|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$1,113.31 |
| Rate for Payer: Aetna Commercial |
$1,035.99
|
| Rate for Payer: Aetna Medicare |
$804.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.99
|
| Rate for Payer: BCBS Complete |
$487.20
|
| Rate for Payer: BCBS MAPPO |
$773.13
|
| Rate for Payer: BCN Medicare Advantage |
$773.13
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,035.99
|
| Rate for Payer: Cofinity Commercial |
$1,113.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.79
|
| Rate for Payer: Nomi Health Commercial |
$927.76
|
| Rate for Payer: PACE SWMI |
$773.13
|
| Rate for Payer: PHP Commercial |
$1,082.38
|
| Rate for Payer: PHP Medicare Advantage |
$773.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$773.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.13
|
| Rate for Payer: UHC Medicare Advantage |
$773.13
|
| Rate for Payer: UMR Bronson Commercial |
$560.28
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 19380
|
| Hospital Charge Code |
19380
|
| Min. Negotiated Rate |
$450.66 |
| Max. Negotiated Rate |
$17,903.47 |
| Rate for Payer: Aetna American Axle |
$791.70
|
| Rate for Payer: Aetna Commercial |
$1,035.30
|
| Rate for Payer: Aetna Medicare |
$6,614.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,950.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,950.31
|
| Rate for Payer: BCBS Complete |
$3,579.55
|
| Rate for Payer: BCBS MAPPO |
$6,360.25
|
| Rate for Payer: BCN Medicare Advantage |
$6,360.25
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$852.60
|
| Rate for Payer: Cofinity Commercial |
$1,047.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$852.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$974.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,360.25
|
| Rate for Payer: Healthscope Commercial |
$1,096.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$852.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$913.50
|
| Rate for Payer: Mclaren Medicaid |
$3,409.09
|
| Rate for Payer: Mclaren Medicare |
$6,360.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,678.26
|
| Rate for Payer: Meridian Medicaid |
$3,579.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,314.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,035.30
|
| Rate for Payer: PACE Medicare |
$6,042.24
|
| Rate for Payer: PACE SWMI |
$6,360.25
|
| Rate for Payer: PHP Commercial |
$1,035.30
|
| Rate for Payer: PHP Medicare Advantage |
$6,360.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,409.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$6,360.25
|
| Rate for Payer: Priority Health SBD |
$767.34
|
| Rate for Payer: Railroad Medicare Medicare |
$6,360.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17,903.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,360.25
|
| Rate for Payer: UHC Exchange |
$12,155.07
|
| Rate for Payer: UHC Medicare Advantage |
$6,360.25
|
| Rate for Payer: UHCCP Medicaid |
$3,409.09
|
| Rate for Payer: UMR Bronson Commercial |
$450.66
|
| Rate for Payer: VA VA |
$6,360.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$913.50
|
|
|
PR REVISION OF RECONSTRUCTED BREAST
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 19380
|
| Min. Negotiated Rate |
$487.20 |
| Max. Negotiated Rate |
$1,113.31 |
| Rate for Payer: Aetna Commercial |
$1,035.99
|
| Rate for Payer: Aetna Medicare |
$804.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.31
|
| Rate for Payer: BCBS Complete |
$487.20
|
| Rate for Payer: BCBS MAPPO |
$773.13
|
| Rate for Payer: BCN Medicare Advantage |
$773.13
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$1,035.99
|
| Rate for Payer: Cofinity Commercial |
$1,113.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.79
|
| Rate for Payer: Nomi Health Commercial |
$927.76
|
| Rate for Payer: PACE SWMI |
$773.13
|
| Rate for Payer: PHP Commercial |
$1,082.38
|
| Rate for Payer: PHP Medicare Advantage |
