|
PR STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 36908
|
| Min. Negotiated Rate |
$197.12 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$264.14
|
| Rate for Payer: Aetna Medicare |
$205.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.14
|
| Rate for Payer: BCBS Complete |
$230.40
|
| Rate for Payer: BCBS MAPPO |
$197.12
|
| Rate for Payer: BCN Medicare Advantage |
$197.12
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$283.85
|
| Rate for Payer: Cofinity Commercial |
$264.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.98
|
| Rate for Payer: Nomi Health Commercial |
$236.54
|
| Rate for Payer: PACE SWMI |
$197.12
|
| Rate for Payer: PHP Commercial |
$275.97
|
| Rate for Payer: PHP Medicare Advantage |
$197.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health Medicare |
$197.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.12
|
| Rate for Payer: UHC Medicare Advantage |
$197.12
|
| Rate for Payer: UMR Bronson Commercial |
$264.96
|
|
|
PR STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS G6002
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$98.31 |
| Rate for Payer: Aetna Commercial |
$91.48
|
| Rate for Payer: Aetna Commercial |
$91.48
|
| Rate for Payer: Aetna Medicare |
$71.00
|
| Rate for Payer: Aetna Medicare |
$71.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.31
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS MAPPO |
$68.27
|
| Rate for Payer: BCBS MAPPO |
$68.27
|
| Rate for Payer: BCN Medicare Advantage |
$68.27
|
| Rate for Payer: BCN Medicare Advantage |
$68.27
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$98.31
|
| Rate for Payer: Cofinity Commercial |
$98.31
|
| Rate for Payer: Cofinity Commercial |
$91.48
|
| Rate for Payer: Cofinity Commercial |
$91.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.68
|
| Rate for Payer: Nomi Health Commercial |
$81.92
|
| Rate for Payer: Nomi Health Commercial |
$81.92
|
| Rate for Payer: PACE SWMI |
$68.27
|
| Rate for Payer: PACE SWMI |
$68.27
|
| Rate for Payer: PHP Commercial |
$95.58
|
| Rate for Payer: PHP Commercial |
$95.58
|
| Rate for Payer: PHP Medicare Advantage |
$68.27
|
| Rate for Payer: PHP Medicare Advantage |
$68.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Medicare |
$68.27
|
| Rate for Payer: Priority Health Medicare |
$68.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.27
|
| Rate for Payer: UHC Medicare Advantage |
$68.27
|
| Rate for Payer: UHC Medicare Advantage |
$68.27
|
| Rate for Payer: UMR Bronson Commercial |
$23.00
|
| Rate for Payer: UMR Bronson Commercial |
$66.70
|
|
|
PR STEREOTACTIC BX ASPIR/EXC BURR INTRACRANIAL LES
|
Professional
|
Both
|
$2,976.00
|
|
|
Service Code
|
HCPCS 61750
|
| Min. Negotiated Rate |
$1,190.40 |
| Max. Negotiated Rate |
$2,016.24 |
| Rate for Payer: Aetna Commercial |
$1,876.23
|
| Rate for Payer: Aetna Medicare |
$1,456.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,016.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,876.23
|
| Rate for Payer: BCBS Complete |
$1,190.40
|
| Rate for Payer: BCBS MAPPO |
$1,400.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,400.17
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Cofinity Commercial |
$2,016.24
|
| Rate for Payer: Cofinity Commercial |
$1,876.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,400.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,470.18
|
| Rate for Payer: Nomi Health Commercial |
$1,680.20
|
| Rate for Payer: PACE SWMI |
$1,400.17
|
| Rate for Payer: PHP Commercial |
$1,960.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,400.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,934.40
|
| Rate for Payer: Priority Health Medicare |
$1,400.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,400.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,400.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,368.96
|
|
|
PR STEREOTACTIC COMPUTER ASSISTED PX SPINAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 61783
|
| Min. Negotiated Rate |
$227.54 |
| Max. Negotiated Rate |
$482.95 |
| Rate for Payer: Aetna Commercial |
$304.90
|
| Rate for Payer: Aetna Medicare |
$236.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.90
|
| Rate for Payer: BCBS Complete |
$297.20
|
| Rate for Payer: BCBS MAPPO |
$227.54
|
| Rate for Payer: BCN Medicare Advantage |
$227.54
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cofinity Commercial |
$327.66
|
| Rate for Payer: Cofinity Commercial |
$304.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$227.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.92
