|
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 |
$92.23 |
| Max. Negotiated Rate |
$6,614.63 |
| Rate for Payer: Aetna Commercial |
$186.53
|
| Rate for Payer: Aetna Medicare |
$144.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.45
|
| Rate for Payer: BCBS Complete |
$96.84
|
| Rate for Payer: BCBS MAPPO |
$139.20
|
| Rate for Payer: BCBS Trust/PPO |
$6,614.63
|
| Rate for Payer: BCN Commercial |
$218.44
|
| 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 |
$186.53
|
| Rate for Payer: Cofinity Commercial |
$200.45
|
| 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: Meridian Medicaid |
$96.84
|
| 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 Choice Medicaid |
$92.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.48
|
| Rate for Payer: Priority Health Medicare |
$139.20
|
| Rate for Payer: Priority Health Narrow Network |
$186.48
|
| Rate for Payer: Priority Health SBD |
$186.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.20
|
| Rate for Payer: UHC Medicare Advantage |
$139.20
|
| Rate for Payer: UHCCP Medicaid |
$92.23
|
| 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 |
$212.16 |
| Max. Negotiated Rate |
$1,035.02 |
| Rate for Payer: Aetna Commercial |
$828.23
|
| Rate for Payer: Aetna Medicare |
$642.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$828.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$890.04
|
| Rate for Payer: BCBS Complete |
$433.21
|
| Rate for Payer: BCBS MAPPO |
$618.08
|
| Rate for Payer: BCBS Trust/PPO |
$212.16
|
| Rate for Payer: BCN Commercial |
$1,035.02
|
| 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 |
$828.23
|
| Rate for Payer: Cofinity Commercial |
$890.04
|
| 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: Meridian Medicaid |
$433.21
|
| 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 Choice Medicaid |
$412.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$783.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$869.16
|
| Rate for Payer: Priority Health Medicare |
$618.08
|
| Rate for Payer: Priority Health Narrow Network |
$869.16
|
| Rate for Payer: Priority Health SBD |
$869.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$618.08
|
| Rate for Payer: UHC Medicare Advantage |
$618.08
|
| Rate for Payer: UHCCP Medicaid |
$412.58
|
| 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 |
$69.44 |
| Max. Negotiated Rate |
$206.12 |
| Rate for Payer: Aetna Commercial |
$142.23
|
| Rate for Payer: Aetna Medicare |
$110.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.84
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS MAPPO |
$106.14
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$172.50
|
| 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 |
$142.23
|
| Rate for Payer: Cofinity Commercial |
$152.84
|
| 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: Meridian Medicaid |
$72.91
|
| 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 Choice Medicaid |
$69.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.29
|
| Rate for Payer: Priority Health Medicare |
$106.14
|
| Rate for Payer: Priority Health Narrow Network |
$146.29
|
| Rate for Payer: Priority Health SBD |
$146.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.14
|
| Rate for Payer: UHC Medicare Advantage |
$106.14
|
| Rate for Payer: UHCCP Medicaid |
$69.44
|
| 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 |
$33.96 |
| Max. Negotiated Rate |
$1,696.69 |
| Rate for Payer: Aetna Commercial |
$1,480.78
|
| Rate for Payer: Aetna Medicare |
$1,149.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,480.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,591.29
|
| Rate for Payer: BCBS Complete |
$788.59
|
| Rate for Payer: BCBS MAPPO |
$1,105.06
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$1,696.69
|
| 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 |
$1,480.78
|
| Rate for Payer: Cofinity Commercial |
$1,591.29
|
| 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: Meridian Medicaid |
$788.59
|
| 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 Choice Medicaid |
$751.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,576.25
|
| Rate for Payer: Priority Health Medicare |
$1,105.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,576.25
|
| Rate for Payer: Priority Health SBD |
$1,576.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,105.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,105.06
|
| Rate for Payer: UHCCP Medicaid |
$751.04
|
| 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 |
$2,507.84 |
| Rate for Payer: Aetna Commercial |
$150.50
|
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.50
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,507.84
|
| Rate for Payer: BCN Commercial |
$99.03
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.93
|
