|
PR VAG HYST 250 GM/< W/RMVL TUBE&/OVARY
|
Professional
|
Both
|
$3,062.00
|
|
|
Service Code
|
HCPCS 58262
|
| Min. Negotiated Rate |
$522.06 |
| Max. Negotiated Rate |
$2,296.50 |
| Rate for Payer: Aetna Commercial |
$1,087.99
|
| Rate for Payer: Aetna Medicare |
$844.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,087.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,169.18
|
| Rate for Payer: BCBS Complete |
$548.16
|
| Rate for Payer: BCBS MAPPO |
$811.93
|
| Rate for Payer: BCN Commercial |
$1,390.36
|
| Rate for Payer: BCN Medicare Advantage |
$811.93
|
| Rate for Payer: Cash Price |
$2,449.60
|
| Rate for Payer: Cash Price |
$2,449.60
|
| Rate for Payer: Cofinity Commercial |
$1,087.99
|
| Rate for Payer: Cofinity Commercial |
$1,169.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$852.53
|
| Rate for Payer: Meridian Medicaid |
$548.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$893.12
|
| Rate for Payer: Nomi Health Commercial |
$974.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,296.50
|
| Rate for Payer: PACE SWMI |
$811.93
|
| Rate for Payer: PHP Commercial |
$1,136.70
|
| Rate for Payer: PHP Medicare Advantage |
$811.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,408.13
|
| Rate for Payer: Priority Health Medicare |
$811.93
|
| Rate for Payer: Priority Health SBD |
$1,408.13
|
| Rate for Payer: Priority Health Tiered Network |
$1,408.13
|
| Rate for Payer: Railroad Medicare Medicare |
$811.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,642.07
|
| Rate for Payer: UHC Core |
$1,642.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$811.93
|
| Rate for Payer: UHC Exchange |
$1,642.07
|
| Rate for Payer: UHC Medicaid |
$522.06
|
| Rate for Payer: UHCCP Medicaid |
$522.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,408.52
|
|
|
PR VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL
|
Professional
|
Both
|
$3,342.00
|
|
|
Service Code
|
HCPCS 58263
|
| Min. Negotiated Rate |
$559.55 |
| Max. Negotiated Rate |
$2,506.50 |
| Rate for Payer: Aetna Commercial |
$1,167.13
|
| Rate for Payer: Aetna Medicare |
$905.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,167.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,254.23
|
| Rate for Payer: BCBS Complete |
$587.53
|
| Rate for Payer: BCBS MAPPO |
$870.99
|
| Rate for Payer: BCN Commercial |
$1,491.46
|
| Rate for Payer: BCN Medicare Advantage |
$870.99
|
| Rate for Payer: Cash Price |
$2,673.60
|
| Rate for Payer: Cash Price |
$2,673.60
|
| Rate for Payer: Cofinity Commercial |
$1,167.13
|
| Rate for Payer: Cofinity Commercial |
$1,254.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.54
|
| Rate for Payer: Meridian Medicaid |
$587.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$958.09
|
| Rate for Payer: Nomi Health Commercial |
$1,045.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,506.50
|
| Rate for Payer: PACE SWMI |
$870.99
|
| Rate for Payer: PHP Commercial |
$1,219.39
|
| Rate for Payer: PHP Medicare Advantage |
$870.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$559.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,510.52
|
| Rate for Payer: Priority Health Medicare |
$870.99
|
| Rate for Payer: Priority Health SBD |
$1,510.52
|
| Rate for Payer: Priority Health Tiered Network |
$1,510.52
|
| Rate for Payer: Railroad Medicare Medicare |
$870.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,765.09
|
| Rate for Payer: UHC Core |
$1,765.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$870.99
|
| Rate for Payer: UHC Exchange |
$1,765.09
|
| Rate for Payer: UHC Medicaid |
$559.55
|
| Rate for Payer: UHCCP Medicaid |
$559.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,537.32
|
|
|
PR VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE
|
Professional
|
Both
|
$3,844.00
|
|
|
Service Code
|
HCPCS 58280
|
| Min. Negotiated Rate |
$594.70 |
| Max. Negotiated Rate |
$2,883.00 |
| Rate for Payer: Aetna Commercial |
$1,240.75
|
| Rate for Payer: Aetna Medicare |
$962.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,240.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.34
|
| Rate for Payer: BCBS Complete |
$624.43
|
| Rate for Payer: BCBS MAPPO |
$925.93
|
| Rate for Payer: BCN Commercial |
$1,586.07
|
| Rate for Payer: BCN Medicare Advantage |
$925.93
|
| Rate for Payer: Cash Price |
$3,075.20
|
| Rate for Payer: Cash Price |
$3,075.20
|
| Rate for Payer: Cofinity Commercial |
$1,240.75
|
| Rate for Payer: Cofinity Commercial |
$1,333.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$925.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.23
|
| Rate for Payer: Meridian Medicaid |
$624.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,018.52
|
| Rate for Payer: Nomi Health Commercial |
$1,111.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,883.00
|
| Rate for Payer: PACE SWMI |
$925.93
|
| Rate for Payer: PHP Commercial |
$1,296.30
|
| Rate for Payer: PHP Medicare Advantage |
$925.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,606.35
|
| Rate for Payer: Priority Health Medicare |
$925.93
|
| Rate for Payer: Priority Health SBD |
$1,606.35
|
| Rate for Payer: Priority Health Tiered Network |
$1,606.35
|
| Rate for Payer: Railroad Medicare Medicare |
$925.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,878.21
|
| Rate for Payer: UHC Core |
$1,878.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$925.93
|
| Rate for Payer: UHC Exchange |
