|
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 Commercial |
$78.10
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.10
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$91.88
|
| Rate for Payer: BCN Commercial |
$91.88
|
| Rate for Payer: Cash Price |
$122.40
|
| 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 |
$60.97 |
| Max. Negotiated Rate |
$118.69 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Medicare |
$85.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.69
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$82.42
|
| Rate for Payer: BCBS Trust/PPO |
$64.41
|
| Rate for Payer: BCN Commercial |
$60.97
|
| Rate for Payer: BCN Medicare Advantage |
$82.42
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$110.45
|
| Rate for Payer: Cofinity Commercial |
$118.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.54
|
| Rate for Payer: Nomi Health Commercial |
$98.91
|
| Rate for Payer: PACE SWMI |
$82.42
|
| Rate for Payer: PHP Commercial |
$115.39
|
| Rate for Payer: PHP Medicare Advantage |
$82.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$82.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.42
|
| Rate for Payer: UHC Medicare Advantage |
$82.42
|
| 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 |
$4.26 |
| Max. Negotiated Rate |
$2,070.41 |
| 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 |
$4.47
|
| Rate for Payer: BCBS MAPPO |
$6.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,070.41
|
| Rate for Payer: BCN Commercial |
$7.85
|
| 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 |
$8.59
|
| Rate for Payer: Cofinity Commercial |
$9.23
|
| 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: Meridian Medicaid |
$4.47
|
| 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 Choice Medicaid |
$4.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.42
|
| Rate for Payer: Priority Health Medicare |
$6.41
|
| Rate for Payer: Priority Health Narrow Network |
$9.42
|
| Rate for Payer: Priority Health SBD |
$9.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.41
|
| Rate for Payer: UHC Medicare Advantage |
$6.41
|
| Rate for Payer: UHCCP Medicaid |
$4.26
|
| 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 |
$1,926.71 |
| Rate for Payer: Aetna Commercial |
$8.01
|
| Rate for Payer: Aetna Medicare |
$6.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.61
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$5.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,926.71
|
| Rate for Payer: BCN Commercial |
$8.80
|
| 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 |
$8.01
|
| Rate for Payer: Cofinity Commercial |
$8.61
|
| 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 HMO/PPO/Tiered Network |
$8.94
|
| Rate for Payer: Priority Health Medicare |
$5.98
|
| Rate for Payer: Priority Health Narrow Network |
$8.94
|
| Rate for Payer: Priority Health SBD |
$8.94
|
| 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 |
$2,312.90 |
| Rate for Payer: Aetna Commercial |
$16.60
|
| Rate for Payer: Aetna Medicare |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.84
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$12.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,312.90
|
| Rate for Payer: BCN Commercial |
$18.57
|
| 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 HMO/PPO/Tiered Network |
$18.36
|
| Rate for Payer: Priority Health Medicare |
$12.39
|
| Rate for Payer: Priority Health Narrow Network |
$18.36
|
| Rate for Payer: Priority Health SBD |
$18.36
|
| 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 |
$129.77 |
| Max. Negotiated Rate |
$3,616.65 |
| Rate for Payer: Aetna Commercial |
$2,885.67
|
| Rate for Payer: Aetna Medicare |
$2,448.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,885.67
|
| Rate for Payer: BCBS Complete |
$1,958.40
|
| Rate for Payer: BCBS Trust/PPO |
$129.77
|
| Rate for Payer: BCN Commercial |
$3,009.06
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Cash Price |
$3,916.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,182.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,616.65
|
| Rate for Payer: Priority Health Narrow Network |
$3,616.65
|
| Rate for Payer: Priority Health SBD |
$3,616.65
|
| 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 |
$81.58 |
| Max. Negotiated Rate |
$1,711.69 |
| Rate for Payer: Aetna Commercial |
$982.41
|
| Rate for Payer: Aetna Medicare |
$762.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.41
|
| Rate for Payer: BCBS Complete |
$85.66
|
| Rate for Payer: BCBS MAPPO |
$733.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,711.69
|
| Rate for Payer: BCN Commercial |
$1,270.56
|
| 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: Meridian Medicaid |
$85.66
|
| 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 Choice Medicaid |
$81.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,200.63
|
| Rate for Payer: Priority Health Medicare |
$733.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,200.63
