|
PR CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST
|
Professional
|
Both
|
$4,911.00
|
|
|
Service Code
|
HCPCS 51590
|
| Min. Negotiated Rate |
$1,839.43 |
| Max. Negotiated Rate |
$3,192.15 |
| Rate for Payer: Aetna Commercial |
$2,464.84
|
| Rate for Payer: Aetna Medicare |
$1,913.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,648.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,464.84
|
| Rate for Payer: BCBS Complete |
$1,964.40
|
| Rate for Payer: BCBS MAPPO |
$1,839.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,839.43
|
| Rate for Payer: Cash Price |
$3,928.80
|
| Rate for Payer: Cash Price |
$3,928.80
|
| Rate for Payer: Cofinity Commercial |
$2,648.78
|
| Rate for Payer: Cofinity Commercial |
$2,464.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,839.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,931.40
|
| Rate for Payer: Nomi Health Commercial |
$2,207.32
|
| Rate for Payer: PACE SWMI |
$1,839.43
|
| Rate for Payer: PHP Commercial |
$2,575.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,839.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,192.15
|
| Rate for Payer: Priority Health Medicare |
$1,839.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,839.43
|
| Rate for Payer: UHC Medicare Advantage |
$1,839.43
|
| Rate for Payer: UMR Bronson Commercial |
$2,259.06
|
|
|
PR CSTC PRTL W/RIMPLTJ URTR IN BLDR URTRONEOCSTOST
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 51565
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,768.45 |
| Rate for Payer: Aetna Commercial |
$1,645.64
|
| Rate for Payer: Aetna Medicare |
$1,277.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,768.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,645.64
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: BCBS MAPPO |
$1,228.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,228.09
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,768.45
|
| Rate for Payer: Cofinity Commercial |
$1,645.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,228.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,289.49
|
| Rate for Payer: Nomi Health Commercial |
$1,473.71
|
| Rate for Payer: PACE SWMI |
$1,228.09
|
| Rate for Payer: PHP Commercial |
$1,719.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,228.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$1,228.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,228.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,228.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,219.92
|
|
|
PR CSTOPLASTY/CSTOURTP PLSTC ANY
|
Professional
|
Both
|
$1,135.00
|
|
|
Service Code
|
HCPCS 51800
|
| Min. Negotiated Rate |
$454.00 |
| Max. Negotiated Rate |
$1,425.82 |
| Rate for Payer: Aetna Commercial |
$1,326.80
|
| Rate for Payer: Aetna Medicare |
$1,029.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.80
|
| Rate for Payer: BCBS Complete |
$454.00
|
| Rate for Payer: BCBS MAPPO |
$990.15
|
| Rate for Payer: BCN Medicare Advantage |
$990.15
|
| Rate for Payer: Cash Price |
$908.00
|
| Rate for Payer: Cash Price |
$908.00
|
| Rate for Payer: Cofinity Commercial |
$1,425.82
|
| Rate for Payer: Cofinity Commercial |
$1,326.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$990.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,039.66
|
| Rate for Payer: Nomi Health Commercial |
$1,188.18
|
| Rate for Payer: PACE SWMI |
$990.15
|
| Rate for Payer: PHP Commercial |
$1,386.21
|
| Rate for Payer: PHP Medicare Advantage |
$990.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$737.75
|
| Rate for Payer: Priority Health Medicare |
$990.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$990.15
|
| Rate for Payer: UHC Medicare Advantage |
$990.15
|
| Rate for Payer: UMR Bronson Commercial |
$522.10
|
|
|
PR CSTOURTP W/UNI/BI URTRONEOCSTOST
|
Professional
|
Both
|
$2,417.00
|
|
|
Service Code
|
HCPCS 51820
|
| Min. Negotiated Rate |
$966.80 |
| Max. Negotiated Rate |
$1,571.05 |
| Rate for Payer: Aetna Commercial |
$1,386.98
|
| Rate for Payer: Aetna Medicare |
$1,076.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,490.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.98
|
| Rate for Payer: BCBS Complete |
$966.80
|
| Rate for Payer: BCBS MAPPO |
$1,035.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,035.06
|
| Rate for Payer: Cash Price |
$1,933.60
|
| Rate for Payer: Cash Price |
$1,933.60
|
| Rate for Payer: Cofinity Commercial |
$1,490.49
|
| Rate for Payer: Cofinity Commercial |
$1,386.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,035.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,086.81
|
| Rate for Payer: Nomi Health Commercial |
$1,242.07
|
| Rate for Payer: PACE SWMI |
$1,035.06
|
| Rate for Payer: PHP Commercial |
