|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Aetna Commercial |
$191.20
|
| Rate for Payer: Aetna Medicare |
$148.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.47
|
| Rate for Payer: BCBS MAPPO |
$142.69
|
| Rate for Payer: BCN Commercial |
$226.08
|
| Rate for Payer: BCN Medicare Advantage |
$142.69
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$205.47
|
| Rate for Payer: Cofinity Commercial |
$191.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$156.96
|
| Rate for Payer: Nomi Health Commercial |
$171.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.75
|
| Rate for Payer: PACE SWMI |
$142.69
|
| Rate for Payer: PHP Commercial |
$199.77
|
| Rate for Payer: PHP Medicare Advantage |
$142.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$214.88
|
| Rate for Payer: Priority Health Medicare |
$142.69
|
| Rate for Payer: Priority Health SBD |
$214.88
|
| Rate for Payer: Priority Health Tiered Network |
$214.88
|
| Rate for Payer: Railroad Medicare Medicare |
$142.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.25
|
| Rate for Payer: UHC Core |
$244.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$142.69
|
| Rate for Payer: UHC Exchange |
$244.25
|
| Rate for Payer: UMR Bronson Commercial |
$155.02
|
|
|
PR FUROSEMIDE INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1940
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$0.59
|
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.59
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.00
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
|
|
PR GARAMYCIN GENTAMICIN INJ
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1580
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.59
|
| Rate for Payer: Aetna Medicare |
$2.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: BCBS MAPPO |
$1.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.59
|
| Rate for Payer: BCN Commercial |
$0.67
|
| Rate for Payer: BCN Medicare Advantage |
$1.93
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.59
|
| Rate for Payer: Cofinity Commercial |
$2.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.12
|
| Rate for Payer: Nomi Health Commercial |
$2.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.00
|
| Rate for Payer: PACE SWMI |
$1.93
|
| Rate for Payer: PHP Commercial |
$2.70
|
| Rate for Payer: PHP Medicare Advantage |
$1.93
|
| Rate for Payer: Priority Health Medicare |
$1.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Core |
$2.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.93
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
|
|
PR GAS DIL/WSHOT DETER LNG VOL DSTRBJ VNTJ&CLSG VOL
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$46.31 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Aetna Commercial |
$62.06
|
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.69
|
| Rate for Payer: BCBS MAPPO |
$46.31
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: BCN Medicare Advantage |
$46.31
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cofinity Commercial |
$62.06
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.94
|
| Rate for Payer: Nomi Health Commercial |
$55.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.25
|
| Rate for Payer: PACE SWMI |
$46.31
|
| Rate for Payer: PHP Commercial |
$64.83
|
| Rate for Payer: PHP Medicare Advantage |
$46.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$62.00
|
| Rate for Payer: Priority Health Medicare |
$46.31
|
| Rate for Payer: Priority Health SBD |
$62.00
|
| Rate for Payer: Priority Health Tiered Network |
$62.00
|
| Rate for Payer: Railroad Medicare Medicare |
$46.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.78
|
| Rate for Payer: UHC Core |
$66.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.31
|
| Rate for Payer: UHC Exchange |
$66.78
|
| Rate for Payer: UMR Bronson Commercial |
$58.42
|
|
|
PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 43753
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$40.23 |
| Rate for Payer: Aetna Commercial |
$27.42
|
| Rate for Payer: Aetna Medicare |
$21.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.46
|
| Rate for Payer: BCBS Complete |
$13.64
|
| Rate for Payer: BCBS MAPPO |
$20.46
|
| Rate for Payer: BCN Commercial |
$31.87
|
| Rate for Payer: BCN Medicare Advantage |
$20.46
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$27.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.48
|
| Rate for Payer: Meridian Medicaid |
$13.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.51
|
| Rate for Payer: Nomi Health Commercial |
$24.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: PACE SWMI |
$20.46
|
| Rate for Payer: PHP Commercial |
$28.64
|
| Rate for Payer: PHP Medicare Advantage |
$20.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$38.83
|
| Rate for Payer: Priority Health Medicare |
$20.46
|
| Rate for Payer: Priority Health SBD |
$38.83
|
| Rate for Payer: Priority Health Tiered Network |
$38.83
|
| Rate for Payer: Railroad Medicare Medicare |
$20.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.23
|
| Rate for Payer: UHC Core |
$40.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$20.46
|
| Rate for Payer: UHC Exchange |
$40.23
|
| Rate for Payer: UHC Medicaid |
$12.99
|
| Rate for Payer: UHCCP Medicaid |
$12.99
|
| Rate for Payer: UMR Bronson Commercial |
$23.92
|
|
|
PR GASTROCNEMIUS RECESSION
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 27687
|
| Min. Negotiated Rate |
$276.90 |
| Max. Negotiated Rate |
$1,173.00 |
| Rate for Payer: Aetna Commercial |