$773.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$773.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$773.13
|
| Rate for Payer: UHC Medicare Advantage |
$773.13
|
| Rate for Payer: UMR Bronson Commercial |
$560.28
|
|
|
PR REVISION PERI-IMPLANT CAPSULE BREAST
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 19370
|
| Min. Negotiated Rate |
$497.60 |
| Max. Negotiated Rate |
$926.52 |
| Rate for Payer: Aetna Commercial |
$862.18
|
| Rate for Payer: Aetna Medicare |
$669.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$926.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$862.18
|
| Rate for Payer: BCBS Complete |
$497.60
|
| Rate for Payer: BCBS MAPPO |
$643.42
|
| Rate for Payer: BCN Medicare Advantage |
$643.42
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cofinity Commercial |
$926.52
|
| Rate for Payer: Cofinity Commercial |
$862.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$643.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$675.59
|
| Rate for Payer: Nomi Health Commercial |
$772.10
|
| Rate for Payer: PACE SWMI |
$643.42
|
| Rate for Payer: PHP Commercial |
$900.79
|
| Rate for Payer: PHP Medicare Advantage |
$643.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health Medicare |
$643.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$643.42
|
| Rate for Payer: UHC Medicare Advantage |
$643.42
|
| Rate for Payer: UMR Bronson Commercial |
$572.24
|
|
|
PR REVISION PROSTHETIC VAGINAL GRAFT LAPAROSCOPIC
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 57426
|
| Min. Negotiated Rate |
$644.80 |
| Max. Negotiated Rate |
$1,202.20 |
| Rate for Payer: Aetna Commercial |
$1,118.71
|
| Rate for Payer: Aetna Medicare |
$868.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.71
|
| Rate for Payer: BCBS Complete |
$644.80
|
| Rate for Payer: BCBS MAPPO |
$834.86
|
| Rate for Payer: BCN Medicare Advantage |
$834.86
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cofinity Commercial |
$1,202.20
|
| Rate for Payer: Cofinity Commercial |
$1,118.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$834.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$876.60
|
| Rate for Payer: Nomi Health Commercial |
$1,001.83
|
| Rate for Payer: PACE SWMI |
$834.86
|
| Rate for Payer: PHP Commercial |
$1,168.80
|
| Rate for Payer: PHP Medicare Advantage |
$834.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.80
|
| Rate for Payer: Priority Health Medicare |
$834.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$834.86
|
| Rate for Payer: UHC Medicare Advantage |
$834.86
|
| Rate for Payer: UMR Bronson Commercial |
$741.52
|
|
|
PR REVISION/REPLMT NEUROSTIMLATOR ELTRD CRANIAL NRV
|
Professional
|
Both
|
$2,230.00
|
|
|
Service Code
|
HCPCS 64569
|
| Min. Negotiated Rate |
$760.86 |
| Max. Negotiated Rate |
$1,449.50 |
| Rate for Payer: Aetna Commercial |
$1,019.55
|
| Rate for Payer: Aetna Medicare |
$791.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,095.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,019.55
|
| Rate for Payer: BCBS Complete |
$892.00
|
| Rate for Payer: BCBS MAPPO |
$760.86
|
| Rate for Payer: BCN Medicare Advantage |
$760.86
|
| Rate for Payer: Cash Price |
$1,784.00
|
| Rate for Payer: Cash Price |
$1,784.00
|
| Rate for Payer: Cofinity Commercial |
$1,095.64
|
| Rate for Payer: Cofinity Commercial |
$1,019.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$798.90
|
| Rate for Payer: Nomi Health Commercial |
$913.03
|
| Rate for Payer: PACE SWMI |
$760.86
|
| Rate for Payer: PHP Commercial |
$1,065.20
|
| Rate for Payer: PHP Medicare Advantage |
$760.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,449.50
|
| Rate for Payer: Priority Health Medicare |
$760.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.86
|
| Rate for Payer: UHC Medicare Advantage |
$760.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,025.80
|
|
|
PR REVISION STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$3,917.00
|
