|
PR VITAMIN K PHYTONADIONE INJ
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3430
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.93 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna Medicare |
$2.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.66
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$2.73
|
| Rate for Payer: BCN Medicare Advantage |
$2.73
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.93
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.87
|
| Rate for Payer: Nomi Health Commercial |
$3.28
|
| Rate for Payer: PACE SWMI |
$2.73
|
| Rate for Payer: PHP Commercial |
$3.82
|
| Rate for Payer: PHP Medicare Advantage |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$2.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.73
|
| Rate for Payer: UHC Medicare Advantage |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING
|
Professional
|
Both
|
$5,124.00
|
|
|
Service Code
|
HCPCS 33427
|
| Min. Negotiated Rate |
$2,049.60 |
| Max. Negotiated Rate |
$3,362.20 |
| Rate for Payer: Aetna Commercial |
$3,128.71
|
| Rate for Payer: Aetna Medicare |
$2,428.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,362.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,128.71
|
| Rate for Payer: BCBS Complete |
$2,049.60
|
| Rate for Payer: BCBS MAPPO |
$2,334.86
|
| Rate for Payer: BCN Medicare Advantage |
$2,334.86
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Cofinity Commercial |
$3,362.20
|
| Rate for Payer: Cofinity Commercial |
$3,128.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,334.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,451.60
|
| Rate for Payer: Nomi Health Commercial |
$2,801.83
|
| Rate for Payer: PACE SWMI |
$2,334.86
|
| Rate for Payer: PHP Commercial |
$3,268.80
|
| Rate for Payer: PHP Medicare Advantage |
$2,334.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,330.60
|
| Rate for Payer: Priority Health Medicare |
$2,334.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,334.86
|
| Rate for Payer: UHC Medicare Advantage |
$2,334.86
|
| Rate for Payer: UMR Bronson Commercial |
$2,357.04
|
|
|
PR VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING
|
Professional
|
Both
|
$8,903.00
|
|
|
Service Code
|
HCPCS 33426
|
| Min. Negotiated Rate |
$2,284.56 |
| Max. Negotiated Rate |
$5,786.95 |
| Rate for Payer: Aetna Commercial |
$3,061.31
|
| Rate for Payer: Aetna Medicare |
$2,375.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,289.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,061.31
|
| Rate for Payer: BCBS Complete |
$3,561.20
|
| Rate for Payer: BCBS MAPPO |
$2,284.56
|
| Rate for Payer: BCN Medicare Advantage |
$2,284.56
|
| Rate for Payer: Cash Price |
$7,122.40
|
| Rate for Payer: Cash Price |
$7,122.40
|
| Rate for Payer: Cofinity Commercial |
$3,289.77
|
| Rate for Payer: Cofinity Commercial |
$3,061.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,284.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,398.79
|
| Rate for Payer: Nomi Health Commercial |
$2,741.47
|
| Rate for Payer: PACE SWMI |
$2,284.56
|
| Rate for Payer: PHP Commercial |
$3,198.38
|
| Rate for Payer: PHP Medicare Advantage |
$2,284.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.95
|
| Rate for Payer: Priority Health Medicare |
$2,284.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,284.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,284.56
|
| Rate for Payer: UMR Bronson Commercial |
$4,095.38
|
|
|
PR VNPNXR <3 YEARS PHY/QHP SKILL FEMORAL/JUGULAR VN
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 36400
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Commercial |
$23.53
|
| Rate for Payer: Aetna Medicare |
$18.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.53
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$17.56
|
| Rate for Payer: BCN Medicare Advantage |
$17.56
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$25.29
|
| Rate for Payer: Cofinity Commercial |
$23.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.44
|
| Rate for Payer: Nomi Health Commercial |
$21.07
|
| Rate for Payer: PACE SWMI |
$17.56
|
| Rate for Payer: PHP Commercial |
$24.58
|
| Rate for Payer: PHP Medicare Advantage |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health Medicare |
$17.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.56
|
| Rate for Payer: UHC Medicare Advantage |
$17.56
|
| Rate for Payer: UMR Bronson Commercial |
$38.18
|
|
|
PR VNPNXR 3 YEARS/> PHYS/QHP SKILL DX/THER PURPOSES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 36410
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$11.58
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.58
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$8.64
|
| Rate for Payer: BCN Medicare Advantage |
$8.64
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Cofinity Commercial |
$11.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.07
|
| Rate for Payer: Nomi Health Commercial |
$10.37
|
| Rate for Payer: PACE SWMI |
$8.64
|
| Rate for Payer: PHP Commercial |
$12.10
|
| Rate for Payer: PHP Medicare Advantage |
$8.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health Medicare |
$8.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.64
|
| Rate for Payer: UHC Medicare Advantage |
$8.64
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
PR VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 36406
