|
PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 61000
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$148.26
|
| Rate for Payer: Aetna Medicare |
$115.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.32
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS MAPPO |
$110.64
|
| Rate for Payer: BCN Commercial |
$238.72
|
| Rate for Payer: BCN Medicare Advantage |
$110.64
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$148.26
|
| Rate for Payer: Cofinity Commercial |
$159.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.17
|
| Rate for Payer: Meridian Medicaid |
$74.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.70
|
| Rate for Payer: Nomi Health Commercial |
$132.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$360.00
|
| Rate for Payer: PACE SWMI |
$110.64
|
| Rate for Payer: PHP Commercial |
$154.90
|
| Rate for Payer: PHP Medicare Advantage |
$110.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$200.70
|
| Rate for Payer: Priority Health Medicare |
$110.64
|
| Rate for Payer: Priority Health SBD |
$200.70
|
| Rate for Payer: Priority Health Tiered Network |
$200.70
|
| Rate for Payer: Railroad Medicare Medicare |
$110.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.24
|
| Rate for Payer: UHC Core |
$198.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$110.64
|
| Rate for Payer: UHC Exchange |
$198.24
|
| Rate for Payer: UHC Medicaid |
$70.93
|
| Rate for Payer: UHCCP Medicaid |
$70.93
|
| Rate for Payer: UMR Bronson Commercial |
$220.80
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM 1ST 100SQ CM
|
Professional
|
Both
|
$506.00
|
|
|
Service Code
|
HCPCS 15277
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$404.27 |
| Rate for Payer: Aetna Commercial |
$263.55
|
| Rate for Payer: Aetna Medicare |
$204.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.22
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS MAPPO |
$196.68
|
| Rate for Payer: BCN Commercial |
$332.15
|
| Rate for Payer: BCN Medicare Advantage |
$196.68
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cash Price |
$404.80
|
| Rate for Payer: Cofinity Commercial |
$263.55
|
| Rate for Payer: Cofinity Commercial |
$283.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.51
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$216.35
|
| Rate for Payer: Nomi Health Commercial |
$236.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$379.50
|
| Rate for Payer: PACE SWMI |
$196.68
|
| Rate for Payer: PHP Commercial |
$275.35
|
| Rate for Payer: PHP Medicare Advantage |
$196.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$304.00
|
| Rate for Payer: Priority Health Medicare |
$196.68
|
| Rate for Payer: Priority Health SBD |
$304.00
|
| Rate for Payer: Priority Health Tiered Network |
$304.00
|
| Rate for Payer: Railroad Medicare Medicare |
$196.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$404.27
|
| Rate for Payer: UHC Core |
$404.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$196.68
|
| Rate for Payer: UHC Exchange |
$404.27
|
| Rate for Payer: UHC Medicaid |
$125.88
|
| Rate for Payer: UHCCP Medicaid |
$125.88
|
| Rate for Payer: UMR Bronson Commercial |
$232.76
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM ADL 100SQ CM
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 15278
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$102.40 |
| Rate for Payer: Aetna Commercial |
$65.41
|
| Rate for Payer: Aetna Medicare |
$50.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.29
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$48.81
|
| Rate for Payer: BCN Commercial |
$83.16
|
| Rate for Payer: BCN Medicare Advantage |
$48.81
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$65.41
|
| Rate for Payer: Cofinity Commercial |
$70.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.25
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.69
|
| Rate for Payer: Nomi Health Commercial |
$58.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: PACE SWMI |
$48.81
|
| Rate for Payer: PHP Commercial |
$68.33
|
| Rate for Payer: PHP Medicare Advantage |
$48.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$76.12
|
| Rate for Payer: Priority Health Medicare |
$48.81
|
| Rate for Payer: Priority Health SBD |
$76.12
|
| Rate for Payer: Priority Health Tiered Network |
$76.12
|
| Rate for Payer: Railroad Medicare Medicare |
$48.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.40
