|
PR TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 25929
|
| Min. Negotiated Rate |
$426.80 |
| Max. Negotiated Rate |
$836.11 |
| Rate for Payer: Aetna Commercial |
$778.04
|
| Rate for Payer: Aetna Medicare |
$603.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.04
|
| Rate for Payer: BCBS Complete |
$426.80
|
| Rate for Payer: BCBS MAPPO |
$580.63
|
| Rate for Payer: BCN Medicare Advantage |
$580.63
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cofinity Commercial |
$836.11
|
| Rate for Payer: Cofinity Commercial |
$778.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.66
|
| Rate for Payer: Nomi Health Commercial |
$696.76
|
| Rate for Payer: PACE SWMI |
$580.63
|
| Rate for Payer: PHP Commercial |
$812.88
|
| Rate for Payer: PHP Medicare Advantage |
$580.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.55
|
| Rate for Payer: Priority Health Medicare |
$580.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$580.63
|
| Rate for Payer: UHC Medicare Advantage |
$580.63
|
| Rate for Payer: UMR Bronson Commercial |
$490.82
|
|
|
PR TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX
|
Professional
|
Both
|
$581.00
|
|
|
Service Code
|
HCPCS 33141
|
| Min. Negotiated Rate |
$126.99 |
| Max. Negotiated Rate |
$377.65 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Aetna Medicare |
$132.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.17
|
| Rate for Payer: BCBS Complete |
$232.40
|
| Rate for Payer: BCBS MAPPO |
$126.99
|
| Rate for Payer: BCN Medicare Advantage |
$126.99
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cofinity Commercial |
$182.87
|
| Rate for Payer: Cofinity Commercial |
$170.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.34
|
| Rate for Payer: Nomi Health Commercial |
$152.39
|
| Rate for Payer: PACE SWMI |
$126.99
|
| Rate for Payer: PHP Commercial |
$177.79
|
| Rate for Payer: PHP Medicare Advantage |
$126.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.65
|
| Rate for Payer: Priority Health Medicare |
$126.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.99
|
| Rate for Payer: UHC Medicare Advantage |
$126.99
|
| Rate for Payer: UMR Bronson Commercial |
$267.26
|
|
|
PR TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR
|
Professional
|
Both
|
$2,474.00
|
|
|
Service Code
|
HCPCS 63057
|
| Min. Negotiated Rate |
$315.91 |
| Max. Negotiated Rate |
$1,608.10 |
| Rate for Payer: Aetna Commercial |
$423.32
|
| Rate for Payer: Aetna Medicare |
$328.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.32
|
| Rate for Payer: BCBS Complete |
$989.60
|
| Rate for Payer: BCBS MAPPO |
$315.91
|
| Rate for Payer: BCN Medicare Advantage |
$315.91
|
| Rate for Payer: Cash Price |
$1,979.20
|
| Rate for Payer: Cash Price |
$1,979.20
|
| Rate for Payer: Cofinity Commercial |
$454.91
|
| Rate for Payer: Cofinity Commercial |
$423.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.71
|
| Rate for Payer: Nomi Health Commercial |
$379.09
|
| Rate for Payer: PACE SWMI |
$315.91
|
| Rate for Payer: PHP Commercial |
$442.27
|
| Rate for Payer: PHP Medicare Advantage |
$315.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.10
|
| Rate for Payer: Priority Health Medicare |
$315.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.91
|
| Rate for Payer: UHC Medicare Advantage |
$315.91
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.04
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR
|
Professional
|
Both
|
$7,074.00
|
|
|
Service Code
|
HCPCS 63056
|
| Min. Negotiated Rate |
$1,458.87 |
| Max. Negotiated Rate |
$4,598.10 |
| Rate for Payer: Aetna Commercial |
$1,954.89
|
| Rate for Payer: Aetna Medicare |
$1,517.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,100.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,954.89
|
| Rate for Payer: BCBS Complete |
$2,829.60
|
| Rate for Payer: BCBS MAPPO |
$1,458.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,458.87
|
| Rate for Payer: Cash Price |
$5,659.20
|
| Rate for Payer: Cash Price |
$5,659.20
|
| Rate for Payer: Cofinity Commercial |
$2,100.77
|
| Rate for Payer: Cofinity Commercial |
$1,954.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,458.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,531.81
|
| Rate for Payer: Nomi Health Commercial |
$1,750.64
|
| Rate for Payer: PACE SWMI |
$1,458.87
|
| Rate for Payer: PHP Commercial |
$2,042.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,458.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,598.10
|
