|
PR VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS
|
Professional
|
Both
|
$8,923.00
|
|
|
Service Code
|
HCPCS 33422
|
| Min. Negotiated Rate |
$495.02 |
| Max. Negotiated Rate |
$5,799.95 |
| Rate for Payer: Aetna Commercial |
$2,131.89
|
| Rate for Payer: Aetna Medicare |
$1,654.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,131.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,290.98
|
| Rate for Payer: BCBS Complete |
$1,098.79
|
| Rate for Payer: BCBS MAPPO |
$1,590.96
|
| Rate for Payer: BCBS Trust/PPO |
$495.02
|
| Rate for Payer: BCN Commercial |
$2,382.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,590.96
|
| Rate for Payer: Cash Price |
$7,138.40
|
| Rate for Payer: Cash Price |
$7,138.40
|
| Rate for Payer: Cofinity Commercial |
$2,131.89
|
| Rate for Payer: Cofinity Commercial |
$2,290.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,590.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,670.51
|
| Rate for Payer: Meridian Medicaid |
$1,098.79
|
| Rate for Payer: Nomi Health Commercial |
$1,909.15
|
| Rate for Payer: PACE SWMI |
$1,590.96
|
| Rate for Payer: PHP Commercial |
$2,227.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,590.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,046.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,799.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,597.96
|
| Rate for Payer: Priority Health Medicare |
$1,590.96
|
| Rate for Payer: Priority Health Narrow Network |
$2,597.96
|
| Rate for Payer: Priority Health SBD |
$2,597.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,590.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,590.96
|
| Rate for Payer: UHCCP Medicaid |
$1,046.47
|
| Rate for Payer: UMR Bronson Commercial |
$4,104.58
|
|
|
PR VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS
|
Professional
|
Both
|
$8,513.00
|
|
|
Service Code
|
HCPCS 33425
|
| Min. Negotiated Rate |
$763.39 |
| Max. Negotiated Rate |
$5,533.45 |
| Rate for Payer: Aetna Commercial |
$3,500.62
|
| Rate for Payer: Aetna Medicare |
$2,716.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,500.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,761.86
|
| Rate for Payer: BCBS Complete |
$1,797.47
|
| Rate for Payer: BCBS MAPPO |
$2,612.40
|
| Rate for Payer: BCBS Trust/PPO |
$763.39
|
| Rate for Payer: BCN Commercial |
$3,906.98
|
| Rate for Payer: BCN Medicare Advantage |
$2,612.40
|
| Rate for Payer: Cash Price |
$6,810.40
|
| Rate for Payer: Cash Price |
$6,810.40
|
| Rate for Payer: Cofinity Commercial |
$3,500.62
|
| Rate for Payer: Cofinity Commercial |
$3,761.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,612.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,743.02
|
| Rate for Payer: Meridian Medicaid |
$1,797.47
|
| Rate for Payer: Nomi Health Commercial |
$3,134.88
|
| Rate for Payer: PACE SWMI |
$2,612.40
|
| Rate for Payer: PHP Commercial |
$3,657.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,612.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,711.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,533.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,266.83
|
| Rate for Payer: Priority Health Medicare |
$2,612.40
|
| Rate for Payer: Priority Health Narrow Network |
$4,266.83
|
| Rate for Payer: Priority Health SBD |
$4,266.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,612.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,612.40
|
| Rate for Payer: UHCCP Medicaid |
$1,711.88
|
| Rate for Payer: UMR Bronson Commercial |
$3,915.98
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION
|
Professional
|
Both
|
$7,544.00
|
|
|
Service Code
|
HCPCS 33463
|
| Min. Negotiated Rate |
$1,183.92 |
| Max. Negotiated Rate |
$4,903.60 |
| Rate for Payer: Aetna Commercial |
$3,943.97
|
| Rate for Payer: Aetna Medicare |
$3,060.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,943.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,238.29
|
| Rate for Payer: BCBS Complete |
$2,024.92
|
| Rate for Payer: BCBS MAPPO |
$2,943.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,183.92
|
| Rate for Payer: BCN Commercial |
$4,392.23
|
| Rate for Payer: BCN Medicare Advantage |
$2,943.26
|
| Rate for Payer: Cash Price |
$6,035.20
|
| Rate for Payer: Cash Price |
$6,035.20
|
| Rate for Payer: Cofinity Commercial |
$3,943.97
|
| Rate for Payer: Cofinity Commercial |
$4,238.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,943.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,090.42
