|
PR EXC HYDROCELE SPRMATIC CORD UNI SPX
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 55500
|
| Min. Negotiated Rate |
$290.00 |
| Max. Negotiated Rate |
$694.18 |
| Rate for Payer: Aetna Commercial |
$502.81
|
| Rate for Payer: Aetna Medicare |
$390.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.81
|
| Rate for Payer: BCBS Complete |
$290.00
|
| Rate for Payer: BCBS MAPPO |
$375.23
|
| Rate for Payer: BCN Medicare Advantage |
$375.23
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cofinity Commercial |
$540.33
|
| Rate for Payer: Cofinity Commercial |
$502.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.23
|
| Rate for Payer: Healthscope Commercial |
$694.18
|
| Rate for Payer: Healthscope Commercial |
$600.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$471.25
|
| Rate for Payer: Nomi Health Commercial |
$450.28
|
| Rate for Payer: PACE SWMI |
$375.23
|
| Rate for Payer: PHP Medicare Advantage |
$375.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.25
|
| Rate for Payer: Priority Health Medicare |
$375.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.23
|
| Rate for Payer: UHC Medicare Advantage |
$375.23
|
|
|
PR EXC ILEOANAL RSVR W/ILEOSTOMY
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 45136
|
| Min. Negotiated Rate |
$1,301.60 |
| Max. Negotiated Rate |
$3,126.15 |
| Rate for Payer: Aetna Commercial |
$2,264.35
|
| Rate for Payer: Aetna Medicare |
$1,757.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,433.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,264.35
|
| Rate for Payer: BCBS Complete |
$1,301.60
|
| Rate for Payer: BCBS MAPPO |
$1,689.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.81
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cofinity Commercial |
$2,433.33
|
| Rate for Payer: Cofinity Commercial |
$2,264.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.81
|
| Rate for Payer: Healthscope Commercial |
$2,703.70
|
| Rate for Payer: Healthscope Commercial |
$3,126.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,115.10
|
| Rate for Payer: Nomi Health Commercial |
$2,027.77
|
| Rate for Payer: PACE SWMI |
$1,689.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,115.10
|
| Rate for Payer: Priority Health Medicare |
$1,689.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.81
|
|
|
PR EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP
|
Professional
|
Both
|
$4,392.00
|
|
|
Service Code
|
HCPCS 33120
|
| Min. Negotiated Rate |
$1,756.80 |
| Max. Negotiated Rate |
$3,710.66 |
| Rate for Payer: Aetna Commercial |
$2,687.72
|
| Rate for Payer: Aetna Medicare |
$2,085.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,888.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,687.72
|
| Rate for Payer: BCBS Complete |
$1,756.80
|
| Rate for Payer: BCBS MAPPO |
$2,005.76
|
| Rate for Payer: BCN Medicare Advantage |
$2,005.76
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cofinity Commercial |
$2,888.29
|
| Rate for Payer: Cofinity Commercial |
$2,687.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,005.76
|
| Rate for Payer: Healthscope Commercial |
$3,209.22
|
| Rate for Payer: Healthscope Commercial |
$3,710.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,106.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,854.80
|
| Rate for Payer: Nomi Health Commercial |
$2,406.91
|
| Rate for Payer: PACE SWMI |
$2,005.76
|
| Rate for Payer: PHP Medicare Advantage |
$2,005.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,854.80
|
| Rate for Payer: Priority Health Medicare |
$2,005.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,005.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,005.76
|
|
|
PR EXCIS CHEST WALL TUMOR/RIBS
|
Professional
|
Both
|
$2,265.00
|
|
|
Service Code
|
HCPCS 19260
|
| Min. Negotiated Rate |
$906.00 |
| Max. Negotiated Rate |
$1,472.25 |
| Rate for Payer: Aetna Medicare |
$1,132.50
|
| Rate for Payer: BCBS Complete |
$906.00
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,472.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.25
|
|
|
PR EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE
|
Professional
|
Both
|
$1,248.00
|
|
|
Service Code
|
HCPCS 15940
|
| Min. Negotiated Rate |
$499.20 |
| Max. Negotiated Rate |
$1,265.42 |
| Rate for Payer: Aetna Commercial |
