|
PR TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 59136
|
| Min. Negotiated Rate |
$101.96 |
| Max. Negotiated Rate |
$1,324.80 |
| Rate for Payer: Aetna Commercial |
$1,177.90
|
| Rate for Payer: Aetna Medicare |
$914.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,177.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.80
|
| Rate for Payer: BCBS Complete |
$608.11
|
| Rate for Payer: BCBS MAPPO |
$879.03
|
| Rate for Payer: BCBS Trust/PPO |
$101.96
|
| Rate for Payer: BCN Commercial |
$1,324.80
|
| Rate for Payer: BCN Medicare Advantage |
$879.03
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cofinity Commercial |
$1,177.90
|
| Rate for Payer: Cofinity Commercial |
$1,265.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$879.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$922.98
|
| Rate for Payer: Meridian Medicaid |
$608.11
|
| Rate for Payer: Nomi Health Commercial |
$1,054.84
|
| Rate for Payer: PACE SWMI |
$879.03
|
| Rate for Payer: PHP Commercial |
$1,230.64
|
| Rate for Payer: PHP Medicare Advantage |
$879.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$579.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,181.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.67
|
| Rate for Payer: Priority Health Medicare |
$879.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,269.67
|
| Rate for Payer: Priority Health SBD |
$1,269.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$879.03
|
| Rate for Payer: UHC Medicare Advantage |
$879.03
|
| Rate for Payer: UHCCP Medicaid |
$579.15
|
| Rate for Payer: UMR Bronson Commercial |
$835.82
|
|
|
PR TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,467.00
|
|
|
Service Code
|
HCPCS 59121
|
| Min. Negotiated Rate |
$286.34 |
| Max. Negotiated Rate |
$1,203.12 |
| Rate for Payer: Aetna Commercial |
$1,067.91
|
| Rate for Payer: Aetna Medicare |
$828.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,067.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.61
|
| Rate for Payer: BCBS Complete |
$552.20
|
| Rate for Payer: BCBS MAPPO |
$796.95
|
| Rate for Payer: BCBS Trust/PPO |
$286.34
|
| Rate for Payer: BCN Commercial |
$1,203.12
|
| Rate for Payer: BCN Medicare Advantage |
$796.95
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cofinity Commercial |
$1,067.91
|
| Rate for Payer: Cofinity Commercial |
$1,147.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.80
|
| Rate for Payer: Meridian Medicaid |
$552.20
|
| Rate for Payer: Nomi Health Commercial |
$956.34
|
| Rate for Payer: PACE SWMI |
$796.95
|
| Rate for Payer: PHP Commercial |
$1,115.73
|
| Rate for Payer: PHP Medicare Advantage |
$796.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$525.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,153.69
|
| Rate for Payer: Priority Health Medicare |
$796.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,153.69
|
| Rate for Payer: Priority Health SBD |
$1,153.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.95
|
| Rate for Payer: UHC Medicare Advantage |
$796.95
|
| Rate for Payer: UHCCP Medicaid |
$525.90
|
| Rate for Payer: UMR Bronson Commercial |
$674.82
|
|
|
PR TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE
|
Professional
|
Both
|
$3,514.00
|
|
|
Service Code
|
HCPCS 24516
|
| Min. Negotiated Rate |
$345.51 |
| Max. Negotiated Rate |
$2,284.10 |
| Rate for Payer: Aetna Commercial |
$1,110.47
|
| Rate for Payer: Aetna Medicare |
$861.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,110.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.34
|
| Rate for Payer: BCBS Complete |
$586.64
|
| Rate for Payer: BCBS MAPPO |
$828.71
|
| Rate for Payer: BCBS Trust/PPO |
$345.51
|
| Rate for Payer: BCN Commercial |
$1,263.24
|
| Rate for Payer: BCN Medicare Advantage |
$828.71
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,110.47
|
| Rate for Payer: Cofinity Commercial |
$1,193.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$828.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$870.15
|
| Rate for Payer: Meridian Medicaid |
$586.64
|
| Rate for Payer: Nomi Health Commercial |
$994.45
|
| Rate for Payer: PACE SWMI |
$828.71
|
| Rate for Payer: PHP Commercial |
$1,160.19
|
| Rate for Payer: PHP Medicare Advantage |
$828.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,284.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,324.56
|
| Rate for Payer: Priority Health Medicare |
