|
PR CYSTO W/DESTRUCTION OF LESIONS
|
Professional
|
Both
|
$2,825.00
|
|
|
Service Code
|
HCPCS 52214
|
| Min. Negotiated Rate |
$110.76 |
| Max. Negotiated Rate |
$2,177.12 |
| Rate for Payer: Aetna Commercial |
$223.71
|
| Rate for Payer: Aetna Medicare |
$173.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.41
|
| Rate for Payer: BCBS Complete |
$116.30
|
| Rate for Payer: BCBS MAPPO |
$166.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,177.12
|
| Rate for Payer: BCN Commercial |
$1,100.50
|
| Rate for Payer: BCN Medicare Advantage |
$166.95
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cash Price |
$2,260.00
|
| Rate for Payer: Cofinity Commercial |
$240.41
|
| Rate for Payer: Cofinity Commercial |
$223.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$175.30
|
| Rate for Payer: Meridian Medicaid |
$116.30
|
| Rate for Payer: Nomi Health Commercial |
$200.34
|
| Rate for Payer: PACE SWMI |
$166.95
|
| Rate for Payer: PHP Commercial |
$233.73
|
| Rate for Payer: PHP Medicare Advantage |
$166.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,836.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$274.29
|
| Rate for Payer: Priority Health Medicare |
$166.95
|
| Rate for Payer: Priority Health Narrow Network |
$274.29
|
| Rate for Payer: Priority Health SBD |
$274.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.95
|
| Rate for Payer: UHC Medicare Advantage |
$166.95
|
| Rate for Payer: UHCCP Medicaid |
$110.76
|
| Rate for Payer: UMR Bronson Commercial |
$1,299.50
|
|
|
PR CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE
|
Professional
|
Both
|
$4,050.00
|
|
|
Service Code
|
HCPCS 52284
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Aetna Commercial |
$210.27
|
| Rate for Payer: Aetna Medicare |
$163.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.27
|
| Rate for Payer: BCBS Complete |
$109.81
|
| Rate for Payer: BCBS MAPPO |
$156.92
|
| Rate for Payer: BCN Medicare Advantage |
$156.92
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cash Price |
$3,240.00
|
| Rate for Payer: Cofinity Commercial |
$225.96
|
| Rate for Payer: Cofinity Commercial |
$210.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.77
|
| Rate for Payer: Meridian Medicaid |
$109.81
|
| Rate for Payer: Nomi Health Commercial |
$188.30
|
| Rate for Payer: PACE SWMI |
$156.92
|
| Rate for Payer: PHP Commercial |
$219.69
|
| Rate for Payer: PHP Medicare Advantage |
$156.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,632.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$258.85
|
| Rate for Payer: Priority Health Medicare |
$156.92
|
| Rate for Payer: Priority Health Narrow Network |
$258.85
|
| Rate for Payer: Priority Health SBD |
$258.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.92
|
| Rate for Payer: UHC Medicare Advantage |
$156.92
|
| Rate for Payer: UHCCP Medicaid |
$104.58
|
| Rate for Payer: UMR Bronson Commercial |
$1,863.00
|
|
|
PR CYSTO W/INSERT URETERAL STENT
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 52332
|
| Min. Negotiated Rate |
$98.83 |
| Max. Negotiated Rate |
$2,268.52 |
| Rate for Payer: Aetna Commercial |
$198.07
|
| Rate for Payer: Aetna Medicare |
$153.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.85
|
| Rate for Payer: BCBS Complete |
$103.77
|
| Rate for Payer: BCBS MAPPO |
$147.81
|
| Rate for Payer: BCBS Trust/PPO |
$2,268.52
|
| Rate for Payer: BCN Commercial |
$588.86
|
| Rate for Payer: BCN Medicare Advantage |
$147.81
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$198.07
|
| Rate for Payer: Cofinity Commercial |
$212.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.20
|
| Rate for Payer: Meridian Medicaid |
$103.77
|
| Rate for Payer: Nomi Health Commercial |
$177.37
|
| Rate for Payer: PACE SWMI |
$147.81
|
| Rate for Payer: PHP Commercial |
$206.93
|
| Rate for Payer: PHP Medicare Advantage |
$147.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.99
|
| Rate for Payer: Priority Health Medicare |
$147.81
|
| Rate for Payer: Priority Health Narrow Network |
$244.99
|
| Rate for Payer: Priority Health SBD |
$244.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.81
|
| Rate for Payer: UHC Medicare Advantage |
$147.81
|
| Rate for Payer: UHCCP Medicaid |
$98.83
|
| Rate for Payer: UMR Bronson Commercial |
$398.82
