|
PR RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT
|
Professional
|
Both
|
$1,117.00
|
|
|
Service Code
|
HCPCS 54415
|
| Min. Negotiated Rate |
$312.26 |
| Max. Negotiated Rate |
$930.17 |
| Rate for Payer: Aetna Commercial |
$643.70
|
| Rate for Payer: Aetna Medicare |
$499.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$691.73
|
| Rate for Payer: BCBS Complete |
$327.87
|
| Rate for Payer: BCBS MAPPO |
$480.37
|
| Rate for Payer: BCN Commercial |
$800.75
|
| Rate for Payer: BCN Medicare Advantage |
$480.37
|
| Rate for Payer: Cash Price |
$893.60
|
| Rate for Payer: Cash Price |
$893.60
|
| Rate for Payer: Cofinity Commercial |
$643.70
|
| Rate for Payer: Cofinity Commercial |
$691.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$504.39
|
| Rate for Payer: Meridian Medicaid |
$327.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$528.41
|
| Rate for Payer: Nomi Health Commercial |
$576.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$837.75
|
| Rate for Payer: PACE SWMI |
$480.37
|
| Rate for Payer: PHP Commercial |
$672.52
|
| Rate for Payer: PHP Medicare Advantage |
$480.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$312.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$872.28
|
| Rate for Payer: Priority Health Medicare |
$480.37
|
| Rate for Payer: Priority Health SBD |
$872.28
|
| Rate for Payer: Priority Health Tiered Network |
$872.28
|
| Rate for Payer: Railroad Medicare Medicare |
$480.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$930.17
|
| Rate for Payer: UHC Core |
$930.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$480.37
|
| Rate for Payer: UHC Exchange |
$930.17
|
| Rate for Payer: UHC Medicaid |
$312.26
|
| Rate for Payer: UHCCP Medicaid |
$312.26
|
| Rate for Payer: UMR Bronson Commercial |
$513.82
|
|
|
PR RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
HCPCS 33272
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$613.82 |
| Rate for Payer: Aetna Commercial |
$412.08
|
| Rate for Payer: Aetna Medicare |
$319.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$412.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$442.83
|
| Rate for Payer: BCBS Complete |
$207.77
|
| Rate for Payer: BCBS MAPPO |
$307.52
|
| Rate for Payer: BCN Commercial |
$514.91
|
| Rate for Payer: BCN Medicare Advantage |
$307.52
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cash Price |
$593.60
|
| Rate for Payer: Cofinity Commercial |
$412.08
|
| Rate for Payer: Cofinity Commercial |
$442.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$307.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$322.90
|
| Rate for Payer: Meridian Medicaid |
$207.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$338.27
|
| Rate for Payer: Nomi Health Commercial |
$369.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$556.50
|
| Rate for Payer: PACE SWMI |
$307.52
|
| Rate for Payer: PHP Commercial |
$430.53
|
| Rate for Payer: PHP Medicare Advantage |
$307.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$553.72
|
| Rate for Payer: Priority Health Medicare |
$307.52
|
| Rate for Payer: Priority Health SBD |
$553.72
|
| Rate for Payer: Priority Health Tiered Network |
$553.72
|
| Rate for Payer: Railroad Medicare Medicare |
$307.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$613.82
|
| Rate for Payer: UHC Core |
$613.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$307.52
|
| Rate for Payer: UHC Exchange |
$613.82
|
| Rate for Payer: UHC Medicaid |
$197.88
|
| Rate for Payer: UHCCP Medicaid |
$197.88
|
| Rate for Payer: UMR Bronson Commercial |
$341.32
|
|
|
PR RMVL PERITONEAL-VENOUS SHUNT
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 49429
|
| Min. Negotiated Rate |
$277.11 |
| Max. Negotiated Rate |
$1,235.25 |
| Rate for Payer: Aetna Commercial |
$578.61
|
| Rate for Payer: Aetna Medicare |
$449.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$578.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$621.79
|
| Rate for Payer: BCBS Complete |
$290.97
|
| Rate for Payer: BCBS MAPPO |
$431.80
|
| Rate for Payer: BCN Commercial |
$689.70
|
| Rate for Payer: BCN Medicare Advantage |
$431.80
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cofinity Commercial |
$578.61
|
| Rate for Payer: Cofinity Commercial |
$621.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$431.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$453.39
|
| Rate for Payer: Meridian Medicaid |
$290.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$474.98
|
| Rate for Payer: Nomi Health Commercial |
$518.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,235.25
|
| Rate for Payer: PACE SWMI |
$431.80
|
| Rate for Payer: PHP Commercial |
$604.52
|
| Rate for Payer: PHP Medicare Advantage |
$431.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$840.36
|
| Rate for Payer: Priority Health Medicare |
$431.80
|
| Rate for Payer: Priority Health SBD |
$840.36
|
| Rate for Payer: Priority Health Tiered Network |
$840.36
|
| Rate for Payer: Railroad Medicare Medicare |
$431.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.84
|
| Rate for Payer: UHC Core |
$816.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$431.80
|
| Rate for Payer: UHC Exchange |
$816.84
|
| Rate for Payer: UHC Medicaid |
$277.11
|
| Rate for Payer: UHCCP Medicaid |
$277.11
|
| Rate for Payer: UMR Bronson Commercial |
