|
PR REMOVAL TUNNELED INTRAPERITONEAL CATHETER
|
Professional
|
Both
|
$981.00
|
|
|
Service Code
|
HCPCS 49422
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$637.65 |
| Rate for Payer: Aetna Commercial |
$286.09
|
| Rate for Payer: Aetna Medicare |
$222.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.09
|
| Rate for Payer: BCBS Complete |
$392.40
|
| Rate for Payer: BCBS MAPPO |
$213.50
|
| Rate for Payer: BCN Medicare Advantage |
$213.50
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cofinity Commercial |
$307.44
|
| Rate for Payer: Cofinity Commercial |
$286.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.18
|
| Rate for Payer: Nomi Health Commercial |
$256.20
|
| Rate for Payer: PACE SWMI |
$213.50
|
| Rate for Payer: PHP Commercial |
$298.90
|
| Rate for Payer: PHP Medicare Advantage |
$213.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$637.65
|
| Rate for Payer: Priority Health Medicare |
$213.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.50
|
| Rate for Payer: UHC Medicare Advantage |
$213.50
|
| Rate for Payer: UMR Bronson Commercial |
$451.26
|
|
|
PR REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE
|
Professional
|
Both
|
$3,380.00
|
|
|
Service Code
|
HCPCS 33977
|
| Min. Negotiated Rate |
$1,077.13 |
| Max. Negotiated Rate |
$2,197.00 |
| Rate for Payer: Aetna Commercial |
$1,443.35
|
| Rate for Payer: Aetna Medicare |
$1,120.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,551.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,443.35
|
| Rate for Payer: BCBS Complete |
$1,352.00
|
| Rate for Payer: BCBS MAPPO |
$1,077.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,077.13
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Cash Price |
$2,704.00
|
| Rate for Payer: Cofinity Commercial |
$1,551.07
|
| Rate for Payer: Cofinity Commercial |
$1,443.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,077.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,130.99
|
| Rate for Payer: Nomi Health Commercial |
$1,292.56
|
| Rate for Payer: PACE SWMI |
$1,077.13
|
| Rate for Payer: PHP Commercial |
$1,507.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,077.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,197.00
|
| Rate for Payer: Priority Health Medicare |
$1,077.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,077.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,077.13
|
| Rate for Payer: UMR Bronson Commercial |
$1,554.80
|
|
|
PR REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST
|
Professional
|
Both
|
$1,352.00
|
|
|
Service Code
|
HCPCS 25251
|
| Min. Negotiated Rate |
$540.80 |
| Max. Negotiated Rate |
$1,002.90 |
| Rate for Payer: Aetna Commercial |
$933.26
|
| Rate for Payer: Aetna Medicare |
$724.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$933.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,002.90
|
| Rate for Payer: BCBS Complete |
$540.80
|
| Rate for Payer: BCBS MAPPO |
$696.46
|
| Rate for Payer: BCN Medicare Advantage |
$696.46
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cash Price |
$1,081.60
|
| Rate for Payer: Cofinity Commercial |
$933.26
|
| Rate for Payer: Cofinity Commercial |
$1,002.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$696.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$731.28
|
| Rate for Payer: Nomi Health Commercial |
$835.75
|
| Rate for Payer: PACE SWMI |
$696.46
|
| Rate for Payer: PHP Commercial |
$975.04
|
| Rate for Payer: PHP Medicare Advantage |
$696.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$878.80
|
| Rate for Payer: Priority Health Medicare |
$696.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$696.46
|
| Rate for Payer: UHC Medicare Advantage |
$696.46
|
| Rate for Payer: UMR Bronson Commercial |
$621.92
|
|
|
PR REMOVE BILE DUCT STONE, PERCUT
|
Professional
|
Both
|
$904.00
|
|
|
Service Code
|
HCPCS 47630
|
| Min. Negotiated Rate |
$361.60 |
| Max. Negotiated Rate |
$587.60 |
| Rate for Payer: Aetna Medicare |
$452.00
|
| Rate for Payer: BCBS Complete |
$361.60
|
| Rate for Payer: Cash Price |
$723.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$587.60
|
| Rate for Payer: UMR Bronson Commercial |