|
| Rate for Payer: Priority Health SBD |
$179.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.14
|
| Rate for Payer: UHC Medicare Advantage |
$733.14
|
| Rate for Payer: UHCCP Medicaid |
$81.58
|
| 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 |
$91.16 |
| Max. Negotiated Rate |
$1,973.73 |
| Rate for Payer: Aetna Commercial |
$188.86
|
| Rate for Payer: Aetna Medicare |
$146.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.95
|
| Rate for Payer: BCBS Complete |
$95.72
|
| Rate for Payer: BCBS MAPPO |
$140.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,973.73
|
| Rate for Payer: BCN Commercial |
$208.66
|
| 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: Meridian Medicaid |
$95.72
|
| 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 Choice Medicaid |
$91.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.09
|
| Rate for Payer: Priority Health Medicare |
$140.94
|
| Rate for Payer: Priority Health Narrow Network |
$227.09
|
| Rate for Payer: Priority Health SBD |
$227.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.94
|
| Rate for Payer: UHC Medicare Advantage |
$140.94
|
| Rate for Payer: UHCCP Medicaid |
$91.16
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR RINGERS LACTATE INFUSION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J7120
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$2.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.55
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$0.74
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: BCN Medicare Advantage |
$2.46
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Cofinity Commercial |
$3.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.59
|
| Rate for Payer: Nomi Health Commercial |
$2.95
|
| Rate for Payer: PACE SWMI |
$2.46
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: PHP Medicare Advantage |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$2.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.46
|
| Rate for Payer: UHC Medicare Advantage |
$2.46
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 24342
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Aetna Commercial |
$1,002.08
|
| Rate for Payer: Aetna Medicare |
$777.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,076.86
|
| Rate for Payer: BCBS Complete |
$530.27
|
| Rate for Payer: BCBS MAPPO |
$747.82
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: BCN Commercial |
$1,140.08
|
| Rate for Payer: BCN Medicare Advantage |
$747.82
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,076.86
|
| Rate for Payer: Cofinity Commercial |
$1,002.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.21
|
| Rate for Payer: Meridian Medicaid |
$530.27
|
| Rate for Payer: Nomi Health Commercial |
$897.38
|
| Rate for Payer: PACE SWMI |
$747.82
|
| Rate for Payer: PHP Commercial |
$1,046.95
|
| Rate for Payer: PHP Medicare Advantage |
$747.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,196.33
|
| Rate for Payer: Priority Health Medicare |
$747.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,196.33
|
| Rate for Payer: Priority Health SBD |
$1,196.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.82
|
| Rate for Payer: UHC Medicare Advantage |
$747.82
|
| Rate for Payer: UHCCP Medicaid |
$505.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,210.72
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
IP
|
$2,632.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$1,158.08 |
| Max. Negotiated Rate |
$2,368.80 |
| Rate for Payer: Cofinity Commercial |
$1,842.40
|
| Rate for Payer: Cofinity Commercial |
$2,263.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,842.40
|
| Rate for Payer: Aetna American Axle |
$1,710.80
|
| Rate for Payer: Aetna Commercial |
$2,237.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,710.80
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.60
|
| Rate for Payer: Healthscope Commercial |
$2,368.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,842.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,974.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.20
|
| Rate for Payer: PHP Commercial |
$2,237.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health SBD |
$1,658.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,158.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,974.00
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$117.28 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Priority Health Narrow Network |
$1,196.33
|
| Rate for Payer: Priority Health SBD |
$1,196.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.82
|
| Rate for Payer: UHC Medicare Advantage |
$747.82
|
| Rate for Payer: UHCCP Medicaid |
$505.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,210.72
|
| Rate for Payer: Aetna Commercial |
$1,002.08
|
| Rate for Payer: Aetna Medicare |
$777.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,076.86
|
| Rate for Payer: BCBS Complete |
$530.27
|
| Rate for Payer: BCBS MAPPO |