|
|
|
PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
HCPCS 52001
|
| Min. Negotiated Rate |
$181.26 |
| Max. Negotiated Rate |
$1,930.41 |
| Rate for Payer: Aetna Commercial |
$364.40
|
| Rate for Payer: Aetna Medicare |
$282.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.59
|
| Rate for Payer: BCBS Complete |
$190.32
|
| Rate for Payer: BCBS MAPPO |
$271.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,930.41
|
| Rate for Payer: BCN Commercial |
$640.16
|
| Rate for Payer: BCN Medicare Advantage |
$271.94
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cash Price |
$616.00
|
| Rate for Payer: Cofinity Commercial |
$364.40
|
| Rate for Payer: Cofinity Commercial |
$391.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.54
|
| Rate for Payer: Meridian Medicaid |
$190.32
|
| Rate for Payer: Nomi Health Commercial |
$326.33
|
| Rate for Payer: PACE SWMI |
$271.94
|
| Rate for Payer: PHP Commercial |
$380.72
|
| Rate for Payer: PHP Medicare Advantage |
$271.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$500.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$451.12
|
| Rate for Payer: Priority Health Medicare |
$271.94
|
| Rate for Payer: Priority Health Narrow Network |
$451.12
|
| Rate for Payer: Priority Health SBD |
$451.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.94
|
| Rate for Payer: UHC Medicare Advantage |
$271.94
|
| Rate for Payer: UHCCP Medicaid |
$181.26
|
| Rate for Payer: UMR Bronson Commercial |
$354.20
|
|
|
PR CYSTO W/REMOVAL OF LESIONS SMALL
|
Professional
|
Both
|
$2,326.00
|
|
|
Service Code
|
HCPCS 52224
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$2,846.48 |
| Rate for Payer: Aetna Commercial |
$258.62
|
| Rate for Payer: Aetna Medicare |
$200.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.92
|
| Rate for Payer: BCBS Complete |
$134.41
|
| Rate for Payer: BCBS MAPPO |
$193.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,846.48
|
| Rate for Payer: BCN Commercial |
$1,149.37
|
| Rate for Payer: BCN Medicare Advantage |
$193.00
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cash Price |
$1,860.80
|
| Rate for Payer: Cofinity Commercial |
$258.62
|
| Rate for Payer: Cofinity Commercial |
$277.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.65
|
| Rate for Payer: Meridian Medicaid |
$134.41
|
| Rate for Payer: Nomi Health Commercial |
$231.60
|
| Rate for Payer: PACE SWMI |
$193.00
|
| Rate for Payer: PHP Commercial |
$270.20
|
| Rate for Payer: PHP Medicare Advantage |
$193.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,511.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.42
|
| Rate for Payer: Priority Health Medicare |
$193.00
|
| Rate for Payer: Priority Health Narrow Network |
$317.42
|
| Rate for Payer: Priority Health SBD |
$317.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.00
|
| Rate for Payer: UHC Medicare Advantage |
$193.00
|
| Rate for Payer: UHCCP Medicaid |
$128.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,069.96
|
|
|
PR CYSTO W/REMOVAL OF TUMORS SMALL
|
Professional
|
Both
|
$1,077.00
|
|
|
Service Code
|
HCPCS 52234
|
| Min. Negotiated Rate |
$155.49 |
| Max. Negotiated Rate |
$5,244.96 |
| Rate for Payer: Aetna Commercial |
$312.43
|
| Rate for Payer: Aetna Medicare |
$242.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$335.75
|
| Rate for Payer: BCBS Complete |
$163.26
|
| Rate for Payer: BCBS MAPPO |
$233.16
|
| Rate for Payer: BCBS Trust/PPO |
$5,244.96
|
| Rate for Payer: BCN Commercial |
$350.87
|
| Rate for Payer: BCN Medicare Advantage |
$233.16
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cash Price |
$861.60
|
| Rate for Payer: Cofinity Commercial |
$312.43
|
| Rate for Payer: Cofinity Commercial |
$335.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$244.82
|
| Rate for Payer: Meridian Medicaid |
$163.26
|
| Rate for Payer: Nomi Health Commercial |
$279.79
|
| Rate for Payer: PACE SWMI |
$233.16
|
| Rate for Payer: PHP Commercial |
$326.42
|
| Rate for Payer: PHP Medicare Advantage |
$233.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$386.13
|
| Rate for Payer: Priority Health Medicare |
$233.16
|
| Rate for Payer: Priority Health Narrow Network |
$386.13
|
| Rate for Payer: Priority Health SBD |
$386.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$233.16