$757.62
|
|
|
PR RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH
|
Professional
|
Both
|
$2,365.00
|
|
|
Service Code
|
HCPCS 62355
|
| Min. Negotiated Rate |
$179.13 |
| Max. Negotiated Rate |
$1,773.75 |
| Rate for Payer: Aetna Commercial |
$365.44
|
| Rate for Payer: Aetna Medicare |
$283.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.72
|
| Rate for Payer: BCBS Complete |
$188.09
|
| Rate for Payer: BCBS MAPPO |
$272.72
|
| Rate for Payer: BCN Commercial |
$426.28
|
| Rate for Payer: BCN Medicare Advantage |
$272.72
|
| Rate for Payer: Cash Price |
$1,892.00
|
| Rate for Payer: Cash Price |
$1,892.00
|
| Rate for Payer: Cofinity Commercial |
$365.44
|
| Rate for Payer: Cofinity Commercial |
$392.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$272.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.36
|
| Rate for Payer: Meridian Medicaid |
$188.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$299.99
|
| Rate for Payer: Nomi Health Commercial |
$327.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,773.75
|
| Rate for Payer: PACE SWMI |
$272.72
|
| Rate for Payer: PHP Commercial |
$381.81
|
| Rate for Payer: PHP Medicare Advantage |
$272.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$495.11
|
| Rate for Payer: Priority Health Medicare |
$272.72
|
| Rate for Payer: Priority Health SBD |
$495.11
|
| Rate for Payer: Priority Health Tiered Network |
$495.11
|
| Rate for Payer: Railroad Medicare Medicare |
$272.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$470.67
|
| Rate for Payer: UHC Core |
$470.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$272.72
|
| Rate for Payer: UHC Exchange |
$470.67
|
| Rate for Payer: UHC Medicaid |
$179.13
|
| Rate for Payer: UHCCP Medicaid |
$179.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,087.90
|
|
|
PR RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY
|
Professional
|
Both
|
$2,719.00
|
|
|
Service Code
|
HCPCS 33237
|
| Min. Negotiated Rate |
$529.52 |
| Max. Negotiated Rate |
$2,039.25 |
| Rate for Payer: Aetna Commercial |
$1,099.52
|
| Rate for Payer: Aetna Medicare |
$853.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,099.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,181.58
|
| Rate for Payer: BCBS Complete |
$556.00
|
| Rate for Payer: BCBS MAPPO |
$820.54
|
| Rate for Payer: BCN Commercial |
$1,246.94
|
| Rate for Payer: BCN Medicare Advantage |
$820.54
|
| Rate for Payer: Cash Price |
$2,175.20
|
| Rate for Payer: Cash Price |
$2,175.20
|
| Rate for Payer: Cofinity Commercial |
$1,099.52
|
| Rate for Payer: Cofinity Commercial |
$1,181.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$820.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$861.57
|
| Rate for Payer: Meridian Medicaid |
$556.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$902.59
|
| Rate for Payer: Nomi Health Commercial |
$984.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,039.25
|
| Rate for Payer: PACE SWMI |
$820.54
|
| Rate for Payer: PHP Commercial |
$1,148.76
|
| Rate for Payer: PHP Medicare Advantage |
$820.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$529.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,340.94
|
| Rate for Payer: Priority Health Medicare |
$820.54
|
| Rate for Payer: Priority Health SBD |
$1,340.94
|
| Rate for Payer: Priority Health Tiered Network |
$1,340.94
|
| Rate for Payer: Railroad Medicare Medicare |
$820.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,480.15
|
| Rate for Payer: UHC Core |
$1,480.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$820.54
|
| Rate for Payer: UHC Exchange |
$1,480.15
|
| Rate for Payer: UHC Medicaid |
$529.52
|
| Rate for Payer: UHCCP Medicaid |
$529.52
|
| Rate for Payer: UMR Bronson Commercial |
$1,250.74
|
|
|
PR RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION
|
Professional
|
Both
|
$850.00
|
|
|
Service Code
|
HCPCS 11008
|
| Min. Negotiated Rate |
$155.92 |
| Max. Negotiated Rate |
$637.50 |
| Rate for Payer: Aetna Commercial |
$330.20
|
| Rate for Payer: Aetna Medicare |
$256.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$354.84
|
| Rate for Payer: BCBS Complete |
$163.72
|
| Rate for Payer: BCBS MAPPO |
$246.42
|
| Rate for Payer: BCN Commercial |
$403.86
|
| Rate for Payer: BCN Medicare Advantage |
$246.42
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cash Price |
$680.00
|
| Rate for Payer: Cofinity Commercial |
$330.20
|
| Rate for Payer: Cofinity Commercial |
$354.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$258.74
|
| Rate for Payer: Meridian Medicaid |
$163.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$271.06
|
| Rate for Payer: Nomi Health Commercial |
$295.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$637.50
|
| Rate for Payer: PACE SWMI |
$246.42
|
| Rate for Payer: PHP Commercial |
$344.99
|
| Rate for Payer: PHP Medicare Advantage |
$246.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$369.64
|
| Rate for Payer: Priority Health Medicare |
$246.42
|
| Rate for Payer: Priority Health SBD |
$369.64
|
| Rate for Payer: Priority Health Tiered Network |
$369.64
|
| Rate for Payer: Railroad Medicare Medicare |
$246.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$491.90
|
| Rate for Payer: UHC Core |
$491.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$246.42
|
| Rate for Payer: UHC Exchange |
