|
PR PROPH TX W/WO METHYLMETHACRYLATE RADIUS
|
Professional
|
Both
|
$2,251.00
|
|
|
Service Code
|
HCPCS 25490
|
| Min. Negotiated Rate |
$695.73 |
| Max. Negotiated Rate |
$1,463.15 |
| Rate for Payer: Aetna Commercial |
$932.28
|
| Rate for Payer: Aetna Medicare |
$723.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.85
|
| Rate for Payer: BCBS Complete |
$900.40
|
| Rate for Payer: BCBS MAPPO |
$695.73
|
| Rate for Payer: BCN Medicare Advantage |
$695.73
|
| Rate for Payer: Cash Price |
$1,800.80
|
| Rate for Payer: Cash Price |
$1,800.80
|
| Rate for Payer: Cofinity Commercial |
$932.28
|
| Rate for Payer: Cofinity Commercial |
$1,001.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.52
|
| Rate for Payer: Nomi Health Commercial |
$834.88
|
| Rate for Payer: PACE SWMI |
$695.73
|
| Rate for Payer: PHP Commercial |
$974.02
|
| Rate for Payer: PHP Medicare Advantage |
$695.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,463.15
|
| Rate for Payer: Priority Health Medicare |
$695.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.73
|
| Rate for Payer: UHC Medicare Advantage |
$695.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,035.46
|
|
|
PR PROSTATE CA SCREENING; DRE
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS G0102
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Commercial |
$11.56
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC
|
Professional
|
Both
|
$3,657.00
|
|
|
Service Code
|
HCPCS 55815
|
| Min. Negotiated Rate |
$1,462.80 |
| Max. Negotiated Rate |
$2,415.04 |
| Rate for Payer: Aetna Commercial |
$2,247.33
|
| Rate for Payer: Aetna Medicare |
$1,744.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,415.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,247.33
|
| Rate for Payer: BCBS Complete |
$1,462.80
|
| Rate for Payer: BCBS MAPPO |
$1,677.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,677.11
|
| Rate for Payer: Cash Price |
$2,925.60
|
| Rate for Payer: Cash Price |
$2,925.60
|
| Rate for Payer: Cofinity Commercial |
$2,415.04
|
| Rate for Payer: Cofinity Commercial |
$2,247.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,677.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,760.97
|
| Rate for Payer: Nomi Health Commercial |
$2,012.53
|
| Rate for Payer: PACE SWMI |
$1,677.11
|
| Rate for Payer: PHP Commercial |
$2,347.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,677.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,377.05
|
| Rate for Payer: Priority Health Medicare |
$1,677.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,677.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,677.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,682.22
|
|
|
PR PROSTATECTOMY RETROPUBIC SUBTOTAL
|
Professional
|
Both
|
$3,341.00
|
|
|
Service Code
|
HCPCS 55831
|
| Min. Negotiated Rate |
$821.66 |
| Max. Negotiated Rate |
$2,171.65 |
| Rate for Payer: Aetna Commercial |
$1,101.02
|
| Rate for Payer: Aetna Medicare |
$854.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,183.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,101.02
|
| Rate for Payer: BCBS Complete |
$1,336.40
|
| Rate for Payer: BCBS MAPPO |
$821.66
|
| Rate for Payer: BCN Medicare Advantage |
$821.66
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cash Price |
$2,672.80
|
| Rate for Payer: Cofinity Commercial |
$1,183.19
|
| Rate for Payer: Cofinity Commercial |
$1,101.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.74
|
| Rate for Payer: Nomi Health Commercial |
$985.99
|
| Rate for Payer: PACE SWMI |
$821.66
|
| Rate for Payer: PHP Commercial |
$1,150.32
|
| Rate for Payer: PHP Medicare Advantage |
$821.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,171.65
|
| Rate for Payer: Priority Health Medicare |
$821.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$821.66
|
| Rate for Payer: UHC Medicare Advantage |
$821.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,536.86
|
|
|
PR PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 55840
|
| Min. Negotiated Rate |
$1,025.20 |
| Max. Negotiated Rate |
$1,665.95 |
| Rate for Payer: Aetna Commercial |
$1,496.67
|
| Rate for Payer: Aetna Medicare |
$1,161.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,608.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,496.67
|
| Rate for Payer: BCBS Complete |
$1,025.20
|
| Rate for Payer: BCBS MAPPO |
$1,116.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,116.92
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cofinity Commercial |
$1,608.36
|
