|
PR ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 44373
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$712.50 |
| Rate for Payer: Aetna Commercial |
$225.46
|
| Rate for Payer: Aetna Medicare |
$174.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.28
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS MAPPO |
$168.25
|
| Rate for Payer: BCN Commercial |
$283.85
|
| Rate for Payer: BCN Medicare Advantage |
$168.25
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$242.28
|
| Rate for Payer: Cofinity Commercial |
$225.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.25
|
| Rate for Payer: Healthscope Commercial |
$311.26
|
| Rate for Payer: Healthscope Commercial |
$269.20
|
| Rate for Payer: Mclaren Medicaid |
$108.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.66
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.12
|
| Rate for Payer: Nomi Health Commercial |
$201.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$712.50
|
| Rate for Payer: PACE SWMI |
$168.25
|
| Rate for Payer: PHP Medicare Advantage |
$168.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$345.86
|
| Rate for Payer: Priority Health Medicare |
$168.25
|
| Rate for Payer: Priority Health SBD |
$345.86
|
| Rate for Payer: Priority Health Tiered Network |
$345.86
|
| Rate for Payer: Railroad Medicare Medicare |
$168.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.25
|
| Rate for Payer: UHC Core |
$339.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.25
|
| Rate for Payer: UHC Exchange |
$339.25
|
| Rate for Payer: UHC Medicaid |
$108.63
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
|
|
PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING
|
Professional
|
Both
|
$1,594.00
|
|
|
Service Code
|
HCPCS 44378
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$1,195.50 |
| Rate for Payer: Aetna Commercial |
$443.83
|
| Rate for Payer: Aetna Medicare |
$344.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.96
|
| Rate for Payer: BCBS Complete |
$224.32
|
| Rate for Payer: BCBS MAPPO |
$331.22
|
| Rate for Payer: BCN Commercial |
$564.22
|
| Rate for Payer: BCN Medicare Advantage |
$331.22
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Cash Price |
$1,275.20
|
| Rate for Payer: Cofinity Commercial |
$476.96
|
| Rate for Payer: Cofinity Commercial |
$443.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.22
|
| Rate for Payer: Healthscope Commercial |
$612.76
|
| Rate for Payer: Healthscope Commercial |
$529.95
|
| Rate for Payer: Mclaren Medicaid |
$213.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$347.78
|
| Rate for Payer: Meridian Medicaid |
$224.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$364.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.31
|
| Rate for Payer: Nomi Health Commercial |
$397.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,195.50
|
| Rate for Payer: PACE SWMI |
$331.22
|
| Rate for Payer: PHP Medicare Advantage |
$331.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$687.46
|
| Rate for Payer: Priority Health Medicare |
$331.22
|
| Rate for Payer: Priority Health SBD |
$687.46
|
| Rate for Payer: Priority Health Tiered Network |
$687.46
|
| Rate for Payer: Railroad Medicare Medicare |
$331.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$679.10
|
| Rate for Payer: UHC Core |
$679.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$331.22
|
| Rate for Payer: UHC Exchange |
$679.10
|
| Rate for Payer: UHC Medicaid |
$213.64
|
| Rate for Payer: UHCCP Medicaid |
$213.64
|
|
|
PR ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
HCPCS 44370
|
| Min. Negotiated Rate |
$150.17 |
| Max. Negotiated Rate |
$1,069.50 |
| Rate for Payer: Aetna Commercial |
$310.61
|
| Rate for Payer: Aetna Medicare |
$241.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.79
|
| Rate for Payer: BCBS Complete |
$157.68
|
| Rate for Payer: BCBS MAPPO |
$231.80
|
| Rate for Payer: BCN Commercial |
$392.41
|
| Rate for Payer: BCN Medicare Advantage |
$231.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cash Price |
$1,140.80
|
| Rate for Payer: Cofinity Commercial |
$333.79
|
| Rate for Payer: Cofinity Commercial |
$310.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.80
|
| Rate for Payer: Healthscope Commercial |
$428.83
|
| Rate for Payer: Healthscope Commercial |
$370.88
|
| Rate for Payer: Mclaren Medicaid |
$150.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.39
|
| Rate for Payer: Meridian Medicaid |
$157.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$254.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$465.53
|
| Rate for Payer: Nomi Health Commercial |
$278.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,069.50
|
| Rate for Payer: PACE SWMI |
$231.80
|
| Rate for Payer: PHP Medicare Advantage |
$231.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$150.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$478.12
|
| Rate for Payer: Priority Health Medicare |
$231.80
|
| Rate for Payer: Priority Health SBD |
$478.12
|
| Rate for Payer: Priority Health Tiered Network |
$478.12
|
| Rate for Payer: Railroad Medicare Medicare |
$231.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$469.57
|
| Rate for Payer: UHC Core |
$469.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$231.80
|
| Rate for Payer: UHC Exchange |
$469.57
|
| Rate for Payer: UHC Medicaid |
$150.17
|
| Rate for Payer: UHCCP Medicaid |
$150.17
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING
|
Professional
|
Both
|
$1,358.00
|
|
|
Service Code
|
HCPCS 44366
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$1,018.50 |
| Rate for Payer: Aetna Commercial |
$278.10
|
| Rate for Payer: Aetna Medicare |
