193.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.26
|
| Rate for Payer: UHC Medicare Advantage |
$193.26
|
| Rate for Payer: UMR Bronson Commercial |
$302.22
|
|
|
PR PARTICAL EXCISION BONE PHALANX TOE
|
Professional
|
Both
|
$914.00
|
|
|
Service Code
|
HCPCS 28124
|
| Min. Negotiated Rate |
$320.80 |
| Max. Negotiated Rate |
$594.10 |
| Rate for Payer: Aetna Commercial |
$429.87
|
| Rate for Payer: Aetna Medicare |
$333.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.87
|
| Rate for Payer: BCBS Complete |
$365.60
|
| Rate for Payer: BCBS MAPPO |
$320.80
|
| Rate for Payer: BCN Medicare Advantage |
$320.80
|
| Rate for Payer: Cash Price |
$731.20
|
| Rate for Payer: Cash Price |
$731.20
|
| Rate for Payer: Cofinity Commercial |
$461.95
|
| Rate for Payer: Cofinity Commercial |
$429.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.84
|
| Rate for Payer: Nomi Health Commercial |
$384.96
|
| Rate for Payer: PACE SWMI |
$320.80
|
| Rate for Payer: PHP Commercial |
$449.12
|
| Rate for Payer: PHP Medicare Advantage |
$320.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$594.10
|
| Rate for Payer: Priority Health Medicare |
$320.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.80
|
| Rate for Payer: UHC Medicare Advantage |
$320.80
|
| Rate for Payer: UMR Bronson Commercial |
$420.44
|
|
|
PR PATELLECTOMY/HEMIPATELLECTOMY
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 27350
|
| Min. Negotiated Rate |
$632.86 |
| Max. Negotiated Rate |
$1,365.65 |
| Rate for Payer: Aetna Commercial |
$848.03
|
| Rate for Payer: Aetna Medicare |
$658.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.03
|
| Rate for Payer: BCBS Complete |
$840.40
|
| Rate for Payer: BCBS MAPPO |
$632.86
|
| Rate for Payer: BCN Medicare Advantage |
$632.86
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cofinity Commercial |
$911.32
|
| Rate for Payer: Cofinity Commercial |
$848.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$632.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$664.50
|
| Rate for Payer: Nomi Health Commercial |
$759.43
|
| Rate for Payer: PACE SWMI |
$632.86
|
| Rate for Payer: PHP Commercial |
$886.00
|
| Rate for Payer: PHP Medicare Advantage |
$632.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,365.65
|
| Rate for Payer: Priority Health Medicare |
$632.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$632.86
|
| Rate for Payer: UHC Medicare Advantage |
$632.86
|
| Rate for Payer: UMR Bronson Commercial |
$966.46
|
|
|
PR PATIENT-INITIATED SPIROMETRIC RECORDING
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 94015
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$40.85 |
| Rate for Payer: Aetna Commercial |
$38.02
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.02
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$28.37
|
| Rate for Payer: BCN Medicare Advantage |
$28.37
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$40.85
|
| Rate for Payer: Cofinity Commercial |
$38.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.79
|
| Rate for Payer: Nomi Health Commercial |
$34.04
|
| Rate for Payer: PACE SWMI |
$28.37
|
| Rate for Payer: PHP Commercial |
$39.72
|
| Rate for Payer: PHP Medicare Advantage |
$28.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$28.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.37
|
| Rate for Payer: UHC Medicare Advantage |
$28.37
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
|
|
PR PCV13 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 90670
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$371.51 |
| Rate for Payer: Aetna Commercial |
$345.71
|
| Rate for Payer: Aetna Medicare |
$268.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.71
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS MAPPO |
$257.99
|
| Rate for Payer: BCN Medicare Advantage |
$257.99
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$371.51
|
| Rate for Payer: Cofinity Commercial |
$345.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.89
|
| Rate for Payer: Nomi Health Commercial |
$309.59
|
| Rate for Payer: PACE SWMI |
$257.99
|
| Rate for Payer: PHP Commercial |
$361.19
|
| Rate for Payer: PHP Medicare Advantage |
$257.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health Medicare |
$257.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.99
|
| Rate for Payer: UHC Medicare Advantage |
$257.99
|
| Rate for Payer: UMR Bronson Commercial |
$133.40
|
|
|
PR PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 90677
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$450.58 |
| Rate for Payer: Aetna Commercial |
$419.29
|
| Rate for Payer: Aetna Medicare |
$325.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.29
|
| Rate for Payer: BCBS Complete |
$158.00
|
| Rate for Payer: BCBS MAPPO |
$312.90
|
| Rate for Payer: BCN Medicare Advantage |
$312.90
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cofinity Commercial |
$450.58
|
| Rate for Payer: Cofinity Commercial |
$419.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.55
|
| Rate for Payer: Nomi Health Commercial |
$375.48
|
| Rate for Payer: PACE SWMI |
$312.90
|
