|
PR THROMBOLYSIS INTRACORONARY NFS SLCTV ANGRPH
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 92975
|
| Min. Negotiated Rate |
$317.20 |
| Max. Negotiated Rate |
$515.45 |
| Rate for Payer: Aetna Commercial |
$479.49
|
| Rate for Payer: Aetna Medicare |
$372.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$515.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.49
|
| Rate for Payer: BCBS Complete |
$317.20
|
| Rate for Payer: BCBS MAPPO |
$357.83
|
| Rate for Payer: BCN Medicare Advantage |
$357.83
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$515.28
|
| Rate for Payer: Cofinity Commercial |
$479.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.72
|
| Rate for Payer: Nomi Health Commercial |
$429.40
|
| Rate for Payer: PACE SWMI |
$357.83
|
| Rate for Payer: PHP Commercial |
$500.96
|
| Rate for Payer: PHP Medicare Advantage |
$357.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health Medicare |
$357.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.83
|
| Rate for Payer: UHC Medicare Advantage |
$357.83
|
| Rate for Payer: UMR Bronson Commercial |
$364.78
|
|
|
PR THROMBOLYSIS VENOUS INFUSION W/IMAGING INIT TX
|
Professional
|
Both
|
$1,611.00
|
|
|
Service Code
|
HCPCS 37212
|
| Min. Negotiated Rate |
$320.96 |
| Max. Negotiated Rate |
$1,047.15 |
| Rate for Payer: Aetna Commercial |
$430.09
|
| Rate for Payer: Aetna Medicare |
$333.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.09
|
| Rate for Payer: BCBS Complete |
$644.40
|
| Rate for Payer: BCBS MAPPO |
$320.96
|
| Rate for Payer: BCN Medicare Advantage |
$320.96
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cofinity Commercial |
$462.18
|
| Rate for Payer: Cofinity Commercial |
$430.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$337.01
|
| Rate for Payer: Nomi Health Commercial |
$385.15
|
| Rate for Payer: PACE SWMI |
$320.96
|
| Rate for Payer: PHP Commercial |
$449.34
|
| Rate for Payer: PHP Medicare Advantage |
$320.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,047.15
|
| Rate for Payer: Priority Health Medicare |
$320.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.96
|
| Rate for Payer: UHC Medicare Advantage |
$320.96
|
| Rate for Payer: UMR Bronson Commercial |
$741.06
|
|
|
PR THRSC CRTJ PRCRD WINDOW/PRTL RESCJ PRCRD SAC
|
Professional
|
Both
|
$3,708.00
|
|
|
Service Code
|
HCPCS 32659
|
| Min. Negotiated Rate |
$705.39 |
| Max. Negotiated Rate |
$2,410.20 |
| Rate for Payer: Aetna Commercial |
$945.22
|
| Rate for Payer: Aetna Medicare |
$733.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$945.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.76
|
| Rate for Payer: BCBS Complete |
$1,483.20
|
| Rate for Payer: BCBS MAPPO |
$705.39
|
| Rate for Payer: BCN Medicare Advantage |
$705.39
|
| Rate for Payer: Cash Price |
$2,966.40
|
| Rate for Payer: Cash Price |
$2,966.40
|
| Rate for Payer: Cofinity Commercial |
$945.22
|
| Rate for Payer: Cofinity Commercial |
$1,015.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$705.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$740.66
|
| Rate for Payer: Nomi Health Commercial |
$846.47
|
| Rate for Payer: PACE SWMI |
$705.39
|
| Rate for Payer: PHP Commercial |
$987.55
|
| Rate for Payer: PHP Medicare Advantage |
$705.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,410.20
|
| Rate for Payer: Priority Health Medicare |
$705.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$705.39
|
| Rate for Payer: UHC Medicare Advantage |
$705.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,705.68
|
|
|
PR THRSC TOT PULM DCRTCTJ INTRAPLEURAL PNEUMONOLSS
|
Professional
|
Both
|
$4,459.00
|
|
|
Service Code
|
HCPCS 32652
|
| Min. Negotiated Rate |
$1,596.19 |
| Max. Negotiated Rate |
$2,898.35 |
| Rate for Payer: Aetna Commercial |
$2,138.89
|
| Rate for Payer: Aetna Medicare |
$1,660.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,298.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,138.89
|
| Rate for Payer: BCBS Complete |
$1,783.60
|
| Rate for Payer: BCBS MAPPO |
$1,596.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,596.19
|
| Rate for Payer: Cash Price |
$3,567.20
|
| Rate for Payer: Cash Price |
$3,567.20
|
| Rate for Payer: Cofinity Commercial |
$2,298.51
|
