|
PR REPAIR ANORECTAL FISTULA PLUG
|
Professional
|
Both
|
$1,037.00
|
|
|
Service Code
|
HCPCS 46707
|
| Min. Negotiated Rate |
$414.80 |
| Max. Negotiated Rate |
$701.68 |
| Rate for Payer: Aetna Commercial |
$652.96
|
| Rate for Payer: Aetna Medicare |
$506.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$701.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.96
|
| Rate for Payer: BCBS Complete |
$414.80
|
| Rate for Payer: BCBS MAPPO |
$487.28
|
| Rate for Payer: BCN Medicare Advantage |
$487.28
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cash Price |
$829.60
|
| Rate for Payer: Cofinity Commercial |
$701.68
|
| Rate for Payer: Cofinity Commercial |
$652.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.64
|
| Rate for Payer: Nomi Health Commercial |
$584.74
|
| Rate for Payer: PACE SWMI |
$487.28
|
| Rate for Payer: PHP Commercial |
$682.19
|
| Rate for Payer: PHP Medicare Advantage |
$487.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.05
|
| Rate for Payer: Priority Health Medicare |
$487.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.28
|
| Rate for Payer: UHC Medicare Advantage |
$487.28
|
| Rate for Payer: UMR Bronson Commercial |
$477.02
|
|
|
PR REPAIR BIFID EARLOBES - BILATERAL
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
HCPCS 00535
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$408.00 |
| Max. Negotiated Rate |
$663.00 |
| Rate for Payer: Aetna Medicare |
$510.00
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: UMR Bronson Commercial |
$469.20
|
|
|
PR REPAIR BIFID EARLOBES - UNILATERAL
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00534
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: UMR Bronson Commercial |
$281.52
|
|
|
PR REPAIR BLOOD VESSEL DIRECT HAND FINGER
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS 35207
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,045.56 |
| Rate for Payer: Aetna Commercial |
$972.95
|
| Rate for Payer: Aetna Medicare |
$755.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$972.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,045.56
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: BCBS MAPPO |
$726.08
|
| Rate for Payer: BCN Medicare Advantage |
$726.08
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cofinity Commercial |
$972.95
|
| Rate for Payer: Cofinity Commercial |
$1,045.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$726.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$762.38
|
| Rate for Payer: Nomi Health Commercial |
$871.30
|
| Rate for Payer: PACE SWMI |
$726.08
|
| Rate for Payer: PHP Commercial |
$1,016.51
|
| Rate for Payer: PHP Medicare Advantage |
$726.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
| Rate for Payer: Priority Health Medicare |
$726.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$726.08
|
| Rate for Payer: UHC Medicare Advantage |
$726.08
|
| Rate for Payer: UMR Bronson Commercial |
$622.38
|
|
|
PR REPAIR BLOOD VESSEL DIRECT INTRA-ABDOMINAL
|
Professional
|
Both
|
$5,052.00
|
|
|
Service Code
|
HCPCS 35221
|
| Min. Negotiated Rate |
$1,412.76 |
| Max. Negotiated Rate |
$3,283.80 |
| Rate for Payer: Aetna Commercial |
$1,893.10
|
| Rate for Payer: Aetna Medicare |
$1,469.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,034.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,893.10
|
| Rate for Payer: BCBS Complete |
$2,020.80
|
| Rate for Payer: BCBS MAPPO |
$1,412.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,412.76
|
| Rate for Payer: Cash Price |
$4,041.60
|
| Rate for Payer: Cash Price |
$4,041.60
|
| Rate for Payer: Cofinity Commercial |
$2,034.37
|
| Rate for Payer: Cofinity Commercial |
$1,893.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,412.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,483.40
|
| Rate for Payer: Nomi Health Commercial |
$1,695.31
|
| Rate for Payer: PACE SWMI |
$1,412.76
|
| Rate for Payer: PHP Commercial |
$1,977.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,412.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,283.80
