|
PR SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 36011
|
| Min. Negotiated Rate |
$148.41 |
| Max. Negotiated Rate |
$485.55 |
| Rate for Payer: Aetna Commercial |
$198.87
|
| Rate for Payer: Aetna Medicare |
$154.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.87
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: BCBS MAPPO |
$148.41
|
| Rate for Payer: BCN Medicare Advantage |
$148.41
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cofinity Commercial |
$213.71
|
| Rate for Payer: Cofinity Commercial |
$198.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.83
|
| Rate for Payer: Nomi Health Commercial |
$178.09
|
| Rate for Payer: PACE SWMI |
$148.41
|
| Rate for Payer: PHP Commercial |
$207.77
|
| Rate for Payer: PHP Medicare Advantage |
$148.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.55
|
| Rate for Payer: Priority Health Medicare |
$148.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.41
|
| Rate for Payer: UHC Medicare Advantage |
$148.41
|
| Rate for Payer: UMR Bronson Commercial |
$343.62
|
|
|
PR SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC
|
Professional
|
Both
|
$980.00
|
|
|
Service Code
|
HCPCS 36012
|
| Min. Negotiated Rate |
$166.65 |
| Max. Negotiated Rate |
$637.00 |
| Rate for Payer: Aetna Commercial |
$223.31
|
| Rate for Payer: Aetna Medicare |
$173.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.31
|
| Rate for Payer: BCBS Complete |
$392.00
|
| Rate for Payer: BCBS MAPPO |
$166.65
|
| Rate for Payer: BCN Medicare Advantage |
$166.65
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cash Price |
$784.00
|
| Rate for Payer: Cofinity Commercial |
$239.98
|
| Rate for Payer: Cofinity Commercial |
$223.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.98
|
| Rate for Payer: Nomi Health Commercial |
$199.98
|
| Rate for Payer: PACE SWMI |
$166.65
|
| Rate for Payer: PHP Commercial |
$233.31
|
| Rate for Payer: PHP Medicare Advantage |
$166.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.00
|
| Rate for Payer: Priority Health Medicare |
$166.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.65
|
| Rate for Payer: UHC Medicare Advantage |
$166.65
|
| Rate for Payer: UMR Bronson Commercial |
$450.80
|
|
|
PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$1,788.00
|
|
|
Service Code
|
HCPCS 36225
|
| Min. Negotiated Rate |
$318.61 |
| Max. Negotiated Rate |
$1,162.20 |
| Rate for Payer: Aetna Commercial |
$426.94
|
| Rate for Payer: Aetna Medicare |
$331.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.94
|
| Rate for Payer: BCBS Complete |
$715.20
|
| Rate for Payer: BCBS MAPPO |
$318.61
|
| Rate for Payer: BCN Medicare Advantage |
$318.61
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cofinity Commercial |
$458.80
|
| Rate for Payer: Cofinity Commercial |
$426.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.54
|
| Rate for Payer: Nomi Health Commercial |
$382.33
|
| Rate for Payer: PACE SWMI |
$318.61
|
| Rate for Payer: PHP Commercial |
$446.05
|
| Rate for Payer: PHP Medicare Advantage |
$318.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,162.20
|
| Rate for Payer: Priority Health Medicare |
$318.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.61
|
| Rate for Payer: UHC Medicare Advantage |
$318.61
|
| Rate for Payer: UMR Bronson Commercial |
$822.48
|
|
|
PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 36226
|
| Min. Negotiated Rate |
$357.06 |
| Max. Negotiated Rate |
$819.00 |
| Rate for Payer: Aetna Commercial |
$478.46
|
| Rate for Payer: Aetna Medicare |
$371.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.46
|
| Rate for Payer: BCBS Complete |
$504.00
|
| Rate for Payer: BCBS MAPPO |
$357.06
|
| Rate for Payer: BCN Medicare Advantage |
$357.06
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cofinity Commercial |
$514.17
|
| Rate for Payer: Cofinity Commercial |
$478.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.91
|
| Rate for Payer: Nomi Health Commercial |
$428.47
|
| Rate for Payer: PACE SWMI |
$357.06
|
| Rate for Payer: PHP Commercial |
$499.88
|
| Rate for Payer: PHP Medicare Advantage |
$357.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.00
|
| Rate for Payer: Priority Health Medicare |
$357.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.06
|
| Rate for Payer: UHC Medicare Advantage |
$357.06
|
| Rate for Payer: UMR Bronson Commercial |
