|
PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE BI
|
Professional
|
Both
|
$5,673.00
|
|
|
Service Code
|
HCPCS 69706
|
| Min. Negotiated Rate |
$232.45 |
| Max. Negotiated Rate |
$3,687.45 |
| Rate for Payer: Aetna Commercial |
$311.48
|
| Rate for Payer: Aetna Medicare |
$241.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$311.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.73
|
| Rate for Payer: BCBS Complete |
$2,269.20
|
| Rate for Payer: BCBS MAPPO |
$232.45
|
| Rate for Payer: BCN Medicare Advantage |
$232.45
|
| Rate for Payer: Cash Price |
$4,538.40
|
| Rate for Payer: Cash Price |
$4,538.40
|
| Rate for Payer: Cofinity Commercial |
$311.48
|
| Rate for Payer: Cofinity Commercial |
$334.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.07
|
| Rate for Payer: Nomi Health Commercial |
$278.94
|
| Rate for Payer: PACE SWMI |
$232.45
|
| Rate for Payer: PHP Commercial |
$325.43
|
| Rate for Payer: PHP Medicare Advantage |
$232.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,687.45
|
| Rate for Payer: Priority Health Medicare |
$232.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$232.45
|
| Rate for Payer: UHC Medicare Advantage |
$232.45
|
| Rate for Payer: UMR Bronson Commercial |
$2,609.58
|
|
|
PR SURG NASOPHARYNGOSCOPY DILAT EUSTACHIAN TUBE UNI
|
Professional
|
Both
|
$5,488.00
|
|
|
Service Code
|
HCPCS 69705
|
| Min. Negotiated Rate |
$166.19 |
| Max. Negotiated Rate |
$3,567.20 |
| Rate for Payer: Aetna Commercial |
$222.69
|
| Rate for Payer: Aetna Medicare |
$172.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.69
|
| Rate for Payer: BCBS Complete |
$2,195.20
|
| Rate for Payer: BCBS MAPPO |
$166.19
|
| Rate for Payer: BCN Medicare Advantage |
$166.19
|
| Rate for Payer: Cash Price |
$4,390.40
|
| Rate for Payer: Cash Price |
$4,390.40
|
| Rate for Payer: Cofinity Commercial |
$239.31
|
| Rate for Payer: Cofinity Commercial |
$222.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.50
|
| Rate for Payer: Nomi Health Commercial |
$199.43
|
| Rate for Payer: PACE SWMI |
$166.19
|
| Rate for Payer: PHP Commercial |
$232.67
|
| Rate for Payer: PHP Medicare Advantage |
$166.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,567.20
|
| Rate for Payer: Priority Health Medicare |
$166.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.19
|
| Rate for Payer: UHC Medicare Advantage |
$166.19
|
| Rate for Payer: UMR Bronson Commercial |
$2,524.48
|
|
|
PR SURG OPENING,ESOPHAGUS,ABD APPRCH
|
Professional
|
Both
|
$2,787.00
|
|
|
Service Code
|
HCPCS 43350
|
| Min. Negotiated Rate |
$1,114.80 |
| Max. Negotiated Rate |
$1,811.55 |
| Rate for Payer: Aetna Medicare |
$1,393.50
|
| Rate for Payer: BCBS Complete |
$1,114.80
|
| Rate for Payer: Cash Price |
$2,229.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,811.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,282.02
|
|
|
PR SURG TX ANAL FISTULA 2ND STAGE
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 46285
|
| Min. Negotiated Rate |
$388.00 |
| Max. Negotiated Rate |
$630.50 |
| Rate for Payer: Aetna Commercial |
$545.09
|
| Rate for Payer: Aetna Medicare |
$423.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.76
|
| Rate for Payer: BCBS Complete |
$388.00
|
| Rate for Payer: BCBS MAPPO |
$406.78
|
| Rate for Payer: BCN Medicare Advantage |
$406.78
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cofinity Commercial |
$545.09
|
| Rate for Payer: Cofinity Commercial |
$585.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.12
|
| Rate for Payer: Nomi Health Commercial |
$488.14
|
| Rate for Payer: PACE SWMI |
$406.78
|
| Rate for Payer: PHP Commercial |
$569.49
|
| Rate for Payer: PHP Medicare Advantage |
$406.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.50
|
| Rate for Payer: Priority Health Medicare |
$406.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.78
|
| Rate for Payer: UHC Medicare Advantage |
$406.78
|
| Rate for Payer: UMR Bronson Commercial |
$446.20
|
|
|
PR SURG TX ANAL FISTULA INTERSPHINCTERIC
|
Professional
|
Both
|
$1,315.00
|
|
|
Service Code
|
HCPCS 46275
|
| Min. Negotiated Rate |
$404.00 |
| Max. Negotiated Rate |
$854.75 |
| Rate for Payer: Aetna Commercial |
$541.36
|