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Commercial |
$11.56
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR VOID PRESSURE STUDIES INTRAABDOMINAL
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 51797
|
| Min. Negotiated Rate |
$149.65 |
| Max. Negotiated Rate |
$336.70 |
| Rate for Payer: Aetna Commercial |
$200.53
|
| Rate for Payer: Aetna Medicare |
$155.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.53
|
| Rate for Payer: BCBS Complete |
$207.20
|
| Rate for Payer: BCBS MAPPO |
$149.65
|
| Rate for Payer: BCN Medicare Advantage |
$149.65
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$215.50
|
| Rate for Payer: Cofinity Commercial |
$200.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.13
|
| Rate for Payer: Nomi Health Commercial |
$179.58
|
| Rate for Payer: PACE SWMI |
$149.65
|
| Rate for Payer: PHP Commercial |
$209.51
|
| Rate for Payer: PHP Medicare Advantage |
$149.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health Medicare |
$149.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.65
|
| Rate for Payer: UHC Medicare Advantage |
$149.65
|
| Rate for Payer: UMR Bronson Commercial |
$238.28
|
|
|
PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 92540
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$139.82 |
| Rate for Payer: Aetna Commercial |
$130.11
|
| Rate for Payer: Aetna Medicare |
$100.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.11
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS MAPPO |
$97.10
|
| Rate for Payer: BCN Medicare Advantage |
$97.10
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$130.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.95
|
| Rate for Payer: Nomi Health Commercial |
$116.52
|
| Rate for Payer: PACE SWMI |
$97.10
|
| Rate for Payer: PHP Commercial |
$135.94
|
| Rate for Payer: PHP Medicare Advantage |
$97.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health Medicare |
$97.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.10
|
| Rate for Payer: UHC Medicare Advantage |
$97.10
|
| Rate for Payer: UMR Bronson Commercial |
$64.40
|
|
|
PR VULVECTOMY RADICAL PARTIAL
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 56630
|
| Min. Negotiated Rate |
$649.20 |
| Max. Negotiated Rate |
$1,322.06 |
| Rate for Payer: Aetna Commercial |
$1,230.25
|
| Rate for Payer: Aetna Medicare |
$954.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.25
|
| Rate for Payer: BCBS Complete |
$649.20
|
| Rate for Payer: BCBS MAPPO |
$918.10
|
| Rate for Payer: BCN Medicare Advantage |
$918.10
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$1,322.06
|
| Rate for Payer: Cofinity Commercial |
$1,230.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.00
|
| Rate for Payer: Nomi Health Commercial |
$1,101.72
|
| Rate for Payer: PACE SWMI |
$918.10
|
| Rate for Payer: PHP Commercial |
$1,285.34
|
| Rate for Payer: PHP Medicare Advantage |
$918.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.95
|
| Rate for Payer: Priority Health Medicare |
$918.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.10
|
| Rate for Payer: UHC Medicare Advantage |
$918.10
|
| Rate for Payer: UMR Bronson Commercial |
$746.58
|
|
|
PR VULVECTOMY SIMPLE PARTIAL
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 56620
|
| Min. Negotiated Rate |
$555.20 |
| Max. Negotiated Rate |
$1,021.15 |
| Rate for Payer: Aetna Commercial |
$743.97
|
| Rate for Payer: Aetna Medicare |
$577.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$799.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.97
|
| Rate for Payer: BCBS Complete |
$628.40
|
| Rate for Payer: BCBS MAPPO |
$555.20
|
| Rate for Payer: BCN Medicare Advantage |
$555.20
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$799.49
|
| Rate for Payer: Cofinity Commercial |
$743.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$582.96
|
| Rate for Payer: Nomi Health Commercial |
$666.24
|
| Rate for Payer: PACE SWMI |
$555.20
|
| Rate for Payer: PHP Commercial |
$777.28
|
| Rate for Payer: PHP Medicare Advantage |
$555.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.15
|
| Rate for Payer: Priority Health Medicare |
$555.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.20
|
| Rate for Payer: UHC Medicare Advantage |
$555.20
|
| Rate for Payer: UMR Bronson Commercial |
$722.66
|
|
|
PR WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 11765
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna Commercial |
$117.20
|
| Rate for Payer: Aetna Medicare |
$90.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.20
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS MAPPO |
$87.46
|
| Rate for Payer: BCN Medicare Advantage |
$87.46
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$125.94
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.83
|
| Rate for Payer: Nomi Health Commercial |
$104.95
|
| Rate for Payer: PACE SWMI |
$87.46
|
| Rate for Payer: PHP Commercial |
$122.44
|
| Rate for Payer: PHP Medicare Advantage |
$87.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health Medicare |
$87.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.46
|
| Rate for Payer: UHC Medicare Advantage |
$87.46
|
| Rate for Payer: UMR Bronson Commercial |
$125.12
|
|
|
PR WEDGE RESCJ/BISCTJ OVARY UNI/BI
|
Professional
|
Both
|
$1,929.00
|
|
|
Service Code
|
HCPCS 58920
|
