|
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 |
$801.73 |
| Max. Negotiated Rate |
$2,554.33 |
| 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 |
$841.82
|
| Rate for Payer: BCBS MAPPO |
$1,196.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,554.33
|
| Rate for Payer: BCN Commercial |
$1,804.19
|
| 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 |
$1,723.62
|
| Rate for Payer: Cofinity Commercial |
$1,603.93
|
| 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: Meridian Medicaid |
$841.82
|
| 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 Choice Medicaid |
$801.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,681.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,990.32
|
| Rate for Payer: Priority Health Medicare |
$1,196.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,990.32
|
| Rate for Payer: Priority Health SBD |
$1,990.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,196.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,196.96
|
| Rate for Payer: UHCCP Medicaid |
$801.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,190.02
|
|
|
PR CUTANEOUS VESICOSTOMY
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 51980
|
| Min. Negotiated Rate |
$457.52 |
| Max. Negotiated Rate |
$2,370.48 |
| Rate for Payer: Aetna Commercial |
$913.92
|
| Rate for Payer: Aetna Medicare |
$709.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.12
|
| Rate for Payer: BCBS Complete |
$480.40
|
| Rate for Payer: BCBS MAPPO |
$682.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,370.48
|
| Rate for Payer: BCN Commercial |
$1,030.14
|
| 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 |
$913.92
|
| Rate for Payer: Cofinity Commercial |
$982.12
|
| 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: Meridian Medicaid |
$480.40
|
| 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 Choice Medicaid |
$457.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.58
|
| Rate for Payer: Priority Health Medicare |
$682.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,136.58
|
| Rate for Payer: Priority Health SBD |
$1,136.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$682.03
|
| Rate for Payer: UHC Medicare Advantage |
$682.03
|
| Rate for Payer: UHCCP Medicaid |
$457.52
|
| 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 |
$8.95 |
| Max. Negotiated Rate |
$1,814.71 |
| Rate for Payer: Aetna Commercial |
$17.85
|
| Rate for Payer: Aetna Medicare |
$13.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.18
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$13.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.71
|
| Rate for Payer: BCN Commercial |
$20.04
|
| 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 |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$19.18
|
| 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: Meridian Medicaid |
$9.40
|
| 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 Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health Medicare |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$19.31
|
| Rate for Payer: Priority Health SBD |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.32
|
| Rate for Payer: UHC Medicare Advantage |
$13.32
|
| Rate for Payer: UHCCP Medicaid |
$8.95
|
| 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 |
$1,426.94 |
| Rate for Payer: Aetna Commercial |
$45.64
|
| Rate for Payer: Aetna Medicare |
$35.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.05
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS MAPPO |
$34.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,426.94
|
| Rate for Payer: BCN Commercial |
$52.29
|
| 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 HMO/PPO/Tiered Network |
$53.20
|
| Rate for Payer: Priority Health Medicare |
$34.06
|
| Rate for Payer: Priority Health Narrow Network |
$53.20
|
| Rate for Payer: Priority Health SBD |
$53.20
|
| 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 |
$13.21 |