$491.90
|
| Rate for Payer: UHC Medicaid |
$155.92
|
| Rate for Payer: UHCCP Medicaid |
$155.92
|
| Rate for Payer: UMR Bronson Commercial |
$391.00
|
|
|
PR RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER
|
Professional
|
Both
|
$3,468.00
|
|
|
Service Code
|
HCPCS 27488
|
| Min. Negotiated Rate |
$701.41 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Aetna Commercial |
$1,447.54
|
| Rate for Payer: Aetna Medicare |
$1,123.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,447.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,555.56
|
| Rate for Payer: BCBS Complete |
$736.48
|
| Rate for Payer: BCBS MAPPO |
$1,080.25
|
| Rate for Payer: BCN Commercial |
$1,817.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,080.25
|
| Rate for Payer: Cash Price |
$2,774.40
|
| Rate for Payer: Cash Price |
$2,774.40
|
| Rate for Payer: Cofinity Commercial |
$1,447.54
|
| Rate for Payer: Cofinity Commercial |
$1,555.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,080.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,134.26
|
| Rate for Payer: Meridian Medicaid |
$736.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,188.28
|
| Rate for Payer: Nomi Health Commercial |
$1,296.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,601.00
|
| Rate for Payer: PACE SWMI |
$1,080.25
|
| Rate for Payer: PHP Commercial |
$1,512.35
|
| Rate for Payer: PHP Medicare Advantage |
$1,080.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$701.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,943.00
|
| Rate for Payer: Priority Health Medicare |
$1,080.25
|
| Rate for Payer: Priority Health SBD |
$1,943.00
|
| Rate for Payer: Priority Health Tiered Network |
$1,943.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,080.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,105.99
|
| Rate for Payer: UHC Core |
$2,105.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,080.25
|
| Rate for Payer: UHC Exchange |
$2,105.99
|
| Rate for Payer: UHC Medicaid |
$701.41
|
| Rate for Payer: UHCCP Medicaid |
$701.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,595.28
|
|
|
PR RMVL/REVJ SLING MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,635.00
|
|
|
Service Code
|
HCPCS 53442
|
| Min. Negotiated Rate |
$456.89 |
| Max. Negotiated Rate |
$1,379.89 |
| Rate for Payer: Aetna Commercial |
$944.06
|
| Rate for Payer: Aetna Medicare |
$732.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,014.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.06
|
| Rate for Payer: BCBS Complete |
$479.73
|
| Rate for Payer: BCBS MAPPO |
$704.52
|
| Rate for Payer: BCN Commercial |
$1,180.71
|
| Rate for Payer: BCN Medicare Advantage |
$704.52
|
| Rate for Payer: Cash Price |
$1,308.00
|
| Rate for Payer: Cash Price |
$1,308.00
|
| Rate for Payer: Cofinity Commercial |
$1,014.51
|
| Rate for Payer: Cofinity Commercial |
$944.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$704.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$739.75
|
| Rate for Payer: Meridian Medicaid |
$479.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$774.97
|
| Rate for Payer: Nomi Health Commercial |
$845.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,226.25
|
| Rate for Payer: PACE SWMI |
$704.52
|
| Rate for Payer: PHP Commercial |
$986.33
|
| Rate for Payer: PHP Medicare Advantage |
$704.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$456.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,286.19
|
| Rate for Payer: Priority Health Medicare |
$704.52
|
| Rate for Payer: Priority Health SBD |
$1,286.19
|
| Rate for Payer: Priority Health Tiered Network |
$1,286.19
|
| Rate for Payer: Railroad Medicare Medicare |
$704.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,379.89
|
| Rate for Payer: UHC Core |
$1,379.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$704.52
|
| Rate for Payer: UHC Exchange |
$1,379.89
|
| Rate for Payer: UHC Medicaid |
$456.89
|
| Rate for Payer: UHCCP Medicaid |
$456.89
|
| Rate for Payer: UMR Bronson Commercial |
$752.10
|
|
|
PR RMVL/REVJ SLING STRESS INCONTINENCE
|
Professional
|
Both
|
$1,271.00
|
|
|
Service Code
|
HCPCS 57287
|
| Min. Negotiated Rate |
$420.89 |
| Max. Negotiated Rate |
$1,536.93 |
| Rate for Payer: Aetna Commercial |
$866.42
|
| Rate for Payer: Aetna Medicare |
$672.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$931.08
|
| Rate for Payer: BCBS Complete |
$441.93
|
| Rate for Payer: BCBS MAPPO |
$646.58
|
| Rate for Payer: BCN Commercial |
$1,536.93
|
| Rate for Payer: BCN Medicare Advantage |
$646.58
|
| Rate for Payer: Cash Price |
$1,016.80
|
| Rate for Payer: Cash Price |
$1,016.80
|
| Rate for Payer: Cofinity Commercial |
$866.42
|
| Rate for Payer: Cofinity Commercial |
$931.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$646.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$678.91
|
| Rate for Payer: Meridian Medicaid |
$441.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$711.24
|
| Rate for Payer: Nomi Health Commercial |
$775.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$953.25
|
| Rate for Payer: PACE SWMI |
$646.58
|
| Rate for Payer: PHP Commercial |
$905.21
|
| Rate for Payer: PHP Medicare Advantage |
$646.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,126.71
|
| Rate for Payer: Priority Health Medicare |
$646.58
|
| Rate for Payer: Priority Health SBD |