| Rate for Payer: Priority Health Narrow Network |
$144.93
|
| Rate for Payer: Priority Health SBD |
$144.93
|
| 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 |
$896.94 |
| Max. Negotiated Rate |
$2,372.93 |
| 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 |
$941.79
|
| Rate for Payer: BCBS MAPPO |
$1,303.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,372.93
|
| Rate for Payer: BCN Commercial |
$2,072.97
|
| 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 |
$1,877.47
|
| Rate for Payer: Cofinity Commercial |
$1,747.09
|
| 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: Meridian Medicaid |
$941.79
|
| 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 Choice Medicaid |
$896.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,343.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,052.99
|
| Rate for Payer: Priority Health Medicare |
$1,303.80
|
| Rate for Payer: Priority Health Narrow Network |
$2,052.99
|
| Rate for Payer: Priority Health SBD |
$2,052.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,303.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,303.80
|
| Rate for Payer: UHCCP Medicaid |
$896.94
|
| 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 |
$964.89 |
| 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) |
$1,884.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,024.78
|
| Rate for Payer: BCBS Complete |
$1,013.13
|
| Rate for Payer: BCBS MAPPO |
$1,406.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,406.93
|
| Rate for Payer: BCN Commercial |
$2,226.41
|
| 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 |
$1,884.17
|
| Rate for Payer: Cofinity Commercial |
$2,024.78
|
| 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: Meridian Medicaid |
$1,013.13
|
| 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 Choice Medicaid |
$964.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,801.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,203.27
|
| Rate for Payer: Priority Health Medicare |
$1,406.10
|
| Rate for Payer: Priority Health Narrow Network |
$2,203.27
|
| Rate for Payer: Priority Health SBD |
$2,203.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,406.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,406.10
|
| Rate for Payer: UHCCP Medicaid |
$964.89
|
| 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 |
$780.01 |
| 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) |
$1,531.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,646.01
|
| Rate for Payer: BCBS Complete |
$819.01
|
| Rate for Payer: BCBS MAPPO |
$1,143.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,123.77
|
| Rate for Payer: BCN Commercial |
$1,808.60
|
| 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 |
$1,531.70
|
| Rate for Payer: Cofinity Commercial |
$1,646.01
|
| 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: Meridian Medicaid |
$819.01
|
| 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 Choice Medicaid |
$780.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,649.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,792.78
|
| Rate for Payer: Priority Health Medicare |
$1,143.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.78
|
| Rate for Payer: Priority Health SBD |
$1,792.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,143.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,143.06
|
| Rate for Payer: UHCCP Medicaid |
$780.01
|
| 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 |
$664.77 |
| 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) |
$1,303.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,400.85
|
| Rate for Payer: BCBS Complete |
$698.01
|
| Rate for Payer: BCBS MAPPO |
$972.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,242.56
|
| Rate for Payer: BCN Commercial |
$1,541.29
|
| 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 |
$1,303.57
|
| Rate for Payer: Cofinity Commercial |
$1,400.85
|
| 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: Meridian Medicaid |
$698.01
|
| 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 Choice Medicaid |
$664.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,555.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,528.68
|
| Rate for Payer: Priority Health Medicare |
$972.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,528.68
|
| Rate for Payer: Priority Health SBD |
$1,528.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$972.81
|
| Rate for Payer: UHC Medicare Advantage |
$972.81
|
| Rate for Payer: UHCCP Medicaid |
$664.77
|
| 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 |
$852.64 |
| Max. Negotiated Rate |
$1,975.73 |
| Rate for Payer: Aetna Commercial |
$1,674.29
|
| Rate for Payer: Aetna Medicare |
$1,299.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,674.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,799.24