$415.84
|
|
|
PR REMOVE DEEP SHOULDER FOREIGN BODY
|
Professional
|
Both
|
$1,039.00
|
|
|
Service Code
|
HCPCS 23331
|
| Min. Negotiated Rate |
$415.60 |
| Max. Negotiated Rate |
$675.35 |
| Rate for Payer: Aetna Medicare |
$519.50
|
| Rate for Payer: BCBS Complete |
$415.60
|
| Rate for Payer: Cash Price |
$831.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.35
|
| Rate for Payer: UMR Bronson Commercial |
$477.94
|
|
|
PR REMOVE INT DWELL URETERAL STENT TRANSURETHRAL
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
HCPCS 50386
|
| Min. Negotiated Rate |
$154.62 |
| Max. Negotiated Rate |
$1,028.30 |
| Rate for Payer: Aetna Commercial |
$207.19
|
| Rate for Payer: Aetna Medicare |
$160.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.19
|
| Rate for Payer: BCBS Complete |
$632.80
|
| Rate for Payer: BCBS MAPPO |
$154.62
|
| Rate for Payer: BCN Medicare Advantage |
$154.62
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: Cofinity Commercial |
$222.65
|
| Rate for Payer: Cofinity Commercial |
$207.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.35
|
| Rate for Payer: Nomi Health Commercial |
$185.54
|
| Rate for Payer: PACE SWMI |
$154.62
|
| Rate for Payer: PHP Commercial |
$216.47
|
| Rate for Payer: PHP Medicare Advantage |
$154.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,028.30
|
| Rate for Payer: Priority Health Medicare |
$154.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$154.62
|
| Rate for Payer: UHC Medicare Advantage |
$154.62
|
| Rate for Payer: UMR Bronson Commercial |
$727.72
|
|
|
PR REMOVE NAIL BED/FINGER TIP
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 11752
|
| Min. Negotiated Rate |
$212.00 |
| Max. Negotiated Rate |
$344.50 |
| Rate for Payer: Aetna Medicare |
$265.00
|
| Rate for Payer: BCBS Complete |
$212.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.50
|
| Rate for Payer: UMR Bronson Commercial |
$243.80
|
|
|
PR REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 50385
|
| Min. Negotiated Rate |
$204.60 |
| Max. Negotiated Rate |
$1,360.45 |
| Rate for Payer: Aetna Commercial |
$274.16
|
| Rate for Payer: Aetna Medicare |
$212.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.62
|
| Rate for Payer: BCBS Complete |
$837.20
|
| Rate for Payer: BCBS MAPPO |
$204.60
|
| Rate for Payer: BCN Medicare Advantage |
$204.60
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cofinity Commercial |
$274.16
|
| Rate for Payer: Cofinity Commercial |
$294.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.83
|
| Rate for Payer: Nomi Health Commercial |
$245.52
|
| Rate for Payer: PACE SWMI |
$204.60
|
| Rate for Payer: PHP Commercial |
$286.44
|
| Rate for Payer: PHP Medicare Advantage |
$204.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,360.45
|
| Rate for Payer: Priority Health Medicare |
$204.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.60
|
| Rate for Payer: UHC Medicare Advantage |
$204.60
|
| Rate for Payer: UMR Bronson Commercial |
$962.78
|
|
|
PR REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$1,924.00
|
|
|
Service Code
|
HCPCS 53446
|
| Min. Negotiated Rate |
$614.46 |
| Max. Negotiated Rate |
$1,250.60 |
| Rate for Payer: Aetna Commercial |
$823.38
|
| Rate for Payer: Aetna Medicare |
$639.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.38
|
| Rate for Payer: BCBS Complete |
$769.60
|
| Rate for Payer: BCBS MAPPO |
$614.46
|
| Rate for Payer: BCN Medicare Advantage |
$614.46
|
| Rate for Payer: Cash Price |
$1,539.20
|
| Rate for Payer: Cash Price |
$1,539.20
|
| Rate for Payer: Cofinity Commercial |
$884.82
|
| Rate for Payer: Cofinity Commercial |
$823.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$645.18
|
| Rate for Payer: Nomi Health Commercial |
$737.35
|
| Rate for Payer: PACE SWMI |
$614.46
|
| Rate for Payer: PHP Commercial |
$860.24
|
| Rate for Payer: PHP Medicare Advantage |
$614.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,250.60
|
| Rate for Payer: Priority Health Medicare |
$614.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.46
|
| Rate for Payer: UHC Medicare Advantage |
$614.46
|
| Rate for Payer: UMR Bronson Commercial |
$885.04
|
|
|
PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 33227
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$462.61 |
| Rate for Payer: Aetna Commercial |
$430.49
|
| Rate for Payer: Aetna Medicare |
$334.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$462.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.49
|
| Rate for Payer: BCBS Complete |
$280.80
|
| Rate for Payer: BCBS MAPPO |
$321.26
|
| Rate for Payer: BCN Medicare Advantage |
$321.26
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$462.61
|
| Rate for Payer: Cofinity Commercial |
$430.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$321.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$337.32
|
| Rate for Payer: Nomi Health Commercial |
$385.51
|
| Rate for Payer: PACE SWMI |
$321.26
|
| Rate for Payer: PHP Commercial |
$449.76
|
| Rate for Payer: PHP Medicare Advantage |
$321.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.30
|
| Rate for Payer: Priority Health Medicare |
$321.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$321.26
|
| Rate for Payer: UHC Medicare Advantage |
$321.26
|
| Rate for Payer: UMR Bronson Commercial |
$322.92
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS
|
Professional
|
Both
|
$727.00
|
|
|
Service Code
|
HCPCS 33228
|
| Min. Negotiated Rate |
$290.80 |
| Max. Negotiated Rate |
$484.66 |
| Rate for Payer: Aetna Commercial |
$451.00
|
| Rate for Payer: Aetna Medicare |
$350.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.00
|
| Rate for Payer: BCBS Complete |
$290.80
|
| Rate for Payer: BCBS MAPPO |
$336.57
|
| Rate for Payer: BCN Medicare Advantage |
$336.57
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cash Price |
$581.60
|
| Rate for Payer: Cofinity Commercial |
$484.66
|
| Rate for Payer: Cofinity Commercial |
$451.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$336.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$353.40
|
| Rate for Payer: Nomi Health Commercial |
$403.88
|
| Rate for Payer: PACE SWMI |
$336.57
|
| Rate for Payer: PHP Commercial |
$471.20
|
| Rate for Payer: PHP Medicare Advantage |
$336.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.55
|
| Rate for Payer: Priority Health Medicare |
$336.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.57
|
| Rate for Payer: UHC Medicare Advantage |
$336.57
|
| Rate for Payer: UMR Bronson Commercial |
$334.42
|
|
|
PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
HCPCS 33229
|
| Min. Negotiated Rate |
$231.20 |
| Max. Negotiated Rate |
$507.90 |
| Rate for Payer: Aetna Commercial |
$472.63
|
| Rate for Payer: Aetna Medicare |
$366.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.63
|
| Rate for Payer: BCBS Complete |
$231.20
|
| Rate for Payer: BCBS MAPPO |
$352.71
|
| Rate for Payer: BCN Medicare Advantage |
$352.71
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cash Price |
$462.40
|
| Rate for Payer: Cofinity Commercial |
$507.90
|
| Rate for Payer: Cofinity Commercial |
$472.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$370.35
|
| Rate for Payer: Nomi Health Commercial |
$423.25
|
| Rate for Payer: PACE SWMI |
$352.71
|
| Rate for Payer: PHP Commercial |
$493.79
|
| Rate for Payer: PHP Medicare Advantage |
$352.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$375.70
|
| Rate for Payer: Priority Health Medicare |
$352.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.71
|
| Rate for Payer: UHC Medicare Advantage |
$352.71
|
| Rate for Payer: UMR Bronson Commercial |
$265.88
|
|
|
PR REMV TISSUE FOR GRAFT OTHR
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 20926
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$532.35 |
| Rate for Payer: Aetna Medicare |
$409.50
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$532.35
|
| Rate for Payer: UMR Bronson Commercial |
$376.74
|
|
|
PR RENAL ANGIO, CARDIAC CATH
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G0275
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR RENAL BIOPSY PRQ TROCAR/NEEDLE
|
Professional
|
Both
|
$1,053.00
|
|
|
Service Code
|
HCPCS 50200
|
| Min. Negotiated Rate |
$119.01 |
| Max. Negotiated Rate |
$684.45 |
| Rate for Payer: Aetna Commercial |