| Min. Negotiated Rate |
$684.91 |
| Max. Negotiated Rate |
$1,253.85 |
| Rate for Payer: Aetna Commercial |
$917.78
|
| Rate for Payer: Aetna Medicare |
$712.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.78
|
| Rate for Payer: BCBS Complete |
$771.60
|
| Rate for Payer: BCBS MAPPO |
$684.91
|
| Rate for Payer: BCN Medicare Advantage |
$684.91
|
| Rate for Payer: Cash Price |
$1,543.20
|
| Rate for Payer: Cash Price |
$1,543.20
|
| Rate for Payer: Cofinity Commercial |
$986.27
|
| Rate for Payer: Cofinity Commercial |
$917.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.16
|
| Rate for Payer: Nomi Health Commercial |
$821.89
|
| Rate for Payer: PACE SWMI |
$684.91
|
| Rate for Payer: PHP Commercial |
$958.87
|
| Rate for Payer: PHP Medicare Advantage |
$684.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.85
|
| Rate for Payer: Priority Health Medicare |
$684.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.91
|
| Rate for Payer: UHC Medicare Advantage |
$684.91
|
| Rate for Payer: UMR Bronson Commercial |
$887.34
|
|
|
PR WEDGING CAST EXCEPT CLUBFOOT CASTS
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 29740
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$88.56
|
| Rate for Payer: Aetna Medicare |
$68.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.56
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$66.09
|
| Rate for Payer: BCN Medicare Advantage |
$66.09
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$95.17
|
| Rate for Payer: Cofinity Commercial |
$88.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.39
|
| Rate for Payer: Nomi Health Commercial |
$79.31
|
| Rate for Payer: PACE SWMI |
$66.09
|
| Rate for Payer: PHP Commercial |
$92.53
|
| Rate for Payer: PHP Medicare Advantage |
$66.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$66.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.09
|
| Rate for Payer: UHC Medicare Advantage |
$66.09
|
| Rate for Payer: UMR Bronson Commercial |
$52.44
|
|
|
PR WESTONE MUSICIAN EAR PLUGS
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 00591
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: UMR Bronson Commercial |
$136.16
|
|
|
PR WET MOUNTS/ W PREPARATIONS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS Q0111
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$26.19 |
| Rate for Payer: Aetna Commercial |
$24.37
|
| Rate for Payer: Aetna Medicare |
$18.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.19
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$18.19
|
| Rate for Payer: BCN Medicare Advantage |
$18.19
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$24.37
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$21.83
|
| Rate for Payer: PACE SWMI |
$18.19
|
| Rate for Payer: PHP Commercial |
$25.47
|
| Rate for Payer: PHP Medicare Advantage |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$18.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.19
|
| Rate for Payer: UHC Medicare Advantage |
$18.19
|
| Rate for Payer: UMR Bronson Commercial |
$5.52
|
|
|
PR WHFO, RIGID W/O JOINTS
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS L3808
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$562.49 |
| Rate for Payer: Aetna Commercial |
$523.43
|
| Rate for Payer: Aetna Medicare |
$406.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.43
|
| Rate for Payer: BCBS Complete |
$133.20
|
| Rate for Payer: BCBS MAPPO |
$390.62
|
| Rate for Payer: BCN Medicare Advantage |
$390.62
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$562.49
|
| Rate for Payer: Cofinity Commercial |
$523.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.15
|
| Rate for Payer: Nomi Health Commercial |
$468.74
|
| Rate for Payer: PACE SWMI |
$390.62
|
| Rate for Payer: PHP Commercial |
$546.87
|
| Rate for Payer: PHP Medicare Advantage |
$390.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
| Rate for Payer: Priority Health Medicare |
$390.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.62
|
| Rate for Payer: UHC Medicare Advantage |
$390.62
|
| Rate for Payer: UMR Bronson Commercial |
$153.18
|
|
|
PR WHFO W/O JOINTS PRE CST
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS L3807
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$394.83 |
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: Aetna Medicare |
$285.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.41
|
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: BCBS MAPPO |
$274.19
|
| Rate for Payer: BCN Medicare Advantage |
$274.19
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$394.83
|
| Rate for Payer: Cofinity Commercial |
$367.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.90
|
| Rate for Payer: Nomi Health Commercial |
$329.03
|
| Rate for Payer: PACE SWMI |
$274.19
|
| Rate for Payer: PHP Commercial |
$383.87
|
| Rate for Payer: PHP Medicare Advantage |
$274.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.10
|
| Rate for Payer: Priority Health Medicare |
$274.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.19
|
| Rate for Payer: UHC Medicare Advantage |
$274.19
|
| Rate for Payer: UMR Bronson Commercial |
$107.64
|
|
|
PR WHO COCK-UP NONMOLDE PRE OTS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS L3908
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$115.76 |
| Rate for Payer: Aetna Commercial |
$107.72
|
