|
PR RMVL EMBEDDED FB VESTIBULE MOUTH COMP
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 40805
|
| Min. Negotiated Rate |
$129.29 |
| Max. Negotiated Rate |
$526.19 |
| Rate for Payer: Aetna Commercial |
$253.51
|
| Rate for Payer: Aetna Medicare |
$196.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.43
|
| Rate for Payer: BCBS Complete |
$135.75
|
| Rate for Payer: BCBS MAPPO |
$189.19
|
| Rate for Payer: BCBS Trust/PPO |
$526.19
|
| Rate for Payer: BCN Commercial |
$416.35
|
| Rate for Payer: BCN Medicare Advantage |
$189.19
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$253.51
|
| Rate for Payer: Cofinity Commercial |
$272.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.65
|
| Rate for Payer: Meridian Medicaid |
$135.75
|
| Rate for Payer: Nomi Health Commercial |
$227.03
|
| Rate for Payer: PACE SWMI |
$189.19
|
| Rate for Payer: PHP Commercial |
$264.87
|
| Rate for Payer: PHP Medicare Advantage |
$189.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.38
|
| Rate for Payer: Priority Health Medicare |
$189.19
|
| Rate for Payer: Priority Health Narrow Network |
$354.38
|
| Rate for Payer: Priority Health SBD |
$354.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.19
|
| Rate for Payer: UHC Medicare Advantage |
$189.19
|
| Rate for Payer: UHCCP Medicaid |
$129.29
|
| Rate for Payer: UMR Bronson Commercial |
$324.30
|
|
|
PR RMVL EMBEDDED FB VESTIBULE MOUTH SMPL
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 40804
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$1,065.05 |
| Rate for Payer: Aetna Commercial |
$148.70
|
| Rate for Payer: Aetna Medicare |
$115.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.80
|
| Rate for Payer: BCBS Complete |
$80.29
|
| Rate for Payer: BCBS MAPPO |
$110.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,065.05
|
| Rate for Payer: BCN Commercial |
$275.12
|
| Rate for Payer: BCN Medicare Advantage |
$110.97
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$148.70
|
| Rate for Payer: Cofinity Commercial |
$159.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.52
|
| Rate for Payer: Meridian Medicaid |
$80.29
|
| Rate for Payer: Nomi Health Commercial |
$133.16
|
| Rate for Payer: PACE SWMI |
$110.97
|
| Rate for Payer: PHP Commercial |
$155.36
|
| Rate for Payer: PHP Medicare Advantage |
$110.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.23
|
| Rate for Payer: Priority Health Medicare |
$110.97
|
| Rate for Payer: Priority Health Narrow Network |
$205.23
|
| Rate for Payer: Priority Health SBD |
$205.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.97
|
| Rate for Payer: UHC Medicare Advantage |
$110.97
|
| Rate for Payer: UHCCP Medicaid |
$76.47
|
| Rate for Payer: UMR Bronson Commercial |
$156.40
|
|
|
PR RMVL ENTIRE LUMBOSARACH SHUNT SYS W/O RPLCMT
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 63746
|
| Min. Negotiated Rate |
$214.49 |
| Max. Negotiated Rate |
$1,077.70 |
| Rate for Payer: Aetna Commercial |
$809.94
|
| Rate for Payer: Aetna Medicare |
$628.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$870.38
|
| Rate for Payer: BCBS Complete |
$423.37
|
| Rate for Payer: BCBS MAPPO |
$604.43
|
| Rate for Payer: BCBS Trust/PPO |
$214.49
|
| Rate for Payer: BCN Commercial |
$999.20
|
| Rate for Payer: BCN Medicare Advantage |
$604.43
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cofinity Commercial |
$809.94
|
| Rate for Payer: Cofinity Commercial |
$870.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$634.65
|
| Rate for Payer: Meridian Medicaid |
$423.37
|
| Rate for Payer: Nomi Health Commercial |
$725.32
|
| Rate for Payer: PACE SWMI |
$604.43
|
| Rate for Payer: PHP Commercial |
$846.20
|
| Rate for Payer: PHP Medicare Advantage |
$604.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,069.76
|
| Rate for Payer: Priority Health Medicare |
$604.43
|
| Rate for Payer: Priority Health Narrow Network |
$1,069.76
|
| Rate for Payer: Priority Health SBD |
$1,069.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$604.43
|
| Rate for Payer: UHC Medicare Advantage |
$604.43
|
| Rate for Payer: UHCCP Medicaid |
$403.21
|
| Rate for Payer: UMR Bronson Commercial |
$762.68
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL ANES
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 69205
