|
PR OPTX SHO DISLC W/FX GR HUMERAL TUBRST INT FIXJ
|
Professional
|
Both
|
$2,939.00
|
|
|
Service Code
|
HCPCS 23670
|
| Min. Negotiated Rate |
$196.12 |
| Max. Negotiated Rate |
$1,910.35 |
| Rate for Payer: Aetna Commercial |
$1,130.17
|
| Rate for Payer: Aetna Medicare |
$877.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,130.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,214.51
|
| Rate for Payer: BCBS Complete |
$597.60
|
| Rate for Payer: BCBS MAPPO |
$843.41
|
| Rate for Payer: BCBS Trust/PPO |
$196.12
|
| Rate for Payer: BCN Commercial |
$1,279.85
|
| Rate for Payer: BCN Medicare Advantage |
$843.41
|
| Rate for Payer: Cash Price |
$2,351.20
|
| Rate for Payer: Cash Price |
$2,351.20
|
| Rate for Payer: Cofinity Commercial |
$1,130.17
|
| Rate for Payer: Cofinity Commercial |
$1,214.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$843.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$885.58
|
| Rate for Payer: Meridian Medicaid |
$597.60
|
| Rate for Payer: Nomi Health Commercial |
$1,012.09
|
| Rate for Payer: PACE SWMI |
$843.41
|
| Rate for Payer: PHP Commercial |
$1,180.77
|
| Rate for Payer: PHP Medicare Advantage |
$843.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$569.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,346.95
|
| Rate for Payer: Priority Health Medicare |
$843.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,346.95
|
| Rate for Payer: Priority Health SBD |
$1,346.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$843.41
|
| Rate for Payer: UHC Medicare Advantage |
$843.41
|
| Rate for Payer: UHCCP Medicaid |
$569.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,351.94
|
|
|
PR OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 23680
|
| Min. Negotiated Rate |
$228.81 |
| Max. Negotiated Rate |
$1,419.72 |
| Rate for Payer: Aetna Commercial |
$1,204.45
|
| Rate for Payer: Aetna Medicare |
$934.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,204.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.33
|
| Rate for Payer: BCBS Complete |
$636.29
|
| Rate for Payer: BCBS MAPPO |
$898.84
|
| Rate for Payer: BCBS Trust/PPO |
$228.81
|
| Rate for Payer: BCN Commercial |
$1,365.86
|
| Rate for Payer: BCN Medicare Advantage |
$898.84
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$1,204.45
|
| Rate for Payer: Cofinity Commercial |
$1,294.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$898.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$943.78
|
| Rate for Payer: Meridian Medicaid |
$636.29
|
| Rate for Payer: Nomi Health Commercial |
$1,078.61
|
| Rate for Payer: PACE SWMI |
$898.84
|
| Rate for Payer: PHP Commercial |
$1,258.38
|
| Rate for Payer: PHP Medicare Advantage |
$898.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$605.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,419.72
|
| Rate for Payer: Priority Health Medicare |
$898.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,419.72
|
| Rate for Payer: Priority Health SBD |
$1,419.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$898.84
|
| Rate for Payer: UHC Medicare Advantage |
$898.84
|
| Rate for Payer: UHCCP Medicaid |
$605.99
|
| Rate for Payer: UMR Bronson Commercial |
$761.30
|
|
|
PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 27178
|
| Min. Negotiated Rate |
$600.23 |
| Max. Negotiated Rate |
$1,421.75 |
| Rate for Payer: Aetna Commercial |
$1,192.67
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,192.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,281.67
|
| Rate for Payer: BCBS Complete |
$630.24
|
| Rate for Payer: BCBS MAPPO |
$890.05
|
| Rate for Payer: BCBS Trust/PPO |
$969.43
|
| Rate for Payer: BCN Commercial |
$1,355.11
|
| Rate for Payer: BCN Medicare Advantage |
$890.05
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cofinity Commercial |
$1,192.67
|
| Rate for Payer: Cofinity Commercial |
$1,281.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.55
|
| Rate for Payer: Meridian Medicaid |
$630.24
|
| Rate for Payer: Nomi Health Commercial |
$1,068.06
|
| Rate for Payer: PACE SWMI |
$890.05
|
| Rate for Payer: PHP Commercial |
$1,246.07
|
| Rate for Payer: PHP Medicare Advantage |
