|
PR BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$681.00
|
|
|
Service Code
|
HCPCS 54505
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$1,963.16 |
| Rate for Payer: Aetna Commercial |
$268.74
|
| Rate for Payer: Aetna Medicare |
$208.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.79
|
| Rate for Payer: BCBS Complete |
$141.79
|
| Rate for Payer: BCBS MAPPO |
$200.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,963.16
|
| Rate for Payer: BCN Commercial |
$303.46
|
| Rate for Payer: BCN Medicare Advantage |
$200.55
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cash Price |
$544.80
|
| Rate for Payer: Cofinity Commercial |
$268.74
|
| Rate for Payer: Cofinity Commercial |
$288.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.58
|
| Rate for Payer: Meridian Medicaid |
$141.79
|
| Rate for Payer: Nomi Health Commercial |
$240.66
|
| Rate for Payer: PACE SWMI |
$200.55
|
| Rate for Payer: PHP Commercial |
$280.77
|
| Rate for Payer: PHP Medicare Advantage |
$200.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$135.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$442.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.48
|
| Rate for Payer: Priority Health Medicare |
$200.55
|
| Rate for Payer: Priority Health Narrow Network |
$334.48
|
| Rate for Payer: Priority Health SBD |
$334.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$200.55
|
| Rate for Payer: UHC Medicare Advantage |
$200.55
|
| Rate for Payer: UHCCP Medicaid |
$135.04
|
| Rate for Payer: UMR Bronson Commercial |
$313.26
|
|
|
PR BIOPSY THYROID PERCUTANEOUS CORE NEEDLE
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 60100
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$172.75 |
| Rate for Payer: Aetna Commercial |
$97.07
|
| Rate for Payer: Aetna Medicare |
$75.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.07
|
| Rate for Payer: BCBS Complete |
$50.55
|
| Rate for Payer: BCBS MAPPO |
$72.44
|
| Rate for Payer: BCBS Trust/PPO |
$172.75
|
| Rate for Payer: BCN Commercial |
$161.26
|
| Rate for Payer: BCN Medicare Advantage |
$72.44
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$104.31
|
| Rate for Payer: Cofinity Commercial |
$97.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.06
|
| Rate for Payer: Meridian Medicaid |
$50.55
|
| Rate for Payer: Nomi Health Commercial |
$86.93
|
| Rate for Payer: PACE SWMI |
$72.44
|
| Rate for Payer: PHP Commercial |
$101.42
|
| Rate for Payer: PHP Medicare Advantage |
$72.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.70
|
| Rate for Payer: Priority Health Medicare |
$72.44
|
| Rate for Payer: Priority Health Narrow Network |
$121.70
|
| Rate for Payer: Priority Health SBD |
$121.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.44
|
| Rate for Payer: UHC Medicare Advantage |
$72.44
|
| Rate for Payer: UHCCP Medicaid |
$48.14
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
PR BIOPSY TONGUE ANTERIOR TWO-THIRDS
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 41100
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$824.68 |
| Rate for Payer: Aetna Commercial |
$136.25
|
| Rate for Payer: Aetna Medicare |
$105.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.42
|
| Rate for Payer: BCBS Complete |
$72.91
|
| Rate for Payer: BCBS MAPPO |
$101.68
|
| Rate for Payer: BCBS Trust/PPO |
$824.68
|
| Rate for Payer: BCN Commercial |
$276.59
|
| Rate for Payer: BCN Medicare Advantage |
$101.68
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$136.25
|
| Rate for Payer: Cofinity Commercial |
$146.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.76
|
| Rate for Payer: Meridian Medicaid |
$72.91
|
| Rate for Payer: Nomi Health Commercial |
$122.02
|
| Rate for Payer: PACE SWMI |
$101.68
|
| Rate for Payer: PHP Commercial |
$142.35
|
| Rate for Payer: PHP Medicare Advantage |
$101.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.29
|
| Rate for Payer: Priority Health Medicare |
$101.68
|
| Rate for Payer: Priority Health Narrow Network |
$193.29
|
| Rate for Payer: Priority Health SBD |
$193.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.68
|