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$1,749.20 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Medicare |
$92.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.75
|
| Rate for Payer: BCBS Complete |
$64.19
|
| Rate for Payer: BCBS MAPPO |
$89.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.20
|
| Rate for Payer: BCN Commercial |
$140.74
|
| Rate for Payer: BCN Medicare Advantage |
$89.41
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$119.81
|
| Rate for Payer: Cofinity Commercial |
$128.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.88
|
| Rate for Payer: Meridian Medicaid |
$64.19
|
| Rate for Payer: Nomi Health Commercial |
$107.29
|
| Rate for Payer: PACE SWMI |
$89.41
|
| Rate for Payer: PHP Commercial |
$125.17
|
| Rate for Payer: PHP Medicare Advantage |
$89.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.08
|
| Rate for Payer: Priority Health Medicare |
$89.41
|
| Rate for Payer: Priority Health Narrow Network |
$140.08
|
| Rate for Payer: Priority Health SBD |
$140.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.41
|
| Rate for Payer: UHC Medicare Advantage |
$89.41
|
| Rate for Payer: UHCCP Medicaid |
$61.13
|
| Rate for Payer: UMR Bronson Commercial |
$86.48
|
|
|
PR RMVL FB XTRNL AUDITORY CANAL W/O ANES
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 69200
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$1,294.34 |
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$47.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.76
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS MAPPO |
$45.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,294.34
|
| Rate for Payer: BCN Commercial |
$117.77
|
| Rate for Payer: BCN Medicare Advantage |
$45.67
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$61.20
|
| Rate for Payer: Cofinity Commercial |
$65.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.95
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Nomi Health Commercial |
$54.80
|
| Rate for Payer: PACE SWMI |
$45.67
|
| Rate for Payer: PHP Commercial |
$63.94
|
| Rate for Payer: PHP Medicare Advantage |
$45.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.07
|
| Rate for Payer: Priority Health Medicare |
$45.67
|
| Rate for Payer: Priority Health Narrow Network |
$69.07
|
| Rate for Payer: Priority Health SBD |
$69.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.67
|
| Rate for Payer: UHC Medicare Advantage |
$45.67
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
| Rate for Payer: UMR Bronson Commercial |
$111.78
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 65220
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$303.77 |
| Rate for Payer: Aetna Commercial |
$51.82
|
| Rate for Payer: Aetna Medicare |
$40.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.68
|
| Rate for Payer: BCBS Complete |
$27.29
|
| Rate for Payer: BCBS MAPPO |
$38.67
|
| Rate for Payer: BCBS Trust/PPO |
$303.77
|
| Rate for Payer: BCN Commercial |
$87.96
|
| Rate for Payer: BCN Medicare Advantage |
$38.67
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$51.82
|
| Rate for Payer: Cofinity Commercial |
$55.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.60
|
| Rate for Payer: Meridian Medicaid |
$27.29
|
| Rate for Payer: Nomi Health Commercial |
$46.40
|
| Rate for Payer: PACE SWMI |
$38.67
|
| Rate for Payer: PHP Commercial |
$54.14
|
| Rate for Payer: PHP Medicare Advantage |
$38.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.94
|
| Rate for Payer: Priority Health Medicare |
$38.67
|
| Rate for Payer: Priority Health Narrow Network |
$71.94
|
| Rate for Payer: Priority Health SBD |
$71.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.67
|
| Rate for Payer: UHC Medicare Advantage |
$38.67
|
| Rate for Payer: UHCCP Medicaid |
$25.99
|
| Rate for Payer: UMR Bronson Commercial |
$75.90
|
|
|
PR RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 65222
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$260.45 |
| Rate for Payer: Aetna Commercial |
$62.14
|
| Rate for Payer: Aetna Medicare |
$48.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.77
|
| Rate for Payer: BCBS Complete |
$33.10
|
| Rate for Payer: BCBS MAPPO |
$46.37
|
| Rate for Payer: BCBS Trust/PPO |
$260.45
|
| Rate for Payer: BCN Commercial |
$97.74
|
| Rate for Payer: BCN Medicare Advantage |
$46.37
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$62.14
