|
PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR
|
Professional
|
Both
|
$2,102.00
|
|
|
Service Code
|
HCPCS 27187
|
| Min. Negotiated Rate |
$840.80 |
| Max. Negotiated Rate |
$1,743.32 |
| Rate for Payer: Aetna Commercial |
$1,207.81
|
| Rate for Payer: Aetna Medicare |
$937.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,207.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.94
|
| Rate for Payer: BCBS Complete |
$840.80
|
| Rate for Payer: BCBS MAPPO |
$901.35
|
| Rate for Payer: BCN Commercial |
$1,512.87
|
| Rate for Payer: BCN Medicare Advantage |
$901.35
|
| Rate for Payer: Cash Price |
$1,681.60
|
| Rate for Payer: Cash Price |
$1,681.60
|
| Rate for Payer: Cofinity Commercial |
$1,297.94
|
| Rate for Payer: Cofinity Commercial |
$1,207.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$901.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$946.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$991.49
|
| Rate for Payer: Nomi Health Commercial |
$1,081.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.50
|
| Rate for Payer: PACE SWMI |
$901.35
|
| Rate for Payer: PHP Commercial |
$1,261.89
|
| Rate for Payer: PHP Medicare Advantage |
$901.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,617.22
|
| Rate for Payer: Priority Health Medicare |
$901.35
|
| Rate for Payer: Priority Health SBD |
$1,617.22
|
| Rate for Payer: Priority Health Tiered Network |
$1,617.22
|
| Rate for Payer: Railroad Medicare Medicare |
$901.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,743.32
|
| Rate for Payer: UHC Core |
$1,743.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$901.35
|
| Rate for Payer: UHC Exchange |
$1,743.32
|
| Rate for Payer: UMR Bronson Commercial |
$966.92
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT
|
Professional
|
Both
|
$2,659.00
|
|
|
Service Code
|
HCPCS 24498
|
| Min. Negotiated Rate |
$785.45 |
| Max. Negotiated Rate |
$1,994.25 |
| Rate for Payer: Aetna Commercial |
$1,052.50
|
| Rate for Payer: Aetna Medicare |
$816.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,052.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,131.05
|
| Rate for Payer: BCBS Complete |
$1,063.60
|
| Rate for Payer: BCBS MAPPO |
$785.45
|
| Rate for Payer: BCN Commercial |
$1,314.17
|
| Rate for Payer: BCN Medicare Advantage |
$785.45
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cofinity Commercial |
$1,131.05
|
| Rate for Payer: Cofinity Commercial |
$1,052.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$785.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$824.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$864.00
|
| Rate for Payer: Nomi Health Commercial |
$942.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,994.25
|
| Rate for Payer: PACE SWMI |
$785.45
|
| Rate for Payer: PHP Commercial |
$1,099.63
|
| Rate for Payer: PHP Medicare Advantage |
$785.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,404.81
|
| Rate for Payer: Priority Health Medicare |
$785.45
|
| Rate for Payer: Priority Health SBD |
$1,404.81
|
| Rate for Payer: Priority Health Tiered Network |
$1,404.81
|
| Rate for Payer: Railroad Medicare Medicare |
$785.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,515.87
|
| Rate for Payer: UHC Core |
$1,515.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$785.45
|
| Rate for Payer: UHC Exchange |
$1,515.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,223.14
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS
|
Professional
|
Both
|
$2,153.00
|
|
|
Service Code
|
HCPCS 23491
|
| Min. Negotiated Rate |
$861.20 |
| Max. Negotiated Rate |
$1,778.68 |
| Rate for Payer: Aetna Commercial |
$1,231.45
|
| Rate for Payer: Aetna Medicare |
$955.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,231.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,323.35
|
| Rate for Payer: BCBS Complete |
$861.20
|
| Rate for Payer: BCBS MAPPO |
$918.99
|
| Rate for Payer: BCN Commercial |
$1,543.25
|
| Rate for Payer: BCN Medicare Advantage |
$918.99
|
| Rate for Payer: Cash Price |
$1,722.40
|
| Rate for Payer: Cash Price |
$1,722.40
|
| Rate for Payer: Cofinity Commercial |
$1,323.35
|
| Rate for Payer: Cofinity Commercial |
$1,231.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,010.89
|
| Rate for Payer: Nomi Health Commercial |
$1,102.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,614.75
|
| Rate for Payer: PACE SWMI |
$918.99
|
| Rate for Payer: PHP Commercial |
$1,286.59
|
| Rate for Payer: PHP Medicare Advantage |
$918.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,649.69
|
| Rate for Payer: Priority Health Medicare |
$918.99
|
| Rate for Payer: Priority Health SBD |
$1,649.69
|
| Rate for Payer: Priority Health Tiered Network |
$1,649.69
|
| Rate for Payer: Railroad Medicare Medicare |
$918.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,778.68
|
| Rate for Payer: UHC Core |
$1,778.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$918.99
|
| Rate for Payer: UHC Exchange |
$1,778.68
|
| Rate for Payer: UMR Bronson Commercial |
$990.38
|
|
|
PR PROPH TX W/WO METHYLMETHACRYLATE RADIUS