| Rate for Payer: Priority Health Medicare |
$1,458.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,458.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,458.87
|
| Rate for Payer: UMR Bronson Commercial |
$3,254.04
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC
|
Professional
|
Both
|
$7,455.00
|
|
|
Service Code
|
HCPCS 63055
|
| Min. Negotiated Rate |
$1,601.56 |
| Max. Negotiated Rate |
$4,845.75 |
| Rate for Payer: Aetna Commercial |
$2,146.09
|
| Rate for Payer: Aetna Medicare |
$1,665.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,306.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,146.09
|
| Rate for Payer: BCBS Complete |
$2,982.00
|
| Rate for Payer: BCBS MAPPO |
$1,601.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,601.56
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: Cofinity Commercial |
$2,306.25
|
| Rate for Payer: Cofinity Commercial |
$2,146.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,601.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,681.64
|
| Rate for Payer: Nomi Health Commercial |
$1,921.87
|
| Rate for Payer: PACE SWMI |
$1,601.56
|
| Rate for Payer: PHP Commercial |
$2,242.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,601.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,845.75
|
| Rate for Payer: Priority Health Medicare |
$1,601.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,601.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,601.56
|
| Rate for Payer: UMR Bronson Commercial |
$3,429.30
|
|
|
PR TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX
|
Professional
|
Both
|
$6,685.00
|
|
|
Service Code
|
HCPCS 55874
|
| Min. Negotiated Rate |
$155.95 |
| Max. Negotiated Rate |
$4,345.25 |
| Rate for Payer: Aetna Commercial |
$208.97
|
| Rate for Payer: Aetna Medicare |
$162.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.97
|
| Rate for Payer: BCBS Complete |
$2,674.00
|
| Rate for Payer: BCBS MAPPO |
$155.95
|
| Rate for Payer: BCN Medicare Advantage |
$155.95
|
| Rate for Payer: Cash Price |
$5,348.00
|
| Rate for Payer: Cash Price |
$5,348.00
|
| Rate for Payer: Cofinity Commercial |
$224.57
|
| Rate for Payer: Cofinity Commercial |
$208.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.75
|
| Rate for Payer: Nomi Health Commercial |
$187.14
|
| Rate for Payer: PACE SWMI |
$155.95
|
| Rate for Payer: PHP Commercial |
$218.33
|
| Rate for Payer: PHP Medicare Advantage |
$155.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,345.25
|
| Rate for Payer: Priority Health Medicare |
$155.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.95
|
| Rate for Payer: UHC Medicare Advantage |
$155.95
|
| Rate for Payer: UMR Bronson Commercial |
$3,075.10
|
|
|
PR TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ
|
Professional
|
Both
|
$2,721.00
|
|
|
Service Code
|
HCPCS 55875
|
| Min. Negotiated Rate |
$745.84 |
| Max. Negotiated Rate |
$1,768.65 |
| Rate for Payer: Aetna Commercial |
$999.43
|
| Rate for Payer: Aetna Medicare |
$775.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.01
|
| Rate for Payer: BCBS Complete |
$1,088.40
|
| Rate for Payer: BCBS MAPPO |
$745.84
|
| Rate for Payer: BCN Medicare Advantage |
$745.84
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cofinity Commercial |
$999.43
|
| Rate for Payer: Cofinity Commercial |
$1,074.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.13
|
| Rate for Payer: Nomi Health Commercial |
$895.01
|
| Rate for Payer: PACE SWMI |
$745.84
|
| Rate for Payer: PHP Commercial |
$1,044.18
|
| Rate for Payer: PHP Medicare Advantage |
$745.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,768.65
|
| Rate for Payer: Priority Health Medicare |
$745.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.84
|
| Rate for Payer: UHC Medicare Advantage |
$745.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,251.66
|
|
|
PR TRANSPLANTATION TESTIS TO THIGH
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 54680
|
| Min. Negotiated Rate |
$568.00 |
| Max. Negotiated Rate |
$1,083.89 |
| Rate for Payer: Aetna Commercial |
$1,008.62
|
| Rate for Payer: Aetna Medicare |
$782.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,083.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.62
|
| Rate for Payer: BCBS Complete |
$568.00
|
| Rate for Payer: BCBS MAPPO |
$752.70
|
| Rate for Payer: BCN Medicare Advantage |
$752.70
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$1,083.89
|
| Rate for Payer: Cofinity Commercial |
