|
PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 49082
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna Commercial |
$93.68
|
| Rate for Payer: Aetna Medicare |
$72.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.68
|
| Rate for Payer: BCBS Complete |
$47.64
|
| Rate for Payer: BCBS MAPPO |
$69.91
|
| Rate for Payer: BCN Commercial |
$108.56
|
| Rate for Payer: BCN Medicare Advantage |
$69.91
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$100.67
|
| Rate for Payer: Cofinity Commercial |
$93.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.41
|
| Rate for Payer: Meridian Medicaid |
$47.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.90
|
| Rate for Payer: Nomi Health Commercial |
$83.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.00
|
| Rate for Payer: PACE SWMI |
$69.91
|
| Rate for Payer: PHP Commercial |
$97.87
|
| Rate for Payer: PHP Medicare Advantage |
$69.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$132.28
|
| Rate for Payer: Priority Health Medicare |
$69.91
|
| Rate for Payer: Priority Health SBD |
$132.28
|
| Rate for Payer: Priority Health Tiered Network |
$132.28
|
| Rate for Payer: Railroad Medicare Medicare |
$69.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.53
|
| Rate for Payer: UHC Core |
$130.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$69.91
|
| Rate for Payer: UHC Exchange |
$130.53
|
| Rate for Payer: UHC Medicaid |
$45.37
|
| Rate for Payer: UHCCP Medicaid |
$45.37
|
| Rate for Payer: UMR Bronson Commercial |
$123.28
|
|
|
PR ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
HCPCS 93657
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$760.22 |
| Rate for Payer: Aetna Commercial |
$352.29
|
| Rate for Payer: Aetna Medicare |
$273.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.58
|
| Rate for Payer: BCBS Complete |
$174.67
|
| Rate for Payer: BCBS MAPPO |
$262.90
|
| Rate for Payer: BCN Commercial |
$447.69
|
| Rate for Payer: BCN Medicare Advantage |
$262.90
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cofinity Commercial |
$352.29
|
| Rate for Payer: Cofinity Commercial |
$378.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.05
|
| Rate for Payer: Meridian Medicaid |
$174.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$289.19
|
| Rate for Payer: Nomi Health Commercial |
$315.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$676.50
|
| Rate for Payer: PACE SWMI |
$262.90
|
| Rate for Payer: PHP Commercial |
$368.06
|
| Rate for Payer: PHP Medicare Advantage |
$262.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$425.51
|
| Rate for Payer: Priority Health Medicare |
$262.90
|
| Rate for Payer: Priority Health SBD |
$425.51
|
| Rate for Payer: Priority Health Tiered Network |
$425.51
|
| Rate for Payer: Railroad Medicare Medicare |
$262.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$760.22
|
| Rate for Payer: UHC Core |
$760.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$262.90
|
| Rate for Payer: UHC Exchange |
$760.22
|
| Rate for Payer: UHC Medicaid |
$166.35
|
| Rate for Payer: UHCCP Medicaid |
$166.35
|
| Rate for Payer: UMR Bronson Commercial |
$414.92
|
|
|
PR ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE
|
Professional
|
Both
|
$7,486.00
|
|
|
Service Code
|
HCPCS 20982
|
| Min. Negotiated Rate |
$205.12 |
| Max. Negotiated Rate |
$5,614.50 |
| Rate for Payer: Aetna Commercial |
$430.60
|
| Rate for Payer: Aetna Medicare |
$334.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.73
|
| Rate for Payer: BCBS Complete |
$215.38
|
| Rate for Payer: BCBS MAPPO |
$321.34
|
| Rate for Payer: BCN Commercial |
$543.80
|
| Rate for Payer: BCN Medicare Advantage |
$321.34
|
| Rate for Payer: Cash Price |
$5,988.80
|
| Rate for Payer: Cash Price |
$5,988.80
|
| Rate for Payer: Cofinity Commercial |
$430.60
|
| Rate for Payer: Cofinity Commercial |
$462.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$321.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$337.41
|
| Rate for Payer: Meridian Medicaid |
$215.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$353.47
|
| Rate for Payer: Nomi Health Commercial |
$385.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,614.50
|
| Rate for Payer: PACE SWMI |
$321.34
|
| Rate for Payer: PHP Commercial |
$449.88
|
| Rate for Payer: PHP Medicare Advantage |
$321.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$581.30
|
| Rate for Payer: Priority Health Medicare |
$321.34
|
| Rate for Payer: Priority Health SBD |
$581.30
|
| Rate for Payer: Priority Health Tiered Network |
$581.30
|
| Rate for Payer: Railroad Medicare Medicare |
