|
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 EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$1,808.90 |
| Rate for Payer: Aetna Commercial |
$135.89
|
| Rate for Payer: Aetna Medicare |
$105.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.03
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$101.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.90
|
| Rate for Payer: BCN Commercial |
$153.45
|
| 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: Meridian Medicaid |
$71.35
|
| 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 Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.24
|
| Rate for Payer: Priority Health Medicare |
$101.41
|
| Rate for Payer: Priority Health Narrow Network |
$158.24
|
| Rate for Payer: Priority Health SBD |
$158.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.41
|
| Rate for Payer: UHC Medicare Advantage |
$101.41
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
| Rate for Payer: UMR Bronson Commercial |
$90.16
|
|
|
PR PELVIC FIXATION OTHER THAN SACRUM
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
HCPCS 22848
|
| Min. Negotiated Rate |
$65.80 |
| 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) |
$468.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.68
|
| Rate for Payer: BCBS Complete |
$241.32
|
| Rate for Payer: BCBS MAPPO |
$349.78
|
| Rate for Payer: BCBS Trust/PPO |
$65.80
|
| Rate for Payer: BCN Commercial |
$575.20
|
| 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 |
$468.71
|
| Rate for Payer: Cofinity Commercial |
$503.68
|
| 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: Meridian Medicaid |
$241.32
|
| 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 Choice Medicaid |
$229.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,164.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.52
|
| Rate for Payer: Priority Health Medicare |
$349.78
|
| Rate for Payer: Priority Health Narrow Network |
$546.52
|
| Rate for Payer: Priority Health SBD |
$546.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.78
|
| Rate for Payer: UHC Medicare Advantage |
$349.78
|
| Rate for Payer: UHCCP Medicaid |
$229.83
|
| 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 |
$238.26 |
| 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) |
$1,374.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,477.58
|
| Rate for Payer: BCBS Complete |
$723.95
|
| Rate for Payer: BCBS MAPPO |
$1,026.10
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$1,557.90
|
| 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 |
$1,374.97
|
| Rate for Payer: Cofinity Commercial |
$1,477.58
|
| 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: Meridian Medicaid |
$723.95
|
| 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 Choice Medicaid |
$689.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,634.45
|
| Rate for Payer: Priority Health Medicare |
$1,026.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,634.45
|
| Rate for Payer: Priority Health SBD |
$1,634.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,026.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.10
|
| Rate for Payer: UHCCP Medicaid |
$689.48
|
| 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 |
$364.00 |
| 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) |
$1,297.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.71
|
| Rate for Payer: BCBS Complete |
$683.92
|
| Rate for Payer: BCBS MAPPO |
$968.55
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: BCN Commercial |
$1,469.46
|
| 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 |
$1,297.86
|
| Rate for Payer: Cofinity Commercial |
$1,394.71
|
| 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: Meridian Medicaid |
$683.92
|
| 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 Choice Medicaid |
$651.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,542.35
|
| Rate for Payer: Priority Health Medicare |
$968.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,542.35
|
| Rate for Payer: Priority Health SBD |
$1,542.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$968.55
|
| Rate for Payer: UHC Medicare Advantage |
$968.55
|
| Rate for Payer: UHCCP Medicaid |
$651.35
|
| 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 |
$25.01 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.01
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$17.37
|
| Rate for Payer: BCBS Trust/PPO |
$17.90
|
| Rate for Payer: BCN Commercial |
$14.68
|
| Rate for Payer: BCN Medicare Advantage |
$17.37
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$23.27
|
| Rate for Payer: Cofinity Commercial |
$25.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.24
|
| Rate for Payer: Nomi Health Commercial |
$20.84
|
| Rate for Payer: PACE SWMI |
$17.37
|