|
|
Service Code
|
HCPCS 69662
|
| Min. Negotiated Rate |
$1,080.82 |
| Max. Negotiated Rate |
$2,546.05 |
| Rate for Payer: Aetna Commercial |
$1,448.30
|
| Rate for Payer: Aetna Medicare |
$1,124.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,448.30
|
| Rate for Payer: BCBS Complete |
$1,566.80
|
| Rate for Payer: BCBS MAPPO |
$1,080.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,080.82
|
| Rate for Payer: Cash Price |
$3,133.60
|
| Rate for Payer: Cash Price |
$3,133.60
|
| Rate for Payer: Cofinity Commercial |
$1,556.38
|
| Rate for Payer: Cofinity Commercial |
$1,448.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,080.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,134.86
|
| Rate for Payer: Nomi Health Commercial |
$1,296.98
|
| Rate for Payer: PACE SWMI |
$1,080.82
|
| Rate for Payer: PHP Commercial |
$1,513.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,080.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,546.05
|
| Rate for Payer: Priority Health Medicare |
$1,080.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,080.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,801.82
|
|
|
PR REVISION TRACHEOSTOMY SCAR
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
HCPCS 31830
|
| Min. Negotiated Rate |
$278.80 |
| Max. Negotiated Rate |
$499.49 |
| Rate for Payer: Aetna Commercial |
$464.81
|
| Rate for Payer: Aetna Medicare |
$360.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.81
|
| Rate for Payer: BCBS Complete |
$278.80
|
| Rate for Payer: BCBS MAPPO |
$346.87
|
| Rate for Payer: BCN Medicare Advantage |
$346.87
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cofinity Commercial |
$499.49
|
| Rate for Payer: Cofinity Commercial |
$464.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$364.21
|
| Rate for Payer: Nomi Health Commercial |
$416.24
|
| Rate for Payer: PACE SWMI |
$346.87
|
| Rate for Payer: PHP Commercial |
$485.62
|
| Rate for Payer: PHP Medicare Advantage |
$346.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.05
|
| Rate for Payer: Priority Health Medicare |
$346.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.87
|
| Rate for Payer: UHC Medicare Advantage |
$346.87
|
| Rate for Payer: UMR Bronson Commercial |
$320.62
|
|
|
PR REVIS PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$2,060.00
|
|
|
Service Code
|
HCPCS 49426
|
| Min. Negotiated Rate |
$652.09 |
| Max. Negotiated Rate |
$1,339.00 |
| Rate for Payer: Aetna Commercial |
$873.80
|
| Rate for Payer: Aetna Medicare |
$678.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$939.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.80
|
| Rate for Payer: BCBS Complete |
$824.00
|
| Rate for Payer: BCBS MAPPO |
$652.09
|
| Rate for Payer: BCN Medicare Advantage |
$652.09
|
| Rate for Payer: Cash Price |
$1,648.00
|
| Rate for Payer: Cash Price |
$1,648.00
|
| Rate for Payer: Cofinity Commercial |
$939.01
|
| Rate for Payer: Cofinity Commercial |
$873.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$684.69
|
| Rate for Payer: Nomi Health Commercial |
$782.51
|
| Rate for Payer: PACE SWMI |
$652.09
|
| Rate for Payer: PHP Commercial |
$912.93
|
| Rate for Payer: PHP Medicare Advantage |
$652.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,339.00
|
| Rate for Payer: Priority Health Medicare |
$652.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$652.09
|
| Rate for Payer: UHC Medicare Advantage |
$652.09
|
| Rate for Payer: UMR Bronson Commercial |
$947.60
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT
|
Professional
|
Both
|
$4,192.00
|
|
|
Service Code
|
HCPCS 23474
|
| Min. Negotiated Rate |
$1,669.59 |
| Max. Negotiated Rate |
$2,724.80 |
| Rate for Payer: Aetna Commercial |
$2,237.25
|
| Rate for Payer: Aetna Medicare |
$1,736.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,404.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,237.25
|
| Rate for Payer: BCBS Complete |
$1,676.80
|