| Rate for Payer: Cofinity Commercial |
$1,496.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,116.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,172.77
|
| Rate for Payer: Nomi Health Commercial |
$1,340.30
|
| Rate for Payer: PACE SWMI |
$1,116.92
|
| Rate for Payer: PHP Commercial |
$1,563.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,116.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.95
|
| Rate for Payer: Priority Health Medicare |
$1,116.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,116.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,116.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,178.98
|
|
|
PR PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES
|
Professional
|
Both
|
$3,269.00
|
|
|
Service Code
|
HCPCS 55821
|
| Min. Negotiated Rate |
$801.00 |
| Max. Negotiated Rate |
$2,124.85 |
| Rate for Payer: Aetna Commercial |
$1,073.34
|
| Rate for Payer: Aetna Medicare |
$833.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,153.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,073.34
|
| Rate for Payer: BCBS Complete |
$1,307.60
|
| Rate for Payer: BCBS MAPPO |
$801.00
|
| Rate for Payer: BCN Medicare Advantage |
$801.00
|
| Rate for Payer: Cash Price |
$2,615.20
|
| Rate for Payer: Cash Price |
$2,615.20
|
| Rate for Payer: Cofinity Commercial |
$1,153.44
|
| Rate for Payer: Cofinity Commercial |
$1,073.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$801.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$841.05
|
| Rate for Payer: Nomi Health Commercial |
$961.20
|
| Rate for Payer: PACE SWMI |
$801.00
|
| Rate for Payer: PHP Commercial |
$1,121.40
|
| Rate for Payer: PHP Medicare Advantage |
$801.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,124.85
|
| Rate for Payer: Priority Health Medicare |
$801.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$801.00
|
| Rate for Payer: UHC Medicare Advantage |
$801.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,503.74
|
|
|
PR PROSTATE NEEDLE BIOPSY ANY APPROACH
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 55700
|
| Min. Negotiated Rate |
$123.40 |
| Max. Negotiated Rate |
$327.60 |
| Rate for Payer: Aetna Commercial |
$165.36
|
| Rate for Payer: Aetna Medicare |
$128.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.36
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: BCBS MAPPO |
$123.40
|
| Rate for Payer: BCN Medicare Advantage |
$123.40
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cofinity Commercial |
$177.70
|
| Rate for Payer: Cofinity Commercial |
$165.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.57
|
| Rate for Payer: Nomi Health Commercial |
$148.08
|
| Rate for Payer: PACE SWMI |
$123.40
|
| Rate for Payer: PHP Commercial |
$172.76
|
| Rate for Payer: PHP Medicare Advantage |
$123.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.60
|
| Rate for Payer: Priority Health Medicare |
$123.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.40
|
| Rate for Payer: UHC Medicare Advantage |
$123.40
|
| Rate for Payer: UMR Bronson Commercial |
$231.84
|
|
|
PR PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 55725
|
| Min. Negotiated Rate |
$428.00 |
| Max. Negotiated Rate |
$821.32 |
| Rate for Payer: Aetna Commercial |
$764.28
|
| Rate for Payer: Aetna Medicare |
$593.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.28
|
| Rate for Payer: BCBS Complete |
$428.00
|
| Rate for Payer: BCBS MAPPO |
$570.36
|
| Rate for Payer: BCN Medicare Advantage |
$570.36
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cofinity Commercial |
$821.32
|
| Rate for Payer: Cofinity Commercial |
$764.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.88
|
| Rate for Payer: Nomi Health Commercial |
$684.43
|
| Rate for Payer: PACE SWMI |
$570.36
|
| Rate for Payer: PHP Commercial |
$798.50
|
| Rate for Payer: PHP Medicare Advantage |
$570.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$695.50
|
| Rate for Payer: Priority Health Medicare |
$570.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.36
|
| Rate for Payer: UHC Medicare Advantage |
$570.36
|
| Rate for Payer: UMR Bronson Commercial |
$492.20
|
|
|
PR PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX
|
Professional
|
Both
|
$4,213.00
|
|
|
Service Code
|
HCPCS 55842
|
| Min. Negotiated Rate |
$1,114.05 |
| Max. Negotiated Rate |
$2,738.45 |
| Rate for Payer: Aetna Commercial |
$1,492.83
|
| Rate for Payer: Aetna Medicare |
$1,158.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,604.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,492.83
