|
PR CUSTOM EAR PLUGS
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
|
PR CUTANANEOUS APPENDICO-VESICOSTOMY
|
Professional
|
Both
|
$2,665.00
|
|
|
Service Code
|
HCPCS 50845
|
| Min. Negotiated Rate |
$719.73 |
| Max. Negotiated Rate |
$2,209.45 |
| Rate for Payer: Aetna Commercial |
$1,493.31
|
| Rate for Payer: Aetna Medicare |
$1,158.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,493.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,604.75
|
| Rate for Payer: BCBS Complete |
$755.72
|
| Rate for Payer: BCBS MAPPO |
$1,114.41
|
| Rate for Payer: BCN Commercial |
$1,874.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,114.41
|
| Rate for Payer: Cash Price |
$2,132.00
|
| Rate for Payer: Cash Price |
$2,132.00
|
| Rate for Payer: Cofinity Commercial |
$1,604.75
|
| Rate for Payer: Cofinity Commercial |
$1,493.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,114.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,170.13
|
| Rate for Payer: Meridian Medicaid |
$755.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,225.85
|
| Rate for Payer: Nomi Health Commercial |
$1,337.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,998.75
|
| Rate for Payer: PACE SWMI |
$1,114.41
|
| Rate for Payer: PHP Commercial |
$1,560.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,114.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$719.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,041.83
|
| Rate for Payer: Priority Health Medicare |
$1,114.41
|
| Rate for Payer: Priority Health SBD |
$2,041.83
|
| Rate for Payer: Priority Health Tiered Network |
$2,041.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1,114.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,209.45
|
| Rate for Payer: UHC Core |
$2,209.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,114.41
|
| Rate for Payer: UHC Exchange |
$2,209.45
|
| Rate for Payer: UHC Medicaid |
$719.73
|
| Rate for Payer: UHCCP Medicaid |
$719.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,225.90
|
|
|
PR CUTANEOUS VESICOSTOMY
|
Professional
|
Both
|
$1,504.00
|
|
|
Service Code
|
HCPCS 51980
|
| Min. Negotiated Rate |
$412.58 |
| Max. Negotiated Rate |
$1,257.71 |
| Rate for Payer: Aetna Commercial |
$854.44
|
| Rate for Payer: Aetna Medicare |
$663.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.20
|
| Rate for Payer: BCBS Complete |
$433.21
|
| Rate for Payer: BCBS MAPPO |
$637.64
|
| Rate for Payer: BCN Commercial |
$1,069.66
|
| Rate for Payer: BCN Medicare Advantage |
$637.64
|
| Rate for Payer: Cash Price |
$1,203.20
|
| Rate for Payer: Cash Price |
$1,203.20
|
| Rate for Payer: Cofinity Commercial |
$854.44
|
| Rate for Payer: Cofinity Commercial |
$918.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.52
|
| Rate for Payer: Meridian Medicaid |
$433.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$701.40
|
| Rate for Payer: Nomi Health Commercial |
$765.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,128.00
|
| Rate for Payer: PACE SWMI |
$637.64
|
| Rate for Payer: PHP Commercial |
$892.70
|
| Rate for Payer: PHP Medicare Advantage |
$637.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$412.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,165.21
|
| Rate for Payer: Priority Health Medicare |
$637.64
|
| Rate for Payer: Priority Health SBD |
$1,165.21
|
| Rate for Payer: Priority Health Tiered Network |
$1,165.21
|
| Rate for Payer: Railroad Medicare Medicare |
$637.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,257.71
|
| Rate for Payer: UHC Core |
$1,257.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$637.64
|
| Rate for Payer: UHC Exchange |
$1,257.71
|
| Rate for Payer: UHC Medicaid |
$412.58
|
| Rate for Payer: UHCCP Medicaid |
$412.58
|
| Rate for Payer: UMR Bronson Commercial |
$691.84
|
|
|
PR CV STRESS TST XERS&/RX CONT ECG W/SI&R
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 93015
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$349.50 |
| Rate for Payer: Aetna Commercial |
$93.13
|
| Rate for Payer: Aetna Medicare |
$72.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.13
|
| Rate for Payer: BCBS MAPPO |
$69.50
|
| Rate for Payer: BCN Commercial |
$109.06
|
| Rate for Payer: BCN Medicare Advantage |
$69.50
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$100.08
|
| Rate for Payer: Cofinity Commercial |
$93.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.45
|
| Rate for Payer: Nomi Health Commercial |
$83.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.50
|
| Rate for Payer: PACE SWMI |
$69.50
|
| Rate for Payer: PHP Commercial |
$97.30
|
| Rate for Payer: PHP Medicare Advantage |
$69.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$103.66
|
| Rate for Payer: Priority Health Medicare |
$69.50
|
| Rate for Payer: Priority Health SBD |
$103.66
|
| Rate for Payer: Priority Health Tiered Network |
$103.66
|
| Rate for Payer: Railroad Medicare Medicare |
$69.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.24
|
| Rate for Payer: UHC Core |
$110.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$69.50
|
| Rate for Payer: UHC Exchange |