| Rate for Payer: Aetna Medicare |
$420.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$541.36
|
| Rate for Payer: BCBS Complete |
$526.00
|
| Rate for Payer: BCBS MAPPO |
$404.00
|
| Rate for Payer: BCN Medicare Advantage |
$404.00
|
| Rate for Payer: Cash Price |
$1,052.00
|
| Rate for Payer: Cash Price |
$1,052.00
|
| Rate for Payer: Cofinity Commercial |
$581.76
|
| Rate for Payer: Cofinity Commercial |
$541.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$424.20
|
| Rate for Payer: Nomi Health Commercial |
$484.80
|
| Rate for Payer: PACE SWMI |
$404.00
|
| Rate for Payer: PHP Commercial |
$565.60
|
| Rate for Payer: PHP Medicare Advantage |
$404.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$854.75
|
| Rate for Payer: Priority Health Medicare |
$404.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$404.00
|
| Rate for Payer: UHC Medicare Advantage |
$404.00
|
| Rate for Payer: UMR Bronson Commercial |
$604.90
|
|
|
PR SURG TX ANAL FISTULA SUBQ
|
Professional
|
Both
|
$862.00
|
|
|
Service Code
|
HCPCS 46270
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$560.30 |
| Rate for Payer: Aetna Commercial |
$515.69
|
| Rate for Payer: Aetna Medicare |
$400.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.69
|
| Rate for Payer: BCBS Complete |
$344.80
|
| Rate for Payer: BCBS MAPPO |
$384.84
|
| Rate for Payer: BCN Medicare Advantage |
$384.84
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cash Price |
$689.60
|
| Rate for Payer: Cofinity Commercial |
$554.17
|
| Rate for Payer: Cofinity Commercial |
$515.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$404.08
|
| Rate for Payer: Nomi Health Commercial |
$461.81
|
| Rate for Payer: PACE SWMI |
$384.84
|
| Rate for Payer: PHP Commercial |
$538.78
|
| Rate for Payer: PHP Medicare Advantage |
$384.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.30
|
| Rate for Payer: Priority Health Medicare |
$384.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$384.84
|
| Rate for Payer: UHC Medicare Advantage |
$384.84
|
| Rate for Payer: UMR Bronson Commercial |
$396.52
|
|
|
PR SURG VENTRICULAR RSTRJ PX W/PROSTC PATCH PFRMD
|
Professional
|
Both
|
$11,334.00
|
|
|
Service Code
|
HCPCS 33548
|
| Min. Negotiated Rate |
$2,816.51 |
| Max. Negotiated Rate |
$7,367.10 |
| Rate for Payer: Aetna Commercial |
$3,774.12
|
| Rate for Payer: Aetna Medicare |
$2,929.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,055.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,774.12
|
| Rate for Payer: BCBS Complete |
$4,533.60
|
| Rate for Payer: BCBS MAPPO |
$2,816.51
|
| Rate for Payer: BCN Medicare Advantage |
$2,816.51
|
| Rate for Payer: Cash Price |
$9,067.20
|
| Rate for Payer: Cash Price |
$9,067.20
|
| Rate for Payer: Cofinity Commercial |
$4,055.77
|
| Rate for Payer: Cofinity Commercial |
$3,774.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,816.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,957.34
|
| Rate for Payer: Nomi Health Commercial |
$3,379.81
|
| Rate for Payer: PACE SWMI |
$2,816.51
|
| Rate for Payer: PHP Commercial |
$3,943.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,816.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,367.10
|
| Rate for Payer: Priority Health Medicare |
$2,816.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,816.51
|
| Rate for Payer: UHC Medicare Advantage |
$2,816.51
|
| Rate for Payer: UMR Bronson Commercial |
$5,213.64
|
|
|
PR SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV
|
Professional
|
Both
|
$1,323.00
|
|
|
Service Code
|
HCPCS 64832
|
| Min. Negotiated Rate |
$316.81 |
| Max. Negotiated Rate |
$859.95 |
| Rate for Payer: Aetna Commercial |
$424.53
|
| Rate for Payer: Aetna Medicare |
$329.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.53
|
| Rate for Payer: BCBS Complete |
$529.20
|
| Rate for Payer: BCBS MAPPO |
$316.81
|
| Rate for Payer: BCN Medicare Advantage |
$316.81
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cash Price |
$1,058.40
|
| Rate for Payer: Cofinity Commercial |
$456.21
|
| Rate for Payer: Cofinity Commercial |
$424.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.65
|
| Rate for Payer: Nomi Health Commercial |
$380.17
|
| Rate for Payer: PACE SWMI |
