|
PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
HCPCS 37223
|
| Min. Negotiated Rate |
$199.60 |
| Max. Negotiated Rate |
$324.35 |
| Rate for Payer: Aetna Commercial |
$271.55
|
| Rate for Payer: Aetna Medicare |
$210.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.55
|
| Rate for Payer: BCBS Complete |
$199.60
|
| Rate for Payer: BCBS MAPPO |
$202.65
|
| Rate for Payer: BCN Medicare Advantage |
$202.65
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Cofinity Commercial |
$291.82
|
| Rate for Payer: Cofinity Commercial |
$271.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$202.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$212.78
|
| Rate for Payer: Nomi Health Commercial |
$243.18
|
| Rate for Payer: PACE SWMI |
$202.65
|
| Rate for Payer: PHP Commercial |
$283.71
|
| Rate for Payer: PHP Medicare Advantage |
$202.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.35
|
| Rate for Payer: Priority Health Medicare |
$202.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.65
|
| Rate for Payer: UHC Medicare Advantage |
$202.65
|
| Rate for Payer: UMR Bronson Commercial |
$229.54
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY
|
Professional
|
Both
|
$2,022.00
|
|
|
Service Code
|
HCPCS 37221
|
| Min. Negotiated Rate |
$470.25 |
| Max. Negotiated Rate |
$1,314.30 |
| Rate for Payer: Aetna Commercial |
$630.13
|
| Rate for Payer: Aetna Medicare |
$489.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.13
|
| Rate for Payer: BCBS Complete |
$808.80
|
| Rate for Payer: BCBS MAPPO |
$470.25
|
| Rate for Payer: BCN Medicare Advantage |
$470.25
|
| Rate for Payer: Cash Price |
$1,617.60
|
| Rate for Payer: Cash Price |
$1,617.60
|
| Rate for Payer: Cofinity Commercial |
$677.16
|
| Rate for Payer: Cofinity Commercial |
$630.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$493.76
|
| Rate for Payer: Nomi Health Commercial |
$564.30
|
| Rate for Payer: PACE SWMI |
$470.25
|
| Rate for Payer: PHP Commercial |
$658.35
|
| Rate for Payer: PHP Medicare Advantage |
$470.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,314.30
|
| Rate for Payer: Priority Health Medicare |
$470.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.25
|
| Rate for Payer: UHC Medicare Advantage |
$470.25
|
| Rate for Payer: UMR Bronson Commercial |
$930.12
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,305.00
|
|
|
Service Code
|
HCPCS 37228
|
| Min. Negotiated Rate |
$516.20 |
| Max. Negotiated Rate |
$848.25 |
| Rate for Payer: Aetna Commercial |
$691.71
|
| Rate for Payer: Aetna Medicare |
$536.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$691.71
|
| Rate for Payer: BCBS Complete |
$522.00
|
| Rate for Payer: BCBS MAPPO |
$516.20
|
| Rate for Payer: BCN Medicare Advantage |
$516.20
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cofinity Commercial |
$743.33
|
| Rate for Payer: Cofinity Commercial |
$691.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$516.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$542.01
|
| Rate for Payer: Nomi Health Commercial |
$619.44
|
| Rate for Payer: PACE SWMI |
$516.20
|
| Rate for Payer: PHP Commercial |
$722.68
|
| Rate for Payer: PHP Medicare Advantage |
$516.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.25
|
| Rate for Payer: Priority Health Medicare |
$516.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$516.20
|
| Rate for Payer: UHC Medicare Advantage |
$516.20
|
| Rate for Payer: UMR Bronson Commercial |
$600.30
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL
|
Professional
|
Both
|
$4,351.00
|
|
|
Service Code
|
HCPCS 37232
|
| Min. Negotiated Rate |
$189.38 |
| Max. Negotiated Rate |
$2,828.15 |
| Rate for Payer: Aetna Commercial |
$253.77
|
| Rate for Payer: Aetna Medicare |
$196.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.77
|
| Rate for Payer: BCBS Complete |
$1,740.40
|
| Rate for Payer: BCBS MAPPO |
$189.38
|
| Rate for Payer: BCN Medicare Advantage |
$189.38
|
| Rate for Payer: Cash Price |
$3,480.80
|
| Rate for Payer: Cash Price |
$3,480.80
|
| Rate for Payer: Cofinity Commercial |
$272.71
|
| Rate for Payer: Cofinity Commercial |
$253.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.85
|
| Rate for Payer: Nomi Health Commercial |
$227.26
|
| Rate for Payer: PACE SWMI |
$189.38
|
| Rate for Payer: PHP Commercial |
$265.13
|
| Rate for Payer: PHP Medicare Advantage |
$189.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,828.15
|
| Rate for Payer: Priority Health Medicare |
$189.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.38
|
| Rate for Payer: UHC Medicare Advantage |
$189.38
|
| Rate for Payer: UMR Bronson Commercial |
$2,001.46
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,733.00
|
|
|
Service Code
|
HCPCS 37229
|
| Min. Negotiated Rate |
$657.99 |
| Max. Negotiated Rate |
$1,776.45 |
| Rate for Payer: Aetna Commercial |
$881.71
|
| Rate for Payer: Aetna Medicare |
$684.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.71