$110.24
|
| Rate for Payer: UMR Bronson Commercial |
$214.36
|
|
|
PR CV STRS TST XERS&/RX CONT ECG I&R ONLY
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 93018
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$131.25 |
| Rate for Payer: Aetna Commercial |
$17.98
|
| Rate for Payer: Aetna Medicare |
$13.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.32
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS MAPPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$20.92
|
| Rate for Payer: BCN Medicare Advantage |
$13.42
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$17.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.09
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.76
|
| Rate for Payer: Nomi Health Commercial |
$16.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.25
|
| Rate for Payer: PACE SWMI |
$13.42
|
| Rate for Payer: PHP Commercial |
$18.79
|
| Rate for Payer: PHP Medicare Advantage |
$13.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.89
|
| Rate for Payer: Priority Health Medicare |
$13.42
|
| Rate for Payer: Priority Health SBD |
$19.89
|
| Rate for Payer: Priority Health Tiered Network |
$19.89
|
| Rate for Payer: Railroad Medicare Medicare |
$13.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.86
|
| Rate for Payer: UHC Core |
$23.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.42
|
| Rate for Payer: UHC Exchange |
$23.86
|
| Rate for Payer: UHC Medicaid |
$8.73
|
| Rate for Payer: UHCCP Medicaid |
$8.73
|
| Rate for Payer: UMR Bronson Commercial |
$80.50
|
|
|
PR CV STRS TST XERS&/RX CONT ECG SUPVJ ONLY W/O I&R
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 93016
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: BCBS Complete |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCN Commercial |
$30.87
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$27.15
|
| Rate for Payer: Cofinity Commercial |
$29.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: Meridian Medicaid |
$13.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.29
|
| Rate for Payer: Nomi Health Commercial |
$24.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.00
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$28.36
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.34
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health SBD |
$29.34
|
| Rate for Payer: Priority Health Tiered Network |
$29.34
|
| Rate for Payer: Railroad Medicare Medicare |
$20.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.81
|
| Rate for Payer: UHC Core |
$35.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.26
|
| Rate for Payer: UHC Exchange |
$35.81
|
| Rate for Payer: UHC Medicaid |
$13.21
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
| Rate for Payer: UMR Bronson Commercial |
$53.36
|
|
|
PR CV STRS TST XERS&/RX CONT ECG TRCG ONLY W/O I&R
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 93017
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Commercial |
$48.00
|
| Rate for Payer: Aetna Medicare |
$37.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.58
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS MAPPO |
$35.82
|
| Rate for Payer: BCN Commercial |
$57.27
|
| Rate for Payer: BCN Medicare Advantage |
$35.82
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$51.58
|
| Rate for Payer: Cofinity Commercial |
$48.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.40
|
| Rate for Payer: Nomi Health Commercial |
$42.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.00
|
| Rate for Payer: PACE SWMI |
$35.82
|
| Rate for Payer: PHP Commercial |
$50.15
|
| Rate for Payer: PHP Medicare Advantage |
$35.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$54.43
|
| Rate for Payer: Priority Health Medicare |
$35.82
|
| Rate for Payer: Priority Health SBD |
$54.43
|
| Rate for Payer: Priority Health Tiered Network |
$54.43
|
| Rate for Payer: Railroad Medicare Medicare |
$35.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.55
|
| Rate for Payer: UHC Core |
$50.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.82
|
| Rate for Payer: UHC Exchange |
$50.55
|
| Rate for Payer: UMR Bronson Commercial |
$53.36
|
|
|
PR CYSTECTOMY COMPLETE SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,895.00
|
|
|
Service Code
|
HCPCS 51570
|
| Min. Negotiated Rate |
$831.77 |
| Max. Negotiated Rate |
$2,612.07 |
| Rate for Payer: Aetna Commercial |
$1,733.30
|
| Rate for Payer: Aetna Medicare |
$1,345.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,733.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,862.65
|
| Rate for Payer: BCBS Complete |
$873.36
|
| Rate for Payer: BCBS MAPPO |
$1,293.51
|
| Rate for Payer: BCN Commercial |
$2,187.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,293.51
|
| Rate for Payer: Cash Price |
$2,316.00
|
| Rate for Payer: Cash Price |
$2,316.00
|
| Rate for Payer: Cofinity Commercial |
$1,862.65
|
| Rate for Payer: Cofinity Commercial |
$1,733.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,293.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,358.19
|