$579.60
|
|
|
PR SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC
|
Professional
|
Both
|
$398.00
|
|
|
Service Code
|
HCPCS 36227
|
| Min. Negotiated Rate |
$117.73 |
| Max. Negotiated Rate |
$258.70 |
| Rate for Payer: Aetna Commercial |
$157.76
|
| Rate for Payer: Aetna Medicare |
$122.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.76
|
| Rate for Payer: BCBS Complete |
$159.20
|
| Rate for Payer: BCBS MAPPO |
$117.73
|
| Rate for Payer: BCN Medicare Advantage |
$117.73
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cofinity Commercial |
$169.53
|
| Rate for Payer: Cofinity Commercial |
$157.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.62
|
| Rate for Payer: Nomi Health Commercial |
$141.28
|
| Rate for Payer: PACE SWMI |
$117.73
|
| Rate for Payer: PHP Commercial |
$164.82
|
| Rate for Payer: PHP Medicare Advantage |
$117.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.70
|
| Rate for Payer: Priority Health Medicare |
$117.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.73
|
| Rate for Payer: UHC Medicare Advantage |
$117.73
|
| Rate for Payer: UMR Bronson Commercial |
$183.08
|
|
|
PR SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
HCPCS 95806
|
| Min. Negotiated Rate |
$87.97 |
| Max. Negotiated Rate |
$368.55 |
| Rate for Payer: Aetna Commercial |
$117.88
|
| Rate for Payer: Aetna Commercial |
$117.88
|
| Rate for Payer: Aetna Medicare |
$91.49
|
| Rate for Payer: Aetna Medicare |
$91.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.68
|
| Rate for Payer: BCBS Complete |
$226.80
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS MAPPO |
$87.97
|
| Rate for Payer: BCBS MAPPO |
$87.97
|
| Rate for Payer: BCN Medicare Advantage |
$87.97
|
| Rate for Payer: BCN Medicare Advantage |
$87.97
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cofinity Commercial |
$126.68
|
| Rate for Payer: Cofinity Commercial |
$126.68
|
| Rate for Payer: Cofinity Commercial |
$117.88
|
| Rate for Payer: Cofinity Commercial |
$117.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.37
|
| Rate for Payer: Nomi Health Commercial |
$105.56
|
| Rate for Payer: Nomi Health Commercial |
$105.56
|
| Rate for Payer: PACE SWMI |
$87.97
|
| Rate for Payer: PACE SWMI |
$87.97
|
| Rate for Payer: PHP Commercial |
$123.16
|
| Rate for Payer: PHP Commercial |
$123.16
|
| Rate for Payer: PHP Medicare Advantage |
$87.97
|
| Rate for Payer: PHP Medicare Advantage |
$87.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.55
|
| Rate for Payer: Priority Health Medicare |
$87.97
|
| Rate for Payer: Priority Health Medicare |
$87.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.97
|
| Rate for Payer: UHC Medicare Advantage |
$87.97
|
| Rate for Payer: UHC Medicare Advantage |
$87.97
|
| Rate for Payer: UMR Bronson Commercial |
$260.82
|
| Rate for Payer: UMR Bronson Commercial |
$68.54
|
|
|
PR SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN
|
Professional
|
Both
|
$1,489.00
|
|
|
Service Code
|
HCPCS 95807
|
| Min. Negotiated Rate |
$371.03 |
| Max. Negotiated Rate |
$967.85 |
| Rate for Payer: Aetna Commercial |
$497.18
|
| Rate for Payer: Aetna Commercial |
$497.18
|
| Rate for Payer: Aetna Medicare |
$385.87
|
| Rate for Payer: Aetna Medicare |
$385.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.28
|
| Rate for Payer: BCBS Complete |
$595.60
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: BCBS MAPPO |
$371.03
|
| Rate for Payer: BCBS MAPPO |
$371.03
|
| Rate for Payer: BCN Medicare Advantage |
$371.03
|
| Rate for Payer: BCN Medicare Advantage |
$371.03
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$1,191.20
|
| Rate for Payer: Cofinity Commercial |
$534.28
|
| Rate for Payer: Cofinity Commercial |
$534.28
|
| Rate for Payer: Cofinity Commercial |
$497.18
|
| Rate for Payer: Cofinity Commercial |
$497.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.58
|
| Rate for Payer: Nomi Health Commercial |
$445.24
|
| Rate for Payer: Nomi Health Commercial |
$445.24
|
| Rate for Payer: PACE SWMI |
$371.03
|
| Rate for Payer: PACE SWMI |
$371.03
|
| Rate for Payer: PHP Commercial |
$519.44
|
| Rate for Payer: PHP Commercial |
$519.44
|
| Rate for Payer: PHP Medicare Advantage |
$371.03
|
| Rate for Payer: PHP Medicare Advantage |
$371.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$967.85
|
| Rate for Payer: Priority Health Medicare |