$159.47
|
| Rate for Payer: Aetna Medicare |
$123.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.47
|
| Rate for Payer: BCBS Complete |
$421.20
|
| Rate for Payer: BCBS MAPPO |
$119.01
|
| Rate for Payer: BCN Medicare Advantage |
$119.01
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cofinity Commercial |
$159.47
|
| Rate for Payer: Cofinity Commercial |
$171.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.96
|
| Rate for Payer: Nomi Health Commercial |
$142.81
|
| Rate for Payer: PACE SWMI |
$119.01
|
| Rate for Payer: PHP Commercial |
$166.61
|
| Rate for Payer: PHP Medicare Advantage |
$119.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.45
|
| Rate for Payer: Priority Health Medicare |
$119.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.01
|
| Rate for Payer: UHC Medicare Advantage |
$119.01
|
| Rate for Payer: UMR Bronson Commercial |
$484.38
|
|
|
PR RENAL BIOPSY SURG EXPOSURE KIDNEY
|
Professional
|
Both
|
$1,699.00
|
|
|
Service Code
|
HCPCS 50205
|
| Min. Negotiated Rate |
$679.60 |
| Max. Negotiated Rate |
$1,104.35 |
| Rate for Payer: Aetna Commercial |
$982.61
|
| Rate for Payer: Aetna Medicare |
$762.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.94
|
| Rate for Payer: BCBS Complete |
$679.60
|
| Rate for Payer: BCBS MAPPO |
$733.29
|
| Rate for Payer: BCN Medicare Advantage |
$733.29
|
| Rate for Payer: Cash Price |
$1,359.20
|
| Rate for Payer: Cash Price |
$1,359.20
|
| Rate for Payer: Cofinity Commercial |
$982.61
|
| Rate for Payer: Cofinity Commercial |
$1,055.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$769.95
|
| Rate for Payer: Nomi Health Commercial |
$879.95
|
| Rate for Payer: PACE SWMI |
$733.29
|
| Rate for Payer: PHP Commercial |
$1,026.61
|
| Rate for Payer: PHP Medicare Advantage |
$733.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,104.35
|
| Rate for Payer: Priority Health Medicare |
$733.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.29
|
| Rate for Payer: UHC Medicare Advantage |
$733.29
|
| Rate for Payer: UMR Bronson Commercial |
$781.54
|
|
|
PR RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 50551
|
| Min. Negotiated Rate |
$278.73 |
| Max. Negotiated Rate |
$471.90 |
| Rate for Payer: Aetna Commercial |
$373.50
|
| Rate for Payer: Aetna Medicare |
$289.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$401.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.50
|
| Rate for Payer: BCBS Complete |
$290.40
|
| Rate for Payer: BCBS MAPPO |
$278.73
|
| Rate for Payer: BCN Medicare Advantage |
$278.73
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$401.37
|
| Rate for Payer: Cofinity Commercial |
$373.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$278.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$292.67
|
| Rate for Payer: Nomi Health Commercial |
$334.48
|
| Rate for Payer: PACE SWMI |
$278.73
|
| Rate for Payer: PHP Commercial |
$390.22
|
| Rate for Payer: PHP Medicare Advantage |
$278.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.90
|
| Rate for Payer: Priority Health Medicare |
$278.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$278.73
|
| Rate for Payer: UHC Medicare Advantage |
$278.73
|
| Rate for Payer: UMR Bronson Commercial |
$333.96
|
|
|
PR RENAL EXPLORATION NOT NECESSITATING OTH SPEC PX
|
Professional
|
Both
|
$2,514.00
|
|
|
Service Code
|
HCPCS 50010
|
| Min. Negotiated Rate |
$673.41 |
| Max. Negotiated Rate |
$1,634.10 |
| Rate for Payer: Aetna Commercial |
$902.37
|
| Rate for Payer: Aetna Medicare |
$700.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$902.37
|
| Rate for Payer: BCBS Complete |
$1,005.60
|
| Rate for Payer: BCBS MAPPO |
$673.41
|
| Rate for Payer: BCN Medicare Advantage |
$673.41
|
| Rate for Payer: Cash Price |
$2,011.20
|
| Rate for Payer: Cash Price |
$2,011.20
|
| Rate for Payer: Cofinity Commercial |
$969.71
|
| Rate for Payer: Cofinity Commercial |
$902.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$673.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$707.08
|
| Rate for Payer: Nomi Health Commercial |
$808.09
|
| Rate for Payer: PACE SWMI |
$673.41
|
| Rate for Payer: PHP Commercial |
$942.77
|