$890.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$600.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,421.75
|
| Rate for Payer: Priority Health Medicare |
$890.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,421.75
|
| Rate for Payer: Priority Health SBD |
$1,421.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.05
|
| Rate for Payer: UHC Medicare Advantage |
$890.05
|
| Rate for Payer: UHCCP Medicaid |
$600.23
|
| Rate for Payer: UMR Bronson Commercial |
$757.62
|
|
|
PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ
|
Professional
|
Both
|
$2,351.00
|
|
|
Service Code
|
HCPCS 27181
|
| Min. Negotiated Rate |
$381.43 |
| Max. Negotiated Rate |
$1,722.49 |
| Rate for Payer: Aetna Commercial |
$1,447.17
|
| Rate for Payer: Aetna Medicare |
$1,123.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,447.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,555.17
|
| Rate for Payer: BCBS Complete |
$763.10
|
| Rate for Payer: BCBS MAPPO |
$1,079.98
|
| Rate for Payer: BCBS Trust/PPO |
$381.43
|
| Rate for Payer: BCN Commercial |
$1,640.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,079.98
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cofinity Commercial |
$1,447.17
|
| Rate for Payer: Cofinity Commercial |
$1,555.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,079.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,133.98
|
| Rate for Payer: Meridian Medicaid |
$763.10
|
| Rate for Payer: Nomi Health Commercial |
$1,295.98
|
| Rate for Payer: PACE SWMI |
$1,079.98
|
| Rate for Payer: PHP Commercial |
$1,511.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,079.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$726.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,722.49
|
| Rate for Payer: Priority Health Medicare |
$1,079.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,722.49
|
| Rate for Payer: Priority Health SBD |
$1,722.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,079.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,079.98
|
| Rate for Payer: UHCCP Medicaid |
$726.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,081.46
|
|
|
PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT
|
Professional
|
Both
|
$1,991.00
|
|
|
Service Code
|
HCPCS 27177
|
| Min. Negotiated Rate |
$723.77 |
| Max. Negotiated Rate |
$1,715.37 |
| Rate for Payer: Aetna Commercial |
$1,441.18
|
| Rate for Payer: Aetna Medicare |
$1,118.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,548.73
|
| Rate for Payer: BCBS Complete |
$759.96
|
| Rate for Payer: BCBS MAPPO |
$1,075.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.86
|
| Rate for Payer: BCN Commercial |
$1,635.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,075.51
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cofinity Commercial |
$1,441.18
|
| Rate for Payer: Cofinity Commercial |
$1,548.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,075.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,129.29
|
| Rate for Payer: Meridian Medicaid |
$759.96
|
| Rate for Payer: Nomi Health Commercial |
$1,290.61
|
| Rate for Payer: PACE SWMI |
$1,075.51
|
| Rate for Payer: PHP Commercial |
$1,505.71
|
| Rate for Payer: PHP Medicare Advantage |
$1,075.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$723.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,715.37
|
| Rate for Payer: Priority Health Medicare |
$1,075.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,715.37
|
| Rate for Payer: Priority Health SBD |
$1,715.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,075.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,075.51
|
| Rate for Payer: UHCCP Medicaid |
$723.77
|
| Rate for Payer: UMR Bronson Commercial |
$915.86
|
|
|
PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM
|
Professional
|
Both
|
$1,986.00
|
|
|
Service Code
|
HCPCS 27258
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$2,598.71 |
| Rate for Payer: Aetna Commercial |
$1,435.33
|
| Rate for Payer: Aetna Medicare |
$1,113.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,435.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,542.44
|
| Rate for Payer: BCBS Complete |
$756.39
|
| Rate for Payer: BCBS MAPPO |
$1,071.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,598.71