|
| Rate for Payer: BCBS Complete |
$895.27
|
| Rate for Payer: BCBS MAPPO |
$1,249.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,237.81
|
| Rate for Payer: BCN Commercial |
$1,975.73
|
| 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 |
$1,674.29
|
| Rate for Payer: Cofinity Commercial |
$1,799.24
|
| 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: Meridian Medicaid |
$895.27
|
| 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 Choice Medicaid |
$852.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,962.04
|
| Rate for Payer: Priority Health Medicare |
$1,249.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,962.04
|
| Rate for Payer: Priority Health SBD |
$1,962.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,249.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,249.47
|
| Rate for Payer: UHCCP Medicaid |
$852.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,234.64
|
|
|
PR TMVI W/PROSTHETIC VALVE PERCUTANEOUS APPROACH
|
Professional
|
Both
|
$3,759.00
|
|
|
Service Code
|
HCPCS 0483T
|
| Min. Negotiated Rate |
$131.11 |
| Max. Negotiated Rate |
$2,443.35 |
| Rate for Payer: Aetna Commercial |
$1,415.73
|
| Rate for Payer: Aetna Medicare |
$1,879.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,415.73
|
| Rate for Payer: BCBS Complete |
$1,503.60
|
| Rate for Payer: BCBS Trust/PPO |
$131.11
|
| Rate for Payer: Cash Price |
$3,007.20
|
| 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 |
$332.49 |
| 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 |
$349.11
|
| Rate for Payer: BCBS MAPPO |
$490.12
|
| Rate for Payer: BCBS Trust/PPO |
$924.00
|
| Rate for Payer: BCN Commercial |
$742.30
|
| 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: Meridian Medicaid |
$349.11
|
| 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 Choice Medicaid |
$332.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,127.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$785.68
|
| Rate for Payer: Priority Health Medicare |
$490.12
|
| Rate for Payer: Priority Health Narrow Network |
$785.68
|
| Rate for Payer: Priority Health SBD |
$785.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$490.12
|
| Rate for Payer: UHC Medicare Advantage |
$490.12
|
| Rate for Payer: UHCCP Medicaid |
$332.49
|
| Rate for Payer: UMR Bronson Commercial |
$798.10
|
|
|
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 |
$511.93 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Aetna American Axle |
$958.10
|
| Rate for Payer: Aetna Commercial |
$1,252.90
|
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,263.01
|
| Rate for Payer: BCN Commercial |
$2,263.01
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,179.20
|
| 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 |
$3,179.00
|
| 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 |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,252.90
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$1,252.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Priority Health SBD |
$928.62
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.12
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$511.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: UMR Bronson Commercial |
$545.38
|
| Rate for Payer: VA VA |
$3,179.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,105.50
|
|
|
PR TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA
|
Professional
|
Both
|
$1,474.00
|
|
|
Service Code
|
HCPCS 25295
|
| Min. Negotiated Rate |
$347.40 |
| 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) |
$684.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.45
|
| Rate for Payer: BCBS Complete |
$364.77
|
| Rate for Payer: BCBS MAPPO |
$510.73
|
| Rate for Payer: BCBS Trust/PPO |
$803.02
|
| Rate for Payer: BCN Commercial |
$781.39
|
| 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: Meridian Medicaid |
$364.77
|
| 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 Choice Medicaid |
$347.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$821.30
|
| Rate for Payer: Priority Health Medicare |
$510.73
|
| Rate for Payer: Priority Health Narrow Network |
$821.30
|
| Rate for Payer: Priority Health SBD |
$821.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.73
|
| Rate for Payer: UHC Medicare Advantage |
$510.73
|
| Rate for Payer: UHCCP Medicaid |
$347.40
|
| 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
|
| Hospital Charge Code |
25295
|
| Min. Negotiated Rate |
$347.40 |
| 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) |
$684.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.45
|
| Rate for Payer: BCBS Complete |
$364.77
|
| Rate for Payer: BCBS MAPPO |
$510.73
|
| Rate for Payer: BCBS Trust/PPO |
$803.02
|
| Rate for Payer: BCN Commercial |
$781.39
|
| 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: Meridian Medicaid |