| Rate for Payer: UHC Medicare Advantage |
$101.68
|
| Rate for Payer: UHCCP Medicaid |
$69.44
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR BIOPSY TONGUE POSTERIOR ONE-THIRD
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 41105
|
| Min. Negotiated Rate |
$71.36 |
| Max. Negotiated Rate |
$609.66 |
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Aetna Commercial |
$139.99
|
| Rate for Payer: Aetna Medicare |
$108.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.44
|
| Rate for Payer: BCBS Complete |
$74.93
|
| Rate for Payer: BCBS MAPPO |
$104.47
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: BCN Commercial |
$276.59
|
| Rate for Payer: BCN Medicare Advantage |
$104.47
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Commercial |
$139.99
|
| Rate for Payer: Cofinity Commercial |
$150.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.69
|
| Rate for Payer: Meridian Medicaid |
$74.93
|
| Rate for Payer: Nomi Health Commercial |
$125.36
|
| Rate for Payer: PACE SWMI |
$104.47
|
| Rate for Payer: PHP Commercial |
$146.26
|
| Rate for Payer: PHP Medicare Advantage |
$104.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.67
|
| Rate for Payer: Priority Health Medicare |
$104.47
|
| Rate for Payer: Priority Health Narrow Network |
$198.67
|
| Rate for Payer: Priority Health SBD |
$198.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.47
|
| Rate for Payer: UHC Medicare Advantage |
$104.47
|
| Rate for Payer: UHCCP Medicaid |
$71.36
|
| Rate for Payer: UMR Bronson Commercial |
$139.84
|
|
|
PR BIOPSY URETHRA
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
HCPCS 53200
|
| Min. Negotiated Rate |
$90.74 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$182.17
|
| Rate for Payer: Aetna Medicare |
$141.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.77
|
| Rate for Payer: BCBS Complete |
$95.28
|
| Rate for Payer: BCBS MAPPO |
$135.95
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: BCN Commercial |
$230.17
|
| Rate for Payer: BCN Medicare Advantage |
$135.95
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cash Price |
$308.80
|
| Rate for Payer: Cofinity Commercial |
$182.17
|
| Rate for Payer: Cofinity Commercial |
$195.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.75
|
| Rate for Payer: Meridian Medicaid |
$95.28
|
| Rate for Payer: Nomi Health Commercial |
$163.14
|
| Rate for Payer: PACE SWMI |
$135.95
|
| Rate for Payer: PHP Commercial |
$190.33
|
| Rate for Payer: PHP Medicare Advantage |
$135.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.30
|
| Rate for Payer: Priority Health Medicare |
$135.95
|
| Rate for Payer: Priority Health Narrow Network |
$225.30
|
| Rate for Payer: Priority Health SBD |
$225.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.95
|
| Rate for Payer: UHC Medicare Advantage |
$135.95
|
| Rate for Payer: UHCCP Medicaid |
$90.74
|
| Rate for Payer: UMR Bronson Commercial |
$177.56
|
|
|
PR BIOPSY VAGINAL MUCOSA EXTENSIVE
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 57105
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$3,594.02 |
| Rate for Payer: Aetna Commercial |
$184.42
|
| Rate for Payer: Aetna Medicare |
$143.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.19
|
| Rate for Payer: BCBS Complete |
$98.86
|
| Rate for Payer: BCBS MAPPO |
$137.63
|
| Rate for Payer: BCBS Trust/PPO |
$3,594.02
|
| Rate for Payer: BCN Commercial |
$260.95
|
| Rate for Payer: BCN Medicare Advantage |
$137.63
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$184.42
|
| Rate for Payer: Cofinity Commercial |
$198.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.51
|
| Rate for Payer: Meridian Medicaid |
$98.86
|
| Rate for Payer: Nomi Health Commercial |
$165.16
|
| Rate for Payer: PACE SWMI |
$137.63
|
| Rate for Payer: PHP Commercial |
$192.68
|
| Rate for Payer: PHP Medicare Advantage |
$137.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$94.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.74
|
| Rate for Payer: Priority Health Medicare |
$137.63
|
| Rate for Payer: Priority Health Narrow Network |
$220.74
|
| Rate for Payer: Priority Health SBD |