| Rate for Payer: Cofinity Commercial |
$2,138.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,596.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,676.00
|
| Rate for Payer: Nomi Health Commercial |
$1,915.43
|
| Rate for Payer: PACE SWMI |
$1,596.19
|
| Rate for Payer: PHP Commercial |
$2,234.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,596.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,898.35
|
| Rate for Payer: Priority Health Medicare |
$1,596.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,596.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,596.19
|
| Rate for Payer: UMR Bronson Commercial |
$2,051.14
|
|
|
PR THYMECTOMY PRTL/TOT RAD MEDSTNL DSJ SPX
|
Professional
|
Both
|
$2,559.00
|
|
|
Service Code
|
HCPCS 60522
|
| Min. Negotiated Rate |
$1,023.60 |
| Max. Negotiated Rate |
$1,892.17 |
| Rate for Payer: Aetna Commercial |
$1,760.77
|
| Rate for Payer: Aetna Medicare |
$1,366.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,892.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,760.77
|
| Rate for Payer: BCBS Complete |
$1,023.60
|
| Rate for Payer: BCBS MAPPO |
$1,314.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,314.01
|
| Rate for Payer: Cash Price |
$2,047.20
|
| Rate for Payer: Cash Price |
$2,047.20
|
| Rate for Payer: Cofinity Commercial |
$1,892.17
|
| Rate for Payer: Cofinity Commercial |
$1,760.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,314.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,379.71
|
| Rate for Payer: Nomi Health Commercial |
$1,576.81
|
| Rate for Payer: PACE SWMI |
$1,314.01
|
| Rate for Payer: PHP Commercial |
$1,839.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,314.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,663.35
|
| Rate for Payer: Priority Health Medicare |
$1,314.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,314.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,314.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,177.14
|
|
|
PR THYMECTOMY PRTL/TOT TRANSCERVICAL APPR SPX
|
Professional
|
Both
|
$3,531.00
|
|
|
Service Code
|
HCPCS 60520
|
| Min. Negotiated Rate |
$1,017.60 |
| Max. Negotiated Rate |
$2,295.15 |
| Rate for Payer: Aetna Commercial |
$1,363.58
|
| Rate for Payer: Aetna Medicare |
$1,058.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,363.58
|
| Rate for Payer: BCBS Complete |
$1,412.40
|
| Rate for Payer: BCBS MAPPO |
$1,017.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,017.60
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cash Price |
$2,824.80
|
| Rate for Payer: Cofinity Commercial |
$1,465.34
|
| Rate for Payer: Cofinity Commercial |
$1,363.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,017.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.48
|
| Rate for Payer: Nomi Health Commercial |
$1,221.12
|
| Rate for Payer: PACE SWMI |
$1,017.60
|
| Rate for Payer: PHP Commercial |
$1,424.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,017.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,295.15
|
| Rate for Payer: Priority Health Medicare |
$1,017.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,017.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,017.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,624.26
|
|
|
PR THYMECTOMY PRTL/TOT W/O RAD MEDSTNL DSJ SPX
|
Professional
|
Both
|
$3,947.00
|
|
|
Service Code
|
HCPCS 60521
|
| Min. Negotiated Rate |
$1,085.03 |
| Max. Negotiated Rate |
$2,565.55 |
| Rate for Payer: Aetna Commercial |
$1,453.94
|
| Rate for Payer: Aetna Medicare |
$1,128.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,562.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,453.94
|
| Rate for Payer: BCBS Complete |
$1,578.80
|
| Rate for Payer: BCBS MAPPO |
$1,085.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,085.03
|
| Rate for Payer: Cash Price |
$3,157.60
|
| Rate for Payer: Cash Price |
$3,157.60
|
| Rate for Payer: Cofinity Commercial |
$1,562.44
|
| Rate for Payer: Cofinity Commercial |
$1,453.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,085.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,139.28
|
| Rate for Payer: Nomi Health Commercial |
$1,302.04
|
| Rate for Payer: PACE SWMI |
$1,085.03
|
| Rate for Payer: PHP Commercial |