|
| Rate for Payer: UHC Core |
$102.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.81
|
| Rate for Payer: UHC Exchange |
$102.40
|
| Rate for Payer: UHC Medicaid |
$31.10
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 15275
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Aetna Commercial |
$111.84
|
| Rate for Payer: Aetna Medicare |
$86.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.18
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCBS MAPPO |
$83.46
|
| Rate for Payer: BCN Commercial |
$139.44
|
| Rate for Payer: BCN Medicare Advantage |
$83.46
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$111.84
|
| Rate for Payer: Cofinity Commercial |
$120.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.63
|
| Rate for Payer: Meridian Medicaid |
$56.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$91.81
|
| Rate for Payer: Nomi Health Commercial |
$100.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.25
|
| Rate for Payer: PACE SWMI |
$83.46
|
| Rate for Payer: PHP Commercial |
$116.84
|
| Rate for Payer: PHP Medicare Advantage |
$83.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$127.62
|
| Rate for Payer: Priority Health Medicare |
$83.46
|
| Rate for Payer: Priority Health SBD |
$127.62
|
| Rate for Payer: Priority Health Tiered Network |
$127.62
|
| Rate for Payer: Railroad Medicare Medicare |
$83.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.78
|
| Rate for Payer: UHC Core |
$168.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.46
|
| Rate for Payer: UHC Exchange |
$168.78
|
| Rate for Payer: UHC Medicaid |
$53.68
|
| Rate for Payer: UHCCP Medicaid |
$53.68
|
| Rate for Payer: UMR Bronson Commercial |
$133.86
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 15276
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Aetna Commercial |
$29.56
|
| Rate for Payer: Aetna Medicare |
$22.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.77
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS MAPPO |
$22.06
|
| Rate for Payer: BCN Commercial |
$36.85
|
| Rate for Payer: BCN Medicare Advantage |
$22.06
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$29.56
|
| Rate for Payer: Cofinity Commercial |
$31.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.16
|
| Rate for Payer: Meridian Medicaid |
$14.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.27
|
| Rate for Payer: Nomi Health Commercial |
$26.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: PACE SWMI |
$22.06
|
| Rate for Payer: PHP Commercial |
$30.88
|
| Rate for Payer: PHP Medicare Advantage |
$22.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.73
|
| Rate for Payer: Priority Health Medicare |
$22.06
|
| Rate for Payer: Priority Health SBD |
$33.73
|
| Rate for Payer: Priority Health Tiered Network |
$33.73
|
| Rate for Payer: Railroad Medicare Medicare |
$22.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.18
|
| Rate for Payer: UHC Core |
$46.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.06
|
| Rate for Payer: UHC Exchange |
$46.18
|
| Rate for Payer: UHC Medicaid |
$14.06
|
| Rate for Payer: UHCCP Medicaid |
$14.06
|
| Rate for Payer: UMR Bronson Commercial |
$31.28
|
|
|
PR SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 41530
|
| Min. Negotiated Rate |
$230.68 |
| Max. Negotiated Rate |
$689.28 |
| Rate for Payer: Aetna Commercial |
$460.46
|
| Rate for Payer: Aetna Medicare |
$357.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.83
|
| Rate for Payer: BCBS Complete |
$242.21
|
| Rate for Payer: BCBS MAPPO |
$343.63
|
| Rate for Payer: BCN Commercial |
$565.70
|
| Rate for Payer: BCN Medicare Advantage |
$343.63
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$460.46
|
| Rate for Payer: Cofinity Commercial |
$494.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$343.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$360.81
|
| Rate for Payer: Meridian Medicaid |
$242.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$377.99
|
| Rate for Payer: Nomi Health Commercial |
$412.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.00
|
| Rate for Payer: PACE SWMI |
$343.63
|
| Rate for Payer: PHP Commercial |
$481.08
|
| Rate for Payer: PHP Medicare Advantage |
$343.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$689.28
|
| Rate for Payer: Priority Health Medicare |
$343.63
|
| Rate for Payer: Priority Health SBD |