$371.03
|
| Rate for Payer: Priority Health Medicare |
$371.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.03
|
| Rate for Payer: UHC Medicare Advantage |
$371.03
|
| Rate for Payer: UHC Medicare Advantage |
$371.03
|
| Rate for Payer: UMR Bronson Commercial |
$684.94
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
|
|
PR SLING OPERATION STRESS INCONTINENCE
|
Professional
|
Both
|
$2,280.00
|
|
|
Service Code
|
HCPCS 57288
|
| Min. Negotiated Rate |
$712.02 |
| Max. Negotiated Rate |
$1,482.00 |
| Rate for Payer: Aetna Commercial |
$954.11
|
| Rate for Payer: Aetna Medicare |
$740.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.31
|
| Rate for Payer: BCBS Complete |
$912.00
|
| Rate for Payer: BCBS MAPPO |
$712.02
|
| Rate for Payer: BCN Medicare Advantage |
$712.02
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cofinity Commercial |
$954.11
|
| Rate for Payer: Cofinity Commercial |
$1,025.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$747.62
|
| Rate for Payer: Nomi Health Commercial |
$854.42
|
| Rate for Payer: PACE SWMI |
$712.02
|
| Rate for Payer: PHP Commercial |
$996.83
|
| Rate for Payer: PHP Medicare Advantage |
$712.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,482.00
|
| Rate for Payer: Priority Health Medicare |
$712.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.02
|
| Rate for Payer: UHC Medicare Advantage |
$712.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,048.80
|
|
|
PR SLING OPRATION CORRJ MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,677.00
|
|
|
Service Code
|
HCPCS 53440
|
| Min. Negotiated Rate |
$670.80 |
| Max. Negotiated Rate |
$1,090.05 |
| Rate for Payer: Aetna Commercial |
$963.79
|
| Rate for Payer: Aetna Medicare |
$748.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$963.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.72
|
| Rate for Payer: BCBS Complete |
$670.80
|
| Rate for Payer: BCBS MAPPO |
$719.25
|
| Rate for Payer: BCN Medicare Advantage |
$719.25
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cash Price |
$1,341.60
|
| Rate for Payer: Cofinity Commercial |
$963.79
|
| Rate for Payer: Cofinity Commercial |
$1,035.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$719.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$755.21
|
| Rate for Payer: Nomi Health Commercial |
$863.10
|
| Rate for Payer: PACE SWMI |
$719.25
|
| Rate for Payer: PHP Commercial |
$1,006.95
|
| Rate for Payer: PHP Medicare Advantage |
$719.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,090.05
|
| Rate for Payer: Priority Health Medicare |
$719.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$719.25
|
| Rate for Payer: UHC Medicare Advantage |
$719.25
|
| Rate for Payer: UMR Bronson Commercial |
$771.42
|
|
|
PR SLINGS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS A4565
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$11.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.42
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$10.76
|
| Rate for Payer: BCN Medicare Advantage |
$10.76
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$15.49
|
| Rate for Payer: Cofinity Commercial |
$14.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.30
|
| Rate for Payer: Nomi Health Commercial |
$12.91
|
| Rate for Payer: PACE SWMI |
$10.76
|
| Rate for Payer: PHP Commercial |
$15.06
|
| Rate for Payer: PHP Medicare Advantage |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$10.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.76
|
| Rate for Payer: UHC Medicare Advantage |
$10.76
|
| Rate for Payer: UMR Bronson Commercial |
$5.52
|
|
|
PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 54001
|
| Min. Negotiated Rate |
$134.00 |
| Max. Negotiated Rate |
$217.75 |
| Rate for Payer: Aetna Commercial |
$180.43
|
| Rate for Payer: Aetna Medicare |
$140.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.43
|
| Rate for Payer: BCBS Complete |
$134.00
|
| Rate for Payer: BCBS MAPPO |
$134.65
|
| Rate for Payer: BCN Medicare Advantage |
$134.65
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$193.90
|
| Rate for Payer: Cofinity Commercial |
$180.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.38
|
| Rate for Payer: Nomi Health Commercial |
$161.58
|
| Rate for Payer: PACE SWMI |
$134.65
|
| Rate for Payer: PHP Commercial |
$188.51
|