|
| Rate for Payer: Priority Health Medicare |
$1,412.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,412.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,412.76
|
| Rate for Payer: UMR Bronson Commercial |
$2,323.92
|
|
|
PR REPAIR BLOOD VESSEL DIRECT LOWER EXTREMITY
|
Professional
|
Both
|
$2,660.00
|
|
|
Service Code
|
HCPCS 35226
|
| Min. Negotiated Rate |
$793.95 |
| Max. Negotiated Rate |
$1,729.00 |
| Rate for Payer: Aetna Commercial |
$1,063.89
|
| Rate for Payer: Aetna Medicare |
$825.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,143.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,063.89
|
| Rate for Payer: BCBS Complete |
$1,064.00
|
| Rate for Payer: BCBS MAPPO |
$793.95
|
| Rate for Payer: BCN Medicare Advantage |
$793.95
|
| Rate for Payer: Cash Price |
$2,128.00
|
| Rate for Payer: Cash Price |
$2,128.00
|
| Rate for Payer: Cofinity Commercial |
$1,143.29
|
| Rate for Payer: Cofinity Commercial |
$1,063.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$793.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$833.65
|
| Rate for Payer: Nomi Health Commercial |
$952.74
|
| Rate for Payer: PACE SWMI |
$793.95
|
| Rate for Payer: PHP Commercial |
$1,111.53
|
| Rate for Payer: PHP Medicare Advantage |
$793.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,729.00
|
| Rate for Payer: Priority Health Medicare |
$793.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$793.95
|
| Rate for Payer: UHC Medicare Advantage |
$793.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,223.60
|
|
|
PR REPAIR BLOOD VESSEL DIRECT NECK
|
Professional
|
Both
|
$4,240.00
|
|
|
Service Code
|
HCPCS 35201
|
| Min. Negotiated Rate |
$890.13 |
| Max. Negotiated Rate |
$2,756.00 |
| Rate for Payer: Aetna Commercial |
$1,192.77
|
| Rate for Payer: Aetna Medicare |
$925.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,281.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,192.77
|
| Rate for Payer: BCBS Complete |
$1,696.00
|
| Rate for Payer: BCBS MAPPO |
$890.13
|
| Rate for Payer: BCN Medicare Advantage |
$890.13
|
| Rate for Payer: Cash Price |
$3,392.00
|
| Rate for Payer: Cash Price |
$3,392.00
|
| Rate for Payer: Cofinity Commercial |
$1,281.79
|
| Rate for Payer: Cofinity Commercial |
$1,192.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.64
|
| Rate for Payer: Nomi Health Commercial |
$1,068.16
|
| Rate for Payer: PACE SWMI |
$890.13
|
| Rate for Payer: PHP Commercial |
$1,246.18
|
| Rate for Payer: PHP Medicare Advantage |
$890.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,756.00
|
| Rate for Payer: Priority Health Medicare |
$890.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.13
|
| Rate for Payer: UHC Medicare Advantage |
$890.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,950.40
|
|
|
PR REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY
|
Professional
|
Both
|
$2,790.00
|
|
|
Service Code
|
HCPCS 35206
|
| Min. Negotiated Rate |
$763.15 |
| Max. Negotiated Rate |
$1,813.50 |
| Rate for Payer: Aetna Commercial |
$1,022.62
|
| Rate for Payer: Aetna Medicare |
$793.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,098.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.62
|
| Rate for Payer: BCBS Complete |
$1,116.00
|
| Rate for Payer: BCBS MAPPO |
$763.15
|
| Rate for Payer: BCN Medicare Advantage |
$763.15
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cofinity Commercial |
$1,098.94
|
| Rate for Payer: Cofinity Commercial |
$1,022.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$763.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$801.31
|
| Rate for Payer: Nomi Health Commercial |
$915.78
|
| Rate for Payer: PACE SWMI |
$763.15
|
| Rate for Payer: PHP Commercial |
$1,068.41
|
| Rate for Payer: PHP Medicare Advantage |
$763.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,813.50
|
| Rate for Payer: Priority Health Medicare |
$763.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$763.15
|
| Rate for Payer: UHC Medicare Advantage |
