|
PR CYSTO W/SUBURTRIC NJX IMPLT MATRL
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS 52327
|
| Min. Negotiated Rate |
$246.27 |
| Max. Negotiated Rate |
$853.45 |
| Rate for Payer: Aetna Commercial |
$330.00
|
| Rate for Payer: Aetna Medicare |
$256.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.00
|
| Rate for Payer: BCBS Complete |
$525.20
|
| Rate for Payer: BCBS MAPPO |
$246.27
|
| Rate for Payer: BCN Medicare Advantage |
$246.27
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Cash Price |
$1,050.40
|
| Rate for Payer: Cofinity Commercial |
$354.63
|
| Rate for Payer: Cofinity Commercial |
$330.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.58
|
| Rate for Payer: Nomi Health Commercial |
$295.52
|
| Rate for Payer: PACE SWMI |
$246.27
|
| Rate for Payer: PHP Commercial |
$344.78
|
| Rate for Payer: PHP Medicare Advantage |
$246.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.45
|
| Rate for Payer: Priority Health Medicare |
$246.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.27
|
| Rate for Payer: UHC Medicare Advantage |
$246.27
|
| Rate for Payer: UMR Bronson Commercial |
$603.98
|
|
|
PR CYSTO W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
HCPCS 52343
|
| Min. Negotiated Rate |
$270.80 |
| Max. Negotiated Rate |
$470.16 |
| Rate for Payer: Aetna Commercial |
$437.51
|
| Rate for Payer: Aetna Medicare |
$339.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.51
|
| Rate for Payer: BCBS Complete |
$270.80
|
| Rate for Payer: BCBS MAPPO |
$326.50
|
| Rate for Payer: BCN Medicare Advantage |
$326.50
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cash Price |
$541.60
|
| Rate for Payer: Cofinity Commercial |
$470.16
|
| Rate for Payer: Cofinity Commercial |
$437.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$326.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$342.82
|
| Rate for Payer: Nomi Health Commercial |
$391.80
|
| Rate for Payer: PACE SWMI |
$326.50
|
| Rate for Payer: PHP Commercial |
$457.10
|
| Rate for Payer: PHP Medicare Advantage |
$326.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.05
|
| Rate for Payer: Priority Health Medicare |
$326.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.50
|
| Rate for Payer: UHC Medicare Advantage |
$326.50
|
| Rate for Payer: UMR Bronson Commercial |
$311.42
|
|
|
PR CYSTO W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$1,537.00
|
|
|
Service Code
|
HCPCS 52341
|
| Min. Negotiated Rate |
$268.94 |
| Max. Negotiated Rate |
$999.05 |
| Rate for Payer: Aetna Commercial |
$360.38
|
| Rate for Payer: Aetna Medicare |
$279.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.38
|
| Rate for Payer: BCBS Complete |
$614.80
|
| Rate for Payer: BCBS MAPPO |
$268.94
|
| Rate for Payer: BCN Medicare Advantage |
$268.94
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cash Price |
$1,229.60
|
| Rate for Payer: Cofinity Commercial |
$387.27
|
| Rate for Payer: Cofinity Commercial |
$360.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$282.39
|
| Rate for Payer: Nomi Health Commercial |
$322.73
|
| Rate for Payer: PACE SWMI |
$268.94
|
| Rate for Payer: PHP Commercial |
$376.52
|
| Rate for Payer: PHP Medicare Advantage |
$268.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.05
|
| Rate for Payer: Priority Health Medicare |
$268.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$268.94
|
| Rate for Payer: UHC Medicare Advantage |
$268.94
|
| Rate for Payer: UMR Bronson Commercial |
$707.02
|
|
|
PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE
|
Professional
|
Both
|
$1,712.00
|
|
|
Service Code
|
HCPCS 52342
|
| Min. Negotiated Rate |
$293.08 |
| Max. Negotiated Rate |
$1,112.80 |
| Rate for Payer: Aetna Commercial |
$392.73
|
| Rate for Payer: Aetna Medicare |
$304.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.73
|
| Rate for Payer: BCBS Complete |
$684.80
|
| Rate for Payer: BCBS MAPPO |
$293.08
|
| Rate for Payer: BCN Medicare Advantage |
$293.08
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cofinity Commercial |
$422.04
|
| Rate for Payer: Cofinity Commercial |
$392.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$293.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$307.73
|
| Rate for Payer: Nomi Health Commercial |
$351.70
|
| Rate for Payer: PACE SWMI |
$293.08
|
| Rate for Payer: PHP Commercial |
$410.31
|
| Rate for Payer: PHP Medicare Advantage |
$293.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,112.80
