|
PR SCREENING PROCTOSCOPY
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS S0601
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Aetna Medicare |
$77.00
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: UMR Bronson Commercial |
$70.84
|
|
|
PR SCREENING TEST PURE TONE AIR ONLY
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 92551
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
|
|
PR SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 99173
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PR SCR MAMMO BI INCL CAD
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS G0202
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: UMR Bronson Commercial |
$95.22
|
|
|
PR SCROTAL EXPLORATION
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 55110
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$537.39 |
| Rate for Payer: Aetna Commercial |
$500.07
|
| Rate for Payer: Aetna Medicare |
$388.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.07
|
| Rate for Payer: BCBS Complete |
$280.80
|
| Rate for Payer: BCBS MAPPO |
$373.19
|
| Rate for Payer: BCN Medicare Advantage |
$373.19
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$500.07
|
| Rate for Payer: Cofinity Commercial |
$537.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.85
|
| Rate for Payer: Nomi Health Commercial |
$447.83
|
| Rate for Payer: PACE SWMI |
$373.19
|
| Rate for Payer: PHP Commercial |
$522.47
|
| Rate for Payer: PHP Medicare Advantage |
$373.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.30
|
| Rate for Payer: Priority Health Medicare |
$373.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.19
|
| Rate for Payer: UHC Medicare Advantage |
$373.19
|
| Rate for Payer: UMR Bronson Commercial |
$322.92
|
|
|
PR SCROTOPLASTY COMPLICATED
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
HCPCS 55180
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$948.11 |
| Rate for Payer: Aetna Commercial |
$882.27
|
| Rate for Payer: Aetna Medicare |
$684.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.27
|
| Rate for Payer: BCBS Complete |
$565.60
|
| Rate for Payer: BCBS MAPPO |
$658.41
|
| Rate for Payer: BCN Medicare Advantage |
$658.41
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cofinity Commercial |
$948.11
|
| Rate for Payer: Cofinity Commercial |
$882.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.33
|
| Rate for Payer: Nomi Health Commercial |
$790.09
|
| Rate for Payer: PACE SWMI |
$658.41
|
| Rate for Payer: PHP Commercial |
$921.77
|
| Rate for Payer: PHP Medicare Advantage |
$658.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.10
|
| Rate for Payer: Priority Health Medicare |
$658.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.41
|
| Rate for Payer: UHC Medicare Advantage |
$658.41
|
| Rate for Payer: UMR Bronson Commercial |
$650.44
|
|
|
PR SCROTOPLASTY SIMPLE
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 55175
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$503.71 |
| Rate for Payer: Aetna Commercial |
$468.73
|
| Rate for Payer: Aetna Medicare |
$363.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.73
|
| Rate for Payer: BCBS Complete |
$273.60
|
| Rate for Payer: BCBS MAPPO |
$349.80
|
| Rate for Payer: BCN Medicare Advantage |
$349.80
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Commercial |
$503.71
|
| Rate for Payer: Cofinity Commercial |
$468.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.29
|
| Rate for Payer: Nomi Health Commercial |
$419.76
|
| Rate for Payer: PACE SWMI |
$349.80
|
| Rate for Payer: PHP Commercial |
$489.72
|
| Rate for Payer: PHP Medicare Advantage |
$349.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.60
|
| Rate for Payer: Priority Health Medicare |
$349.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.80
|
| Rate for Payer: UHC Medicare Advantage |
$349.80
|
| Rate for Payer: UMR Bronson Commercial |
$314.64
|
|
|
PR SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN
|
Professional
|
Both
|
$2,346.00
|
|
|
Service Code
|
HCPCS 49900
|
| Min. Negotiated Rate |