$1,449.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,035.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.05
|
| Rate for Payer: Priority Health Medicare |
$1,035.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,035.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,035.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,111.82
|
|
|
PR CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
HCPCS 42972
|
| Min. Negotiated Rate |
$374.80 |
| Max. Negotiated Rate |
$696.79 |
| Rate for Payer: Aetna Commercial |
$648.40
|
| Rate for Payer: Aetna Medicare |
$503.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.40
|
| Rate for Payer: BCBS Complete |
$374.80
|
| Rate for Payer: BCBS MAPPO |
$483.88
|
| Rate for Payer: BCN Medicare Advantage |
$483.88
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cofinity Commercial |
$696.79
|
| Rate for Payer: Cofinity Commercial |
$648.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$483.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$508.07
|
| Rate for Payer: Nomi Health Commercial |
$580.66
|
| Rate for Payer: PACE SWMI |
$483.88
|
| Rate for Payer: PHP Commercial |
$677.43
|
| Rate for Payer: PHP Medicare Advantage |
$483.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.05
|
| Rate for Payer: Priority Health Medicare |
$483.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$483.88
|
| Rate for Payer: UHC Medicare Advantage |
$483.88
|
| Rate for Payer: UMR Bronson Commercial |
$431.02
|
|
|
PR CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS
|
Professional
|
Both
|
$749.00
|
|
|
Service Code
|
HCPCS 42970
|
| Min. Negotiated Rate |
$299.60 |
| Max. Negotiated Rate |
$563.95 |
| Rate for Payer: Aetna Commercial |
$524.78
|
| Rate for Payer: Aetna Medicare |
$407.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.78
|
| Rate for Payer: BCBS Complete |
$299.60
|
| Rate for Payer: BCBS MAPPO |
$391.63
|
| Rate for Payer: BCN Medicare Advantage |
$391.63
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cash Price |
$599.20
|
| Rate for Payer: Cofinity Commercial |
$563.95
|
| Rate for Payer: Cofinity Commercial |
$524.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.21
|
| Rate for Payer: Nomi Health Commercial |
$469.96
|
| Rate for Payer: PACE SWMI |
$391.63
|
| Rate for Payer: PHP Commercial |
$548.28
|
| Rate for Payer: PHP Medicare Advantage |
$391.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$486.85
|
| Rate for Payer: Priority Health Medicare |
$391.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.63
|
| Rate for Payer: UHC Medicare Advantage |
$391.63
|
| Rate for Payer: UMR Bronson Commercial |
$344.54
|
|
|
PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 30905
|
| Min. Negotiated Rate |
$102.72 |
| Max. Negotiated Rate |
$373.75 |
| Rate for Payer: Aetna Commercial |
$137.64
|
| Rate for Payer: Aetna Medicare |
$106.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.64
|
| Rate for Payer: BCBS Complete |
$230.00
|
| Rate for Payer: BCBS MAPPO |
$102.72
|
| Rate for Payer: BCN Medicare Advantage |
$102.72
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cofinity Commercial |
$147.92
|
| Rate for Payer: Cofinity Commercial |
$137.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.86
|
| Rate for Payer: Nomi Health Commercial |
$123.26
|
| Rate for Payer: PACE SWMI |
$102.72
|
| Rate for Payer: PHP Commercial |
$143.81
|
| Rate for Payer: PHP Medicare Advantage |
$102.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.75
|
| Rate for Payer: Priority Health Medicare |
$102.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.72
|
| Rate for Payer: UHC Medicare Advantage |
$102.72
|
| Rate for Payer: UMR Bronson Commercial |
$264.50
|
|
|
PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ
|
Professional
|
Both
|
$599.00
|
|
|
Service Code
|
HCPCS 30906
|
| Min. Negotiated Rate |
$127.39 |
| Max. Negotiated Rate |
$389.35 |
| Rate for Payer: Aetna Commercial |
$170.70
|
| Rate for Payer: Aetna Medicare |
$132.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.70
|
| Rate for Payer: BCBS Complete |
$239.60
|
| Rate for Payer: BCBS MAPPO |
$127.39
|
| Rate for Payer: BCN Medicare Advantage |
$127.39
|
| Rate for Payer: Cash Price |
$479.20
|
| Rate for Payer: Cash Price |
$479.20
|
| Rate for Payer: Cofinity Commercial |
$183.44
|
| Rate for Payer: Cofinity Commercial |
$170.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.76
|
| Rate for Payer: Nomi Health Commercial |
$152.87
|
| Rate for Payer: PACE SWMI |
$127.39
|
| Rate for Payer: PHP Commercial |
$178.35
|
| Rate for Payer: PHP Medicare Advantage |
$127.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.35
|
| Rate for Payer: Priority Health Medicare |