|
| Rate for Payer: BCN Commercial |
$1,628.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.14
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cofinity Commercial |
$1,435.33
|
| Rate for Payer: Cofinity Commercial |
$1,542.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,124.70
|
| Rate for Payer: Meridian Medicaid |
$756.39
|
| Rate for Payer: Nomi Health Commercial |
$1,285.37
|
| Rate for Payer: PACE SWMI |
$1,071.14
|
| Rate for Payer: PHP Commercial |
$1,499.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,708.24
|
| Rate for Payer: Priority Health Medicare |
$1,071.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,708.24
|
| Rate for Payer: Priority Health SBD |
$1,708.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.14
|
| Rate for Payer: UHCCP Medicaid |
$720.37
|
| Rate for Payer: UMR Bronson Commercial |
$913.56
|
|
|
PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
HCPCS 23532
|
| Min. Negotiated Rate |
$411.73 |
| Max. Negotiated Rate |
$1,389.70 |
| Rate for Payer: Aetna Commercial |
$814.10
|
| Rate for Payer: Aetna Medicare |
$631.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$814.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$874.86
|
| Rate for Payer: BCBS Complete |
$432.32
|
| Rate for Payer: BCBS MAPPO |
$607.54
|
| Rate for Payer: BCBS Trust/PPO |
$525.66
|
| Rate for Payer: BCN Commercial |
$926.54
|
| Rate for Payer: BCN Medicare Advantage |
$607.54
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cofinity Commercial |
$814.10
|
| Rate for Payer: Cofinity Commercial |
$874.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.92
|
| Rate for Payer: Meridian Medicaid |
$432.32
|
| Rate for Payer: Nomi Health Commercial |
$729.05
|
| Rate for Payer: PACE SWMI |
$607.54
|
| Rate for Payer: PHP Commercial |
$850.56
|
| Rate for Payer: PHP Medicare Advantage |
$607.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$973.96
|
| Rate for Payer: Priority Health Medicare |
$607.54
|
| Rate for Payer: Priority Health Narrow Network |
$973.96
|
| Rate for Payer: Priority Health SBD |
$973.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.54
|
| Rate for Payer: UHC Medicare Advantage |
$607.54
|
| Rate for Payer: UHCCP Medicaid |
$411.73
|
| Rate for Payer: UMR Bronson Commercial |
$983.48
|
|
|
PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27536
|
| Min. Negotiated Rate |
$769.57 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$1,533.71
|
| Rate for Payer: Aetna Medicare |
$1,190.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,533.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,648.17
|
| Rate for Payer: BCBS Complete |
$808.05
|
| Rate for Payer: BCBS MAPPO |
$1,144.56
|
| Rate for Payer: BCBS Trust/PPO |
$803.02
|
| Rate for Payer: BCN Commercial |
$1,737.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.56
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,533.71
|
| Rate for Payer: Cofinity Commercial |
$1,648.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,201.79
|
| Rate for Payer: Meridian Medicaid |
$808.05
|
| Rate for Payer: Nomi Health Commercial |
$1,373.47
|
| Rate for Payer: PACE SWMI |
$1,144.56
|
| Rate for Payer: PHP Commercial |
$1,602.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$769.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,823.75
|
| Rate for Payer: Priority Health Medicare |
$1,144.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,823.75
|
| Rate for Payer: Priority Health SBD |
$1,823.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,144.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,144.56
|
| Rate for Payer: UHCCP Medicaid |
$769.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,424.62
|
|
|
PR OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,586.00
|
|
|
Service Code
|
HCPCS 27758
|
| Min. Negotiated Rate |
$583.19 |
| Max. Negotiated Rate |
$2,330.90 |
| Rate for Payer: Aetna Commercial |
$1,158.03
|
| Rate for Payer: Aetna Medicare |
$898.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,158.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,244.45
|
| Rate for Payer: BCBS Complete |
$612.35
|
| Rate for Payer: BCBS MAPPO |
$864.20
|
