|
PR TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 52630
|
| Min. Negotiated Rate |
$315.60 |
| Max. Negotiated Rate |
$559.27 |
| Rate for Payer: Aetna Commercial |
$520.43
|
| Rate for Payer: Aetna Medicare |
$403.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.43
|
| Rate for Payer: BCBS Complete |
$315.60
|
| Rate for Payer: BCBS MAPPO |
$388.38
|
| Rate for Payer: BCN Medicare Advantage |
$388.38
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$559.27
|
| Rate for Payer: Cofinity Commercial |
$520.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.80
|
| Rate for Payer: Nomi Health Commercial |
$466.06
|
| Rate for Payer: PACE SWMI |
$388.38
|
| Rate for Payer: PHP Commercial |
$543.73
|
| Rate for Payer: PHP Medicare Advantage |
$388.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health Medicare |
$388.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$388.38
|
| Rate for Payer: UHC Medicare Advantage |
$388.38
|
| Rate for Payer: UMR Bronson Commercial |
$362.94
|
|
|
PR TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 95921
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$114.12 |
| Rate for Payer: Aetna Commercial |
$106.19
|
| Rate for Payer: Aetna Medicare |
$82.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.19
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: BCBS MAPPO |
$79.25
|
| Rate for Payer: BCN Medicare Advantage |
$79.25
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$114.12
|
| Rate for Payer: Cofinity Commercial |
$106.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.21
|
| Rate for Payer: Nomi Health Commercial |
$95.10
|
| Rate for Payer: PACE SWMI |
$79.25
|
| Rate for Payer: PHP Commercial |
$110.95
|
| Rate for Payer: PHP Medicare Advantage |
$79.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$79.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.25
|
| Rate for Payer: UHC Medicare Advantage |
$79.25
|
| Rate for Payer: UMR Bronson Commercial |
$70.84
|
|
|
PR TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 95924
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$195.52 |
| Rate for Payer: Aetna Commercial |
$181.95
|
| Rate for Payer: Aetna Medicare |
$141.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.95
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$135.78
|
| Rate for Payer: BCN Medicare Advantage |
$135.78
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$181.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.57
|
| Rate for Payer: Nomi Health Commercial |
$162.94
|
| Rate for Payer: PACE SWMI |
$135.78
|
| Rate for Payer: PHP Commercial |
$190.09
|
| Rate for Payer: PHP Medicare Advantage |
$135.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$135.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.78
|
| Rate for Payer: UHC Medicare Advantage |
$135.78
|
| Rate for Payer: UMR Bronson Commercial |
$83.26
|
|
|
PR TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 95922
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$120.25 |
| Rate for Payer: Aetna Commercial |
$109.42
|
| Rate for Payer: Aetna Medicare |
$84.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.42
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS MAPPO |
$81.66
|
| Rate for Payer: BCN Medicare Advantage |
$81.66
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$117.59
|
| Rate for Payer: Cofinity Commercial |
$109.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.74
|
| Rate for Payer: Nomi Health Commercial |
$97.99
|
| Rate for Payer: PACE SWMI |
$81.66
|
| Rate for Payer: PHP Commercial |
$114.32
|
| Rate for Payer: PHP Medicare Advantage |
$81.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| Rate for Payer: Priority Health Medicare |
$81.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.66
|
| Rate for Payer: UHC Medicare Advantage |
$81.66
|
| Rate for Payer: UMR Bronson Commercial |
$85.10
|
|
|
PR TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 31730
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$207.96 |
| Rate for Payer: Aetna Commercial |
$193.52
|
| Rate for Payer: Aetna Medicare |
$150.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.52
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS MAPPO |
$144.42
|