| Max. Negotiated Rate |
$1,780.90 |
| 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 |
$13.87
|
| Rate for Payer: BCBS MAPPO |
$19.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,780.90
|
| Rate for Payer: BCN Commercial |
$30.29
|
| 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: Meridian Medicaid |
$13.87
|
| 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 Choice Medicaid |
$13.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.19
|
| Rate for Payer: Priority Health Medicare |
$19.65
|
| Rate for Payer: Priority Health Narrow Network |
$29.19
|
| Rate for Payer: Priority Health SBD |
$29.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.65
|
| Rate for Payer: UHC Medicare Advantage |
$19.65
|
| Rate for Payer: UHCCP Medicaid |
$13.21
|
| 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 |
$2,485.65 |
| Rate for Payer: Aetna Commercial |
$89.82
|
| Rate for Payer: Aetna Medicare |
$69.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.52
|
| Rate for Payer: BCBS Complete |
$180.80
|
| Rate for Payer: BCBS MAPPO |
$67.03
|
| Rate for Payer: BCBS Trust/PPO |
$2,485.65
|
| Rate for Payer: BCN Commercial |
$102.62
|
| 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 HMO/PPO/Tiered Network |
$101.70
|
| Rate for Payer: Priority Health Medicare |
$67.03
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| Rate for Payer: Priority Health SBD |
$101.70
|
| 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 |
$935.71 |
| Max. Negotiated Rate |
$3,145.50 |
| 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 |
$982.50
|
| Rate for Payer: BCBS MAPPO |
$1,402.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,145.50
|
| Rate for Payer: BCN Commercial |
$2,115.97
|
| 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: Meridian Medicaid |
$982.50
|
| 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 Choice Medicaid |
$935.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,827.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,328.53
|
| Rate for Payer: Priority Health Medicare |
$1,402.72
|
| Rate for Payer: Priority Health Narrow Network |
$2,328.53
|
| Rate for Payer: Priority Health SBD |
$2,328.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,402.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,402.72
|
| Rate for Payer: UHCCP Medicaid |
$935.71
|
| 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 |
$803.65 |
| 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) |
$1,613.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,733.47
|
| Rate for Payer: BCBS Complete |
$843.83
|
| Rate for Payer: BCBS MAPPO |
$1,203.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,383.69
|
| Rate for Payer: BCN Commercial |
$1,811.04
|
| 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 |
$1,613.09
|
| Rate for Payer: Cofinity Commercial |
$1,733.47
|
| 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: Meridian Medicaid |
$843.83
|
| 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 Choice Medicaid |
$803.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,038.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,997.78
|
| Rate for Payer: Priority Health Medicare |
$1,203.80
|
| Rate for Payer: Priority Health Narrow Network |
$1,997.78
|
| Rate for Payer: Priority Health SBD |
$1,997.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,203.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,203.80
|
| Rate for Payer: UHCCP Medicaid |
$803.65
|
| Rate for Payer: UMR Bronson Commercial |
$3,565.92
|
|
|
PR CYSTECTOMY PARTIAL SIMPLE
|
Professional
|
Both
|
$1,545.00
|
|
|
Service Code
|
HCPCS 51550
|
| Min. Negotiated Rate |
$615.36 |
| Max. Negotiated Rate |
$2,405.35 |
| Rate for Payer: Aetna Commercial |
$1,234.15
|
| Rate for Payer: Aetna Medicare |
$957.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,234.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,326.25
|
| Rate for Payer: BCBS Complete |
$646.13
|
| Rate for Payer: BCBS MAPPO |
