|
PR TMVI W/PROSTHETIC VALVE PERCUTANEOUS APPROACH
|
Professional
|
Both
|
$3,759.00
|
|
|
Service Code
|
HCPCS 0483T
|
| Min. Negotiated Rate |
$1,503.60 |
| Max. Negotiated Rate |
$2,443.35 |
| Rate for Payer: Aetna Medicare |
$1,879.50
|
| Rate for Payer: BCBS Complete |
$1,503.60
|
| Rate for Payer: Cash Price |
$3,007.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,443.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,729.14
|
|
|
PR TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN
|
Professional
|
Both
|
$1,735.00
|
|
|
Service Code
|
HCPCS 27681
|
| Min. Negotiated Rate |
$490.12 |
| Max. Negotiated Rate |
$1,127.75 |
| Rate for Payer: Aetna Commercial |
$656.76
|
| Rate for Payer: Aetna Medicare |
$509.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$656.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.77
|
| Rate for Payer: BCBS Complete |
$694.00
|
| Rate for Payer: BCBS MAPPO |
$490.12
|
| Rate for Payer: BCN Medicare Advantage |
$490.12
|
| Rate for Payer: Cash Price |
$1,388.00
|
| Rate for Payer: Cash Price |
$1,388.00
|
| Rate for Payer: Cofinity Commercial |
$656.76
|
| Rate for Payer: Cofinity Commercial |
$705.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$514.63
|
| Rate for Payer: Nomi Health Commercial |
$588.14
|
| Rate for Payer: PACE SWMI |
$490.12
|
| Rate for Payer: PHP Commercial |
$686.17
|
| Rate for Payer: PHP Medicare Advantage |
$490.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.75
|
| Rate for Payer: Priority Health Medicare |
$490.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.12
|
| Rate for Payer: UHC Medicare Advantage |
$490.12
|
| Rate for Payer: UMR Bronson Commercial |
$798.10
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$510.73 |
| Max. Negotiated Rate |
$958.10 |
| Rate for Payer: Aetna Commercial |
$684.38
|
| Rate for Payer: Aetna Medicare |
$531.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.38
|
| Rate for Payer: BCBS Complete |
$589.60
|
| Rate for Payer: BCBS MAPPO |
$510.73
|
| Rate for Payer: BCN Medicare Advantage |
$510.73
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$684.38
|
| Rate for Payer: Cofinity Commercial |
$735.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.27
|
| Rate for Payer: Nomi Health Commercial |
$612.88
|
| Rate for Payer: PACE SWMI |
$510.73
|
| Rate for Payer: PHP Commercial |
$715.02
|
| Rate for Payer: PHP Medicare Advantage |
$510.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health Medicare |
$510.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.73
|
| Rate for Payer: UHC Medicare Advantage |
$510.73
|
| Rate for Payer: UMR Bronson Commercial |
$678.04
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 25295
|
| Min. Negotiated Rate |
$510.73 |
| Max. Negotiated Rate |
$958.10 |
| Rate for Payer: Aetna Commercial |
$684.38
|
| Rate for Payer: Aetna Medicare |
$531.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.38
|
| Rate for Payer: BCBS Complete |
$589.60
|
| Rate for Payer: BCBS MAPPO |
$510.73
|
| Rate for Payer: BCN Medicare Advantage |
$510.73
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$735.45
|
| Rate for Payer: Cofinity Commercial |
$684.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.27
|
| Rate for Payer: Nomi Health Commercial |
$612.88
|
| Rate for Payer: PACE SWMI |
$510.73
|
| Rate for Payer: PHP Commercial |
$715.02
|
| Rate for Payer: PHP Medicare Advantage |
$510.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health Medicare |
$510.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.73
|
| Rate for Payer: UHC Medicare Advantage |
$510.73
|
| Rate for Payer: UMR Bronson Commercial |
$678.04
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Facility
|
IP
|
$1,474.00
|
|
|
Service Code
|
CPT 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$648.56 |
| Max. Negotiated Rate |
$1,326.60 |
| Rate for Payer: Aetna American Axle |
$958.10
|
| Rate for Payer: Aetna Commercial |
$1,252.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.10
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$1,031.80
|
| Rate for Payer: Cofinity Commercial |
$1,267.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,031.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,179.20
|
| Rate for Payer: Healthscope Commercial |
$1,326.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,031.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,105.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,252.90
|
| Rate for Payer: PHP Commercial |
$1,252.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health SBD |
$928.62
|
| Rate for Payer: UMR Bronson Commercial |
$648.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,105.50
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Facility
|
OP
|
$1,474.00
|
|
|
Service Code
|
CPT 25295
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$545.38 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna American Axle |
$958.10
|
| Rate for Payer: Aetna Commercial |
$1,252.90
|
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cash Price |
$1,179.20
|
| Rate for Payer: Cofinity Commercial |
$1,267.64