| Rate for Payer: BCN Medicare Advantage |
$144.42
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$207.96
|
| Rate for Payer: Cofinity Commercial |
$193.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.64
|
| Rate for Payer: Nomi Health Commercial |
$173.30
|
| Rate for Payer: PACE SWMI |
$144.42
|
| Rate for Payer: PHP Commercial |
$202.19
|
| Rate for Payer: PHP Medicare Advantage |
$144.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health Medicare |
$144.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.42
|
| Rate for Payer: UHC Medicare Advantage |
$144.42
|
| Rate for Payer: UMR Bronson Commercial |
$140.30
|
|
|
PR TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 44015
|
| Min. Negotiated Rate |
$136.65 |
| Max. Negotiated Rate |
$807.95 |
| Rate for Payer: Aetna Commercial |
$183.11
|
| Rate for Payer: Aetna Medicare |
$142.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.11
|
| Rate for Payer: BCBS Complete |
$497.20
|
| Rate for Payer: BCBS MAPPO |
$136.65
|
| Rate for Payer: BCN Medicare Advantage |
$136.65
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cofinity Commercial |
$196.78
|
| Rate for Payer: Cofinity Commercial |
$183.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.48
|
| Rate for Payer: Nomi Health Commercial |
$163.98
|
| Rate for Payer: PACE SWMI |
$136.65
|
| Rate for Payer: PHP Commercial |
$191.31
|
| Rate for Payer: PHP Medicare Advantage |
$136.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health Medicare |
$136.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.65
|
| Rate for Payer: UHC Medicare Advantage |
$136.65
|
| Rate for Payer: UMR Bronson Commercial |
$571.78
|
|
|
PR TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 32551
|
| Min. Negotiated Rate |
$149.09 |
| Max. Negotiated Rate |
$391.30 |
| Rate for Payer: Aetna Commercial |
$199.78
|
| Rate for Payer: Aetna Medicare |
$155.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.78
|
| Rate for Payer: BCBS Complete |
$240.80
|
| Rate for Payer: BCBS MAPPO |
$149.09
|
| Rate for Payer: BCN Medicare Advantage |
$149.09
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cofinity Commercial |
$214.69
|
| Rate for Payer: Cofinity Commercial |
$199.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.54
|
| Rate for Payer: Nomi Health Commercial |
$178.91
|
| Rate for Payer: PACE SWMI |
$149.09
|
| Rate for Payer: PHP Commercial |
$208.73
|
| Rate for Payer: PHP Medicare Advantage |
$149.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.30
|
| Rate for Payer: Priority Health Medicare |
$149.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.09
|
| Rate for Payer: UHC Medicare Advantage |
$149.09
|
| Rate for Payer: UMR Bronson Commercial |
$276.92
|
|
|
PR TUBOTUBAL ANASTATOMOSIS
|
Professional
|
Both
|
$1,653.00
|
|
|
Service Code
|
HCPCS 58750
|
| Min. Negotiated Rate |
$661.20 |
| Max. Negotiated Rate |
$1,258.33 |
| Rate for Payer: Aetna Commercial |
$1,170.95
|
| Rate for Payer: Aetna Medicare |
$908.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.95
|
| Rate for Payer: BCBS Complete |
$661.20
|
| Rate for Payer: BCBS MAPPO |
$873.84
|
| Rate for Payer: BCN Medicare Advantage |
$873.84
|
| Rate for Payer: Cash Price |
$1,322.40
|
| Rate for Payer: Cash Price |
$1,322.40
|
| Rate for Payer: Cofinity Commercial |
$1,258.33
|
| Rate for Payer: Cofinity Commercial |
$1,170.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.53
|
| Rate for Payer: Nomi Health Commercial |
$1,048.61
|
| Rate for Payer: PACE SWMI |
$873.84
|
| Rate for Payer: PHP Commercial |
$1,223.38
|
| Rate for Payer: PHP Medicare Advantage |
$873.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,074.45
|
| Rate for Payer: Priority Health Medicare |
$873.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$873.84
|
| Rate for Payer: UHC Medicare Advantage |
$873.84
|
| Rate for Payer: UMR Bronson Commercial |
$760.38
|
|
|
PR TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA
|
Professional
|
Both
|
$3,910.00
|
|
|
Service Code
|
HCPCS 61108
|
| Min. Negotiated Rate |
$895.06 |
| Max. Negotiated Rate |
$2,541.50 |
| Rate for Payer: Aetna Commercial |
$1,199.38
|
| Rate for Payer: Aetna Medicare |
