|
PR VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT
|
Professional
|
Both
|
$749.00
|
|
|
Service Code
|
HCPCS 40500
|
| Min. Negotiated Rate |
$299.60 |
| Max. Negotiated Rate |
$504.07 |
| Rate for Payer: Aetna Commercial |
$469.07
|
| Rate for Payer: Aetna Medicare |
$364.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.07
|
| Rate for Payer: BCBS Complete |
$299.60
|
| Rate for Payer: BCBS MAPPO |
$350.05
|
| Rate for Payer: BCN Medicare Advantage |
$350.05
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cofinity Commercial |
$504.07
|
| Rate for Payer: Cofinity Commercial |
$469.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.55
|
| Rate for Payer: Nomi Health Commercial |
$420.06
|
| Rate for Payer: PACE SWMI |
$350.05
|
| Rate for Payer: PHP Commercial |
$490.07
|
| Rate for Payer: PHP Medicare Advantage |
$350.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.85
|
| Rate for Payer: Priority Health Medicare |
$350.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.05
|
| Rate for Payer: UHC Medicare Advantage |
$350.05
|
| Rate for Payer: UMR Bronson Commercial |
$344.54
|
|
|
PR VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG
|
Professional
|
Both
|
$8,574.00
|
|
|
Service Code
|
HCPCS 63102
|
| Min. Negotiated Rate |
$2,252.37 |
| Max. Negotiated Rate |
$5,573.10 |
| Rate for Payer: Aetna Commercial |
$3,018.18
|
| Rate for Payer: Aetna Medicare |
$2,342.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,243.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,018.18
|
| Rate for Payer: BCBS Complete |
$3,429.60
|
| Rate for Payer: BCBS MAPPO |
$2,252.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,252.37
|
| Rate for Payer: Cash Price |
$6,859.20
|
| Rate for Payer: Cash Price |
$6,859.20
|
| Rate for Payer: Cofinity Commercial |
$3,243.41
|
| Rate for Payer: Cofinity Commercial |
$3,018.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,252.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,364.99
|
| Rate for Payer: Nomi Health Commercial |
$2,702.84
|
| Rate for Payer: PACE SWMI |
$2,252.37
|
| Rate for Payer: PHP Commercial |
$3,153.32
|
| Rate for Payer: PHP Medicare Advantage |
$2,252.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,573.10
|
| Rate for Payer: Priority Health Medicare |
$2,252.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,252.37
|
| Rate for Payer: UHC Medicare Advantage |
$2,252.37
|
| Rate for Payer: UMR Bronson Commercial |
$3,944.04
|
|
|
PR VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG
|
Professional
|
Both
|
$4,871.00
|
|
|
Service Code
|
HCPCS 63101
|
| Min. Negotiated Rate |
$1,948.40 |
| Max. Negotiated Rate |
$3,283.53 |
| Rate for Payer: Aetna Commercial |
$3,055.51
|
| Rate for Payer: Aetna Medicare |
$2,371.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,283.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,055.51
|
| Rate for Payer: BCBS Complete |
$1,948.40
|
| Rate for Payer: BCBS MAPPO |
$2,280.23
|
| Rate for Payer: BCN Medicare Advantage |
$2,280.23
|
| Rate for Payer: Cash Price |
$3,896.80
|
| Rate for Payer: Cash Price |
$3,896.80
|
| Rate for Payer: Cofinity Commercial |
$3,283.53
|
| Rate for Payer: Cofinity Commercial |
$3,055.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,280.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,394.24
|
| Rate for Payer: Nomi Health Commercial |
$2,736.28
|
| Rate for Payer: PACE SWMI |
$2,280.23
|
| Rate for Payer: PHP Commercial |
$3,192.32
|
| Rate for Payer: PHP Medicare Advantage |
$2,280.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,166.15
|
| Rate for Payer: Priority Health Medicare |
$2,280.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,280.23
|
| Rate for Payer: UHC Medicare Advantage |
$2,280.23
|
| Rate for Payer: UMR Bronson Commercial |
$2,240.66
|
|
|
PR VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG
|
Professional
|
Both
|
$6,437.00
|
|
|
Service Code
|
HCPCS 63081
|
| Min. Negotiated Rate |
$1,729.63 |
| Max. Negotiated Rate |
$4,184.05 |
| Rate for Payer: Aetna Commercial |
$2,317.70
|
| Rate for Payer: Aetna Medicare |
$1,798.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,490.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,317.70
|
| Rate for Payer: BCBS Complete |
$2,574.80
|
| Rate for Payer: BCBS MAPPO |
$1,729.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,729.63
|
| Rate for Payer: Cash Price |
$5,149.60
|
| Rate for Payer: Cash Price |
$5,149.60
|
| Rate for Payer: Cofinity Commercial |
$2,490.67
|
| Rate for Payer: Cofinity Commercial |
$2,317.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,729.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,816.11
|
| Rate for Payer: Nomi Health Commercial |
$2,075.56
|
| Rate for Payer: PACE SWMI |
$1,729.63
|
