|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,523.00
|
|
|
Service Code
|
HCPCS 14021
|
| Min. Negotiated Rate |
$395.54 |
| Max. Negotiated Rate |
$1,224.25 |
| Rate for Payer: Aetna Commercial |
$808.41
|
| Rate for Payer: Aetna Medicare |
$627.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.74
|
| Rate for Payer: BCBS Complete |
$415.32
|
| Rate for Payer: BCBS MAPPO |
$603.29
|
| Rate for Payer: BCN Commercial |
$1,069.66
|
| Rate for Payer: BCN Medicare Advantage |
$603.29
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Commercial |
$808.41
|
| Rate for Payer: Cofinity Commercial |
$868.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.45
|
| Rate for Payer: Meridian Medicaid |
$415.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$663.62
|
| Rate for Payer: Nomi Health Commercial |
$723.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PACE SWMI |
$603.29
|
| Rate for Payer: PHP Commercial |
$844.61
|
| Rate for Payer: PHP Medicare Advantage |
$603.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$979.01
|
| Rate for Payer: Priority Health Medicare |
$603.29
|
| Rate for Payer: Priority Health SBD |
$979.01
|
| Rate for Payer: Priority Health Tiered Network |
$979.01
|
| Rate for Payer: Railroad Medicare Medicare |
$603.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,224.25
|
| Rate for Payer: UHC Core |
$1,224.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$603.29
|
| Rate for Payer: UHC Exchange |
$1,224.25
|
| Rate for Payer: UHC Medicaid |
$395.54
|
| Rate for Payer: UHCCP Medicaid |
$395.54
|
| Rate for Payer: UMR Bronson Commercial |
$700.58
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$563.51 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna American Axle |
$989.95
|
| Rate for Payer: Aetna Commercial |
$1,294.55
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$989.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.85
|
| Rate for Payer: BCN Commercial |
$1,725.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Advantage |
$1,066.10
|
| Rate for Payer: Cofinity Commercial |
$1,309.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,218.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,370.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,066.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,142.25
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.55
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$1,294.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$959.49
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: UMR Bronson Commercial |
$563.51
|
| Rate for Payer: VA VA |
$2,055.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,142.25
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Professional
|
Both
|
$1,523.00
|
|
|
Service Code
|
HCPCS 14021
|
| Hospital Charge Code |
14021
|
| Min. Negotiated Rate |
$395.54 |
| Max. Negotiated Rate |
$1,224.25 |
| Rate for Payer: Aetna Commercial |
$808.41
|
| Rate for Payer: Aetna Medicare |
$627.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.74
|
| Rate for Payer: BCBS Complete |
$415.32
|
| Rate for Payer: BCBS MAPPO |
$603.29
|
| Rate for Payer: BCN Commercial |
$1,069.66
|
| Rate for Payer: BCN Medicare Advantage |
$603.29
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Commercial |
$808.41
|
| Rate for Payer: Cofinity Commercial |
$868.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.45
|
| Rate for Payer: Meridian Medicaid |
$415.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$663.62
|
| Rate for Payer: Nomi Health Commercial |
$723.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PACE SWMI |
$603.29
|
| Rate for Payer: PHP Commercial |
$844.61
|
| Rate for Payer: PHP Medicare Advantage |
$603.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$979.01
|
| Rate for Payer: Priority Health Medicare |
$603.29
|
| Rate for Payer: Priority Health SBD |
$979.01
|
| Rate for Payer: Priority Health Tiered Network |
$979.01
|
| Rate for Payer: Railroad Medicare Medicare |
$603.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,224.25
|
| Rate for Payer: UHC Core |
$1,224.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$603.29
|
| Rate for Payer: UHC Exchange |
$1,224.25
|
| Rate for Payer: UHC Medicaid |
$395.54
|
| Rate for Payer: UHCCP Medicaid |
$395.54
|
| Rate for Payer: UMR Bronson Commercial |
$700.58
|
|
|
PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
14021
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$670.12 |
| Max. Negotiated Rate |
$1,370.70 |
| Rate for Payer: Aetna American Axle |
$989.95
|
| Rate for Payer: Aetna Commercial |
$1,294.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$989.95