$220.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.63
|
| Rate for Payer: UHC Medicare Advantage |
$137.63
|
| Rate for Payer: UHCCP Medicaid |
$94.15
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR BIOPSY VAGINAL MUCOSA SIMPLE
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 57100
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$3,206.78 |
| Rate for Payer: Aetna Commercial |
$84.69
|
| Rate for Payer: Aetna Medicare |
$65.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.01
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS MAPPO |
$63.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,206.78
|
| Rate for Payer: BCN Commercial |
$151.98
|
| Rate for Payer: BCN Medicare Advantage |
$63.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cofinity Commercial |
$84.69
|
| Rate for Payer: Cofinity Commercial |
$91.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.36
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$75.84
|
| Rate for Payer: PACE SWMI |
$63.20
|
| Rate for Payer: PHP Commercial |
$88.48
|
| Rate for Payer: PHP Medicare Advantage |
$63.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.22
|
| Rate for Payer: Priority Health Medicare |
$63.20
|
| Rate for Payer: Priority Health Narrow Network |
$97.22
|
| Rate for Payer: Priority Health SBD |
$97.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.20
|
| Rate for Payer: UHC Medicare Advantage |
$63.20
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$77.74
|
|
|
PR BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL
|
Professional
|
Both
|
$1,327.00
|
|
|
Service Code
|
HCPCS 20251
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$862.55 |
| Rate for Payer: Aetna Commercial |
$559.88
|
| Rate for Payer: Aetna Medicare |
$434.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.66
|
| Rate for Payer: BCBS Complete |
$293.87
|
| Rate for Payer: BCBS MAPPO |
$417.82
|
| Rate for Payer: BCBS Trust/PPO |
$106.88
|
| Rate for Payer: BCN Commercial |
$618.67
|
| Rate for Payer: BCN Medicare Advantage |
$417.82
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cash Price |
$1,061.60
|
| Rate for Payer: Cofinity Commercial |
$559.88
|
| Rate for Payer: Cofinity Commercial |
$601.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$417.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$438.71
|
| Rate for Payer: Meridian Medicaid |
$293.87
|
| Rate for Payer: Nomi Health Commercial |
$501.38
|
| Rate for Payer: PACE SWMI |
$417.82
|
| Rate for Payer: PHP Commercial |
$584.95
|
| Rate for Payer: PHP Medicare Advantage |
$417.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$862.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$644.22
|
| Rate for Payer: Priority Health Medicare |
$417.82
|
| Rate for Payer: Priority Health Narrow Network |
$644.22
|
| Rate for Payer: Priority Health SBD |
$644.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$417.82
|
| Rate for Payer: UHC Medicare Advantage |
$417.82
|
| Rate for Payer: UHCCP Medicaid |
$279.88
|
| Rate for Payer: UMR Bronson Commercial |
$610.42
|
|
|
PR BIOPSY VERTEBRAL BODY OPEN THORACIC
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 20250
|
| Min. Negotiated Rate |
$254.54 |
| Max. Negotiated Rate |
$602.48 |
| Rate for Payer: Aetna Commercial |
$508.36
|
| Rate for Payer: Aetna Medicare |
$394.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.29
|
| Rate for Payer: BCBS Complete |
$267.27
|
| Rate for Payer: BCBS MAPPO |
$379.37
|
| Rate for Payer: BCBS Trust/PPO |
$556.70
|
| Rate for Payer: BCN Commercial |
$569.80
|
| Rate for Payer: BCN Medicare Advantage |
$379.37
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cofinity Commercial |
$508.36
|
| Rate for Payer: Cofinity Commercial |
$546.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.34
|
| Rate for Payer: Meridian Medicaid |
$267.27
|
| Rate for Payer: Nomi Health Commercial |
$455.24
|
| Rate for Payer: PACE SWMI |
$379.37
|
| Rate for Payer: PHP Commercial |
$531.12
|
| Rate for Payer: PHP Medicare Advantage |
$379.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$602.48
|
| Rate for Payer: Priority Health Medicare |
$379.37
|