|
| Rate for Payer: Meridian Medicaid |
$2,024.92
|
| Rate for Payer: Nomi Health Commercial |
$3,531.91
|
| Rate for Payer: PACE SWMI |
$2,943.26
|
| Rate for Payer: PHP Commercial |
$4,120.56
|
| Rate for Payer: PHP Medicare Advantage |
$2,943.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,928.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,903.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,801.85
|
| Rate for Payer: Priority Health Medicare |
$2,943.26
|
| Rate for Payer: Priority Health Narrow Network |
$4,801.85
|
| Rate for Payer: Priority Health SBD |
$4,801.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,943.26
|
| Rate for Payer: UHC Medicare Advantage |
$2,943.26
|
| Rate for Payer: UHCCP Medicaid |
$1,928.50
|
| Rate for Payer: UMR Bronson Commercial |
$3,470.24
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION
|
Professional
|
Both
|
$5,116.00
|
|
|
Service Code
|
HCPCS 33464
|
| Min. Negotiated Rate |
$309.58 |
| Max. Negotiated Rate |
$3,809.45 |
| Rate for Payer: Aetna Commercial |
$3,125.93
|
| Rate for Payer: Aetna Medicare |
$2,426.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,125.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,359.20
|
| Rate for Payer: BCBS Complete |
$1,607.15
|
| Rate for Payer: BCBS MAPPO |
$2,332.78
|
| Rate for Payer: BCBS Trust/PPO |
$309.58
|
| Rate for Payer: BCN Commercial |
$3,487.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,332.78
|
| Rate for Payer: Cash Price |
$4,092.80
|
| Rate for Payer: Cash Price |
$4,092.80
|
| Rate for Payer: Cofinity Commercial |
$3,359.20
|
| Rate for Payer: Cofinity Commercial |
$3,125.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,332.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,449.42
|
| Rate for Payer: Meridian Medicaid |
$1,607.15
|
| Rate for Payer: Nomi Health Commercial |
$2,799.34
|
| Rate for Payer: PACE SWMI |
$2,332.78
|
| Rate for Payer: PHP Commercial |
$3,265.89
|
| Rate for Payer: PHP Medicare Advantage |
$2,332.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,530.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,325.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,809.45
|
| Rate for Payer: Priority Health Medicare |
$2,332.78
|
| Rate for Payer: Priority Health Narrow Network |
$3,809.45
|
| Rate for Payer: Priority Health SBD |
$3,809.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,332.78
|
| Rate for Payer: UHC Medicare Advantage |
$2,332.78
|
| Rate for Payer: UHCCP Medicaid |
$1,530.62
|
| Rate for Payer: UMR Bronson Commercial |
$2,353.36
|
|
|
PR VANTAS IMPLANT
|
Professional
|
Both
|
$3,401.00
|
|
|
Service Code
|
HCPCS J9225
|
| Min. Negotiated Rate |
$1,360.40 |
| Max. Negotiated Rate |
$5,264.35 |
| Rate for Payer: Aetna Commercial |
$4,678.90
|
| Rate for Payer: Aetna Medicare |
$1,700.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.90
|
| Rate for Payer: BCBS Complete |
$1,360.40
|
| Rate for Payer: BCBS Trust/PPO |
$5,264.35
|
| Rate for Payer: BCN Commercial |
$5,264.35
|
| Rate for Payer: Cash Price |
$2,720.80
|
| Rate for Payer: Cash Price |
$2,720.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,210.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,564.46
|
|
|
PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 90716
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$177.68 |
| Rate for Payer: Aetna Commercial |
$177.68
|
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.68
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS Trust/PPO |
$160.76
|
| Rate for Payer: BCN Commercial |
$157.78
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
PR VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 37500
|
| Min. Negotiated Rate |
$396.82 |
| Max. Negotiated Rate |
$1,413.20 |
| Rate for Payer: Aetna Commercial |
$813.25
|
| Rate for Payer: Aetna Medicare |
$631.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.94
|
| Rate for Payer: BCBS Complete |
$416.66
|
| Rate for Payer: BCBS MAPPO |
$606.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,413.20
|
| Rate for Payer: BCN Commercial |
$902.59
|
| Rate for Payer: BCN Medicare Advantage |
$606.90
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cofinity Commercial |
$813.25
|
| Rate for Payer: Cofinity Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.24
|
| Rate for Payer: Meridian Medicaid |
$416.66
|
| Rate for Payer: Nomi Health Commercial |
$728.28
|
| Rate for Payer: PACE SWMI |