$321.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$648.55
|
| Rate for Payer: UHC Core |
$648.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$321.34
|
| Rate for Payer: UHC Exchange |
$648.55
|
| Rate for Payer: UHC Medicaid |
$205.12
|
| Rate for Payer: UHCCP Medicaid |
$205.12
|
| Rate for Payer: UMR Bronson Commercial |
$3,443.56
|
|
|
PR ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS
|
Professional
|
Both
|
$3,879.00
|
|
|
Service Code
|
HCPCS 33256
|
| Min. Negotiated Rate |
$1,165.11 |
| Max. Negotiated Rate |
$3,449.69 |
| Rate for Payer: Aetna Commercial |
$2,446.52
|
| Rate for Payer: Aetna Medicare |
$1,898.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,446.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,629.09
|
| Rate for Payer: BCBS Complete |
$1,223.37
|
| Rate for Payer: BCBS MAPPO |
$1,825.76
|
| Rate for Payer: BCN Commercial |
$2,828.53
|
| Rate for Payer: BCN Medicare Advantage |
$1,825.76
|
| Rate for Payer: Cash Price |
$3,103.20
|
| Rate for Payer: Cash Price |
$3,103.20
|
| Rate for Payer: Cofinity Commercial |
$2,446.52
|
| Rate for Payer: Cofinity Commercial |
$2,629.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,825.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,917.05
|
| Rate for Payer: Meridian Medicaid |
$1,223.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,008.34
|
| Rate for Payer: Nomi Health Commercial |
$2,190.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,909.25
|
| Rate for Payer: PACE SWMI |
$1,825.76
|
| Rate for Payer: PHP Commercial |
$2,556.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,825.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,165.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,041.73
|
| Rate for Payer: Priority Health Medicare |
$1,825.76
|
| Rate for Payer: Priority Health SBD |
$3,041.73
|
| Rate for Payer: Priority Health Tiered Network |
$3,041.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,825.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,449.69
|
| Rate for Payer: UHC Core |
$3,449.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,825.76
|
| Rate for Payer: UHC Exchange |
$3,449.69
|
| Rate for Payer: UHC Medicaid |
$1,165.11
|
| Rate for Payer: UHCCP Medicaid |
$1,165.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,784.34
|
|
|
PR ABLATION & RECONSTRUCTION ATRIA LIMITED
|
Professional
|
Both
|
$3,460.00
|
|
|
Service Code
|
HCPCS 33254
|
| Min. Negotiated Rate |
$824.74 |
| Max. Negotiated Rate |
$2,595.00 |
| Rate for Payer: Aetna Commercial |
$1,727.17
|
| Rate for Payer: Aetna Medicare |
$1,340.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,727.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,856.06
|
| Rate for Payer: BCBS Complete |
$865.98
|
| Rate for Payer: BCBS MAPPO |
$1,288.93
|
| Rate for Payer: BCN Commercial |
$2,006.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,288.93
|
| Rate for Payer: Cash Price |
$2,768.00
|
| Rate for Payer: Cash Price |
$2,768.00
|
| Rate for Payer: Cofinity Commercial |
$1,727.17
|
| Rate for Payer: Cofinity Commercial |
$1,856.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,288.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,353.38
|
| Rate for Payer: Meridian Medicaid |
$865.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,417.82
|
| Rate for Payer: Nomi Health Commercial |
$1,546.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,595.00
|
| Rate for Payer: PACE SWMI |
$1,288.93
|
| Rate for Payer: PHP Commercial |
$1,804.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,288.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$824.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,157.59
|
| Rate for Payer: Priority Health Medicare |
$1,288.93
|
| Rate for Payer: Priority Health SBD |
$2,157.59
|
| Rate for Payer: Priority Health Tiered Network |
$2,157.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,288.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,400.71
|
| Rate for Payer: UHC Core |
$2,400.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,288.93
|
| Rate for Payer: UHC Exchange |
$2,400.71
|
| Rate for Payer: UHC Medicaid |
$824.74
|
| Rate for Payer: UHCCP Medicaid |
$824.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,591.60
|
|
|
PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 30802
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$430.50 |
| Rate for Payer: Aetna Commercial |
$235.05
|
| Rate for Payer: Aetna Medicare |
$182.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.59