| Rate for Payer: Priority Health Narrow Network |
$602.48
|
| Rate for Payer: Priority Health SBD |
$602.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.37
|
| Rate for Payer: UHC Medicare Advantage |
$379.37
|
| Rate for Payer: UHCCP Medicaid |
$254.54
|
| Rate for Payer: UMR Bronson Commercial |
$369.38
|
|
|
PR BIOPSY VESTIBULE MOUTH
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 40808
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$547.85 |
| Rate for Payer: Aetna Commercial |
$113.32
|
| Rate for Payer: Aetna Medicare |
$87.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.78
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS MAPPO |
$84.57
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCN Commercial |
$249.22
|
| Rate for Payer: BCN Medicare Advantage |
$84.57
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$113.32
|
| Rate for Payer: Cofinity Commercial |
$121.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.80
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| Rate for Payer: Nomi Health Commercial |
$101.48
|
| Rate for Payer: PACE SWMI |
$84.57
|
| Rate for Payer: PHP Commercial |
$118.40
|
| Rate for Payer: PHP Medicare Advantage |
$84.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.48
|
| Rate for Payer: Priority Health Medicare |
$84.57
|
| Rate for Payer: Priority Health Narrow Network |
$160.48
|
| Rate for Payer: Priority Health SBD |
$160.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.57
|
| Rate for Payer: UHC Medicare Advantage |
$84.57
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
| Rate for Payer: UMR Bronson Commercial |
$140.30
|
|
|
PR BIOPSY VULVA/PERINEUM 1 LESION SPX
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 56605
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$2,173.43 |
| Rate for Payer: Aetna Commercial |
$76.07
|
| Rate for Payer: Aetna Medicare |
$59.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.75
|
| Rate for Payer: BCBS Complete |
$39.58
|
| Rate for Payer: BCBS MAPPO |
$56.77
|
| Rate for Payer: BCBS Trust/PPO |
$2,173.43
|
| Rate for Payer: BCN Commercial |
$114.27
|
| Rate for Payer: BCN Medicare Advantage |
$56.77
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$76.07
|
| Rate for Payer: Cofinity Commercial |
$81.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.61
|
| Rate for Payer: Meridian Medicaid |
$39.58
|
| Rate for Payer: Nomi Health Commercial |
$68.12
|
| Rate for Payer: PACE SWMI |
$56.77
|
| Rate for Payer: PHP Commercial |
$79.48
|
| Rate for Payer: PHP Medicare Advantage |
$56.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.80
|
| Rate for Payer: Priority Health Medicare |
$56.77
|
| Rate for Payer: Priority Health Narrow Network |
$87.80
|
| Rate for Payer: Priority Health SBD |
$87.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.77
|
| Rate for Payer: UHC Medicare Advantage |
$56.77
|
| Rate for Payer: UHCCP Medicaid |
$37.70
|
| Rate for Payer: UMR Bronson Commercial |
$140.30
|
|
|
PR BIOPSY VULVA/PERINEUM EACH ADDL LESION
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 56606
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$1,893.96 |
| Rate for Payer: Aetna Commercial |
$36.98
|
| Rate for Payer: Aetna Medicare |
$28.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.74
|
| Rate for Payer: BCBS Complete |
$19.24
|
| Rate for Payer: BCBS MAPPO |
$27.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,893.96
|
| Rate for Payer: BCN Commercial |
$56.68
|
| Rate for Payer: BCN Medicare Advantage |
$27.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$39.74
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.98
|
| Rate for Payer: Meridian Medicaid |
$19.24
|
| Rate for Payer: Nomi Health Commercial |
$33.12
|
| Rate for Payer: PACE SWMI |
$27.60
|
| Rate for Payer: PHP Commercial |
$38.64
|
| Rate for Payer: PHP Medicare Advantage |
$27.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.16
|
| Rate for Payer: Priority Health Medicare |
$27.60
|
| Rate for Payer: Priority Health Narrow Network |
$43.16
|
| Rate for Payer: Priority Health SBD |
$43.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.60
