|
PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 95783
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$1,470.43 |
| Rate for Payer: Aetna Commercial |
$1,234.86
|
| Rate for Payer: Aetna Commercial |
$1,234.86
|
| Rate for Payer: Aetna Medicare |
$958.40
|
| Rate for Payer: Aetna Medicare |
$958.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,234.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,327.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,327.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,234.86
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS Complete |
$87.90
|
| Rate for Payer: BCBS MAPPO |
$921.54
|
| Rate for Payer: BCBS MAPPO |
$921.54
|
| Rate for Payer: BCBS Trust/PPO |
$686.79
|
| Rate for Payer: BCBS Trust/PPO |
$686.79
|
| Rate for Payer: BCN Commercial |
$1,470.43
|
| Rate for Payer: BCN Commercial |
$1,470.43
|
| Rate for Payer: BCN Medicare Advantage |
$921.54
|
| Rate for Payer: BCN Medicare Advantage |
$921.54
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$1,234.86
|
| Rate for Payer: Cofinity Commercial |
$1,327.02
|
| Rate for Payer: Cofinity Commercial |
$1,327.02
|
| Rate for Payer: Cofinity Commercial |
$1,234.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$967.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$967.62
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Meridian Medicaid |
$87.90
|
| Rate for Payer: Nomi Health Commercial |
$1,105.85
|
| Rate for Payer: Nomi Health Commercial |
$1,105.85
|
| Rate for Payer: PACE SWMI |
$921.54
|
| Rate for Payer: PACE SWMI |
$921.54
|
| Rate for Payer: PHP Commercial |
$1,290.16
|
| Rate for Payer: PHP Commercial |
$1,290.16
|
| Rate for Payer: PHP Medicare Advantage |
$921.54
|
| Rate for Payer: PHP Medicare Advantage |
$921.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,408.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,408.96
|
| Rate for Payer: Priority Health Medicare |
$921.54
|
| Rate for Payer: Priority Health Medicare |
$921.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,408.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,408.96
|
| Rate for Payer: Priority Health SBD |
$179.12
|
| Rate for Payer: Priority Health SBD |
$179.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$921.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$921.54
|
| Rate for Payer: UHC Medicare Advantage |
$921.54
|
| Rate for Payer: UHC Medicare Advantage |
$921.54
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
| Rate for Payer: UMR Bronson Commercial |
$852.38
|
| Rate for Payer: UMR Bronson Commercial |
$129.72
|
|
|
PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 95808
|
| Min. Negotiated Rate |
$51.33 |
| Max. Negotiated Rate |
$769.73 |
| Rate for Payer: Aetna Commercial |
$590.34
|
| Rate for Payer: Aetna Commercial |
$590.34
|
| Rate for Payer: Aetna Medicare |
$458.17
|
| Rate for Payer: Aetna Medicare |
$458.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.34
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: BCBS MAPPO |
$440.55
|
| Rate for Payer: BCBS MAPPO |
$440.55
|
| Rate for Payer: BCBS Trust/PPO |
$769.73
|
| Rate for Payer: BCBS Trust/PPO |
$769.73
|
| Rate for Payer: BCN Commercial |
$644.36
|
| Rate for Payer: BCN Commercial |
$644.36
|
| Rate for Payer: BCN Medicare Advantage |
$440.55
|
| Rate for Payer: BCN Medicare Advantage |
$440.55
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$590.34
|
| Rate for Payer: Cofinity Commercial |
$634.39
|
| Rate for Payer: Cofinity Commercial |
$634.39
|
| Rate for Payer: Cofinity Commercial |
$590.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.58
|
| Rate for Payer: Meridian Medicaid |
$53.90
|
| Rate for Payer: Meridian Medicaid |
$53.90
|
| Rate for Payer: Nomi Health Commercial |
$528.66
|
| Rate for Payer: Nomi Health Commercial |
$528.66
|
| Rate for Payer: PACE SWMI |
$440.55
|
| Rate for Payer: PACE SWMI |
$440.55
|
| Rate for Payer: PHP Commercial |
$616.77
|
| Rate for Payer: PHP Commercial |
$616.77
|
| Rate for Payer: PHP Medicare Advantage |
$440.55
|
| Rate for Payer: PHP Medicare Advantage |
$440.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$695.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$695.21
|
| Rate for Payer: Priority Health Medicare |
$440.55
|
| Rate for Payer: Priority Health Medicare |
$440.55
|
| Rate for Payer: Priority Health Narrow Network |
$695.21
|
| Rate for Payer: Priority Health Narrow Network |
$695.21
|
| Rate for Payer: Priority Health SBD |
$110.36
|
| Rate for Payer: Priority Health SBD |
$110.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.55
|
| Rate for Payer: UHC Medicare Advantage |
$440.55
|
| Rate for Payer: UHC Medicare Advantage |
$440.55
|
| Rate for Payer: UHCCP Medicaid |
$51.33
|
| Rate for Payer: UHCCP Medicaid |
$51.33
|
| Rate for Payer: UMR Bronson Commercial |
$800.40
|
| Rate for Payer: UMR Bronson Commercial |
$197.80
|
|
