|
PR PLASTIC REPAIR URETHROCELE
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 57230
|
| Min. Negotiated Rate |
$323.60 |
| Max. Negotiated Rate |
$573.90 |
| Rate for Payer: Aetna Commercial |
$534.04
|
| Rate for Payer: Aetna Medicare |
$414.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$573.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.04
|
| Rate for Payer: BCBS Complete |
$323.60
|
| Rate for Payer: BCBS MAPPO |
$398.54
|
| Rate for Payer: BCN Medicare Advantage |
$398.54
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$573.90
|
| Rate for Payer: Cofinity Commercial |
$534.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$418.47
|
| Rate for Payer: Nomi Health Commercial |
$478.25
|
| Rate for Payer: PACE SWMI |
$398.54
|
| Rate for Payer: PHP Commercial |
$557.96
|
| Rate for Payer: PHP Medicare Advantage |
$398.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health Medicare |
$398.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$398.54
|
| Rate for Payer: UHC Medicare Advantage |
$398.54
|
| Rate for Payer: UMR Bronson Commercial |
$372.14
|
|
|
PR PLASTIC RPR PENIS CORRECT ANGULATION
|
Professional
|
Both
|
$3,801.00
|
|
|
Service Code
|
HCPCS 54360
|
| Min. Negotiated Rate |
$689.38 |
| Max. Negotiated Rate |
$2,470.65 |
| Rate for Payer: Aetna Commercial |
$923.77
|
| Rate for Payer: Aetna Medicare |
$716.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$992.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.77
|
| Rate for Payer: BCBS Complete |
$1,520.40
|
| Rate for Payer: BCBS MAPPO |
$689.38
|
| Rate for Payer: BCN Medicare Advantage |
$689.38
|
| Rate for Payer: Cash Price |
$3,040.80
|
| Rate for Payer: Cash Price |
$3,040.80
|
| Rate for Payer: Cofinity Commercial |
$992.71
|
| Rate for Payer: Cofinity Commercial |
$923.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.85
|
| Rate for Payer: Nomi Health Commercial |
$827.26
|
| Rate for Payer: PACE SWMI |
$689.38
|
| Rate for Payer: PHP Commercial |
$965.13
|
| Rate for Payer: PHP Medicare Advantage |
$689.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,470.65
|
| Rate for Payer: Priority Health Medicare |
$689.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.38
|
| Rate for Payer: UHC Medicare Advantage |
$689.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,748.46
|
|
|
PR PLASTICS COSMETIC CONSULT OFFICE VISIT
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 00690
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna Medicare |
$36.00
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.80
|
| Rate for Payer: UMR Bronson Commercial |
$33.12
|
|
|
PR PLASTICS COSMETIC FAT GRAFTING
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 00691
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Aetna Medicare |
$1,250.00
|
| Rate for Payer: BCBS Complete |
$1,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,625.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,150.00
|
|
|
PR PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH
|
Professional
|
Both
|
$1,097.00
|
|
|
Service Code
|
HCPCS 57220
|
| Min. Negotiated Rate |
$329.56 |
| Max. Negotiated Rate |
$713.05 |
| Rate for Payer: Aetna Commercial |
$441.61
|
| Rate for Payer: Aetna Medicare |
$342.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.61
|
| Rate for Payer: BCBS Complete |
$438.80
|
| Rate for Payer: BCBS MAPPO |
$329.56
|
| Rate for Payer: BCN Medicare Advantage |
$329.56
|
| Rate for Payer: Cash Price |
$877.60
|
| Rate for Payer: Cash Price |
$877.60
|
| Rate for Payer: Cofinity Commercial |
$441.61
|
| Rate for Payer: Cofinity Commercial |
$474.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$346.04
|
| Rate for Payer: Nomi Health Commercial |
$395.47
|
| Rate for Payer: PACE SWMI |
$329.56
|
| Rate for Payer: PHP Commercial |
$461.38
|
| Rate for Payer: PHP Medicare Advantage |
$329.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.05
|
| Rate for Payer: Priority Health Medicare |
$329.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.56
|
| Rate for Payer: UHC Medicare Advantage |
$329.56
|
| Rate for Payer: UMR Bronson Commercial |
$504.62
|
|
|
PR PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 94726
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$73.58 |
| Rate for Payer: Aetna Commercial |
$68.47
|
| Rate for Payer: Aetna Commercial |