$747.82
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: BCN Commercial |
$1,140.08
|
| Rate for Payer: BCN Medicare Advantage |
$747.82
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,076.86
|
| Rate for Payer: Cofinity Commercial |
$1,002.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.21
|
| Rate for Payer: Meridian Medicaid |
$530.27
|
| Rate for Payer: Nomi Health Commercial |
$897.38
|
| Rate for Payer: PACE SWMI |
$747.82
|
| Rate for Payer: PHP Commercial |
$1,046.95
|
| Rate for Payer: PHP Medicare Advantage |
$747.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$505.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,196.33
|
| Rate for Payer: Priority Health Medicare |
$747.82
|
|
|
PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF
|
Facility
|
OP
|
$2,632.00
|
|
|
Service Code
|
CPT 24342
|
| Hospital Charge Code |
24342
|
| Min. Negotiated Rate |
$751.14 |
| Max. Negotiated Rate |
$21,998.64 |
| Rate for Payer: Aetna American Axle |
$1,710.80
|
| Rate for Payer: Aetna Commercial |
$2,237.20
|
| Rate for Payer: Aetna Medicare |
$7,279.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,710.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,749.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,749.10
|
| Rate for Payer: BCBS Complete |
$3,939.19
|
| Rate for Payer: BCBS MAPPO |
$6,999.28
|
| Rate for Payer: BCBS Trust/PPO |
$4,667.92
|
| Rate for Payer: BCN Commercial |
$4,667.92
|
| Rate for Payer: BCN Medicare Advantage |
$6,999.28
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,842.40
|
| Rate for Payer: Cofinity Commercial |
$2,263.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,842.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,105.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,999.28
|
| Rate for Payer: Healthscope Commercial |
$2,368.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,842.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,974.00
|
| Rate for Payer: Mclaren Medicaid |
$3,751.61
|
| Rate for Payer: Mclaren Medicare |
$6,999.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,349.24
|
| Rate for Payer: Meridian Medicaid |
$3,939.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,049.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,237.20
|
| Rate for Payer: Nomi Health Commercial |
$14,698.49
|
| Rate for Payer: PACE Medicare |
$6,649.32
|
| Rate for Payer: PACE SWMI |
$6,999.28
|
| Rate for Payer: PHP Commercial |
$2,237.20
|
| Rate for Payer: PHP Medicare Advantage |
$6,999.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,751.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,710.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,998.64
|
| Rate for Payer: Priority Health Medicare |
$6,999.28
|
| Rate for Payer: Priority Health Narrow Network |
$17,598.91
|
| Rate for Payer: Priority Health SBD |
$1,658.16
|
| Rate for Payer: Railroad Medicare Medicare |
$6,999.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.25
|
| Rate for Payer: UHC Core |
$6,395.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,999.28
|
| Rate for Payer: UHC Exchange |
$751.14
|
| Rate for Payer: UHC Medicare Advantage |
$6,999.28
|
| Rate for Payer: UHCCP Medicaid |
$3,751.61
|
| Rate for Payer: UMR Bronson Commercial |
$973.84
|
| Rate for Payer: VA VA |
$6,999.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,974.00
|
|
|
PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 90673
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$120.23 |
| Rate for Payer: Aetna Commercial |
$111.88
|
| Rate for Payer: Aetna Medicare |
$86.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.23
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$83.49
|
| Rate for Payer: BCBS Trust/PPO |
$30.00
|
| Rate for Payer: BCN Commercial |
$30.00
|
| Rate for Payer: BCN Medicare Advantage |
$83.49
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$120.23
|
| Rate for Payer: Cofinity Commercial |
$111.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.67
|
| Rate for Payer: Nomi Health Commercial |
$100.19
|
| Rate for Payer: PACE SWMI |
$83.49
|
| Rate for Payer: PHP Commercial |
$116.89
|
| Rate for Payer: PHP Medicare Advantage |
$83.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.45
|
| Rate for Payer: Priority Health Medicare |
$83.49
|
| Rate for Payer: Priority Health Narrow Network |
$42.45
|
| Rate for Payer: Priority Health SBD |
$42.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.49
|
| Rate for Payer: UHC Medicare Advantage |
$83.49
|
| Rate for Payer: UMR Bronson Commercial |
$51.06
|
|
|
PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 90682
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$73.62 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna Medicare |
$46.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.40
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS Trust/PPO |
$73.62
|
| Rate for Payer: BCN Commercial |
$73.62
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