$316.81
|
| Rate for Payer: PHP Commercial |
$443.53
|
| Rate for Payer: PHP Medicare Advantage |
$316.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.95
|
| Rate for Payer: Priority Health Medicare |
$316.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.81
|
| Rate for Payer: UHC Medicare Advantage |
$316.81
|
| Rate for Payer: UMR Bronson Commercial |
$608.58
|
|
|
PR SUTR ESOPHGL WND/INJ CRV APPR
|
Professional
|
Both
|
$2,855.00
|
|
|
Service Code
|
HCPCS 43410
|
| Min. Negotiated Rate |
$989.66 |
| Max. Negotiated Rate |
$1,855.75 |
| Rate for Payer: Aetna Commercial |
$1,326.14
|
| Rate for Payer: Aetna Medicare |
$1,029.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.14
|
| Rate for Payer: BCBS Complete |
$1,142.00
|
| Rate for Payer: BCBS MAPPO |
$989.66
|
| Rate for Payer: BCN Medicare Advantage |
$989.66
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cash Price |
$2,284.00
|
| Rate for Payer: Cofinity Commercial |
$1,425.11
|
| Rate for Payer: Cofinity Commercial |
$1,326.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$989.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,039.14
|
| Rate for Payer: Nomi Health Commercial |
$1,187.59
|
| Rate for Payer: PACE SWMI |
$989.66
|
| Rate for Payer: PHP Commercial |
$1,385.52
|
| Rate for Payer: PHP Medicare Advantage |
$989.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.75
|
| Rate for Payer: Priority Health Medicare |
$989.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$989.66
|
| Rate for Payer: UHC Medicare Advantage |
$989.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,313.30
|
|
|
PR SUTR ESOPHGL WND/INJ TTHRC/TABDL APPR
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 43415
|
| Min. Negotiated Rate |
$1,630.40 |
| Max. Negotiated Rate |
$3,561.64 |
| Rate for Payer: Aetna Commercial |
$3,314.30
|
| Rate for Payer: Aetna Medicare |
$2,572.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,561.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,314.30
|
| Rate for Payer: BCBS Complete |
$1,630.40
|
| Rate for Payer: BCBS MAPPO |
$2,473.36
|
| Rate for Payer: BCN Medicare Advantage |
$2,473.36
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cofinity Commercial |
$3,561.64
|
| Rate for Payer: Cofinity Commercial |
$3,314.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,473.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,597.03
|
| Rate for Payer: Nomi Health Commercial |
$2,968.03
|
| Rate for Payer: PACE SWMI |
$2,473.36
|
| Rate for Payer: PHP Commercial |
$3,462.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,473.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,649.40
|
| Rate for Payer: Priority Health Medicare |
$2,473.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,473.36
|
| Rate for Payer: UHC Medicare Advantage |
$2,473.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,874.96
|
|
|
PR SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
HCPCS 27381
|
| Min. Negotiated Rate |
$634.40 |
| Max. Negotiated Rate |
$1,133.99 |
| Rate for Payer: Aetna Commercial |
$1,055.24
|
| Rate for Payer: Aetna Medicare |
$818.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.24
|
| Rate for Payer: BCBS Complete |
$634.40
|
| Rate for Payer: BCBS MAPPO |
$787.49
|
| Rate for Payer: BCN Medicare Advantage |
$787.49
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cofinity Commercial |
$1,133.99
|
| Rate for Payer: Cofinity Commercial |
$1,055.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.86
|
| Rate for Payer: Nomi Health Commercial |
$944.99
|
| Rate for Payer: PACE SWMI |
$787.49
|
| Rate for Payer: PHP Commercial |
$1,102.49
|
| Rate for Payer: PHP Medicare Advantage |
$787.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,030.90
|
| Rate for Payer: Priority Health Medicare |
$787.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.49
|
| Rate for Payer: UHC Medicare Advantage |
$787.49
|
| Rate for Payer: UMR Bronson Commercial |
$729.56
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/COLOSTOMY
|
Professional
|
Both
|
$2,938.00
|
|
|
Service Code
|
HCPCS 44605
|
| Min. Negotiated Rate |
$1,175.20 |
| Max. Negotiated Rate |
$1,909.70 |
| Rate for Payer: Aetna Commercial |
$1,671.96