$215.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.86
|
| Rate for Payer: BCBS Complete |
$140.90
|
| Rate for Payer: BCBS MAPPO |
$207.54
|
| Rate for Payer: BCN Commercial |
$352.57
|
| Rate for Payer: BCN Medicare Advantage |
$207.54
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cash Price |
$1,086.40
|
| Rate for Payer: Cofinity Commercial |
$298.86
|
| Rate for Payer: Cofinity Commercial |
$278.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.54
|
| Rate for Payer: Healthscope Commercial |
$383.95
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Mclaren Medicaid |
$134.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.92
|
| Rate for Payer: Meridian Medicaid |
$140.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$228.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$418.91
|
| Rate for Payer: Nomi Health Commercial |
$249.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,018.50
|
| Rate for Payer: PACE SWMI |
$207.54
|
| Rate for Payer: PHP Medicare Advantage |
$207.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$429.58
|
| Rate for Payer: Priority Health Medicare |
$207.54
|
| Rate for Payer: Priority Health SBD |
$429.58
|
| Rate for Payer: Priority Health Tiered Network |
$429.58
|
| Rate for Payer: Railroad Medicare Medicare |
$207.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.57
|
| Rate for Payer: UHC Core |
$423.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$207.54
|
| Rate for Payer: UHC Exchange |
$423.57
|
| Rate for Payer: UHC Medicaid |
$134.19
|
| Rate for Payer: UHCCP Medicaid |
$134.19
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT
|
Professional
|
Both
|
$1,578.00
|
|
|
Service Code
|
HCPCS 44379
|
| Min. Negotiated Rate |
$228.76 |
| Max. Negotiated Rate |
$1,183.50 |
| Rate for Payer: Aetna Commercial |
$474.65
|
| Rate for Payer: Aetna Medicare |
$368.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.08
|
| Rate for Payer: BCBS Complete |
$240.20
|
| Rate for Payer: BCBS MAPPO |
$354.22
|
| Rate for Payer: BCN Commercial |
$600.57
|
| Rate for Payer: BCN Medicare Advantage |
$354.22
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cash Price |
$1,262.40
|
| Rate for Payer: Cofinity Commercial |
$510.08
|
| Rate for Payer: Cofinity Commercial |
$474.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.22
|
| Rate for Payer: Healthscope Commercial |
$655.31
|
| Rate for Payer: Healthscope Commercial |
$566.75
|
| Rate for Payer: Mclaren Medicaid |
$228.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.93
|
| Rate for Payer: Meridian Medicaid |
$240.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$389.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.66
|
| Rate for Payer: Nomi Health Commercial |
$425.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,183.50
|
| Rate for Payer: PACE SWMI |
$354.22
|
| Rate for Payer: PHP Medicare Advantage |
$354.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$731.75
|
| Rate for Payer: Priority Health Medicare |
$354.22
|
| Rate for Payer: Priority Health SBD |
$731.75
|
| Rate for Payer: Priority Health Tiered Network |
$731.75
|
| Rate for Payer: Railroad Medicare Medicare |
$354.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$721.46
|
| Rate for Payer: UHC Core |
$721.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$354.22
|
| Rate for Payer: UHC Exchange |
$721.46
|
| Rate for Payer: UHC Medicaid |
$228.76
|
| Rate for Payer: UHCCP Medicaid |
$228.76
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE
|
Professional
|
Both
|
$968.00
|
|
|
Service Code
|
HCPCS 44372
|
| Min. Negotiated Rate |
$135.26 |
| Max. Negotiated Rate |
$726.00 |
| Rate for Payer: Aetna Commercial |
$281.12
|
| Rate for Payer: Aetna Medicare |
$218.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.10
|
| Rate for Payer: BCBS Complete |
$142.02
|
| Rate for Payer: BCBS MAPPO |
$209.79
|
| Rate for Payer: BCN Commercial |
$353.57
|
| Rate for Payer: BCN Medicare Advantage |
$209.79
|
| Rate for Payer: Cash Price |
$774.40
|
| Rate for Payer: Cash Price |
$774.40
|
| Rate for Payer: Cofinity Commercial |
$302.10
|
| Rate for Payer: Cofinity Commercial |
$281.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.79
|
| Rate for Payer: Healthscope Commercial |
$388.11
|
| Rate for Payer: Healthscope Commercial |
$335.66
|
| Rate for Payer: Mclaren Medicaid |
$135.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.28
|
| Rate for Payer: Meridian Medicaid |
$142.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.08
|
| Rate for Payer: Nomi Health Commercial |
$251.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$726.00
|
| Rate for Payer: PACE SWMI |
$209.79
|
| Rate for Payer: PHP Medicare Advantage |
$209.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$430.80
|
| Rate for Payer: Priority Health Medicare |
$209.79
|
| Rate for Payer: Priority Health SBD |
$430.80
|
| Rate for Payer: Priority Health Tiered Network |
$430.80
|
| Rate for Payer: Railroad Medicare Medicare |
$209.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$423.93
|
| Rate for Payer: UHC Core |
$423.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$209.79
|
| Rate for Payer: UHC Exchange |
$423.93
|
| Rate for Payer: UHC Medicaid |
$135.26
|
| Rate for Payer: UHCCP Medicaid |
$135.26
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
HCPCS 44363
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$752.25 |
| Rate for Payer: Aetna Commercial |
$224.14
|
| Rate for Payer: Aetna Medicare |
$173.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.87
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCBS MAPPO |
$167.27
|
| Rate for Payer: BCN Commercial |
$281.86
