|
PR SUB GRFT F/S/N/H/F/G/M/D >= 100SCM ADL 100SQ CM
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 15278
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$83.85 |
| Rate for Payer: Aetna Commercial |
$72.19
|
| Rate for Payer: Aetna Medicare |
$56.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.19
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$53.87
|
| Rate for Payer: BCN Medicare Advantage |
$53.87
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$77.57
|
| Rate for Payer: Cofinity Commercial |
$72.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.56
|
| Rate for Payer: Nomi Health Commercial |
$64.64
|
| Rate for Payer: PACE SWMI |
$53.87
|
| Rate for Payer: PHP Commercial |
$75.42
|
| Rate for Payer: PHP Medicare Advantage |
$53.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health Medicare |
$53.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.87
|
| Rate for Payer: UHC Medicare Advantage |
$53.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.34
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 15275
|
| Min. Negotiated Rate |
$89.30 |
| Max. Negotiated Rate |
$183.95 |
| Rate for Payer: Aetna Commercial |
$119.66
|
| Rate for Payer: Aetna Medicare |
$92.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.66
|
| Rate for Payer: BCBS Complete |
$113.20
|
| Rate for Payer: BCBS MAPPO |
$89.30
|
| Rate for Payer: BCN Medicare Advantage |
$89.30
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$128.59
|
| Rate for Payer: Cofinity Commercial |
$119.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.77
|
| Rate for Payer: Nomi Health Commercial |
$107.16
|
| Rate for Payer: PACE SWMI |
$89.30
|
| Rate for Payer: PHP Commercial |
$125.02
|
| Rate for Payer: PHP Medicare Advantage |
$89.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.95
|
| Rate for Payer: Priority Health Medicare |
$89.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.30
|
| Rate for Payer: UHC Medicare Advantage |
$89.30
|
| Rate for Payer: UMR Bronson Commercial |
$130.18
|
|
|
PR SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 15276
|
| Min. Negotiated Rate |
$23.75 |
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Medicare |
$24.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.82
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS MAPPO |
$23.75
|
| Rate for Payer: BCN Medicare Advantage |
$23.75
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$34.20
|
| Rate for Payer: Cofinity Commercial |
$31.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.94
|
| Rate for Payer: Nomi Health Commercial |
$28.50
|
| Rate for Payer: PACE SWMI |
$23.75
|
| Rate for Payer: PHP Commercial |
$33.25
|
| Rate for Payer: PHP Medicare Advantage |
$23.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$23.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.75
|
| Rate for Payer: UHC Medicare Advantage |
$23.75
|
| Rate for Payer: UMR Bronson Commercial |
$30.36
|
|
|
PR SUBMUCOSAL ABLTJ TONGUE RF 1/> SITES PR SESSION
|
Professional
|
Both
|
$734.00
|
|
|
Service Code
|
HCPCS 41530
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$502.66 |
| Rate for Payer: Aetna Commercial |
$467.75
|
| Rate for Payer: Aetna Medicare |
$363.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.75
|
| Rate for Payer: BCBS Complete |
$293.60
|
| Rate for Payer: BCBS MAPPO |
$349.07
|
| Rate for Payer: BCN Medicare Advantage |
$349.07
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cofinity Commercial |
$502.66
|
| Rate for Payer: Cofinity Commercial |
$467.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.52
|
| Rate for Payer: Nomi Health Commercial |
$418.88
|
| Rate for Payer: PACE SWMI |
$349.07
|
| Rate for Payer: PHP Commercial |
$488.70
|
| Rate for Payer: PHP Medicare Advantage |
$349.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.10
|
| Rate for Payer: Priority Health Medicare |
$349.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.07
|
| Rate for Payer: UHC Medicare Advantage |
$349.07
|
| Rate for Payer: UMR Bronson Commercial |
$337.64
|
|
|
PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 30140
|
| Min. Negotiated Rate |
$170.61 |
| Max. Negotiated Rate |
$744.25 |
| Rate for Payer: Aetna Commercial |
$228.62
|
| Rate for Payer: Aetna Medicare |
$177.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.62
|
