|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Facility
|
OP
|
$6,003.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$1,696.23 |
| Max. Negotiated Rate |
$13,752.00 |
| Rate for Payer: Aetna American Axle |
$3,901.95
|
| Rate for Payer: Aetna Commercial |
$5,102.55
|
| Rate for Payer: Aetna Medicare |
$3,001.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,901.95
|
| Rate for Payer: BCBS Complete |
$2,401.20
|
| Rate for Payer: BCBS Trust/PPO |
$13,673.23
|
| Rate for Payer: BCN Commercial |
$13,673.23
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$5,162.58
|
| Rate for Payer: Cofinity Commercial |
$4,202.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,802.40
|
| Rate for Payer: Healthscope Commercial |
$5,402.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,202.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,502.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,102.55
|
| Rate for Payer: PHP Commercial |
$5,102.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health SBD |
$3,781.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,865.85
|
| Rate for Payer: UHC Core |
$13,752.00
|
| Rate for Payer: UHC Exchange |
$1,696.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,221.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,502.25
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Professional
|
Both
|
$6,003.00
|
|
|
Service Code
|
HCPCS 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$861.66 |
| Max. Negotiated Rate |
$3,901.95 |
| Rate for Payer: BCBS Trust/PPO |
$861.66
|
| Rate for Payer: BCN Commercial |
$2,813.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,686.61
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$2,260.06
|
| Rate for Payer: Cofinity Commercial |
$2,428.72
|
| Rate for Payer: Aetna Commercial |
$2,260.06
|
| Rate for Payer: Aetna Medicare |
$1,754.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,260.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,428.72
|
| Rate for Payer: BCBS Complete |
$1,185.34
|
| Rate for Payer: BCBS MAPPO |
$1,686.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,686.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,770.94
|
| Rate for Payer: Meridian Medicaid |
$1,185.34
|
| Rate for Payer: Nomi Health Commercial |
$2,023.93
|
| Rate for Payer: PACE SWMI |
$1,686.61
|
| Rate for Payer: PHP Commercial |
$2,361.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,686.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,128.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,677.12
|
| Rate for Payer: Priority Health Medicare |
$1,686.61
|
| Rate for Payer: Priority Health Narrow Network |
$2,677.12
|
| Rate for Payer: Priority Health SBD |
$2,677.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,686.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,686.61
|
| Rate for Payer: UHCCP Medicaid |
$1,128.90
|
| Rate for Payer: UMR Bronson Commercial |
$2,761.38
|
|
|
PR REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE
|
Facility
|
IP
|
$6,003.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
27487
|
| Min. Negotiated Rate |
$2,641.32 |
| Max. Negotiated Rate |
$5,402.70 |
| Rate for Payer: Aetna American Axle |
$3,901.95
|
| Rate for Payer: Aetna Commercial |
$5,102.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,901.95
|
| Rate for Payer: Cash Price |
$4,802.40
|
| Rate for Payer: Cofinity Commercial |
$4,202.10
|
| Rate for Payer: Cofinity Commercial |
$5,162.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,202.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,802.40
|
| Rate for Payer: Healthscope Commercial |
$5,402.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,202.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,502.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,102.55
|
| Rate for Payer: PHP Commercial |
$5,102.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,901.95
|
| Rate for Payer: Priority Health SBD |
$3,781.89
|
| Rate for Payer: UMR Bronson Commercial |
$2,641.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,502.25
|
|
|
PR REVJ UR-CUTAN ANAST RPR FSCAL DFCT & HERNIA
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
HCPCS 50728
|
| Min. Negotiated Rate |
$356.07 |
| Max. Negotiated Rate |
$1,116.34 |
| Rate for Payer: Aetna Commercial |
$896.85
|
| Rate for Payer: Aetna Medicare |
$696.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$896.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.78
