|
PR SPLENECTOMY PARTIAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,997.00
|
|
|
Service Code
|
HCPCS 38101
|
| Min. Negotiated Rate |
$1,133.26 |
| Max. Negotiated Rate |
$1,948.05 |
| Rate for Payer: Aetna Commercial |
$1,518.57
|
| Rate for Payer: Aetna Medicare |
$1,178.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.57
|
| Rate for Payer: BCBS Complete |
$1,198.80
|
| Rate for Payer: BCBS MAPPO |
$1,133.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.26
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cash Price |
$2,397.60
|
| Rate for Payer: Cofinity Commercial |
$1,631.89
|
| Rate for Payer: Cofinity Commercial |
$1,518.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.92
|
| Rate for Payer: Nomi Health Commercial |
$1,359.91
|
| Rate for Payer: PACE SWMI |
$1,133.26
|
| Rate for Payer: PHP Commercial |
$1,586.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,133.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,948.05
|
| Rate for Payer: Priority Health Medicare |
$1,133.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,378.62
|
|
|
PR SPLENECTOMY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$4,732.00
|
|
|
Service Code
|
HCPCS 38100
|
| Min. Negotiated Rate |
$1,116.53 |
| Max. Negotiated Rate |
$3,075.80 |
| Rate for Payer: Aetna Commercial |
$1,496.15
|
| Rate for Payer: Aetna Medicare |
$1,161.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,607.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,496.15
|
| Rate for Payer: BCBS Complete |
$1,892.80
|
| Rate for Payer: BCBS MAPPO |
$1,116.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,116.53
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cash Price |
$3,785.60
|
| Rate for Payer: Cofinity Commercial |
$1,607.80
|
| Rate for Payer: Cofinity Commercial |
$1,496.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,116.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,172.36
|
| Rate for Payer: Nomi Health Commercial |
$1,339.84
|
| Rate for Payer: PACE SWMI |
$1,116.53
|
| Rate for Payer: PHP Commercial |
$1,563.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,116.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,075.80
|
| Rate for Payer: Priority Health Medicare |
$1,116.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,116.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,116.53
|
| Rate for Payer: UMR Bronson Commercial |
$2,176.72
|
|
|
PR SPLINT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS A4570
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
OP
|
$1,602.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$592.74 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna American Axle |
$1,041.30
|
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,041.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$1,121.40
|
| Rate for Payer: Cofinity Commercial |
$1,377.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,121.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Healthscope Commercial |
$1,441.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,121.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,201.50
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Commercial |
$1,361.70
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Priority Health SBD |
$1,009.26
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$6,823.53
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: UMR Bronson Commercial |
$592.74
|
| Rate for Payer: VA VA |
$3,570.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,201.50
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Facility
|
IP
|
$1,602.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
15120
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$704.88 |
| Max. Negotiated Rate |
$1,441.80 |
| Rate for Payer: Aetna American Axle |
$1,041.30
|
| Rate for Payer: Aetna Commercial |
$1,361.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,041.30
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$1,121.40
|
| Rate for Payer: Cofinity Commercial |
$1,377.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,121.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,281.60
|
| Rate for Payer: Healthscope Commercial |
$1,441.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,121.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,201.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,361.70
|
| Rate for Payer: PHP Commercial |