$798.93 |
| Max. Negotiated Rate |
$1,524.90 |
| Rate for Payer: Aetna Commercial |
$1,070.57
|
| Rate for Payer: Aetna Medicare |
$830.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.57
|
| Rate for Payer: BCBS Complete |
$938.40
|
| Rate for Payer: BCBS MAPPO |
$798.93
|
| Rate for Payer: BCN Medicare Advantage |
$798.93
|
| Rate for Payer: Cash Price |
$1,876.80
|
| Rate for Payer: Cash Price |
$1,876.80
|
| Rate for Payer: Cofinity Commercial |
$1,150.46
|
| Rate for Payer: Cofinity Commercial |
$1,070.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.88
|
| Rate for Payer: Nomi Health Commercial |
$958.72
|
| Rate for Payer: PACE SWMI |
$798.93
|
| Rate for Payer: PHP Commercial |
$1,118.50
|
| Rate for Payer: PHP Medicare Advantage |
$798.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,524.90
|
| Rate for Payer: Priority Health Medicare |
$798.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.93
|
| Rate for Payer: UHC Medicare Advantage |
$798.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,079.16
|
|
|
PR SECONDARY CLOSURE SURG WOUND/DEHSN XTNSV/COMP
|
Professional
|
Both
|
$1,792.00
|
|
|
Service Code
|
HCPCS 13160
|
| Min. Negotiated Rate |
$716.80 |
| Max. Negotiated Rate |
$1,164.80 |
| Rate for Payer: Aetna Commercial |
$1,022.26
|
| Rate for Payer: Aetna Medicare |
$793.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,098.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,022.26
|
| Rate for Payer: BCBS Complete |
$716.80
|
| Rate for Payer: BCBS MAPPO |
$762.88
|
| Rate for Payer: BCN Medicare Advantage |
$762.88
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cofinity Commercial |
$1,098.55
|
| Rate for Payer: Cofinity Commercial |
$1,022.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$762.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$801.02
|
| Rate for Payer: Nomi Health Commercial |
$915.46
|
| Rate for Payer: PACE SWMI |
$762.88
|
| Rate for Payer: PHP Commercial |
$1,068.03
|
| Rate for Payer: PHP Medicare Advantage |
$762.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,164.80
|
| Rate for Payer: Priority Health Medicare |
$762.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.88
|
| Rate for Payer: UHC Medicare Advantage |
$762.88
|
| Rate for Payer: UMR Bronson Commercial |
$824.32
|
|
|
PR SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ
|
Professional
|
Both
|
$4,570.00
|
|
|
Service Code
|
HCPCS 21275
|
| Min. Negotiated Rate |
$805.18 |
| Max. Negotiated Rate |
$2,970.50 |
| Rate for Payer: Aetna Commercial |
$1,078.94
|
| Rate for Payer: Aetna Medicare |
$837.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.94
|
| Rate for Payer: BCBS Complete |
$1,828.00
|
| Rate for Payer: BCBS MAPPO |
$805.18
|
| Rate for Payer: BCN Medicare Advantage |
$805.18
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cofinity Commercial |
$1,159.46
|
| Rate for Payer: Cofinity Commercial |
$1,078.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$845.44
|
| Rate for Payer: Nomi Health Commercial |
$966.22
|
| Rate for Payer: PACE SWMI |
$805.18
|
| Rate for Payer: PHP Commercial |
$1,127.25
|
| Rate for Payer: PHP Medicare Advantage |
$805.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.50
|
| Rate for Payer: Priority Health Medicare |
$805.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.18
|
| Rate for Payer: UHC Medicare Advantage |
$805.18
|
| Rate for Payer: UMR Bronson Commercial |
$2,102.20
|
|
|
PR SECONDARY RPR DURA CSF LEAK FREE TISSUE GRAFT
|
Professional
|
Both
|
$6,290.00
|
|
|
Service Code
|
HCPCS 61618
|
| Min. Negotiated Rate |
$1,269.44 |
| Max. Negotiated Rate |
$4,088.50 |
| Rate for Payer: Aetna Commercial |
$1,701.05
|
| Rate for Payer: Aetna Medicare |
$1,320.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,827.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,701.05
|
| Rate for Payer: BCBS Complete |
$2,516.00
|
| Rate for Payer: BCBS MAPPO |
$1,269.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,269.44
|
| Rate for Payer: Cash Price |
$5,032.00
|