$1,519.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,085.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,565.55
|
| Rate for Payer: Priority Health Medicare |
$1,085.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,085.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,085.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,815.62
|
|
|
PR THYROIDECTOMY RMVL REMAINING TISS FLWG PRTL RMVL
|
Professional
|
Both
|
$3,191.00
|
|
|
Service Code
|
HCPCS 60260
|
| Min. Negotiated Rate |
$1,048.26 |
| Max. Negotiated Rate |
$2,074.15 |
| Rate for Payer: Aetna Commercial |
$1,404.67
|
| Rate for Payer: Aetna Medicare |
$1,090.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,404.67
|
| Rate for Payer: BCBS Complete |
$1,276.40
|
| Rate for Payer: BCBS MAPPO |
$1,048.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.26
|
| Rate for Payer: Cash Price |
$2,552.80
|
| Rate for Payer: Cash Price |
$2,552.80
|
| Rate for Payer: Cofinity Commercial |
$1,509.49
|
| Rate for Payer: Cofinity Commercial |
$1,404.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.67
|
| Rate for Payer: Nomi Health Commercial |
$1,257.91
|
| Rate for Payer: PACE SWMI |
$1,048.26
|
| Rate for Payer: PHP Commercial |
$1,467.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,074.15
|
| Rate for Payer: Priority Health Medicare |
$1,048.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,467.86
|
|
|
PR THYROIDECTOMY SUBSTERNAL CERVICAL APPROACH
|
Professional
|
Both
|
$2,186.00
|
|
|
Service Code
|
HCPCS 60271
|
| Min. Negotiated Rate |
$874.40 |
| Max. Negotiated Rate |
$1,465.68 |
| Rate for Payer: Aetna Commercial |
$1,363.89
|
| Rate for Payer: Aetna Medicare |
$1,058.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,465.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,363.89
|
| Rate for Payer: BCBS Complete |
$874.40
|
| Rate for Payer: BCBS MAPPO |
$1,017.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,017.83
|
| Rate for Payer: Cash Price |
$1,748.80
|
| Rate for Payer: Cash Price |
$1,748.80
|
| Rate for Payer: Cofinity Commercial |
$1,465.68
|
| Rate for Payer: Cofinity Commercial |
$1,363.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,017.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.72
|
| Rate for Payer: Nomi Health Commercial |
$1,221.40
|
| Rate for Payer: PACE SWMI |
$1,017.83
|
| Rate for Payer: PHP Commercial |
$1,424.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,017.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,420.90
|
| Rate for Payer: Priority Health Medicare |
$1,017.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,017.83
|
| Rate for Payer: UHC Medicare Advantage |
$1,017.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,005.56
|
|
|
PR THYROIDECTOMY TOTAL/COMPLETE
|
Professional
|
Both
|
$3,110.00
|
|
|
Service Code
|
HCPCS 60240
|
| Min. Negotiated Rate |
$885.06 |
| Max. Negotiated Rate |
$2,021.50 |
| Rate for Payer: Aetna Commercial |
$1,185.98
|
| Rate for Payer: Aetna Medicare |
$920.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,274.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.98
|
| Rate for Payer: BCBS Complete |
$1,244.00
|
| Rate for Payer: BCBS MAPPO |
$885.06
|
| Rate for Payer: BCN Medicare Advantage |
$885.06
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Cofinity Commercial |
$1,274.49
|
| Rate for Payer: Cofinity Commercial |
$1,185.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$929.31
|
| Rate for Payer: Nomi Health Commercial |
$1,062.07
|
| Rate for Payer: PACE SWMI |
$885.06
|
| Rate for Payer: PHP Commercial |
$1,239.08
|
| Rate for Payer: PHP Medicare Advantage |
$885.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,021.50
|
| Rate for Payer: Priority Health Medicare |
$885.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.06
|
| Rate for Payer: UHC Medicare Advantage |
$885.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,430.60
|
|
|
PR THYROIDECTOMY TOTAL/SUBTOTAL LMTD NECK DISSECT
|
Professional
|
Both
|
$2,397.00
|
|
|
Service Code
|
HCPCS 60252
|
| Min. Negotiated Rate |
$958.80 |
| Max. Negotiated Rate |
$1,828.87 |
| Rate for Payer: Aetna Commercial |
$1,701.87
|
| Rate for Payer: Aetna Medicare |
$1,320.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,828.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,701.87