$1,008.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$752.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$790.34
|
| Rate for Payer: Nomi Health Commercial |
$903.24
|
| Rate for Payer: PACE SWMI |
$752.70
|
| Rate for Payer: PHP Commercial |
$1,053.78
|
| Rate for Payer: PHP Medicare Advantage |
$752.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.00
|
| Rate for Payer: Priority Health Medicare |
$752.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$752.70
|
| Rate for Payer: UHC Medicare Advantage |
$752.70
|
| Rate for Payer: UMR Bronson Commercial |
$653.20
|
|
|
PR TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN
|
Professional
|
Both
|
$1,880.00
|
|
|
Service Code
|
HCPCS 27397
|
| Min. Negotiated Rate |
$752.00 |
| Max. Negotiated Rate |
$1,273.49 |
| Rate for Payer: Aetna Commercial |
$1,185.06
|
| Rate for Payer: Aetna Medicare |
$919.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.06
|
| Rate for Payer: BCBS Complete |
$752.00
|
| Rate for Payer: BCBS MAPPO |
$884.37
|
| Rate for Payer: BCN Medicare Advantage |
$884.37
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cofinity Commercial |
$1,273.49
|
| Rate for Payer: Cofinity Commercial |
$1,185.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$884.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$928.59
|
| Rate for Payer: Nomi Health Commercial |
$1,061.24
|
| Rate for Payer: PACE SWMI |
$884.37
|
| Rate for Payer: PHP Commercial |
$1,238.12
|
| Rate for Payer: PHP Medicare Advantage |
$884.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.00
|
| Rate for Payer: Priority Health Medicare |
$884.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$884.37
|
| Rate for Payer: UHC Medicare Advantage |
$884.37
|
| Rate for Payer: UMR Bronson Commercial |
$864.80
|
|
|
PR TRANSPOSITION OVARY
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 58825
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$979.37 |
| Rate for Payer: Aetna Commercial |
$911.36
|
| Rate for Payer: Aetna Medicare |
$707.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.36
|
| Rate for Payer: BCBS Complete |
$585.20
|
| Rate for Payer: BCBS MAPPO |
$680.12
|
| Rate for Payer: BCN Medicare Advantage |
$680.12
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cofinity Commercial |
$979.37
|
| Rate for Payer: Cofinity Commercial |
$911.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.13
|
| Rate for Payer: Nomi Health Commercial |
$816.14
|
| Rate for Payer: PACE SWMI |
$680.12
|
| Rate for Payer: PHP Commercial |
$952.17
|
| Rate for Payer: PHP Medicare Advantage |
$680.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
| Rate for Payer: Priority Health Medicare |
$680.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.12
|
| Rate for Payer: UHC Medicare Advantage |
$680.12
|
| Rate for Payer: UMR Bronson Commercial |
$672.98
|
|
|
PR TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM
|
Professional
|
Both
|
$5,079.00
|
|
|
Service Code
|
HCPCS 61598
|
| Min. Negotiated Rate |
$2,031.60 |
| Max. Negotiated Rate |
$4,003.78 |
| Rate for Payer: Aetna Commercial |
$3,725.74
|
| Rate for Payer: Aetna Medicare |
$2,891.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,003.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,725.74
|
| Rate for Payer: BCBS Complete |
$2,031.60
|
| Rate for Payer: BCBS MAPPO |
$2,780.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,780.40
|
| Rate for Payer: Cash Price |
$4,063.20
|
| Rate for Payer: Cash Price |
$4,063.20
|
| Rate for Payer: Cofinity Commercial |
$4,003.78
|
| Rate for Payer: Cofinity Commercial |
$3,725.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,780.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,919.42
|
| Rate for Payer: Nomi Health Commercial |
$3,336.48
|
| Rate for Payer: PACE SWMI |
$2,780.40
|
| Rate for Payer: PHP Commercial |
$3,892.56
|
| Rate for Payer: PHP Medicare Advantage |
$2,780.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,301.35
|
| Rate for Payer: Priority Health Medicare |
$2,780.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,780.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,780.40
|
| Rate for Payer: UMR Bronson Commercial |
$2,336.34
|
|
|
PR TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 45000
|
| Min. Negotiated Rate |
$327.20 |
| Max. Negotiated Rate |
$591.97 |
| Rate for Payer: Aetna Commercial |
$550.86
|
| Rate for Payer: Aetna Medicare |
$427.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$591.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$550.86