| Rate for Payer: PHP Medicare Advantage |
$673.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,634.10
|
| Rate for Payer: Priority Health Medicare |
$673.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$673.41
|
| Rate for Payer: UHC Medicare Advantage |
$673.41
|
| Rate for Payer: UMR Bronson Commercial |
$1,156.44
|
|
|
PR RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
HCPCS 50555
|
| Min. Negotiated Rate |
$313.60 |
| Max. Negotiated Rate |
$509.60 |
| Rate for Payer: Aetna Commercial |
$434.24
|
| Rate for Payer: Aetna Medicare |
$337.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.24
|
| Rate for Payer: BCBS Complete |
$313.60
|
| Rate for Payer: BCBS MAPPO |
$324.06
|
| Rate for Payer: BCN Medicare Advantage |
$324.06
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Cash Price |
$627.20
|
| Rate for Payer: Cofinity Commercial |
$466.65
|
| Rate for Payer: Cofinity Commercial |
$434.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$340.26
|
| Rate for Payer: Nomi Health Commercial |
$388.87
|
| Rate for Payer: PACE SWMI |
$324.06
|
| Rate for Payer: PHP Commercial |
$453.68
|
| Rate for Payer: PHP Medicare Advantage |
$324.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$509.60
|
| Rate for Payer: Priority Health Medicare |
$324.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.06
|
| Rate for Payer: UHC Medicare Advantage |
$324.06
|
| Rate for Payer: UMR Bronson Commercial |
$360.64
|
|
|
PR RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI
|
Professional
|
Both
|
$831.00
|
|
|
Service Code
|
HCPCS 50557
|
| Min. Negotiated Rate |
$327.85 |
| Max. Negotiated Rate |
$540.15 |
| Rate for Payer: Aetna Commercial |
$439.32
|
| Rate for Payer: Aetna Medicare |
$340.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.32
|
| Rate for Payer: BCBS Complete |
$332.40
|
| Rate for Payer: BCBS MAPPO |
$327.85
|
| Rate for Payer: BCN Medicare Advantage |
$327.85
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cash Price |
$664.80
|
| Rate for Payer: Cofinity Commercial |
$472.10
|
| Rate for Payer: Cofinity Commercial |
$439.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.24
|
| Rate for Payer: Nomi Health Commercial |
$393.42
|
| Rate for Payer: PACE SWMI |
$327.85
|
| Rate for Payer: PHP Commercial |
$458.99
|
| Rate for Payer: PHP Medicare Advantage |
$327.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$540.15
|
| Rate for Payer: Priority Health Medicare |
$327.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.85
|
| Rate for Payer: UHC Medicare Advantage |
$327.85
|
| Rate for Payer: UMR Bronson Commercial |
$382.26
|
|
|
PR RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS
|
Professional
|
Both
|
$908.00
|
|
|
Service Code
|
HCPCS 50561
|
| Min. Negotiated Rate |
$363.20 |
| Max. Negotiated Rate |
$590.20 |
| Rate for Payer: Aetna Commercial |
$500.78
|
| Rate for Payer: Aetna Medicare |
$388.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.78
|
| Rate for Payer: BCBS Complete |
$363.20
|
| Rate for Payer: BCBS MAPPO |
$373.72
|
| Rate for Payer: BCN Medicare Advantage |
$373.72
|
| Rate for Payer: Cash Price |
$726.40
|
| Rate for Payer: Cash Price |
$726.40
|
| Rate for Payer: Cofinity Commercial |
$538.16
|
| Rate for Payer: Cofinity Commercial |
$500.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.41
|
| Rate for Payer: Nomi Health Commercial |
$448.46
|
| Rate for Payer: PACE SWMI |
$373.72
|
| Rate for Payer: PHP Commercial |
$523.21
|
| Rate for Payer: PHP Medicare Advantage |
$373.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$590.20
|
| Rate for Payer: Priority Health Medicare |
$373.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.72
|
| Rate for Payer: UHC Medicare Advantage |
$373.72
|
| Rate for Payer: UMR Bronson Commercial |
$417.68
|
|
|
PR RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA
|
Professional
|
Both
|
$726.00
|
|
|
Service Code
|
HCPCS 50553
|
| Min. Negotiated Rate |
$290.40 |
| Max. Negotiated Rate |
$471.90 |
| Rate for Payer: Aetna Commercial |
$398.76
|
| Rate for Payer: Aetna Medicare |
$309.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.76
|
| Rate for Payer: BCBS Complete |
