|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,636.00
|
|
|
Service Code
|
HCPCS 49525
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,063.40 |
| Rate for Payer: Aetna Commercial |
$750.51
|
| Rate for Payer: Aetna Medicare |
$582.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.52
|
| Rate for Payer: BCBS Complete |
$391.17
|
| Rate for Payer: BCBS MAPPO |
$560.08
|
| Rate for Payer: BCBS Trust/PPO |
$515.62
|
| Rate for Payer: BCN Commercial |
$842.48
|
| Rate for Payer: BCN Medicare Advantage |
$560.08
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cofinity Commercial |
$750.51
|
| Rate for Payer: Cofinity Commercial |
$806.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$560.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$588.08
|
| Rate for Payer: Meridian Medicaid |
$391.17
|
| Rate for Payer: Nomi Health Commercial |
$672.10
|
| Rate for Payer: PACE SWMI |
$560.08
|
| Rate for Payer: PHP Commercial |
$784.11
|
| Rate for Payer: PHP Medicare Advantage |
$560.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.50
|
| Rate for Payer: Priority Health Medicare |
$560.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,034.50
|
| Rate for Payer: Priority Health SBD |
$1,034.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$560.08
|
| Rate for Payer: UHC Medicare Advantage |
$560.08
|
| Rate for Payer: UHCCP Medicaid |
$372.54
|
| Rate for Payer: UMR Bronson Commercial |
$752.56
|
|
|
PR RPR INGUN HERNIA SLIDING ANY AGE
|
Professional
|
Both
|
$1,636.00
|
|
|
Service Code
|
HCPCS 49525
|
| Hospital Charge Code |
49525
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$1,063.40 |
| Rate for Payer: Aetna Commercial |
$750.51
|
| Rate for Payer: Aetna Medicare |
$582.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$750.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$806.52
|
| Rate for Payer: BCBS Complete |
$391.17
|
| Rate for Payer: BCBS MAPPO |
$560.08
|
| Rate for Payer: BCBS Trust/PPO |
$515.62
|
| Rate for Payer: BCN Commercial |
$842.48
|
| Rate for Payer: BCN Medicare Advantage |
$560.08
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cash Price |
$1,308.80
|
| Rate for Payer: Cofinity Commercial |
$806.52
|
| Rate for Payer: Cofinity Commercial |
$750.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$560.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$588.08
|
| Rate for Payer: Meridian Medicaid |
$391.17
|
| Rate for Payer: Nomi Health Commercial |
$672.10
|
| Rate for Payer: PACE SWMI |
$560.08
|
| Rate for Payer: PHP Commercial |
$784.11
|
| Rate for Payer: PHP Medicare Advantage |
$560.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$372.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,034.50
|
| Rate for Payer: Priority Health Medicare |
$560.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,034.50
|
| Rate for Payer: Priority Health SBD |
$1,034.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$560.08
|
| Rate for Payer: UHC Medicare Advantage |
$560.08
|
| Rate for Payer: UHCCP Medicaid |
$372.54
|
| Rate for Payer: UMR Bronson Commercial |
$752.56
|
|
|
PR RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 12046
|
| Min. Negotiated Rate |
$205.33 |
| Max. Negotiated Rate |
$1,305.00 |
| Rate for Payer: Aetna Commercial |
$409.73
|
| Rate for Payer: Aetna Medicare |
$318.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$440.31
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS MAPPO |
$305.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.00
|
| Rate for Payer: BCN Commercial |
$734.48
|
| Rate for Payer: BCN Medicare Advantage |
$305.77
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$409.73
|
| Rate for Payer: Cofinity Commercial |
$440.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.06
|
| Rate for Payer: Meridian Medicaid |
$215.60
|
| Rate for Payer: Nomi Health Commercial |
$366.92
|
| Rate for Payer: PACE SWMI |
$305.77
|
| Rate for Payer: PHP Commercial |
$428.08
|
| Rate for Payer: PHP Medicare Advantage |
$305.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.55
|
| Rate for Payer: Priority Health Medicare |
$305.77
|
| Rate for Payer: Priority Health Narrow Network |
$432.55
|
| Rate for Payer: Priority Health SBD |
$432.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.77
|
| Rate for Payer: UHC Medicare Advantage |
$305.77
|
| Rate for Payer: UHCCP Medicaid |
$205.33
|
| Rate for Payer: UMR Bronson Commercial |
$426.88
|
|
|
PR RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 41250
|
| Min. Negotiated Rate |
$99.36 |
| Max. Negotiated Rate |
$1,744.97 |
| Rate for Payer: Aetna Commercial |
$196.79
|
| Rate for Payer: Aetna Medicare |
$152.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.48
|
| Rate for Payer: BCBS Complete |
$104.66
|
| Rate for Payer: BCBS MAPPO |
$146.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,744.97
|
| Rate for Payer: BCN Commercial |
$420.26
|
| Rate for Payer: BCN Medicare Advantage |
$146.86
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$196.79
|
| Rate for Payer: Cofinity Commercial |