| Rate for Payer: Meridian Medicaid |
$873.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,422.86
|
| Rate for Payer: Nomi Health Commercial |
$1,552.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,171.25
|
| Rate for Payer: PACE SWMI |
$1,293.51
|
| Rate for Payer: PHP Commercial |
$1,810.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,293.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$831.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,383.04
|
| Rate for Payer: Priority Health Medicare |
$1,293.51
|
| Rate for Payer: Priority Health SBD |
$2,383.04
|
| Rate for Payer: Priority Health Tiered Network |
$2,383.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,293.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,612.07
|
| Rate for Payer: UHC Core |
$2,612.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,293.51
|
| Rate for Payer: UHC Exchange |
$2,612.07
|
| Rate for Payer: UHC Medicaid |
$831.77
|
| Rate for Payer: UHCCP Medicaid |
$831.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,331.70
|
|
|
PR CYSTECTOMY PARTIAL COMPLICATED
|
Professional
|
Both
|
$7,985.00
|
|
|
Service Code
|
HCPCS 51555
|
| Min. Negotiated Rate |
$720.15 |
| Max. Negotiated Rate |
$5,988.75 |
| Rate for Payer: Aetna Commercial |
$1,499.66
|
| Rate for Payer: Aetna Medicare |
$1,163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,499.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,611.58
|
| Rate for Payer: BCBS Complete |
$756.16
|
| Rate for Payer: BCBS MAPPO |
$1,119.15
|
| Rate for Payer: BCN Commercial |
$1,878.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,119.15
|
| Rate for Payer: Cash Price |
$6,388.00
|
| Rate for Payer: Cash Price |
$6,388.00
|
| Rate for Payer: Cofinity Commercial |
$1,499.66
|
| Rate for Payer: Cofinity Commercial |
$1,611.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,119.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,175.11
|
| Rate for Payer: Meridian Medicaid |
$756.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,231.07
|
| Rate for Payer: Nomi Health Commercial |
$1,342.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,988.75
|
| Rate for Payer: PACE SWMI |
$1,119.15
|
| Rate for Payer: PHP Commercial |
$1,566.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,119.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,046.71
|
| Rate for Payer: Priority Health Medicare |
$1,119.15
|
| Rate for Payer: Priority Health SBD |
$2,046.71
|
| Rate for Payer: Priority Health Tiered Network |
$2,046.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1,119.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,240.74
|
| Rate for Payer: UHC Core |
$2,240.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,119.15
|
| Rate for Payer: UHC Exchange |
$2,240.74
|
| Rate for Payer: UHC Medicaid |
$720.15
|
| Rate for Payer: UHCCP Medicaid |
$720.15
|
| Rate for Payer: UMR Bronson Commercial |
$3,673.10
|
|
|
PR CYSTECTOMY PARTIAL SIMPLE
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 51550
|
| Min. Negotiated Rate |
$555.72 |
| Max. Negotiated Rate |
$1,702.22 |
| Rate for Payer: Aetna Commercial |
$1,155.62
|
| Rate for Payer: Aetna Medicare |
$896.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,241.86
|
| Rate for Payer: BCBS Complete |
$583.51
|
| Rate for Payer: BCBS MAPPO |
$862.40
|
| Rate for Payer: BCN Commercial |
$1,438.67
|
| Rate for Payer: BCN Medicare Advantage |
$862.40
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cofinity Commercial |
$1,155.62
|
| Rate for Payer: Cofinity Commercial |
$1,241.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$862.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$905.52
|
| Rate for Payer: Meridian Medicaid |
$583.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$948.64
|
| Rate for Payer: Nomi Health Commercial |
$1,034.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,193.25
|
| Rate for Payer: PACE SWMI |
$862.40
|
| Rate for Payer: PHP Commercial |
$1,207.36
|
| Rate for Payer: PHP Medicare Advantage |
$862.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$555.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,567.18
|
| Rate for Payer: Priority Health Medicare |
$862.40
|
| Rate for Payer: Priority Health SBD |
$1,567.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,567.18
|
| Rate for Payer: Railroad Medicare Medicare |
$862.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,702.22
|
| Rate for Payer: UHC Core |
$1,702.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$862.40
|
| Rate for Payer: UHC Exchange |
$1,702.22
|
| Rate for Payer: UHC Medicaid |
$555.72
|
| Rate for Payer: UHCCP Medicaid |
$555.72
|
| Rate for Payer: UMR Bronson Commercial |
$731.86
|
|
|
PR CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY
|
Professional
|
Both
|
$3,910.00
|
|
|
Service Code
|
HCPCS 51575
|
| Min. Negotiated Rate |
$1,026.23 |
| Max. Negotiated Rate |
$3,229.13 |
| Rate for Payer: Aetna Commercial |
$2,139.95
|
| Rate for Payer: Aetna Medicare |
$1,660.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,139.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,299.65
