|
PR EXC MUCOSA VESTIBULE MOUTH AS DON GRF
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 40818
|
| Min. Negotiated Rate |
$157.19 |
| Max. Negotiated Rate |
$485.40 |
| Rate for Payer: Aetna Commercial |
$315.70
|
| Rate for Payer: Aetna Medicare |
$245.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.26
|
| Rate for Payer: BCBS Complete |
$165.05
|
| Rate for Payer: BCBS MAPPO |
$235.60
|
| Rate for Payer: BCN Commercial |
$398.38
|
| Rate for Payer: BCN Medicare Advantage |
$235.60
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$315.70
|
| Rate for Payer: Cofinity Commercial |
$339.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.38
|
| Rate for Payer: Meridian Medicaid |
$165.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$259.16
|
| Rate for Payer: Nomi Health Commercial |
$282.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$450.00
|
| Rate for Payer: PACE SWMI |
$235.60
|
| Rate for Payer: PHP Commercial |
$329.84
|
| Rate for Payer: PHP Medicare Advantage |
$235.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$485.40
|
| Rate for Payer: Priority Health Medicare |
$235.60
|
| Rate for Payer: Priority Health SBD |
$485.40
|
| Rate for Payer: Priority Health Tiered Network |
$485.40
|
| Rate for Payer: Railroad Medicare Medicare |
$235.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.71
|
| Rate for Payer: UHC Core |
$463.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$235.60
|
| Rate for Payer: UHC Exchange |
$463.71
|
| Rate for Payer: UHC Medicaid |
$157.19
|
| Rate for Payer: UHCCP Medicaid |
$157.19
|
| Rate for Payer: UMR Bronson Commercial |
$276.00
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV
|
Professional
|
Both
|
$1,962.00
|
|
|
Service Code
|
HCPCS 64788
|
| Min. Negotiated Rate |
$249.42 |
| Max. Negotiated Rate |
$1,471.50 |
| Rate for Payer: Aetna Commercial |
$508.76
|
| Rate for Payer: Aetna Medicare |
$394.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.72
|
| Rate for Payer: BCBS Complete |
$261.89
|
| Rate for Payer: BCBS MAPPO |
$379.67
|
| Rate for Payer: BCN Commercial |
$622.48
|
| Rate for Payer: BCN Medicare Advantage |
$379.67
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cash Price |
$1,569.60
|
| Rate for Payer: Cofinity Commercial |
$508.76
|
| Rate for Payer: Cofinity Commercial |
$546.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.65
|
| Rate for Payer: Meridian Medicaid |
$261.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$417.64
|
| Rate for Payer: Nomi Health Commercial |
$455.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,471.50
|
| Rate for Payer: PACE SWMI |
$379.67
|
| Rate for Payer: PHP Commercial |
$531.54
|
| Rate for Payer: PHP Medicare Advantage |
$379.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$249.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$722.99
|
| Rate for Payer: Priority Health Medicare |
$379.67
|
| Rate for Payer: Priority Health SBD |
$722.99
|
| Rate for Payer: Priority Health Tiered Network |
$722.99
|
| Rate for Payer: Railroad Medicare Medicare |
$379.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$700.02
|
| Rate for Payer: UHC Core |
$700.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$379.67
|
| Rate for Payer: UHC Exchange |
$700.02
|
| Rate for Payer: UHC Medicaid |
$249.42
|
| Rate for Payer: UHCCP Medicaid |
$249.42
|
| Rate for Payer: UMR Bronson Commercial |
$902.52
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA EXTNSV
|
Professional
|
Both
|
$2,063.00
|
|
|
Service Code
|
HCPCS 64792
|
| Min. Negotiated Rate |
$773.62 |
| Max. Negotiated Rate |
$1,894.82 |
| Rate for Payer: Aetna Commercial |
$1,607.38
|
| Rate for Payer: Aetna Medicare |
$1,247.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,607.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,727.34
|
| Rate for Payer: BCBS Complete |
$812.30
|
| Rate for Payer: BCBS MAPPO |
$1,199.54
|
| Rate for Payer: BCN Commercial |
$1,631.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,199.54
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cash Price |
$1,650.40
|
| Rate for Payer: Cofinity Commercial |
$1,607.38
|
| Rate for Payer: Cofinity Commercial |
$1,727.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,199.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,259.52
|
| Rate for Payer: Meridian Medicaid |
$812.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,319.49
|
| Rate for Payer: Nomi Health Commercial |
$1,439.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,547.25
|
| Rate for Payer: PACE SWMI |
$1,199.54
|
| Rate for Payer: PHP Commercial |
$1,679.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,199.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$773.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,894.82
|
| Rate for Payer: Priority Health Medicare |
$1,199.54
|
| Rate for Payer: Priority Health SBD |
$1,894.82
|
| Rate for Payer: Priority Health Tiered Network |
$1,894.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,199.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,859.26
|
| Rate for Payer: UHC Core |
$1,859.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,199.54
|
| Rate for Payer: UHC Exchange |
$1,859.26
|
| Rate for Payer: UHC Medicaid |
$773.62
|
| Rate for Payer: UHCCP Medicaid |
$773.62
|
| Rate for Payer: UMR Bronson Commercial |
$948.98
|
|
|
PR EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV
|
Professional
|
Both
|
$2,452.00
|
|
|
Service Code
|
HCPCS 64790
|
| Min. Negotiated Rate |
$512.69 |
| Max. Negotiated Rate |
$1,839.00 |