$127.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.39
|
| Rate for Payer: UHC Medicare Advantage |
$127.39
|
| Rate for Payer: UMR Bronson Commercial |
$275.54
|
|
|
PR CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
HCPCS 42961
|
| Min. Negotiated Rate |
$312.00 |
| Max. Negotiated Rate |
$574.23 |
| Rate for Payer: Aetna Commercial |
$534.35
|
| Rate for Payer: Aetna Medicare |
$414.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$574.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.35
|
| Rate for Payer: BCBS Complete |
$312.00
|
| Rate for Payer: BCBS MAPPO |
$398.77
|
| Rate for Payer: BCN Medicare Advantage |
$398.77
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cash Price |
$624.00
|
| Rate for Payer: Cofinity Commercial |
$574.23
|
| Rate for Payer: Cofinity Commercial |
$534.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.71
|
| Rate for Payer: Nomi Health Commercial |
$478.52
|
| Rate for Payer: PACE SWMI |
$398.77
|
| Rate for Payer: PHP Commercial |
$558.28
|
| Rate for Payer: PHP Medicare Advantage |
$398.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$507.00
|
| Rate for Payer: Priority Health Medicare |
$398.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$398.77
|
| Rate for Payer: UHC Medicare Advantage |
$398.77
|
| Rate for Payer: UMR Bronson Commercial |
$358.80
|
|
|
PR CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ
|
Professional
|
Both
|
$1,901.00
|
|
|
Service Code
|
HCPCS 42962
|
| Min. Negotiated Rate |
$492.46 |
| Max. Negotiated Rate |
$1,235.65 |
| Rate for Payer: Aetna Commercial |
$659.90
|
| Rate for Payer: Aetna Medicare |
$512.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$659.90
|
| Rate for Payer: BCBS Complete |
$760.40
|
| Rate for Payer: BCBS MAPPO |
$492.46
|
| Rate for Payer: BCN Medicare Advantage |
$492.46
|
| Rate for Payer: Cash Price |
$1,520.80
|
| Rate for Payer: Cash Price |
$1,520.80
|
| Rate for Payer: Cofinity Commercial |
$709.14
|
| Rate for Payer: Cofinity Commercial |
$659.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$492.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$517.08
|
| Rate for Payer: Nomi Health Commercial |
$590.95
|
| Rate for Payer: PACE SWMI |
$492.46
|
| Rate for Payer: PHP Commercial |
$689.44
|
| Rate for Payer: PHP Medicare Advantage |
$492.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.65
|
| Rate for Payer: Priority Health Medicare |
$492.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$492.46
|
| Rate for Payer: UHC Medicare Advantage |
$492.46
|
| Rate for Payer: UMR Bronson Commercial |
$874.46
|
|
|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS
|
Professional
|
Both
|
$539.00
|
|
|
Service Code
|
HCPCS 95929
|
| Min. Negotiated Rate |
$213.84 |
| Max. Negotiated Rate |
$350.35 |
| Rate for Payer: Aetna Commercial |
$286.55
|
| Rate for Payer: Aetna Medicare |
$222.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.55
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS MAPPO |
$213.84
|
| Rate for Payer: BCN Medicare Advantage |
$213.84
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cash Price |
$431.20
|
| Rate for Payer: Cofinity Commercial |
$307.93
|
| Rate for Payer: Cofinity Commercial |
$286.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.53
|
| Rate for Payer: Nomi Health Commercial |
$256.61
|
| Rate for Payer: PACE SWMI |
$213.84
|
| Rate for Payer: PHP Commercial |
$299.38
|
| Rate for Payer: PHP Medicare Advantage |
$213.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.35
|
| Rate for Payer: Priority Health Medicare |
$213.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.84
|
| Rate for Payer: UHC Medicare Advantage |
$213.84
|
| Rate for Payer: UMR Bronson Commercial |
$247.94
|
|
|
PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
HCPCS 95928
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$323.05 |
| Rate for Payer: Aetna Commercial |
$286.26
|
| Rate for Payer: Aetna Commercial |
$286.26
|
| Rate for Payer: Aetna Medicare |
$222.18
|
| Rate for Payer: Aetna Medicare |
$222.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.26
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS Complete |
$198.80
|
| Rate for Payer: BCBS MAPPO |
$213.63
|
| Rate for Payer: BCBS MAPPO |
$213.63
|
| Rate for Payer: BCN Medicare Advantage |
$213.63
|
| Rate for Payer: BCN Medicare Advantage |
$213.63
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$307.63
|
| Rate for Payer: Cofinity Commercial |
$286.26
|
| Rate for Payer: Cofinity Commercial |
$307.63
|
| Rate for Payer: Cofinity Commercial |
$286.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.31
|
| Rate for Payer: Nomi Health Commercial |
$256.36
|