| Rate for Payer: BCBS MAPPO |
$1,669.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,669.59
|
| Rate for Payer: Cash Price |
$3,353.60
|
| Rate for Payer: Cash Price |
$3,353.60
|
| Rate for Payer: Cofinity Commercial |
$2,404.21
|
| Rate for Payer: Cofinity Commercial |
$2,237.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,669.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,753.07
|
| Rate for Payer: Nomi Health Commercial |
$2,003.51
|
| Rate for Payer: PACE SWMI |
$1,669.59
|
| Rate for Payer: PHP Commercial |
$2,337.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,669.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,724.80
|
| Rate for Payer: Priority Health Medicare |
$1,669.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,669.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,928.32
|
|
|
PR REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT
|
Professional
|
Both
|
$3,586.00
|
|
|
Service Code
|
HCPCS 23473
|
| Min. Negotiated Rate |
$1,434.40 |
| Max. Negotiated Rate |
$2,330.90 |
| Rate for Payer: Aetna Commercial |
$2,071.59
|
| Rate for Payer: Aetna Medicare |
$1,607.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,226.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,071.59
|
| Rate for Payer: BCBS Complete |
$1,434.40
|
| Rate for Payer: BCBS MAPPO |
$1,545.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,545.96
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cofinity Commercial |
$2,226.18
|
| Rate for Payer: Cofinity Commercial |
$2,071.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,545.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.26
|
| Rate for Payer: Nomi Health Commercial |
$1,855.15
|
| Rate for Payer: PACE SWMI |
$1,545.96
|
| Rate for Payer: PHP Commercial |
$2,164.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,545.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,330.90
|
| Rate for Payer: Priority Health Medicare |
$1,545.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,545.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,545.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,649.56
|
|
|
PR REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT
|
Professional
|
Both
|
$2,083.00
|
|
|
Service Code
|
HCPCS 25449
|
| Min. Negotiated Rate |
$833.20 |
| Max. Negotiated Rate |
$1,433.85 |
| Rate for Payer: Aetna Commercial |
$1,334.28
|
| Rate for Payer: Aetna Medicare |
$1,035.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,433.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,334.28
|
| Rate for Payer: BCBS Complete |
$833.20
|
| Rate for Payer: BCBS MAPPO |
$995.73
|
| Rate for Payer: BCN Medicare Advantage |
$995.73
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cofinity Commercial |
$1,433.85
|
| Rate for Payer: Cofinity Commercial |
$1,334.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$995.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,045.52
|
| Rate for Payer: Nomi Health Commercial |
$1,194.88
|
| Rate for Payer: PACE SWMI |
$995.73
|
| Rate for Payer: PHP Commercial |
$1,394.02
|
| Rate for Payer: PHP Medicare Advantage |
$995.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.95
|
| Rate for Payer: Priority Health Medicare |
$995.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$995.73
|
| Rate for Payer: UHC Medicare Advantage |
$995.73
|
| Rate for Payer: UMR Bronson Commercial |
$958.18
|
|
|
PR REVJ COLOSTOMY COMP RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$2,125.00
|
|
|
Service Code
|
HCPCS 44345
|
| Min. Negotiated Rate |
$850.00 |
| Max. Negotiated Rate |
$1,460.16 |
| Rate for Payer: Aetna Commercial |
$1,358.76
|
| Rate for Payer: Aetna Medicare |
$1,054.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,460.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,358.76
|
| Rate for Payer: BCBS Complete |
$850.00
|
| Rate for Payer: BCBS MAPPO |