|
| Rate for Payer: Cofinity Commercial |
$1,031.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,031.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,179.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,326.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,031.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,105.50
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,252.90
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$1,252.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health SBD |
$928.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: UMR Bronson Commercial |
$545.38
|
| Rate for Payer: VA VA |
$3,164.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,105.50
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 24358
|
| Min. Negotiated Rate |
$513.88 |
| Max. Negotiated Rate |
$1,012.05 |
| Rate for Payer: Aetna Commercial |
$688.60
|
| Rate for Payer: Aetna Medicare |
$534.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$688.60
|
| Rate for Payer: BCBS Complete |
$622.80
|
| Rate for Payer: BCBS MAPPO |
$513.88
|
| Rate for Payer: BCN Medicare Advantage |
$513.88
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cash Price |
$1,245.60
|
| Rate for Payer: Cofinity Commercial |
$739.99
|
| Rate for Payer: Cofinity Commercial |
$688.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$513.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$539.57
|
| Rate for Payer: Nomi Health Commercial |
$616.66
|
| Rate for Payer: PACE SWMI |
$513.88
|
| Rate for Payer: PHP Commercial |
$719.43
|
| Rate for Payer: PHP Medicare Advantage |
$513.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health Medicare |
$513.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$513.88
|
| Rate for Payer: UHC Medicare Advantage |
$513.88
|
| Rate for Payer: UMR Bronson Commercial |
$716.22
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 24359
|
| Min. Negotiated Rate |
$641.95 |
| Max. Negotiated Rate |
$1,204.45 |
| Rate for Payer: Aetna Commercial |
$860.21
|
| Rate for Payer: Aetna Medicare |
$667.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.21
|
| Rate for Payer: BCBS Complete |
$741.20
|
| Rate for Payer: BCBS MAPPO |
$641.95
|
| Rate for Payer: BCN Medicare Advantage |
$641.95
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$924.41
|
| Rate for Payer: Cofinity Commercial |
$860.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.05
|
| Rate for Payer: Nomi Health Commercial |
$770.34
|
| Rate for Payer: PACE SWMI |
$641.95
|
| Rate for Payer: PHP Commercial |
$898.73
|
| Rate for Payer: PHP Medicare Advantage |
$641.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health Medicare |
$641.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.95
|
| Rate for Payer: UHC Medicare Advantage |
$641.95
|
| Rate for Payer: UMR Bronson Commercial |
$852.38
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$685.61 |
| Max. Negotiated Rate |
$8,907.47 |
| Rate for Payer: Aetna American Axle |
$1,204.45
|
| Rate for Payer: Aetna Commercial |
$1,575.05
|
| Rate for Payer: Aetna Medicare |
$3,290.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,204.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,955.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,955.50
|
| Rate for Payer: BCBS Complete |
$1,780.92
|
| Rate for Payer: BCBS MAPPO |
$3,164.40
|
| Rate for Payer: BCN Medicare Advantage |
$3,164.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$1,297.10
|
| Rate for Payer: Cofinity Commercial |
$1,593.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,297.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,482.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,164.40
|
| Rate for Payer: Healthscope Commercial |
$1,667.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,297.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,389.75
|
| Rate for Payer: Mclaren Medicaid |
$1,696.12
|
| Rate for Payer: Mclaren Medicare |
$3,164.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,322.62
|
| Rate for Payer: Meridian Medicaid |
$1,780.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,639.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,575.05
|
| Rate for Payer: PACE Medicare |
$3,006.18
|
| Rate for Payer: PACE SWMI |
$3,164.40
|
| Rate for Payer: PHP Commercial |
$1,575.05
|
| Rate for Payer: PHP Medicare Advantage |
$3,164.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,696.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health Medicare |
$3,164.40
|
| Rate for Payer: Priority Health SBD |
$1,167.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3,164.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,907.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,164.40
|
| Rate for Payer: UHC Exchange |
$6,047.48
|
| Rate for Payer: UHC Medicare Advantage |
$3,164.40
|
| Rate for Payer: UHCCP Medicaid |
$1,696.12
|
| Rate for Payer: UMR Bronson Commercial |
$685.61
|
| Rate for Payer: VA VA |
$3,164.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,389.75
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$641.95 |
| Max. Negotiated Rate |