|
PR PORTOENETEROSTOMY
|
Professional
|
Both
|
$4,815.00
|
|
|
Service Code
|
HCPCS 47701
|
| Min. Negotiated Rate |
$362.41 |
| Max. Negotiated Rate |
$3,129.75 |
| Rate for Payer: Aetna Commercial |
$2,255.96
|
| Rate for Payer: Aetna Medicare |
$1,750.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,255.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,424.31
|
| Rate for Payer: BCBS Complete |
$1,167.90
|
| Rate for Payer: BCBS MAPPO |
$1,683.55
|
| Rate for Payer: BCBS Trust/PPO |
$362.41
|
| Rate for Payer: BCN Commercial |
$2,534.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,683.55
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Cofinity Commercial |
$2,255.96
|
| Rate for Payer: Cofinity Commercial |
$2,424.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,683.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,767.73
|
| Rate for Payer: Meridian Medicaid |
$1,167.90
|
| Rate for Payer: Nomi Health Commercial |
$2,020.26
|
| Rate for Payer: PACE SWMI |
$1,683.55
|
| Rate for Payer: PHP Commercial |
$2,356.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,683.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,112.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,129.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,104.67
|
| Rate for Payer: Priority Health Medicare |
$1,683.55
|
| Rate for Payer: Priority Health Narrow Network |
$3,104.67
|
| Rate for Payer: Priority Health SBD |
$3,104.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,683.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,683.55
|
| Rate for Payer: UHCCP Medicaid |
$1,112.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,214.90
|
|
|
PR POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 92542
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$1,840.07 |
| Rate for Payer: Aetna Commercial |
$36.03
|
| Rate for Payer: Aetna Medicare |
$27.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.72
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$26.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,840.07
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Medicare Advantage |
$26.89
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$36.03
|
| Rate for Payer: Cofinity Commercial |
$38.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.23
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Nomi Health Commercial |
$32.27
|
| Rate for Payer: PACE SWMI |
$26.89
|
| Rate for Payer: PHP Commercial |
$37.65
|
| Rate for Payer: PHP Medicare Advantage |
$26.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.90
|
| Rate for Payer: Priority Health Medicare |
$26.89
|
| Rate for Payer: Priority Health Narrow Network |
$38.90
|
| Rate for Payer: Priority Health SBD |
$33.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.89
|
| Rate for Payer: UHC Medicare Advantage |
$26.89
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
|
|
PR POST-CATARACT LASER SURGERY
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 66821
|
| Min. Negotiated Rate |
$196.81 |
| Max. Negotiated Rate |
$543.38 |
| Rate for Payer: Aetna Commercial |
$380.90
|
| Rate for Payer: Aetna Medicare |
$295.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.32
|
| Rate for Payer: BCBS Complete |
$206.65
|
| Rate for Payer: BCBS MAPPO |
$284.25
|
| Rate for Payer: BCBS Trust/PPO |
$417.89
|
| Rate for Payer: BCN Commercial |
$483.30
|
| Rate for Payer: BCN Medicare Advantage |
$284.25
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$380.90
|
| Rate for Payer: Cofinity Commercial |
$409.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.46
|
| Rate for Payer: Meridian Medicaid |
$206.65
|
| Rate for Payer: Nomi Health Commercial |
$341.10
|
| Rate for Payer: PACE SWMI |
$284.25
|
| Rate for Payer: PHP Commercial |
$397.95
|
| Rate for Payer: PHP Medicare Advantage |
$284.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$543.38
|
| Rate for Payer: Priority Health Medicare |
$284.25
|
| Rate for Payer: Priority Health Narrow Network |
$543.38
|
| Rate for Payer: Priority Health SBD |
$543.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.25
|
| Rate for Payer: UHC Medicare Advantage |
$284.25
|
| Rate for Payer: UHCCP Medicaid |
$196.81
|
| Rate for Payer: UMR Bronson Commercial |
$264.04
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,407.00
|
|
|
Service Code
|
HCPCS 57250
|
| Min. Negotiated Rate |
$395.33 |
| Max. Negotiated Rate |
$1,809.43 |
| Rate for Payer: Aetna Commercial |
$790.04
|
| Rate for Payer: Aetna Medicare |
$613.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$790.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$849.00
|
| Rate for Payer: BCBS Complete |
$415.10
|
| Rate for Payer: BCBS MAPPO |
$589.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,809.43
|
| Rate for Payer: BCN Commercial |
$904.06
|
| Rate for Payer: BCN Medicare Advantage |
$589.58
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$790.04