|
| Rate for Payer: Cash Price |
$1,218.40
|
| Rate for Payer: Cofinity Advantage |
$1,066.10
|
| Rate for Payer: Cofinity Commercial |
$1,309.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,218.40
|
| Rate for Payer: Healthscope Commercial |
$1,370.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,066.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,142.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,142.25
|
| Rate for Payer: PHP Commercial |
$1,294.55
|
| Rate for Payer: Priority Health SBD |
$959.49
|
| Rate for Payer: UMR Bronson Commercial |
$670.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,142.25
|
|
|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,302.00
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$445.60 |
| Max. Negotiated Rate |
$1,726.50 |
| Rate for Payer: Aetna Commercial |
$911.29
|
| Rate for Payer: Aetna Medicare |
$707.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.30
|
| Rate for Payer: BCBS Complete |
$467.88
|
| Rate for Payer: BCBS MAPPO |
$680.07
|
| Rate for Payer: BCN Commercial |
$1,231.01
|
| Rate for Payer: BCN Medicare Advantage |
$680.07
|
| Rate for Payer: Cash Price |
$1,841.60
|
| Rate for Payer: Cash Price |
$1,841.60
|
| Rate for Payer: Cofinity Commercial |
$911.29
|
| Rate for Payer: Cofinity Commercial |
$979.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.07
|
| Rate for Payer: Meridian Medicaid |
$467.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$748.08
|
| Rate for Payer: Nomi Health Commercial |
$816.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,726.50
|
| Rate for Payer: PACE SWMI |
$680.07
|
| Rate for Payer: PHP Commercial |
$952.10
|
| Rate for Payer: PHP Medicare Advantage |
$680.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,126.70
|
| Rate for Payer: Priority Health Medicare |
$680.07
|
| Rate for Payer: Priority Health SBD |
$1,126.70
|
| Rate for Payer: Priority Health Tiered Network |
$1,126.70
|
| Rate for Payer: Railroad Medicare Medicare |
$680.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,413.07
|
| Rate for Payer: UHC Core |
$1,413.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$680.07
|
| Rate for Payer: UHC Exchange |
$1,413.07
|
| Rate for Payer: UHC Medicaid |
$445.60
|
| Rate for Payer: UHCCP Medicaid |
$445.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,058.92
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$116.51 |
| Max. Negotiated Rate |
$385.74 |
| Rate for Payer: Aetna Commercial |
$244.08
|
| Rate for Payer: Aetna Medicare |
$189.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.30
|
| Rate for Payer: BCBS Complete |
$122.34
|
| Rate for Payer: BCBS MAPPO |
$182.15
|
| Rate for Payer: BCN Commercial |
$320.20
|
| Rate for Payer: BCN Medicare Advantage |
$182.15
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$244.08
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.26
|
| Rate for Payer: Meridian Medicaid |
$122.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$200.37
|
| Rate for Payer: Nomi Health Commercial |
$218.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.50
|
| Rate for Payer: PACE SWMI |
$182.15
|
| Rate for Payer: PHP Commercial |
$255.01
|
| Rate for Payer: PHP Medicare Advantage |
$182.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$293.07
|
| Rate for Payer: Priority Health Medicare |
$182.15
|
| Rate for Payer: Priority Health SBD |
$293.07
|
| Rate for Payer: Priority Health Tiered Network |
$293.07
|
| Rate for Payer: Railroad Medicare Medicare |
$182.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$385.74
|
| Rate for Payer: UHC Core |
$385.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.15
|
| Rate for Payer: UHC Exchange |
$385.74
|
| Rate for Payer: UHC Medicaid |
$116.51
|
| Rate for Payer: UHCCP Medicaid |
$116.51
|
| Rate for Payer: UMR Bronson Commercial |
$214.36
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,204.00
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$321.84 |
| Max. Negotiated Rate |
$965.65 |
| Rate for Payer: Aetna Commercial |
$654.52
|
| Rate for Payer: Aetna Medicare |
$507.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$703.37
|
| Rate for Payer: BCBS Complete |
$337.93
|
| Rate for Payer: BCBS MAPPO |
$488.45
|
| Rate for Payer: BCN Commercial |
$857.02
|
| Rate for Payer: BCN Medicare Advantage |
$488.45
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cash Price |
$963.20
|
| Rate for Payer: Cofinity Commercial |
$654.52
|
| Rate for Payer: Cofinity Commercial |
$703.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.87
|
| Rate for Payer: Meridian Medicaid |
$337.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$537.29