| Rate for Payer: PHP Commercial |
$438.06
|
| Rate for Payer: PHP Medicare Advantage |
$312.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.75
|
| Rate for Payer: Priority Health Medicare |
$312.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$312.90
|
| Rate for Payer: UHC Medicare Advantage |
$312.90
|
| Rate for Payer: UMR Bronson Commercial |
$181.70
|
|
|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ BY PHYS/QHP
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 96573
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$281.45 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Medicare |
$203.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.90
|
| Rate for Payer: BCBS Complete |
$146.00
|
| Rate for Payer: BCBS MAPPO |
$195.45
|
| Rate for Payer: BCN Medicare Advantage |
$195.45
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cofinity Commercial |
$281.45
|
| Rate for Payer: Cofinity Commercial |
$261.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$205.22
|
| Rate for Payer: Nomi Health Commercial |
$234.54
|
| Rate for Payer: PACE SWMI |
$195.45
|
| Rate for Payer: PHP Commercial |
$273.63
|
| Rate for Payer: PHP Medicare Advantage |
$195.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.25
|
| Rate for Payer: Priority Health Medicare |
$195.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$195.45
|
| Rate for Payer: UHC Medicare Advantage |
$195.45
|
| Rate for Payer: UMR Bronson Commercial |
$167.90
|
|
|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ PER DAY
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 96567
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$167.73 |
| Rate for Payer: Aetna Commercial |
$156.08
|
| Rate for Payer: Aetna Medicare |
$121.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.08
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: BCBS MAPPO |
$116.48
|
| Rate for Payer: BCN Medicare Advantage |
$116.48
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$167.73
|
| Rate for Payer: Cofinity Commercial |
$156.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.30
|
| Rate for Payer: Nomi Health Commercial |
$139.78
|
| Rate for Payer: PACE SWMI |
$116.48
|
| Rate for Payer: PHP Commercial |
$163.07
|
| Rate for Payer: PHP Medicare Advantage |
$116.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
| Rate for Payer: Priority Health Medicare |
$116.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.48
|
| Rate for Payer: UHC Medicare Advantage |
$116.48
|
| Rate for Payer: UMR Bronson Commercial |
$100.28
|
|
|
PR PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
HCPCS 38770
|
| Min. Negotiated Rate |
$519.20 |
| Max. Negotiated Rate |
$1,112.44 |
| Rate for Payer: Aetna Commercial |
$1,035.19
|
| Rate for Payer: Aetna Medicare |
$803.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.19
|
| Rate for Payer: BCBS Complete |
$519.20
|
| Rate for Payer: BCBS MAPPO |
$772.53
|
| Rate for Payer: BCN Medicare Advantage |
$772.53
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cofinity Commercial |
$1,112.44
|
| Rate for Payer: Cofinity Commercial |
$1,035.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.16
|
| Rate for Payer: Nomi Health Commercial |
$927.04
|
| Rate for Payer: PACE SWMI |
$772.53
|
| Rate for Payer: PHP Commercial |
$1,081.54
|
| Rate for Payer: PHP Medicare Advantage |
$772.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.70
|
| Rate for Payer: Priority Health Medicare |
$772.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.53
|
| Rate for Payer: UHC Medicare Advantage |
$772.53
|
| Rate for Payer: UMR Bronson Commercial |
$597.08
|
|
|
PR PELVIC EXAMINATION
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 99459
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Medicare |
$19.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.27
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$18.86
|
| Rate for Payer: BCN Medicare Advantage |
$18.86
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$27.16
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.80
|
| Rate for Payer: Nomi Health Commercial |
$22.63
|
| Rate for Payer: PACE SWMI |
$18.86
|
| Rate for Payer: PHP Commercial |
$26.40
|
| Rate for Payer: PHP Medicare Advantage |
$18.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$18.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.86
|
| Rate for Payer: UHC Medicare Advantage |
$18.86
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 57410
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$146.03 |
| Rate for Payer: Aetna Commercial |
$135.89
|
| Rate for Payer: Aetna Medicare |
$105.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.89
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS MAPPO |
$101.41
|
| Rate for Payer: BCN Medicare Advantage |
$101.41
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$146.03
|
| Rate for Payer: Cofinity Commercial |
$135.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.48
|
| Rate for Payer: Nomi Health Commercial |
$121.69
|
| Rate for Payer: PACE SWMI |
$101.41
|
| Rate for Payer: PHP Commercial |
$141.97
|
| Rate for Payer: PHP Medicare Advantage |
