|
PR PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS
|
Professional
|
Both
|
$5,574.00
|
|
|
Service Code
|
HCPCS 33910
|
| Min. Negotiated Rate |
$2,229.60 |
| Max. Negotiated Rate |
$3,623.10 |
| Rate for Payer: Aetna Commercial |
$3,345.39
|
| Rate for Payer: Aetna Medicare |
$2,596.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,595.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,345.39
|
| Rate for Payer: BCBS Complete |
$2,229.60
|
| Rate for Payer: BCBS MAPPO |
$2,496.56
|
| Rate for Payer: BCN Medicare Advantage |
$2,496.56
|
| Rate for Payer: Cash Price |
$4,459.20
|
| Rate for Payer: Cash Price |
$4,459.20
|
| Rate for Payer: Cofinity Commercial |
$3,595.05
|
| Rate for Payer: Cofinity Commercial |
$3,345.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,496.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,621.39
|
| Rate for Payer: Nomi Health Commercial |
$2,995.87
|
| Rate for Payer: PACE SWMI |
$2,496.56
|
| Rate for Payer: PHP Commercial |
$3,495.18
|
| Rate for Payer: PHP Medicare Advantage |
$2,496.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,623.10
|
| Rate for Payer: Priority Health Medicare |
$2,496.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,496.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,496.56
|
| Rate for Payer: UMR Bronson Commercial |
$2,564.04
|
|
|
PR PULMONARY COMPLIANCE STUDY
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 94750
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$111.80 |
| Rate for Payer: Aetna Medicare |
$86.00
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: UMR Bronson Commercial |
$79.12
|
|
|
PR PULMONARY STRESS TESTING
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 94618
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$46.07 |
| Rate for Payer: Aetna Commercial |
$42.87
|
| Rate for Payer: Aetna Medicare |
$33.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.07
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$31.99
|
| Rate for Payer: BCN Medicare Advantage |
$31.99
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$42.87
|
| Rate for Payer: Cofinity Commercial |
$46.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.59
|
| Rate for Payer: Nomi Health Commercial |
$38.39
|
| Rate for Payer: PACE SWMI |
$31.99
|
| Rate for Payer: PHP Commercial |
$44.79
|
| Rate for Payer: PHP Medicare Advantage |
$31.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$31.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.99
|
| Rate for Payer: UHC Medicare Advantage |
$31.99
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR PULMONARY STRESS TESTING,SIMPLE
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 94620
|
| Min. Negotiated Rate |
$143.20 |
| Max. Negotiated Rate |
$232.70 |
| Rate for Payer: Aetna Medicare |
$179.00
|
| Rate for Payer: BCBS Complete |
$143.20
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.70
|
| Rate for Payer: UMR Bronson Commercial |
$164.68
|
|
|
PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 11105
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Commercial |
$32.43
|
| Rate for Payer: Aetna Medicare |
$25.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.85
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS MAPPO |
$24.20
|
| Rate for Payer: BCN Medicare Advantage |
$24.20
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$32.43
|
| Rate for Payer: Cofinity Commercial |
$34.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.41
|
| Rate for Payer: Nomi Health Commercial |
$29.04
|
| Rate for Payer: PACE SWMI |
$24.20
|
| Rate for Payer: PHP Commercial |
$33.88
|
| Rate for Payer: PHP Medicare Advantage |
$24.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Medicare |
$24.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.20
|
| Rate for Payer: UHC Medicare Advantage |
$24.20
|
| Rate for Payer: UMR Bronson Commercial |
$83.72
|
|
|
PR PUNCH BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
HCPCS 11104
|
| Min. Negotiated Rate |
$44.49 |
| Max. Negotiated Rate |
$158.60 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Aetna Medicare |
$46.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.62
|
| Rate for Payer: BCBS Complete |
$97.60
|
| Rate for Payer: BCBS MAPPO |
$44.49
|
| Rate for Payer: BCN Medicare Advantage |
$44.49
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cash Price |
$195.20
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Cofinity Commercial |
$59.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.71
|
| Rate for Payer: Nomi Health Commercial |
$53.39
|
| Rate for Payer: PACE SWMI |
$44.49
|
| Rate for Payer: PHP Commercial |
$62.29
|
| Rate for Payer: PHP Medicare Advantage |
$44.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.60
|
| Rate for Payer: Priority Health Medicare |
$44.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.49
|
| Rate for Payer: UHC Medicare Advantage |
$44.49
|
| Rate for Payer: UMR Bronson Commercial |
$112.24
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
10160
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$79.55 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna American Axle |
$139.75
|
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.25
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health SBD |
$135.45