$68.47
|
| Rate for Payer: Aetna Medicare |
$53.14
|
| Rate for Payer: Aetna Medicare |
$53.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.58
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$51.10
|
| Rate for Payer: BCBS MAPPO |
$51.10
|
| Rate for Payer: BCN Medicare Advantage |
$51.10
|
| Rate for Payer: BCN Medicare Advantage |
$51.10
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$73.58
|
| Rate for Payer: Cofinity Commercial |
$73.58
|
| Rate for Payer: Cofinity Commercial |
$68.47
|
| Rate for Payer: Cofinity Commercial |
$68.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.66
|
| Rate for Payer: Nomi Health Commercial |
$61.32
|
| Rate for Payer: Nomi Health Commercial |
$61.32
|
| Rate for Payer: PACE SWMI |
$51.10
|
| Rate for Payer: PACE SWMI |
$51.10
|
| Rate for Payer: PHP Commercial |
$71.54
|
| Rate for Payer: PHP Commercial |
$71.54
|
| Rate for Payer: PHP Medicare Advantage |
$51.10
|
| Rate for Payer: PHP Medicare Advantage |
$51.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Medicare |
$51.10
|
| Rate for Payer: Priority Health Medicare |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.10
|
| Rate for Payer: UHC Medicare Advantage |
$51.10
|
| Rate for Payer: UHC Medicare Advantage |
$51.10
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
| Rate for Payer: UMR Bronson Commercial |
$46.92
|
|
|
PR PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX
|
Professional
|
Both
|
$2,177.00
|
|
|
Service Code
|
HCPCS 32215
|
| Min. Negotiated Rate |
$772.04 |
| Max. Negotiated Rate |
$1,415.05 |
| Rate for Payer: Aetna Commercial |
$1,034.53
|
| Rate for Payer: Aetna Medicare |
$802.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,111.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,034.53
|
| Rate for Payer: BCBS Complete |
$870.80
|
| Rate for Payer: BCBS MAPPO |
$772.04
|
| Rate for Payer: BCN Medicare Advantage |
$772.04
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Cash Price |
$1,741.60
|
| Rate for Payer: Cofinity Commercial |
$1,111.74
|
| Rate for Payer: Cofinity Commercial |
$1,034.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$810.64
|
| Rate for Payer: Nomi Health Commercial |
$926.45
|
| Rate for Payer: PACE SWMI |
$772.04
|
| Rate for Payer: PHP Commercial |
$1,080.86
|
| Rate for Payer: PHP Medicare Advantage |
$772.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,415.05
|
| Rate for Payer: Priority Health Medicare |
$772.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.04
|
| Rate for Payer: UHC Medicare Advantage |
$772.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,001.42
|
|
|
PR PLEURECTOMY PARIETAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,949.00
|
|
|
Service Code
|
HCPCS 32310
|
| Min. Negotiated Rate |
$883.98 |
| Max. Negotiated Rate |
$1,916.85 |
| Rate for Payer: Aetna Commercial |
$1,184.53
|
| Rate for Payer: Aetna Medicare |
$919.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,272.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,184.53
|
| Rate for Payer: BCBS Complete |
$1,179.60
|
| Rate for Payer: BCBS MAPPO |
$883.98
|
| Rate for Payer: BCN Medicare Advantage |
$883.98
|
| Rate for Payer: Cash Price |
$2,359.20
|
| Rate for Payer: Cash Price |
$2,359.20
|
| Rate for Payer: Cofinity Commercial |
$1,272.93
|
| Rate for Payer: Cofinity Commercial |
$1,184.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$883.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$928.18
|
| Rate for Payer: Nomi Health Commercial |
$1,060.78
|
| Rate for Payer: PACE SWMI |
$883.98
|
| Rate for Payer: PHP Commercial |
$1,237.57
|
| Rate for Payer: PHP Medicare Advantage |
$883.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,916.85
|
| Rate for Payer: Priority Health Medicare |
$883.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$883.98
|
| Rate for Payer: UHC Medicare Advantage |
$883.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,356.54
|
|
|
PR PL GLYCOLIC 35/70
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00067
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
|
PR PL ILLUMINIZE
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 00069
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
PR PL JESSNERS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00068
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
|