| Rate for Payer: UMR Bronson Commercial |
$42.78
|
|
|
PR R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I
|
Professional
|
Both
|
$2,804.00
|
|
|
Service Code
|
HCPCS 93461
|
| Min. Negotiated Rate |
$256.67 |
| Max. Negotiated Rate |
$2,006.02 |
| Rate for Payer: Aetna Commercial |
$1,596.72
|
| Rate for Payer: Aetna Commercial |
$1,596.72
|
| Rate for Payer: Aetna Medicare |
$1,239.24
|
| Rate for Payer: Aetna Medicare |
$1,239.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,715.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,596.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,596.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,715.88
|
| Rate for Payer: BCBS Complete |
$269.50
|
| Rate for Payer: BCBS Complete |
$269.50
|
| Rate for Payer: BCBS MAPPO |
$1,191.58
|
| Rate for Payer: BCBS MAPPO |
$1,191.58
|
| Rate for Payer: BCBS Trust/PPO |
$716.90
|
| Rate for Payer: BCBS Trust/PPO |
$716.90
|
| Rate for Payer: BCN Commercial |
$2,006.02
|
| Rate for Payer: BCN Commercial |
$2,006.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,191.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,191.58
|
| Rate for Payer: Cash Price |
$2,243.20
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Cash Price |
$2,243.20
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Cofinity Commercial |
$1,715.88
|
| Rate for Payer: Cofinity Commercial |
$1,596.72
|
| Rate for Payer: Cofinity Commercial |
$1,596.72
|
| Rate for Payer: Cofinity Commercial |
$1,715.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,191.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,191.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.16
|
| Rate for Payer: Meridian Medicaid |
$269.50
|
| Rate for Payer: Meridian Medicaid |
$269.50
|
| Rate for Payer: Nomi Health Commercial |
$1,429.90
|
| Rate for Payer: Nomi Health Commercial |
$1,429.90
|
| Rate for Payer: PACE SWMI |
$1,191.58
|
| Rate for Payer: PACE SWMI |
$1,191.58
|
| Rate for Payer: PHP Commercial |
$1,668.21
|
| Rate for Payer: PHP Commercial |
$1,668.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,191.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,191.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,897.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,906.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,906.88
|
| Rate for Payer: Priority Health Medicare |
$1,191.58
|
| Rate for Payer: Priority Health Medicare |
$1,191.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,906.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,906.88
|
| Rate for Payer: Priority Health SBD |
$566.42
|
| Rate for Payer: Priority Health SBD |
$566.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,191.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,191.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,191.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,191.58
|
| Rate for Payer: UHCCP Medicaid |
$256.67
|
| Rate for Payer: UHCCP Medicaid |
$256.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,289.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,342.74
|
|
|
PR R & L HRT CATH WINJX HRT ART& L VENTR IMG
|
Professional
|
Both
|
$1,229.00
|
|
|
Service Code
|
HCPCS 93460
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$1,818.86 |
| Rate for Payer: Aetna Commercial |
$1,447.32
|
| Rate for Payer: Aetna Medicare |
$1,123.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,447.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,555.33
|
| Rate for Payer: BCBS Complete |
$244.00
|
| Rate for Payer: BCBS MAPPO |
$1,080.09
|
| Rate for Payer: BCBS Trust/PPO |
$728.00
|
| Rate for Payer: BCN Commercial |
$1,818.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,080.09
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cash Price |
$983.20
|
| Rate for Payer: Cofinity Commercial |
$1,447.32
|
| Rate for Payer: Cofinity Commercial |
$1,555.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,080.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,134.09
|
| Rate for Payer: Meridian Medicaid |
$244.00
|
| Rate for Payer: Nomi Health Commercial |
$1,296.11
|
| Rate for Payer: PACE SWMI |
$1,080.09
|
| Rate for Payer: PHP Commercial |
$1,512.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,080.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$798.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,728.43
|
| Rate for Payer: Priority Health Medicare |
$1,080.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,728.43
|
| Rate for Payer: Priority Health SBD |
$512.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,080.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,080.09
|
| Rate for Payer: UHCCP Medicaid |
$232.38
|
| Rate for Payer: UMR Bronson Commercial |
$565.34
|
|
|
PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I
|
Professional
|
Both
|
$672.00
|
|
|
Service Code
|
HCPCS 93453
|
| Min. Negotiated Rate |
$196.17 |
| Max. Negotiated Rate |