$921.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,405.35
|
| Rate for Payer: BCN Commercial |
$1,387.84
|
| Rate for Payer: BCN Medicare Advantage |
$921.01
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cash Price |
$1,236.00
|
| Rate for Payer: Cofinity Commercial |
$1,234.15
|
| Rate for Payer: Cofinity Commercial |
$1,326.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$967.06
|
| Rate for Payer: Meridian Medicaid |
$646.13
|
| Rate for Payer: Nomi Health Commercial |
$1,105.21
|
| Rate for Payer: PACE SWMI |
$921.01
|
| Rate for Payer: PHP Commercial |
$1,289.41
|
| Rate for Payer: PHP Medicare Advantage |
$921.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$615.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,531.23
|
| Rate for Payer: Priority Health Medicare |
$921.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,531.23
|
| Rate for Payer: Priority Health SBD |
$1,531.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$921.01
|
| Rate for Payer: UHC Medicare Advantage |
$921.01
|
| Rate for Payer: UHCCP Medicaid |
$615.36
|
| Rate for Payer: UMR Bronson Commercial |
$710.70
|
|
|
PR CYSTECTOMY W/BI PELVIC LYMPHADENECTOMY
|
Professional
|
Both
|
$3,796.00
|
|
|
Service Code
|
HCPCS 51575
|
| Min. Negotiated Rate |
$1,152.97 |
| Max. Negotiated Rate |
$3,111.16 |
| Rate for Payer: Aetna Commercial |
$2,316.16
|
| Rate for Payer: Aetna Medicare |
$1,797.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,316.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,489.01
|
| Rate for Payer: BCBS Complete |
$1,210.62
|
| Rate for Payer: BCBS MAPPO |
$1,728.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,111.16
|
| Rate for Payer: BCN Commercial |
$2,610.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,728.48
|
| Rate for Payer: Cash Price |
$3,036.80
|
| Rate for Payer: Cash Price |
$3,036.80
|
| Rate for Payer: Cofinity Commercial |
$2,316.16
|
| Rate for Payer: Cofinity Commercial |
$2,489.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,728.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,814.90
|
| Rate for Payer: Meridian Medicaid |
$1,210.62
|
| Rate for Payer: Nomi Health Commercial |
$2,074.18
|
| Rate for Payer: PACE SWMI |
$1,728.48
|
| Rate for Payer: PHP Commercial |
$2,419.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,728.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,152.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,467.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,866.45
|
| Rate for Payer: Priority Health Medicare |
$1,728.48
|
| Rate for Payer: Priority Health Narrow Network |
$2,866.45
|
| Rate for Payer: Priority Health SBD |
$2,866.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,728.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,728.48
|
| Rate for Payer: UHCCP Medicaid |
$1,152.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,746.16
|
|
|
PR CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS
|
Professional
|
Both
|
$773.00
|
|
|
Service Code
|
HCPCS 52281
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$2,364.67 |
| Rate for Payer: Aetna Commercial |
$193.74
|
| Rate for Payer: Aetna Medicare |
$150.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.20
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$144.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,364.67
|
| Rate for Payer: BCN Commercial |
$478.42
|
| Rate for Payer: BCN Medicare Advantage |
$144.58
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cash Price |
$618.40
|
| Rate for Payer: Cofinity Commercial |
$193.74
|
| Rate for Payer: Cofinity Commercial |
$208.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.81
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Nomi Health Commercial |
$173.50
|
| Rate for Payer: PACE SWMI |
$144.58
|
| Rate for Payer: PHP Commercial |
$202.41
|
| Rate for Payer: PHP Medicare Advantage |