$1,878.21
|
| Rate for Payer: UHC Medicaid |
$594.70
|
| Rate for Payer: UHCCP Medicaid |
$594.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,768.24
|
|
|
PR VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$2,209.00
|
|
|
Service Code
|
HCPCS 59612
|
| Min. Negotiated Rate |
$793.18 |
| Max. Negotiated Rate |
$1,674.98 |
| Rate for Payer: Aetna Commercial |
$1,119.72
|
| Rate for Payer: Aetna Medicare |
$869.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,203.28
|
| Rate for Payer: BCBS Complete |
$832.84
|
| Rate for Payer: BCBS MAPPO |
$835.61
|
| Rate for Payer: BCN Commercial |
$1,674.98
|
| Rate for Payer: BCN Medicare Advantage |
$835.61
|
| Rate for Payer: Cash Price |
$1,767.20
|
| Rate for Payer: Cash Price |
$1,767.20
|
| Rate for Payer: Cofinity Commercial |
$1,119.72
|
| Rate for Payer: Cofinity Commercial |
$1,203.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$877.39
|
| Rate for Payer: Meridian Medicaid |
$832.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$919.17
|
| Rate for Payer: Nomi Health Commercial |
$1,002.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,656.75
|
| Rate for Payer: PACE SWMI |
$835.61
|
| Rate for Payer: PHP Commercial |
$1,169.85
|
| Rate for Payer: PHP Medicare Advantage |
$835.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$793.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,278.19
|
| Rate for Payer: Priority Health Medicare |
$835.61
|
| Rate for Payer: Priority Health SBD |
$1,278.19
|
| Rate for Payer: Priority Health Tiered Network |
$1,278.19
|
| Rate for Payer: Railroad Medicare Medicare |
$835.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,166.64
|
| Rate for Payer: UHC Core |
$1,166.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$835.61
|
| Rate for Payer: UHC Exchange |
$1,166.64
|
| Rate for Payer: UHC Medicaid |
$793.18
|
| Rate for Payer: UHCCP Medicaid |
$793.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,016.14
|
|
|
PR VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$2,029.00
|
|
|
Service Code
|
HCPCS 59409
|
| Min. Negotiated Rate |
$693.27 |
| Max. Negotiated Rate |
$1,595.20 |
| Rate for Payer: Aetna Commercial |
$977.88
|
| Rate for Payer: Aetna Medicare |
$758.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,050.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$977.88
|
| Rate for Payer: BCBS Complete |
$727.93
|
| Rate for Payer: BCBS MAPPO |
$729.76
|
| Rate for Payer: BCN Commercial |
$1,595.20
|
| Rate for Payer: BCN Medicare Advantage |
$729.76
|
| Rate for Payer: Cash Price |
$1,623.20
|
| Rate for Payer: Cash Price |
$1,623.20
|
| Rate for Payer: Cofinity Commercial |
$1,050.85
|
| Rate for Payer: Cofinity Commercial |
$977.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$729.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$766.25
|
| Rate for Payer: Meridian Medicaid |
$727.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$802.74
|
| Rate for Payer: Nomi Health Commercial |
$875.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,521.75
|
| Rate for Payer: PACE SWMI |
$729.76
|
| Rate for Payer: PHP Commercial |
$1,021.66
|
| Rate for Payer: PHP Medicare Advantage |
$729.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$693.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,127.76
|
| Rate for Payer: Priority Health Medicare |
$729.76
|
| Rate for Payer: Priority Health SBD |
$1,127.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,127.76
|
| Rate for Payer: Railroad Medicare Medicare |
$729.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,031.64
|
| Rate for Payer: UHC Core |
$1,031.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$729.76
|
| Rate for Payer: UHC Exchange |
$1,031.64
|
| Rate for Payer: UHC Medicaid |
$693.27
|
| Rate for Payer: UHCCP Medicaid |
$693.27
|
| Rate for Payer: UMR Bronson Commercial |
$933.34
|
|
|
PR VAGINAL DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,309.00
|
|
|
Service Code
|
HCPCS 59410
|
| Min. Negotiated Rate |
$934.83 |
| Max. Negotiated Rate |
$1,851.61 |
| Rate for Payer: Aetna Commercial |
$1,319.11
|
| Rate for Payer: Aetna Medicare |
$1,023.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,319.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,417.55
|
| Rate for Payer: BCBS Complete |
$981.57
|
| Rate for Payer: BCBS MAPPO |
$984.41
|
| Rate for Payer: BCN Commercial |
$1,851.61
|
| Rate for Payer: BCN Medicare Advantage |
$984.41
|
| Rate for Payer: Cash Price |
$1,847.20
|
| Rate for Payer: Cash Price |
$1,847.20
|
| Rate for Payer: Cofinity Commercial |
$1,319.11
|
| Rate for Payer: Cofinity Commercial |
$1,417.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$984.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,033.63
|
| Rate for Payer: Meridian Medicaid |
$981.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,082.85
|
| Rate for Payer: Nomi Health Commercial |
$1,181.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,731.75
|
| Rate for Payer: PACE SWMI |
$984.41
|
| Rate for Payer: PHP Commercial |
$1,378.17
|
| Rate for Payer: PHP Medicare Advantage |
$984.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$934.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,527.34
|
| Rate for Payer: Priority Health Medicare |
$984.41
|
| Rate for Payer: Priority Health SBD |
$1,527.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,527.34