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS MAPPO |
$175.41
|
| Rate for Payer: BCN Commercial |
$300.78
|
| Rate for Payer: BCN Medicare Advantage |
$175.41
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$235.05
|
| Rate for Payer: Cofinity Commercial |
$252.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.18
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.95
|
| Rate for Payer: Nomi Health Commercial |
$210.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$430.50
|
| Rate for Payer: PACE SWMI |
$175.41
|
| Rate for Payer: PHP Commercial |
$245.57
|
| Rate for Payer: PHP Medicare Advantage |
$175.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$283.24
|
| Rate for Payer: Priority Health Medicare |
$175.41
|
| Rate for Payer: Priority Health SBD |
$283.24
|
| Rate for Payer: Priority Health Tiered Network |
$283.24
|
| Rate for Payer: Railroad Medicare Medicare |
$175.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.19
|
| Rate for Payer: UHC Core |
$333.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$175.41
|
| Rate for Payer: UHC Exchange |
$333.19
|
| Rate for Payer: UHC Medicaid |
$116.94
|
| Rate for Payer: UHCCP Medicaid |
$116.94
|
| Rate for Payer: UMR Bronson Commercial |
$264.04
|
|
|
PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 30801
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$287.25 |
| Rate for Payer: Aetna Commercial |
$177.50
|
| Rate for Payer: Aetna Medicare |
$137.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.74
|
| Rate for Payer: BCBS Complete |
$93.93
|
| Rate for Payer: BCBS MAPPO |
$132.46
|
| Rate for Payer: BCN Commercial |
$224.59
|
| Rate for Payer: BCN Medicare Advantage |
$132.46
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$177.50
|
| Rate for Payer: Cofinity Commercial |
$190.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.08
|
| Rate for Payer: Meridian Medicaid |
$93.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.71
|
| Rate for Payer: Nomi Health Commercial |
$158.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.25
|
| Rate for Payer: PACE SWMI |
$132.46
|
| Rate for Payer: PHP Commercial |
$185.44
|
| Rate for Payer: PHP Medicare Advantage |
$132.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$211.49
|
| Rate for Payer: Priority Health Medicare |
$132.46
|
| Rate for Payer: Priority Health SBD |
$211.49
|
| Rate for Payer: Priority Health Tiered Network |
$211.49
|
| Rate for Payer: Railroad Medicare Medicare |
$132.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$242.45
|
| Rate for Payer: UHC Core |
$242.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.46
|
| Rate for Payer: UHC Exchange |
$242.45
|
| Rate for Payer: UHC Medicaid |
$89.46
|
| Rate for Payer: UHCCP Medicaid |
$89.46
|
| Rate for Payer: UMR Bronson Commercial |
$176.18
|
|
|
PR ABRASION 1 LESION
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 15786
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$341.25 |
| Rate for Payer: Aetna Commercial |
$155.31
|
| Rate for Payer: Aetna Medicare |
$120.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.90
|
| Rate for Payer: BCBS Complete |
$79.62
|
| Rate for Payer: BCBS MAPPO |
$115.90
|
| Rate for Payer: BCN Commercial |
$203.18
|
| Rate for Payer: BCN Medicare Advantage |
$115.90
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Cofinity Commercial |
$155.31
|
| Rate for Payer: Cofinity Commercial |
$166.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.69
|
| Rate for Payer: Meridian Medicaid |
$79.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.49
|
| Rate for Payer: Nomi Health Commercial |
$139.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$341.25
|
| Rate for Payer: PACE SWMI |
$115.90
|
| Rate for Payer: PHP Commercial |
$162.26
|
| Rate for Payer: PHP Medicare Advantage |
$115.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$185.95
|
| Rate for Payer: Priority Health Medicare |
$115.90
|
| Rate for Payer: Priority Health SBD |
$185.95
|
| Rate for Payer: Priority Health Tiered Network |
$185.95
|
| Rate for Payer: Railroad Medicare Medicare |
$115.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.42
|
| Rate for Payer: UHC Core |
$233.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.90
|
| Rate for Payer: UHC Exchange |
$233.42
|
| Rate for Payer: UHC Medicaid |
$75.83
|
| Rate for Payer: UHCCP Medicaid |
$75.83
|
| Rate for Payer: UMR Bronson Commercial |
$209.30
|
|
|
PR ACETABULOPLASTY RESECTION FEMORAL HEAD
|
Professional
|
Both
|
$2,035.00
|
|
|
Service Code
|
HCPCS 27122
|
| Min. Negotiated Rate |
$644.54 |
| Max. Negotiated Rate |