|
| Rate for Payer: BCBS Complete |
$1,077.54
|
| Rate for Payer: BCBS MAPPO |
$1,596.98
|
| Rate for Payer: BCN Commercial |
$2,695.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,596.98
|
| Rate for Payer: Cash Price |
$3,128.00
|
| Rate for Payer: Cash Price |
$3,128.00
|
| Rate for Payer: Cofinity Commercial |
$2,139.95
|
| Rate for Payer: Cofinity Commercial |
$2,299.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,596.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,676.83
|
| Rate for Payer: Meridian Medicaid |
$1,077.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,756.68
|
| Rate for Payer: Nomi Health Commercial |
$1,916.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,932.50
|
| Rate for Payer: PACE SWMI |
$1,596.98
|
| Rate for Payer: PHP Commercial |
$2,235.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,596.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,936.36
|
| Rate for Payer: Priority Health Medicare |
$1,596.98
|
| Rate for Payer: Priority Health SBD |
$2,936.36
|
| Rate for Payer: Priority Health Tiered Network |
$2,936.36
|
| Rate for Payer: Railroad Medicare Medicare |
$1,596.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,229.13
|
| Rate for Payer: UHC Core |
$3,229.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,596.98
|
| Rate for Payer: UHC Exchange |
$3,229.13
|
| Rate for Payer: UHC Medicaid |
$1,026.23
|
| Rate for Payer: UHCCP Medicaid |
$1,026.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,798.60
|
|
|
PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
HCPCS 52281
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$597.00 |
| Rate for Payer: Aetna Commercial |
$181.05
|
| Rate for Payer: Aetna Medicare |
$140.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.56
|
| Rate for Payer: BCBS Complete |
$91.48
|
| Rate for Payer: BCBS MAPPO |
$135.11
|
| Rate for Payer: BCN Commercial |
$226.08
|
| Rate for Payer: BCN Medicare Advantage |
$135.11
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cash Price |
$636.80
|
| Rate for Payer: Cofinity Commercial |
$181.05
|
| Rate for Payer: Cofinity Commercial |
$194.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.87
|
| Rate for Payer: Meridian Medicaid |
$91.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$148.62
|
| Rate for Payer: Nomi Health Commercial |
$162.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$597.00
|
| Rate for Payer: PACE SWMI |
$135.11
|
| Rate for Payer: PHP Commercial |
$189.15
|
| Rate for Payer: PHP Medicare Advantage |
$135.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$246.27
|
| Rate for Payer: Priority Health Medicare |
$135.11
|
| Rate for Payer: Priority Health SBD |
$246.27
|
| Rate for Payer: Priority Health Tiered Network |
$246.27
|
| Rate for Payer: Railroad Medicare Medicare |
$135.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.46
|
| Rate for Payer: UHC Core |
$267.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$135.11
|
| Rate for Payer: UHC Exchange |
$267.46
|
| Rate for Payer: UHC Medicaid |
$87.12
|
| Rate for Payer: UHCCP Medicaid |
$87.12
|
| Rate for Payer: UMR Bronson Commercial |
$366.16
|
|
|
PR CYSTO FRAGMENTATION URETERAL STONE
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS 52325
|
| Min. Negotiated Rate |
$179.56 |
| Max. Negotiated Rate |
$566.18 |
| Rate for Payer: Aetna Commercial |
$375.39
|
| Rate for Payer: Aetna Medicare |
$291.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.40
|
| Rate for Payer: BCBS Complete |
$188.54
|
| Rate for Payer: BCBS MAPPO |
$280.14
|
| Rate for Payer: BCN Commercial |
$472.08
|
| Rate for Payer: BCN Medicare Advantage |
$280.14
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cofinity Commercial |
$375.39
|
| Rate for Payer: Cofinity Commercial |
$403.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.15
|
| Rate for Payer: Meridian Medicaid |
$188.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$308.15
|
| Rate for Payer: Nomi Health Commercial |
$336.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.75
|
| Rate for Payer: PACE SWMI |
$280.14
|
| Rate for Payer: PHP Commercial |
$392.20
|
| Rate for Payer: PHP Medicare Advantage |
$280.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$514.25
|
| Rate for Payer: Priority Health Medicare |
$280.14
|
| Rate for Payer: Priority Health SBD |
$514.25
|
| Rate for Payer: Priority Health Tiered Network |
$514.25
|
| Rate for Payer: Railroad Medicare Medicare |
$280.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.18
|
| Rate for Payer: UHC Core |
$566.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$280.14
|
| Rate for Payer: UHC Exchange |
$566.18
|
| Rate for Payer: UHC Medicaid |
$179.56
|
| Rate for Payer: UHCCP Medicaid |
$179.56
|
| Rate for Payer: UMR Bronson Commercial |
$315.10
|
|
|
PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 52305
|
| Min. Negotiated Rate |
$156.13 |
| Max. Negotiated Rate |
$493.52 |
| Rate for Payer: Aetna Commercial |
$326.04
|
| Rate for Payer: Aetna Medicare |
$253.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.37