$144.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$502.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.66
|
| Rate for Payer: Priority Health Medicare |
$144.58
|
| Rate for Payer: Priority Health Narrow Network |
$239.66
|
| Rate for Payer: Priority Health SBD |
$239.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.58
|
| Rate for Payer: UHC Medicare Advantage |
$144.58
|
| Rate for Payer: UHCCP Medicaid |
$96.70
|
| Rate for Payer: UMR Bronson Commercial |
$355.58
|
|
|
PR CYSTO FRAGMENTATION URETERAL STONE
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
HCPCS 52325
|
| Min. Negotiated Rate |
$201.92 |
| Max. Negotiated Rate |
$4,083.76 |
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Aetna Commercial |
$406.46
|
| Rate for Payer: Aetna Medicare |
$315.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.80
|
| Rate for Payer: BCBS Complete |
$212.02
|
| Rate for Payer: BCBS MAPPO |
$303.33
|
| Rate for Payer: BCBS Trust/PPO |
$4,083.76
|
| Rate for Payer: BCN Commercial |
$456.42
|
| Rate for Payer: BCN Medicare Advantage |
$303.33
|
| Rate for Payer: Cash Price |
$532.00
|
| Rate for Payer: Cofinity Commercial |
$406.46
|
| Rate for Payer: Cofinity Commercial |
$436.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.50
|
| Rate for Payer: Meridian Medicaid |
$212.02
|
| Rate for Payer: Nomi Health Commercial |
$364.00
|
| Rate for Payer: PACE SWMI |
$303.33
|
| Rate for Payer: PHP Commercial |
$424.66
|
| Rate for Payer: PHP Medicare Advantage |
$303.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$432.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$501.71
|
| Rate for Payer: Priority Health Medicare |
$303.33
|
| Rate for Payer: Priority Health Narrow Network |
$501.71
|
| Rate for Payer: Priority Health SBD |
$501.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.33
|
| Rate for Payer: UHC Medicare Advantage |
$303.33
|
| Rate for Payer: UHCCP Medicaid |
$201.92
|
| Rate for Payer: UMR Bronson Commercial |
$305.90
|
|
|
PR CYSTO INC/RESCJ ORIFICE BLDR DIVERTICULUM 1/MLT
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 52305
|
| Min. Negotiated Rate |
$175.51 |
| Max. Negotiated Rate |
$894.94 |
| Rate for Payer: Aetna Commercial |
$352.97
|
| Rate for Payer: Aetna Medicare |
$273.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.31
|
| Rate for Payer: BCBS Complete |
$184.29
|
| Rate for Payer: BCBS MAPPO |
$263.41
|
| Rate for Payer: BCBS Trust/PPO |
$894.94
|
| Rate for Payer: BCN Commercial |
$397.79
|
| Rate for Payer: BCN Medicare Advantage |
$263.41
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$352.97
|
| Rate for Payer: Cofinity Commercial |
$379.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.58
|
| Rate for Payer: Meridian Medicaid |
$184.29
|
| Rate for Payer: Nomi Health Commercial |
$316.09
|
| Rate for Payer: PACE SWMI |
$263.41
|
| Rate for Payer: PHP Commercial |
$368.77
|
| Rate for Payer: PHP Medicare Advantage |
$263.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$436.19
|
| Rate for Payer: Priority Health Medicare |
$263.41
|
| Rate for Payer: Priority Health Narrow Network |
$436.19
|
| Rate for Payer: Priority Health SBD |
$436.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.41
|
| Rate for Payer: UHC Medicare Advantage |
$263.41
|
| Rate for Payer: UHCCP Medicaid |
$175.51
|
| Rate for Payer: UMR Bronson Commercial |
$251.62
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT EA ADDL
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 52442
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$1,276.43 |
| Rate for Payer: Aetna Commercial |
$65.00
|
| Rate for Payer: Aetna Medicare |
$50.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.85
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$48.51
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: BCN Commercial |
$1,276.43
|
| Rate for Payer: BCN Medicare Advantage |
$48.51
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cofinity Commercial |
$65.00
|
| Rate for Payer: Cofinity Commercial |