| Rate for Payer: Aetna Commercial |
$1,059.59
|
| Rate for Payer: Aetna Medicare |
$822.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.67
|
| Rate for Payer: BCBS Complete |
$538.32
|
| Rate for Payer: BCBS MAPPO |
$790.74
|
| Rate for Payer: BCN Commercial |
$1,299.73
|
| Rate for Payer: BCN Medicare Advantage |
$790.74
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cofinity Commercial |
$1,059.59
|
| Rate for Payer: Cofinity Commercial |
$1,138.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$830.28
|
| Rate for Payer: Meridian Medicaid |
$538.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$869.81
|
| Rate for Payer: Nomi Health Commercial |
$948.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,839.00
|
| Rate for Payer: PACE SWMI |
$790.74
|
| Rate for Payer: PHP Commercial |
$1,107.04
|
| Rate for Payer: PHP Medicare Advantage |
$790.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,509.61
|
| Rate for Payer: Priority Health Medicare |
$790.74
|
| Rate for Payer: Priority Health SBD |
$1,509.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,509.61
|
| Rate for Payer: Railroad Medicare Medicare |
$790.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,465.83
|
| Rate for Payer: UHC Core |
$1,465.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$790.74
|
| Rate for Payer: UHC Exchange |
$1,465.83
|
| Rate for Payer: UHC Medicaid |
$512.69
|
| Rate for Payer: UHCCP Medicaid |
$512.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.92
|
|
|
PR EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
HCPCS 64774
|
| Min. Negotiated Rate |
$262.63 |
| Max. Negotiated Rate |
$941.25 |
| Rate for Payer: Aetna Commercial |
$537.39
|
| Rate for Payer: Aetna Medicare |
$417.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.50
|
| Rate for Payer: BCBS Complete |
$275.76
|
| Rate for Payer: BCBS MAPPO |
$401.04
|
| Rate for Payer: BCN Commercial |
$654.35
|
| Rate for Payer: BCN Medicare Advantage |
$401.04
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cofinity Commercial |
$537.39
|
| Rate for Payer: Cofinity Commercial |
$577.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$401.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$421.09
|
| Rate for Payer: Meridian Medicaid |
$275.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$441.14
|
| Rate for Payer: Nomi Health Commercial |
$481.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$941.25
|
| Rate for Payer: PACE SWMI |
$401.04
|
| Rate for Payer: PHP Commercial |
$561.46
|
| Rate for Payer: PHP Medicare Advantage |
$401.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$760.01
|
| Rate for Payer: Priority Health Medicare |
$401.04
|
| Rate for Payer: Priority Health SBD |
$760.01
|
| Rate for Payer: Priority Health Tiered Network |
$760.01
|
| Rate for Payer: Railroad Medicare Medicare |
$401.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$714.60
|
| Rate for Payer: UHC Core |
$714.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$401.04
|
| Rate for Payer: UHC Exchange |
$714.60
|
| Rate for Payer: UHC Medicaid |
$262.63
|
| Rate for Payer: UHCCP Medicaid |
$262.63
|
| Rate for Payer: UMR Bronson Commercial |
$577.30
|
|
|
PR EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 64776
|
| Min. Negotiated Rate |
$238.77 |
| Max. Negotiated Rate |
$972.75 |
| Rate for Payer: Aetna Commercial |
$488.14
|
| Rate for Payer: Aetna Medicare |
$378.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$524.56
|
| Rate for Payer: BCBS Complete |
$250.71
|
| Rate for Payer: BCBS MAPPO |
$364.28
|
| Rate for Payer: BCN Commercial |
$613.51
|
| Rate for Payer: BCN Medicare Advantage |
$364.28
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$488.14
|
| Rate for Payer: Cofinity Commercial |
$524.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$364.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$382.49
|
| Rate for Payer: Meridian Medicaid |
$250.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$400.71
|
| Rate for Payer: Nomi Health Commercial |
$437.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$972.75
|
| Rate for Payer: PACE SWMI |
$364.28
|
| Rate for Payer: PHP Commercial |
$509.99
|
| Rate for Payer: PHP Medicare Advantage |
$364.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$712.59
|
| Rate for Payer: Priority Health Medicare |
$364.28
|
| Rate for Payer: Priority Health SBD |
$712.59
|
| Rate for Payer: Priority Health Tiered Network |
$712.59
|
| Rate for Payer: Railroad Medicare Medicare |
$364.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$679.47
|
| Rate for Payer: UHC Core |
$679.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$364.28
|
| Rate for Payer: UHC Exchange |
$679.47
|
| Rate for Payer: UHC Medicaid |
$238.77
|
| Rate for Payer: UHCCP Medicaid |
$238.77
|
| Rate for Payer: UMR Bronson Commercial |
$596.62
|
|
|
PR EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT
|
Professional
|
Both
|
$458.00
|
|
|
Service Code
|
HCPCS 64783
|
| Min. Negotiated Rate |
$118.22 |
| Max. Negotiated Rate |
$386.26 |
| Rate for Payer: Aetna Commercial |
$248.42
|
| Rate for Payer: Aetna Medicare |
$192.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.96
|
| Rate for Payer: BCBS Complete |
$124.13
|
| Rate for Payer: BCBS MAPPO |
$185.39
|
| Rate for Payer: BCN Commercial |
$320.20
|
| Rate for Payer: BCN Medicare Advantage |
$185.39
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cash Price |
$366.40
|
| Rate for Payer: Cofinity Commercial |
$248.42
|
| Rate for Payer: Cofinity Commercial |
$266.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.66