$916.57
|
| Rate for Payer: Aetna Medicare |
$711.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.97
|
| Rate for Payer: BCBS Complete |
$499.20
|
| Rate for Payer: BCBS MAPPO |
$684.01
|
| Rate for Payer: BCN Medicare Advantage |
$684.01
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cofinity Commercial |
$916.57
|
| Rate for Payer: Cofinity Commercial |
$984.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.01
|
| Rate for Payer: Healthscope Commercial |
$1,094.42
|
| Rate for Payer: Healthscope Commercial |
$1,265.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$811.20
|
| Rate for Payer: Nomi Health Commercial |
$820.81
|
| Rate for Payer: PACE SWMI |
$684.01
|
| Rate for Payer: PHP Medicare Advantage |
$684.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$811.20
|
| Rate for Payer: Priority Health Medicare |
$684.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.01
|
| Rate for Payer: UHC Medicare Advantage |
$684.01
|
|
|
PR EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE
|
Professional
|
Both
|
$1,617.00
|
|
|
Service Code
|
HCPCS 15944
|
| Min. Negotiated Rate |
$646.80 |
| Max. Negotiated Rate |
$1,648.59 |
| Rate for Payer: Aetna Commercial |
$1,194.11
|
| Rate for Payer: Aetna Medicare |
$926.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,283.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,194.11
|
| Rate for Payer: BCBS Complete |
$646.80
|
| Rate for Payer: BCBS MAPPO |
$891.13
|
| Rate for Payer: BCN Medicare Advantage |
$891.13
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cofinity Commercial |
$1,283.23
|
| Rate for Payer: Cofinity Commercial |
$1,194.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$891.13
|
| Rate for Payer: Healthscope Commercial |
$1,648.59
|
| Rate for Payer: Healthscope Commercial |
$1,425.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$935.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.05
|
| Rate for Payer: Nomi Health Commercial |
$1,069.36
|
| Rate for Payer: PACE SWMI |
$891.13
|
| Rate for Payer: PHP Medicare Advantage |
$891.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.05
|
| Rate for Payer: Priority Health Medicare |
$891.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$891.13
|
| Rate for Payer: UHC Medicare Advantage |
$891.13
|
|
|
PR EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$3,352.00
|
|
|
Service Code
|
HCPCS 15946
|
| Min. Negotiated Rate |
$1,340.80 |
| Max. Negotiated Rate |
$2,841.47 |
| Rate for Payer: Aetna Commercial |
$2,058.15
|
| Rate for Payer: Aetna Medicare |
$1,597.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,211.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,058.15
|
| Rate for Payer: BCBS Complete |
$1,340.80
|
| Rate for Payer: BCBS MAPPO |
$1,535.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,535.93
|
| Rate for Payer: Cash Price |
$2,681.60
|
| Rate for Payer: Cash Price |
$2,681.60
|
| Rate for Payer: Cofinity Commercial |
$2,211.74
|
| Rate for Payer: Cofinity Commercial |
$2,058.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,535.93
|
| Rate for Payer: Healthscope Commercial |
$2,457.49
|
| Rate for Payer: Healthscope Commercial |
$2,841.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,612.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,178.80
|
| Rate for Payer: Nomi Health Commercial |
$1,843.12
|
| Rate for Payer: PACE SWMI |
$1,535.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,535.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,178.80
|
| Rate for Payer: Priority Health Medicare |
$1,535.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,535.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,535.93
|
|
|
PR EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 15941
|
| Min. Negotiated Rate |
$646.40 |
| Max. Negotiated Rate |
$1,669.53 |
| Rate for Payer: Aetna Commercial |
$1,209.28
|
| Rate for Payer: Aetna Medicare |
$938.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.28
|
| Rate for Payer: BCBS Complete |
$646.40
|
| Rate for Payer: BCBS MAPPO |
$902.45
|
| Rate for Payer: BCN Medicare Advantage |
$902.45
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$1,299.53
|
| Rate for Payer: Cofinity Commercial |
$1,209.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.45