|
| Rate for Payer: BCBS Complete |
$958.80
|
| Rate for Payer: BCBS MAPPO |
$1,270.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,270.05
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cash Price |
$1,917.60
|
| Rate for Payer: Cofinity Commercial |
$1,828.87
|
| Rate for Payer: Cofinity Commercial |
$1,701.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,270.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,333.55
|
| Rate for Payer: Nomi Health Commercial |
$1,524.06
|
| Rate for Payer: PACE SWMI |
$1,270.05
|
| Rate for Payer: PHP Commercial |
$1,778.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,270.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,558.05
|
| Rate for Payer: Priority Health Medicare |
$1,270.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,270.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,270.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,102.62
|
|
|
PR THYROIDECTOMY TOTAL/SUBTOTAL RAD NECK DISSECT
|
Professional
|
Both
|
$3,161.00
|
|
|
Service Code
|
HCPCS 60254
|
| Min. Negotiated Rate |
$1,264.40 |
| Max. Negotiated Rate |
$2,312.50 |
| Rate for Payer: Aetna Commercial |
$2,151.91
|
| Rate for Payer: Aetna Medicare |
$1,670.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,312.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,151.91
|
| Rate for Payer: BCBS Complete |
$1,264.40
|
| Rate for Payer: BCBS MAPPO |
$1,605.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,605.90
|
| Rate for Payer: Cash Price |
$2,528.80
|
| Rate for Payer: Cash Price |
$2,528.80
|
| Rate for Payer: Cofinity Commercial |
$2,312.50
|
| Rate for Payer: Cofinity Commercial |
$2,151.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,605.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,686.19
|
| Rate for Payer: Nomi Health Commercial |
$1,927.08
|
| Rate for Payer: PACE SWMI |
$1,605.90
|
| Rate for Payer: PHP Commercial |
$2,248.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,605.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,054.65
|
| Rate for Payer: Priority Health Medicare |
$1,605.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,605.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,605.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,454.06
|
|
|
PR THYROIDECT W/SUBSTERNAL SPLIT/TRANSTHORACIC
|
Professional
|
Both
|
$5,453.00
|
|
|
Service Code
|
HCPCS 60270
|
| Min. Negotiated Rate |
$1,313.07 |
| Max. Negotiated Rate |
$3,544.45 |
| Rate for Payer: Aetna Commercial |
$1,759.51
|
| Rate for Payer: Aetna Medicare |
$1,365.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,890.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,759.51
|
| Rate for Payer: BCBS Complete |
$2,181.20
|
| Rate for Payer: BCBS MAPPO |
$1,313.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,313.07
|
| Rate for Payer: Cash Price |
$4,362.40
|
| Rate for Payer: Cash Price |
$4,362.40
|
| Rate for Payer: Cofinity Commercial |
$1,890.82
|
| Rate for Payer: Cofinity Commercial |
$1,759.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,313.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,378.72
|
| Rate for Payer: Nomi Health Commercial |
$1,575.68
|
| Rate for Payer: PACE SWMI |
$1,313.07
|
| Rate for Payer: PHP Commercial |
$1,838.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,313.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,544.45
|
| Rate for Payer: Priority Health Medicare |
$1,313.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,313.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,313.07
|
| Rate for Payer: UMR Bronson Commercial |
$2,508.38
|
|
|
PR TIS CLTR SKN AGRFT F/S/N/H/F/G/M/DGT 1ST 25SQCM/
|
Professional
|
Both
|
$1,325.00
|
|
|
Service Code
|
HCPCS 15155
|
| Min. Negotiated Rate |
$530.00 |
| Max. Negotiated Rate |
$1,002.76 |
| Rate for Payer: Aetna Commercial |
$933.12
|
| Rate for Payer: Aetna Medicare |
$724.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.76
|
| Rate for Payer: BCBS Complete |
$530.00
|
| Rate for Payer: BCBS MAPPO |
$696.36
|
| Rate for Payer: BCN Medicare Advantage |
$696.36
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cash Price |
$1,060.00
|
| Rate for Payer: Cofinity Commercial |