|
| Rate for Payer: BCBS Complete |
$163.94
|
| Rate for Payer: BCBS MAPPO |
$243.31
|
| Rate for Payer: BCN Commercial |
$410.33
|
| Rate for Payer: BCN Medicare Advantage |
$243.31
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$326.04
|
| Rate for Payer: Cofinity Commercial |
$350.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.48
|
| Rate for Payer: Meridian Medicaid |
$163.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$267.64
|
| Rate for Payer: Nomi Health Commercial |
$291.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$422.25
|
| Rate for Payer: PACE SWMI |
$243.31
|
| Rate for Payer: PHP Commercial |
$340.63
|
| Rate for Payer: PHP Medicare Advantage |
$243.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$447.00
|
| Rate for Payer: Priority Health Medicare |
$243.31
|
| Rate for Payer: Priority Health SBD |
$447.00
|
| Rate for Payer: Priority Health Tiered Network |
$447.00
|
| Rate for Payer: Railroad Medicare Medicare |
$243.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$493.52
|
| Rate for Payer: UHC Core |
$493.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$243.31
|
| Rate for Payer: UHC Exchange |
$493.52
|
| Rate for Payer: UHC Medicaid |
$156.13
|
| Rate for Payer: UHCCP Medicaid |
$156.13
|
| Rate for Payer: UMR Bronson Commercial |
$258.98
|
|
|
PR CYSTO INSJ PERM ADJTBL TRANSPROSTATIC 1 IMPLANT
|
Professional
|
Both
|
$2,315.00
|
|
|
Service Code
|
HCPCS 52441
|
| Min. Negotiated Rate |
$117.36 |
| Max. Negotiated Rate |
$1,736.25 |
| Rate for Payer: Aetna Commercial |
$244.98
|
| Rate for Payer: Aetna Medicare |
$190.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.26
|
| Rate for Payer: BCBS Complete |
$123.23
|
| Rate for Payer: BCBS MAPPO |
$182.82
|
| Rate for Payer: BCN Commercial |
$310.74
|
| Rate for Payer: BCN Medicare Advantage |
$182.82
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Cash Price |
$1,852.00
|
| Rate for Payer: Cofinity Commercial |
$244.98
|
| Rate for Payer: Cofinity Commercial |
$263.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.96
|
| Rate for Payer: Meridian Medicaid |
$123.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$201.10
|
| Rate for Payer: Nomi Health Commercial |
$219.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,736.25
|
| Rate for Payer: PACE SWMI |
$182.82
|
| Rate for Payer: PHP Commercial |
$255.95
|
| Rate for Payer: PHP Medicare Advantage |
$182.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$338.49
|
| Rate for Payer: Priority Health Medicare |
$182.82
|
| Rate for Payer: Priority Health SBD |
$338.49
|
| Rate for Payer: Priority Health Tiered Network |
$338.49
|
| Rate for Payer: Railroad Medicare Medicare |
$182.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.60
|
| Rate for Payer: UHC Core |
$372.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$182.82
|
| Rate for Payer: UHC Exchange |
$372.60
|
| Rate for Payer: UHC Medicaid |
$117.36
|
| Rate for Payer: UHCCP Medicaid |
$117.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,064.90
|
|
|
PR CYSTO INSJ PERM ADJTBL TRANSPROSTATIC IMPLANT EA
|
Professional
|
Both
|
$1,772.00
|
|
|
Service Code
|
HCPCS 52442
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$1,329.00 |
| Rate for Payer: Aetna Commercial |
$59.01
|
| Rate for Payer: Aetna Medicare |
$45.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.42
|
| Rate for Payer: BCBS Complete |
$29.53
|
| Rate for Payer: BCBS MAPPO |
$44.04
|
| Rate for Payer: BCN Commercial |
$75.19
|
| Rate for Payer: BCN Medicare Advantage |
$44.04
|
| Rate for Payer: Cash Price |
$1,417.60
|
| Rate for Payer: Cash Price |
$1,417.60
|
| Rate for Payer: Cofinity Commercial |
$59.01
|
| Rate for Payer: Cofinity Commercial |
$63.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.24
|
| Rate for Payer: Meridian Medicaid |
$29.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.44
|
| Rate for Payer: Nomi Health Commercial |
$52.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,329.00
|
| Rate for Payer: PACE SWMI |
$44.04
|
| Rate for Payer: PHP Commercial |
$61.66
|
| Rate for Payer: PHP Medicare Advantage |
$44.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81.91
|
| Rate for Payer: Priority Health Medicare |
$44.04
|
| Rate for Payer: Priority Health SBD |
$81.91
|
| Rate for Payer: Priority Health Tiered Network |
$81.91
|
| Rate for Payer: Railroad Medicare Medicare |
$44.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.85
|
| Rate for Payer: UHC Core |
$89.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.04
|
| Rate for Payer: UHC Exchange |
$89.85
|
| Rate for Payer: UHC Medicaid |
$28.12
|
| Rate for Payer: UHCCP Medicaid |
$28.12
|
| Rate for Payer: UMR Bronson Commercial |
$815.12
|
|
|
PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR
|
Professional
|
Both
|
$972.00
|
|
|
Service Code
|
HCPCS 52334
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Aetna Commercial |
$216.79
|
| Rate for Payer: Aetna Medicare |
$168.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.96
|
| Rate for Payer: BCBS Complete |
