|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/ULNA
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
HCPCS 25450
|
| Min. Negotiated Rate |
$376.37 |
| Max. Negotiated Rate |
$1,099.19 |
| Rate for Payer: Aetna Commercial |
$768.81
|
| Rate for Payer: Aetna Medicare |
$596.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$768.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.19
|
| Rate for Payer: BCBS Complete |
$395.19
|
| Rate for Payer: BCBS MAPPO |
$573.74
|
| Rate for Payer: BCN Commercial |
$949.65
|
| Rate for Payer: BCN Medicare Advantage |
$573.74
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cofinity Commercial |
$826.19
|
| Rate for Payer: Cofinity Commercial |
$768.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.74
|
| Rate for Payer: Healthscope Commercial |
$917.98
|
| Rate for Payer: Healthscope Commercial |
$1,061.42
|
| Rate for Payer: Mclaren Medicaid |
$376.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$602.43
|
| Rate for Payer: Meridian Medicaid |
$395.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$631.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,099.19
|
| Rate for Payer: Nomi Health Commercial |
$688.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$973.50
|
| Rate for Payer: PACE SWMI |
$573.74
|
| Rate for Payer: PHP Medicare Advantage |
$573.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$376.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,015.15
|
| Rate for Payer: Priority Health Medicare |
$573.74
|
| Rate for Payer: Priority Health SBD |
$1,015.15
|
| Rate for Payer: Priority Health Tiered Network |
$1,015.15
|
| Rate for Payer: Railroad Medicare Medicare |
$573.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,073.70
|
| Rate for Payer: UHC Core |
$1,073.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$573.74
|
| Rate for Payer: UHC Exchange |
$1,073.70
|
| Rate for Payer: UHC Medicaid |
$376.37
|
| Rate for Payer: UHCCP Medicaid |
$376.37
|
|
|
PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 27185
|
| Min. Negotiated Rate |
$431.75 |
| Max. Negotiated Rate |
$1,277.69 |
| Rate for Payer: Aetna Commercial |
$885.20
|
| Rate for Payer: Aetna Medicare |
$687.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.26
|
| Rate for Payer: BCBS Complete |
$453.34
|
| Rate for Payer: BCBS MAPPO |
$660.60
|
| Rate for Payer: BCN Commercial |
$1,098.55
|
| Rate for Payer: BCN Medicare Advantage |
$660.60
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$951.26
|
| Rate for Payer: Cofinity Commercial |
$885.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$660.60
|
| Rate for Payer: Healthscope Commercial |
$1,222.11
|
| Rate for Payer: Healthscope Commercial |
$1,056.96
|
| Rate for Payer: Mclaren Medicaid |
$431.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$693.63
|
| Rate for Payer: Meridian Medicaid |
$453.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$726.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,277.69
|
| Rate for Payer: Nomi Health Commercial |
$792.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: PACE SWMI |
$660.60
|
| Rate for Payer: PHP Medicare Advantage |
$660.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,174.31
|
| Rate for Payer: Priority Health Medicare |
$660.60
|
| Rate for Payer: Priority Health SBD |
$1,174.31
|
| Rate for Payer: Priority Health Tiered Network |
$1,174.31
|
| Rate for Payer: Railroad Medicare Medicare |
$660.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,253.03
|
| Rate for Payer: UHC Core |
$1,253.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$660.60
|
| Rate for Payer: UHC Exchange |
$1,253.03
|
| Rate for Payer: UHC Medicaid |
$431.75
|
| Rate for Payer: UHCCP Medicaid |
$431.75
|
|
|
PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 59300
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna Commercial |
$179.95
|
| Rate for Payer: Aetna Medicare |
$139.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.38
|
| Rate for Payer: BCBS Complete |
$89.46
|
| Rate for Payer: BCBS MAPPO |
$134.29
|
| Rate for Payer: BCN Commercial |
$221.10
|
| Rate for Payer: BCN Medicare Advantage |
$134.29
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$193.38
|
| Rate for Payer: Cofinity Commercial |
$179.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.29
|
| Rate for Payer: Healthscope Commercial |
$248.44
|
| Rate for Payer: Healthscope Commercial |
$214.86
|
| Rate for Payer: Mclaren Medicaid |
$85.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.00
|
| Rate for Payer: Meridian Medicaid |
$89.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.39
|
| Rate for Payer: Nomi Health Commercial |
$161.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.00
|