|
Professional
|
Both
|
$2,319.00
|
|
|
Service Code
|
HCPCS 25490
|
| Min. Negotiated Rate |
$661.81 |
| Max. Negotiated Rate |
$1,739.25 |
| Rate for Payer: Aetna Commercial |
$886.83
|
| Rate for Payer: Aetna Medicare |
$688.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$886.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$953.01
|
| Rate for Payer: BCBS Complete |
$927.60
|
| Rate for Payer: BCBS MAPPO |
$661.81
|
| Rate for Payer: BCN Commercial |
$1,100.04
|
| Rate for Payer: BCN Medicare Advantage |
$661.81
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cash Price |
$1,855.20
|
| Rate for Payer: Cofinity Commercial |
$953.01
|
| Rate for Payer: Cofinity Commercial |
$886.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$661.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$694.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$727.99
|
| Rate for Payer: Nomi Health Commercial |
$794.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,739.25
|
| Rate for Payer: PACE SWMI |
$661.81
|
| Rate for Payer: PHP Commercial |
$926.53
|
| Rate for Payer: PHP Medicare Advantage |
$661.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,175.91
|
| Rate for Payer: Priority Health Medicare |
$661.81
|
| Rate for Payer: Priority Health SBD |
$1,175.91
|
| Rate for Payer: Priority Health Tiered Network |
$1,175.91
|
| Rate for Payer: Railroad Medicare Medicare |
$661.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,253.79
|
| Rate for Payer: UHC Core |
$1,253.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$661.81
|
| Rate for Payer: UHC Exchange |
$1,253.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,066.74
|
|
|
PR PROSTATE CA SCREENING; DRE
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G0102
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.96
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS MAPPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$12.95
|
| Rate for Payer: BCN Medicare Advantage |
$7.61
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.99
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.37
|
| Rate for Payer: Nomi Health Commercial |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.00
|
| Rate for Payer: PACE SWMI |
$7.61
|
| Rate for Payer: PHP Commercial |
$10.65
|
| Rate for Payer: PHP Medicare Advantage |
$7.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.64
|
| Rate for Payer: Priority Health Medicare |
$7.61
|
| Rate for Payer: Priority Health SBD |
$11.64
|
| Rate for Payer: Priority Health Tiered Network |
$11.64
|
| Rate for Payer: Railroad Medicare Medicare |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.18
|
| Rate for Payer: UHC Core |
$14.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.61
|
| Rate for Payer: UHC Exchange |
$14.18
|
| Rate for Payer: UHC Medicaid |
$4.90
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC
|
Professional
|
Both
|
$3,767.00
|
|
|
Service Code
|
HCPCS 55815
|
| Min. Negotiated Rate |
$997.27 |
| Max. Negotiated Rate |
$3,121.59 |
| Rate for Payer: Aetna Commercial |
$2,078.26
|
| Rate for Payer: Aetna Medicare |
$1,612.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,078.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,233.35
|
| Rate for Payer: BCBS Complete |
$1,047.13
|
| Rate for Payer: BCBS MAPPO |
$1,550.94
|
| Rate for Payer: BCN Commercial |
$2,616.89
|
| Rate for Payer: BCN Medicare Advantage |
$1,550.94
|
| Rate for Payer: Cash Price |
$3,013.60
|
| Rate for Payer: Cash Price |
$3,013.60
|
| Rate for Payer: Cofinity Commercial |
$2,078.26
|
| Rate for Payer: Cofinity Commercial |
$2,233.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,550.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,628.49
|
| Rate for Payer: Meridian Medicaid |
$1,047.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,706.03
|
| Rate for Payer: Nomi Health Commercial |
$1,861.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,825.25
|
| Rate for Payer: PACE SWMI |
$1,550.94
|
| Rate for Payer: PHP Commercial |
$2,171.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,550.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$997.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,850.65
|
| Rate for Payer: Priority Health Medicare |
$1,550.94
|
| Rate for Payer: Priority Health SBD |
$2,850.65
|
| Rate for Payer: Priority Health Tiered Network |
$2,850.65
|
| Rate for Payer: Railroad Medicare Medicare |
$1,550.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,121.59
|
| Rate for Payer: UHC Core |
$3,121.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,550.94
|
| Rate for Payer: UHC Exchange |
$3,121.59
|
| Rate for Payer: UHC Medicaid |
$997.27
|
| Rate for Payer: UHCCP Medicaid |
$997.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,732.82
|
|
|
PR PROSTATECTOMY RETROPUBIC SUBTOTAL
|
Professional
|
Both
|
$3,441.00
|
|
|
Service Code
|
HCPCS 55831
|
| Min. Negotiated Rate |
$494.16 |
| Max. Negotiated Rate |
$2,580.75 |
| Rate for Payer: Aetna Commercial |
$1,026.59
|
| Rate for Payer: Aetna Medicare |