$109.37
|
| Rate for Payer: BCBS MAPPO |
$161.78
|
| Rate for Payer: BCN Commercial |
$271.90
|
| Rate for Payer: BCN Medicare Advantage |
$161.78
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cofinity Commercial |
$216.79
|
| Rate for Payer: Cofinity Commercial |
$232.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.87
|
| Rate for Payer: Meridian Medicaid |
$109.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$177.96
|
| Rate for Payer: Nomi Health Commercial |
$194.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$729.00
|
| Rate for Payer: PACE SWMI |
$161.78
|
| Rate for Payer: PHP Commercial |
$226.49
|
| Rate for Payer: PHP Medicare Advantage |
$161.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$296.18
|
| Rate for Payer: Priority Health Medicare |
$161.78
|
| Rate for Payer: Priority Health SBD |
$296.18
|
| Rate for Payer: Priority Health Tiered Network |
$296.18
|
| Rate for Payer: Railroad Medicare Medicare |
$161.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.86
|
| Rate for Payer: UHC Core |
$322.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$161.78
|
| Rate for Payer: UHC Exchange |
$322.86
|
| Rate for Payer: UHC Medicaid |
$104.16
|
| Rate for Payer: UHCCP Medicaid |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$447.12
|
|
|
PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Professional
|
Both
|
$1,069.00
|
|
|
Service Code
|
HCPCS 51050
|
| Min. Negotiated Rate |
$276.69 |
| Max. Negotiated Rate |
$828.78 |
| Rate for Payer: Aetna Commercial |
$570.84
|
| Rate for Payer: Aetna Medicare |
$443.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.44
|
| Rate for Payer: BCBS Complete |
$290.52
|
| Rate for Payer: BCBS MAPPO |
$426.00
|
| Rate for Payer: BCN Commercial |
$712.11
|
| Rate for Payer: BCN Medicare Advantage |
$426.00
|
| Rate for Payer: Cash Price |
$855.20
|
| Rate for Payer: Cash Price |
$855.20
|
| Rate for Payer: Cofinity Commercial |
$570.84
|
| Rate for Payer: Cofinity Commercial |
$613.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$426.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$447.30
|
| Rate for Payer: Meridian Medicaid |
$290.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$468.60
|
| Rate for Payer: Nomi Health Commercial |
$511.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$801.75
|
| Rate for Payer: PACE SWMI |
$426.00
|
| Rate for Payer: PHP Commercial |
$596.40
|
| Rate for Payer: PHP Medicare Advantage |
$426.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$775.71
|
| Rate for Payer: Priority Health Medicare |
$426.00
|
| Rate for Payer: Priority Health SBD |
$775.71
|
| Rate for Payer: Priority Health Tiered Network |
$775.71
|
| Rate for Payer: Railroad Medicare Medicare |
$426.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$828.78
|
| Rate for Payer: UHC Core |
$828.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$426.00
|
| Rate for Payer: UHC Exchange |
$828.78
|
| Rate for Payer: UHC Medicaid |
$276.69
|
| Rate for Payer: UHCCP Medicaid |
$276.69
|
| Rate for Payer: UMR Bronson Commercial |
$491.74
|
|
|
PR CYSTO MANJ W/O RMVL URETERAL STONE
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
HCPCS 52330
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$811.50 |
| Rate for Payer: Aetna Commercial |
$307.85
|
| Rate for Payer: Aetna Medicare |
$238.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.83
|
| Rate for Payer: BCBS Complete |
$154.77
|
| Rate for Payer: BCBS MAPPO |
$229.74
|
| Rate for Payer: BCN Commercial |
$388.92
|
| Rate for Payer: BCN Medicare Advantage |
$229.74
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cash Price |
$865.60
|
| Rate for Payer: Cofinity Commercial |
$307.85
|
| Rate for Payer: Cofinity Commercial |
$330.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.23
|
| Rate for Payer: Meridian Medicaid |
$154.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$252.71
|
| Rate for Payer: Nomi Health Commercial |
$275.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$811.50
|
| Rate for Payer: PACE SWMI |
$229.74
|
| Rate for Payer: PHP Commercial |
$321.64
|
| Rate for Payer: PHP Medicare Advantage |
$229.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$147.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$423.67
|
| Rate for Payer: Priority Health Medicare |
$229.74
|
| Rate for Payer: Priority Health SBD |
$423.67
|
| Rate for Payer: Priority Health Tiered Network |
$423.67
|
| Rate for Payer: Railroad Medicare Medicare |
$229.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.55
|
| Rate for Payer: UHC Core |
$466.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$229.74
|
| Rate for Payer: UHC Exchange |
$466.55
|
| Rate for Payer: UHC Medicaid |
$147.40
|
| Rate for Payer: UHCCP Medicaid |
$147.40
|
| Rate for Payer: UMR Bronson Commercial |
$497.72
|
|
|
PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 52354
|
| Min. Negotiated Rate |
$233.66 |
| Max. Negotiated Rate |
$738.72 |
| Rate for Payer: Aetna Commercial |
$488.51
|
| Rate for Payer: Aetna Medicare |
$379.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.97