$606.90
|
| Rate for Payer: PHP Commercial |
$849.66
|
| Rate for Payer: PHP Medicare Advantage |
$606.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$396.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$987.60
|
| Rate for Payer: Priority Health Medicare |
$606.90
|
| Rate for Payer: Priority Health Narrow Network |
$987.60
|
| Rate for Payer: Priority Health SBD |
$987.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$606.90
|
| Rate for Payer: UHC Medicare Advantage |
$606.90
|
| Rate for Payer: UHCCP Medicaid |
$396.82
|
| Rate for Payer: UMR Bronson Commercial |
$614.10
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 37242
|
| Min. Negotiated Rate |
$295.86 |
| Max. Negotiated Rate |
$10,507.06 |
| Rate for Payer: Aetna Commercial |
$603.31
|
| Rate for Payer: Aetna Medicare |
$468.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.33
|
| Rate for Payer: BCBS Complete |
$310.65
|
| Rate for Payer: BCBS MAPPO |
$450.23
|
| Rate for Payer: BCBS Trust/PPO |
$658.79
|
| Rate for Payer: BCN Commercial |
$10,507.06
|
| Rate for Payer: BCN Medicare Advantage |
$450.23
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cofinity Commercial |
$603.31
|
| Rate for Payer: Cofinity Commercial |
$648.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.74
|
| Rate for Payer: Meridian Medicaid |
$310.65
|
| Rate for Payer: Nomi Health Commercial |
$540.28
|
| Rate for Payer: PACE SWMI |
$450.23
|
| Rate for Payer: PHP Commercial |
$630.32
|
| Rate for Payer: PHP Medicare Advantage |
$450.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$736.05
|
| Rate for Payer: Priority Health Medicare |
$450.23
|
| Rate for Payer: Priority Health Narrow Network |
$736.05
|
| Rate for Payer: Priority Health SBD |
$736.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$450.23
|
| Rate for Payer: UHC Medicare Advantage |
$450.23
|
| Rate for Payer: UHCCP Medicaid |
$295.86
|
| Rate for Payer: UMR Bronson Commercial |
$696.90
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Professional
|
Both
|
$9,702.00
|
|
|
Service Code
|
HCPCS 37244
|
| Min. Negotiated Rate |
$410.88 |
| Max. Negotiated Rate |
$9,737.39 |
| Rate for Payer: Aetna Commercial |
$831.43
|
| Rate for Payer: Aetna Medicare |
$645.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$893.48
|
| Rate for Payer: BCBS Complete |
$431.42
|
| Rate for Payer: BCBS MAPPO |
$620.47
|
| Rate for Payer: BCBS Trust/PPO |
$624.45
|
| Rate for Payer: BCN Commercial |
$9,737.39
|
| Rate for Payer: BCN Medicare Advantage |
$620.47
|
| Rate for Payer: Cash Price |
$7,761.60
|
| Rate for Payer: Cash Price |
$7,761.60
|
| Rate for Payer: Cofinity Commercial |
$831.43
|
| Rate for Payer: Cofinity Commercial |
$893.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$620.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$651.49
|
| Rate for Payer: Meridian Medicaid |
$431.42
|
| Rate for Payer: Nomi Health Commercial |
$744.56
|
| Rate for Payer: PACE SWMI |
$620.47
|
| Rate for Payer: PHP Commercial |
$868.66
|
| Rate for Payer: PHP Medicare Advantage |
$620.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$410.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,306.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,019.51
|
| Rate for Payer: Priority Health Medicare |
$620.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,019.51
|
| Rate for Payer: Priority Health SBD |
$1,019.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$620.47
|
| Rate for Payer: UHC Medicare Advantage |
$620.47
|
| Rate for Payer: UHCCP Medicaid |
$410.88
|
| Rate for Payer: UMR Bronson Commercial |
$4,462.92
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 37241
|
| Min. Negotiated Rate |
$265.82 |
| Max. Negotiated Rate |
$6,882.05 |
| Rate for Payer: Aetna Commercial |
$540.85
|
| Rate for Payer: Aetna Medicare |
$419.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.21
|
| Rate for Payer: BCBS Complete |
$279.11
|
| Rate for Payer: BCBS MAPPO |
$403.62
|
| Rate for Payer: BCBS Trust/PPO |
$583.24
|
| Rate for Payer: BCN Commercial |
$6,882.05
|
| Rate for Payer: BCN Medicare Advantage |
$403.62
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$540.85
|
| Rate for Payer: Cofinity Commercial |
$581.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.80
|
| Rate for Payer: Meridian Medicaid |
$279.11
|
| Rate for Payer: Nomi Health Commercial |
$484.34
|
| Rate for Payer: PACE SWMI |
$403.62
|
| Rate for Payer: PHP Commercial |