|
| Rate for Payer: BCBS Complete |
$1,685.20
|
| Rate for Payer: BCBS MAPPO |
$1,114.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,114.05
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cash Price |
$3,370.40
|
| Rate for Payer: Cofinity Commercial |
$1,604.23
|
| Rate for Payer: Cofinity Commercial |
$1,492.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,114.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,169.75
|
| Rate for Payer: Nomi Health Commercial |
$1,336.86
|
| Rate for Payer: PACE SWMI |
$1,114.05
|
| Rate for Payer: PHP Commercial |
$1,559.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,114.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,738.45
|
| Rate for Payer: Priority Health Medicare |
$1,114.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,114.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,114.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,937.98
|
|
|
PR PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM
|
Professional
|
Both
|
$2,838.00
|
|
|
Service Code
|
HCPCS 55845
|
| Min. Negotiated Rate |
$1,135.20 |
| Max. Negotiated Rate |
$1,869.55 |
| Rate for Payer: Aetna Commercial |
$1,739.72
|
| Rate for Payer: Aetna Medicare |
$1,350.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,869.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,739.72
|
| Rate for Payer: BCBS Complete |
$1,135.20
|
| Rate for Payer: BCBS MAPPO |
$1,298.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,298.30
|
| Rate for Payer: Cash Price |
$2,270.40
|
| Rate for Payer: Cash Price |
$2,270.40
|
| Rate for Payer: Cofinity Commercial |
$1,869.55
|
| Rate for Payer: Cofinity Commercial |
$1,739.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,298.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,363.21
|
| Rate for Payer: Nomi Health Commercial |
$1,557.96
|
| Rate for Payer: PACE SWMI |
$1,298.30
|
| Rate for Payer: PHP Commercial |
$1,817.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,298.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,844.70
|
| Rate for Payer: Priority Health Medicare |
$1,298.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,298.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,298.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,305.48
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT
|
Professional
|
Both
|
$1,967.00
|
|
|
Service Code
|
HCPCS 23335
|
| Min. Negotiated Rate |
$786.80 |
| Max. Negotiated Rate |
$1,754.45 |
| Rate for Payer: Aetna Commercial |
$1,632.62
|
| Rate for Payer: Aetna Medicare |
$1,267.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,754.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,632.62
|
| Rate for Payer: BCBS Complete |
$786.80
|
| Rate for Payer: BCBS MAPPO |
$1,218.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.37
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cash Price |
$1,573.60
|
| Rate for Payer: Cofinity Commercial |
$1,754.45
|
| Rate for Payer: Cofinity Commercial |
$1,632.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,279.29
|
| Rate for Payer: Nomi Health Commercial |
$1,462.04
|
| Rate for Payer: PACE SWMI |
$1,218.37
|
| Rate for Payer: PHP Commercial |
$1,705.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,278.55
|
| Rate for Payer: Priority Health Medicare |
$1,218.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,218.37
|
| Rate for Payer: UMR Bronson Commercial |
$904.82
|
|
|
PR PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
HCPCS 24160
|
| Min. Negotiated Rate |
$820.80 |
| Max. Negotiated Rate |
$1,744.14 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna Medicare |
$1,259.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,744.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,623.02
|
| Rate for Payer: BCBS Complete |
$820.80
|
| Rate for Payer: BCBS MAPPO |
$1,211.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,211.21
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Cofinity Commercial |
$1,744.14
|
| Rate for Payer: Cofinity Commercial |
$1,623.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,211.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,271.77
|
| Rate for Payer: Nomi Health Commercial |
$1,453.45
|
| Rate for Payer: PACE SWMI |
$1,211.21
|
| Rate for Payer: PHP Commercial |
$1,695.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,211.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,333.80
|
| Rate for Payer: Priority Health Medicare |