| Rate for Payer: PHP Commercial |
$24.32
|
| Rate for Payer: PHP Medicare Advantage |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$17.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.37
|
| Rate for Payer: UHC Medicare Advantage |
$17.37
|
| 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 |
$42.19 |
| Rate for Payer: Aetna Commercial |
$39.26
|
| Rate for Payer: Aetna Medicare |
$30.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.19
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$21.19
|
| Rate for Payer: BCN Commercial |
$16.84
|
| Rate for Payer: BCN Medicare Advantage |
$29.30
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$39.26
|
| Rate for Payer: Cofinity Commercial |
$42.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.76
|
| Rate for Payer: Nomi Health Commercial |
$35.16
|
| Rate for Payer: PACE SWMI |
$29.30
|
| Rate for Payer: PHP Commercial |
$41.02
|
| Rate for Payer: PHP Medicare Advantage |
$29.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$29.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.30
|
| Rate for Payer: UHC Medicare Advantage |
$29.30
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR PENILE PLETHYSMOGRAPHY
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 54240
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$680.45 |
| Rate for Payer: Aetna Commercial |
$136.10
|
| Rate for Payer: Aetna Medicare |
$105.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.26
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS MAPPO |
$101.57
|
| Rate for Payer: BCBS Trust/PPO |
$680.45
|
| Rate for Payer: BCN Commercial |
$155.89
|
| 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 |
$136.10
|
| Rate for Payer: Cofinity Commercial |
$146.26
|
| 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: Meridian Medicaid |
$43.17
|
| 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 Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.50
|
| Rate for Payer: Priority Health Medicare |
$101.57
|
| Rate for Payer: Priority Health Narrow Network |
$171.50
|
| Rate for Payer: Priority Health SBD |
$101.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.57
|
| Rate for Payer: UHC Medicare Advantage |
$101.57
|
| Rate for Payer: UHCCP Medicaid |
$41.11
|
| 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 |
$316.45 |
| 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) |
$1,028.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.05
|
| Rate for Payer: BCBS Complete |
$502.76
|
| Rate for Payer: BCBS MAPPO |
$714.22
|
| Rate for Payer: BCBS Trust/PPO |
$316.45
|
| Rate for Payer: BCN Commercial |
$1,078.02
|
| 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 |
$1,028.48
|
| Rate for Payer: Cofinity Commercial |
$957.05
|
| 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: Meridian Medicaid |
$502.76
|
| 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 Choice Medicaid |
$478.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,380.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.82
|
| Rate for Payer: Priority Health Medicare |
$714.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.82
|
| Rate for Payer: Priority Health SBD |
$1,189.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$714.22
|
| Rate for Payer: UHC Medicare Advantage |
$714.22
|
| Rate for Payer: UHCCP Medicaid |
$478.82
|
| 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 |
$311.17 |
| Max. Negotiated Rate |
$1,028.98 |
| Rate for Payer: Aetna Commercial |
$826.78
|
| Rate for Payer: Aetna Medicare |
$641.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.48
|
| Rate for Payer: BCBS Complete |
$435.00
|
| Rate for Payer: BCBS MAPPO |
$617.00
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: BCN Commercial |
$931.42
|
| 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: Meridian Medicaid |
$435.00
|
| 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 Choice Medicaid |
$414.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,028.98
|
| Rate for Payer: Priority Health Medicare |
$617.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,028.98
|
| Rate for Payer: Priority Health SBD |
$1,028.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$617.00
|
| Rate for Payer: UHC Medicare Advantage |
$617.00
|
| Rate for Payer: UHCCP Medicaid |
$414.29
|
| Rate for Payer: UMR Bronson Commercial |
$614.56
|
|
|
PR PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 94642
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$217.66 |
| Rate for Payer: Aetna Commercial |
$46.35
|
| Rate for Payer: Aetna Medicare |
$95.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.35
|
| Rate for Payer: BCBS Complete |
$18.94
|
| Rate for Payer: BCBS Trust/PPO |
$217.66
|
| Rate for Payer: BCN Commercial |
$177.14