|
| Rate for Payer: Cofinity Commercial |
$849.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$619.06
|
| Rate for Payer: Meridian Medicaid |
$415.10
|
| Rate for Payer: Nomi Health Commercial |
$707.50
|
| Rate for Payer: PACE SWMI |
$589.58
|
| Rate for Payer: PHP Commercial |
$825.41
|
| Rate for Payer: PHP Medicare Advantage |
$589.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$922.14
|
| Rate for Payer: Priority Health Medicare |
$589.58
|
| Rate for Payer: Priority Health Narrow Network |
$922.14
|
| Rate for Payer: Priority Health SBD |
$922.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$589.58
|
| Rate for Payer: UHC Medicare Advantage |
$589.58
|
| Rate for Payer: UHCCP Medicaid |
$395.33
|
| Rate for Payer: UMR Bronson Commercial |
$647.22
|
|
|
PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,333.00
|
|
|
Service Code
|
HCPCS 22840
|
| Min. Negotiated Rate |
$482.23 |
| Max. Negotiated Rate |
$21,897.63 |
| Rate for Payer: Aetna Commercial |
$984.98
|
| Rate for Payer: Aetna Medicare |
$764.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,058.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.98
|
| Rate for Payer: BCBS Complete |
$506.34
|
| Rate for Payer: BCBS MAPPO |
$735.06
|
| Rate for Payer: BCBS Trust/PPO |
$21,897.63
|
| Rate for Payer: BCN Commercial |
$1,213.35
|
| Rate for Payer: BCN Medicare Advantage |
$735.06
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cofinity Commercial |
$1,058.49
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$771.81
|
| Rate for Payer: Meridian Medicaid |
$506.34
|
| Rate for Payer: Nomi Health Commercial |
$882.07
|
| Rate for Payer: PACE SWMI |
$735.06
|
| Rate for Payer: PHP Commercial |
$1,029.08
|
| Rate for Payer: PHP Medicare Advantage |
$735.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$482.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,166.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,150.03
|
| Rate for Payer: Priority Health Medicare |
$735.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,150.03
|
| Rate for Payer: Priority Health SBD |
$1,150.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$735.06
|
| Rate for Payer: UHC Medicare Advantage |
$735.06
|
| Rate for Payer: UHCCP Medicaid |
$482.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,533.18
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE
|
Professional
|
Both
|
$3,929.00
|
|
|
Service Code
|
HCPCS 22844
|
| Min. Negotiated Rate |
$53.49 |
| Max. Negotiated Rate |
$2,553.85 |
| Rate for Payer: Aetna Commercial |
$1,286.20
|
| Rate for Payer: Aetna Medicare |
$998.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,286.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,382.18
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$959.85
|
| Rate for Payer: BCBS Trust/PPO |
$53.49
|
| Rate for Payer: BCN Commercial |
$1,576.55
|
| Rate for Payer: BCN Medicare Advantage |
$959.85
|
| Rate for Payer: Cash Price |
$3,143.20
|
| Rate for Payer: Cash Price |
$3,143.20
|
| Rate for Payer: Cofinity Commercial |
$1,286.20
|
| Rate for Payer: Cofinity Commercial |
$1,382.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$959.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,007.84
|
| Rate for Payer: Meridian Medicaid |
$662.00
|
| Rate for Payer: Nomi Health Commercial |
$1,151.82
|
| Rate for Payer: PACE SWMI |
$959.85
|
| Rate for Payer: PHP Commercial |
$1,343.79
|
| Rate for Payer: PHP Medicare Advantage |
$959.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,553.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,493.51
|
| Rate for Payer: Priority Health Medicare |
$959.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,493.51
|
| Rate for Payer: Priority Health SBD |
$1,493.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$959.85
|
| Rate for Payer: UHC Medicare Advantage |
$959.85
|
| Rate for Payer: UHCCP Medicaid |
$630.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,807.34
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,720.00
|
|
|
Service Code
|
HCPCS 22842
|
| Min. Negotiated Rate |
$483.43 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna Commercial |
$998.69
|
| Rate for Payer: Aetna Medicare |
$775.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,073.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$998.69
|
| Rate for Payer: BCBS Complete |
$512.61
|
| Rate for Payer: BCBS MAPPO |
$745.29
|
| Rate for Payer: BCBS Trust/PPO |
$483.43
|
| Rate for Payer: BCN Commercial |
$1,222.50
|
| Rate for Payer: BCN Medicare Advantage |
$745.29
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cofinity Commercial |
$1,073.22
|
| Rate for Payer: Cofinity Commercial |
$998.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$782.55
|
| Rate for Payer: Meridian Medicaid |
$512.61
|
| Rate for Payer: Nomi Health Commercial |
$894.35
|
| Rate for Payer: PACE SWMI |
$745.29
