|
PR REVSC EVASC TPVT ANGIOP UNI CPLX LES EA ADDL VSL
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 37283
|
| Min. Negotiated Rate |
$122.26 |
| Max. Negotiated Rate |
$357.55 |
| Rate for Payer: Aetna Commercial |
$260.32
|
| Rate for Payer: Aetna Medicare |
$202.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.75
|
| Rate for Payer: BCBS Complete |
$128.37
|
| Rate for Payer: BCBS MAPPO |
$194.27
|
| Rate for Payer: BCN Medicare Advantage |
$194.27
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$279.75
|
| Rate for Payer: Cofinity Commercial |
$260.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$194.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.98
|
| Rate for Payer: Meridian Medicaid |
$128.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$213.70
|
| Rate for Payer: Nomi Health Commercial |
$233.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.75
|
| Rate for Payer: PACE SWMI |
$194.27
|
| Rate for Payer: PHP Commercial |
$271.98
|
| Rate for Payer: PHP Medicare Advantage |
$194.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$282.19
|
| Rate for Payer: Priority Health Medicare |
$194.27
|
| Rate for Payer: Priority Health SBD |
$282.19
|
| Rate for Payer: Priority Health Tiered Network |
$282.19
|
| Rate for Payer: Railroad Medicare Medicare |
$194.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.55
|
| Rate for Payer: UHC Core |
$357.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$194.27
|
| Rate for Payer: UHC Exchange |
$357.55
|
| Rate for Payer: UHC Medicaid |
$122.26
|
| Rate for Payer: UHCCP Medicaid |
$122.26
|
| Rate for Payer: UMR Bronson Commercial |
$166.06
|
|
|
PR REVSC EVASC TPVT ANGIOP UNI SF LES 1ST VSL
|
Professional
|
Both
|
$1,134.00
|
|
|
Service Code
|
HCPCS 37280
|
| Min. Negotiated Rate |
$285.42 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Aetna Commercial |
$608.07
|
| Rate for Payer: Aetna Medicare |
$471.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.44
|
| Rate for Payer: BCBS Complete |
$299.69
|
| Rate for Payer: BCBS MAPPO |
$453.78
|
| Rate for Payer: BCN Medicare Advantage |
$453.78
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cash Price |
$907.20
|
| Rate for Payer: Cofinity Commercial |
$653.44
|
| Rate for Payer: Cofinity Commercial |
$608.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$476.47
|
| Rate for Payer: Meridian Medicaid |
$299.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$499.16
|
| Rate for Payer: Nomi Health Commercial |
$544.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$850.50
|
| Rate for Payer: PACE SWMI |
$453.78
|
| Rate for Payer: PHP Commercial |
$635.29
|
| Rate for Payer: PHP Medicare Advantage |
$453.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$285.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$659.93
|
| Rate for Payer: Priority Health Medicare |
$453.78
|
| Rate for Payer: Priority Health SBD |
$659.93
|
| Rate for Payer: Priority Health Tiered Network |
$659.93
|
| Rate for Payer: Railroad Medicare Medicare |
$453.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$834.43
|
| Rate for Payer: UHC Core |
$834.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$453.78
|
| Rate for Payer: UHC Exchange |
$834.43
|
| Rate for Payer: UHC Medicaid |
$285.42
|
| Rate for Payer: UHCCP Medicaid |
$285.42
|
| Rate for Payer: UMR Bronson Commercial |
$521.64
|
|
|
PR REVSC EVASC TPVT ANGIOP UNI SF LES EA ADDL VSL
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 37281
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$255.75 |
| Rate for Payer: Aetna Commercial |
$182.74
|
| Rate for Payer: Aetna Medicare |
$141.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.37
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$136.37
|
| Rate for Payer: BCN Medicare Advantage |
$136.37
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cofinity Commercial |
$196.37
|
| Rate for Payer: Cofinity Commercial |
$182.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.19
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.01
|
| Rate for Payer: Nomi Health Commercial |
$163.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.75
|
| Rate for Payer: PACE SWMI |
$136.37
|
| Rate for Payer: PHP Commercial |
$190.92
|
| Rate for Payer: PHP Medicare Advantage |
$136.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$198.47
|
| Rate for Payer: Priority Health Medicare |
$136.37
|
| Rate for Payer: Priority Health SBD |
$198.47
|
| Rate for Payer: Priority Health Tiered Network |
$198.47
|
| Rate for Payer: Railroad Medicare Medicare |
$136.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.05
|
| Rate for Payer: UHC Core |
$251.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$136.37
|
| Rate for Payer: UHC Exchange |
$251.05
|
| Rate for Payer: UHC Medicaid |