$1,930.88 |
| Rate for Payer: Aetna Commercial |
$1,329.82
|
| Rate for Payer: Aetna Medicare |
$1,032.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,329.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,429.06
|
| Rate for Payer: BCBS Complete |
$676.77
|
| Rate for Payer: BCBS MAPPO |
$992.40
|
| Rate for Payer: BCN Commercial |
$1,670.23
|
| Rate for Payer: BCN Medicare Advantage |
$992.40
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cofinity Commercial |
$1,329.82
|
| Rate for Payer: Cofinity Commercial |
$1,429.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,042.02
|
| Rate for Payer: Meridian Medicaid |
$676.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,091.64
|
| Rate for Payer: Nomi Health Commercial |
$1,190.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,526.25
|
| Rate for Payer: PACE SWMI |
$992.40
|
| Rate for Payer: PHP Commercial |
$1,389.36
|
| Rate for Payer: PHP Medicare Advantage |
$992.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$644.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,785.42
|
| Rate for Payer: Priority Health Medicare |
$992.40
|
| Rate for Payer: Priority Health SBD |
$1,785.42
|
| Rate for Payer: Priority Health Tiered Network |
$1,785.42
|
| Rate for Payer: Railroad Medicare Medicare |
$992.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,930.88
|
| Rate for Payer: UHC Core |
$1,930.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$992.40
|
| Rate for Payer: UHC Exchange |
$1,930.88
|
| Rate for Payer: UHC Medicaid |
$644.54
|
| Rate for Payer: UHCCP Medicaid |
$644.54
|
| Rate for Payer: UMR Bronson Commercial |
$936.10
|
|
|
PR ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 92570
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$48.06 |
| Rate for Payer: Aetna Commercial |
$31.25
|
| Rate for Payer: Aetna Medicare |
$24.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.58
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$23.32
|
| Rate for Payer: BCN Commercial |
$42.82
|
| Rate for Payer: BCN Medicare Advantage |
$23.32
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$33.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.49
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.65
|
| Rate for Payer: Nomi Health Commercial |
$27.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: PACE SWMI |
$23.32
|
| Rate for Payer: PHP Commercial |
$32.65
|
| Rate for Payer: PHP Medicare Advantage |
$23.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.50
|
| Rate for Payer: Priority Health Medicare |
$23.32
|
| Rate for Payer: Priority Health SBD |
$39.50
|
| Rate for Payer: Priority Health Tiered Network |
$39.50
|
| Rate for Payer: Railroad Medicare Medicare |
$23.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.06
|
| Rate for Payer: UHC Core |
$48.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.32
|
| Rate for Payer: UHC Exchange |
$48.06
|
| Rate for Payer: UHC Medicaid |
$15.12
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
| Rate for Payer: UMR Bronson Commercial |
$27.60
|
|
|
PR ACROMIOPLASTY/ACROMIONECTOMY PRTL +-LIGAMENT RLS
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS 23130
|
| Min. Negotiated Rate |
$376.80 |
| Max. Negotiated Rate |
$1,065.35 |
| Rate for Payer: Railroad Medicare Medicare |
$572.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,065.35
|
| Rate for Payer: UHC Core |
$1,065.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$572.95
|
| Rate for Payer: UHC Exchange |
$1,065.35
|
| Rate for Payer: UHC Medicaid |
$376.80
|
| Rate for Payer: UHCCP Medicaid |
$376.80
|
| Rate for Payer: UMR Bronson Commercial |
$541.42
|
| Rate for Payer: Aetna Commercial |
$767.75
|
| Rate for Payer: Aetna Medicare |
$595.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$767.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.05
|
| Rate for Payer: BCBS Complete |
$395.64
|
| Rate for Payer: BCBS MAPPO |
$572.95
|
| Rate for Payer: BCN Commercial |
$949.16
|
| Rate for Payer: BCN Medicare Advantage |
$572.95
|
| Rate for Payer: Cash Price |
$941.60
|
| Rate for Payer: Cash Price |
$941.60
|
| Rate for Payer: Cofinity Commercial |
$767.75
|
| Rate for Payer: Cofinity Commercial |
$825.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$601.60
|
| Rate for Payer: Meridian Medicaid |
$395.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$630.25
|
| Rate for Payer: Nomi Health Commercial |
$687.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$882.75
|
| Rate for Payer: PACE SWMI |
$572.95
|
| Rate for Payer: PHP Commercial |
$802.13
|