|
| Rate for Payer: Nomi Health Commercial |
$586.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$903.00
|
| Rate for Payer: PACE SWMI |
$488.45
|
| Rate for Payer: PHP Commercial |
$683.83
|
| Rate for Payer: PHP Medicare Advantage |
$488.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$321.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$784.40
|
| Rate for Payer: Priority Health Medicare |
$488.45
|
| Rate for Payer: Priority Health SBD |
$784.40
|
| Rate for Payer: Priority Health Tiered Network |
$784.40
|
| Rate for Payer: Railroad Medicare Medicare |
$488.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$965.65
|
| Rate for Payer: UHC Core |
$965.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$488.45
|
| Rate for Payer: UHC Exchange |
$965.65
|
| Rate for Payer: UHC Medicaid |
$321.84
|
| Rate for Payer: UHCCP Medicaid |
$321.84
|
| Rate for Payer: UMR Bronson Commercial |
$553.84
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$2,129.00
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$365.72 |
| Max. Negotiated Rate |
$1,596.75 |
| Rate for Payer: Aetna Commercial |
$747.01
|
| Rate for Payer: Aetna Medicare |
$579.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$802.76
|
| Rate for Payer: BCBS Complete |
$384.01
|
| Rate for Payer: BCBS MAPPO |
$557.47
|
| Rate for Payer: BCN Commercial |
$1,001.94
|
| Rate for Payer: BCN Medicare Advantage |
$557.47
|
| Rate for Payer: Cash Price |
$1,703.20
|
| Rate for Payer: Cash Price |
$1,703.20
|
| Rate for Payer: Cofinity Commercial |
$747.01
|
| Rate for Payer: Cofinity Commercial |
$802.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.34
|
| Rate for Payer: Meridian Medicaid |
$384.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$613.22
|
| Rate for Payer: Nomi Health Commercial |
$668.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.75
|
| Rate for Payer: PACE SWMI |
$557.47
|
| Rate for Payer: PHP Commercial |
$780.46
|
| Rate for Payer: PHP Medicare Advantage |
$557.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$917.03
|
| Rate for Payer: Priority Health Medicare |
$557.47
|
| Rate for Payer: Priority Health SBD |
$917.03
|
| Rate for Payer: Priority Health Tiered Network |
$917.03
|
| Rate for Payer: Railroad Medicare Medicare |
$557.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,146.45
|
| Rate for Payer: UHC Core |
$1,146.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$557.47
|
| Rate for Payer: UHC Exchange |
$1,146.45
|
| Rate for Payer: UHC Medicaid |
$365.72
|
| Rate for Payer: UHCCP Medicaid |
$365.72
|
| Rate for Payer: UMR Bronson Commercial |
$979.34
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,338.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
14040
|
| Min. Negotiated Rate |
$348.26 |
| Max. Negotiated Rate |
$1,075.72 |
| Rate for Payer: Aetna Commercial |
$711.12
|
| Rate for Payer: Aetna Medicare |
$551.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.19
|
| Rate for Payer: BCBS Complete |
$365.67
|
| Rate for Payer: BCBS MAPPO |
$530.69
|
| Rate for Payer: BCN Commercial |
$941.18
|
| Rate for Payer: BCN Medicare Advantage |
$530.69
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Commercial |
$711.12
|
| Rate for Payer: Cofinity Commercial |
$764.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.22
|
| Rate for Payer: Meridian Medicaid |
$365.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$583.76
|
| Rate for Payer: Nomi Health Commercial |
$636.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PACE SWMI |
$530.69
|
| Rate for Payer: PHP Commercial |
$742.97
|
| Rate for Payer: PHP Medicare Advantage |
$530.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$861.43
|
| Rate for Payer: Priority Health Medicare |
$530.69
|
| Rate for Payer: Priority Health SBD |
$861.43
|
| Rate for Payer: Priority Health Tiered Network |
$861.43
|
| Rate for Payer: Railroad Medicare Medicare |
$530.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.72
|
| Rate for Payer: UHC Core |
$1,075.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$530.69
|
| Rate for Payer: UHC Exchange |
$1,075.72
|
| Rate for Payer: UHC Medicaid |
$348.26
|
| Rate for Payer: UHCCP Medicaid |
$348.26
|
| Rate for Payer: UMR Bronson Commercial |
$615.48
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
OP
|
$1,338.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$495.06 |
| Max. Negotiated Rate |
$6,648.46 |
| Rate for Payer: Aetna American Axle |
$869.70
|
| Rate for Payer: Aetna Commercial |
$1,137.30
|
| Rate for Payer: Aetna Medicare |
$2,138.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,569.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,569.82
