|
PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 99495
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$162.22
|
| Rate for Payer: Aetna Medicare |
$125.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.33
|
| Rate for Payer: BCBS Complete |
$81.86
|
| Rate for Payer: BCBS MAPPO |
$121.06
|
| Rate for Payer: BCN Commercial |
$150.75
|
| Rate for Payer: BCN Medicare Advantage |
$121.06
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$162.22
|
| Rate for Payer: Cofinity Commercial |
$174.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.11
|
| Rate for Payer: Meridian Medicaid |
$81.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.17
|
| Rate for Payer: Nomi Health Commercial |
$145.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
| Rate for Payer: PACE SWMI |
$121.06
|
| Rate for Payer: PHP Commercial |
$169.48
|
| Rate for Payer: PHP Medicare Advantage |
$121.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$185.89
|
| Rate for Payer: Priority Health Medicare |
$121.06
|
| Rate for Payer: Priority Health SBD |
$185.89
|
| Rate for Payer: Priority Health Tiered Network |
$185.89
|
| Rate for Payer: Railroad Medicare Medicare |
$121.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.02
|
| Rate for Payer: UHC Core |
$174.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$121.06
|
| Rate for Payer: UHC Exchange |
$174.02
|
| Rate for Payer: UHC Medicaid |
$77.96
|
| Rate for Payer: UHCCP Medicaid |
$77.96
|
| Rate for Payer: UMR Bronson Commercial |
$119.14
|
|
|
PR TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 75962
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Aetna Medicare |
$59.50
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.25
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
|
|
PR TRANSMASTOID ANTROTOMY
|
Professional
|
Both
|
$1,833.00
|
|
|
Service Code
|
HCPCS 69501
|
| Min. Negotiated Rate |
$405.34 |
| Max. Negotiated Rate |
$1,374.75 |
| Rate for Payer: Aetna Commercial |
$825.27
|
| Rate for Payer: Aetna Medicare |
$640.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$825.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$886.85
|
| Rate for Payer: BCBS Complete |
$425.61
|
| Rate for Payer: BCBS MAPPO |
$615.87
|
| Rate for Payer: BCN Commercial |
$1,063.19
|
| Rate for Payer: BCN Medicare Advantage |
$615.87
|
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Cash Price |
$1,466.40
|
| Rate for Payer: Cofinity Commercial |
$886.85
|
| Rate for Payer: Cofinity Commercial |
$825.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.66
|
| Rate for Payer: Meridian Medicaid |
$425.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$677.46
|
| Rate for Payer: Nomi Health Commercial |
$739.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,374.75
|
| Rate for Payer: PACE SWMI |
$615.87
|
| Rate for Payer: PHP Commercial |
$862.22
|
| Rate for Payer: PHP Medicare Advantage |
$615.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,050.54
|
| Rate for Payer: Priority Health Medicare |
$615.87
|
| Rate for Payer: Priority Health SBD |
$1,050.54
|
| Rate for Payer: Priority Health Tiered Network |
$1,050.54
|
| Rate for Payer: Railroad Medicare Medicare |
$615.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,227.33
|
| Rate for Payer: UHC Core |
$1,227.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$615.87
|
| Rate for Payer: UHC Exchange |
$1,227.33
|
| Rate for Payer: UHC Medicaid |
$405.34
|
| Rate for Payer: UHCCP Medicaid |
$405.34
|
| Rate for Payer: UMR Bronson Commercial |
$843.18
|
|
|
PR TRANSMETACARPAL AMPUTATION RE-AMPUTATION
|
Professional
|
Both
|
$2,332.00
|
|
|
Service Code
|
HCPCS 25931
|
| Min. Negotiated Rate |
$498.85 |
| Max. Negotiated Rate |
$1,749.00 |
| Rate for Payer: Aetna Commercial |
$1,003.69
|
| Rate for Payer: Aetna Medicare |
$778.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.59
|
| Rate for Payer: BCBS Complete |
$523.79
|
| Rate for Payer: BCBS MAPPO |
$749.02
|
| Rate for Payer: BCN Commercial |
$1,202.63
|
| Rate for Payer: BCN Medicare Advantage |
$749.02
|
| Rate for Payer: Cash Price |
$1,865.60
|
| Rate for Payer: Cash Price |
$1,865.60
|
| Rate for Payer: Cofinity Commercial |
$1,003.69
|
| Rate for Payer: Cofinity Commercial |
$1,078.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$749.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$786.47
|
| Rate for Payer: Meridian Medicaid |
$523.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$823.92
|
| Rate for Payer: Nomi Health Commercial |
$898.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,749.00
|
| Rate for Payer: PACE SWMI |
$749.02
|
| Rate for Payer: PHP Commercial |
$1,048.63
|
| Rate for Payer: PHP Medicare Advantage |
$749.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$498.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,285.57
|
| Rate for Payer: Priority Health Medicare |
$749.02
|
| Rate for Payer: Priority Health SBD |
$1,285.57
|
| Rate for Payer: Priority Health Tiered Network |
$1,285.57
|
| Rate for Payer: Railroad Medicare Medicare |