|
| Rate for Payer: BCBS Complete |
$327.20
|
| Rate for Payer: BCBS MAPPO |
$411.09
|
| Rate for Payer: BCN Medicare Advantage |
$411.09
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$591.97
|
| Rate for Payer: Cofinity Commercial |
$550.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$431.64
|
| Rate for Payer: Nomi Health Commercial |
$493.31
|
| Rate for Payer: PACE SWMI |
$411.09
|
| Rate for Payer: PHP Commercial |
$575.53
|
| Rate for Payer: PHP Medicare Advantage |
$411.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health Medicare |
$411.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.09
|
| Rate for Payer: UHC Medicare Advantage |
$411.09
|
| Rate for Payer: UMR Bronson Commercial |
$376.28
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 93293
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: Aetna Medicare |
$39.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.38
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$37.60
|
| Rate for Payer: BCN Medicare Advantage |
$37.60
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$54.14
|
| Rate for Payer: Cofinity Commercial |
$50.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.48
|
| Rate for Payer: Nomi Health Commercial |
$45.12
|
| Rate for Payer: PACE SWMI |
$37.60
|
| Rate for Payer: PHP Commercial |
$52.64
|
| Rate for Payer: PHP Medicare Advantage |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$37.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.60
|
| Rate for Payer: UHC Medicare Advantage |
$37.60
|
| Rate for Payer: UMR Bronson Commercial |
$83.26
|
|
|
PR TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV
|
Professional
|
Both
|
$6,249.00
|
|
|
Service Code
|
HCPCS 61595
|
| Min. Negotiated Rate |
$2,295.10 |
| Max. Negotiated Rate |
$4,061.85 |
| Rate for Payer: Aetna Commercial |
$3,075.43
|
| Rate for Payer: Aetna Medicare |
$2,386.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,304.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.43
|
| Rate for Payer: BCBS Complete |
$2,499.60
|
| Rate for Payer: BCBS MAPPO |
$2,295.10
|
| Rate for Payer: BCN Medicare Advantage |
$2,295.10
|
| Rate for Payer: Cash Price |
$4,999.20
|
| Rate for Payer: Cash Price |
$4,999.20
|
| Rate for Payer: Cofinity Commercial |
$3,304.94
|
| Rate for Payer: Cofinity Commercial |
$3,075.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,295.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,409.86
|
| Rate for Payer: Nomi Health Commercial |
$2,754.12
|
| Rate for Payer: PACE SWMI |
$2,295.10
|
| Rate for Payer: PHP Commercial |
$3,213.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,295.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,061.85
|
| Rate for Payer: Priority Health Medicare |
$2,295.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,295.10
|
| Rate for Payer: UHC Medicare Advantage |
$2,295.10
|
| Rate for Payer: UMR Bronson Commercial |
$2,874.54
|
|
|
PR TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR
|
Professional
|
Both
|
$2,160.00
|
|
|
Service Code
|
HCPCS 50770
|
| Min. Negotiated Rate |
$864.00 |
| Max. Negotiated Rate |
$1,582.73 |
| Rate for Payer: Aetna Commercial |
$1,472.82
|
| Rate for Payer: Aetna Medicare |
$1,143.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.82
|
| Rate for Payer: BCBS Complete |
$864.00
|
| Rate for Payer: BCBS MAPPO |
$1,099.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.12
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cofinity Commercial |
$1,582.73
|
| Rate for Payer: Cofinity Commercial |
$1,472.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,154.08
|
| Rate for Payer: Nomi Health Commercial |
$1,318.94
|
| Rate for Payer: PACE SWMI |
$1,099.12
|
| Rate for Payer: PHP Commercial |
$1,538.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,404.00
|
| Rate for Payer: Priority Health Medicare |
$1,099.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.12
|
| Rate for Payer: UMR Bronson Commercial |
$993.60
|
|
|
PR TRANSURETHRAL INCISION PROSTATE
|
Professional
|
Both
|
$1,465.00
|
|
|
Service Code
|
HCPCS 52450
|
| Min. Negotiated Rate |
$454.40 |
| Max. Negotiated Rate |
$952.25 |
| Rate for Payer: Aetna Commercial |
$608.90
|
| Rate for Payer: Aetna Medicare |
$472.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.90
|
| Rate for Payer: BCBS Complete |
$586.00
|
| Rate for Payer: BCBS MAPPO |
$454.40
|
| Rate for Payer: BCN Medicare Advantage |
$454.40
|