|
| Rate for Payer: UHC Medicare Advantage |
$27.60
|
| Rate for Payer: UHCCP Medicaid |
$18.32
|
| Rate for Payer: UMR Bronson Commercial |
$88.32
|
|
|
PR BKBENCH PREPJ CADAVER DONOR HEART/LUNG ALLOGRAFT
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 33933
|
| Min. Negotiated Rate |
$251.71 |
| Max. Negotiated Rate |
$1,305.43 |
| Rate for Payer: Aetna Commercial |
$536.72
|
| Rate for Payer: Aetna Medicare |
$337.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$536.72
|
| Rate for Payer: BCBS Complete |
$264.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.43
|
| Rate for Payer: BCN Commercial |
$627.12
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Meridian Medicaid |
$264.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.49
|
| Rate for Payer: Priority Health Narrow Network |
$676.49
|
| Rate for Payer: Priority Health SBD |
$676.49
|
| Rate for Payer: UHCCP Medicaid |
$251.71
|
| Rate for Payer: UMR Bronson Commercial |
$310.04
|
|
|
PR BLADDER INSTILLATION ANTICARCINOGENIC AGENT
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 51720
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$2,209.35 |
| Rate for Payer: Aetna Commercial |
$56.44
|
| Rate for Payer: Aetna Medicare |
$43.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.65
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS MAPPO |
$42.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,209.35
|
| Rate for Payer: BCN Commercial |
$102.88
|
| Rate for Payer: BCN Medicare Advantage |
$42.12
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$56.44
|
| Rate for Payer: Cofinity Commercial |
$60.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.23
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Nomi Health Commercial |
$50.54
|
| Rate for Payer: PACE SWMI |
$42.12
|
| Rate for Payer: PHP Commercial |
$58.97
|
| Rate for Payer: PHP Medicare Advantage |
$42.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.70
|
| Rate for Payer: Priority Health Medicare |
$42.12
|
| Rate for Payer: Priority Health Narrow Network |
$68.70
|
| Rate for Payer: Priority Health SBD |
$68.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.12
|
| Rate for Payer: UHC Medicare Advantage |
$42.12
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
| Rate for Payer: UMR Bronson Commercial |
$125.12
|
|
|
PR BLADDER PRESSURE MEASUREMENT DURING FILLING
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
HCPCS 51726
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$3,274.93 |
| Rate for Payer: Aetna Commercial |
$337.17
|
| Rate for Payer: Aetna Medicare |
$261.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.33
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCBS MAPPO |
$251.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,274.93
|
| Rate for Payer: BCN Commercial |
$441.76
|
| Rate for Payer: BCN Medicare Advantage |
$251.62
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cofinity Commercial |
$337.17
|
| Rate for Payer: Cofinity Commercial |
$362.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$264.20
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Nomi Health Commercial |
$301.94
|
| Rate for Payer: PACE SWMI |
$251.62
|
| Rate for Payer: PHP Commercial |
$352.27
|
| Rate for Payer: PHP Medicare Advantage |
$251.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$479.87
|
| Rate for Payer: Priority Health Medicare |
$251.62
|
| Rate for Payer: Priority Health Narrow Network |
$479.87
|
| Rate for Payer: Priority Health SBD |
$132.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.62
|
| Rate for Payer: UHC Medicare Advantage |
$251.62
|
| Rate for Payer: UHCCP Medicaid |
$53.25
|
| Rate for Payer: UMR Bronson Commercial |
$322.00
|
|
|
PR BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 38206
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$1,117.35 |
| Rate for Payer: Aetna Commercial |
$103.27
|
| Rate for Payer: Aetna Medicare |
$80.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.98
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS MAPPO |
$77.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.35
|