|
| Rate for Payer: Priority Health Medicare |
$293.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.08
|
| Rate for Payer: UHC Medicare Advantage |
$293.08
|
| Rate for Payer: UMR Bronson Commercial |
$787.52
|
|
|
PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY
|
Professional
|
Both
|
$824.00
|
|
|
Service Code
|
HCPCS 52353
|
| Min. Negotiated Rate |
$329.60 |
| Max. Negotiated Rate |
$535.60 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| Rate for Payer: Aetna Medicare |
$385.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.09
|
| Rate for Payer: BCBS Complete |
$329.60
|
| Rate for Payer: BCBS MAPPO |
$370.96
|
| Rate for Payer: BCN Medicare Advantage |
$370.96
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Cofinity Commercial |
$534.18
|
| Rate for Payer: Cofinity Commercial |
$497.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$445.15
|
| Rate for Payer: PACE SWMI |
$370.96
|
| Rate for Payer: PHP Commercial |
$519.34
|
| Rate for Payer: PHP Medicare Advantage |
$370.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.60
|
| Rate for Payer: Priority Health Medicare |
$370.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.96
|
| Rate for Payer: UHC Medicare Advantage |
$370.96
|
| Rate for Payer: UMR Bronson Commercial |
$379.04
|
|
|
PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 52352
|
| Min. Negotiated Rate |
$336.09 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Aetna Commercial |
$450.36
|
| Rate for Payer: Aetna Medicare |
$349.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.36
|
| Rate for Payer: BCBS Complete |
$1,200.00
|
| Rate for Payer: BCBS MAPPO |
$336.09
|
| Rate for Payer: BCN Medicare Advantage |
$336.09
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cofinity Commercial |
$483.97
|
| Rate for Payer: Cofinity Commercial |
$450.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$336.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$352.89
|
| Rate for Payer: Nomi Health Commercial |
$403.31
|
| Rate for Payer: PACE SWMI |
$336.09
|
| Rate for Payer: PHP Commercial |
$470.53
|
| Rate for Payer: PHP Medicare Advantage |
$336.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.00
|
| Rate for Payer: Priority Health Medicare |
$336.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.09
|
| Rate for Payer: UHC Medicare Advantage |
$336.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,380.00
|
|
|
PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 52351
|
| Min. Negotiated Rate |
$243.20 |
| Max. Negotiated Rate |
$413.97 |
| Rate for Payer: Aetna Commercial |
$385.22
|
| Rate for Payer: Aetna Medicare |
$298.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.22
|
| Rate for Payer: BCBS Complete |
$243.20
|
| Rate for Payer: BCBS MAPPO |
$287.48
|
| Rate for Payer: BCN Medicare Advantage |
$287.48
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$413.97
|
| Rate for Payer: Cofinity Commercial |
$385.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$287.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.85
|
| Rate for Payer: Nomi Health Commercial |
$344.98
|
| Rate for Payer: PACE SWMI |
$287.48
|
| Rate for Payer: PHP Commercial |
$402.47
|
| Rate for Payer: PHP Medicare Advantage |
$287.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health Medicare |
$287.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.48
|
| Rate for Payer: UHC Medicare Advantage |
$287.48
|
| Rate for Payer: UMR Bronson Commercial |
$279.68
|
|
|
PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 52346
|
| Min. Negotiated Rate |
$353.60 |
| Max. Negotiated Rate |
$608.69 |
| Rate for Payer: Aetna Commercial |
$566.42
|
| Rate for Payer: Aetna Medicare |
$439.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$566.42
|
| Rate for Payer: BCBS Complete |
$353.60
|
| Rate for Payer: BCBS MAPPO |
$422.70
|
| Rate for Payer: BCN Medicare Advantage |
$422.70
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$608.69
|
| Rate for Payer: Cofinity Commercial |
$566.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$443.83
|
| Rate for Payer: Nomi Health Commercial |
$507.24
|
| Rate for Payer: PACE SWMI |
$422.70
|
| Rate for Payer: PHP Commercial |
$591.78
|
| Rate for Payer: PHP Medicare Advantage |
$422.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health Medicare |
$422.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$422.70
|