$1,126.71
|
| Rate for Payer: Priority Health Tiered Network |
$1,126.71
|
| Rate for Payer: Railroad Medicare Medicare |
$646.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,255.72
|
| Rate for Payer: UHC Core |
$1,255.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$646.58
|
| Rate for Payer: UHC Exchange |
$1,255.72
|
| Rate for Payer: UHC Medicaid |
$420.89
|
| Rate for Payer: UHCCP Medicaid |
$420.89
|
| Rate for Payer: UMR Bronson Commercial |
$584.66
|
|
|
PR RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS
|
Professional
|
Both
|
$1,723.00
|
|
|
Service Code
|
HCPCS 54410
|
| Min. Negotiated Rate |
$498.85 |
| Max. Negotiated Rate |
$1,517.99 |
| Rate for Payer: Aetna Commercial |
$1,033.11
|
| Rate for Payer: Aetna Medicare |
$801.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,110.21
|
| Rate for Payer: BCBS Complete |
$523.79
|
| Rate for Payer: BCBS MAPPO |
$770.98
|
| Rate for Payer: BCN Commercial |
$1,293.75
|
| Rate for Payer: BCN Medicare Advantage |
$770.98
|
| Rate for Payer: Cash Price |
$1,378.40
|
| Rate for Payer: Cash Price |
$1,378.40
|
| Rate for Payer: Cofinity Commercial |
$1,033.11
|
| Rate for Payer: Cofinity Commercial |
$1,110.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$770.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.53
|
| Rate for Payer: Meridian Medicaid |
$523.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$848.08
|
| Rate for Payer: Nomi Health Commercial |
$925.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,292.25
|
| Rate for Payer: PACE SWMI |
$770.98
|
| Rate for Payer: PHP Commercial |
$1,079.37
|
| Rate for Payer: PHP Medicare Advantage |
$770.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,409.32
|
| Rate for Payer: Priority Health Medicare |
$770.98
|
| Rate for Payer: Priority Health SBD |
$1,409.32
|
| Rate for Payer: Priority Health Tiered Network |
$1,409.32
|
| Rate for Payer: Railroad Medicare Medicare |
$770.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,517.99
|
| Rate for Payer: UHC Core |
$1,517.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$770.98
|
| Rate for Payer: UHC Exchange |
$1,517.99
|
| Rate for Payer: UHC Medicaid |
$498.85
|
| Rate for Payer: UHCCP Medicaid |
$498.85
|
| Rate for Payer: UMR Bronson Commercial |
$792.58
|
|
|
PR RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ
|
Professional
|
Both
|
$2,215.00
|
|
|
Service Code
|
HCPCS 50382
|
| Min. Negotiated Rate |
$138.24 |
| Max. Negotiated Rate |
$1,661.25 |
| Rate for Payer: Aetna Commercial |
$290.65
|
| Rate for Payer: Aetna Medicare |
$225.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$290.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$312.34
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: BCBS MAPPO |
$216.90
|
| Rate for Payer: BCN Commercial |
$367.51
|
| Rate for Payer: BCN Medicare Advantage |
$216.90
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cash Price |
$1,772.00
|
| Rate for Payer: Cofinity Commercial |
$290.65
|
| Rate for Payer: Cofinity Commercial |
$312.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$227.75
|
| Rate for Payer: Meridian Medicaid |
$145.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$238.59
|
| Rate for Payer: Nomi Health Commercial |
$260.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,661.25
|
| Rate for Payer: PACE SWMI |
$216.90
|
| Rate for Payer: PHP Commercial |
$303.66
|
| Rate for Payer: PHP Medicare Advantage |
$216.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$400.34
|
| Rate for Payer: Priority Health Medicare |
$216.90
|
| Rate for Payer: Priority Health SBD |
$400.34
|
| Rate for Payer: Priority Health Tiered Network |
$400.34
|
| Rate for Payer: Railroad Medicare Medicare |
$216.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$457.46
|
| Rate for Payer: UHC Core |
$457.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$216.90
|
| Rate for Payer: UHC Exchange |
$457.46
|
| Rate for Payer: UHC Medicaid |
$138.24
|
| Rate for Payer: UHCCP Medicaid |
$138.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,018.90
|
|
|
PR RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD
|
Professional
|
Both
|
$2,732.00
|
|
|
Service Code
|
HCPCS 53448
|
| Min. Negotiated Rate |
$728.89 |
| Max. Negotiated Rate |
$2,261.86 |
| Rate for Payer: Aetna Commercial |
$1,515.74
|
| Rate for Payer: Aetna Medicare |
$1,176.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,515.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.86
|
| Rate for Payer: BCBS Complete |
$765.33
|
| Rate for Payer: BCBS MAPPO |
$1,131.15
|
| Rate for Payer: BCN Commercial |
$1,900.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,131.15
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Cofinity Commercial |
$1,515.74
|
| Rate for Payer: Cofinity Commercial |
$1,628.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,131.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,187.71
|
| Rate for Payer: Meridian Medicaid |
$765.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,244.27
|
| Rate for Payer: Nomi Health Commercial |
$1,357.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,049.00
|
| Rate for Payer: PACE SWMI |
$1,131.15
|
| Rate for Payer: PHP Commercial |
$1,583.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,131.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$728.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,070.59