$828.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,324.56
|
| Rate for Payer: Priority Health SBD |
$1,324.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$828.71
|
| Rate for Payer: UHC Medicare Advantage |
$828.71
|
| Rate for Payer: UHCCP Medicaid |
$558.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,616.44
|
|
|
PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 59812
|
| Min. Negotiated Rate |
$198.73 |
| Max. Negotiated Rate |
$1,118.94 |
| Rate for Payer: Aetna Commercial |
$400.75
|
| Rate for Payer: Aetna Medicare |
$311.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.66
|
| Rate for Payer: BCBS Complete |
$208.67
|
| Rate for Payer: BCBS MAPPO |
$299.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.94
|
| Rate for Payer: BCN Commercial |
$536.56
|
| Rate for Payer: BCN Medicare Advantage |
$299.07
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$400.75
|
| Rate for Payer: Cofinity Commercial |
$430.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.02
|
| Rate for Payer: Meridian Medicaid |
$208.67
|
| Rate for Payer: Nomi Health Commercial |
$358.88
|
| Rate for Payer: PACE SWMI |
$299.07
|
| Rate for Payer: PHP Commercial |
$418.70
|
| Rate for Payer: PHP Medicare Advantage |
$299.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.49
|
| Rate for Payer: Priority Health Medicare |
$299.07
|
| Rate for Payer: Priority Health Narrow Network |
$435.49
|
| Rate for Payer: Priority Health SBD |
$435.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.07
|
| Rate for Payer: UHC Medicare Advantage |
$299.07
|
| Rate for Payer: UHCCP Medicaid |
$198.73
|
| Rate for Payer: UMR Bronson Commercial |
$351.90
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$4,106.00
|
|
|
Service Code
|
HCPCS 27245
|
| Min. Negotiated Rate |
$793.43 |
| Max. Negotiated Rate |
$2,668.90 |
| Rate for Payer: Aetna Commercial |
$1,582.58
|
| Rate for Payer: Aetna Medicare |
$1,228.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,700.68
|
| Rate for Payer: BCBS Complete |
$833.10
|
| Rate for Payer: BCBS MAPPO |
$1,181.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,447.01
|
| Rate for Payer: BCN Commercial |
$1,792.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,181.03
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cofinity Commercial |
$1,582.58
|
| Rate for Payer: Cofinity Commercial |
$1,700.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,181.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,240.08
|
| Rate for Payer: Meridian Medicaid |
$833.10
|
| Rate for Payer: Nomi Health Commercial |
$1,417.24
|
| Rate for Payer: PACE SWMI |
$1,181.03
|
| Rate for Payer: PHP Commercial |
$1,653.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,181.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$793.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,668.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,880.24
|
| Rate for Payer: Priority Health Medicare |
$1,181.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,880.24
|
| Rate for Payer: Priority Health SBD |
$1,880.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,181.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,181.03
|
| Rate for Payer: UHCCP Medicaid |
$793.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,888.76
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 27244
|
| Min. Negotiated Rate |
$794.49 |
| Max. Negotiated Rate |
$2,256.15 |
| Rate for Payer: Aetna Commercial |
$1,584.78
|
| Rate for Payer: Aetna Medicare |
$1,229.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,584.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,703.04
|
| Rate for Payer: BCBS Complete |
$834.21
|
| Rate for Payer: BCBS MAPPO |
$1,182.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,189.73
|
| Rate for Payer: BCN Commercial |
$1,976.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.67
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$1,584.78
|
| Rate for Payer: Cofinity Commercial |
$1,703.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,241.80
|
| Rate for Payer: Meridian Medicaid |
$834.21
|
| Rate for Payer: Nomi Health Commercial |
$1,419.20
|
| Rate for Payer: PACE SWMI |
$1,182.67
|
| Rate for Payer: PHP Commercial |
$1,655.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$794.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,882.79