| Rate for Payer: Nomi Health Commercial |
$256.36
|
| Rate for Payer: PACE SWMI |
$213.63
|
| Rate for Payer: PACE SWMI |
$213.63
|
| Rate for Payer: PHP Commercial |
$299.08
|
| Rate for Payer: PHP Commercial |
$299.08
|
| Rate for Payer: PHP Medicare Advantage |
$213.63
|
| Rate for Payer: PHP Medicare Advantage |
$213.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.05
|
| Rate for Payer: Priority Health Medicare |
$213.63
|
| Rate for Payer: Priority Health Medicare |
$213.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.63
|
| Rate for Payer: UHC Medicare Advantage |
$213.63
|
| Rate for Payer: UHC Medicare Advantage |
$213.63
|
| Rate for Payer: UMR Bronson Commercial |
$156.40
|
| Rate for Payer: UMR Bronson Commercial |
$228.62
|
|
|
PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 95939
|
| Min. Negotiated Rate |
$131.20 |
| Max. Negotiated Rate |
$713.00 |
| Rate for Payer: Aetna Commercial |
$663.49
|
| Rate for Payer: Aetna Medicare |
$514.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$713.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.49
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$495.14
|
| Rate for Payer: BCN Medicare Advantage |
$495.14
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$713.00
|
| Rate for Payer: Cofinity Commercial |
$663.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$495.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$519.90
|
| Rate for Payer: Nomi Health Commercial |
$594.17
|
| Rate for Payer: PACE SWMI |
$495.14
|
| Rate for Payer: PHP Commercial |
$693.20
|
| Rate for Payer: PHP Medicare Advantage |
$495.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health Medicare |
$495.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$495.14
|
| Rate for Payer: UHC Medicare Advantage |
$495.14
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR CURETTAGE POSTPARTUM
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 59160
|
| Min. Negotiated Rate |
$182.06 |
| Max. Negotiated Rate |
$354.90 |
| Rate for Payer: Aetna Commercial |
$243.96
|
| Rate for Payer: Aetna Medicare |
$189.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.96
|
| Rate for Payer: BCBS Complete |
$218.40
|
| Rate for Payer: BCBS MAPPO |
$182.06
|
| Rate for Payer: BCN Medicare Advantage |
$182.06
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$262.17
|
| Rate for Payer: Cofinity Commercial |
$243.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.16
|
| Rate for Payer: Nomi Health Commercial |
$218.47
|
| Rate for Payer: PACE SWMI |
$182.06
|
| Rate for Payer: PHP Commercial |
$254.88
|
| Rate for Payer: PHP Medicare Advantage |
$182.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health Medicare |
$182.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.06
|
| Rate for Payer: UHC Medicare Advantage |
$182.06
|
| Rate for Payer: UMR Bronson Commercial |
$251.16
|
|
|
PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX 1ST
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
HCPCS 46940
|
| Min. Negotiated Rate |
$138.72 |
| Max. Negotiated Rate |
$311.35 |
| Rate for Payer: Aetna Commercial |
$185.88
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.88
|
| Rate for Payer: BCBS Complete |
$191.60
|
| Rate for Payer: BCBS MAPPO |
$138.72
|
| Rate for Payer: BCN Medicare Advantage |
$138.72
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cash Price |
$383.20
|
| Rate for Payer: Cofinity Commercial |
$199.76
|
| Rate for Payer: Cofinity Commercial |
$185.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.66
|
| Rate for Payer: Nomi Health Commercial |
$166.46
|
| Rate for Payer: PACE SWMI |
$138.72
|
| Rate for Payer: PHP Commercial |
$194.21
|
| Rate for Payer: PHP Medicare Advantage |
$138.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$311.35
|
| Rate for Payer: Priority Health Medicare |
$138.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.72
|
| Rate for Payer: UHC Medicare Advantage |
$138.72
|
| Rate for Payer: UMR Bronson Commercial |
$220.34
|
|
|
PR CURTG/CAUT ANAL FISSURE W/DILAT SPHNCTR SPX SBSQ
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 46942
|
| Min. Negotiated Rate |
$124.14 |
| Max. Negotiated Rate |
$217.75 |
| Rate for Payer: Aetna Commercial |
$166.35
|
| Rate for Payer: Aetna Medicare |
$129.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.35
|
| Rate for Payer: BCBS Complete |
$134.00
|
| Rate for Payer: BCBS MAPPO |
$124.14
|
| Rate for Payer: BCN Medicare Advantage |
$124.14
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$178.76
|
| Rate for Payer: Cofinity Commercial |
$166.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.35
|
| Rate for Payer: Nomi Health Commercial |
$148.97
|
| Rate for Payer: PACE SWMI |
$124.14