$364.77
|
| 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 Choice Medicaid |
$347.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$958.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$821.30
|
| Rate for Payer: Priority Health Medicare |
$510.73
|
| Rate for Payer: Priority Health Narrow Network |
$821.30
|
| Rate for Payer: Priority Health SBD |
$821.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.73
|
| Rate for Payer: UHC Medicare Advantage |
$510.73
|
| Rate for Payer: UHCCP Medicaid |
$347.40
|
| 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 TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN
|
Professional
|
Both
|
$1,557.00
|
|
|
Service Code
|
HCPCS 24358
|
| Min. Negotiated Rate |
$222.41 |
| 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) |
$688.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.99
|
| Rate for Payer: BCBS Complete |
$367.24
|
| Rate for Payer: BCBS MAPPO |
$513.88
|
| Rate for Payer: BCBS Trust/PPO |
$222.41
|
| Rate for Payer: BCN Commercial |
$783.35
|
| 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 |
$688.60
|
| Rate for Payer: Cofinity Commercial |
$739.99
|
| 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: Meridian Medicaid |
$367.24
|
| 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 Choice Medicaid |
$349.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,012.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$825.89
|
| Rate for Payer: Priority Health Medicare |
$513.88
|
| Rate for Payer: Priority Health Narrow Network |
$825.89
|
| Rate for Payer: Priority Health SBD |
$825.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$513.88
|
| Rate for Payer: UHC Medicare Advantage |
$513.88
|
| Rate for Payer: UHCCP Medicaid |
$349.75
|
| 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
|
| Hospital Charge Code |
24359
|
| Min. Negotiated Rate |
$191.45 |
| 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) |
$860.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.41
|
| Rate for Payer: BCBS Complete |
$456.47
|
| Rate for Payer: BCBS MAPPO |
$641.95
|
| Rate for Payer: BCBS Trust/PPO |
$191.45
|
| Rate for Payer: BCN Commercial |
$978.82
|
| 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 |
$860.21
|
| Rate for Payer: Cofinity Commercial |
$924.41
|
| 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: Meridian Medicaid |
$456.47
|
| 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 Choice Medicaid |
$434.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,029.94
|
| Rate for Payer: Priority Health Medicare |
$641.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.94
|
| Rate for Payer: Priority Health SBD |
$1,029.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.95
|
| Rate for Payer: UHC Medicare Advantage |
$641.95
|
| Rate for Payer: UHCCP Medicaid |
$434.73
|
| Rate for Payer: UMR Bronson Commercial |
$852.38
|
|
|
PR TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 24359
|
| Min. Negotiated Rate |
$191.45 |
| 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) |
$860.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.41
|
| Rate for Payer: BCBS Complete |
$456.47
|
| Rate for Payer: BCBS MAPPO |
$641.95
|
| Rate for Payer: BCBS Trust/PPO |
$191.45
|
| Rate for Payer: BCN Commercial |
$978.82
|
| 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 |
$860.21
|
| Rate for Payer: Cofinity Commercial |
$924.41
|
| 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: Meridian Medicaid |
$456.47
|
| 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 Choice Medicaid |
$434.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,029.94
|
| Rate for Payer: Priority Health Medicare |
$641.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.94
|
| Rate for Payer: Priority Health SBD |
$1,029.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.95
|
| Rate for Payer: UHC Medicare Advantage |
$641.95
|
| Rate for Payer: UHCCP Medicaid |
$434.73
|
| 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 |
$644.94 |
| Max. Negotiated Rate |
$9,991.56 |
| Rate for Payer: Aetna American Axle |
$1,204.45
|
| Rate for Payer: Aetna Commercial |
$1,575.05
|
| Rate for Payer: Aetna Medicare |
$3,306.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,204.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,973.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,973.75
|
| Rate for Payer: BCBS Complete |
$1,789.14
|
| Rate for Payer: BCBS MAPPO |
$3,179.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,396.83
|
| Rate for Payer: BCN Commercial |
$3,396.83
|
| Rate for Payer: BCN Medicare Advantage |
$3,179.00
|
| Rate for Payer: Cash Price |
$1,482.40
|
| 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 |
$3,179.00
|
| 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 |