|
| Rate for Payer: Priority Health Medicare |
$1,182.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,882.79
|
| Rate for Payer: Priority Health SBD |
$1,882.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,182.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,182.67
|
| Rate for Payer: UHCCP Medicaid |
$794.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,596.66
|
|
|
PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59820
|
| Min. Negotiated Rate |
$249.85 |
| Max. Negotiated Rate |
$1,022.79 |
| Rate for Payer: Aetna Commercial |
$498.55
|
| Rate for Payer: Aetna Medicare |
$386.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.75
|
| Rate for Payer: BCBS Complete |
$262.34
|
| Rate for Payer: BCBS MAPPO |
$372.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,022.79
|
| Rate for Payer: BCN Commercial |
$650.43
|
| Rate for Payer: BCN Medicare Advantage |
$372.05
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$498.55
|
| Rate for Payer: Cofinity Commercial |
$535.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.65
|
| Rate for Payer: Meridian Medicaid |
$262.34
|
| Rate for Payer: Nomi Health Commercial |
$446.46
|
| Rate for Payer: PACE SWMI |
$372.05
|
| Rate for Payer: PHP Commercial |
$520.87
|
| Rate for Payer: PHP Medicare Advantage |
$372.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.20
|
| Rate for Payer: Priority Health Medicare |
$372.05
|
| Rate for Payer: Priority Health Narrow Network |
$548.20
|
| Rate for Payer: Priority Health SBD |
$548.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.05
|
| Rate for Payer: UHC Medicare Advantage |
$372.05
|
| Rate for Payer: UHCCP Medicaid |
$249.85
|
| Rate for Payer: UMR Bronson Commercial |
$375.36
|
|
|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$2,210.41 |
| Rate for Payer: Aetna Commercial |
$489.76
|
| Rate for Payer: Aetna Medicare |
$380.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.31
|
| Rate for Payer: BCBS Complete |
$256.30
|
| Rate for Payer: BCBS MAPPO |
$365.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,210.41
|
| Rate for Payer: BCN Commercial |
$641.15
|
| Rate for Payer: BCN Medicare Advantage |
$365.49
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$489.76
|
| Rate for Payer: Cofinity Commercial |
$526.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$365.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$383.76
|
| Rate for Payer: Meridian Medicaid |
$256.30
|
| Rate for Payer: Nomi Health Commercial |
$438.59
|
| Rate for Payer: PACE SWMI |
$365.49
|
| Rate for Payer: PHP Commercial |
$511.69
|
| Rate for Payer: PHP Medicare Advantage |
$365.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$535.63
|
| Rate for Payer: Priority Health Medicare |
$365.49
|
| Rate for Payer: Priority Health Narrow Network |
$535.63
|
| Rate for Payer: Priority Health SBD |
$535.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$365.49
|
| Rate for Payer: UHC Medicare Advantage |
$365.49
|
| Rate for Payer: UHCCP Medicaid |
$244.10
|
| Rate for Payer: UMR Bronson Commercial |
$375.36
|
|
|
PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 28232
|
| Min. Negotiated Rate |
$156.77 |
| Max. Negotiated Rate |
$1,182.86 |
| Rate for Payer: Aetna Commercial |
$307.57
|
| Rate for Payer: Aetna Medicare |
$238.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.52
|
| Rate for Payer: BCBS Complete |
$164.61
|
| Rate for Payer: BCBS MAPPO |
$229.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,182.86
|
| Rate for Payer: BCN Commercial |
$547.32
|
| Rate for Payer: BCN Medicare Advantage |
$229.53
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cofinity Commercial |
$307.57
|
| Rate for Payer: Cofinity Commercial |
$330.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.01
|
| Rate for Payer: Meridian Medicaid |
$164.61
|
| Rate for Payer: Nomi Health Commercial |
$275.44
|
| Rate for Payer: PACE SWMI |
$229.53
|
| Rate for Payer: PHP Commercial |
$321.34
|
| Rate for Payer: PHP Medicare Advantage |
$229.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.48
|
| Rate for Payer: Priority Health Medicare |
$229.53
|
| Rate for Payer: Priority Health Narrow Network |
$372.48
|
| Rate for Payer: Priority Health SBD |
$372.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.53
|
| Rate for Payer: UHC Medicare Advantage |
$229.53
|
| Rate for Payer: UHCCP Medicaid |