|
| Rate for Payer: PHP Commercial |
$1,043.41
|
| Rate for Payer: PHP Medicare Advantage |
$745.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$488.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,160.71
|
| Rate for Payer: Priority Health Medicare |
$745.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,160.71
|
| Rate for Payer: Priority Health SBD |
$1,160.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.29
|
| Rate for Payer: UHC Medicare Advantage |
$745.29
|
| Rate for Payer: UHCCP Medicaid |
$488.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,711.20
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG
|
Professional
|
Both
|
$4,091.00
|
|
|
Service Code
|
HCPCS 22843
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$2,659.15 |
| Rate for Payer: Aetna Commercial |
$1,070.35
|
| Rate for Payer: Aetna Medicare |
$830.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.23
|
| Rate for Payer: BCBS Complete |
$549.29
|
| Rate for Payer: BCBS MAPPO |
$798.77
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$1,308.59
|
| Rate for Payer: BCN Medicare Advantage |
$798.77
|
| Rate for Payer: Cash Price |
$3,272.80
|
| Rate for Payer: Cash Price |
$3,272.80
|
| Rate for Payer: Cofinity Commercial |
$1,070.35
|
| Rate for Payer: Cofinity Commercial |
$1,150.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.71
|
| Rate for Payer: Meridian Medicaid |
$549.29
|
| Rate for Payer: Nomi Health Commercial |
$958.52
|
| Rate for Payer: PACE SWMI |
$798.77
|
| Rate for Payer: PHP Commercial |
$1,118.28
|
| Rate for Payer: PHP Medicare Advantage |
$798.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$523.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,659.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,243.14
|
| Rate for Payer: Priority Health Medicare |
$798.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,243.14
|
| Rate for Payer: Priority Health SBD |
$1,243.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.77
|
| Rate for Payer: UHC Medicare Advantage |
$798.77
|
| Rate for Payer: UHCCP Medicaid |
$523.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,881.86
|
|
|
PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 59430
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$233.83
|
| Rate for Payer: Aetna Medicare |
$181.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.28
|
| Rate for Payer: BCBS Complete |
$174.07
|
| Rate for Payer: BCBS MAPPO |
$174.50
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$309.12
|
| Rate for Payer: BCN Medicare Advantage |
$174.50
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$233.83
|
| Rate for Payer: Cofinity Commercial |
$251.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.22
|
| Rate for Payer: Meridian Medicaid |
$174.07
|
| Rate for Payer: Nomi Health Commercial |
$209.40
|
| Rate for Payer: PACE SWMI |
$174.50
|
| Rate for Payer: PHP Commercial |
$244.30
|
| Rate for Payer: PHP Medicare Advantage |
$174.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.05
|
| Rate for Payer: Priority Health Medicare |
$174.50
|
| Rate for Payer: Priority Health Narrow Network |
$251.05
|
| Rate for Payer: Priority Health SBD |
$251.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.50
|
| Rate for Payer: UHC Medicare Advantage |
$174.50
|
| Rate for Payer: UHCCP Medicaid |
$165.78
|
| Rate for Payer: UMR Bronson Commercial |
$206.54
|
|
|
PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 64566
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$861.13 |
| Rate for Payer: Aetna Commercial |
$38.26
|
| Rate for Payer: Aetna Medicare |
$29.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS MAPPO |
$28.55
|
| Rate for Payer: BCBS Trust/PPO |
$861.13
|
| Rate for Payer: BCN Commercial |
$171.52
|
| Rate for Payer: BCN Medicare Advantage |
$28.55
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Cofinity Commercial |
$41.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.98
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Nomi Health Commercial |
$34.26
|
| Rate for Payer: PACE SWMI |
$28.55
|
| Rate for Payer: PHP Commercial |
$39.97
|
| Rate for Payer: PHP Medicare Advantage |
$28.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.19
|
| Rate for Payer: Priority Health Medicare |
$28.55
|
| Rate for Payer: Priority Health Narrow Network |
$51.19
|
| Rate for Payer: Priority Health SBD |
$51.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.55
|
| Rate for Payer: UHC Medicare Advantage |
$28.55
|
| Rate for Payer: UHCCP Medicaid |
$18.96
|
| Rate for Payer: UMR Bronson Commercial |
$106.26
|
|
|
PR POTASSIUM HYDROXIDE PREPS
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS Q0112
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$334.41 |
| Rate for Payer: Aetna Commercial |
$7.81
|
| Rate for Payer: Aetna Medicare |
$6.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.40