|
| Rate for Payer: Railroad Medicare Medicare |
$984.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,325.76
|
| Rate for Payer: UHC Core |
$1,325.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$984.41
|
| Rate for Payer: UHC Exchange |
$1,325.76
|
| Rate for Payer: UHC Medicaid |
$934.83
|
| Rate for Payer: UHCCP Medicaid |
$934.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,062.14
|
|
|
PR VAGINAL DELIVERY & POSTPARTUM CARE VBAC
|
Professional
|
Both
|
$2,490.00
|
|
|
Service Code
|
HCPCS 59614
|
| Min. Negotiated Rate |
$1,026.23 |
| Max. Negotiated Rate |
$1,944.19 |
| Rate for Payer: Aetna Commercial |
$1,448.03
|
| Rate for Payer: Aetna Medicare |
$1,123.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,448.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.09
|
| Rate for Payer: BCBS Complete |
$1,077.54
|
| Rate for Payer: BCBS MAPPO |
$1,080.62
|
| Rate for Payer: BCN Commercial |
$1,944.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,080.62
|
| Rate for Payer: Cash Price |
$1,992.00
|
| Rate for Payer: Cash Price |
$1,992.00
|
| Rate for Payer: Cofinity Commercial |
$1,448.03
|
| Rate for Payer: Cofinity Commercial |
$1,556.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,080.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,134.65
|
| Rate for Payer: Meridian Medicaid |
$1,077.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,188.68
|
| Rate for Payer: Nomi Health Commercial |
$1,296.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,867.50
|
| Rate for Payer: PACE SWMI |
$1,080.62
|
| Rate for Payer: PHP Commercial |
$1,512.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,080.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,026.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,651.92
|
| Rate for Payer: Priority Health Medicare |
$1,080.62
|
| Rate for Payer: Priority Health SBD |
$1,651.92
|
| Rate for Payer: Priority Health Tiered Network |
$1,651.92
|
| Rate for Payer: Railroad Medicare Medicare |
$1,080.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,448.84
|
| Rate for Payer: UHC Core |
$1,448.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,080.62
|
| Rate for Payer: UHC Exchange |
$1,448.84
|
| Rate for Payer: UHC Medicaid |
$1,026.23
|
| Rate for Payer: UHCCP Medicaid |
$1,026.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,145.40
|
|
|
PR VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE
|
Professional
|
Both
|
$2,305.00
|
|
|
Service Code
|
HCPCS 58294
|
| Min. Negotiated Rate |
$682.03 |
| Max. Negotiated Rate |
$2,169.22 |
| Rate for Payer: Aetna Commercial |
$1,425.83
|
| Rate for Payer: Aetna Medicare |
$1,106.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,532.23
|
| Rate for Payer: BCBS Complete |
$716.13
|
| Rate for Payer: BCBS MAPPO |
$1,064.05
|
| Rate for Payer: BCN Commercial |
$1,820.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,064.05
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Cofinity Commercial |
$1,425.83
|
| Rate for Payer: Cofinity Commercial |
$1,532.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,064.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,117.25
|
| Rate for Payer: Meridian Medicaid |
$716.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,170.45
|
| Rate for Payer: Nomi Health Commercial |
$1,276.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,728.75
|
| Rate for Payer: PACE SWMI |
$1,064.05
|
| Rate for Payer: PHP Commercial |
$1,489.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,064.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$682.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,843.38
|
| Rate for Payer: Priority Health Medicare |
$1,064.05
|
| Rate for Payer: Priority Health SBD |
$1,843.38
|
| Rate for Payer: Priority Health Tiered Network |
$1,843.38
|
| Rate for Payer: Railroad Medicare Medicare |
$1,064.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,169.22
|
| Rate for Payer: UHC Core |
$2,169.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,064.05
|
| Rate for Payer: UHC Exchange |
$2,169.22
|
| Rate for Payer: UHC Medicaid |
$682.03
|
| Rate for Payer: UHCCP Medicaid |
$682.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,060.30
|
|
|
PR VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE
|
Professional
|
Both
|
$2,840.00
|
|
|
Service Code
|
HCPCS 58270
|
| Min. Negotiated Rate |
$506.09 |
| Max. Negotiated Rate |
$2,130.00 |
| Rate for Payer: Aetna Commercial |
$1,054.63
|
| Rate for Payer: Aetna Medicare |
$818.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,054.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.34
|
| Rate for Payer: BCBS Complete |
$531.39
|
| Rate for Payer: BCBS MAPPO |
$787.04
|
| Rate for Payer: BCN Commercial |
$1,340.57
|
| Rate for Payer: BCN Medicare Advantage |
$787.04
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cash Price |
$2,272.00
|
| Rate for Payer: Cofinity Commercial |
$1,054.63
|
| Rate for Payer: Cofinity Commercial |
$1,133.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.39
|
| Rate for Payer: Meridian Medicaid |
$531.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$865.74
|
| Rate for Payer: Nomi Health Commercial |
$944.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,130.00
|
| Rate for Payer: PACE SWMI |
$787.04
|
| Rate for Payer: PHP Commercial |
$1,101.86
|
| Rate for Payer: PHP Medicare Advantage |