|
| Rate for Payer: BCN Medicare Advantage |
$167.27
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cash Price |
$802.40
|
| Rate for Payer: Cofinity Commercial |
$240.87
|
| Rate for Payer: Cofinity Commercial |
$224.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$167.27
|
| Rate for Payer: Healthscope Commercial |
$309.45
|
| Rate for Payer: Healthscope Commercial |
$267.63
|
| Rate for Payer: Mclaren Medicaid |
$108.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.63
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.73
|
| Rate for Payer: Nomi Health Commercial |
$200.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$752.25
|
| Rate for Payer: PACE SWMI |
$167.27
|
| Rate for Payer: PHP Medicare Advantage |
$167.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$343.42
|
| Rate for Payer: Priority Health Medicare |
$167.27
|
| Rate for Payer: Priority Health SBD |
$343.42
|
| Rate for Payer: Priority Health Tiered Network |
$343.42
|
| Rate for Payer: Railroad Medicare Medicare |
$167.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.46
|
| Rate for Payer: UHC Core |
$338.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$167.27
|
| Rate for Payer: UHC Exchange |
$338.46
|
| Rate for Payer: UHC Medicaid |
$108.20
|
| Rate for Payer: UHCCP Medicaid |
$108.20
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY
|
Professional
|
Both
|
$1,154.00
|
|
|
Service Code
|
HCPCS 44365
|
| Min. Negotiated Rate |
$102.67 |
| Max. Negotiated Rate |
$865.50 |
| Rate for Payer: PHP Medicare Advantage |
$158.61
|
| Rate for Payer: Aetna Commercial |
$212.54
|
| Rate for Payer: Aetna Medicare |
$164.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.40
|
| Rate for Payer: BCBS Complete |
$107.80
|
| Rate for Payer: BCBS MAPPO |
$158.61
|
| Rate for Payer: BCN Commercial |
$268.41
|
| Rate for Payer: BCN Medicare Advantage |
$158.61
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cofinity Commercial |
$228.40
|
| Rate for Payer: Cofinity Commercial |
$212.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.61
|
| Rate for Payer: Healthscope Commercial |
$293.43
|
| Rate for Payer: Healthscope Commercial |
$253.78
|
| Rate for Payer: Mclaren Medicaid |
$102.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.54
|
| Rate for Payer: Meridian Medicaid |
$107.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$174.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.32
|
| Rate for Payer: Nomi Health Commercial |
$190.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$865.50
|
| Rate for Payer: PACE SWMI |
$158.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$327.05
|
| Rate for Payer: Priority Health Medicare |
$158.61
|
| Rate for Payer: Priority Health SBD |
$327.05
|
| Rate for Payer: Priority Health Tiered Network |
$327.05
|
| Rate for Payer: Railroad Medicare Medicare |
$158.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.00
|
| Rate for Payer: UHC Core |
$320.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$158.61
|
| Rate for Payer: UHC Exchange |
$320.00
|
| Rate for Payer: UHC Medicaid |
$102.67
|
| Rate for Payer: UHCCP Medicaid |
$102.67
|
|
|
PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE
|
Professional
|
Both
|
$1,154.00
|
|
|
Service Code
|
HCPCS 44364
|
| Min. Negotiated Rate |
$115.02 |
| Max. Negotiated Rate |
$865.50 |
| Rate for Payer: Aetna Commercial |
$238.21
|
| Rate for Payer: Aetna Medicare |
$184.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.99
|
| Rate for Payer: BCBS Complete |
$120.77
|
| Rate for Payer: BCBS MAPPO |
$177.77
|
| Rate for Payer: BCN Commercial |
$300.78
|
| Rate for Payer: BCN Medicare Advantage |
$177.77
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cash Price |
$923.20
|
| Rate for Payer: Cofinity Commercial |
$255.99
|
| Rate for Payer: Cofinity Commercial |
$238.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.77
|
| Rate for Payer: Healthscope Commercial |
$328.87
|
| Rate for Payer: Healthscope Commercial |
$284.43
|
| Rate for Payer: Mclaren Medicaid |
$115.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$186.66
|
| Rate for Payer: Meridian Medicaid |
$120.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$195.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.80
|
| Rate for Payer: Nomi Health Commercial |
$213.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$865.50
|
| Rate for Payer: PACE SWMI |
$177.77
|
| Rate for Payer: PHP Medicare Advantage |
$177.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$366.48
|
| Rate for Payer: Priority Health Medicare |
$177.77
|
| Rate for Payer: Priority Health SBD |
$366.48
|
| Rate for Payer: Priority Health Tiered Network |
$366.48
|
| Rate for Payer: Railroad Medicare Medicare |
$177.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$360.44
|
| Rate for Payer: UHC Core |
$360.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$177.77
|
| Rate for Payer: UHC Exchange |
$360.44
|
| Rate for Payer: UHC Medicaid |
$115.02
|
| Rate for Payer: UHCCP Medicaid |
$115.02
|
|
|
PR ENTEROTOMY SM INT OTH/THN DUO DCMPRN
|
Professional
|
Both
|
$2,847.00
|
|
|
Service Code
|
HCPCS 44021
|
| Min. Negotiated Rate |
$579.57 |
| Max. Negotiated Rate |
$2,135.25 |
| Rate for Payer: Aetna Commercial |
$1,212.08
|
| Rate for Payer: Aetna Medicare |
$940.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,212.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.54
|
| Rate for Payer: BCBS Complete |
$608.55
|
| Rate for Payer: BCBS MAPPO |
$904.54
|
| Rate for Payer: BCN Commercial |
$1,464.57
|
| Rate for Payer: BCN Medicare Advantage |
$904.54
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cash Price |
$2,277.60
