|
PR EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F
|
Professional
|
Both
|
$2,651.00
|
|
|
Service Code
|
HCPCS 26390
|
| Min. Negotiated Rate |
$153.74 |
| Max. Negotiated Rate |
$1,723.15 |
| Rate for Payer: Aetna Commercial |
$1,106.95
|
| Rate for Payer: Aetna Medicare |
$859.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,106.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,189.56
|
| Rate for Payer: BCBS Complete |
$594.02
|
| Rate for Payer: BCBS MAPPO |
$826.08
|
| Rate for Payer: BCBS Trust/PPO |
$153.74
|
| Rate for Payer: BCN Commercial |
$1,303.31
|
| Rate for Payer: BCN Medicare Advantage |
$826.08
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cofinity Commercial |
$1,106.95
|
| Rate for Payer: Cofinity Commercial |
$1,189.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$826.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$867.38
|
| Rate for Payer: Meridian Medicaid |
$594.02
|
| Rate for Payer: Nomi Health Commercial |
$991.30
|
| Rate for Payer: PACE SWMI |
$826.08
|
| Rate for Payer: PHP Commercial |
$1,156.51
|
| Rate for Payer: PHP Medicare Advantage |
$826.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$565.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,355.61
|
| Rate for Payer: Priority Health Medicare |
$826.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,355.61
|
| Rate for Payer: Priority Health SBD |
$1,355.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$826.08
|
| Rate for Payer: UHC Medicare Advantage |
$826.08
|
| Rate for Payer: UHCCP Medicaid |
$565.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,219.46
|
|
|
PR EXC FRENUM LABIAL/BUCCAL
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 40819
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$760.22 |
| Rate for Payer: Aetna Commercial |
$254.35
|
| Rate for Payer: Aetna Medicare |
$197.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.33
|
| Rate for Payer: BCBS Complete |
$137.10
|
| Rate for Payer: BCBS MAPPO |
$189.81
|
| Rate for Payer: BCBS Trust/PPO |
$760.22
|
| Rate for Payer: BCN Commercial |
$394.36
|
| Rate for Payer: BCN Medicare Advantage |
$189.81
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$254.35
|
| Rate for Payer: Cofinity Commercial |
$273.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.30
|
| Rate for Payer: Meridian Medicaid |
$137.10
|
| Rate for Payer: Nomi Health Commercial |
$227.77
|
| Rate for Payer: PACE SWMI |
$189.81
|
| Rate for Payer: PHP Commercial |
$265.73
|
| Rate for Payer: PHP Medicare Advantage |
$189.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.56
|
| Rate for Payer: Priority Health Medicare |
$189.81
|
| Rate for Payer: Priority Health Narrow Network |
$358.56
|
| Rate for Payer: Priority Health SBD |
$358.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.81
|
| Rate for Payer: UHC Medicare Advantage |
$189.81
|
| Rate for Payer: UHCCP Medicaid |
$130.57
|
| Rate for Payer: UMR Bronson Commercial |
$234.60
|
|
|
PR EXC/FULGURATION URETHRAL CARUNCLE
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 53265
|
| Min. Negotiated Rate |
$122.05 |
| Max. Negotiated Rate |
$1,099.39 |
| Rate for Payer: Aetna Commercial |
$243.93
|
| Rate for Payer: Aetna Medicare |
$189.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.14
|
| Rate for Payer: BCBS Complete |
$128.15
|
| Rate for Payer: BCBS MAPPO |
$182.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.39
|
| Rate for Payer: BCN Commercial |
$334.26
|
| Rate for Payer: BCN Medicare Advantage |
$182.04
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$243.93
|
| Rate for Payer: Cofinity Commercial |
$262.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.14
|
| Rate for Payer: Meridian Medicaid |
$128.15
|
| Rate for Payer: Nomi Health Commercial |
$218.45
|
| Rate for Payer: PACE SWMI |
$182.04
|
| Rate for Payer: PHP Commercial |
$254.86
|
| Rate for Payer: PHP Medicare Advantage |
$182.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.98
|
| Rate for Payer: Priority Health Medicare |
$182.04
|
| Rate for Payer: Priority Health Narrow Network |
$301.98
|
| Rate for Payer: Priority Health SBD |
$301.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.04
|
| Rate for Payer: UHC Medicare Advantage |
$182.04
|
| Rate for Payer: UHCCP Medicaid |
$122.05
|
| Rate for Payer: UMR Bronson Commercial |
$189.52
|
|
|
PR EXC/FULGURATION URETHRAL POLYP DSTL URETHRA
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 53260
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$546.26 |