$1,211.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,211.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,211.21
|
| Rate for Payer: UMR Bronson Commercial |
$943.92
|
|
|
PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT
|
Professional
|
Both
|
$2,533.00
|
|
|
Service Code
|
HCPCS 23334
|
| Min. Negotiated Rate |
$1,013.20 |
| Max. Negotiated Rate |
$1,646.45 |
| Rate for Payer: Aetna Commercial |
$1,371.99
|
| Rate for Payer: Aetna Medicare |
$1,064.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,474.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.99
|
| Rate for Payer: BCBS Complete |
$1,013.20
|
| Rate for Payer: BCBS MAPPO |
$1,023.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,023.87
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cofinity Commercial |
$1,474.37
|
| Rate for Payer: Cofinity Commercial |
$1,371.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,023.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,075.06
|
| Rate for Payer: Nomi Health Commercial |
$1,228.64
|
| Rate for Payer: PACE SWMI |
$1,023.87
|
| Rate for Payer: PHP Commercial |
$1,433.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,023.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,646.45
|
| Rate for Payer: Priority Health Medicare |
$1,023.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,023.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,023.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,165.18
|
|
|
PR PROSTHESIS REMOVAL RADIAL HEAD
|
Professional
|
Both
|
$2,287.00
|
|
|
Service Code
|
HCPCS 24164
|
| Min. Negotiated Rate |
$702.11 |
| Max. Negotiated Rate |
$1,486.55 |
| Rate for Payer: Aetna Commercial |
$940.83
|
| Rate for Payer: Aetna Medicare |
$730.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.04
|
| Rate for Payer: BCBS Complete |
$914.80
|
| Rate for Payer: BCBS MAPPO |
$702.11
|
| Rate for Payer: BCN Medicare Advantage |
$702.11
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cash Price |
$1,829.60
|
| Rate for Payer: Cofinity Commercial |
$940.83
|
| Rate for Payer: Cofinity Commercial |
$1,011.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.22
|
| Rate for Payer: Nomi Health Commercial |
$842.53
|
| Rate for Payer: PACE SWMI |
$702.11
|
| Rate for Payer: PHP Commercial |
$982.95
|
| Rate for Payer: PHP Medicare Advantage |
$702.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,486.55
|
| Rate for Payer: Priority Health Medicare |
$702.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$702.11
|
| Rate for Payer: UHC Medicare Advantage |
$702.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,052.02
|
|
|
PR PROSTHESIS SERVICE APHAKIA TEMPORARY
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 92358
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
|
|
PR PROTECTOR HEEL OR ELBOW
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS E0191
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS
|
Professional
|
Both
|
$1,398.00
|
|
|
Service Code
|
HCPCS 62267
|
| Min. Negotiated Rate |
$146.06 |
| Max. Negotiated Rate |
$908.70 |
| Rate for Payer: Aetna Commercial |
$195.72
|
| Rate for Payer: Aetna Medicare |
$151.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.72
|
| Rate for Payer: BCBS Complete |
$559.20
|
| Rate for Payer: BCBS MAPPO |
$146.06
|
| Rate for Payer: BCN Medicare Advantage |
$146.06
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cash Price |
$1,118.40
|
| Rate for Payer: Cofinity Commercial |
$210.33
|
| Rate for Payer: Cofinity Commercial |
$195.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.36
|
| Rate for Payer: Nomi Health Commercial |
$175.27
|
| Rate for Payer: PACE SWMI |
$146.06
|
| Rate for Payer: PHP Commercial |
$204.48
|
| Rate for Payer: PHP Medicare Advantage |
$146.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$908.70
|
| Rate for Payer: Priority Health Medicare |
$146.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.06
|
| Rate for Payer: UHC Medicare Advantage |
$146.06
|
| Rate for Payer: UMR Bronson Commercial |
$643.08
|
|
|
PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE
|
Professional
|
Both
|
$2,680.00
|
|
|
Service Code
|
HCPCS 92986
|
| Min. Negotiated Rate |
$1,072.00 |
| Max. Negotiated Rate |
$1,814.64 |
| Rate for Payer: Aetna Commercial |
$1,688.63
|
| Rate for Payer: Aetna Medicare |
$1,310.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,814.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,688.63
|
| Rate for Payer: BCBS Complete |
$1,072.00
|
| Rate for Payer: BCBS MAPPO |