|
| Rate for Payer: Cofinity Commercial |
$66.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.69
|
| Rate for Payer: Meridian Medicaid |
$33.10
|
| Rate for Payer: Nomi Health Commercial |
$55.64
|
| Rate for Payer: PACE SWMI |
$46.37
|
| Rate for Payer: PHP Commercial |
$64.92
|
| Rate for Payer: PHP Medicare Advantage |
$46.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.15
|
| Rate for Payer: Priority Health Medicare |
$46.37
|
| Rate for Payer: Priority Health Narrow Network |
$87.15
|
| Rate for Payer: Priority Health SBD |
$87.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.37
|
| Rate for Payer: UHC Medicare Advantage |
$46.37
|
| Rate for Payer: UHCCP Medicaid |
$31.52
|
| Rate for Payer: UMR Bronson Commercial |
$84.18
|
|
|
PR RMVL FB XTRNL EYE EMBED SCJNCL/SCLERAL NONPERFOR
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 65210
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$264.15 |
| Rate for Payer: Aetna Commercial |
$44.94
|
| Rate for Payer: Aetna Medicare |
$34.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.30
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS MAPPO |
$33.54
|
| Rate for Payer: BCBS Trust/PPO |
$264.15
|
| Rate for Payer: BCN Commercial |
$44.76
|
| Rate for Payer: BCN Medicare Advantage |
$33.54
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$44.94
|
| Rate for Payer: Cofinity Commercial |
$48.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.22
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Nomi Health Commercial |
$40.25
|
| Rate for Payer: PACE SWMI |
$33.54
|
| Rate for Payer: PHP Commercial |
$46.96
|
| Rate for Payer: PHP Medicare Advantage |
$33.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.99
|
| Rate for Payer: Priority Health Medicare |
$33.54
|
| Rate for Payer: Priority Health Narrow Network |
$61.99
|
| Rate for Payer: Priority Health SBD |
$61.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.54
|
| Rate for Payer: UHC Medicare Advantage |
$33.54
|
| Rate for Payer: UHCCP Medicaid |
$22.79
|
| Rate for Payer: UMR Bronson Commercial |
$89.70
|
|
|
PR RMVL FECAL IMPACTION/FB SPX UNDER ANES
|
Professional
|
Both
|
$613.00
|
|
|
Service Code
|
HCPCS 45915
|
| Min. Negotiated Rate |
$148.46 |
| Max. Negotiated Rate |
$1,239.39 |
| Rate for Payer: Aetna Commercial |
$294.34
|
| Rate for Payer: Aetna Medicare |
$228.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.31
|
| Rate for Payer: BCBS Complete |
$155.88
|
| Rate for Payer: BCBS MAPPO |
$219.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,239.39
|
| Rate for Payer: BCN Commercial |
$518.49
|
| Rate for Payer: BCN Medicare Advantage |
$219.66
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cash Price |
$490.40
|
| Rate for Payer: Cofinity Commercial |
$294.34
|
| Rate for Payer: Cofinity Commercial |
$316.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.64
|
| Rate for Payer: Meridian Medicaid |
$155.88
|
| Rate for Payer: Nomi Health Commercial |
$263.59
|
| Rate for Payer: PACE SWMI |
$219.66
|
| Rate for Payer: PHP Commercial |
$307.52
|
| Rate for Payer: PHP Medicare Advantage |
$219.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$398.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$411.05
|
| Rate for Payer: Priority Health Medicare |
$219.66
|
| Rate for Payer: Priority Health Narrow Network |
$411.05
|
| Rate for Payer: Priority Health SBD |
$411.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.66
|
| Rate for Payer: UHC Medicare Advantage |
$219.66
|
| Rate for Payer: UHCCP Medicaid |
$148.46
|
| Rate for Payer: UMR Bronson Commercial |
$281.98
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 20525
|
| Hospital Charge Code |
20525
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$684.64 |
| Rate for Payer: Aetna Commercial |
$319.56
|
| Rate for Payer: Aetna Medicare |
$248.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.41
|
| Rate for Payer: BCBS Complete |
$169.08
|
| Rate for Payer: BCBS MAPPO |
$238.48
|
| Rate for Payer: BCBS Trust/PPO |
$195.38
|
| Rate for Payer: BCN Commercial |
$684.64
|
| Rate for Payer: BCN Medicare Advantage |
$238.48
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$343.41
|
| Rate for Payer: Cofinity Commercial |
$319.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.40
|