$689.28
|
| Rate for Payer: Priority Health Tiered Network |
$689.28
|
| Rate for Payer: Railroad Medicare Medicare |
$343.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.30
|
| Rate for Payer: UHC Core |
$634.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$343.63
|
| Rate for Payer: UHC Exchange |
$634.30
|
| Rate for Payer: UHC Medicaid |
$230.68
|
| Rate for Payer: UHCCP Medicaid |
$230.68
|
| Rate for Payer: UMR Bronson Commercial |
$347.76
|
|
|
PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 30140
|
| Min. Negotiated Rate |
$97.77 |
| Max. Negotiated Rate |
$884.25 |
| Rate for Payer: Aetna Commercial |
$203.13
|
| Rate for Payer: Aetna Medicare |
$157.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.29
|
| Rate for Payer: BCBS Complete |
$102.66
|
| Rate for Payer: BCBS MAPPO |
$151.59
|
| Rate for Payer: BCN Commercial |
$267.42
|
| Rate for Payer: BCN Medicare Advantage |
$151.59
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cofinity Commercial |
$203.13
|
| Rate for Payer: Cofinity Commercial |
$218.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$159.17
|
| Rate for Payer: Meridian Medicaid |
$102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$166.75
|
| Rate for Payer: Nomi Health Commercial |
$181.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$884.25
|
| Rate for Payer: PACE SWMI |
$151.59
|
| Rate for Payer: PHP Commercial |
$212.23
|
| Rate for Payer: PHP Medicare Advantage |
$151.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$251.83
|
| Rate for Payer: Priority Health Medicare |
$151.59
|
| Rate for Payer: Priority Health SBD |
$251.83
|
| Rate for Payer: Priority Health Tiered Network |
$251.83
|
| Rate for Payer: Railroad Medicare Medicare |
$151.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$311.84
|
| Rate for Payer: UHC Core |
$311.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$151.59
|
| Rate for Payer: UHC Exchange |
$311.84
|
| Rate for Payer: UHC Medicaid |
$97.77
|
| Rate for Payer: UHCCP Medicaid |
$97.77
|
| Rate for Payer: UMR Bronson Commercial |
$542.34
|
|
|
PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99462
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$122.25 |
| Rate for Payer: Aetna Commercial |
$47.07
|
| Rate for Payer: Aetna Medicare |
$36.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.59
|
| Rate for Payer: BCBS Complete |
$23.71
|
| Rate for Payer: BCBS MAPPO |
$35.13
|
| Rate for Payer: BCN Commercial |
$59.26
|
| Rate for Payer: BCN Medicare Advantage |
$35.13
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$47.07
|
| Rate for Payer: Cofinity Commercial |
$50.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.89
|
| Rate for Payer: Meridian Medicaid |
$23.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.64
|
| Rate for Payer: Nomi Health Commercial |
$42.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.25
|
| Rate for Payer: PACE SWMI |
$35.13
|
| Rate for Payer: PHP Commercial |
$49.18
|
| Rate for Payer: PHP Medicare Advantage |
$35.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$35.13
|
| Rate for Payer: Priority Health SBD |
$53.30
|
| Rate for Payer: Priority Health Tiered Network |
$53.30
|
| Rate for Payer: Railroad Medicare Medicare |
$35.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.71
|
| Rate for Payer: UHC Core |
$59.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.13
|
| Rate for Payer: UHC Exchange |
$59.71
|
| Rate for Payer: UHC Medicaid |
$22.58
|
| Rate for Payer: UHCCP Medicaid |
$22.58
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
HCPCS 99469
|
| Min. Negotiated Rate |
$334.07 |
| Max. Negotiated Rate |
$612.75 |
| Rate for Payer: Aetna Commercial |
$447.65
|
| Rate for Payer: Aetna Medicare |
$347.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$481.06
|
| Rate for Payer: BCBS Complete |
$350.77
|
| Rate for Payer: BCBS MAPPO |
$334.07
|
| Rate for Payer: BCN Commercial |
$568.20
|
| Rate for Payer: BCN Medicare Advantage |
$334.07
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cash Price |
$653.60
|
| Rate for Payer: Cofinity Commercial |
$447.65
|
| Rate for Payer: Cofinity Commercial |
$481.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$350.77
|
| Rate for Payer: Meridian Medicaid |
$350.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$367.48
|
| Rate for Payer: Nomi Health Commercial |