$1,260.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,260.17
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cash Price |
$2,144.00
|
| Rate for Payer: Cofinity Commercial |
$1,814.64
|
| Rate for Payer: Cofinity Commercial |
$1,688.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,260.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,323.18
|
| Rate for Payer: Nomi Health Commercial |
$1,512.20
|
| Rate for Payer: PACE SWMI |
$1,260.17
|
| Rate for Payer: PHP Commercial |
$1,764.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,260.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,742.00
|
| Rate for Payer: Priority Health Medicare |
$1,260.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,260.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,260.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,232.80
|
|
|
PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING
|
Professional
|
Both
|
$1,989.00
|
|
|
Service Code
|
HCPCS 64561
|
| Min. Negotiated Rate |
$289.62 |
| Max. Negotiated Rate |
$1,292.85 |
| Rate for Payer: Aetna Commercial |
$388.09
|
| Rate for Payer: Aetna Medicare |
$301.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.09
|
| Rate for Payer: BCBS Complete |
$795.60
|
| Rate for Payer: BCBS MAPPO |
$289.62
|
| Rate for Payer: BCN Medicare Advantage |
$289.62
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cofinity Commercial |
$417.05
|
| Rate for Payer: Cofinity Commercial |
$388.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$304.10
|
| Rate for Payer: Nomi Health Commercial |
$347.54
|
| Rate for Payer: PACE SWMI |
$289.62
|
| Rate for Payer: PHP Commercial |
$405.47
|
| Rate for Payer: PHP Medicare Advantage |
$289.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.85
|
| Rate for Payer: Priority Health Medicare |
$289.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.62
|
| Rate for Payer: UHC Medicare Advantage |
$289.62
|
| Rate for Payer: UMR Bronson Commercial |
$914.94
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE
|
Professional
|
Both
|
$454.00
|
|
|
Service Code
|
HCPCS 64553
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$641.20 |
| Rate for Payer: Aetna Commercial |
$596.68
|
| Rate for Payer: Aetna Medicare |
$463.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.68
|
| Rate for Payer: BCBS Complete |
$181.60
|
| Rate for Payer: BCBS MAPPO |
$445.28
|
| Rate for Payer: BCN Medicare Advantage |
$445.28
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cash Price |
$363.20
|
| Rate for Payer: Cofinity Commercial |
$641.20
|
| Rate for Payer: Cofinity Commercial |
$596.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.54
|
| Rate for Payer: Nomi Health Commercial |
$534.34
|
| Rate for Payer: PACE SWMI |
$445.28
|
| Rate for Payer: PHP Commercial |
$623.39
|
| Rate for Payer: PHP Medicare Advantage |
$445.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.10
|
| Rate for Payer: Priority Health Medicare |
$445.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$445.28
|
| Rate for Payer: UHC Medicare Advantage |
$445.28
|
| Rate for Payer: UMR Bronson Commercial |
$208.84
|
|
|
PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 64555
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$447.84 |
| Rate for Payer: Aetna Commercial |
$416.74
|
| Rate for Payer: Aetna Medicare |
$323.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$447.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.74
|
| Rate for Payer: BCBS Complete |
$199.20
|
| Rate for Payer: BCBS MAPPO |
$311.00
|
| Rate for Payer: BCN Medicare Advantage |
$311.00
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cofinity Commercial |
$447.84
|
| Rate for Payer: Cofinity Commercial |
$416.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.55
|
| Rate for Payer: Nomi Health Commercial |
$373.20
|
| Rate for Payer: PACE SWMI |
$311.00
|
| Rate for Payer: PHP Commercial |
$435.40
|
| Rate for Payer: PHP Medicare Advantage |
$311.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.70
|
| Rate for Payer: Priority Health Medicare |
$311.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.00
|
| Rate for Payer: UHC Medicare Advantage |
$311.00
|
| Rate for Payer: UMR Bronson Commercial |
$229.08
|
|
|
PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL
|
Professional
|
Both
|
$5,346.00
|
|
|
Service Code
|
HCPCS 63650
|
| Min. Negotiated Rate |
$395.29 |
| Max. Negotiated Rate |
$3,474.90 |
| Rate for Payer: Aetna Commercial |
$529.69
|