$565.04
|
| Rate for Payer: Aetna Medicare |
$438.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$607.20
|
| Rate for Payer: BCBS Complete |
$290.75
|
| Rate for Payer: BCBS MAPPO |
$421.67
|
| Rate for Payer: BCN Commercial |
$693.69
|
| Rate for Payer: BCN Medicare Advantage |
$421.67
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$565.04
|
| Rate for Payer: Cofinity Commercial |
$607.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$442.75
|
| Rate for Payer: Meridian Medicaid |
$290.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$463.84
|
| Rate for Payer: Nomi Health Commercial |
$506.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,173.00
|
| Rate for Payer: PACE SWMI |
$421.67
|
| Rate for Payer: PHP Commercial |
$590.34
|
| Rate for Payer: PHP Medicare Advantage |
$421.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$276.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$741.54
|
| Rate for Payer: Priority Health Medicare |
$421.67
|
| Rate for Payer: Priority Health SBD |
$741.54
|
| Rate for Payer: Priority Health Tiered Network |
$741.54
|
| Rate for Payer: Railroad Medicare Medicare |
$421.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$791.20
|
| Rate for Payer: UHC Core |
$791.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$421.67
|
| Rate for Payer: UHC Exchange |
$791.20
|
| Rate for Payer: UHC Medicaid |
$276.90
|
| Rate for Payer: UHCCP Medicaid |
$276.90
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
PR GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,561.00
|
|
|
Service Code
|
HCPCS 43810
|
| Min. Negotiated Rate |
$609.61 |
| Max. Negotiated Rate |
$1,920.75 |
| Rate for Payer: Aetna Commercial |
$1,276.14
|
| Rate for Payer: Aetna Medicare |
$990.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.37
|
| Rate for Payer: BCBS Complete |
$640.09
|
| Rate for Payer: BCBS MAPPO |
$952.34
|
| Rate for Payer: BCN Commercial |
$1,531.30
|
| Rate for Payer: BCN Medicare Advantage |
$952.34
|
| Rate for Payer: Cash Price |
$2,048.80
|
| Rate for Payer: Cash Price |
$2,048.80
|
| Rate for Payer: Cofinity Commercial |
$1,276.14
|
| Rate for Payer: Cofinity Commercial |
$1,371.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$952.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$999.96
|
| Rate for Payer: Meridian Medicaid |
$640.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,047.57
|
| Rate for Payer: Nomi Health Commercial |
$1,142.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,920.75
|
| Rate for Payer: PACE SWMI |
$952.34
|
| Rate for Payer: PHP Commercial |
$1,333.28
|
| Rate for Payer: PHP Medicare Advantage |
$952.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$609.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,865.77
|
| Rate for Payer: Priority Health Medicare |
$952.34
|
| Rate for Payer: Priority Health SBD |
$1,865.77
|
| Rate for Payer: Priority Health Tiered Network |
$1,865.77
|
| Rate for Payer: Railroad Medicare Medicare |
$952.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,818.28
|
| Rate for Payer: UHC Core |
$1,818.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$952.34
|
| Rate for Payer: UHC Exchange |
$1,818.28
|
| Rate for Payer: UHC Medicaid |
$609.61
|
| Rate for Payer: UHCCP Medicaid |
$609.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,178.06
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$162.38 |
| Max. Negotiated Rate |
$292.76 |
| Rate for Payer: Aetna Commercial |
$252.11
|
| Rate for Payer: Aetna Commercial |
$252.11
|
| Rate for Payer: Aetna Medicare |
$195.67
|
| Rate for Payer: Aetna Medicare |
$195.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.11
|
| Rate for Payer: BCBS MAPPO |
$188.14
|
| Rate for Payer: BCBS MAPPO |
$188.14
|
| Rate for Payer: BCN Commercial |
$278.87
|
| Rate for Payer: BCN Commercial |
$278.87
|
| Rate for Payer: BCN Medicare Advantage |
$188.14
|
| Rate for Payer: BCN Medicare Advantage |
$188.14
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$270.92
|
| Rate for Payer: Cofinity Commercial |
$270.92
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Cofinity Commercial |
$252.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$206.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$206.95
|
| Rate for Payer: Nomi Health Commercial |
$225.77
|
| Rate for Payer: Nomi Health Commercial |
$225.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.00
|
| Rate for Payer: PACE SWMI |
$188.14
|
| Rate for Payer: PACE SWMI |
$188.14
|
| Rate for Payer: PHP Commercial |
$263.40
|
| Rate for Payer: PHP Commercial |
$263.40
|
| Rate for Payer: PHP Medicare Advantage |
$188.14
|
| Rate for Payer: PHP Medicare Advantage |
$188.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$257.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$257.18
|
| Rate for Payer: Priority Health Medicare |
$188.14
|
| Rate for Payer: Priority Health Medicare |
$188.14
|
| Rate for Payer: Priority Health SBD |
$257.18
|
| Rate for Payer: Priority Health SBD |
$257.18
|
| Rate for Payer: Priority Health Tiered Network |
$257.18
|
| Rate for Payer: Priority Health Tiered Network |
$257.18
|
| Rate for Payer: Railroad Medicare Medicare |
$188.14
|
| Rate for Payer: Railroad Medicare Medicare |
$188.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.76
|
| Rate for Payer: UHC Core |
$292.76
|
| Rate for Payer: UHC Core |
$292.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.14
|
| Rate for Payer: UHC Exchange |
$292.76
|
| Rate for Payer: UHC Exchange |
$292.76
|