|
| Rate for Payer: Nomi Health Commercial |
$273.05
|
| Rate for Payer: PACE SWMI |
$227.54
|
| Rate for Payer: PHP Commercial |
$318.56
|
| Rate for Payer: PHP Medicare Advantage |
$227.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health Medicare |
$227.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$227.54
|
| Rate for Payer: UHC Medicare Advantage |
$227.54
|
| Rate for Payer: UMR Bronson Commercial |
$341.78
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 COMPLEX CRANIAL LES
|
Professional
|
Both
|
$8,316.00
|
|
|
Service Code
|
HCPCS 61798
|
| Min. Negotiated Rate |
$1,370.62 |
| Max. Negotiated Rate |
$5,405.40 |
| Rate for Payer: Aetna Commercial |
$1,836.63
|
| Rate for Payer: Aetna Medicare |
$1,425.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,973.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,836.63
|
| Rate for Payer: BCBS Complete |
$3,326.40
|
| Rate for Payer: BCBS MAPPO |
$1,370.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,370.62
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cofinity Commercial |
$1,973.69
|
| Rate for Payer: Cofinity Commercial |
$1,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,370.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,439.15
|
| Rate for Payer: Nomi Health Commercial |
$1,644.74
|
| Rate for Payer: PACE SWMI |
$1,370.62
|
| Rate for Payer: PHP Commercial |
$1,918.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,370.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,405.40
|
| Rate for Payer: Priority Health Medicare |
$1,370.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,370.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,370.62
|
| Rate for Payer: UMR Bronson Commercial |
$3,825.36
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 SIMPLE CRANIAL LES
|
Professional
|
Both
|
$8,316.00
|
|
|
Service Code
|
HCPCS 61796
|
| Min. Negotiated Rate |
$1,012.43 |
| Max. Negotiated Rate |
$5,405.40 |
| Rate for Payer: Aetna Commercial |
$1,356.66
|
| Rate for Payer: Aetna Medicare |
$1,052.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,457.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,356.66
|
| Rate for Payer: BCBS Complete |
$3,326.40
|
| Rate for Payer: BCBS MAPPO |
$1,012.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,012.43
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cofinity Commercial |
$1,457.90
|
| Rate for Payer: Cofinity Commercial |
$1,356.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,012.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,063.05
|
| Rate for Payer: Nomi Health Commercial |
$1,214.92
|
| Rate for Payer: PACE SWMI |
$1,012.43
|
| Rate for Payer: PHP Commercial |
$1,417.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,012.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,405.40
|
| Rate for Payer: Priority Health Medicare |
$1,012.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,012.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,012.43
|
| Rate for Payer: UMR Bronson Commercial |
$3,825.36
|
|
|
PR STEREOTACTIC RADIOSURGERY 1 SPINAL LESION
|
Professional
|
Both
|
$2,336.00
|
|
|
Service Code
|
HCPCS 63620
|
| Min. Negotiated Rate |
$934.40 |
| Max. Negotiated Rate |
$1,612.07 |
| Rate for Payer: Aetna Commercial |
$1,500.12
|
| Rate for Payer: Aetna Medicare |
$1,164.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,612.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,500.12
|
| Rate for Payer: BCBS Complete |
$934.40
|
| Rate for Payer: BCBS MAPPO |
$1,119.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,119.49
|
| Rate for Payer: Cash Price |
$1,868.80
|
| Rate for Payer: Cash Price |
$1,868.80
|
| Rate for Payer: Cofinity Commercial |
$1,612.07
|
| Rate for Payer: Cofinity Commercial |
$1,500.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,119.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,175.46
|
| Rate for Payer: Nomi Health Commercial |
$1,343.39
|
| Rate for Payer: PACE SWMI |
$1,119.49
|
| Rate for Payer: PHP Commercial |
$1,567.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,119.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,518.40
|
| Rate for Payer: Priority Health Medicare |
$1,119.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,119.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,119.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,074.56
|
|
|
PR STERILE SALINE OR WATER
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS A4218