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$744.66
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: UMR Bronson Commercial |
$79.55
|
| Rate for Payer: VA VA |
$389.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.25
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 10160
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$122.33
|
| Rate for Payer: Aetna Medicare |
$94.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.33
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$91.29
|
| Rate for Payer: BCN Medicare Advantage |
$91.29
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$131.46
|
| Rate for Payer: Cofinity Commercial |
$122.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.85
|
| Rate for Payer: Nomi Health Commercial |
$109.55
|
| Rate for Payer: PACE SWMI |
$91.29
|
| Rate for Payer: PHP Commercial |
$127.81
|
| Rate for Payer: PHP Medicare Advantage |
$91.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$91.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.29
|
| Rate for Payer: UHC Medicare Advantage |
$91.29
|
| Rate for Payer: UMR Bronson Commercial |
$98.90
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
10160
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna American Axle |
$139.75
|
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health SBD |
$135.45
|
| Rate for Payer: UMR Bronson Commercial |
$94.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.25
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
10160
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$139.75 |
| Rate for Payer: Aetna Commercial |
$122.33
|
| Rate for Payer: Aetna Medicare |
$94.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.33
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$91.29
|
| Rate for Payer: BCN Medicare Advantage |
$91.29
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$122.33
|
| Rate for Payer: Cofinity Commercial |
$131.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.85
|
| Rate for Payer: Nomi Health Commercial |
$109.55
|
| Rate for Payer: PACE SWMI |
$91.29
|
| Rate for Payer: PHP Commercial |
$127.81
|
| Rate for Payer: PHP Medicare Advantage |
$91.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$91.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.29
|
| Rate for Payer: UHC Medicare Advantage |
$91.29
|
| Rate for Payer: UMR Bronson Commercial |
$98.90
|
|
|
PR PUNCTURE ASPIRATION CYST BREAST EACH ADDL CYST
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 19001
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$26.16
|
| Rate for Payer: Aetna Medicare |
$20.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.16
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$19.52
|
| Rate for Payer: BCN Medicare Advantage |
$19.52
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$28.11
|
| Rate for Payer: Cofinity Commercial |
$26.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.50
|
| Rate for Payer: Nomi Health Commercial |
$23.42
|
| Rate for Payer: PACE SWMI |
$19.52
|
| Rate for Payer: PHP Commercial |
$27.33
|
| Rate for Payer: PHP Medicare Advantage |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health Medicare |
$19.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.52
|
| Rate for Payer: UHC Medicare Advantage |
$19.52
|
| Rate for Payer: UMR Bronson Commercial |
$34.50
|
|
|
PR PUNCTURE ASPIRATION CYST OF BREAST
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 19000
|
| Min. Negotiated Rate |
$40.86 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Aetna Commercial |
$54.75
|
| Rate for Payer: Aetna Medicare |
$42.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.75
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: BCBS MAPPO |
$40.86
|
| Rate for Payer: BCN Medicare Advantage |
$40.86
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cofinity Commercial |
$58.84
|
| Rate for Payer: Cofinity Commercial |
$54.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.90
|
| Rate for Payer: Nomi Health Commercial |
$49.03
|
| Rate for Payer: PACE SWMI |
$40.86
|
| Rate for Payer: PHP Commercial |
$57.20
|
| Rate for Payer: PHP Medicare Advantage |
$40.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
| Rate for Payer: Priority Health Medicare |
$40.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.86
|
| Rate for Payer: UHC Medicare Advantage |
$40.86
|
| Rate for Payer: UMR Bronson Commercial |
$87.86
|
|
|
PR PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 61070
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$260.65 |
| Rate for Payer: Aetna Commercial |
$71.98
|
| Rate for Payer: Aetna Medicare |
$55.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.98
|
| Rate for Payer: BCBS Complete |
$160.40
|
| Rate for Payer: BCBS MAPPO |
$53.72
|
| Rate for Payer: BCN Medicare Advantage |
$53.72
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cofinity Commercial |
$77.36
|
| Rate for Payer: Cofinity Commercial |
$71.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.41
|
| Rate for Payer: Nomi Health Commercial |
$64.46
|
| Rate for Payer: PACE SWMI |
$53.72
|
| Rate for Payer: PHP Commercial |
$75.21
|
| Rate for Payer: PHP Medicare Advantage |
$53.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.65
|
| Rate for Payer: Priority Health Medicare |