| Rate for Payer: PHP Medicare Advantage |
$572.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$376.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,014.61
|
| Rate for Payer: Priority Health Medicare |
$572.95
|
| Rate for Payer: Priority Health SBD |
$1,014.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,014.61
|
|
|
PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 95803
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$228.99 |
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Aetna Commercial |
$169.40
|
| Rate for Payer: Aetna Medicare |
$131.48
|
| Rate for Payer: Aetna Medicare |
$131.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.40
|
| Rate for Payer: BCBS MAPPO |
$126.42
|
| Rate for Payer: BCBS MAPPO |
$126.42
|
| Rate for Payer: BCN Commercial |
$194.71
|
| Rate for Payer: BCN Commercial |
$194.71
|
| Rate for Payer: BCN Medicare Advantage |
$126.42
|
| Rate for Payer: BCN Medicare Advantage |
$126.42
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$497.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$182.04
|
| Rate for Payer: Cofinity Commercial |
$182.04
|
| Rate for Payer: Cofinity Commercial |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$169.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.06
|
| Rate for Payer: Nomi Health Commercial |
$151.70
|
| Rate for Payer: Nomi Health Commercial |
$151.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$466.50
|
| Rate for Payer: PACE SWMI |
$126.42
|
| Rate for Payer: PACE SWMI |
$126.42
|
| Rate for Payer: PHP Commercial |
$176.99
|
| Rate for Payer: PHP Commercial |
$176.99
|
| Rate for Payer: PHP Medicare Advantage |
$126.42
|
| Rate for Payer: PHP Medicare Advantage |
$126.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$179.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$179.56
|
| Rate for Payer: Priority Health Medicare |
$126.42
|
| Rate for Payer: Priority Health Medicare |
$126.42
|
| Rate for Payer: Priority Health SBD |
$179.56
|
| Rate for Payer: Priority Health SBD |
$179.56
|
| Rate for Payer: Priority Health Tiered Network |
$179.56
|
| Rate for Payer: Priority Health Tiered Network |
$179.56
|
| Rate for Payer: Railroad Medicare Medicare |
$126.42
|
| Rate for Payer: Railroad Medicare Medicare |
$126.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.99
|
| Rate for Payer: UHC Core |
$228.99
|
| Rate for Payer: UHC Core |
$228.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$126.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$126.42
|
| Rate for Payer: UHC Exchange |
$228.99
|
| Rate for Payer: UHC Exchange |
$228.99
|
| Rate for Payer: UMR Bronson Commercial |
$286.12
|
| Rate for Payer: UMR Bronson Commercial |
$43.24
|
|
|
PR ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 97155
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$54.88 |
| Rate for Payer: Aetna Commercial |
$20.80
|
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.80
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCN Commercial |
$25.38
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$45.93
|
| Rate for Payer: Priority Health SBD |
$45.93
|
| Rate for Payer: Priority Health Tiered Network |
$45.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.88
|
| Rate for Payer: UHC Core |
$54.88
|
| Rate for Payer: UHC Exchange |
$54.88
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
|
|
PR ADDITIONAL KIT 2-4 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$210.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: UMR Bronson Commercial |
$96.60
|
|
|
PR ADDITIONAL KIT 4-10 CC, INJECTION, PLATELET RICH PLASMA
|
Professional
|
Both
|
$315.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: UMR Bronson Commercial |
$144.90
|
|
|
PR ADENOIDECTOMY PRIMARY <AGE 12
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 42830
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$396.21 |
| Rate for Payer: Aetna Commercial |
$252.76
|
| Rate for Payer: Aetna Medicare |
$196.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.63
|
| Rate for Payer: BCBS Complete |
$130.84
|
| Rate for Payer: BCBS MAPPO |
$188.63
|
| Rate for Payer: BCN Commercial |
$325.18
|
| Rate for Payer: BCN Medicare Advantage |
$188.63
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cofinity Commercial |
$271.63
|
| Rate for Payer: Cofinity Commercial |
$252.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.06
|
| Rate for Payer: Meridian Medicaid |
$130.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$207.49
|
| Rate for Payer: Nomi Health Commercial |