|
| Rate for Payer: Meridian Medicaid |
$124.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$203.93
|
| Rate for Payer: Nomi Health Commercial |
$222.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.50
|
| Rate for Payer: PACE SWMI |
$185.39
|
| Rate for Payer: PHP Commercial |
$259.55
|
| Rate for Payer: PHP Medicare Advantage |
$185.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$371.91
|
| Rate for Payer: Priority Health Medicare |
$185.39
|
| Rate for Payer: Priority Health SBD |
$371.91
|
| Rate for Payer: Priority Health Tiered Network |
$371.91
|
| Rate for Payer: Railroad Medicare Medicare |
$185.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.26
|
| Rate for Payer: UHC Core |
$386.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$185.39
|
| Rate for Payer: UHC Exchange |
$386.26
|
| Rate for Payer: UHC Medicaid |
$118.22
|
| Rate for Payer: UHCCP Medicaid |
$118.22
|
| Rate for Payer: UMR Bronson Commercial |
$210.68
|
|
|
PR EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE
|
Professional
|
Both
|
$1,745.00
|
|
|
Service Code
|
HCPCS 64782
|
| Min. Negotiated Rate |
$278.18 |
| Max. Negotiated Rate |
$1,308.75 |
| Rate for Payer: Aetna Commercial |
$569.97
|
| Rate for Payer: Aetna Medicare |
$442.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$612.50
|
| Rate for Payer: BCBS Complete |
$292.09
|
| Rate for Payer: BCBS MAPPO |
$425.35
|
| Rate for Payer: BCN Commercial |
$698.67
|
| Rate for Payer: BCN Medicare Advantage |
$425.35
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Cash Price |
$1,396.00
|
| Rate for Payer: Cofinity Commercial |
$569.97
|
| Rate for Payer: Cofinity Commercial |
$612.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$446.62
|
| Rate for Payer: Meridian Medicaid |
$292.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$467.88
|
| Rate for Payer: Nomi Health Commercial |
$510.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,308.75
|
| Rate for Payer: PACE SWMI |
$425.35
|
| Rate for Payer: PHP Commercial |
$595.49
|
| Rate for Payer: PHP Medicare Advantage |
$425.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$278.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$811.49
|
| Rate for Payer: Priority Health Medicare |
$425.35
|
| Rate for Payer: Priority Health SBD |
$811.49
|
| Rate for Payer: Priority Health Tiered Network |
$811.49
|
| Rate for Payer: Railroad Medicare Medicare |
$425.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$795.89
|
| Rate for Payer: UHC Core |
$795.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$425.35
|
| Rate for Payer: UHC Exchange |
$795.89
|
| Rate for Payer: UHC Medicaid |
$278.18
|
| Rate for Payer: UHCCP Medicaid |
$278.18
|
| Rate for Payer: UMR Bronson Commercial |
$802.70
|
|
|
PR EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC
|
Professional
|
Both
|
$2,564.00
|
|
|
Service Code
|
HCPCS 64784
|
| Min. Negotiated Rate |
$429.20 |
| Max. Negotiated Rate |
$1,923.00 |
| Rate for Payer: Aetna Commercial |
$883.81
|
| Rate for Payer: Aetna Medicare |
$685.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$883.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$949.77
|
| Rate for Payer: BCBS Complete |
$450.66
|
| Rate for Payer: BCBS MAPPO |
$659.56
|
| Rate for Payer: BCN Commercial |
$1,104.52
|
| Rate for Payer: BCN Medicare Advantage |
$659.56
|
| Rate for Payer: Cash Price |
$2,051.20
|
| Rate for Payer: Cash Price |
$2,051.20
|
| Rate for Payer: Cofinity Commercial |
$883.81
|
| Rate for Payer: Cofinity Commercial |
$949.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$659.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$692.54
|
| Rate for Payer: Meridian Medicaid |
$450.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$725.52
|
| Rate for Payer: Nomi Health Commercial |
$791.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,923.00
|
| Rate for Payer: PACE SWMI |
$659.56
|
| Rate for Payer: PHP Commercial |
$923.38
|
| Rate for Payer: PHP Medicare Advantage |
$659.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,282.89
|
| Rate for Payer: Priority Health Medicare |
$659.56
|
| Rate for Payer: Priority Health SBD |
$1,282.89
|
| Rate for Payer: Priority Health Tiered Network |
$1,282.89
|
| Rate for Payer: Railroad Medicare Medicare |
$659.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,277.51
|
| Rate for Payer: UHC Core |
$1,277.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$659.56
|
| Rate for Payer: UHC Exchange |
$1,277.51
|
| Rate for Payer: UHC Medicaid |
$429.20
|
| Rate for Payer: UHCCP Medicaid |
$429.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,179.44
|
|
|
PR EXC PRESAC/SACROCOCCYGEAL TUMOR
|
Professional
|
Both
|
$4,120.00
|
|
|
Service Code
|
HCPCS 49215
|
| Min. Negotiated Rate |
$1,277.57 |
| Max. Negotiated Rate |
$4,028.25 |
| Rate for Payer: Aetna Commercial |
$2,672.63
|
| Rate for Payer: Aetna Medicare |
$2,074.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,672.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,872.08
|
| Rate for Payer: BCBS Complete |
$1,341.45
|
| Rate for Payer: BCBS MAPPO |
$1,994.50
|
| Rate for Payer: BCN Commercial |
$3,306.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,994.50
|
| Rate for Payer: Cash Price |
$3,296.00
|
| Rate for Payer: Cash Price |
$3,296.00
|
| Rate for Payer: Cofinity Commercial |
$2,672.63
|
| Rate for Payer: Cofinity Commercial |
$2,872.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,994.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,094.22
|