$565.07
|
| Rate for Payer: PHP Medicare Advantage |
$403.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$265.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.05
|
| Rate for Payer: Priority Health Medicare |
$403.62
|
| Rate for Payer: Priority Health Narrow Network |
$661.05
|
| Rate for Payer: Priority Health SBD |
$661.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.62
|
| Rate for Payer: UHC Medicare Advantage |
$403.62
|
| Rate for Payer: UHCCP Medicaid |
$265.82
|
| Rate for Payer: UMR Bronson Commercial |
$317.86
|
|
|
PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT
|
Professional
|
Both
|
$1,217.00
|
|
|
Service Code
|
HCPCS 37243
|
| Min. Negotiated Rate |
$349.32 |
| Max. Negotiated Rate |
$12,761.33 |
| Rate for Payer: Aetna Commercial |
$706.96
|
| Rate for Payer: Aetna Medicare |
$548.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$759.72
|
| Rate for Payer: BCBS Complete |
$366.79
|
| Rate for Payer: BCBS MAPPO |
$527.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,206.64
|
| Rate for Payer: BCN Commercial |
$12,761.33
|
| Rate for Payer: BCN Medicare Advantage |
$527.58
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cash Price |
$973.60
|
| Rate for Payer: Cofinity Commercial |
$706.96
|
| Rate for Payer: Cofinity Commercial |
$759.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$527.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.96
|
| Rate for Payer: Meridian Medicaid |
$366.79
|
| Rate for Payer: Nomi Health Commercial |
$633.10
|
| Rate for Payer: PACE SWMI |
$527.58
|
| Rate for Payer: PHP Commercial |
$738.61
|
| Rate for Payer: PHP Medicare Advantage |
$527.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$864.74
|
| Rate for Payer: Priority Health Medicare |
$527.58
|
| Rate for Payer: Priority Health Narrow Network |
$864.74
|
| Rate for Payer: Priority Health SBD |
$864.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$527.58
|
| Rate for Payer: UHC Medicare Advantage |
$527.58
|
| Rate for Payer: UHCCP Medicaid |
$349.32
|
| Rate for Payer: UMR Bronson Commercial |
$559.82
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$392.92 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Aetna American Axle |
$580.45
|
| Rate for Payer: Aetna Commercial |
$759.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.45
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$625.10
|
| Rate for Payer: Cofinity Commercial |
$767.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Healthscope Commercial |
$803.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.05
|
| Rate for Payer: PHP Commercial |
$759.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health SBD |
$562.59
|
| Rate for Payer: UMR Bronson Commercial |
$392.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.75
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 55250
|
| Min. Negotiated Rate |
$148.89 |
| Max. Negotiated Rate |
$1,543.69 |
| Rate for Payer: Aetna Commercial |
$293.55
|
| Rate for Payer: Aetna Medicare |
$227.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.46
|
| Rate for Payer: BCBS Complete |
$156.33
|
| Rate for Payer: BCBS MAPPO |
$219.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.69
|
| Rate for Payer: BCN Commercial |
$393.05
|
| Rate for Payer: BCN Medicare Advantage |
$219.07
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$315.46
|
| Rate for Payer: Cofinity Commercial |
$293.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.02
|
| Rate for Payer: Meridian Medicaid |
$156.33
|
| Rate for Payer: Nomi Health Commercial |
$262.88
|
| Rate for Payer: PACE SWMI |
$219.07
|
| Rate for Payer: PHP Commercial |
$306.70
|
| Rate for Payer: PHP Medicare Advantage |
$219.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.09
|
| Rate for Payer: Priority Health Medicare |
$219.07
|
| Rate for Payer: Priority Health Narrow Network |
$369.09
|
| Rate for Payer: Priority Health SBD |
$369.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.07
|
| Rate for Payer: UHC Medicare Advantage |
$219.07
|
| Rate for Payer: UHCCP Medicaid |
$148.89
|
| Rate for Payer: UMR Bronson Commercial |
$410.78
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
55250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$330.41 |
| Max. Negotiated Rate |
$6,308.24 |
| Rate for Payer: Aetna American Axle |
$580.45
|
| Rate for Payer: Aetna Commercial |
$759.05
|
| Rate for Payer: Aetna Medicare |