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Meridian Medicaid |
$18.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.35
|
| Rate for Payer: Priority Health Narrow Network |
$58.35
|
| Rate for Payer: Priority Health SBD |
$58.35
|
| Rate for Payer: UHCCP Medicaid |
$18.04
|
| Rate for Payer: UMR Bronson Commercial |
$87.40
|
|
|
PR PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 92972
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$201.52 |
| Rate for Payer: Aetna Commercial |
$184.83
|
| Rate for Payer: Aetna Medicare |
$143.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: BCBS Complete |
$96.39
|
| Rate for Payer: BCBS MAPPO |
$137.93
|
| Rate for Payer: BCN Medicare Advantage |
$137.93
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$198.62
|
| Rate for Payer: Cofinity Commercial |
$184.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.83
|
| Rate for Payer: Meridian Medicaid |
$96.39
|
| Rate for Payer: Nomi Health Commercial |
$165.52
|
| Rate for Payer: PACE SWMI |
$137.93
|
| Rate for Payer: PHP Commercial |
$193.10
|
| Rate for Payer: PHP Medicare Advantage |
$137.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.52
|
| Rate for Payer: Priority Health Medicare |
$137.93
|
| Rate for Payer: Priority Health Narrow Network |
$201.52
|
| Rate for Payer: Priority Health SBD |
$201.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.93
|
| Rate for Payer: UHC Medicare Advantage |
$137.93
|
| Rate for Payer: UHCCP Medicaid |
$91.80
|
| Rate for Payer: UMR Bronson Commercial |
$107.18
|
|
|
PR PERCUTANEOUS TX MALAR AREA FRACTURE
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 21355
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$661.18 |
| Rate for Payer: Aetna Commercial |
$418.79
|
| Rate for Payer: Aetna Medicare |
$325.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.79
|
| Rate for Payer: BCBS Complete |
$223.43
|
| Rate for Payer: BCBS MAPPO |
$312.53
|
| Rate for Payer: BCBS Trust/PPO |
$32.75
|
| Rate for Payer: BCN Commercial |
$661.18
|
| Rate for Payer: BCN Medicare Advantage |
$312.53
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$450.04
|
| Rate for Payer: Cofinity Commercial |
$418.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.16
|
| Rate for Payer: Meridian Medicaid |
$223.43
|
| Rate for Payer: Nomi Health Commercial |
$375.04
|
| Rate for Payer: PACE SWMI |
$312.53
|
| Rate for Payer: PHP Commercial |
$437.54
|
| Rate for Payer: PHP Medicare Advantage |
$312.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.34
|
| Rate for Payer: Priority Health Medicare |
$312.53
|
| Rate for Payer: Priority Health Narrow Network |
$507.34
|
| Rate for Payer: Priority Health SBD |
$507.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$312.53
|
| Rate for Payer: UHC Medicare Advantage |
$312.53
|
| Rate for Payer: UHCCP Medicaid |
$212.79
|
| Rate for Payer: UMR Bronson Commercial |
$421.36
|
|
|
PR PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 22522
|
| Min. Negotiated Rate |
$287.60 |
| Max. Negotiated Rate |
$467.35 |
| Rate for Payer: Aetna Medicare |
$359.50
|
| Rate for Payer: BCBS Complete |
$287.60
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
| Rate for Payer: UMR Bronson Commercial |
$330.74
|
|
|
PR PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX
|
Professional
|
Both
|
$5,744.00
|
|
|
Service Code
|
HCPCS 22521
|
| Min. Negotiated Rate |
$2,297.60 |
| Max. Negotiated Rate |
$3,733.60 |
| Rate for Payer: Aetna Medicare |
$2,872.00
|
| Rate for Payer: BCBS Complete |
$2,297.60
|
| Rate for Payer: Cash Price |
$4,595.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,733.60
|
| Rate for Payer: UMR Bronson Commercial |
$2,642.24
|
|
|
PR PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX
|
Professional
|
Both
|
$7,841.00
|
|
|
Service Code
|
HCPCS 22520
|
| Min. Negotiated Rate |
$3,136.40 |
| Max. Negotiated Rate |
$5,096.65 |
| Rate for Payer: Aetna Medicare |
$3,920.50
|
| Rate for Payer: BCBS Complete |
$3,136.40
|
| Rate for Payer: Cash Price |
$6,272.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,096.65
|
| Rate for Payer: UMR Bronson Commercial |
$3,606.86
|
|
|
PR PERCUT DILATN RENAL TRACT
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 50395
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$225.55 |
| Rate for Payer: Aetna Medicare |
$173.50
|
| Rate for Payer: BCBS Complete |
$138.80
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.55
|
| Rate for Payer: UMR Bronson Commercial |
$159.62
|
|
|
PR PERCUT INSERT KIDNEY CATH/DRAIN
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 50392
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$237.25 |
| Rate for Payer: Aetna Medicare |
$182.50
|
| Rate for Payer: BCBS Complete |
$146.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.25