| Rate for Payer: Cash Price |
$5,032.00
|
| Rate for Payer: Cofinity Commercial |
$1,827.99
|
| Rate for Payer: Cofinity Commercial |
$1,701.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,269.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,332.91
|
| Rate for Payer: Nomi Health Commercial |
$1,523.33
|
| Rate for Payer: PACE SWMI |
$1,269.44
|
| Rate for Payer: PHP Commercial |
$1,777.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,269.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,088.50
|
| Rate for Payer: Priority Health Medicare |
$1,269.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,269.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.44
|
| Rate for Payer: UMR Bronson Commercial |
$2,893.40
|
|
|
PR SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL
|
Professional
|
Both
|
$2,567.00
|
|
|
Service Code
|
HCPCS 37186
|
| Min. Negotiated Rate |
$233.80 |
| Max. Negotiated Rate |
$1,668.55 |
| Rate for Payer: Aetna Commercial |
$313.29
|
| Rate for Payer: Aetna Medicare |
$243.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.29
|
| Rate for Payer: BCBS Complete |
$1,026.80
|
| Rate for Payer: BCBS MAPPO |
$233.80
|
| Rate for Payer: BCN Medicare Advantage |
$233.80
|
| Rate for Payer: Cash Price |
$2,053.60
|
| Rate for Payer: Cash Price |
$2,053.60
|
| Rate for Payer: Cofinity Commercial |
$336.67
|
| Rate for Payer: Cofinity Commercial |
$313.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.49
|
| Rate for Payer: Nomi Health Commercial |
$280.56
|
| Rate for Payer: PACE SWMI |
$233.80
|
| Rate for Payer: PHP Commercial |
$327.32
|
| Rate for Payer: PHP Medicare Advantage |
$233.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,668.55
|
| Rate for Payer: Priority Health Medicare |
$233.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.80
|
| Rate for Payer: UHC Medicare Advantage |
$233.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,180.82
|
|
|
PR SEC RPR DURA CSF LEAK LOCAL/REGIONALIZED FLAP
|
Professional
|
Both
|
$9,939.00
|
|
|
Service Code
|
HCPCS 61619
|
| Min. Negotiated Rate |
$1,389.53 |
| Max. Negotiated Rate |
$6,460.35 |
| Rate for Payer: Aetna Commercial |
$1,861.97
|
| Rate for Payer: Aetna Medicare |
$1,445.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,000.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,861.97
|
| Rate for Payer: BCBS Complete |
$3,975.60
|
| Rate for Payer: BCBS MAPPO |
$1,389.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,389.53
|
| Rate for Payer: Cash Price |
$7,951.20
|
| Rate for Payer: Cash Price |
$7,951.20
|
| Rate for Payer: Cofinity Commercial |
$2,000.92
|
| Rate for Payer: Cofinity Commercial |
$1,861.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,389.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,459.01
|
| Rate for Payer: Nomi Health Commercial |
$1,667.44
|
| Rate for Payer: PACE SWMI |
$1,389.53
|
| Rate for Payer: PHP Commercial |
$1,945.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,389.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,460.35
|
| Rate for Payer: Priority Health Medicare |
$1,389.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,389.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,389.53
|
| Rate for Payer: UMR Bronson Commercial |
$4,571.94
|
|
|
PR SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 97535
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$43.99 |
| Rate for Payer: Aetna Commercial |
$40.94
|
| Rate for Payer: Aetna Medicare |
$31.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.94
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$30.55
|
| Rate for Payer: BCN Medicare Advantage |
$30.55
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$43.99
|
| Rate for Payer: Cofinity Commercial |
$40.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.08
|
| Rate for Payer: Nomi Health Commercial |
$36.66
|
| Rate for Payer: PACE SWMI |
$30.55
|
| Rate for Payer: PHP Commercial |
$42.77
|
| Rate for Payer: PHP Medicare Advantage |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Medicare |