$763.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,283.40
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT INTRA-ABDOMINAL
|
Professional
|
Both
|
$3,839.00
|
|
|
Service Code
|
HCPCS 35251
|
| Min. Negotiated Rate |
$1,535.60 |
| Max. Negotiated Rate |
$2,495.35 |
| Rate for Payer: Aetna Commercial |
$2,226.45
|
| Rate for Payer: Aetna Medicare |
$1,727.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,392.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,226.45
|
| Rate for Payer: BCBS Complete |
$1,535.60
|
| Rate for Payer: BCBS MAPPO |
$1,661.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,661.53
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cash Price |
$3,071.20
|
| Rate for Payer: Cofinity Commercial |
$2,392.60
|
| Rate for Payer: Cofinity Commercial |
$2,226.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,661.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,744.61
|
| Rate for Payer: Nomi Health Commercial |
$1,993.84
|
| Rate for Payer: PACE SWMI |
$1,661.53
|
| Rate for Payer: PHP Commercial |
$2,326.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,661.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,495.35
|
| Rate for Payer: Priority Health Medicare |
$1,661.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,661.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,661.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,765.94
|
|
|
PR REPAIR BLOOD VESSEL VEIN GRAFT LOWER EXTREMITY
|
Professional
|
Both
|
$4,575.00
|
|
|
Service Code
|
HCPCS 35256
|
| Min. Negotiated Rate |
$978.13 |
| Max. Negotiated Rate |
$2,973.75 |
| Rate for Payer: Aetna Commercial |
$1,310.69
|
| Rate for Payer: Aetna Medicare |
$1,017.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,408.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.69
|
| Rate for Payer: BCBS Complete |
$1,830.00
|
| Rate for Payer: BCBS MAPPO |
$978.13
|
| Rate for Payer: BCN Medicare Advantage |
$978.13
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cash Price |
$3,660.00
|
| Rate for Payer: Cofinity Commercial |
$1,408.51
|
| Rate for Payer: Cofinity Commercial |
$1,310.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$978.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,027.04
|
| Rate for Payer: Nomi Health Commercial |
$1,173.76
|
| Rate for Payer: PACE SWMI |
$978.13
|
| Rate for Payer: PHP Commercial |
$1,369.38
|
| Rate for Payer: PHP Medicare Advantage |
$978.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,973.75
|
| Rate for Payer: Priority Health Medicare |
$978.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$978.13
|
| Rate for Payer: UHC Medicare Advantage |
$978.13
|
| Rate for Payer: UMR Bronson Commercial |
$2,104.50
|
|
|
PR REPAIR BLOOD VESSEL W/GRAFT OTHER/THAN VEIN NECK
|
Professional
|
Both
|
$4,692.00
|
|
|
Service Code
|
HCPCS 35261
|
| Min. Negotiated Rate |
$945.40 |
| Max. Negotiated Rate |
$3,049.80 |
| Rate for Payer: Aetna Commercial |
$1,266.84
|
| Rate for Payer: Aetna Medicare |
$983.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,361.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.84
|
| Rate for Payer: BCBS Complete |
$1,876.80
|
| Rate for Payer: BCBS MAPPO |
$945.40
|
| Rate for Payer: BCN Medicare Advantage |
$945.40
|
| Rate for Payer: Cash Price |
$3,753.60
|
| Rate for Payer: Cash Price |
$3,753.60
|
| Rate for Payer: Cofinity Commercial |
$1,361.38
|
| Rate for Payer: Cofinity Commercial |
$1,266.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.67
|
| Rate for Payer: Nomi Health Commercial |
$1,134.48
|
| Rate for Payer: PACE SWMI |
$945.40
|
| Rate for Payer: PHP Commercial |
$1,323.56
|
| Rate for Payer: PHP Medicare Advantage |
$945.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,049.80
|
| Rate for Payer: Priority Health Medicare |
$945.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.40
|
| Rate for Payer: UHC Medicare Advantage |
$945.40
|
| Rate for Payer: UMR Bronson Commercial |
$2,158.32