| Rate for Payer: PACE SWMI |
$134.29
|
| Rate for Payer: PHP Medicare Advantage |
$134.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$208.72
|
| Rate for Payer: Priority Health Medicare |
$134.29
|
| Rate for Payer: Priority Health SBD |
$208.72
|
| Rate for Payer: Priority Health Tiered Network |
$208.72
|
| Rate for Payer: Railroad Medicare Medicare |
$134.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.02
|
| Rate for Payer: UHC Core |
$261.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$134.29
|
| Rate for Payer: UHC Exchange |
$261.02
|
| Rate for Payer: UHC Medicaid |
$85.20
|
| Rate for Payer: UHCCP Medicaid |
$85.20
|
|
|
PR EPOETIN ALFA, NON-ESRD
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS J0885
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna Commercial |
$9.80
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.80
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$5.88
|
| Rate for Payer: BCN Commercial |
$5.38
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$13.52
|
| Rate for Payer: Healthscope Commercial |
$11.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.09
|
| Rate for Payer: Nomi Health Commercial |
$8.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: Railroad Medicare Medicare |
$7.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.74
|
| Rate for Payer: UHC Core |
$7.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.31
|
| Rate for Payer: UHC Exchange |
$7.74
|
|
|
PR ERCP,ABLATION TUMOR
|
Professional
|
Both
|
$1,705.00
|
|
|
Service Code
|
HCPCS 43272
|
| Min. Negotiated Rate |
$682.00 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Medicare |
$852.50
|
| Rate for Payer: BCBS Complete |
$682.00
|
| Rate for Payer: Cash Price |
$1,364.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,108.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,278.75
|
|
|
PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA
|
Professional
|
Both
|
$1,221.00
|
|
|
Service Code
|
HCPCS 43277
|
| Min. Negotiated Rate |
$210.44 |
| Max. Negotiated Rate |
$915.75 |
| Rate for Payer: Aetna Commercial |
$437.19
|
| Rate for Payer: Aetna Medicare |
$339.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.81
|
| Rate for Payer: BCBS Complete |
$220.96
|
| Rate for Payer: BCBS MAPPO |
$326.26
|
| Rate for Payer: BCN Commercial |
$555.25
|
| Rate for Payer: BCN Medicare Advantage |
$326.26
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cash Price |
$976.80
|
| Rate for Payer: Cofinity Commercial |
$469.81
|
| Rate for Payer: Cofinity Commercial |
$437.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.26
|
| Rate for Payer: Healthscope Commercial |
$603.58
|
| Rate for Payer: Healthscope Commercial |
$522.02
|
| Rate for Payer: Mclaren Medicaid |
$210.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$342.57
|
| Rate for Payer: Meridian Medicaid |
$220.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$358.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$660.55
|
| Rate for Payer: Nomi Health Commercial |
$391.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.75
|
| Rate for Payer: PACE SWMI |
$326.26
|
| Rate for Payer: PHP Medicare Advantage |
$326.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$676.53
|
| Rate for Payer: Priority Health Medicare |
$326.26
|
| Rate for Payer: Priority Health SBD |
$676.53
|
| Rate for Payer: Priority Health Tiered Network |
$676.53
|
| Rate for Payer: Railroad Medicare Medicare |
$326.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$668.13
|
| Rate for Payer: UHC Core |
$668.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$326.26
|
| Rate for Payer: UHC Exchange |
$668.13
|
| Rate for Payer: UHC Medicaid |
$210.44
|
| Rate for Payer: UHCCP Medicaid |
$210.44
|
|
|
PR ERCP,BALLOON DIL DUCTS
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 43271
|
| Min. Negotiated Rate |
$688.80 |
| Max. Negotiated Rate |
$1,291.50 |
| Rate for Payer: Aetna Medicare |
$861.00
|
| Rate for Payer: BCBS Complete |
$688.80
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,119.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,291.50
|
|
|
PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE
|
Professional
|
Both
|
$1,532.00
|
|
|
Service Code
|
HCPCS 43276
|
| Min. Negotiated Rate |
$267.32 |
| Max. Negotiated Rate |
$1,149.00 |
| Rate for Payer: Aetna Commercial |
$555.87
|
| Rate for Payer: Aetna Medicare |
$431.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$597.36
|
| Rate for Payer: BCBS Complete |
$280.69
|
| Rate for Payer: BCBS MAPPO |
$414.83
|
| Rate for Payer: BCN Commercial |
$705.64
|
| Rate for Payer: BCN Medicare Advantage |
$414.83
|
| Rate for Payer: Cash Price |
$1,225.60
|
| Rate for Payer: Cash Price |
$1,225.60
|
| Rate for Payer: Cofinity Commercial |