$101.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$101.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.41
|
| Rate for Payer: UHC Medicare Advantage |
$101.41
|
| Rate for Payer: UMR Bronson Commercial |
$90.16
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$146.03 |
| Rate for Payer: Aetna Commercial |
$135.89
|
| Rate for Payer: Aetna Medicare |
$105.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.89
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS MAPPO |
$101.41
|
| Rate for Payer: BCN Medicare Advantage |
$101.41
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$135.89
|
| Rate for Payer: Cofinity Commercial |
$146.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.48
|
| Rate for Payer: Nomi Health Commercial |
$121.69
|
| Rate for Payer: PACE SWMI |
$101.41
|
| Rate for Payer: PHP Commercial |
$141.97
|
| Rate for Payer: PHP Medicare Advantage |
$101.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$101.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.41
|
| Rate for Payer: UHC Medicare Advantage |
$101.41
|
| Rate for Payer: UMR Bronson Commercial |
$90.16
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna American Axle |
$127.40
|
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Exchange |
$5,926.19
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,662.10
|
| Rate for Payer: UMR Bronson Commercial |
$72.52
|
| Rate for Payer: VA VA |
$3,100.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$86.24 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna American Axle |
$127.40
|
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: UMR Bronson Commercial |
$86.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
PR PELVIC FIXATION OTHER THAN SACRUM
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
HCPCS 22848
|
| Min. Negotiated Rate |
$349.78 |
| Max. Negotiated Rate |
$1,164.15 |
| Rate for Payer: Aetna Commercial |
$468.71
|
| Rate for Payer: Aetna Medicare |
$363.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.71
|
| Rate for Payer: BCBS Complete |
$716.40
|
| Rate for Payer: BCBS MAPPO |
$349.78
|
| Rate for Payer: BCN Medicare Advantage |
$349.78
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cofinity Commercial |
$503.68
|
| Rate for Payer: Cofinity Commercial |
$468.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.27
|
| Rate for Payer: Nomi Health Commercial |
$419.74
|
| Rate for Payer: PACE SWMI |
$349.78
|
| Rate for Payer: PHP Commercial |
$489.69
|
| Rate for Payer: PHP Medicare Advantage |
$349.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,164.15
|
| Rate for Payer: Priority Health Medicare |
$349.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.78
|
| Rate for Payer: UHC Medicare Advantage |
$349.78
|
| Rate for Payer: UMR Bronson Commercial |
$823.86
|
|
|
PR PELVIC RING FRACTURE UNI/BIL
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS G0413
|
| Min. Negotiated Rate |
$1,026.10 |
| Max. Negotiated Rate |
$2,061.80 |
| Rate for Payer: Aetna Commercial |
$1,374.97
|
| Rate for Payer: Aetna Medicare |
$1,067.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,477.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.97
|
| Rate for Payer: BCBS Complete |
$1,268.80
|
| Rate for Payer: BCBS MAPPO |
$1,026.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,026.10
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cofinity Commercial |
$1,477.58
|
| Rate for Payer: Cofinity Commercial |
$1,374.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,026.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,077.40
|
| Rate for Payer: Nomi Health Commercial |
$1,231.32
|
| Rate for Payer: PACE SWMI |
$1,026.10
|
| Rate for Payer: PHP Commercial |
$1,436.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,026.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health Medicare |
$1,026.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,026.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,459.12
|
|
|
PR PELVIC RING FX TREAT INT FIX
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS G0414
|
| Min. Negotiated Rate |
$968.55 |
| Max. Negotiated Rate |
$2,037.10 |
| Rate for Payer: Aetna Commercial |
$1,297.86
|
| Rate for Payer: Aetna Medicare |
$1,007.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.86
|
| Rate for Payer: BCBS Complete |
$1,253.60
|
| Rate for Payer: BCBS MAPPO |
$968.55
|
| Rate for Payer: BCN Medicare Advantage |
$968.55
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cofinity Commercial |
$1,394.71
|
| Rate for Payer: Cofinity Commercial |
$1,297.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$968.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,016.98
|
| Rate for Payer: Nomi Health Commercial |
$1,162.26
|
| Rate for Payer: PACE SWMI |
$968.55
|
| Rate for Payer: PHP Commercial |
$1,355.97
|
| Rate for Payer: PHP Medicare Advantage |
$968.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
| Rate for Payer: Priority Health Medicare |
$968.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$968.55
|
| Rate for Payer: UHC Medicare Advantage |
$968.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,441.64