$787.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$506.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,357.71
|
| Rate for Payer: Priority Health Medicare |
$787.04
|
| Rate for Payer: Priority Health SBD |
$1,357.71
|
| Rate for Payer: Priority Health Tiered Network |
$1,357.71
|
| Rate for Payer: Railroad Medicare Medicare |
$787.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,578.48
|
| Rate for Payer: UHC Core |
$1,578.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$787.04
|
| Rate for Payer: UHC Exchange |
$1,578.48
|
| Rate for Payer: UHC Medicaid |
$506.09
|
| Rate for Payer: UHCCP Medicaid |
$506.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,306.40
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS > 250 GM
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 58290
|
| Min. Negotiated Rate |
$645.18 |
| Max. Negotiated Rate |
$2,253.75 |
| Rate for Payer: Aetna Commercial |
$1,347.73
|
| Rate for Payer: Aetna Medicare |
$1,046.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,347.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,448.31
|
| Rate for Payer: BCBS Complete |
$677.44
|
| Rate for Payer: BCBS MAPPO |
$1,005.77
|
| Rate for Payer: BCN Commercial |
$1,722.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,005.77
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$1,347.73
|
| Rate for Payer: Cofinity Commercial |
$1,448.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,005.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,056.06
|
| Rate for Payer: Meridian Medicaid |
$677.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,106.35
|
| Rate for Payer: Nomi Health Commercial |
$1,206.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,253.75
|
| Rate for Payer: PACE SWMI |
$1,005.77
|
| Rate for Payer: PHP Commercial |
$1,408.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,005.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$645.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,744.03
|
| Rate for Payer: Priority Health Medicare |
$1,005.77
|
| Rate for Payer: Priority Health SBD |
$1,744.03
|
| Rate for Payer: Priority Health Tiered Network |
$1,744.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,005.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,047.53
|
| Rate for Payer: UHC Core |
$2,047.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,005.77
|
| Rate for Payer: UHC Exchange |
$2,047.53
|
| Rate for Payer: UHC Medicaid |
$645.18
|
| Rate for Payer: UHCCP Medicaid |
$645.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,382.30
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,765.00
|
|
|
Service Code
|
HCPCS 58260
|
| Min. Negotiated Rate |
$473.07 |
| Max. Negotiated Rate |
$2,073.75 |
| Rate for Payer: Aetna Commercial |
$984.51
|
| Rate for Payer: Aetna Medicare |
$764.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,057.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$984.51
|
| Rate for Payer: BCBS Complete |
$496.72
|
| Rate for Payer: BCBS MAPPO |
$734.71
|
| Rate for Payer: BCN Commercial |
$1,257.90
|
| Rate for Payer: BCN Medicare Advantage |
$734.71
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Cash Price |
$2,212.00
|
| Rate for Payer: Cofinity Commercial |
$1,057.98
|
| Rate for Payer: Cofinity Commercial |
$984.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$734.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$771.45
|
| Rate for Payer: Meridian Medicaid |
$496.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$808.18
|
| Rate for Payer: Nomi Health Commercial |
$881.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,073.75
|
| Rate for Payer: PACE SWMI |
$734.71
|
| Rate for Payer: PHP Commercial |
$1,028.59
|
| Rate for Payer: PHP Medicare Advantage |
$734.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$473.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,273.98
|
| Rate for Payer: Priority Health Medicare |
$734.71
|
| Rate for Payer: Priority Health SBD |
$1,273.98
|
| Rate for Payer: Priority Health Tiered Network |
$1,273.98
|
| Rate for Payer: Railroad Medicare Medicare |
$734.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,477.63
|
| Rate for Payer: UHC Core |
$1,477.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$734.71
|
| Rate for Payer: UHC Exchange |
$1,477.63
|
| Rate for Payer: UHC Medicaid |
$473.07
|
| Rate for Payer: UHCCP Medicaid |
$473.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,271.90
|
|
|
PR VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY
|
Professional
|
Both
|
$2,488.00
|
|
|
Service Code
|
HCPCS 58275
|
| Min. Negotiated Rate |
$558.49 |
| Max. Negotiated Rate |
$1,866.00 |
| Rate for Payer: Aetna Commercial |
$1,164.30
|
| Rate for Payer: Aetna Medicare |
$903.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,164.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.19
|
| Rate for Payer: BCBS Complete |
$586.41
|
| Rate for Payer: BCBS MAPPO |
$868.88
|
| Rate for Payer: BCN Commercial |
$1,486.97
|
| Rate for Payer: BCN Medicare Advantage |
$868.88
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Cash Price |
$1,990.40
|
| Rate for Payer: Cofinity Commercial |
$1,164.30
|
| Rate for Payer: Cofinity Commercial |
$1,251.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$912.32
|
| Rate for Payer: Meridian Medicaid |
$586.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$955.77
|