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT NECK
|
Professional
|
Both
|
$1,896.00
|
|
|
Service Code
|
HCPCS 35231
|
| Min. Negotiated Rate |
$758.40 |
| Max. Negotiated Rate |
$1,719.17 |
| Rate for Payer: Aetna Commercial |
$1,599.79
|
| Rate for Payer: Aetna Medicare |
$1,241.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,719.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,599.79
|
| Rate for Payer: BCBS Complete |
$758.40
|
| Rate for Payer: BCBS MAPPO |
$1,193.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,193.87
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cofinity Commercial |
$1,719.17
|
| Rate for Payer: Cofinity Commercial |
$1,599.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,193.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,253.56
|
| Rate for Payer: Nomi Health Commercial |
$1,432.64
|
| Rate for Payer: PACE SWMI |
$1,193.87
|
| Rate for Payer: PHP Commercial |
$1,671.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,193.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,232.40
|
| Rate for Payer: Priority Health Medicare |
$1,193.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,193.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,193.87
|
| Rate for Payer: UMR Bronson Commercial |
$872.16
|
|
|
PR REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY
|
Professional
|
Both
|
$3,698.00
|
|
|
Service Code
|
HCPCS 35236
|
| Min. Negotiated Rate |
$966.53 |
| Max. Negotiated Rate |
$2,403.70 |
| Rate for Payer: Aetna Commercial |
$1,295.15
|
| Rate for Payer: Aetna Medicare |
$1,005.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,391.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,295.15
|
| Rate for Payer: BCBS Complete |
$1,479.20
|
| Rate for Payer: BCBS MAPPO |
$966.53
|
| Rate for Payer: BCN Medicare Advantage |
$966.53
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cash Price |
$2,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,391.80
|
| Rate for Payer: Cofinity Commercial |
$1,295.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$966.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,014.86
|
| Rate for Payer: Nomi Health Commercial |
$1,159.84
|
| Rate for Payer: PACE SWMI |
$966.53
|
| Rate for Payer: PHP Commercial |
$1,353.14
|
| Rate for Payer: PHP Medicare Advantage |
$966.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,403.70
|
| Rate for Payer: Priority Health Medicare |
$966.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$966.53
|
| Rate for Payer: UHC Medicare Advantage |
$966.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,701.08
|
|
|
PR REPAIR BROW PTOSIS
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 67900
|
| Min. Negotiated Rate |
$468.29 |
| Max. Negotiated Rate |
$861.90 |
| Rate for Payer: Aetna Commercial |
$627.51
|
| Rate for Payer: Aetna Medicare |
$487.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$674.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$627.51
|
| Rate for Payer: BCBS Complete |
$530.40
|
| Rate for Payer: BCBS MAPPO |
$468.29
|
| Rate for Payer: BCN Medicare Advantage |
$468.29
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$674.34
|
| Rate for Payer: Cofinity Commercial |
$627.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$491.70
|
| Rate for Payer: Nomi Health Commercial |
$561.95
|
| Rate for Payer: PACE SWMI |
$468.29
|
| Rate for Payer: PHP Commercial |
$655.61
|
| Rate for Payer: PHP Medicare Advantage |
$468.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.90
|
| Rate for Payer: Priority Health Medicare |
$468.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$468.29
|
| Rate for Payer: UHC Medicare Advantage |
$468.29
|
| Rate for Payer: UMR Bronson Commercial |
$609.96
|
|
|
PR REPAIR CARDIAC WOUND W/CARDIOPULMONARY BYPASS
|
Professional
|
Both
|
$7,686.00
|
|
|
Service Code
|
HCPCS 33305
|
| Min. Negotiated Rate |
$3,074.40 |
| Max. Negotiated Rate |
$5,642.31 |
| Rate for Payer: Aetna Commercial |
$5,250.48
|
| Rate for Payer: Aetna Medicare |