$597.36
|
| Rate for Payer: Cofinity Commercial |
$555.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.83
|
| Rate for Payer: Healthscope Commercial |
$663.73
|
| Rate for Payer: Healthscope Commercial |
$767.44
|
| Rate for Payer: Mclaren Medicaid |
$267.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.57
|
| Rate for Payer: Meridian Medicaid |
$280.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$456.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$841.21
|
| Rate for Payer: Nomi Health Commercial |
$497.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,149.00
|
| Rate for Payer: PACE SWMI |
$414.83
|
| Rate for Payer: PHP Medicare Advantage |
$414.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$267.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$859.78
|
| Rate for Payer: Priority Health Medicare |
$414.83
|
| Rate for Payer: Priority Health SBD |
$859.78
|
| Rate for Payer: Priority Health Tiered Network |
$859.78
|
| Rate for Payer: Railroad Medicare Medicare |
$414.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$850.70
|
| Rate for Payer: UHC Core |
$850.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$414.83
|
| Rate for Payer: UHC Exchange |
$850.70
|
| Rate for Payer: UHC Medicaid |
$267.32
|
| Rate for Payer: UHCCP Medicaid |
$267.32
|
|
|
PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD
|
Professional
|
Both
|
$1,962.00
|
|
|
Service Code
|
HCPCS 43265
|
| Min. Negotiated Rate |
$240.26 |
| Max. Negotiated Rate |
$1,471.50 |
| Rate for Payer: Aetna Commercial |
$499.44
|
| Rate for Payer: Aetna Medicare |
$387.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.72
|
| Rate for Payer: BCBS Complete |
$252.27
|
| Rate for Payer: BCBS MAPPO |
$372.72
|
| Rate for Payer: BCN Commercial |
$633.93
|
| Rate for Payer: BCN Medicare Advantage |
$372.72
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cofinity Commercial |
$536.72
|
| Rate for Payer: Cofinity Commercial |
$499.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.72
|
| Rate for Payer: Healthscope Commercial |
$689.53
|
| Rate for Payer: Healthscope Commercial |
$596.35
|
| Rate for Payer: Mclaren Medicaid |
$240.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.36
|
| Rate for Payer: Meridian Medicaid |
$252.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$755.69
|
| Rate for Payer: Nomi Health Commercial |
$447.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,471.50
|
| Rate for Payer: PACE SWMI |
$372.72
|
| Rate for Payer: PHP Medicare Advantage |
$372.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$772.40
|
| Rate for Payer: Priority Health Medicare |
$372.72
|
| Rate for Payer: Priority Health SBD |
$772.40
|
| Rate for Payer: Priority Health Tiered Network |
$772.40
|
| Rate for Payer: Railroad Medicare Medicare |
$372.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$765.57
|
| Rate for Payer: UHC Core |
$765.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$372.72
|
| Rate for Payer: UHC Exchange |
$765.57
|
| Rate for Payer: UHC Medicaid |
$240.26
|
| Rate for Payer: UHCCP Medicaid |
$240.26
|
|
|
PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING
|
Professional
|
Both
|
$1,137.00
|
|
|
Service Code
|
HCPCS 43260
|
| Min. Negotiated Rate |
$179.13 |
| Max. Negotiated Rate |
$852.75 |
| Rate for Payer: Aetna Commercial |
$371.85
|
| Rate for Payer: Aetna Medicare |
$288.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.60
|
| Rate for Payer: BCBS Complete |
$188.09
|
| Rate for Payer: BCBS MAPPO |
$277.50
|
| Rate for Payer: BCN Commercial |
$473.58
|
| Rate for Payer: BCN Medicare Advantage |
$277.50
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cash Price |
$909.60
|
| Rate for Payer: Cofinity Commercial |
$399.60
|
| Rate for Payer: Cofinity Commercial |
$371.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$277.50
|
| Rate for Payer: Healthscope Commercial |
$513.38
|
| Rate for Payer: Healthscope Commercial |
$444.00
|
| Rate for Payer: Mclaren Medicaid |
$179.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$291.38
|
| Rate for Payer: Meridian Medicaid |
$188.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$305.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$562.52
|
| Rate for Payer: Nomi Health Commercial |
$333.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.75
|
| Rate for Payer: PACE SWMI |
$277.50
|
| Rate for Payer: PHP Medicare Advantage |
$277.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$577.04
|
| Rate for Payer: Priority Health Medicare |
$277.50
|
| Rate for Payer: Priority Health SBD |
$577.04
|
| Rate for Payer: Priority Health Tiered Network |
$577.04
|
| Rate for Payer: Railroad Medicare Medicare |
$277.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.43