| Rate for Payer: Nomi Health Commercial |
$1,042.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,866.00
|
| Rate for Payer: PACE SWMI |
$868.88
|
| Rate for Payer: PHP Commercial |
$1,216.43
|
| Rate for Payer: PHP Medicare Advantage |
$868.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,505.99
|
| Rate for Payer: Priority Health Medicare |
$868.88
|
| Rate for Payer: Priority Health SBD |
$1,505.99
|
| Rate for Payer: Priority Health Tiered Network |
$1,505.99
|
| Rate for Payer: Railroad Medicare Medicare |
$868.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,751.47
|
| Rate for Payer: UHC Core |
$1,751.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$868.88
|
| Rate for Payer: UHC Exchange |
$1,751.47
|
| Rate for Payer: UHC Medicaid |
$558.49
|
| Rate for Payer: UHCCP Medicaid |
$558.49
|
| Rate for Payer: UMR Bronson Commercial |
$1,144.48
|
|
|
PR VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$2,086.00
|
|
|
Service Code
|
HCPCS 57110
|
| Min. Negotiated Rate |
$508.86 |
| Max. Negotiated Rate |
$1,597.09 |
| Rate for Payer: Aetna Commercial |
$1,059.63
|
| Rate for Payer: Aetna Medicare |
$822.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,059.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,138.71
|
| Rate for Payer: BCBS Complete |
$534.30
|
| Rate for Payer: BCBS MAPPO |
$790.77
|
| Rate for Payer: BCN Commercial |
$1,352.51
|
| Rate for Payer: BCN Medicare Advantage |
$790.77
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Cash Price |
$1,668.80
|
| Rate for Payer: Cofinity Commercial |
$1,059.63
|
| Rate for Payer: Cofinity Commercial |
$1,138.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$790.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$830.31
|
| Rate for Payer: Meridian Medicaid |
$534.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$869.85
|
| Rate for Payer: Nomi Health Commercial |
$948.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,564.50
|
| Rate for Payer: PACE SWMI |
$790.77
|
| Rate for Payer: PHP Commercial |
$1,107.08
|
| Rate for Payer: PHP Medicare Advantage |
$790.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,369.80
|
| Rate for Payer: Priority Health Medicare |
$790.77
|
| Rate for Payer: Priority Health SBD |
$1,369.80
|
| Rate for Payer: Priority Health Tiered Network |
$1,369.80
|
| Rate for Payer: Railroad Medicare Medicare |
$790.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,597.09
|
| Rate for Payer: UHC Core |
$1,597.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$790.77
|
| Rate for Payer: UHC Exchange |
$1,597.09
|
| Rate for Payer: UHC Medicaid |
$508.86
|
| Rate for Payer: UHCCP Medicaid |
$508.86
|
| Rate for Payer: UMR Bronson Commercial |
$959.56
|
|
|
PR VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 57106
|
| Min. Negotiated Rate |
$313.96 |
| Max. Negotiated Rate |
$1,539.75 |
| Rate for Payer: Aetna Commercial |
$643.84
|
| Rate for Payer: Aetna Medicare |
$499.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$691.89
|
| Rate for Payer: BCBS Complete |
$329.66
|
| Rate for Payer: BCBS MAPPO |
$480.48
|
| Rate for Payer: BCN Commercial |
$808.22
|
| Rate for Payer: BCN Medicare Advantage |
$480.48
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cofinity Commercial |
$643.84
|
| Rate for Payer: Cofinity Commercial |
$691.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$504.50
|
| Rate for Payer: Meridian Medicaid |
$329.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$528.53
|
| Rate for Payer: Nomi Health Commercial |
$576.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,539.75
|
| Rate for Payer: PACE SWMI |
$480.48
|
| Rate for Payer: PHP Commercial |
$672.67
|
| Rate for Payer: PHP Medicare Advantage |
$480.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$818.55
|
| Rate for Payer: Priority Health Medicare |
$480.48
|
| Rate for Payer: Priority Health SBD |
$818.55
|
| Rate for Payer: Priority Health Tiered Network |
$818.55
|
| Rate for Payer: Railroad Medicare Medicare |
$480.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$901.65
|
| Rate for Payer: UHC Core |
$901.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$480.48
|
| Rate for Payer: UHC Exchange |
$901.65
|
| Rate for Payer: UHC Medicaid |
$313.96
|
| Rate for Payer: UHCCP Medicaid |
$313.96
|
| Rate for Payer: UMR Bronson Commercial |
$944.38
|
|
|
PR VAGINOPLASTY INTERSEX STATE
|
Professional
|
Both
|
$2,609.00
|
|
|
Service Code
|
HCPCS 57335
|
| Min. Negotiated Rate |
$660.73 |
| Max. Negotiated Rate |
$2,074.65 |
| Rate for Payer: Aetna Commercial |
$1,376.74
|
| Rate for Payer: Aetna Medicare |
$1,068.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,376.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,479.48
|
| Rate for Payer: BCBS Complete |
$693.77
|
| Rate for Payer: BCBS MAPPO |
$1,027.42
|
| Rate for Payer: BCN Commercial |
$1,760.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,027.42
|
| Rate for Payer: Cash Price |
$2,087.20
|
| Rate for Payer: Cash Price |
$2,087.20
|
| Rate for Payer: Cofinity Commercial |
$1,376.74
|
| Rate for Payer: Cofinity Commercial |
$1,479.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,027.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,078.79
|
| Rate for Payer: Meridian Medicaid |
$693.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,130.16
|
| Rate for Payer: Nomi Health Commercial |