$930.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,288.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,199.38
|
| Rate for Payer: BCBS Complete |
$1,564.00
|
| Rate for Payer: BCBS MAPPO |
$895.06
|
| Rate for Payer: BCN Medicare Advantage |
$895.06
|
| Rate for Payer: Cash Price |
$3,128.00
|
| Rate for Payer: Cash Price |
$3,128.00
|
| Rate for Payer: Cofinity Commercial |
$1,288.89
|
| Rate for Payer: Cofinity Commercial |
$1,199.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$895.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$939.81
|
| Rate for Payer: Nomi Health Commercial |
$1,074.07
|
| Rate for Payer: PACE SWMI |
$895.06
|
| Rate for Payer: PHP Commercial |
$1,253.08
|
| Rate for Payer: PHP Medicare Advantage |
$895.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,541.50
|
| Rate for Payer: Priority Health Medicare |
$895.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$895.06
|
| Rate for Payer: UHC Medicare Advantage |
$895.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,798.60
|
|
|
PR TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE
|
Professional
|
Both
|
$2,479.00
|
|
|
Service Code
|
HCPCS 61107
|
| Min. Negotiated Rate |
$309.66 |
| Max. Negotiated Rate |
$1,611.35 |
| Rate for Payer: Aetna Commercial |
$414.94
|
| Rate for Payer: Aetna Medicare |
$322.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.94
|
| Rate for Payer: BCBS Complete |
$991.60
|
| Rate for Payer: BCBS MAPPO |
$309.66
|
| Rate for Payer: BCN Medicare Advantage |
$309.66
|
| Rate for Payer: Cash Price |
$1,983.20
|
| Rate for Payer: Cash Price |
$1,983.20
|
| Rate for Payer: Cofinity Commercial |
$445.91
|
| Rate for Payer: Cofinity Commercial |
$414.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.14
|
| Rate for Payer: Nomi Health Commercial |
$371.59
|
| Rate for Payer: PACE SWMI |
$309.66
|
| Rate for Payer: PHP Commercial |
$433.52
|
| Rate for Payer: PHP Medicare Advantage |
$309.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,611.35
|
| Rate for Payer: Priority Health Medicare |
$309.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.66
|
| Rate for Payer: UHC Medicare Advantage |
$309.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,140.34
|
|
|
PR TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE
|
Professional
|
Both
|
$2,149.00
|
|
|
Service Code
|
HCPCS 61105
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,396.85 |
| Rate for Payer: Aetna Commercial |
$615.86
|
| Rate for Payer: Aetna Medicare |
$477.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.86
|
| Rate for Payer: BCBS Complete |
$859.60
|
| Rate for Payer: BCBS MAPPO |
$459.60
|
| Rate for Payer: BCN Medicare Advantage |
$459.60
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cash Price |
$1,719.20
|
| Rate for Payer: Cofinity Commercial |
$661.82
|
| Rate for Payer: Cofinity Commercial |
$615.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.58
|
| Rate for Payer: Nomi Health Commercial |
$551.52
|
| Rate for Payer: PACE SWMI |
$459.60
|
| Rate for Payer: PHP Commercial |
$643.44
|
| Rate for Payer: PHP Medicare Advantage |
$459.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,396.85
|
| Rate for Payer: Priority Health Medicare |
$459.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.60
|
| Rate for Payer: UHC Medicare Advantage |
$459.60
|
| Rate for Payer: UMR Bronson Commercial |
$988.54
|
|
|
PR TWO AREA LIPOSUCTION - 2 AREA 2.0 HR
|
Professional
|
Both
|
$2,754.00
|
|
|
Service Code
|
HCPCS 00528
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,101.60 |
| Max. Negotiated Rate |
$1,790.10 |
| Rate for Payer: Aetna Medicare |
$1,377.00
|
| Rate for Payer: BCBS Complete |
$1,101.60
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,790.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,266.84
|
|
|
PR TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON
|
Professional
|
Both
|
$1,465.00
|
|
|
Service Code
|
HCPCS 46280
|
| Min. Negotiated Rate |
$460.26 |
| Max. Negotiated Rate |
$952.25 |
| Rate for Payer: Aetna Commercial |
$616.75
|
| Rate for Payer: Aetna Medicare |
$478.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.77
|
| Rate for Payer: BCBS Complete |
$586.00
|
| Rate for Payer: BCBS MAPPO |
$460.26
|
| Rate for Payer: BCN Medicare Advantage |
$460.26
|