|
| Rate for Payer: Aetna Medicare |
$1,297.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,796.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,671.96
|
| Rate for Payer: BCBS Complete |
$1,175.20
|
| Rate for Payer: BCBS MAPPO |
$1,247.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,247.73
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cash Price |
$2,350.40
|
| Rate for Payer: Cofinity Commercial |
$1,796.73
|
| Rate for Payer: Cofinity Commercial |
$1,671.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,247.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,310.12
|
| Rate for Payer: Nomi Health Commercial |
$1,497.28
|
| Rate for Payer: PACE SWMI |
$1,247.73
|
| Rate for Payer: PHP Commercial |
$1,746.82
|
| Rate for Payer: PHP Medicare Advantage |
$1,247.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,909.70
|
| Rate for Payer: Priority Health Medicare |
$1,247.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,247.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,247.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,351.48
|
|
|
PR SUTR LG INTESTINE 1/MULT PERFORAT W/O COLOSTOMY
|
Professional
|
Both
|
$3,081.00
|
|
|
Service Code
|
HCPCS 44604
|
| Min. Negotiated Rate |
$1,020.78 |
| Max. Negotiated Rate |
$2,002.65 |
| Rate for Payer: Aetna Commercial |
$1,367.85
|
| Rate for Payer: Aetna Medicare |
$1,061.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,469.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,367.85
|
| Rate for Payer: BCBS Complete |
$1,232.40
|
| Rate for Payer: BCBS MAPPO |
$1,020.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,020.78
|
| Rate for Payer: Cash Price |
$2,464.80
|
| Rate for Payer: Cash Price |
$2,464.80
|
| Rate for Payer: Cofinity Commercial |
$1,469.92
|
| Rate for Payer: Cofinity Commercial |
$1,367.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,020.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,071.82
|
| Rate for Payer: Nomi Health Commercial |
$1,224.94
|
| Rate for Payer: PACE SWMI |
$1,020.78
|
| Rate for Payer: PHP Commercial |
$1,429.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,020.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,002.65
|
| Rate for Payer: Priority Health Medicare |
$1,020.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,020.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,020.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,417.26
|
|
|
PR SUTR&/LIG THORACIC DUCT THORACIC APPROACH
|
Professional
|
Both
|
$5,927.00
|
|
|
Service Code
|
HCPCS 38381
|
| Min. Negotiated Rate |
$780.23 |
| Max. Negotiated Rate |
$3,852.55 |
| Rate for Payer: Aetna Commercial |
$1,045.51
|
| Rate for Payer: Aetna Medicare |
$811.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,123.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,045.51
|
| Rate for Payer: BCBS Complete |
$2,370.80
|
| Rate for Payer: BCBS MAPPO |
$780.23
|
| Rate for Payer: BCN Medicare Advantage |
$780.23
|
| Rate for Payer: Cash Price |
$4,741.60
|
| Rate for Payer: Cash Price |
$4,741.60
|
| Rate for Payer: Cofinity Commercial |
$1,123.53
|
| Rate for Payer: Cofinity Commercial |
$1,045.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$780.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$819.24
|
| Rate for Payer: Nomi Health Commercial |
$936.28
|
| Rate for Payer: PACE SWMI |
$780.23
|
| Rate for Payer: PHP Commercial |
$1,092.32
|
| Rate for Payer: PHP Medicare Advantage |
$780.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,852.55
|
| Rate for Payer: Priority Health Medicare |
$780.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$780.23
|
| Rate for Payer: UHC Medicare Advantage |
$780.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,726.42
|
|
|
PR SUTR NRV ITPRL W/WO GRF/DCMPRN LAT GENICULATE
|
Professional
|
Both
|
$2,055.00
|
|
|
Service Code
|
HCPCS 69740
|
| Min. Negotiated Rate |
$822.00 |
| Max. Negotiated Rate |
$1,571.83 |
| Rate for Payer: Aetna Commercial |
$1,462.68
|
| Rate for Payer: Aetna Medicare |
$1,135.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,571.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,462.68
|
| Rate for Payer: BCBS Complete |
$822.00
|