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR STERNAL DEBRIDEMENT
|
Professional
|
Both
|
$4,148.00
|
|
|
Service Code
|
HCPCS 21627
|
| Min. Negotiated Rate |
$526.48 |
| Max. Negotiated Rate |
$2,696.20 |
| Rate for Payer: Aetna Commercial |
$705.48
|
| Rate for Payer: Aetna Medicare |
$547.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.13
|
| Rate for Payer: BCBS Complete |
$1,659.20
|
| Rate for Payer: BCBS MAPPO |
$526.48
|
| Rate for Payer: BCN Medicare Advantage |
$526.48
|
| Rate for Payer: Cash Price |
$3,318.40
|
| Rate for Payer: Cash Price |
$3,318.40
|
| Rate for Payer: Cofinity Commercial |
$705.48
|
| Rate for Payer: Cofinity Commercial |
$758.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$526.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$552.80
|
| Rate for Payer: Nomi Health Commercial |
$631.78
|
| Rate for Payer: PACE SWMI |
$526.48
|
| Rate for Payer: PHP Commercial |
$737.07
|
| Rate for Payer: PHP Medicare Advantage |
$526.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,696.20
|
| Rate for Payer: Priority Health Medicare |
$526.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$526.48
|
| Rate for Payer: UHC Medicare Advantage |
$526.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,908.08
|
|
|
PR STOT/TOT HYSTERECTOMY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 59525
|
| Min. Negotiated Rate |
$456.80 |
| Max. Negotiated Rate |
$742.30 |
| Rate for Payer: Aetna Commercial |
$631.33
|
| Rate for Payer: Aetna Medicare |
$489.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.33
|
| Rate for Payer: BCBS Complete |
$456.80
|
| Rate for Payer: BCBS MAPPO |
$471.14
|
| Rate for Payer: BCN Medicare Advantage |
$471.14
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Commercial |
$678.44
|
| Rate for Payer: Cofinity Commercial |
$631.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$471.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$494.70
|
| Rate for Payer: Nomi Health Commercial |
$565.37
|
| Rate for Payer: PACE SWMI |
$471.14
|
| Rate for Payer: PHP Commercial |
$659.60
|
| Rate for Payer: PHP Medicare Advantage |
$471.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.30
|
| Rate for Payer: Priority Health Medicare |
$471.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$471.14
|
| Rate for Payer: UHC Medicare Advantage |
$471.14
|
| Rate for Payer: UMR Bronson Commercial |
$525.32
|
|
|
PR STRABISMUS RECESSION/RESCJ 1 HRZNTL MUSC
|
Professional
|
Both
|
$1,445.00
|
|
|
Service Code
|
HCPCS 67311
|
| Min. Negotiated Rate |
$421.31 |
| Max. Negotiated Rate |
$939.25 |
| Rate for Payer: Aetna Commercial |
$564.56
|
| Rate for Payer: Aetna Medicare |
$438.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.56
|
| Rate for Payer: BCBS Complete |
$578.00
|
| Rate for Payer: BCBS MAPPO |
$421.31
|
| Rate for Payer: BCN Medicare Advantage |
$421.31
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cash Price |
$1,156.00
|
| Rate for Payer: Cofinity Commercial |
$606.69
|
| Rate for Payer: Cofinity Commercial |
$564.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.38
|
| Rate for Payer: Nomi Health Commercial |
$505.57
|
| Rate for Payer: PACE SWMI |
$421.31
|
| Rate for Payer: PHP Commercial |
$589.83
|
| Rate for Payer: PHP Medicare Advantage |
$421.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$939.25
|
| Rate for Payer: Priority Health Medicare |
$421.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.31
|
| Rate for Payer: UHC Medicare Advantage |
$421.31
|
| Rate for Payer: UMR Bronson Commercial |
$664.70
|
|
|
PR STRAIGHT TIP URINE CATHETER
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4351
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$3.39
|
| Rate for Payer: Aetna Medicare |
$2.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.39
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$2.53
|
| Rate for Payer: BCN Medicare Advantage |
$2.53
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Cofinity Commercial |
$3.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.66
|
| Rate for Payer: Nomi Health Commercial |
$3.04
|
| Rate for Payer: PACE SWMI |
$2.53
|
| Rate for Payer: PHP Commercial |
$3.54
|
| Rate for Payer: PHP Medicare Advantage |
$2.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$2.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.53
|
| Rate for Payer: UHC Medicare Advantage |
$2.53
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR STRAPPING ANKLE &/FOOT
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 29540
|
| Min. Negotiated Rate |