|
| Rate for Payer: Cofinity Commercial |
$1,302.54
|
| Rate for Payer: Cofinity Commercial |
$1,212.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$904.54
|
| Rate for Payer: Healthscope Commercial |
$1,673.40
|
| Rate for Payer: Healthscope Commercial |
$1,447.26
|
| Rate for Payer: Mclaren Medicaid |
$579.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$949.77
|
| Rate for Payer: Meridian Medicaid |
$608.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$994.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,740.64
|
| Rate for Payer: Nomi Health Commercial |
$1,085.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,135.25
|
| Rate for Payer: PACE SWMI |
$904.54
|
| Rate for Payer: PHP Medicare Advantage |
$904.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$579.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,784.47
|
| Rate for Payer: Priority Health Medicare |
$904.54
|
| Rate for Payer: Priority Health SBD |
$1,784.47
|
| Rate for Payer: Priority Health Tiered Network |
$1,784.47
|
| Rate for Payer: Railroad Medicare Medicare |
$904.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,737.23
|
| Rate for Payer: UHC Core |
$1,737.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$904.54
|
| Rate for Payer: UHC Exchange |
$1,737.23
|
| Rate for Payer: UHC Medicaid |
$579.57
|
| Rate for Payer: UHCCP Medicaid |
$579.57
|
|
|
PR ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL
|
Professional
|
Both
|
$3,034.00
|
|
|
Service Code
|
HCPCS 44020
|
| Min. Negotiated Rate |
$583.62 |
| Max. Negotiated Rate |
$2,275.50 |
| Rate for Payer: Aetna Commercial |
$1,220.18
|
| Rate for Payer: Aetna Medicare |
$947.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,220.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,311.24
|
| Rate for Payer: BCBS Complete |
$612.80
|
| Rate for Payer: BCBS MAPPO |
$910.58
|
| Rate for Payer: BCN Commercial |
$1,466.05
|
| Rate for Payer: BCN Medicare Advantage |
$910.58
|
| Rate for Payer: Cash Price |
$2,427.20
|
| Rate for Payer: Cash Price |
$2,427.20
|
| Rate for Payer: Cofinity Commercial |
$1,311.24
|
| Rate for Payer: Cofinity Commercial |
$1,220.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$910.58
|
| Rate for Payer: Healthscope Commercial |
$1,684.57
|
| Rate for Payer: Healthscope Commercial |
$1,456.93
|
| Rate for Payer: Mclaren Medicaid |
$583.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$956.11
|
| Rate for Payer: Meridian Medicaid |
$612.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,001.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,741.82
|
| Rate for Payer: Nomi Health Commercial |
$1,092.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,275.50
|
| Rate for Payer: PACE SWMI |
$910.58
|
| Rate for Payer: PHP Medicare Advantage |
$910.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$583.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,786.29
|
| Rate for Payer: Priority Health Medicare |
$910.58
|
| Rate for Payer: Priority Health SBD |
$1,786.29
|
| Rate for Payer: Priority Health Tiered Network |
$1,786.29
|
| Rate for Payer: Railroad Medicare Medicare |
$910.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,737.29
|
| Rate for Payer: UHC Core |
$1,737.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$910.58
|
| Rate for Payer: UHC Exchange |
$1,737.29
|
| Rate for Payer: UHC Medicaid |
$583.62
|
| Rate for Payer: UHCCP Medicaid |
$583.62
|
|
|
PR ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
HCPCS 44128
|
| Min. Negotiated Rate |
$139.30 |
| Max. Negotiated Rate |
$1,539.00 |
| Rate for Payer: Aetna Commercial |
$295.32
|
| Rate for Payer: Aetna Medicare |
$229.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.36
|
| Rate for Payer: BCBS Complete |
$146.26
|
| Rate for Payer: BCBS MAPPO |
$220.39
|
| Rate for Payer: BCN Commercial |
$361.04
|
| Rate for Payer: BCN Medicare Advantage |
$220.39
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cofinity Commercial |
$317.36
|
| Rate for Payer: Cofinity Commercial |
$295.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.39
|
| Rate for Payer: Healthscope Commercial |
$407.72
|
| Rate for Payer: Healthscope Commercial |
$352.62
|
| Rate for Payer: Mclaren Medicaid |
$139.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.41
|
| Rate for Payer: Meridian Medicaid |
$146.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$242.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.47
|
| Rate for Payer: Nomi Health Commercial |
$264.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,539.00
|
| Rate for Payer: PACE SWMI |
$220.39
|
| Rate for Payer: PHP Medicare Advantage |
$220.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$139.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$439.90
|
| Rate for Payer: Priority Health Medicare |
$220.39
|
| Rate for Payer: Priority Health SBD |
$439.90
|
| Rate for Payer: Priority Health Tiered Network |
$439.90
|
| Rate for Payer: Railroad Medicare Medicare |
$220.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$437.87
|
| Rate for Payer: UHC Core |
$437.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$220.39
|
| Rate for Payer: UHC Exchange |
$437.87
|
| Rate for Payer: UHC Medicaid |
$139.30
|
| Rate for Payer: UHCCP Medicaid |
$139.30
|
|
|
PR ENTRC RESCJ ATRESIA RESCJ & ANAST SGM W/TAPRING
|
Professional
|
Both
|
$5,178.00
|
|
|
Service Code
|
HCPCS 44127
|
| Min. Negotiated Rate |
$1,675.67 |
| Max. Negotiated Rate |
$5,196.26 |
| Rate for Payer: Aetna Commercial |
$3,526.32
|
| Rate for Payer: Aetna Medicare |
$2,736.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,526.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,789.48