| Rate for Payer: UMR Bronson Commercial |
$58.88
|
| Rate for Payer: UMR Bronson Commercial |
$162.38
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$147.66 |
| Max. Negotiated Rate |
$255.49 |
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna Commercial |
$233.62
|
| Rate for Payer: Aetna Medicare |
$181.31
|
| Rate for Payer: Aetna Medicare |
$181.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.62
|
| Rate for Payer: BCBS MAPPO |
$174.34
|
| Rate for Payer: BCBS MAPPO |
$174.34
|
| Rate for Payer: BCN Commercial |
$246.50
|
| Rate for Payer: BCN Commercial |
$246.50
|
| Rate for Payer: BCN Medicare Advantage |
$174.34
|
| Rate for Payer: BCN Medicare Advantage |
$174.34
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cofinity Commercial |
$251.05
|
| Rate for Payer: Cofinity Commercial |
$251.05
|
| Rate for Payer: Cofinity Commercial |
$233.62
|
| Rate for Payer: Cofinity Commercial |
$233.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$191.77
|
| Rate for Payer: Nomi Health Commercial |
$209.21
|
| Rate for Payer: Nomi Health Commercial |
$209.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: PACE SWMI |
$174.34
|
| Rate for Payer: PACE SWMI |
$174.34
|
| Rate for Payer: PHP Commercial |
$244.08
|
| Rate for Payer: PHP Commercial |
$244.08
|
| Rate for Payer: PHP Medicare Advantage |
$174.34
|
| Rate for Payer: PHP Medicare Advantage |
$174.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$227.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$227.33
|
| Rate for Payer: Priority Health Medicare |
$174.34
|
| Rate for Payer: Priority Health Medicare |
$174.34
|
| Rate for Payer: Priority Health SBD |
$227.33
|
| Rate for Payer: Priority Health SBD |
$227.33
|
| Rate for Payer: Priority Health Tiered Network |
$227.33
|
| Rate for Payer: Priority Health Tiered Network |
$227.33
|
| Rate for Payer: Railroad Medicare Medicare |
$174.34
|
| Rate for Payer: Railroad Medicare Medicare |
$174.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.49
|
| Rate for Payer: UHC Core |
$255.49
|
| Rate for Payer: UHC Core |
$255.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.34
|
| Rate for Payer: UHC Exchange |
$255.49
|
| Rate for Payer: UHC Exchange |
$255.49
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
| Rate for Payer: UMR Bronson Commercial |
$147.66
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$414.46 |
| Max. Negotiated Rate |
$737.33 |
| Rate for Payer: Aetna Commercial |
$622.07
|
| Rate for Payer: Aetna Commercial |
$622.07
|
| Rate for Payer: Aetna Medicare |
$482.80
|
| Rate for Payer: Aetna Medicare |
$482.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$668.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$668.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$622.07
|
| Rate for Payer: BCBS MAPPO |
$464.23
|
| Rate for Payer: BCBS MAPPO |
$464.23
|
| Rate for Payer: BCN Commercial |
$652.85
|
| Rate for Payer: BCN Commercial |
$652.85
|
| Rate for Payer: BCN Medicare Advantage |
$464.23
|
| Rate for Payer: BCN Medicare Advantage |
$464.23
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$668.49
|
| Rate for Payer: Cofinity Commercial |
$668.49
|
| Rate for Payer: Cofinity Commercial |
$622.07
|
| Rate for Payer: Cofinity Commercial |
$622.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$464.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$487.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$487.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$510.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$510.65
|
| Rate for Payer: Nomi Health Commercial |
$557.08
|
| Rate for Payer: Nomi Health Commercial |
$557.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$675.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.50
|
| Rate for Payer: PACE SWMI |
$464.23
|
| Rate for Payer: PACE SWMI |
$464.23
|
| Rate for Payer: PHP Commercial |
$649.92
|
| Rate for Payer: PHP Commercial |
$649.92
|
| Rate for Payer: PHP Medicare Advantage |
$464.23
|
| Rate for Payer: PHP Medicare Advantage |
$464.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$602.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$602.07
|
| Rate for Payer: Priority Health Medicare |
$464.23
|
| Rate for Payer: Priority Health Medicare |
$464.23
|
| Rate for Payer: Priority Health SBD |
$602.07
|
| Rate for Payer: Priority Health SBD |
$602.07
|
| Rate for Payer: Priority Health Tiered Network |
$602.07
|
| Rate for Payer: Priority Health Tiered Network |
$602.07
|
| Rate for Payer: Railroad Medicare Medicare |
$464.23
|
| Rate for Payer: Railroad Medicare Medicare |
$464.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$737.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$737.33
|
| Rate for Payer: UHC Core |
$737.33
|
| Rate for Payer: UHC Core |
$737.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$464.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$464.23
|
| Rate for Payer: UHC Exchange |
$737.33
|
| Rate for Payer: UHC Exchange |
$737.33
|
| Rate for Payer: UMR Bronson Commercial |
$80.04
|
| Rate for Payer: UMR Bronson Commercial |
$414.46
|
|
|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,700.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$801.31 |
| Max. Negotiated Rate |
$2,463.44 |
| Rate for Payer: Aetna Commercial |
$1,676.38
|
| Rate for Payer: Aetna Medicare |
$1,301.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,676.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,801.48
|
| Rate for Payer: BCBS Complete |
$841.38
|
| Rate for Payer: BCBS MAPPO |