|
| Rate for Payer: UHC Core |
$569.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$277.50
|
| Rate for Payer: UHC Exchange |
$569.43
|
| Rate for Payer: UHC Medicaid |
$179.13
|
| Rate for Payer: UHCCP Medicaid |
$179.13
|
|
|
PR ERCP,INSERT STENT,BILIARY/PANC
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
HCPCS 43268
|
| Min. Negotiated Rate |
$702.40 |
| Max. Negotiated Rate |
$1,317.00 |
| Rate for Payer: Aetna Medicare |
$878.00
|
| Rate for Payer: BCBS Complete |
$702.40
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,317.00
|
|
|
PR ERCP,NASOBILIARY DRAIN TUBE
|
Professional
|
Both
|
$1,698.00
|
|
|
Service Code
|
HCPCS 43267
|
| Min. Negotiated Rate |
$679.20 |
| Max. Negotiated Rate |
$1,273.50 |
| Rate for Payer: Aetna Medicare |
$849.00
|
| Rate for Payer: BCBS Complete |
$679.20
|
| Rate for Payer: Cash Price |
$1,358.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,103.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,273.50
|
|
|
PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT
|
Professional
|
Both
|
$1,894.00
|
|
|
Service Code
|
HCPCS 43264
|
| Min. Negotiated Rate |
$202.35 |
| Max. Negotiated Rate |
$1,420.50 |
| Rate for Payer: Aetna Commercial |
$420.32
|
| Rate for Payer: Aetna Medicare |
$326.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.68
|
| Rate for Payer: BCBS Complete |
$212.47
|
| Rate for Payer: BCBS MAPPO |
$313.67
|
| Rate for Payer: BCN Commercial |
$534.83
|
| Rate for Payer: BCN Medicare Advantage |
$313.67
|
| Rate for Payer: Cash Price |
$1,515.20
|
| Rate for Payer: Cash Price |
$1,515.20
|
| Rate for Payer: Cofinity Commercial |
$451.68
|
| Rate for Payer: Cofinity Commercial |
$420.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.67
|
| Rate for Payer: Healthscope Commercial |
$580.29
|
| Rate for Payer: Healthscope Commercial |
$501.87
|
| Rate for Payer: Mclaren Medicaid |
$202.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.35
|
| Rate for Payer: Meridian Medicaid |
$212.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$345.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$635.54
|
| Rate for Payer: Nomi Health Commercial |
$376.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,420.50
|
| Rate for Payer: PACE SWMI |
$313.67
|
| Rate for Payer: PHP Medicare Advantage |
$313.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$651.65
|
| Rate for Payer: Priority Health Medicare |
$313.67
|
| Rate for Payer: Priority Health SBD |
$651.65
|
| Rate for Payer: Priority Health Tiered Network |
$651.65
|
| Rate for Payer: Railroad Medicare Medicare |
$313.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.71
|
| Rate for Payer: UHC Core |
$641.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$313.67
|
| Rate for Payer: UHC Exchange |
$641.71
|
| Rate for Payer: UHC Medicaid |
$202.35
|
| Rate for Payer: UHCCP Medicaid |
$202.35
|
|
|
PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT
|
Professional
|
Both
|
$843.00
|
|
|
Service Code
|
HCPCS 43275
|
| Min. Negotiated Rate |
$209.38 |
| Max. Negotiated Rate |
$672.89 |
| Rate for Payer: Aetna Commercial |
$435.08
|
| Rate for Payer: Aetna Medicare |
$337.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.55
|
| Rate for Payer: BCBS Complete |
$219.85
|
| Rate for Payer: BCBS MAPPO |
$324.69
|
| Rate for Payer: BCN Commercial |
$552.26
|
| Rate for Payer: BCN Medicare Advantage |
$324.69
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cofinity Commercial |
$467.55
|
| Rate for Payer: Cofinity Commercial |
$435.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.69
|
| Rate for Payer: Healthscope Commercial |
$600.68
|
| Rate for Payer: Healthscope Commercial |
$519.50
|
| Rate for Payer: Mclaren Medicaid |
$209.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.92
|
| Rate for Payer: Meridian Medicaid |
$219.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$357.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$656.44
|
| Rate for Payer: Nomi Health Commercial |
$389.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.25
|
| Rate for Payer: PACE SWMI |
$324.69
|
| Rate for Payer: PHP Medicare Advantage |
$324.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$672.89
|
| Rate for Payer: Priority Health Medicare |
$324.69
|
| Rate for Payer: Priority Health SBD |
$672.89
|
| Rate for Payer: Priority Health Tiered Network |
$672.89
|
| Rate for Payer: Railroad Medicare Medicare |
$324.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$664.47
|
| Rate for Payer: UHC Core |
$664.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$324.69
|
| Rate for Payer: UHC Exchange |
$664.47
|
| Rate for Payer: UHC Medicaid |
$209.38
|
| Rate for Payer: UHCCP Medicaid |
$209.38
|
|
|