|
| Rate for Payer: UHC Medicare Advantage |
$233.16
|
| Rate for Payer: UHCCP Medicaid |
$155.49
|
| Rate for Payer: UMR Bronson Commercial |
$495.42
|
|
|
PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
HCPCS 52300
|
| Min. Negotiated Rate |
$176.79 |
| Max. Negotiated Rate |
$1,512.52 |
| Rate for Payer: Aetna Commercial |
$355.34
|
| Rate for Payer: Aetna Medicare |
$275.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$355.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.86
|
| Rate for Payer: BCBS Complete |
$185.63
|
| Rate for Payer: BCBS MAPPO |
$265.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,512.52
|
| Rate for Payer: BCN Commercial |
$400.23
|
| Rate for Payer: BCN Medicare Advantage |
$265.18
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cash Price |
$440.00
|
| Rate for Payer: Cofinity Commercial |
$355.34
|
| Rate for Payer: Cofinity Commercial |
$381.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$265.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$278.44
|
| Rate for Payer: Meridian Medicaid |
$185.63
|
| Rate for Payer: Nomi Health Commercial |
$318.22
|
| Rate for Payer: PACE SWMI |
$265.18
|
| Rate for Payer: PHP Commercial |
$371.25
|
| Rate for Payer: PHP Medicare Advantage |
$265.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$176.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.39
|
| Rate for Payer: Priority Health Medicare |
$265.18
|
| Rate for Payer: Priority Health Narrow Network |
$439.39
|
| Rate for Payer: Priority Health SBD |
$439.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$265.18
|
| Rate for Payer: UHC Medicare Advantage |
$265.18
|
| Rate for Payer: UHCCP Medicaid |
$176.79
|
| Rate for Payer: UMR Bronson Commercial |
$253.00
|
|
|
PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 52301
|
| Min. Negotiated Rate |
$183.18 |
| Max. Negotiated Rate |
$1,202.94 |
| Rate for Payer: Aetna Commercial |
$368.30
|
| Rate for Payer: Aetna Medicare |
$285.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.78
|
| Rate for Payer: BCBS Complete |
$192.34
|
| Rate for Payer: BCBS MAPPO |
$274.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$413.42
|
| Rate for Payer: BCN Medicare Advantage |
$274.85
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$368.30
|
| Rate for Payer: Cofinity Commercial |
$395.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.59
|
| Rate for Payer: Meridian Medicaid |
$192.34
|
| Rate for Payer: Nomi Health Commercial |
$329.82
|
| Rate for Payer: PACE SWMI |
$274.85
|
| Rate for Payer: PHP Commercial |
$384.79
|
| Rate for Payer: PHP Medicare Advantage |
$274.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.38
|
| Rate for Payer: Priority Health Medicare |
$274.85
|
| Rate for Payer: Priority Health Narrow Network |
$455.38
|
| Rate for Payer: Priority Health SBD |
$455.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.85
|
| Rate for Payer: UHC Medicare Advantage |
$274.85
|
| Rate for Payer: UHCCP Medicaid |
$183.18
|
| Rate for Payer: UMR Bronson Commercial |
$268.18
|
|
|
PR CYSTO W/SIMPLE REMOVAL STONE & STENT
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 52310
|
| Min. Negotiated Rate |
$96.28 |
| Max. Negotiated Rate |
$904.45 |
| Rate for Payer: Aetna Commercial |
$193.30
|
| Rate for Payer: Aetna Medicare |
$150.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.72
|
| Rate for Payer: BCBS Complete |
$101.09
|
| Rate for Payer: BCBS MAPPO |
$144.25
|
| Rate for Payer: BCBS Trust/PPO |
$904.45
|
| Rate for Payer: BCN Commercial |
$466.69
|
| Rate for Payer: BCN Medicare Advantage |
$144.25
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cofinity Commercial |
$193.30
|
| Rate for Payer: Cofinity Commercial |
$207.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.46
|
| Rate for Payer: Meridian Medicaid |
$101.09
|
| Rate for Payer: Nomi Health Commercial |
$173.10
|
| Rate for Payer: PACE SWMI |
$144.25
|
| Rate for Payer: PHP Commercial |
$201.95
|
| Rate for Payer: PHP Medicare Advantage |
$144.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$383.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.61
|
| Rate for Payer: Priority Health Medicare |
$144.25
|
| Rate for Payer: Priority Health Narrow Network |
$238.61
|
| Rate for Payer: Priority Health SBD |