$400.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$612.75
|
| Rate for Payer: PACE SWMI |
$334.07
|
| Rate for Payer: PHP Commercial |
$467.70
|
| Rate for Payer: PHP Medicare Advantage |
$334.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$334.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$598.52
|
| Rate for Payer: Priority Health Medicare |
$334.07
|
| Rate for Payer: Priority Health SBD |
$598.52
|
| Rate for Payer: Priority Health Tiered Network |
$598.52
|
| Rate for Payer: Railroad Medicare Medicare |
$334.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$564.52
|
| Rate for Payer: UHC Core |
$564.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$334.07
|
| Rate for Payer: UHC Exchange |
$564.52
|
| Rate for Payer: UHC Medicaid |
$334.07
|
| Rate for Payer: UHCCP Medicaid |
$334.07
|
| Rate for Payer: UMR Bronson Commercial |
$375.82
|
|
|
PR SUBSEQUENT INJECTION, PLATELET RICH PLASMA, ANY SITE, INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED
|
Professional
|
Both
|
$315.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: UMR Bronson Commercial |
$144.90
|
|
|
PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 99476
|
| Min. Negotiated Rate |
$302.92 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Aetna Commercial |
$406.31
|
| Rate for Payer: Aetna Medicare |
$315.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.64
|
| Rate for Payer: BCBS Complete |
$318.07
|
| Rate for Payer: BCBS MAPPO |
$303.22
|
| Rate for Payer: BCN Commercial |
$500.97
|
| Rate for Payer: BCN Medicare Advantage |
$303.22
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cofinity Commercial |
$436.64
|
| Rate for Payer: Cofinity Commercial |
$406.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.38
|
| Rate for Payer: Meridian Medicaid |
$318.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.54
|
| Rate for Payer: Nomi Health Commercial |
$363.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.50
|
| Rate for Payer: PACE SWMI |
$303.22
|
| Rate for Payer: PHP Commercial |
$424.51
|
| Rate for Payer: PHP Medicare Advantage |
$303.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$450.63
|
| Rate for Payer: Priority Health Medicare |
$303.22
|
| Rate for Payer: Priority Health SBD |
$450.63
|
| Rate for Payer: Priority Health Tiered Network |
$450.63
|
| Rate for Payer: Railroad Medicare Medicare |
$303.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$491.05
|
| Rate for Payer: UHC Core |
$491.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.22
|
| Rate for Payer: UHC Exchange |
$491.05
|
| Rate for Payer: UHC Medicaid |
$302.92
|
| Rate for Payer: UHCCP Medicaid |
$302.92
|
| Rate for Payer: UMR Bronson Commercial |
$444.36
|
|
|
PR SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 99472
|
| Min. Negotiated Rate |
$342.70 |
| Max. Negotiated Rate |
$619.98 |
| Rate for Payer: Aetna Commercial |
$467.02
|
| Rate for Payer: Aetna Medicare |
$362.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.87
|
| Rate for Payer: BCBS Complete |
$365.95
|
| Rate for Payer: BCBS MAPPO |
$348.52
|
| Rate for Payer: BCN Commercial |
$590.60
|
| Rate for Payer: BCN Medicare Advantage |
$348.52
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Commercial |
$467.02
|
| Rate for Payer: Cofinity Commercial |
$501.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.95
|
| Rate for Payer: Meridian Medicaid |
$365.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$383.37
|
| Rate for Payer: Nomi Health Commercial |
$418.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$558.75
|
| Rate for Payer: PACE SWMI |
$348.52
|
| Rate for Payer: PHP Commercial |
$487.93
|
| Rate for Payer: PHP Medicare Advantage |
$348.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$619.98
|
| Rate for Payer: Priority Health Medicare |
$348.52
|
| Rate for Payer: Priority Health SBD |
$619.98
|
| Rate for Payer: Priority Health Tiered Network |
$619.98
|
| Rate for Payer: Railroad Medicare Medicare |
$348.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$570.29
|
| Rate for Payer: UHC Core |
$570.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$348.52
|
| Rate for Payer: UHC Exchange |
$570.29
|
| Rate for Payer: UHC Medicaid |
$348.52
|
| Rate for Payer: UHCCP Medicaid |
$348.52
|
| Rate for Payer: UMR Bronson Commercial |
$342.70
|
|
|
PR SUBTEMPORAL CRANIAL DECOMPRESSION
|
Professional
|
Both
|
$4,363.00