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$5.83
|
| Rate for Payer: BCBS Trust/PPO |
$334.41
|
| Rate for Payer: BCN Commercial |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$5.83
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.12
|
| Rate for Payer: Nomi Health Commercial |
$7.00
|
| Rate for Payer: PACE SWMI |
$5.83
|
| Rate for Payer: PHP Commercial |
$8.16
|
| Rate for Payer: PHP Medicare Advantage |
$5.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Medicare |
$5.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.83
|
| Rate for Payer: UHC Medicare Advantage |
$5.83
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
|
|
PR PPPS, INITIAL VISIT
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS G0438
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$387.24 |
| Rate for Payer: Aetna Commercial |
$207.70
|
| Rate for Payer: Aetna Medicare |
$161.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.70
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCBS MAPPO |
$155.00
|
| Rate for Payer: BCBS Trust/PPO |
$387.24
|
| Rate for Payer: BCN Commercial |
$239.95
|
| Rate for Payer: BCN Medicare Advantage |
$155.00
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$223.20
|
| Rate for Payer: Cofinity Commercial |
$207.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.75
|
| Rate for Payer: Nomi Health Commercial |
$186.00
|
| Rate for Payer: PACE SWMI |
$155.00
|
| Rate for Payer: PHP Commercial |
$217.00
|
| Rate for Payer: PHP Medicare Advantage |
$155.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.97
|
| Rate for Payer: Priority Health Medicare |
$155.00
|
| Rate for Payer: Priority Health Narrow Network |
$217.97
|
| Rate for Payer: Priority Health SBD |
$217.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.00
|
| Rate for Payer: UHC Medicare Advantage |
$155.00
|
| Rate for Payer: UMR Bronson Commercial |
$119.14
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS G0439
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$163.28
|
| Rate for Payer: Aetna Medicare |
$126.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.46
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$121.85
|
| Rate for Payer: BCBS Trust/PPO |
$728.00
|
| Rate for Payer: BCN Commercial |
$187.65
|
| Rate for Payer: BCN Medicare Advantage |
$121.85
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$175.46
|
| Rate for Payer: Cofinity Commercial |
$163.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.94
|
| Rate for Payer: Nomi Health Commercial |
$146.22
|
| Rate for Payer: PACE SWMI |
$121.85
|
| Rate for Payer: PHP Commercial |
$170.59
|
| Rate for Payer: PHP Medicare Advantage |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.48
|
| Rate for Payer: Priority Health Medicare |
$121.85
|
| Rate for Payer: Priority Health Narrow Network |
$171.48
|
| Rate for Payer: Priority Health SBD |
$171.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.85
|
| Rate for Payer: UHC Medicare Advantage |
$121.85
|
| Rate for Payer: UMR Bronson Commercial |
$80.50
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 90732
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$218.03 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: Aetna Medicare |
$138.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.85
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS MAPPO |
$133.47
|
| Rate for Payer: BCBS Trust/PPO |
$138.56
|
| Rate for Payer: BCN Commercial |
$218.03
|
| Rate for Payer: BCN Medicare Advantage |
$133.47
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$192.20
|
| Rate for Payer: Cofinity Commercial |
$178.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.15
|
| Rate for Payer: Nomi Health Commercial |
$160.17
|
| Rate for Payer: PACE SWMI |
$133.47
|
| Rate for Payer: PHP Commercial |
$186.86
|
| Rate for Payer: PHP Medicare Advantage |
$133.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.90
|
| Rate for Payer: Priority Health Medicare |
$133.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.47
|
| Rate for Payer: UHC Medicare Advantage |
$133.47
|
| Rate for Payer: UMR Bronson Commercial |
$67.16
|
|
|
PR PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX
|
Professional
|
Both
|
$4,652.00
|
|
|
Service Code
|
HCPCS 45112
|
| Min. Negotiated Rate |
$234.04 |
| Max. Negotiated Rate |
$3,211.47 |
| Rate for Payer: Aetna Commercial |
$2,313.01
|
| Rate for Payer: Aetna Medicare |
$1,795.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,313.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,485.63
|
| Rate for Payer: BCBS Complete |
$1,208.83
|
| Rate for Payer: BCBS MAPPO |
$1,726.13
|
| Rate for Payer: BCBS Trust/PPO |
$234.04
|
| Rate for Payer: BCN Commercial |
$2,621.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,726.13
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$2,313.01
|
| Rate for Payer: Cofinity Commercial |