| Rate for Payer: PHP Medicare Advantage |
$134.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.75
|
| Rate for Payer: Priority Health Medicare |
$134.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.65
|
| Rate for Payer: UHC Medicare Advantage |
$134.65
|
| Rate for Payer: UMR Bronson Commercial |
$154.10
|
|
|
PR SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 95800
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$167.50 |
| Rate for Payer: Aetna Commercial |
$155.87
|
| Rate for Payer: Aetna Commercial |
$155.87
|
| Rate for Payer: Aetna Medicare |
$120.97
|
| Rate for Payer: Aetna Medicare |
$120.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.50
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$116.32
|
| Rate for Payer: BCBS MAPPO |
$116.32
|
| Rate for Payer: BCN Medicare Advantage |
$116.32
|
| Rate for Payer: BCN Medicare Advantage |
$116.32
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$167.50
|
| Rate for Payer: Cofinity Commercial |
$167.50
|
| Rate for Payer: Cofinity Commercial |
$155.87
|
| Rate for Payer: Cofinity Commercial |
$155.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.14
|
| Rate for Payer: Nomi Health Commercial |
$139.58
|
| Rate for Payer: Nomi Health Commercial |
$139.58
|
| Rate for Payer: PACE SWMI |
$116.32
|
| Rate for Payer: PACE SWMI |
$116.32
|
| Rate for Payer: PHP Commercial |
$162.85
|
| Rate for Payer: PHP Commercial |
$162.85
|
| Rate for Payer: PHP Medicare Advantage |
$116.32
|
| Rate for Payer: PHP Medicare Advantage |
$116.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$116.32
|
| Rate for Payer: Priority Health Medicare |
$116.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.32
|
| Rate for Payer: UHC Medicare Advantage |
$116.32
|
| Rate for Payer: UHC Medicare Advantage |
$116.32
|
| Rate for Payer: UMR Bronson Commercial |
$41.86
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR SMOKE/TOBACCO COUNSELNG 3-10
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS G0375
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Commercial |
$76.39
|
| Rate for Payer: Aetna Medicare |
$59.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.09
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$57.01
|
| Rate for Payer: BCN Medicare Advantage |
$57.01
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$76.39
|
| Rate for Payer: Cofinity Commercial |
$82.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.86
|
| Rate for Payer: Nomi Health Commercial |
$68.41
|
| Rate for Payer: PACE SWMI |
$57.01
|
| Rate for Payer: PHP Commercial |
$79.81
|
| Rate for Payer: PHP Medicare Advantage |
$57.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$57.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.01
|
| Rate for Payer: UHC Medicare Advantage |
$57.01
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$92.08 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$123.39
|
| Rate for Payer: Aetna Medicare |
$95.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.39
|
| Rate for Payer: BCBS Complete |
$229.20
|
| Rate for Payer: BCBS MAPPO |
$92.08
|
| Rate for Payer: BCN Medicare Advantage |
$92.08
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cofinity Commercial |
$132.60
|
| Rate for Payer: Cofinity Commercial |
$123.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.68
|
| Rate for Payer: Nomi Health Commercial |
$110.50
|
| Rate for Payer: PACE SWMI |
$92.08
|
| Rate for Payer: PHP Commercial |
$128.91
|
| Rate for Payer: PHP Medicare Advantage |
$92.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.45
|
| Rate for Payer: Priority Health Medicare |
$92.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.08
|
| Rate for Payer: UHC Medicare Advantage |
$92.08
|
| Rate for Payer: UMR Bronson Commercial |
$263.58
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$731.00
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Aetna Commercial |
$152.71
|
| Rate for Payer: Aetna Medicare |
$118.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.71
|
| Rate for Payer: BCBS Complete |
$292.40
|
| Rate for Payer: BCBS MAPPO |
$113.96
|
| Rate for Payer: BCN Medicare Advantage |
$113.96
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cash Price |
$584.80
|
| Rate for Payer: Cofinity Commercial |
$164.10
|
| Rate for Payer: Cofinity Commercial |
$152.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.66