$1,204.45 |
| Rate for Payer: Aetna Commercial |
$860.21
|
| Rate for Payer: Aetna Medicare |
$667.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$860.21
|
| Rate for Payer: BCBS Complete |
$741.20
|
| Rate for Payer: BCBS MAPPO |
$641.95
|
| Rate for Payer: BCN Medicare Advantage |
$641.95
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$924.41
|
| Rate for Payer: Cofinity Commercial |
$860.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.05
|
| Rate for Payer: Nomi Health Commercial |
$770.34
|
| Rate for Payer: PACE SWMI |
$641.95
|
| Rate for Payer: PHP Commercial |
$898.73
|
| Rate for Payer: PHP Medicare Advantage |
$641.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health Medicare |
$641.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.95
|
| Rate for Payer: UHC Medicare Advantage |
$641.95
|
| Rate for Payer: UMR Bronson Commercial |
$852.38
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 24359
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$815.32 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Aetna American Axle |
$1,204.45
|
| Rate for Payer: Aetna Commercial |
$1,575.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,204.45
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$1,297.10
|
| Rate for Payer: Cofinity Commercial |
$1,593.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,297.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,482.40
|
| Rate for Payer: Healthscope Commercial |
$1,667.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,297.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,389.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,575.05
|
| Rate for Payer: PHP Commercial |
$1,575.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health SBD |
$1,167.39
|
| Rate for Payer: UMR Bronson Commercial |
$815.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,389.75
|
|
|
PR TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,276.00
|
|
|
Service Code
|
HCPCS 25290
|
| Min. Negotiated Rate |
$423.48 |
| Max. Negotiated Rate |
$829.40 |
| Rate for Payer: Aetna Commercial |
$567.46
|
| Rate for Payer: Aetna Medicare |
$440.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.46
|
| Rate for Payer: BCBS Complete |
$510.40
|
| Rate for Payer: BCBS MAPPO |
$423.48
|
| Rate for Payer: BCN Medicare Advantage |
$423.48
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cofinity Commercial |
$609.81
|
| Rate for Payer: Cofinity Commercial |
$567.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.65
|
| Rate for Payer: Nomi Health Commercial |
$508.18
|
| Rate for Payer: PACE SWMI |
$423.48
|
| Rate for Payer: PHP Commercial |
$592.87
|
| Rate for Payer: PHP Medicare Advantage |
$423.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.40
|
| Rate for Payer: Priority Health Medicare |
$423.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.48
|
| Rate for Payer: UHC Medicare Advantage |
$423.48
|
| Rate for Payer: UMR Bronson Commercial |
$586.96
|
|
|
PR TOBACCO USE CESSATION INTENSIVE >10 MINUTES
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 99407
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$33.96 |
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Medicare |
$24.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.60
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$23.58
|
| Rate for Payer: BCN Medicare Advantage |
$23.58
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$31.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.76
|
| Rate for Payer: Nomi Health Commercial |
$28.30
|
| Rate for Payer: PACE SWMI |
$23.58
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Medicare Advantage |
$23.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Medicare |
$23.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.58
|
| Rate for Payer: UHC Medicare Advantage |
$23.58
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
|
|
PR TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 99406
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$14.97
|
| Rate for Payer: Aetna Medicare |
$11.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.97
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$11.17
|
| Rate for Payer: BCN Medicare Advantage |
$11.17
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| Rate for Payer: Cofinity Commercial |
$14.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.73
|
| Rate for Payer: Nomi Health Commercial |
$13.40
|
| Rate for Payer: PACE SWMI |
$11.17
|
| Rate for Payer: PHP Commercial |
$15.64
|
| Rate for Payer: PHP Medicare Advantage |
$11.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$11.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.17
|
| Rate for Payer: UHC Medicare Advantage |
$11.17
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR TOBACCO-USE COUNSEL>10MIN
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS G0437
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
|
PR TOBACCO-USE COUNSEL 3-10 MIN
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS G0436
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
|
|
PR TONE DECAY TEST