$156.77
|
| Rate for Payer: UMR Bronson Commercial |
$292.10
|
|
|
PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
HCPCS 28230
|
| Min. Negotiated Rate |
$185.95 |
| Max. Negotiated Rate |
$920.30 |
| Rate for Payer: Aetna Commercial |
$366.42
|
| Rate for Payer: Aetna Medicare |
$284.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.77
|
| Rate for Payer: BCBS Complete |
$195.25
|
| Rate for Payer: BCBS MAPPO |
$273.45
|
| Rate for Payer: BCBS Trust/PPO |
$920.30
|
| Rate for Payer: BCN Commercial |
$630.40
|
| Rate for Payer: BCN Medicare Advantage |
$273.45
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cofinity Commercial |
$366.42
|
| Rate for Payer: Cofinity Commercial |
$393.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.12
|
| Rate for Payer: Meridian Medicaid |
$195.25
|
| Rate for Payer: Nomi Health Commercial |
$328.14
|
| Rate for Payer: PACE SWMI |
$273.45
|
| Rate for Payer: PHP Commercial |
$382.83
|
| Rate for Payer: PHP Medicare Advantage |
$273.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$185.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.15
|
| Rate for Payer: Priority Health Medicare |
$273.45
|
| Rate for Payer: Priority Health Narrow Network |
$439.15
|
| Rate for Payer: Priority Health SBD |
$439.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.45
|
| Rate for Payer: UHC Medicare Advantage |
$273.45
|
| Rate for Payer: UHCCP Medicaid |
$185.95
|
| Rate for Payer: UMR Bronson Commercial |
$285.66
|
|
|
PR TX SEPTIC ABORTION SURGICAL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 59830
|
| Min. Negotiated Rate |
$298.84 |
| Max. Negotiated Rate |
$1,227.77 |
| Rate for Payer: Aetna Commercial |
$602.02
|
| Rate for Payer: Aetna Medicare |
$467.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.95
|
| Rate for Payer: BCBS Complete |
$313.78
|
| Rate for Payer: BCBS MAPPO |
$449.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,227.77
|
| Rate for Payer: BCN Commercial |
$685.61
|
| Rate for Payer: BCN Medicare Advantage |
$449.27
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$602.02
|
| Rate for Payer: Cofinity Commercial |
$646.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.73
|
| Rate for Payer: Meridian Medicaid |
$313.78
|
| Rate for Payer: Nomi Health Commercial |
$539.12
|
| Rate for Payer: PACE SWMI |
$449.27
|
| Rate for Payer: PHP Commercial |
$628.98
|
| Rate for Payer: PHP Medicare Advantage |
$449.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$657.19
|
| Rate for Payer: Priority Health Medicare |
$449.27
|
| Rate for Payer: Priority Health Narrow Network |
$657.19
|
| Rate for Payer: Priority Health SBD |
$657.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.27
|
| Rate for Payer: UHC Medicare Advantage |
$449.27
|
| Rate for Payer: UHCCP Medicaid |
$298.84
|
| Rate for Payer: UMR Bronson Commercial |
$460.00
|
|
|
PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU
|
Professional
|
Both
|
$6,455.00
|
|
|
Service Code
|
HCPCS 27176
|
| Min. Negotiated Rate |
$600.23 |
| Max. Negotiated Rate |
$4,195.75 |
| Rate for Payer: Aetna Commercial |
$1,192.67
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,192.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,281.67
|
| Rate for Payer: BCBS Complete |
$630.24
|
| Rate for Payer: BCBS MAPPO |
$890.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,365.66
|
| Rate for Payer: BCN Commercial |
$1,355.11
|
| Rate for Payer: BCN Medicare Advantage |
$890.05
|
| Rate for Payer: Cash Price |
$5,164.00
|
| Rate for Payer: Cash Price |
$5,164.00
|
| Rate for Payer: Cofinity Commercial |
$1,192.67
|
| Rate for Payer: Cofinity Commercial |
$1,281.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.55
|
| Rate for Payer: Meridian Medicaid |
$630.24
|
| Rate for Payer: Nomi Health Commercial |
$1,068.06
|
| Rate for Payer: PACE SWMI |
$890.05
|
| Rate for Payer: PHP Commercial |
$1,246.07
|
| Rate for Payer: PHP Medicare Advantage |
$890.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$600.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,195.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,421.75
|
| Rate for Payer: Priority Health Medicare |
$890.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,421.75
|
| Rate for Payer: Priority Health SBD |
$1,421.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.05
|