$211.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.20
|
| Rate for Payer: Meridian Medicaid |
$104.66
|
| Rate for Payer: Nomi Health Commercial |
$176.23
|
| Rate for Payer: PACE SWMI |
$146.86
|
| Rate for Payer: PHP Commercial |
$205.60
|
| Rate for Payer: PHP Medicare Advantage |
$146.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$276.81
|
| Rate for Payer: Priority Health Medicare |
$146.86
|
| Rate for Payer: Priority Health Narrow Network |
$276.81
|
| Rate for Payer: Priority Health SBD |
$276.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.86
|
| Rate for Payer: UHC Medicare Advantage |
$146.86
|
| Rate for Payer: UHCCP Medicaid |
$99.68
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
PR RPR LAC TONGUE FLOOR MOUTH > 2.6 CM/CPLX
|
Professional
|
Both
|
$1,084.00
|
|
|
Service Code
|
HCPCS 41252
|
| Min. Negotiated Rate |
$134.83 |
| Max. Negotiated Rate |
$704.60 |
| Rate for Payer: Aetna Commercial |
$267.40
|
| Rate for Payer: Aetna Medicare |
$207.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.35
|
| Rate for Payer: BCBS Complete |
$141.57
|
| Rate for Payer: BCBS MAPPO |
$199.55
|
| Rate for Payer: BCBS Trust/PPO |
$370.34
|
| Rate for Payer: BCN Commercial |
$484.76
|
| Rate for Payer: BCN Medicare Advantage |
$199.55
|
| Rate for Payer: Cash Price |
$867.20
|
| Rate for Payer: Cash Price |
$867.20
|
| Rate for Payer: Cofinity Commercial |
$267.40
|
| Rate for Payer: Cofinity Commercial |
$287.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.53
|
| Rate for Payer: Meridian Medicaid |
$141.57
|
| Rate for Payer: Nomi Health Commercial |
$239.46
|
| Rate for Payer: PACE SWMI |
$199.55
|
| Rate for Payer: PHP Commercial |
$279.37
|
| Rate for Payer: PHP Medicare Advantage |
$199.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$704.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.26
|
| Rate for Payer: Priority Health Medicare |
$199.55
|
| Rate for Payer: Priority Health Narrow Network |
$375.26
|
| Rate for Payer: Priority Health SBD |
$375.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.55
|
| Rate for Payer: UHC Medicare Advantage |
$199.55
|
| Rate for Payer: UHCCP Medicaid |
$134.83
|
| Rate for Payer: UMR Bronson Commercial |
$498.64
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS RMVL PROSTH
|
Professional
|
Both
|
$3,409.00
|
|
|
Service Code
|
HCPCS 49606
|
| Min. Negotiated Rate |
$731.02 |
| Max. Negotiated Rate |
$2,215.85 |
| Rate for Payer: Aetna Commercial |
$1,483.55
|
| Rate for Payer: Aetna Medicare |
$1,151.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,483.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,594.27
|
| Rate for Payer: BCBS Complete |
$767.57
|
| Rate for Payer: BCBS MAPPO |
$1,107.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.86
|
| Rate for Payer: BCN Commercial |
$1,659.06
|
| Rate for Payer: BCN Medicare Advantage |
$1,107.13
|
| Rate for Payer: Cash Price |
$2,727.20
|
| Rate for Payer: Cash Price |
$2,727.20
|
| Rate for Payer: Cofinity Commercial |
$1,483.55
|
| Rate for Payer: Cofinity Commercial |
$1,594.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,107.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,162.49
|
| Rate for Payer: Meridian Medicaid |
$767.57
|
| Rate for Payer: Nomi Health Commercial |
$1,328.56
|
| Rate for Payer: PACE SWMI |
$1,107.13
|
| Rate for Payer: PHP Commercial |
$1,549.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,107.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$731.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,215.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,034.38
|
| Rate for Payer: Priority Health Medicare |
$1,107.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,034.38
|
| Rate for Payer: Priority Health SBD |
$2,034.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,107.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,107.13
|
| Rate for Payer: UHCCP Medicaid |
$731.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,568.14
|
|
|
PR RPR LG OMPHALOCELE/GASTROSCHISIS W/WO PROSTH
|
Professional
|
Both
|
$9,119.00
|
|
|
Service Code
|
HCPCS 49605
|
| Min. Negotiated Rate |
$2,106.86 |
| Max. Negotiated Rate |
$8,749.64 |
| Rate for Payer: Aetna Commercial |
$6,405.13
|
| Rate for Payer: Aetna Medicare |
$4,971.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,405.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,883.13
|
| Rate for Payer: BCBS Complete |
$3,294.82
|
| Rate for Payer: BCBS MAPPO |
$4,779.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,106.86
|
| Rate for Payer: BCN Commercial |
$7,143.98
|
| Rate for Payer: BCN Medicare Advantage |
$4,779.95
|
| Rate for Payer: Cash Price |
$7,295.20
|
| Rate for Payer: Cash Price |
$7,295.20
|
| Rate for Payer: Cofinity Commercial |
$6,405.13
|
| Rate for Payer: Cofinity Commercial |
$6,883.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,779.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,018.95
|
| Rate for Payer: Meridian Medicaid |
$3,294.82
|
| Rate for Payer: Nomi Health Commercial |
$5,735.94
|