$749.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,322.38
|
| Rate for Payer: UHC Core |
$1,322.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$749.02
|
| Rate for Payer: UHC Exchange |
$1,322.38
|
| Rate for Payer: UHC Medicaid |
$498.85
|
| Rate for Payer: UHCCP Medicaid |
$498.85
|
| Rate for Payer: UMR Bronson Commercial |
$1,072.72
|
|
|
PR TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ
|
Professional
|
Both
|
$1,099.00
|
|
|
Service Code
|
HCPCS 25929
|
| Min. Negotiated Rate |
$364.66 |
| Max. Negotiated Rate |
$1,039.93 |
| Rate for Payer: Aetna Commercial |
$745.01
|
| Rate for Payer: Aetna Medicare |
$578.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$745.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$800.61
|
| Rate for Payer: BCBS Complete |
$382.89
|
| Rate for Payer: BCBS MAPPO |
$555.98
|
| Rate for Payer: BCN Commercial |
$920.26
|
| Rate for Payer: BCN Medicare Advantage |
$555.98
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cash Price |
$879.20
|
| Rate for Payer: Cofinity Commercial |
$745.01
|
| Rate for Payer: Cofinity Commercial |
$800.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.78
|
| Rate for Payer: Meridian Medicaid |
$382.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$611.58
|
| Rate for Payer: Nomi Health Commercial |
$667.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$824.25
|
| Rate for Payer: PACE SWMI |
$555.98
|
| Rate for Payer: PHP Commercial |
$778.37
|
| Rate for Payer: PHP Medicare Advantage |
$555.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$364.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$983.74
|
| Rate for Payer: Priority Health Medicare |
$555.98
|
| Rate for Payer: Priority Health SBD |
$983.74
|
| Rate for Payer: Priority Health Tiered Network |
$983.74
|
| Rate for Payer: Railroad Medicare Medicare |
$555.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,039.93
|
| Rate for Payer: UHC Core |
$1,039.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$555.98
|
| Rate for Payer: UHC Exchange |
$1,039.93
|
| Rate for Payer: UHC Medicaid |
$364.66
|
| Rate for Payer: UHCCP Medicaid |
$364.66
|
| Rate for Payer: UMR Bronson Commercial |
$505.54
|
|
|
PR TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
HCPCS 33141
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$448.50 |
| Rate for Payer: Aetna Commercial |
$161.94
|
| Rate for Payer: Aetna Medicare |
$125.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.02
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS MAPPO |
$120.85
|
| Rate for Payer: BCN Commercial |
$193.22
|
| Rate for Payer: BCN Medicare Advantage |
$120.85
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Cofinity Commercial |
$161.94
|
| Rate for Payer: Cofinity Commercial |
$174.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.89
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$132.94
|
| Rate for Payer: Nomi Health Commercial |
$145.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$448.50
|
| Rate for Payer: PACE SWMI |
$120.85
|
| Rate for Payer: PHP Commercial |
$169.19
|
| Rate for Payer: PHP Medicare Advantage |
$120.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$207.77
|
| Rate for Payer: Priority Health Medicare |
$120.85
|
| Rate for Payer: Priority Health SBD |
$207.77
|
| Rate for Payer: Priority Health Tiered Network |
$207.77
|
| Rate for Payer: Railroad Medicare Medicare |
$120.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.05
|
| Rate for Payer: UHC Core |
$236.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$120.85
|
| Rate for Payer: UHC Exchange |
$236.05
|
| Rate for Payer: UHC Medicaid |
$76.25
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
| Rate for Payer: UMR Bronson Commercial |
$275.08
|
|
|
PR TRANSORAL LOWER ESOPHAGEAL MYOTOMY
|
Professional
|
Both
|
$1,684.00
|
|
|
Service Code
|
HCPCS 43497
|
| Min. Negotiated Rate |
$458.16 |
| Max. Negotiated Rate |
$1,430.13 |
| Rate for Payer: Aetna Commercial |
$946.83
|
| Rate for Payer: Aetna Medicare |
$734.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,017.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.83
|
| Rate for Payer: BCBS Complete |
$481.07
|
| Rate for Payer: BCBS MAPPO |
$706.59
|
| Rate for Payer: BCN Commercial |
$1,173.74
|
| Rate for Payer: BCN Medicare Advantage |
$706.59
|
| Rate for Payer: Cash Price |
$1,347.20
|
| Rate for Payer: Cash Price |
$1,347.20
|
| Rate for Payer: Cofinity Commercial |
$1,017.49
|
| Rate for Payer: Cofinity Commercial |
$946.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$706.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$741.92
|
| Rate for Payer: Meridian Medicaid |
$481.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$777.25
|
| Rate for Payer: Nomi Health Commercial |
$847.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,263.00
|
| Rate for Payer: PACE SWMI |
$706.59
|
| Rate for Payer: PHP Commercial |
$989.23
|
| Rate for Payer: PHP Medicare Advantage |