| Rate for Payer: Aetna Commercial |
$233.24
|
| Rate for Payer: Aetna Medicare |
$181.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.65
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS MAPPO |
$174.06
|
| Rate for Payer: BCBS Trust/PPO |
$546.26
|
| Rate for Payer: BCN Commercial |
$302.00
|
| Rate for Payer: BCN Medicare Advantage |
$174.06
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$250.65
|
| Rate for Payer: Cofinity Commercial |
$233.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.76
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Nomi Health Commercial |
$208.87
|
| Rate for Payer: PACE SWMI |
$174.06
|
| Rate for Payer: PHP Commercial |
$243.68
|
| Rate for Payer: PHP Medicare Advantage |
$174.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$290.27
|
| Rate for Payer: Priority Health Medicare |
$174.06
|
| Rate for Payer: Priority Health Narrow Network |
$290.27
|
| Rate for Payer: Priority Health SBD |
$290.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.06
|
| Rate for Payer: UHC Medicare Advantage |
$174.06
|
| Rate for Payer: UHCCP Medicaid |
$116.94
|
| Rate for Payer: UMR Bronson Commercial |
$126.50
|
|
|
PR EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 50435
|
| Min. Negotiated Rate |
$62.62 |
| Max. Negotiated Rate |
$888.91 |
| Rate for Payer: Aetna Commercial |
$125.16
|
| Rate for Payer: Aetna Medicare |
$97.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.50
|
| Rate for Payer: BCBS Complete |
$65.75
|
| Rate for Payer: BCBS MAPPO |
$93.40
|
| Rate for Payer: BCN Commercial |
$888.91
|
| Rate for Payer: BCN Medicare Advantage |
$93.40
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$125.16
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.07
|
| Rate for Payer: Meridian Medicaid |
$65.75
|
| Rate for Payer: Nomi Health Commercial |
$112.08
|
| Rate for Payer: PACE SWMI |
$93.40
|
| Rate for Payer: PHP Commercial |
$130.76
|
| Rate for Payer: PHP Medicare Advantage |
$93.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.52
|
| Rate for Payer: Priority Health Medicare |
$93.40
|
| Rate for Payer: Priority Health Narrow Network |
$155.52
|
| Rate for Payer: Priority Health SBD |
$155.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.40
|
| Rate for Payer: UHC Medicare Advantage |
$93.40
|
| Rate for Payer: UHCCP Medicaid |
$62.62
|
| Rate for Payer: UMR Bronson Commercial |
$586.04
|
|
|
PR EXCHNG ABSC/CST DRG CATH RAD GID SPX
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 49423
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$1,009.05 |
| Rate for Payer: Aetna Commercial |
$89.19
|
| Rate for Payer: Aetna Medicare |
$69.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.85
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS MAPPO |
$66.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,009.05
|
| Rate for Payer: BCN Commercial |
$875.23
|
| Rate for Payer: BCN Medicare Advantage |
$66.56
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$89.19
|
| Rate for Payer: Cofinity Commercial |
$95.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.89
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Nomi Health Commercial |
$79.87
|
| Rate for Payer: PACE SWMI |
$66.56
|
| Rate for Payer: PHP Commercial |
$93.18
|
| Rate for Payer: PHP Medicare Advantage |
$66.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$828.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.89
|
| Rate for Payer: Priority Health Medicare |
$66.56
|
| Rate for Payer: Priority Health Narrow Network |
$122.89
|
| Rate for Payer: Priority Health SBD |
$122.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.56
|
| Rate for Payer: UHC Medicare Advantage |
$66.56
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
| Rate for Payer: UMR Bronson Commercial |
$586.04
|
|
|
PR EXC HYDROCELE SPRMATIC CORD UNI SPX
|
Professional
|
Both
|
$725.00
|
|
|
Service Code
|
HCPCS 55500
|
| Min. Negotiated Rate |
$252.83 |
| Max. Negotiated Rate |
$2,419.09 |
| Rate for Payer: Aetna Commercial |
$502.81
|
| Rate for Payer: Aetna Medicare |
$390.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.33
|
| Rate for Payer: BCBS Complete |
$265.47
|
| Rate for Payer: BCBS MAPPO |
$375.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,419.09
|
| Rate for Payer: BCN Commercial |
$570.77
|
| Rate for Payer: BCN Medicare Advantage |
$375.23
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cash Price |
$580.00
|
| Rate for Payer: Cofinity Commercial |
$502.81
|