$238.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.25
|
| Rate for Payer: UHC Medicare Advantage |
$144.25
|
| Rate for Payer: UHCCP Medicaid |
$96.28
|
| Rate for Payer: UMR Bronson Commercial |
$271.40
|
|
|
PR CYSTO W/SUBURTRIC NJX IMPLT MATRL
|
Professional
|
Both
|
$1,313.00
|
|
|
Service Code
|
HCPCS 52327
|
| Min. Negotiated Rate |
$163.37 |
| Max. Negotiated Rate |
$2,129.58 |
| Rate for Payer: Aetna Commercial |
$330.00
|
| Rate for Payer: Aetna Medicare |
$256.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.63
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS MAPPO |
$246.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,129.58
|
| Rate for Payer: BCN Commercial |
$369.44
|
| 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 |
$330.00
|
| Rate for Payer: Cofinity Commercial |
$354.63
|
| 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: Meridian Medicaid |
$171.54
|
| 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 Choice Medicaid |
$163.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$853.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.84
|
| Rate for Payer: Priority Health Medicare |
$246.27
|
| Rate for Payer: Priority Health Narrow Network |
$405.84
|
| Rate for Payer: Priority Health SBD |
$405.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$246.27
|
| Rate for Payer: UHC Medicare Advantage |
$246.27
|
| Rate for Payer: UHCCP Medicaid |
$163.37
|
| 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 |
$217.47 |
| Max. Negotiated Rate |
$2,659.46 |
| Rate for Payer: Aetna Commercial |
$437.51
|
| Rate for Payer: Aetna Medicare |
$339.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$470.16
|
| Rate for Payer: BCBS Complete |
$228.34
|
| Rate for Payer: BCBS MAPPO |
$326.50
|
| Rate for Payer: BCBS Trust/PPO |
$2,659.46
|
| Rate for Payer: BCN Commercial |
$490.63
|
| 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 |
$437.51
|
| Rate for Payer: Cofinity Commercial |
$470.16
|
| 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: Meridian Medicaid |
$228.34
|
| 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 Choice Medicaid |
$217.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.52
|
| Rate for Payer: Priority Health Medicare |
$326.50
|
| Rate for Payer: Priority Health Narrow Network |
$539.52
|
| Rate for Payer: Priority Health SBD |
$539.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$326.50
|
| Rate for Payer: UHC Medicare Advantage |
$326.50
|
| Rate for Payer: UHCCP Medicaid |
$217.47
|
| 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 |
$179.35 |
| Max. Negotiated Rate |
$2,160.75 |
| Rate for Payer: Aetna Commercial |
$360.38
|
| Rate for Payer: Aetna Medicare |
$279.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.27
|
| Rate for Payer: BCBS Complete |
$188.32
|
| Rate for Payer: BCBS MAPPO |
$268.94
|
| Rate for Payer: BCBS Trust/PPO |
$2,160.75
|
| Rate for Payer: BCN Commercial |
$405.60
|
| 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 |
$360.38
|
| Rate for Payer: Cofinity Commercial |
$387.27
|
| 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: Meridian Medicaid |
$188.32
|
| 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 Choice Medicaid |
$179.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$999.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.32
|
| Rate for Payer: Priority Health Medicare |
$268.94
|
| Rate for Payer: Priority Health Narrow Network |
$446.32
|
| Rate for Payer: Priority Health SBD |
$446.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$268.94
|
| Rate for Payer: UHC Medicare Advantage |
$268.94
|
| Rate for Payer: UHCCP Medicaid |
$179.35
|
| 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 |
$195.32 |
| 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) |
$392.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.04
|
| Rate for Payer: BCBS Complete |
$205.09
|
| Rate for Payer: BCBS MAPPO |
$293.08
|
| Rate for Payer: BCBS Trust/PPO |
$440.60
|
| Rate for Payer: BCN Commercial |
$440.30
|
| 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 |
$392.73
|
| Rate for Payer: Cofinity Commercial |
$422.04
|
| 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: Meridian Medicaid |
$205.09
|