$706.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$458.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,430.13
|
| Rate for Payer: Priority Health Medicare |
$706.59
|
| Rate for Payer: Priority Health SBD |
$1,430.13
|
| Rate for Payer: Priority Health Tiered Network |
$1,430.13
|
| Rate for Payer: Railroad Medicare Medicare |
$706.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,425.69
|
| Rate for Payer: UHC Core |
$1,425.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$706.59
|
| Rate for Payer: UHC Exchange |
$1,425.69
|
| Rate for Payer: UHC Medicaid |
$458.16
|
| Rate for Payer: UHCCP Medicaid |
$458.16
|
| Rate for Payer: UMR Bronson Commercial |
$774.64
|
|
|
PR TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR
|
Professional
|
Both
|
$2,548.00
|
|
|
Service Code
|
HCPCS 63057
|
| Min. Negotiated Rate |
$183.39 |
| Max. Negotiated Rate |
$1,911.00 |
| Rate for Payer: Aetna Commercial |
$388.79
|
| Rate for Payer: Aetna Medicare |
$301.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.80
|
| Rate for Payer: BCBS Complete |
$192.56
|
| Rate for Payer: BCBS MAPPO |
$290.14
|
| Rate for Payer: BCN Commercial |
$530.11
|
| Rate for Payer: BCN Medicare Advantage |
$290.14
|
| Rate for Payer: Cash Price |
$2,038.40
|
| Rate for Payer: Cash Price |
$2,038.40
|
| Rate for Payer: Cofinity Commercial |
$388.79
|
| Rate for Payer: Cofinity Commercial |
$417.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$304.65
|
| Rate for Payer: Meridian Medicaid |
$192.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$319.15
|
| Rate for Payer: Nomi Health Commercial |
$348.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,911.00
|
| Rate for Payer: PACE SWMI |
$290.14
|
| Rate for Payer: PHP Commercial |
$406.20
|
| Rate for Payer: PHP Medicare Advantage |
$290.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$183.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$560.47
|
| Rate for Payer: Priority Health Medicare |
$290.14
|
| Rate for Payer: Priority Health SBD |
$560.47
|
| Rate for Payer: Priority Health Tiered Network |
$560.47
|
| Rate for Payer: Railroad Medicare Medicare |
$290.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.26
|
| Rate for Payer: UHC Core |
$569.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$290.14
|
| Rate for Payer: UHC Exchange |
$569.26
|
| Rate for Payer: UHC Medicaid |
$183.39
|
| Rate for Payer: UHCCP Medicaid |
$183.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,172.08
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR
|
Professional
|
Both
|
$7,286.00
|
|
|
Service Code
|
HCPCS 63056
|
| Min. Negotiated Rate |
$895.88 |
| Max. Negotiated Rate |
$5,464.50 |
| Rate for Payer: Aetna Commercial |
$1,870.91
|
| Rate for Payer: Aetna Medicare |
$1,452.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,870.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,010.53
|
| Rate for Payer: BCBS Complete |
$940.67
|
| Rate for Payer: BCBS MAPPO |
$1,396.20
|
| Rate for Payer: BCN Commercial |
$2,479.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,396.20
|
| Rate for Payer: Cash Price |
$5,828.80
|
| Rate for Payer: Cash Price |
$5,828.80
|
| Rate for Payer: Cofinity Commercial |
$1,870.91
|
| Rate for Payer: Cofinity Commercial |
$2,010.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,396.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,466.01
|
| Rate for Payer: Meridian Medicaid |
$940.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,535.82
|
| Rate for Payer: Nomi Health Commercial |
$1,675.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,464.50
|
| Rate for Payer: PACE SWMI |
$1,396.20
|
| Rate for Payer: PHP Commercial |
$1,954.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,396.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$895.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,621.87
|
| Rate for Payer: Priority Health Medicare |
$1,396.20
|
| Rate for Payer: Priority Health SBD |
$2,621.87
|
| Rate for Payer: Priority Health Tiered Network |
$2,621.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,396.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,626.32
|
| Rate for Payer: UHC Core |
$2,626.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,396.20
|
| Rate for Payer: UHC Exchange |
$2,626.32
|
| Rate for Payer: UHC Medicaid |
$895.88
|
| Rate for Payer: UHCCP Medicaid |
$895.88
|
| Rate for Payer: UMR Bronson Commercial |
$3,351.56
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC
|
Professional
|
Both
|
$7,679.00
|
|
|
Service Code
|
HCPCS 63055
|
| Min. Negotiated Rate |
$990.45 |
| Max. Negotiated Rate |
$5,759.25 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Aetna Medicare |
$1,608.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,072.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,226.95
|
| Rate for Payer: BCBS Complete |
$1,039.97
|
| Rate for Payer: BCBS MAPPO |
$1,546.49
|
| Rate for Payer: BCN Commercial |
$2,712.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,546.49
|
| Rate for Payer: Cash Price |
$6,143.20
|
| Rate for Payer: Cash Price |