$290.40
|
| Rate for Payer: BCBS MAPPO |
$297.58
|
| Rate for Payer: BCN Medicare Advantage |
$297.58
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$428.52
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.46
|
| Rate for Payer: Nomi Health Commercial |
$357.10
|
| Rate for Payer: PACE SWMI |
$297.58
|
| Rate for Payer: PHP Commercial |
$416.61
|
| Rate for Payer: PHP Medicare Advantage |
$297.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.90
|
| Rate for Payer: Priority Health Medicare |
$297.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.58
|
| Rate for Payer: UHC Medicare Advantage |
$297.58
|
| Rate for Payer: UMR Bronson Commercial |
$333.96
|
|
|
PR RENAL NDSC NEPHROTOMY W/WO IRRIGATION
|
Professional
|
Both
|
$954.00
|
|
|
Service Code
|
HCPCS 50570
|
| Min. Negotiated Rate |
$381.60 |
| Max. Negotiated Rate |
$670.52 |
| Rate for Payer: Aetna Commercial |
$623.96
|
| Rate for Payer: Aetna Medicare |
$484.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.96
|
| Rate for Payer: BCBS Complete |
$381.60
|
| Rate for Payer: BCBS MAPPO |
$465.64
|
| Rate for Payer: BCN Medicare Advantage |
$465.64
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cofinity Commercial |
$670.52
|
| Rate for Payer: Cofinity Commercial |
$623.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.92
|
| Rate for Payer: Nomi Health Commercial |
$558.77
|
| Rate for Payer: PACE SWMI |
$465.64
|
| Rate for Payer: PHP Commercial |
$651.90
|
| Rate for Payer: PHP Medicare Advantage |
$465.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$620.10
|
| Rate for Payer: Priority Health Medicare |
$465.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.64
|
| Rate for Payer: UHC Medicare Advantage |
$465.64
|
| Rate for Payer: UMR Bronson Commercial |
$438.84
|
|
|
PR REOPENING RECENT LAPAROTOMY
|
Professional
|
Both
|
$2,127.00
|
|
|
Service Code
|
HCPCS 49002
|
| Min. Negotiated Rate |
$850.80 |
| Max. Negotiated Rate |
$1,457.60 |
| Rate for Payer: Aetna Commercial |
$1,356.37
|
| Rate for Payer: Aetna Medicare |
$1,052.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,457.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,356.37
|
| Rate for Payer: BCBS Complete |
$850.80
|
| Rate for Payer: BCBS MAPPO |
$1,012.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,012.22
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cofinity Commercial |
$1,457.60
|
| Rate for Payer: Cofinity Commercial |
$1,356.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,012.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,062.83
|
| Rate for Payer: Nomi Health Commercial |
$1,214.66
|
| Rate for Payer: PACE SWMI |
$1,012.22
|
| Rate for Payer: PHP Commercial |
$1,417.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,012.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,382.55
|
| Rate for Payer: Priority Health Medicare |
$1,012.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,012.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,012.22
|
| Rate for Payer: UMR Bronson Commercial |
$978.42
|
|
|
PR REPAIR ANAL FISTULA W/FIBRIN GLUE
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 46706
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$252.03 |
| Rate for Payer: Aetna Commercial |
$234.53
|
| Rate for Payer: Aetna Medicare |
$182.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.53
|
| Rate for Payer: BCBS Complete |
$136.40
|
| Rate for Payer: BCBS MAPPO |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$175.02
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cofinity Commercial |
$252.03
|
| Rate for Payer: Cofinity Commercial |
$234.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.77
|
| Rate for Payer: Nomi Health Commercial |
$210.02
|
| Rate for Payer: PACE SWMI |
$175.02
|
| Rate for Payer: PHP Commercial |
$245.03
|
| Rate for Payer: PHP Medicare Advantage |
$175.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.65
|
| Rate for Payer: Priority Health Medicare |
$175.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.02
|
| Rate for Payer: UHC Medicare Advantage |
$175.02
|
| Rate for Payer: UMR Bronson Commercial |
$156.86
|
|