|
| Rate for Payer: BCBS Complete |
$1,759.45
|
| Rate for Payer: BCBS MAPPO |
$2,631.58
|
| Rate for Payer: BCN Commercial |
$4,264.71
|
| Rate for Payer: BCN Medicare Advantage |
$2,631.58
|
| Rate for Payer: Cash Price |
$4,142.40
|
| Rate for Payer: Cash Price |
$4,142.40
|
| Rate for Payer: Cofinity Commercial |
$3,789.48
|
| Rate for Payer: Cofinity Commercial |
$3,526.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,631.58
|
| Rate for Payer: Healthscope Commercial |
$4,868.42
|
| Rate for Payer: Healthscope Commercial |
$4,210.53
|
| Rate for Payer: Mclaren Medicaid |
$1,675.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,763.16
|
| Rate for Payer: Meridian Medicaid |
$1,759.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,894.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,110.43
|
| Rate for Payer: Nomi Health Commercial |
$3,157.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,883.50
|
| Rate for Payer: PACE SWMI |
$2,631.58
|
| Rate for Payer: PHP Medicare Advantage |
$2,631.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,675.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,196.26
|
| Rate for Payer: Priority Health Medicare |
$2,631.58
|
| Rate for Payer: Priority Health SBD |
$5,196.26
|
| Rate for Payer: Priority Health Tiered Network |
$5,196.26
|
| Rate for Payer: Railroad Medicare Medicare |
$2,631.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,115.86
|
| Rate for Payer: UHC Core |
$5,115.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,631.58
|
| Rate for Payer: UHC Exchange |
$5,115.86
|
| Rate for Payer: UHC Medicaid |
$1,675.67
|
| Rate for Payer: UHCCP Medicaid |
$1,675.67
|
|
|
PR ENTRC RESCJ ATRESIA RESCJ & ANAST W/O TAPRING
|
Professional
|
Both
|
$4,462.00
|
|
|
Service Code
|
HCPCS 44126
|
| Min. Negotiated Rate |
$1,457.35 |
| Max. Negotiated Rate |
$4,505.18 |
| Rate for Payer: Aetna Commercial |
$3,063.01
|
| Rate for Payer: Aetna Medicare |
$2,377.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,063.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,291.60
|
| Rate for Payer: BCBS Complete |
$1,530.22
|
| Rate for Payer: BCBS MAPPO |
$2,285.83
|
| Rate for Payer: BCN Commercial |
$3,697.51
|
| Rate for Payer: BCN Medicare Advantage |
$2,285.83
|
| Rate for Payer: Cash Price |
$3,569.60
|
| Rate for Payer: Cash Price |
$3,569.60
|
| Rate for Payer: Cofinity Commercial |
$3,291.60
|
| Rate for Payer: Cofinity Commercial |
$3,063.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,285.83
|
| Rate for Payer: Healthscope Commercial |
$4,228.79
|
| Rate for Payer: Healthscope Commercial |
$3,657.33
|
| Rate for Payer: Mclaren Medicaid |
$1,457.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,400.12
|
| Rate for Payer: Meridian Medicaid |
$1,530.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,514.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,422.89
|
| Rate for Payer: Nomi Health Commercial |
$2,743.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,346.50
|
| Rate for Payer: PACE SWMI |
$2,285.83
|
| Rate for Payer: PHP Medicare Advantage |
$2,285.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,457.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,505.18
|
| Rate for Payer: Priority Health Medicare |
$2,285.83
|
| Rate for Payer: Priority Health SBD |
$4,505.18
|
| Rate for Payer: Priority Health Tiered Network |
$4,505.18
|
| Rate for Payer: Railroad Medicare Medicare |
$2,285.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,421.32
|
| Rate for Payer: UHC Core |
$4,421.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,285.83
|
| Rate for Payer: UHC Exchange |
$4,421.32
|
| Rate for Payer: UHC Medicaid |
$1,457.35
|
| Rate for Payer: UHCCP Medicaid |
$1,457.35
|
|
|
PR ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$3,415.00
|
|
|
Service Code
|
HCPCS 44120
|
| Min. Negotiated Rate |
$724.63 |
| Max. Negotiated Rate |
$2,561.25 |
| Rate for Payer: PHP Medicare Advantage |
$1,133.22
|
| Rate for Payer: Aetna Commercial |
$1,518.51
|
| Rate for Payer: Aetna Medicare |
$1,178.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.84
|
| Rate for Payer: BCBS Complete |
$760.86
|
| Rate for Payer: BCBS MAPPO |
$1,133.22
|
| Rate for Payer: BCN Commercial |
$1,832.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.22
|
| Rate for Payer: Cash Price |
$2,732.00
|
| Rate for Payer: Cash Price |
$2,732.00
|
| Rate for Payer: Cofinity Commercial |
$1,631.84
|
| Rate for Payer: Cofinity Commercial |
$1,518.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.22
|
| Rate for Payer: Healthscope Commercial |
$2,096.46
|
| Rate for Payer: Healthscope Commercial |
$1,813.15
|
| Rate for Payer: Mclaren Medicaid |
$724.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.88
|
| Rate for Payer: Meridian Medicaid |
$760.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,246.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,184.57
|
| Rate for Payer: Nomi Health Commercial |
$1,359.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,561.25
|
| Rate for Payer: PACE SWMI |
$1,133.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$724.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,232.87
|
| Rate for Payer: Priority Health Medicare |
$1,133.22
|
| Rate for Payer: Priority Health SBD |
$2,232.87
|
| Rate for Payer: Priority Health Tiered Network |
$2,232.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,133.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,183.58
|
| Rate for Payer: UHC Core |
$2,183.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,133.22
|
| Rate for Payer: UHC Exchange |
$2,183.58
|
| Rate for Payer: UHC Medicaid |
$724.63
|