|
| Rate for Payer: BCBS Complete |
$1,093.20
|
| Rate for Payer: BCBS MAPPO |
$657.99
|
| Rate for Payer: BCN Medicare Advantage |
$657.99
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cash Price |
$2,186.40
|
| Rate for Payer: Cofinity Commercial |
$947.51
|
| Rate for Payer: Cofinity Commercial |
$881.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.89
|
| Rate for Payer: Nomi Health Commercial |
$789.59
|
| Rate for Payer: PACE SWMI |
$657.99
|
| Rate for Payer: PHP Commercial |
$921.19
|
| Rate for Payer: PHP Medicare Advantage |
$657.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,776.45
|
| Rate for Payer: Priority Health Medicare |
$657.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.99
|
| Rate for Payer: UHC Medicare Advantage |
$657.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,257.18
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 37233
|
| Min. Negotiated Rate |
$305.92 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Aetna Commercial |
$409.93
|
| Rate for Payer: Aetna Medicare |
$318.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.93
|
| Rate for Payer: BCBS Complete |
$456.40
|
| Rate for Payer: BCBS MAPPO |
$305.92
|
| Rate for Payer: BCN Medicare Advantage |
$305.92
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Cofinity Commercial |
$440.52
|
| Rate for Payer: Cofinity Commercial |
$409.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.22
|
| Rate for Payer: Nomi Health Commercial |
$367.10
|
| Rate for Payer: PACE SWMI |
$305.92
|
| Rate for Payer: PHP Commercial |
$428.29
|
| Rate for Payer: PHP Medicare Advantage |
$305.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.65
|
| Rate for Payer: Priority Health Medicare |
$305.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.92
|
| Rate for Payer: UHC Medicare Advantage |
$305.92
|
| Rate for Payer: UMR Bronson Commercial |
$524.86
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$2,739.00
|
|
|
Service Code
|
HCPCS 37230
|
| Min. Negotiated Rate |
$661.66 |
| Max. Negotiated Rate |
$1,780.35 |
| Rate for Payer: Aetna Commercial |
$886.62
|
| Rate for Payer: Aetna Medicare |
$688.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$952.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$886.62
|
| Rate for Payer: BCBS Complete |
$1,095.60
|
| Rate for Payer: BCBS MAPPO |
$661.66
|
| Rate for Payer: BCN Medicare Advantage |
$661.66
|
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Cash Price |
$2,191.20
|
| Rate for Payer: Cofinity Commercial |
$952.79
|
| Rate for Payer: Cofinity Commercial |
$886.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$661.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$694.74
|
| Rate for Payer: Nomi Health Commercial |
$793.99
|
| Rate for Payer: PACE SWMI |
$661.66
|
| Rate for Payer: PHP Commercial |
$926.32
|
| Rate for Payer: PHP Medicare Advantage |
$661.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.35
|
| Rate for Payer: Priority Health Medicare |
$661.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$661.66
|
| Rate for Payer: UHC Medicare Advantage |
$661.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,259.94
|
|
|
PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 37234
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$385.33 |
| Rate for Payer: Aetna Commercial |
$358.57
|
| Rate for Payer: Aetna Medicare |
$278.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.57
|
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: BCBS MAPPO |
$267.59
|
| Rate for Payer: BCN Medicare Advantage |
$267.59
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Cofinity Commercial |
$385.33
|
| Rate for Payer: Cofinity Commercial |
$358.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$280.97
|
| Rate for Payer: Nomi Health Commercial |
$321.11
|
| Rate for Payer: PACE SWMI |
$267.59
|
| Rate for Payer: PHP Commercial |
$374.63
|
| Rate for Payer: PHP Medicare Advantage |
$267.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health Medicare |
$267.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.59
|
| Rate for Payer: UHC Medicare Advantage |
$267.59
|
| Rate for Payer: UMR Bronson Commercial |
$239.20
|
|
|
PR RHINOPLASTY EXTERNAL
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 00536
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,264.80 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,454.52
|
|
|
PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR
|
Professional
|
Both
|
$2,464.00
|
|
|
Service Code
|
HCPCS 30420
|
| Min. Negotiated Rate |
$985.60 |
| Max. Negotiated Rate |
$1,935.88 |
| Rate for Payer: Aetna Commercial |
$1,801.44
|
| Rate for Payer: Aetna Medicare |
$1,398.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,801.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,935.88
|
| Rate for Payer: BCBS Complete |
$985.60
|
| Rate for Payer: BCBS MAPPO |
$1,344.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,344.36