| Rate for Payer: Meridian Medicaid |
$1,341.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,193.95
|
| Rate for Payer: Nomi Health Commercial |
$2,393.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,090.00
|
| Rate for Payer: PACE SWMI |
$1,994.50
|
| Rate for Payer: PHP Commercial |
$2,792.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,994.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,277.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,028.25
|
| Rate for Payer: Priority Health Medicare |
$1,994.50
|
| Rate for Payer: Priority Health SBD |
$4,028.25
|
| Rate for Payer: Priority Health Tiered Network |
$4,028.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,994.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,948.88
|
| Rate for Payer: UHC Core |
$3,948.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,994.50
|
| Rate for Payer: UHC Exchange |
$3,948.88
|
| Rate for Payer: UHC Medicaid |
$1,277.57
|
| Rate for Payer: UHCCP Medicaid |
$1,277.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,895.20
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$1,841.00
|
|
|
Service Code
|
HCPCS 42415
|
| Min. Negotiated Rate |
$586.82 |
| Max. Negotiated Rate |
$1,941.01 |
| Rate for Payer: Aetna Commercial |
$1,215.19
|
| Rate for Payer: Aetna Medicare |
$943.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,215.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.88
|
| Rate for Payer: BCBS Complete |
$616.16
|
| Rate for Payer: BCBS MAPPO |
$906.86
|
| Rate for Payer: BCN Commercial |
$1,593.04
|
| Rate for Payer: BCN Medicare Advantage |
$906.86
|
| Rate for Payer: Cash Price |
$1,472.80
|
| Rate for Payer: Cash Price |
$1,472.80
|
| Rate for Payer: Cofinity Commercial |
$1,215.19
|
| Rate for Payer: Cofinity Commercial |
$1,305.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$906.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$952.20
|
| Rate for Payer: Meridian Medicaid |
$616.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$997.55
|
| Rate for Payer: Nomi Health Commercial |
$1,088.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,380.75
|
| Rate for Payer: PACE SWMI |
$906.86
|
| Rate for Payer: PHP Commercial |
$1,269.60
|
| Rate for Payer: PHP Medicare Advantage |
$906.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,941.01
|
| Rate for Payer: Priority Health Medicare |
$906.86
|
| Rate for Payer: Priority Health SBD |
$1,941.01
|
| Rate for Payer: Priority Health Tiered Network |
$1,941.01
|
| Rate for Payer: Railroad Medicare Medicare |
$906.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,842.36
|
| Rate for Payer: UHC Core |
$1,842.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$906.86
|
| Rate for Payer: UHC Exchange |
$1,842.36
|
| Rate for Payer: UHC Medicaid |
$586.82
|
| Rate for Payer: UHCCP Medicaid |
$586.82
|
| Rate for Payer: UMR Bronson Commercial |
$846.86
|
|
|
PR EXC PRTD TUM/PRTD GLND LAT LOBE W/O NRV DSJ
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 42410
|
| Min. Negotiated Rate |
$355.28 |
| Max. Negotiated Rate |
$1,157.09 |
| Rate for Payer: Aetna Commercial |
$731.95
|
| Rate for Payer: Aetna Medicare |
$568.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$731.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.57
|
| Rate for Payer: BCBS Complete |
$373.04
|
| Rate for Payer: BCBS MAPPO |
$546.23
|
| Rate for Payer: BCN Commercial |
$949.65
|
| Rate for Payer: BCN Medicare Advantage |
$546.23
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Cofinity Commercial |
$731.95
|
| Rate for Payer: Cofinity Commercial |
$786.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$573.54
|
| Rate for Payer: Meridian Medicaid |
$373.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$600.85
|
| Rate for Payer: Nomi Health Commercial |
$655.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$915.00
|
| Rate for Payer: PACE SWMI |
$546.23
|
| Rate for Payer: PHP Commercial |
$764.72
|
| Rate for Payer: PHP Medicare Advantage |
$546.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$355.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,157.09
|
| Rate for Payer: Priority Health Medicare |
$546.23
|
| Rate for Payer: Priority Health SBD |
$1,157.09
|
| Rate for Payer: Priority Health Tiered Network |
$1,157.09
|
| Rate for Payer: Railroad Medicare Medicare |
$546.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,087.71
|
| Rate for Payer: UHC Core |
$1,087.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$546.23
|
| Rate for Payer: UHC Exchange |
$1,087.71
|
| Rate for Payer: UHC Medicaid |
$355.28
|
| Rate for Payer: UHCCP Medicaid |
$355.28
|
| Rate for Payer: UMR Bronson Commercial |
$561.20
|
|
|
PR EXC PRTD TUM/PRTD GLND TOT DSJ&PRSRV FACIAL NR
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 42420
|
| Min. Negotiated Rate |
$654.12 |
| Max. Negotiated Rate |
$2,172.18 |
| Rate for Payer: Aetna Commercial |
$1,356.41
|
| Rate for Payer: Aetna Medicare |
$1,052.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,356.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,457.64
|
| Rate for Payer: BCBS Complete |
$686.83
|
| Rate for Payer: BCBS MAPPO |
$1,012.25
|
| Rate for Payer: BCN Commercial |
$1,782.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,012.25
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cofinity Commercial |
$1,356.41
|
| Rate for Payer: Cofinity Commercial |
$1,457.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,012.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,062.86
|
| Rate for Payer: Meridian Medicaid |