| 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 Choice Medicaid |
$195.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,112.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$485.73
|
| Rate for Payer: Priority Health Medicare |
$293.08
|
| Rate for Payer: Priority Health Narrow Network |
$485.73
|
| Rate for Payer: Priority Health SBD |
$485.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$293.08
|
| Rate for Payer: UHC Medicare Advantage |
$293.08
|
| Rate for Payer: UHCCP Medicaid |
$195.32
|
| 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 |
$247.08 |
| Max. Negotiated Rate |
$7,607.52 |
| Rate for Payer: Aetna Commercial |
$497.09
|
| Rate for Payer: Aetna Medicare |
$385.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.18
|
| Rate for Payer: BCBS Complete |
$259.43
|
| Rate for Payer: BCBS MAPPO |
$370.96
|
| Rate for Payer: BCBS Trust/PPO |
$7,607.52
|
| Rate for Payer: BCN Commercial |
$558.56
|
| 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 |
$497.09
|
| Rate for Payer: Cofinity Commercial |
$534.18
|
| 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: Meridian Medicaid |
$259.43
|
| 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 Choice Medicaid |
$247.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$535.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.62
|
| Rate for Payer: Priority Health Medicare |
$370.96
|
| Rate for Payer: Priority Health Narrow Network |
$614.62
|
| Rate for Payer: Priority Health SBD |
$614.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.96
|
| Rate for Payer: UHC Medicare Advantage |
$370.96
|
| Rate for Payer: UHCCP Medicaid |
$247.08
|
| 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 |
$223.86 |
| 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) |
$450.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$483.97
|
| Rate for Payer: BCBS Complete |
$235.05
|
| Rate for Payer: BCBS MAPPO |
$336.09
|
| Rate for Payer: BCBS Trust/PPO |
$677.97
|
| Rate for Payer: BCN Commercial |
$504.80
|
| 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 |
$450.36
|
| Rate for Payer: Cofinity Commercial |
$483.97
|
| 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: Meridian Medicaid |
$235.05
|
| 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 Choice Medicaid |
$223.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,950.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$555.50
|
| Rate for Payer: Priority Health Medicare |
$336.09
|
| Rate for Payer: Priority Health Narrow Network |
$555.50
|
| Rate for Payer: Priority Health SBD |
$555.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.09
|
| Rate for Payer: UHC Medicare Advantage |
$336.09
|
| Rate for Payer: UHCCP Medicaid |
$223.86
|
| 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 |
$191.49 |
| Max. Negotiated Rate |
$475.62 |
| Rate for Payer: Aetna Commercial |
$385.22
|
| Rate for Payer: Aetna Medicare |
$298.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.97
|
| Rate for Payer: BCBS Complete |
$201.06
|
| Rate for Payer: BCBS MAPPO |
$287.48
|
| Rate for Payer: BCBS Trust/PPO |
$393.43
|
| Rate for Payer: BCN Commercial |
$431.01
|
| 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 |
$385.22
|
| Rate for Payer: Cofinity Commercial |
$413.97
|
| 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: Meridian Medicaid |
$201.06
|
| 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 Choice Medicaid |
$191.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$475.62
|
| Rate for Payer: Priority Health Medicare |
$287.48
|
| Rate for Payer: Priority Health Narrow Network |
$475.62
|
| Rate for Payer: Priority Health SBD |
$475.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$287.48
|
| Rate for Payer: UHC Medicare Advantage |
$287.48
|
| Rate for Payer: UHCCP Medicaid |
$191.49
|
| 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 |
$281.37 |
| Max. Negotiated Rate |
$2,753.98 |
| Rate for Payer: Aetna Commercial |
$566.42
|
| Rate for Payer: Aetna Medicare |
$439.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$566.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.69
|
| Rate for Payer: BCBS Complete |
$295.44
|
| Rate for Payer: BCBS MAPPO |
$422.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,753.98
|
| Rate for Payer: BCN Commercial |