|
| Rate for Payer: BCBS Complete |
$471.90
|
| Rate for Payer: BCBS MAPPO |
$669.29
|
| Rate for Payer: BCBS Trust/PPO |
$356.07
|
| Rate for Payer: BCN Commercial |
$1,010.10
|
| Rate for Payer: BCN Medicare Advantage |
$669.29
|
| Rate for Payer: Cash Price |
$1,148.00
|
| Rate for Payer: Cash Price |
$1,148.00
|
| Rate for Payer: Cofinity Commercial |
$896.85
|
| Rate for Payer: Cofinity Commercial |
$963.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$702.75
|
| Rate for Payer: Meridian Medicaid |
$471.90
|
| Rate for Payer: Nomi Health Commercial |
$803.15
|
| Rate for Payer: PACE SWMI |
$669.29
|
| Rate for Payer: PHP Commercial |
$937.01
|
| Rate for Payer: PHP Medicare Advantage |
$669.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$932.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.34
|
| Rate for Payer: Priority Health Medicare |
$669.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,116.34
|
| Rate for Payer: Priority Health SBD |
$1,116.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$669.29
|
| Rate for Payer: UHC Medicare Advantage |
$669.29
|
| Rate for Payer: UHCCP Medicaid |
$449.43
|
| Rate for Payer: UMR Bronson Commercial |
$660.10
|
|
|
PR REVJ URINARY-CUTANEOUS ANASTAMOSIS
|
Professional
|
Both
|
$1,296.00
|
|
|
Service Code
|
HCPCS 50727
|
| Min. Negotiated Rate |
$328.66 |
| Max. Negotiated Rate |
$4,557.12 |
| Rate for Payer: Aetna Commercial |
$653.14
|
| Rate for Payer: Aetna Medicare |
$506.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$701.88
|
| Rate for Payer: BCBS Complete |
$345.09
|
| Rate for Payer: BCBS MAPPO |
$487.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,557.12
|
| Rate for Payer: BCN Commercial |
$739.37
|
| Rate for Payer: BCN Medicare Advantage |
$487.42
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cofinity Commercial |
$653.14
|
| Rate for Payer: Cofinity Commercial |
$701.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.79
|
| Rate for Payer: Meridian Medicaid |
$345.09
|
| Rate for Payer: Nomi Health Commercial |
$584.90
|
| Rate for Payer: PACE SWMI |
$487.42
|
| Rate for Payer: PHP Commercial |
$682.39
|
| Rate for Payer: PHP Medicare Advantage |
$487.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$842.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$820.21
|
| Rate for Payer: Priority Health Medicare |
$487.42
|
| Rate for Payer: Priority Health Narrow Network |
$820.21
|
| Rate for Payer: Priority Health SBD |
$820.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.42
|
| Rate for Payer: UHC Medicare Advantage |
$487.42
|
| Rate for Payer: UHCCP Medicaid |
$328.66
|
| Rate for Payer: UMR Bronson Commercial |
$596.16
|
|
|
PR REV/RMV PRPH SAC/GSTRC NPG/RCV DTCH CONN ELTR RA
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
HCPCS 64595
|
| Min. Negotiated Rate |
$147.82 |
| Max. Negotiated Rate |
$2,181.88 |
| Rate for Payer: Aetna Commercial |
$294.91
|
| Rate for Payer: Aetna Medicare |
$228.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.92
|
| Rate for Payer: BCBS Complete |
$155.21
|
| Rate for Payer: BCBS MAPPO |
$220.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,181.88
|
| Rate for Payer: BCN Commercial |
$339.14
|
| Rate for Payer: BCN Medicare Advantage |
$220.08
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cash Price |
$556.80
|
| Rate for Payer: Cofinity Commercial |
$294.91
|
| Rate for Payer: Cofinity Commercial |
$316.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.08
|
| Rate for Payer: Meridian Medicaid |
$155.21
|
| Rate for Payer: Nomi Health Commercial |
$264.10
|
| Rate for Payer: PACE SWMI |
$220.08
|
| Rate for Payer: PHP Commercial |
$308.11
|
| Rate for Payer: PHP Medicare Advantage |
$220.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$452.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$391.84
|
| Rate for Payer: Priority Health Medicare |
$220.08
|
| Rate for Payer: Priority Health Narrow Network |
$391.84
|
| Rate for Payer: Priority Health SBD |
$391.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.08
|
| Rate for Payer: UHC Medicare Advantage |
$220.08
|
| Rate for Payer: UHCCP Medicaid |
$147.82
|
| Rate for Payer: UMR Bronson Commercial |
$320.16
|
|
|
PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
HCPCS 37224
|
| Min. Negotiated Rate |
$276.05 |
| Max. Negotiated Rate |
$4,307.21 |
| Rate for Payer: Aetna Commercial |
$567.99
|