$686.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,113.47
|
| Rate for Payer: Nomi Health Commercial |
$1,214.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,569.75
|
| Rate for Payer: PACE SWMI |
$1,012.25
|
| Rate for Payer: PHP Commercial |
$1,417.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,012.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$654.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,172.18
|
| Rate for Payer: Priority Health Medicare |
$1,012.25
|
| Rate for Payer: Priority Health SBD |
$2,172.18
|
| Rate for Payer: Priority Health Tiered Network |
$2,172.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,012.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,071.70
|
| Rate for Payer: UHC Core |
$2,071.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,012.25
|
| Rate for Payer: UHC Exchange |
$2,071.70
|
| Rate for Payer: UHC Medicaid |
$654.12
|
| Rate for Payer: UHCCP Medicaid |
$654.12
|
| Rate for Payer: UMR Bronson Commercial |
$962.78
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST ABDL & PRNL APPROACH
|
Professional
|
Both
|
$2,784.00
|
|
|
Service Code
|
HCPCS 45135
|
| Min. Negotiated Rate |
$762.75 |
| Max. Negotiated Rate |
$2,355.43 |
| Rate for Payer: Aetna Commercial |
$1,578.47
|
| Rate for Payer: Aetna Medicare |
$1,225.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,578.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,696.26
|
| Rate for Payer: BCBS Complete |
$800.89
|
| Rate for Payer: BCBS MAPPO |
$1,177.96
|
| Rate for Payer: BCN Commercial |
$1,933.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,177.96
|
| Rate for Payer: Cash Price |
$2,227.20
|
| Rate for Payer: Cash Price |
$2,227.20
|
| Rate for Payer: Cofinity Commercial |
$1,578.47
|
| Rate for Payer: Cofinity Commercial |
$1,696.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,177.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,236.86
|
| Rate for Payer: Meridian Medicaid |
$800.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,295.76
|
| Rate for Payer: Nomi Health Commercial |
$1,413.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,088.00
|
| Rate for Payer: PACE SWMI |
$1,177.96
|
| Rate for Payer: PHP Commercial |
$1,649.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,177.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,355.43
|
| Rate for Payer: Priority Health Medicare |
$1,177.96
|
| Rate for Payer: Priority Health SBD |
$2,355.43
|
| Rate for Payer: Priority Health Tiered Network |
$2,355.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,177.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,282.69
|
| Rate for Payer: UHC Core |
$2,282.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,177.96
|
| Rate for Payer: UHC Exchange |
$2,282.69
|
| Rate for Payer: UHC Medicaid |
$762.75
|
| Rate for Payer: UHCCP Medicaid |
$762.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,280.64
|
|
|
PR EXC RCT PROCIDENTIA W/ANAST PERINEAL APPROACH
|
Professional
|
Both
|
$2,912.00
|
|
|
Service Code
|
HCPCS 45130
|
| Min. Negotiated Rate |
$640.70 |
| Max. Negotiated Rate |
$2,184.00 |
| Rate for Payer: Aetna Commercial |
$1,330.74
|
| Rate for Payer: Aetna Medicare |
$1,032.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,330.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,430.05
|
| Rate for Payer: BCBS Complete |
$672.74
|
| Rate for Payer: BCBS MAPPO |
$993.09
|
| Rate for Payer: BCN Commercial |
$1,618.93
|
| Rate for Payer: BCN Medicare Advantage |
$993.09
|
| Rate for Payer: Cash Price |
$2,329.60
|
| Rate for Payer: Cash Price |
$2,329.60
|
| Rate for Payer: Cofinity Commercial |
$1,330.74
|
| Rate for Payer: Cofinity Commercial |
$1,430.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$993.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,042.74
|
| Rate for Payer: Meridian Medicaid |
$672.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,092.40
|
| Rate for Payer: Nomi Health Commercial |
$1,191.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,184.00
|
| Rate for Payer: PACE SWMI |
$993.09
|
| Rate for Payer: PHP Commercial |
$1,390.33
|
| Rate for Payer: PHP Medicare Advantage |
$993.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,972.56
|
| Rate for Payer: Priority Health Medicare |
$993.09
|
| Rate for Payer: Priority Health SBD |
$1,972.56
|
| Rate for Payer: Priority Health Tiered Network |
$1,972.56
|
| Rate for Payer: Railroad Medicare Medicare |
$993.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,917.57
|
| Rate for Payer: UHC Core |
$1,917.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$993.09
|
| Rate for Payer: UHC Exchange |
$1,917.57
|
| Rate for Payer: UHC Medicaid |
$640.70
|
| Rate for Payer: UHCCP Medicaid |
$640.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,339.52
|
|
|
PR EXC RCT TUM INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 45172
|
| Min. Negotiated Rate |
$506.94 |
| Max. Negotiated Rate |
$1,509.01 |
| Rate for Payer: Aetna Commercial |
$1,039.49
|
| Rate for Payer: Aetna Medicare |
$806.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,039.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,117.07
|
| Rate for Payer: BCBS Complete |
$532.29
|
| Rate for Payer: BCBS MAPPO |
$775.74
|
| Rate for Payer: BCN Commercial |
$1,238.48
|
| Rate for Payer: BCN Medicare Advantage |
$775.74
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cofinity Commercial |
$1,039.49
|
| Rate for Payer: Cofinity Commercial |
$1,117.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$775.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$814.53