|
|
|
PR PENG BENZATHINE/PROCAINE INJ
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J0558
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$28.11 |
| Rate for Payer: Aetna Commercial |
$26.16
|
| Rate for Payer: Aetna Medicare |
$20.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.16
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$19.52
|
| Rate for Payer: BCN Medicare Advantage |
$19.52
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$28.11
|
| Rate for Payer: Cofinity Commercial |
$26.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.50
|
| Rate for Payer: Nomi Health Commercial |
$23.42
|
| Rate for Payer: PACE SWMI |
$19.52
|
| Rate for Payer: PHP Commercial |
$27.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$19.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.52
|
| Rate for Payer: UHC Medicare Advantage |
$19.52
|
| Rate for Payer: UMR Bronson Commercial |
$2.76
|
|
|
PR PENICILLIN G BENZATHINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0561
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$43.21 |
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$30.01
|
| Rate for Payer: BCN Medicare Advantage |
$30.01
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$43.21
|
| Rate for Payer: Cofinity Commercial |
$40.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.51
|
| Rate for Payer: Nomi Health Commercial |
$36.01
|
| Rate for Payer: PACE SWMI |
$30.01
|
| Rate for Payer: PHP Commercial |
$42.01
|
| Rate for Payer: PHP Medicare Advantage |
$30.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$30.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.01
|
| Rate for Payer: UHC Medicare Advantage |
$30.01
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR PENILE PLETHYSMOGRAPHY
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 54240
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$146.26 |
| Rate for Payer: Aetna Commercial |
$136.10
|
| Rate for Payer: Aetna Medicare |
$105.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.10
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$101.57
|
| Rate for Payer: BCN Medicare Advantage |
$101.57
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$146.26
|
| Rate for Payer: Cofinity Commercial |
$136.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.65
|
| Rate for Payer: Nomi Health Commercial |
$121.88
|
| Rate for Payer: PACE SWMI |
$101.57
|
| Rate for Payer: PHP Commercial |
$142.20
|
| Rate for Payer: PHP Medicare Advantage |
$101.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Medicare |
$101.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.57
|
| Rate for Payer: UHC Medicare Advantage |
$101.57
|
| Rate for Payer: UMR Bronson Commercial |
$86.48
|
|
|
PR PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR
|
Professional
|
Both
|
$5,200.00
|
|
|
Service Code
|
HCPCS 54304
|
| Min. Negotiated Rate |
$714.22 |
| Max. Negotiated Rate |
$3,380.00 |
| Rate for Payer: Aetna Commercial |
$957.05
|
| Rate for Payer: Aetna Medicare |
$742.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,028.48
|
| Rate for Payer: BCBS Complete |
$2,080.00
|
| Rate for Payer: BCBS MAPPO |
$714.22
|
| Rate for Payer: BCN Medicare Advantage |
$714.22
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Cofinity Commercial |
$957.05
|
| Rate for Payer: Cofinity Commercial |
$1,028.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$714.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$749.93
|
| Rate for Payer: Nomi Health Commercial |
$857.06
|
| Rate for Payer: PACE SWMI |
$714.22
|
| Rate for Payer: PHP Commercial |
$999.91
|
| Rate for Payer: PHP Medicare Advantage |
$714.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,380.00
|
| Rate for Payer: Priority Health Medicare |
$714.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$714.22
|
| Rate for Payer: UHC Medicare Advantage |
$714.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,392.00
|
|
|
PR PENIS STRAIGHTENING CHORDEE
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS 54300
|
| Min. Negotiated Rate |
$534.40 |
| Max. Negotiated Rate |
$888.48 |
| Rate for Payer: Aetna Commercial |
$826.78
|
| Rate for Payer: Aetna Medicare |
$641.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.78
|
| Rate for Payer: BCBS Complete |
$534.40
|
| Rate for Payer: BCBS MAPPO |
$617.00
|
| Rate for Payer: BCN Medicare Advantage |
$617.00
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cofinity Commercial |
$888.48
|
| Rate for Payer: Cofinity Commercial |
$826.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$617.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.85
|
| Rate for Payer: Nomi Health Commercial |
$740.40
|
| Rate for Payer: PACE SWMI |
$617.00
|
| Rate for Payer: PHP Commercial |
$863.80
|
| Rate for Payer: PHP Medicare Advantage |
$617.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.40
|
| Rate for Payer: Priority Health Medicare |
$617.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$617.00
|
| Rate for Payer: UHC Medicare Advantage |
$617.00
|
| Rate for Payer: UMR Bronson Commercial |
$614.56
|
|