| Rate for Payer: Cofinity Commercial |
$540.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.99
|
| Rate for Payer: Meridian Medicaid |
$265.47
|
| Rate for Payer: Nomi Health Commercial |
$450.28
|
| Rate for Payer: PACE SWMI |
$375.23
|
| Rate for Payer: PHP Commercial |
$525.32
|
| Rate for Payer: PHP Medicare Advantage |
$375.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$629.01
|
| Rate for Payer: Priority Health Medicare |
$375.23
|
| Rate for Payer: Priority Health Narrow Network |
$629.01
|
| Rate for Payer: Priority Health SBD |
$629.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$375.23
|
| Rate for Payer: UHC Medicare Advantage |
$375.23
|
| Rate for Payer: UHCCP Medicaid |
$252.83
|
| Rate for Payer: UMR Bronson Commercial |
$333.50
|
|
|
PR EXC ILEOANAL RSVR W/ILEOSTOMY
|
Professional
|
Both
|
$3,254.00
|
|
|
Service Code
|
HCPCS 45136
|
| Min. Negotiated Rate |
$1,131.88 |
| Max. Negotiated Rate |
$3,163.14 |
| Rate for Payer: Aetna Commercial |
$2,264.35
|
| Rate for Payer: Aetna Medicare |
$1,757.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,264.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,433.33
|
| Rate for Payer: BCBS Complete |
$1,188.47
|
| Rate for Payer: BCBS MAPPO |
$1,689.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,476.07
|
| Rate for Payer: BCN Commercial |
$2,582.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,689.81
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cash Price |
$2,603.20
|
| Rate for Payer: Cofinity Commercial |
$2,264.35
|
| Rate for Payer: Cofinity Commercial |
$2,433.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,689.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,774.30
|
| Rate for Payer: Meridian Medicaid |
$1,188.47
|
| Rate for Payer: Nomi Health Commercial |
$2,027.77
|
| Rate for Payer: PACE SWMI |
$1,689.81
|
| Rate for Payer: PHP Commercial |
$2,365.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,689.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,131.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,115.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,163.14
|
| Rate for Payer: Priority Health Medicare |
$1,689.81
|
| Rate for Payer: Priority Health Narrow Network |
$3,163.14
|
| Rate for Payer: Priority Health SBD |
$3,163.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,689.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,689.81
|
| Rate for Payer: UHCCP Medicaid |
$1,131.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,496.84
|
|
|
PR EXC INTRACARDIAC TUMOR RESCJ CARDIOPULMONARY BYP
|
Professional
|
Both
|
$4,392.00
|
|
|
Service Code
|
HCPCS 33120
|
| Min. Negotiated Rate |
$1,008.52 |
| Max. Negotiated Rate |
$3,268.59 |
| Rate for Payer: Aetna Commercial |
$2,687.72
|
| Rate for Payer: Aetna Medicare |
$2,085.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,687.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,888.29
|
| Rate for Payer: BCBS Complete |
$1,379.70
|
| Rate for Payer: BCBS MAPPO |
$2,005.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.52
|
| Rate for Payer: BCN Commercial |
$2,991.68
|
| Rate for Payer: BCN Medicare Advantage |
$2,005.76
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cash Price |
$3,513.60
|
| Rate for Payer: Cofinity Commercial |
$2,687.72
|
| Rate for Payer: Cofinity Commercial |
$2,888.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,005.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,106.05
|
| Rate for Payer: Meridian Medicaid |
$1,379.70
|
| Rate for Payer: Nomi Health Commercial |
$2,406.91
|
| Rate for Payer: PACE SWMI |
$2,005.76
|
| Rate for Payer: PHP Commercial |
$2,808.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,005.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,314.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,854.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,268.59
|
| Rate for Payer: Priority Health Medicare |
$2,005.76
|
| Rate for Payer: Priority Health Narrow Network |
$3,268.59
|
| Rate for Payer: Priority Health SBD |
$3,268.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,005.76
|
| Rate for Payer: UHC Medicare Advantage |
$2,005.76
|
| Rate for Payer: UHCCP Medicaid |
$1,314.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,020.32
|
|
|
PR EXCIS CHEST WALL TUMOR/RIBS
|
Professional
|
Both
|
$2,265.00
|
|
|
Service Code
|
HCPCS 19260
|
| Min. Negotiated Rate |
$906.00 |
| Max. Negotiated Rate |
$1,472.25 |
| Rate for Payer: Aetna Medicare |
$1,132.50
|
| Rate for Payer: BCBS Complete |