| Rate for Payer: BCBS MAPPO |
$1,091.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,091.55
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cofinity Commercial |
$1,571.83
|
| Rate for Payer: Cofinity Commercial |
$1,462.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,091.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,146.13
|
| Rate for Payer: Nomi Health Commercial |
$1,309.86
|
| Rate for Payer: PACE SWMI |
$1,091.55
|
| Rate for Payer: PHP Commercial |
$1,528.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,091.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,335.75
|
| Rate for Payer: Priority Health Medicare |
$1,091.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,091.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,091.55
|
| Rate for Payer: UMR Bronson Commercial |
$945.30
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS
|
Professional
|
Both
|
$3,175.00
|
|
|
Service Code
|
HCPCS 64857
|
| Min. Negotiated Rate |
$1,008.34 |
| Max. Negotiated Rate |
$2,063.75 |
| Rate for Payer: Aetna Commercial |
$1,351.18
|
| Rate for Payer: Aetna Medicare |
$1,048.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,452.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,351.18
|
| Rate for Payer: BCBS Complete |
$1,270.00
|
| Rate for Payer: BCBS MAPPO |
$1,008.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,008.34
|
| Rate for Payer: Cash Price |
$2,540.00
|
| Rate for Payer: Cash Price |
$2,540.00
|
| Rate for Payer: Cofinity Commercial |
$1,452.01
|
| Rate for Payer: Cofinity Commercial |
$1,351.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,008.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,058.76
|
| Rate for Payer: Nomi Health Commercial |
$1,210.01
|
| Rate for Payer: PACE SWMI |
$1,008.34
|
| Rate for Payer: PHP Commercial |
$1,411.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,008.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,063.75
|
| Rate for Payer: Priority Health Medicare |
$1,008.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,008.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,008.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,460.50
|
|
|
PR SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS
|
Professional
|
Both
|
$3,953.00
|
|
|
Service Code
|
HCPCS 64856
|
| Min. Negotiated Rate |
$974.79 |
| Max. Negotiated Rate |
$2,569.45 |
| Rate for Payer: Aetna Commercial |
$1,306.22
|
| Rate for Payer: Aetna Medicare |
$1,013.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,403.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,306.22
|
| Rate for Payer: BCBS Complete |
$1,581.20
|
| Rate for Payer: BCBS MAPPO |
$974.79
|
| Rate for Payer: BCN Medicare Advantage |
$974.79
|
| Rate for Payer: Cash Price |
$3,162.40
|
| Rate for Payer: Cash Price |
$3,162.40
|
| Rate for Payer: Cofinity Commercial |
$1,403.70
|
| Rate for Payer: Cofinity Commercial |
$1,306.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,023.53
|
| Rate for Payer: Nomi Health Commercial |
$1,169.75
|
| Rate for Payer: PACE SWMI |
$974.79
|
| Rate for Payer: PHP Commercial |
$1,364.71
|
| Rate for Payer: PHP Medicare Advantage |
$974.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,569.45
|
| Rate for Payer: Priority Health Medicare |
$974.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.79
|
| Rate for Payer: UHC Medicare Advantage |
$974.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,818.38
|
|
|
PR SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ
|
Professional
|
Both
|
$2,342.00
|
|
|
Service Code
|
HCPCS 27386
|
| Min. Negotiated Rate |
$821.35 |
| Max. Negotiated Rate |
$1,522.30 |
| Rate for Payer: Aetna Commercial |
$1,100.61
|
| Rate for Payer: Aetna Medicare |
$854.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.61
|
| Rate for Payer: BCBS Complete |
$936.80
|
| Rate for Payer: BCBS MAPPO |
$821.35
|
| Rate for Payer: BCN Medicare Advantage |
$821.35
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cash Price |
$1,873.60
|
| Rate for Payer: Cofinity Commercial |
$1,182.74
|
| Rate for Payer: Cofinity Commercial |
$1,100.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.42
|
| Rate for Payer: Nomi Health Commercial |