$69.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.94
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Nomi Health Commercial |
$58.21
|
| Rate for Payer: PACE SWMI |
$48.51
|
| Rate for Payer: PHP Commercial |
$67.91
|
| Rate for Payer: PHP Medicare Advantage |
$48.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.36
|
| Rate for Payer: Priority Health Medicare |
$48.51
|
| Rate for Payer: Priority Health Narrow Network |
$79.36
|
| Rate for Payer: Priority Health SBD |
$79.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.51
|
| Rate for Payer: UHC Medicare Advantage |
$48.51
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
| Rate for Payer: UMR Bronson Commercial |
$791.20
|
|
|
PR CYSTO INSERTION TRANSPROSTATIC IMPLANT SINGLE
|
Professional
|
Both
|
$2,248.00
|
|
|
Service Code
|
HCPCS 52441
|
| Min. Negotiated Rate |
$132.91 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Aetna Commercial |
$267.50
|
| Rate for Payer: Aetna Medicare |
$207.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.47
|
| Rate for Payer: BCBS Complete |
$139.56
|
| Rate for Payer: BCBS MAPPO |
$199.63
|
| Rate for Payer: BCBS Trust/PPO |
$528.83
|
| Rate for Payer: BCN Commercial |
$1,866.75
|
| Rate for Payer: BCN Medicare Advantage |
$199.63
|
| Rate for Payer: Cash Price |
$1,798.40
|
| Rate for Payer: Cash Price |
$1,798.40
|
| Rate for Payer: Cofinity Commercial |
$267.50
|
| Rate for Payer: Cofinity Commercial |
$287.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.61
|
| Rate for Payer: Meridian Medicaid |
$139.56
|
| Rate for Payer: Nomi Health Commercial |
$239.56
|
| Rate for Payer: PACE SWMI |
$199.63
|
| Rate for Payer: PHP Commercial |
$279.48
|
| Rate for Payer: PHP Medicare Advantage |
$199.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,461.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.15
|
| Rate for Payer: Priority Health Medicare |
$199.63
|
| Rate for Payer: Priority Health Narrow Network |
$329.15
|
| Rate for Payer: Priority Health SBD |
$329.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.63
|
| Rate for Payer: UHC Medicare Advantage |
$199.63
|
| Rate for Payer: UHCCP Medicaid |
$132.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,034.08
|
|
|
PR CYSTO INSJ URTRL GD WIRE PRQ NFROS RTRGR
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 52334
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$2,807.39 |
| Rate for Payer: Aetna Commercial |
$233.36
|
| Rate for Payer: Aetna Medicare |
$181.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.78
|
| Rate for Payer: BCBS Complete |
$122.12
|
| Rate for Payer: BCBS MAPPO |
$174.15
|
| Rate for Payer: BCBS Trust/PPO |
$2,807.39
|
| Rate for Payer: BCN Commercial |
$261.44
|
| Rate for Payer: BCN Medicare Advantage |
$174.15
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cash Price |
$755.20
|
| Rate for Payer: Cofinity Commercial |
$233.36
|
| Rate for Payer: Cofinity Commercial |
$250.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.86
|
| Rate for Payer: Meridian Medicaid |
$122.12
|
| Rate for Payer: Nomi Health Commercial |
$208.98
|
| Rate for Payer: PACE SWMI |
$174.15
|
| Rate for Payer: PHP Commercial |
$243.81
|
| Rate for Payer: PHP Medicare Advantage |
$174.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$613.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.07
|
| Rate for Payer: Priority Health Medicare |
$174.15
|
| Rate for Payer: Priority Health Narrow Network |
$287.07
|
| Rate for Payer: Priority Health SBD |
$287.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.15
|
| Rate for Payer: UHC Medicare Advantage |
$174.15
|
| Rate for Payer: UHCCP Medicaid |
$116.30
|
| Rate for Payer: UMR Bronson Commercial |
$434.24
|
|
|
PR CYSTOLITHOTOMY CYSTOTOMY W/RMVL CALCULUS
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
HCPCS 51050
|
| Min. Negotiated Rate |
$304.59 |
| Max. Negotiated Rate |
$3,253.27 |
| Rate for Payer: Aetna Commercial |
$606.54