$226.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.50
|
| Rate for Payer: PACE SWMI |
$188.63
|
| Rate for Payer: PHP Commercial |
$264.08
|
| Rate for Payer: PHP Medicare Advantage |
$188.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$396.21
|
| Rate for Payer: Priority Health Medicare |
$188.63
|
| Rate for Payer: Priority Health SBD |
$396.21
|
| Rate for Payer: Priority Health Tiered Network |
$396.21
|
| Rate for Payer: Railroad Medicare Medicare |
$188.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$357.97
|
| Rate for Payer: UHC Core |
$357.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.63
|
| Rate for Payer: UHC Exchange |
$357.97
|
| Rate for Payer: UHC Medicaid |
$124.61
|
| Rate for Payer: UHCCP Medicaid |
$124.61
|
| Rate for Payer: UMR Bronson Commercial |
$179.40
|
|
|
PR ADENOIDECTOMY PRIMARY AGE 12/>
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 42831
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$274.83
|
| Rate for Payer: Aetna Medicare |
$213.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.34
|
| Rate for Payer: BCBS Complete |
$142.46
|
| Rate for Payer: BCBS MAPPO |
$205.10
|
| Rate for Payer: BCN Commercial |
$353.07
|
| Rate for Payer: BCN Medicare Advantage |
$205.10
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$274.83
|
| Rate for Payer: Cofinity Commercial |
$295.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.35
|
| Rate for Payer: Meridian Medicaid |
$142.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$225.61
|
| Rate for Payer: Nomi Health Commercial |
$246.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$498.75
|
| Rate for Payer: PACE SWMI |
$205.10
|
| Rate for Payer: PHP Commercial |
$287.14
|
| Rate for Payer: PHP Medicare Advantage |
$205.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$430.20
|
| Rate for Payer: Priority Health Medicare |
$205.10
|
| Rate for Payer: Priority Health SBD |
$430.20
|
| Rate for Payer: Priority Health Tiered Network |
$430.20
|
| Rate for Payer: Railroad Medicare Medicare |
$205.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.08
|
| Rate for Payer: UHC Core |
$387.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$205.10
|
| Rate for Payer: UHC Exchange |
$387.08
|
| Rate for Payer: UHC Medicaid |
$135.68
|
| Rate for Payer: UHCCP Medicaid |
$135.68
|
| Rate for Payer: UMR Bronson Commercial |
$305.90
|
|
|
PR ADENOIDECTOMY SECONDARY AGE 12/>
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 42836
|
| Min. Negotiated Rate |
$142.07 |
| Max. Negotiated Rate |
$468.75 |
| Rate for Payer: Aetna Commercial |
$289.39
|
| Rate for Payer: Aetna Medicare |
$224.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.98
|
| Rate for Payer: BCBS Complete |
$149.17
|
| Rate for Payer: BCBS MAPPO |
$215.96
|
| Rate for Payer: BCN Commercial |
$374.98
|
| Rate for Payer: BCN Medicare Advantage |
$215.96
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cofinity Commercial |
$289.39
|
| Rate for Payer: Cofinity Commercial |
$310.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$226.76
|
| Rate for Payer: Meridian Medicaid |
$149.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$237.56
|
| Rate for Payer: Nomi Health Commercial |
$259.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.75
|
| Rate for Payer: PACE SWMI |
$215.96
|
| Rate for Payer: PHP Commercial |
$302.34
|
| Rate for Payer: PHP Medicare Advantage |
$215.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$456.89
|
| Rate for Payer: Priority Health Medicare |
$215.96
|
| Rate for Payer: Priority Health SBD |
$456.89
|
| Rate for Payer: Priority Health Tiered Network |
$456.89
|
| Rate for Payer: Railroad Medicare Medicare |
$215.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.62
|
| Rate for Payer: UHC Core |
$415.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$215.96
|
| Rate for Payer: UHC Exchange |
$415.62
|
| Rate for Payer: UHC Medicaid |
$142.07
|
| Rate for Payer: UHCCP Medicaid |
$142.07
|
| Rate for Payer: UMR Bronson Commercial |
$287.50
|
|
|
PR ADENOIDECTOMY SECONDARY<AGE 12
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
HCPCS 42835
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna Commercial |
$236.75
|
| Rate for Payer: Aetna Medicare |
$183.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.42
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS MAPPO |
$176.68
|
| Rate for Payer: BCN Commercial |
$303.27
|
| Rate for Payer: BCN Medicare Advantage |
$176.68
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cofinity Commercial |
$236.75
|
| Rate for Payer: Cofinity Commercial |