| Rate for Payer: UHC Medicare Advantage |
$890.05
|
| Rate for Payer: UHCCP Medicaid |
$600.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,969.30
|
|
|
PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES
|
Professional
|
Both
|
$873.00
|
|
|
Service Code
|
HCPCS 27257
|
| Min. Negotiated Rate |
$234.30 |
| Max. Negotiated Rate |
$2,684.82 |
| Rate for Payer: Aetna Commercial |
$467.71
|
| Rate for Payer: Aetna Medicare |
$363.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.62
|
| Rate for Payer: BCBS Complete |
$246.02
|
| Rate for Payer: BCBS MAPPO |
$349.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,684.82
|
| Rate for Payer: BCN Commercial |
$528.75
|
| Rate for Payer: BCN Medicare Advantage |
$349.04
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cofinity Commercial |
$467.71
|
| Rate for Payer: Cofinity Commercial |
$502.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.49
|
| Rate for Payer: Meridian Medicaid |
$246.02
|
| Rate for Payer: Nomi Health Commercial |
$418.85
|
| Rate for Payer: PACE SWMI |
$349.04
|
| Rate for Payer: PHP Commercial |
$488.66
|
| Rate for Payer: PHP Medicare Advantage |
$349.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$234.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.68
|
| Rate for Payer: Priority Health Medicare |
$349.04
|
| Rate for Payer: Priority Health Narrow Network |
$555.68
|
| Rate for Payer: Priority Health SBD |
$555.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.04
|
| Rate for Payer: UHC Medicare Advantage |
$349.04
|
| Rate for Payer: UHCCP Medicaid |
$234.30
|
| Rate for Payer: UMR Bronson Commercial |
$401.58
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12020
|
| Hospital Charge Code |
12020
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$441.27 |
| Rate for Payer: Aetna Commercial |
$241.05
|
| Rate for Payer: Aetna Medicare |
$187.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.04
|
| Rate for Payer: BCBS Complete |
$127.93
|
| Rate for Payer: BCBS MAPPO |
$179.89
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$441.27
|
| Rate for Payer: BCN Medicare Advantage |
$179.89
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$259.04
|
| Rate for Payer: Cofinity Commercial |
$241.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.88
|
| Rate for Payer: Meridian Medicaid |
$127.93
|
| Rate for Payer: Nomi Health Commercial |
$215.87
|
| Rate for Payer: PACE SWMI |
$179.89
|
| Rate for Payer: PHP Commercial |
$251.85
|
| Rate for Payer: PHP Medicare Advantage |
$179.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.56
|
| Rate for Payer: Priority Health Medicare |
$179.89
|
| Rate for Payer: Priority Health Narrow Network |
$255.56
|
| Rate for Payer: Priority Health SBD |
$255.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.89
|
| Rate for Payer: UHC Medicare Advantage |
$179.89
|
| Rate for Payer: UHCCP Medicaid |
$121.84
|
| Rate for Payer: UMR Bronson Commercial |
$216.20
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Aetna American Axle |
$305.50
|
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health SBD |
$296.10
|
| Rate for Payer: UMR Bronson Commercial |
$206.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.50
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 12020
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$441.27 |
| Rate for Payer: Aetna Commercial |
$241.05
|
| Rate for Payer: Aetna Medicare |
$187.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.04
|
| Rate for Payer: BCBS Complete |
$127.93
|
| Rate for Payer: BCBS MAPPO |
$179.89
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$441.27
|
| Rate for Payer: BCN Medicare Advantage |
$179.89
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$241.05
|
| Rate for Payer: Cofinity Commercial |
$259.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.88
|
| Rate for Payer: Meridian Medicaid |
$127.93
|
| Rate for Payer: Nomi Health Commercial |
$215.87
|
| Rate for Payer: PACE SWMI |
$179.89
|
| Rate for Payer: PHP Commercial |
$251.85
|
| Rate for Payer: PHP Medicare Advantage |
$179.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$255.56
|
| Rate for Payer: Priority Health Medicare |
$179.89
|
| Rate for Payer: Priority Health Narrow Network |
$255.56
|
| Rate for Payer: Priority Health SBD |
$255.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.89
|
| Rate for Payer: UHC Medicare Advantage |