$796.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.20
|
| Rate for Payer: BCBS Complete |
$518.87
|
| Rate for Payer: BCBS MAPPO |
$766.11
|
| Rate for Payer: BCN Commercial |
$1,285.29
|
| Rate for Payer: BCN Medicare Advantage |
$766.11
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cofinity Commercial |
$1,026.59
|
| Rate for Payer: Cofinity Commercial |
$1,103.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.42
|
| Rate for Payer: Meridian Medicaid |
$518.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$842.72
|
| Rate for Payer: Nomi Health Commercial |
$919.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,580.75
|
| Rate for Payer: PACE SWMI |
$766.11
|
| Rate for Payer: PHP Commercial |
$1,072.55
|
| Rate for Payer: PHP Medicare Advantage |
$766.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$494.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,400.09
|
| Rate for Payer: Priority Health Medicare |
$766.11
|
| Rate for Payer: Priority Health SBD |
$1,400.09
|
| Rate for Payer: Priority Health Tiered Network |
$1,400.09
|
| Rate for Payer: Railroad Medicare Medicare |
$766.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,671.97
|
| Rate for Payer: UHC Core |
$1,671.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$766.11
|
| Rate for Payer: UHC Exchange |
$1,671.97
|
| Rate for Payer: UHC Medicaid |
$494.16
|
| Rate for Payer: UHCCP Medicaid |
$494.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,582.86
|
|
|
PR PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING
|
Professional
|
Both
|
$2,640.00
|
|
|
Service Code
|
HCPCS 55840
|
| Min. Negotiated Rate |
$666.48 |
| Max. Negotiated Rate |
$2,069.71 |
| Rate for Payer: Aetna Commercial |
$1,386.02
|
| Rate for Payer: Aetna Medicare |
$1,075.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,386.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,489.45
|
| Rate for Payer: BCBS Complete |
$699.80
|
| Rate for Payer: BCBS MAPPO |
$1,034.34
|
| Rate for Payer: BCN Commercial |
$1,745.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,034.34
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cash Price |
$2,112.00
|
| Rate for Payer: Cofinity Commercial |
$1,386.02
|
| Rate for Payer: Cofinity Commercial |
$1,489.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,034.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,086.06
|
| Rate for Payer: Meridian Medicaid |
$699.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,137.77
|
| Rate for Payer: Nomi Health Commercial |
$1,241.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,980.00
|
| Rate for Payer: PACE SWMI |
$1,034.34
|
| Rate for Payer: PHP Commercial |
$1,448.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,034.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$666.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,901.88
|
| Rate for Payer: Priority Health Medicare |
$1,034.34
|
| Rate for Payer: Priority Health SBD |
$1,901.88
|
| Rate for Payer: Priority Health Tiered Network |
$1,901.88
|
| Rate for Payer: Railroad Medicare Medicare |
$1,034.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,069.71
|
| Rate for Payer: UHC Core |
$2,069.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,034.34
|
| Rate for Payer: UHC Exchange |
$2,069.71
|
| Rate for Payer: UHC Medicaid |
$666.48
|
| Rate for Payer: UHCCP Medicaid |
$666.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,214.40
|
|
|
PR PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES
|
Professional
|
Both
|
$3,367.00
|
|
|
Service Code
|
HCPCS 55821
|
| Min. Negotiated Rate |
$481.59 |
| Max. Negotiated Rate |
$2,525.25 |
| Rate for Payer: Aetna Commercial |
$1,000.02
|
| Rate for Payer: Aetna Medicare |
$776.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.64
|
| Rate for Payer: BCBS Complete |
$505.67
|
| Rate for Payer: BCBS MAPPO |
$746.28
|
| Rate for Payer: BCN Commercial |
$1,253.41
|
| Rate for Payer: BCN Medicare Advantage |
$746.28
|
| Rate for Payer: Cash Price |
$2,693.60
|
| Rate for Payer: Cash Price |
$2,693.60
|
| Rate for Payer: Cofinity Commercial |
$1,000.02
|
| Rate for Payer: Cofinity Commercial |
$1,074.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.59
|
| Rate for Payer: Meridian Medicaid |
$505.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$820.91
|
| Rate for Payer: Nomi Health Commercial |
$895.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,525.25
|
| Rate for Payer: PACE SWMI |
$746.28
|
| Rate for Payer: PHP Commercial |
$1,044.79
|
| Rate for Payer: PHP Medicare Advantage |
$746.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$481.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,365.38
|
| Rate for Payer: Priority Health Medicare |
$746.28
|
| Rate for Payer: Priority Health SBD |
$1,365.38
|
| Rate for Payer: Priority Health Tiered Network |
$1,365.38
|
| Rate for Payer: Railroad Medicare Medicare |
$746.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,543.97
|
| Rate for Payer: UHC Core |
$1,543.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$746.28
|
| Rate for Payer: UHC Exchange |
$1,543.97