|
| Rate for Payer: Meridian Medicaid |
$532.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$853.31
|
| Rate for Payer: Nomi Health Commercial |
$930.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,454.25
|
| Rate for Payer: PACE SWMI |
$775.74
|
| Rate for Payer: PHP Commercial |
$1,086.04
|
| Rate for Payer: PHP Medicare Advantage |
$775.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$506.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,509.01
|
| Rate for Payer: Priority Health Medicare |
$775.74
|
| Rate for Payer: Priority Health SBD |
$1,509.01
|
| Rate for Payer: Priority Health Tiered Network |
$1,509.01
|
| Rate for Payer: Railroad Medicare Medicare |
$775.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,426.24
|
| Rate for Payer: UHC Core |
$1,426.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$775.74
|
| Rate for Payer: UHC Exchange |
$1,426.24
|
| Rate for Payer: UHC Medicaid |
$506.94
|
| Rate for Payer: UHCCP Medicaid |
$506.94
|
| Rate for Payer: UMR Bronson Commercial |
$891.94
|
|
|
PR EXC RCT TUM NOT INCL MUSCULARIS PROPRIA
|
Professional
|
Both
|
$1,411.00
|
|
|
Service Code
|
HCPCS 45171
|
| Min. Negotiated Rate |
$390.22 |
| Max. Negotiated Rate |
$1,135.24 |
| Rate for Payer: Aetna Commercial |
$794.58
|
| Rate for Payer: Aetna Medicare |
$616.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$853.88
|
| Rate for Payer: BCBS Complete |
$409.73
|
| Rate for Payer: BCBS MAPPO |
$592.97
|
| Rate for Payer: BCN Commercial |
$931.72
|
| Rate for Payer: BCN Medicare Advantage |
$592.97
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cash Price |
$1,128.80
|
| Rate for Payer: Cofinity Commercial |
$794.58
|
| Rate for Payer: Cofinity Commercial |
$853.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$592.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$622.62
|
| Rate for Payer: Meridian Medicaid |
$409.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$652.27
|
| Rate for Payer: Nomi Health Commercial |
$711.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,058.25
|
| Rate for Payer: PACE SWMI |
$592.97
|
| Rate for Payer: PHP Commercial |
$830.16
|
| Rate for Payer: PHP Medicare Advantage |
$592.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,135.24
|
| Rate for Payer: Priority Health Medicare |
$592.97
|
| Rate for Payer: Priority Health SBD |
$1,135.24
|
| Rate for Payer: Priority Health Tiered Network |
$1,135.24
|
| Rate for Payer: Railroad Medicare Medicare |
$592.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,056.88
|
| Rate for Payer: UHC Core |
$1,056.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$592.97
|
| Rate for Payer: UHC Exchange |
$1,056.88
|
| Rate for Payer: UHC Medicaid |
$390.22
|
| Rate for Payer: UHCCP Medicaid |
$390.22
|
| Rate for Payer: UMR Bronson Commercial |
$649.06
|
|
|
PR EXC RCT TUM PROCTOTOMY TRANSSAC/TRANSCOCCYGEAL
|
Professional
|
Both
|
$2,155.00
|
|
|
Service Code
|
HCPCS 45160
|
| Min. Negotiated Rate |
$622.60 |
| Max. Negotiated Rate |
$1,887.02 |
| Rate for Payer: Aetna Commercial |
$1,297.51
|
| Rate for Payer: Aetna Medicare |
$1,007.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.34
|
| Rate for Payer: BCBS Complete |
$653.73
|
| Rate for Payer: BCBS MAPPO |
$968.29
|
| Rate for Payer: BCN Commercial |
$1,548.72
|
| Rate for Payer: BCN Medicare Advantage |
$968.29
|
| Rate for Payer: Cash Price |
$1,724.00
|
| Rate for Payer: Cash Price |
$1,724.00
|
| Rate for Payer: Cofinity Commercial |
$1,297.51
|
| Rate for Payer: Cofinity Commercial |
$1,394.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$968.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,016.70
|
| Rate for Payer: Meridian Medicaid |
$653.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,065.12
|
| Rate for Payer: Nomi Health Commercial |
$1,161.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,616.25
|
| Rate for Payer: PACE SWMI |
$968.29
|
| Rate for Payer: PHP Commercial |
$1,355.61
|
| Rate for Payer: PHP Medicare Advantage |
$968.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$622.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,887.02
|
| Rate for Payer: Priority Health Medicare |
$968.29
|
| Rate for Payer: Priority Health SBD |
$1,887.02
|
| Rate for Payer: Priority Health Tiered Network |
$1,887.02
|
| Rate for Payer: Railroad Medicare Medicare |
$968.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,822.67
|
| Rate for Payer: UHC Core |
$1,822.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$968.29
|
| Rate for Payer: UHC Exchange |
$1,822.67
|
| Rate for Payer: UHC Medicaid |
$622.60
|
| Rate for Payer: UHCCP Medicaid |
$622.60
|
| Rate for Payer: UMR Bronson Commercial |
$991.30
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR
|
Professional
|
Both
|
$1,595.00
|
|
|
Service Code
|
HCPCS 15936
|
| Min. Negotiated Rate |
$534.42 |
| Max. Negotiated Rate |
$1,580.18 |
| Rate for Payer: Aetna Commercial |
$1,104.03
|
| Rate for Payer: Aetna Medicare |
$856.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,186.42
|
| Rate for Payer: BCBS Complete |
$561.14
|
| Rate for Payer: BCBS MAPPO |
$823.90
|
| Rate for Payer: BCN Commercial |
$1,340.57
|
| Rate for Payer: BCN Medicare Advantage |
$823.90
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cash Price |
$1,276.00
|
| Rate for Payer: Cofinity Commercial |
$1,104.03
|
| Rate for Payer: Cofinity Commercial |
$1,186.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$865.10
|
| Rate for Payer: Meridian Medicaid |
$561.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$906.29