$933.12
|
| Rate for Payer: Cofinity Commercial |
$1,002.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$696.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$731.18
|
| Rate for Payer: Nomi Health Commercial |
$835.63
|
| Rate for Payer: PACE SWMI |
$696.36
|
| Rate for Payer: PHP Commercial |
$974.90
|
| Rate for Payer: PHP Medicare Advantage |
$696.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$861.25
|
| Rate for Payer: Priority Health Medicare |
$696.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$696.36
|
| Rate for Payer: UHC Medicare Advantage |
$696.36
|
| Rate for Payer: UMR Bronson Commercial |
$609.50
|
|
|
PR TIS CLTR SKN AGRFT F/S/N/H/F/G/M/DGT AD 1-75SQCM
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 15156
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Commercial |
$196.36
|
| Rate for Payer: Aetna Medicare |
$152.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.36
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$146.54
|
| Rate for Payer: BCN Medicare Advantage |
$146.54
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$211.02
|
| Rate for Payer: Cofinity Commercial |
$196.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.87
|
| Rate for Payer: Nomi Health Commercial |
$175.85
|
| Rate for Payer: PACE SWMI |
$146.54
|
| Rate for Payer: PHP Commercial |
$205.16
|
| Rate for Payer: PHP Medicare Advantage |
$146.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$146.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.54
|
| Rate for Payer: UHC Medicare Advantage |
$146.54
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
PR TISS CLTR SKIN AGRFT T/A/L EA ADD 100 SQCM/EA 1%
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 15152
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$200.45 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna Medicare |
$144.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.53
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$139.20
|
| Rate for Payer: BCN Medicare Advantage |
$139.20
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$200.45
|
| Rate for Payer: Cofinity Commercial |
$186.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.16
|
| Rate for Payer: Nomi Health Commercial |
$167.04
|
| Rate for Payer: PACE SWMI |
$139.20
|
| Rate for Payer: PHP Commercial |
$194.88
|
| Rate for Payer: PHP Medicare Advantage |
$139.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$139.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.20
|
| Rate for Payer: UHC Medicare Advantage |
$139.20
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR TISS CLTR SKIN AUTOGRAFT T/A/L 1ST 25 SQ CM/<
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 15150
|
| Min. Negotiated Rate |
$482.00 |
| Max. Negotiated Rate |
$890.04 |
| Rate for Payer: Aetna Commercial |
$828.23
|
| Rate for Payer: Aetna Medicare |
$642.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$890.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.23
|
| Rate for Payer: BCBS Complete |
$482.00
|
| Rate for Payer: BCBS MAPPO |
$618.08
|
| Rate for Payer: BCN Medicare Advantage |
$618.08
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cofinity Commercial |
$890.04
|
| Rate for Payer: Cofinity Commercial |
$828.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$618.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$648.98
|
| Rate for Payer: Nomi Health Commercial |
$741.70
|
| Rate for Payer: PACE SWMI |
$618.08
|
| Rate for Payer: PHP Commercial |
$865.31
|
| Rate for Payer: PHP Medicare Advantage |
$618.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$783.25
|
| Rate for Payer: Priority Health Medicare |
$618.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$618.08
|
| Rate for Payer: UHC Medicare Advantage |
$618.08
|
| Rate for Payer: UMR Bronson Commercial |
$554.30
|
|
|
PR TISS CLTR SKIN AUTOGRAFT T/A/L ADDL 1-75 SQCM
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 15151
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$152.84 |
| Rate for Payer: Aetna Commercial |
$142.23
|
| Rate for Payer: Aetna Medicare |
$110.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.23
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$106.14
|
