|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$500.83 |
| Rate for Payer: Aetna Commercial |
$194.31
|
| Rate for Payer: Aetna Medicare |
$150.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.81
|
| Rate for Payer: BCBS Complete |
$102.66
|
| Rate for Payer: BCBS MAPPO |
$145.01
|
| Rate for Payer: BCBS Trust/PPO |
$500.83
|
| Rate for Payer: BCN Commercial |
$221.37
|
| Rate for Payer: BCN Medicare Advantage |
$145.01
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Cofinity Commercial |
$208.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.26
|
| Rate for Payer: Meridian Medicaid |
$102.66
|
| Rate for Payer: Nomi Health Commercial |
$174.01
|
| Rate for Payer: PACE SWMI |
$145.01
|
| Rate for Payer: PHP Commercial |
$203.01
|
| Rate for Payer: PHP Medicare Advantage |
$145.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.52
|
| Rate for Payer: Priority Health Medicare |
$145.01
|
| Rate for Payer: Priority Health Narrow Network |
$205.52
|
| Rate for Payer: Priority Health SBD |
$205.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.01
|
| Rate for Payer: UHC Medicare Advantage |
$145.01
|
| Rate for Payer: UHCCP Medicaid |
$97.77
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$2,410.10 |
| Rate for Payer: Aetna Commercial |
$93.59
|
| Rate for Payer: Aetna Medicare |
$72.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.59
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$69.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,410.10
|
| Rate for Payer: BCN Commercial |
$107.51
|
| Rate for Payer: BCN Medicare Advantage |
$69.84
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$100.57
|
| Rate for Payer: Cofinity Commercial |
$93.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.33
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Nomi Health Commercial |
$83.81
|
| Rate for Payer: PACE SWMI |
$69.84
|
| Rate for Payer: PHP Commercial |
$97.78
|
| Rate for Payer: PHP Medicare Advantage |
$69.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.05
|
| Rate for Payer: Priority Health Medicare |
$69.84
|
| Rate for Payer: Priority Health Narrow Network |
$105.05
|
| Rate for Payer: Priority Health SBD |
$105.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.84
|
| Rate for Payer: UHC Medicare Advantage |
$69.84
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$63.02 |
| Max. Negotiated Rate |
$323.85 |
| Rate for Payer: Aetna Commercial |
$136.02
|
| Rate for Payer: Aetna Medicare |
$105.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.17
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: BCBS MAPPO |
$101.51
|
| Rate for Payer: BCBS Trust/PPO |
$323.85
|
| Rate for Payer: BCN Commercial |
$153.93
|
| Rate for Payer: BCN Medicare Advantage |
$101.51
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Cofinity Commercial |
$146.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.59
|
| Rate for Payer: Meridian Medicaid |
$72.02
|
| Rate for Payer: Nomi Health Commercial |
$121.81
|
| Rate for Payer: PACE SWMI |
$101.51
|
| Rate for Payer: PHP Commercial |
$142.11
|
| Rate for Payer: PHP Medicare Advantage |
$101.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.47
|
| Rate for Payer: Priority Health Medicare |
$101.51
|
| Rate for Payer: Priority Health Narrow Network |
$138.47
|
| Rate for Payer: Priority Health SBD |
$138.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.51
|
| Rate for Payer: UHC Medicare Advantage |
$101.51
|
| Rate for Payer: UHCCP Medicaid |
$68.59
|
| Rate for Payer: UMR Bronson Commercial |
$63.02
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 99307
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$2,395.31 |
| Rate for Payer: Aetna Commercial |
$50.14
|
| Rate for Payer: Aetna Medicare |
$38.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.88
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS MAPPO |
$37.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,395.31
|
| Rate for Payer: BCN Commercial |
$57.17
|
| Rate for Payer: BCN Medicare Advantage |
$37.42
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$50.14
|
| Rate for Payer: Cofinity Commercial |
$53.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.29
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: Nomi Health Commercial |
$44.90
|
| Rate for Payer: PACE SWMI |
$37.42
|
| Rate for Payer: PHP Commercial |
$52.39
|
| Rate for Payer: PHP Medicare Advantage |
$37.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.85
|
| Rate for Payer: Priority Health Medicare |
$37.42
|
| Rate for Payer: Priority Health Narrow Network |
$53.85
|
| Rate for Payer: Priority Health SBD |
$53.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.42
|
| Rate for Payer: UHC Medicare Advantage |
$37.42
|
| Rate for Payer: UHCCP Medicaid |
$25.35
|
| Rate for Payer: UMR Bronson Commercial |
$30.82
|
|
|
PR SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 99224
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
|
|
PR SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99225
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: UMR Bronson Commercial |
$69.00
|
|
|
PR SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 99226
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: UMR Bronson Commercial |
$103.04
|
|
|
PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 99493
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$687.85 |
| Rate for Payer: Aetna Commercial |