|
| Rate for Payer: BCBS Complete |
$1,129.08
|
| Rate for Payer: BCBS MAPPO |
$2,055.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,496.03
|
| Rate for Payer: BCN Commercial |
$2,496.03
|
| Rate for Payer: BCN Medicare Advantage |
$2,055.86
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Advantage |
$936.60
|
| Rate for Payer: Cofinity Commercial |
$1,150.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,055.86
|
| Rate for Payer: Healthscope Commercial |
$1,204.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$936.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,003.50
|
| Rate for Payer: Mclaren Medicaid |
$2,055.86
|
| Rate for Payer: Mclaren Medicare |
$2,055.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,158.65
|
| Rate for Payer: Meridian Medicaid |
$2,158.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,364.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,261.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.30
|
| Rate for Payer: Nomi Health Commercial |
$6,167.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PACE Medicare |
$1,953.07
|
| Rate for Payer: PACE SWMI |
$2,055.86
|
| Rate for Payer: PHP Commercial |
$1,137.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,055.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$6,648.46
|
| Rate for Payer: Priority Health Medicare |
$2,055.86
|
| Rate for Payer: Priority Health SBD |
$842.94
|
| Rate for Payer: Priority Health Tiered Network |
$5,318.77
|
| Rate for Payer: Railroad Medicare Medicare |
$2,055.86
|
| Rate for Payer: UHC Medicaid |
$1,075.21
|
| Rate for Payer: UHCCP Medicaid |
$1,075.21
|
| Rate for Payer: UMR Bronson Commercial |
$495.06
|
| Rate for Payer: VA VA |
$2,055.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,003.50
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,338.00
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$348.26 |
| Max. Negotiated Rate |
$1,075.72 |
| Rate for Payer: Aetna Commercial |
$711.12
|
| Rate for Payer: Aetna Medicare |
$551.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$711.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.19
|
| Rate for Payer: BCBS Complete |
$365.67
|
| Rate for Payer: BCBS MAPPO |
$530.69
|
| Rate for Payer: BCN Commercial |
$941.18
|
| Rate for Payer: BCN Medicare Advantage |
$530.69
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Commercial |
$711.12
|
| Rate for Payer: Cofinity Commercial |
$764.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$530.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$557.22
|
| Rate for Payer: Meridian Medicaid |
$365.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$583.76
|
| Rate for Payer: Nomi Health Commercial |
$636.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PACE SWMI |
$530.69
|
| Rate for Payer: PHP Commercial |
$742.97
|
| Rate for Payer: PHP Medicare Advantage |
$530.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$861.43
|
| Rate for Payer: Priority Health Medicare |
$530.69
|
| Rate for Payer: Priority Health SBD |
$861.43
|
| Rate for Payer: Priority Health Tiered Network |
$861.43
|
| Rate for Payer: Railroad Medicare Medicare |
$530.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.72
|
| Rate for Payer: UHC Core |
$1,075.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$530.69
|
| Rate for Payer: UHC Exchange |
$1,075.72
|
| Rate for Payer: UHC Medicaid |
$348.26
|
| Rate for Payer: UHCCP Medicaid |
$348.26
|
| Rate for Payer: UMR Bronson Commercial |
$615.48
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
IP
|
$1,338.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$588.72 |
| Max. Negotiated Rate |
$1,204.20 |
| Rate for Payer: Aetna American Axle |
$869.70
|
| Rate for Payer: Aetna Commercial |
$1,137.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$869.70
|
| Rate for Payer: Cash Price |
$1,070.40
|
| Rate for Payer: Cofinity Advantage |
$936.60
|
| Rate for Payer: Cofinity Commercial |
$1,150.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,070.40
|
| Rate for Payer: Healthscope Commercial |
$1,204.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$936.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,003.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,137.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,003.50
|
| Rate for Payer: PHP Commercial |
$1,137.30
|
| Rate for Payer: Priority Health SBD |
$842.94
|
| Rate for Payer: UMR Bronson Commercial |
$588.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,003.50
|
|
|
PR ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS S2083
|
| Min. Negotiated Rate |
$54.28 |
| Max. Negotiated Rate |