| Rate for Payer: Cash Price |
$1,172.00
|
| Rate for Payer: Cash Price |
$1,172.00
|
| Rate for Payer: Cofinity Commercial |
$616.75
|
| Rate for Payer: Cofinity Commercial |
$662.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.27
|
| Rate for Payer: Nomi Health Commercial |
$552.31
|
| Rate for Payer: PACE SWMI |
$460.26
|
| Rate for Payer: PHP Commercial |
$644.36
|
| Rate for Payer: PHP Medicare Advantage |
$460.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$952.25
|
| Rate for Payer: Priority Health Medicare |
$460.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$460.26
|
| Rate for Payer: UHC Medicare Advantage |
$460.26
|
| Rate for Payer: UMR Bronson Commercial |
$673.90
|
|
|
PR TX ECTOPIC PREGNANCY ABDL PREGNANCY
|
Professional
|
Both
|
$1,505.00
|
|
|
Service Code
|
HCPCS 59130
|
| Min. Negotiated Rate |
$602.00 |
| Max. Negotiated Rate |
$1,333.45 |
| Rate for Payer: Aetna Commercial |
$1,240.85
|
| Rate for Payer: Aetna Medicare |
$963.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,333.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,240.85
|
| Rate for Payer: BCBS Complete |
$602.00
|
| Rate for Payer: BCBS MAPPO |
$926.01
|
| Rate for Payer: BCN Medicare Advantage |
$926.01
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cash Price |
$1,204.00
|
| Rate for Payer: Cofinity Commercial |
$1,333.45
|
| Rate for Payer: Cofinity Commercial |
$1,240.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$926.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$972.31
|
| Rate for Payer: Nomi Health Commercial |
$1,111.21
|
| Rate for Payer: PACE SWMI |
$926.01
|
| Rate for Payer: PHP Commercial |
$1,296.41
|
| Rate for Payer: PHP Medicare Advantage |
$926.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$978.25
|
| Rate for Payer: Priority Health Medicare |
$926.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$926.01
|
| Rate for Payer: UHC Medicare Advantage |
$926.01
|
| Rate for Payer: UMR Bronson Commercial |
$692.30
|
|
|
PR TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR
|
Professional
|
Both
|
$1,729.00
|
|
|
Service Code
|
HCPCS 59120
|
| Min. Negotiated Rate |
$691.60 |
| Max. Negotiated Rate |
$1,146.64 |
| Rate for Payer: Aetna Commercial |
$1,067.02
|
| Rate for Payer: Aetna Medicare |
$828.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,146.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,067.02
|
| Rate for Payer: BCBS Complete |
$691.60
|
| Rate for Payer: BCBS MAPPO |
$796.28
|
| Rate for Payer: BCN Medicare Advantage |
$796.28
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cash Price |
$1,383.20
|
| Rate for Payer: Cofinity Commercial |
$1,146.64
|
| Rate for Payer: Cofinity Commercial |
$1,067.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.09
|
| Rate for Payer: Nomi Health Commercial |
$955.54
|
| Rate for Payer: PACE SWMI |
$796.28
|
| Rate for Payer: PHP Commercial |
$1,114.79
|
| Rate for Payer: PHP Medicare Advantage |
$796.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,123.85
|
| Rate for Payer: Priority Health Medicare |
$796.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.28
|
| Rate for Payer: UHC Medicare Advantage |
$796.28
|
| Rate for Payer: UMR Bronson Commercial |
$795.34
|
|
|
PR TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 59136
|
| Min. Negotiated Rate |
$726.80 |
| Max. Negotiated Rate |
$1,265.80 |
| Rate for Payer: Aetna Commercial |
$1,177.90
|
| Rate for Payer: Aetna Medicare |
$914.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,265.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,177.90
|
| Rate for Payer: BCBS Complete |
$726.80
|
| Rate for Payer: BCBS MAPPO |
$879.03
|
| Rate for Payer: BCN Medicare Advantage |
$879.03
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cofinity Commercial |
$1,265.80
|
| Rate for Payer: Cofinity Commercial |
$1,177.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$879.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$922.98
|
| Rate for Payer: Nomi Health Commercial |
$1,054.84
|
| Rate for Payer: PACE SWMI |
$879.03
|
| Rate for Payer: PHP Commercial |
$1,230.64
|
| Rate for Payer: PHP Medicare Advantage |
$879.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,181.05
|