$130.44
|
| Rate for Payer: Aetna Medicare |
$101.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$97.34
|
| Rate for Payer: BCBS Trust/PPO |
$687.85
|
| Rate for Payer: BCN Commercial |
$154.35
|
| Rate for Payer: BCN Medicare Advantage |
$97.34
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$140.17
|
| Rate for Payer: Cofinity Commercial |
$130.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.21
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Nomi Health Commercial |
$116.81
|
| Rate for Payer: PACE SWMI |
$97.34
|
| Rate for Payer: PHP Commercial |
$136.28
|
| Rate for Payer: PHP Medicare Advantage |
$97.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.29
|
| Rate for Payer: Priority Health Medicare |
$97.34
|
| Rate for Payer: Priority Health Narrow Network |
$154.29
|
| Rate for Payer: Priority Health SBD |
$154.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.34
|
| Rate for Payer: UHC Medicare Advantage |
$97.34
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
| Rate for Payer: UMR Bronson Commercial |
$115.92
|
|
|
PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 49185
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$1,875.55 |
| Rate for Payer: Aetna Commercial |
$152.02
|
| Rate for Payer: Aetna Medicare |
$117.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.37
|
| Rate for Payer: BCBS Complete |
$79.17
|
| Rate for Payer: BCBS MAPPO |
$113.45
|
| Rate for Payer: BCBS Trust/PPO |
$585.36
|
| Rate for Payer: BCN Commercial |
$1,875.55
|
| Rate for Payer: BCN Medicare Advantage |
$113.45
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cofinity Commercial |
$163.37
|
| Rate for Payer: Cofinity Commercial |
$152.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.12
|
| Rate for Payer: Meridian Medicaid |
$79.17
|
| Rate for Payer: Nomi Health Commercial |
$136.14
|
| Rate for Payer: PACE SWMI |
$113.45
|
| Rate for Payer: PHP Commercial |
$158.83
|
| Rate for Payer: PHP Medicare Advantage |
$113.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.21
|
| Rate for Payer: Priority Health Medicare |
$113.45
|
| Rate for Payer: Priority Health Narrow Network |
$208.21
|
| Rate for Payer: Priority Health SBD |
$208.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.45
|
| Rate for Payer: UHC Medicare Advantage |
$113.45
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,042.82
|
|
|
PR SCREENING PAP SMEAR BY PHYS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS P3001
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$2,624.07 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$23.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.02
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS MAPPO |
$22.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,624.07
|
| Rate for Payer: BCN Commercial |
$33.23
|
| Rate for Payer: BCN Medicare Advantage |
$22.93
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$30.73
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.08
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: PACE SWMI |
$22.93
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: PHP Medicare Advantage |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Medicare |
$22.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.93
|
| Rate for Payer: UHC Medicare Advantage |
$22.93
|
| Rate for Payer: UMR Bronson Commercial |
$29.44
|
|
|
PR SCREENING PROCTOSCOPY
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS S0601
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna Medicare |
$77.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.45
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: BCBS Trust/PPO |
$45.43
|
| Rate for Payer: BCN Commercial |
$67.02
|
| Rate for Payer: Cash Price |
$123.20
|
| 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 |
$1,709.05 |
| Rate for Payer: Aetna Commercial |
$12.13
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.13
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.05
|
| Rate for Payer: BCN Commercial |
$17.59
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.19
|
| Rate for Payer: Priority Health Narrow Network |
$17.19
|
| Rate for Payer: Priority Health SBD |
$17.19
|
| 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 |
$3.23 |
| Max. Negotiated Rate |
$1,121.05 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.23
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,121.05
|
| Rate for Payer: BCN Commercial |
$4.39
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.52
|
| Rate for Payer: Priority Health Narrow Network |
$4.52
|
| Rate for Payer: Priority Health SBD |
$4.52
|
| 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 |
$251.55 |
| Max. Negotiated Rate |
$2,153.88 |
| Rate for Payer: Aetna Commercial |
$500.07
|
| Rate for Payer: Aetna Medicare |
$388.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.39
|
| Rate for Payer: BCBS Complete |
$264.13
|
| Rate for Payer: BCBS MAPPO |
$373.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,153.88
|
| Rate for Payer: BCN Commercial |
$562.96
|
| 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 |
$537.39
|
| Rate for Payer: Cofinity Commercial |
$500.07
|
| 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: Meridian Medicaid |
$264.13
|
| 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 Choice Medicaid |
$251.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$622.61
|