$4,075.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,642.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,250.48
|
| Rate for Payer: BCBS Complete |
$3,074.40
|
| Rate for Payer: BCBS MAPPO |
$3,918.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,918.27
|
| Rate for Payer: Cash Price |
$6,148.80
|
| Rate for Payer: Cash Price |
$6,148.80
|
| Rate for Payer: Cofinity Commercial |
$5,642.31
|
| Rate for Payer: Cofinity Commercial |
$5,250.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,918.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,114.18
|
| Rate for Payer: Nomi Health Commercial |
$4,701.92
|
| Rate for Payer: PACE SWMI |
$3,918.27
|
| Rate for Payer: PHP Commercial |
$5,485.58
|
| Rate for Payer: PHP Medicare Advantage |
$3,918.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,995.90
|
| Rate for Payer: Priority Health Medicare |
$3,918.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,918.27
|
| Rate for Payer: UHC Medicare Advantage |
$3,918.27
|
| Rate for Payer: UMR Bronson Commercial |
$3,535.56
|
|
|
PR REPAIR CARDIAC WOUND W/O BYPASS
|
Professional
|
Both
|
$4,597.00
|
|
|
Service Code
|
HCPCS 33300
|
| Min. Negotiated Rate |
$1,838.80 |
| Max. Negotiated Rate |
$3,379.67 |
| Rate for Payer: Aetna Commercial |
$3,144.97
|
| Rate for Payer: Aetna Medicare |
$2,440.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,379.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,144.97
|
| Rate for Payer: BCBS Complete |
$1,838.80
|
| Rate for Payer: BCBS MAPPO |
$2,346.99
|
| Rate for Payer: BCN Medicare Advantage |
$2,346.99
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cofinity Commercial |
$3,379.67
|
| Rate for Payer: Cofinity Commercial |
$3,144.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,346.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,464.34
|
| Rate for Payer: Nomi Health Commercial |
$2,816.39
|
| Rate for Payer: PACE SWMI |
$2,346.99
|
| Rate for Payer: PHP Commercial |
$3,285.79
|
| Rate for Payer: PHP Medicare Advantage |
$2,346.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,988.05
|
| Rate for Payer: Priority Health Medicare |
$2,346.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,346.99
|
| Rate for Payer: UHC Medicare Advantage |
$2,346.99
|
| Rate for Payer: UMR Bronson Commercial |
$2,114.62
|
|
|
PR REPAIR CHOANAL ATRESIA INTRANASAL
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
HCPCS 30540
|
| Min. Negotiated Rate |
$490.80 |
| Max. Negotiated Rate |
$988.04 |
| Rate for Payer: Aetna Commercial |
$919.43
|
| Rate for Payer: Aetna Medicare |
$713.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$919.43
|
| Rate for Payer: BCBS Complete |
$490.80
|
| Rate for Payer: BCBS MAPPO |
$686.14
|
| Rate for Payer: BCN Medicare Advantage |
$686.14
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cash Price |
$981.60
|
| Rate for Payer: Cofinity Commercial |
$988.04
|
| Rate for Payer: Cofinity Commercial |
$919.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$686.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$720.45
|
| Rate for Payer: Nomi Health Commercial |
$823.37
|
| Rate for Payer: PACE SWMI |
$686.14
|
| Rate for Payer: PHP Commercial |
$960.60
|
| Rate for Payer: PHP Medicare Advantage |
$686.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$797.55
|
| Rate for Payer: Priority Health Medicare |
$686.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$686.14
|
| Rate for Payer: UHC Medicare Advantage |
$686.14
|
| Rate for Payer: UMR Bronson Commercial |
$564.42
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 13151
|
| Min. Negotiated Rate |
$263.21 |
| Max. Negotiated Rate |
$603.20 |
| Rate for Payer: Aetna Commercial |
$352.70
|
| Rate for Payer: Aetna Medicare |
$273.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.70
|
| Rate for Payer: BCBS Complete |
$371.20
|
| Rate for Payer: BCBS MAPPO |
$263.21
|
| Rate for Payer: BCN Medicare Advantage |
$263.21
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$379.02
|