$16.70 |
| Max. Negotiated Rate |
$45.50 |
| Rate for Payer: Aetna Commercial |
$22.38
|
| Rate for Payer: Aetna Medicare |
$17.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.38
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS MAPPO |
$16.70
|
| Rate for Payer: BCN Medicare Advantage |
$16.70
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$24.05
|
| Rate for Payer: Cofinity Commercial |
$22.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.54
|
| Rate for Payer: Nomi Health Commercial |
$20.04
|
| Rate for Payer: PACE SWMI |
$16.70
|
| Rate for Payer: PHP Commercial |
$23.38
|
| Rate for Payer: PHP Medicare Advantage |
$16.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Medicare |
$16.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.70
|
| Rate for Payer: UHC Medicare Advantage |
$16.70
|
| Rate for Payer: UMR Bronson Commercial |
$32.20
|
|
|
PR STRAPPING ELBOW/WRIST
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 29260
|
| Min. Negotiated Rate |
$17.88 |
| Max. Negotiated Rate |
$38.35 |
| Rate for Payer: Aetna Commercial |
$23.96
|
| Rate for Payer: Aetna Medicare |
$18.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.96
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$17.88
|
| Rate for Payer: BCN Medicare Advantage |
$17.88
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$25.75
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.77
|
| Rate for Payer: Nomi Health Commercial |
$21.46
|
| Rate for Payer: PACE SWMI |
$17.88
|
| Rate for Payer: PHP Commercial |
$25.03
|
| Rate for Payer: PHP Medicare Advantage |
$17.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$17.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.88
|
| Rate for Payer: UHC Medicare Advantage |
$17.88
|
| Rate for Payer: UMR Bronson Commercial |
$27.14
|
|
|
PR STRAPPING HAND/FINGER
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 29280
|
| Min. Negotiated Rate |
$18.85 |
| Max. Negotiated Rate |
$66.95 |
| Rate for Payer: Aetna Commercial |
$25.26
|
| Rate for Payer: Aetna Medicare |
$19.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.26
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$18.85
|
| Rate for Payer: BCN Medicare Advantage |
$18.85
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$27.14
|
| Rate for Payer: Cofinity Commercial |
$25.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.79
|
| Rate for Payer: Nomi Health Commercial |
$22.62
|
| Rate for Payer: PACE SWMI |
$18.85
|
| Rate for Payer: PHP Commercial |
$26.39
|
| Rate for Payer: PHP Medicare Advantage |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$18.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.85
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
|
PR STRAPPING TOES
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 29550
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$38.35 |
| Rate for Payer: Aetna Commercial |
$14.22
|
| Rate for Payer: Aetna Medicare |
$11.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.22
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$10.61
|
| Rate for Payer: BCN Medicare Advantage |
$10.61
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$14.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.14
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: PACE SWMI |
$10.61
|
| Rate for Payer: PHP Commercial |
$14.85
|
| Rate for Payer: PHP Medicare Advantage |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$10.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.61
|
| Rate for Payer: UHC Medicare Advantage |
$10.61
|
| Rate for Payer: UMR Bronson Commercial |
$27.14
|
|
|
PR STRAPPING UNNA BOOT
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 29580
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna Commercial |
$33.61
|
| Rate for Payer: Aetna Medicare |
$26.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.61
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: BCBS MAPPO |
$25.08
|
| Rate for Payer: BCN Medicare Advantage |
$25.08
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$36.12
|
| Rate for Payer: Cofinity Commercial |
$33.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.33
|
| Rate for Payer: Nomi Health Commercial |
$30.10
|
| Rate for Payer: PACE SWMI |
$25.08
|
| Rate for Payer: PHP Commercial |
$35.11
|
| Rate for Payer: PHP Medicare Advantage |
$25.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.75
|
| Rate for Payer: Priority Health Medicare |
$25.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.08
|