PR ERCP,RMV F.B./CHANGE STENT
|
Professional
|
Both
|
$1,744.00
|
|
|
Service Code
|
HCPCS 43269
|
| Min. Negotiated Rate |
$697.60 |
| Max. Negotiated Rate |
$1,308.00 |
| Rate for Payer: Aetna Medicare |
$872.00
|
| Rate for Payer: BCBS Complete |
$697.60
|
| Rate for Payer: Cash Price |
$1,395.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,133.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,308.00
|
|
|
PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS 43274
|
| Min. Negotiated Rate |
$256.45 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$533.09
|
| Rate for Payer: Aetna Medicare |
$413.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$572.88
|
| Rate for Payer: BCBS Complete |
$269.27
|
| Rate for Payer: BCBS MAPPO |
$397.83
|
| Rate for Payer: BCN Commercial |
$678.25
|
| Rate for Payer: BCN Medicare Advantage |
$397.83
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cofinity Commercial |
$572.88
|
| Rate for Payer: Cofinity Commercial |
$533.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$397.83
|
| Rate for Payer: Healthscope Commercial |
$636.53
|
| Rate for Payer: Healthscope Commercial |
$735.99
|
| Rate for Payer: Mclaren Medicaid |
$256.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$417.72
|
| Rate for Payer: Meridian Medicaid |
$269.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$437.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$807.73
|
| Rate for Payer: Nomi Health Commercial |
$477.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,104.00
|
| Rate for Payer: PACE SWMI |
$397.83
|
| Rate for Payer: PHP Medicare Advantage |
$397.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$256.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$826.40
|
| Rate for Payer: Priority Health Medicare |
$397.83
|
| Rate for Payer: Priority Health SBD |
$826.40
|
| Rate for Payer: Priority Health Tiered Network |
$826.40
|
| Rate for Payer: Railroad Medicare Medicare |
$397.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$817.66
|
| Rate for Payer: UHC Core |
$817.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$397.83
|
| Rate for Payer: UHC Exchange |
$817.66
|
| Rate for Payer: UHC Medicaid |
$256.45
|
| Rate for Payer: UHCCP Medicaid |
$256.45
|
|
|
PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE
|
Professional
|
Both
|
$1,388.00
|
|
|
Service Code
|
HCPCS 43278
|
| Min. Negotiated Rate |
$240.05 |
| Max. Negotiated Rate |
$1,041.00 |
| Rate for Payer: Aetna Commercial |
$499.00
|
| Rate for Payer: Aetna Medicare |
$387.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.24
|
| Rate for Payer: BCBS Complete |
$252.05
|
| Rate for Payer: BCBS MAPPO |
$372.39
|
| Rate for Payer: BCN Commercial |
$634.93
|
| Rate for Payer: BCN Medicare Advantage |
$372.39
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cash Price |
$1,110.40
|
| Rate for Payer: Cofinity Commercial |
$536.24
|
| Rate for Payer: Cofinity Commercial |
$499.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.39
|
| Rate for Payer: Healthscope Commercial |
$688.92
|
| Rate for Payer: Healthscope Commercial |
$595.82
|
| Rate for Payer: Mclaren Medicaid |
$240.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.01
|
| Rate for Payer: Meridian Medicaid |
$252.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$409.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$755.10
|
| Rate for Payer: Nomi Health Commercial |
$446.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,041.00
|
| Rate for Payer: PACE SWMI |
$372.39
|
| Rate for Payer: PHP Medicare Advantage |
$372.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$773.62
|
| Rate for Payer: Priority Health Medicare |
$372.39
|
| Rate for Payer: Priority Health SBD |
$773.62
|
| Rate for Payer: Priority Health Tiered Network |
$773.62
|
| Rate for Payer: Railroad Medicare Medicare |
$372.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$765.57
|
| Rate for Payer: UHC Core |
$765.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$372.39
|
| Rate for Payer: UHC Exchange |
$765.57
|
| Rate for Payer: UHC Medicaid |
$240.05
|
| Rate for Payer: UHCCP Medicaid |
$240.05
|
|
|
PR ERCP W/BIOPSY SINGLE/MULTIPLE
|
Professional
|
Both
|
$1,205.00
|
|
|
Service Code
|
HCPCS 43261
|
| Min. Negotiated Rate |
$188.51 |
| Max. Negotiated Rate |
$903.75 |
| Rate for Payer: Aetna Commercial |
$391.48
|
| Rate for Payer: Aetna Medicare |
$303.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.70
|
| Rate for Payer: BCBS Complete |
$197.94
|
| Rate for Payer: BCBS MAPPO |
$292.15
|
| Rate for Payer: BCN Commercial |
$496.49
|
| Rate for Payer: BCN Medicare Advantage |
$292.15
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cash Price |
$964.00
|
| Rate for Payer: Cofinity Commercial |