| Rate for Payer: PACE SWMI |
$4,779.95
|
| Rate for Payer: PHP Commercial |
$6,691.93
|
| Rate for Payer: PHP Medicare Advantage |
$4,779.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,137.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,927.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,749.64
|
| Rate for Payer: Priority Health Medicare |
$4,779.95
|
| Rate for Payer: Priority Health Narrow Network |
$8,749.64
|
| Rate for Payer: Priority Health SBD |
$8,749.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,779.95
|
| Rate for Payer: UHC Medicare Advantage |
$4,779.95
|
| Rate for Payer: UHCCP Medicaid |
$3,137.92
|
| Rate for Payer: UMR Bronson Commercial |
$4,194.74
|
|
|
PR RPR LIP FTH OVER ONE-HALF VERT HEIGHT/COMPLEX
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 40654
|
| Min. Negotiated Rate |
$277.54 |
| Max. Negotiated Rate |
$861.54 |
| Rate for Payer: Aetna Commercial |
$545.30
|
| Rate for Payer: Aetna Medicare |
$423.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.99
|
| Rate for Payer: BCBS Complete |
$291.42
|
| Rate for Payer: BCBS MAPPO |
$406.94
|
| Rate for Payer: BCBS Trust/PPO |
$842.64
|
| Rate for Payer: BCN Commercial |
$861.54
|
| Rate for Payer: BCN Medicare Advantage |
$406.94
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Cofinity Commercial |
$545.30
|
| Rate for Payer: Cofinity Commercial |
$585.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$406.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.29
|
| Rate for Payer: Meridian Medicaid |
$291.42
|
| Rate for Payer: Nomi Health Commercial |
$488.33
|
| Rate for Payer: PACE SWMI |
$406.94
|
| Rate for Payer: PHP Commercial |
$569.72
|
| Rate for Payer: PHP Medicare Advantage |
$406.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$770.79
|
| Rate for Payer: Priority Health Medicare |
$406.94
|
| Rate for Payer: Priority Health Narrow Network |
$770.79
|
| Rate for Payer: Priority Health SBD |
$770.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$406.94
|
| Rate for Payer: UHC Medicare Advantage |
$406.94
|
| Rate for Payer: UHCCP Medicaid |
$277.54
|
| Rate for Payer: UMR Bronson Commercial |
$348.68
|
|
|
PR RPR LW IMPERFORATE ANUS W/ANOPRNL FSTL CUT-BK
|
Professional
|
Both
|
$1,188.00
|
|
|
Service Code
|
HCPCS 46715
|
| Min. Negotiated Rate |
$231.40 |
| Max. Negotiated Rate |
$1,001.08 |
| Rate for Payer: Aetna Commercial |
$720.84
|
| Rate for Payer: Aetna Medicare |
$559.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$774.63
|
| Rate for Payer: BCBS Complete |
$379.09
|
| Rate for Payer: BCBS MAPPO |
$537.94
|
| Rate for Payer: BCBS Trust/PPO |
$231.40
|
| Rate for Payer: BCN Commercial |
$816.58
|
| Rate for Payer: BCN Medicare Advantage |
$537.94
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cash Price |
$950.40
|
| Rate for Payer: Cofinity Commercial |
$720.84
|
| Rate for Payer: Cofinity Commercial |
$774.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.84
|
| Rate for Payer: Meridian Medicaid |
$379.09
|
| Rate for Payer: Nomi Health Commercial |
$645.53
|
| Rate for Payer: PACE SWMI |
$537.94
|
| Rate for Payer: PHP Commercial |
$753.12
|
| Rate for Payer: PHP Medicare Advantage |
$537.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$361.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$772.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,001.08
|
| Rate for Payer: Priority Health Medicare |
$537.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,001.08
|
| Rate for Payer: Priority Health SBD |
$1,001.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.94
|
| Rate for Payer: UHC Medicare Advantage |
$537.94
|
| Rate for Payer: UHCCP Medicaid |
$361.04
|
| Rate for Payer: UMR Bronson Commercial |
$546.48
|
|
|
PR RPR LW IMPERFORATE ANUS W/TRPOS FISTULA
|
Professional
|
Both
|
$2,992.00
|
|
|
Service Code
|
HCPCS 46716
|
| Min. Negotiated Rate |
$117.81 |
| Max. Negotiated Rate |
$2,222.91 |
| Rate for Payer: Aetna Commercial |
$1,604.03
|
| Rate for Payer: Aetna Medicare |
$1,244.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,604.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,723.74
|
| Rate for Payer: BCBS Complete |
$841.38
|
| Rate for Payer: BCBS MAPPO |
$1,197.04
|
| Rate for Payer: BCBS Trust/PPO |
$117.81
|
| Rate for Payer: BCN Commercial |
$1,807.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,197.04
|
| Rate for Payer: Cash Price |
$2,393.60
|
| Rate for Payer: Cash Price |
$2,393.60
|
| Rate for Payer: Cofinity Commercial |
$1,604.03
|
| Rate for Payer: Cofinity Commercial |
$1,723.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,197.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,256.89
|
| Rate for Payer: Meridian Medicaid |
$841.38
|
| Rate for Payer: Nomi Health Commercial |
$1,436.45
|
| Rate for Payer: PACE SWMI |
$1,197.04
|
| Rate for Payer: PHP Commercial |
$1,675.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,197.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$801.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,944.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,222.91