| Rate for Payer: Cofinity Commercial |
$352.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.37
|
| Rate for Payer: Nomi Health Commercial |
$315.85
|
| Rate for Payer: PACE SWMI |
$263.21
|
| Rate for Payer: PHP Commercial |
$368.49
|
| Rate for Payer: PHP Medicare Advantage |
$263.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health Medicare |
$263.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.21
|
| Rate for Payer: UHC Medicare Advantage |
$263.21
|
| Rate for Payer: UMR Bronson Commercial |
$426.88
|
|
|
PR REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM
|
Professional
|
Both
|
$1,232.00
|
|
|
Service Code
|
HCPCS 13152
|
| Min. Negotiated Rate |
$316.36 |
| Max. Negotiated Rate |
$800.80 |
| Rate for Payer: Aetna Commercial |
$423.92
|
| Rate for Payer: Aetna Medicare |
$329.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.92
|
| Rate for Payer: BCBS Complete |
$492.80
|
| Rate for Payer: BCBS MAPPO |
$316.36
|
| Rate for Payer: BCN Medicare Advantage |
$316.36
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cash Price |
$985.60
|
| Rate for Payer: Cofinity Commercial |
$455.56
|
| Rate for Payer: Cofinity Commercial |
$423.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.18
|
| Rate for Payer: Nomi Health Commercial |
$379.63
|
| Rate for Payer: PACE SWMI |
$316.36
|
| Rate for Payer: PHP Commercial |
$442.90
|
| Rate for Payer: PHP Medicare Advantage |
$316.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$800.80
|
| Rate for Payer: Priority Health Medicare |
$316.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.36
|
| Rate for Payer: UHC Medicare Advantage |
$316.36
|
| Rate for Payer: UMR Bronson Commercial |
$566.72
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM
|
Professional
|
Both
|
$605.00
|
|
|
Service Code
|
HCPCS 13131
|
| Min. Negotiated Rate |
$229.33 |
| Max. Negotiated Rate |
$393.25 |
| Rate for Payer: Aetna Commercial |
$307.30
|
| Rate for Payer: Aetna Medicare |
$238.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.30
|
| Rate for Payer: BCBS Complete |
$242.00
|
| Rate for Payer: BCBS MAPPO |
$229.33
|
| Rate for Payer: BCN Medicare Advantage |
$229.33
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cash Price |
$484.00
|
| Rate for Payer: Cofinity Commercial |
$330.24
|
| Rate for Payer: Cofinity Commercial |
$307.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.80
|
| Rate for Payer: Nomi Health Commercial |
$275.20
|
| Rate for Payer: PACE SWMI |
$229.33
|
| Rate for Payer: PHP Commercial |
$321.06
|
| Rate for Payer: PHP Medicare Advantage |
$229.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.25
|
| Rate for Payer: Priority Health Medicare |
$229.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.33
|
| Rate for Payer: UHC Medicare Advantage |
$229.33
|
| Rate for Payer: UMR Bronson Commercial |
$278.30
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM
|
Professional
|
Both
|
$1,306.00
|
|
|
Service Code
|
HCPCS 13132
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$848.90 |
| Rate for Payer: Aetna Commercial |
$382.44
|
| Rate for Payer: Aetna Medicare |
$296.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.44
|
| Rate for Payer: BCBS Complete |
$522.40
|
| Rate for Payer: BCBS MAPPO |
$285.40
|
| Rate for Payer: BCN Medicare Advantage |
$285.40
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cash Price |
$1,044.80
|
| Rate for Payer: Cofinity Commercial |
$410.98
|
| Rate for Payer: Cofinity Commercial |
$382.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.67
|
| Rate for Payer: Nomi Health Commercial |
$342.48
|
| Rate for Payer: PACE SWMI |
$285.40
|
| Rate for Payer: PHP Commercial |
$399.56
|
| Rate for Payer: PHP Medicare Advantage |
$285.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.90
|
| Rate for Payer: Priority Health Medicare |
$285.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.40
|
| Rate for Payer: UHC Medicare Advantage |
$285.40
|
| Rate for Payer: UMR Bronson Commercial |
$600.76
|
|
|