$1,703.94
|
| Rate for Payer: Mclaren Medicare |
$3,179.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,337.95
|
| Rate for Payer: Meridian Medicaid |
$1,789.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,655.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,575.05
|
| Rate for Payer: Nomi Health Commercial |
$6,675.90
|
| Rate for Payer: PACE Medicare |
$3,020.05
|
| Rate for Payer: PACE SWMI |
$3,179.00
|
| Rate for Payer: PHP Commercial |
$1,575.05
|
| Rate for Payer: PHP Medicare Advantage |
$3,179.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,703.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,991.56
|
| Rate for Payer: Priority Health Medicare |
$3,179.00
|
| Rate for Payer: Priority Health Narrow Network |
$7,993.25
|
| Rate for Payer: Priority Health SBD |
$1,167.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3,179.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$709.43
|
| Rate for Payer: UHC Core |
$5,042.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,179.00
|
| Rate for Payer: UHC Exchange |
$644.94
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.00
|
| Rate for Payer: UHCCP Medicaid |
$1,703.94
|
| Rate for Payer: UMR Bronson Commercial |
$685.61
|
| Rate for Payer: VA VA |
$3,179.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,389.75
|
|
|
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 |
$288.62 |
| Max. Negotiated Rate |
$1,061.88 |
| Rate for Payer: Aetna Commercial |
$567.46
|
| Rate for Payer: Aetna Medicare |
$440.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.81
|
| Rate for Payer: BCBS Complete |
$303.05
|
| Rate for Payer: BCBS MAPPO |
$423.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.88
|
| Rate for Payer: BCN Commercial |
$646.52
|
| 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 |
$567.46
|
| Rate for Payer: Cofinity Commercial |
$609.81
|
| 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: Meridian Medicaid |
$303.05
|
| 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 Choice Medicaid |
$288.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$681.87
|
| Rate for Payer: Priority Health Medicare |
$423.48
|
| Rate for Payer: Priority Health Narrow Network |
$681.87
|
| Rate for Payer: Priority Health SBD |
$681.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.48
|
| Rate for Payer: UHC Medicare Advantage |
$423.48
|
| Rate for Payer: UHCCP Medicaid |
$288.62
|
| 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 |
$15.76 |
| Max. Negotiated Rate |
$1,526.79 |
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Medicare |
$24.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.96
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$23.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,526.79
|
| Rate for Payer: BCN Commercial |
$29.38
|
| 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 |
$31.60
|
| Rate for Payer: Cofinity Commercial |
$33.96
|
| 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: Meridian Medicaid |
$16.55
|
| 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 Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.20
|
| Rate for Payer: Priority Health Medicare |
$23.58
|
| Rate for Payer: Priority Health Narrow Network |
$33.20
|
| Rate for Payer: Priority Health SBD |
$33.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.58
|
| Rate for Payer: UHC Medicare Advantage |
$23.58
|
| Rate for Payer: UHCCP Medicaid |
$15.76
|
| 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 |
$7.46 |
| Max. Negotiated Rate |
$1,290.64 |
| Rate for Payer: Aetna Commercial |
$14.97
|
| Rate for Payer: Aetna Medicare |
$11.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.08
|
| Rate for Payer: BCBS Complete |
$7.83
|
| Rate for Payer: BCBS MAPPO |
$11.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.64
|
| Rate for Payer: BCN Commercial |
$15.76
|
| 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 |
$14.97
|
| Rate for Payer: Cofinity Commercial |
$16.08
|
| 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: Meridian Medicaid |
$7.83
|
| 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 Choice Medicaid |
$7.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.71
|
| Rate for Payer: Priority Health Medicare |
$11.17
|
| Rate for Payer: Priority Health Narrow Network |
$15.71
|
| Rate for Payer: Priority Health SBD |
$15.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.17
|
| Rate for Payer: UHC Medicare Advantage |
$11.17
|
| Rate for Payer: UHCCP Medicaid |
$7.46
|
| 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 |
$32.16 |
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.16
|
| Rate for Payer: Priority Health Narrow Network |
$32.16
|
| Rate for Payer: Priority Health SBD |
$32.16
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