$85.84
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
| Rate for Payer: UMR Bronson Commercial |
$156.86
|
|
|
PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,098.00
|
|
|
Service Code
|
HCPCS 37224
|
| Min. Negotiated Rate |
$439.20 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Aetna Commercial |
$598.07
|
| Rate for Payer: Aetna Medicare |
$549.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.07
|
| Rate for Payer: BCBS Complete |
$439.20
|
| Rate for Payer: BCN Commercial |
$645.38
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$823.50
|
| Rate for Payer: UMR Bronson Commercial |
$505.08
|
|
|
PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,387.00
|
|
|
Service Code
|
HCPCS 37225
|
| Min. Negotiated Rate |
$809.21 |
| Max. Negotiated Rate |
$1,790.25 |
| Rate for Payer: Aetna Commercial |
$809.21
|
| Rate for Payer: Aetna Medicare |
$1,193.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.21
|
| Rate for Payer: BCBS Complete |
$954.80
|
| Rate for Payer: BCN Commercial |
$865.99
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: Cash Price |
$1,909.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,790.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,098.02
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
HCPCS 37226
|
| Min. Negotiated Rate |
$476.00 |
| Max. Negotiated Rate |
$892.50 |
| Rate for Payer: Aetna Commercial |
$699.45
|
| Rate for Payer: Aetna Medicare |
$595.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$699.45
|
| Rate for Payer: BCBS Complete |
$476.00
|
| Rate for Payer: BCN Commercial |
$753.44
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Cash Price |
$952.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$892.50
|
| Rate for Payer: UMR Bronson Commercial |
$547.40
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,026.00
|
|
|
Service Code
|
HCPCS 37227
|
| Min. Negotiated Rate |
$810.40 |
| Max. Negotiated Rate |
$1,519.50 |
| Rate for Payer: Aetna Commercial |
$970.23
|
| Rate for Payer: Aetna Medicare |
$1,013.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.23
|
| Rate for Payer: BCBS Complete |
$810.40
|
| Rate for Payer: BCN Commercial |
$1,038.79
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,519.50
|
| Rate for Payer: UMR Bronson Commercial |
$931.96
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 37223
|
| Min. Negotiated Rate |
$205.60 |
| Max. Negotiated Rate |
$385.50 |
| Rate for Payer: Aetna Commercial |
$286.46
|
| Rate for Payer: Aetna Medicare |
$257.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.46
|
| Rate for Payer: BCBS Complete |
$205.60
|
| Rate for Payer: BCN Commercial |
$307.76
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$385.50
|
| Rate for Payer: UMR Bronson Commercial |
$236.44
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY
|
Professional
|
Both
|
$2,083.00
|
|
|
Service Code
|
HCPCS 37221
|
| Min. Negotiated Rate |
$664.33 |
| Max. Negotiated Rate |
$1,562.25 |
| Rate for Payer: Aetna Commercial |
$664.33
|
| Rate for Payer: Aetna Medicare |
$1,041.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$664.33
|
| Rate for Payer: BCBS Complete |
$833.20
|
| Rate for Payer: BCN Commercial |
$715.60
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,562.25
|
| Rate for Payer: UMR Bronson Commercial |
$958.18
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
HCPCS 37228
|
| Min. Negotiated Rate |
$537.60 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$728.29
|
| Rate for Payer: Aetna Medicare |
$672.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.29
|
| Rate for Payer: BCBS Complete |
$537.60
|
| Rate for Payer: BCN Commercial |
$785.81
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,008.00
|
| Rate for Payer: UMR Bronson Commercial |
$618.24
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL
|
Professional
|
Both
|
$4,482.00
|
|
|
Service Code
|
HCPCS 37232
|
| Min. Negotiated Rate |
$268.20 |
| Max. Negotiated Rate |
$3,361.50 |
| Rate for Payer: Aetna Commercial |
$268.20
|
| Rate for Payer: Aetna Medicare |
$2,241.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.20
|
| Rate for Payer: BCBS Complete |
$1,792.80
|
| Rate for Payer: BCN Commercial |
$288.83
|
| Rate for Payer: Cash Price |
$3,585.60
|
| Rate for Payer: Cash Price |
$3,585.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,361.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,061.72
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,815.00
|
|
|
Service Code
|
HCPCS 37229
|
| Min. Negotiated Rate |
$937.57 |
| Max. Negotiated Rate |
$2,111.25 |
| Rate for Payer: Aetna Commercial |
$937.57
|
| Rate for Payer: Aetna Medicare |
$1,407.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$937.57
|
| Rate for Payer: BCBS Complete |
$1,126.00
|