| Rate for Payer: UHC Medicare Advantage |
$422.70
|
| Rate for Payer: UMR Bronson Commercial |
$406.64
|
|
|
PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE
|
Professional
|
Both
|
$799.00
|
|
|
Service Code
|
HCPCS 52344
|
| Min. Negotiated Rate |
$319.60 |
| Max. Negotiated Rate |
$519.35 |
| Rate for Payer: Aetna Commercial |
$469.23
|
| Rate for Payer: Aetna Medicare |
$364.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.23
|
| Rate for Payer: BCBS Complete |
$319.60
|
| Rate for Payer: BCBS MAPPO |
$350.17
|
| Rate for Payer: BCN Medicare Advantage |
$350.17
|
| Rate for Payer: Cash Price |
$639.20
|
| Rate for Payer: Cash Price |
$639.20
|
| Rate for Payer: Cofinity Commercial |
$504.24
|
| Rate for Payer: Cofinity Commercial |
$469.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.68
|
| Rate for Payer: Nomi Health Commercial |
$420.20
|
| Rate for Payer: PACE SWMI |
$350.17
|
| Rate for Payer: PHP Commercial |
$490.24
|
| Rate for Payer: PHP Medicare Advantage |
$350.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.35
|
| Rate for Payer: Priority Health Medicare |
$350.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.17
|
| Rate for Payer: UHC Medicare Advantage |
$350.17
|
| Rate for Payer: UMR Bronson Commercial |
$367.54
|
|
|
PR CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX
|
Professional
|
Both
|
$1,127.00
|
|
|
Service Code
|
HCPCS 52345
|
| Min. Negotiated Rate |
$373.54 |
| Max. Negotiated Rate |
$732.55 |
| Rate for Payer: Aetna Commercial |
$500.54
|
| Rate for Payer: Aetna Medicare |
$388.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.54
|
| Rate for Payer: BCBS Complete |
$450.80
|
| Rate for Payer: BCBS MAPPO |
$373.54
|
| Rate for Payer: BCN Medicare Advantage |
$373.54
|
| Rate for Payer: Cash Price |
$901.60
|
| Rate for Payer: Cash Price |
$901.60
|
| Rate for Payer: Cofinity Commercial |
$537.90
|
| Rate for Payer: Cofinity Commercial |
$500.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.22
|
| Rate for Payer: Nomi Health Commercial |
$448.25
|
| Rate for Payer: PACE SWMI |
$373.54
|
| Rate for Payer: PHP Commercial |
$522.96
|
| Rate for Payer: PHP Medicare Advantage |
$373.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.55
|
| Rate for Payer: Priority Health Medicare |
$373.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.54
|
| Rate for Payer: UHC Medicare Advantage |
$373.54
|
| Rate for Payer: UMR Bronson Commercial |
$518.42
|
|
|
PR DACRYOCSTORHINOSTOMY
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 68720
|
| Min. Negotiated Rate |
$628.80 |
| Max. Negotiated Rate |
$1,071.40 |
| Rate for Payer: Aetna Commercial |
$997.00
|
| Rate for Payer: Aetna Medicare |
$773.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,071.40
|
| Rate for Payer: BCBS Complete |
$628.80
|
| Rate for Payer: BCBS MAPPO |
$744.03
|
| Rate for Payer: BCN Medicare Advantage |
$744.03
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cash Price |
$1,257.60
|
| Rate for Payer: Cofinity Commercial |
$997.00
|
| Rate for Payer: Cofinity Commercial |
$1,071.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$781.23
|
| Rate for Payer: Nomi Health Commercial |
$892.84
|
| Rate for Payer: PACE SWMI |
$744.03
|
| Rate for Payer: PHP Commercial |
$1,041.64
|
| Rate for Payer: PHP Medicare Advantage |
$744.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health Medicare |
$744.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.03
|
| Rate for Payer: UHC Medicare Advantage |
$744.03
|
| Rate for Payer: UMR Bronson Commercial |
$723.12
|
|
|
PR DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS 01996
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
|
|
PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 11000
|
| Min. Negotiated Rate |
$25.64 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna Commercial |
$34.36
|
| Rate for Payer: Aetna Medicare |
$26.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.92
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$25.64
|
| Rate for Payer: BCN Medicare Advantage |
$25.64
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Cofinity Commercial |
$36.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.92
|
| Rate for Payer: Nomi Health Commercial |
$30.77
|
| Rate for Payer: PACE SWMI |
$25.64
|
| Rate for Payer: PHP Commercial |
$35.90
|
| Rate for Payer: PHP Medicare Advantage |
$25.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health Medicare |