| Rate for Payer: Meridian Medicaid |
$169.08
|
| Rate for Payer: Nomi Health Commercial |
$286.18
|
| Rate for Payer: PACE SWMI |
$238.48
|
| Rate for Payer: PHP Commercial |
$333.87
|
| Rate for Payer: PHP Medicare Advantage |
$238.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.10
|
| Rate for Payer: Priority Health Medicare |
$238.48
|
| Rate for Payer: Priority Health Narrow Network |
$379.10
|
| Rate for Payer: Priority Health SBD |
$379.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.48
|
| Rate for Payer: UHC Medicare Advantage |
$238.48
|
| Rate for Payer: UHCCP Medicaid |
$161.03
|
| Rate for Payer: UMR Bronson Commercial |
$353.28
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$337.92 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Aetna American Axle |
$499.20
|
| Rate for Payer: Aetna Commercial |
$652.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.20
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$660.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$537.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.40
|
| Rate for Payer: Healthscope Commercial |
$691.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$537.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$576.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.80
|
| Rate for Payer: PHP Commercial |
$652.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health SBD |
$483.84
|
| Rate for Payer: UMR Bronson Commercial |
$337.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$576.00
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
20525
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$238.21 |
| Max. Negotiated Rate |
$8,813.49 |
| Rate for Payer: Mclaren Medicaid |
$1,503.04
|
| Rate for Payer: Mclaren Medicare |
$2,804.18
|
| Rate for Payer: Aetna American Axle |
$499.20
|
| Rate for Payer: Aetna Commercial |
$652.80
|
| Rate for Payer: Aetna Medicare |
$2,916.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,505.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,505.22
|
| Rate for Payer: BCBS Complete |
$1,578.19
|
| Rate for Payer: BCBS MAPPO |
$2,804.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,874.25
|
| Rate for Payer: BCN Commercial |
$1,874.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,804.18
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$537.60
|
| Rate for Payer: Cofinity Commercial |
$660.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$537.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$614.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,804.18
|
| Rate for Payer: Healthscope Commercial |
$691.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$537.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$576.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,944.39
|
| Rate for Payer: Meridian Medicaid |
$1,578.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,224.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$652.80
|
| Rate for Payer: Nomi Health Commercial |
$5,888.78
|
| Rate for Payer: PACE Medicare |
$2,663.97
|
| Rate for Payer: PACE SWMI |
$2,804.18
|
| Rate for Payer: PHP Commercial |
$652.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,804.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,503.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,813.49
|
| Rate for Payer: Priority Health Medicare |
$2,804.18
|
| Rate for Payer: Priority Health Narrow Network |
$7,050.79
|
| Rate for Payer: Priority Health SBD |
$483.84
|
| Rate for Payer: Railroad Medicare Medicare |
$2,804.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$262.03
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,804.18
|
| Rate for Payer: UHC Exchange |
$238.21
|
| Rate for Payer: UHC Medicare Advantage |
$2,804.18
|
| Rate for Payer: UHCCP Medicaid |
$1,503.04
|
| Rate for Payer: UMR Bronson Commercial |
$284.16
|
| Rate for Payer: VA VA |
$2,804.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$576.00
|
|
|
PR RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP
|
Professional
|
Both
|
$768.00
|
|
|
Service Code
|
HCPCS 20525
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$684.64 |
| Rate for Payer: Aetna Commercial |
$319.56
|
| Rate for Payer: Aetna Medicare |
$248.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.41
|
| Rate for Payer: BCBS Complete |
$169.08
|