| Rate for Payer: BCBS Trust/PPO |
$623.39
|
| Rate for Payer: BCN Commercial |
$1,316.50
|
| Rate for Payer: BCN Medicare Advantage |
$864.20
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cofinity Commercial |
$1,244.45
|
| Rate for Payer: Cofinity Commercial |
$1,158.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.41
|
| Rate for Payer: Meridian Medicaid |
$612.35
|
| Rate for Payer: Nomi Health Commercial |
$1,037.04
|
| Rate for Payer: PACE SWMI |
$864.20
|
| Rate for Payer: PHP Commercial |
$1,209.88
|
| Rate for Payer: PHP Medicare Advantage |
$864.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$583.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,330.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,382.57
|
| Rate for Payer: Priority Health Medicare |
$864.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,382.57
|
| Rate for Payer: Priority Health SBD |
$1,382.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$864.20
|
| Rate for Payer: UHC Medicare Advantage |
$864.20
|
| Rate for Payer: UHCCP Medicaid |
$583.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,649.56
|
|
|
PROPYLENE GLYCOL 1 %-GLYCERIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$26.80
|
|
|
Service Code
|
NDC 10119002003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna American Axle |
$17.42
|
| Rate for Payer: Aetna Commercial |
$22.78
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.42
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: Cash Price |
$21.44
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.44
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.78
|
| Rate for Payer: PHP Commercial |
$22.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$16.88
|
| Rate for Payer: UMR Bronson Commercial |
$9.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.10
|
|
|
PROPYLENE GLYCOL 1 %-GLYCERIN 0.3 % EYE DROPS
|
Facility
|
IP
|
$26.80
|
|
|
Service Code
|
NDC 10119002003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna American Axle |
$17.42
|
| Rate for Payer: Aetna Commercial |
$22.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.42
|
| Rate for Payer: Cash Price |
$21.44
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.44
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.78
|
| Rate for Payer: PHP Commercial |
$22.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$16.88
|
| Rate for Payer: UMR Bronson Commercial |
$11.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.10
|
|
|
PROPYLPARABEN (BULK) CRYSTALS
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 38779155105
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna American Axle |
$133.38
|
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: UMR Bronson Commercial |
$75.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
PROPYLPARABEN (BULK) CRYSTALS
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 38779155105
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.29 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna American Axle |
$133.38
|
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$252.48
|
|
|
Service Code
|
NDC 00228234810
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$227.23 |
| Rate for Payer: Aetna American Axle |
$164.11
|
| Rate for Payer: Aetna Commercial |
$214.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.11
|
| Rate for Payer: Cash Price |
$201.98
|
| Rate for Payer: Cofinity Commercial |
$176.74
|
| Rate for Payer: Cofinity Commercial |
$217.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.98
|
| Rate for Payer: Healthscope Commercial |
$227.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.61
|
| Rate for Payer: PHP Commercial |
$214.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.11
|
| Rate for Payer: Priority Health SBD |
$159.06
|
| Rate for Payer: UMR Bronson Commercial |
$111.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.36
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
OP
|
$252.48
|
|
|
Service Code
|
NDC 00228234810
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.42 |
| Max. Negotiated Rate |
$227.23 |
| Rate for Payer: Aetna American Axle |
$164.11
|
| Rate for Payer: Aetna Commercial |
$214.61
|
| Rate for Payer: Aetna Medicare |