| Rate for Payer: UHCCP Medicaid |
$724.63
|
|
|
PR EO W/O JOINTS CF
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS L3702
|
| Min. Negotiated Rate |
$105.31 |
| Max. Negotiated Rate |
$597.49 |
| Rate for Payer: Aetna Commercial |
$432.78
|
| Rate for Payer: Aetna Medicare |
$335.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$465.08
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$322.97
|
| Rate for Payer: BCN Commercial |
$309.22
|
| Rate for Payer: BCN Medicare Advantage |
$322.97
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$465.08
|
| Rate for Payer: Cofinity Commercial |
$432.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.97
|
| Rate for Payer: Healthscope Commercial |
$597.49
|
| Rate for Payer: Healthscope Commercial |
$516.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$339.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$355.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.38
|
| Rate for Payer: Nomi Health Commercial |
$387.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.50
|
| Rate for Payer: PACE SWMI |
$322.97
|
| Rate for Payer: PHP Medicare Advantage |
$322.97
|
| Rate for Payer: Priority Health Medicare |
$322.97
|
| Rate for Payer: Railroad Medicare Medicare |
$322.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.31
|
| Rate for Payer: UHC Core |
$105.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$322.97
|
| Rate for Payer: UHC Exchange |
$105.31
|
|
|
PR EPDRM AGRFT T/A/L EA ADD 100 SQCM/EA 1%INFT/CHLD
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
HCPCS 15111
|
| Min. Negotiated Rate |
$57.72 |
| Max. Negotiated Rate |
$196.50 |
| Rate for Payer: Aetna Commercial |
$121.81
|
| Rate for Payer: Aetna Medicare |
$94.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.90
|
| Rate for Payer: BCBS Complete |
$60.61
|
| Rate for Payer: BCBS MAPPO |
$90.90
|
| Rate for Payer: BCN Commercial |
$151.88
|
| Rate for Payer: BCN Medicare Advantage |
$90.90
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Cofinity Commercial |
$130.90
|
| Rate for Payer: Cofinity Commercial |
$121.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.90
|
| Rate for Payer: Healthscope Commercial |
$168.16
|
| Rate for Payer: Healthscope Commercial |
$145.44
|
| Rate for Payer: Mclaren Medicaid |
$57.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.44
|
| Rate for Payer: Meridian Medicaid |
$60.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$99.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.54
|
| Rate for Payer: Nomi Health Commercial |
$109.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.50
|
| Rate for Payer: PACE SWMI |
$90.90
|
| Rate for Payer: PHP Medicare Advantage |
$90.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$139.02
|
| Rate for Payer: Priority Health Medicare |
$90.90
|
| Rate for Payer: Priority Health SBD |
$139.02
|
| Rate for Payer: Priority Health Tiered Network |
$139.02
|
| Rate for Payer: Railroad Medicare Medicare |
$90.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$185.68
|
| Rate for Payer: UHC Core |
$185.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$90.90
|
| Rate for Payer: UHC Exchange |
$185.68
|
| Rate for Payer: UHC Medicaid |
$57.72
|
| Rate for Payer: UHCCP Medicaid |
$57.72
|
|
|
PR EP EVAL 1/2CHMB PACG CVDFB LDS TSTG OF PULSE GEN
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 93641
|
| Min. Negotiated Rate |
$276.50 |
| Max. Negotiated Rate |
$1,037.93 |
| Rate for Payer: Aetna Commercial |
$765.30
|
| Rate for Payer: Aetna Medicare |
$276.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.30
|
| Rate for Payer: BCN Commercial |
$445.71
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$828.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$414.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$799.41
|
| Rate for Payer: Priority Health SBD |
$799.41
|
| Rate for Payer: Priority Health Tiered Network |
$799.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,037.93
|
| Rate for Payer: UHC Core |
$1,037.93
|
| Rate for Payer: UHC Exchange |
$1,037.93
|
|
|
PR EP EVAL 1/2 CHMB TRANSVNS PAC CVDFB
|
Professional
|
Both
|
$1,786.00
|
|
|
Service Code
|
HCPCS 93642
|
| Min. Negotiated Rate |
$321.18 |
| Max. Negotiated Rate |
$1,339.50 |
| Rate for Payer: Aetna Commercial |
$430.38
|
| Rate for Payer: Aetna Medicare |
$334.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.50
|
| Rate for Payer: BCBS MAPPO |
$321.18
|
| Rate for Payer: BCN Commercial |
$487.53
|
| Rate for Payer: BCN Medicare Advantage |
$321.18
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cash Price |
$1,428.80
|
| Rate for Payer: Cofinity Commercial |
$430.38
|
| Rate for Payer: Cofinity Commercial |
$462.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$321.18
|
| Rate for Payer: Healthscope Commercial |
$513.89
|
| Rate for Payer: Healthscope Commercial |
$594.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$337.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$353.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$484.53
|
| Rate for Payer: Nomi Health Commercial |
$385.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,339.50
|
| Rate for Payer: PACE SWMI |
$321.18
|
| Rate for Payer: PHP Medicare Advantage |
$321.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$463.36
|
| Rate for Payer: Priority Health Medicare |
$321.18
|
| Rate for Payer: Priority Health SBD |
$463.36
|
| Rate for Payer: Priority Health Tiered Network |
$463.36
|
| Rate for Payer: Railroad Medicare Medicare |
$321.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$543.39
|
| Rate for Payer: UHC Core |
$543.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$321.18