$985.62
|
| Rate for Payer: PACE SWMI |
$821.35
|
| Rate for Payer: PHP Commercial |
$1,149.89
|
| Rate for Payer: PHP Medicare Advantage |
$821.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,522.30
|
| Rate for Payer: Priority Health Medicare |
$821.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.35
|
| Rate for Payer: UHC Medicare Advantage |
$821.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,077.32
|
|
|
PR SUTR RPR AORTA/GRT VSL W/O SHUNT/CARD BYP
|
Professional
|
Both
|
$2,203.00
|
|
|
Service Code
|
HCPCS 33320
|
| Min. Negotiated Rate |
$881.20 |
| Max. Negotiated Rate |
$1,479.28 |
| Rate for Payer: Aetna Commercial |
$1,376.56
|
| Rate for Payer: Aetna Medicare |
$1,068.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,376.56
|
| Rate for Payer: BCBS Complete |
$881.20
|
| Rate for Payer: BCBS MAPPO |
$1,027.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,027.28
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Cash Price |
$1,762.40
|
| Rate for Payer: Cofinity Commercial |
$1,479.28
|
| Rate for Payer: Cofinity Commercial |
$1,376.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,027.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,078.64
|
| Rate for Payer: Nomi Health Commercial |
$1,232.74
|
| Rate for Payer: PACE SWMI |
$1,027.28
|
| Rate for Payer: PHP Commercial |
$1,438.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,027.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,431.95
|
| Rate for Payer: Priority Health Medicare |
$1,027.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,027.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,027.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,013.38
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC FULL THICK
|
Professional
|
Both
|
$1,151.00
|
|
|
Service Code
|
HCPCS 67935
|
| Min. Negotiated Rate |
$406.98 |
| Max. Negotiated Rate |
$748.15 |
| Rate for Payer: Aetna Commercial |
$545.35
|
| Rate for Payer: Aetna Medicare |
$423.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.35
|
| Rate for Payer: BCBS Complete |
$460.40
|
| Rate for Payer: BCBS MAPPO |
$406.98
|
| Rate for Payer: BCN Medicare Advantage |
$406.98
|
| Rate for Payer: Cash Price |
$920.80
|
| Rate for Payer: Cash Price |
$920.80
|
| Rate for Payer: Cofinity Commercial |
$586.05
|
| Rate for Payer: Cofinity Commercial |
$545.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.33
|
| Rate for Payer: Nomi Health Commercial |
$488.38
|
| Rate for Payer: PACE SWMI |
$406.98
|
| Rate for Payer: PHP Commercial |
$569.77
|
| Rate for Payer: PHP Medicare Advantage |
$406.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$748.15
|
| Rate for Payer: Priority Health Medicare |
$406.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.98
|
| Rate for Payer: UHC Medicare Advantage |
$406.98
|
| Rate for Payer: UMR Bronson Commercial |
$529.46
|
|
|
PR SUTR WND EYELID/MARGIN/TARSUS/CONJUNC PRTL THICK
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 67930
|
| Min. Negotiated Rate |
$219.58 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$294.24
|
| Rate for Payer: Aetna Medicare |
$228.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.24
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$219.58
|
| Rate for Payer: BCN Medicare Advantage |
$219.58
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$316.20
|
| Rate for Payer: Cofinity Commercial |
$294.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.56
|
| Rate for Payer: Nomi Health Commercial |
$263.50
|
| Rate for Payer: PACE SWMI |
$219.58
|
| Rate for Payer: PHP Commercial |
$307.41
|
| Rate for Payer: PHP Medicare Advantage |
$219.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$219.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.58
|
| Rate for Payer: UHC Medicare Advantage |
$219.58
|
| Rate for Payer: UMR Bronson Commercial |
$351.90
|
|
|
PR SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE
|
Professional
|
Both
|
$2,150.00
|
|
|
Service Code
|
HCPCS 64834
|
| Min. Negotiated Rate |
$717.69 |
| Max. Negotiated Rate |
$1,397.50 |
| Rate for Payer: Aetna Commercial |
$961.70
|
| Rate for Payer: Aetna Medicare |
$746.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.47