|
|
|
Service Code
|
HCPCS 61340
|
| Min. Negotiated Rate |
$910.58 |
| Max. Negotiated Rate |
$3,272.25 |
| Rate for Payer: Aetna Commercial |
$1,903.31
|
| Rate for Payer: Aetna Medicare |
$1,477.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,903.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,045.35
|
| Rate for Payer: BCBS Complete |
$956.11
|
| Rate for Payer: BCBS MAPPO |
$1,420.38
|
| Rate for Payer: BCN Commercial |
$3,041.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,420.38
|
| Rate for Payer: Cash Price |
$3,490.40
|
| Rate for Payer: Cash Price |
$3,490.40
|
| Rate for Payer: Cofinity Commercial |
$1,903.31
|
| Rate for Payer: Cofinity Commercial |
$2,045.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,420.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,491.40
|
| Rate for Payer: Meridian Medicaid |
$956.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,562.42
|
| Rate for Payer: Nomi Health Commercial |
$1,704.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,272.25
|
| Rate for Payer: PACE SWMI |
$1,420.38
|
| Rate for Payer: PHP Commercial |
$1,988.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,420.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$910.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,557.09
|
| Rate for Payer: Priority Health Medicare |
$1,420.38
|
| Rate for Payer: Priority Health SBD |
$2,557.09
|
| Rate for Payer: Priority Health Tiered Network |
$2,557.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,420.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,536.12
|
| Rate for Payer: UHC Core |
$2,536.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,420.38
|
| Rate for Payer: UHC Exchange |
$2,536.12
|
| Rate for Payer: UHC Medicaid |
$910.58
|
| Rate for Payer: UHCCP Medicaid |
$910.58
|
| Rate for Payer: UMR Bronson Commercial |
$2,006.98
|
|
|
PR SUCTION ASSISTED LIPECTOMY HEAD & NECK
|
Professional
|
Both
|
$2,101.00
|
|
|
Service Code
|
HCPCS 15876
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$1,575.75 |
| Rate for Payer: Aetna Commercial |
$367.50
|
| Rate for Payer: Aetna Medicare |
$1,050.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.50
|
| Rate for Payer: BCBS Complete |
$488.01
|
| Rate for Payer: BCN Commercial |
$878.21
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Cash Price |
$1,680.80
|
| Rate for Payer: Meridian Medicaid |
$488.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$217.36
|
| Rate for Payer: Priority Health SBD |
$217.36
|
| Rate for Payer: Priority Health Tiered Network |
$217.36
|
| Rate for Payer: UHC Medicaid |
$464.77
|
| Rate for Payer: UHCCP Medicaid |
$464.77
|
| Rate for Payer: UMR Bronson Commercial |
$966.46
|
|
|
PR SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY
|
Professional
|
Both
|
$3,257.00
|
|
|
Service Code
|
HCPCS 15879
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$2,442.75 |
| Rate for Payer: Aetna Commercial |
$656.25
|
| Rate for Payer: Aetna Medicare |
$1,628.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$656.25
|
| Rate for Payer: BCBS Complete |
$1,302.80
|
| Rate for Payer: BCN Commercial |
$900.16
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Cash Price |
$2,605.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,442.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$217.36
|
| Rate for Payer: Priority Health SBD |
$217.36
|
| Rate for Payer: Priority Health Tiered Network |
$217.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,498.22
|
|
|
PR SUCTION ASSISTED LIPECTOMY TRUNK
|
Professional
|
Both
|
$2,837.00
|
|
|
Service Code
|
HCPCS 15877
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$2,127.75 |
| Rate for Payer: Aetna Commercial |
$656.25
|
| Rate for Payer: Aetna Medicare |
$1,418.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$656.25
|
| Rate for Payer: BCBS Complete |
$1,134.80
|
| Rate for Payer: BCN Commercial |
$878.21
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Cash Price |
$2,269.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,127.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$217.36
|
| Rate for Payer: Priority Health SBD |
$217.36
|
| Rate for Payer: Priority Health Tiered Network |
$217.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,305.02
|
|
|
PR SUMATRIPTAN SUCCINATE / 6 MG
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS J3030