| Rate for Payer: BCBS MAPPO |
$238.48
|
| Rate for Payer: BCBS Trust/PPO |
$195.38
|
| Rate for Payer: BCN Commercial |
$684.64
|
| Rate for Payer: BCN Medicare Advantage |
$238.48
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cash Price |
$614.40
|
| Rate for Payer: Cofinity Commercial |
$319.56
|
| Rate for Payer: Cofinity Commercial |
$343.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.40
|
| Rate for Payer: Meridian Medicaid |
$169.08
|
| Rate for Payer: Nomi Health Commercial |
$286.18
|
| Rate for Payer: PACE SWMI |
$238.48
|
| Rate for Payer: PHP Commercial |
$333.87
|
| Rate for Payer: PHP Medicare Advantage |
$238.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$161.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$379.10
|
| Rate for Payer: Priority Health Medicare |
$238.48
|
| Rate for Payer: Priority Health Narrow Network |
$379.10
|
| Rate for Payer: Priority Health SBD |
$379.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.48
|
| Rate for Payer: UHC Medicare Advantage |
$238.48
|
| Rate for Payer: UHCCP Medicaid |
$161.03
|
| Rate for Payer: UMR Bronson Commercial |
$353.28
|
|
|
PR RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 27086
|
| Min. Negotiated Rate |
$110.55 |
| Max. Negotiated Rate |
$459.36 |
| Rate for Payer: Aetna Commercial |
$216.77
|
| Rate for Payer: Aetna Medicare |
$168.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.95
|
| Rate for Payer: BCBS Complete |
$116.08
|
| Rate for Payer: BCBS MAPPO |
$161.77
|
| Rate for Payer: BCBS Trust/PPO |
$227.17
|
| Rate for Payer: BCN Commercial |
$459.36
|
| Rate for Payer: BCN Medicare Advantage |
$161.77
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$216.77
|
| Rate for Payer: Cofinity Commercial |
$232.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.86
|
| Rate for Payer: Meridian Medicaid |
$116.08
|
| Rate for Payer: Nomi Health Commercial |
$194.12
|
| Rate for Payer: PACE SWMI |
$161.77
|
| Rate for Payer: PHP Commercial |
$226.48
|
| Rate for Payer: PHP Medicare Advantage |
$161.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$262.06
|
| Rate for Payer: Priority Health Medicare |
$161.77
|
| Rate for Payer: Priority Health Narrow Network |
$262.06
|
| Rate for Payer: Priority Health SBD |
$262.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.77
|
| Rate for Payer: UHC Medicare Advantage |
$161.77
|
| Rate for Payer: UHCCP Medicaid |
$110.55
|
| Rate for Payer: UMR Bronson Commercial |
$186.76
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 24200
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$318.13 |
| Rate for Payer: Aetna Commercial |
$184.08
|
| Rate for Payer: Aetna Medicare |
$142.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.81
|
| Rate for Payer: BCBS Complete |
$98.19
|
| Rate for Payer: BCBS MAPPO |
$137.37
|
| Rate for Payer: BCBS Trust/PPO |
$116.23
|
| Rate for Payer: BCN Commercial |
$318.13
|
| Rate for Payer: BCN Medicare Advantage |
$137.37
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$184.08
|
| Rate for Payer: Cofinity Commercial |
$197.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.24
|
| Rate for Payer: Meridian Medicaid |
$98.19
|
| Rate for Payer: Nomi Health Commercial |
$164.84
|
| Rate for Payer: PACE SWMI |
$137.37
|
| Rate for Payer: PHP Commercial |
$192.32
|
| Rate for Payer: PHP Medicare Advantage |
$137.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.82
|
| Rate for Payer: Priority Health Medicare |
$137.37
|
| Rate for Payer: Priority Health Narrow Network |
$218.82
|
| Rate for Payer: Priority Health SBD |
$218.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.37
|
| Rate for Payer: UHC Medicare Advantage |
$137.37
|
| Rate for Payer: UHCCP Medicaid |
$93.51
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$121.36 |
| Max. Negotiated Rate |
$4,989.41 |
| Rate for Payer: Aetna American Axle |
$213.20
|
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna Medicare |
$1,650.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,984.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,984.35
|
| Rate for Payer: BCBS Complete |
$893.43
|
| Rate for Payer: BCBS MAPPO |
$1,587.48
|
| Rate for Payer: BCBS Trust/PPO |
$179.97
|
| Rate for Payer: BCN Commercial |
$179.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,587.48
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,587.48