$1,361.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health SBD |
$1,009.26
|
| Rate for Payer: UMR Bronson Commercial |
$704.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,201.50
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 15120
|
| Hospital Charge Code |
15120
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$1,041.30 |
| Rate for Payer: Aetna Commercial |
$882.26
|
| Rate for Payer: Aetna Medicare |
$684.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.26
|
| Rate for Payer: BCBS Complete |
$640.80
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCN Medicare Advantage |
$658.40
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$882.26
|
| Rate for Payer: Cofinity Commercial |
$948.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Nomi Health Commercial |
$790.08
|
| Rate for Payer: PACE SWMI |
$658.40
|
| Rate for Payer: PHP Commercial |
$921.76
|
| Rate for Payer: PHP Medicare Advantage |
$658.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health Medicare |
$658.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
| Rate for Payer: UMR Bronson Commercial |
$736.92
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%
|
Professional
|
Both
|
$1,602.00
|
|
|
Service Code
|
HCPCS 15120
|
| Min. Negotiated Rate |
$640.80 |
| Max. Negotiated Rate |
$1,041.30 |
| Rate for Payer: Aetna Commercial |
$882.26
|
| Rate for Payer: Aetna Medicare |
$684.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.10
|
| Rate for Payer: BCBS Complete |
$640.80
|
| Rate for Payer: BCBS MAPPO |
$658.40
|
| Rate for Payer: BCN Medicare Advantage |
$658.40
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cash Price |
$1,281.60
|
| Rate for Payer: Cofinity Commercial |
$882.26
|
| Rate for Payer: Cofinity Commercial |
$948.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.32
|
| Rate for Payer: Nomi Health Commercial |
$790.08
|
| Rate for Payer: PACE SWMI |
$658.40
|
| Rate for Payer: PHP Commercial |
$921.76
|
| Rate for Payer: PHP Medicare Advantage |
$658.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,041.30
|
| Rate for Payer: Priority Health Medicare |
$658.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.40
|
| Rate for Payer: UHC Medicare Advantage |
$658.40
|
| Rate for Payer: UMR Bronson Commercial |
$736.92
|
|
|
PR SPLT AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM/EA 1%
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 15121
|
| Min. Negotiated Rate |
$125.12 |
| Max. Negotiated Rate |
$325.00 |
| Rate for Payer: Aetna Commercial |
$167.66
|
| Rate for Payer: Aetna Medicare |
$130.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.66
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: BCBS MAPPO |
$125.12
|
| Rate for Payer: BCN Medicare Advantage |
$125.12
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$180.17
|
| Rate for Payer: Cofinity Commercial |
$167.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.38
|
| Rate for Payer: Nomi Health Commercial |
$150.14
|
| Rate for Payer: PACE SWMI |
$125.12
|
| Rate for Payer: PHP Commercial |
$175.17
|
| Rate for Payer: PHP Medicare Advantage |
$125.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.00
|
| Rate for Payer: Priority Health Medicare |
$125.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.12
|
| Rate for Payer: UHC Medicare Advantage |
$125.12
|
| Rate for Payer: UMR Bronson Commercial |
$230.00
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 15100
|
| Min. Negotiated Rate |
$683.63 |
| Max. Negotiated Rate |
$1,398.80 |
| Rate for Payer: Aetna Commercial |
$916.06
|
| Rate for Payer: Aetna Medicare |
$710.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.06
|
| Rate for Payer: BCBS Complete |
$860.80
|
| Rate for Payer: BCBS MAPPO |
$683.63
|
| Rate for Payer: BCN Medicare Advantage |
$683.63
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$984.43
|
| Rate for Payer: Cofinity Commercial |
$916.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.81
|
| Rate for Payer: Nomi Health Commercial |
$820.36
|
| Rate for Payer: PACE SWMI |
$683.63
|
| Rate for Payer: PHP Commercial |
$957.08
|
| Rate for Payer: PHP Medicare Advantage |
$683.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health Medicare |
$683.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.63
|
| Rate for Payer: UHC Medicare Advantage |
$683.63
|
| Rate for Payer: UMR Bronson Commercial |
$989.92
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