|
| Rate for Payer: BCBS Complete |
$245.34
|
| Rate for Payer: BCBS MAPPO |
$364.56
|
| Rate for Payer: BCN Commercial |
$616.01
|
| Rate for Payer: BCN Medicare Advantage |
$364.56
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cofinity Commercial |
$488.51
|
| Rate for Payer: Cofinity Commercial |
$524.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$364.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$382.79
|
| Rate for Payer: Meridian Medicaid |
$245.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$401.02
|
| Rate for Payer: Nomi Health Commercial |
$437.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$588.75
|
| Rate for Payer: PACE SWMI |
$364.56
|
| Rate for Payer: PHP Commercial |
$510.38
|
| Rate for Payer: PHP Medicare Advantage |
$364.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$233.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$671.03
|
| Rate for Payer: Priority Health Medicare |
$364.56
|
| Rate for Payer: Priority Health SBD |
$671.03
|
| Rate for Payer: Priority Health Tiered Network |
$671.03
|
| Rate for Payer: Railroad Medicare Medicare |
$364.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$738.72
|
| Rate for Payer: UHC Core |
$738.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$364.56
|
| Rate for Payer: UHC Exchange |
$738.72
|
| Rate for Payer: UHC Medicaid |
$233.66
|
| Rate for Payer: UHCCP Medicaid |
$233.66
|
| Rate for Payer: UMR Bronson Commercial |
$361.10
|
|
|
PR CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
HCPCS 52355
|
| Min. Negotiated Rate |
$261.35 |
| Max. Negotiated Rate |
$1,122.00 |
| Rate for Payer: Aetna Commercial |
$546.51
|
| Rate for Payer: Aetna Medicare |
$424.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.29
|
| Rate for Payer: BCBS Complete |
$274.42
|
| Rate for Payer: BCBS MAPPO |
$407.84
|
| Rate for Payer: BCN Commercial |
$690.20
|
| Rate for Payer: BCN Medicare Advantage |
$407.84
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Cofinity Commercial |
$546.51
|
| Rate for Payer: Cofinity Commercial |
$587.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.23
|
| Rate for Payer: Meridian Medicaid |
$274.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$448.62
|
| Rate for Payer: Nomi Health Commercial |
$489.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,122.00
|
| Rate for Payer: PACE SWMI |
$407.84
|
| Rate for Payer: PHP Commercial |
$570.98
|
| Rate for Payer: PHP Medicare Advantage |
$407.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$751.85
|
| Rate for Payer: Priority Health Medicare |
$407.84
|
| Rate for Payer: Priority Health SBD |
$751.85
|
| Rate for Payer: Priority Health Tiered Network |
$751.85
|
| Rate for Payer: Railroad Medicare Medicare |
$407.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$828.01
|
| Rate for Payer: UHC Core |
$828.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$407.84
|
| Rate for Payer: UHC Exchange |
$828.01
|
| Rate for Payer: UHC Medicaid |
$261.35
|
| Rate for Payer: UHCCP Medicaid |
$261.35
|
| Rate for Payer: UMR Bronson Commercial |
$688.16
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED
|
Professional
|
Both
|
$3,293.00
|
|
|
Service Code
|
HCPCS 51865
|
| Min. Negotiated Rate |
$516.53 |
| Max. Negotiated Rate |
$2,469.75 |
| Rate for Payer: Aetna Commercial |
$1,072.31
|
| Rate for Payer: Aetna Medicare |
$832.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,072.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.33
|
| Rate for Payer: BCBS Complete |
$542.36
|
| Rate for Payer: BCBS MAPPO |
$800.23
|
| Rate for Payer: BCN Commercial |
$1,337.08
|
| Rate for Payer: BCN Medicare Advantage |
$800.23
|
| Rate for Payer: Cash Price |
$2,634.40
|
| Rate for Payer: Cash Price |
$2,634.40
|
| Rate for Payer: Cofinity Commercial |
$1,072.31
|
| Rate for Payer: Cofinity Commercial |
$1,152.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$840.24
|
| Rate for Payer: Meridian Medicaid |
$542.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$880.25
|
| Rate for Payer: Nomi Health Commercial |
$960.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,469.75
|
| Rate for Payer: PACE SWMI |
$800.23
|
| Rate for Payer: PHP Commercial |
$1,120.32
|
| Rate for Payer: PHP Medicare Advantage |
$800.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,456.51
|
| Rate for Payer: Priority Health Medicare |
$800.23
|
| Rate for Payer: Priority Health SBD |
$1,456.51
|
| Rate for Payer: Priority Health Tiered Network |
$1,456.51
|
| Rate for Payer: Railroad Medicare Medicare |
$800.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,587.72
|
| Rate for Payer: UHC Core |
$1,587.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$800.23
|
| Rate for Payer: UHC Exchange |
$1,587.72
|
| Rate for Payer: UHC Medicaid |
$516.53
|
| Rate for Payer: UHCCP Medicaid |
$516.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,514.78
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE
|
Professional
|
Both
|
$2,521.00
|
|
|
Service Code
|
HCPCS 51860
|
| Min. Negotiated Rate |
$434.95 |