$2,087.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,508.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,508.86
|
| Rate for Payer: BCBS Complete |
$1,129.59
|
| Rate for Payer: BCBS MAPPO |
$2,007.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,369.87
|
| Rate for Payer: BCN Commercial |
$1,369.87
|
| Rate for Payer: BCN Medicare Advantage |
$2,007.09
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$767.98
|
| Rate for Payer: Cofinity Commercial |
$625.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$625.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$714.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,007.09
|
| Rate for Payer: Healthscope Commercial |
$803.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$625.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$669.75
|
| Rate for Payer: Mclaren Medicaid |
$1,075.80
|
| Rate for Payer: Mclaren Medicare |
$2,007.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,107.44
|
| Rate for Payer: Meridian Medicaid |
$1,129.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,308.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.05
|
| Rate for Payer: Nomi Health Commercial |
$4,214.89
|
| Rate for Payer: PACE Medicare |
$1,906.74
|
| Rate for Payer: PACE SWMI |
$2,007.09
|
| Rate for Payer: PHP Commercial |
$759.05
|
| Rate for Payer: PHP Medicare Advantage |
$2,007.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,308.24
|
| Rate for Payer: Priority Health Medicare |
$2,007.09
|
| Rate for Payer: Priority Health Narrow Network |
$5,046.59
|
| Rate for Payer: Priority Health SBD |
$562.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,007.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,649.76
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,007.09
|
| Rate for Payer: UHC Exchange |
$3,835.75
|
| Rate for Payer: UHC Medicare Advantage |
$2,007.09
|
| Rate for Payer: UHCCP Medicaid |
$1,075.80
|
| Rate for Payer: UMR Bronson Commercial |
$330.41
|
| Rate for Payer: VA VA |
$2,007.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$669.75
|
|
|
PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 55250
|
| Hospital Charge Code |
55250
|
| Min. Negotiated Rate |
$148.89 |
| Max. Negotiated Rate |
$1,543.69 |
| Rate for Payer: Aetna Commercial |
$293.55
|
| Rate for Payer: Aetna Medicare |
$227.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.46
|
| Rate for Payer: BCBS Complete |
$156.33
|
| Rate for Payer: BCBS MAPPO |
$219.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,543.69
|
| Rate for Payer: BCN Commercial |
$393.05
|
| Rate for Payer: BCN Medicare Advantage |
$219.07
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cofinity Commercial |
$293.55
|
| Rate for Payer: Cofinity Commercial |
$315.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.02
|
| Rate for Payer: Meridian Medicaid |
$156.33
|
| Rate for Payer: Nomi Health Commercial |
$262.88
|
| Rate for Payer: PACE SWMI |
$219.07
|
| Rate for Payer: PHP Commercial |
$306.70
|
| Rate for Payer: PHP Medicare Advantage |
$219.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.09
|
| Rate for Payer: Priority Health Medicare |
$219.07
|
| Rate for Payer: Priority Health Narrow Network |
$369.09
|
| Rate for Payer: Priority Health SBD |
$369.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.07
|
| Rate for Payer: UHC Medicare Advantage |
$219.07
|
| Rate for Payer: UHCCP Medicaid |
$148.89
|
| Rate for Payer: UMR Bronson Commercial |
$410.78
|
|
|
PR VASOVASOSTOMY VASOVASORRHAPHY
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
HCPCS 55400
|
| Min. Negotiated Rate |
$380.80 |
| Max. Negotiated Rate |
$2,224.67 |
| Rate for Payer: Aetna Commercial |
$640.88
|
| Rate for Payer: Aetna Medicare |
$497.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$688.71
|
| Rate for Payer: BCBS Complete |
$380.80
|
| Rate for Payer: BCBS MAPPO |
$478.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,224.67
|
| Rate for Payer: BCN Commercial |
$722.27
|
| Rate for Payer: BCN Medicare Advantage |
$478.27
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cofinity Commercial |
$688.71
|
| Rate for Payer: Cofinity Commercial |
$640.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$478.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$502.18
|
| Rate for Payer: Nomi Health Commercial |
$573.92
|
| Rate for Payer: PACE SWMI |
$478.27
|
| Rate for Payer: PHP Commercial |
$669.58
|
| Rate for Payer: PHP Medicare Advantage |