$126.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.11
|
| Rate for Payer: BCBS Complete |
$100.99
|
| Rate for Payer: Cash Price |
$201.98
|
| Rate for Payer: Cofinity Commercial |
$176.74
|
| Rate for Payer: Cofinity Commercial |
$217.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.98
|
| Rate for Payer: Healthscope Commercial |
$227.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.61
|
| Rate for Payer: PHP Commercial |
$214.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.11
|
| Rate for Payer: Priority Health SBD |
$159.06
|
| Rate for Payer: UMR Bronson Commercial |
$93.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.36
|
|
|
PR ORAL DEXAMETHASONE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J8540
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.02
|
| Rate for Payer: Aetna Medicare |
$0.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.02
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.02
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.02
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Cofinity Commercial |
$0.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.02
|
| Rate for Payer: Nomi Health Commercial |
$0.02
|
| Rate for Payer: PACE SWMI |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.02
|
| Rate for Payer: PHP Medicare Advantage |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.02
|
| Rate for Payer: UHC Medicare Advantage |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
|
|
PR ORAL POLIOVIRUS IMMUNIZATN,LIVE,OPC
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 90712
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
|
|
PR ORAL PRESCRIP DRUG NON CHEMO
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J8499
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
|
|
PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 95933
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$120.21 |
| Rate for Payer: Aetna Commercial |
$97.50
|
| Rate for Payer: Aetna Medicare |
$75.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: BCBS Complete |
$20.58
|
| Rate for Payer: BCBS MAPPO |
$72.76
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCN Commercial |
$120.21
|
| Rate for Payer: BCN Medicare Advantage |
$72.76
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$104.77
|
| Rate for Payer: Cofinity Commercial |
$97.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.40
|
| Rate for Payer: Meridian Medicaid |
$20.58
|
| Rate for Payer: Nomi Health Commercial |
$87.31
|
| Rate for Payer: PACE SWMI |
$72.76
|
| Rate for Payer: PHP Commercial |
$101.86
|
| Rate for Payer: PHP Medicare Advantage |
$72.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.72
|
| Rate for Payer: Priority Health Medicare |
$72.76
|
| Rate for Payer: Priority Health Narrow Network |
$111.72
|
| Rate for Payer: Priority Health SBD |
$41.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.76
|
| Rate for Payer: UHC Medicare Advantage |
$72.76
|
| Rate for Payer: UHCCP Medicaid |
$19.60
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ
|
Professional
|
Both
|
$7,956.00
|
|
|
Service Code
|
HCPCS 61584
|
| Min. Negotiated Rate |
$420.53 |
| Max. Negotiated Rate |
$5,935.30 |
| Rate for Payer: BCBS Trust/PPO |
$420.53
|
| Rate for Payer: Aetna Commercial |
$3,755.54
|
| Rate for Payer: Aetna Medicare |
$2,914.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,755.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,035.80
|
| Rate for Payer: BCBS Complete |
$1,951.79
|
| Rate for Payer: BCBS MAPPO |
$2,802.64
|
| Rate for Payer: BCN Commercial |
$5,935.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,802.64
|
| Rate for Payer: Cash Price |
$6,364.80
|
| Rate for Payer: Cash Price |
$6,364.80
|
| Rate for Payer: Cofinity Commercial |
$3,755.54
|
| Rate for Payer: Cofinity Commercial |
$4,035.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,802.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,942.77
|
| Rate for Payer: Meridian Medicaid |
$1,951.79
|
| Rate for Payer: Nomi Health Commercial |
$3,363.17
|
| Rate for Payer: PACE SWMI |
$2,802.64
|
| Rate for Payer: PHP Commercial |