|
| Rate for Payer: Aetna Medicare |
$470.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$606.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$651.80
|
| Rate for Payer: BCBS Complete |
$319.82
|
| Rate for Payer: BCBS MAPPO |
$452.64
|
| Rate for Payer: BCBS Trust/PPO |
$3,253.27
|
| Rate for Payer: BCN Commercial |
$682.20
|
| Rate for Payer: BCN Medicare Advantage |
$452.64
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cofinity Commercial |
$606.54
|
| Rate for Payer: Cofinity Commercial |
$651.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$452.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$475.27
|
| Rate for Payer: Meridian Medicaid |
$319.82
|
| Rate for Payer: Nomi Health Commercial |
$543.17
|
| Rate for Payer: PACE SWMI |
$452.64
|
| Rate for Payer: PHP Commercial |
$633.70
|
| Rate for Payer: PHP Medicare Advantage |
$452.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$674.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$755.23
|
| Rate for Payer: Priority Health Medicare |
$452.64
|
| Rate for Payer: Priority Health Narrow Network |
$755.23
|
| Rate for Payer: Priority Health SBD |
$755.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$452.64
|
| Rate for Payer: UHC Medicare Advantage |
$452.64
|
| Rate for Payer: UHCCP Medicaid |
$304.59
|
| Rate for Payer: UMR Bronson Commercial |
$477.48
|
|
|
PR CYSTO MANJ W/O RMVL URETERAL STONE
|
Professional
|
Both
|
$1,050.00
|
|
|
Service Code
|
HCPCS 52330
|
| Min. Negotiated Rate |
$166.35 |
| Max. Negotiated Rate |
$6,449.49 |
| Rate for Payer: Aetna Commercial |
$334.72
|
| Rate for Payer: Aetna Medicare |
$259.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.70
|
| Rate for Payer: BCBS Complete |
$174.67
|
| Rate for Payer: BCBS MAPPO |
$249.79
|
| Rate for Payer: BCBS Trust/PPO |
$6,449.49
|
| Rate for Payer: BCN Commercial |
$884.01
|
| Rate for Payer: BCN Medicare Advantage |
$249.79
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cofinity Commercial |
$334.72
|
| Rate for Payer: Cofinity Commercial |
$359.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$262.28
|
| Rate for Payer: Meridian Medicaid |
$174.67
|
| Rate for Payer: Nomi Health Commercial |
$299.75
|
| Rate for Payer: PACE SWMI |
$249.79
|
| Rate for Payer: PHP Commercial |
$349.71
|
| Rate for Payer: PHP Medicare Advantage |
$249.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$682.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.30
|
| Rate for Payer: Priority Health Medicare |
$249.79
|
| Rate for Payer: Priority Health Narrow Network |
$413.30
|
| Rate for Payer: Priority Health SBD |
$413.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.79
|
| Rate for Payer: UHC Medicare Advantage |
$249.79
|
| Rate for Payer: UHCCP Medicaid |
$166.35
|
| Rate for Payer: UMR Bronson Commercial |
$483.00
|
|
|
PR CYSTO/PYELOSCOPY BX&/FULGURATION PELIVC LESION
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 52354
|
| Min. Negotiated Rate |
$263.48 |
| Max. Negotiated Rate |
$654.03 |
| Rate for Payer: Aetna Commercial |
$530.44
|
| Rate for Payer: Aetna Medicare |
$411.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.02
|
| Rate for Payer: BCBS Complete |
$276.65
|
| Rate for Payer: BCBS MAPPO |
$395.85
|
| Rate for Payer: BCBS Trust/PPO |
$475.77
|
| Rate for Payer: BCN Commercial |
$593.74
|
| Rate for Payer: BCN Medicare Advantage |
$395.85
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cofinity Commercial |
$530.44
|
| Rate for Payer: Cofinity Commercial |
$570.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.64
|
| Rate for Payer: Meridian Medicaid |
$276.65
|
| Rate for Payer: Nomi Health Commercial |
$475.02
|
| Rate for Payer: PACE SWMI |
$395.85
|
| Rate for Payer: PHP Commercial |
$554.19
|
| Rate for Payer: PHP Medicare Advantage |
$395.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$654.03
|
| Rate for Payer: Priority Health Medicare |
$395.85
|
| Rate for Payer: Priority Health Narrow Network |