$635.28
|
| 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 |
$566.42
|
| Rate for Payer: Cofinity Commercial |
$608.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$443.84
|
| Rate for Payer: Meridian Medicaid |
$295.44
|
| 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 Choice Medicaid |
$281.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$699.84
|
| Rate for Payer: Priority Health Medicare |
$422.70
|
| Rate for Payer: Priority Health Narrow Network |
$699.84
|
| Rate for Payer: Priority Health SBD |
$699.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$422.70
|
| Rate for Payer: UHC Medicare Advantage |
$422.70
|
| Rate for Payer: UHCCP Medicaid |
$281.37
|
| 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 |
$233.24 |
| Max. Negotiated Rate |
$3,736.67 |
| Rate for Payer: Aetna Commercial |
$469.23
|
| Rate for Payer: Aetna Medicare |
$364.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.24
|
| Rate for Payer: BCBS Complete |
$244.90
|
| Rate for Payer: BCBS MAPPO |
$350.17
|
| Rate for Payer: BCBS Trust/PPO |
$3,736.67
|
| Rate for Payer: BCN Commercial |
$525.33
|
| 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 |
$469.23
|
| Rate for Payer: Cofinity Commercial |
$504.24
|
| 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: Meridian Medicaid |
$244.90
|
| 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 Choice Medicaid |
$233.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$519.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$580.00
|
| Rate for Payer: Priority Health Medicare |
$350.17
|
| Rate for Payer: Priority Health Narrow Network |
$580.00
|
| Rate for Payer: Priority Health SBD |
$580.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.17
|
| Rate for Payer: UHC Medicare Advantage |
$350.17
|
| Rate for Payer: UHCCP Medicaid |
$233.24
|
| 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 |
$248.78 |
| Max. Negotiated Rate |
$3,934.25 |
| Rate for Payer: Aetna Commercial |
$500.54
|
| Rate for Payer: Aetna Medicare |
$388.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.90
|
| Rate for Payer: BCBS Complete |
$261.22
|
| Rate for Payer: BCBS MAPPO |
$373.54
|
| Rate for Payer: BCBS Trust/PPO |
$3,934.25
|
| Rate for Payer: BCN Commercial |
$561.49
|
| 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 |
$500.54
|
| Rate for Payer: Cofinity Commercial |
$537.90
|
| 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: Meridian Medicaid |
$261.22
|
| 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 Choice Medicaid |
$248.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$618.88
|
| Rate for Payer: Priority Health Medicare |
$373.54
|
| Rate for Payer: Priority Health Narrow Network |
$618.88
|
| Rate for Payer: Priority Health SBD |
$618.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.54
|
| Rate for Payer: UHC Medicare Advantage |
$373.54
|
| Rate for Payer: UHCCP Medicaid |
$248.78
|
| Rate for Payer: UMR Bronson Commercial |
$518.42
|
|
|
PR DACRYOCSTORHINOSTOMY
|
Professional
|
Both
|
$1,572.00
|
|
|
Service Code
|
HCPCS 68720
|
| Min. Negotiated Rate |
$245.66 |
| Max. Negotiated Rate |
$1,411.96 |
| Rate for Payer: Aetna Commercial |
$997.00
|
| Rate for Payer: Aetna Medicare |
$773.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,071.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.00
|
| Rate for Payer: BCBS Complete |
$537.65
|
| Rate for Payer: BCBS MAPPO |
$744.03
|
| Rate for Payer: BCBS Trust/PPO |
$245.66
|
| Rate for Payer: BCN Commercial |
$1,172.83
|
| 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 |
$1,071.40
|
| Rate for Payer: Cofinity Commercial |
$997.00
|
| 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: Meridian Medicaid |
$537.65
|
| 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 Choice Medicaid |
$512.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,411.96
|
| Rate for Payer: Priority Health Medicare |
$744.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,411.96
|
| Rate for Payer: Priority Health SBD |
$1,411.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.03
|
| Rate for Payer: UHC Medicare Advantage |
$744.03
|
| Rate for Payer: UHCCP Medicaid |
$512.05
|
| 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 |
$133.50 |