|
| Rate for Payer: Priority Health Medicare |
$1,197.04
|
| Rate for Payer: Priority Health Narrow Network |
$2,222.91
|
| Rate for Payer: Priority Health SBD |
$2,222.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,197.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,197.04
|
| Rate for Payer: UHCCP Medicaid |
$801.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,376.32
|
|
|
PR RPR NEONATAL DIPHRG HERNIA W/WO CHEST TUBE INSJ
|
Professional
|
Both
|
$10,278.00
|
|
|
Service Code
|
HCPCS 39503
|
| Min. Negotiated Rate |
$516.15 |
| Max. Negotiated Rate |
$9,094.20 |
| Rate for Payer: Aetna Commercial |
$7,485.83
|
| Rate for Payer: Aetna Medicare |
$5,809.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7,485.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8,044.47
|
| Rate for Payer: BCBS Complete |
$3,830.67
|
| Rate for Payer: BCBS MAPPO |
$5,586.44
|
| Rate for Payer: BCBS Trust/PPO |
$516.15
|
| Rate for Payer: BCN Commercial |
$8,336.35
|
| Rate for Payer: BCN Medicare Advantage |
$5,586.44
|
| Rate for Payer: Cash Price |
$8,222.40
|
| Rate for Payer: Cash Price |
$8,222.40
|
| Rate for Payer: Cofinity Commercial |
$7,485.83
|
| Rate for Payer: Cofinity Commercial |
$8,044.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,586.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,865.76
|
| Rate for Payer: Meridian Medicaid |
$3,830.67
|
| Rate for Payer: Nomi Health Commercial |
$6,703.73
|
| Rate for Payer: PACE SWMI |
$5,586.44
|
| Rate for Payer: PHP Commercial |
$7,821.02
|
| Rate for Payer: PHP Medicare Advantage |
$5,586.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,648.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,680.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,094.20
|
| Rate for Payer: Priority Health Medicare |
$5,586.44
|
| Rate for Payer: Priority Health Narrow Network |
$9,094.20
|
| Rate for Payer: Priority Health SBD |
$9,094.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,586.44
|
| Rate for Payer: UHC Medicare Advantage |
$5,586.44
|
| Rate for Payer: UHCCP Medicaid |
$3,648.26
|
| Rate for Payer: UMR Bronson Commercial |
$4,727.88
|
|
|
PR RPR NFLTBL URETHRAL/BLADDER NECK SPHINCTER
|
Professional
|
Both
|
$1,165.00
|
|
|
Service Code
|
HCPCS 53449
|
| Min. Negotiated Rate |
$319.62 |
| Max. Negotiated Rate |
$977.86 |
| Rate for Payer: Aetna Commercial |
$785.78
|
| Rate for Payer: Aetna Medicare |
$609.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$785.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.42
|
| Rate for Payer: BCBS Complete |
$413.75
|
| Rate for Payer: BCBS MAPPO |
$586.40
|
| Rate for Payer: BCBS Trust/PPO |
$319.62
|
| Rate for Payer: BCN Commercial |
$887.44
|
| Rate for Payer: BCN Medicare Advantage |
$586.40
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cash Price |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$785.78
|
| Rate for Payer: Cofinity Commercial |
$844.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$586.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$615.72
|
| Rate for Payer: Meridian Medicaid |
$413.75
|
| Rate for Payer: Nomi Health Commercial |
$703.68
|
| Rate for Payer: PACE SWMI |
$586.40
|
| Rate for Payer: PHP Commercial |
$820.96
|
| Rate for Payer: PHP Medicare Advantage |
$586.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$394.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$757.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$977.86
|
| Rate for Payer: Priority Health Medicare |
$586.40
|
| Rate for Payer: Priority Health Narrow Network |
$977.86
|
| Rate for Payer: Priority Health SBD |
$977.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$586.40
|
| Rate for Payer: UHC Medicare Advantage |
$586.40
|
| Rate for Payer: UHCCP Medicaid |
$394.05
|
| Rate for Payer: UMR Bronson Commercial |
$535.90
|
|
|
PR RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE
|
Professional
|
Both
|
$3,865.00
|
|
|
Service Code
|
HCPCS 27472
|
| Min. Negotiated Rate |
$522.49 |
| Max. Negotiated Rate |
$2,512.25 |
| Rate for Payer: Aetna Commercial |
$1,632.56
|
| Rate for Payer: Aetna Medicare |
$1,267.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,632.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,754.40
|
| Rate for Payer: BCBS Complete |
$859.27
|
| Rate for Payer: BCBS MAPPO |
$1,218.33
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: BCN Commercial |
$1,850.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,218.33
|
| Rate for Payer: Cash Price |
$3,092.00
|
| Rate for Payer: Cash Price |
$3,092.00
|
| Rate for Payer: Cofinity Commercial |
$1,632.56
|
| Rate for Payer: Cofinity Commercial |
$1,754.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,218.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,279.25
|
| Rate for Payer: Meridian Medicaid |
$859.27
|
| Rate for Payer: Nomi Health Commercial |
$1,462.00
|
| Rate for Payer: PACE SWMI |
$1,218.33
|
| Rate for Payer: PHP Commercial |