|
| Rate for Payer: Priority Health Medicare |
$1,131.15
|
| Rate for Payer: Priority Health SBD |
$2,070.59
|
| Rate for Payer: Priority Health Tiered Network |
$2,070.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1,131.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,261.86
|
| Rate for Payer: UHC Core |
$2,261.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,131.15
|
| Rate for Payer: UHC Exchange |
$2,261.86
|
| Rate for Payer: UHC Medicaid |
$728.89
|
| Rate for Payer: UHCCP Medicaid |
$728.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,256.72
|
|
|
PR RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL
|
Professional
|
Both
|
$2,195.00
|
|
|
Service Code
|
HCPCS 54411
|
| Min. Negotiated Rate |
$592.14 |
| Max. Negotiated Rate |
$1,816.79 |
| Rate for Payer: Aetna Commercial |
$1,227.99
|
| Rate for Payer: Aetna Medicare |
$953.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,227.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,319.63
|
| Rate for Payer: BCBS Complete |
$621.75
|
| Rate for Payer: BCBS MAPPO |
$916.41
|
| Rate for Payer: BCN Commercial |
$1,539.26
|
| Rate for Payer: BCN Medicare Advantage |
$916.41
|
| Rate for Payer: Cash Price |
$1,756.00
|
| Rate for Payer: Cash Price |
$1,756.00
|
| Rate for Payer: Cofinity Commercial |
$1,227.99
|
| Rate for Payer: Cofinity Commercial |
$1,319.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$916.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$962.23
|
| Rate for Payer: Meridian Medicaid |
$621.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,008.05
|
| Rate for Payer: Nomi Health Commercial |
$1,099.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,646.25
|
| Rate for Payer: PACE SWMI |
$916.41
|
| Rate for Payer: PHP Commercial |
$1,282.97
|
| Rate for Payer: PHP Medicare Advantage |
$916.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$592.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,676.75
|
| Rate for Payer: Priority Health Medicare |
$916.41
|
| Rate for Payer: Priority Health SBD |
$1,676.75
|
| Rate for Payer: Priority Health Tiered Network |
$1,676.75
|
| Rate for Payer: Railroad Medicare Medicare |
$916.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,816.79
|
| Rate for Payer: UHC Core |
$1,816.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$916.41
|
| Rate for Payer: UHC Exchange |
$1,816.79
|
| Rate for Payer: UHC Medicaid |
$592.14
|
| Rate for Payer: UHCCP Medicaid |
$592.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,009.70
|
|
|
PR RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC
|
Professional
|
Both
|
$2,590.00
|
|
|
Service Code
|
HCPCS 53447
|
| Min. Negotiated Rate |
$466.04 |
| Max. Negotiated Rate |
$1,942.50 |
| Rate for Payer: Aetna Commercial |
$965.50
|
| Rate for Payer: Aetna Medicare |
$749.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,037.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$965.50
|
| Rate for Payer: BCBS Complete |
$489.34
|
| Rate for Payer: BCBS MAPPO |
$720.52
|
| Rate for Payer: BCN Commercial |
$1,206.61
|
| Rate for Payer: BCN Medicare Advantage |
$720.52
|
| Rate for Payer: Cash Price |
$2,072.00
|
| Rate for Payer: Cash Price |
$2,072.00
|
| Rate for Payer: Cofinity Commercial |
$1,037.55
|
| Rate for Payer: Cofinity Commercial |
$965.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$720.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$756.55
|
| Rate for Payer: Meridian Medicaid |
$489.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$792.57
|
| Rate for Payer: Nomi Health Commercial |
$864.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,942.50
|
| Rate for Payer: PACE SWMI |
$720.52
|
| Rate for Payer: PHP Commercial |
$1,008.73
|
| Rate for Payer: PHP Medicare Advantage |
$720.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$466.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,314.40
|
| Rate for Payer: Priority Health Medicare |
$720.52
|
| Rate for Payer: Priority Health SBD |
$1,314.40
|
| Rate for Payer: Priority Health Tiered Network |
$1,314.40
|
| Rate for Payer: Railroad Medicare Medicare |
$720.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,425.37
|
| Rate for Payer: UHC Core |
$1,425.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$720.52
|
| Rate for Payer: UHC Exchange |
$1,425.37
|
| Rate for Payer: UHC Medicaid |
$466.04
|
| Rate for Payer: UHCCP Medicaid |
$466.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,191.40
|
|
|
PR RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 54417
|
| Min. Negotiated Rate |
$517.59 |
| Max. Negotiated Rate |
$1,769.25 |
| Rate for Payer: Aetna Commercial |
$1,073.63
|
| Rate for Payer: Aetna Medicare |
$833.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,073.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,153.76
|
| Rate for Payer: BCBS Complete |
$543.47
|
| Rate for Payer: BCBS MAPPO |
$801.22
|
| Rate for Payer: BCN Commercial |
$1,346.04
|
| Rate for Payer: BCN Medicare Advantage |
$801.22
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cofinity Commercial |
$1,073.63
|
| Rate for Payer: Cofinity Commercial |
$1,153.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$801.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$841.28
|
| Rate for Payer: Meridian Medicaid |