$906.00
|
| Rate for Payer: Cash Price |
$1,812.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,041.90
|
|
|
PR EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE
|
Professional
|
Both
|
$1,248.00
|
|
|
Service Code
|
HCPCS 15940
|
| Min. Negotiated Rate |
$459.65 |
| Max. Negotiated Rate |
$1,038.93 |
| Rate for Payer: Aetna Commercial |
$916.57
|
| Rate for Payer: Aetna Medicare |
$711.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$916.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.97
|
| Rate for Payer: BCBS Complete |
$482.63
|
| Rate for Payer: BCBS MAPPO |
$684.01
|
| Rate for Payer: BCBS Trust/PPO |
$540.00
|
| Rate for Payer: BCN Commercial |
$1,038.93
|
| Rate for Payer: BCN Medicare Advantage |
$684.01
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cofinity Commercial |
$984.97
|
| Rate for Payer: Cofinity Commercial |
$916.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.21
|
| Rate for Payer: Meridian Medicaid |
$482.63
|
| Rate for Payer: Nomi Health Commercial |
$820.81
|
| Rate for Payer: PACE SWMI |
$684.01
|
| Rate for Payer: PHP Commercial |
$957.61
|
| Rate for Payer: PHP Medicare Advantage |
$684.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$811.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$965.35
|
| Rate for Payer: Priority Health Medicare |
$684.01
|
| Rate for Payer: Priority Health Narrow Network |
$965.35
|
| Rate for Payer: Priority Health SBD |
$965.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.01
|
| Rate for Payer: UHC Medicare Advantage |
$684.01
|
| Rate for Payer: UHCCP Medicaid |
$459.65
|
| Rate for Payer: UMR Bronson Commercial |
$574.08
|
|
|
PR EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE
|
Professional
|
Both
|
$1,617.00
|
|
|
Service Code
|
HCPCS 15944
|
| Min. Negotiated Rate |
$604.28 |
| Max. Negotiated Rate |
$2,275.40 |
| Rate for Payer: Aetna Commercial |
$1,194.11
|
| Rate for Payer: Aetna Medicare |
$926.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,194.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,283.23
|
| Rate for Payer: BCBS Complete |
$634.49
|
| Rate for Payer: BCBS MAPPO |
$891.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,275.40
|
| Rate for Payer: BCN Commercial |
$1,369.28
|
| Rate for Payer: BCN Medicare Advantage |
$891.13
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cofinity Commercial |
$1,194.11
|
| Rate for Payer: Cofinity Commercial |
$1,283.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$891.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$935.69
|
| Rate for Payer: Meridian Medicaid |
$634.49
|
| Rate for Payer: Nomi Health Commercial |
$1,069.36
|
| Rate for Payer: PACE SWMI |
$891.13
|
| Rate for Payer: PHP Commercial |
$1,247.58
|
| Rate for Payer: PHP Medicare Advantage |
$891.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$604.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,269.66
|
| Rate for Payer: Priority Health Medicare |
$891.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,269.66
|
| Rate for Payer: Priority Health SBD |
$1,269.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$891.13
|
| Rate for Payer: UHC Medicare Advantage |
$891.13
|
| Rate for Payer: UHCCP Medicaid |
$604.28
|
| Rate for Payer: UMR Bronson Commercial |
$743.82
|
|
|
PR EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN
|
Professional
|
Both
|
$3,352.00
|
|
|
Service Code
|
HCPCS 15946
|
| Min. Negotiated Rate |
$1,030.92 |
| Max. Negotiated Rate |
$2,363.25 |
| Rate for Payer: Aetna Commercial |
$2,058.15
|
| Rate for Payer: Aetna Medicare |
$1,597.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,058.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,211.74
|
| Rate for Payer: BCBS Complete |
$1,082.47
|
| Rate for Payer: BCBS MAPPO |
$1,535.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.35
|
| Rate for Payer: BCN Commercial |
$2,363.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,535.93
|
| Rate for Payer: Cash Price |
$2,681.60
|
| Rate for Payer: Cash Price |
$2,681.60
|
| Rate for Payer: Cofinity Commercial |
$2,058.15
|
| Rate for Payer: Cofinity Commercial |
$2,211.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,535.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,612.73
|
| Rate for Payer: Meridian Medicaid |
$1,082.47
|
| Rate for Payer: Nomi Health Commercial |
$1,843.12
|
| Rate for Payer: PACE SWMI |
$1,535.93
|
| Rate for Payer: PHP Commercial |