PR PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 47541
|
| Min. Negotiated Rate |
$315.08 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Aetna Commercial |
$422.21
|
| Rate for Payer: Aetna Medicare |
$327.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.21
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: BCBS MAPPO |
$315.08
|
| Rate for Payer: BCN Medicare Advantage |
$315.08
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cofinity Commercial |
$453.72
|
| Rate for Payer: Cofinity Commercial |
$422.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.83
|
| Rate for Payer: Nomi Health Commercial |
$378.10
|
| Rate for Payer: PACE SWMI |
$315.08
|
| Rate for Payer: PHP Commercial |
$441.11
|
| Rate for Payer: PHP Medicare Advantage |
$315.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
| Rate for Payer: Priority Health Medicare |
$315.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.08
|
| Rate for Payer: UHC Medicare Advantage |
$315.08
|
| Rate for Payer: UMR Bronson Commercial |
$985.32
|
|
|
PR PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST
|
Professional
|
Both
|
$10,186.00
|
|
|
Service Code
|
HCPCS 19296
|
| Min. Negotiated Rate |
$204.23 |
| Max. Negotiated Rate |
$6,620.90 |
| Rate for Payer: Aetna Commercial |
$273.67
|
| Rate for Payer: Aetna Medicare |
$212.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.67
|
| Rate for Payer: BCBS Complete |
$4,074.40
|
| Rate for Payer: BCBS MAPPO |
$204.23
|
| Rate for Payer: BCN Medicare Advantage |
$204.23
|
| Rate for Payer: Cash Price |
$8,148.80
|
| Rate for Payer: Cash Price |
$8,148.80
|
| Rate for Payer: Cofinity Commercial |
$294.09
|
| Rate for Payer: Cofinity Commercial |
$273.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.44
|
| Rate for Payer: Nomi Health Commercial |
$245.08
|
| Rate for Payer: PACE SWMI |
$204.23
|
| Rate for Payer: PHP Commercial |
$285.92
|
| Rate for Payer: PHP Medicare Advantage |
$204.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,620.90
|
| Rate for Payer: Priority Health Medicare |
$204.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.23
|
| Rate for Payer: UHC Medicare Advantage |
$204.23
|
| Rate for Payer: UMR Bronson Commercial |
$4,685.56
|
|
|
PR PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR
|
Professional
|
Both
|
$1,219.00
|
|
|
Service Code
|
HCPCS 34813
|
| Min. Negotiated Rate |
$225.47 |
| Max. Negotiated Rate |
$792.35 |
| Rate for Payer: Aetna Commercial |
$302.13
|
| Rate for Payer: Aetna Medicare |
$234.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.13
|
| Rate for Payer: BCBS Complete |
$487.60
|
| Rate for Payer: BCBS MAPPO |
$225.47
|
| Rate for Payer: BCN Medicare Advantage |
$225.47
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cofinity Commercial |
$324.68
|
| Rate for Payer: Cofinity Commercial |
$302.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.74
|
| Rate for Payer: Nomi Health Commercial |
$270.56
|
| Rate for Payer: PACE SWMI |
$225.47
|
| Rate for Payer: PHP Commercial |
$315.66
|
| Rate for Payer: PHP Medicare Advantage |
$225.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.35
|
| Rate for Payer: Priority Health Medicare |
$225.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.47
|
| Rate for Payer: UHC Medicare Advantage |
$225.47
|
| Rate for Payer: UMR Bronson Commercial |
$560.74
|
|
|
PR PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 55876
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: Aetna Commercial |
$129.83
|
| Rate for Payer: Aetna Medicare |
$100.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.83
|
| Rate for Payer: BCBS Complete |
$110.80
|
| Rate for Payer: BCBS MAPPO |
$96.89
|
| Rate for Payer: BCN Medicare Advantage |
$96.89
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$139.52
|
| Rate for Payer: Cofinity Commercial |
$129.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.73
|
| Rate for Payer: Nomi Health Commercial |
$116.27
|
| Rate for Payer: PACE SWMI |
$96.89
|
| Rate for Payer: PHP Commercial |
$135.65
|
| Rate for Payer: PHP Medicare Advantage |
$96.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health Medicare |
$96.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.89
|
| Rate for Payer: UHC Medicare Advantage |
$96.89
|
| Rate for Payer: UMR Bronson Commercial |
$127.42
|
|
|
PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 50432