$543.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$881.34
|
| Rate for Payer: Nomi Health Commercial |
$961.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,769.25
|
| Rate for Payer: PACE SWMI |
$801.22
|
| Rate for Payer: PHP Commercial |
$1,121.71
|
| Rate for Payer: PHP Medicare Advantage |
$801.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$517.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,466.28
|
| Rate for Payer: Priority Health Medicare |
$801.22
|
| Rate for Payer: Priority Health SBD |
$1,466.28
|
| Rate for Payer: Priority Health Tiered Network |
$1,466.28
|
| Rate for Payer: Railroad Medicare Medicare |
$801.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,587.32
|
| Rate for Payer: UHC Core |
$1,587.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$801.22
|
| Rate for Payer: UHC Exchange |
$1,587.32
|
| Rate for Payer: UHC Medicaid |
$517.59
|
| Rate for Payer: UHCCP Medicaid |
$517.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,085.14
|
|
|
PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 50387
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$926.25 |
| Rate for Payer: Aetna Commercial |
$96.35
|
| Rate for Payer: Aetna Medicare |
$74.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.35
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCBS MAPPO |
$71.90
|
| Rate for Payer: BCN Commercial |
$121.50
|
| Rate for Payer: BCN Medicare Advantage |
$71.90
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cofinity Commercial |
$103.54
|
| Rate for Payer: Cofinity Commercial |
$96.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.50
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.09
|
| Rate for Payer: Nomi Health Commercial |
$86.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$926.25
|
| Rate for Payer: PACE SWMI |
$71.90
|
| Rate for Payer: PHP Commercial |
$100.66
|
| Rate for Payer: PHP Medicare Advantage |
$71.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$132.37
|
| Rate for Payer: Priority Health Medicare |
$71.90
|
| Rate for Payer: Priority Health SBD |
$132.37
|
| Rate for Payer: Priority Health Tiered Network |
$132.37
|
| Rate for Payer: Railroad Medicare Medicare |
$71.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.76
|
| Rate for Payer: UHC Core |
$149.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.90
|
| Rate for Payer: UHC Exchange |
$149.76
|
| Rate for Payer: UHC Medicaid |
$45.80
|
| Rate for Payer: UHCCP Medicaid |
$45.80
|
| Rate for Payer: UMR Bronson Commercial |
$568.10
|
|
|
PR RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE
|
Professional
|
Both
|
$1,749.00
|
|
|
Service Code
|
HCPCS 69711
|
| Min. Negotiated Rate |
$478.19 |
| Max. Negotiated Rate |
$1,444.43 |
| Rate for Payer: Aetna Commercial |
$972.18
|
| Rate for Payer: Aetna Medicare |
$754.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$972.18
|
| Rate for Payer: BCBS Complete |
$502.10
|
| Rate for Payer: BCBS MAPPO |
$725.51
|
| Rate for Payer: BCN Commercial |
$1,251.93
|
| Rate for Payer: BCN Medicare Advantage |
$725.51
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cofinity Commercial |
$1,044.73
|
| Rate for Payer: Cofinity Commercial |
$972.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$725.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$761.79
|
| Rate for Payer: Meridian Medicaid |
$502.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$798.06
|
| Rate for Payer: Nomi Health Commercial |
$870.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,311.75
|
| Rate for Payer: PACE SWMI |
$725.51
|
| Rate for Payer: PHP Commercial |
$1,015.71
|
| Rate for Payer: PHP Medicare Advantage |
$725.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,237.02
|
| Rate for Payer: Priority Health Medicare |
$725.51
|
| Rate for Payer: Priority Health SBD |
$1,237.02
|
| Rate for Payer: Priority Health Tiered Network |
$1,237.02
|
| Rate for Payer: Railroad Medicare Medicare |
$725.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,444.43
|
| Rate for Payer: UHC Core |
$1,444.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$725.51
|
| Rate for Payer: UHC Exchange |
$1,444.43
|
| Rate for Payer: UHC Medicaid |
$478.19
|
| Rate for Payer: UHCCP Medicaid |
$478.19
|
| Rate for Payer: UMR Bronson Commercial |
$804.54
|
|
|
PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
HCPCS 19330
|
| Min. Negotiated Rate |
$377.86 |
| Max. Negotiated Rate |
$1,105.82 |
| Rate for Payer: Aetna Commercial |
$775.44
|
| Rate for Payer: Aetna Medicare |
$601.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$775.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$833.31
|
| Rate for Payer: BCBS Complete |
$396.75
|
| Rate for Payer: BCBS MAPPO |
$578.69
|
| Rate for Payer: BCN Commercial |
$978.53
|
| Rate for Payer: BCN Medicare Advantage |
$578.69
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cofinity Commercial |
$775.44
|
| Rate for Payer: Cofinity Commercial |
$833.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$578.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$607.62
|
| Rate for Payer: Meridian Medicaid |
$396.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$636.56
|
| Rate for Payer: Nomi Health Commercial |
$694.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$884.25
|
| Rate for Payer: PACE SWMI |