$254.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.51
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.35
|
| Rate for Payer: Nomi Health Commercial |
$212.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$396.00
|
| Rate for Payer: PACE SWMI |
$176.68
|
| Rate for Payer: PHP Commercial |
$247.35
|
| Rate for Payer: PHP Medicare Advantage |
$176.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$369.51
|
| Rate for Payer: Priority Health Medicare |
$176.68
|
| Rate for Payer: Priority Health SBD |
$369.51
|
| Rate for Payer: Priority Health Tiered Network |
$369.51
|
| Rate for Payer: Railroad Medicare Medicare |
$176.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$330.98
|
| Rate for Payer: UHC Core |
$330.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.68
|
| Rate for Payer: UHC Exchange |
$330.98
|
| Rate for Payer: UHC Medicaid |
$116.94
|
| Rate for Payer: UHCCP Medicaid |
$116.94
|
| Rate for Payer: UMR Bronson Commercial |
$242.88
|
|
|
PR ADENOSINE INJ 1MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J0153
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.64
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.69
|
| Rate for Payer: BCBS MAPPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.18
|
| Rate for Payer: BCN Medicare Advantage |
$0.48
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.64
|
| Rate for Payer: Cofinity Commercial |
$0.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.53
|
| Rate for Payer: Nomi Health Commercial |
$0.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.48
|
| Rate for Payer: PHP Commercial |
$0.67
|
| Rate for Payer: PHP Medicare Advantage |
$0.48
|
| Rate for Payer: Priority Health Medicare |
$0.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.53
|
| Rate for Payer: UHC Core |
$0.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
|
|
PR ADENOSINE INJECTION
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS J0152
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$92.25 |
| Rate for Payer: Aetna Medicare |
$61.50
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.25
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
|
|
PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 14000
|
| Min. Negotiated Rate |
$296.71 |
| Max. Negotiated Rate |
$861.09 |
| Rate for Payer: Aetna Commercial |
$603.95
|
| Rate for Payer: Aetna Medicare |
$468.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$649.02
|
| Rate for Payer: BCBS Complete |
$311.55
|
| Rate for Payer: BCBS MAPPO |
$450.71
|
| Rate for Payer: BCN Commercial |
$764.90
|
| Rate for Payer: BCN Medicare Advantage |
$450.71
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$603.95
|
| Rate for Payer: Cofinity Commercial |
$649.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$473.25
|
| Rate for Payer: Meridian Medicaid |
$311.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$495.78
|
| Rate for Payer: Nomi Health Commercial |
$540.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$803.25
|
| Rate for Payer: PACE SWMI |
$450.71
|
| Rate for Payer: PHP Commercial |
$630.99
|
| Rate for Payer: PHP Medicare Advantage |
$450.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$700.08
|
| Rate for Payer: Priority Health Medicare |
$450.71
|
| Rate for Payer: Priority Health SBD |
$700.08
|
| Rate for Payer: Priority Health Tiered Network |
$700.08
|
| Rate for Payer: Railroad Medicare Medicare |
$450.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$861.09
|
| Rate for Payer: UHC Core |
$861.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$450.71
|
| Rate for Payer: UHC Exchange |
$861.09
|
| Rate for Payer: UHC Medicaid |
$296.71
|
| Rate for Payer: UHCCP Medicaid |
$296.71
|
| Rate for Payer: UMR Bronson Commercial |
$492.66
|
|
|
PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM
|
Professional
|
Both
|
$1,395.00
|
|
|
Service Code
|
HCPCS 14001
|
| Min. Negotiated Rate |
$383.83 |
| Max. Negotiated Rate |
$1,123.19 |
| Rate for Payer: Aetna Commercial |
$785.44
|
| Rate for Payer: Aetna Medicare |
$609.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.06
|
| Rate for Payer: BCBS Complete |
$403.02
|
| Rate for Payer: BCBS MAPPO |
$586.15
|
| Rate for Payer: BCN Commercial |
$987.00
|
| Rate for Payer: BCN Medicare Advantage |
$586.15
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cash Price |
$1,116.00
|
| Rate for Payer: Cofinity Commercial |
$785.44
|
| Rate for Payer: Cofinity Commercial |
$844.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.46
|
| Rate for Payer: Meridian Medicaid |