|
| Rate for Payer: UHC Medicaid |
$481.59
|
| Rate for Payer: UHCCP Medicaid |
$481.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,548.82
|
|
|
PR PROSTATE NEEDLE BIOPSY ANY APPROACH
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
HCPCS 55700
|
| Min. Negotiated Rate |
$167.16 |
| Max. Negotiated Rate |
$389.25 |
| Rate for Payer: Aetna Commercial |
$167.16
|
| Rate for Payer: Aetna Medicare |
$259.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.16
|
| Rate for Payer: BCBS Complete |
$207.60
|
| Rate for Payer: BCN Commercial |
$192.22
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Cash Price |
$415.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$389.25
|
| Rate for Payer: UMR Bronson Commercial |
$238.74
|
|
|
PR PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED
|
Professional
|
Both
|
$1,102.00
|
|
|
Service Code
|
HCPCS 55725
|
| Min. Negotiated Rate |
$348.68 |
| Max. Negotiated Rate |
$1,044.54 |
| Rate for Payer: Aetna Commercial |
$719.37
|
| Rate for Payer: Aetna Medicare |
$558.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.05
|
| Rate for Payer: BCBS Complete |
$366.11
|
| Rate for Payer: BCBS MAPPO |
$536.84
|
| Rate for Payer: BCN Commercial |
$897.37
|
| Rate for Payer: BCN Medicare Advantage |
$536.84
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cash Price |
$881.60
|
| Rate for Payer: Cofinity Commercial |
$773.05
|
| Rate for Payer: Cofinity Commercial |
$719.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.68
|
| Rate for Payer: Meridian Medicaid |
$366.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$590.52
|
| Rate for Payer: Nomi Health Commercial |
$644.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$826.50
|
| Rate for Payer: PACE SWMI |
$536.84
|
| Rate for Payer: PHP Commercial |
$751.58
|
| Rate for Payer: PHP Medicare Advantage |
$536.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$348.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$977.51
|
| Rate for Payer: Priority Health Medicare |
$536.84
|
| Rate for Payer: Priority Health SBD |
$977.51
|
| Rate for Payer: Priority Health Tiered Network |
$977.51
|
| Rate for Payer: Railroad Medicare Medicare |
$536.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,044.54
|
| Rate for Payer: UHC Core |
$1,044.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$536.84
|
| Rate for Payer: UHC Exchange |
$1,044.54
|
| Rate for Payer: UHC Medicaid |
$348.68
|
| Rate for Payer: UHCCP Medicaid |
$348.68
|
| Rate for Payer: UMR Bronson Commercial |
$506.92
|
|
|
PR PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX
|
Professional
|
Both
|
$4,339.00
|
|
|
Service Code
|
HCPCS 55842
|
| Min. Negotiated Rate |
$664.99 |
| Max. Negotiated Rate |
$3,254.25 |
| Rate for Payer: Aetna Commercial |
$1,382.77
|
| Rate for Payer: Aetna Medicare |
$1,073.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,382.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,485.96
|
| Rate for Payer: BCBS Complete |
$698.24
|
| Rate for Payer: BCBS MAPPO |
$1,031.92
|
| Rate for Payer: BCN Commercial |
$1,741.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,031.92
|
| Rate for Payer: Cash Price |
$3,471.20
|
| Rate for Payer: Cash Price |
$3,471.20
|
| Rate for Payer: Cofinity Commercial |
$1,382.77
|
| Rate for Payer: Cofinity Commercial |
$1,485.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,031.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,083.52
|
| Rate for Payer: Meridian Medicaid |
$698.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,135.11
|
| Rate for Payer: Nomi Health Commercial |
$1,238.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,254.25
|
| Rate for Payer: PACE SWMI |
$1,031.92
|
| Rate for Payer: PHP Commercial |
$1,444.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,031.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$664.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,897.54
|
| Rate for Payer: Priority Health Medicare |
$1,031.92
|
| Rate for Payer: Priority Health SBD |
$1,897.54
|
| Rate for Payer: Priority Health Tiered Network |
$1,897.54
|
| Rate for Payer: Railroad Medicare Medicare |
$1,031.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,070.97
|
| Rate for Payer: UHC Core |
$2,070.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,031.92
|
| Rate for Payer: UHC Exchange |
$2,070.97
|
| Rate for Payer: UHC Medicaid |
$664.99
|
| Rate for Payer: UHCCP Medicaid |
$664.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,995.94
|
|
|
PR PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM
|
Professional
|
Both
|
$2,923.00
|
|
|
Service Code
|
HCPCS 55845
|
| Min. Negotiated Rate |
$771.27 |
| Max. Negotiated Rate |
$2,412.51 |
| Rate for Payer: Aetna Commercial |
$1,605.90
|
| Rate for Payer: Aetna Medicare |
$1,246.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,605.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,725.74
|
| Rate for Payer: BCBS Complete |
$809.83
|
| Rate for Payer: BCBS MAPPO |
$1,198.43
|
| Rate for Payer: BCN Commercial |
$2,027.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,198.43