| Rate for Payer: Aetna Medicare |
$440.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.37
|
| Rate for Payer: BCBS Complete |
$289.85
|
| Rate for Payer: BCBS MAPPO |
$423.87
|
| Rate for Payer: BCBS Trust/PPO |
$622.87
|
| Rate for Payer: BCN Commercial |
$4,307.21
|
| Rate for Payer: BCN Medicare Advantage |
$423.87
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cofinity Commercial |
$567.99
|
| Rate for Payer: Cofinity Commercial |
$610.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.06
|
| Rate for Payer: Meridian Medicaid |
$289.85
|
| Rate for Payer: Nomi Health Commercial |
$508.64
|
| Rate for Payer: PACE SWMI |
$423.87
|
| Rate for Payer: PHP Commercial |
$593.42
|
| Rate for Payer: PHP Medicare Advantage |
$423.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$688.18
|
| Rate for Payer: Priority Health Medicare |
$423.87
|
| Rate for Payer: Priority Health Narrow Network |
$688.18
|
| Rate for Payer: Priority Health SBD |
$688.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.87
|
| Rate for Payer: UHC Medicare Advantage |
$423.87
|
| Rate for Payer: UHCCP Medicaid |
$276.05
|
| Rate for Payer: UMR Bronson Commercial |
$490.36
|
|
|
PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$2,317.00
|
|
|
Service Code
|
HCPCS 37225
|
| Min. Negotiated Rate |
$370.41 |
| Max. Negotiated Rate |
$12,917.21 |
| Rate for Payer: Aetna Commercial |
$760.17
|
| Rate for Payer: Aetna Medicare |
$589.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$760.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$816.90
|
| Rate for Payer: BCBS Complete |
$388.93
|
| Rate for Payer: BCBS MAPPO |
$567.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,131.41
|
| Rate for Payer: BCN Commercial |
$12,917.21
|
| Rate for Payer: BCN Medicare Advantage |
$567.29
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Cofinity Commercial |
$760.17
|
| Rate for Payer: Cofinity Commercial |
$816.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$595.65
|
| Rate for Payer: Meridian Medicaid |
$388.93
|
| Rate for Payer: Nomi Health Commercial |
$680.75
|
| Rate for Payer: PACE SWMI |
$567.29
|
| Rate for Payer: PHP Commercial |
$794.21
|
| Rate for Payer: PHP Medicare Advantage |
$567.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$370.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,506.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$925.91
|
| Rate for Payer: Priority Health Medicare |
$567.29
|
| Rate for Payer: Priority Health Narrow Network |
$925.91
|
| Rate for Payer: Priority Health SBD |
$925.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.29
|
| Rate for Payer: UHC Medicare Advantage |
$567.29
|
| Rate for Payer: UHCCP Medicaid |
$370.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,065.82
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
HCPCS 37226
|
| Min. Negotiated Rate |
$322.27 |
| Max. Negotiated Rate |
$12,021.96 |
| Rate for Payer: Aetna Commercial |
$663.39
|
| Rate for Payer: Aetna Medicare |
$514.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$712.90
|
| Rate for Payer: BCBS Complete |
$338.38
|
| Rate for Payer: BCBS MAPPO |
$495.07
|
| Rate for Payer: BCBS Trust/PPO |
$496.60
|
| Rate for Payer: BCN Commercial |
$12,021.96
|
| Rate for Payer: BCN Medicare Advantage |
$495.07
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cash Price |
$924.00
|
| Rate for Payer: Cofinity Commercial |
$663.39
|
| Rate for Payer: Cofinity Commercial |
$712.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$519.82
|
| Rate for Payer: Meridian Medicaid |
$338.38
|
| Rate for Payer: Nomi Health Commercial |
$594.08
|
| Rate for Payer: PACE SWMI |
$495.07
|
| Rate for Payer: PHP Commercial |
$693.10
|
| Rate for Payer: PHP Medicare Advantage |
$495.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$750.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$802.53
|
| Rate for Payer: Priority Health Medicare |
$495.07
|
| Rate for Payer: Priority Health Narrow Network |
$802.53
|
| Rate for Payer: Priority Health SBD |
$802.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$495.07
|
| Rate for Payer: UHC Medicare Advantage |
$495.07
|
| Rate for Payer: UHCCP Medicaid |
$322.27
|
| Rate for Payer: UMR Bronson Commercial |
$531.30
|
|
|
PR REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL
|
Professional
|
Both
|
$1,967.00
|
|
|
Service Code
|
HCPCS 37227
|
| Min. Negotiated Rate |
$444.32 |
| Max. Negotiated Rate |
$16,544.66 |