PR REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 13133
|
| Min. Negotiated Rate |
$118.59 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Commercial |
$158.91
|
| Rate for Payer: Aetna Medicare |
$123.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.91
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$118.59
|
| Rate for Payer: BCN Medicare Advantage |
$118.59
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$170.77
|
| Rate for Payer: Cofinity Commercial |
$158.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.52
|
| Rate for Payer: Nomi Health Commercial |
$142.31
|
| Rate for Payer: PACE SWMI |
$118.59
|
| Rate for Payer: PHP Commercial |
$166.03
|
| Rate for Payer: PHP Medicare Advantage |
$118.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health Medicare |
$118.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.59
|
| Rate for Payer: UHC Medicare Advantage |
$118.59
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 13120
|
| Min. Negotiated Rate |
$216.90 |
| Max. Negotiated Rate |
$355.55 |
| Rate for Payer: Aetna Commercial |
$290.65
|
| Rate for Payer: Aetna Medicare |
$225.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.65
|
| Rate for Payer: BCBS Complete |
$218.80
|
| Rate for Payer: BCBS MAPPO |
$216.90
|
| Rate for Payer: BCN Medicare Advantage |
$216.90
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$312.34
|
| Rate for Payer: Cofinity Commercial |
$290.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.75
|
| Rate for Payer: Nomi Health Commercial |
$260.28
|
| Rate for Payer: PACE SWMI |
$216.90
|
| Rate for Payer: PHP Commercial |
$303.66
|
| Rate for Payer: PHP Medicare Advantage |
$216.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health Medicare |
$216.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.90
|
| Rate for Payer: UHC Medicare Advantage |
$216.90
|
| Rate for Payer: UMR Bronson Commercial |
$251.62
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 13121
|
| Hospital Charge Code |
13121
|
| Min. Negotiated Rate |
$244.04 |
| Max. Negotiated Rate |
$583.70 |
| Rate for Payer: Aetna Commercial |
$327.01
|
| Rate for Payer: Aetna Medicare |
$253.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.01
|
| Rate for Payer: BCBS Complete |
$359.20
|
| Rate for Payer: BCBS MAPPO |
$244.04
|
| Rate for Payer: BCN Medicare Advantage |
$244.04
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$327.01
|
| Rate for Payer: Cofinity Commercial |
$351.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.24
|
| Rate for Payer: Nomi Health Commercial |
$292.85
|
| Rate for Payer: PACE SWMI |
$244.04
|
| Rate for Payer: PHP Commercial |
$341.66
|
| Rate for Payer: PHP Medicare Advantage |
$244.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health Medicare |
$244.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.04
|
| Rate for Payer: UHC Medicare Advantage |
$244.04
|
| Rate for Payer: UMR Bronson Commercial |
$413.08
|
|
|
PR REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM
|
Facility
|
IP
|
$898.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
13121
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$395.12 |
| Max. Negotiated Rate |
$808.20 |
| Rate for Payer: Aetna American Axle |
$583.70
|
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.70
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$628.60
|
| Rate for Payer: Cofinity Commercial |
$772.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$628.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$718.40
|
| Rate for Payer: Healthscope Commercial |
$808.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$628.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$673.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$763.30
|
| Rate for Payer: PHP Commercial |
$763.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$583.70
|
| Rate for Payer: Priority Health SBD |
$565.74
|
| Rate for Payer: UMR Bronson Commercial |
$395.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$673.50
|
|