|
| Rate for Payer: Cash Price |
$2,338.40
|
| Rate for Payer: Cash Price |
$2,338.40
|
| Rate for Payer: Cofinity Commercial |
$1,605.90
|
| Rate for Payer: Cofinity Commercial |
$1,725.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,198.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,258.35
|
| Rate for Payer: Meridian Medicaid |
$809.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,318.27
|
| Rate for Payer: Nomi Health Commercial |
$1,438.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,192.25
|
| Rate for Payer: PACE SWMI |
$1,198.43
|
| Rate for Payer: PHP Commercial |
$1,677.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,198.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$771.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,208.37
|
| Rate for Payer: Priority Health Medicare |
$1,198.43
|
| Rate for Payer: Priority Health SBD |
$2,208.37
|
| Rate for Payer: Priority Health Tiered Network |
$2,208.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,198.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,412.51
|
| Rate for Payer: UHC Core |
$2,412.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,198.43
|
| Rate for Payer: UHC Exchange |
$2,412.51
|
| Rate for Payer: UHC Medicaid |
$771.27
|
| Rate for Payer: UHCCP Medicaid |
$771.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,344.58
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT
|
Professional
|
Both
|
$2,026.00
|
|
|
Service Code
|
HCPCS 23335
|
| Min. Negotiated Rate |
$732.29 |
| Max. Negotiated Rate |
$2,232.16 |
| Rate for Payer: Aetna Commercial |
$1,513.29
|
| Rate for Payer: Aetna Medicare |
$1,174.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,513.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,626.22
|
| Rate for Payer: BCBS Complete |
$768.90
|
| Rate for Payer: BCBS MAPPO |
$1,129.32
|
| Rate for Payer: BCN Commercial |
$1,913.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,129.32
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Cofinity Commercial |
$1,513.29
|
| Rate for Payer: Cofinity Commercial |
$1,626.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,129.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,185.79
|
| Rate for Payer: Meridian Medicaid |
$768.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,242.25
|
| Rate for Payer: Nomi Health Commercial |
$1,355.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,519.50
|
| Rate for Payer: PACE SWMI |
$1,129.32
|
| Rate for Payer: PHP Commercial |
$1,581.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,129.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$732.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,045.20
|
| Rate for Payer: Priority Health Medicare |
$1,129.32
|
| Rate for Payer: Priority Health SBD |
$2,045.20
|
| Rate for Payer: Priority Health Tiered Network |
$2,045.20
|
| Rate for Payer: Railroad Medicare Medicare |
$1,129.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,232.16
|
| Rate for Payer: UHC Core |
$2,232.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,129.32
|
| Rate for Payer: UHC Exchange |
$2,232.16
|
| Rate for Payer: UHC Medicaid |
$732.29
|
| Rate for Payer: UHCCP Medicaid |
$732.29
|
| Rate for Payer: UMR Bronson Commercial |
$931.96
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS
|
Professional
|
Both
|
$2,114.00
|
|
|
Service Code
|
HCPCS 24160
|
| Min. Negotiated Rate |
$732.29 |
| Max. Negotiated Rate |
$2,205.89 |
| Rate for Payer: Aetna Commercial |
$1,513.10
|
| Rate for Payer: Aetna Medicare |
$1,174.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,513.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,626.02
|
| Rate for Payer: BCBS Complete |
$768.90
|
| Rate for Payer: BCBS MAPPO |
$1,129.18
|
| Rate for Payer: BCN Commercial |
$1,901.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,129.18
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cash Price |
$1,691.20
|
| Rate for Payer: Cofinity Commercial |
$1,513.10
|
| Rate for Payer: Cofinity Commercial |
$1,626.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,129.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,185.64
|
| Rate for Payer: Meridian Medicaid |
$768.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,242.10
|
| Rate for Payer: Nomi Health Commercial |
$1,355.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,585.50
|
| Rate for Payer: PACE SWMI |
$1,129.18
|
| Rate for Payer: PHP Commercial |
$1,580.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,129.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$732.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,032.95
|
| Rate for Payer: Priority Health Medicare |
$1,129.18
|
| Rate for Payer: Priority Health SBD |
$2,032.95
|
| Rate for Payer: Priority Health Tiered Network |
$2,032.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,129.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,205.89
|
| Rate for Payer: UHC Core |
$2,205.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,129.18
|
| Rate for Payer: UHC Exchange |
$2,205.89
|