|
| Rate for Payer: Nomi Health Commercial |
$136.75
|
| Rate for Payer: PACE SWMI |
$113.96
|
| Rate for Payer: PHP Commercial |
$159.54
|
| Rate for Payer: PHP Medicare Advantage |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.15
|
| Rate for Payer: Priority Health Medicare |
$113.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.96
|
| Rate for Payer: UHC Medicare Advantage |
$113.96
|
| Rate for Payer: UMR Bronson Commercial |
$336.26
|
|
|
PR SO 8 ABD RESTRAINT PRE OTS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS L3650
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$113.79 |
| Rate for Payer: Aetna Commercial |
$105.89
|
| Rate for Payer: Aetna Medicare |
$82.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.89
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$79.02
|
| Rate for Payer: BCN Medicare Advantage |
$79.02
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$113.79
|
| Rate for Payer: Cofinity Commercial |
$105.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.97
|
| Rate for Payer: Nomi Health Commercial |
$94.82
|
| Rate for Payer: PACE SWMI |
$79.02
|
| Rate for Payer: PHP Commercial |
$110.63
|
| Rate for Payer: PHP Medicare Advantage |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health Medicare |
$79.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.02
|
| Rate for Payer: UHC Medicare Advantage |
$79.02
|
| Rate for Payer: UMR Bronson Commercial |
$31.74
|
|
|
PR SPECIAL CASTING MATERIAL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4590
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$38.74 |
| Rate for Payer: Aetna Commercial |
$36.05
|
| Rate for Payer: Aetna Medicare |
$27.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.74
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$26.90
|
| Rate for Payer: BCN Medicare Advantage |
$26.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$36.05
|
| Rate for Payer: Cofinity Commercial |
$38.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.25
|
| Rate for Payer: Nomi Health Commercial |
$32.28
|
| Rate for Payer: PACE SWMI |
$26.90
|
| Rate for Payer: PHP Commercial |
$37.66
|
| Rate for Payer: PHP Medicare Advantage |
$26.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$26.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.90
|
| Rate for Payer: UHC Medicare Advantage |
$26.90
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$59.95 |
| Rate for Payer: Aetna Commercial |
$55.78
|
| Rate for Payer: Aetna Medicare |
$43.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.78
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS MAPPO |
$41.63
|
| Rate for Payer: BCN Medicare Advantage |
$41.63
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$59.95
|
| Rate for Payer: Cofinity Commercial |
$55.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.71
|
| Rate for Payer: Nomi Health Commercial |
$49.96
|
| Rate for Payer: PACE SWMI |
$41.63
|
| Rate for Payer: PHP Commercial |
$58.28
|
| Rate for Payer: PHP Medicare Advantage |
$41.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$41.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.63
|
| Rate for Payer: UHC Medicare Advantage |
$41.63
|
| Rate for Payer: UMR Bronson Commercial |
$30.36
|
|
|
PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 46080
|
| Min. Negotiated Rate |
$152.94 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$204.94
|
| Rate for Payer: Aetna Medicare |
$159.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.94
|
| Rate for Payer: BCBS Complete |
$360.00
|
| Rate for Payer: BCBS MAPPO |
$152.94
|
| Rate for Payer: BCN Medicare Advantage |
$152.94
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$220.23
|
| Rate for Payer: Cofinity Commercial |
$204.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$152.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.59
|
| Rate for Payer: Nomi Health Commercial |
$183.53
|
| Rate for Payer: PACE SWMI |
$152.94
|
| Rate for Payer: PHP Commercial |
$214.12
|
| Rate for Payer: PHP Medicare Advantage |
$152.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.00
|
| Rate for Payer: Priority Health Medicare |
$152.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$152.94
|
| Rate for Payer: UHC Medicare Advantage |
$152.94
|
| Rate for Payer: UMR Bronson Commercial |
$414.00
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT
|
Professional
|
Both
|
$1,510.00
|
|
|
Service Code
|
HCPCS 46750
|
| Min. Negotiated Rate |
$604.00 |
| Max. Negotiated Rate |
$1,031.53 |
| Rate for Payer: Aetna Commercial |
$959.90
|
| Rate for Payer: Aetna Medicare |
$744.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.53
|
| Rate for Payer: BCBS Complete |
$604.00
|
| Rate for Payer: BCBS MAPPO |
$716.34
|
| Rate for Payer: BCN Medicare Advantage |
$716.34
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cash Price |
$1,208.00
|
| Rate for Payer: Cofinity Commercial |
$959.90
|
| Rate for Payer: Cofinity Commercial |
$1,031.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.16
|
| Rate for Payer: Nomi Health Commercial |
$859.61
|
| Rate for Payer: PACE SWMI |
$716.34
|
| Rate for Payer: PHP Commercial |
$1,002.88
|
| Rate for Payer: PHP Medicare Advantage |
$716.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$981.50
|
| Rate for Payer: Priority Health Medicare |
$716.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.34
|
| Rate for Payer: UHC Medicare Advantage |
$716.34
|
| Rate for Payer: UMR Bronson Commercial |
$694.60
|
|
|
PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 46751
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$933.54 |
| Rate for Payer: Aetna Commercial |
$868.71
|
| Rate for Payer: Aetna Medicare |
$674.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.71
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$648.29
|
| Rate for Payer: BCN Medicare Advantage |
$648.29
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$933.54
|
| Rate for Payer: Cofinity Commercial |
$868.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$648.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$680.70
|
| Rate for Payer: Nomi Health Commercial |
$777.95
|
| Rate for Payer: PACE SWMI |
$648.29
|
| Rate for Payer: PHP Commercial |
$907.61
|
| Rate for Payer: PHP Medicare Advantage |
$648.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$648.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$648.29
|
| Rate for Payer: UHC Medicare Advantage |
$648.29
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
|
PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 46761
|
| Min. Negotiated Rate |
$755.20 |
| Max. Negotiated Rate |
$1,258.88 |
| Rate for Payer: Aetna Commercial |
$1,171.45
|
| Rate for Payer: Aetna Medicare |
$909.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.45
|
| Rate for Payer: BCBS Complete |
$755.20
|
| Rate for Payer: BCBS MAPPO |
$874.22
|
| Rate for Payer: BCN Medicare Advantage |
$874.22
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$1,258.88
|
| Rate for Payer: Cofinity Commercial |
$1,171.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.93
|
| Rate for Payer: Nomi Health Commercial |
$1,049.06
|
| Rate for Payer: PACE SWMI |
$874.22
|
| Rate for Payer: PHP Commercial |
$1,223.91
|
| Rate for Payer: PHP Medicare Advantage |
$874.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health Medicare |
$874.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.22
|
| Rate for Payer: UHC Medicare Advantage |
$874.22
|
| Rate for Payer: UMR Bronson Commercial |
$868.48
|
|
|
PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX
|
Professional
|
Both
|
$2,697.00
|
|
|
Service Code
|
HCPCS 38102
|
| Min. Negotiated Rate |
$253.38 |
| Max. Negotiated Rate |
$1,753.05 |
| Rate for Payer: Aetna Commercial |
$339.53
|
| Rate for Payer: Aetna Medicare |
$263.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.53
|
| Rate for Payer: BCBS Complete |
$1,078.80
|
| Rate for Payer: BCBS MAPPO |
$253.38
|
| Rate for Payer: BCN Medicare Advantage |
$253.38
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cash Price |
$2,157.60
|
| Rate for Payer: Cofinity Commercial |
$364.87
|
| Rate for Payer: Cofinity Commercial |
$339.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.05
|
| Rate for Payer: Nomi Health Commercial |
$304.06
|
| Rate for Payer: PACE SWMI |
$253.38
|
| Rate for Payer: PHP Commercial |
$354.73
|
| Rate for Payer: PHP Medicare Advantage |
$253.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.05
|
| Rate for Payer: Priority Health Medicare |
$253.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.38
|
| Rate for Payer: UHC Medicare Advantage |
$253.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,240.62
|
|