| Rate for Payer: Priority Health Medicare |
$373.19
|
| Rate for Payer: Priority Health Narrow Network |
$622.61
|
| Rate for Payer: Priority Health SBD |
$622.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.19
|
| Rate for Payer: UHC Medicare Advantage |
$373.19
|
| Rate for Payer: UHCCP Medicaid |
$251.55
|
| Rate for Payer: UMR Bronson Commercial |
$322.92
|
|
|
PR SCROTOPLASTY COMPLICATED
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
HCPCS 55180
|
| Min. Negotiated Rate |
$442.40 |
| Max. Negotiated Rate |
$1,956.82 |
| Rate for Payer: Aetna Commercial |
$882.27
|
| Rate for Payer: Aetna Medicare |
$684.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.11
|
| Rate for Payer: BCBS Complete |
$464.52
|
| Rate for Payer: BCBS MAPPO |
$658.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,956.82
|
| Rate for Payer: BCN Commercial |
$996.41
|
| 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 |
$882.27
|
| Rate for Payer: Cofinity Commercial |
$948.11
|
| 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: Meridian Medicaid |
$464.52
|
| 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 Choice Medicaid |
$442.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,099.28
|
| Rate for Payer: Priority Health Medicare |
$658.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,099.28
|
| Rate for Payer: Priority Health SBD |
$1,099.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.41
|
| Rate for Payer: UHC Medicare Advantage |
$658.41
|
| Rate for Payer: UHCCP Medicaid |
$442.40
|
| Rate for Payer: UMR Bronson Commercial |
$650.44
|
|
|
PR SCROTOPLASTY SIMPLE
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 55175
|
| Min. Negotiated Rate |
$236.22 |
| Max. Negotiated Rate |
$1,287.47 |
| Rate for Payer: Aetna Commercial |
$468.73
|
| Rate for Payer: Aetna Medicare |
$363.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.71
|
| Rate for Payer: BCBS Complete |
$248.03
|
| Rate for Payer: BCBS MAPPO |
$349.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,287.47
|
| Rate for Payer: BCN Commercial |
$530.22
|
| 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 |
$468.73
|
| Rate for Payer: Cofinity Commercial |
$503.71
|
| 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: Meridian Medicaid |
$248.03
|
| 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 Choice Medicaid |
$236.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$585.86
|
| Rate for Payer: Priority Health Medicare |
$349.80
|
| Rate for Payer: Priority Health Narrow Network |
$585.86
|
| Rate for Payer: Priority Health SBD |
$585.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.80
|
| Rate for Payer: UHC Medicare Advantage |
$349.80
|
| Rate for Payer: UHCCP Medicaid |
$236.22
|
| 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 |
$533.78 |
| Max. Negotiated Rate |
$4,854.55 |
| Rate for Payer: Aetna Commercial |
$1,070.57
|
| Rate for Payer: Aetna Medicare |
$830.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.46
|
| Rate for Payer: BCBS Complete |
$560.47
|
| Rate for Payer: BCBS MAPPO |
$798.93
|
| Rate for Payer: BCBS Trust/PPO |
$4,854.55
|
| Rate for Payer: BCN Commercial |
$1,200.68
|
| 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 |
$1,070.57
|
| Rate for Payer: Cofinity Commercial |
$1,150.46
|
| 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: Meridian Medicaid |
$560.47
|
| 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 Choice Medicaid |
$533.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,524.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,482.53
|
| Rate for Payer: Priority Health Medicare |
$798.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,482.53
|
| Rate for Payer: Priority Health SBD |
$1,482.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.93
|
| Rate for Payer: UHC Medicare Advantage |
$798.93
|
| Rate for Payer: UHCCP Medicaid |
$533.78
|
| 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 |
$349.63 |
| 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) |
$1,022.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,098.55
|
| Rate for Payer: BCBS Complete |
$539.45
|
| Rate for Payer: BCBS MAPPO |
$762.88
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: BCN Commercial |
$1,160.61
|
| 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 |
$1,022.26
|
| Rate for Payer: Cofinity Commercial |
$1,098.55
|
| 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: Meridian Medicaid |
$539.45
|
| 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 Choice Medicaid |
$513.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,164.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,078.68
|
| Rate for Payer: Priority Health Medicare |
$762.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,078.68
|
| Rate for Payer: Priority Health SBD |
$1,078.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$762.88
|
| Rate for Payer: UHC Medicare Advantage |
$762.88
|
| Rate for Payer: UHCCP Medicaid |
$513.76
|
| 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 |
$544.43 |
| Max. Negotiated Rate |
$3,205.12 |
| Rate for Payer: Aetna Commercial |
$1,078.94
|
| Rate for Payer: Aetna Medicare |
$837.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.46
|
| Rate for Payer: BCBS Complete |
$571.65
|
| Rate for Payer: BCBS MAPPO |
$805.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,205.12
|
| Rate for Payer: BCN Commercial |
$1,235.37
|