|
| Rate for Payer: Cash Price |
$1,971.20
|
| Rate for Payer: Cash Price |
$1,971.20
|
| Rate for Payer: Cofinity Commercial |
$1,801.44
|
| Rate for Payer: Cofinity Commercial |
$1,935.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,344.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,411.58
|
| Rate for Payer: Nomi Health Commercial |
$1,613.23
|
| Rate for Payer: PACE SWMI |
$1,344.36
|
| Rate for Payer: PHP Commercial |
$1,882.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,344.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.60
|
| Rate for Payer: Priority Health Medicare |
$1,344.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,344.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,344.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,133.44
|
|
|
PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION
|
Professional
|
Both
|
$2,030.00
|
|
|
Service Code
|
HCPCS 30435
|
| Min. Negotiated Rate |
$812.00 |
| Max. Negotiated Rate |
$1,785.34 |
| Rate for Payer: Aetna Commercial |
$1,661.36
|
| Rate for Payer: Aetna Medicare |
$1,289.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,785.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,661.36
|
| Rate for Payer: BCBS Complete |
$812.00
|
| Rate for Payer: BCBS MAPPO |
$1,239.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,239.82
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cash Price |
$1,624.00
|
| Rate for Payer: Cofinity Commercial |
$1,785.34
|
| Rate for Payer: Cofinity Commercial |
$1,661.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,239.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,301.81
|
| Rate for Payer: Nomi Health Commercial |
$1,487.78
|
| Rate for Payer: PACE SWMI |
$1,239.82
|
| Rate for Payer: PHP Commercial |
$1,735.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,239.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,319.50
|
| Rate for Payer: Priority Health Medicare |
$1,239.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,239.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,239.82
|
| Rate for Payer: UMR Bronson Commercial |
$933.80
|
|
|
PR RHINOPLASTY SECONDARY MAJOR REVISION
|
Professional
|
Both
|
$3,500.00
|
|
|
Service Code
|
HCPCS 30450
|
| Min. Negotiated Rate |
$1,400.00 |
| Max. Negotiated Rate |
$2,355.31 |
| Rate for Payer: Aetna Commercial |
$2,191.74
|
| Rate for Payer: Aetna Medicare |
$1,701.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,355.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,191.74
|
| Rate for Payer: BCBS Complete |
$1,400.00
|
| Rate for Payer: BCBS MAPPO |
$1,635.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,635.63
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cash Price |
$2,800.00
|
| Rate for Payer: Cofinity Commercial |
$2,355.31
|
| Rate for Payer: Cofinity Commercial |
$2,191.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,635.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,717.41
|
| Rate for Payer: Nomi Health Commercial |
$1,962.76
|
| Rate for Payer: PACE SWMI |
$1,635.63
|
| Rate for Payer: PHP Commercial |
$2,289.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,635.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,275.00
|
| Rate for Payer: Priority Health Medicare |
$1,635.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,635.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,635.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,610.00
|
|
|
PR RHINP DFRM W/COLUM LNGTH TIP ONLY
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 30460
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$1,127.23 |
| Rate for Payer: Aetna Commercial |
$1,048.95
|
| Rate for Payer: Aetna Medicare |
$814.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.95
|
| Rate for Payer: BCBS Complete |
$548.00
|
| Rate for Payer: BCBS MAPPO |
$782.80
|
| Rate for Payer: BCN Medicare Advantage |
$782.80
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$1,127.23
|
| Rate for Payer: Cofinity Commercial |
$1,048.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$782.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$821.94
|
| Rate for Payer: Nomi Health Commercial |
$939.36
|
| Rate for Payer: PACE SWMI |
$782.80
|
| Rate for Payer: PHP Commercial |
$1,095.92
|
| Rate for Payer: PHP Medicare Advantage |
$782.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health Medicare |
$782.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$782.80
|
| Rate for Payer: UHC Medicare Advantage |
$782.80
|
| Rate for Payer: UMR Bronson Commercial |
$630.20
|
|
|
PR RHINP PRIM COMPLETE XTRNL PARTS
|
Professional
|
Both
|
$3,084.00
|
|
|
Service Code
|
HCPCS 30410
|
| Min. Negotiated Rate |
$1,233.60 |
| Max. Negotiated Rate |
$2,004.60 |
| Rate for Payer: Aetna Commercial |
$1,758.50
|
| Rate for Payer: Aetna Commercial |
$1,758.50
|
| Rate for Payer: Aetna Medicare |
$1,364.80
|
| Rate for Payer: Aetna Medicare |