$1,705.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,218.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$818.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,512.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,940.28
|
| Rate for Payer: Priority Health Medicare |
$1,218.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,940.28
|
| Rate for Payer: Priority Health SBD |
$1,940.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,218.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,218.33
|
| Rate for Payer: UHCCP Medicaid |
$818.35
|
| Rate for Payer: UMR Bronson Commercial |
$1,777.90
|
|
|
PR RPR NON/MAL FEMUR DSTL H/N W/O GRF
|
Professional
|
Both
|
$2,927.00
|
|
|
Service Code
|
HCPCS 27470
|
| Min. Negotiated Rate |
$266.79 |
| Max. Negotiated Rate |
$1,902.55 |
| Rate for Payer: Aetna Commercial |
$1,522.92
|
| Rate for Payer: Aetna Medicare |
$1,181.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,522.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,636.57
|
| Rate for Payer: BCBS Complete |
$802.68
|
| Rate for Payer: BCBS MAPPO |
$1,136.51
|
| Rate for Payer: BCBS Trust/PPO |
$266.79
|
| Rate for Payer: BCN Commercial |
$1,728.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,136.51
|
| Rate for Payer: Cash Price |
$2,341.60
|
| Rate for Payer: Cash Price |
$2,341.60
|
| Rate for Payer: Cofinity Commercial |
$1,522.92
|
| Rate for Payer: Cofinity Commercial |
$1,636.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,136.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,193.34
|
| Rate for Payer: Meridian Medicaid |
$802.68
|
| Rate for Payer: Nomi Health Commercial |
$1,363.81
|
| Rate for Payer: PACE SWMI |
$1,136.51
|
| Rate for Payer: PHP Commercial |
$1,591.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,136.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$764.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,902.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,814.59
|
| Rate for Payer: Priority Health Medicare |
$1,136.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,814.59
|
| Rate for Payer: Priority Health SBD |
$1,814.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,136.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,136.51
|
| Rate for Payer: UHCCP Medicaid |
$764.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,346.42
|
|
|
PR RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH
|
Professional
|
Both
|
$5,421.00
|
|
|
Service Code
|
HCPCS 27725
|
| Min. Negotiated Rate |
$789.17 |
| Max. Negotiated Rate |
$3,523.65 |
| Rate for Payer: Aetna Commercial |
$1,570.35
|
| Rate for Payer: Aetna Medicare |
$1,218.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,570.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,687.54
|
| Rate for Payer: BCBS Complete |
$828.63
|
| Rate for Payer: BCBS MAPPO |
$1,171.90
|
| Rate for Payer: BCBS Trust/PPO |
$800.37
|
| Rate for Payer: BCN Commercial |
$1,779.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,171.90
|
| Rate for Payer: Cash Price |
$4,336.80
|
| Rate for Payer: Cash Price |
$4,336.80
|
| Rate for Payer: Cofinity Commercial |
$1,570.35
|
| Rate for Payer: Cofinity Commercial |
$1,687.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,171.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,230.50
|
| Rate for Payer: Meridian Medicaid |
$828.63
|
| Rate for Payer: Nomi Health Commercial |
$1,406.28
|
| Rate for Payer: PACE SWMI |
$1,171.90
|
| Rate for Payer: PHP Commercial |
$1,640.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,171.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$789.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,523.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,870.07
|
| Rate for Payer: Priority Health Medicare |
$1,171.90
|
| Rate for Payer: Priority Health Narrow Network |
$1,870.07
|
| Rate for Payer: Priority Health SBD |
$1,870.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,171.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,171.90
|
| Rate for Payer: UHCCP Medicaid |
$789.17
|
| Rate for Payer: UMR Bronson Commercial |
$2,493.66
|
|
|
PR RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT
|
Professional
|
Both
|
$4,771.00
|
|
|
Service Code
|
HCPCS 27724
|
| Min. Negotiated Rate |
$322.79 |
| Max. Negotiated Rate |
$3,101.15 |
| Rate for Payer: Aetna Commercial |
$1,619.16
|
| Rate for Payer: Aetna Medicare |
$1,256.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,619.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,740.00
|
| Rate for Payer: BCBS Complete |
$849.87
|
| Rate for Payer: BCBS MAPPO |
$1,208.33
|
| Rate for Payer: BCBS Trust/PPO |
$322.79
|
| Rate for Payer: BCN Commercial |
$1,834.50
|
| Rate for Payer: BCN Medicare Advantage |
$1,208.33
|
| Rate for Payer: Cash Price |
$3,816.80
|
| Rate for Payer: Cash Price |
$3,816.80
|
| Rate for Payer: Cofinity Commercial |
$1,619.16
|
| Rate for Payer: Cofinity Commercial |
$1,740.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,208.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,268.75
|
| Rate for Payer: Meridian Medicaid |
$849.87
|
| Rate for Payer: Nomi Health Commercial |