$179.89
|
| Rate for Payer: UHCCP Medicaid |
$121.84
|
| Rate for Payer: UMR Bronson Commercial |
$216.20
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
12020
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$173.90 |
| Max. Negotiated Rate |
$1,885.01 |
| Rate for Payer: Aetna American Axle |
$305.50
|
| Rate for Payer: Aetna Commercial |
$399.50
|
| Rate for Payer: Aetna Medicare |
$623.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$749.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$749.69
|
| Rate for Payer: BCBS Complete |
$337.54
|
| Rate for Payer: BCBS MAPPO |
$599.75
|
| Rate for Payer: BCBS Trust/PPO |
$651.59
|
| Rate for Payer: BCN Commercial |
$651.59
|
| Rate for Payer: BCN Medicare Advantage |
$599.75
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cofinity Commercial |
$329.00
|
| Rate for Payer: Cofinity Commercial |
$404.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$329.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.75
|
| Rate for Payer: Healthscope Commercial |
$423.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.50
|
| Rate for Payer: Mclaren Medicaid |
$321.47
|
| Rate for Payer: Mclaren Medicare |
$599.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$629.74
|
| Rate for Payer: Meridian Medicaid |
$337.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$689.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.50
|
| Rate for Payer: Nomi Health Commercial |
$1,259.48
|
| Rate for Payer: PACE Medicare |
$569.76
|
| Rate for Payer: PACE SWMI |
$599.75
|
| Rate for Payer: PHP Commercial |
$399.50
|
| Rate for Payer: PHP Medicare Advantage |
$599.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,885.01
|
| Rate for Payer: Priority Health Medicare |
$599.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,508.01
|
| Rate for Payer: Priority Health SBD |
$296.10
|
| Rate for Payer: Railroad Medicare Medicare |
$599.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.24
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$599.75
|
| Rate for Payer: UHC Exchange |
$180.22
|
| Rate for Payer: UHC Medicare Advantage |
$599.75
|
| Rate for Payer: UHCCP Medicaid |
$321.47
|
| Rate for Payer: UMR Bronson Commercial |
$173.90
|
| Rate for Payer: VA VA |
$599.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.50
|
|
|
PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 12021
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$259.98 |
| Rate for Payer: Aetna Commercial |
$178.51
|
| Rate for Payer: Aetna Medicare |
$138.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.84
|
| Rate for Payer: BCBS Complete |
$95.06
|
| Rate for Payer: BCBS MAPPO |
$133.22
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$259.98
|
| Rate for Payer: BCN Medicare Advantage |
$133.22
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$178.51
|
| Rate for Payer: Cofinity Commercial |
$191.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.88
|
| Rate for Payer: Meridian Medicaid |
$95.06
|
| Rate for Payer: Nomi Health Commercial |
$159.86
|
| Rate for Payer: PACE SWMI |
$133.22
|
| Rate for Payer: PHP Commercial |
$186.51
|
| Rate for Payer: PHP Medicare Advantage |
$133.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.89
|
| Rate for Payer: Priority Health Medicare |
$133.22
|
| Rate for Payer: Priority Health Narrow Network |
$191.89
|
| Rate for Payer: Priority Health SBD |
$191.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.22
|
| Rate for Payer: UHC Medicare Advantage |
$133.22
|
| Rate for Payer: UHCCP Medicaid |
$90.53
|
| Rate for Payer: UMR Bronson Commercial |
$160.54
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28455
|
| Min. Negotiated Rate |
$151.02 |
| Max. Negotiated Rate |
$1,001.66 |
| Rate for Payer: Aetna Commercial |
$295.30
|
| Rate for Payer: Aetna Medicare |
$229.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.33
|
| Rate for Payer: BCBS Complete |
$158.57
|
| Rate for Payer: BCBS MAPPO |
$220.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.66
|
| Rate for Payer: BCN Commercial |
$434.44
|
| Rate for Payer: BCN Medicare Advantage |
$220.37
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cofinity Commercial |
$295.30
|
| Rate for Payer: Cofinity Commercial |
$317.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.39
|
| Rate for Payer: Meridian Medicaid |
$158.57
|