| 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 |
$1,078.94
|
| Rate for Payer: Cofinity Commercial |
$1,159.46
|
| 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: Meridian Medicaid |
$571.65
|
| 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 Choice Medicaid |
$544.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,290.97
|
| Rate for Payer: Priority Health Medicare |
$805.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,290.97
|
| Rate for Payer: Priority Health SBD |
$1,290.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.18
|
| Rate for Payer: UHC Medicare Advantage |
$805.18
|
| Rate for Payer: UHCCP Medicaid |
$544.43
|
| 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 |
$44.38 |
| 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) |
$1,701.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,827.99
|
| Rate for Payer: BCBS Complete |
$882.30
|
| Rate for Payer: BCBS MAPPO |
$1,269.44
|
| Rate for Payer: BCBS Trust/PPO |
$44.38
|
| Rate for Payer: BCN Commercial |
$2,635.81
|
| 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 |
$1,701.05
|
| Rate for Payer: Cofinity Commercial |
$1,827.99
|
| 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: Meridian Medicaid |
$882.30
|
| 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 Choice Medicaid |
$840.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,088.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,221.97
|
| Rate for Payer: Priority Health Medicare |
$1,269.44
|
| Rate for Payer: Priority Health Narrow Network |
$2,221.97
|
| Rate for Payer: Priority Health SBD |
$2,221.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,269.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,269.44
|
| Rate for Payer: UHCCP Medicaid |
$840.29
|
| 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 |
$152.51 |
| Max. Negotiated Rate |
$1,745.07 |
| Rate for Payer: Aetna Commercial |
$313.29
|
| Rate for Payer: Aetna Medicare |
$243.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.67
|
| Rate for Payer: BCBS Complete |
$160.14
|
| Rate for Payer: BCBS MAPPO |
$233.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.73
|
| Rate for Payer: BCN Commercial |
$1,745.07
|
| 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 |
$313.29
|
| Rate for Payer: Cofinity Commercial |
$336.67
|
| 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: Meridian Medicaid |
$160.14
|
| 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 Choice Medicaid |
$152.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,668.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$377.59
|
| Rate for Payer: Priority Health Medicare |
$233.80
|
| Rate for Payer: Priority Health Narrow Network |
$377.59
|
| Rate for Payer: Priority Health SBD |
$377.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.80
|
| Rate for Payer: UHC Medicare Advantage |
$233.80
|
| Rate for Payer: UHCCP Medicaid |
$152.51
|
| 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 |
$18.49 |
| 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) |
$1,861.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,000.92
|
| Rate for Payer: BCBS Complete |
$968.18
|
| Rate for Payer: BCBS MAPPO |
$1,389.53
|
| Rate for Payer: BCBS Trust/PPO |
$18.49
|
| Rate for Payer: BCN Commercial |
$2,915.79
|
| 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 |
$1,861.97
|
| Rate for Payer: Cofinity Commercial |
$2,000.92
|
| 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: Meridian Medicaid |
$968.18
|
| 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 Choice Medicaid |
$922.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,460.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,464.81
|
| Rate for Payer: Priority Health Medicare |
$1,389.53
|
| Rate for Payer: Priority Health Narrow Network |
$2,464.81
|
| Rate for Payer: Priority Health SBD |
$2,464.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,389.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,389.53
|
| Rate for Payer: UHCCP Medicaid |
$922.08
|
| 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 |
$88.75 |
| Rate for Payer: Aetna Commercial |
$40.94
|
| Rate for Payer: Aetna Medicare |
$31.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.99
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$30.55
|
| Rate for Payer: BCBS Trust/PPO |
$88.75
|
| Rate for Payer: BCN Commercial |
$31.97
|
| 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 HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$30.55
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| 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 |
$23.22 |
| Max. Negotiated Rate |
$970.49 |
| 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 |
$24.38
|
| Rate for Payer: BCBS MAPPO |
$58.44
|
| Rate for Payer: BCBS Trust/PPO |
$970.49
|
| Rate for Payer: BCN Commercial |
$91.87
|
| 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: Meridian Medicaid |
$24.38
|
| 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 Choice Medicaid |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.31
|
| Rate for Payer: Priority Health Medicare |
$58.44
|
| Rate for Payer: Priority Health Narrow Network |
$79.31
|
| Rate for Payer: Priority Health SBD |
$45.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.44
|
| Rate for Payer: UHC Medicare Advantage |
$58.44
|
| Rate for Payer: UHCCP Medicaid |
$23.22
|
| Rate for Payer: UMR Bronson Commercial |
$46.92
|
|