| Rate for Payer: BCN Commercial |
$1,005.42
|
| Rate for Payer: Cash Price |
$2,252.00
|
| Rate for Payer: Cash Price |
$2,252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,111.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,294.90
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 37233
|
| Min. Negotiated Rate |
$437.50 |
| Max. Negotiated Rate |
$881.25 |
| Rate for Payer: Aetna Commercial |
$437.50
|
| Rate for Payer: Aetna Medicare |
$587.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.50
|
| Rate for Payer: BCBS Complete |
$470.00
|
| Rate for Payer: BCN Commercial |
$467.60
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$881.25
|
| Rate for Payer: UMR Bronson Commercial |
$540.50
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$2,821.00
|
|
|
Service Code
|
HCPCS 37230
|
| Min. Negotiated Rate |
$935.98 |
| Max. Negotiated Rate |
$2,115.75 |
| Rate for Payer: Aetna Commercial |
$935.98
|
| Rate for Payer: Aetna Medicare |
$1,410.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$935.98
|
| Rate for Payer: BCBS Complete |
$1,128.40
|
| Rate for Payer: BCN Commercial |
$1,009.41
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,115.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,297.66
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
HCPCS 37234
|
| Min. Negotiated Rate |
$214.40 |
| Max. Negotiated Rate |
$408.84 |
| Rate for Payer: Aetna Commercial |
$383.02
|
| Rate for Payer: Aetna Medicare |
$268.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.02
|
| Rate for Payer: BCBS Complete |
$214.40
|
| Rate for Payer: BCN Commercial |
$408.84
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$402.00
|
| Rate for Payer: UMR Bronson Commercial |
$246.56
|
|
|
PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR
|
Professional
|
Both
|
$2,538.00
|
|
|
Service Code
|
HCPCS 30420
|
| Min. Negotiated Rate |
$836.88 |
| Max. Negotiated Rate |
$2,420.04 |
| Rate for Payer: Aetna Commercial |
$1,693.85
|
| Rate for Payer: Aetna Medicare |
$1,314.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,693.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,820.26
|
| Rate for Payer: BCBS Complete |
$878.72
|
| Rate for Payer: BCBS MAPPO |
$1,264.07
|
| Rate for Payer: BCN Commercial |
$2,154.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,264.07
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cash Price |
$2,030.40
|
| Rate for Payer: Cofinity Commercial |
$1,693.85
|
| Rate for Payer: Cofinity Commercial |
$1,820.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,264.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,327.27
|
| Rate for Payer: Meridian Medicaid |
$878.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,390.48
|
| Rate for Payer: Nomi Health Commercial |
$1,516.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,903.50
|
| Rate for Payer: PACE SWMI |
$1,264.07
|
| Rate for Payer: PHP Commercial |
$1,769.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,264.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,028.68
|
| Rate for Payer: Priority Health Medicare |
$1,264.07
|
| Rate for Payer: Priority Health SBD |
$2,028.68
|
| Rate for Payer: Priority Health Tiered Network |
$2,028.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1,264.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,420.04
|
| Rate for Payer: UHC Core |
$2,420.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,264.07
|
| Rate for Payer: UHC Exchange |
$2,420.04
|
| Rate for Payer: UHC Medicaid |
$836.88
|
| Rate for Payer: UHCCP Medicaid |
$836.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,167.48
|
|
|
PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION
|
Professional
|
Both
|
$2,091.00
|
|
|
Service Code
|
HCPCS 30435
|
| Min. Negotiated Rate |
$823.03 |
| Max. Negotiated Rate |
$2,241.87 |
| Rate for Payer: Aetna Commercial |
$1,649.62
|
| Rate for Payer: Aetna Medicare |
$1,280.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,649.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,772.73
|
| Rate for Payer: BCBS Complete |
$864.18
|
| Rate for Payer: BCBS MAPPO |
$1,231.06
|
| Rate for Payer: BCN Commercial |
$1,999.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,231.06
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cash Price |
$1,672.80
|
| Rate for Payer: Cofinity Commercial |
$1,649.62
|
| Rate for Payer: Cofinity Commercial |
$1,772.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,231.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,292.61
|
| Rate for Payer: Meridian Medicaid |
$864.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,354.17
|
| Rate for Payer: Nomi Health Commercial |
$1,477.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,568.25
|
| Rate for Payer: PACE SWMI |
$1,231.06
|
| Rate for Payer: PHP Commercial |