| Rate for Payer: UHC Medicaid |
$732.29
|
| Rate for Payer: UHCCP Medicaid |
$732.29
|
| Rate for Payer: UMR Bronson Commercial |
$972.44
|
|
|
PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT
|
Professional
|
Both
|
$2,609.00
|
|
|
Service Code
|
HCPCS 23334
|
| Min. Negotiated Rate |
$622.39 |
| Max. Negotiated Rate |
$1,956.75 |
| Rate for Payer: Aetna Commercial |
$1,282.45
|
| Rate for Payer: Aetna Medicare |
$995.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,282.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,378.15
|
| Rate for Payer: BCBS Complete |
$653.51
|
| Rate for Payer: BCBS MAPPO |
$957.05
|
| Rate for Payer: BCN Commercial |
$1,611.46
|
| Rate for Payer: BCN Medicare Advantage |
$957.05
|
| Rate for Payer: Cash Price |
$2,087.20
|
| Rate for Payer: Cash Price |
$2,087.20
|
| Rate for Payer: Cofinity Commercial |
$1,282.45
|
| Rate for Payer: Cofinity Commercial |
$1,378.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$957.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.90
|
| Rate for Payer: Meridian Medicaid |
$653.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,052.76
|
| Rate for Payer: Nomi Health Commercial |
$1,148.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,956.75
|
| Rate for Payer: PACE SWMI |
$957.05
|
| Rate for Payer: PHP Commercial |
$1,339.87
|
| Rate for Payer: PHP Medicare Advantage |
$957.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$622.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,722.61
|
| Rate for Payer: Priority Health Medicare |
$957.05
|
| Rate for Payer: Priority Health SBD |
$1,722.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,722.61
|
| Rate for Payer: Railroad Medicare Medicare |
$957.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,869.11
|
| Rate for Payer: UHC Core |
$1,869.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$957.05
|
| Rate for Payer: UHC Exchange |
$1,869.11
|
| Rate for Payer: UHC Medicaid |
$622.39
|
| Rate for Payer: UHCCP Medicaid |
$622.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,200.14
|
|
|
PR PROSTHESIS REMOVAL RADIAL HEAD
|
Professional
|
Both
|
$2,356.00
|
|
|
Service Code
|
HCPCS 24164
|
| Min. Negotiated Rate |
$435.16 |
| Max. Negotiated Rate |
$1,767.00 |
| Rate for Payer: Aetna Commercial |
$892.91
|
| Rate for Payer: Aetna Medicare |
$693.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$892.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$959.54
|
| Rate for Payer: BCBS Complete |
$456.92
|
| Rate for Payer: BCBS MAPPO |
$666.35
|
| Rate for Payer: BCN Commercial |
$1,108.51
|
| Rate for Payer: BCN Medicare Advantage |
$666.35
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cash Price |
$1,884.80
|
| Rate for Payer: Cofinity Commercial |
$892.91
|
| Rate for Payer: Cofinity Commercial |
$959.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$666.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$699.67
|
| Rate for Payer: Meridian Medicaid |
$456.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$732.99
|
| Rate for Payer: Nomi Health Commercial |
$799.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,767.00
|
| Rate for Payer: PACE SWMI |
$666.35
|
| Rate for Payer: PHP Commercial |
$932.89
|
| Rate for Payer: PHP Medicare Advantage |
$666.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$435.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,184.96
|
| Rate for Payer: Priority Health Medicare |
$666.35
|
| Rate for Payer: Priority Health SBD |
$1,184.96
|
| Rate for Payer: Priority Health Tiered Network |
$1,184.96
|
| Rate for Payer: Railroad Medicare Medicare |
$666.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,259.41
|
| Rate for Payer: UHC Core |
$1,259.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$666.35
|
| Rate for Payer: UHC Exchange |
$1,259.41
|
| Rate for Payer: UHC Medicaid |
$435.16
|
| Rate for Payer: UHCCP Medicaid |
$435.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,083.76
|
|
|
PR PROSTHESIS SERVICE APHAKIA TEMPORARY
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 92358
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Aetna Commercial |
$11.22
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.22
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.91
|
| Rate for Payer: Priority Health SBD |
$14.91
|
| Rate for Payer: Priority Health Tiered Network |
$14.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.00
|
| Rate for Payer: UHC Core |
$13.00
|
| Rate for Payer: UHC Exchange |
$13.00
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PR PROTECTOR HEEL OR ELBOW
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS E0191
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$10.47
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.47
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCN Commercial |
$13.63
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.64
|
| Rate for Payer: UHC Core |
$4.64
|
| Rate for Payer: UHC Exchange |
$4.64
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
|
|
PR PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 62267