| Rate for Payer: Nomi Health Commercial |
$264.44
|
| Rate for Payer: PACE SWMI |
$220.37
|
| Rate for Payer: PHP Commercial |
$308.52
|
| Rate for Payer: PHP Medicare Advantage |
$220.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$151.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$357.22
|
| Rate for Payer: Priority Health Medicare |
$220.37
|
| Rate for Payer: Priority Health Narrow Network |
$357.22
|
| Rate for Payer: Priority Health SBD |
$357.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.37
|
| Rate for Payer: UHC Medicare Advantage |
$220.37
|
| Rate for Payer: UHCCP Medicaid |
$151.02
|
| Rate for Payer: UMR Bronson Commercial |
$371.68
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$921.88 |
| Rate for Payer: Aetna Commercial |
$247.93
|
| Rate for Payer: Aetna Medicare |
$192.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.43
|
| Rate for Payer: BCBS Complete |
$134.19
|
| Rate for Payer: BCBS MAPPO |
$185.02
|
| Rate for Payer: BCBS Trust/PPO |
$921.88
|
| Rate for Payer: BCN Commercial |
$313.24
|
| Rate for Payer: BCN Medicare Advantage |
$185.02
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$247.93
|
| Rate for Payer: Cofinity Commercial |
$266.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.27
|
| Rate for Payer: Meridian Medicaid |
$134.19
|
| Rate for Payer: Nomi Health Commercial |
$222.02
|
| Rate for Payer: PACE SWMI |
$185.02
|
| Rate for Payer: PHP Commercial |
$259.03
|
| Rate for Payer: PHP Medicare Advantage |
$185.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.27
|
| Rate for Payer: Priority Health Medicare |
$185.02
|
| Rate for Payer: Priority Health Narrow Network |
$302.27
|
| Rate for Payer: Priority Health SBD |
$302.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.02
|
| Rate for Payer: UHC Medicare Advantage |
$185.02
|
| Rate for Payer: UHCCP Medicaid |
$127.80
|
| Rate for Payer: UMR Bronson Commercial |
$268.18
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$4,265.00
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$647.31 |
| Max. Negotiated Rate |
$2,772.25 |
| Rate for Payer: Aetna Commercial |
$1,288.91
|
| Rate for Payer: Aetna Medicare |
$1,000.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,288.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,385.09
|
| Rate for Payer: BCBS Complete |
$679.68
|
| Rate for Payer: BCBS MAPPO |
$961.87
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.30
|
| Rate for Payer: BCN Commercial |
$1,609.37
|
| Rate for Payer: BCN Medicare Advantage |
$961.87
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cofinity Commercial |
$1,288.91
|
| Rate for Payer: Cofinity Commercial |
$1,385.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$961.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,009.96
|
| Rate for Payer: Meridian Medicaid |
$679.68
|
| Rate for Payer: Nomi Health Commercial |
$1,154.24
|
| Rate for Payer: PACE SWMI |
$961.87
|
| Rate for Payer: PHP Commercial |
$1,346.62
|
| Rate for Payer: PHP Medicare Advantage |
$961.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$647.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,772.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,533.19
|
| Rate for Payer: Priority Health Medicare |
$961.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,533.19
|
| Rate for Payer: Priority Health SBD |
$1,533.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$961.87
|
| Rate for Payer: UHC Medicare Advantage |
$961.87
|
| Rate for Payer: UHCCP Medicaid |
$647.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,961.90
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$184.67 |
| Max. Negotiated Rate |
$4,016.66 |
| Rate for Payer: Aetna Commercial |
$366.87
|
| Rate for Payer: Aetna Medicare |
$284.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.24
|
| Rate for Payer: BCBS Complete |
$193.90
|
| Rate for Payer: BCBS MAPPO |
$273.78
|
| Rate for Payer: BCBS Trust/PPO |
$4,016.66
|
| Rate for Payer: BCN Commercial |
$565.40
|
| Rate for Payer: BCN Medicare Advantage |
$273.78
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Cofinity Commercial |
$366.87
|
| Rate for Payer: Cofinity Commercial |
$394.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.47
|
| Rate for Payer: Meridian Medicaid |
$193.90
|
| Rate for Payer: Nomi Health Commercial |
$328.54
|
| Rate for Payer: PACE SWMI |
$273.78
|