| Rate for Payer: BCBS Complete |
$458.00
|
| Rate for Payer: BCBS MAPPO |
$170.61
|
| Rate for Payer: BCN Medicare Advantage |
$170.61
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$245.68
|
| Rate for Payer: Cofinity Commercial |
$228.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.14
|
| Rate for Payer: Nomi Health Commercial |
$204.73
|
| Rate for Payer: PACE SWMI |
$170.61
|
| Rate for Payer: PHP Commercial |
$238.85
|
| Rate for Payer: PHP Medicare Advantage |
$170.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health Medicare |
$170.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.61
|
| Rate for Payer: UHC Medicare Advantage |
$170.61
|
| Rate for Payer: UMR Bronson Commercial |
$526.70
|
|
|
PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99462
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$102.70 |
| Rate for Payer: Aetna Commercial |
$50.80
|
| Rate for Payer: Aetna Medicare |
$39.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.80
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$37.91
|
| Rate for Payer: BCN Medicare Advantage |
$37.91
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$54.59
|
| Rate for Payer: Cofinity Commercial |
$50.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.81
|
| Rate for Payer: Nomi Health Commercial |
$45.49
|
| Rate for Payer: PACE SWMI |
$37.91
|
| Rate for Payer: PHP Commercial |
$53.07
|
| Rate for Payer: PHP Medicare Advantage |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$37.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.91
|
| Rate for Payer: UHC Medicare Advantage |
$37.91
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 99469
|
| Min. Negotiated Rate |
$317.20 |
| Max. Negotiated Rate |
$523.87 |
| Rate for Payer: Aetna Commercial |
$487.49
|
| Rate for Payer: Aetna Medicare |
$378.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.49
|
| Rate for Payer: BCBS Complete |
$317.20
|
| Rate for Payer: BCBS MAPPO |
$363.80
|
| Rate for Payer: BCN Medicare Advantage |
$363.80
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$523.87
|
| Rate for Payer: Cofinity Commercial |
$487.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.99
|
| Rate for Payer: Nomi Health Commercial |
$436.56
|
| Rate for Payer: PACE SWMI |
$363.80
|
| Rate for Payer: PHP Commercial |
$509.32
|
| Rate for Payer: PHP Medicare Advantage |
$363.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health Medicare |
$363.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.80
|
| Rate for Payer: UHC Medicare Advantage |
$363.80
|
| Rate for Payer: UMR Bronson Commercial |
$364.78
|
|
|
PR SUBSEQUENT INJECTION, PLATELET RICH PLASMA, ANY SITE, INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00672
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99479
|
| Min. Negotiated Rate |
$113.46 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$152.04
|
| Rate for Payer: Aetna Medicare |
$118.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.38
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$113.46
|
| Rate for Payer: BCN Medicare Advantage |
$113.46
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$152.04
|
| Rate for Payer: Cofinity Commercial |
$163.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.13
|
| Rate for Payer: Nomi Health Commercial |
$136.15
|
| Rate for Payer: PACE SWMI |
$113.46
|
| Rate for Payer: PHP Commercial |
$158.84
|
| Rate for Payer: PHP Medicare Advantage |
$113.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$113.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.46
|
| Rate for Payer: UHC Medicare Advantage |
$113.46
|
| Rate for Payer: UMR Bronson Commercial |
$176.18
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 99478
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: Aetna Medicare |
$129.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.45
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$124.96
|
| Rate for Payer: BCN Medicare Advantage |
$124.96
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$179.94
|
| Rate for Payer: Cofinity Commercial |
$167.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.21
|
| Rate for Payer: Nomi Health Commercial |
$149.95
|
| Rate for Payer: PACE SWMI |
$124.96
|
| Rate for Payer: PHP Commercial |
$174.94
|
| Rate for Payer: PHP Medicare Advantage |