$403.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$644.76
|
| Rate for Payer: Nomi Health Commercial |
$703.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,046.25
|
| Rate for Payer: PACE SWMI |
$586.15
|
| Rate for Payer: PHP Commercial |
$820.61
|
| Rate for Payer: PHP Medicare Advantage |
$586.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$903.36
|
| Rate for Payer: Priority Health Medicare |
$586.15
|
| Rate for Payer: Priority Health SBD |
$903.36
|
| Rate for Payer: Priority Health Tiered Network |
$903.36
|
| Rate for Payer: Railroad Medicare Medicare |
$586.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,123.19
|
| Rate for Payer: UHC Core |
$1,123.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$586.15
|
| Rate for Payer: UHC Exchange |
$1,123.19
|
| Rate for Payer: UHC Medicaid |
$383.83
|
| Rate for Payer: UHCCP Medicaid |
$383.83
|
| Rate for Payer: UMR Bronson Commercial |
$641.70
|
|
|
PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM
|
Professional
|
Both
|
$1,779.00
|
|
|
Service Code
|
HCPCS 14301
|
| Min. Negotiated Rate |
$489.90 |
| Max. Negotiated Rate |
$1,514.36 |
| Rate for Payer: Aetna Commercial |
$1,007.59
|
| Rate for Payer: Aetna Medicare |
$782.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,007.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,082.78
|
| Rate for Payer: BCBS Complete |
$514.39
|
| Rate for Payer: BCBS MAPPO |
$751.93
|
| Rate for Payer: BCN Commercial |
$1,307.20
|
| Rate for Payer: BCN Medicare Advantage |
$751.93
|
| Rate for Payer: Cash Price |
$1,423.20
|
| Rate for Payer: Cash Price |
$1,423.20
|
| Rate for Payer: Cofinity Commercial |
$1,007.59
|
| Rate for Payer: Cofinity Commercial |
$1,082.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$751.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$789.53
|
| Rate for Payer: Meridian Medicaid |
$514.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$827.12
|
| Rate for Payer: Nomi Health Commercial |
$902.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,334.25
|
| Rate for Payer: PACE SWMI |
$751.93
|
| Rate for Payer: PHP Commercial |
$1,052.70
|
| Rate for Payer: PHP Medicare Advantage |
$751.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,196.43
|
| Rate for Payer: Priority Health Medicare |
$751.93
|
| Rate for Payer: Priority Health SBD |
$1,196.43
|
| Rate for Payer: Priority Health Tiered Network |
$1,196.43
|
| Rate for Payer: Railroad Medicare Medicare |
$751.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,514.36
|
| Rate for Payer: UHC Core |
$1,514.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$751.93
|
| Rate for Payer: UHC Exchange |
$1,514.36
|
| Rate for Payer: UHC Medicaid |
$489.90
|
| Rate for Payer: UHCCP Medicaid |
$489.90
|
| Rate for Payer: UMR Bronson Commercial |
$818.34
|
|
|
PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,663.00
|
|
|
Service Code
|
HCPCS 14041
|
| Min. Negotiated Rate |
$416.20 |
| Max. Negotiated Rate |
$1,320.28 |
| Rate for Payer: Aetna Commercial |
$851.96
|
| Rate for Payer: Aetna Medicare |
$661.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.54
|
| Rate for Payer: BCBS Complete |
$437.01
|
| Rate for Payer: BCBS MAPPO |
$635.79
|
| Rate for Payer: BCN Commercial |
$1,148.35
|
| Rate for Payer: BCN Medicare Advantage |
$635.79
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cofinity Commercial |
$851.96
|
| Rate for Payer: Cofinity Commercial |
$915.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$635.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$667.58
|
| Rate for Payer: Meridian Medicaid |
$437.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$699.37
|
| Rate for Payer: Nomi Health Commercial |
$762.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,247.25
|
| Rate for Payer: PACE SWMI |
$635.79
|
| Rate for Payer: PHP Commercial |
$890.11
|
| Rate for Payer: PHP Medicare Advantage |
$635.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$416.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,051.03
|
| Rate for Payer: Priority Health Medicare |
$635.79
|
| Rate for Payer: Priority Health SBD |
$1,051.03
|
| Rate for Payer: Priority Health Tiered Network |
$1,051.03
|
| Rate for Payer: Railroad Medicare Medicare |
$635.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,320.28
|
| Rate for Payer: UHC Core |
$1,320.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$635.79
|
| Rate for Payer: UHC Exchange |
$1,320.28
|
| Rate for Payer: UHC Medicaid |
$416.20
|
| Rate for Payer: UHCCP Medicaid |
$416.20
|
| Rate for Payer: UMR Bronson Commercial |
$764.98
|
|