$420.70
|
| Rate for Payer: Cofinity Commercial |
$391.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.15
|
| Rate for Payer: Healthscope Commercial |
$540.48
|
| Rate for Payer: Healthscope Commercial |
$467.44
|
| Rate for Payer: Mclaren Medicaid |
$188.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$306.76
|
| Rate for Payer: Meridian Medicaid |
$197.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$321.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$591.32
|
| Rate for Payer: Nomi Health Commercial |
$350.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$903.75
|
| Rate for Payer: PACE SWMI |
$292.15
|
| Rate for Payer: PHP Medicare Advantage |
$292.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$604.93
|
| Rate for Payer: Priority Health Medicare |
$292.15
|
| Rate for Payer: Priority Health SBD |
$604.93
|
| Rate for Payer: Priority Health Tiered Network |
$604.93
|
| Rate for Payer: Railroad Medicare Medicare |
$292.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$596.99
|
| Rate for Payer: UHC Core |
$596.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$292.15
|
| Rate for Payer: UHC Exchange |
$596.99
|
| Rate for Payer: UHC Medicaid |
$188.51
|
| Rate for Payer: UHCCP Medicaid |
$188.51
|
|
|
PR ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI
|
Professional
|
Both
|
$1,671.00
|
|
|
Service Code
|
HCPCS 43263
|
| Min. Negotiated Rate |
$198.94 |
| Max. Negotiated Rate |
$1,253.25 |
| Rate for Payer: Aetna Commercial |
$413.12
|
| Rate for Payer: Aetna Medicare |
$320.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.95
|
| Rate for Payer: BCBS Complete |
$208.89
|
| Rate for Payer: BCBS MAPPO |
$308.30
|
| Rate for Payer: BCN Commercial |
$524.87
|
| Rate for Payer: BCN Medicare Advantage |
$308.30
|
| Rate for Payer: Cash Price |
$1,336.80
|
| Rate for Payer: Cash Price |
$1,336.80
|
| Rate for Payer: Cofinity Commercial |
$443.95
|
| Rate for Payer: Cofinity Commercial |
$413.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.30
|
| Rate for Payer: Healthscope Commercial |
$570.36
|
| Rate for Payer: Healthscope Commercial |
$493.28
|
| Rate for Payer: Mclaren Medicaid |
$198.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.71
|
| Rate for Payer: Meridian Medicaid |
$208.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$339.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$624.08
|
| Rate for Payer: Nomi Health Commercial |
$369.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,253.25
|
| Rate for Payer: PACE SWMI |
$308.30
|
| Rate for Payer: PHP Medicare Advantage |
$308.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$639.52
|
| Rate for Payer: Priority Health Medicare |
$308.30
|
| Rate for Payer: Priority Health SBD |
$639.52
|
| Rate for Payer: Priority Health Tiered Network |
$639.52
|
| Rate for Payer: Railroad Medicare Medicare |
$308.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$630.05
|
| Rate for Payer: UHC Core |
$630.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$308.30
|
| Rate for Payer: UHC Exchange |
$630.05
|
| Rate for Payer: UHC Medicaid |
$198.94
|
| Rate for Payer: UHCCP Medicaid |
$198.94
|
|
|
PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
HCPCS 43262
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$1,304.25 |
| Rate for Payer: Aetna Commercial |
$412.30
|
| Rate for Payer: Aetna Medicare |
$320.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.07
|
| Rate for Payer: BCBS Complete |
$208.45
|
| Rate for Payer: BCBS MAPPO |
$307.69
|
| Rate for Payer: BCN Commercial |
$523.88
|
| Rate for Payer: BCN Medicare Advantage |
$307.69
|
| Rate for Payer: Cash Price |
$1,391.20
|
| Rate for Payer: Cash Price |
$1,391.20
|
| Rate for Payer: Cofinity Commercial |
$443.07
|
| Rate for Payer: Cofinity Commercial |
$412.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.69
|
| Rate for Payer: Healthscope Commercial |
$569.23
|
| Rate for Payer: Healthscope Commercial |
$492.30
|
| Rate for Payer: Mclaren Medicaid |
$198.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.07
|
| Rate for Payer: Meridian Medicaid |
$208.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$338.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$623.52
|
| Rate for Payer: Nomi Health Commercial |
$369.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,304.25
|
| Rate for Payer: PACE SWMI |
$307.69
|
| Rate for Payer: PHP Medicare Advantage |
$307.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$638.32
|
| Rate for Payer: Priority Health Medicare |
$307.69
|
| Rate for Payer: Priority Health SBD |
$638.32
|
| Rate for Payer: Priority Health Tiered Network |
$638.32
|
| Rate for Payer: Railroad Medicare Medicare |
$307.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$630.05