$3,923.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,802.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,858.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,171.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,960.91
|
| Rate for Payer: Priority Health Medicare |
$2,802.64
|
| Rate for Payer: Priority Health Narrow Network |
$4,960.91
|
| Rate for Payer: Priority Health SBD |
$4,960.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,802.64
|
| Rate for Payer: UHC Medicare Advantage |
$2,802.64
|
| Rate for Payer: UHCCP Medicaid |
$1,858.85
|
| Rate for Payer: UMR Bronson Commercial |
$3,659.76
|
|
|
PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE
|
Professional
|
Both
|
$5,759.00
|
|
|
Service Code
|
HCPCS 61592
|
| Min. Negotiated Rate |
$397.28 |
| Max. Negotiated Rate |
$6,472.23 |
| Rate for Payer: Aetna Commercial |
$4,132.02
|
| Rate for Payer: Aetna Medicare |
$3,206.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,132.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,440.38
|
| Rate for Payer: BCBS Complete |
$2,141.45
|
| Rate for Payer: BCBS MAPPO |
$3,083.60
|
| Rate for Payer: BCBS Trust/PPO |
$397.28
|
| Rate for Payer: BCN Commercial |
$6,472.23
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.60
|
| Rate for Payer: Cash Price |
$4,607.20
|
| Rate for Payer: Cash Price |
$4,607.20
|
| Rate for Payer: Cofinity Commercial |
$4,132.02
|
| Rate for Payer: Cofinity Commercial |
$4,440.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,237.78
|
| Rate for Payer: Meridian Medicaid |
$2,141.45
|
| Rate for Payer: Nomi Health Commercial |
$3,700.32
|
| Rate for Payer: PACE SWMI |
$3,083.60
|
| Rate for Payer: PHP Commercial |
$4,317.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,039.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,743.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,463.65
|
| Rate for Payer: Priority Health Medicare |
$3,083.60
|
| Rate for Payer: Priority Health Narrow Network |
$5,463.65
|
| Rate for Payer: Priority Health SBD |
$5,463.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.60
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.60
|
| Rate for Payer: UHCCP Medicaid |
$2,039.48
|
| Rate for Payer: UMR Bronson Commercial |
$2,649.14
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN
|
Professional
|
Both
|
$3,588.00
|
|
|
Service Code
|
HCPCS 67445
|
| Min. Negotiated Rate |
$348.68 |
| Max. Negotiated Rate |
$2,661.32 |
| Rate for Payer: Aetna Commercial |
$1,869.29
|
| Rate for Payer: Aetna Medicare |
$1,450.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,869.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,008.79
|
| Rate for Payer: BCBS Complete |
$1,006.42
|
| Rate for Payer: BCBS MAPPO |
$1,394.99
|
| Rate for Payer: BCBS Trust/PPO |
$348.68
|
| Rate for Payer: BCN Commercial |
$2,217.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,394.99
|
| Rate for Payer: Cash Price |
$2,870.40
|
| Rate for Payer: Cash Price |
$2,870.40
|
| Rate for Payer: Cofinity Commercial |
$1,869.29
|
| Rate for Payer: Cofinity Commercial |
$2,008.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,394.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,464.74
|
| Rate for Payer: Meridian Medicaid |
$1,006.42
|
| Rate for Payer: Nomi Health Commercial |
$1,673.99
|
| Rate for Payer: PACE SWMI |
$1,394.99
|
| Rate for Payer: PHP Commercial |
$1,952.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,394.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$958.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,661.32
|
| Rate for Payer: Priority Health Medicare |
$1,394.99
|
| Rate for Payer: Priority Health Narrow Network |
$2,661.32
|
| Rate for Payer: Priority Health SBD |
$2,661.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,394.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,394.99
|
| Rate for Payer: UHCCP Medicaid |
$958.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,650.48
|
|
|
PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY
|
Professional
|
Both
|
$1,662.00
|
|
|
Service Code
|
HCPCS 67400
|
| Min. Negotiated Rate |
$359.77 |
| Max. Negotiated Rate |
$1,809.71 |
| Rate for Payer: Aetna Commercial |
$1,258.73
|
| Rate for Payer: Aetna Medicare |