OP
|
$2,152.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$796.24 |
| Max. Negotiated Rate |
$5,021.81 |
| Rate for Payer: Aetna American Axle |
$1,398.80
|
| Rate for Payer: Aetna Commercial |
$1,829.20
|
| Rate for Payer: Aetna Medicare |
$1,855.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,230.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,230.01
|
| Rate for Payer: BCBS Complete |
$1,004.04
|
| Rate for Payer: BCBS MAPPO |
$1,784.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.01
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,506.40
|
| Rate for Payer: Cofinity Commercial |
$1,850.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,506.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.01
|
| Rate for Payer: Healthscope Commercial |
$1,936.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,506.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,614.00
|
| Rate for Payer: Mclaren Medicaid |
$956.23
|
| Rate for Payer: Mclaren Medicare |
$1,784.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,873.21
|
| Rate for Payer: Meridian Medicaid |
$1,004.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,051.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.20
|
| Rate for Payer: PACE Medicare |
$1,694.81
|
| Rate for Payer: PACE SWMI |
$1,784.01
|
| Rate for Payer: PHP Commercial |
$1,829.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$956.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health Medicare |
$1,784.01
|
| Rate for Payer: Priority Health SBD |
$1,355.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,784.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,021.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.01
|
| Rate for Payer: UHC Exchange |
$3,409.42
|
| Rate for Payer: UHC Medicare Advantage |
$1,784.01
|
| Rate for Payer: UHCCP Medicaid |
$956.23
|
| Rate for Payer: UMR Bronson Commercial |
$796.24
|
| Rate for Payer: VA VA |
$1,784.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,614.00
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Facility
|
IP
|
$2,152.00
|
|
|
Service Code
|
CPT 15100
|
| Hospital Charge Code |
15100
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$946.88 |
| Max. Negotiated Rate |
$1,936.80 |
| Rate for Payer: Aetna American Axle |
$1,398.80
|
| Rate for Payer: Aetna Commercial |
$1,829.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,398.80
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,506.40
|
| Rate for Payer: Cofinity Commercial |
$1,850.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,506.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,721.60
|
| Rate for Payer: Healthscope Commercial |
$1,936.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,506.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,614.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,829.20
|
| Rate for Payer: PHP Commercial |
$1,829.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health SBD |
$1,355.76
|
| Rate for Payer: UMR Bronson Commercial |
$946.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,614.00
|
|
|
PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,152.00
|
|
|
Service Code
|
HCPCS 15100
|
| Hospital Charge Code |
15100
|
| Min. Negotiated Rate |
$683.63 |
| Max. Negotiated Rate |
$1,398.80 |
| Rate for Payer: Aetna Commercial |
$916.06
|
| Rate for Payer: Aetna Medicare |
$710.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.06
|
| Rate for Payer: BCBS Complete |
$860.80
|
| Rate for Payer: BCBS MAPPO |
$683.63
|
| Rate for Payer: BCN Medicare Advantage |
$683.63
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cash Price |
$1,721.60
|
| Rate for Payer: Cofinity Commercial |
$916.06
|
| Rate for Payer: Cofinity Commercial |
$984.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$717.81
|
| Rate for Payer: Nomi Health Commercial |
$820.36
|
| Rate for Payer: PACE SWMI |
$683.63
|
| Rate for Payer: PHP Commercial |
$957.08
|
| Rate for Payer: PHP Medicare Advantage |
$683.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,398.80
|
| Rate for Payer: Priority Health Medicare |
$683.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$683.63
|
| Rate for Payer: UHC Medicare Advantage |
$683.63
|
| Rate for Payer: UMR Bronson Commercial |
$989.92
|
|
|
PR SPLT AGRFT T/A/L EA ADD 100 SQCM/EA 1% INFT/CHLD
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
HCPCS 15101