$25.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.64
|
| Rate for Payer: UHC Medicare Advantage |
$25.64
|
| Rate for Payer: UMR Bronson Commercial |
$41.40
|
|
|
PR DBRDMT EXTNSVE ECZMT/INFCT SKN EA ADDL 10%
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 11001
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$14.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.87
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$14.08
|
| Rate for Payer: BCN Medicare Advantage |
$14.08
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| Rate for Payer: Cofinity Commercial |
$18.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.78
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: PACE SWMI |
$14.08
|
| Rate for Payer: PHP Commercial |
$19.71
|
| Rate for Payer: PHP Medicare Advantage |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$14.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.08
|
| Rate for Payer: UHC Medicare Advantage |
$14.08
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
|
PR DBRDMT FX&/DISLC SUBQ T/M/F BONE
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
HCPCS 11012
|
| Min. Negotiated Rate |
$398.34 |
| Max. Negotiated Rate |
$791.70 |
| Rate for Payer: Aetna Commercial |
$533.78
|
| Rate for Payer: Aetna Medicare |
$414.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.78
|
| Rate for Payer: BCBS Complete |
$487.20
|
| Rate for Payer: BCBS MAPPO |
$398.34
|
| Rate for Payer: BCN Medicare Advantage |
$398.34
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cash Price |
$974.40
|
| Rate for Payer: Cofinity Commercial |
$573.61
|
| Rate for Payer: Cofinity Commercial |
$533.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.26
|
| Rate for Payer: Nomi Health Commercial |
$478.01
|
| Rate for Payer: PACE SWMI |
$398.34
|
| Rate for Payer: PHP Commercial |
$557.68
|
| Rate for Payer: PHP Medicare Advantage |
$398.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health Medicare |
$398.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$398.34
|
| Rate for Payer: UHC Medicare Advantage |
$398.34
|
| Rate for Payer: UMR Bronson Commercial |
$560.28
|
|
|
PR DBRDMT SKN SBQ T/M/F NECRO INFCTJ XTRNL GENT&PER
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 11004
|
| Min. Negotiated Rate |
$426.80 |
| Max. Negotiated Rate |
$787.46 |
| Rate for Payer: Aetna Commercial |
$732.78
|
| Rate for Payer: Aetna Medicare |
$568.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.78
|
| Rate for Payer: BCBS Complete |
$426.80
|
| Rate for Payer: BCBS MAPPO |
$546.85
|
| Rate for Payer: BCN Medicare Advantage |
$546.85
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cofinity Commercial |
$787.46
|
| Rate for Payer: Cofinity Commercial |
$732.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$574.19
|
| Rate for Payer: Nomi Health Commercial |
$656.22
|
| Rate for Payer: PACE SWMI |
$546.85
|
| Rate for Payer: PHP Commercial |
$765.59
|
| Rate for Payer: PHP Medicare Advantage |
$546.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.55
|
| Rate for Payer: Priority Health Medicare |
$546.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$546.85
|
| Rate for Payer: UHC Medicare Advantage |
$546.85
|
| Rate for Payer: UMR Bronson Commercial |
$490.82
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
IP
|
$1,423.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$626.12 |
| Max. Negotiated Rate |
$1,280.70 |
| Rate for Payer: Aetna American Axle |
$924.95
|
| Rate for Payer: Aetna Commercial |
$1,209.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.95
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,223.78
|
| Rate for Payer: Cofinity Commercial |
$996.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$996.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.40
|
| Rate for Payer: Healthscope Commercial |
$1,280.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$996.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.55
|
| Rate for Payer: PHP Commercial |
$1,209.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health SBD |
$896.49
|
| Rate for Payer: UMR Bronson Commercial |
$626.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.25
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 11005
|
| Min. Negotiated Rate |
$569.20 |
| Max. Negotiated Rate |
$1,077.09 |
| Rate for Payer: Aetna Commercial |
$1,002.29
|
| Rate for Payer: Aetna Medicare |