$578.69
|
| Rate for Payer: PHP Commercial |
$810.17
|
| Rate for Payer: PHP Medicare Advantage |
$578.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$895.61
|
| Rate for Payer: Priority Health Medicare |
$578.69
|
| Rate for Payer: Priority Health SBD |
$895.61
|
| Rate for Payer: Priority Health Tiered Network |
$895.61
|
| Rate for Payer: Railroad Medicare Medicare |
$578.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,105.82
|
| Rate for Payer: UHC Core |
$1,105.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$578.69
|
| Rate for Payer: UHC Exchange |
$1,105.82
|
| Rate for Payer: UHC Medicaid |
$377.86
|
| Rate for Payer: UHCCP Medicaid |
$377.86
|
| Rate for Payer: UMR Bronson Commercial |
$542.34
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 11201
|
| Min. Negotiated Rate |
$8.31 |
| Max. Negotiated Rate |
$34.50 |
| Rate for Payer: Aetna Commercial |
$17.31
|
| Rate for Payer: Aetna Medicare |
$13.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.60
|
| Rate for Payer: BCBS Complete |
$8.73
|
| Rate for Payer: BCBS MAPPO |
$12.92
|
| Rate for Payer: BCN Commercial |
$18.85
|
| Rate for Payer: BCN Medicare Advantage |
$12.92
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$17.31
|
| Rate for Payer: Cofinity Commercial |
$18.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.57
|
| Rate for Payer: Meridian Medicaid |
$8.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.21
|
| Rate for Payer: Nomi Health Commercial |
$15.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: PACE SWMI |
$12.92
|
| Rate for Payer: PHP Commercial |
$18.09
|
| Rate for Payer: PHP Medicare Advantage |
$12.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21.88
|
| Rate for Payer: Priority Health Medicare |
$12.92
|
| Rate for Payer: Priority Health SBD |
$21.88
|
| Rate for Payer: Priority Health Tiered Network |
$21.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.71
|
| Rate for Payer: UHC Core |
$28.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.92
|
| Rate for Payer: UHC Exchange |
$28.71
|
| Rate for Payer: UHC Medicaid |
$8.31
|
| Rate for Payer: UHCCP Medicaid |
$8.31
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
11200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Advantage |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: UMR Bronson Commercial |
$79.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 11200
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: Aetna Medicare |
$68.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.08
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS MAPPO |
$66.03
|
| Rate for Payer: BCN Commercial |
$91.50
|
| Rate for Payer: BCN Medicare Advantage |
$66.03
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$88.48
|
| Rate for Payer: Cofinity Commercial |
$95.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.33
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.63
|
| Rate for Payer: Nomi Health Commercial |
$79.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PACE SWMI |
$66.03
|
| Rate for Payer: PHP Commercial |
$92.44
|
| Rate for Payer: PHP Medicare Advantage |
$66.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$106.20
|
| Rate for Payer: Priority Health Medicare |
$66.03
|
| Rate for Payer: Priority Health SBD |
$106.20
|
| Rate for Payer: Priority Health Tiered Network |
$106.20
|
| Rate for Payer: Railroad Medicare Medicare |
$66.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.51
|
| Rate for Payer: UHC Core |
$125.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$66.03
|
| Rate for Payer: UHC Exchange |
$125.51
|
| Rate for Payer: UHC Medicaid |
$44.09
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
| Rate for Payer: UMR Bronson Commercial |
$82.80
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
11200
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$646.50 |
| Rate for Payer: Aetna American Axle |
$117.00
|
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Medicare |
$207.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$249.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$249.89
|
| Rate for Payer: BCBS Complete |
$109.79
|
| Rate for Payer: BCBS MAPPO |
$199.91
|
| Rate for Payer: BCBS Trust/PPO |
$176.33
|
| Rate for Payer: BCN Commercial |
$176.33
|
| Rate for Payer: BCN Medicare Advantage |
$199.91
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Advantage |
$126.00
|
| Rate for Payer: Cofinity Commercial |
$154.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.91
|
| Rate for Payer: Healthscope Commercial |
$162.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.00
|
| Rate for Payer: Mclaren Medicaid |
$199.91
|
| Rate for Payer: Mclaren Medicare |
$199.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.91
|
| Rate for Payer: Meridian Medicaid |
$209.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Nomi Health Commercial |
$599.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PACE Medicare |
$189.91
|
| Rate for Payer: PACE SWMI |
$199.91
|
| Rate for Payer: PHP Commercial |
$153.00
|
| Rate for Payer: PHP Medicare Advantage |
$199.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.50
|
| Rate for Payer: Priority Health Medicare |
$199.91
|
| Rate for Payer: Priority Health SBD |
$113.40
|
| Rate for Payer: Priority Health Tiered Network |
$517.20
|