$1,251.03
|
| Rate for Payer: BCN Commercial |
$2,021.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,251.03
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cash Price |
$2,160.00
|
| Rate for Payer: Cofinity Commercial |
$1,676.38
|
| Rate for Payer: Cofinity Commercial |
$1,801.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,251.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,313.58
|
| Rate for Payer: Meridian Medicaid |
$841.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,376.13
|
| Rate for Payer: Nomi Health Commercial |
$1,501.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,025.00
|
| Rate for Payer: PACE SWMI |
$1,251.03
|
| Rate for Payer: PHP Commercial |
$1,751.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,251.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$801.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,463.44
|
| Rate for Payer: Priority Health Medicare |
$1,251.03
|
| Rate for Payer: Priority Health SBD |
$2,463.44
|
| Rate for Payer: Priority Health Tiered Network |
$2,463.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,251.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,399.58
|
| Rate for Payer: UHC Core |
$2,399.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,251.03
|
| Rate for Payer: UHC Exchange |
$2,399.58
|
| Rate for Payer: UHC Medicaid |
$801.31
|
| Rate for Payer: UHCCP Medicaid |
$801.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,242.00
|
|
|
PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$2,658.00
|
|
|
Service Code
|
HCPCS 43825
|
| Min. Negotiated Rate |
$784.69 |
| Max. Negotiated Rate |
$2,403.98 |
| Rate for Payer: Aetna Commercial |
$1,642.95
|
| Rate for Payer: Aetna Medicare |
$1,275.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,642.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,765.56
|
| Rate for Payer: BCBS Complete |
$823.92
|
| Rate for Payer: BCBS MAPPO |
$1,226.08
|
| Rate for Payer: BCN Commercial |
$1,973.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,226.08
|
| Rate for Payer: Cash Price |
$2,126.40
|
| Rate for Payer: Cash Price |
$2,126.40
|
| Rate for Payer: Cofinity Commercial |
$1,642.95
|
| Rate for Payer: Cofinity Commercial |
$1,765.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,226.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,287.38
|
| Rate for Payer: Meridian Medicaid |
$823.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,348.69
|
| Rate for Payer: Nomi Health Commercial |
$1,471.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,993.50
|
| Rate for Payer: PACE SWMI |
$1,226.08
|
| Rate for Payer: PHP Commercial |
$1,716.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,226.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$784.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,403.98
|
| Rate for Payer: Priority Health Medicare |
$1,226.08
|
| Rate for Payer: Priority Health SBD |
$2,403.98
|
| Rate for Payer: Priority Health Tiered Network |
$2,403.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,226.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,340.68
|
| Rate for Payer: UHC Core |
$2,340.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,226.08
|
| Rate for Payer: UHC Exchange |
$2,340.68
|
| Rate for Payer: UHC Medicaid |
$784.69
|
| Rate for Payer: UHCCP Medicaid |
$784.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,222.68
|
|
|
PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$2,906.00
|
|
|
Service Code
|
HCPCS 43840
|
| Min. Negotiated Rate |
$811.53 |
| Max. Negotiated Rate |
$2,490.13 |
| Rate for Payer: Aetna Commercial |
$1,698.96
|
| Rate for Payer: Aetna Medicare |
$1,318.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,698.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,825.75
|
| Rate for Payer: BCBS Complete |
$852.11
|
| Rate for Payer: BCBS MAPPO |
$1,267.88
|
| Rate for Payer: BCN Commercial |
$2,043.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,267.88
|
| Rate for Payer: Cash Price |
$2,324.80
|
| Rate for Payer: Cash Price |
$2,324.80
|
| Rate for Payer: Cofinity Commercial |
$1,698.96
|
| Rate for Payer: Cofinity Commercial |
$1,825.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,267.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,331.27
|
| Rate for Payer: Meridian Medicaid |
$852.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,394.67
|
| Rate for Payer: Nomi Health Commercial |
$1,521.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,179.50
|
| Rate for Payer: PACE SWMI |
$1,267.88
|
| Rate for Payer: PHP Commercial |
$1,775.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,267.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,490.13
|
| Rate for Payer: Priority Health Medicare |
$1,267.88
|
| Rate for Payer: Priority Health SBD |
$2,490.13
|
| Rate for Payer: Priority Health Tiered Network |
$2,490.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1,267.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,429.67
|
| Rate for Payer: UHC Core |
$2,429.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,267.88
|
| Rate for Payer: UHC Exchange |
$2,429.67
|
| Rate for Payer: UHC Medicaid |
$811.53
|
| Rate for Payer: UHCCP Medicaid |
$811.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,336.76
|
|
|
PR GASTROSTOMY OPEN NEONATAL FOR FEEDING
|
Professional
|
Both
|
$2,196.00
|
|
|
Service Code
|
HCPCS 43831
|
| Min. Negotiated Rate |
$381.91 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Aetna Commercial |
$786.19
|
| Rate for Payer: Aetna Medicare |