| Rate for Payer: PHP Commercial |
$2,421.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,729.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,184.05
|
| Rate for Payer: Priority Health Medicare |
$1,729.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,729.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,729.63
|
| Rate for Payer: UMR Bronson Commercial |
$2,961.02
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG
|
Professional
|
Both
|
$2,146.00
|
|
|
Service Code
|
HCPCS 63082
|
| Min. Negotiated Rate |
$260.12 |
| Max. Negotiated Rate |
$1,394.90 |
| Rate for Payer: Aetna Commercial |
$348.56
|
| Rate for Payer: Aetna Medicare |
$270.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.56
|
| Rate for Payer: BCBS Complete |
$858.40
|
| Rate for Payer: BCBS MAPPO |
$260.12
|
| Rate for Payer: BCN Medicare Advantage |
$260.12
|
| Rate for Payer: Cash Price |
$1,716.80
|
| Rate for Payer: Cash Price |
$1,716.80
|
| Rate for Payer: Cofinity Commercial |
$374.57
|
| Rate for Payer: Cofinity Commercial |
$348.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.13
|
| Rate for Payer: Nomi Health Commercial |
$312.14
|
| Rate for Payer: PACE SWMI |
$260.12
|
| Rate for Payer: PHP Commercial |
$364.17
|
| Rate for Payer: PHP Medicare Advantage |
$260.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.90
|
| Rate for Payer: Priority Health Medicare |
$260.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.12
|
| Rate for Payer: UHC Medicare Advantage |
$260.12
|
| Rate for Payer: UMR Bronson Commercial |
$987.16
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG
|
Professional
|
Both
|
$7,092.00
|
|
|
Service Code
|
HCPCS 63085
|
| Min. Negotiated Rate |
$1,891.77 |
| Max. Negotiated Rate |
$4,609.80 |
| Rate for Payer: Aetna Commercial |
$2,534.97
|
| Rate for Payer: Aetna Medicare |
$1,967.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,724.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,534.97
|
| Rate for Payer: BCBS Complete |
$2,836.80
|
| Rate for Payer: BCBS MAPPO |
$1,891.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,891.77
|
| Rate for Payer: Cash Price |
$5,673.60
|
| Rate for Payer: Cash Price |
$5,673.60
|
| Rate for Payer: Cofinity Commercial |
$2,724.15
|
| Rate for Payer: Cofinity Commercial |
$2,534.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,891.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,986.36
|
| Rate for Payer: Nomi Health Commercial |
$2,270.12
|
| Rate for Payer: PACE SWMI |
$1,891.77
|
| Rate for Payer: PHP Commercial |
$2,648.48
|
| Rate for Payer: PHP Medicare Advantage |
$1,891.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,609.80
|
| Rate for Payer: Priority Health Medicare |
$1,891.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,891.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,891.77
|
| Rate for Payer: UMR Bronson Commercial |
$3,262.32
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG
|
Professional
|
Both
|
$2,364.00
|
|
|
Service Code
|
HCPCS 63086
|
| Min. Negotiated Rate |
$186.51 |
| Max. Negotiated Rate |
$1,536.60 |
| Rate for Payer: Aetna Commercial |
$249.92
|
| Rate for Payer: Aetna Medicare |
$193.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.92
|
| Rate for Payer: BCBS Complete |
$945.60
|
| Rate for Payer: BCBS MAPPO |
$186.51
|
| Rate for Payer: BCN Medicare Advantage |
$186.51
|
| Rate for Payer: Cash Price |
$1,891.20
|
| Rate for Payer: Cash Price |
$1,891.20
|
| Rate for Payer: Cofinity Commercial |
$268.57
|
| Rate for Payer: Cofinity Commercial |
$249.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.84
|
| Rate for Payer: Nomi Health Commercial |
$223.81
|
| Rate for Payer: PACE SWMI |
$186.51
|
| Rate for Payer: PHP Commercial |
$261.11
|
| Rate for Payer: PHP Medicare Advantage |
$186.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,536.60
|
| Rate for Payer: Priority Health Medicare |
$186.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.51
|
| Rate for Payer: UHC Medicare Advantage |
$186.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,087.44
|
|
|
PR VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 63308
|
| Min. Negotiated Rate |
$313.23 |
| Max. Negotiated Rate |
$1,016.60 |
| Rate for Payer: Aetna Commercial |
$419.73
|
| Rate for Payer: Aetna Medicare |
$325.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.73
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$313.23
|
| Rate for Payer: BCN Medicare Advantage |
$313.23
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$451.05
|
| Rate for Payer: Cofinity Commercial |
$419.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.89
|
| Rate for Payer: Nomi Health Commercial |
$375.88
|
| Rate for Payer: PACE SWMI |
$313.23
|
| Rate for Payer: PHP Commercial |
$438.52
|