|
| Rate for Payer: Healthscope Commercial |
$1,669.53
|
| Rate for Payer: Healthscope Commercial |
$1,443.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.40
|
| Rate for Payer: Nomi Health Commercial |
$1,082.94
|
| Rate for Payer: PACE SWMI |
$902.45
|
| Rate for Payer: PHP Medicare Advantage |
$902.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health Medicare |
$902.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$902.45
|
| Rate for Payer: UHC Medicare Advantage |
$902.45
|
|
|
PR EXCISION 1ST &/CERVICAL RIB
|
Professional
|
Both
|
$1,202.00
|
|
|
Service Code
|
HCPCS 21615
|
| Min. Negotiated Rate |
$480.80 |
| Max. Negotiated Rate |
$1,119.66 |
| Rate for Payer: Aetna Commercial |
$810.99
|
| Rate for Payer: Aetna Medicare |
$629.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$871.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$810.99
|
| Rate for Payer: BCBS Complete |
$480.80
|
| Rate for Payer: BCBS MAPPO |
$605.22
|
| Rate for Payer: BCN Medicare Advantage |
$605.22
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cofinity Commercial |
$871.52
|
| Rate for Payer: Cofinity Commercial |
$810.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.22
|
| Rate for Payer: Healthscope Commercial |
$1,119.66
|
| Rate for Payer: Healthscope Commercial |
$968.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$635.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$781.30
|
| Rate for Payer: Nomi Health Commercial |
$726.26
|
| Rate for Payer: PACE SWMI |
$605.22
|
| Rate for Payer: PHP Medicare Advantage |
$605.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health Medicare |
$605.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.22
|
| Rate for Payer: UHC Medicare Advantage |
$605.22
|
|
|
PR EXCISION AMPULLA VATER
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
HCPCS 48148
|
| Min. Negotiated Rate |
$738.80 |
| Max. Negotiated Rate |
$2,248.30 |
| Rate for Payer: Aetna Commercial |
$1,628.50
|
| Rate for Payer: Aetna Medicare |
$1,263.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,750.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.50
|
| Rate for Payer: BCBS Complete |
$738.80
|
| Rate for Payer: BCBS MAPPO |
$1,215.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,215.30
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,750.03
|
| Rate for Payer: Cofinity Commercial |
$1,628.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,215.30
|
| Rate for Payer: Healthscope Commercial |
$2,248.30
|
| Rate for Payer: Healthscope Commercial |
$1,944.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,276.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,200.55
|
| Rate for Payer: Nomi Health Commercial |
$1,458.36
|
| Rate for Payer: PACE SWMI |
$1,215.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,215.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health Medicare |
$1,215.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,215.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.30
|
|
|
PR EXCISION AURAL POLYP
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 69540
|
| Min. Negotiated Rate |
$120.34 |
| Max. Negotiated Rate |
$244.40 |
| Rate for Payer: Aetna Commercial |
$161.26
|
| Rate for Payer: Aetna Medicare |
$125.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.26
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: BCBS MAPPO |
$120.34
|
| Rate for Payer: BCN Medicare Advantage |
$120.34
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$173.29
|
| Rate for Payer: Cofinity Commercial |
$161.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.34
|
| Rate for Payer: Healthscope Commercial |
$192.54
|
| Rate for Payer: Healthscope Commercial |
$222.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$244.40
|
| Rate for Payer: Nomi Health Commercial |
$144.41
|
| Rate for Payer: PACE SWMI |
$120.34
|
| Rate for Payer: PHP Medicare Advantage |
$120.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health Medicare |
$120.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.34
|
| Rate for Payer: UHC Medicare Advantage |
$120.34
|
|
|
PR EXCISION BARTHOLINS GLAND OR CYST
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 56740
|
| Min. Negotiated Rate |
$300.06 |
| Max. Negotiated Rate |
$603.85 |