|
| Rate for Payer: BCBS Complete |
$860.00
|
| Rate for Payer: BCBS MAPPO |
$717.69
|
| Rate for Payer: BCN Medicare Advantage |
$717.69
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cash Price |
$1,720.00
|
| Rate for Payer: Cofinity Commercial |
$961.70
|
| Rate for Payer: Cofinity Commercial |
$1,033.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.57
|
| Rate for Payer: Nomi Health Commercial |
$861.23
|
| Rate for Payer: PACE SWMI |
$717.69
|
| Rate for Payer: PHP Commercial |
$1,004.77
|
| Rate for Payer: PHP Medicare Advantage |
$717.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,397.50
|
| Rate for Payer: Priority Health Medicare |
$717.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.69
|
| Rate for Payer: UHC Medicare Advantage |
$717.69
|
| Rate for Payer: UMR Bronson Commercial |
$989.00
|
|
|
PR SUTURE 1 NERVE MEDIAN MOTOR THENAR
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 64835
|
| Min. Negotiated Rate |
$787.47 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$1,055.21
|
| Rate for Payer: Aetna Medicare |
$818.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.21
|
| Rate for Payer: BCBS Complete |
$914.80
|
| Rate for Payer: BCBS MAPPO |
$787.47
|
| Rate for Payer: BCN Medicare Advantage |
$787.47
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$1,133.96
|
| Rate for Payer: Cofinity Commercial |
$1,055.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.84
|
| Rate for Payer: Nomi Health Commercial |
$944.96
|
| Rate for Payer: PACE SWMI |
$787.47
|
| Rate for Payer: PHP Commercial |
$1,102.46
|
| Rate for Payer: PHP Medicare Advantage |
$787.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health Medicare |
$787.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.47
|
| Rate for Payer: UHC Medicare Advantage |
$787.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,052.02
|
|
|
PR SUTURE 1 NERVE ULNAR MOTOR
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
HCPCS 64836
|
| Min. Negotiated Rate |
$722.00 |
| Max. Negotiated Rate |
$1,173.25 |
| Rate for Payer: Aetna Commercial |
$1,055.21
|
| Rate for Payer: Aetna Medicare |
$818.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.21
|
| Rate for Payer: BCBS Complete |
$722.00
|
| Rate for Payer: BCBS MAPPO |
$787.47
|
| Rate for Payer: BCN Medicare Advantage |
$787.47
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Cofinity Commercial |
$1,133.96
|
| Rate for Payer: Cofinity Commercial |
$1,055.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.84
|
| Rate for Payer: Nomi Health Commercial |
$944.96
|
| Rate for Payer: PACE SWMI |
$787.47
|
| Rate for Payer: PHP Commercial |
$1,102.46
|
| Rate for Payer: PHP Medicare Advantage |
$787.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.25
|
| Rate for Payer: Priority Health Medicare |
$787.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$787.47
|
| Rate for Payer: UHC Medicare Advantage |
$787.47
|
| Rate for Payer: UMR Bronson Commercial |
$830.30
|
|
|
PR SUTURE BRACHIAL PLEXUS
|
Professional
|
Both
|
$3,705.00
|
|
|
Service Code
|
HCPCS 64861
|
| Min. Negotiated Rate |
$1,482.00 |
| Max. Negotiated Rate |
$2,408.25 |
| Rate for Payer: Aetna Commercial |
$2,023.86
|
| Rate for Payer: Aetna Medicare |
$1,570.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,174.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,023.86
|
| Rate for Payer: BCBS Complete |
$1,482.00
|
| Rate for Payer: BCBS MAPPO |
$1,510.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.34
|
| Rate for Payer: Cash Price |
$2,964.00
|
| Rate for Payer: Cash Price |
$2,964.00
|
| Rate for Payer: Cofinity Commercial |
$2,174.89
|
| Rate for Payer: Cofinity Commercial |
$2,023.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,585.86
|
| Rate for Payer: Nomi Health Commercial |
$1,812.41
|
| Rate for Payer: PACE SWMI |
$1,510.34
|
| Rate for Payer: PHP Commercial |
$2,114.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,408.25
|
| Rate for Payer: Priority Health Medicare |
$1,510.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,510.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,510.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,704.30
|
|