| Rate for Payer: Aetna Medicare |
$83.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.72
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$80.39
|
| Rate for Payer: BCN Medicare Advantage |
$80.39
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$115.76
|
| Rate for Payer: Cofinity Commercial |
$107.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.41
|
| Rate for Payer: Nomi Health Commercial |
$96.47
|
| Rate for Payer: PACE SWMI |
$80.39
|
| Rate for Payer: PHP Commercial |
$112.55
|
| Rate for Payer: PHP Medicare Advantage |
$80.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health Medicare |
$80.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.39
|
| Rate for Payer: UHC Medicare Advantage |
$80.39
|
| Rate for Payer: UMR Bronson Commercial |
$31.74
|
|
|
PR WHO W/NONTORSION JNT(S) CF
|
Professional
|
Both
|
$926.00
|
|
|
Service Code
|
HCPCS L3905
|
| Min. Negotiated Rate |
$370.40 |
| Max. Negotiated Rate |
$1,565.87 |
| Rate for Payer: Aetna Commercial |
$1,457.13
|
| Rate for Payer: Aetna Medicare |
$1,130.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,565.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,457.13
|
| Rate for Payer: BCBS Complete |
$370.40
|
| Rate for Payer: BCBS MAPPO |
$1,087.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,087.41
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cofinity Commercial |
$1,565.87
|
| Rate for Payer: Cofinity Commercial |
$1,457.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,087.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,141.78
|
| Rate for Payer: Nomi Health Commercial |
$1,304.89
|
| Rate for Payer: PACE SWMI |
$1,087.41
|
| Rate for Payer: PHP Commercial |
$1,522.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,087.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.90
|
| Rate for Payer: Priority Health Medicare |
$1,087.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,087.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,087.41
|
| Rate for Payer: UMR Bronson Commercial |
$425.96
|
|
|
PR WHO W/O JOINTS CF
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS L3906
|
| Min. Negotiated Rate |
$189.20 |
| Max. Negotiated Rate |
$800.18 |
| Rate for Payer: Aetna Commercial |
$744.61
|
| Rate for Payer: Aetna Medicare |
$577.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$800.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.61
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCBS MAPPO |
$555.68
|
| Rate for Payer: BCN Medicare Advantage |
$555.68
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$800.18
|
| Rate for Payer: Cofinity Commercial |
$744.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.46
|
| Rate for Payer: Nomi Health Commercial |
$666.82
|
| Rate for Payer: PACE SWMI |
$555.68
|
| Rate for Payer: PHP Commercial |
$777.95
|
| Rate for Payer: PHP Medicare Advantage |
$555.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health Medicare |
$555.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.68
|
| Rate for Payer: UHC Medicare Advantage |
$555.68
|
| Rate for Payer: UMR Bronson Commercial |
$217.58
|
|
|
PR WINDOWING CAST
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 29730
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.28
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCN Medicare Advantage |
$42.75
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$61.56
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: Nomi Health Commercial |
$51.30
|
| Rate for Payer: PACE SWMI |
$42.75
|
| Rate for Payer: PHP Commercial |
$59.85
|
| Rate for Payer: PHP Medicare Advantage |
$42.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$42.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.75
|
| Rate for Payer: UHC Medicare Advantage |
$42.75
|
| Rate for Payer: UMR Bronson Commercial |
$52.44
|
|
|
PR WORK HARDENING/CONDITIONING 1ST 2 HR
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 97545
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna Medicare |
$99.00
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: UMR Bronson Commercial |
$91.08
|
|
|
PR WORK HARDENING/CONDITIONING EACH HOUR
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 97546
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: UMR Bronson Commercial |
$45.54
|
|
|
PR WORK RELATED/MED DBLT XM TREATING PHYS
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99455
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
|
PR WOUND CLOSURE BY ADHESIVE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS G0168
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Medicare |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.15
|
| Rate for Payer: BCBS Complete |
$80.80
|
| Rate for Payer: BCBS MAPPO |
$13.99
|
| Rate for Payer: BCN Medicare Advantage |
$13.99
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$18.75
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.69
|
| Rate for Payer: Nomi Health Commercial |
$16.79
|
| Rate for Payer: PACE SWMI |
$13.99
|
| Rate for Payer: PHP Commercial |
$19.59
|
| Rate for Payer: PHP Medicare Advantage |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.30
|
| Rate for Payer: Priority Health Medicare |
$13.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.99
|
| Rate for Payer: UHC Medicare Advantage |
$13.99
|
| Rate for Payer: UMR Bronson Commercial |
$92.92
|
|