|
| Min. Negotiated Rate |
$105.79 |
| Max. Negotiated Rate |
$896.35 |
| Rate for Payer: Aetna Commercial |
$141.76
|
| Rate for Payer: Aetna Medicare |
$110.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.76
|
| Rate for Payer: BCBS Complete |
$551.60
|
| Rate for Payer: BCBS MAPPO |
$105.79
|
| Rate for Payer: BCN Medicare Advantage |
$105.79
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$152.34
|
| Rate for Payer: Cofinity Commercial |
$141.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.08
|
| Rate for Payer: Nomi Health Commercial |
$126.95
|
| Rate for Payer: PACE SWMI |
$105.79
|
| Rate for Payer: PHP Commercial |
$148.11
|
| Rate for Payer: PHP Medicare Advantage |
$105.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$896.35
|
| Rate for Payer: Priority Health Medicare |
$105.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.79
|
| Rate for Payer: UHC Medicare Advantage |
$105.79
|
| Rate for Payer: UMR Bronson Commercial |
$634.34
|
|
|
PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 94010
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$52.00 |
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Commercial |
$33.26
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Aetna Medicare |
$25.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.26
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS MAPPO |
$24.82
|
| Rate for Payer: BCBS MAPPO |
$24.82
|
| Rate for Payer: BCN Medicare Advantage |
$24.82
|
| Rate for Payer: BCN Medicare Advantage |
$24.82
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$35.74
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Cofinity Commercial |
$35.74
|
| Rate for Payer: Cofinity Commercial |
$33.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.06
|
| Rate for Payer: Nomi Health Commercial |
$29.78
|
| Rate for Payer: Nomi Health Commercial |
$29.78
|
| Rate for Payer: PACE SWMI |
$24.82
|
| Rate for Payer: PACE SWMI |
$24.82
|
| Rate for Payer: PHP Commercial |
$34.75
|
| Rate for Payer: PHP Commercial |
$34.75
|
| Rate for Payer: PHP Medicare Advantage |
$24.82
|
| Rate for Payer: PHP Medicare Advantage |
$24.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.00
|
| Rate for Payer: Priority Health Medicare |
$24.82
|
| Rate for Payer: Priority Health Medicare |
$24.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.82
|
| Rate for Payer: UHC Medicare Advantage |
$24.82
|
| Rate for Payer: UHC Medicare Advantage |
$24.82
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$36.80
|
|
|
PR SPONTANEOUS NYSTAGMUS TEST
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 92541
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.72 |
| Rate for Payer: Aetna Commercial |
$31.38
|
| Rate for Payer: Aetna Medicare |
$24.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.38
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$23.42
|
| Rate for Payer: BCN Medicare Advantage |
$23.42
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$33.72
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.59
|
| Rate for Payer: Nomi Health Commercial |
$28.10
|
| Rate for Payer: PACE SWMI |
$23.42
|
| Rate for Payer: PHP Commercial |
$32.79
|
| Rate for Payer: PHP Medicare Advantage |
$23.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$23.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.42
|
| Rate for Payer: UHC Medicare Advantage |
$23.42
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
|
|
PR SPORTS PHYSICAL
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00099
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS
|
Professional
|
Both
|
$1,214.00
|
|
|
Service Code
|
HCPCS 37765
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$789.10 |
| Rate for Payer: Aetna Commercial |
$344.98
|
| Rate for Payer: Aetna Medicare |
$267.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.73
|
| Rate for Payer: BCBS Complete |
$485.60
|
| Rate for Payer: BCBS MAPPO |
$257.45
|
| Rate for Payer: BCN Medicare Advantage |
$257.45
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cash Price |
$971.20
|
| Rate for Payer: Cofinity Commercial |
$344.98
|
| Rate for Payer: Cofinity Commercial |
$370.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.32
|
| Rate for Payer: Nomi Health Commercial |
$308.94
|
| Rate for Payer: PACE SWMI |
$257.45
|
| Rate for Payer: PHP Commercial |
$360.43
|
| Rate for Payer: PHP Medicare Advantage |