|
| Min. Negotiated Rate |
$192.01 |
| Max. Negotiated Rate |
$1,050.40 |
| Rate for Payer: Aetna Commercial |
$257.29
|
| Rate for Payer: Aetna Medicare |
$199.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.29
|
| Rate for Payer: BCBS Complete |
$646.40
|
| Rate for Payer: BCBS MAPPO |
$192.01
|
| Rate for Payer: BCN Medicare Advantage |
$192.01
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$276.49
|
| Rate for Payer: Cofinity Commercial |
$257.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.61
|
| Rate for Payer: Nomi Health Commercial |
$230.41
|
| Rate for Payer: PACE SWMI |
$192.01
|
| Rate for Payer: PHP Commercial |
$268.81
|
| Rate for Payer: PHP Medicare Advantage |
$192.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health Medicare |
$192.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.01
|
| Rate for Payer: UHC Medicare Advantage |
$192.01
|
| Rate for Payer: UMR Bronson Commercial |
$743.36
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN
|
Professional
|
Both
|
$2,278.00
|
|
|
Service Code
|
HCPCS 33883
|
| Min. Negotiated Rate |
$911.20 |
| Max. Negotiated Rate |
$1,528.99 |
| Rate for Payer: Aetna Commercial |
$1,422.81
|
| Rate for Payer: Aetna Medicare |
$1,104.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,528.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,422.81
|
| Rate for Payer: BCBS Complete |
$911.20
|
| Rate for Payer: BCBS MAPPO |
$1,061.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,061.80
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cofinity Commercial |
$1,528.99
|
| Rate for Payer: Cofinity Commercial |
$1,422.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,061.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,114.89
|
| Rate for Payer: Nomi Health Commercial |
$1,274.16
|
| Rate for Payer: PACE SWMI |
$1,061.80
|
| Rate for Payer: PHP Commercial |
$1,486.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,061.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.70
|
| Rate for Payer: Priority Health Medicare |
$1,061.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,061.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,061.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,047.88
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 33884
|
| Min. Negotiated Rate |
$350.80 |
| Max. Negotiated Rate |
$570.05 |
| Rate for Payer: Aetna Commercial |
$510.25
|
| Rate for Payer: Aetna Medicare |
$396.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.25
|
| Rate for Payer: BCBS Complete |
$350.80
|
| Rate for Payer: BCBS MAPPO |
$380.78
|
| Rate for Payer: BCN Medicare Advantage |
$380.78
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Cofinity Commercial |
$548.32
|
| Rate for Payer: Cofinity Commercial |
$510.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.82
|
| Rate for Payer: Nomi Health Commercial |
$456.94
|
| Rate for Payer: PACE SWMI |
$380.78
|
| Rate for Payer: PHP Commercial |
$533.09
|
| Rate for Payer: PHP Medicare Advantage |
$380.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.05
|
| Rate for Payer: Priority Health Medicare |
$380.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$380.78
|
| Rate for Payer: UHC Medicare Advantage |
$380.78
|
| Rate for Payer: UMR Bronson Commercial |
$403.42
|
|
|
PR PLMT SFT TISS LOCLZJ DEV PERQ 1ST LESION
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 10035
|
| Min. Negotiated Rate |
$79.33 |
| Max. Negotiated Rate |
$154.05 |
| Rate for Payer: Aetna Commercial |
$106.30
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.30
|
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: BCBS MAPPO |
$79.33
|
| Rate for Payer: BCN Medicare Advantage |
$79.33
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.30
|
| Rate for Payer: Nomi Health Commercial |
$95.20
|
| Rate for Payer: PACE SWMI |
$79.33
|
| Rate for Payer: PHP Commercial |
$111.06
|
| Rate for Payer: PHP Medicare Advantage |
$79.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.05
|
| Rate for Payer: Priority Health Medicare |
$79.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.33
|
| Rate for Payer: UHC Medicare Advantage |
$79.33
|
| Rate for Payer: UMR Bronson Commercial |
$109.02
|
|
|
PR PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 50693
|
| Min. Negotiated Rate |
$191.01 |