| Rate for Payer: UHC Medicare Advantage |
$25.08
|
| Rate for Payer: UMR Bronson Commercial |
$43.70
|
|
|
PR STRTCTC BX ASPIR/EXC BURR ICRA LESION W/CT&I/MR
|
Professional
|
Both
|
$7,034.00
|
|
|
Service Code
|
HCPCS 61751
|
| Min. Negotiated Rate |
$1,376.14 |
| Max. Negotiated Rate |
$4,572.10 |
| Rate for Payer: Aetna Commercial |
$1,844.03
|
| Rate for Payer: Aetna Medicare |
$1,431.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,981.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,844.03
|
| Rate for Payer: BCBS Complete |
$2,813.60
|
| Rate for Payer: BCBS MAPPO |
$1,376.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,376.14
|
| Rate for Payer: Cash Price |
$5,627.20
|
| Rate for Payer: Cash Price |
$5,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,981.64
|
| Rate for Payer: Cofinity Commercial |
$1,844.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,376.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,444.95
|
| Rate for Payer: Nomi Health Commercial |
$1,651.37
|
| Rate for Payer: PACE SWMI |
$1,376.14
|
| Rate for Payer: PHP Commercial |
$1,926.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,376.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,572.10
|
| Rate for Payer: Priority Health Medicare |
$1,376.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,376.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,376.14
|
| Rate for Payer: UMR Bronson Commercial |
$3,235.64
|
|
|
PR STRTCTC CPTR ASSTD PX CRANIAL INTRADURAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 61781
|
| Min. Negotiated Rate |
$233.28 |
| Max. Negotiated Rate |
$482.95 |
| Rate for Payer: Aetna Commercial |
$312.60
|
| Rate for Payer: Aetna Medicare |
$242.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.60
|
| Rate for Payer: BCBS Complete |
$297.20
|
| Rate for Payer: BCBS MAPPO |
$233.28
|
| Rate for Payer: BCN Medicare Advantage |
$233.28
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cofinity Commercial |
$335.92
|
| Rate for Payer: Cofinity Commercial |
$312.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.94
|
| Rate for Payer: Nomi Health Commercial |
$279.94
|
| Rate for Payer: PACE SWMI |
$233.28
|
| Rate for Payer: PHP Commercial |
$326.59
|
| Rate for Payer: PHP Medicare Advantage |
$233.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health Medicare |
$233.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.28
|
| Rate for Payer: UHC Medicare Advantage |
$233.28
|
| Rate for Payer: UMR Bronson Commercial |
$341.78
|
|
|
PR STRTCTC CPTR ASSTD PX EXTRADURAL CRANIAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 61782
|
| Min. Negotiated Rate |
$165.66 |
| Max. Negotiated Rate |
$482.95 |
| Rate for Payer: Aetna Commercial |
$221.98
|
| Rate for Payer: Aetna Medicare |
$172.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.98
|
| Rate for Payer: BCBS Complete |
$297.20
|
| Rate for Payer: BCBS MAPPO |
$165.66
|
| Rate for Payer: BCN Medicare Advantage |
$165.66
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Cofinity Commercial |
$238.55
|
| Rate for Payer: Cofinity Commercial |
$221.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.94
|
| Rate for Payer: Nomi Health Commercial |
$198.79
|
| Rate for Payer: PACE SWMI |
$165.66
|
| Rate for Payer: PHP Commercial |
$231.92
|
| Rate for Payer: PHP Medicare Advantage |
$165.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$482.95
|
| Rate for Payer: Priority Health Medicare |
$165.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.66
|
| Rate for Payer: UHC Medicare Advantage |
$165.66
|
| Rate for Payer: UMR Bronson Commercial |
$341.78
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES COMPLEX
|
Professional
|
Both
|
$8,316.00
|
|
|
Service Code
|
HCPCS 61799
|
| Min. Negotiated Rate |
$299.20 |
| Max. Negotiated Rate |
$5,405.40 |
| Rate for Payer: Aetna Commercial |
$400.93
|
| Rate for Payer: Aetna Medicare |
$311.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.93
|
| Rate for Payer: BCBS Complete |
$3,326.40
|
| Rate for Payer: BCBS MAPPO |
$299.20
|
| Rate for Payer: BCN Medicare Advantage |
$299.20
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cofinity Commercial |
$430.85
|
| Rate for Payer: Cofinity Commercial |
$400.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.16
|
| Rate for Payer: Nomi Health Commercial |
$359.04
|
| Rate for Payer: PACE SWMI |
$299.20
|
| Rate for Payer: PHP Commercial |
$418.88
|
| Rate for Payer: PHP Medicare Advantage |
$299.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,405.40
|