|
| Rate for Payer: PHP Commercial |
$173.80
|
| Rate for Payer: PHP Medicare Advantage |
$124.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.75
|
| Rate for Payer: Priority Health Medicare |
$124.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.14
|
| Rate for Payer: UHC Medicare Advantage |
$124.14
|
| Rate for Payer: UMR Bronson Commercial |
$154.10
|
|
|
PR CUSTOM EAR PLUGS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00592
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
PR CUTANANEOUS APPENDICO-VESICOSTOMY
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
HCPCS 50845
|
| Min. Negotiated Rate |
$1,034.80 |
| Max. Negotiated Rate |
$1,723.62 |
| Rate for Payer: Aetna Commercial |
$1,603.93
|
| Rate for Payer: Aetna Medicare |
$1,244.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,603.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,723.62
|
| Rate for Payer: BCBS Complete |
$1,034.80
|
| Rate for Payer: BCBS MAPPO |
$1,196.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,196.96
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cofinity Commercial |
$1,603.93
|
| Rate for Payer: Cofinity Commercial |
$1,723.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,196.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,256.81
|
| Rate for Payer: Nomi Health Commercial |
$1,436.35
|
| Rate for Payer: PACE SWMI |
$1,196.96
|
| Rate for Payer: PHP Commercial |
$1,675.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,196.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.55
|
| Rate for Payer: Priority Health Medicare |
$1,196.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,196.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,196.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,190.02
|
|
|
PR CUTANEOUS VESICOSTOMY
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 51980
|
| Min. Negotiated Rate |
$584.00 |
| Max. Negotiated Rate |
$982.12 |
| Rate for Payer: Aetna Commercial |
$913.92
|
| Rate for Payer: Aetna Medicare |
$709.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.92
|
| Rate for Payer: BCBS Complete |
$584.00
|
| Rate for Payer: BCBS MAPPO |
$682.03
|
| Rate for Payer: BCN Medicare Advantage |
$682.03
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cofinity Commercial |
$982.12
|
| Rate for Payer: Cofinity Commercial |
$913.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$682.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$716.13
|
| Rate for Payer: Nomi Health Commercial |
$818.44
|
| Rate for Payer: PACE SWMI |
$682.03
|
| Rate for Payer: PHP Commercial |
$954.84
|
| Rate for Payer: PHP Medicare Advantage |
$682.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.00
|
| Rate for Payer: Priority Health Medicare |
$682.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$682.03
|
| Rate for Payer: UHC Medicare Advantage |
$682.03
|
| Rate for Payer: UMR Bronson Commercial |
$671.60
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG I&R ONLY
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 93018
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$110.50 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.85
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$13.32
|
| Rate for Payer: BCN Medicare Advantage |
$13.32
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| Rate for Payer: Cofinity Commercial |
$17.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.99
|
| Rate for Payer: Nomi Health Commercial |
$15.98
|
| Rate for Payer: PACE SWMI |
$13.32
|
| Rate for Payer: PHP Commercial |
$18.65
|
| Rate for Payer: PHP Medicare Advantage |
$13.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$13.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.32
|
| Rate for Payer: UHC Medicare Advantage |
$13.32
|
| Rate for Payer: UMR Bronson Commercial |
$78.20
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG TRCG ONLY
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 93017
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Commercial |
$45.64
|
| Rate for Payer: Aetna Medicare |
$35.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.64
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS MAPPO |
$34.06
|
| Rate for Payer: BCN Medicare Advantage |
$34.06
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$49.05
|
| Rate for Payer: Cofinity Commercial |
$45.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.76
|
| Rate for Payer: Nomi Health Commercial |
$40.87
|
| Rate for Payer: PACE SWMI |
$34.06
|
| Rate for Payer: PHP Commercial |
$47.68
|
| Rate for Payer: PHP Medicare Advantage |
$34.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health Medicare |
$34.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.06