| Rate for Payer: BCN Commercial |
$120.21
|
| Rate for Payer: BCN Medicare Advantage |
$77.07
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$103.27
|
| Rate for Payer: Cofinity Commercial |
$110.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.92
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Nomi Health Commercial |
$92.48
|
| Rate for Payer: PACE SWMI |
$77.07
|
| Rate for Payer: PHP Commercial |
$107.90
|
| Rate for Payer: PHP Medicare Advantage |
$77.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.44
|
| Rate for Payer: Priority Health Medicare |
$77.07
|
| Rate for Payer: Priority Health Narrow Network |
$162.44
|
| Rate for Payer: Priority Health SBD |
$162.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.07
|
| Rate for Payer: UHC Medicare Advantage |
$77.07
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
| Rate for Payer: UMR Bronson Commercial |
$212.06
|
|
|
PR BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 51700
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$1,655.16 |
| Rate for Payer: Aetna Commercial |
$38.26
|
| Rate for Payer: Aetna Medicare |
$29.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.11
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS MAPPO |
$28.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,655.16
|
| Rate for Payer: BCN Commercial |
$89.53
|
| Rate for Payer: BCN Medicare Advantage |
$28.55
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Cofinity Commercial |
$41.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.98
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Nomi Health Commercial |
$34.26
|
| Rate for Payer: PACE SWMI |
$28.55
|
| Rate for Payer: PHP Commercial |
$39.97
|
| Rate for Payer: PHP Medicare Advantage |
$28.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.41
|
| Rate for Payer: Priority Health Medicare |
$28.55
|
| Rate for Payer: Priority Health Narrow Network |
$47.41
|
| Rate for Payer: Priority Health SBD |
$47.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.55
|
| Rate for Payer: UHC Medicare Advantage |
$28.55
|
| Rate for Payer: UHCCP Medicaid |
$18.96
|
| Rate for Payer: UMR Bronson Commercial |
$80.96
|
|
|
PR BLEPHAROPLASTY LOWER EYELID W/HERNIATED FAT PAD
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 15821
|
| Min. Negotiated Rate |
$312.59 |
| Max. Negotiated Rate |
$903.57 |
| Rate for Payer: Aetna Commercial |
$684.28
|
| Rate for Payer: Aetna Medicare |
$531.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$735.35
|
| Rate for Payer: BCBS Complete |
$368.57
|
| Rate for Payer: BCBS MAPPO |
$510.66
|
| Rate for Payer: BCBS Trust/PPO |
$312.59
|
| Rate for Payer: BCN Commercial |
$903.57
|
| Rate for Payer: BCN Medicare Advantage |
$510.66
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$684.28
|
| Rate for Payer: Cofinity Commercial |
$735.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$536.19
|
| Rate for Payer: Meridian Medicaid |
$368.57
|
| Rate for Payer: Nomi Health Commercial |
$612.79
|
| Rate for Payer: PACE SWMI |
$510.66
|
| Rate for Payer: PHP Commercial |
$714.92
|
| Rate for Payer: PHP Medicare Advantage |
$510.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.46
|
| Rate for Payer: Priority Health Medicare |
$510.66
|
| Rate for Payer: Priority Health Narrow Network |
$745.46
|
| Rate for Payer: Priority Health SBD |
$745.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.66
|
| Rate for Payer: UHC Medicare Advantage |
$510.66
|
| Rate for Payer: UHCCP Medicaid |
$351.02
|
| Rate for Payer: UMR Bronson Commercial |
$422.28
|
|
|
PR BLEPHAROPLASTY UPPER EYELID
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 15822
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Commercial |
$495.48
|
| Rate for Payer: Aetna Medicare |
$384.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$532.45
|
| Rate for Payer: BCBS Complete |
$267.27
|
| Rate for Payer: BCBS MAPPO |
$369.76
|
| Rate for Payer: BCBS Trust/PPO |
$31.71
|
| Rate for Payer: BCN Commercial |
$675.35
|
| Rate for Payer: BCN Medicare Advantage |
$369.76
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$495.48
|