$124.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$124.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.96
|
| Rate for Payer: UHC Medicare Advantage |
$124.96
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99480
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$146.52
|
| Rate for Payer: Aetna Medicare |
$113.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.52
|
| Rate for Payer: BCBS Complete |
$153.20
|
| Rate for Payer: BCBS MAPPO |
$109.34
|
| Rate for Payer: BCN Medicare Advantage |
$109.34
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$157.45
|
| Rate for Payer: Cofinity Commercial |
$146.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.81
|
| Rate for Payer: Nomi Health Commercial |
$131.21
|
| Rate for Payer: PACE SWMI |
$109.34
|
| Rate for Payer: PHP Commercial |
$153.08
|
| Rate for Payer: PHP Medicare Advantage |
$109.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health Medicare |
$109.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.34
|
| Rate for Payer: UHC Medicare Advantage |
$109.34
|
| Rate for Payer: UMR Bronson Commercial |
$176.18
|
|
|
PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 99476
|
| Min. Negotiated Rate |
$320.79 |
| Max. Negotiated Rate |
$609.70 |
| Rate for Payer: Aetna Commercial |
$429.86
|
| Rate for Payer: Aetna Medicare |
$333.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.86
|
| Rate for Payer: BCBS Complete |
$375.20
|
| Rate for Payer: BCBS MAPPO |
$320.79
|
| Rate for Payer: BCN Medicare Advantage |
$320.79
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$461.94
|
| Rate for Payer: Cofinity Commercial |
$429.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.83
|
| Rate for Payer: Nomi Health Commercial |
$384.95
|
| Rate for Payer: PACE SWMI |
$320.79
|
| Rate for Payer: PHP Commercial |
$449.11
|
| Rate for Payer: PHP Medicare Advantage |
$320.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health Medicare |
$320.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.79
|
| Rate for Payer: UHC Medicare Advantage |
$320.79
|
| Rate for Payer: UMR Bronson Commercial |
$431.48
|
|
|
PR SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 99472
|
| Min. Negotiated Rate |
$289.20 |
| Max. Negotiated Rate |
$546.15 |
| Rate for Payer: Aetna Commercial |
$508.22
|
| Rate for Payer: Aetna Medicare |
$394.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.22
|
| Rate for Payer: BCBS Complete |
$289.20
|
| Rate for Payer: BCBS MAPPO |
$379.27
|
| Rate for Payer: BCN Medicare Advantage |
$379.27
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$546.15
|
| Rate for Payer: Cofinity Commercial |
$508.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.23
|
| Rate for Payer: Nomi Health Commercial |
$455.12
|
| Rate for Payer: PACE SWMI |
$379.27
|
| Rate for Payer: PHP Commercial |
$530.98
|
| Rate for Payer: PHP Medicare Advantage |
$379.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.95
|
| Rate for Payer: Priority Health Medicare |
$379.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.27
|
| Rate for Payer: UHC Medicare Advantage |
$379.27
|
| Rate for Payer: UMR Bronson Commercial |
$332.58
|
|
|
PR SUBTEMPORAL CRANIAL DECOMPRESSION
|
Professional
|
Both
|
$4,236.00
|
|
|
Service Code
|
HCPCS 61340
|
| Min. Negotiated Rate |
$1,430.75 |
| Max. Negotiated Rate |
$2,753.40 |
| Rate for Payer: Aetna Commercial |
$1,917.20
|
| Rate for Payer: Aetna Medicare |
$1,487.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,060.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,917.20
|
| Rate for Payer: BCBS Complete |
$1,694.40
|
| Rate for Payer: BCBS MAPPO |
$1,430.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,430.75
|
| Rate for Payer: Cash Price |
$3,388.80
|
| Rate for Payer: Cash Price |
$3,388.80
|
| Rate for Payer: Cofinity Commercial |
$2,060.28
|
| Rate for Payer: Cofinity Commercial |
$1,917.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,430.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,502.29
|
| Rate for Payer: Nomi Health Commercial |
$1,716.90
|
| Rate for Payer: PACE SWMI |
$1,430.75
|
| Rate for Payer: PHP Commercial |
$2,003.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,430.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,753.40
|
| Rate for Payer: Priority Health Medicare |