$1,450.00
|
| Rate for Payer: PACE SWMI |
$1,208.33
|
| Rate for Payer: PHP Commercial |
$1,691.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,208.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$809.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,101.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,920.44
|
| Rate for Payer: Priority Health Medicare |
$1,208.33
|
| Rate for Payer: Priority Health Narrow Network |
$1,920.44
|
| Rate for Payer: Priority Health SBD |
$1,920.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,208.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,208.33
|
| Rate for Payer: UHCCP Medicaid |
$809.40
|
| Rate for Payer: UMR Bronson Commercial |
$2,194.66
|
|
|
PR RPR NON/MALUNION METARSAL W/WO BONE GRAFT
|
Professional
|
Both
|
$1,316.00
|
|
|
Service Code
|
HCPCS 28322
|
| Min. Negotiated Rate |
$375.31 |
| Max. Negotiated Rate |
$2,539.54 |
| Rate for Payer: Aetna Commercial |
$743.19
|
| Rate for Payer: Aetna Medicare |
$576.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.65
|
| Rate for Payer: BCBS Complete |
$394.08
|
| Rate for Payer: BCBS MAPPO |
$554.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,539.54
|
| Rate for Payer: BCN Commercial |
$1,150.84
|
| Rate for Payer: BCN Medicare Advantage |
$554.62
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cofinity Commercial |
$743.19
|
| Rate for Payer: Cofinity Commercial |
$798.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$554.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$582.35
|
| Rate for Payer: Meridian Medicaid |
$394.08
|
| Rate for Payer: Nomi Health Commercial |
$665.54
|
| Rate for Payer: PACE SWMI |
$554.62
|
| Rate for Payer: PHP Commercial |
$776.47
|
| Rate for Payer: PHP Medicare Advantage |
$554.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$855.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$892.03
|
| Rate for Payer: Priority Health Medicare |
$554.62
|
| Rate for Payer: Priority Health Narrow Network |
$892.03
|
| Rate for Payer: Priority Health SBD |
$892.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$554.62
|
| Rate for Payer: UHC Medicare Advantage |
$554.62
|
| Rate for Payer: UHCCP Medicaid |
$375.31
|
| Rate for Payer: UMR Bronson Commercial |
$605.36
|
|
|
PR RPR NON-STRUCT PROSTC VALVE DYSFUNCTION W/BYPASS
|
Professional
|
Both
|
$7,025.00
|
|
|
Service Code
|
HCPCS 33496
|
| Min. Negotiated Rate |
$807.24 |
| Max. Negotiated Rate |
$4,566.25 |
| Rate for Payer: Aetna Commercial |
$2,132.54
|
| Rate for Payer: Aetna Medicare |
$1,655.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,132.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,291.69
|
| Rate for Payer: BCBS Complete |
$1,098.79
|
| Rate for Payer: BCBS MAPPO |
$1,591.45
|
| Rate for Payer: BCBS Trust/PPO |
$807.24
|
| Rate for Payer: BCN Commercial |
$2,383.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,591.45
|
| Rate for Payer: Cash Price |
$5,620.00
|
| Rate for Payer: Cash Price |
$5,620.00
|
| Rate for Payer: Cofinity Commercial |
$2,132.54
|
| Rate for Payer: Cofinity Commercial |
$2,291.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,591.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,671.02
|
| Rate for Payer: Meridian Medicaid |
$1,098.79
|
| Rate for Payer: Nomi Health Commercial |
$1,909.74
|
| Rate for Payer: PACE SWMI |
$1,591.45
|
| Rate for Payer: PHP Commercial |
$2,228.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,591.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,046.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,566.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,599.03
|
| Rate for Payer: Priority Health Medicare |
$1,591.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,599.03
|
| Rate for Payer: Priority Health SBD |
$2,599.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,591.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,591.45
|
| Rate for Payer: UHCCP Medicaid |
$1,046.47
|
| Rate for Payer: UMR Bronson Commercial |
$3,231.50
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT
|
Professional
|
Both
|
$3,241.00
|
|
|
Service Code
|
HCPCS 25405
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$2,106.65 |
| Rate for Payer: Aetna Commercial |
$1,341.03
|
| Rate for Payer: Aetna Medicare |
$1,040.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,341.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,441.11
|
| Rate for Payer: BCBS Complete |
$708.30
|
| Rate for Payer: BCBS MAPPO |
$1,000.77
|
| Rate for Payer: BCBS Trust/PPO |
$25.89
|
| Rate for Payer: BCN Commercial |
$1,520.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,000.77
|
| Rate for Payer: Cash Price |
$2,592.80
|
| Rate for Payer: Cash Price |
$2,592.80
|
| Rate for Payer: Cofinity Commercial |
$1,341.03
|
| Rate for Payer: Cofinity Commercial |
$1,441.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,000.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,050.81
|
| Rate for Payer: Meridian Medicaid |
$708.30
|
| Rate for Payer: Nomi Health Commercial |