$610.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.86
|
| Rate for Payer: BCBS Complete |
$401.01
|
| Rate for Payer: BCBS MAPPO |
$586.71
|
| Rate for Payer: BCN Commercial |
$923.26
|
| Rate for Payer: BCN Medicare Advantage |
$586.71
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Cofinity Commercial |
$786.19
|
| Rate for Payer: Cofinity Commercial |
$844.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$616.05
|
| Rate for Payer: Meridian Medicaid |
$401.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$645.38
|
| Rate for Payer: Nomi Health Commercial |
$704.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,647.00
|
| Rate for Payer: PACE SWMI |
$586.71
|
| Rate for Payer: PHP Commercial |
$821.39
|
| Rate for Payer: PHP Medicare Advantage |
$586.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$381.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,124.92
|
| Rate for Payer: Priority Health Medicare |
$586.71
|
| Rate for Payer: Priority Health SBD |
$1,124.92
|
| Rate for Payer: Priority Health Tiered Network |
$1,124.92
|
| Rate for Payer: Railroad Medicare Medicare |
$586.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,062.84
|
| Rate for Payer: UHC Core |
$1,062.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$586.71
|
| Rate for Payer: UHC Exchange |
$1,062.84
|
| Rate for Payer: UHC Medicaid |
$381.91
|
| Rate for Payer: UHCCP Medicaid |
$381.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,010.16
|
|
|
PR GASTROSTOMY OPEN W/CONSTJ GASTRIC TUBE
|
Professional
|
Both
|
$3,022.00
|
|
|
Service Code
|
HCPCS 43832
|
| Min. Negotiated Rate |
$628.78 |
| Max. Negotiated Rate |
$2,266.50 |
| Rate for Payer: Aetna Commercial |
$1,314.47
|
| Rate for Payer: Aetna Medicare |
$1,020.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,314.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,412.57
|
| Rate for Payer: BCBS Complete |
$660.22
|
| Rate for Payer: BCBS MAPPO |
$980.95
|
| Rate for Payer: BCN Commercial |
$1,575.11
|
| Rate for Payer: BCN Medicare Advantage |
$980.95
|
| Rate for Payer: Cash Price |
$2,417.60
|
| Rate for Payer: Cash Price |
$2,417.60
|
| Rate for Payer: Cofinity Commercial |
$1,314.47
|
| Rate for Payer: Cofinity Commercial |
$1,412.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$980.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.00
|
| Rate for Payer: Meridian Medicaid |
$660.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,079.05
|
| Rate for Payer: Nomi Health Commercial |
$1,177.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,266.50
|
| Rate for Payer: PACE SWMI |
$980.95
|
| Rate for Payer: PHP Commercial |
$1,373.33
|
| Rate for Payer: PHP Medicare Advantage |
$980.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$628.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,919.17
|
| Rate for Payer: Priority Health Medicare |
$980.95
|
| Rate for Payer: Priority Health SBD |
$1,919.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,919.17
|
| Rate for Payer: Railroad Medicare Medicare |
$980.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,856.63
|
| Rate for Payer: UHC Core |
$1,856.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$980.95
|
| Rate for Payer: UHC Exchange |
$1,856.63
|
| Rate for Payer: UHC Medicaid |
$628.78
|
| Rate for Payer: UHCCP Medicaid |
$628.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,390.12
|
|
|
PR GASTROSTOMY OPEN W/O CONSTJ GASTRIC TUBE SPX
|
Professional
|
Both
|
$2,196.00
|
|
|
Service Code
|
HCPCS 43830
|
| Min. Negotiated Rate |
$431.11 |
| Max. Negotiated Rate |
$1,647.00 |
| Rate for Payer: Aetna Commercial |
$894.18
|
| Rate for Payer: Aetna Medicare |
$693.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.91
|
| Rate for Payer: BCBS Complete |
$452.67
|
| Rate for Payer: BCBS MAPPO |
$667.30
|
| Rate for Payer: BCN Commercial |
$1,060.21
|
| Rate for Payer: BCN Medicare Advantage |
$667.30
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Cash Price |
$1,756.80
|
| Rate for Payer: Cofinity Commercial |
$894.18
|
| Rate for Payer: Cofinity Commercial |
$960.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$667.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$700.66
|
| Rate for Payer: Meridian Medicaid |
$452.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$734.03
|
| Rate for Payer: Nomi Health Commercial |
$800.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,647.00
|
| Rate for Payer: PACE SWMI |
$667.30
|
| Rate for Payer: PHP Commercial |
$934.22
|
| Rate for Payer: PHP Medicare Advantage |
$667.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,291.79
|
| Rate for Payer: Priority Health Medicare |
$667.30
|
| Rate for Payer: Priority Health SBD |
$1,291.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,291.79
|
| Rate for Payer: Railroad Medicare Medicare |
$667.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,245.75
|
| Rate for Payer: UHC Core |
$1,245.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$667.30
|
| Rate for Payer: UHC Exchange |
$1,245.75
|
| Rate for Payer: UHC Medicaid |
$431.11
|
| Rate for Payer: UHCCP Medicaid |
$431.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,010.16
|
|
|
PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,324.00
|
|
|
Service Code
|
HCPCS 43500
|
| Min. Negotiated Rate |
$479.46 |
| Max. Negotiated Rate |
$1,743.00 |
| Rate for Payer: Aetna Commercial |
$999.81
|
| Rate for Payer: Aetna Medicare |
$775.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.81
|
| Rate for Payer: BCBS Complete |