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Aetna Commercial |
$60.24
|
| Rate for Payer: Aetna Medicare |
$57.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.24
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.00
|
| Rate for Payer: UHC Core |
$49.00
|
| Rate for Payer: UHC Exchange |
$49.00
|
| Rate for Payer: UMR Bronson Commercial |
$52.90
|
|
|
PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 99377
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: Aetna Medicare |
$70.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.68
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$71.22
|
| Rate for Payer: Priority Health SBD |
$71.22
|
| Rate for Payer: Priority Health Tiered Network |
$71.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.67
|
| Rate for Payer: UHC Core |
$80.67
|
| Rate for Payer: UHC Exchange |
$80.67
|
| Rate for Payer: UMR Bronson Commercial |
$64.40
|
|
|
PR SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99485
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Aetna Commercial |
$75.97
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.97
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCN Commercial |
$108.06
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$97.20
|
| Rate for Payer: Priority Health SBD |
$97.20
|
| Rate for Payer: Priority Health Tiered Network |
$97.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.70
|
| Rate for Payer: UHC Core |
$109.70
|
| Rate for Payer: UHC Exchange |
$109.70
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 99379
|
| Min. Negotiated Rate |
$55.68 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: Aetna Medicare |
$70.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.68
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$71.22
|
| Rate for Payer: Priority Health SBD |
$71.22
|
| Rate for Payer: Priority Health Tiered Network |
$71.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.67
|
| Rate for Payer: UHC Core |
$80.67
|
| Rate for Payer: UHC Exchange |
$80.67
|
| Rate for Payer: UMR Bronson Commercial |
$64.40
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS 99380
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$133.50 |
| Rate for Payer: Aetna Commercial |
$87.31
|
| Rate for Payer: Aetna Medicare |
$89.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$71.20
|
| Rate for Payer: BCN Commercial |
$125.99
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$113.34
|
| Rate for Payer: Priority Health SBD |
$113.34
|
| Rate for Payer: Priority Health Tiered Network |
$113.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.74
|
| Rate for Payer: UHC Core |
$126.74
|
| Rate for Payer: UHC Exchange |
$126.74
|
| Rate for Payer: UMR Bronson Commercial |
$81.88
|
|
|
PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 99375
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$143.25 |
| Rate for Payer: Aetna Commercial |
$87.31
|
| Rate for Payer: Aetna Medicare |
$95.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.31
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: BCN Commercial |
$125.99
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$113.34
|
| Rate for Payer: Priority Health SBD |
$113.34
|
| Rate for Payer: Priority Health Tiered Network |
$113.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.74
|
| Rate for Payer: UHC Core |
$126.74
|
| Rate for Payer: UHC Exchange |
$126.74
|
| Rate for Payer: UMR Bronson Commercial |
$87.86
|
|
|
PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$3,337.00
|
|
|
Service Code
|
HCPCS 58180
|
| Min. Negotiated Rate |
$552.74 |
| Max. Negotiated Rate |
$2,502.75 |
| Rate for Payer: Aetna Commercial |
$1,152.73
|
| Rate for Payer: Aetna Medicare |
$894.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.76
|
| Rate for Payer: BCBS Complete |
$580.38
|
| Rate for Payer: BCBS MAPPO |
$860.25
|
| Rate for Payer: BCN Commercial |
$1,442.65
|
| Rate for Payer: BCN Medicare Advantage |
$860.25
|
| Rate for Payer: Cash Price |
$2,669.60
|
| Rate for Payer: Cash Price |
$2,669.60
|
| Rate for Payer: Cofinity Commercial |
$1,152.73
|
| Rate for Payer: Cofinity Commercial |
$1,238.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$860.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$903.26
|
| Rate for Payer: Meridian Medicaid |
$580.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$946.27
|
| Rate for Payer: Nomi Health Commercial |