|
| Rate for Payer: UHC Exchange |
$543.39
|
|
|
PR EPIDERMAL AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/<
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
HCPCS 15115
|
| Min. Negotiated Rate |
$415.14 |
| Max. Negotiated Rate |
$1,219.61 |
| Rate for Payer: Aetna Commercial |
$857.72
|
| Rate for Payer: Aetna Medicare |
$665.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.73
|
| Rate for Payer: BCBS Complete |
$435.90
|
| Rate for Payer: BCBS MAPPO |
$640.09
|
| Rate for Payer: BCN Commercial |
$1,054.22
|
| Rate for Payer: BCN Medicare Advantage |
$640.09
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cofinity Commercial |
$921.73
|
| Rate for Payer: Cofinity Commercial |
$857.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.09
|
| Rate for Payer: Healthscope Commercial |
$1,184.17
|
| Rate for Payer: Healthscope Commercial |
$1,024.14
|
| Rate for Payer: Mclaren Medicaid |
$415.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.09
|
| Rate for Payer: Meridian Medicaid |
$435.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$704.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,219.61
|
| Rate for Payer: Nomi Health Commercial |
$768.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,134.00
|
| Rate for Payer: PACE SWMI |
$640.09
|
| Rate for Payer: PHP Medicare Advantage |
$640.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$415.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$964.90
|
| Rate for Payer: Priority Health Medicare |
$640.09
|
| Rate for Payer: Priority Health SBD |
$964.90
|
| Rate for Payer: Priority Health Tiered Network |
$964.90
|
| Rate for Payer: Railroad Medicare Medicare |
$640.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,199.52
|
| Rate for Payer: UHC Core |
$1,199.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$640.09
|
| Rate for Payer: UHC Exchange |
$1,199.52
|
| Rate for Payer: UHC Medicaid |
$415.14
|
| Rate for Payer: UHCCP Medicaid |
$415.14
|
|
|
PR EPIDERMAL AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 15116
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$267.91 |
| Rate for Payer: Aetna Commercial |
$164.89
|
| Rate for Payer: Aetna Medicare |
$127.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.19
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS MAPPO |
$123.05
|
| Rate for Payer: BCN Commercial |
$205.66
|
| Rate for Payer: BCN Medicare Advantage |
$123.05
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$177.19
|
| Rate for Payer: Cofinity Commercial |
$164.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.05
|
| Rate for Payer: Healthscope Commercial |
$227.64
|
| Rate for Payer: Healthscope Commercial |
$196.88
|
| Rate for Payer: Mclaren Medicaid |
$78.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.20
|
| Rate for Payer: Meridian Medicaid |
$82.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$135.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$249.16
|
| Rate for Payer: Nomi Health Commercial |
$147.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.00
|
| Rate for Payer: PACE SWMI |
$123.05
|
| Rate for Payer: PHP Medicare Advantage |
$123.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$188.24
|
| Rate for Payer: Priority Health Medicare |
$123.05
|
| Rate for Payer: Priority Health SBD |
$188.24
|
| Rate for Payer: Priority Health Tiered Network |
$188.24
|
| Rate for Payer: Railroad Medicare Medicare |
$123.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.91
|
| Rate for Payer: UHC Core |
$267.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$123.05
|
| Rate for Payer: UHC Exchange |
$267.91
|
| Rate for Payer: UHC Medicaid |
$78.17
|
| Rate for Payer: UHCCP Medicaid |
$78.17
|
|
|
PR EPIDIDYMECTOMY BILATERAL
|
Professional
|
Both
|
$1,104.00
|
|
|
Service Code
|
HCPCS 54861
|
| Min. Negotiated Rate |
$331.64 |
| Max. Negotiated Rate |
$998.85 |
| Rate for Payer: Aetna Commercial |
$684.87
|
| Rate for Payer: Aetna Medicare |
$531.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.98
|
| Rate for Payer: BCBS Complete |
$348.22
|
| Rate for Payer: BCBS MAPPO |
$511.10
|
| Rate for Payer: BCN Commercial |
$854.04
|
| Rate for Payer: BCN Medicare Advantage |
$511.10
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cofinity Commercial |
$735.98
|
| Rate for Payer: Cofinity Commercial |
$684.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$511.10
|
| Rate for Payer: Healthscope Commercial |
$945.53
|
| Rate for Payer: Healthscope Commercial |
$817.76
|
| Rate for Payer: Mclaren Medicaid |
$331.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.65
|
| Rate for Payer: Meridian Medicaid |
$348.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$562.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.33
|
| Rate for Payer: Nomi Health Commercial |
$613.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$828.00
|
| Rate for Payer: PACE SWMI |
$511.10
|
| Rate for Payer: PHP Medicare Advantage |
$511.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$331.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$930.32
|
| Rate for Payer: Priority Health Medicare |
$511.10
|
| Rate for Payer: Priority Health SBD |
$930.32
|
| Rate for Payer: Priority Health Tiered Network |
$930.32
|
| Rate for Payer: Railroad Medicare Medicare |
$511.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$998.85
|
| Rate for Payer: UHC Core |
$998.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$511.10
|
| Rate for Payer: UHC Exchange |
$998.85
|
| Rate for Payer: UHC Medicaid |
$331.64
|
| Rate for Payer: UHCCP Medicaid |
$331.64
|
|
|
PR EPIDIDYMECTOMY UNILATERAL
|
Professional
|
Both
|
$779.00
|
|
|
Service Code
|