$777.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.29
|
| Rate for Payer: BCBS Complete |
$569.20
|
| Rate for Payer: BCBS MAPPO |
$747.98
|
| Rate for Payer: BCN Medicare Advantage |
$747.98
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,077.09
|
| Rate for Payer: Cofinity Commercial |
$1,002.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.38
|
| Rate for Payer: Nomi Health Commercial |
$897.58
|
| Rate for Payer: PACE SWMI |
$747.98
|
| Rate for Payer: PHP Commercial |
$1,047.17
|
| Rate for Payer: PHP Medicare Advantage |
$747.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health Medicare |
$747.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.98
|
| Rate for Payer: UHC Medicare Advantage |
$747.98
|
| Rate for Payer: UMR Bronson Commercial |
$654.58
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Facility
|
OP
|
$1,423.00
|
|
|
Service Code
|
CPT 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$526.51 |
| Max. Negotiated Rate |
$1,280.70 |
| Rate for Payer: Aetna American Axle |
$924.95
|
| Rate for Payer: Aetna Commercial |
$1,209.55
|
| Rate for Payer: Aetna Medicare |
$711.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.95
|
| Rate for Payer: BCBS Complete |
$569.20
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,223.78
|
| Rate for Payer: Cofinity Commercial |
$996.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$996.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,138.40
|
| Rate for Payer: Healthscope Commercial |
$1,280.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$996.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,067.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,209.55
|
| Rate for Payer: PHP Commercial |
$1,209.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health SBD |
$896.49
|
| Rate for Payer: UMR Bronson Commercial |
$526.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,067.25
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ ABDL WALL
|
Professional
|
Both
|
$1,423.00
|
|
|
Service Code
|
HCPCS 11005
|
| Hospital Charge Code |
11005
|
| Min. Negotiated Rate |
$569.20 |
| Max. Negotiated Rate |
$1,077.09 |
| Rate for Payer: Aetna Commercial |
$1,002.29
|
| Rate for Payer: Aetna Medicare |
$777.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,077.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.29
|
| Rate for Payer: BCBS Complete |
$569.20
|
| Rate for Payer: BCBS MAPPO |
$747.98
|
| Rate for Payer: BCN Medicare Advantage |
$747.98
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cash Price |
$1,138.40
|
| Rate for Payer: Cofinity Commercial |
$1,002.29
|
| Rate for Payer: Cofinity Commercial |
$1,077.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$747.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$785.38
|
| Rate for Payer: Nomi Health Commercial |
$897.58
|
| Rate for Payer: PACE SWMI |
$747.98
|
| Rate for Payer: PHP Commercial |
$1,047.17
|
| Rate for Payer: PHP Medicare Advantage |
$747.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$924.95
|
| Rate for Payer: Priority Health Medicare |
$747.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$747.98
|
| Rate for Payer: UHC Medicare Advantage |
$747.98
|
| Rate for Payer: UMR Bronson Commercial |
$654.58
|
|
|
PR DBRDMT SKN SUBQ T/M/F NECRO INFCTJ GENT PER&ABDL
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 11006
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$975.34 |
| Rate for Payer: Aetna Commercial |
$907.61
|
| Rate for Payer: Aetna Medicare |
$704.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$907.61
|
| Rate for Payer: BCBS Complete |
$520.40
|
| Rate for Payer: BCBS MAPPO |
$677.32
|
| Rate for Payer: BCN Medicare Advantage |
$677.32
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$975.34
|
| Rate for Payer: Cofinity Commercial |
$907.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$711.19
|
| Rate for Payer: Nomi Health Commercial |
$812.78
|
| Rate for Payer: PACE SWMI |
$677.32
|
| Rate for Payer: PHP Commercial |
$948.25
|
| Rate for Payer: PHP Medicare Advantage |
$677.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$845.65
|
| Rate for Payer: Priority Health Medicare |
$677.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$677.32
|
| Rate for Payer: UHC Medicare Advantage |
$677.32
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 11010
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$532.35 |