$109.78 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: Aetna Medicare |
$59.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.62
|
| Rate for Payer: BCN Commercial |
$109.78
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$88.50
|
| Rate for Payer: UMR Bronson Commercial |
$54.28
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$1,056.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$274.13 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$559.07
|
| Rate for Payer: Aetna Medicare |
$433.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.07
|
| Rate for Payer: BCBS Complete |
$287.84
|
| Rate for Payer: BCBS MAPPO |
$417.22
|
| Rate for Payer: BCN Commercial |
$687.71
|
| Rate for Payer: BCN Medicare Advantage |
$417.22
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cash Price |
$844.80
|
| Rate for Payer: Cofinity Commercial |
$600.80
|
| Rate for Payer: Cofinity Commercial |
$559.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.08
|
| Rate for Payer: Meridian Medicaid |
$287.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$458.94
|
| Rate for Payer: Nomi Health Commercial |
$500.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$792.00
|
| Rate for Payer: PACE SWMI |
$417.22
|
| Rate for Payer: PHP Commercial |
$584.11
|
| Rate for Payer: PHP Medicare Advantage |
$417.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$735.15
|
| Rate for Payer: Priority Health Medicare |
$417.22
|
| Rate for Payer: Priority Health SBD |
$735.15
|
| Rate for Payer: Priority Health Tiered Network |
$735.15
|
| Rate for Payer: Railroad Medicare Medicare |
$417.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$770.63
|
| Rate for Payer: UHC Core |
$770.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$417.22
|
| Rate for Payer: UHC Exchange |
$770.63
|
| Rate for Payer: UHC Medicaid |
$274.13
|
| Rate for Payer: UHCCP Medicaid |
$274.13
|
| Rate for Payer: UMR Bronson Commercial |
$485.76
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: BCN Commercial |
$22.11
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47.76
|
| Rate for Payer: Priority Health SBD |
$47.76
|
| Rate for Payer: Priority Health Tiered Network |
$47.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Exchange |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: BCN Commercial |
$22.11
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47.76
|
| Rate for Payer: Priority Health SBD |
$47.76
|
| Rate for Payer: Priority Health Tiered Network |
$47.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Exchange |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS G0009
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$47.76 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: BCN Commercial |
$22.11
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47.76
|
| Rate for Payer: Priority Health SBD |
$47.76
|
| Rate for Payer: Priority Health Tiered Network |
$47.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Exchange |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
PR ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 96380
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$38.06
|
| Rate for Payer: Aetna Medicare |
$29.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.90
|
| Rate for Payer: BCBS MAPPO |
$28.40
|
| Rate for Payer: BCN Commercial |
$27.07
|
| Rate for Payer: BCN Medicare Advantage |
$28.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$38.06
|
| Rate for Payer: Cofinity Commercial |
$40.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.24
|
| Rate for Payer: Nomi Health Commercial |
$34.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.00
|
| Rate for Payer: PACE SWMI |
$28.40
|
| Rate for Payer: PHP Commercial |
$39.76
|
| Rate for Payer: PHP Medicare Advantage |
$28.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$31.69
|
| Rate for Payer: Priority Health Medicare |
$28.40
|
| Rate for Payer: Priority Health SBD |
$31.69
|
| Rate for Payer: Priority Health Tiered Network |
$31.69
|
| Rate for Payer: Railroad Medicare Medicare |
$28.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.22
|
| Rate for Payer: UHC Core |
$23.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.40
|
| Rate for Payer: UHC Exchange |
$23.22
|
| Rate for Payer: UMR Bronson Commercial |
$40.48
|
|
|
PR ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 96381
|
| Min. Negotiated Rate |
$20.03 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$30.59
|
| Rate for Payer: Aetna Medicare |
$23.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.88
|
| Rate for Payer: BCBS MAPPO |
$22.83
|
| Rate for Payer: BCN Commercial |
$27.07
|