$503.43
|
| Rate for Payer: BCBS MAPPO |
$746.13
|
| Rate for Payer: BCN Commercial |
$1,188.18
|
| Rate for Payer: BCN Medicare Advantage |
$746.13
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cash Price |
$1,859.20
|
| Rate for Payer: Cofinity Commercial |
$1,074.43
|
| Rate for Payer: Cofinity Commercial |
$999.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.44
|
| Rate for Payer: Meridian Medicaid |
$503.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$820.74
|
| Rate for Payer: Nomi Health Commercial |
$895.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,743.00
|
| Rate for Payer: PACE SWMI |
$746.13
|
| Rate for Payer: PHP Commercial |
$1,044.58
|
| Rate for Payer: PHP Medicare Advantage |
$746.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,447.73
|
| Rate for Payer: Priority Health Medicare |
$746.13
|
| Rate for Payer: Priority Health SBD |
$1,447.73
|
| Rate for Payer: Priority Health Tiered Network |
$1,447.73
|
| Rate for Payer: Railroad Medicare Medicare |
$746.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,395.50
|
| Rate for Payer: UHC Core |
$1,395.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$746.13
|
| Rate for Payer: UHC Exchange |
$1,395.50
|
| Rate for Payer: UHC Medicaid |
$479.46
|
| Rate for Payer: UHCCP Medicaid |
$479.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,069.04
|
|
|
PR GASTROTOMY W/SUTR RPR PRE-ESOPG/GASTRIC LAC
|
Professional
|
Both
|
$3,057.00
|
|
|
Service Code
|
HCPCS 43502
|
| Min. Negotiated Rate |
$907.59 |
| Max. Negotiated Rate |
$2,791.09 |
| Rate for Payer: Aetna Commercial |
$1,903.40
|
| Rate for Payer: Aetna Medicare |
$1,477.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,903.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,045.45
|
| Rate for Payer: BCBS Complete |
$952.97
|
| Rate for Payer: BCBS MAPPO |
$1,420.45
|
| Rate for Payer: BCN Commercial |
$2,290.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,420.45
|
| Rate for Payer: Cash Price |
$2,445.60
|
| Rate for Payer: Cash Price |
$2,445.60
|
| Rate for Payer: Cofinity Commercial |
$1,903.40
|
| Rate for Payer: Cofinity Commercial |
$2,045.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,420.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,491.47
|
| Rate for Payer: Meridian Medicaid |
$952.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,562.49
|
| Rate for Payer: Nomi Health Commercial |
$1,704.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,292.75
|
| Rate for Payer: PACE SWMI |
$1,420.45
|
| Rate for Payer: PHP Commercial |
$1,988.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,420.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$907.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,791.09
|
| Rate for Payer: Priority Health Medicare |
$1,420.45
|
| Rate for Payer: Priority Health SBD |
$2,791.09
|
| Rate for Payer: Priority Health Tiered Network |
$2,791.09
|
| Rate for Payer: Railroad Medicare Medicare |
$1,420.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,727.45
|
| Rate for Payer: UHC Core |
$2,727.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,420.45
|
| Rate for Payer: UHC Exchange |
$2,727.45
|
| Rate for Payer: UHC Medicaid |
$907.59
|
| Rate for Payer: UHCCP Medicaid |
$907.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,406.22
|
|
|
PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER
|
Professional
|
Both
|
$4,095.00
|
|
|
Service Code
|
HCPCS 43501
|
| Min. Negotiated Rate |
$808.97 |
| Max. Negotiated Rate |
$3,071.25 |
| Rate for Payer: Aetna Commercial |
$1,694.18
|
| Rate for Payer: Aetna Medicare |
$1,314.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,694.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,820.61
|
| Rate for Payer: BCBS Complete |
$849.42
|
| Rate for Payer: BCBS MAPPO |
$1,264.31
|
| Rate for Payer: BCN Commercial |
$2,021.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,264.31
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Cash Price |
$3,276.00
|
| Rate for Payer: Cofinity Commercial |
$1,694.18
|
| Rate for Payer: Cofinity Commercial |
$1,820.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,264.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,327.53
|
| Rate for Payer: Meridian Medicaid |
$849.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,390.74
|
| Rate for Payer: Nomi Health Commercial |
$1,517.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,071.25
|
| Rate for Payer: PACE SWMI |
$1,264.31
|
| Rate for Payer: PHP Commercial |
$1,770.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,264.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$808.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,462.82
|
| Rate for Payer: Priority Health Medicare |
$1,264.31
|
| Rate for Payer: Priority Health SBD |
$2,462.82
|
| Rate for Payer: Priority Health Tiered Network |
$2,462.82
|
| Rate for Payer: Railroad Medicare Medicare |
$1,264.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,405.65
|
| Rate for Payer: UHC Core |
$2,405.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,264.31
|
| Rate for Payer: UHC Exchange |
$2,405.65
|
| Rate for Payer: UHC Medicaid |
$808.97
|
| Rate for Payer: UHCCP Medicaid |
$808.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,883.70
|
|
|
PR GEL-ONE
|
Professional
|
Both
|
$1,408.00
|
|
|
Service Code
|
HCPCS J7326
|
| Min. Negotiated Rate |
$526.79 |
| Max. Negotiated Rate |
$1,159.20 |
| Rate for Payer: Aetna Commercial |
$705.90
|
| Rate for Payer: Aetna Medicare |