$6,143.20
|
| Rate for Payer: Cofinity Commercial |
$2,072.30
|
| Rate for Payer: Cofinity Commercial |
$2,226.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,546.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,623.81
|
| Rate for Payer: Meridian Medicaid |
$1,039.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,701.14
|
| Rate for Payer: Nomi Health Commercial |
$1,855.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,759.25
|
| Rate for Payer: PACE SWMI |
$1,546.49
|
| Rate for Payer: PHP Commercial |
$2,165.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,546.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$990.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,868.26
|
| Rate for Payer: Priority Health Medicare |
$1,546.49
|
| Rate for Payer: Priority Health SBD |
$2,868.26
|
| Rate for Payer: Priority Health Tiered Network |
$2,868.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1,546.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,869.10
|
| Rate for Payer: UHC Core |
$2,869.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,546.49
|
| Rate for Payer: UHC Exchange |
$2,869.10
|
| Rate for Payer: UHC Medicaid |
$990.45
|
| Rate for Payer: UHCCP Medicaid |
$990.45
|
| Rate for Payer: UMR Bronson Commercial |
$3,532.34
|
|
|
PR TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX
|
Professional
|
Both
|
$6,886.00
|
|
|
Service Code
|
HCPCS 55874
|
| Min. Negotiated Rate |
$90.95 |
| Max. Negotiated Rate |
$5,164.50 |
| Rate for Payer: Aetna Commercial |
$189.17
|
| Rate for Payer: Aetna Medicare |
$146.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.28
|
| Rate for Payer: BCBS Complete |
$95.50
|
| Rate for Payer: BCBS MAPPO |
$141.17
|
| Rate for Payer: BCN Commercial |
$244.51
|
| Rate for Payer: BCN Medicare Advantage |
$141.17
|
| Rate for Payer: Cash Price |
$5,508.80
|
| Rate for Payer: Cash Price |
$5,508.80
|
| Rate for Payer: Cofinity Commercial |
$189.17
|
| Rate for Payer: Cofinity Commercial |
$203.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.23
|
| Rate for Payer: Meridian Medicaid |
$95.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$155.29
|
| Rate for Payer: Nomi Health Commercial |
$169.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,164.50
|
| Rate for Payer: PACE SWMI |
$141.17
|
| Rate for Payer: PHP Commercial |
$197.64
|
| Rate for Payer: PHP Medicare Advantage |
$141.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$266.35
|
| Rate for Payer: Priority Health Medicare |
$141.17
|
| Rate for Payer: Priority Health SBD |
$266.35
|
| Rate for Payer: Priority Health Tiered Network |
$266.35
|
| Rate for Payer: Railroad Medicare Medicare |
$141.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.68
|
| Rate for Payer: UHC Core |
$291.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$141.17
|
| Rate for Payer: UHC Exchange |
$291.68
|
| Rate for Payer: UHC Medicaid |
$90.95
|
| Rate for Payer: UHCCP Medicaid |
$90.95
|
| Rate for Payer: UMR Bronson Commercial |
$3,167.56
|
|
|
PR TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ
|
Professional
|
Both
|
$2,803.00
|
|
|
Service Code
|
HCPCS 55875
|
| Min. Negotiated Rate |
$438.57 |
| Max. Negotiated Rate |
$2,102.25 |
| Rate for Payer: Aetna Commercial |
$906.19
|
| Rate for Payer: Aetna Medicare |
$703.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$906.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$973.81
|
| Rate for Payer: BCBS Complete |
$460.50
|
| Rate for Payer: BCBS MAPPO |
$676.26
|
| Rate for Payer: BCN Commercial |
$1,174.73
|
| Rate for Payer: BCN Medicare Advantage |
$676.26
|
| Rate for Payer: Cash Price |
$2,242.40
|
| Rate for Payer: Cash Price |
$2,242.40
|
| Rate for Payer: Cofinity Commercial |
$906.19
|
| Rate for Payer: Cofinity Commercial |
$973.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$710.07
|
| Rate for Payer: Meridian Medicaid |
$460.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$743.89
|
| Rate for Payer: Nomi Health Commercial |
$811.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,102.25
|
| Rate for Payer: PACE SWMI |
$676.26
|
| Rate for Payer: PHP Commercial |
$946.76
|
| Rate for Payer: PHP Medicare Advantage |
$676.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$438.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,279.66
|
| Rate for Payer: Priority Health Medicare |
$676.26
|
| Rate for Payer: Priority Health SBD |
$1,279.66
|
| Rate for Payer: Priority Health Tiered Network |
$1,279.66
|
| Rate for Payer: Railroad Medicare Medicare |
$676.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,354.75
|
| Rate for Payer: UHC Core |
$1,354.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$676.26
|
| Rate for Payer: UHC Exchange |
$1,354.75
|
| Rate for Payer: UHC Medicaid |
$438.57
|
| Rate for Payer: UHCCP Medicaid |
$438.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,289.38
|
|
|
PR TRANSPLANTATION TESTIS TO THIGH
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 54680
|
| Min. Negotiated Rate |
$453.90 |