| Rate for Payer: Aetna Commercial |
$913.18
|
| Rate for Payer: Aetna Medicare |
$708.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$981.33
|
| Rate for Payer: BCBS Complete |
$466.54
|
| Rate for Payer: BCBS MAPPO |
$681.48
|
| Rate for Payer: BCBS Trust/PPO |
$690.49
|
| Rate for Payer: BCN Commercial |
$16,544.66
|
| Rate for Payer: BCN Medicare Advantage |
$681.48
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cofinity Commercial |
$913.18
|
| Rate for Payer: Cofinity Commercial |
$981.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.55
|
| Rate for Payer: Meridian Medicaid |
$466.54
|
| Rate for Payer: Nomi Health Commercial |
$817.78
|
| Rate for Payer: PACE SWMI |
$681.48
|
| Rate for Payer: PHP Commercial |
$954.07
|
| Rate for Payer: PHP Medicare Advantage |
$681.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,278.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,107.79
|
| Rate for Payer: Priority Health Medicare |
$681.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,107.79
|
| Rate for Payer: Priority Health SBD |
$1,107.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.48
|
| Rate for Payer: UHC Medicare Advantage |
$681.48
|
| Rate for Payer: UHCCP Medicaid |
$444.32
|
| Rate for Payer: UMR Bronson Commercial |
$904.82
|
|
|
PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
HCPCS 37223
|
| Min. Negotiated Rate |
$131.63 |
| Max. Negotiated Rate |
$1,876.52 |
| Rate for Payer: Aetna Commercial |
$271.55
|
| Rate for Payer: Aetna Medicare |
$210.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.82
|
| Rate for Payer: BCBS Complete |
$138.21
|
| Rate for Payer: BCBS MAPPO |
$202.65
|
| Rate for Payer: BCBS Trust/PPO |
$374.83
|
| Rate for Payer: BCN Commercial |
$1,876.52
|
| 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 |
$271.55
|
| Rate for Payer: Cofinity Commercial |
$291.82
|
| 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: Meridian Medicaid |
$138.21
|
| 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 Choice Medicaid |
$131.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$327.60
|
| Rate for Payer: Priority Health Medicare |
$202.65
|
| Rate for Payer: Priority Health Narrow Network |
$327.60
|
| Rate for Payer: Priority Health SBD |
$327.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$202.65
|
| Rate for Payer: UHC Medicare Advantage |
$202.65
|
| Rate for Payer: UHCCP Medicaid |
$131.63
|
| 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 |
$306.08 |
| Max. Negotiated Rate |
$4,542.26 |
| Rate for Payer: Aetna Commercial |
$630.14
|
| Rate for Payer: Aetna Medicare |
$489.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.16
|
| Rate for Payer: BCBS Complete |
$321.38
|
| Rate for Payer: BCBS MAPPO |
$470.25
|
| Rate for Payer: BCBS Trust/PPO |
$652.45
|
| Rate for Payer: BCN Commercial |
$4,542.26
|
| 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 |
$630.14
|
| Rate for Payer: Cofinity Commercial |
$677.16
|
| 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: Meridian Medicaid |
$321.38
|
| 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 Choice Medicaid |
$306.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,314.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$762.63
|
| Rate for Payer: Priority Health Medicare |
$470.25
|
| Rate for Payer: Priority Health Narrow Network |
$762.63
|
| Rate for Payer: Priority Health SBD |
$762.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.25
|
| Rate for Payer: UHC Medicare Advantage |
$470.25
|
| Rate for Payer: UHCCP Medicaid |
$306.08
|
| 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 |
$336.11 |
| Max. Negotiated Rate |
$6,115.79 |
| Rate for Payer: Aetna Commercial |
$691.71
|
| Rate for Payer: Aetna Medicare |
$536.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$691.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.33
|
| Rate for Payer: BCBS Complete |
$352.92
|
| Rate for Payer: BCBS MAPPO |
$516.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.15
|
| Rate for Payer: BCN Commercial |
$6,115.79
|
| 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 |
$691.71
|
| Rate for Payer: Cofinity Commercial |
$743.33
|
| 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: Meridian Medicaid |
$352.92
|
| 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 Choice Medicaid |
$336.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$848.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$836.56