$2,150.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,535.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,030.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,178.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,182.63
|
| Rate for Payer: Priority Health Medicare |
$1,535.93
|
| Rate for Payer: Priority Health Narrow Network |
$2,182.63
|
| Rate for Payer: Priority Health SBD |
$2,182.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,535.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,535.93
|
| Rate for Payer: UHCCP Medicaid |
$1,030.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,541.92
|
|
|
PR EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 15941
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$1,372.69 |
| Rate for Payer: Aetna Commercial |
$1,209.28
|
| Rate for Payer: Aetna Medicare |
$938.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.53
|
| Rate for Payer: BCBS Complete |
$643.22
|
| Rate for Payer: BCBS MAPPO |
$902.45
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$1,372.69
|
| Rate for Payer: BCN Medicare Advantage |
$902.45
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$1,209.28
|
| Rate for Payer: Cofinity Commercial |
$1,299.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.57
|
| Rate for Payer: Meridian Medicaid |
$643.22
|
| Rate for Payer: Nomi Health Commercial |
$1,082.94
|
| Rate for Payer: PACE SWMI |
$902.45
|
| Rate for Payer: PHP Commercial |
$1,263.43
|
| Rate for Payer: PHP Medicare Advantage |
$902.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$612.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,261.53
|
| Rate for Payer: Priority Health Medicare |
$902.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,261.53
|
| Rate for Payer: Priority Health SBD |
$1,261.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$902.45
|
| Rate for Payer: UHC Medicare Advantage |
$902.45
|
| Rate for Payer: UHCCP Medicaid |
$612.59
|
| Rate for Payer: UMR Bronson Commercial |
$743.36
|
|
|
PR EXCISION 1ST &/CERVICAL RIB
|
Professional
|
Both
|
$1,202.00
|
|
|
Service Code
|
HCPCS 21615
|
| Min. Negotiated Rate |
$400.23 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$810.99
|
| Rate for Payer: Aetna Medicare |
$629.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$810.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$871.52
|
| Rate for Payer: BCBS Complete |
$420.24
|
| Rate for Payer: BCBS MAPPO |
$605.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$904.54
|
| Rate for Payer: BCN Medicare Advantage |
$605.22
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cofinity Commercial |
$810.99
|
| Rate for Payer: Cofinity Commercial |
$871.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$605.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$635.48
|
| Rate for Payer: Meridian Medicaid |
$420.24
|
| Rate for Payer: Nomi Health Commercial |
$726.26
|
| Rate for Payer: PACE SWMI |
$605.22
|
| Rate for Payer: PHP Commercial |
$847.31
|
| Rate for Payer: PHP Medicare Advantage |
$605.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$781.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$949.53
|
| Rate for Payer: Priority Health Medicare |
$605.22
|
| Rate for Payer: Priority Health Narrow Network |
$949.53
|
| Rate for Payer: Priority Health SBD |
$949.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$605.22
|
| Rate for Payer: UHC Medicare Advantage |
$605.22
|
| Rate for Payer: UHCCP Medicaid |
$400.23
|
| Rate for Payer: UMR Bronson Commercial |
$552.92
|
|
|
PR EXCISION AMPULLA VATER
|
Professional
|
Both
|
$1,847.00
|
|
|
Service Code
|
HCPCS 48148
|
| Min. Negotiated Rate |
$804.29 |
| Max. Negotiated Rate |
$2,241.40 |
| Rate for Payer: Aetna Commercial |
$1,628.50
|
| Rate for Payer: Aetna Medicare |
$1,263.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,750.03
|
| Rate for Payer: BCBS Complete |
$844.50
|
| Rate for Payer: BCBS MAPPO |
$1,215.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,258.41
|
| Rate for Payer: BCN Commercial |
$1,828.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,215.30
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cash Price |
$1,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,628.50
|
| Rate for Payer: Cofinity Commercial |
$1,750.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,215.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,276.06
|
| Rate for Payer: Meridian Medicaid |
$844.50
|
| Rate for Payer: Nomi Health Commercial |
$1,458.36
|
| Rate for Payer: PACE SWMI |
$1,215.30
|
| Rate for Payer: PHP Commercial |