| Max. Negotiated Rate |
$1,390.61 |
| Rate for Payer: Aetna Commercial |
$941.12
|
| Rate for Payer: Aetna Medicare |
$730.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,011.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.12
|
| Rate for Payer: BCBS Complete |
$476.60
|
| Rate for Payer: BCBS MAPPO |
$702.33
|
| Rate for Payer: BCN Commercial |
$1,179.22
|
| Rate for Payer: BCN Medicare Advantage |
$702.33
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cofinity Commercial |
$1,011.36
|
| Rate for Payer: Cofinity Commercial |
$941.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$702.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$737.45
|
| Rate for Payer: Meridian Medicaid |
$476.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$772.56
|
| Rate for Payer: Nomi Health Commercial |
$842.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,097.25
|
| Rate for Payer: PACE SWMI |
$702.33
|
| Rate for Payer: PHP Commercial |
$983.26
|
| Rate for Payer: PHP Medicare Advantage |
$702.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,284.56
|
| Rate for Payer: Priority Health Medicare |
$702.33
|
| Rate for Payer: Priority Health SBD |
$1,284.56
|
| Rate for Payer: Priority Health Tiered Network |
$1,284.56
|
| Rate for Payer: Railroad Medicare Medicare |
$702.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,390.61
|
| Rate for Payer: UHC Core |
$1,390.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$702.33
|
| Rate for Payer: UHC Exchange |
$1,390.61
|
| Rate for Payer: UHC Medicaid |
$453.90
|
| Rate for Payer: UHCCP Medicaid |
$453.90
|
| Rate for Payer: UMR Bronson Commercial |
$672.98
|
|
|
PR TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN
|
Professional
|
Both
|
$1,936.00
|
|
|
Service Code
|
HCPCS 27397
|
| Min. Negotiated Rate |
$546.13 |
| Max. Negotiated Rate |
$1,598.35 |
| Rate for Payer: Aetna Commercial |
$1,121.11
|
| Rate for Payer: Aetna Medicare |
$870.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,121.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,204.78
|
| Rate for Payer: BCBS Complete |
$573.44
|
| Rate for Payer: BCBS MAPPO |
$836.65
|
| Rate for Payer: BCN Commercial |
$1,395.84
|
| Rate for Payer: BCN Medicare Advantage |
$836.65
|
| Rate for Payer: Cash Price |
$1,548.80
|
| Rate for Payer: Cash Price |
$1,548.80
|
| Rate for Payer: Cofinity Commercial |
$1,121.11
|
| Rate for Payer: Cofinity Commercial |
$1,204.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$836.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$878.48
|
| Rate for Payer: Meridian Medicaid |
$573.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$920.32
|
| Rate for Payer: Nomi Health Commercial |
$1,003.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,452.00
|
| Rate for Payer: PACE SWMI |
$836.65
|
| Rate for Payer: PHP Commercial |
$1,171.31
|
| Rate for Payer: PHP Medicare Advantage |
$836.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$546.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,492.11
|
| Rate for Payer: Priority Health Medicare |
$836.65
|
| Rate for Payer: Priority Health SBD |
$1,492.11
|
| Rate for Payer: Priority Health Tiered Network |
$1,492.11
|
| Rate for Payer: Railroad Medicare Medicare |
$836.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,598.35
|
| Rate for Payer: UHC Core |
$1,598.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$836.65
|
| Rate for Payer: UHC Exchange |
$1,598.35
|
| Rate for Payer: UHC Medicaid |
$546.13
|
| Rate for Payer: UHCCP Medicaid |
$546.13
|
| Rate for Payer: UMR Bronson Commercial |
$890.56
|
|
|
PR TRANSPOSITION OVARY
|
Professional
|
Both
|
$1,507.00
|
|
|
Service Code
|
HCPCS 58825
|
| Min. Negotiated Rate |
$400.23 |
| Max. Negotiated Rate |
$1,247.13 |
| Rate for Payer: Aetna Commercial |
$831.99
|
| Rate for Payer: Aetna Medicare |
$645.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$894.08
|
| Rate for Payer: BCBS Complete |
$420.24
|
| Rate for Payer: BCBS MAPPO |
$620.89
|
| Rate for Payer: BCN Commercial |
$1,063.68
|
| Rate for Payer: BCN Medicare Advantage |
$620.89
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cash Price |
$1,205.60
|
| Rate for Payer: Cofinity Commercial |
$831.99
|
| Rate for Payer: Cofinity Commercial |
$894.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$620.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$651.93
|
| Rate for Payer: Meridian Medicaid |
$420.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$682.98
|
| Rate for Payer: Nomi Health Commercial |
$745.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,130.25
|
| Rate for Payer: PACE SWMI |
$620.89
|
| Rate for Payer: PHP Commercial |
$869.25
|
| Rate for Payer: PHP Medicare Advantage |
$620.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,077.28
|
| Rate for Payer: Priority Health Medicare |
$620.89
|
| Rate for Payer: Priority Health SBD |
$1,077.28
|
| Rate for Payer: Priority Health Tiered Network |
$1,077.28
|
| Rate for Payer: Railroad Medicare Medicare |