|
| Rate for Payer: Priority Health Medicare |
$516.20
|
| Rate for Payer: Priority Health Narrow Network |
$836.56
|
| Rate for Payer: Priority Health SBD |
$836.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$516.20
|
| Rate for Payer: UHC Medicare Advantage |
$516.20
|
| Rate for Payer: UHCCP Medicaid |
$336.11
|
| 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 |
$123.54 |
| 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) |
$253.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.71
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS MAPPO |
$189.38
|
| Rate for Payer: BCBS Trust/PPO |
$1,565.35
|
| Rate for Payer: BCN Commercial |
$1,206.05
|
| 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 |
$253.77
|
| Rate for Payer: Cofinity Commercial |
$272.71
|
| 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: Meridian Medicaid |
$129.72
|
| 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 Choice Medicaid |
$123.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,828.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$307.92
|
| Rate for Payer: Priority Health Medicare |
$189.38
|
| Rate for Payer: Priority Health Narrow Network |
$307.92
|
| Rate for Payer: Priority Health SBD |
$307.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.38
|
| Rate for Payer: UHC Medicare Advantage |
$189.38
|
| Rate for Payer: UHCCP Medicaid |
$123.54
|
| 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 |
$430.05 |
| Max. Negotiated Rate |
$13,126.37 |
| Rate for Payer: Aetna Commercial |
$881.71
|
| Rate for Payer: Aetna Medicare |
$684.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$947.51
|
| Rate for Payer: BCBS Complete |
$451.55
|
| Rate for Payer: BCBS MAPPO |
$657.99
|
| Rate for Payer: BCBS Trust/PPO |
$476.53
|
| Rate for Payer: BCN Commercial |
$13,126.37
|
| 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 |
$881.71
|
| Rate for Payer: Cofinity Commercial |
$947.51
|
| 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: Meridian Medicaid |
$451.55
|
| 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 Choice Medicaid |
$430.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,776.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,071.62
|
| Rate for Payer: Priority Health Medicare |
$657.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,071.62
|
| Rate for Payer: Priority Health SBD |
$1,071.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.99
|
| Rate for Payer: UHC Medicare Advantage |
$657.99
|
| Rate for Payer: UHCCP Medicaid |
$430.05
|
| 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 |
$200.01 |
| Max. Negotiated Rate |
$1,531.51 |
| Rate for Payer: Aetna Commercial |
$409.93
|
| Rate for Payer: Aetna Medicare |
$318.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.52
|
| Rate for Payer: BCBS Complete |
$210.01
|
| Rate for Payer: BCBS MAPPO |
$305.92
|
| Rate for Payer: BCBS Trust/PPO |
$495.55
|
| Rate for Payer: BCN Commercial |
$1,531.51
|
| 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 |
$409.93
|
| Rate for Payer: Cofinity Commercial |
$440.52
|
| 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: Meridian Medicaid |
$210.01
|
| 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 Choice Medicaid |
$200.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.79
|
| Rate for Payer: Priority Health Medicare |
$305.92
|
| Rate for Payer: Priority Health Narrow Network |
$497.79
|
| Rate for Payer: Priority Health SBD |
$497.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.92
|
| Rate for Payer: UHC Medicare Advantage |
$305.92
|
| Rate for Payer: UHCCP Medicaid |
$200.01
|
| 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 |
$431.75 |
| Max. Negotiated Rate |
$13,145.42 |
| Rate for Payer: Aetna Commercial |
$886.62
|
| Rate for Payer: Aetna Medicare |
$688.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$886.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$952.79
|
| Rate for Payer: BCBS Complete |
$453.34
|
| Rate for Payer: BCBS MAPPO |
$661.66
|
| Rate for Payer: BCBS Trust/PPO |
$709.51
|
| Rate for Payer: BCN Commercial |
$13,145.42
|
| 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 |
$886.62
|
| Rate for Payer: Cofinity Commercial |
$952.79
|
| 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: Meridian Medicaid |
$453.34
|
| 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 Choice Medicaid |