$1,723.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,231.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$823.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,883.31
|
| Rate for Payer: Priority Health Medicare |
$1,231.06
|
| Rate for Payer: Priority Health SBD |
$1,883.31
|
| Rate for Payer: Priority Health Tiered Network |
$1,883.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,231.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,241.87
|
| Rate for Payer: UHC Core |
$2,241.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,231.06
|
| Rate for Payer: UHC Exchange |
$2,241.87
|
| Rate for Payer: UHC Medicaid |
$823.03
|
| Rate for Payer: UHCCP Medicaid |
$823.03
|
| Rate for Payer: UMR Bronson Commercial |
$961.86
|
|
|
PR RHINOPLASTY SECONDARY MAJOR REVISION
|
Professional
|
Both
|
$3,605.00
|
|
|
Service Code
|
HCPCS 30450
|
| Min. Negotiated Rate |
$1,046.26 |
| Max. Negotiated Rate |
$2,985.13 |
| Rate for Payer: Aetna Commercial |
$2,116.28
|
| Rate for Payer: Aetna Medicare |
$1,642.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,116.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,274.21
|
| Rate for Payer: BCBS Complete |
$1,098.57
|
| Rate for Payer: BCBS MAPPO |
$1,579.31
|
| Rate for Payer: BCN Commercial |
$2,616.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,579.31
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cofinity Commercial |
$2,116.28
|
| Rate for Payer: Cofinity Commercial |
$2,274.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,579.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,658.28
|
| Rate for Payer: Meridian Medicaid |
$1,098.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,737.24
|
| Rate for Payer: Nomi Health Commercial |
$1,895.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,703.75
|
| Rate for Payer: PACE SWMI |
$1,579.31
|
| Rate for Payer: PHP Commercial |
$2,211.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,579.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,046.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,464.34
|
| Rate for Payer: Priority Health Medicare |
$1,579.31
|
| Rate for Payer: Priority Health SBD |
$2,464.34
|
| Rate for Payer: Priority Health Tiered Network |
$2,464.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,579.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,985.13
|
| Rate for Payer: UHC Core |
$2,985.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,579.31
|
| Rate for Payer: UHC Exchange |
$2,985.13
|
| Rate for Payer: UHC Medicaid |
$1,046.26
|
| Rate for Payer: UHCCP Medicaid |
$1,046.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,658.30
|
|
|
PR RHINP DFRM W/COLUM LNGTH TIP ONLY
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 30460
|
| Min. Negotiated Rate |
$489.47 |
| Max. Negotiated Rate |
$1,436.74 |
| Rate for Payer: Aetna Commercial |
$996.29
|
| Rate for Payer: Aetna Medicare |
$773.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$996.29
|
| Rate for Payer: BCBS Complete |
$513.94
|
| Rate for Payer: BCBS MAPPO |
$743.50
|
| Rate for Payer: BCN Commercial |
$1,245.45
|
| Rate for Payer: BCN Medicare Advantage |
$743.50
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cofinity Commercial |
$1,070.64
|
| Rate for Payer: Cofinity Commercial |
$996.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$743.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$780.67
|
| Rate for Payer: Meridian Medicaid |
$513.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$817.85
|
| Rate for Payer: Nomi Health Commercial |
$892.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.25
|
| Rate for Payer: PACE SWMI |
$743.50
|
| Rate for Payer: PHP Commercial |
$1,040.90
|
| Rate for Payer: PHP Medicare Advantage |
$743.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,172.85
|
| Rate for Payer: Priority Health Medicare |
$743.50
|
| Rate for Payer: Priority Health SBD |
$1,172.85
|
| Rate for Payer: Priority Health Tiered Network |
$1,172.85
|
| Rate for Payer: Railroad Medicare Medicare |
$743.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,436.74
|
| Rate for Payer: UHC Core |
$1,436.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$743.50
|
| Rate for Payer: UHC Exchange |
$1,436.74
|
| Rate for Payer: UHC Medicaid |
$489.47
|
| Rate for Payer: UHCCP Medicaid |
$489.47
|
| Rate for Payer: UMR Bronson Commercial |
$649.06
|
|
|
PR RHINP PRIM COMPLETE XTRNL PARTS
|
Professional
|
Both
|
$3,152.00
|
|
|
Service Code
|
HCPCS 30410
|
| Min. Negotiated Rate |
$863.72 |
| Max. Negotiated Rate |
$2,377.99 |
| Rate for Payer: Aetna Commercial |
$1,734.62
|
| Rate for Payer: Aetna Commercial |
$1,734.62
|
| Rate for Payer: Aetna Medicare |
$1,346.27
|
| Rate for Payer: Aetna Medicare |