| Rate for Payer: Railroad Medicare Medicare |
$199.91
|
| Rate for Payer: UHC Medicaid |
$104.55
|
| Rate for Payer: UHCCP Medicaid |
$104.55
|
| Rate for Payer: UMR Bronson Commercial |
$66.60
|
| Rate for Payer: VA VA |
$199.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.00
|
|
|
PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 11200
|
| Hospital Charge Code |
11200
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: Aetna Medicare |
$68.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.08
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS MAPPO |
$66.03
|
| Rate for Payer: BCN Commercial |
$91.50
|
| Rate for Payer: BCN Medicare Advantage |
$66.03
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$88.48
|
| Rate for Payer: Cofinity Commercial |
$95.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.33
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.63
|
| Rate for Payer: Nomi Health Commercial |
$79.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PACE SWMI |
$66.03
|
| Rate for Payer: PHP Commercial |
$92.44
|
| Rate for Payer: PHP Medicare Advantage |
$66.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$106.20
|
| Rate for Payer: Priority Health Medicare |
$66.03
|
| Rate for Payer: Priority Health SBD |
$106.20
|
| Rate for Payer: Priority Health Tiered Network |
$106.20
|
| Rate for Payer: Railroad Medicare Medicare |
$66.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.51
|
| Rate for Payer: UHC Core |
$125.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$66.03
|
| Rate for Payer: UHC Exchange |
$125.51
|
| Rate for Payer: UHC Medicaid |
$44.09
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
| Rate for Payer: UMR Bronson Commercial |
$82.80
|
|
|
PR RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR
|
Professional
|
Both
|
$4,060.00
|
|
|
Service Code
|
HCPCS 63662
|
| Min. Negotiated Rate |
$541.87 |
| Max. Negotiated Rate |
$3,045.00 |
| Rate for Payer: Aetna Commercial |
$1,118.75
|
| Rate for Payer: Aetna Medicare |
$868.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.24
|
| Rate for Payer: BCBS Complete |
$568.96
|
| Rate for Payer: BCBS MAPPO |
$834.89
|
| Rate for Payer: BCN Commercial |
$1,301.22
|
| Rate for Payer: BCN Medicare Advantage |
$834.89
|
| Rate for Payer: Cash Price |
$3,248.00
|
| Rate for Payer: Cash Price |
$3,248.00
|
| Rate for Payer: Cofinity Commercial |
$1,118.75
|
| Rate for Payer: Cofinity Commercial |
$1,202.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$834.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$876.63
|
| Rate for Payer: Meridian Medicaid |
$568.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$918.38
|
| Rate for Payer: Nomi Health Commercial |
$1,001.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,045.00
|
| Rate for Payer: PACE SWMI |
$834.89
|
| Rate for Payer: PHP Commercial |
$1,168.85
|
| Rate for Payer: PHP Medicare Advantage |
$834.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$541.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,511.34
|
| Rate for Payer: Priority Health Medicare |
$834.89
|
| Rate for Payer: Priority Health SBD |
$1,511.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,511.34
|
| Rate for Payer: Railroad Medicare Medicare |
$834.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,473.47
|
| Rate for Payer: UHC Core |
$1,473.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$834.89
|
| Rate for Payer: UHC Exchange |
$1,473.47
|
| Rate for Payer: UHC Medicaid |
$541.87
|
| Rate for Payer: UHCCP Medicaid |
$541.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,867.60
|
|
|
PR RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR
|
Professional
|
Both
|
$1,876.00
|
|
|
Service Code
|
HCPCS 63661
|
| Min. Negotiated Rate |
$197.03 |
| Max. Negotiated Rate |
$1,407.00 |
| Rate for Payer: Aetna Commercial |
$406.73
|
| Rate for Payer: Aetna Medicare |
$315.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.08
|
| Rate for Payer: BCBS Complete |
$206.88
|
| Rate for Payer: BCBS MAPPO |
$303.53
|
| Rate for Payer: BCN Commercial |
$498.48
|
| Rate for Payer: BCN Medicare Advantage |
$303.53
|
| Rate for Payer: Cash Price |
$1,500.80
|
| Rate for Payer: Cash Price |
$1,500.80
|
| Rate for Payer: Cofinity Commercial |
$406.73
|
| Rate for Payer: Cofinity Commercial |
$437.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.71
|
| Rate for Payer: Meridian Medicaid |
$206.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.88
|
| Rate for Payer: Nomi Health Commercial |
$364.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,407.00
|
| Rate for Payer: PACE SWMI |
$303.53
|
| Rate for Payer: PHP Commercial |
$424.94
|
| Rate for Payer: PHP Medicare Advantage |
$303.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$578.98
|
| Rate for Payer: Priority Health Medicare |
$303.53
|
| Rate for Payer: Priority Health SBD |
$578.98
|
| Rate for Payer: Priority Health Tiered Network |
$578.98
|
| Rate for Payer: Railroad Medicare Medicare |
$303.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$567.69
|
| Rate for Payer: UHC Core |
$567.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.53
|
| Rate for Payer: UHC Exchange |
$567.69
|
| Rate for Payer: UHC Medicaid |
$197.03
|
| Rate for Payer: UHCCP Medicaid |
$197.03
|
| Rate for Payer: UMR Bronson Commercial |
$862.96
|
|