| Max. Negotiated Rate |
$365.95 |
| Rate for Payer: Aetna Commercial |
$255.95
|
| Rate for Payer: Aetna Medicare |
$198.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.95
|
| Rate for Payer: BCBS Complete |
$225.20
|
| Rate for Payer: BCBS MAPPO |
$191.01
|
| Rate for Payer: BCN Medicare Advantage |
$191.01
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$275.05
|
| Rate for Payer: Cofinity Commercial |
$255.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.56
|
| Rate for Payer: Nomi Health Commercial |
$229.21
|
| Rate for Payer: PACE SWMI |
$191.01
|
| Rate for Payer: PHP Commercial |
$267.41
|
| Rate for Payer: PHP Medicare Advantage |
$191.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.95
|
| Rate for Payer: Priority Health Medicare |
$191.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.01
|
| Rate for Payer: UHC Medicare Advantage |
$191.01
|
| Rate for Payer: UMR Bronson Commercial |
$258.98
|
|
|
PR PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 35685
|
| Min. Negotiated Rate |
$177.20 |
| Max. Negotiated Rate |
$287.95 |
| Rate for Payer: Aetna Commercial |
$255.56
|
| Rate for Payer: Aetna Medicare |
$198.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.56
|
| Rate for Payer: BCBS Complete |
$177.20
|
| Rate for Payer: BCBS MAPPO |
$190.72
|
| Rate for Payer: BCN Medicare Advantage |
$190.72
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$274.64
|
| Rate for Payer: Cofinity Commercial |
$255.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.26
|
| Rate for Payer: Nomi Health Commercial |
$228.86
|
| Rate for Payer: PACE SWMI |
$190.72
|
| Rate for Payer: PHP Commercial |
$267.01
|
| Rate for Payer: PHP Medicare Advantage |
$190.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.95
|
| Rate for Payer: Priority Health Medicare |
$190.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.72
|
| Rate for Payer: UHC Medicare Advantage |
$190.72
|
| Rate for Payer: UMR Bronson Commercial |
$203.78
|
|
|
PR PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 34839
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR PL REJUV/PERFECT
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 00071
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
|
PR PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL
|
Professional
|
Both
|
$1,883.00
|
|
|
Service Code
|
HCPCS 40720
|
| Min. Negotiated Rate |
$753.20 |
| Max. Negotiated Rate |
$1,413.40 |
| Rate for Payer: Aetna Commercial |
$1,315.25
|
| Rate for Payer: Aetna Medicare |
$1,020.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.25
|
| Rate for Payer: BCBS Complete |
$753.20
|
| Rate for Payer: BCBS MAPPO |
$981.53
|
| Rate for Payer: BCN Medicare Advantage |
$981.53
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cofinity Commercial |
$1,413.40
|
| Rate for Payer: Cofinity Commercial |
$1,315.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.61
|
| Rate for Payer: Nomi Health Commercial |
$1,177.84
|
| Rate for Payer: PACE SWMI |
$981.53
|
| Rate for Payer: PHP Commercial |
$1,374.14
|
| Rate for Payer: PHP Medicare Advantage |
$981.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,223.95
|
| Rate for Payer: Priority Health Medicare |
$981.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.53
|
| Rate for Payer: UHC Medicare Advantage |
$981.53
|
| Rate for Payer: UMR Bronson Commercial |
$866.18
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 42500
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$566.80 |
| Rate for Payer: Aetna Commercial |
$438.98
|
| Rate for Payer: Aetna Medicare |
$340.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.98
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: BCBS MAPPO |
$327.60
|
| Rate for Payer: BCN Medicare Advantage |
$327.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$471.74
|
| Rate for Payer: Cofinity Commercial |
$438.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.98
|
| Rate for Payer: Nomi Health Commercial |
$393.12
|
| Rate for Payer: PACE SWMI |
$327.60
|
| Rate for Payer: PHP Commercial |
$458.64
|
| Rate for Payer: PHP Medicare Advantage |
$327.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health Medicare |
$327.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.60
|
| Rate for Payer: UHC Medicare Advantage |
$327.60
|
| Rate for Payer: UMR Bronson Commercial |
$401.12
|
|