$1,232.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,956.75
|
| Rate for Payer: PACE SWMI |
$1,027.42
|
| Rate for Payer: PHP Commercial |
$1,438.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,027.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$660.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,783.37
|
| Rate for Payer: Priority Health Medicare |
$1,027.42
|
| Rate for Payer: Priority Health SBD |
$1,783.37
|
| Rate for Payer: Priority Health Tiered Network |
$1,783.37
|
| Rate for Payer: Railroad Medicare Medicare |
$1,027.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,074.65
|
| Rate for Payer: UHC Core |
$2,074.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,027.42
|
| Rate for Payer: UHC Exchange |
$2,074.65
|
| Rate for Payer: UHC Medicaid |
$660.73
|
| Rate for Payer: UHCCP Medicaid |
$660.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,200.14
|
|
|
PR VAGNC PRTL RMVL VAG WALL W/RMVL PARAVAGINAL TISS
|
Professional
|
Both
|
$2,648.00
|
|
|
Service Code
|
HCPCS 57107
|
| Min. Negotiated Rate |
$842.42 |
| Max. Negotiated Rate |
$2,536.54 |
| Rate for Payer: Aetna Commercial |
$1,754.74
|
| Rate for Payer: Aetna Medicare |
$1,361.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,754.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,885.69
|
| Rate for Payer: BCBS Complete |
$884.54
|
| Rate for Payer: BCBS MAPPO |
$1,309.51
|
| Rate for Payer: BCN Commercial |
$2,186.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,309.51
|
| Rate for Payer: Cash Price |
$2,118.40
|
| Rate for Payer: Cash Price |
$2,118.40
|
| Rate for Payer: Cofinity Commercial |
$1,754.74
|
| Rate for Payer: Cofinity Commercial |
$1,885.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,309.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,374.99
|
| Rate for Payer: Meridian Medicaid |
$884.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,440.46
|
| Rate for Payer: Nomi Health Commercial |
$1,571.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,986.00
|
| Rate for Payer: PACE SWMI |
$1,309.51
|
| Rate for Payer: PHP Commercial |
$1,833.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,309.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$842.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,214.58
|
| Rate for Payer: Priority Health Medicare |
$1,309.51
|
| Rate for Payer: Priority Health SBD |
$2,214.58
|
| Rate for Payer: Priority Health Tiered Network |
$2,214.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,309.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,536.54
|
| Rate for Payer: UHC Core |
$2,536.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,309.51
|
| Rate for Payer: UHC Exchange |
$2,536.54
|
| Rate for Payer: UHC Medicaid |
$842.42
|
| Rate for Payer: UHCCP Medicaid |
$842.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,218.08
|
|
|
PR VAGOTOMY PFRMD W/PRTL DSTL GSTRCT
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 43635
|
| Min. Negotiated Rate |
$64.33 |
| Max. Negotiated Rate |
$203.86 |
| Rate for Payer: Aetna Commercial |
$136.36
|
| Rate for Payer: Aetna Medicare |
$105.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.53
|
| Rate for Payer: BCBS Complete |
$67.55
|
| Rate for Payer: BCBS MAPPO |
$101.76
|
| Rate for Payer: BCN Commercial |
$167.32
|
| Rate for Payer: BCN Medicare Advantage |
$101.76
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$136.36
|
| Rate for Payer: Cofinity Commercial |
$146.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.85
|
| Rate for Payer: Meridian Medicaid |
$67.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.94
|
| Rate for Payer: Nomi Health Commercial |
$122.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PACE SWMI |
$101.76
|
| Rate for Payer: PHP Commercial |
$142.46
|
| Rate for Payer: PHP Medicare Advantage |
$101.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$203.86
|
| Rate for Payer: Priority Health Medicare |
$101.76
|
| Rate for Payer: Priority Health SBD |
$203.86
|
| Rate for Payer: Priority Health Tiered Network |
$203.86
|
| Rate for Payer: Railroad Medicare Medicare |
$101.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.62
|
| Rate for Payer: UHC Core |
$202.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.76
|
| Rate for Payer: UHC Exchange |
$202.62
|
| Rate for Payer: UHC Medicaid |
$64.33
|
| Rate for Payer: UHCCP Medicaid |
$64.33
|
| Rate for Payer: UMR Bronson Commercial |
$96.60
|
|
|
PR VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP
|
Professional
|
Both
|
$5,005.00
|
|
|
Service Code
|
HCPCS 33460
|
| Min. Negotiated Rate |
$1,431.15 |
| Max. Negotiated Rate |
$4,296.08 |
| Rate for Payer: Aetna Commercial |
$3,016.42
|
| Rate for Payer: Aetna Medicare |
$2,341.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,016.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,241.53
|
| Rate for Payer: BCBS Complete |
$1,502.71
|
| Rate for Payer: BCBS MAPPO |
$2,251.06
|
| Rate for Payer: BCN Commercial |
$3,507.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,251.06
|
| Rate for Payer: Cash Price |
$4,004.00
|
| Rate for Payer: Cash Price |
$4,004.00
|
| Rate for Payer: Cofinity Commercial |
$3,016.42
|
| Rate for Payer: Cofinity Commercial |
$3,241.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,251.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,363.61
|
| Rate for Payer: Meridian Medicaid |