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.00
|
| Rate for Payer: Mclaren Medicaid |
$850.89
|
| Rate for Payer: Mclaren Medicare |
$1,587.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.85
|
| Rate for Payer: Meridian Medicaid |
$893.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,825.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: Nomi Health Commercial |
$3,333.71
|
| Rate for Payer: PACE Medicare |
$1,508.11
|
| Rate for Payer: PACE SWMI |
$1,587.48
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,587.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$850.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,989.41
|
| Rate for Payer: Priority Health Medicare |
$1,587.48
|
| Rate for Payer: Priority Health Narrow Network |
$3,991.53
|
| Rate for Payer: Priority Health SBD |
$206.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1,587.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.01
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,587.48
|
| Rate for Payer: UHC Exchange |
$136.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,587.48
|
| Rate for Payer: UHCCP Medicaid |
$850.89
|
| Rate for Payer: UMR Bronson Commercial |
$121.36
|
| Rate for Payer: VA VA |
$1,587.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.00
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$318.13 |
| Rate for Payer: Aetna Commercial |
$184.08
|
| Rate for Payer: Aetna Medicare |
$142.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.81
|
| Rate for Payer: BCBS Complete |
$98.19
|
| Rate for Payer: BCBS MAPPO |
$137.37
|
| Rate for Payer: BCBS Trust/PPO |
$116.23
|
| Rate for Payer: BCN Commercial |
$318.13
|
| Rate for Payer: BCN Medicare Advantage |
$137.37
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$197.81
|
| Rate for Payer: Cofinity Commercial |
$184.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.24
|
| Rate for Payer: Meridian Medicaid |
$98.19
|
| Rate for Payer: Nomi Health Commercial |
$164.84
|
| Rate for Payer: PACE SWMI |
$137.37
|
| Rate for Payer: PHP Commercial |
$192.32
|
| Rate for Payer: PHP Medicare Advantage |
$137.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.82
|
| Rate for Payer: Priority Health Medicare |
$137.37
|
| Rate for Payer: Priority Health Narrow Network |
$218.82
|
| Rate for Payer: Priority Health SBD |
$218.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.37
|
| Rate for Payer: UHC Medicare Advantage |
$137.37
|
| Rate for Payer: UHCCP Medicaid |
$93.51
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 24200
|
| Hospital Charge Code |
24200
|
| Min. Negotiated Rate |
$144.32 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Aetna American Axle |
$213.20
|
| Rate for Payer: Aetna Commercial |
$278.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.20
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$282.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$262.40
|
| Rate for Payer: Healthscope Commercial |
$295.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.80
|
| Rate for Payer: PHP Commercial |
$278.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health SBD |
$206.64
|
| Rate for Payer: UMR Bronson Commercial |
$144.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.00
|
|
|
PR RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA
|
Professional
|
Both
|
$3,292.00
|
|
|
Service Code
|
HCPCS 27091
|
| Min. Negotiated Rate |
$538.87 |
| Max. Negotiated Rate |
$2,434.38 |
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Aetna Commercial |
$2,054.81
|
| Rate for Payer: Aetna Medicare |
$1,594.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,054.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,208.15
|
| Rate for Payer: BCBS Complete |
$1,078.66
|
| Rate for Payer: BCBS MAPPO |
$1,533.44
|
| Rate for Payer: BCBS Trust/PPO |
$538.87
|
| Rate for Payer: BCN Commercial |
$2,324.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,533.44
|
| Rate for Payer: Cash Price |
$2,633.60
|
| Rate for Payer: Cofinity Commercial |
$2,054.81
|
| Rate for Payer: Cofinity Commercial |
$2,208.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,533.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,610.11
|
| Rate for Payer: Meridian Medicaid |
$1,078.66
|
| Rate for Payer: Nomi Health Commercial |
$1,840.13
|