$30.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.55
|
| Rate for Payer: UHC Medicare Advantage |
$30.55
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
PR SENSORMOTOR XM W/MLT MEAS OCULAR DEVIJ W/I&R SPX
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 92060
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Aetna Commercial |
$78.31
|
| Rate for Payer: Aetna Medicare |
$60.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.31
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$58.44
|
| Rate for Payer: BCN Medicare Advantage |
$58.44
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$84.15
|
| Rate for Payer: Cofinity Commercial |
$78.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.36
|
| Rate for Payer: Nomi Health Commercial |
$70.13
|
| Rate for Payer: PACE SWMI |
$58.44
|
| Rate for Payer: PHP Commercial |
$81.82
|
| Rate for Payer: PHP Medicare Advantage |
$58.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Medicare |
$58.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.44
|
| Rate for Payer: UHC Medicare Advantage |
$58.44
|
| Rate for Payer: UMR Bronson Commercial |
$46.92
|
|
|
PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 30520
|
| Min. Negotiated Rate |
$624.37 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$836.66
|
| Rate for Payer: Aetna Commercial |
$836.66
|
| Rate for Payer: Aetna Medicare |
$649.34
|
| Rate for Payer: Aetna Medicare |
$649.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.09
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: BCBS Complete |
$728.00
|
| Rate for Payer: BCBS MAPPO |
$624.37
|
| Rate for Payer: BCBS MAPPO |
$624.37
|
| Rate for Payer: BCN Medicare Advantage |
$624.37
|
| Rate for Payer: BCN Medicare Advantage |
$624.37
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$1,456.00
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cofinity Commercial |
$899.09
|
| Rate for Payer: Cofinity Commercial |
$899.09
|
| Rate for Payer: Cofinity Commercial |
$836.66
|
| Rate for Payer: Cofinity Commercial |
$836.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.59
|
| Rate for Payer: Nomi Health Commercial |
$749.24
|
| Rate for Payer: Nomi Health Commercial |
$749.24
|
| Rate for Payer: PACE SWMI |
$624.37
|
| Rate for Payer: PACE SWMI |
$624.37
|
| Rate for Payer: PHP Commercial |
$874.12
|
| Rate for Payer: PHP Commercial |
$874.12
|
| Rate for Payer: PHP Medicare Advantage |
$624.37
|
| Rate for Payer: PHP Medicare Advantage |
$624.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: Priority Health Medicare |
$624.37
|
| Rate for Payer: Priority Health Medicare |
$624.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.37
|
| Rate for Payer: UHC Medicare Advantage |
$624.37
|
| Rate for Payer: UHC Medicare Advantage |
$624.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,454.52
|
| Rate for Payer: UMR Bronson Commercial |
$837.20
|
|
|
PR SEQUESTRECTOMY FOREARM &/WRIST
|
Professional
|
Both
|
$2,257.00
|
|
|
Service Code
|
HCPCS 25145
|
| Min. Negotiated Rate |
$505.88 |
| Max. Negotiated Rate |
$1,467.05 |
| Rate for Payer: Aetna Commercial |
$677.88
|
| Rate for Payer: Aetna Medicare |
$526.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.88
|
| Rate for Payer: BCBS Complete |
$902.80
|
| Rate for Payer: BCBS MAPPO |
$505.88
|
| Rate for Payer: BCN Medicare Advantage |
$505.88
|
| Rate for Payer: Cash Price |
$1,805.60
|
| Rate for Payer: Cash Price |
$1,805.60
|
| Rate for Payer: Cofinity Commercial |
$728.47
|
| Rate for Payer: Cofinity Commercial |
$677.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.17
|
| Rate for Payer: Nomi Health Commercial |
$607.06
|
| Rate for Payer: PACE SWMI |
$505.88
|
| Rate for Payer: PHP Commercial |
$708.23
|
| Rate for Payer: PHP Medicare Advantage |
$505.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,467.05
|
| Rate for Payer: Priority Health Medicare |
$505.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$505.88
|
| Rate for Payer: UHC Medicare Advantage |
$505.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,038.22