$478.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$618.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$799.44
|
| Rate for Payer: Priority Health Medicare |
$478.27
|
| Rate for Payer: Priority Health Narrow Network |
$799.44
|
| Rate for Payer: Priority Health SBD |
$799.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$478.27
|
| Rate for Payer: UHC Medicare Advantage |
$478.27
|
| Rate for Payer: UMR Bronson Commercial |
$437.92
|
|
|
PR VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG
|
Professional
|
Both
|
$2,770.00
|
|
|
Service Code
|
HCPCS 63103
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$4,342.63 |
| Rate for Payer: PHP Medicare Advantage |
$286.24
|
| Rate for Payer: Aetna Commercial |
$383.56
|
| Rate for Payer: Aetna Medicare |
$297.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$383.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.19
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS MAPPO |
$286.24
|
| Rate for Payer: BCBS Trust/PPO |
$4,342.63
|
| Rate for Payer: BCN Commercial |
$429.06
|
| Rate for Payer: BCN Medicare Advantage |
$286.24
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cash Price |
$2,216.00
|
| Rate for Payer: Cofinity Commercial |
$383.56
|
| Rate for Payer: Cofinity Commercial |
$412.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$300.55
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Nomi Health Commercial |
$343.49
|
| Rate for Payer: PACE SWMI |
$286.24
|
| Rate for Payer: PHP Commercial |
$400.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,800.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$499.32
|
| Rate for Payer: Priority Health Medicare |
$286.24
|
| Rate for Payer: Priority Health Narrow Network |
$499.32
|
| Rate for Payer: Priority Health SBD |
$499.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.24
|
| Rate for Payer: UHC Medicare Advantage |
$286.24
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
| Rate for Payer: UMR Bronson Commercial |
$1,274.20
|
|
|
PR VCRPEC LES 1 SGM XDRL CERVICAL
|
Professional
|
Both
|
$4,705.00
|
|
|
Service Code
|
HCPCS 63300
|
| Min. Negotiated Rate |
$519.85 |
| Max. Negotiated Rate |
$3,125.09 |
| Rate for Payer: Aetna Commercial |
$2,400.78
|
| Rate for Payer: Aetna Medicare |
$1,863.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,579.95
|
| Rate for Payer: BCBS Complete |
$1,241.48
|
| Rate for Payer: BCBS MAPPO |
$1,791.63
|
| Rate for Payer: BCBS Trust/PPO |
$519.85
|
| Rate for Payer: BCN Commercial |
$2,941.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,791.63
|
| Rate for Payer: Cash Price |
$3,764.00
|
| Rate for Payer: Cash Price |
$3,764.00
|
| Rate for Payer: Cofinity Commercial |
$2,400.78
|
| Rate for Payer: Cofinity Commercial |
$2,579.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,791.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,881.21
|
| Rate for Payer: Meridian Medicaid |
$1,241.48
|
| Rate for Payer: Nomi Health Commercial |
$2,149.96
|
| Rate for Payer: PACE SWMI |
$1,791.63
|
| Rate for Payer: PHP Commercial |
$2,508.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,791.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,182.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,058.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,125.09
|
| Rate for Payer: Priority Health Medicare |
$1,791.63
|
| Rate for Payer: Priority Health Narrow Network |
$3,125.09
|
| Rate for Payer: Priority Health SBD |
$3,125.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,791.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,791.63
|
| Rate for Payer: UHCCP Medicaid |
$1,182.36
|
| Rate for Payer: UMR Bronson Commercial |
$2,164.30
|
|
|
PR VCRPEC LES 1 SGM XDRL THORACIC TTHRC
|
Professional
|
Both
|
$4,655.00
|
|
|
Service Code
|
HCPCS 63301
|
| Min. Negotiated Rate |
$1,378.75 |
| Max. Negotiated Rate |
$3,822.91 |
| Rate for Payer: Aetna Commercial |
$2,807.22
|
| Rate for Payer: Aetna Medicare |
$2,178.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,807.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,016.71
|
| Rate for Payer: BCBS Complete |
$1,447.69
|
| Rate for Payer: BCBS MAPPO |
$2,094.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,593.88
|
| Rate for Payer: BCN Commercial |
$3,585.18
|
| Rate for Payer: BCN Medicare Advantage |
$2,094.94
|
| Rate for Payer: Cash Price |
$3,724.00
|
| Rate for Payer: Cash Price |
$3,724.00
|
| Rate for Payer: Cofinity Commercial |
$2,807.22