$620.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,247.13
|
| Rate for Payer: UHC Core |
$1,247.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$620.89
|
| Rate for Payer: UHC Exchange |
$1,247.13
|
| Rate for Payer: UHC Medicaid |
$400.23
|
| Rate for Payer: UHCCP Medicaid |
$400.23
|
| Rate for Payer: UMR Bronson Commercial |
$693.22
|
|
|
PR TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM
|
Professional
|
Both
|
$5,231.00
|
|
|
Service Code
|
HCPCS 61598
|
| Min. Negotiated Rate |
$1,816.04 |
| Max. Negotiated Rate |
$5,003.53 |
| Rate for Payer: Aetna Commercial |
$3,768.11
|
| Rate for Payer: Aetna Medicare |
$2,924.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,768.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,049.31
|
| Rate for Payer: BCBS Complete |
$1,906.84
|
| Rate for Payer: BCBS MAPPO |
$2,812.02
|
| Rate for Payer: BCN Commercial |
$4,305.54
|
| Rate for Payer: BCN Medicare Advantage |
$2,812.02
|
| Rate for Payer: Cash Price |
$4,184.80
|
| Rate for Payer: Cash Price |
$4,184.80
|
| Rate for Payer: Cofinity Commercial |
$3,768.11
|
| Rate for Payer: Cofinity Commercial |
$4,049.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,812.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,952.62
|
| Rate for Payer: Meridian Medicaid |
$1,906.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,093.22
|
| Rate for Payer: Nomi Health Commercial |
$3,374.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,923.25
|
| Rate for Payer: PACE SWMI |
$2,812.02
|
| Rate for Payer: PHP Commercial |
$3,936.83
|
| Rate for Payer: PHP Medicare Advantage |
$2,812.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,816.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,000.81
|
| Rate for Payer: Priority Health Medicare |
$2,812.02
|
| Rate for Payer: Priority Health SBD |
$5,000.81
|
| Rate for Payer: Priority Health Tiered Network |
$5,000.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2,812.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,003.53
|
| Rate for Payer: UHC Core |
$5,003.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,812.02
|
| Rate for Payer: UHC Exchange |
$5,003.53
|
| Rate for Payer: UHC Medicaid |
$1,816.04
|
| Rate for Payer: UHCCP Medicaid |
$1,816.04
|
| Rate for Payer: UMR Bronson Commercial |
$2,406.26
|
|
|
PR TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
|
Professional
|
Both
|
$843.00
|
|
|
Service Code
|
HCPCS 45000
|
| Min. Negotiated Rate |
$263.27 |
| Max. Negotiated Rate |
$789.40 |
| Rate for Payer: Aetna Commercial |
$539.90
|
| Rate for Payer: Aetna Medicare |
$419.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.19
|
| Rate for Payer: BCBS Complete |
$276.43
|
| Rate for Payer: BCBS MAPPO |
$402.91
|
| Rate for Payer: BCN Commercial |
$647.87
|
| Rate for Payer: BCN Medicare Advantage |
$402.91
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cash Price |
$674.40
|
| Rate for Payer: Cofinity Commercial |
$539.90
|
| Rate for Payer: Cofinity Commercial |
$580.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.06
|
| Rate for Payer: Meridian Medicaid |
$276.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$443.20
|
| Rate for Payer: Nomi Health Commercial |
$483.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$632.25
|
| Rate for Payer: PACE SWMI |
$402.91
|
| Rate for Payer: PHP Commercial |
$564.07
|
| Rate for Payer: PHP Medicare Advantage |
$402.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$263.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$789.40
|
| Rate for Payer: Priority Health Medicare |
$402.91
|
| Rate for Payer: Priority Health SBD |
$789.40
|
| Rate for Payer: Priority Health Tiered Network |
$789.40
|
| Rate for Payer: Railroad Medicare Medicare |
$402.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$749.19
|
| Rate for Payer: UHC Core |
$749.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$402.91
|
| Rate for Payer: UHC Exchange |
$749.19
|
| Rate for Payer: UHC Medicaid |
$263.27
|
| Rate for Payer: UHCCP Medicaid |
$263.27
|
| Rate for Payer: UMR Bronson Commercial |
$387.78
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 93293
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$50.00
|
| Rate for Payer: Aetna Medicare |
$38.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.73
|
| Rate for Payer: BCBS MAPPO |
$37.31
|
| Rate for Payer: BCN Commercial |
$61.75
|
| Rate for Payer: BCN Medicare Advantage |
$37.31
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Cofinity Commercial |
$53.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.04
|
| Rate for Payer: Nomi Health Commercial |
$44.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.50
|
| Rate for Payer: PACE SWMI |
$37.31
|
| Rate for Payer: PHP Commercial |
$52.23
|
| Rate for Payer: PHP Medicare Advantage |
$37.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$58.69
|
| Rate for Payer: Priority Health Medicare |
$37.31
|
| Rate for Payer: Priority Health SBD |
$58.69
|
| Rate for Payer: Priority Health Tiered Network |
$58.69
|
| Rate for Payer: Railroad Medicare Medicare |