$654.03
|
| Rate for Payer: Priority Health SBD |
$654.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$395.85
|
| Rate for Payer: UHC Medicare Advantage |
$395.85
|
| Rate for Payer: UHCCP Medicaid |
$263.48
|
| Rate for Payer: UMR Bronson Commercial |
$350.52
|
|
|
PR CYSTO/PYELOSCOPY RESCJ PELVIC TUMOR
|
Professional
|
Both
|
$1,452.00
|
|
|
Service Code
|
HCPCS 52355
|
| Min. Negotiated Rate |
$295.22 |
| Max. Negotiated Rate |
$7,524.58 |
| Rate for Payer: Aetna Commercial |
$594.49
|
| Rate for Payer: Aetna Medicare |
$461.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.86
|
| Rate for Payer: BCBS Complete |
$309.98
|
| Rate for Payer: BCBS MAPPO |
$443.65
|
| Rate for Payer: BCBS Trust/PPO |
$7,524.58
|
| Rate for Payer: BCN Commercial |
$665.09
|
| Rate for Payer: BCN Medicare Advantage |
$443.65
|
| Rate for Payer: Cash Price |
$1,161.60
|
| Rate for Payer: Cash Price |
$1,161.60
|
| Rate for Payer: Cofinity Commercial |
$594.49
|
| Rate for Payer: Cofinity Commercial |
$638.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$465.83
|
| Rate for Payer: Meridian Medicaid |
$309.98
|
| Rate for Payer: Nomi Health Commercial |
$532.38
|
| Rate for Payer: PACE SWMI |
$443.65
|
| Rate for Payer: PHP Commercial |
$621.11
|
| Rate for Payer: PHP Medicare Advantage |
$443.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$943.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.86
|
| Rate for Payer: Priority Health Medicare |
$443.65
|
| Rate for Payer: Priority Health Narrow Network |
$732.86
|
| Rate for Payer: Priority Health SBD |
$732.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$443.65
|
| Rate for Payer: UHC Medicare Advantage |
$443.65
|
| Rate for Payer: UHCCP Medicaid |
$295.22
|
| Rate for Payer: UMR Bronson Commercial |
$667.92
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT COMPLICATED
|
Professional
|
Both
|
$3,197.00
|
|
|
Service Code
|
HCPCS 51865
|
| Min. Negotiated Rate |
$571.91 |
| Max. Negotiated Rate |
$2,078.05 |
| Rate for Payer: Aetna Commercial |
$1,145.35
|
| Rate for Payer: Aetna Medicare |
$888.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,145.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.83
|
| Rate for Payer: BCBS Complete |
$600.51
|
| Rate for Payer: BCBS MAPPO |
$854.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,532.07
|
| Rate for Payer: BCN Commercial |
$1,294.51
|
| Rate for Payer: BCN Medicare Advantage |
$854.74
|
| Rate for Payer: Cash Price |
$2,557.60
|
| Rate for Payer: Cash Price |
$2,557.60
|
| Rate for Payer: Cofinity Commercial |
$1,145.35
|
| Rate for Payer: Cofinity Commercial |
$1,230.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$854.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$897.48
|
| Rate for Payer: Meridian Medicaid |
$600.51
|
| Rate for Payer: Nomi Health Commercial |
$1,025.69
|
| Rate for Payer: PACE SWMI |
$854.74
|
| Rate for Payer: PHP Commercial |
$1,196.64
|
| Rate for Payer: PHP Medicare Advantage |
$854.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,078.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,424.70
|
| Rate for Payer: Priority Health Medicare |
$854.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,424.70
|
| Rate for Payer: Priority Health SBD |
$1,424.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$854.74
|
| Rate for Payer: UHC Medicare Advantage |
$854.74
|
| Rate for Payer: UHCCP Medicaid |
$571.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,470.62
|
|
|
PR CYSTORRHAPHY SUTR BLDR WND INJ/RPT SIMPLE
|
Professional
|
Both
|
$2,448.00
|
|
|
Service Code
|
HCPCS 51860
|
| Min. Negotiated Rate |
$476.91 |
| Max. Negotiated Rate |
$2,379.46 |
| Rate for Payer: Aetna Commercial |
$954.40
|
| Rate for Payer: Aetna Medicare |
$740.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,025.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$954.40
|
| Rate for Payer: BCBS Complete |
$500.76
|
| Rate for Payer: BCBS MAPPO |