$1,014.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,014.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cofinity Commercial |
$1,460.16
|
| Rate for Payer: Cofinity Commercial |
$1,358.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,014.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,064.70
|
| Rate for Payer: Nomi Health Commercial |
$1,216.80
|
| Rate for Payer: PACE SWMI |
$1,014.00
|
| Rate for Payer: PHP Commercial |
$1,419.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,014.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,381.25
|
| Rate for Payer: Priority Health Medicare |
$1,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,014.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,014.00
|
| Rate for Payer: UMR Bronson Commercial |
$977.50
|
|
|
PR REVJ COLOSTOMY SMPL RLS SUPFC SCAR SPX
|
Professional
|
Both
|
$1,114.00
|
|
|
Service Code
|
HCPCS 44340
|
| Min. Negotiated Rate |
$445.60 |
| Max. Negotiated Rate |
$869.41 |
| Rate for Payer: Aetna Commercial |
$809.04
|
| Rate for Payer: Aetna Medicare |
$627.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.04
|
| Rate for Payer: BCBS Complete |
$445.60
|
| Rate for Payer: BCBS MAPPO |
$603.76
|
| Rate for Payer: BCN Medicare Advantage |
$603.76
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cofinity Commercial |
$869.41
|
| Rate for Payer: Cofinity Commercial |
$809.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.95
|
| Rate for Payer: Nomi Health Commercial |
$724.51
|
| Rate for Payer: PACE SWMI |
$603.76
|
| Rate for Payer: PHP Commercial |
$845.26
|
| Rate for Payer: PHP Medicare Advantage |
$603.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$724.10
|
| Rate for Payer: Priority Health Medicare |
$603.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$603.76
|
| Rate for Payer: UHC Medicare Advantage |
$603.76
|
| Rate for Payer: UMR Bronson Commercial |
$512.44
|
|
|
PR REVJ COLOSTOMY W/RPR PARACLST HERNIA SPX
|
Professional
|
Both
|
$2,861.00
|
|
|
Service Code
|
HCPCS 44346
|
| Min. Negotiated Rate |
$1,142.04 |
| Max. Negotiated Rate |
$1,859.65 |
| Rate for Payer: Aetna Commercial |
$1,530.33
|
| Rate for Payer: Aetna Medicare |
$1,187.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,644.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,530.33
|
| Rate for Payer: BCBS Complete |
$1,144.40
|
| Rate for Payer: BCBS MAPPO |
$1,142.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.04
|
| Rate for Payer: Cash Price |
$2,288.80
|
| Rate for Payer: Cash Price |
$2,288.80
|
| Rate for Payer: Cofinity Commercial |
$1,644.54
|
| Rate for Payer: Cofinity Commercial |
$1,530.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.14
|
| Rate for Payer: Nomi Health Commercial |
$1,370.45
|
| Rate for Payer: PACE SWMI |
$1,142.04
|
| Rate for Payer: PHP Commercial |
$1,598.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,859.65
|
| Rate for Payer: Priority Health Medicare |
$1,142.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,142.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,142.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,316.06
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/AUTOG VN PATCH GRF
|
Professional
|
Both
|
$2,619.00
|
|
|
Service Code
|
HCPCS 35884
|
| Min. Negotiated Rate |
$1,047.60 |
| Max. Negotiated Rate |
$1,719.01 |
| Rate for Payer: Aetna Commercial |
$1,599.64
|
| Rate for Payer: Aetna Medicare |
$1,241.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,719.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,599.64
|
| Rate for Payer: BCBS Complete |
$1,047.60
|
| Rate for Payer: BCBS MAPPO |
$1,193.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,193.76
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cash Price |
$2,095.20
|
| Rate for Payer: Cofinity Commercial |
$1,719.01
|
| Rate for Payer: Cofinity Commercial |
$1,599.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,193.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,253.45