| Rate for Payer: PACE SWMI |
$1,533.44
|
| Rate for Payer: PHP Commercial |
$2,146.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,533.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,027.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,139.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,434.38
|
| Rate for Payer: Priority Health Medicare |
$1,533.44
|
| Rate for Payer: Priority Health Narrow Network |
$2,434.38
|
| Rate for Payer: Priority Health SBD |
$2,434.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,533.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,533.44
|
| Rate for Payer: UHCCP Medicaid |
$1,027.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,514.32
|
|
|
PR RMVL I-AORT BALO ASST DEV W/RPR FEM ART W/WO GRF
|
Professional
|
Both
|
$2,625.00
|
|
|
Service Code
|
HCPCS 33971
|
| Min. Negotiated Rate |
$446.66 |
| Max. Negotiated Rate |
$1,706.25 |
| Rate for Payer: Aetna Commercial |
$906.08
|
| Rate for Payer: Aetna Medicare |
$703.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$906.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$973.70
|
| Rate for Payer: BCBS Complete |
$468.99
|
| Rate for Payer: BCBS MAPPO |
$676.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.81
|
| Rate for Payer: BCN Commercial |
$1,016.94
|
| Rate for Payer: BCN Medicare Advantage |
$676.18
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cofinity Commercial |
$906.08
|
| Rate for Payer: Cofinity Commercial |
$973.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.99
|
| Rate for Payer: Meridian Medicaid |
$468.99
|
| Rate for Payer: Nomi Health Commercial |
$811.42
|
| Rate for Payer: PACE SWMI |
$676.18
|
| Rate for Payer: PHP Commercial |
$946.65
|
| Rate for Payer: PHP Medicare Advantage |
$676.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,706.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,113.64
|
| Rate for Payer: Priority Health Medicare |
$676.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,113.64
|
| Rate for Payer: Priority Health SBD |
$1,113.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$676.18
|
| Rate for Payer: UHC Medicare Advantage |
$676.18
|
| Rate for Payer: UHCCP Medicaid |
$446.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,207.50
|
|
|
PR RMVL IMPLANTABLE PT-ACTIVATED CAR EVENT RECORDER
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 33284
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: Aetna Medicare |
$245.00
|
| Rate for Payer: BCBS Complete |
$196.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: UMR Bronson Commercial |
$225.40
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD
|
Professional
|
Both
|
$671.00
|
|
|
Service Code
|
HCPCS 33262
|
| Min. Negotiated Rate |
$234.73 |
| Max. Negotiated Rate |
$5,175.23 |
| Rate for Payer: Aetna Commercial |
$472.32
|
| Rate for Payer: Aetna Medicare |
$366.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.57
|
| Rate for Payer: BCBS Complete |
$246.47
|
| Rate for Payer: BCBS MAPPO |
$352.48
|
| Rate for Payer: BCBS Trust/PPO |
$5,175.23
|
| Rate for Payer: BCN Commercial |
$539.50
|
| Rate for Payer: BCN Medicare Advantage |
$352.48
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cash Price |
$536.80
|
| Rate for Payer: Cofinity Commercial |
$507.57
|
| Rate for Payer: Cofinity Commercial |
$472.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.10
|
| Rate for Payer: Meridian Medicaid |
$246.47
|
| Rate for Payer: Nomi Health Commercial |
$422.98
|
| Rate for Payer: PACE SWMI |
$352.48
|
| Rate for Payer: PHP Commercial |
$493.47
|
| Rate for Payer: PHP Medicare Advantage |
$352.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$436.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$584.48
|
| Rate for Payer: Priority Health Medicare |
$352.48
|
| Rate for Payer: Priority Health Narrow Network |
$584.48
|
| Rate for Payer: Priority Health SBD |
$584.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.48
|
| Rate for Payer: UHC Medicare Advantage |
$352.48
|
| Rate for Payer: UHCCP Medicaid |
$234.73
|
| Rate for Payer: UMR Bronson Commercial |
$308.66
|
|
|
PR RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 33263
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$6,021.04 |
| Rate for Payer: Aetna Commercial |
$491.65
|
| Rate for Payer: Aetna Medicare |