$2,485.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,726.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,812.44
|
| Rate for Payer: Meridian Medicaid |
$1,208.83
|
| Rate for Payer: Nomi Health Commercial |
$2,071.36
|
| Rate for Payer: PACE SWMI |
$1,726.13
|
| Rate for Payer: PHP Commercial |
$2,416.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,726.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,151.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,211.47
|
| Rate for Payer: Priority Health Medicare |
$1,726.13
|
| Rate for Payer: Priority Health Narrow Network |
$3,211.47
|
| Rate for Payer: Priority Health SBD |
$3,211.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,726.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,726.13
|
| Rate for Payer: UHCCP Medicaid |
$1,151.27
|
| Rate for Payer: UMR Bronson Commercial |
$2,139.92
|
|
|
PR PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST
|
Professional
|
Both
|
$4,725.00
|
|
|
Service Code
|
HCPCS 45110
|
| Min. Negotiated Rate |
$389.36 |
| Max. Negotiated Rate |
$3,226.98 |
| Rate for Payer: Aetna Commercial |
$2,319.65
|
| Rate for Payer: Aetna Medicare |
$1,800.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,319.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,492.76
|
| Rate for Payer: BCBS Complete |
$1,211.96
|
| Rate for Payer: BCBS MAPPO |
$1,731.08
|
| Rate for Payer: BCBS Trust/PPO |
$389.36
|
| Rate for Payer: BCN Commercial |
$2,639.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,731.08
|
| Rate for Payer: Cash Price |
$3,780.00
|
| Rate for Payer: Cash Price |
$3,780.00
|
| Rate for Payer: Cofinity Commercial |
$2,319.65
|
| Rate for Payer: Cofinity Commercial |
$2,492.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,731.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,817.63
|
| Rate for Payer: Meridian Medicaid |
$1,211.96
|
| Rate for Payer: Nomi Health Commercial |
$2,077.30
|
| Rate for Payer: PACE SWMI |
$1,731.08
|
| Rate for Payer: PHP Commercial |
$2,423.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,731.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,154.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,071.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,226.98
|
| Rate for Payer: Priority Health Medicare |
$1,731.08
|
| Rate for Payer: Priority Health Narrow Network |
$3,226.98
|
| Rate for Payer: Priority Health SBD |
$3,226.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,731.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,731.08
|
| Rate for Payer: UHCCP Medicaid |
$1,154.25
|
| Rate for Payer: UMR Bronson Commercial |
$2,173.50
|
|
|
PR PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS
|
Professional
|
Both
|
$4,993.00
|
|
|
Service Code
|
HCPCS 45120
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$3,245.45 |
| Rate for Payer: Aetna Commercial |
$2,084.18
|
| Rate for Payer: Aetna Medicare |
$1,617.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,084.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,239.72
|
| Rate for Payer: BCBS Complete |
$1,079.56
|
| Rate for Payer: BCBS MAPPO |
$1,555.36
|
| Rate for Payer: BCBS Trust/PPO |
$234.57
|
| Rate for Payer: BCN Commercial |
$2,334.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,555.36
|
| Rate for Payer: Cash Price |
$3,994.40
|
| Rate for Payer: Cash Price |
$3,994.40
|
| Rate for Payer: Cofinity Commercial |
$2,084.18
|
| Rate for Payer: Cofinity Commercial |
$2,239.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,555.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,633.13
|
| Rate for Payer: Meridian Medicaid |
$1,079.56
|
| Rate for Payer: Nomi Health Commercial |
$1,866.43
|
| Rate for Payer: PACE SWMI |
$1,555.36
|
| Rate for Payer: PHP Commercial |
$2,177.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,555.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,028.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,245.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,864.24
|
| Rate for Payer: Priority Health Medicare |
$1,555.36
|
| Rate for Payer: Priority Health Narrow Network |
$2,864.24
|
| Rate for Payer: Priority Health SBD |
$2,864.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,555.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.36
|
| Rate for Payer: UHCCP Medicaid |
$1,028.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,296.78
|
|
|
PR PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS
|
Professional
|
Both
|
$4,900.00
|
|
|
Service Code
|
HCPCS 45121
|
| Min. Negotiated Rate |
$188.07 |
| Max. Negotiated Rate |
$3,185.00 |
| Rate for Payer: Aetna Commercial |
$2,273.89
|
| Rate for Payer: Aetna Medicare |
$1,764.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,273.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,443.58
|
| Rate for Payer: BCBS Complete |
$1,176.85
|
| Rate for Payer: BCBS MAPPO |
$1,696.93
|
| Rate for Payer: BCBS Trust/PPO |
$188.07
|