|
| Rate for Payer: Nomi Health Commercial |
$1,432.51
|
| Rate for Payer: PACE SWMI |
$1,193.76
|
| Rate for Payer: PHP Commercial |
$1,671.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,193.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,702.35
|
| Rate for Payer: Priority Health Medicare |
$1,193.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,193.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,193.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,204.74
|
|
|
PR REVJ FEM ANAST BPG GRN OPN W/NONAUTOG PATCH GRF
|
Professional
|
Both
|
$2,362.00
|
|
|
Service Code
|
HCPCS 35883
|
| Min. Negotiated Rate |
$944.80 |
| Max. Negotiated Rate |
$1,650.10 |
| Rate for Payer: Aetna Commercial |
$1,535.51
|
| Rate for Payer: Aetna Medicare |
$1,191.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,650.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,535.51
|
| Rate for Payer: BCBS Complete |
$944.80
|
| Rate for Payer: BCBS MAPPO |
$1,145.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,145.90
|
| Rate for Payer: Cash Price |
$1,889.60
|
| Rate for Payer: Cash Price |
$1,889.60
|
| Rate for Payer: Cofinity Commercial |
$1,650.10
|
| Rate for Payer: Cofinity Commercial |
$1,535.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,145.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,203.19
|
| Rate for Payer: Nomi Health Commercial |
$1,375.08
|
| Rate for Payer: PACE SWMI |
$1,145.90
|
| Rate for Payer: PHP Commercial |
$1,604.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,145.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,535.30
|
| Rate for Payer: Priority Health Medicare |
$1,145.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,145.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,145.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,086.52
|
|
|
PR REVJ GSTR/JJ ANAST W/RCNSTJ W/O VGTMY
|
Professional
|
Both
|
$5,384.00
|
|
|
Service Code
|
HCPCS 43860
|
| Min. Negotiated Rate |
$1,591.27 |
| Max. Negotiated Rate |
$3,499.60 |
| Rate for Payer: Aetna Commercial |
$2,132.30
|
| Rate for Payer: Aetna Medicare |
$1,654.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,291.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,132.30
|
| Rate for Payer: BCBS Complete |
$2,153.60
|
| Rate for Payer: BCBS MAPPO |
$1,591.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,591.27
|
| Rate for Payer: Cash Price |
$4,307.20
|
| Rate for Payer: Cash Price |
$4,307.20
|
| Rate for Payer: Cofinity Commercial |
$2,291.43
|
| Rate for Payer: Cofinity Commercial |
$2,132.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,591.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,670.83
|
| Rate for Payer: Nomi Health Commercial |
$1,909.52
|
| Rate for Payer: PACE SWMI |
$1,591.27
|
| Rate for Payer: PHP Commercial |
$2,227.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,591.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,499.60
|
| Rate for Payer: Priority Health Medicare |
$1,591.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,591.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,591.27
|
| Rate for Payer: UMR Bronson Commercial |
$2,476.64
|
|
|
PR REVJ ILEOSTOMY COMPLIC RCNSTJ IN-DEPTH SPX
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 44314
|
| Min. Negotiated Rate |
$964.69 |
| Max. Negotiated Rate |
$1,681.55 |
| Rate for Payer: Aetna Commercial |
$1,292.68
|
| Rate for Payer: Aetna Medicare |
$1,003.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,389.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,292.68
|
| Rate for Payer: BCBS Complete |
$1,034.80
|
| Rate for Payer: BCBS MAPPO |
$964.69
|
| Rate for Payer: BCN Medicare Advantage |
$964.69
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cofinity Commercial |
$1,389.15
|
| Rate for Payer: Cofinity Commercial |
$1,292.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$964.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,012.92