$1,701.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,215.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$804.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,241.40
|
| Rate for Payer: Priority Health Medicare |
$1,215.30
|
| Rate for Payer: Priority Health Narrow Network |
$2,241.40
|
| Rate for Payer: Priority Health SBD |
$2,241.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,215.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.30
|
| Rate for Payer: UHCCP Medicaid |
$804.29
|
| Rate for Payer: UMR Bronson Commercial |
$849.62
|
|
|
PR EXCISION AURAL POLYP
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 69540
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$2,401.65 |
| Rate for Payer: Aetna Commercial |
$161.26
|
| Rate for Payer: Aetna Medicare |
$125.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.29
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$120.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,401.65
|
| Rate for Payer: BCN Commercial |
$313.73
|
| Rate for Payer: BCN Medicare Advantage |
$120.34
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Commercial |
$161.26
|
| Rate for Payer: Cofinity Commercial |
$173.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.36
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Nomi Health Commercial |
$144.41
|
| Rate for Payer: PACE SWMI |
$120.34
|
| Rate for Payer: PHP Commercial |
$168.48
|
| Rate for Payer: PHP Medicare Advantage |
$120.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.12
|
| Rate for Payer: Priority Health Medicare |
$120.34
|
| Rate for Payer: Priority Health Narrow Network |
$192.12
|
| Rate for Payer: Priority Health SBD |
$192.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.34
|
| Rate for Payer: UHC Medicare Advantage |
$120.34
|
| Rate for Payer: UHCCP Medicaid |
$83.28
|
| Rate for Payer: UMR Bronson Commercial |
$172.96
|
|
|
PR EXCISION BARTHOLINS GLAND OR CYST
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 56740
|
| Min. Negotiated Rate |
$201.71 |
| Max. Negotiated Rate |
$1,879.16 |
| Rate for Payer: Aetna Commercial |
$402.08
|
| Rate for Payer: Aetna Medicare |
$312.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.09
|
| Rate for Payer: BCBS Complete |
$211.80
|
| Rate for Payer: BCBS MAPPO |
$300.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.16
|
| Rate for Payer: BCN Commercial |
$463.27
|
| Rate for Payer: BCN Medicare Advantage |
$300.06
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cofinity Commercial |
$402.08
|
| Rate for Payer: Cofinity Commercial |
$432.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.06
|
| Rate for Payer: Meridian Medicaid |
$211.80
|
| Rate for Payer: Nomi Health Commercial |
$360.07
|
| Rate for Payer: PACE SWMI |
$300.06
|
| Rate for Payer: PHP Commercial |
$420.08
|
| Rate for Payer: PHP Medicare Advantage |
$300.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$201.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$472.24
|
| Rate for Payer: Priority Health Medicare |
$300.06
|
| Rate for Payer: Priority Health Narrow Network |
$472.24
|
| Rate for Payer: Priority Health SBD |
$472.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.06
|
| Rate for Payer: UHC Medicare Advantage |
$300.06
|
| Rate for Payer: UHCCP Medicaid |
$201.71
|
| Rate for Payer: UMR Bronson Commercial |
$427.34
|
|
|
PR EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
HCPCS 21040
|
| Min. Negotiated Rate |
$235.58 |
| Max. Negotiated Rate |
$681.71 |
| Rate for Payer: Aetna Commercial |
$461.34
|
| Rate for Payer: Aetna Medicare |
$358.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.76
|
| Rate for Payer: BCBS Complete |
$247.36
|
| Rate for Payer: BCBS MAPPO |
$344.28
|
| Rate for Payer: BCBS Trust/PPO |
$332.62
|
| Rate for Payer: BCN Commercial |
$681.71
|
| Rate for Payer: BCN Medicare Advantage |
$344.28
|
| Rate for Payer: Cash Price |
$780.80
|
| Rate for Payer: Cash Price |
$780.80
|
| Rate for Payer: Cofinity Commercial |
$461.34
|
| Rate for Payer: Cofinity Commercial |
$495.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.49
|
| Rate for Payer: Meridian Medicaid |
$247.36
|
| Rate for Payer: Nomi Health Commercial |
$413.14
|
| Rate for Payer: PACE SWMI |
$344.28
|
| Rate for Payer: PHP Commercial |
$481.99
|
| Rate for Payer: PHP Medicare Advantage |
$344.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$553.64
|
| Rate for Payer: Priority Health Medicare |
$344.28
|
| Rate for Payer: Priority Health Narrow Network |