|
| Rate for Payer: UHC Core |
$630.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$307.69
|
| Rate for Payer: UHC Exchange |
$630.05
|
| Rate for Payer: UHC Medicaid |
$198.52
|
| Rate for Payer: UHCCP Medicaid |
$198.52
|
|
|
PR ESCHAROTOMY EACH ADDITIONAL INCISION
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 16036
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$335.25 |
| Rate for Payer: Aetna Commercial |
$99.07
|
| Rate for Payer: Aetna Medicare |
$76.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.07
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$73.93
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$73.93
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cofinity Commercial |
$99.07
|
| Rate for Payer: Cofinity Commercial |
$106.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.93
|
| Rate for Payer: Healthscope Commercial |
$136.77
|
| Rate for Payer: Healthscope Commercial |
$118.29
|
| Rate for Payer: Mclaren Medicaid |
$46.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.63
|
| Rate for Payer: Meridian Medicaid |
$49.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.40
|
| Rate for Payer: Nomi Health Commercial |
$88.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.25
|
| Rate for Payer: PACE SWMI |
$73.93
|
| Rate for Payer: PHP Medicare Advantage |
$73.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$112.58
|
| Rate for Payer: Priority Health Medicare |
$73.93
|
| Rate for Payer: Priority Health SBD |
$112.58
|
| Rate for Payer: Priority Health Tiered Network |
$112.58
|
| Rate for Payer: Railroad Medicare Medicare |
$73.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.66
|
| Rate for Payer: UHC Core |
$145.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.93
|
| Rate for Payer: UHC Exchange |
$145.66
|
| Rate for Payer: UHC Medicaid |
$46.86
|
| Rate for Payer: UHCCP Medicaid |
$46.86
|
|
|
PR ESCHAROTOMY INITIAL INCISION
|
Professional
|
Both
|
$886.00
|
|
|
Service Code
|
HCPCS 16035
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$664.50 |
| Rate for Payer: Aetna Commercial |
$239.11
|
| Rate for Payer: Aetna Medicare |
$185.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.95
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS MAPPO |
$178.44
|
| Rate for Payer: BCN Commercial |
$291.32
|
| Rate for Payer: BCN Medicare Advantage |
$178.44
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cash Price |
$708.80
|
| Rate for Payer: Cofinity Commercial |
$256.95
|
| Rate for Payer: Cofinity Commercial |
$239.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.44
|
| Rate for Payer: Healthscope Commercial |
$330.11
|
| Rate for Payer: Healthscope Commercial |
$285.50
|
| Rate for Payer: Mclaren Medicaid |
$113.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.36
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$196.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.82
|
| Rate for Payer: Nomi Health Commercial |
$214.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$664.50
|
| Rate for Payer: PACE SWMI |
$178.44
|
| Rate for Payer: PHP Medicare Advantage |
$178.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$266.64
|
| Rate for Payer: Priority Health Medicare |
$178.44
|
| Rate for Payer: Priority Health SBD |
$266.64
|
| Rate for Payer: Priority Health Tiered Network |
$266.64
|
| Rate for Payer: Railroad Medicare Medicare |
$178.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.01
|
| Rate for Payer: UHC Core |
$351.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$178.44
|
| Rate for Payer: UHC Exchange |
$351.01
|
| Rate for Payer: UHC Medicaid |
$113.96
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH
|
Professional
|
Both
|
$3,570.00
|
|
|
Service Code
|
HCPCS 43325
|
| Min. Negotiated Rate |
$811.74 |
| Max. Negotiated Rate |
$2,677.50 |
| Rate for Payer: Aetna Commercial |
$1,700.06
|
| Rate for Payer: Aetna Medicare |
$1,319.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,700.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,826.93
|
| Rate for Payer: BCBS Complete |
$852.33
|
| Rate for Payer: BCBS MAPPO |
$1,268.70
|
| Rate for Payer: BCN Commercial |
$2,041.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,268.70
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cash Price |
$2,856.00
|
| Rate for Payer: Cofinity Commercial |
$1,826.93
|
| Rate for Payer: Cofinity Commercial |
$1,700.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,268.70
|
| Rate for Payer: Healthscope Commercial |
$2,347.09
|
| Rate for Payer: Healthscope Commercial |
$2,029.92
|
| Rate for Payer: Mclaren Medicaid |
$811.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,332.13
|
| Rate for Payer: Meridian Medicaid |