| Max. Negotiated Rate |
$1,890.75 |
| Rate for Payer: Aetna Commercial |
$901.53
|
| Rate for Payer: Aetna Medicare |
$699.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$901.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.80
|
| Rate for Payer: BCBS Complete |
$456.70
|
| Rate for Payer: BCBS MAPPO |
$672.78
|
| Rate for Payer: BCN Commercial |
$1,114.98
|
| Rate for Payer: BCN Medicare Advantage |
$672.78
|
| Rate for Payer: Cash Price |
$2,016.80
|
| Rate for Payer: Cash Price |
$2,016.80
|
| Rate for Payer: Cofinity Commercial |
$901.53
|
| Rate for Payer: Cofinity Commercial |
$968.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.42
|
| Rate for Payer: Meridian Medicaid |
$456.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$740.06
|
| Rate for Payer: Nomi Health Commercial |
$807.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,890.75
|
| Rate for Payer: PACE SWMI |
$672.78
|
| Rate for Payer: PHP Commercial |
$941.89
|
| Rate for Payer: PHP Medicare Advantage |
$672.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,214.58
|
| Rate for Payer: Priority Health Medicare |
$672.78
|
| Rate for Payer: Priority Health SBD |
$1,214.58
|
| Rate for Payer: Priority Health Tiered Network |
$1,214.58
|
| Rate for Payer: Railroad Medicare Medicare |
$672.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,315.28
|
| Rate for Payer: UHC Core |
$1,315.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$672.78
|
| Rate for Payer: UHC Exchange |
$1,315.28
|
| Rate for Payer: UHC Medicaid |
$434.95
|
| Rate for Payer: UHCCP Medicaid |
$434.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,159.66
|
|
|
PR CYSTOSTOMY CYSTOTOMY W/DRAINAGE
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
HCPCS 51040
|
| Min. Negotiated Rate |
$174.02 |
| Max. Negotiated Rate |
$505.91 |
| Rate for Payer: Aetna Commercial |
$356.32
|
| Rate for Payer: Aetna Medicare |
$276.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.91
|
| Rate for Payer: BCBS Complete |
$182.72
|
| Rate for Payer: BCBS MAPPO |
$265.91
|
| Rate for Payer: BCN Commercial |
$441.21
|
| Rate for Payer: BCN Medicare Advantage |
$265.91
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$356.32
|
| Rate for Payer: Cofinity Commercial |
$382.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$279.21
|
| Rate for Payer: Meridian Medicaid |
$182.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$292.50
|
| Rate for Payer: Nomi Health Commercial |
$319.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$421.50
|
| Rate for Payer: PACE SWMI |
$265.91
|
| Rate for Payer: PHP Commercial |
$372.27
|
| Rate for Payer: PHP Medicare Advantage |
$265.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$480.62
|
| Rate for Payer: Priority Health Medicare |
$265.91
|
| Rate for Payer: Priority Health SBD |
$480.62
|
| Rate for Payer: Priority Health Tiered Network |
$480.62
|
| Rate for Payer: Railroad Medicare Medicare |
$265.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$505.91
|
| Rate for Payer: UHC Core |
$505.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$265.91
|
| Rate for Payer: UHC Exchange |
$505.91
|
| Rate for Payer: UHC Medicaid |
$174.02
|
| Rate for Payer: UHCCP Medicaid |
$174.02
|
| Rate for Payer: UMR Bronson Commercial |
$258.52
|
|
|
PR CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL
|
Professional
|
Both
|
$2,524.00
|
|
|
Service Code
|
HCPCS 51020
|
| Min. Negotiated Rate |
$277.75 |
| Max. Negotiated Rate |
$1,893.00 |
| Rate for Payer: Aetna Commercial |
$571.54
|
| Rate for Payer: Aetna Medicare |
$443.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$614.19
|
| Rate for Payer: BCBS Complete |
$291.64
|
| Rate for Payer: BCBS MAPPO |
$426.52
|
| Rate for Payer: BCN Commercial |
$708.63
|
| Rate for Payer: BCN Medicare Advantage |
$426.52
|
| Rate for Payer: Cash Price |
$2,019.20
|
| Rate for Payer: Cash Price |
$2,019.20
|
| Rate for Payer: Cofinity Commercial |
$571.54
|
| Rate for Payer: Cofinity Commercial |
$614.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$426.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$447.85
|
| Rate for Payer: Meridian Medicaid |
$291.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$469.17
|
| Rate for Payer: Nomi Health Commercial |
$511.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,893.00
|
| Rate for Payer: PACE SWMI |
$426.52
|
| Rate for Payer: PHP Commercial |
$597.13
|
| Rate for Payer: PHP Medicare Advantage |
$426.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$771.92
|
| Rate for Payer: Priority Health Medicare |
$426.52
|
| Rate for Payer: Priority Health SBD |
$771.92
|
| Rate for Payer: Priority Health Tiered Network |
$771.92
|
| Rate for Payer: Railroad Medicare Medicare |
$426.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.94
|
| Rate for Payer: UHC Core |
$821.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$426.52
|
| Rate for Payer: UHC Exchange |
$821.94
|
| Rate for Payer: UHC Medicaid |
$277.75
|
| Rate for Payer: UHCCP Medicaid |
$277.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,161.04
|
|