|
| Rate for Payer: UHC Medicare Advantage |
$34.06
|
| Rate for Payer: UMR Bronson Commercial |
$51.98
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/O I&R
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 93016
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Commercial |
$26.33
|
| Rate for Payer: Aetna Medicare |
$20.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.33
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS MAPPO |
$19.65
|
| Rate for Payer: BCN Medicare Advantage |
$19.65
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$28.30
|
| Rate for Payer: Cofinity Commercial |
$26.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.63
|
| Rate for Payer: Nomi Health Commercial |
$23.58
|
| Rate for Payer: PACE SWMI |
$19.65
|
| Rate for Payer: PHP Commercial |
$27.51
|
| Rate for Payer: PHP Medicare Advantage |
$19.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health Medicare |
$19.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.65
|
| Rate for Payer: UHC Medicare Advantage |
$19.65
|
| Rate for Payer: UMR Bronson Commercial |
$51.98
|
|
|
PR CV STRS TST XERS&/OR RX CONT ECG W/SI&R
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
HCPCS 93015
|
| Min. Negotiated Rate |
$67.03 |
| Max. Negotiated Rate |
$293.80 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna Medicare |
$69.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.82
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$67.03
|
| Rate for Payer: BCN Medicare Advantage |
$67.03
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$96.52
|
| Rate for Payer: Cofinity Commercial |
$89.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.38
|
| Rate for Payer: Nomi Health Commercial |
$80.44
|
| Rate for Payer: PACE SWMI |
$67.03
|
| Rate for Payer: PHP Commercial |
$93.84
|
| Rate for Payer: PHP Medicare Advantage |
$67.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health Medicare |
$67.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.03
|
| Rate for Payer: UHC Medicare Advantage |
$67.03
|
| Rate for Payer: UMR Bronson Commercial |
$207.92
|
|
|
PR CYSTECTOMY COMPLETE SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,811.00
|
|
|
Service Code
|
HCPCS 51570
|
| Min. Negotiated Rate |
$1,124.40 |
| Max. Negotiated Rate |
$2,019.92 |
| Rate for Payer: Aetna Commercial |
$1,879.64
|
| Rate for Payer: Aetna Medicare |
$1,458.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,019.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,879.64
|
| Rate for Payer: BCBS Complete |
$1,124.40
|
| Rate for Payer: BCBS MAPPO |
$1,402.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,402.72
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cofinity Commercial |
$2,019.92
|
| Rate for Payer: Cofinity Commercial |
$1,879.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,402.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,472.86
|
| Rate for Payer: Nomi Health Commercial |
$1,683.26
|
| Rate for Payer: PACE SWMI |
$1,402.72
|
| Rate for Payer: PHP Commercial |
$1,963.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,402.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,827.15
|
| Rate for Payer: Priority Health Medicare |
$1,402.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,402.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,402.72
|
| Rate for Payer: UMR Bronson Commercial |
$1,293.06
|
|
|
PR CYSTECTOMY PARTIAL COMPLICATED
|
Professional
|
Both
|
$7,752.00
|
|
|
Service Code
|
HCPCS 51555
|
| Min. Negotiated Rate |
$1,203.80 |
| Max. Negotiated Rate |
$5,038.80 |
| Rate for Payer: Aetna Commercial |
$1,613.09
|
| Rate for Payer: Aetna Medicare |
$1,251.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,733.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,613.09
|
| Rate for Payer: BCBS Complete |
$3,100.80
|
| Rate for Payer: BCBS MAPPO |
$1,203.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,203.80
|
| Rate for Payer: Cash Price |
$6,201.60
|
| Rate for Payer: Cash Price |
$6,201.60
|
| Rate for Payer: Cofinity Commercial |
$1,733.47
|
| Rate for Payer: Cofinity Commercial |
$1,613.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,203.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,263.99
|
| Rate for Payer: Nomi Health Commercial |
$1,444.56
|
| Rate for Payer: PACE SWMI |
$1,203.80
|
| Rate for Payer: PHP Commercial |
$1,685.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,203.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,038.80
|
| Rate for Payer: Priority Health Medicare |
$1,203.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,203.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,203.80
|
| Rate for Payer: UMR Bronson Commercial |
$3,565.92
|
|