|
| Rate for Payer: Cofinity Commercial |
$3,016.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,094.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,199.69
|
| Rate for Payer: Meridian Medicaid |
$1,447.69
|
| Rate for Payer: Nomi Health Commercial |
$2,513.93
|
| Rate for Payer: PACE SWMI |
$2,094.94
|
| Rate for Payer: PHP Commercial |
$2,932.92
|
| Rate for Payer: PHP Medicare Advantage |
$2,094.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,378.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,025.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,822.91
|
| Rate for Payer: Priority Health Medicare |
$2,094.94
|
| Rate for Payer: Priority Health Narrow Network |
$3,822.91
|
| Rate for Payer: Priority Health SBD |
$3,822.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,094.94
|
| Rate for Payer: UHC Medicare Advantage |
$2,094.94
|
| Rate for Payer: UHCCP Medicaid |
$1,378.75
|
| Rate for Payer: UMR Bronson Commercial |
$2,141.30
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG
|
Professional
|
Both
|
$9,223.00
|
|
|
Service Code
|
HCPCS 63087
|
| Min. Negotiated Rate |
$232.45 |
| Max. Negotiated Rate |
$5,994.95 |
| Rate for Payer: Aetna Commercial |
$3,187.73
|
| Rate for Payer: Aetna Medicare |
$2,474.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,187.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,425.62
|
| Rate for Payer: BCBS Complete |
$1,646.52
|
| Rate for Payer: BCBS MAPPO |
$2,378.90
|
| Rate for Payer: BCBS Trust/PPO |
$232.45
|
| Rate for Payer: BCN Commercial |
$3,891.88
|
| Rate for Payer: BCN Medicare Advantage |
$2,378.90
|
| Rate for Payer: Cash Price |
$7,378.40
|
| Rate for Payer: Cash Price |
$7,378.40
|
| Rate for Payer: Cofinity Commercial |
$3,187.73
|
| Rate for Payer: Cofinity Commercial |
$3,425.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,378.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,497.84
|
| Rate for Payer: Meridian Medicaid |
$1,646.52
|
| Rate for Payer: Nomi Health Commercial |
$2,854.68
|
| Rate for Payer: PACE SWMI |
$2,378.90
|
| Rate for Payer: PHP Commercial |
$3,330.46
|
| Rate for Payer: PHP Medicare Advantage |
$2,378.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,568.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,994.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,157.88
|
| Rate for Payer: Priority Health Medicare |
$2,378.90
|
| Rate for Payer: Priority Health Narrow Network |
$4,157.88
|
| Rate for Payer: Priority Health SBD |
$4,157.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,378.90
|
| Rate for Payer: UHC Medicare Advantage |
$2,378.90
|
| Rate for Payer: UHCCP Medicaid |
$1,568.11
|
| Rate for Payer: UMR Bronson Commercial |
$4,242.58
|
|
|
PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 63088
|
| Min. Negotiated Rate |
$165.29 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$338.87
|
| Rate for Payer: Aetna Medicare |
$263.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.16
|
| Rate for Payer: BCBS Complete |
$173.55
|
| Rate for Payer: BCBS MAPPO |
$252.89
|
| Rate for Payer: BCBS Trust/PPO |
$342.34
|
| Rate for Payer: BCN Commercial |
$375.79
|
| Rate for Payer: BCN Medicare Advantage |
$252.89
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cofinity Commercial |
$338.87
|
| Rate for Payer: Cofinity Commercial |
$364.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.53
|
| Rate for Payer: Meridian Medicaid |
$173.55
|
| Rate for Payer: Nomi Health Commercial |
$303.47
|
| Rate for Payer: PACE SWMI |
$252.89
|
| Rate for Payer: PHP Commercial |
$354.05
|
| Rate for Payer: PHP Medicare Advantage |
$252.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$165.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$440.76
|
| Rate for Payer: Priority Health Medicare |
$252.89
|
| Rate for Payer: Priority Health Narrow Network |
$440.76
|
| Rate for Payer: Priority Health SBD |
$440.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.89
|
| Rate for Payer: UHC Medicare Advantage |
$252.89
|
| Rate for Payer: UHCCP Medicaid |
$165.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,454.52
|
|
|
PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG
|
Professional
|
Both
|
$7,274.00
|
|
|
Service Code
|
HCPCS 63090
|
| Min. Negotiated Rate |
$1,253.29 |
| Max. Negotiated Rate |
$4,728.10 |
| Rate for Payer: Aetna Commercial |
$2,535.27
|
| Rate for Payer: Aetna Medicare |