$257.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.10
|
| Rate for Payer: Priority Health Medicare |
$257.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.45
|
| Rate for Payer: UHC Medicare Advantage |
$257.45
|
| Rate for Payer: UMR Bronson Commercial |
$558.44
|
|
|
PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS
|
Professional
|
Both
|
$1,250.00
|
|
|
Service Code
|
HCPCS 37766
|
| Min. Negotiated Rate |
$318.26 |
| Max. Negotiated Rate |
$812.50 |
| Rate for Payer: Aetna Commercial |
$426.47
|
| Rate for Payer: Aetna Medicare |
$330.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.47
|
| Rate for Payer: BCBS Complete |
$500.00
|
| Rate for Payer: BCBS MAPPO |
$318.26
|
| Rate for Payer: BCN Medicare Advantage |
$318.26
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cash Price |
$1,000.00
|
| Rate for Payer: Cofinity Commercial |
$458.29
|
| Rate for Payer: Cofinity Commercial |
$426.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$318.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$334.17
|
| Rate for Payer: Nomi Health Commercial |
$381.91
|
| Rate for Payer: PACE SWMI |
$318.26
|
| Rate for Payer: PHP Commercial |
$445.56
|
| Rate for Payer: PHP Medicare Advantage |
$318.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$812.50
|
| Rate for Payer: Priority Health Medicare |
$318.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$318.26
|
| Rate for Payer: UHC Medicare Advantage |
$318.26
|
| Rate for Payer: UMR Bronson Commercial |
$575.00
|
|
|
PR STAGING CELIOTOMY,HODGKIN'S DIS/LYMPHOMA
|
Professional
|
Both
|
$1,743.00
|
|
|
Service Code
|
HCPCS 49220
|
| Min. Negotiated Rate |
$697.20 |
| Max. Negotiated Rate |
$1,132.95 |
| Rate for Payer: Aetna Medicare |
$871.50
|
| Rate for Payer: BCBS Complete |
$697.20
|
| Rate for Payer: Cash Price |
$1,394.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,132.95
|
| Rate for Payer: UMR Bronson Commercial |
$801.78
|
|
|
PR STANDARDIZED COGNITIVE PERFORMANCE TESTING
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 96125
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$138.36 |
| Rate for Payer: Aetna Commercial |
$128.75
|
| Rate for Payer: Aetna Medicare |
$99.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.36
|
| Rate for Payer: BCBS Complete |
$74.80
|
| Rate for Payer: BCBS MAPPO |
$96.08
|
| Rate for Payer: BCN Medicare Advantage |
$96.08
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cofinity Commercial |
$128.75
|
| Rate for Payer: Cofinity Commercial |
$138.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.88
|
| Rate for Payer: Nomi Health Commercial |
$115.30
|
| Rate for Payer: PACE SWMI |
$96.08
|
| Rate for Payer: PHP Commercial |
$134.51
|
| Rate for Payer: PHP Medicare Advantage |
$96.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.55
|
| Rate for Payer: Priority Health Medicare |
$96.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.08
|
| Rate for Payer: UHC Medicare Advantage |
$96.08
|
| Rate for Payer: UMR Bronson Commercial |
$86.02
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY
|
Professional
|
Both
|
$1,701.00
|
|
|
Service Code
|
HCPCS 69660
|
| Min. Negotiated Rate |
$680.40 |
| Max. Negotiated Rate |
$1,247.49 |
| Rate for Payer: Aetna Commercial |
$1,160.86
|
| Rate for Payer: Aetna Medicare |
$900.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,160.86
|
| Rate for Payer: BCBS Complete |
$680.40
|
| Rate for Payer: BCBS MAPPO |
$866.31
|
| Rate for Payer: BCN Medicare Advantage |
$866.31
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cash Price |
$1,360.80
|
| Rate for Payer: Cofinity Commercial |
$1,247.49
|
| Rate for Payer: Cofinity Commercial |
$1,160.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$866.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$909.63
|
| Rate for Payer: Nomi Health Commercial |
$1,039.57
|
| Rate for Payer: PACE SWMI |
$866.31
|
| Rate for Payer: PHP Commercial |
$1,212.83
|
| Rate for Payer: PHP Medicare Advantage |
$866.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,105.65
|
| Rate for Payer: Priority Health Medicare |
$866.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$866.31
|
| Rate for Payer: UHC Medicare Advantage |
$866.31
|
| Rate for Payer: UMR Bronson Commercial |
$782.46
|
|
|
PR STAPEDECTOMY/STAPEDOTOMY W/FOOTPLATE DRILL OUT
|
Professional
|
Both
|
$2,433.00
|
|
|
Service Code
|
HCPCS 69661
|
| Min. Negotiated Rate |
$973.20 |
| Max. Negotiated Rate |