|
| Min. Negotiated Rate |
$86.05 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$179.68
|
| Rate for Payer: Aetna Medicare |
$139.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.68
|
| Rate for Payer: BCBS Complete |
$90.35
|
| Rate for Payer: BCBS MAPPO |
$134.09
|
| Rate for Payer: BCN Commercial |
$228.07
|
| Rate for Payer: BCN Medicare Advantage |
$134.09
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cofinity Commercial |
$193.09
|
| Rate for Payer: Cofinity Commercial |
$179.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.79
|
| Rate for Payer: Meridian Medicaid |
$90.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$147.50
|
| Rate for Payer: Nomi Health Commercial |
$160.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.00
|
| Rate for Payer: PACE SWMI |
$134.09
|
| Rate for Payer: PHP Commercial |
$187.73
|
| Rate for Payer: PHP Medicare Advantage |
$134.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$86.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$264.91
|
| Rate for Payer: Priority Health Medicare |
$134.09
|
| Rate for Payer: Priority Health SBD |
$264.91
|
| Rate for Payer: Priority Health Tiered Network |
$264.91
|
| Rate for Payer: Railroad Medicare Medicare |
$134.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$278.30
|
| Rate for Payer: UHC Core |
$278.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$134.09
|
| Rate for Payer: UHC Exchange |
$278.30
|
| Rate for Payer: UHC Medicaid |
$86.05
|
| Rate for Payer: UHCCP Medicaid |
$86.05
|
| Rate for Payer: UMR Bronson Commercial |
$662.40
|
|
|
PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE
|
Professional
|
Both
|
$2,760.00
|
|
|
Service Code
|
HCPCS 92986
|
| Min. Negotiated Rate |
$744.86 |
| Max. Negotiated Rate |
$2,165.77 |
| Rate for Payer: Aetna Commercial |
$1,564.80
|
| Rate for Payer: Aetna Medicare |
$1,214.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,564.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,681.57
|
| Rate for Payer: BCBS Complete |
$782.10
|
| Rate for Payer: BCBS MAPPO |
$1,167.76
|
| Rate for Payer: BCN Commercial |
$1,946.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,167.76
|
| Rate for Payer: Cash Price |
$2,208.00
|
| Rate for Payer: Cash Price |
$2,208.00
|
| Rate for Payer: Cofinity Commercial |
$1,564.80
|
| Rate for Payer: Cofinity Commercial |
$1,681.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,167.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,226.15
|
| Rate for Payer: Meridian Medicaid |
$782.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,284.54
|
| Rate for Payer: Nomi Health Commercial |
$1,401.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,070.00
|
| Rate for Payer: PACE SWMI |
$1,167.76
|
| Rate for Payer: PHP Commercial |
$1,634.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,167.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$744.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,850.15
|
| Rate for Payer: Priority Health Medicare |
$1,167.76
|
| Rate for Payer: Priority Health SBD |
$1,850.15
|
| Rate for Payer: Priority Health Tiered Network |
$1,850.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1,167.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,165.77
|
| Rate for Payer: UHC Core |
$2,165.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,167.76
|
| Rate for Payer: UHC Exchange |
$2,165.77
|
| Rate for Payer: UHC Medicaid |
$744.86
|
| Rate for Payer: UHCCP Medicaid |
$744.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,269.60
|
|
|
PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING
|
Professional
|
Both
|
$2,049.00
|
|
|
Service Code
|
HCPCS 64561
|
| Min. Negotiated Rate |
$172.96 |
| Max. Negotiated Rate |
$1,536.75 |
| Rate for Payer: Aetna Commercial |
$359.70
|
| Rate for Payer: Aetna Medicare |
$279.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.54
|
| Rate for Payer: BCBS Complete |
$181.61
|
| Rate for Payer: BCBS MAPPO |
$268.43
|
| Rate for Payer: BCN Commercial |
$452.66
|
| Rate for Payer: BCN Medicare Advantage |
$268.43
|
| Rate for Payer: Cash Price |
$1,639.20
|
| Rate for Payer: Cash Price |
$1,639.20
|
| Rate for Payer: Cofinity Commercial |
$359.70
|
| Rate for Payer: Cofinity Commercial |
$386.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.85
|
| Rate for Payer: Meridian Medicaid |
$181.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$295.27
|
| Rate for Payer: Nomi Health Commercial |
$322.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,536.75
|
| Rate for Payer: PACE SWMI |
$268.43
|
| Rate for Payer: PHP Commercial |
$375.80
|
| Rate for Payer: PHP Medicare Advantage |
$268.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$525.76
|
| Rate for Payer: Priority Health Medicare |
$268.43
|
| Rate for Payer: Priority Health SBD |
$525.76
|
| Rate for Payer: Priority Health Tiered Network |
$525.76
|
| Rate for Payer: Railroad Medicare Medicare |
$268.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$536.42
|
| Rate for Payer: UHC Core |
$536.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$268.43