| Rate for Payer: BCN Commercial |
$2,547.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,696.93
|
| Rate for Payer: Cash Price |
$3,920.00
|
| Rate for Payer: Cash Price |
$3,920.00
|
| Rate for Payer: Cofinity Commercial |
$2,273.89
|
| Rate for Payer: Cofinity Commercial |
$2,443.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,696.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,781.78
|
| Rate for Payer: Meridian Medicaid |
$1,176.85
|
| Rate for Payer: Nomi Health Commercial |
$2,036.32
|
| Rate for Payer: PACE SWMI |
$1,696.93
|
| Rate for Payer: PHP Commercial |
$2,375.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,696.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,120.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,185.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,125.55
|
| Rate for Payer: Priority Health Medicare |
$1,696.93
|
| Rate for Payer: Priority Health Narrow Network |
$3,125.55
|
| Rate for Payer: Priority Health SBD |
$3,125.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,696.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,696.93
|
| Rate for Payer: UHCCP Medicaid |
$1,120.81
|
| Rate for Payer: UMR Bronson Commercial |
$2,254.00
|
|
|
PR PRCTECT PRTL RESCJ RECTUM TABDL APPR
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
HCPCS 45111
|
| Min. Negotiated Rate |
$283.70 |
| Max. Negotiated Rate |
$1,941.92 |
| Rate for Payer: Aetna Commercial |
$1,396.43
|
| Rate for Payer: Aetna Medicare |
$1,083.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,500.64
|
| Rate for Payer: BCBS Complete |
$728.88
|
| Rate for Payer: BCBS MAPPO |
$1,042.11
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$1,575.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,042.11
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cofinity Commercial |
$1,396.43
|
| Rate for Payer: Cofinity Commercial |
$1,500.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,042.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,094.22
|
| Rate for Payer: Meridian Medicaid |
$728.88
|
| Rate for Payer: Nomi Health Commercial |
$1,250.53
|
| Rate for Payer: PACE SWMI |
$1,042.11
|
| Rate for Payer: PHP Commercial |
$1,458.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,042.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$694.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,282.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,941.92
|
| Rate for Payer: Priority Health Medicare |
$1,042.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,941.92
|
| Rate for Payer: Priority Health SBD |
$1,941.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,042.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,042.11
|
| Rate for Payer: UHCCP Medicaid |
$694.17
|
| Rate for Payer: UMR Bronson Commercial |
$907.58
|
|
|
PR PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH
|
Professional
|
Both
|
$3,259.00
|
|
|
Service Code
|
HCPCS 45114
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$3,245.47 |
| Rate for Payer: Aetna Commercial |
$2,367.44
|
| Rate for Payer: Aetna Medicare |
$1,837.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,367.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,544.12
|
| Rate for Payer: BCBS Complete |
$1,223.14
|
| Rate for Payer: BCBS MAPPO |
$1,766.75
|
| Rate for Payer: BCBS Trust/PPO |
$86.17
|
| Rate for Payer: BCN Commercial |
$2,647.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,766.75
|
| Rate for Payer: Cash Price |
$2,607.20
|
| Rate for Payer: Cash Price |
$2,607.20
|
| Rate for Payer: Cofinity Commercial |
$2,367.44
|
| Rate for Payer: Cofinity Commercial |
$2,544.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,766.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,855.09
|
| Rate for Payer: Meridian Medicaid |
$1,223.14
|
| Rate for Payer: Nomi Health Commercial |
$2,120.10
|
| Rate for Payer: PACE SWMI |
$1,766.75
|
| Rate for Payer: PHP Commercial |
$2,473.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,766.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,164.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,118.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,245.47
|
| Rate for Payer: Priority Health Medicare |
$1,766.75
|
| Rate for Payer: Priority Health Narrow Network |
$3,245.47
|
| Rate for Payer: Priority Health SBD |
$3,245.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,766.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,766.75
|
| Rate for Payer: UHCCP Medicaid |
$1,164.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,499.14
|
|
|
PR PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY
|
Professional
|
Both
|
$3,811.00
|
|
|
Service Code
|
HCPCS 45116
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$2,738.96 |
| Rate for Payer: Aetna Commercial |
$1,969.63
|
| Rate for Payer: Aetna Medicare |
$1,528.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,969.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,116.61