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 92563
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Aetna Commercial |
$42.37
|
| Rate for Payer: Aetna Medicare |
$32.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.37
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS MAPPO |
$31.62
|
| Rate for Payer: BCN Medicare Advantage |
$31.62
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$45.53
|
| Rate for Payer: Cofinity Commercial |
$42.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.20
|
| Rate for Payer: Nomi Health Commercial |
$37.94
|
| Rate for Payer: PACE SWMI |
$31.62
|
| Rate for Payer: PHP Commercial |
$44.27
|
| Rate for Payer: PHP Medicare Advantage |
$31.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health Medicare |
$31.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.62
|
| Rate for Payer: UHC Medicare Advantage |
$31.62
|
| Rate for Payer: UMR Bronson Commercial |
$26.22
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 42820
|
| Min. Negotiated Rate |
$279.29 |
| Max. Negotiated Rate |
$590.85 |
| Rate for Payer: Aetna Commercial |
$374.25
|
| Rate for Payer: Aetna Medicare |
$290.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.25
|
| Rate for Payer: BCBS Complete |
$363.60
|
| Rate for Payer: BCBS MAPPO |
$279.29
|
| Rate for Payer: BCN Medicare Advantage |
$279.29
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Cofinity Commercial |
$374.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.25
|
| Rate for Payer: Nomi Health Commercial |
$335.15
|
| Rate for Payer: PACE SWMI |
$279.29
|
| Rate for Payer: PHP Commercial |
$391.01
|
| Rate for Payer: PHP Medicare Advantage |
$279.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.85
|
| Rate for Payer: Priority Health Medicare |
$279.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.29
|
| Rate for Payer: UHC Medicare Advantage |
$279.29
|
| Rate for Payer: UMR Bronson Commercial |
$418.14
|
|
|
PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>
|
Professional
|
Both
|
$579.00
|
|
|
Service Code
|
HCPCS 42821
|
| Min. Negotiated Rate |
$231.60 |
| Max. Negotiated Rate |
$419.13 |
| Rate for Payer: Aetna Commercial |
$390.02
|
| Rate for Payer: Aetna Medicare |
$302.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$390.02
|
| Rate for Payer: BCBS Complete |
$231.60
|
| Rate for Payer: BCBS MAPPO |
$291.06
|
| Rate for Payer: BCN Medicare Advantage |
$291.06
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Cofinity Commercial |
$419.13
|
| Rate for Payer: Cofinity Commercial |
$390.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.61
|
| Rate for Payer: Nomi Health Commercial |
$349.27
|
| Rate for Payer: PACE SWMI |
$291.06
|
| Rate for Payer: PHP Commercial |
$407.48
|
| Rate for Payer: PHP Medicare Advantage |
$291.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$376.35
|
| Rate for Payer: Priority Health Medicare |
$291.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.06
|
| Rate for Payer: UHC Medicare Advantage |
$291.06
|
| Rate for Payer: UMR Bronson Commercial |
$266.34
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 42825
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$370.01 |
| Rate for Payer: Aetna Commercial |
$344.31
|
| Rate for Payer: Aetna Medicare |
$267.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$344.31
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$256.95
|
| Rate for Payer: BCN Medicare Advantage |
$256.95
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$370.01
|
| Rate for Payer: Cofinity Commercial |
$344.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.80
|
| Rate for Payer: Nomi Health Commercial |
$308.34
|
| Rate for Payer: PACE SWMI |
$256.95
|
| Rate for Payer: PHP Commercial |
$359.73
|
| Rate for Payer: PHP Medicare Advantage |
$256.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health Medicare |
$256.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.95
|
| Rate for Payer: UHC Medicare Advantage |
$256.95
|
| Rate for Payer: UMR Bronson Commercial |
$223.10
|
|
|
PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 42826
|
| Min. Negotiated Rate |
$189.20 |
| Max. Negotiated Rate |
$352.24 |
| Rate for Payer: Aetna Commercial |
$327.78
|
| Rate for Payer: Aetna Medicare |
$254.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.78
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCBS MAPPO |
$244.61
|
| Rate for Payer: BCN Medicare Advantage |
$244.61
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$352.24
|
| Rate for Payer: Cofinity Commercial |
$327.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.84
|
| Rate for Payer: Nomi Health Commercial |
$293.53
|
| Rate for Payer: PACE SWMI |
$244.61
|
| Rate for Payer: PHP Commercial |
$342.45
|
| Rate for Payer: PHP Medicare Advantage |
$244.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health Medicare |
$244.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$244.61
|
| Rate for Payer: UHC Medicare Advantage |
$244.61
|
| Rate for Payer: UMR Bronson Commercial |
$217.58
|
|
|
PR TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM
|