|
| Rate for Payer: UHC Exchange |
$536.42
|
| Rate for Payer: UHC Medicaid |
$172.96
|
| Rate for Payer: UHCCP Medicaid |
$172.96
|
| Rate for Payer: UMR Bronson Commercial |
$942.54
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 64553
|
| Min. Negotiated Rate |
$187.20 |
| Max. Negotiated Rate |
$797.61 |
| Rate for Payer: Aetna Commercial |
$599.30
|
| Rate for Payer: Aetna Medicare |
$465.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.03
|
| Rate for Payer: BCBS Complete |
$187.20
|
| Rate for Payer: BCBS MAPPO |
$447.24
|
| Rate for Payer: BCN Commercial |
$686.72
|
| Rate for Payer: BCN Medicare Advantage |
$447.24
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Commercial |
$644.03
|
| Rate for Payer: Cofinity Commercial |
$599.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$491.96
|
| Rate for Payer: Nomi Health Commercial |
$536.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.00
|
| Rate for Payer: PACE SWMI |
$447.24
|
| Rate for Payer: PHP Commercial |
$626.14
|
| Rate for Payer: PHP Medicare Advantage |
$447.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$797.61
|
| Rate for Payer: Priority Health Medicare |
$447.24
|
| Rate for Payer: Priority Health SBD |
$797.61
|
| Rate for Payer: Priority Health Tiered Network |
$797.61
|
| Rate for Payer: Railroad Medicare Medicare |
$447.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$628.71
|
| Rate for Payer: UHC Core |
$628.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.24
|
| Rate for Payer: UHC Exchange |
$628.71
|
| Rate for Payer: UMR Bronson Commercial |
$215.28
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
HCPCS 64555
|
| Min. Negotiated Rate |
$187.44 |
| Max. Negotiated Rate |
$602.02 |
| Rate for Payer: Aetna Commercial |
$387.09
|
| Rate for Payer: Aetna Medicare |
$300.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.97
|
| Rate for Payer: BCBS Complete |
$196.81
|
| Rate for Payer: BCBS MAPPO |
$288.87
|
| Rate for Payer: BCN Commercial |
$488.52
|
| Rate for Payer: BCN Medicare Advantage |
$288.87
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Cofinity Commercial |
$415.97
|
| Rate for Payer: Cofinity Commercial |
$387.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.31
|
| Rate for Payer: Meridian Medicaid |
$196.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$317.76
|
| Rate for Payer: Nomi Health Commercial |
$346.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$384.75
|
| Rate for Payer: PACE SWMI |
$288.87
|
| Rate for Payer: PHP Commercial |
$404.42
|
| Rate for Payer: PHP Medicare Advantage |
$288.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$567.41
|
| Rate for Payer: Priority Health Medicare |
$288.87
|
| Rate for Payer: Priority Health SBD |
$567.41
|
| Rate for Payer: Priority Health Tiered Network |
$567.41
|
| Rate for Payer: Railroad Medicare Medicare |
$288.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.02
|
| Rate for Payer: UHC Core |
$602.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$288.87
|
| Rate for Payer: UHC Exchange |
$602.02
|
| Rate for Payer: UHC Medicaid |
$187.44
|
| Rate for Payer: UHCCP Medicaid |
$187.44
|
| Rate for Payer: UMR Bronson Commercial |
$235.98
|
|
|
PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
Professional
|
Both
|
$5,506.00
|
|
|
Service Code
|
HCPCS 63650
|
| Min. Negotiated Rate |
$239.41 |
| Max. Negotiated Rate |
$4,129.50 |
| Rate for Payer: Aetna Commercial |
$494.08
|
| Rate for Payer: Aetna Medicare |
$383.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$494.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$530.96
|
| Rate for Payer: BCBS Complete |
$251.38
|
| Rate for Payer: BCBS MAPPO |
$368.72
|
| Rate for Payer: BCN Commercial |
$621.48
|
| Rate for Payer: BCN Medicare Advantage |
$368.72
|
| Rate for Payer: Cash Price |
$4,404.80
|
| Rate for Payer: Cash Price |
$4,404.80
|
| Rate for Payer: Cofinity Commercial |
$494.08
|
| Rate for Payer: Cofinity Commercial |
$530.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$368.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$387.16
|
| Rate for Payer: Meridian Medicaid |
$251.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$405.59
|
| Rate for Payer: Nomi Health Commercial |
$442.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,129.50
|
| Rate for Payer: PACE SWMI |
$368.72
|
| Rate for Payer: PHP Commercial |
$516.21
|
| Rate for Payer: PHP Medicare Advantage |
$368.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$721.83
|
| Rate for Payer: Priority Health Medicare |
$368.72
|
| Rate for Payer: Priority Health SBD |
$721.83
|
| Rate for Payer: Priority Health Tiered Network |
$721.83
|
| Rate for Payer: Railroad Medicare Medicare |
$368.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$727.70
|
| Rate for Payer: UHC Core |
$727.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$368.72
|
| Rate for Payer: UHC Exchange |
$727.70
|
| Rate for Payer: UHC Medicaid |
$239.41
|
| Rate for Payer: UHCCP Medicaid |
$239.41
|
| Rate for Payer: UMR Bronson Commercial |
$2,532.76
|
|