| Rate for Payer: Aetna Commercial |
$402.08
|
| Rate for Payer: Aetna Medicare |
$312.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.08
|
| Rate for Payer: BCBS Complete |
$371.60
|
| Rate for Payer: BCBS MAPPO |
$300.06
|
| Rate for Payer: BCN Medicare Advantage |
$300.06
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cofinity Commercial |
$432.09
|
| Rate for Payer: Cofinity Commercial |
$402.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.06
|
| Rate for Payer: Healthscope Commercial |
$555.11
|
| Rate for Payer: Healthscope Commercial |
$480.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.85
|
| Rate for Payer: Nomi Health Commercial |
$360.07
|
| Rate for Payer: PACE SWMI |
$300.06
|
| Rate for Payer: PHP Medicare Advantage |
$300.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.85
|
| Rate for Payer: Priority Health Medicare |
$300.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.06
|
| Rate for Payer: UHC Medicare Advantage |
$300.06
|
|
|
PR EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
HCPCS 21040
|
| Min. Negotiated Rate |
$344.28 |
| Max. Negotiated Rate |
$636.92 |
| Rate for Payer: Aetna Commercial |
$461.34
|
| Rate for Payer: Aetna Medicare |
$358.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.34
|
| Rate for Payer: BCBS Complete |
$390.40
|
| Rate for Payer: BCBS MAPPO |
$344.28
|
| Rate for Payer: BCN Medicare Advantage |
$344.28
|
| Rate for Payer: Cash Price |
$780.80
|
| Rate for Payer: Cash Price |
$780.80
|
| Rate for Payer: Cofinity Commercial |
$495.76
|
| Rate for Payer: Cofinity Commercial |
$461.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.28
|
| Rate for Payer: Healthscope Commercial |
$550.85
|
| Rate for Payer: Healthscope Commercial |
$636.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$634.40
|
| Rate for Payer: Nomi Health Commercial |
$413.14
|
| Rate for Payer: PACE SWMI |
$344.28
|
| Rate for Payer: PHP Medicare Advantage |
$344.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.40
|
| Rate for Payer: Priority Health Medicare |
$344.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$344.28
|
| Rate for Payer: UHC Medicare Advantage |
$344.28
|
|
|
PR EXCISION BONE CYST/BENIGN TUMOR DEEP
|
Professional
|
Both
|
$1,497.00
|
|
|
Service Code
|
HCPCS 27066
|
| Min. Negotiated Rate |
$598.80 |
| Max. Negotiated Rate |
$1,462.48 |
| Rate for Payer: Aetna Commercial |
$1,059.31
|
| Rate for Payer: Aetna Medicare |
$822.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.31
|
| Rate for Payer: BCBS Complete |
$598.80
|
| Rate for Payer: BCBS MAPPO |
$790.53
|
| Rate for Payer: BCN Medicare Advantage |
$790.53
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Cofinity Commercial |
$1,138.36
|
| Rate for Payer: Cofinity Commercial |
$1,059.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.53
|
| Rate for Payer: Healthscope Commercial |
$1,462.48
|
| Rate for Payer: Healthscope Commercial |
$1,264.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$830.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$973.05
|
| Rate for Payer: Nomi Health Commercial |
$948.64
|
| Rate for Payer: PACE SWMI |
$790.53
|
| Rate for Payer: PHP Medicare Advantage |
$790.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.05
|
| Rate for Payer: Priority Health Medicare |
$790.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$790.53
|
| Rate for Payer: UHC Medicare Advantage |
$790.53
|
|
|
PR EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 27065
|
| Min. Negotiated Rate |
$362.00 |
| Max. Negotiated Rate |
$935.69 |
| Rate for Payer: Aetna Commercial |
$677.75
|
| Rate for Payer: Aetna Medicare |
$526.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.75
|
| Rate for Payer: BCBS Complete |
$362.00
|
| Rate for Payer: BCBS MAPPO |
$505.78
|
| Rate for Payer: BCN Medicare Advantage |
$505.78
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cofinity Commercial |
$728.32
|
| Rate for Payer: Cofinity Commercial |
$677.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.78
|
| Rate for Payer: Healthscope Commercial |
$809.25
|
| Rate for Payer: Healthscope Commercial |
$935.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$588.25
|
| Rate for Payer: Nomi Health Commercial |
$606.94
|
| Rate for Payer: PACE SWMI |