$553.64
|
| Rate for Payer: Priority Health SBD |
$553.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$344.28
|
| Rate for Payer: UHC Medicare Advantage |
$344.28
|
| Rate for Payer: UHCCP Medicaid |
$235.58
|
| Rate for Payer: UMR Bronson Commercial |
$448.96
|
|
|
PR EXCISION BONE CYST/BENIGN TUMOR DEEP
|
Professional
|
Both
|
$1,497.00
|
|
|
Service Code
|
HCPCS 27066
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$1,259.94 |
| Rate for Payer: Aetna Commercial |
$1,059.31
|
| Rate for Payer: Aetna Medicare |
$822.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.36
|
| Rate for Payer: BCBS Complete |
$560.91
|
| Rate for Payer: BCBS MAPPO |
$790.53
|
| Rate for Payer: BCBS Trust/PPO |
$80.30
|
| Rate for Payer: BCN Commercial |
$1,207.52
|
| Rate for Payer: BCN Medicare Advantage |
$790.53
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Cofinity Commercial |
$1,059.31
|
| Rate for Payer: Cofinity Commercial |
$1,138.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$830.06
|
| Rate for Payer: Meridian Medicaid |
$560.91
|
| Rate for Payer: Nomi Health Commercial |
$948.64
|
| Rate for Payer: PACE SWMI |
$790.53
|
| Rate for Payer: PHP Commercial |
$1,106.74
|
| Rate for Payer: PHP Medicare Advantage |
$790.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$534.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$973.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,259.94
|
| Rate for Payer: Priority Health Medicare |
$790.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,259.94
|
| Rate for Payer: Priority Health SBD |
$1,259.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$790.53
|
| Rate for Payer: UHC Medicare Advantage |
$790.53
|
| Rate for Payer: UHCCP Medicaid |
$534.20
|
| Rate for Payer: UMR Bronson Commercial |
$688.62
|
|
|
PR EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL
|
Professional
|
Both
|
$905.00
|
|
|
Service Code
|
HCPCS 27065
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$4,717.19 |
| Rate for Payer: Aetna Commercial |
$677.75
|
| Rate for Payer: Aetna Medicare |
$526.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.32
|
| Rate for Payer: BCBS Complete |
$361.20
|
| Rate for Payer: BCBS MAPPO |
$505.78
|
| Rate for Payer: BCBS Trust/PPO |
$4,717.19
|
| Rate for Payer: BCN Commercial |
$780.42
|
| Rate for Payer: BCN Medicare Advantage |
$505.78
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cofinity Commercial |
$677.75
|
| Rate for Payer: Cofinity Commercial |
$728.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.07
|
| Rate for Payer: Meridian Medicaid |
$361.20
|
| Rate for Payer: Nomi Health Commercial |
$606.94
|
| Rate for Payer: PACE SWMI |
$505.78
|
| Rate for Payer: PHP Commercial |
$708.09
|
| Rate for Payer: PHP Medicare Advantage |
$505.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$588.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$813.67
|
| Rate for Payer: Priority Health Medicare |
$505.78
|
| Rate for Payer: Priority Health Narrow Network |
$813.67
|
| Rate for Payer: Priority Health SBD |
$813.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$505.78
|
| Rate for Payer: UHC Medicare Advantage |
$505.78
|
| Rate for Payer: UHCCP Medicaid |
$344.00
|
| Rate for Payer: UMR Bronson Commercial |
$416.30
|
|
|
PR EXCISION BONE MANDIBLE
|
Professional
|
Both
|
$1,596.00
|
|
|
Service Code
|
HCPCS 21025
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$1,154.25 |
| Rate for Payer: Aetna Commercial |
$851.64
|
| Rate for Payer: Aetna Medicare |
$660.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$851.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$915.19
|
| Rate for Payer: BCBS Complete |
$453.56
|
| Rate for Payer: BCBS MAPPO |
$635.55
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$1,154.25
|
| Rate for Payer: BCN Medicare Advantage |
$635.55
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cofinity Commercial |
$851.64
|
| Rate for Payer: Cofinity Commercial |
$915.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$635.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$667.33
|
| Rate for Payer: Meridian Medicaid |
$453.56
|
| Rate for Payer: Nomi Health Commercial |
$762.66
|
| Rate for Payer: PACE SWMI |
$635.55
|
| Rate for Payer: PHP Commercial |
$889.77
|
| Rate for Payer: PHP Medicare Advantage |
$635.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,037.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,012.13
|
| Rate for Payer: Priority Health Medicare |