| Rate for Payer: Aetna Commercial |
$353.49
|
| Rate for Payer: Aetna Medicare |
$274.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$353.49
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: BCBS MAPPO |
$263.80
|
| Rate for Payer: BCN Medicare Advantage |
$263.80
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$379.87
|
| Rate for Payer: Cofinity Commercial |
$353.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.99
|
| Rate for Payer: Nomi Health Commercial |
$316.56
|
| Rate for Payer: PACE SWMI |
$263.80
|
| Rate for Payer: PHP Commercial |
$369.32
|
| Rate for Payer: PHP Medicare Advantage |
$263.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: Priority Health Medicare |
$263.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.80
|
| Rate for Payer: UHC Medicare Advantage |
$263.80
|
| Rate for Payer: UMR Bronson Commercial |
$376.74
|
|
|
PR DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
HCPCS 11011
|
| Min. Negotiated Rate |
$286.77 |
| Max. Negotiated Rate |
$577.85 |
| Rate for Payer: Aetna Commercial |
$384.27
|
| Rate for Payer: Aetna Medicare |
$298.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$384.27
|
| Rate for Payer: BCBS Complete |
$355.60
|
| Rate for Payer: BCBS MAPPO |
$286.77
|
| Rate for Payer: BCN Medicare Advantage |
$286.77
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Cofinity Commercial |
$412.95
|
| Rate for Payer: Cofinity Commercial |
$384.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$286.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$301.11
|
| Rate for Payer: Nomi Health Commercial |
$344.12
|
| Rate for Payer: PACE SWMI |
$286.77
|
| Rate for Payer: PHP Commercial |
$401.48
|
| Rate for Payer: PHP Medicare Advantage |
$286.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.85
|
| Rate for Payer: Priority Health Medicare |
$286.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$286.77
|
| Rate for Payer: UHC Medicare Advantage |
$286.77
|
| Rate for Payer: UMR Bronson Commercial |
$408.94
|
|
|
PR DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
HCPCS 27057
|
| Min. Negotiated Rate |
$700.40 |
| Max. Negotiated Rate |
$1,399.49 |
| Rate for Payer: Aetna Commercial |
$1,302.31
|
| Rate for Payer: Aetna Medicare |
$1,010.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,399.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.31
|
| Rate for Payer: BCBS Complete |
$700.40
|
| Rate for Payer: BCBS MAPPO |
$971.87
|
| Rate for Payer: BCN Medicare Advantage |
$971.87
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cash Price |
$1,400.80
|
| Rate for Payer: Cofinity Commercial |
$1,399.49
|
| Rate for Payer: Cofinity Commercial |
$1,302.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$971.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,020.46
|
| Rate for Payer: Nomi Health Commercial |
$1,166.24
|
| Rate for Payer: PACE SWMI |
$971.87
|
| Rate for Payer: PHP Commercial |
$1,360.62
|
| Rate for Payer: PHP Medicare Advantage |
$971.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.15
|
| Rate for Payer: Priority Health Medicare |
$971.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$971.87
|
| Rate for Payer: UHC Medicare Advantage |
$971.87
|
| Rate for Payer: UMR Bronson Commercial |
$805.46
|
|
|
PR DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS
|
Professional
|
Both
|
$1,340.00
|
|
|
Service Code
|
HCPCS 27498
|
| Min. Negotiated Rate |
$536.00 |
| Max. Negotiated Rate |
$917.32 |
| Rate for Payer: Aetna Commercial |
$853.62
|
| Rate for Payer: Aetna Medicare |
$662.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$853.62
|
| Rate for Payer: BCBS Complete |
$536.00
|
| Rate for Payer: BCBS MAPPO |
$637.03
|
| Rate for Payer: BCN Medicare Advantage |
$637.03
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,072.00
|
| Rate for Payer: Cofinity Commercial |
$917.32
|
| Rate for Payer: Cofinity Commercial |
$853.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.88
|
| Rate for Payer: Nomi Health Commercial |
$764.44
|
| Rate for Payer: PACE SWMI |
$637.03
|
| Rate for Payer: PHP Commercial |
$891.84
|
| Rate for Payer: PHP Medicare Advantage |
$637.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$871.00
|
| Rate for Payer: Priority Health Medicare |
$637.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$637.03
|
| Rate for Payer: UHC Medicare Advantage |
$637.03
|
| Rate for Payer: UMR Bronson Commercial |
$616.40
|
|