|
|
|
PR SEQUESTRECTOMY SHAFT/DISTAL HUMERUS
|
Professional
|
Both
|
$2,220.00
|
|
|
Service Code
|
HCPCS 24134
|
| Min. Negotiated Rate |
$724.18 |
| Max. Negotiated Rate |
$1,443.00 |
| Rate for Payer: Aetna Commercial |
$970.40
|
| Rate for Payer: Aetna Medicare |
$753.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$970.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,042.82
|
| Rate for Payer: BCBS Complete |
$888.00
|
| Rate for Payer: BCBS MAPPO |
$724.18
|
| Rate for Payer: BCN Medicare Advantage |
$724.18
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Cofinity Commercial |
$970.40
|
| Rate for Payer: Cofinity Commercial |
$1,042.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$724.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$760.39
|
| Rate for Payer: Nomi Health Commercial |
$869.02
|
| Rate for Payer: PACE SWMI |
$724.18
|
| Rate for Payer: PHP Commercial |
$1,013.85
|
| Rate for Payer: PHP Medicare Advantage |
$724.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,443.00
|
| Rate for Payer: Priority Health Medicare |
$724.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$724.18
|
| Rate for Payer: UHC Medicare Advantage |
$724.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,021.20
|
|
|
PR SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 99050
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
PR SESAMOIDECTOMY FIRST TOE SPX
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
HCPCS 28315
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$577.85 |
| Rate for Payer: Aetna Commercial |
$419.15
|
| Rate for Payer: Aetna Medicare |
$325.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.43
|
| Rate for Payer: BCBS Complete |
$355.60
|
| Rate for Payer: BCBS MAPPO |
$312.80
|
| Rate for Payer: BCN Medicare Advantage |
$312.80
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cofinity Commercial |
$419.15
|
| Rate for Payer: Cofinity Commercial |
$450.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.44
|
| Rate for Payer: Nomi Health Commercial |
$375.36
|
| Rate for Payer: PACE SWMI |
$312.80
|
| Rate for Payer: PHP Commercial |
$437.92
|
| Rate for Payer: PHP Medicare Advantage |
$312.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.85
|
| Rate for Payer: Priority Health Medicare |
$312.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$312.80
|
| Rate for Payer: UHC Medicare Advantage |
$312.80
|
| Rate for Payer: UMR Bronson Commercial |
$408.94
|
|
|
PR SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 26185
|
| Min. Negotiated Rate |
$540.89 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$724.79
|
| Rate for Payer: Aetna Medicare |
$562.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.79
|
| Rate for Payer: BCBS Complete |
$672.00
|
| Rate for Payer: BCBS MAPPO |
$540.89
|
| Rate for Payer: BCN Medicare Advantage |
$540.89
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cofinity Commercial |
$778.88
|
| Rate for Payer: Cofinity Commercial |
$724.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$567.93
|
| Rate for Payer: Nomi Health Commercial |
$649.07
|
| Rate for Payer: PACE SWMI |
$540.89
|
| Rate for Payer: PHP Commercial |
$757.25
|
| Rate for Payer: PHP Medicare Advantage |
$540.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
| Rate for Payer: Priority Health Medicare |
$540.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.89
|
| Rate for Payer: UHC Medicare Advantage |
$540.89
|
| Rate for Payer: UMR Bronson Commercial |
$772.80
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 45335
|
| Min. Negotiated Rate |
$63.87 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$85.59
|
| Rate for Payer: Aetna Medicare |
$66.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.59
|
| Rate for Payer: BCBS Complete |
$260.00
|
| Rate for Payer: BCBS MAPPO |
$63.87
|
| Rate for Payer: BCN Medicare Advantage |
$63.87
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$91.97
|
| Rate for Payer: Cofinity Commercial |
$85.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.06