$37.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.24
|
| Rate for Payer: UHC Core |
$79.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.31
|
| Rate for Payer: UHC Exchange |
$79.24
|
| Rate for Payer: UMR Bronson Commercial |
$85.56
|
|
|
PR TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV
|
Professional
|
Both
|
$6,436.00
|
|
|
Service Code
|
HCPCS 61595
|
| Min. Negotiated Rate |
$1,394.09 |
| Max. Negotiated Rate |
$4,827.00 |
| Rate for Payer: Aetna Commercial |
$2,884.68
|
| Rate for Payer: Aetna Medicare |
$2,238.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,884.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,099.96
|
| Rate for Payer: BCBS Complete |
$1,463.79
|
| Rate for Payer: BCBS MAPPO |
$2,152.75
|
| Rate for Payer: BCN Commercial |
$3,589.94
|
| Rate for Payer: BCN Medicare Advantage |
$2,152.75
|
| Rate for Payer: Cash Price |
$5,148.80
|
| Rate for Payer: Cash Price |
$5,148.80
|
| Rate for Payer: Cofinity Commercial |
$3,099.96
|
| Rate for Payer: Cofinity Commercial |
$2,884.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,152.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,260.39
|
| Rate for Payer: Meridian Medicaid |
$1,463.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,368.03
|
| Rate for Payer: Nomi Health Commercial |
$2,583.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,827.00
|
| Rate for Payer: PACE SWMI |
$2,152.75
|
| Rate for Payer: PHP Commercial |
$3,013.85
|
| Rate for Payer: PHP Medicare Advantage |
$2,152.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,394.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,169.66
|
| Rate for Payer: Priority Health Medicare |
$2,152.75
|
| Rate for Payer: Priority Health SBD |
$4,169.66
|
| Rate for Payer: Priority Health Tiered Network |
$4,169.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,152.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,142.38
|
| Rate for Payer: UHC Core |
$4,142.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,152.75
|
| Rate for Payer: UHC Exchange |
$4,142.38
|
| Rate for Payer: UHC Medicaid |
$1,394.09
|
| Rate for Payer: UHCCP Medicaid |
$1,394.09
|
| Rate for Payer: UMR Bronson Commercial |
$2,960.56
|
|
|
PR TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR
|
Professional
|
Both
|
$2,225.00
|
|
|
Service Code
|
HCPCS 50770
|
| Min. Negotiated Rate |
$657.11 |
| Max. Negotiated Rate |
$2,040.01 |
| Rate for Payer: Aetna Commercial |
$1,366.81
|
| Rate for Payer: Aetna Medicare |
$1,060.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,366.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,468.81
|
| Rate for Payer: BCBS Complete |
$689.97
|
| Rate for Payer: BCBS MAPPO |
$1,020.01
|
| Rate for Payer: BCN Commercial |
$1,717.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,020.01
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cofinity Commercial |
$1,366.81
|
| Rate for Payer: Cofinity Commercial |
$1,468.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,020.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,071.01
|
| Rate for Payer: Meridian Medicaid |
$689.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,122.01
|
| Rate for Payer: Nomi Health Commercial |
$1,224.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,668.75
|
| Rate for Payer: PACE SWMI |
$1,020.01
|
| Rate for Payer: PHP Commercial |
$1,428.01
|
| Rate for Payer: PHP Medicare Advantage |
$1,020.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$657.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,870.95
|
| Rate for Payer: Priority Health Medicare |
$1,020.01
|
| Rate for Payer: Priority Health SBD |
$1,870.95
|
| Rate for Payer: Priority Health Tiered Network |
$1,870.95
|
| Rate for Payer: Railroad Medicare Medicare |
$1,020.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,040.01
|
| Rate for Payer: UHC Core |
$2,040.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,020.01
|
| Rate for Payer: UHC Exchange |
$2,040.01
|
| Rate for Payer: UHC Medicaid |
$657.11
|
| Rate for Payer: UHCCP Medicaid |
$657.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,023.50
|
|
|
PR TRANSURETHRAL INCISION PROSTATE
|
Professional
|
Both
|
$1,509.00
|
|
|
Service Code
|
HCPCS 52450
|
| Min. Negotiated Rate |
$428.99 |
| Max. Negotiated Rate |
$1,131.75 |
| Rate for Payer: Aetna Commercial |
$574.85
|
| Rate for Payer: Aetna Medicare |
$446.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$574.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.75
|
| Rate for Payer: BCBS Complete |
$603.60
|
| Rate for Payer: BCBS MAPPO |
$428.99
|
| Rate for Payer: BCN Commercial |
$716.59
|
| Rate for Payer: BCN Medicare Advantage |
$428.99
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cash Price |
$1,207.20
|
| Rate for Payer: Cofinity Commercial |
$617.75
|
| Rate for Payer: Cofinity Commercial |
$574.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$428.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$450.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$471.89