| Rate for Payer: BCN Medicare Advantage |
$22.83
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$32.88
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.11
|
| Rate for Payer: Nomi Health Commercial |
$27.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.00
|
| Rate for Payer: PACE SWMI |
$22.83
|
| Rate for Payer: PHP Commercial |
$31.96
|
| Rate for Payer: PHP Medicare Advantage |
$22.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.09
|
| Rate for Payer: Priority Health Medicare |
$22.83
|
| Rate for Payer: Priority Health SBD |
$27.09
|
| Rate for Payer: Priority Health Tiered Network |
$27.09
|
| Rate for Payer: Railroad Medicare Medicare |
$22.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.03
|
| Rate for Payer: UHC Core |
$20.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.83
|
| Rate for Payer: UHC Exchange |
$20.03
|
| Rate for Payer: UMR Bronson Commercial |
$40.48
|
|
|
PR ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR
|
Professional
|
Both
|
$4,570.00
|
|
|
Service Code
|
HCPCS 60545
|
| Min. Negotiated Rate |
$748.91 |
| Max. Negotiated Rate |
$3,427.50 |
| Rate for Payer: Aetna Commercial |
$1,563.40
|
| Rate for Payer: Aetna Medicare |
$1,213.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,563.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,680.08
|
| Rate for Payer: BCBS Complete |
$786.36
|
| Rate for Payer: BCBS MAPPO |
$1,166.72
|
| Rate for Payer: BCN Commercial |
$1,865.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,166.72
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cash Price |
$3,656.00
|
| Rate for Payer: Cofinity Commercial |
$1,563.40
|
| Rate for Payer: Cofinity Commercial |
$1,680.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,166.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,225.06
|
| Rate for Payer: Meridian Medicaid |
$786.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,283.39
|
| Rate for Payer: Nomi Health Commercial |
$1,400.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,427.50
|
| Rate for Payer: PACE SWMI |
$1,166.72
|
| Rate for Payer: PHP Commercial |
$1,633.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,166.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$748.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,023.30
|
| Rate for Payer: Priority Health Medicare |
$1,166.72
|
| Rate for Payer: Priority Health SBD |
$2,023.30
|
| Rate for Payer: Priority Health Tiered Network |
$2,023.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,166.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,188.57
|
| Rate for Payer: UHC Core |
$2,188.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,166.72
|
| Rate for Payer: UHC Exchange |
$2,188.57
|
| Rate for Payer: UHC Medicaid |
$748.91
|
| Rate for Payer: UHCCP Medicaid |
$748.91
|
| Rate for Payer: UMR Bronson Commercial |
$2,102.20
|
|
|
PR ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX
|
Professional
|
Both
|
$3,470.00
|
|
|
Service Code
|
HCPCS 60540
|
| Min. Negotiated Rate |
$644.75 |
| Max. Negotiated Rate |
$2,602.50 |
| Rate for Payer: Aetna Commercial |
$1,343.82
|
| Rate for Payer: Aetna Medicare |
$1,042.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,343.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,444.10
|
| Rate for Payer: BCBS Complete |
$676.99
|
| Rate for Payer: BCBS MAPPO |
$1,002.85
|
| Rate for Payer: BCN Commercial |
$1,619.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,002.85
|
| Rate for Payer: Cash Price |
$2,776.00
|
| Rate for Payer: Cash Price |
$2,776.00
|
| Rate for Payer: Cofinity Commercial |
$1,343.82
|
| Rate for Payer: Cofinity Commercial |
$1,444.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,002.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,052.99
|
| Rate for Payer: Meridian Medicaid |
$676.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,103.13
|
| Rate for Payer: Nomi Health Commercial |
$1,203.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,602.50
|
| Rate for Payer: PACE SWMI |
$1,002.85
|
| Rate for Payer: PHP Commercial |
$1,403.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,002.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$644.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,756.55
|
| Rate for Payer: Priority Health Medicare |
$1,002.85
|
| Rate for Payer: Priority Health SBD |
$1,756.55
|
| Rate for Payer: Priority Health Tiered Network |
$1,756.55
|
| Rate for Payer: Railroad Medicare Medicare |
$1,002.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,897.05
|
| Rate for Payer: UHC Core |
$1,897.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,002.85
|
| Rate for Payer: UHC Exchange |