$852.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,395.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,434.81
|
| Rate for Payer: Nomi Health Commercial |
$1,522.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,677.50
|
| Rate for Payer: PACE SWMI |
$1,268.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,268.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,487.71
|
| Rate for Payer: Priority Health Medicare |
$1,268.70
|
| Rate for Payer: Priority Health SBD |
$2,487.71
|
| Rate for Payer: Priority Health Tiered Network |
$2,487.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,268.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,426.08
|
| Rate for Payer: UHC Core |
$2,426.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,268.70
|
| Rate for Payer: UHC Exchange |
$2,426.08
|
| Rate for Payer: UHC Medicaid |
$811.74
|
| Rate for Payer: UHCCP Medicaid |
$811.74
|
|
|
PR ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY
|
Professional
|
Both
|
$2,159.00
|
|
|
Service Code
|
HCPCS 43327
|
| Min. Negotiated Rate |
$504.60 |
| Max. Negotiated Rate |
$1,619.25 |
| Rate for Payer: Aetna Commercial |
$1,052.30
|
| Rate for Payer: Aetna Medicare |
$816.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,052.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,130.83
|
| Rate for Payer: BCBS Complete |
$529.83
|
| Rate for Payer: BCBS MAPPO |
$785.30
|
| Rate for Payer: BCN Commercial |
$1,255.91
|
| Rate for Payer: BCN Medicare Advantage |
$785.30
|
| Rate for Payer: Cash Price |
$1,727.20
|
| Rate for Payer: Cash Price |
$1,727.20
|
| Rate for Payer: Cofinity Commercial |
$1,130.83
|
| Rate for Payer: Cofinity Commercial |
$1,052.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.30
|
| Rate for Payer: Healthscope Commercial |
$1,452.81
|
| Rate for Payer: Healthscope Commercial |
$1,256.48
|
| Rate for Payer: Mclaren Medicaid |
$504.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.57
|
| Rate for Payer: Meridian Medicaid |
$529.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$863.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,466.91
|
| Rate for Payer: Nomi Health Commercial |
$942.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,619.25
|
| Rate for Payer: PACE SWMI |
$785.30
|
| Rate for Payer: PHP Medicare Advantage |
$785.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$504.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,530.24
|
| Rate for Payer: Priority Health Medicare |
$785.30
|
| Rate for Payer: Priority Health SBD |
$1,530.24
|
| Rate for Payer: Priority Health Tiered Network |
$1,530.24
|
| Rate for Payer: Railroad Medicare Medicare |
$785.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,461.29
|
| Rate for Payer: UHC Core |
$1,461.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$785.30
|
| Rate for Payer: UHC Exchange |
$1,461.29
|
| Rate for Payer: UHC Medicaid |
$504.60
|
| Rate for Payer: UHCCP Medicaid |
$504.60
|
|
|
PR ESOPG/GSTR TAMPONADE W/BALO SENGSTAKEN TYPE
|
Professional
|
Both
|
$913.00
|
|
|
Service Code
|
HCPCS 43460
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$684.75 |
| Rate for Payer: Aetna Commercial |
$248.11
|
| Rate for Payer: Aetna Medicare |
$192.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.63
|
| Rate for Payer: BCBS Complete |
$125.70
|
| Rate for Payer: BCBS MAPPO |
$185.16
|
| Rate for Payer: BCN Commercial |
$313.73
|
| Rate for Payer: BCN Medicare Advantage |
$185.16
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cash Price |
$730.40
|
| Rate for Payer: Cofinity Commercial |
$266.63
|
| Rate for Payer: Cofinity Commercial |
$248.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.16
|
| Rate for Payer: Healthscope Commercial |
$342.55
|
| Rate for Payer: Healthscope Commercial |
$296.26
|
| Rate for Payer: Mclaren Medicaid |
$119.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.42
|
| Rate for Payer: Meridian Medicaid |
$125.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.20
|
| Rate for Payer: Nomi Health Commercial |
$222.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$684.75
|
| Rate for Payer: PACE SWMI |
$185.16
|
| Rate for Payer: PHP Medicare Advantage |
$185.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$382.25
|
| Rate for Payer: Priority Health Medicare |
$185.16
|
| Rate for Payer: Priority Health SBD |
$382.25
|
| Rate for Payer: Priority Health Tiered Network |
$382.25
|
| Rate for Payer: Railroad Medicare Medicare |
$185.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.60
|
| Rate for Payer: UHC Core |
$374.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.16
|
| Rate for Payer: UHC Exchange |
$374.60
|
| Rate for Payer: UHC Medicaid |
$119.71
|
| Rate for Payer: UHCCP Medicaid |
$119.71
|
|