$53.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.72
|
| Rate for Payer: UHC Medicare Advantage |
$53.72
|
| Rate for Payer: UMR Bronson Commercial |
$184.46
|
|
|
PR PURE TONE AUDIOMETRY AIR & BONE
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 92553
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$61.65 |
| Rate for Payer: Aetna Commercial |
$57.37
|
| Rate for Payer: Aetna Medicare |
$44.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.37
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS MAPPO |
$42.81
|
| Rate for Payer: BCN Medicare Advantage |
$42.81
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.65
|
| Rate for Payer: Cofinity Commercial |
$57.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.95
|
| Rate for Payer: Nomi Health Commercial |
$51.37
|
| Rate for Payer: PACE SWMI |
$42.81
|
| Rate for Payer: PHP Commercial |
$59.93
|
| Rate for Payer: PHP Medicare Advantage |
$42.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.25
|
| Rate for Payer: Priority Health Medicare |
$42.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.81
|
| Rate for Payer: UHC Medicare Advantage |
$42.81
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
|
|
PR PURE TONE AUDIOMETRY AIR ONLY
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 92552
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$51.05 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Medicare |
$36.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.50
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$35.45
|
| Rate for Payer: BCN Medicare Advantage |
$35.45
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$51.05
|
| Rate for Payer: Cofinity Commercial |
$47.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.22
|
| Rate for Payer: Nomi Health Commercial |
$42.54
|
| Rate for Payer: PACE SWMI |
$35.45
|
| Rate for Payer: PHP Commercial |
$49.63
|
| Rate for Payer: PHP Medicare Advantage |
$35.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health Medicare |
$35.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.45
|
| Rate for Payer: UHC Medicare Advantage |
$35.45
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
|
|
PR PVB THORACIC CONT CATHETER INFUSION W/IMG GID
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 64463
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$104.71
|
| Rate for Payer: Aetna Medicare |
$81.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.71
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: BCBS MAPPO |
$78.14
|
| Rate for Payer: BCN Medicare Advantage |
$78.14
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$112.52
|
| Rate for Payer: Cofinity Commercial |
$104.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.05
|
| Rate for Payer: Nomi Health Commercial |
$93.77
|
| Rate for Payer: PACE SWMI |
$78.14
|
| Rate for Payer: PHP Commercial |
$109.40
|
| Rate for Payer: PHP Medicare Advantage |
$78.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health Medicare |
$78.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.14
|
| Rate for Payer: UHC Medicare Advantage |
$78.14
|
| Rate for Payer: UMR Bronson Commercial |
$145.82
|
|
|
PR PYELOPLASTY COMPLICATED
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 50405
|
| Min. Negotiated Rate |
$1,067.20 |
| Max. Negotiated Rate |
$1,914.32 |
| Rate for Payer: Aetna Commercial |
$1,781.38
|
| Rate for Payer: Aetna Medicare |
$1,382.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,914.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,781.38
|
| Rate for Payer: BCBS Complete |
$1,067.20
|
| Rate for Payer: BCBS MAPPO |
$1,329.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,329.39
|
| Rate for Payer: Cash Price |
$2,134.40
|
| Rate for Payer: Cash Price |
$2,134.40
|
| Rate for Payer: Cofinity Commercial |
$1,914.32
|
| Rate for Payer: Cofinity Commercial |
$1,781.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,329.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,395.86
|
| Rate for Payer: Nomi Health Commercial |
$1,595.27
|
| Rate for Payer: PACE SWMI |
$1,329.39
|
| Rate for Payer: PHP Commercial |
$1,861.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,329.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,734.20
|
| Rate for Payer: Priority Health Medicare |
$1,329.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,329.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,329.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,227.28
|
|
|
PR PYELOPLASTY SIMPLE
|
Professional
|
Both
|
$1,795.00
|
|
|
Service Code
|
HCPCS 50400
|
| Min. Negotiated Rate |
$718.00 |
| Max. Negotiated Rate |
$1,585.92 |
| Rate for Payer: Aetna Commercial |
$1,475.78
|
| Rate for Payer: Aetna Medicare |
$1,145.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,585.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,475.78
|
| Rate for Payer: BCBS Complete |
$718.00
|
| Rate for Payer: BCBS MAPPO |
$1,101.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,101.33
|
| Rate for Payer: Cash Price |
$1,436.00
|
| Rate for Payer: Cash Price |
$1,436.00
|
| Rate for Payer: Cofinity Commercial |
$1,585.92
|
| Rate for Payer: Cofinity Commercial |
$1,475.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,101.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,156.40
|
| Rate for Payer: Nomi Health Commercial |