$505.78
|
| Rate for Payer: PHP Medicare Advantage |
$505.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.25
|
| Rate for Payer: Priority Health Medicare |
$505.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$505.78
|
| Rate for Payer: UHC Medicare Advantage |
$505.78
|
|
|
PR EXCISION BONE MANDIBLE
|
Professional
|
Both
|
$1,596.00
|
|
|
Service Code
|
HCPCS 21025
|
| Min. Negotiated Rate |
$635.55 |
| Max. Negotiated Rate |
$1,175.77 |
| Rate for Payer: Aetna Commercial |
$851.64
|
| Rate for Payer: Aetna Medicare |
$660.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.64
|
| Rate for Payer: BCBS Complete |
$638.40
|
| Rate for Payer: BCBS MAPPO |
$635.55
|
| Rate for Payer: BCN Medicare Advantage |
$635.55
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cofinity Commercial |
$915.19
|
| Rate for Payer: Cofinity Commercial |
$851.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$635.55
|
| Rate for Payer: Healthscope Commercial |
$1,175.77
|
| Rate for Payer: Healthscope Commercial |
$1,016.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$667.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,037.40
|
| Rate for Payer: Nomi Health Commercial |
$762.66
|
| Rate for Payer: PACE SWMI |
$635.55
|
| Rate for Payer: PHP Medicare Advantage |
$635.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,037.40
|
| Rate for Payer: Priority Health Medicare |
$635.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$635.55
|
| Rate for Payer: UHC Medicare Advantage |
$635.55
|
|
|
PR EXCISION CHALAZION MULTIPLE SAME LID
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 67801
|
| Min. Negotiated Rate |
$116.40 |
| Max. Negotiated Rate |
$226.38 |
| Rate for Payer: Aetna Commercial |
$163.98
|
| Rate for Payer: Aetna Medicare |
$127.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.98
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$122.37
|
| Rate for Payer: BCN Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$176.21
|
| Rate for Payer: Cofinity Commercial |
$163.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.37
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| Rate for Payer: Healthscope Commercial |
$226.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.15
|
| Rate for Payer: Nomi Health Commercial |
$146.84
|
| Rate for Payer: PACE SWMI |
$122.37
|
| Rate for Payer: PHP Medicare Advantage |
$122.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health Medicare |
$122.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.37
|
| Rate for Payer: UHC Medicare Advantage |
$122.37
|
|
|
PR EXCISION CHALAZION SINGLE
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 67800
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$176.21 |
| Rate for Payer: Aetna Commercial |
$127.64
|
| Rate for Payer: Aetna Medicare |
$99.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.64
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS MAPPO |
$95.25
|
| Rate for Payer: BCN Medicare Advantage |
$95.25
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Cofinity Commercial |
$127.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.25
|
| Rate for Payer: Healthscope Commercial |
$176.21
|
| Rate for Payer: Healthscope Commercial |
$152.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Nomi Health Commercial |
$114.30
|
| Rate for Payer: PACE SWMI |
$95.25
|
| Rate for Payer: PHP Medicare Advantage |
$95.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health Medicare |
$95.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.25
|
| Rate for Payer: UHC Medicare Advantage |
$95.25
|
|
|
PR EXCISION CHEST WALL TUMOR INCLUDING RIBS
|
Professional
|
Both
|
$2,439.00
|
|
|
Service Code
|
HCPCS 21601
|
| Min. Negotiated Rate |
$975.60 |
| Max. Negotiated Rate |
$2,042.34 |
| Rate for Payer: Aetna Commercial |
$1,479.32
|
| Rate for Payer: Aetna Medicare |
$1,148.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,589.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.32
|
| Rate for Payer: BCBS Complete |
$975.60
|
| Rate for Payer: BCBS MAPPO |
$1,103.97
|
| Rate for Payer: BCN Medicare Advantage |
$1,103.97
|
| Rate for Payer: Cash Price |
$1,951.20
|
| Rate for Payer: Cash Price |
$1,951.20
|
| Rate for Payer: Cofinity Commercial |
$1,589.72
|