$547.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$758.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.90
|
| Rate for Payer: BCBS MAPPO |
$526.79
|
| Rate for Payer: BCBS Trust/PPO |
$538.01
|
| Rate for Payer: BCN Commercial |
$1,159.20
|
| Rate for Payer: BCN Medicare Advantage |
$526.79
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cash Price |
$1,126.40
|
| Rate for Payer: Cofinity Commercial |
$705.90
|
| Rate for Payer: Cofinity Commercial |
$758.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$526.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$579.47
|
| Rate for Payer: Nomi Health Commercial |
$632.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,056.00
|
| Rate for Payer: PACE SWMI |
$526.79
|
| Rate for Payer: PHP Commercial |
$737.51
|
| Rate for Payer: PHP Medicare Advantage |
$526.79
|
| Rate for Payer: Priority Health Medicare |
$526.79
|
| Rate for Payer: Railroad Medicare Medicare |
$526.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.05
|
| Rate for Payer: UHC Core |
$528.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$526.79
|
| Rate for Payer: UHC Exchange |
$528.05
|
| Rate for Payer: UMR Bronson Commercial |
$647.68
|
|
|
PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 91112
|
| Min. Negotiated Rate |
$92.92 |
| Max. Negotiated Rate |
$2,333.04 |
| Rate for Payer: Aetna Commercial |
$2,171.03
|
| Rate for Payer: Aetna Commercial |
$2,171.03
|
| Rate for Payer: Aetna Medicare |
$1,684.98
|
| Rate for Payer: Aetna Medicare |
$1,684.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,171.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,171.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,333.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,333.04
|
| Rate for Payer: BCBS MAPPO |
$1,620.17
|
| Rate for Payer: BCBS MAPPO |
$1,620.17
|
| Rate for Payer: BCN Commercial |
$2,275.28
|
| Rate for Payer: BCN Commercial |
$2,275.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.17
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$2,816.00
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$2,333.04
|
| Rate for Payer: Cofinity Commercial |
$2,171.03
|
| Rate for Payer: Cofinity Commercial |
$2,171.03
|
| Rate for Payer: Cofinity Commercial |
$2,333.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,701.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,701.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,782.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,782.19
|
| Rate for Payer: Nomi Health Commercial |
$1,944.20
|
| Rate for Payer: Nomi Health Commercial |
$1,944.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$1,620.17
|
| Rate for Payer: PACE SWMI |
$1,620.17
|
| Rate for Payer: PHP Commercial |
$2,268.24
|
| Rate for Payer: PHP Commercial |
$2,268.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,098.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,098.28
|
| Rate for Payer: Priority Health Medicare |
$1,620.17
|
| Rate for Payer: Priority Health Medicare |
$1,620.17
|
| Rate for Payer: Priority Health SBD |
$2,098.28
|
| Rate for Payer: Priority Health SBD |
$2,098.28
|
| Rate for Payer: Priority Health Tiered Network |
$2,098.28
|
| Rate for Payer: Priority Health Tiered Network |
$2,098.28
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,190.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,190.07
|
| Rate for Payer: UHC Core |
$2,190.07
|
| Rate for Payer: UHC Core |
$2,190.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,620.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,620.17
|
| Rate for Payer: UHC Exchange |
$2,190.07
|
| Rate for Payer: UHC Exchange |
$2,190.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,619.20
|
| Rate for Payer: UMR Bronson Commercial |
$92.92
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$1,667.00
|
|
|
Service Code
|
HCPCS 91110
|
| Min. Negotiated Rate |
$739.47 |
| Max. Negotiated Rate |
$1,308.43 |
| Rate for Payer: Aetna Commercial |
$990.89
|
| Rate for Payer: Aetna Medicare |
$769.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,064.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.89
|
| Rate for Payer: BCBS MAPPO |
$739.47
|
| Rate for Payer: BCN Commercial |
$1,040.28
|
| Rate for Payer: BCN Medicare Advantage |
$739.47
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cash Price |
$1,333.60
|
| Rate for Payer: Cofinity Commercial |
$1,064.84
|
| Rate for Payer: Cofinity Commercial |
$990.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$739.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$776.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$813.42
|
| Rate for Payer: Nomi Health Commercial |
$887.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,250.25
|
| Rate for Payer: PACE SWMI |
$739.47
|
| Rate for Payer: PHP Commercial |
$1,035.26
|
| Rate for Payer: PHP Medicare Advantage |
$739.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$959.36
|
| Rate for Payer: Priority Health Medicare |
$739.47
|
| Rate for Payer: Priority Health SBD |
$959.36
|
| Rate for Payer: Priority Health Tiered Network |
$959.36
|
| Rate for Payer: Railroad Medicare Medicare |
$739.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,308.43
|
| Rate for Payer: UHC Core |
$1,308.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$739.47
|
| Rate for Payer: UHC Exchange |
$1,308.43
|
| Rate for Payer: UMR Bronson Commercial |
$766.82
|
|
|
PR GLOSSECTOMY HEMIGLOSSECTOMY
|
Professional
|
Both
|
$2,460.00
|
|
|
Service Code
|
HCPCS 41130
|
| Min. Negotiated Rate |
$755.51 |