| Rate for Payer: Cofinity Commercial |
$532.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$369.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.25
|
| Rate for Payer: Meridian Medicaid |
$267.27
|
| Rate for Payer: Nomi Health Commercial |
$443.71
|
| Rate for Payer: PACE SWMI |
$369.76
|
| Rate for Payer: PHP Commercial |
$517.66
|
| Rate for Payer: PHP Medicare Advantage |
$369.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$541.37
|
| Rate for Payer: Priority Health Medicare |
$369.76
|
| Rate for Payer: Priority Health Narrow Network |
$541.37
|
| Rate for Payer: Priority Health SBD |
$541.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$369.76
|
| Rate for Payer: UHC Medicare Advantage |
$369.76
|
| Rate for Payer: UHCCP Medicaid |
$254.54
|
| Rate for Payer: UMR Bronson Commercial |
$434.24
|
|
|
PR BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 15823
|
| Min. Negotiated Rate |
$46.61 |
| Max. Negotiated Rate |
$905.03 |
| Rate for Payer: Aetna Commercial |
$683.83
|
| Rate for Payer: Aetna Medicare |
$530.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.86
|
| Rate for Payer: BCBS Complete |
$368.57
|
| Rate for Payer: BCBS MAPPO |
$510.32
|
| Rate for Payer: BCBS Trust/PPO |
$46.61
|
| Rate for Payer: BCN Commercial |
$905.03
|
| Rate for Payer: BCN Medicare Advantage |
$510.32
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$683.83
|
| Rate for Payer: Cofinity Commercial |
$734.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.84
|
| Rate for Payer: Meridian Medicaid |
$368.57
|
| Rate for Payer: Nomi Health Commercial |
$612.38
|
| Rate for Payer: PACE SWMI |
$510.32
|
| Rate for Payer: PHP Commercial |
$714.45
|
| Rate for Payer: PHP Medicare Advantage |
$510.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$351.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.91
|
| Rate for Payer: Priority Health Medicare |
$510.32
|
| Rate for Payer: Priority Health Narrow Network |
$745.91
|
| Rate for Payer: Priority Health SBD |
$745.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.32
|
| Rate for Payer: UHC Medicare Advantage |
$510.32
|
| Rate for Payer: UHCCP Medicaid |
$351.02
|
| Rate for Payer: UMR Bronson Commercial |
$422.28
|
|
|
PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 67700
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$498.19 |
| Rate for Payer: Aetna Commercial |
$144.57
|
| Rate for Payer: Aetna Medicare |
$112.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.36
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS MAPPO |
$107.89
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: BCN Commercial |
$416.84
|
| Rate for Payer: BCN Medicare Advantage |
$107.89
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$144.57
|
| Rate for Payer: Cofinity Commercial |
$155.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.28
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Nomi Health Commercial |
$129.47
|
| Rate for Payer: PACE SWMI |
$107.89
|
| Rate for Payer: PHP Commercial |
$151.05
|
| Rate for Payer: PHP Medicare Advantage |
$107.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.97
|
| Rate for Payer: Priority Health Medicare |
$107.89
|
| Rate for Payer: Priority Health Narrow Network |
$202.97
|
| Rate for Payer: Priority Health SBD |
$202.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.89
|
| Rate for Payer: UHC Medicare Advantage |
$107.89
|
| Rate for Payer: UHCCP Medicaid |
$74.34
|
| Rate for Payer: UMR Bronson Commercial |
$203.78
|
|
|
PR BLUE TIDAL
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00072
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
|
PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE
|
Professional
|
Both
|
$1,253.00
|
|
|
Service Code
|
HCPCS 20902
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$814.45 |
| Rate for Payer: Aetna Commercial |
$351.95
|
| Rate for Payer: Aetna Medicare |
$273.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.22
|
| Rate for Payer: BCBS Complete |
$184.06
|
| Rate for Payer: BCBS MAPPO |
$262.65
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$400.72
|
| Rate for Payer: BCN Medicare Advantage |