|
| Rate for Payer: Nomi Health Commercial |
$514.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,131.75
|
| Rate for Payer: PACE SWMI |
$428.99
|
| Rate for Payer: PHP Commercial |
$600.59
|
| Rate for Payer: PHP Medicare Advantage |
$428.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$780.61
|
| Rate for Payer: Priority Health Medicare |
$428.99
|
| Rate for Payer: Priority Health SBD |
$780.61
|
| Rate for Payer: Priority Health Tiered Network |
$780.61
|
| Rate for Payer: Railroad Medicare Medicare |
$428.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$827.07
|
| Rate for Payer: UHC Core |
$827.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$428.99
|
| Rate for Payer: UHC Exchange |
$827.07
|
| Rate for Payer: UMR Bronson Commercial |
$694.14
|
|
|
PR TRANSURETHRAL RESECTION BLADDER NECK
|
Professional
|
Both
|
$1,738.00
|
|
|
Service Code
|
HCPCS 52500
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$1,303.50 |
| Rate for Payer: Aetna Commercial |
$461.23
|
| Rate for Payer: Aetna Medicare |
$357.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$495.65
|
| Rate for Payer: BCBS Complete |
$235.96
|
| Rate for Payer: BCBS MAPPO |
$344.20
|
| Rate for Payer: BCN Commercial |
$743.48
|
| Rate for Payer: BCN Medicare Advantage |
$344.20
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cash Price |
$1,390.40
|
| Rate for Payer: Cofinity Commercial |
$495.65
|
| Rate for Payer: Cofinity Commercial |
$461.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$361.41
|
| Rate for Payer: Meridian Medicaid |
$235.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$378.62
|
| Rate for Payer: Nomi Health Commercial |
$413.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,303.50
|
| Rate for Payer: PACE SWMI |
$344.20
|
| Rate for Payer: PHP Commercial |
$481.88
|
| Rate for Payer: PHP Medicare Advantage |
$344.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$224.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$809.89
|
| Rate for Payer: Priority Health Medicare |
$344.20
|
| Rate for Payer: Priority Health SBD |
$809.89
|
| Rate for Payer: Priority Health Tiered Network |
$809.89
|
| Rate for Payer: Railroad Medicare Medicare |
$344.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.46
|
| Rate for Payer: UHC Core |
$858.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$344.20
|
| Rate for Payer: UHC Exchange |
$858.46
|
| Rate for Payer: UHC Medicaid |
$224.72
|
| Rate for Payer: UHCCP Medicaid |
$224.72
|
| Rate for Payer: UMR Bronson Commercial |
$799.48
|
|
|
PR TRANSV AORTIC ARCH GRAFT W BYPASS
|
Professional
|
Both
|
$10,594.00
|
|
|
Service Code
|
HCPCS 33870
|
| Min. Negotiated Rate |
$4,237.60 |
| Max. Negotiated Rate |
$7,945.50 |
| Rate for Payer: Aetna Medicare |
$5,297.00
|
| Rate for Payer: BCBS Complete |
$4,237.60
|
| Rate for Payer: Cash Price |
$8,475.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,945.50
|
| Rate for Payer: UMR Bronson Commercial |
$4,873.24
|
|
|
PR TRANSVRS A-ARCH GRF W/CARD BYP PRFD HYPOTHERMIA
|
Professional
|
Both
|
$5,798.00
|
|
|
Service Code
|
HCPCS 33871
|
| Min. Negotiated Rate |
$1,915.30 |
| Max. Negotiated Rate |
$5,842.66 |
| Rate for Payer: Aetna Commercial |
$4,047.87
|
| Rate for Payer: Aetna Medicare |
$3,141.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,047.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,349.95
|
| Rate for Payer: BCBS Complete |
$2,011.07
|
| Rate for Payer: BCBS MAPPO |
$3,020.80
|
| Rate for Payer: BCN Commercial |
$4,762.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,020.80
|
| Rate for Payer: Cash Price |
$4,638.40
|
| Rate for Payer: Cash Price |
$4,638.40
|
| Rate for Payer: Cofinity Commercial |
$4,349.95
|
| Rate for Payer: Cofinity Commercial |
$4,047.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,020.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,171.84
|
| Rate for Payer: Meridian Medicaid |
$2,011.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,322.88
|
| Rate for Payer: Nomi Health Commercial |
$3,624.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,348.50
|
| Rate for Payer: PACE SWMI |
$3,020.80
|
| Rate for Payer: PHP Commercial |
$4,229.12
|
| Rate for Payer: PHP Medicare Advantage |
$3,020.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,915.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,121.67
|
| Rate for Payer: Priority Health Medicare |
$3,020.80
|
| Rate for Payer: Priority Health SBD |
$5,121.67
|
| Rate for Payer: Priority Health Tiered Network |
$5,121.67
|
| Rate for Payer: Railroad Medicare Medicare |
$3,020.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,842.66
|
| Rate for Payer: UHC Core |
$5,842.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,020.80
|
| Rate for Payer: UHC Exchange |
$5,842.66
|
| Rate for Payer: UHC Medicaid |
$1,915.30
|
| Rate for Payer: UHCCP Medicaid |
$1,915.30
|
| Rate for Payer: UMR Bronson Commercial |
$2,667.08
|
|
|
PR TRAY FEE
|
Professional
|
Both
|
$35.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