$1,678.12 |
| Rate for Payer: Aetna Commercial |
$1,329.59
|
| Rate for Payer: Aetna Medicare |
$1,031.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,329.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,428.81
|
| Rate for Payer: BCBS Complete |
$205.98
|
| Rate for Payer: BCBS MAPPO |
$992.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,507.77
|
| Rate for Payer: BCN Commercial |
$1,678.12
|
| Rate for Payer: BCN Medicare Advantage |
$992.23
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$1,329.59
|
| Rate for Payer: Cofinity Commercial |
$1,428.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,041.84
|
| Rate for Payer: Meridian Medicaid |
$205.98
|
| Rate for Payer: Nomi Health Commercial |
$1,190.68
|
| Rate for Payer: PACE SWMI |
$992.23
|
| Rate for Payer: PHP Commercial |
$1,389.12
|
| Rate for Payer: PHP Medicare Advantage |
$992.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,593.31
|
| Rate for Payer: Priority Health Medicare |
$992.23
|
| Rate for Payer: Priority Health Narrow Network |
$1,593.31
|
| Rate for Payer: Priority Health SBD |
$433.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.23
|
| Rate for Payer: UHC Medicare Advantage |
$992.23
|
| Rate for Payer: UHCCP Medicaid |
$196.17
|
| Rate for Payer: UMR Bronson Commercial |
$309.12
|
|
|
PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ
|
Professional
|
Both
|
$1,796.00
|
|
|
Service Code
|
HCPCS 33244
|
| Min. Negotiated Rate |
$542.72 |
| Max. Negotiated Rate |
$1,352.96 |
| Rate for Payer: Aetna Commercial |
$1,094.55
|
| Rate for Payer: Aetna Medicare |
$849.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,094.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,176.24
|
| Rate for Payer: BCBS Complete |
$569.86
|
| Rate for Payer: BCBS MAPPO |
$816.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.68
|
| Rate for Payer: BCN Commercial |
$1,250.53
|
| Rate for Payer: BCN Medicare Advantage |
$816.83
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cofinity Commercial |
$1,094.55
|
| Rate for Payer: Cofinity Commercial |
$1,176.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$857.67
|
| Rate for Payer: Meridian Medicaid |
$569.86
|
| Rate for Payer: Nomi Health Commercial |
$980.20
|
| Rate for Payer: PACE SWMI |
$816.83
|
| Rate for Payer: PHP Commercial |
$1,143.56
|
| Rate for Payer: PHP Medicare Advantage |
$816.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,352.96
|
| Rate for Payer: Priority Health Medicare |
$816.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,352.96
|
| Rate for Payer: Priority Health SBD |
$1,352.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$816.83
|
| Rate for Payer: UHC Medicare Advantage |
$816.83
|
| Rate for Payer: UHCCP Medicaid |
$542.72
|
| Rate for Payer: UMR Bronson Commercial |
$826.16
|
|
|
PR RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA
|
Professional
|
Both
|
$2,480.00
|
|
|
Service Code
|
HCPCS 33974
|
| Min. Negotiated Rate |
$564.02 |
| Max. Negotiated Rate |
$2,513.12 |
| Rate for Payer: Aetna Commercial |
$1,142.66
|
| Rate for Payer: Aetna Medicare |
$886.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,142.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.93
|
| Rate for Payer: BCBS Complete |
$592.22
|
| Rate for Payer: BCBS MAPPO |
$852.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,513.12
|
| Rate for Payer: BCN Commercial |
$1,280.82
|
| Rate for Payer: BCN Medicare Advantage |
$852.73
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cofinity Commercial |
$1,142.66
|
| Rate for Payer: Cofinity Commercial |
$1,227.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$852.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.37
|
| Rate for Payer: Meridian Medicaid |
$592.22
|
| Rate for Payer: Nomi Health Commercial |
$1,023.28
|
| Rate for Payer: PACE SWMI |
$852.73
|
| Rate for Payer: PHP Commercial |
$1,193.82
|
| Rate for Payer: PHP Medicare Advantage |
$852.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$564.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,399.22
|
| Rate for Payer: Priority Health Medicare |
$852.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,399.22
|
| Rate for Payer: Priority Health SBD |
$1,399.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$852.73
|
| Rate for Payer: UHC Medicare Advantage |
$852.73
|
| Rate for Payer: UHCCP Medicaid |
$564.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,140.80
|
|
|
PR RMVL BONE FLAP/PROSTHETIC PLATE SKULL
|
Professional
|
Both
|
$3,371.00
|
|
|
Service Code
|
HCPCS 62142
|
| Min. Negotiated Rate |
$586.82 |
| Max. Negotiated Rate |
$2,191.15 |
| Rate for Payer: Aetna Commercial |
$1,186.07
|
| Rate for Payer: Aetna Medicare |
$920.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,186.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,274.59
|
| Rate for Payer: BCBS Complete |
$616.16
|
| Rate for Payer: BCBS MAPPO |
$885.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,320.75