$1,626.03 |
| Rate for Payer: Aetna Commercial |
$1,513.11
|
| Rate for Payer: Aetna Medicare |
$1,174.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,626.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,513.11
|
| Rate for Payer: BCBS Complete |
$973.20
|
| Rate for Payer: BCBS MAPPO |
$1,129.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,129.19
|
| Rate for Payer: Cash Price |
$1,946.40
|
| Rate for Payer: Cash Price |
$1,946.40
|
| Rate for Payer: Cofinity Commercial |
$1,626.03
|
| Rate for Payer: Cofinity Commercial |
$1,513.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,129.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,185.65
|
| Rate for Payer: Nomi Health Commercial |
$1,355.03
|
| Rate for Payer: PACE SWMI |
$1,129.19
|
| Rate for Payer: PHP Commercial |
$1,580.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,129.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,581.45
|
| Rate for Payer: Priority Health Medicare |
$1,129.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,129.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,129.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,119.18
|
|
|
PR STAPES MOBILIZATION
|
Professional
|
Both
|
$1,454.00
|
|
|
Service Code
|
HCPCS 69650
|
| Min. Negotiated Rate |
$581.60 |
| Max. Negotiated Rate |
$1,079.76 |
| Rate for Payer: Aetna Commercial |
$1,004.77
|
| Rate for Payer: Aetna Medicare |
$779.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,079.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.77
|
| Rate for Payer: BCBS Complete |
$581.60
|
| Rate for Payer: BCBS MAPPO |
$749.83
|
| Rate for Payer: BCN Medicare Advantage |
$749.83
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cash Price |
$1,163.20
|
| Rate for Payer: Cofinity Commercial |
$1,079.76
|
| Rate for Payer: Cofinity Commercial |
$1,004.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$749.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$787.32
|
| Rate for Payer: Nomi Health Commercial |
$899.80
|
| Rate for Payer: PACE SWMI |
$749.83
|
| Rate for Payer: PHP Commercial |
$1,049.76
|
| Rate for Payer: PHP Medicare Advantage |
$749.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.10
|
| Rate for Payer: Priority Health Medicare |
$749.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$749.83
|
| Rate for Payer: UHC Medicare Advantage |
$749.83
|
| Rate for Payer: UMR Bronson Commercial |
$668.84
|
|
|
PR STENGER TEST PURE TONE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 92565
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$28.12 |
| Rate for Payer: Aetna Commercial |
$26.17
|
| Rate for Payer: Aetna Medicare |
$20.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.17
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$19.53
|
| Rate for Payer: BCN Medicare Advantage |
$19.53
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$28.12
|
| Rate for Payer: Cofinity Commercial |
$26.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.51
|
| Rate for Payer: Nomi Health Commercial |
$23.44
|
| Rate for Payer: PACE SWMI |
$19.53
|
| Rate for Payer: PHP Commercial |
$27.34
|
| Rate for Payer: PHP Medicare Advantage |
$19.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: Priority Health Medicare |
$19.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.53
|
| Rate for Payer: UHC Medicare Advantage |
$19.53
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR STENGER TEST SPEECH
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 92577
|
| Min. Negotiated Rate |
$20.42 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Commercial |
$27.36
|
| Rate for Payer: Aetna Medicare |
$21.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.36
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS MAPPO |
$20.42
|
| Rate for Payer: BCN Medicare Advantage |
$20.42
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$29.40
|
| Rate for Payer: Cofinity Commercial |
$27.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.44
|
| Rate for Payer: Nomi Health Commercial |
$24.50
|
| Rate for Payer: PACE SWMI |
$20.42
|
| Rate for Payer: PHP Commercial |
$28.59
|
| Rate for Payer: PHP Medicare Advantage |
$20.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health Medicare |
$20.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.42
|
| Rate for Payer: UHC Medicare Advantage |
$20.42
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