$1,346.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,734.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,734.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,864.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,864.07
|
| Rate for Payer: BCBS Complete |
$906.91
|
| Rate for Payer: BCBS Complete |
$906.91
|
| Rate for Payer: BCBS MAPPO |
$1,294.49
|
| Rate for Payer: BCBS MAPPO |
$1,294.49
|
| Rate for Payer: BCN Commercial |
$2,112.93
|
| Rate for Payer: BCN Commercial |
$2,112.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,294.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,294.49
|
| Rate for Payer: Cash Price |
$2,521.60
|
| Rate for Payer: Cash Price |
$2,541.60
|
| Rate for Payer: Cash Price |
$2,521.60
|
| Rate for Payer: Cash Price |
$2,541.60
|
| Rate for Payer: Cofinity Commercial |
$1,734.62
|
| Rate for Payer: Cofinity Commercial |
$1,864.07
|
| Rate for Payer: Cofinity Commercial |
$1,734.62
|
| Rate for Payer: Cofinity Commercial |
$1,864.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,294.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,294.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,359.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,359.21
|
| Rate for Payer: Meridian Medicaid |
$906.91
|
| Rate for Payer: Meridian Medicaid |
$906.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,423.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,423.94
|
| Rate for Payer: Nomi Health Commercial |
$1,553.39
|
| Rate for Payer: Nomi Health Commercial |
$1,553.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,364.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,382.75
|
| Rate for Payer: PACE SWMI |
$1,294.49
|
| Rate for Payer: PACE SWMI |
$1,294.49
|
| Rate for Payer: PHP Commercial |
$1,812.29
|
| Rate for Payer: PHP Commercial |
$1,812.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,294.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,294.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$863.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$863.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,989.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,989.75
|
| Rate for Payer: Priority Health Medicare |
$1,294.49
|
| Rate for Payer: Priority Health Medicare |
$1,294.49
|
| Rate for Payer: Priority Health SBD |
$1,989.75
|
| Rate for Payer: Priority Health SBD |
$1,989.75
|
| Rate for Payer: Priority Health Tiered Network |
$1,989.75
|
| Rate for Payer: Priority Health Tiered Network |
$1,989.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,294.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1,294.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,377.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,377.99
|
| Rate for Payer: UHC Core |
$2,377.99
|
| Rate for Payer: UHC Core |
$2,377.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,294.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,294.49
|
| Rate for Payer: UHC Exchange |
$2,377.99
|
| Rate for Payer: UHC Exchange |
$2,377.99
|
| Rate for Payer: UHC Medicaid |
$863.72
|
| Rate for Payer: UHC Medicaid |
$863.72
|
| Rate for Payer: UHCCP Medicaid |
$863.72
|
| Rate for Payer: UHCCP Medicaid |
$863.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,449.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,461.42
|
|
|
PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Professional
|
Both
|
$1,576.00
|
|
|
Service Code
|
HCPCS 30400
|
| Min. Negotiated Rate |
$724.96 |
| Max. Negotiated Rate |
$2,041.16 |
| Rate for Payer: Aetna Commercial |
$1,523.50
|
| Rate for Payer: Aetna Medicare |
$1,182.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,523.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,637.19
|
| Rate for Payer: BCBS Complete |
$800.89
|
| Rate for Payer: BCBS MAPPO |
$1,136.94
|
| Rate for Payer: BCN Commercial |
$1,833.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,136.94
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cash Price |
$1,260.80
|
| Rate for Payer: Cofinity Commercial |
$1,523.50
|
| Rate for Payer: Cofinity Commercial |
$1,637.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,136.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,193.79
|
| Rate for Payer: Meridian Medicaid |
$800.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,250.63
|
| Rate for Payer: Nomi Health Commercial |
$1,364.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,182.00
|
| Rate for Payer: PACE SWMI |
$1,136.94
|
| Rate for Payer: PHP Commercial |
$1,591.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,136.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,726.68
|
| Rate for Payer: Priority Health Medicare |
$1,136.94
|
| Rate for Payer: Priority Health SBD |
$1,726.68
|
| Rate for Payer: Priority Health Tiered Network |
$1,726.68
|