| Rate for Payer: PHP Commercial |
$383.29
|
| Rate for Payer: PHP Medicare Advantage |
$273.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$184.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$421.68
|
| Rate for Payer: Priority Health Medicare |
$273.78
|
| Rate for Payer: Priority Health Narrow Network |
$421.68
|
| Rate for Payer: Priority Health SBD |
$421.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.78
|
| Rate for Payer: UHC Medicare Advantage |
$273.78
|
| Rate for Payer: UHCCP Medicaid |
$184.67
|
| Rate for Payer: UMR Bronson Commercial |
$307.28
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$1,875.47 |
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.53
|
| Rate for Payer: BCBS Complete |
$7.16
|
| Rate for Payer: BCBS MAPPO |
$10.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,875.47
|
| Rate for Payer: BCN Commercial |
$23.95
|
| Rate for Payer: BCN Medicare Advantage |
$10.09
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.59
|
| Rate for Payer: Meridian Medicaid |
$7.16
|
| Rate for Payer: Nomi Health Commercial |
$12.11
|
| Rate for Payer: PACE SWMI |
$10.09
|
| Rate for Payer: PHP Commercial |
$14.13
|
| Rate for Payer: PHP Medicare Advantage |
$10.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.47
|
| Rate for Payer: Priority Health Medicare |
$10.09
|
| Rate for Payer: Priority Health Narrow Network |
$14.47
|
| Rate for Payer: Priority Health SBD |
$14.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.09
|
| Rate for Payer: UHC Medicare Advantage |
$10.09
|
| Rate for Payer: UHCCP Medicaid |
$6.82
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 92550
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$1,749.20 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Medicare |
$21.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.16
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$20.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.20
|
| Rate for Payer: BCN Commercial |
$32.25
|
| Rate for Payer: BCN Medicare Advantage |
$20.25
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$29.16
|
| Rate for Payer: Cofinity Commercial |
$27.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.26
|
| Rate for Payer: Nomi Health Commercial |
$24.30
|
| Rate for Payer: PACE SWMI |
$20.25
|
| Rate for Payer: PHP Commercial |
$28.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.40
|
| Rate for Payer: Priority Health Medicare |
$20.25
|
| Rate for Payer: Priority Health Narrow Network |
$29.40
|
| Rate for Payer: Priority Health SBD |
$29.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.25
|
| Rate for Payer: UHC Medicare Advantage |
$20.25
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR
|
Professional
|
Both
|
$2,793.00
|
|
|
Service Code
|
HCPCS 69646
|
| Min. Negotiated Rate |
$1,001.74 |
| Max. Negotiated Rate |
$2,319.26 |
| Rate for Payer: Aetna Commercial |
$1,957.90
|
| Rate for Payer: Aetna Medicare |
$1,519.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,104.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,957.90
|
| Rate for Payer: BCBS Complete |
$1,051.83
|
| Rate for Payer: BCBS MAPPO |
$1,461.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,089.35
|
| Rate for Payer: BCN Commercial |
$2,319.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,461.12
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cofinity Commercial |
$2,104.01
|
| Rate for Payer: Cofinity Commercial |
$1,957.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,461.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,534.18
|
| Rate for Payer: Meridian Medicaid |
$1,051.83
|
| Rate for Payer: Nomi Health Commercial |
$1,753.34
|
| Rate for Payer: PACE SWMI |
$1,461.12
|
| Rate for Payer: PHP Commercial |
$2,045.57
|
| Rate for Payer: PHP Medicare Advantage |
$1,461.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,001.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,815.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,300.07
|
| Rate for Payer: Priority Health Medicare |
$1,461.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,300.07
|
| Rate for Payer: Priority Health SBD |
$2,300.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,461.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,461.12
|
| Rate for Payer: UHCCP Medicaid |
$1,001.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,284.78
|
|