$431.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,780.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,072.16
|
| Rate for Payer: Priority Health Medicare |
$661.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,072.16
|
| Rate for Payer: Priority Health SBD |
$1,072.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$661.66
|
| Rate for Payer: UHC Medicare Advantage |
$661.66
|
| Rate for Payer: UHCCP Medicaid |
$431.75
|
| 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 |
$174.87 |
| Max. Negotiated Rate |
$5,352.48 |
| Rate for Payer: Aetna Commercial |
$358.57
|
| Rate for Payer: Aetna Medicare |
$278.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.33
|
| Rate for Payer: BCBS Complete |
$183.61
|
| Rate for Payer: BCBS MAPPO |
$267.59
|
| Rate for Payer: BCBS Trust/PPO |
$790.87
|
| Rate for Payer: BCN Commercial |
$5,352.48
|
| 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 |
$358.57
|
| Rate for Payer: Cofinity Commercial |
$385.33
|
| 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: Meridian Medicaid |
$183.61
|
| 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 Choice Medicaid |
$174.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.03
|
| Rate for Payer: Priority Health Medicare |
$267.59
|
| Rate for Payer: Priority Health Narrow Network |
$435.03
|
| Rate for Payer: Priority Health SBD |
$435.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.59
|
| Rate for Payer: UHC Medicare Advantage |
$267.59
|
| Rate for Payer: UHCCP Medicaid |
$174.87
|
| 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 |
$782.41 |
| Max. Negotiated Rate |
$2,150.18 |
| 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 |
$967.51
|
| Rate for Payer: BCBS MAPPO |
$1,344.36
|
| Rate for Payer: BCBS Trust/PPO |
$782.41
|
| Rate for Payer: BCN Commercial |
$2,150.18
|
| 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 |
$1,935.88
|
| Rate for Payer: Cofinity Commercial |
$1,801.44
|
| 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: Meridian Medicaid |
$967.51
|
| 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 Choice Medicaid |
$921.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,601.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,029.98
|
| Rate for Payer: Priority Health Medicare |
$1,344.36
|
| Rate for Payer: Priority Health Narrow Network |
$2,029.98
|
| Rate for Payer: Priority Health SBD |
$2,029.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,344.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,344.36
|
| Rate for Payer: UHCCP Medicaid |
$921.44
|
| 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 |
$855.41 |
| Max. Negotiated Rate |
$1,983.05 |
| Rate for Payer: Aetna Commercial |
$1,661.36
|
| Rate for Payer: Aetna Medicare |
$1,289.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,661.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,785.34
|
| Rate for Payer: BCBS Complete |
$898.18
|
| Rate for Payer: BCBS MAPPO |
$1,239.82
|
| Rate for Payer: BCBS Trust/PPO |
$987.39
|
| Rate for Payer: BCN Commercial |
$1,983.05
|
| 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 |
$1,661.36
|
| Rate for Payer: Cofinity Commercial |
$1,785.34
|
| 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: Meridian Medicaid |
$898.18
|
| 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 Choice Medicaid |
$855.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,319.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,869.63
|
| Rate for Payer: Priority Health Medicare |
$1,239.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,869.63
|
| Rate for Payer: Priority Health SBD |
$1,869.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,239.82
|
| Rate for Payer: UHC Medicare Advantage |
$1,239.82
|
| Rate for Payer: UHCCP Medicaid |
$855.41
|
| 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 |
$858.49 |
| Max. Negotiated Rate |
$2,584.13 |
| Rate for Payer: Aetna Commercial |
$2,191.74
|
| Rate for Payer: Aetna Medicare |
$1,701.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,191.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,355.31
|
| Rate for Payer: BCBS Complete |
$1,175.29
|
| Rate for Payer: BCBS MAPPO |
$1,635.63
|
| Rate for Payer: BCBS Trust/PPO |
$858.49
|
| Rate for Payer: BCN Commercial |
$2,584.13
|
| 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 |
$2,191.74
|
| Rate for Payer: Cofinity Commercial |
$2,355.31
|
| 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: Meridian Medicaid |