| Rate for Payer: PHP Medicare Advantage |
$313.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$313.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.23
|
| Rate for Payer: UHC Medicare Advantage |
$313.23
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
PR VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL
|
Professional
|
Both
|
$1,757.00
|
|
|
Service Code
|
HCPCS 22512
|
| Min. Negotiated Rate |
$199.05 |
| Max. Negotiated Rate |
$1,142.05 |
| Rate for Payer: Aetna Commercial |
$266.73
|
| Rate for Payer: Aetna Medicare |
$207.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.73
|
| Rate for Payer: BCBS Complete |
$702.80
|
| Rate for Payer: BCBS MAPPO |
$199.05
|
| Rate for Payer: BCN Medicare Advantage |
$199.05
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cofinity Commercial |
$286.63
|
| Rate for Payer: Cofinity Commercial |
$266.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.00
|
| Rate for Payer: Nomi Health Commercial |
$238.86
|
| Rate for Payer: PACE SWMI |
$199.05
|
| Rate for Payer: PHP Commercial |
$278.67
|
| Rate for Payer: PHP Medicare Advantage |
$199.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.05
|
| Rate for Payer: Priority Health Medicare |
$199.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.05
|
| Rate for Payer: UHC Medicare Advantage |
$199.05
|
| Rate for Payer: UMR Bronson Commercial |
$808.22
|
|
|
PR VESICULOTOMY COMPLICATED
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 55605
|
| Min. Negotiated Rate |
$332.00 |
| Max. Negotiated Rate |
$721.27 |
| Rate for Payer: Aetna Commercial |
$671.18
|
| Rate for Payer: Aetna Medicare |
$520.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.18
|
| Rate for Payer: BCBS Complete |
$332.00
|
| Rate for Payer: BCBS MAPPO |
$500.88
|
| Rate for Payer: BCN Medicare Advantage |
$500.88
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cofinity Commercial |
$721.27
|
| Rate for Payer: Cofinity Commercial |
$671.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$525.92
|
| Rate for Payer: Nomi Health Commercial |
$601.06
|
| Rate for Payer: PACE SWMI |
$500.88
|
| Rate for Payer: PHP Commercial |
$701.23
|
| Rate for Payer: PHP Medicare Advantage |
$500.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.50
|
| Rate for Payer: Priority Health Medicare |
$500.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$500.88
|
| Rate for Payer: UHC Medicare Advantage |
$500.88
|
| Rate for Payer: UMR Bronson Commercial |
$381.80
|
|
|
PR VESSEL MAPPING HEMO ACCESS
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS G0365
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Aetna Medicare |
$183.00
|
| Rate for Payer: BCBS Complete |
$146.40
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: UMR Bronson Commercial |
$168.36
|
|
|
PR VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV
|
Professional
|
Both
|
$3,629.00
|
|
|
Service Code
|
HCPCS 43640
|
| Min. Negotiated Rate |
$1,160.40 |
| Max. Negotiated Rate |
$2,358.85 |
| Rate for Payer: Aetna Commercial |
$1,554.94
|
| Rate for Payer: Aetna Medicare |
$1,206.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,554.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,670.98
|
| Rate for Payer: BCBS Complete |
$1,451.60
|
| Rate for Payer: BCBS MAPPO |
$1,160.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,160.40
|
| Rate for Payer: Cash Price |
$2,903.20
|
| Rate for Payer: Cash Price |
$2,903.20
|
| Rate for Payer: Cofinity Commercial |
$1,554.94
|
| Rate for Payer: Cofinity Commercial |
$1,670.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,160.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,218.42
|
| Rate for Payer: Nomi Health Commercial |
$1,392.48
|
| Rate for Payer: PACE SWMI |
$1,160.40
|
| Rate for Payer: PHP Commercial |
$1,624.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,160.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,358.85
|
| Rate for Payer: Priority Health Medicare |
$1,160.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,160.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,160.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,669.34
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 34845
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$566.15 |
| Rate for Payer: Aetna Medicare |
$435.50
|
| Rate for Payer: BCBS Complete |
$348.40
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.15
|
| Rate for Payer: UMR Bronson Commercial |
$400.66
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS
|
Professional
|
Both
|
$3,060.00
|
|
|
Service Code
|
HCPCS 34846
|
| Min. Negotiated Rate |
$1,224.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Aetna Medicare |
$1,530.00
|
| Rate for Payer: BCBS Complete |