$1,321.60
|
| Rate for Payer: PACE SWMI |
$1,101.33
|
| Rate for Payer: PHP Commercial |
$1,541.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,101.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,166.75
|
| Rate for Payer: Priority Health Medicare |
$1,101.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,101.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,101.33
|
| Rate for Payer: UMR Bronson Commercial |
$825.70
|
|
|
PR PYLOROMYOTOMY CUTTING PYLORIC MUSC
|
Professional
|
Both
|
$2,256.00
|
|
|
Service Code
|
HCPCS 43520
|
| Min. Negotiated Rate |
$694.38 |
| Max. Negotiated Rate |
$1,466.40 |
| Rate for Payer: Aetna Commercial |
$930.47
|
| Rate for Payer: Aetna Medicare |
$722.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$930.47
|
| Rate for Payer: BCBS Complete |
$902.40
|
| Rate for Payer: BCBS MAPPO |
$694.38
|
| Rate for Payer: BCN Medicare Advantage |
$694.38
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cofinity Commercial |
$999.91
|
| Rate for Payer: Cofinity Commercial |
$930.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.10
|
| Rate for Payer: Nomi Health Commercial |
$833.26
|
| Rate for Payer: PACE SWMI |
$694.38
|
| Rate for Payer: PHP Commercial |
$972.13
|
| Rate for Payer: PHP Medicare Advantage |
$694.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,466.40
|
| Rate for Payer: Priority Health Medicare |
$694.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$694.38
|
| Rate for Payer: UHC Medicare Advantage |
$694.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,037.76
|
|
|
PR PYLOROPLASTY
|
Professional
|
Both
|
$2,557.00
|
|
|
Service Code
|
HCPCS 43800
|
| Min. Negotiated Rate |
$904.63 |
| Max. Negotiated Rate |
$1,662.05 |
| Rate for Payer: Aetna Commercial |
$1,212.20
|
| Rate for Payer: Aetna Medicare |
$940.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,212.20
|
| Rate for Payer: BCBS Complete |
$1,022.80
|
| Rate for Payer: BCBS MAPPO |
$904.63
|
| Rate for Payer: BCN Medicare Advantage |
$904.63
|
| Rate for Payer: Cash Price |
$2,045.60
|
| Rate for Payer: Cash Price |
$2,045.60
|
| Rate for Payer: Cofinity Commercial |
$1,302.67
|
| Rate for Payer: Cofinity Commercial |
$1,212.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$904.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$949.86
|
| Rate for Payer: Nomi Health Commercial |
$1,085.56
|
| Rate for Payer: PACE SWMI |
$904.63
|
| Rate for Payer: PHP Commercial |
$1,266.48
|
| Rate for Payer: PHP Medicare Advantage |
$904.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,662.05
|
| Rate for Payer: Priority Health Medicare |
$904.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$904.63
|
| Rate for Payer: UHC Medicare Advantage |
$904.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,176.22
|
|
|
PR QUADRICEPSPLASTY
|
Professional
|
Both
|
$2,049.00
|
|
|
Service Code
|
HCPCS 27430
|
| Min. Negotiated Rate |
$716.80 |
| Max. Negotiated Rate |
$1,331.85 |
| Rate for Payer: Aetna Commercial |
$960.51
|
| Rate for Payer: Aetna Medicare |
$745.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,032.19
|
| Rate for Payer: BCBS Complete |
$819.60
|
| Rate for Payer: BCBS MAPPO |
$716.80
|
| Rate for Payer: BCN Medicare Advantage |
$716.80
|
| Rate for Payer: Cash Price |
$1,639.20
|
| Rate for Payer: Cash Price |
$1,639.20
|
| Rate for Payer: Cofinity Commercial |
$960.51
|
| Rate for Payer: Cofinity Commercial |
$1,032.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.64
|
| Rate for Payer: Nomi Health Commercial |
$860.16
|
| Rate for Payer: PACE SWMI |
$716.80
|
| Rate for Payer: PHP Commercial |
$1,003.52
|
| Rate for Payer: PHP Medicare Advantage |
$716.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.85
|
| Rate for Payer: Priority Health Medicare |
$716.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.80
|
| Rate for Payer: UHC Medicare Advantage |
$716.80
|
| Rate for Payer: UMR Bronson Commercial |
$942.54
|
|
|
PR QUAL NONMD EST PT 11-20M
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2062
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR QUAL NONMD EST PT 21>MIN
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2063
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR QUAL NONMD EST PT 5-10M
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2061
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 90375
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$402.98 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare |
$291.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.00
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS MAPPO |
$279.85
|
| Rate for Payer: BCN Medicare Advantage |
$279.85
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$402.98
|
| Rate for Payer: Cofinity Commercial |
$375.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.84
|
| Rate for Payer: Nomi Health Commercial |
$335.82
|
| Rate for Payer: PACE SWMI |
$279.85
|
| Rate for Payer: PHP Commercial |
$391.79
|
| Rate for Payer: PHP Medicare Advantage |
$279.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.00
|
| Rate for Payer: Priority Health Medicare |
$279.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.85
|
| Rate for Payer: UHC Medicare Advantage |
$279.85
|
| Rate for Payer: UMR Bronson Commercial |
$101.20
|
|