|
| Rate for Payer: Nomi Health Commercial |
$988.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,196.25
|
| Rate for Payer: PACE SWMI |
$823.90
|
| Rate for Payer: PHP Commercial |
$1,153.46
|
| Rate for Payer: PHP Medicare Advantage |
$823.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$534.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,226.97
|
| Rate for Payer: Priority Health Medicare |
$823.90
|
| Rate for Payer: Priority Health SBD |
$1,226.97
|
| Rate for Payer: Priority Health Tiered Network |
$1,226.97
|
| Rate for Payer: Railroad Medicare Medicare |
$823.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,580.18
|
| Rate for Payer: UHC Core |
$1,580.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$823.90
|
| Rate for Payer: UHC Exchange |
$1,580.18
|
| Rate for Payer: UHC Medicaid |
$534.42
|
| Rate for Payer: UHCCP Medicaid |
$534.42
|
| Rate for Payer: UMR Bronson Commercial |
$733.70
|
|
|
PR EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC
|
Professional
|
Both
|
$2,170.00
|
|
|
Service Code
|
HCPCS 15937
|
| Min. Negotiated Rate |
$586.39 |
| Max. Negotiated Rate |
$1,827.49 |
| Rate for Payer: Aetna Commercial |
$1,208.73
|
| Rate for Payer: Aetna Medicare |
$938.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,208.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,298.94
|
| Rate for Payer: BCBS Complete |
$615.71
|
| Rate for Payer: BCBS MAPPO |
$902.04
|
| Rate for Payer: BCN Commercial |
$1,479.50
|
| Rate for Payer: BCN Medicare Advantage |
$902.04
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Cofinity Commercial |
$1,208.73
|
| Rate for Payer: Cofinity Commercial |
$1,298.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.14
|
| Rate for Payer: Meridian Medicaid |
$615.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$992.24
|
| Rate for Payer: Nomi Health Commercial |
$1,082.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,627.50
|
| Rate for Payer: PACE SWMI |
$902.04
|
| Rate for Payer: PHP Commercial |
$1,262.86
|
| Rate for Payer: PHP Medicare Advantage |
$902.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,354.12
|
| Rate for Payer: Priority Health Medicare |
$902.04
|
| Rate for Payer: Priority Health SBD |
$1,354.12
|
| Rate for Payer: Priority Health Tiered Network |
$1,354.12
|
| Rate for Payer: Railroad Medicare Medicare |
$902.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,827.49
|
| Rate for Payer: UHC Core |
$1,827.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$902.04
|
| Rate for Payer: UHC Exchange |
$1,827.49
|
| Rate for Payer: UHC Medicaid |
$586.39
|
| Rate for Payer: UHCCP Medicaid |
$586.39
|
| Rate for Payer: UMR Bronson Commercial |
$998.20
|
|
|
PR EXC SUBLINGUAL SALIVARY CYST RANULA
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 42408
|
| Min. Negotiated Rate |
$206.82 |
| Max. Negotiated Rate |
$644.38 |
| Rate for Payer: Aetna Commercial |
$420.75
|
| Rate for Payer: Aetna Medicare |
$326.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.15
|
| Rate for Payer: BCBS Complete |
$217.16
|
| Rate for Payer: BCBS MAPPO |
$313.99
|
| Rate for Payer: BCN Commercial |
$528.85
|
| Rate for Payer: BCN Medicare Advantage |
$313.99
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$420.75
|
| Rate for Payer: Cofinity Commercial |
$452.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.69
|
| Rate for Payer: Meridian Medicaid |
$217.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$345.39
|
| Rate for Payer: Nomi Health Commercial |
$376.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$562.50
|
| Rate for Payer: PACE SWMI |
$313.99
|
| Rate for Payer: PHP Commercial |
$439.59
|
| Rate for Payer: PHP Medicare Advantage |
$313.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$206.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$644.38
|
| Rate for Payer: Priority Health Medicare |
$313.99
|
| Rate for Payer: Priority Health SBD |
$644.38
|
| Rate for Payer: Priority Health Tiered Network |
$644.38
|
| Rate for Payer: Railroad Medicare Medicare |
$313.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.93
|
| Rate for Payer: UHC Core |
$602.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$313.99
|
| Rate for Payer: UHC Exchange |
$602.93
|
| Rate for Payer: UHC Medicaid |
$206.82
|
| Rate for Payer: UHCCP Medicaid |
$206.82
|
| Rate for Payer: UMR Bronson Commercial |
$345.00
|
|
|
PR EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA
|
Professional
|
Both
|
$1,856.00
|
|
|
Service Code
|
HCPCS 25109
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$1,392.00 |
| Rate for Payer: Aetna Commercial |
$657.91
|
| Rate for Payer: Aetna Medicare |
$510.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.01
|
| Rate for Payer: BCBS Complete |
$338.83
|
| Rate for Payer: BCBS MAPPO |
$490.98
|
| Rate for Payer: BCN Commercial |
$826.65
|
| Rate for Payer: BCN Medicare Advantage |
$490.98
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cash Price |
$1,484.80
|
| Rate for Payer: Cofinity Commercial |
$657.91
|
| Rate for Payer: Cofinity Commercial |
$707.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.53
|
| Rate for Payer: Meridian Medicaid |
$338.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$540.08
|
| Rate for Payer: Nomi Health Commercial |
$589.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,392.00
|
| Rate for Payer: PACE SWMI |
$490.98
|
| Rate for Payer: PHP Commercial |
$687.37
|
| Rate for Payer: PHP Medicare Advantage |
$490.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$883.66