| Rate for Payer: BCN Medicare Advantage |
$106.14
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$152.84
|
| Rate for Payer: Cofinity Commercial |
$142.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.45
|
| Rate for Payer: Nomi Health Commercial |
$127.37
|
| Rate for Payer: PACE SWMI |
$106.14
|
| Rate for Payer: PHP Commercial |
$148.60
|
| Rate for Payer: PHP Medicare Advantage |
$106.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health Medicare |
$106.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.14
|
| Rate for Payer: UHC Medicare Advantage |
$106.14
|
| Rate for Payer: UMR Bronson Commercial |
$105.80
|
|
|
PR TISSUE EXPANDER PLACEMENT BREAST RECONSTRUCTION
|
Professional
|
Both
|
$2,448.00
|
|
|
Service Code
|
HCPCS 19357
|
| Min. Negotiated Rate |
$979.20 |
| Max. Negotiated Rate |
$1,591.29 |
| Rate for Payer: Aetna Commercial |
$1,480.78
|
| Rate for Payer: Aetna Medicare |
$1,149.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,591.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,480.78
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS MAPPO |
$1,105.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,105.06
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,591.29
|
| Rate for Payer: Cofinity Commercial |
$1,480.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,105.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,160.31
|
| Rate for Payer: Nomi Health Commercial |
$1,326.07
|
| Rate for Payer: PACE SWMI |
$1,105.06
|
| Rate for Payer: PHP Commercial |
$1,547.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,105.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health Medicare |
$1,105.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,105.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,105.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,126.08
|
|
|
PR TIXAGEV AND CILGAV INJ
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS M0220
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP
|
Professional
|
Both
|
$3,605.00
|
|
|
Service Code
|
HCPCS 69637
|
| Min. Negotiated Rate |
$1,303.80 |
| Max. Negotiated Rate |
$2,343.25 |
| Rate for Payer: Aetna Commercial |
$1,747.09
|
| Rate for Payer: Aetna Medicare |
$1,355.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,747.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,877.47
|
| Rate for Payer: BCBS Complete |
$1,442.00
|
| Rate for Payer: BCBS MAPPO |
$1,303.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,303.80
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Cofinity Commercial |
$1,747.09
|
| Rate for Payer: Cofinity Commercial |
$1,877.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,303.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,368.99
|
| Rate for Payer: Nomi Health Commercial |
$1,564.56
|
| Rate for Payer: PACE SWMI |
$1,303.80
|
| Rate for Payer: PHP Commercial |
$1,825.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,303.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,343.25
|
| Rate for Payer: Priority Health Medicare |
$1,303.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,303.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,303.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,658.30
|
|
|
PR TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR
|
Professional
|
Both
|
$4,310.00
|
|
|
Service Code
|
HCPCS 69644
|
| Min. Negotiated Rate |
$1,406.10 |
| Max. Negotiated Rate |
$2,801.50 |
| Rate for Payer: Aetna Commercial |
$1,884.17
|
| Rate for Payer: Aetna Medicare |
$1,462.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,024.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,884.17
|
| Rate for Payer: BCBS Complete |
$1,724.00
|
| Rate for Payer: BCBS MAPPO |
$1,406.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,406.10
|
| Rate for Payer: Cash Price |
$3,448.00
|
| Rate for Payer: Cash Price |
$3,448.00
|
| Rate for Payer: Cofinity Commercial |
$2,024.78
|
| Rate for Payer: Cofinity Commercial |
$1,884.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,406.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,476.40
|
| Rate for Payer: Nomi Health Commercial |
$1,687.32
|
| Rate for Payer: PACE SWMI |
$1,406.10
|
| Rate for Payer: PHP Commercial |