|
| Rate for Payer: BCBS Complete |
$1,031.03
|
| Rate for Payer: BCBS MAPPO |
$1,469.87
|
| Rate for Payer: BCBS Trust/PPO |
$187.02
|
| Rate for Payer: BCN Commercial |
$2,233.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,469.87
|
| Rate for Payer: Cash Price |
$3,048.80
|
| Rate for Payer: Cash Price |
$3,048.80
|
| Rate for Payer: Cofinity Commercial |
$1,969.63
|
| Rate for Payer: Cofinity Commercial |
$2,116.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,469.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,543.36
|
| Rate for Payer: Meridian Medicaid |
$1,031.03
|
| Rate for Payer: Nomi Health Commercial |
$1,763.84
|
| Rate for Payer: PACE SWMI |
$1,469.87
|
| Rate for Payer: PHP Commercial |
$2,057.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,469.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$981.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,477.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,738.96
|
| Rate for Payer: Priority Health Medicare |
$1,469.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,738.96
|
| Rate for Payer: Priority Health SBD |
$2,738.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,469.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,469.87
|
| Rate for Payer: UHCCP Medicaid |
$981.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,753.06
|
|
|
PR PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR
|
Professional
|
Both
|
$5,455.00
|
|
|
Service Code
|
HCPCS 45113
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$3,545.75 |
| Rate for Payer: Aetna Commercial |
$2,370.54
|
| Rate for Payer: Aetna Medicare |
$1,839.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,370.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,547.45
|
| Rate for Payer: BCBS Complete |
$1,241.26
|
| Rate for Payer: BCBS MAPPO |
$1,769.06
|
| Rate for Payer: BCBS Trust/PPO |
$234.57
|
| Rate for Payer: BCN Commercial |
$2,697.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,769.06
|
| Rate for Payer: Cash Price |
$4,364.00
|
| Rate for Payer: Cash Price |
$4,364.00
|
| Rate for Payer: Cofinity Commercial |
$2,370.54
|
| Rate for Payer: Cofinity Commercial |
$2,547.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,769.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,857.51
|
| Rate for Payer: Meridian Medicaid |
$1,241.26
|
| Rate for Payer: Nomi Health Commercial |
$2,122.87
|
| Rate for Payer: PACE SWMI |
$1,769.06
|
| Rate for Payer: PHP Commercial |
$2,476.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,769.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,182.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,545.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,301.55
|
| Rate for Payer: Priority Health Medicare |
$1,769.06
|
| Rate for Payer: Priority Health Narrow Network |
$3,301.55
|
| Rate for Payer: Priority Health SBD |
$3,301.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,769.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.06
|
| Rate for Payer: UHCCP Medicaid |
$1,182.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,509.30
|
|
|
PR PRCTECT PRTL W/O ANAST PRNL APPR
|
Professional
|
Both
|
$3,047.00
|
|
|
Service Code
|
HCPCS 45123
|
| Min. Negotiated Rate |
$710.78 |
| Max. Negotiated Rate |
$2,046.11 |
| Rate for Payer: Aetna Commercial |
$1,426.31
|
| Rate for Payer: Aetna Medicare |
$1,106.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,426.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.75
|
| Rate for Payer: BCBS Complete |
$746.32
|
| Rate for Payer: BCBS MAPPO |
$1,064.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,046.11
|
| Rate for Payer: BCN Commercial |
$1,621.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,064.41
|
| Rate for Payer: Cash Price |
$2,437.60
|
| Rate for Payer: Cash Price |
$2,437.60
|
| Rate for Payer: Cofinity Commercial |
$1,532.75
|
| Rate for Payer: Cofinity Commercial |
$1,426.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,064.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,117.63
|
| Rate for Payer: Meridian Medicaid |
$746.32
|
| Rate for Payer: Nomi Health Commercial |
$1,277.29
|
| Rate for Payer: PACE SWMI |
$1,064.41
|
| Rate for Payer: PHP Commercial |
$1,490.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,064.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$710.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,980.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,981.88
|
| Rate for Payer: Priority Health Medicare |
$1,064.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,981.88
|
| Rate for Payer: Priority Health SBD |
$1,981.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,064.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,064.41
|
| Rate for Payer: UHCCP Medicaid |
$710.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,401.62
|
|