|
| Rate for Payer: Nomi Health Commercial |
$76.64
|
| Rate for Payer: PACE SWMI |
$63.87
|
| Rate for Payer: PHP Commercial |
$89.42
|
| Rate for Payer: PHP Medicare Advantage |
$63.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: Priority Health Medicare |
$63.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.87
|
| Rate for Payer: UHC Medicare Advantage |
$63.87
|
| Rate for Payer: UMR Bronson Commercial |
$299.00
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
45335
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna American Axle |
$422.50
|
| Rate for Payer: Aetna Commercial |
$552.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.50
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$455.00
|
| Rate for Payer: Cofinity Commercial |
$559.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.00
|
| Rate for Payer: Healthscope Commercial |
$585.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.50
|
| Rate for Payer: PHP Commercial |
$552.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: Priority Health SBD |
$409.50
|
| Rate for Payer: UMR Bronson Commercial |
$286.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.50
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
45335
|
| Min. Negotiated Rate |
$240.50 |
| Max. Negotiated Rate |
$2,502.92 |
| Rate for Payer: Aetna American Axle |
$422.50
|
| Rate for Payer: Aetna Commercial |
$552.50
|
| Rate for Payer: Aetna Medicare |
$924.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,111.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,111.46
|
| Rate for Payer: BCBS Complete |
$500.42
|
| Rate for Payer: BCBS MAPPO |
$889.17
|
| Rate for Payer: BCN Medicare Advantage |
$889.17
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$455.00
|
| Rate for Payer: Cofinity Commercial |
$559.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.17
|
| Rate for Payer: Healthscope Commercial |
$585.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.50
|
| Rate for Payer: Mclaren Medicaid |
$476.60
|
| Rate for Payer: Mclaren Medicare |
$889.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.63
|
| Rate for Payer: Meridian Medicaid |
$500.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,022.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.50
|
| Rate for Payer: PACE Medicare |
$844.71
|
| Rate for Payer: PACE SWMI |
$889.17
|
| Rate for Payer: PHP Commercial |
$552.50
|
| Rate for Payer: PHP Medicare Advantage |
$889.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: Priority Health Medicare |
$889.17
|
| Rate for Payer: Priority Health SBD |
$409.50
|
| Rate for Payer: Railroad Medicare Medicare |
$889.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,502.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$889.17
|
| Rate for Payer: UHC Exchange |
$1,699.29
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: UMR Bronson Commercial |
$240.50
|
| Rate for Payer: VA VA |
$889.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.50
|
|
|
PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
HCPCS 45335
|
| Hospital Charge Code |
45335
|
| Min. Negotiated Rate |
$63.87 |
| Max. Negotiated Rate |
$422.50 |
| Rate for Payer: Aetna Commercial |
$85.59
|
| Rate for Payer: Aetna Medicare |
$66.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.59
|
| Rate for Payer: BCBS Complete |
$260.00
|
| Rate for Payer: BCBS MAPPO |
$63.87
|
| Rate for Payer: BCN Medicare Advantage |
$63.87
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$85.59
|
| Rate for Payer: Cofinity Commercial |
$91.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.06
|
| Rate for Payer: Nomi Health Commercial |
$76.64
|
| Rate for Payer: PACE SWMI |
$63.87
|
| Rate for Payer: PHP Commercial |
$89.42
|
| Rate for Payer: PHP Medicare Advantage |
$63.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.50
|
| Rate for Payer: Priority Health Medicare |
$63.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.87
|
| Rate for Payer: UHC Medicare Advantage |
$63.87
|
| Rate for Payer: UMR Bronson Commercial |
$299.00
|
|