$1,200.92
|
| Rate for Payer: PACE SWMI |
$1,000.77
|
| Rate for Payer: PHP Commercial |
$1,401.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,000.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$674.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,594.77
|
| Rate for Payer: Priority Health Medicare |
$1,000.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,594.77
|
| Rate for Payer: Priority Health SBD |
$1,594.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,000.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,000.77
|
| Rate for Payer: UHCCP Medicaid |
$674.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,490.86
|
|
|
PR RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF
|
Professional
|
Both
|
$3,275.00
|
|
|
Service Code
|
HCPCS 25415
|
| Min. Negotiated Rate |
$272.95 |
| Max. Negotiated Rate |
$2,128.75 |
| Rate for Payer: Aetna Commercial |
$1,251.47
|
| Rate for Payer: Aetna Medicare |
$971.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.86
|
| Rate for Payer: BCBS Complete |
$660.66
|
| Rate for Payer: BCBS MAPPO |
$933.93
|
| Rate for Payer: BCBS Trust/PPO |
$272.95
|
| Rate for Payer: BCN Commercial |
$1,422.05
|
| Rate for Payer: BCN Medicare Advantage |
$933.93
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cofinity Commercial |
$1,251.47
|
| Rate for Payer: Cofinity Commercial |
$1,344.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.63
|
| Rate for Payer: Meridian Medicaid |
$660.66
|
| Rate for Payer: Nomi Health Commercial |
$1,120.72
|
| Rate for Payer: PACE SWMI |
$933.93
|
| Rate for Payer: PHP Commercial |
$1,307.50
|
| Rate for Payer: PHP Medicare Advantage |
$933.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$629.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,491.48
|
| Rate for Payer: Priority Health Medicare |
$933.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,491.48
|
| Rate for Payer: Priority Health SBD |
$1,491.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.93
|
| Rate for Payer: UHC Medicare Advantage |
$933.93
|
| Rate for Payer: UHCCP Medicaid |
$629.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,506.50
|
|
|
PR RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 25400
|
| Min. Negotiated Rate |
$211.32 |
| Max. Negotiated Rate |
$1,711.45 |
| Rate for Payer: Aetna Commercial |
$1,038.00
|
| Rate for Payer: Aetna Medicare |
$805.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,038.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,115.47
|
| Rate for Payer: BCBS Complete |
$549.51
|
| Rate for Payer: BCBS MAPPO |
$774.63
|
| Rate for Payer: BCBS Trust/PPO |
$211.32
|
| Rate for Payer: BCN Commercial |
$1,182.60
|
| Rate for Payer: BCN Medicare Advantage |
$774.63
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cofinity Commercial |
$1,038.00
|
| Rate for Payer: Cofinity Commercial |
$1,115.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$813.36
|
| Rate for Payer: Meridian Medicaid |
$549.51
|
| Rate for Payer: Nomi Health Commercial |
$929.56
|
| Rate for Payer: PACE SWMI |
$774.63
|
| Rate for Payer: PHP Commercial |
$1,084.48
|
| Rate for Payer: PHP Medicare Advantage |
$774.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$523.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,239.07
|
| Rate for Payer: Priority Health Medicare |
$774.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,239.07
|
| Rate for Payer: Priority Health SBD |
$1,239.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$774.63
|
| Rate for Payer: UHC Medicare Advantage |
$774.63
|
| Rate for Payer: UHCCP Medicaid |
$523.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,211.18
|
|
|
PR RPR NON-UNION MTCRPL/PHALANX
|
Professional
|
Both
|
$2,109.00
|
|
|
Service Code
|
HCPCS 26546
|
| Min. Negotiated Rate |
$243.55 |
| Max. Negotiated Rate |
$1,603.93 |
| Rate for Payer: Aetna Commercial |
$1,317.86
|
| Rate for Payer: Aetna Medicare |
$1,022.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,317.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,416.21
|
| Rate for Payer: BCBS Complete |
$709.64
|
| Rate for Payer: BCBS MAPPO |
$983.48
|
| Rate for Payer: BCBS Trust/PPO |
$243.55
|
| Rate for Payer: BCN Commercial |
$1,538.85
|
| Rate for Payer: BCN Medicare Advantage |
$983.48
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cash Price |
$1,687.20
|
| Rate for Payer: Cofinity Commercial |
$1,317.86
|
| Rate for Payer: Cofinity Commercial |
$1,416.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$983.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,032.65
|
| Rate for Payer: Meridian Medicaid |
$709.64
|
| Rate for Payer: Nomi Health Commercial |
$1,180.18
|
| Rate for Payer: PACE SWMI |
$983.48
|
| Rate for Payer: PHP Commercial |
$1,376.87
|
| Rate for Payer: PHP Medicare Advantage |
$983.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$675.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,370.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,603.93
|
| Rate for Payer: Priority Health Medicare |
$983.48
|
| Rate for Payer: Priority Health Narrow Network |