$1,897.05
|
| Rate for Payer: UHC Medicaid |
$644.75
|
| Rate for Payer: UHCCP Medicaid |
$644.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,596.20
|
|
|
PR ADRENALIN EPINEPHRINE INJECT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J0171
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Commercial |
$0.77
|
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.77
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCN Commercial |
$0.08
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 99498
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$104.95 |
| Rate for Payer: Aetna Commercial |
$83.96
|
| Rate for Payer: Aetna Medicare |
$65.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.23
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS MAPPO |
$62.66
|
| Rate for Payer: BCN Commercial |
$77.01
|
| Rate for Payer: BCN Medicare Advantage |
$62.66
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$90.23
|
| Rate for Payer: Cofinity Commercial |
$83.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.79
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.93
|
| Rate for Payer: Nomi Health Commercial |
$75.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.00
|
| Rate for Payer: PACE SWMI |
$62.66
|
| Rate for Payer: PHP Commercial |
$87.72
|
| Rate for Payer: PHP Medicare Advantage |
$62.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.33
|
| Rate for Payer: Priority Health Medicare |
$62.66
|
| Rate for Payer: Priority Health SBD |
$92.33
|
| Rate for Payer: Priority Health Tiered Network |
$92.33
|
| Rate for Payer: Railroad Medicare Medicare |
$62.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.95
|
| Rate for Payer: UHC Core |
$104.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.66
|
| Rate for Payer: UHC Exchange |
$104.95
|
| Rate for Payer: UHC Medicaid |
$40.47
|
| Rate for Payer: UHCCP Medicaid |
$40.47
|
| Rate for Payer: UMR Bronson Commercial |
$38.64
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$111.48 |
| Rate for Payer: Aetna Commercial |
$87.21
|
| Rate for Payer: Aetna Medicare |
$67.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.72
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS MAPPO |
$65.08
|
| Rate for Payer: BCN Commercial |
$81.36
|
| Rate for Payer: BCN Medicare Advantage |
$65.08
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$87.21
|
| Rate for Payer: Cofinity Commercial |
$93.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.33
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.59
|
| Rate for Payer: Nomi Health Commercial |
$78.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.50
|
| Rate for Payer: PACE SWMI |
$65.08
|
| Rate for Payer: PHP Commercial |
$91.11
|
| Rate for Payer: PHP Medicare Advantage |
$65.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$97.57
|
| Rate for Payer: Priority Health Medicare |
$65.08
|
| Rate for Payer: Priority Health SBD |
$97.57
|
| Rate for Payer: Priority Health Tiered Network |
$97.57
|
| Rate for Payer: Railroad Medicare Medicare |
$65.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.48
|
| Rate for Payer: UHC Core |
$111.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65.08
|
| Rate for Payer: UHC Exchange |
$111.48
|
| Rate for Payer: UHC Medicaid |
$41.96
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$48.76
|
|
|
PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 92651
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$145.54 |
| Rate for Payer: Aetna Commercial |
$102.27
|
| Rate for Payer: Aetna Medicare |
$79.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.90
|
| Rate for Payer: BCBS MAPPO |
$76.32
|
| Rate for Payer: BCN Commercial |
$118.03
|
| Rate for Payer: BCN Medicare Advantage |
$76.32
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$102.27
|
| Rate for Payer: Cofinity Commercial |
$109.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.95
|
| Rate for Payer: Nomi Health Commercial |
$91.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.50
|
| Rate for Payer: PACE SWMI |
$76.32
|
| Rate for Payer: PHP Commercial |
$106.85
|
| Rate for Payer: PHP Medicare Advantage |
$76.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$108.84
|
| Rate for Payer: Priority Health Medicare |
$76.32
|
| Rate for Payer: Priority Health SBD |
$108.84
|
| Rate for Payer: Priority Health Tiered Network |
$108.84
|
| Rate for Payer: Railroad Medicare Medicare |
$76.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.54
|
| Rate for Payer: UHC Core |
$145.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.32
|
| Rate for Payer: UHC Exchange |
$145.54
|
| Rate for Payer: UMR Bronson Commercial |
$76.36
|
|