$976.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,352.66
|
| Rate for Payer: BCBS Complete |
$682.80
|
| Rate for Payer: BCBS MAPPO |
$939.35
|
| Rate for Payer: BCBS Trust/PPO |
$359.77
|
| Rate for Payer: BCN Commercial |
$1,509.04
|
| Rate for Payer: BCN Medicare Advantage |
$939.35
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cofinity Commercial |
$1,258.73
|
| Rate for Payer: Cofinity Commercial |
$1,352.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$986.32
|
| Rate for Payer: Meridian Medicaid |
$682.80
|
| Rate for Payer: Nomi Health Commercial |
$1,127.22
|
| Rate for Payer: PACE SWMI |
$939.35
|
| Rate for Payer: PHP Commercial |
$1,315.09
|
| Rate for Payer: PHP Medicare Advantage |
$939.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$650.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,809.71
|
| Rate for Payer: Priority Health Medicare |
$939.35
|
| Rate for Payer: Priority Health Narrow Network |
$1,809.71
|
| Rate for Payer: Priority Health SBD |
$1,809.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.35
|
| Rate for Payer: UHC Medicare Advantage |
$939.35
|
| Rate for Payer: UHCCP Medicaid |
$650.29
|
| Rate for Payer: UMR Bronson Commercial |
$764.52
|
|
|
PR ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 67413
|
| Min. Negotiated Rate |
$604.07 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Commercial |
$1,168.43
|
| Rate for Payer: Aetna Medicare |
$906.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,168.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,255.62
|
| Rate for Payer: BCBS Complete |
$634.27
|
| Rate for Payer: BCBS MAPPO |
$871.96
|
| Rate for Payer: BCN Commercial |
$1,407.88
|
| Rate for Payer: BCN Medicare Advantage |
$871.96
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,168.43
|
| Rate for Payer: Cofinity Commercial |
$1,255.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$871.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.56
|
| Rate for Payer: Meridian Medicaid |
$634.27
|
| Rate for Payer: Nomi Health Commercial |
$1,046.35
|
| Rate for Payer: PACE SWMI |
$871.96
|
| Rate for Payer: PHP Commercial |
$1,220.74
|
| Rate for Payer: PHP Medicare Advantage |
$871.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$604.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,682.19
|
| Rate for Payer: Priority Health Medicare |
$871.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,682.19
|
| Rate for Payer: Priority Health SBD |
$1,682.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$871.96
|
| Rate for Payer: UHC Medicare Advantage |
$871.96
|
| Rate for Payer: UHCCP Medicaid |
$604.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,219.92
|
|
|
PR ORCHIECTOMY PARTIAL
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS 54522
|
| Min. Negotiated Rate |
$377.44 |
| Max. Negotiated Rate |
$1,501.96 |
| Rate for Payer: Aetna Commercial |
$753.44
|
| Rate for Payer: Aetna Medicare |
$584.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$753.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.67
|
| Rate for Payer: BCBS Complete |
$396.31
|
| Rate for Payer: BCBS MAPPO |
$562.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,501.96
|
| Rate for Payer: BCN Commercial |
$848.84
|
| Rate for Payer: BCN Medicare Advantage |
$562.27
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cofinity Commercial |
$753.44
|
| Rate for Payer: Cofinity Commercial |
$809.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$562.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$590.38
|
| Rate for Payer: Meridian Medicaid |
$396.31
|
| Rate for Payer: Nomi Health Commercial |
$674.72
|
| Rate for Payer: PACE SWMI |
$562.27
|
| Rate for Payer: PHP Commercial |
$787.18
|
| Rate for Payer: PHP Medicare Advantage |
$562.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$937.38
|
| Rate for Payer: Priority Health Medicare |
$562.27
|
| Rate for Payer: Priority Health Narrow Network |
$937.38
|
| Rate for Payer: Priority Health SBD |
$937.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$562.27
|
| Rate for Payer: UHC Medicare Advantage |
$562.27
|
| Rate for Payer: UHCCP Medicaid |
$377.44
|
| Rate for Payer: UMR Bronson Commercial |
$507.38
|
|