| Rate for Payer: Cash Price |
$1,172.00
|
| Rate for Payer: Cash Price |
$1,172.00
|
| Rate for Payer: Cofinity Commercial |
$654.34
|
| Rate for Payer: Cofinity Commercial |
$608.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$454.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$477.12
|
| Rate for Payer: Nomi Health Commercial |
$545.28
|
| Rate for Payer: PACE SWMI |
$454.40
|
| Rate for Payer: PHP Commercial |
$636.16
|
| Rate for Payer: PHP Medicare Advantage |
$454.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.25
|
| Rate for Payer: Priority Health Medicare |
$454.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$454.40
|
| Rate for Payer: UHC Medicare Advantage |
$454.40
|
| Rate for Payer: UMR Bronson Commercial |
$673.90
|
|
|
PR TRANSURETHRAL RESECTION BLADDER NECK
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
HCPCS 52500
|
| Min. Negotiated Rate |
$471.78 |
| Max. Negotiated Rate |
$1,096.55 |
| Rate for Payer: Aetna Commercial |
$632.19
|
| Rate for Payer: Aetna Medicare |
$490.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$632.19
|
| Rate for Payer: BCBS Complete |
$674.80
|
| Rate for Payer: BCBS MAPPO |
$471.78
|
| Rate for Payer: BCN Medicare Advantage |
$471.78
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cash Price |
$1,349.60
|
| Rate for Payer: Cofinity Commercial |
$679.36
|
| Rate for Payer: Cofinity Commercial |
$632.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$471.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$495.37
|
| Rate for Payer: Nomi Health Commercial |
$566.14
|
| Rate for Payer: PACE SWMI |
$471.78
|
| Rate for Payer: PHP Commercial |
$660.49
|
| Rate for Payer: PHP Medicare Advantage |
$471.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,096.55
|
| Rate for Payer: Priority Health Medicare |
$471.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$471.78
|
| Rate for Payer: UHC Medicare Advantage |
$471.78
|
| Rate for Payer: UMR Bronson Commercial |
$776.02
|
|
|
PR TRANSV AORTIC ARCH GRAFT W BYPASS
|
Professional
|
Both
|
$10,285.00
|
|
|
Service Code
|
HCPCS 33870
|
| Min. Negotiated Rate |
$4,114.00 |
| Max. Negotiated Rate |
$6,685.25 |
| Rate for Payer: Aetna Medicare |
$5,142.50
|
| Rate for Payer: BCBS Complete |
$4,114.00
|
| Rate for Payer: Cash Price |
$8,228.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,685.25
|
| Rate for Payer: UMR Bronson Commercial |
$4,731.10
|
|
|
PR TRANSVRS A-ARCH GRF W/CARD BYP PRFD HYPOTHERMIA
|
Professional
|
Both
|
$5,629.00
|
|
|
Service Code
|
HCPCS 33871
|
| Min. Negotiated Rate |
$2,251.60 |
| Max. Negotiated Rate |
$4,487.05 |
| Rate for Payer: Aetna Commercial |
$4,175.45
|
| Rate for Payer: Aetna Medicare |
$3,240.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,175.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,487.05
|
| Rate for Payer: BCBS Complete |
$2,251.60
|
| Rate for Payer: BCBS MAPPO |
$3,116.01
|
| Rate for Payer: BCN Medicare Advantage |
$3,116.01
|
| Rate for Payer: Cash Price |
$4,503.20
|
| Rate for Payer: Cash Price |
$4,503.20
|
| Rate for Payer: Cofinity Commercial |
$4,175.45
|
| Rate for Payer: Cofinity Commercial |
$4,487.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,116.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.81
|
| Rate for Payer: Nomi Health Commercial |
$3,739.21
|
| Rate for Payer: PACE SWMI |
$3,116.01
|
| Rate for Payer: PHP Commercial |
$4,362.41
|
| Rate for Payer: PHP Medicare Advantage |
$3,116.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,658.85
|
| Rate for Payer: Priority Health Medicare |
$3,116.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,116.01
|
| Rate for Payer: UHC Medicare Advantage |
$3,116.01
|
| Rate for Payer: UMR Bronson Commercial |
$2,589.34
|
|
|
PR TRAY FEE
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 00521
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
PR TREATMENT CLOSED ELBOW DISLOCATION REQ ANES
|
Professional
|
Both
|
$1,312.00
|
|
|
Service Code
|
HCPCS 24605
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$852.80 |
| Rate for Payer: Aetna Commercial |
$619.62
|
| Rate for Payer: Aetna Medicare |
$480.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$619.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$665.86
|
| Rate for Payer: BCBS Complete |
$524.80
|
| Rate for Payer: BCBS MAPPO |
$462.40
|
| Rate for Payer: BCN Medicare Advantage |
$462.40
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cash Price |
$1,049.60
|
| Rate for Payer: Cofinity Commercial |