$712.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,379.46
|
| Rate for Payer: BCN Commercial |
$1,080.96
|
| Rate for Payer: BCN Medicare Advantage |
$712.24
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,025.63
|
| Rate for Payer: Cofinity Commercial |
$954.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$712.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$747.85
|
| Rate for Payer: Meridian Medicaid |
$500.76
|
| Rate for Payer: Nomi Health Commercial |
$854.69
|
| Rate for Payer: PACE SWMI |
$712.24
|
| Rate for Payer: PHP Commercial |
$997.14
|
| Rate for Payer: PHP Medicare Advantage |
$712.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.82
|
| Rate for Payer: Priority Health Medicare |
$712.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.82
|
| Rate for Payer: Priority Health SBD |
$1,189.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$712.24
|
| Rate for Payer: UHC Medicare Advantage |
$712.24
|
| Rate for Payer: UHCCP Medicaid |
$476.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,126.08
|
|
|
PR CYSTOSTOMY CYSTOTOMY W/DRAINAGE
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 51040
|
| Min. Negotiated Rate |
$188.72 |
| Max. Negotiated Rate |
$3,051.99 |
| Rate for Payer: Aetna Commercial |
$373.42
|
| Rate for Payer: Aetna Medicare |
$289.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.28
|
| Rate for Payer: BCBS Complete |
$198.16
|
| Rate for Payer: BCBS MAPPO |
$278.67
|
| Rate for Payer: BCBS Trust/PPO |
$3,051.99
|
| Rate for Payer: BCN Commercial |
$422.22
|
| Rate for Payer: BCN Medicare Advantage |
$278.67
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$373.42
|
| Rate for Payer: Cofinity Commercial |
$401.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.60
|
| Rate for Payer: Meridian Medicaid |
$198.16
|
| Rate for Payer: Nomi Health Commercial |
$334.40
|
| Rate for Payer: PACE SWMI |
$278.67
|
| Rate for Payer: PHP Commercial |
$390.14
|
| Rate for Payer: PHP Medicare Advantage |
$278.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$188.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$468.69
|
| Rate for Payer: Priority Health Medicare |
$278.67
|
| Rate for Payer: Priority Health Narrow Network |
$468.69
|
| Rate for Payer: Priority Health SBD |
$468.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.67
|
| Rate for Payer: UHC Medicare Advantage |
$278.67
|
| Rate for Payer: UHCCP Medicaid |
$188.72
|
| Rate for Payer: UMR Bronson Commercial |
$251.16
|
|
|
PR CYSTOTOMY/CYSTOSTOMY FULG&/INSJ RADACT MATRL
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 51020
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$3,049.88 |
| Rate for Payer: Aetna Commercial |
$601.90
|
| Rate for Payer: Aetna Medicare |
$467.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.82
|
| Rate for Payer: BCBS Complete |
$318.26
|
| Rate for Payer: BCBS MAPPO |
$449.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,049.88
|
| Rate for Payer: BCN Commercial |
$680.73
|
| Rate for Payer: BCN Medicare Advantage |
$449.18
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cofinity Commercial |
$601.90
|
| Rate for Payer: Cofinity Commercial |
$646.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.64
|
| Rate for Payer: Meridian Medicaid |
$318.26
|
| Rate for Payer: Nomi Health Commercial |
$539.02
|
| Rate for Payer: PACE SWMI |
$449.18
|
| Rate for Payer: PHP Commercial |
$628.85
|
| Rate for Payer: PHP Medicare Advantage |
$449.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,592.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$754.16
|
| Rate for Payer: Priority Health Medicare |
$449.18
|
| Rate for Payer: Priority Health Narrow Network |
$754.16
|
| Rate for Payer: Priority Health SBD |
$754.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.18
|
| Rate for Payer: UHC Medicare Advantage |
$449.18
|
| Rate for Payer: UHCCP Medicaid |
$303.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.00
|
|