|
| Rate for Payer: Nomi Health Commercial |
$1,157.63
|
| Rate for Payer: PACE SWMI |
$964.69
|
| Rate for Payer: PHP Commercial |
$1,350.57
|
| Rate for Payer: PHP Medicare Advantage |
$964.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.55
|
| Rate for Payer: Priority Health Medicare |
$964.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$964.69
|
| Rate for Payer: UHC Medicare Advantage |
$964.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,190.02
|
|
|
PR REVJ ILEOSTOMY SIMPLE RLS SUPERFICIAL SCAR SPX
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 44312
|
| Min. Negotiated Rate |
$495.20 |
| Max. Negotiated Rate |
$828.58 |
| Rate for Payer: Aetna Commercial |
$771.04
|
| Rate for Payer: Aetna Medicare |
$598.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$771.04
|
| Rate for Payer: BCBS Complete |
$495.20
|
| Rate for Payer: BCBS MAPPO |
$575.40
|
| Rate for Payer: BCN Medicare Advantage |
$575.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$828.58
|
| Rate for Payer: Cofinity Commercial |
$771.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$575.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$604.17
|
| Rate for Payer: Nomi Health Commercial |
$690.48
|
| Rate for Payer: PACE SWMI |
$575.40
|
| Rate for Payer: PHP Commercial |
$805.56
|
| Rate for Payer: PHP Medicare Advantage |
$575.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.70
|
| Rate for Payer: Priority Health Medicare |
$575.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$575.40
|
| Rate for Payer: UHC Medicare Advantage |
$575.40
|
| Rate for Payer: UMR Bronson Commercial |
$569.48
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR
|
Professional
|
Both
|
$4,128.00
|
|
|
Service Code
|
HCPCS 63664
|
| Min. Negotiated Rate |
$870.61 |
| Max. Negotiated Rate |
$2,683.20 |
| Rate for Payer: Aetna Commercial |
$1,166.62
|
| Rate for Payer: Aetna Medicare |
$905.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,253.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,166.62
|
| Rate for Payer: BCBS Complete |
$1,651.20
|
| Rate for Payer: BCBS MAPPO |
$870.61
|
| Rate for Payer: BCN Medicare Advantage |
$870.61
|
| Rate for Payer: Cash Price |
$3,302.40
|
| Rate for Payer: Cash Price |
$3,302.40
|
| Rate for Payer: Cofinity Commercial |
$1,253.68
|
| Rate for Payer: Cofinity Commercial |
$1,166.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.14
|
| Rate for Payer: Nomi Health Commercial |
$1,044.73
|
| Rate for Payer: PACE SWMI |
$870.61
|
| Rate for Payer: PHP Commercial |
$1,218.85
|
| Rate for Payer: PHP Medicare Advantage |
$870.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,683.20
|
| Rate for Payer: Priority Health Medicare |
$870.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.61
|
| Rate for Payer: UHC Medicare Advantage |
$870.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,898.88
|
|
|
PR REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR
|
Professional
|
Both
|
$4,817.00
|
|
|
Service Code
|
HCPCS 63663
|
| Min. Negotiated Rate |
$431.97 |
| Max. Negotiated Rate |
$3,131.05 |
| Rate for Payer: Aetna Commercial |
$578.84
|
| Rate for Payer: Aetna Medicare |
$449.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.84
|
| Rate for Payer: BCBS Complete |
$1,926.80
|
| Rate for Payer: BCBS MAPPO |
$431.97
|
| Rate for Payer: BCN Medicare Advantage |
$431.97
|
| Rate for Payer: Cash Price |
$3,853.60
|
| Rate for Payer: Cash Price |
$3,853.60
|
| Rate for Payer: Cofinity Commercial |
$622.04
|
| Rate for Payer: Cofinity Commercial |
$578.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$431.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$453.57
|
| Rate for Payer: Nomi Health Commercial |
$518.36
|
| Rate for Payer: PACE SWMI |
$431.97
|
| Rate for Payer: PHP Commercial |
$604.76
|
| Rate for Payer: PHP Medicare Advantage |
$431.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,131.05