|
| Rate for Payer: Priority Health Medicare |
$490.98
|
| Rate for Payer: Priority Health SBD |
$883.66
|
| Rate for Payer: Priority Health Tiered Network |
$883.66
|
| Rate for Payer: Railroad Medicare Medicare |
$490.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$933.04
|
| Rate for Payer: UHC Core |
$933.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$490.98
|
| Rate for Payer: UHC Exchange |
$933.04
|
| Rate for Payer: UHC Medicaid |
$322.70
|
| Rate for Payer: UHCCP Medicaid |
$322.70
|
| Rate for Payer: UMR Bronson Commercial |
$853.76
|
|
|
PR EXC THROMBOSED HEMORRHOID XTRNL
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 46320
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$141.33
|
| Rate for Payer: Aetna Medicare |
$109.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.88
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS MAPPO |
$105.47
|
| Rate for Payer: BCN Commercial |
$171.30
|
| Rate for Payer: BCN Medicare Advantage |
$105.47
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$141.33
|
| Rate for Payer: Cofinity Commercial |
$151.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.74
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.02
|
| Rate for Payer: Nomi Health Commercial |
$126.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.50
|
| Rate for Payer: PACE SWMI |
$105.47
|
| Rate for Payer: PHP Commercial |
$147.66
|
| Rate for Payer: PHP Medicare Advantage |
$105.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$208.72
|
| Rate for Payer: Priority Health Medicare |
$105.47
|
| Rate for Payer: Priority Health SBD |
$208.72
|
| Rate for Payer: Priority Health Tiered Network |
$208.72
|
| Rate for Payer: Railroad Medicare Medicare |
$105.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.25
|
| Rate for Payer: UHC Core |
$195.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$105.47
|
| Rate for Payer: UHC Exchange |
$195.25
|
| Rate for Payer: UHC Medicaid |
$69.01
|
| Rate for Payer: UHCCP Medicaid |
$69.01
|
| Rate for Payer: UMR Bronson Commercial |
$168.36
|
|
|
PR EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 15950
|
| Min. Negotiated Rate |
$375.31 |
| Max. Negotiated Rate |
$1,063.61 |
| Rate for Payer: Aetna Commercial |
$764.52
|
| Rate for Payer: Aetna Medicare |
$593.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.58
|
| Rate for Payer: BCBS Complete |
$394.08
|
| Rate for Payer: BCBS MAPPO |
$570.54
|
| Rate for Payer: BCN Commercial |
$964.59
|
| Rate for Payer: BCN Medicare Advantage |
$570.54
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cofinity Commercial |
$764.52
|
| Rate for Payer: Cofinity Commercial |
$821.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.07
|
| Rate for Payer: Meridian Medicaid |
$394.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$627.59
|
| Rate for Payer: Nomi Health Commercial |
$684.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.25
|
| Rate for Payer: PACE SWMI |
$570.54
|
| Rate for Payer: PHP Commercial |
$798.76
|
| Rate for Payer: PHP Medicare Advantage |
$570.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$882.85
|
| Rate for Payer: Priority Health Medicare |
$570.54
|
| Rate for Payer: Priority Health SBD |
$882.85
|
| Rate for Payer: Priority Health Tiered Network |
$882.85
|
| Rate for Payer: Railroad Medicare Medicare |
$570.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,063.61
|
| Rate for Payer: UHC Core |
$1,063.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$570.54
|
| Rate for Payer: UHC Exchange |
$1,063.61
|
| Rate for Payer: UHC Medicaid |
$375.31
|
| Rate for Payer: UHCCP Medicaid |
$375.31
|
| Rate for Payer: UMR Bronson Commercial |
$568.10
|
|
|
PR EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$2,055.00
|
|
|
Service Code
|
HCPCS 15956
|
| Min. Negotiated Rate |
$697.15 |
| Max. Negotiated Rate |
$2,046.45 |
| Rate for Payer: Aetna Commercial |
$1,436.48
|
| Rate for Payer: Aetna Medicare |
$1,114.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,436.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,543.68
|
| Rate for Payer: BCBS Complete |
$732.01
|
| Rate for Payer: BCBS MAPPO |
$1,072.00
|
| Rate for Payer: BCN Commercial |
$1,754.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,072.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cofinity Commercial |
$1,436.48
|
| Rate for Payer: Cofinity Commercial |
$1,543.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,072.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,125.60
|
| Rate for Payer: Meridian Medicaid |
$732.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,179.20
|
| Rate for Payer: Nomi Health Commercial |
$1,286.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,541.25
|
| Rate for Payer: PACE SWMI |
$1,072.00
|
| Rate for Payer: PHP Commercial |
$1,500.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,072.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$697.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,606.17
|
| Rate for Payer: Priority Health Medicare |
$1,072.00
|
| Rate for Payer: Priority Health SBD |
$1,606.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,606.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,072.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,046.45
|
| Rate for Payer: UHC Core |
$2,046.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,072.00
|
| Rate for Payer: UHC Exchange |
$2,046.45
|
| Rate for Payer: UHC Medicaid |
$697.15
|
| Rate for Payer: UHCCP Medicaid |
$697.15
|
| Rate for Payer: UMR Bronson Commercial |
$945.30
|
|