$635.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,012.13
|
| Rate for Payer: Priority Health SBD |
$1,012.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$635.55
|
| Rate for Payer: UHC Medicare Advantage |
$635.55
|
| Rate for Payer: UHCCP Medicaid |
$431.96
|
| Rate for Payer: UMR Bronson Commercial |
$734.16
|
|
|
PR EXCISION CHALAZION MULTIPLE SAME LID
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 67801
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$552.60 |
| Rate for Payer: Aetna Commercial |
$163.98
|
| Rate for Payer: Aetna Medicare |
$127.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.21
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS MAPPO |
$122.37
|
| Rate for Payer: BCBS Trust/PPO |
$552.60
|
| Rate for Payer: BCN Commercial |
$237.49
|
| Rate for Payer: BCN Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$163.98
|
| Rate for Payer: Cofinity Commercial |
$176.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.49
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Nomi Health Commercial |
$146.84
|
| Rate for Payer: PACE SWMI |
$122.37
|
| Rate for Payer: PHP Commercial |
$171.32
|
| Rate for Payer: PHP Medicare Advantage |
$122.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.11
|
| Rate for Payer: Priority Health Medicare |
$122.37
|
| Rate for Payer: Priority Health Narrow Network |
$228.11
|
| Rate for Payer: Priority Health SBD |
$228.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.37
|
| Rate for Payer: UHC Medicare Advantage |
$122.37
|
| Rate for Payer: UHCCP Medicaid |
$83.50
|
| Rate for Payer: UMR Bronson Commercial |
$133.86
|
|
|
PR EXCISION CHALAZION SINGLE
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 67800
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$127.64
|
| Rate for Payer: Aetna Medicare |
$99.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.16
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$95.25
|
| Rate for Payer: BCBS Trust/PPO |
$552.07
|
| Rate for Payer: BCN Commercial |
$150.39
|
| Rate for Payer: BCN Medicare Advantage |
$95.25
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$127.64
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.01
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Nomi Health Commercial |
$114.30
|
| Rate for Payer: PACE SWMI |
$95.25
|
| Rate for Payer: PHP Commercial |
$133.35
|
| Rate for Payer: PHP Medicare Advantage |
$95.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.80
|
| Rate for Payer: Priority Health Medicare |
$95.25
|
| Rate for Payer: Priority Health Narrow Network |
$177.80
|
| Rate for Payer: Priority Health SBD |
$177.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.25
|
| Rate for Payer: UHC Medicare Advantage |
$95.25
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
| Rate for Payer: UMR Bronson Commercial |
$90.62
|
|
|
PR EXCISION CHEST WALL TUMOR INCLUDING RIBS
|
Professional
|
Both
|
$2,439.00
|
|
|
Service Code
|
HCPCS 21601
|
| Min. Negotiated Rate |
$267.70 |
| Max. Negotiated Rate |
$1,753.54 |
| Rate for Payer: Aetna Commercial |
$1,479.32
|
| Rate for Payer: Aetna Medicare |
$1,148.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,589.72
|
| Rate for Payer: BCBS Complete |
$770.92
|
| Rate for Payer: BCBS MAPPO |
$1,103.97
|
| Rate for Payer: BCBS Trust/PPO |
$267.70
|
| Rate for Payer: BCN Commercial |
$1,664.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,103.97
|
| Rate for Payer: Cash Price |
$1,951.20
|
| Rate for Payer: Cash Price |
$1,951.20
|
| Rate for Payer: Cofinity Commercial |
$1,479.32
|
| Rate for Payer: Cofinity Commercial |
$1,589.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,103.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,159.17
|
| Rate for Payer: Meridian Medicaid |
$770.92
|
| Rate for Payer: Nomi Health Commercial |
$1,324.76
|
| Rate for Payer: PACE SWMI |
$1,103.97
|
| Rate for Payer: PHP Commercial |
$1,545.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,103.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$734.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,585.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,753.54
|
| Rate for Payer: Priority Health Medicare |
$1,103.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,753.54
|
| Rate for Payer: Priority Health SBD |
$1,753.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,103.97
|
| Rate for Payer: UHC Medicare Advantage |
$1,103.97
|
| Rate for Payer: UHCCP Medicaid |
$734.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,121.94
|
|