| Rate for Payer: Cofinity Commercial |
$1,479.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,103.97
|
| Rate for Payer: Healthscope Commercial |
$1,766.35
|
| Rate for Payer: Healthscope Commercial |
$2,042.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,159.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,585.35
|
| Rate for Payer: Nomi Health Commercial |
$1,324.76
|
| Rate for Payer: PACE SWMI |
$1,103.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,103.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,585.35
|
| Rate for Payer: Priority Health Medicare |
$1,103.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,103.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,103.97
|
|
|
PR EXCISION CHOLEDOCHAL CYST
|
Professional
|
Both
|
$2,307.00
|
|
|
Service Code
|
HCPCS 47715
|
| Min. Negotiated Rate |
$922.80 |
| Max. Negotiated Rate |
$2,389.79 |
| Rate for Payer: Aetna Commercial |
$1,730.99
|
| Rate for Payer: Aetna Medicare |
$1,343.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,860.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,730.99
|
| Rate for Payer: BCBS Complete |
$922.80
|
| Rate for Payer: BCBS MAPPO |
$1,291.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,291.78
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cash Price |
$1,845.60
|
| Rate for Payer: Cofinity Commercial |
$1,860.16
|
| Rate for Payer: Cofinity Commercial |
$1,730.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,291.78
|
| Rate for Payer: Healthscope Commercial |
$2,389.79
|
| Rate for Payer: Healthscope Commercial |
$2,066.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,356.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,499.55
|
| Rate for Payer: Nomi Health Commercial |
$1,550.14
|
| Rate for Payer: PACE SWMI |
$1,291.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,291.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,499.55
|
| Rate for Payer: Priority Health Medicare |
$1,291.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,291.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,291.78
|
|
|
PR EXCISION CH WAL TUM W/RIB W/MEDSTNL LYMPHADEC
|
Professional
|
Both
|
$3,746.00
|
|
|
Service Code
|
HCPCS 21603
|
| Min. Negotiated Rate |
$1,498.40 |
| Max. Negotiated Rate |
$2,976.95 |
| Rate for Payer: Aetna Commercial |
$2,156.27
|
| Rate for Payer: Aetna Medicare |
$1,673.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,317.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,156.27
|
| Rate for Payer: BCBS Complete |
$1,498.40
|
| Rate for Payer: BCBS MAPPO |
$1,609.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,609.16
|
| Rate for Payer: Cash Price |
$2,996.80
|
| Rate for Payer: Cash Price |
$2,996.80
|
| Rate for Payer: Cofinity Commercial |
$2,317.19
|
| Rate for Payer: Cofinity Commercial |
$2,156.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,609.16
|
| Rate for Payer: Healthscope Commercial |
$2,574.66
|
| Rate for Payer: Healthscope Commercial |
$2,976.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,689.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,434.90
|
| Rate for Payer: Nomi Health Commercial |
$1,930.99
|
| Rate for Payer: PACE SWMI |
$1,609.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,609.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,434.90
|
| Rate for Payer: Priority Health Medicare |
$1,609.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,609.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,609.16
|
|
|
PR EXCISION CH WAL TUM W/RIB W/O MEDSTNL LYMPHADEC
|
Professional
|
Both
|
$3,125.00
|
|
|
Service Code
|
HCPCS 21602
|
| Min. Negotiated Rate |
$1,250.00 |
| Max. Negotiated Rate |
$2,734.84 |
| Rate for Payer: Aetna Commercial |
$1,980.91
|
| Rate for Payer: Aetna Medicare |
$1,537.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,128.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,980.91
|
| Rate for Payer: BCBS Complete |
$1,250.00
|
| Rate for Payer: BCBS MAPPO |
$1,478.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,478.29
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cofinity Commercial |
$2,128.74
|
| Rate for Payer: Cofinity Commercial |
$1,980.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,478.29
|
| Rate for Payer: Healthscope Commercial |
$2,734.84