Professional
|
Both
|
$2,410.00
|
|
|
Service Code
|
HCPCS 58200
|
| Min. Negotiated Rate |
$964.00 |
| Max. Negotiated Rate |
$1,871.18 |
| Rate for Payer: Aetna Commercial |
$1,741.24
|
| Rate for Payer: Aetna Medicare |
$1,351.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,871.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,741.24
|
| Rate for Payer: BCBS Complete |
$964.00
|
| Rate for Payer: BCBS MAPPO |
$1,299.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,299.43
|
| Rate for Payer: Cash Price |
$1,928.00
|
| Rate for Payer: Cash Price |
$1,928.00
|
| Rate for Payer: Cofinity Commercial |
$1,871.18
|
| Rate for Payer: Cofinity Commercial |
$1,741.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,299.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,364.40
|
| Rate for Payer: Nomi Health Commercial |
$1,559.32
|
| Rate for Payer: PACE SWMI |
$1,299.43
|
| Rate for Payer: PHP Commercial |
$1,819.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,299.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,566.50
|
| Rate for Payer: Priority Health Medicare |
$1,299.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,299.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,299.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,108.60
|
|
|
PR TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY
|
Professional
|
Both
|
$3,357.00
|
|
|
Service Code
|
HCPCS 58152
|
| Min. Negotiated Rate |
$1,189.85 |
| Max. Negotiated Rate |
$2,182.05 |
| Rate for Payer: Aetna Commercial |
$1,594.40
|
| Rate for Payer: Aetna Medicare |
$1,237.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,713.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,594.40
|
| Rate for Payer: BCBS Complete |
$1,342.80
|
| Rate for Payer: BCBS MAPPO |
$1,189.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,189.85
|
| Rate for Payer: Cash Price |
$2,685.60
|
| Rate for Payer: Cash Price |
$2,685.60
|
| Rate for Payer: Cofinity Commercial |
$1,713.38
|
| Rate for Payer: Cofinity Commercial |
$1,594.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,189.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,249.34
|
| Rate for Payer: Nomi Health Commercial |
$1,427.82
|
| Rate for Payer: PACE SWMI |
$1,189.85
|
| Rate for Payer: PHP Commercial |
$1,665.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,189.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,182.05
|
| Rate for Payer: Priority Health Medicare |
$1,189.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,189.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,189.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,544.22
|
|
|
PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$3,216.00
|
|
|
Service Code
|
HCPCS 58150
|
| Min. Negotiated Rate |
$979.07 |
| Max. Negotiated Rate |
$2,090.40 |
| Rate for Payer: Aetna Commercial |
$1,311.95
|
| Rate for Payer: Aetna Medicare |
$1,018.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,409.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,311.95
|
| Rate for Payer: BCBS Complete |
$1,286.40
|
| Rate for Payer: BCBS MAPPO |
$979.07
|
| Rate for Payer: BCN Medicare Advantage |
$979.07
|
| Rate for Payer: Cash Price |
$2,572.80
|
| Rate for Payer: Cash Price |
$2,572.80
|
| Rate for Payer: Cofinity Commercial |
$1,409.86
|
| Rate for Payer: Cofinity Commercial |
$1,311.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,028.02
|
| Rate for Payer: Nomi Health Commercial |
$1,174.88
|
| Rate for Payer: PACE SWMI |
$979.07
|
| Rate for Payer: PHP Commercial |
$1,370.70
|
| Rate for Payer: PHP Medicare Advantage |
$979.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,090.40
|
| Rate for Payer: Priority Health Medicare |
$979.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.07
|
| Rate for Payer: UHC Medicare Advantage |
$979.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,479.36
|
|
|
PR TOTAL DISC ARTHRP ANT 2ND LEVEL CERVICAL
|
Professional
|
Both
|
$1,076.00
|
|
|
Service Code
|
HCPCS 22858
|
| Min. Negotiated Rate |
$430.40 |
| Max. Negotiated Rate |
$712.32 |
| Rate for Payer: Aetna Commercial |
$662.86
|
| Rate for Payer: Aetna Medicare |
$514.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$712.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.86
|
| Rate for Payer: BCBS Complete |
$430.40
|
| Rate for Payer: BCBS MAPPO |
$494.67
|
| Rate for Payer: BCN Medicare Advantage |
$494.67
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cofinity Commercial |
$712.32
|
| Rate for Payer: Cofinity Commercial |
$662.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$494.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$519.40
|
| Rate for Payer: Nomi Health Commercial |
$593.60
|
| Rate for Payer: PACE SWMI |
$494.67
|
| Rate for Payer: PHP Commercial |
$692.54
|
| Rate for Payer: PHP Medicare Advantage |
$494.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.40
|
| Rate for Payer: Priority Health Medicare |
$494.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$494.67
|
| Rate for Payer: UHC Medicare Advantage |
$494.67
|
| Rate for Payer: UMR Bronson Commercial |
$494.96
|
|