$381.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$491.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.34
|
| Rate for Payer: BCBS Complete |
$256.30
|
| Rate for Payer: BCBS MAPPO |
$366.90
|
| Rate for Payer: BCBS Trust/PPO |
$6,021.04
|
| Rate for Payer: BCN Commercial |
$560.02
|
| Rate for Payer: BCN Medicare Advantage |
$366.90
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cofinity Commercial |
$491.65
|
| Rate for Payer: Cofinity Commercial |
$528.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$385.24
|
| Rate for Payer: Meridian Medicaid |
$256.30
|
| Rate for Payer: Nomi Health Commercial |
$440.28
|
| Rate for Payer: PACE SWMI |
$366.90
|
| Rate for Payer: PHP Commercial |
$513.66
|
| Rate for Payer: PHP Medicare Advantage |
$366.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$511.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$607.34
|
| Rate for Payer: Priority Health Medicare |
$366.90
|
| Rate for Payer: Priority Health Narrow Network |
$607.34
|
| Rate for Payer: Priority Health SBD |
$607.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$366.90
|
| Rate for Payer: UHC Medicare Advantage |
$366.90
|
| Rate for Payer: UHCCP Medicaid |
$244.10
|
| Rate for Payer: UMR Bronson Commercial |
$362.02
|
|
|
PR RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 33264
|
| Min. Negotiated Rate |
$254.32 |
| Max. Negotiated Rate |
$2,214.63 |
| Rate for Payer: Aetna Commercial |
$512.43
|
| Rate for Payer: Aetna Medicare |
$397.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$550.67
|
| Rate for Payer: BCBS Complete |
$267.04
|
| Rate for Payer: BCBS MAPPO |
$382.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,214.63
|
| Rate for Payer: BCN Commercial |
$583.97
|
| Rate for Payer: BCN Medicare Advantage |
$382.41
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$512.43
|
| Rate for Payer: Cofinity Commercial |
$550.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$382.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$401.53
|
| Rate for Payer: Meridian Medicaid |
$267.04
|
| Rate for Payer: Nomi Health Commercial |
$458.89
|
| Rate for Payer: PACE SWMI |
$382.41
|
| Rate for Payer: PHP Commercial |
$535.37
|
| Rate for Payer: PHP Medicare Advantage |
$382.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.40
|
| Rate for Payer: Priority Health Medicare |
$382.41
|
| Rate for Payer: Priority Health Narrow Network |
$633.40
|
| Rate for Payer: Priority Health SBD |
$633.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$382.41
|
| Rate for Payer: UHC Medicare Advantage |
$382.41
|
| Rate for Payer: UHCCP Medicaid |
$254.32
|
| Rate for Payer: UMR Bronson Commercial |
$378.12
|
|
|
PR RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH
|
Professional
|
Both
|
$1,392.00
|
|
|
Service Code
|
HCPCS 54406
|
| Min. Negotiated Rate |
$469.24 |
| Max. Negotiated Rate |
$1,959.10 |
| Rate for Payer: Aetna Commercial |
$937.33
|
| Rate for Payer: Aetna Medicare |
$727.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$937.33
|
| Rate for Payer: BCBS Complete |
$492.70
|
| Rate for Payer: BCBS MAPPO |
$699.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.10
|
| Rate for Payer: BCN Commercial |
$1,055.55
|
| Rate for Payer: BCN Medicare Advantage |
$699.50
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cash Price |
$1,113.60
|
| Rate for Payer: Cofinity Commercial |
$1,007.28
|
| Rate for Payer: Cofinity Commercial |
$937.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$699.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$734.48
|
| Rate for Payer: Meridian Medicaid |
$492.70
|
| Rate for Payer: Nomi Health Commercial |
$839.40
|
| Rate for Payer: PACE SWMI |
$699.50
|
| Rate for Payer: PHP Commercial |
$979.30
|
| Rate for Payer: PHP Medicare Advantage |
$699.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$469.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$904.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,165.33
|
| Rate for Payer: Priority Health Medicare |
$699.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,165.33
|
| Rate for Payer: Priority Health SBD |
$1,165.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$699.50
|
| Rate for Payer: UHC Medicare Advantage |
$699.50
|
| Rate for Payer: UHCCP Medicaid |
$469.24
|
| Rate for Payer: UMR Bronson Commercial |
$640.32
|
|