|
| Rate for Payer: Priority Health Medicare |
$431.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$431.97
|
| Rate for Payer: UHC Medicare Advantage |
$431.97
|
| Rate for Payer: UMR Bronson Commercial |
$2,215.82
|
|
|
PR REVJ LXTR ARTL BYP OPN VEIN PATCH ANGIOP
|
Professional
|
Both
|
$1,825.00
|
|
|
Service Code
|
HCPCS 35879
|
| Min. Negotiated Rate |
$730.00 |
| Max. Negotiated Rate |
$1,273.87 |
| Rate for Payer: Aetna Commercial |
$1,185.40
|
| Rate for Payer: Aetna Medicare |
$920.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.40
|
| Rate for Payer: BCBS Complete |
$730.00
|
| Rate for Payer: BCBS MAPPO |
$884.63
|
| Rate for Payer: BCN Medicare Advantage |
$884.63
|
| Rate for Payer: Cash Price |
$1,460.00
|
| Rate for Payer: Cash Price |
$1,460.00
|
| Rate for Payer: Cofinity Commercial |
$1,273.87
|
| Rate for Payer: Cofinity Commercial |
$1,185.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$884.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$928.86
|
| Rate for Payer: Nomi Health Commercial |
$1,061.56
|
| Rate for Payer: PACE SWMI |
$884.63
|
| Rate for Payer: PHP Commercial |
$1,238.48
|
| Rate for Payer: PHP Medicare Advantage |
$884.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,186.25
|
| Rate for Payer: Priority Health Medicare |
$884.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$884.63
|
| Rate for Payer: UHC Medicare Advantage |
$884.63
|
| Rate for Payer: UMR Bronson Commercial |
$839.50
|
|
|
PR REVJ LXTR ARTL BYP OPN W/SGMTL VEIN INTERPOS
|
Professional
|
Both
|
$2,119.00
|
|
|
Service Code
|
HCPCS 35881
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$1,412.88 |
| Rate for Payer: Aetna Commercial |
$1,314.77
|
| Rate for Payer: Aetna Medicare |
$1,020.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,412.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,314.77
|
| Rate for Payer: BCBS Complete |
$847.60
|
| Rate for Payer: BCBS MAPPO |
$981.17
|
| Rate for Payer: BCN Medicare Advantage |
$981.17
|
| Rate for Payer: Cash Price |
$1,695.20
|
| Rate for Payer: Cash Price |
$1,695.20
|
| Rate for Payer: Cofinity Commercial |
$1,412.88
|
| Rate for Payer: Cofinity Commercial |
$1,314.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.23
|
| Rate for Payer: Nomi Health Commercial |
$1,177.40
|
| Rate for Payer: PACE SWMI |
$981.17
|
| Rate for Payer: PHP Commercial |
$1,373.64
|
| Rate for Payer: PHP Medicare Advantage |
$981.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,377.35
|
| Rate for Payer: Priority Health Medicare |
$981.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.17
|
| Rate for Payer: UHC Medicare Advantage |
$981.17
|
| Rate for Payer: UMR Bronson Commercial |
$974.74
|
|
|
PR REVJ MASTOIDECTOMY RSLTG COMPL MASTOIDECTOMY
|
Professional
|
Both
|
$2,087.00
|
|
|
Service Code
|
HCPCS 69601
|
| Min. Negotiated Rate |
$834.80 |
| Max. Negotiated Rate |
$1,374.62 |
| Rate for Payer: Aetna Commercial |
$1,279.16
|
| Rate for Payer: Aetna Medicare |
$992.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,279.16
|
| Rate for Payer: BCBS Complete |
$834.80
|
| Rate for Payer: BCBS MAPPO |
$954.60
|
| Rate for Payer: BCN Medicare Advantage |
$954.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cofinity Commercial |
$1,374.62
|
| Rate for Payer: Cofinity Commercial |
$1,279.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$954.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,002.33
|
| Rate for Payer: Nomi Health Commercial |
$1,145.52
|
| Rate for Payer: PACE SWMI |
$954.60
|
| Rate for Payer: PHP Commercial |
$1,336.44
|
| Rate for Payer: PHP Medicare Advantage |
$954.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,356.55
|
| Rate for Payer: Priority Health Medicare |
$954.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$954.60
|
| Rate for Payer: UHC Medicare Advantage |
$954.60
|
| Rate for Payer: UMR Bronson Commercial |
$960.02
|
|