$262.65
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cash Price |
$1,002.40
|
| Rate for Payer: Cofinity Commercial |
$378.22
|
| Rate for Payer: Cofinity Commercial |
$351.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.78
|
| Rate for Payer: Meridian Medicaid |
$184.06
|
| Rate for Payer: Nomi Health Commercial |
$315.18
|
| Rate for Payer: PACE SWMI |
$262.65
|
| Rate for Payer: PHP Commercial |
$367.71
|
| Rate for Payer: PHP Medicare Advantage |
$262.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$814.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$418.28
|
| Rate for Payer: Priority Health Medicare |
$262.65
|
| Rate for Payer: Priority Health Narrow Network |
$418.28
|
| Rate for Payer: Priority Health SBD |
$418.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.65
|
| Rate for Payer: UHC Medicare Advantage |
$262.65
|
| Rate for Payer: UHCCP Medicaid |
$175.30
|
| Rate for Payer: UMR Bronson Commercial |
$576.38
|
|
|
PR BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$909.00
|
|
|
Service Code
|
HCPCS 20900
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$590.85 |
| Rate for Payer: Aetna Commercial |
$231.27
|
| Rate for Payer: Aetna Medicare |
$179.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.53
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: BCBS MAPPO |
$172.59
|
| Rate for Payer: BCBS Trust/PPO |
$580.95
|
| Rate for Payer: BCN Commercial |
$574.19
|
| Rate for Payer: BCN Medicare Advantage |
$172.59
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cash Price |
$727.20
|
| Rate for Payer: Cofinity Commercial |
$231.27
|
| Rate for Payer: Cofinity Commercial |
$248.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.22
|
| Rate for Payer: Meridian Medicaid |
$121.22
|
| Rate for Payer: Nomi Health Commercial |
$207.11
|
| Rate for Payer: PACE SWMI |
$172.59
|
| Rate for Payer: PHP Commercial |
$241.63
|
| Rate for Payer: PHP Medicare Advantage |
$172.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$274.28
|
| Rate for Payer: Priority Health Medicare |
$172.59
|
| Rate for Payer: Priority Health Narrow Network |
$274.28
|
| Rate for Payer: Priority Health SBD |
$274.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.59
|
| Rate for Payer: UHC Medicare Advantage |
$172.59
|
| Rate for Payer: UHCCP Medicaid |
$115.45
|
| Rate for Payer: UMR Bronson Commercial |
$418.14
|
|
|
PR BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR
|
Professional
|
Both
|
$4,588.00
|
|
|
Service Code
|
HCPCS 20962
|
| Min. Negotiated Rate |
$1,721.25 |
| Max. Negotiated Rate |
$4,077.50 |
| Rate for Payer: Aetna Commercial |
$3,433.25
|
| Rate for Payer: Aetna Medicare |
$2,664.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,433.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,689.47
|
| Rate for Payer: BCBS Complete |
$1,807.31
|
| Rate for Payer: BCBS MAPPO |
$2,562.13
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$3,886.45
|
| Rate for Payer: BCN Medicare Advantage |
$2,562.13
|
| Rate for Payer: Cash Price |
$3,670.40
|
| Rate for Payer: Cash Price |
$3,670.40
|
| Rate for Payer: Cofinity Commercial |
$3,433.25
|
| Rate for Payer: Cofinity Commercial |
$3,689.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,562.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,690.24
|
| Rate for Payer: Meridian Medicaid |
$1,807.31
|
| Rate for Payer: Nomi Health Commercial |
$3,074.56
|
| Rate for Payer: PACE SWMI |
$2,562.13
|
| Rate for Payer: PHP Commercial |
$3,586.98
|
| Rate for Payer: PHP Medicare Advantage |
$2,562.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,721.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,982.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,077.50
|
| Rate for Payer: Priority Health Medicare |
$2,562.13
|
| Rate for Payer: Priority Health Narrow Network |
$4,077.50
|
| Rate for Payer: Priority Health SBD |
$4,077.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,562.13
|
| Rate for Payer: UHC Medicare Advantage |
$2,562.13
|
| Rate for Payer: UHCCP Medicaid |
$1,721.25
|
| Rate for Payer: UMR Bronson Commercial |
$2,110.48
|
|