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.50
|
| Rate for Payer: Priority Health Narrow Network |
$133.50
|
| Rate for Payer: Priority Health SBD |
$133.50
|
| 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 |
$11.15 |
| Max. Negotiated Rate |
$67.93 |
| 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 |
$17.89
|
| Rate for Payer: BCBS MAPPO |
$25.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$67.93
|
| 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: Meridian Medicaid |
$17.89
|
| 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 Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.03
|
| Rate for Payer: Priority Health Medicare |
$25.64
|
| Rate for Payer: Priority Health Narrow Network |
$37.03
|
| Rate for Payer: Priority Health SBD |
$37.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.64
|
| Rate for Payer: UHC Medicare Advantage |
$25.64
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
| 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 |
$9.37 |
| Max. Negotiated Rate |
$2,904.75 |
| Rate for Payer: Aetna Commercial |
$18.87
|
| Rate for Payer: Aetna Medicare |
$14.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.28
|
| Rate for Payer: BCBS Complete |
$9.84
|
| Rate for Payer: BCBS MAPPO |
$14.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.75
|
| Rate for Payer: BCN Commercial |
$32.20
|
| 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 |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$20.28
|
| 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: Meridian Medicaid |
$9.84
|
| 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 Choice Medicaid |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.87
|
| Rate for Payer: Priority Health Medicare |
$14.08
|
| Rate for Payer: Priority Health Narrow Network |
$19.87
|
| Rate for Payer: Priority Health SBD |
$19.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.08
|
| Rate for Payer: UHC Medicare Advantage |
$14.08
|
| Rate for Payer: UHCCP Medicaid |
$9.37
|
| 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 |
$25.40 |
| Max. Negotiated Rate |
$955.37 |
| Rate for Payer: Aetna Commercial |
$533.78
|
| Rate for Payer: Aetna Medicare |
$414.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.61
|
| Rate for Payer: BCBS Complete |
$278.89
|
| Rate for Payer: BCBS MAPPO |
$398.34
|
| Rate for Payer: BCBS Trust/PPO |
$25.40
|
| Rate for Payer: BCN Commercial |
$955.37
|
| 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 |
$533.78
|
| Rate for Payer: Cofinity Commercial |
$573.61
|
| 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: Meridian Medicaid |
$278.89
|
| 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 Choice Medicaid |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$791.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$559.89
|
| Rate for Payer: Priority Health Medicare |
$398.34
|
| Rate for Payer: Priority Health Narrow Network |
$559.89
|
| Rate for Payer: Priority Health SBD |
$559.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$398.34
|
| Rate for Payer: UHC Medicare Advantage |
$398.34
|
| Rate for Payer: UHCCP Medicaid |
$265.61
|
| 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 |
$360.18 |
| Max. Negotiated Rate |
$2,904.75 |
| Rate for Payer: Aetna Commercial |
$732.78
|
| Rate for Payer: Aetna Medicare |
$568.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.46
|
| Rate for Payer: BCBS Complete |
$378.19
|
| Rate for Payer: BCBS MAPPO |
$546.85
|
| Rate for Payer: BCBS Trust/PPO |
$2,904.75
|
| Rate for Payer: BCN Commercial |
$820.97
|
| 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 |
$732.78
|
| Rate for Payer: Cofinity Commercial |
$787.46
|
| 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: Meridian Medicaid |
$378.19
|
| 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 Choice Medicaid |
$360.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$760.35
|
| Rate for Payer: Priority Health Medicare |
$546.85
|
| Rate for Payer: Priority Health Narrow Network |
$760.35
|
| Rate for Payer: Priority Health SBD |
$760.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$546.85
|
| Rate for Payer: UHC Medicare Advantage |
$546.85
|
| Rate for Payer: UHCCP Medicaid |
$360.18
|
| Rate for Payer: UMR Bronson Commercial |
$490.82
|
|