|
| Rate for Payer: Healthscope Commercial |
$2,365.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,552.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,031.25
|
| Rate for Payer: Nomi Health Commercial |
$1,773.95
|
| Rate for Payer: PACE SWMI |
$1,478.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,478.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,031.25
|
| Rate for Payer: Priority Health Medicare |
$1,478.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,478.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,478.29
|
|
|
PR EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA
|
Professional
|
Both
|
$2,082.00
|
|
|
Service Code
|
HCPCS 27635
|
| Min. Negotiated Rate |
$555.51 |
| Max. Negotiated Rate |
$1,353.30 |
| Rate for Payer: Aetna Commercial |
$744.38
|
| Rate for Payer: Aetna Medicare |
$577.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$799.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.38
|
| Rate for Payer: BCBS Complete |
$832.80
|
| Rate for Payer: BCBS MAPPO |
$555.51
|
| Rate for Payer: BCN Medicare Advantage |
$555.51
|
| Rate for Payer: Cash Price |
$1,665.60
|
| Rate for Payer: Cash Price |
$1,665.60
|
| Rate for Payer: Cofinity Commercial |
$799.93
|
| Rate for Payer: Cofinity Commercial |
$744.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.51
|
| Rate for Payer: Healthscope Commercial |
$1,027.69
|
| Rate for Payer: Healthscope Commercial |
$888.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,353.30
|
| Rate for Payer: Nomi Health Commercial |
$666.61
|
| Rate for Payer: PACE SWMI |
$555.51
|
| Rate for Payer: PHP Medicare Advantage |
$555.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.30
|
| Rate for Payer: Priority Health Medicare |
$555.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.51
|
| Rate for Payer: UHC Medicare Advantage |
$555.51
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES
|
Professional
|
Both
|
$1,621.00
|
|
|
Service Code
|
HCPCS 25130
|
| Min. Negotiated Rate |
$438.21 |
| Max. Negotiated Rate |
$1,053.65 |
| Rate for Payer: Aetna Commercial |
$587.20
|
| Rate for Payer: Aetna Medicare |
$455.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.20
|
| Rate for Payer: BCBS Complete |
$648.40
|
| Rate for Payer: BCBS MAPPO |
$438.21
|
| Rate for Payer: BCN Medicare Advantage |
$438.21
|
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Cofinity Commercial |
$631.02
|
| Rate for Payer: Cofinity Commercial |
$587.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$438.21
|
| Rate for Payer: Healthscope Commercial |
$810.69
|
| Rate for Payer: Healthscope Commercial |
$701.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$460.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.65
|
| Rate for Payer: Nomi Health Commercial |
$525.85
|
| Rate for Payer: PACE SWMI |
$438.21
|
| Rate for Payer: PHP Medicare Advantage |
$438.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,053.65
|
| Rate for Payer: Priority Health Medicare |
$438.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$438.21
|
| Rate for Payer: UHC Medicare Advantage |
$438.21
|
|
|
PR EXCISION/CURETTAGE CYST/TUMOR FEMUR
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 27355
|
| Min. Negotiated Rate |
$590.33 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$791.04
|
| Rate for Payer: Aetna Medicare |
$613.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.04
|
| Rate for Payer: BCBS Complete |
$914.80
|
| Rate for Payer: BCBS MAPPO |
$590.33
|
| Rate for Payer: BCN Medicare Advantage |
$590.33
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$850.08
|
| Rate for Payer: Cofinity Commercial |
$791.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$590.33
|
| Rate for Payer: Healthscope Commercial |
$1,092.11
|
| Rate for Payer: Healthscope Commercial |
$944.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$619.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,486.55
|
| Rate for Payer: Nomi Health Commercial |
$708.40
|
| Rate for Payer: PACE SWMI |
$590.33
|
| Rate for Payer: PHP Medicare Advantage |
$590.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health Medicare |
$590.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$590.33
|
| Rate for Payer: UHC Medicare Advantage |
$590.33
|
|