$1,032.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,502.75
|
| Rate for Payer: PACE SWMI |
$860.25
|
| Rate for Payer: PHP Commercial |
$1,204.35
|
| Rate for Payer: PHP Medicare Advantage |
$860.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$552.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,461.10
|
| Rate for Payer: Priority Health Medicare |
$860.25
|
| Rate for Payer: Priority Health SBD |
$1,461.10
|
| Rate for Payer: Priority Health Tiered Network |
$1,461.10
|
| Rate for Payer: Railroad Medicare Medicare |
$860.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,702.02
|
| Rate for Payer: UHC Core |
$1,702.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$860.25
|
| Rate for Payer: UHC Exchange |
$1,702.02
|
| Rate for Payer: UHC Medicaid |
$552.74
|
| Rate for Payer: UHCCP Medicaid |
$552.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,535.02
|
|
|
PR SUPRAHYOID LYMPHADENECTOMY
|
Professional
|
Both
|
$1,504.00
|
|
|
Service Code
|
HCPCS 38700
|
| Min. Negotiated Rate |
$452.84 |
| Max. Negotiated Rate |
$1,616.74 |
| Rate for Payer: Aetna Commercial |
$936.04
|
| Rate for Payer: Aetna Medicare |
$726.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,005.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.04
|
| Rate for Payer: BCBS Complete |
$475.48
|
| Rate for Payer: BCBS MAPPO |
$698.54
|
| Rate for Payer: BCN Commercial |
$1,215.07
|
| Rate for Payer: BCN Medicare Advantage |
$698.54
|
| Rate for Payer: Cash Price |
$1,203.20
|
| Rate for Payer: Cash Price |
$1,203.20
|
| Rate for Payer: Cofinity Commercial |
$1,005.90
|
| Rate for Payer: Cofinity Commercial |
$936.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$698.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$733.47
|
| Rate for Payer: Meridian Medicaid |
$475.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$768.39
|
| Rate for Payer: Nomi Health Commercial |
$838.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,128.00
|
| Rate for Payer: PACE SWMI |
$698.54
|
| Rate for Payer: PHP Commercial |
$977.96
|
| Rate for Payer: PHP Medicare Advantage |
$698.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$452.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,616.74
|
| Rate for Payer: Priority Health Medicare |
$698.54
|
| Rate for Payer: Priority Health SBD |
$1,616.74
|
| Rate for Payer: Priority Health Tiered Network |
$1,616.74
|
| Rate for Payer: Railroad Medicare Medicare |
$698.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,404.32
|
| Rate for Payer: UHC Core |
$1,404.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$698.54
|
| Rate for Payer: UHC Exchange |
$1,404.32
|
| Rate for Payer: UHC Medicaid |
$452.84
|
| Rate for Payer: UHCCP Medicaid |
$452.84
|
| Rate for Payer: UMR Bronson Commercial |
$691.84
|
|
|
PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 36253
|
| Min. Negotiated Rate |
$194.47 |
| Max. Negotiated Rate |
$637.83 |
| Rate for Payer: Aetna Commercial |
$409.32
|
| Rate for Payer: Aetna Medicare |
$317.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.86
|
| Rate for Payer: BCBS Complete |
$204.19
|
| Rate for Payer: BCBS MAPPO |
$305.46
|
| Rate for Payer: BCN Commercial |
$515.41
|
| Rate for Payer: BCN Medicare Advantage |
$305.46
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$409.32
|
| Rate for Payer: Cofinity Commercial |
$439.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$320.73
|
| Rate for Payer: Meridian Medicaid |
$204.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.01
|
| Rate for Payer: Nomi Health Commercial |
$366.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.75
|
| Rate for Payer: PACE SWMI |
$305.46
|
| Rate for Payer: PHP Commercial |
$427.64
|
| Rate for Payer: PHP Medicare Advantage |
$305.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$554.26
|
| Rate for Payer: Priority Health Medicare |
$305.46
|
| Rate for Payer: Priority Health SBD |
$554.26
|
| Rate for Payer: Priority Health Tiered Network |
$554.26
|
| Rate for Payer: Railroad Medicare Medicare |
$305.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$637.83
|
| Rate for Payer: UHC Core |
$637.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.46
|
| Rate for Payer: UHC Exchange |
$637.83
|
| Rate for Payer: UHC Medicaid |
$194.47
|
| Rate for Payer: UHCCP Medicaid |
$194.47
|
| Rate for Payer: UMR Bronson Commercial |
$339.02
|
|