$1,502.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,476.17
|
| Rate for Payer: Nomi Health Commercial |
$2,701.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,753.75
|
| Rate for Payer: PACE SWMI |
$2,251.06
|
| Rate for Payer: PHP Commercial |
$3,151.48
|
| Rate for Payer: PHP Medicare Advantage |
$2,251.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,431.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,772.18
|
| Rate for Payer: Priority Health Medicare |
$2,251.06
|
| Rate for Payer: Priority Health SBD |
$3,772.18
|
| Rate for Payer: Priority Health Tiered Network |
$3,772.18
|
| Rate for Payer: Railroad Medicare Medicare |
$2,251.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,296.08
|
| Rate for Payer: UHC Core |
$4,296.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,251.06
|
| Rate for Payer: UHC Exchange |
$4,296.08
|
| Rate for Payer: UHC Medicaid |
$1,431.15
|
| Rate for Payer: UHCCP Medicaid |
$1,431.15
|
| Rate for Payer: UMR Bronson Commercial |
$2,302.30
|
|
|
PR VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS
|
Professional
|
Both
|
$9,191.00
|
|
|
Service Code
|
HCPCS 33422
|
| Min. Negotiated Rate |
$1,012.82 |
| Max. Negotiated Rate |
$6,893.25 |
| Rate for Payer: Aetna Commercial |
$2,123.22
|
| Rate for Payer: Aetna Medicare |
$1,647.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,123.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,281.67
|
| Rate for Payer: BCBS Complete |
$1,063.46
|
| Rate for Payer: BCBS MAPPO |
$1,584.49
|
| Rate for Payer: BCN Commercial |
$2,446.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,584.49
|
| Rate for Payer: Cash Price |
$7,352.80
|
| Rate for Payer: Cash Price |
$7,352.80
|
| Rate for Payer: Cofinity Commercial |
$2,123.22
|
| Rate for Payer: Cofinity Commercial |
$2,281.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,584.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,663.71
|
| Rate for Payer: Meridian Medicaid |
$1,063.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,742.94
|
| Rate for Payer: Nomi Health Commercial |
$1,901.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,893.25
|
| Rate for Payer: PACE SWMI |
$1,584.49
|
| Rate for Payer: PHP Commercial |
$2,218.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,584.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,012.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,630.98
|
| Rate for Payer: Priority Health Medicare |
$1,584.49
|
| Rate for Payer: Priority Health SBD |
$2,630.98
|
| Rate for Payer: Priority Health Tiered Network |
$2,630.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,584.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,961.74
|
| Rate for Payer: UHC Core |
$2,961.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,584.49
|
| Rate for Payer: UHC Exchange |
$2,961.74
|
| Rate for Payer: UHC Medicaid |
$1,012.82
|
| Rate for Payer: UHCCP Medicaid |
$1,012.82
|
| Rate for Payer: UMR Bronson Commercial |
$4,227.86
|
|
|
PR VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS
|
Professional
|
Both
|
$8,768.00
|
|
|
Service Code
|
HCPCS 33425
|
| Min. Negotiated Rate |
$1,626.04 |
| Max. Negotiated Rate |
$6,576.00 |
| Rate for Payer: Aetna Commercial |
$3,425.09
|
| Rate for Payer: Aetna Medicare |
$2,658.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,425.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,680.70
|
| Rate for Payer: BCBS Complete |
$1,707.34
|
| Rate for Payer: BCBS MAPPO |
$2,556.04
|
| Rate for Payer: BCN Commercial |
$4,002.28
|
| Rate for Payer: BCN Medicare Advantage |
$2,556.04
|
| Rate for Payer: Cash Price |
$7,014.40
|
| Rate for Payer: Cash Price |
$7,014.40
|
| Rate for Payer: Cofinity Commercial |
$3,425.09
|
| Rate for Payer: Cofinity Commercial |
$3,680.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,556.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,683.84
|
| Rate for Payer: Meridian Medicaid |
$1,707.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,811.64
|
| Rate for Payer: Nomi Health Commercial |
$3,067.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,576.00
|
| Rate for Payer: PACE SWMI |
$2,556.04
|
| Rate for Payer: PHP Commercial |
$3,578.46
|
| Rate for Payer: PHP Medicare Advantage |
$2,556.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,626.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,303.94
|
| Rate for Payer: Priority Health Medicare |
$2,556.04
|
| Rate for Payer: Priority Health SBD |
$4,303.94
|
| Rate for Payer: Priority Health Tiered Network |
$4,303.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2,556.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,875.10
|
| Rate for Payer: UHC Core |
$4,875.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,556.04
|
| Rate for Payer: UHC Exchange |
$4,875.10
|
| Rate for Payer: UHC Medicaid |
$1,626.04
|
| Rate for Payer: UHCCP Medicaid |
$1,626.04
|
| Rate for Payer: UMR Bronson Commercial |
$4,033.28
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION
|
Professional
|
Both
|
$7,770.00
|
|
|
Service Code
|
HCPCS 33463
|
| Min. Negotiated Rate |
$1,827.33 |
| Max. Negotiated Rate |
$5,827.50 |
| Rate for Payer: Aetna Commercial |
$3,853.45
|
| Rate for Payer: Aetna Medicare |
$2,990.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,853.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,141.02
|
| Rate for Payer: BCBS Complete |
$1,918.70