$1,364.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,758.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,758.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,889.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,889.73
|
| Rate for Payer: BCBS Complete |
$1,233.60
|
| Rate for Payer: BCBS Complete |
$1,224.00
|
| Rate for Payer: BCBS MAPPO |
$1,312.31
|
| Rate for Payer: BCBS MAPPO |
$1,312.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,312.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,312.31
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cofinity Commercial |
$1,889.73
|
| Rate for Payer: Cofinity Commercial |
$1,889.73
|
| Rate for Payer: Cofinity Commercial |
$1,758.50
|
| Rate for Payer: Cofinity Commercial |
$1,758.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,312.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,312.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,377.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,377.93
|
| Rate for Payer: Nomi Health Commercial |
$1,574.77
|
| Rate for Payer: Nomi Health Commercial |
$1,574.77
|
| Rate for Payer: PACE SWMI |
$1,312.31
|
| Rate for Payer: PACE SWMI |
$1,312.31
|
| Rate for Payer: PHP Commercial |
$1,837.23
|
| Rate for Payer: PHP Commercial |
$1,837.23
|
| Rate for Payer: PHP Medicare Advantage |
$1,312.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,312.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,989.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,004.60
|
| Rate for Payer: Priority Health Medicare |
$1,312.31
|
| Rate for Payer: Priority Health Medicare |
$1,312.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,312.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,312.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,312.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,312.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,418.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,407.60
|
|
|
PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI
|
Professional
|
Both
|
$1,530.00
|
|
|
Service Code
|
HCPCS 30400
|
| Min. Negotiated Rate |
$612.00 |
| Max. Negotiated Rate |
$1,631.58 |
| Rate for Payer: Aetna Commercial |
$1,518.27
|
| Rate for Payer: Aetna Medicare |
$1,178.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.27
|
| Rate for Payer: BCBS Complete |
$612.00
|
| Rate for Payer: BCBS MAPPO |
$1,133.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.04
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cash Price |
$1,224.00
|
| Rate for Payer: Cofinity Commercial |
$1,631.58
|
| Rate for Payer: Cofinity Commercial |
$1,518.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.69
|
| Rate for Payer: Nomi Health Commercial |
$1,359.65
|
| Rate for Payer: PACE SWMI |
$1,133.04
|
| Rate for Payer: PHP Commercial |
$1,586.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,133.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health Medicare |
$1,133.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.04
|
| Rate for Payer: UMR Bronson Commercial |
$703.80
|
|
|
PR RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 90384
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR RHO D IMMUNE GLOBULIN INJ
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS J2790
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$118.92 |
| Rate for Payer: Aetna Commercial |
$110.66
|
| Rate for Payer: Aetna Medicare |
$85.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.92
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$82.58
|
| Rate for Payer: BCN Medicare Advantage |
$82.58
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$110.66
|
| Rate for Payer: Cofinity Commercial |
$118.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.71
|
| Rate for Payer: Nomi Health Commercial |
$99.10
|
| Rate for Payer: PACE SWMI |
$82.58
|
| Rate for Payer: PHP Commercial |
$115.61
|
| Rate for Payer: PHP Medicare Advantage |
$82.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$82.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.58
|
| Rate for Payer: UHC Medicare Advantage |
$82.58
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 93042
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Commercial |
$8.59
|
| Rate for Payer: Aetna Medicare |
$6.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.59
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$6.41
|
| Rate for Payer: BCN Medicare Advantage |
$6.41
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$9.23
|
| Rate for Payer: Cofinity Commercial |
$8.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.73
|
| Rate for Payer: Nomi Health Commercial |
$7.69
|
| Rate for Payer: PACE SWMI |
$6.41
|
| Rate for Payer: PHP Commercial |
$8.97
|
| Rate for Payer: PHP Medicare Advantage |
$6.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.41
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
|
|
PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 93041