HCPCS 54860
|
| Min. Negotiated Rate |
$247.29 |
| Max. Negotiated Rate |
$736.15 |
| Rate for Payer: Aetna Commercial |
$509.33
|
| Rate for Payer: Aetna Medicare |
$395.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.34
|
| Rate for Payer: BCBS Complete |
$259.65
|
| Rate for Payer: BCBS MAPPO |
$380.10
|
| Rate for Payer: BCN Commercial |
$631.94
|
| Rate for Payer: BCN Medicare Advantage |
$380.10
|
| Rate for Payer: Cash Price |
$623.20
|
| Rate for Payer: Cash Price |
$623.20
|
| Rate for Payer: Cofinity Commercial |
$547.34
|
| Rate for Payer: Cofinity Commercial |
$509.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.10
|
| Rate for Payer: Healthscope Commercial |
$703.18
|
| Rate for Payer: Healthscope Commercial |
$608.16
|
| Rate for Payer: Mclaren Medicaid |
$247.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.11
|
| Rate for Payer: Meridian Medicaid |
$259.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$418.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$736.15
|
| Rate for Payer: Nomi Health Commercial |
$456.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$584.25
|
| Rate for Payer: PACE SWMI |
$380.10
|
| Rate for Payer: PHP Medicare Advantage |
$380.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$247.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$688.39
|
| Rate for Payer: Priority Health Medicare |
$380.10
|
| Rate for Payer: Priority Health SBD |
$688.39
|
| Rate for Payer: Priority Health Tiered Network |
$688.39
|
| Rate for Payer: Railroad Medicare Medicare |
$380.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$734.78
|
| Rate for Payer: UHC Core |
$734.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$380.10
|
| Rate for Payer: UHC Exchange |
$734.78
|
| Rate for Payer: UHC Medicaid |
$247.29
|
| Rate for Payer: UHCCP Medicaid |
$247.29
|
|
|
PR EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI
|
Professional
|
Both
|
$1,774.00
|
|
|
Service Code
|
HCPCS 54900
|
| Min. Negotiated Rate |
$462.21 |
| Max. Negotiated Rate |
$1,413.40 |
| Rate for Payer: Aetna Commercial |
$957.78
|
| Rate for Payer: Aetna Medicare |
$743.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.78
|
| Rate for Payer: BCBS Complete |
$485.32
|
| Rate for Payer: BCBS MAPPO |
$714.76
|
| Rate for Payer: BCN Commercial |
$1,199.63
|
| Rate for Payer: BCN Medicare Advantage |
$714.76
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cofinity Commercial |
$957.78
|
| Rate for Payer: Cofinity Commercial |
$1,029.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$714.76
|
| Rate for Payer: Healthscope Commercial |
$1,322.31
|
| Rate for Payer: Healthscope Commercial |
$1,143.62
|
| Rate for Payer: Mclaren Medicaid |
$462.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$750.50
|
| Rate for Payer: Meridian Medicaid |
$485.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$786.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,407.17
|
| Rate for Payer: Nomi Health Commercial |
$857.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,330.50
|
| Rate for Payer: PACE SWMI |
$714.76
|
| Rate for Payer: PHP Medicare Advantage |
$714.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$462.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,306.80
|
| Rate for Payer: Priority Health Medicare |
$714.76
|
| Rate for Payer: Priority Health SBD |
$1,306.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,306.80
|
| Rate for Payer: Railroad Medicare Medicare |
$714.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,413.40
|
| Rate for Payer: UHC Core |
$1,413.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$714.76
|
| Rate for Payer: UHC Exchange |
$1,413.40
|
| Rate for Payer: UHC Medicaid |
$462.21
|
| Rate for Payer: UHCCP Medicaid |
$462.21
|
|
|
PR EPIDRM AGRFT T/A/L 1ST 100 SQCM/</1% INFT/CHLD
|
Professional
|
Both
|
$1,656.00
|
|
|
Service Code
|
HCPCS 15110
|
| Min. Negotiated Rate |
$428.13 |
| Max. Negotiated Rate |
$1,262.93 |
| Rate for Payer: Aetna Commercial |
$884.19
|
| Rate for Payer: Aetna Medicare |
$686.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$950.17
|
| Rate for Payer: BCBS Complete |
$449.54
|
| Rate for Payer: BCBS MAPPO |
$659.84
|
| Rate for Payer: BCN Commercial |
$1,074.64
|
| Rate for Payer: BCN Medicare Advantage |
$659.84
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Cash Price |
$1,324.80
|
| Rate for Payer: Cofinity Commercial |
$950.17
|
| Rate for Payer: Cofinity Commercial |
$884.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$659.84
|
| Rate for Payer: Healthscope Commercial |
$1,220.70
|
| Rate for Payer: Healthscope Commercial |
$1,055.74
|
| Rate for Payer: Mclaren Medicaid |
$428.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$692.83
|
| Rate for Payer: Meridian Medicaid |
$449.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$725.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,262.93
|
| Rate for Payer: Nomi Health Commercial |
$791.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,242.00
|
| Rate for Payer: PACE SWMI |
$659.84
|
| Rate for Payer: PHP Medicare Advantage |
$659.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$983.58
|
| Rate for Payer: Priority Health Medicare |
$659.84
|
| Rate for Payer: Priority Health SBD |
$983.58
|
| Rate for Payer: Priority Health Tiered Network |
$983.58
|
| Rate for Payer: Railroad Medicare Medicare |
$659.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,215.13
|
| Rate for Payer: UHC Core |
$1,215.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$659.84
|
| Rate for Payer: UHC Exchange |
$1,215.13
|
| Rate for Payer: UHC Medicaid |
$428.13
|
| Rate for Payer: UHCCP Medicaid |
$428.13
|
|