| Max. Negotiated Rate |
$2,377.88 |
| Rate for Payer: Aetna Commercial |
$1,531.23
|
| Rate for Payer: Aetna Medicare |
$1,188.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,531.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,645.50
|
| Rate for Payer: BCBS Complete |
$793.29
|
| Rate for Payer: BCBS MAPPO |
$1,142.71
|
| Rate for Payer: BCN Commercial |
$1,951.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,142.71
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cash Price |
$1,968.00
|
| Rate for Payer: Cofinity Commercial |
$1,645.50
|
| Rate for Payer: Cofinity Commercial |
$1,531.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,142.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,199.85
|
| Rate for Payer: Meridian Medicaid |
$793.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,256.98
|
| Rate for Payer: Nomi Health Commercial |
$1,371.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,845.00
|
| Rate for Payer: PACE SWMI |
$1,142.71
|
| Rate for Payer: PHP Commercial |
$1,599.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,142.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$755.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,377.88
|
| Rate for Payer: Priority Health Medicare |
$1,142.71
|
| Rate for Payer: Priority Health SBD |
$2,377.88
|
| Rate for Payer: Priority Health Tiered Network |
$2,377.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,142.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,254.74
|
| Rate for Payer: UHC Core |
$2,254.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,142.71
|
| Rate for Payer: UHC Exchange |
$2,254.74
|
| Rate for Payer: UHC Medicaid |
$755.51
|
| Rate for Payer: UHCCP Medicaid |
$755.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,131.60
|
|
|
PR GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$1,957.00
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$623.45 |
| Max. Negotiated Rate |
$1,921.59 |
| Rate for Payer: Aetna Commercial |
$1,253.92
|
| Rate for Payer: Aetna Medicare |
$973.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,253.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.49
|
| Rate for Payer: BCBS Complete |
$654.62
|
| Rate for Payer: BCBS MAPPO |
$935.76
|
| Rate for Payer: BCN Commercial |
$1,577.10
|
| Rate for Payer: BCN Medicare Advantage |
$935.76
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cash Price |
$1,565.60
|
| Rate for Payer: Cofinity Commercial |
$1,253.92
|
| Rate for Payer: Cofinity Commercial |
$1,347.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$935.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$982.55
|
| Rate for Payer: Meridian Medicaid |
$654.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,029.34
|
| Rate for Payer: Nomi Health Commercial |
$1,122.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,467.75
|
| Rate for Payer: PACE SWMI |
$935.76
|
| Rate for Payer: PHP Commercial |
$1,310.06
|
| Rate for Payer: PHP Medicare Advantage |
$935.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,921.59
|
| Rate for Payer: Priority Health Medicare |
$935.76
|
| Rate for Payer: Priority Health SBD |
$1,921.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,921.59
|
| Rate for Payer: Railroad Medicare Medicare |
$935.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,813.64
|
| Rate for Payer: UHC Core |
$1,813.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$935.76
|
| Rate for Payer: UHC Exchange |
$1,813.64
|
| Rate for Payer: UHC Medicaid |
$623.45
|
| Rate for Payer: UHCCP Medicaid |
$623.45
|
| Rate for Payer: UMR Bronson Commercial |
$900.22
|
|
|
PR GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ
|
Professional
|
Both
|
$4,063.00
|
|
|
Service Code
|
HCPCS 41135
|
| Min. Negotiated Rate |
$1,222.41 |
| Max. Negotiated Rate |
$3,918.45 |
| Rate for Payer: Aetna Commercial |
$2,501.74
|
| Rate for Payer: Aetna Medicare |
$1,941.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,501.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,688.44
|
| Rate for Payer: BCBS Complete |
$1,283.53
|
| Rate for Payer: BCBS MAPPO |
$1,866.97
|
| Rate for Payer: BCN Commercial |
$3,215.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,866.97
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Cofinity Commercial |
$2,501.74
|
| Rate for Payer: Cofinity Commercial |
$2,688.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,866.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,960.32
|
| Rate for Payer: Meridian Medicaid |
$1,283.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,053.67
|
| Rate for Payer: Nomi Health Commercial |
$2,240.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,047.25
|
| Rate for Payer: PACE SWMI |
$1,866.97
|
| Rate for Payer: PHP Commercial |
$2,613.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,866.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,222.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,918.45
|
| Rate for Payer: Priority Health Medicare |
$1,866.97
|
| Rate for Payer: Priority Health SBD |
$3,918.45
|
| Rate for Payer: Priority Health Tiered Network |
$3,918.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,866.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,749.20
|
| Rate for Payer: UHC Core |
$3,749.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,866.97
|
| Rate for Payer: UHC Exchange |
$3,749.20
|
| Rate for Payer: UHC Medicaid |
$1,222.41
|
| Rate for Payer: UHCCP Medicaid |
$1,222.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,868.98
|
|