| Rate for Payer: Aetna Medicare |
$411.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$529.69
|
| Rate for Payer: BCBS Complete |
$2,138.40
|
| Rate for Payer: BCBS MAPPO |
$395.29
|
| Rate for Payer: BCN Medicare Advantage |
$395.29
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Cash Price |
$4,276.80
|
| Rate for Payer: Cofinity Commercial |
$569.22
|
| Rate for Payer: Cofinity Commercial |
$529.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.05
|
| Rate for Payer: Nomi Health Commercial |
$474.35
|
| Rate for Payer: PACE SWMI |
$395.29
|
| Rate for Payer: PHP Commercial |
$553.41
|
| Rate for Payer: PHP Medicare Advantage |
$395.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,474.90
|
| Rate for Payer: Priority Health Medicare |
$395.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$395.29
|
| Rate for Payer: UHC Medicare Advantage |
$395.29
|
| Rate for Payer: UMR Bronson Commercial |
$2,459.16
|
|
|
PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL
|
Professional
|
Both
|
$2,470.00
|
|
|
Service Code
|
HCPCS 47533
|
| Min. Negotiated Rate |
$247.34 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Aetna Commercial |
$331.44
|
| Rate for Payer: Aetna Medicare |
$257.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.44
|
| Rate for Payer: BCBS Complete |
$988.00
|
| Rate for Payer: BCBS MAPPO |
$247.34
|
| Rate for Payer: BCN Medicare Advantage |
$247.34
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Cash Price |
$1,976.00
|
| Rate for Payer: Cofinity Commercial |
$356.17
|
| Rate for Payer: Cofinity Commercial |
$331.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.71
|
| Rate for Payer: Nomi Health Commercial |
$296.81
|
| Rate for Payer: PACE SWMI |
$247.34
|
| Rate for Payer: PHP Commercial |
$346.28
|
| Rate for Payer: PHP Medicare Advantage |
$247.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,605.50
|
| Rate for Payer: Priority Health Medicare |
$247.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.34
|
| Rate for Payer: UHC Medicare Advantage |
$247.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,136.20
|
|
|
PR PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 28436
|
| Min. Negotiated Rate |
$456.80 |
| Max. Negotiated Rate |
$742.30 |
| Rate for Payer: Aetna Commercial |
$634.52
|
| Rate for Payer: Aetna Medicare |
$492.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$681.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.52
|
| Rate for Payer: BCBS Complete |
$456.80
|
| Rate for Payer: BCBS MAPPO |
$473.52
|
| Rate for Payer: BCN Medicare Advantage |
$473.52
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Commercial |
$681.87
|
| Rate for Payer: Cofinity Commercial |
$634.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$473.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$497.20
|
| Rate for Payer: Nomi Health Commercial |
$568.22
|
| Rate for Payer: PACE SWMI |
$473.52
|
| Rate for Payer: PHP Commercial |
$662.93
|
| Rate for Payer: PHP Medicare Advantage |
$473.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.30
|
| Rate for Payer: Priority Health Medicare |
$473.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$473.52
|
| Rate for Payer: UHC Medicare Advantage |
$473.52
|
| Rate for Payer: UMR Bronson Commercial |
$525.32
|
|
|
PR PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE
|
Professional
|
Both
|
$1,659.00
|
|
|
Service Code
|
HCPCS 27756
|
| Min. Negotiated Rate |
$569.25 |
| Max. Negotiated Rate |
$1,078.35 |
| Rate for Payer: Aetna Commercial |
$762.79
|
| Rate for Payer: Aetna Medicare |
$592.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$819.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.79
|
| Rate for Payer: BCBS Complete |
$663.60
|
| Rate for Payer: BCBS MAPPO |
$569.25
|
| Rate for Payer: BCN Medicare Advantage |
$569.25
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cash Price |
$1,327.20
|
| Rate for Payer: Cofinity Commercial |
$819.72
|
| Rate for Payer: Cofinity Commercial |
$762.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$597.71
|
| Rate for Payer: Nomi Health Commercial |
$683.10
|
| Rate for Payer: PACE SWMI |
$569.25
|
| Rate for Payer: PHP Commercial |
$796.95
|
| Rate for Payer: PHP Medicare Advantage |
$569.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,078.35
|
| Rate for Payer: Priority Health Medicare |
$569.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$569.25
|
| Rate for Payer: UHC Medicare Advantage |
$569.25
|
| Rate for Payer: UMR Bronson Commercial |
$763.14
|
|