$1,968.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,406.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,801.50
|
| Rate for Payer: Priority Health Medicare |
$1,406.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,406.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,406.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,982.60
|
|
|
PR TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR
|
Professional
|
Both
|
$4,076.00
|
|
|
Service Code
|
HCPCS 69643
|
| Min. Negotiated Rate |
$1,143.06 |
| Max. Negotiated Rate |
$2,649.40 |
| Rate for Payer: Aetna Commercial |
$1,531.70
|
| Rate for Payer: Aetna Medicare |
$1,188.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,646.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,531.70
|
| Rate for Payer: BCBS Complete |
$1,630.40
|
| Rate for Payer: BCBS MAPPO |
$1,143.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,143.06
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cash Price |
$3,260.80
|
| Rate for Payer: Cofinity Commercial |
$1,646.01
|
| Rate for Payer: Cofinity Commercial |
$1,531.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,143.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,200.21
|
| Rate for Payer: Nomi Health Commercial |
$1,371.67
|
| Rate for Payer: PACE SWMI |
$1,143.06
|
| Rate for Payer: PHP Commercial |
$1,600.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,143.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,649.40
|
| Rate for Payer: Priority Health Medicare |
$1,143.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,143.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,143.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,874.96
|
|
|
PR TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$3,931.00
|
|
|
Service Code
|
HCPCS 69641
|
| Min. Negotiated Rate |
$972.81 |
| Max. Negotiated Rate |
$2,555.15 |
| Rate for Payer: Aetna Commercial |
$1,303.57
|
| Rate for Payer: Aetna Medicare |
$1,011.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,400.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,303.57
|
| Rate for Payer: BCBS Complete |
$1,572.40
|
| Rate for Payer: BCBS MAPPO |
$972.81
|
| Rate for Payer: BCN Medicare Advantage |
$972.81
|
| Rate for Payer: Cash Price |
$3,144.80
|
| Rate for Payer: Cash Price |
$3,144.80
|
| Rate for Payer: Cofinity Commercial |
$1,400.85
|
| Rate for Payer: Cofinity Commercial |
$1,303.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$972.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,021.45
|
| Rate for Payer: Nomi Health Commercial |
$1,167.37
|
| Rate for Payer: PACE SWMI |
$972.81
|
| Rate for Payer: PHP Commercial |
$1,361.93
|
| Rate for Payer: PHP Medicare Advantage |
$972.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,555.15
|
| Rate for Payer: Priority Health Medicare |
$972.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$972.81
|
| Rate for Payer: UHC Medicare Advantage |
$972.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,808.26
|
|
|
PR TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$2,684.00
|
|
|
Service Code
|
HCPCS 69642
|
| Min. Negotiated Rate |
$1,073.60 |
| Max. Negotiated Rate |
$1,799.24 |
| Rate for Payer: Aetna Commercial |
$1,674.29
|
| Rate for Payer: Aetna Medicare |
$1,299.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,799.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,674.29
|
| Rate for Payer: BCBS Complete |
$1,073.60
|
| Rate for Payer: BCBS MAPPO |
$1,249.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,249.47
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cofinity Commercial |
$1,799.24
|
| Rate for Payer: Cofinity Commercial |
$1,674.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,249.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,311.94
|
| Rate for Payer: Nomi Health Commercial |
$1,499.36
|
| Rate for Payer: PACE SWMI |
$1,249.47
|
| Rate for Payer: PHP Commercial |
$1,749.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,249.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.60
|
| Rate for Payer: Priority Health Medicare |
$1,249.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,249.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,249.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,234.64
|
|