$1,430.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,430.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,430.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,948.56
|
|
|
PR SUCTION ASSISTED LIPECTOMY HEAD & NECK
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 15876
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Medicare |
$1,020.00
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
| Rate for Payer: UMR Bronson Commercial |
$938.40
|
|
|
PR SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 15879
|
| Min. Negotiated Rate |
$1,264.80 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,454.52
|
|
|
PR SUCTION ASSISTED LIPECTOMY TRUNK
|
Professional
|
Both
|
$2,754.00
|
|
|
Service Code
|
HCPCS 15877
|
| Min. Negotiated Rate |
$1,101.60 |
| Max. Negotiated Rate |
$1,790.10 |
| Rate for Payer: Aetna Medicare |
$1,377.00
|
| Rate for Payer: BCBS Complete |
$1,101.60
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,790.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,266.84
|
|
|
PR SUMATRIPTAN SUCCINATE / 6 MG
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS J3030
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
|
PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99377
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: UMR Bronson Commercial |
$62.56
|
|
|
PR SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 99485
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99379
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: UMR Bronson Commercial |
$62.56
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99380
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$112.45 |
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: UMR Bronson Commercial |
$79.58
|
|
|
PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 99375
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Aetna Medicare |
$92.50
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| Rate for Payer: UMR Bronson Commercial |
$85.10
|
|
|
PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$3,240.00
|
|
|
Service Code
|
HCPCS 58180
|
| Min. Negotiated Rate |
$925.11 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna Commercial |
$1,239.65
|
| Rate for Payer: Aetna Medicare |
$962.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,332.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,239.65
|
| Rate for Payer: BCBS Complete |
$1,296.00
|
| Rate for Payer: BCBS MAPPO |
$925.11
|
| Rate for Payer: BCN Medicare Advantage |
$925.11
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cofinity Commercial |
$1,332.16
|
| Rate for Payer: Cofinity Commercial |
$1,239.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$925.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$971.37
|
| Rate for Payer: Nomi Health Commercial |
$1,110.13
|
| Rate for Payer: PACE SWMI |
$925.11
|
| Rate for Payer: PHP Commercial |
$1,295.15
|
| Rate for Payer: PHP Medicare Advantage |
$925.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.00
|
| Rate for Payer: Priority Health Medicare |
$925.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$925.11
|
| Rate for Payer: UHC Medicare Advantage |
$925.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,490.40
|
|
|
PR SUPRAHYOID LYMPHADENECTOMY
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 38700
|
| Min. Negotiated Rate |
$584.00 |
| Max. Negotiated Rate |
$1,111.80 |
| Rate for Payer: Aetna Commercial |
$1,034.59
|
| Rate for Payer: Aetna Medicare |
$802.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,111.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,034.59
|
| Rate for Payer: BCBS Complete |
$584.00
|
| Rate for Payer: BCBS MAPPO |
$772.08
|
| Rate for Payer: BCN Medicare Advantage |
$772.08
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cofinity Commercial |
$1,111.80
|
| Rate for Payer: Cofinity Commercial |
$1,034.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$810.68
|
| Rate for Payer: Nomi Health Commercial |
$926.50
|
| Rate for Payer: PACE SWMI |
$772.08
|
| Rate for Payer: PHP Commercial |
$1,080.91
|
| Rate for Payer: PHP Medicare Advantage |
$772.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.00
|
| Rate for Payer: Priority Health Medicare |
$772.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.08
|
| Rate for Payer: UHC Medicare Advantage |
$772.08
|
| Rate for Payer: UMR Bronson Commercial |
$671.60
|
|