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Commercial |
$8.01
|
| Rate for Payer: Aetna Medicare |
$6.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.01
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$5.98
|
| Rate for Payer: BCN Medicare Advantage |
$5.98
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$8.61
|
| Rate for Payer: Cofinity Commercial |
$8.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.28
|
| Rate for Payer: Nomi Health Commercial |
$7.18
|
| Rate for Payer: PACE SWMI |
$5.98
|
| Rate for Payer: PHP Commercial |
$8.37
|
| Rate for Payer: PHP Medicare Advantage |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health Medicare |
$5.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.98
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
|
|
PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 93040
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$16.60
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.60
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCN Medicare Advantage |
$12.39
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$17.84
|
| Rate for Payer: Cofinity Commercial |
$16.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.01
|
| Rate for Payer: Nomi Health Commercial |
$14.87
|
| Rate for Payer: PACE SWMI |
$12.39
|
| Rate for Payer: PHP Commercial |
$17.35
|
| Rate for Payer: PHP Medicare Advantage |
$12.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.39
|
| Rate for Payer: UHC Medicare Advantage |
$12.39
|
| Rate for Payer: UMR Bronson Commercial |
$20.70
|
|
|
PR RHYTIDECTOMY 3 HOURS
|
Professional
|
Both
|
$4,896.00
|
|
|
Service Code
|
HCPCS 00539
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,958.40 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: BCBS Complete |
$1,958.40
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: UMR Bronson Commercial |
$2,252.16
|
|
|
PR RHYTIDECTOMY SMAS FLAP
|
Professional
|
Both
|
$4,896.00
|
|
|
Service Code
|
HCPCS 15829
|
| Min. Negotiated Rate |
$1,958.40 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: BCBS Complete |
$1,958.40
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: UMR Bronson Commercial |
$2,252.16
|
|
|
PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 93451
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$1,055.72 |
| Rate for Payer: Aetna Commercial |
$982.41
|
| Rate for Payer: Aetna Medicare |
$762.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.72
|
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: BCBS MAPPO |
$733.14
|
| Rate for Payer: BCN Medicare Advantage |
$733.14
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$982.41
|
| Rate for Payer: Cofinity Commercial |
$1,055.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$769.80
|
| Rate for Payer: Nomi Health Commercial |
$879.77
|
| Rate for Payer: PACE SWMI |
$733.14
|
| Rate for Payer: PHP Commercial |
$1,026.40
|
| Rate for Payer: PHP Medicare Advantage |
$733.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health Medicare |
$733.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.14
|
| Rate for Payer: UHC Medicare Advantage |
$733.14
|
| Rate for Payer: UMR Bronson Commercial |
$205.16
|
|
|
PR RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 35697
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$213.20 |
| Rate for Payer: Aetna Commercial |
$188.86
|
| Rate for Payer: Aetna Medicare |
$146.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.86
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$140.94
|
| Rate for Payer: BCN Medicare Advantage |
$140.94
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$202.95
|
| Rate for Payer: Cofinity Commercial |
$188.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.99
|
| Rate for Payer: Nomi Health Commercial |
$169.13
|
| Rate for Payer: PACE SWMI |
$140.94
|
| Rate for Payer: PHP Commercial |
$197.32
|
| Rate for Payer: PHP Medicare Advantage |
$140.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$140.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.94
|
| Rate for Payer: UHC Medicare Advantage |
$140.94
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR RINGERS LACTATE INFUSION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J7120
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Aetna Medicare |
$2.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.23
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$2.41
|
| Rate for Payer: BCN Medicare Advantage |
$2.41
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.53
|
| Rate for Payer: Nomi Health Commercial |
$2.89
|
| Rate for Payer: PACE SWMI |
$2.41
|
| Rate for Payer: PHP Commercial |
$3.37
|
| Rate for Payer: PHP Medicare Advantage |
$2.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$2.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.41
|
| Rate for Payer: UHC Medicare Advantage |
$2.41
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