$1,603.93
|
| Rate for Payer: Priority Health SBD |
$1,603.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$983.48
|
| Rate for Payer: UHC Medicare Advantage |
$983.48
|
| Rate for Payer: UHCCP Medicaid |
$675.85
|
| Rate for Payer: UMR Bronson Commercial |
$970.14
|
|
|
PR RPR NONUNION SCAPHOID CARPAL B1 W/WO RDL STYLODC
|
Professional
|
Both
|
$1,376.00
|
|
|
Service Code
|
HCPCS 25440
|
| Min. Negotiated Rate |
$502.68 |
| Max. Negotiated Rate |
$1,264.75 |
| Rate for Payer: Aetna Commercial |
$996.02
|
| Rate for Payer: Aetna Medicare |
$773.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$996.02
|
| Rate for Payer: BCBS Complete |
$527.81
|
| Rate for Payer: BCBS MAPPO |
$743.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,264.75
|
| Rate for Payer: BCN Commercial |
$1,131.77
|
| Rate for Payer: BCN Medicare Advantage |
$743.30
|
| Rate for Payer: Cash Price |
$1,100.80
|
| Rate for Payer: Cash Price |
$1,100.80
|
| Rate for Payer: Cofinity Commercial |
$1,070.35
|
| Rate for Payer: Cofinity Commercial |
$996.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$743.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$780.46
|
| Rate for Payer: Meridian Medicaid |
$527.81
|
| Rate for Payer: Nomi Health Commercial |
$891.96
|
| Rate for Payer: PACE SWMI |
$743.30
|
| Rate for Payer: PHP Commercial |
$1,040.62
|
| Rate for Payer: PHP Medicare Advantage |
$743.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$502.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.21
|
| Rate for Payer: Priority Health Medicare |
$743.30
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.21
|
| Rate for Payer: Priority Health SBD |
$1,189.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$743.30
|
| Rate for Payer: UHC Medicare Advantage |
$743.30
|
| Rate for Payer: UHCCP Medicaid |
$502.68
|
| Rate for Payer: UMR Bronson Commercial |
$632.96
|
|
|
PR RPR NSL VLV COLLAPSE SUBQ/SBMCSL LAT WALL IMPLT
|
Professional
|
Both
|
$419.00
|
|
|
Service Code
|
HCPCS 30468
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$3,788.72 |
| Rate for Payer: Aetna Commercial |
$216.33
|
| Rate for Payer: Aetna Medicare |
$167.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.47
|
| Rate for Payer: BCBS Complete |
$113.84
|
| Rate for Payer: BCBS MAPPO |
$161.44
|
| Rate for Payer: BCBS Trust/PPO |
$627.09
|
| Rate for Payer: BCN Commercial |
$3,788.72
|
| Rate for Payer: BCN Medicare Advantage |
$161.44
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cofinity Commercial |
$216.33
|
| Rate for Payer: Cofinity Commercial |
$232.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.51
|
| Rate for Payer: Meridian Medicaid |
$113.84
|
| Rate for Payer: Nomi Health Commercial |
$193.73
|
| Rate for Payer: PACE SWMI |
$161.44
|
| Rate for Payer: PHP Commercial |
$226.02
|
| Rate for Payer: PHP Medicare Advantage |
$161.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.51
|
| Rate for Payer: Priority Health Medicare |
$161.44
|
| Rate for Payer: Priority Health Narrow Network |
$234.51
|
| Rate for Payer: Priority Health SBD |
$234.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.44
|
| Rate for Payer: UHC Medicare Advantage |
$161.44
|
| Rate for Payer: UHCCP Medicaid |
$108.42
|
| Rate for Payer: UMR Bronson Commercial |
$192.74
|
|
|
PR RPR PARAESOPH HIATAL HERNIA THORCOABDOM W/O MESH
|
Professional
|
Both
|
$2,725.00
|
|
|
Service Code
|
HCPCS 43336
|
| Min. Negotiated Rate |
$914.84 |
| Max. Negotiated Rate |
$2,555.81 |
| Rate for Payer: Aetna Commercial |
$1,867.17
|
| Rate for Payer: Aetna Medicare |
$1,449.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,867.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,006.51
|
| Rate for Payer: BCBS Complete |
$960.58
|
| Rate for Payer: BCBS MAPPO |
$1,393.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,143.04
|
| Rate for Payer: BCN Commercial |
$2,085.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,393.41
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cash Price |
$2,180.00
|
| Rate for Payer: Cofinity Commercial |
$1,867.17
|
| Rate for Payer: Cofinity Commercial |
$2,006.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,393.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,463.08
|
| Rate for Payer: Meridian Medicaid |
$960.58
|
| Rate for Payer: Nomi Health Commercial |
$1,672.09
|
| Rate for Payer: PACE SWMI |
$1,393.41
|
| Rate for Payer: PHP Commercial |
$1,950.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,393.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$914.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,771.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,555.81
|
| Rate for Payer: Priority Health Medicare |
$1,393.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,555.81
|
| Rate for Payer: Priority Health SBD |
$2,555.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,393.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,393.41
|
| Rate for Payer: UHCCP Medicaid |
$914.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,253.50
|
|