| Rate for Payer: Priority Health Medicare |
$299.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.20
|
| Rate for Payer: UHC Medicare Advantage |
$299.20
|
| Rate for Payer: UMR Bronson Commercial |
$3,825.36
|
|
|
PR STRTCTC RADIOSURGERY EA ADDL CRANIAL LES SIMPLE
|
Professional
|
Both
|
$8,316.00
|
|
|
Service Code
|
HCPCS 61797
|
| Min. Negotiated Rate |
$216.92 |
| Max. Negotiated Rate |
$5,405.40 |
| Rate for Payer: Aetna Commercial |
$290.67
|
| Rate for Payer: Aetna Medicare |
$225.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.67
|
| Rate for Payer: BCBS Complete |
$3,326.40
|
| Rate for Payer: BCBS MAPPO |
$216.92
|
| Rate for Payer: BCN Medicare Advantage |
$216.92
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cash Price |
$6,652.80
|
| Rate for Payer: Cofinity Commercial |
$312.36
|
| Rate for Payer: Cofinity Commercial |
$290.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.77
|
| Rate for Payer: Nomi Health Commercial |
$260.30
|
| Rate for Payer: PACE SWMI |
$216.92
|
| Rate for Payer: PHP Commercial |
$303.69
|
| Rate for Payer: PHP Medicare Advantage |
$216.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,405.40
|
| Rate for Payer: Priority Health Medicare |
$216.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.92
|
| Rate for Payer: UHC Medicare Advantage |
$216.92
|
| Rate for Payer: UMR Bronson Commercial |
$3,825.36
|
|
|
PR SUBCUTANEOUS HORMONE PELLET IMPLANTATION
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 11980
|
| Min. Negotiated Rate |
$53.06 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Medicare |
$55.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.10
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS MAPPO |
$53.06
|
| Rate for Payer: BCN Medicare Advantage |
$53.06
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$76.41
|
| Rate for Payer: Cofinity Commercial |
$71.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.71
|
| Rate for Payer: Nomi Health Commercial |
$63.67
|
| Rate for Payer: PACE SWMI |
$53.06
|
| Rate for Payer: PHP Commercial |
$74.28
|
| Rate for Payer: PHP Medicare Advantage |
$53.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Medicare |
$53.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.06
|
| Rate for Payer: UHC Medicare Advantage |
$53.06
|
| Rate for Payer: UMR Bronson Commercial |
$83.72
|
|
|
PR SUBDURAL TAP FONTANELLE/SUTUR INFANT UNI/BI INIT
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 61000
|
| Min. Negotiated Rate |
$112.23 |
| Max. Negotiated Rate |
$302.90 |
| Rate for Payer: Aetna Commercial |
$150.39
|
| Rate for Payer: Aetna Medicare |
$116.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.39
|
| Rate for Payer: BCBS Complete |
$186.40
|
| Rate for Payer: BCBS MAPPO |
$112.23
|
| Rate for Payer: BCN Medicare Advantage |
$112.23
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$161.61
|
| Rate for Payer: Cofinity Commercial |
$150.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.84
|
| Rate for Payer: Nomi Health Commercial |
$134.68
|
| Rate for Payer: PACE SWMI |
$112.23
|
| Rate for Payer: PHP Commercial |
$157.12
|
| Rate for Payer: PHP Medicare Advantage |
$112.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.90
|
| Rate for Payer: Priority Health Medicare |
$112.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.23
|
| Rate for Payer: UHC Medicare Advantage |
$112.23
|
| Rate for Payer: UMR Bronson Commercial |
$214.36
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM 1ST 100SQ CM
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 15277
|
| Min. Negotiated Rate |
$196.40 |
| Max. Negotiated Rate |
$319.15 |
| Rate for Payer: Aetna Commercial |
$286.87
|
| Rate for Payer: Aetna Medicare |
$222.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.87
|
| Rate for Payer: BCBS Complete |
$196.40
|
| Rate for Payer: BCBS MAPPO |
$214.08
|
| Rate for Payer: BCN Medicare Advantage |
$214.08
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$308.28
|
| Rate for Payer: Cofinity Commercial |
$286.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.78
|
| Rate for Payer: Nomi Health Commercial |
$256.90
|
| Rate for Payer: PACE SWMI |
$214.08
|
| Rate for Payer: PHP Commercial |
$299.71
|
| Rate for Payer: PHP Medicare Advantage |
$214.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.15
|
| Rate for Payer: Priority Health Medicare |
$214.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.08
|
| Rate for Payer: UHC Medicare Advantage |
$214.08
|
| Rate for Payer: UMR Bronson Commercial |
$225.86
|
|