$619.62
|
| Rate for Payer: Cofinity Commercial |
$665.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$462.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$485.52
|
| Rate for Payer: Nomi Health Commercial |
$554.88
|
| Rate for Payer: PACE SWMI |
$462.40
|
| Rate for Payer: PHP Commercial |
$647.36
|
| Rate for Payer: PHP Medicare Advantage |
$462.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$852.80
|
| Rate for Payer: Priority Health Medicare |
$462.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$462.40
|
| Rate for Payer: UHC Medicare Advantage |
$462.40
|
| Rate for Payer: UMR Bronson Commercial |
$603.52
|
|
|
PR TREATMENT CLOSED ELBOW DISLOCATION W/O ANES
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 24600
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$487.50 |
| Rate for Payer: Aetna Commercial |
$452.63
|
| Rate for Payer: Aetna Medicare |
$351.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$486.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.63
|
| Rate for Payer: BCBS Complete |
$300.00
|
| Rate for Payer: BCBS MAPPO |
$337.78
|
| Rate for Payer: BCN Medicare Advantage |
$337.78
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$452.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$337.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$354.67
|
| Rate for Payer: Nomi Health Commercial |
$405.34
|
| Rate for Payer: PACE SWMI |
$337.78
|
| Rate for Payer: PHP Commercial |
$472.89
|
| Rate for Payer: PHP Medicare Advantage |
$337.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$487.50
|
| Rate for Payer: Priority Health Medicare |
$337.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$337.78
|
| Rate for Payer: UHC Medicare Advantage |
$337.78
|
| Rate for Payer: UMR Bronson Commercial |
$345.00
|
|
|
PR TRIAMCINOLONE ACET INJ NOS
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J3301
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$1.13
|
| Rate for Payer: Aetna Medicare |
$0.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.13
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$0.84
|
| Rate for Payer: BCN Medicare Advantage |
$0.84
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$1.21
|
| Rate for Payer: Cofinity Commercial |
$1.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.88
|
| Rate for Payer: Nomi Health Commercial |
$1.01
|
| Rate for Payer: PACE SWMI |
$0.84
|
| Rate for Payer: PHP Commercial |
$1.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$0.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.84
|
| Rate for Payer: UHC Medicare Advantage |
$0.84
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR TRIMETHOBENZAMIDE HCL INJ
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS J3250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$82.81 |
| Rate for Payer: Aetna Commercial |
$77.06
|
| Rate for Payer: Aetna Medicare |
$59.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.06
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$57.51
|
| Rate for Payer: BCN Medicare Advantage |
$57.51
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$82.81
|
| Rate for Payer: Cofinity Commercial |
$77.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.39
|
| Rate for Payer: Nomi Health Commercial |
$69.01
|
| Rate for Payer: PACE SWMI |
$57.51
|
| Rate for Payer: PHP Commercial |
$80.51
|
| Rate for Payer: PHP Medicare Advantage |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$57.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.51
|
| Rate for Payer: UHC Medicare Advantage |
$57.51
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
|
|
PR TRIMMING NONDYSTROPHIC NAILS ANY NUMBER
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 11719
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Commercial |
$9.46
|
| Rate for Payer: Aetna Medicare |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.17
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$7.06
|
| Rate for Payer: BCN Medicare Advantage |
$7.06
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Cofinity Commercial |
$10.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.41
|
| Rate for Payer: Nomi Health Commercial |
$8.47
|
| Rate for Payer: PACE SWMI |
$7.06
|
| Rate for Payer: PHP Commercial |
$9.88
|
| Rate for Payer: PHP Medicare Advantage |
$7.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$7.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.06
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