|
| Rate for Payer: BCBS MAPPO |
$2,875.71
|
| Rate for Payer: BCN Commercial |
$4,508.72
|
| Rate for Payer: BCN Medicare Advantage |
$2,875.71
|
| Rate for Payer: Cash Price |
$6,216.00
|
| Rate for Payer: Cash Price |
$6,216.00
|
| Rate for Payer: Cofinity Commercial |
$3,853.45
|
| Rate for Payer: Cofinity Commercial |
$4,141.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,875.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,019.50
|
| Rate for Payer: Meridian Medicaid |
$1,918.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,163.28
|
| Rate for Payer: Nomi Health Commercial |
$3,450.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,827.50
|
| Rate for Payer: PACE SWMI |
$2,875.71
|
| Rate for Payer: PHP Commercial |
$4,025.99
|
| Rate for Payer: PHP Medicare Advantage |
$2,875.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,827.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,848.55
|
| Rate for Payer: Priority Health Medicare |
$2,875.71
|
| Rate for Payer: Priority Health SBD |
$4,848.55
|
| Rate for Payer: Priority Health Tiered Network |
$4,848.55
|
| Rate for Payer: Railroad Medicare Medicare |
$2,875.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,511.61
|
| Rate for Payer: UHC Core |
$5,511.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,875.71
|
| Rate for Payer: UHC Exchange |
$5,511.61
|
| Rate for Payer: UHC Medicaid |
$1,827.33
|
| Rate for Payer: UHCCP Medicaid |
$1,827.33
|
| Rate for Payer: UMR Bronson Commercial |
$3,574.20
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION
|
Professional
|
Both
|
$5,269.00
|
|
|
Service Code
|
HCPCS 33464
|
| Min. Negotiated Rate |
$1,449.25 |
| Max. Negotiated Rate |
$4,354.26 |
| Rate for Payer: Aetna Commercial |
$3,050.56
|
| Rate for Payer: Aetna Medicare |
$2,367.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,050.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,278.22
|
| Rate for Payer: BCBS Complete |
$1,521.71
|
| Rate for Payer: BCBS MAPPO |
$2,276.54
|
| Rate for Payer: BCN Commercial |
$3,578.49
|
| Rate for Payer: BCN Medicare Advantage |
$2,276.54
|
| Rate for Payer: Cash Price |
$4,215.20
|
| Rate for Payer: Cash Price |
$4,215.20
|
| Rate for Payer: Cofinity Commercial |
$3,050.56
|
| Rate for Payer: Cofinity Commercial |
$3,278.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,276.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,390.37
|
| Rate for Payer: Meridian Medicaid |
$1,521.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,504.19
|
| Rate for Payer: Nomi Health Commercial |
$2,731.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,951.75
|
| Rate for Payer: PACE SWMI |
$2,276.54
|
| Rate for Payer: PHP Commercial |
$3,187.16
|
| Rate for Payer: PHP Medicare Advantage |
$2,276.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,449.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,848.22
|
| Rate for Payer: Priority Health Medicare |
$2,276.54
|
| Rate for Payer: Priority Health SBD |
$3,848.22
|
| Rate for Payer: Priority Health Tiered Network |
$3,848.22
|
| Rate for Payer: Railroad Medicare Medicare |
$2,276.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,354.26
|
| Rate for Payer: UHC Core |
$4,354.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,276.54
|
| Rate for Payer: UHC Exchange |
$4,354.26
|
| Rate for Payer: UHC Medicaid |
$1,449.25
|
| Rate for Payer: UHCCP Medicaid |
$1,449.25
|
| Rate for Payer: UMR Bronson Commercial |
$2,423.74
|
|
|
PR VANTAS IMPLANT
|
Professional
|
Both
|
$3,503.00
|
|
|
Service Code
|
HCPCS J9225
|
| Min. Negotiated Rate |
$1,611.38 |
| Max. Negotiated Rate |
$5,264.35 |
| Rate for Payer: Aetna Commercial |
$4,678.90
|
| Rate for Payer: Aetna Medicare |
$1,751.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,678.90
|
| Rate for Payer: BCBS Trust/PPO |
$5,264.35
|
| Rate for Payer: BCN Commercial |
$5,264.35
|
| Rate for Payer: Cash Price |
$2,802.40
|
| Rate for Payer: Cash Price |
$2,802.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,627.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,873.86
|
| Rate for Payer: UHC Core |
$4,873.86
|
| Rate for Payer: UHC Exchange |
$4,873.86
|
| Rate for Payer: UMR Bronson Commercial |
$1,611.38
|
|
|
PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 90716
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$192.12 |
| Rate for Payer: Aetna Commercial |
$177.68
|
| Rate for Payer: Aetna Medicare |
$111.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.68
|
| Rate for Payer: BCBS Trust/PPO |
$192.12
|
| Rate for Payer: BCN Commercial |
$179.94
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.12
|
| Rate for Payer: UHC Core |
$192.12
|
| Rate for Payer: UHC Exchange |
$192.12
|
| Rate for Payer: UMR Bronson Commercial |
$102.12
|
|
|
PR VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX
|
Professional
|
Both
|
$1,375.00
|
|
|
Service Code
|
HCPCS 37500
|
| Min. Negotiated Rate |
$550.00 |
| Max. Negotiated Rate |
$1,031.25 |
| Rate for Payer: Aetna Commercial |
$846.67
|
| Rate for Payer: Aetna Medicare |
$687.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.67
|
| Rate for Payer: BCBS Complete |
$550.00
|
| Rate for Payer: BCN Commercial |
$927.74
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Cash Price |
$1,100.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,031.25
|
| Rate for Payer: UMR Bronson Commercial |
$632.50
|
|