| Rate for Payer: Railroad Medicare Medicare |
$1,136.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,041.16
|
| Rate for Payer: UHC Core |
$2,041.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,136.94
|
| Rate for Payer: UHC Exchange |
$2,041.16
|
| Rate for Payer: UHC Medicaid |
$762.75
|
| Rate for Payer: UHCCP Medicaid |
$762.75
|
| Rate for Payer: UMR Bronson Commercial |
$724.96
|
|
|
PR RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 90384
|
| Min. Negotiated Rate |
$72.68 |
| Max. Negotiated Rate |
$250.00 |
| Rate for Payer: Aetna Commercial |
$78.10
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.10
|
| Rate for Payer: BCBS Trust/PPO |
$85.31
|
| Rate for Payer: BCN Commercial |
$250.00
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.31
|
| Rate for Payer: UHC Core |
$85.31
|
| Rate for Payer: UHC Exchange |
$85.31
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
PR RHO D IMMUNE GLOBULIN INJ
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS J2790
|
| Min. Negotiated Rate |
$63.27 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Aetna Commercial |
$105.73
|
| Rate for Payer: Aetna Medicare |
$82.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.62
|
| Rate for Payer: BCBS MAPPO |
$78.90
|
| Rate for Payer: BCBS Trust/PPO |
$67.20
|
| Rate for Payer: BCN Commercial |
$63.27
|
| Rate for Payer: BCN Medicare Advantage |
$78.90
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$105.73
|
| Rate for Payer: Cofinity Commercial |
$113.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.79
|
| Rate for Payer: Nomi Health Commercial |
$94.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
| Rate for Payer: PACE SWMI |
$78.90
|
| Rate for Payer: PHP Commercial |
$110.46
|
| Rate for Payer: PHP Medicare Advantage |
$78.90
|
| Rate for Payer: Priority Health Medicare |
$78.90
|
| Rate for Payer: Railroad Medicare Medicare |
$78.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.53
|
| Rate for Payer: UHC Core |
$80.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$78.90
|
| Rate for Payer: UHC Exchange |
$80.53
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 93042
|
| Min. Negotiated Rate |
$4.47 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: Aetna Commercial |
$9.26
|
| Rate for Payer: Aetna Medicare |
$7.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.95
|
| Rate for Payer: BCBS Complete |
$4.69
|
| Rate for Payer: BCBS MAPPO |
$6.91
|
| Rate for Payer: BCN Commercial |
$7.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.91
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Cofinity Commercial |
$9.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.26
|
| Rate for Payer: Meridian Medicaid |
$4.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.60
|
| Rate for Payer: Nomi Health Commercial |
$8.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: PACE SWMI |
$6.91
|
| Rate for Payer: PHP Commercial |
$9.67
|
| Rate for Payer: PHP Medicare Advantage |
$6.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.47
|
| Rate for Payer: Priority Health Medicare |
$6.91
|
| Rate for Payer: Priority Health SBD |
$9.47
|
| Rate for Payer: Priority Health Tiered Network |
$9.47
|
| Rate for Payer: Railroad Medicare Medicare |
$6.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.41
|
| Rate for Payer: UHC Core |
$11.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.91
|
| Rate for Payer: UHC Exchange |
$11.41
|
| Rate for Payer: UHC Medicaid |
$4.47
|
| Rate for Payer: UHCCP Medicaid |
$4.47
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
|
|
PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 93041
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Medicare |
$7.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.90
|
| Rate for Payer: BCBS MAPPO |
$7.39
|
| Rate for Payer: BCN Commercial |
$9.96
|
| Rate for Payer: BCN Medicare Advantage |
$7.39
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$10.64
|
| Rate for Payer: Cofinity Commercial |
$9.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.13
|
| Rate for Payer: Nomi Health Commercial |
$8.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.00
|
| Rate for Payer: PACE SWMI |
$7.39
|
| Rate for Payer: PHP Commercial |
$10.35
|
| Rate for Payer: PHP Medicare Advantage |
$7.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.47
|
| Rate for Payer: Priority Health Medicare |
$7.39
|
| Rate for Payer: Priority Health SBD |
$9.47
|
| Rate for Payer: Priority Health Tiered Network |
$9.47
|
| Rate for Payer: Railroad Medicare Medicare |
$7.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.55
|
| Rate for Payer: UHC Core |
$8.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.39
|
| Rate for Payer: UHC Exchange |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
|