|
| Rate for Payer: BCN Commercial |
$1,831.09
|
| Rate for Payer: BCN Medicare Advantage |
$885.13
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cash Price |
$2,696.80
|
| Rate for Payer: Cofinity Commercial |
$1,186.07
|
| Rate for Payer: Cofinity Commercial |
$1,274.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$929.39
|
| Rate for Payer: Meridian Medicaid |
$616.16
|
| Rate for Payer: Nomi Health Commercial |
$1,062.16
|
| Rate for Payer: PACE SWMI |
$885.13
|
| Rate for Payer: PHP Commercial |
$1,239.18
|
| Rate for Payer: PHP Medicare Advantage |
$885.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,191.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,553.72
|
| Rate for Payer: Priority Health Medicare |
$885.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,553.72
|
| Rate for Payer: Priority Health SBD |
$1,553.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.13
|
| Rate for Payer: UHC Medicare Advantage |
$885.13
|
| Rate for Payer: UHCCP Medicaid |
$586.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,550.66
|
|
|
PR RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT
|
Professional
|
Both
|
$2,207.00
|
|
|
Service Code
|
HCPCS 62256
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$1,434.55 |
| Rate for Payer: Aetna Commercial |
$807.54
|
| Rate for Payer: Aetna Medicare |
$626.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.80
|
| Rate for Payer: BCBS Complete |
$422.03
|
| Rate for Payer: BCBS MAPPO |
$602.64
|
| Rate for Payer: BCBS Trust/PPO |
$87.02
|
| Rate for Payer: BCN Commercial |
$1,256.21
|
| Rate for Payer: BCN Medicare Advantage |
$602.64
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cash Price |
$1,765.60
|
| Rate for Payer: Cofinity Commercial |
$807.54
|
| Rate for Payer: Cofinity Commercial |
$867.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$632.77
|
| Rate for Payer: Meridian Medicaid |
$422.03
|
| Rate for Payer: Nomi Health Commercial |
$723.17
|
| Rate for Payer: PACE SWMI |
$602.64
|
| Rate for Payer: PHP Commercial |
$843.70
|
| Rate for Payer: PHP Medicare Advantage |
$602.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$401.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,434.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,070.32
|
| Rate for Payer: Priority Health Medicare |
$602.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,070.32
|
| Rate for Payer: Priority Health SBD |
$1,070.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.64
|
| Rate for Payer: UHC Medicare Advantage |
$602.64
|
| Rate for Payer: UHCCP Medicaid |
$401.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,015.22
|
|
|
PR RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT
|
Professional
|
Both
|
$5,127.00
|
|
|
Service Code
|
HCPCS 62258
|
| Min. Negotiated Rate |
$586.41 |
| Max. Negotiated Rate |
$3,332.55 |
| Rate for Payer: Aetna Commercial |
$1,471.57
|
| Rate for Payer: Aetna Medicare |
$1,142.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,471.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.39
|
| Rate for Payer: BCBS Complete |
$761.30
|
| Rate for Payer: BCBS MAPPO |
$1,098.19
|
| Rate for Payer: BCBS Trust/PPO |
$586.41
|
| Rate for Payer: BCN Commercial |
$2,282.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,098.19
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cash Price |
$4,101.60
|
| Rate for Payer: Cofinity Commercial |
$1,581.39
|
| Rate for Payer: Cofinity Commercial |
$1,471.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,098.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,153.10
|
| Rate for Payer: Meridian Medicaid |
$761.30
|
| Rate for Payer: Nomi Health Commercial |
$1,317.83
|
| Rate for Payer: PACE SWMI |
$1,098.19
|
| Rate for Payer: PHP Commercial |
$1,537.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,098.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$725.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,332.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.33
|
| Rate for Payer: Priority Health Medicare |
$1,098.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,935.33
|
| Rate for Payer: Priority Health SBD |
$1,935.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,098.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,098.19
|
| Rate for Payer: UHCCP Medicaid |
$725.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,358.42
|
|
|
PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 97602
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$917.66 |
| Rate for Payer: Aetna Commercial |
$89.75
|
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.75
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS Trust/PPO |
$917.66
|
| Rate for Payer: BCN Commercial |
$167.04
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.57
|
| Rate for Payer: Priority Health Narrow Network |
$109.57
|
| Rate for Payer: Priority Health SBD |
$109.57
|
| Rate for Payer: UMR Bronson Commercial |
$69.00
|
|