|
| Rate for Payer: UMR Bronson Commercial |
$167.90
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, EA ADD
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 22525
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna Medicare |
$252.50
|
| Rate for Payer: BCBS Complete |
$202.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.25
|
| Rate for Payer: UMR Bronson Commercial |
$232.30
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, LUMBAR
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 22524
|
| Min. Negotiated Rate |
$430.00 |
| Max. Negotiated Rate |
$698.75 |
| Rate for Payer: Aetna Medicare |
$537.50
|
| Rate for Payer: BCBS Complete |
$430.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.75
|
| Rate for Payer: UMR Bronson Commercial |
$494.50
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, THOR
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 22523
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Aetna Medicare |
$570.50
|
| Rate for Payer: BCBS Complete |
$456.40
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.65
|
| Rate for Payer: UMR Bronson Commercial |
$524.86
|
|
|
PR PEREYRA PX W/ANTERIOR COLPORRHAPHY
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 57289
|
| Min. Negotiated Rate |
$508.22 |
| Max. Negotiated Rate |
$2,673.73 |
| Rate for Payer: Aetna Commercial |
$1,015.83
|
| Rate for Payer: Aetna Medicare |
$788.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.64
|
| Rate for Payer: BCBS Complete |
$533.63
|
| Rate for Payer: BCBS MAPPO |
$758.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,673.73
|
| Rate for Payer: BCN Commercial |
$1,165.98
|
| Rate for Payer: BCN Medicare Advantage |
$758.08
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cofinity Commercial |
$1,091.64
|
| Rate for Payer: Cofinity Commercial |
$1,015.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$758.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$795.98
|
| Rate for Payer: Meridian Medicaid |
$533.63
|
| Rate for Payer: Nomi Health Commercial |
$909.70
|
| Rate for Payer: PACE SWMI |
$758.08
|
| Rate for Payer: PHP Commercial |
$1,061.31
|
| Rate for Payer: PHP Medicare Advantage |
$758.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.02
|
| Rate for Payer: Priority Health Medicare |
$758.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.02
|
| Rate for Payer: Priority Health SBD |
$1,189.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$758.08
|
| Rate for Payer: UHC Medicare Advantage |
$758.08
|
| Rate for Payer: UHCCP Medicaid |
$508.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,017.98
|
|
|
PR PERICARDIOCENTESIS INITIAL
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
HCPCS 33010
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$293.15 |
| Rate for Payer: Aetna Medicare |
$225.50
|
| Rate for Payer: BCBS Complete |
$180.40
|
| Rate for Payer: Cash Price |
$360.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.15
|
| Rate for Payer: UMR Bronson Commercial |
$207.46
|
|
|
PR PERICARDIOCENTESIS SUBSEQUENT
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 33011
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$292.50 |
| Rate for Payer: Aetna Medicare |
$225.00
|
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.50
|
| Rate for Payer: UMR Bronson Commercial |
$207.00
|
|
|
PR PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
HCPCS 33016
|
| Min. Negotiated Rate |
$146.76 |
| Max. Negotiated Rate |
$1,116.83 |
| Rate for Payer: Aetna Commercial |
$300.05
|
| Rate for Payer: Aetna Medicare |
$232.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.44
|
| Rate for Payer: BCBS Complete |
$154.10
|
| Rate for Payer: BCBS MAPPO |
$223.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,116.83
|
| Rate for Payer: BCN Commercial |
$335.23
|
| Rate for Payer: BCN Medicare Advantage |
$223.92
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cofinity Commercial |
$300.05
|
| Rate for Payer: Cofinity Commercial |
$322.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.12
|
| Rate for Payer: Meridian Medicaid |
$154.10
|
| Rate for Payer: Nomi Health Commercial |
$268.70
|
| Rate for Payer: PACE SWMI |
$223.92
|
| Rate for Payer: PHP Commercial |
$313.49
|
| Rate for Payer: PHP Medicare Advantage |
$223.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$321.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.37
|
| Rate for Payer: Priority Health Medicare |
$223.92
|
| Rate for Payer: Priority Health Narrow Network |
$365.37
|
| Rate for Payer: Priority Health SBD |
$365.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.92
|
| Rate for Payer: UHC Medicare Advantage |
$223.92
|
| Rate for Payer: UHCCP Medicaid |
$146.76
|
| Rate for Payer: UMR Bronson Commercial |
$227.70
|
|