$1,175.29
|
| 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 Choice Medicaid |
$1,119.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,275.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,438.76
|
| Rate for Payer: Priority Health Medicare |
$1,635.63
|
| Rate for Payer: Priority Health Narrow Network |
$2,438.76
|
| Rate for Payer: Priority Health SBD |
$2,438.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,635.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,635.63
|
| Rate for Payer: UHCCP Medicaid |
$1,119.32
|
| 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 |
$532.71 |
| Max. Negotiated Rate |
$1,222.67 |
| Rate for Payer: Aetna Commercial |
$1,048.95
|
| Rate for Payer: Aetna Medicare |
$814.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,127.23
|
| Rate for Payer: BCBS Complete |
$559.35
|
| Rate for Payer: BCBS MAPPO |
$782.80
|
| Rate for Payer: BCBS Trust/PPO |
$557.88
|
| Rate for Payer: BCN Commercial |
$1,222.67
|
| 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 |
$1,048.95
|
| Rate for Payer: Cofinity Commercial |
$1,127.23
|
| 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: Meridian Medicaid |
$559.35
|
| 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 Choice Medicaid |
$532.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,156.34
|
| Rate for Payer: Priority Health Medicare |
$782.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,156.34
|
| Rate for Payer: Priority Health SBD |
$1,156.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$782.80
|
| Rate for Payer: UHC Medicare Advantage |
$782.80
|
| Rate for Payer: UHCCP Medicaid |
$532.71
|
| Rate for Payer: UMR Bronson Commercial |
$630.20
|
|
|
PR RHINP PRIM COMPLETE XTRNL PARTS
|
Professional
|
Both
|
$3,060.00
|
|
|
Service Code
|
HCPCS 30410
|
| Min. Negotiated Rate |
$562.64 |
| Max. Negotiated Rate |
$2,093.01 |
| 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 |
$948.95
|
| Rate for Payer: BCBS Complete |
$948.95
|
| Rate for Payer: BCBS MAPPO |
$1,312.31
|
| Rate for Payer: BCBS MAPPO |
$1,312.31
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCBS Trust/PPO |
$562.64
|
| Rate for Payer: BCN Commercial |
$2,093.01
|
| Rate for Payer: BCN Commercial |
$2,093.01
|
| 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 |
$2,448.00
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cash Price |
$2,467.20
|
| Rate for Payer: Cofinity Commercial |
$1,758.50
|
| 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: 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: Meridian Medicaid |
$948.95
|
| Rate for Payer: Meridian Medicaid |
$948.95
|
| 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 Choice Medicaid |
$903.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$903.76
|
| 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 HMO/PPO/Tiered Network |
$1,974.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,974.37
|
| Rate for Payer: Priority Health Medicare |
$1,312.31
|
| Rate for Payer: Priority Health Medicare |
$1,312.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,974.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,974.37
|
| Rate for Payer: Priority Health SBD |
$1,974.37
|
| Rate for Payer: Priority Health SBD |
$1,974.37
|
| 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: UHCCP Medicaid |
$903.76
|
| Rate for Payer: UHCCP Medicaid |
$903.76
|
| 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 |
$703.80 |
| Max. Negotiated Rate |
$1,845.35 |
| Rate for Payer: Aetna Commercial |
$1,518.27
|
| Rate for Payer: Aetna Medicare |
$1,178.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.58
|
| Rate for Payer: BCBS Complete |
$823.48
|
| Rate for Payer: BCBS MAPPO |
$1,133.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.35
|
| Rate for Payer: BCN Commercial |
$1,821.79
|
| 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: Meridian Medicaid |
$823.48
|
| 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 Choice Medicaid |
$784.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$994.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,716.68
|
| Rate for Payer: Priority Health Medicare |
$1,133.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,716.68
|
| Rate for Payer: Priority Health SBD |
$1,716.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.04
|
| Rate for Payer: UHCCP Medicaid |
$784.27
|
| Rate for Payer: UMR Bronson Commercial |
$703.80
|
|