$1,224.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,989.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,407.60
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS
|
Professional
|
Both
|
$5,100.00
|
|
|
Service Code
|
HCPCS 34847
|
| Min. Negotiated Rate |
$2,040.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Aetna Medicare |
$2,550.00
|
| Rate for Payer: BCBS Complete |
$2,040.00
|
| Rate for Payer: Cash Price |
$4,080.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,315.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,346.00
|
|
|
PR VISCO GEL SPACER - LARGE
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00039
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
|
PR VISCO GEL SPACER - MEDIUM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00038
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
|
PR VISCO GEL SPACER - SMALL
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00037
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
|
PR VISION EXAM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$18.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
PR VISION EXAM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna American Axle |
$33.15
|
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UMR Bronson Commercial |
$22.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.25
|
|
|
PR VISIT TO DETERM LDCT ELIG
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS G0296
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna Medicare |
$24.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.34
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$23.85
|
| Rate for Payer: BCN Medicare Advantage |
$23.85
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$34.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.04
|
| Rate for Payer: Nomi Health Commercial |
$28.62
|
| Rate for Payer: PACE SWMI |
$23.85
|
| Rate for Payer: PHP Commercial |
$33.39
|
| Rate for Payer: PHP Medicare Advantage |
$23.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health Medicare |
$23.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.85
|
| Rate for Payer: UHC Medicare Advantage |
$23.85
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
|
|
PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 95930
|
| Min. Negotiated Rate |
$59.52 |
| Max. Negotiated Rate |
$177.45 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: Aetna Medicare |
$61.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.76
|
| Rate for Payer: BCBS Complete |
$109.20
|
| Rate for Payer: BCBS MAPPO |
$59.52
|
| Rate for Payer: BCN Medicare Advantage |
$59.52
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$85.71
|
| Rate for Payer: Cofinity Commercial |
$79.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.50
|
| Rate for Payer: Nomi Health Commercial |
$71.42
|
| Rate for Payer: PACE SWMI |
$59.52
|
| Rate for Payer: PHP Commercial |
$83.33
|
| Rate for Payer: PHP Medicare Advantage |
$59.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health Medicare |
$59.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.52
|
| Rate for Payer: UHC Medicare Advantage |
$59.52
|
| Rate for Payer: UMR Bronson Commercial |
$125.58
|
|
|
PR VISUAL REINFORCEMENT AUDIOMETRY
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 92579
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Aetna Medicare |
$35.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.36
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$34.60
|
| Rate for Payer: BCN Medicare Advantage |
$34.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Cofinity Commercial |
$46.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.33
|
| Rate for Payer: Nomi Health Commercial |
$41.52
|
| Rate for Payer: PACE SWMI |
$34.60
|
| Rate for Payer: PHP Commercial |
$48.44
|
| Rate for Payer: PHP Medicare Advantage |
$34.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$34.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.60
|
| Rate for Payer: UHC Medicare Advantage |
$34.60
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
PR VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 94150
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
PR VITAMIN B12 INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3420
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.45
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$1.01
|
| Rate for Payer: BCN Medicare Advantage |
$1.01
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.06
|
| Rate for Payer: Nomi Health Commercial |
$1.21
|
| Rate for Payer: PACE SWMI |
$1.01
|
| Rate for Payer: PHP Commercial |
$1.41
|
| Rate for Payer: PHP Medicare Advantage |
$1.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$1.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.01
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