$1,967.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,535.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,724.47
|
| Rate for Payer: BCBS Complete |
$1,315.95
|
| Rate for Payer: BCBS MAPPO |
$1,891.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,683.69
|
| Rate for Payer: BCN Commercial |
$3,133.20
|
| Rate for Payer: BCN Medicare Advantage |
$1,891.99
|
| Rate for Payer: Cash Price |
$5,819.20
|
| Rate for Payer: Cash Price |
$5,819.20
|
| Rate for Payer: Cofinity Commercial |
$2,535.27
|
| Rate for Payer: Cofinity Commercial |
$2,724.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,891.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,986.59
|
| Rate for Payer: Meridian Medicaid |
$1,315.95
|
| Rate for Payer: Nomi Health Commercial |
$2,270.39
|
| Rate for Payer: PACE SWMI |
$1,891.99
|
| Rate for Payer: PHP Commercial |
$2,648.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,891.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,253.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,728.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,336.08
|
| Rate for Payer: Priority Health Medicare |
$1,891.99
|
| Rate for Payer: Priority Health Narrow Network |
$3,336.08
|
| Rate for Payer: Priority Health SBD |
$3,336.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,891.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,891.99
|
| Rate for Payer: UHCCP Medicaid |
$1,253.29
|
| Rate for Payer: UMR Bronson Commercial |
$3,346.04
|
|
|
PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG
|
Professional
|
Both
|
$2,478.00
|
|
|
Service Code
|
HCPCS 63091
|
| Min. Negotiated Rate |
$111.61 |
| Max. Negotiated Rate |
$2,079.39 |
| Rate for Payer: Aetna Commercial |
$227.57
|
| Rate for Payer: Aetna Medicare |
$176.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.56
|
| Rate for Payer: BCBS Complete |
$117.19
|
| Rate for Payer: BCBS MAPPO |
$169.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,079.39
|
| Rate for Payer: BCN Commercial |
$281.41
|
| Rate for Payer: BCN Medicare Advantage |
$169.83
|
| Rate for Payer: Cash Price |
$1,982.40
|
| Rate for Payer: Cash Price |
$1,982.40
|
| Rate for Payer: Cofinity Commercial |
$227.57
|
| Rate for Payer: Cofinity Commercial |
$244.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.32
|
| Rate for Payer: Meridian Medicaid |
$117.19
|
| Rate for Payer: Nomi Health Commercial |
$203.80
|
| Rate for Payer: PACE SWMI |
$169.83
|
| Rate for Payer: PHP Commercial |
$237.76
|
| Rate for Payer: PHP Medicare Advantage |
$169.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,610.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.43
|
| Rate for Payer: Priority Health Medicare |
$169.83
|
| Rate for Payer: Priority Health Narrow Network |
$297.43
|
| Rate for Payer: Priority Health SBD |
$297.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.83
|
| Rate for Payer: UHC Medicare Advantage |
$169.83
|
| Rate for Payer: UHCCP Medicaid |
$111.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,139.88
|
|
|
PR VEIN SCREEN
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 00515
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR VEN CATHJ SLCTV ORGAN BLD SAMPLING
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 36500
|
| Min. Negotiated Rate |
$114.59 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$233.47
|
| Rate for Payer: Aetna Medicare |
$181.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.89
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: BCBS MAPPO |
$174.23
|
| Rate for Payer: BCBS Trust/PPO |
$428.45
|
| Rate for Payer: BCN Commercial |
$259.49
|
| Rate for Payer: BCN Medicare Advantage |
$174.23
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$233.47
|
| Rate for Payer: Cofinity Commercial |
$250.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.94
|
| Rate for Payer: Meridian Medicaid |
$120.32
|
| Rate for Payer: Nomi Health Commercial |
$209.08
|
| Rate for Payer: PACE SWMI |
$174.23
|
| Rate for Payer: PHP Commercial |
$243.92
|
| Rate for Payer: PHP Medicare Advantage |
$174.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.46
|
| Rate for Payer: Priority Health Medicare |
$174.23
|
| Rate for Payer: Priority Health Narrow Network |
$283.46
|
| Rate for Payer: Priority Health SBD |
$283.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.23
|
| Rate for Payer: UHC Medicare Advantage |
$174.23
|
| Rate for Payer: UHCCP Medicaid |
$114.59
|
| Rate for Payer: UMR Bronson Commercial |
$160.54
|
|