| Rate for Payer: Priority Health Medicare |
$879.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$879.03
|
| Rate for Payer: UHC Medicare Advantage |
$879.03
|
| Rate for Payer: UMR Bronson Commercial |
$835.82
|
|
|
PR TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY
|
Professional
|
Both
|
$1,467.00
|
|
|
Service Code
|
HCPCS 59121
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$1,147.61 |
| Rate for Payer: Aetna Commercial |
$1,067.91
|
| Rate for Payer: Aetna Medicare |
$828.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,147.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,067.91
|
| Rate for Payer: BCBS Complete |
$586.80
|
| Rate for Payer: BCBS MAPPO |
$796.95
|
| Rate for Payer: BCN Medicare Advantage |
$796.95
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cofinity Commercial |
$1,147.61
|
| Rate for Payer: Cofinity Commercial |
$1,067.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$796.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$836.80
|
| Rate for Payer: Nomi Health Commercial |
$956.34
|
| Rate for Payer: PACE SWMI |
$796.95
|
| Rate for Payer: PHP Commercial |
$1,115.73
|
| Rate for Payer: PHP Medicare Advantage |
$796.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.55
|
| Rate for Payer: Priority Health Medicare |
$796.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$796.95
|
| Rate for Payer: UHC Medicare Advantage |
$796.95
|
| Rate for Payer: UMR Bronson Commercial |
$674.82
|
|
|
PR TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE
|
Professional
|
Both
|
$3,514.00
|
|
|
Service Code
|
HCPCS 24516
|
| Min. Negotiated Rate |
$828.71 |
| Max. Negotiated Rate |
$2,284.10 |
| Rate for Payer: Aetna Commercial |
$1,110.47
|
| Rate for Payer: Aetna Medicare |
$861.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,110.47
|
| Rate for Payer: BCBS Complete |
$1,405.60
|
| Rate for Payer: BCBS MAPPO |
$828.71
|
| Rate for Payer: BCN Medicare Advantage |
$828.71
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cash Price |
$2,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,193.34
|
| Rate for Payer: Cofinity Commercial |
$1,110.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$828.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$870.15
|
| Rate for Payer: Nomi Health Commercial |
$994.45
|
| Rate for Payer: PACE SWMI |
$828.71
|
| Rate for Payer: PHP Commercial |
$1,160.19
|
| Rate for Payer: PHP Medicare Advantage |
$828.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,284.10
|
| Rate for Payer: Priority Health Medicare |
$828.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$828.71
|
| Rate for Payer: UHC Medicare Advantage |
$828.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,616.44
|
|
|
PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL
|
Professional
|
Both
|
$765.00
|
|
|
Service Code
|
HCPCS 59812
|
| Min. Negotiated Rate |
$299.07 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Aetna Commercial |
$400.75
|
| Rate for Payer: Aetna Medicare |
$311.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.75
|
| Rate for Payer: BCBS Complete |
$306.00
|
| Rate for Payer: BCBS MAPPO |
$299.07
|
| Rate for Payer: BCN Medicare Advantage |
$299.07
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Cofinity Commercial |
$430.66
|
| Rate for Payer: Cofinity Commercial |
$400.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.02
|
| Rate for Payer: Nomi Health Commercial |
$358.88
|
| Rate for Payer: PACE SWMI |
$299.07
|
| Rate for Payer: PHP Commercial |
$418.70
|
| Rate for Payer: PHP Medicare Advantage |
$299.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$497.25
|
| Rate for Payer: Priority Health Medicare |
$299.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$299.07
|
| Rate for Payer: UHC Medicare Advantage |
$299.07
|
| Rate for Payer: UMR Bronson Commercial |
$351.90
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW
|
Professional
|
Both
|
$4,106.00
|
|
|
Service Code
|
HCPCS 27245
|
| Min. Negotiated Rate |
$1,181.03 |
| Max. Negotiated Rate |
$2,668.90 |
| Rate for Payer: Aetna Commercial |
$1,582.58
|
| Rate for Payer: Aetna Medicare |
$1,228.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,700.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.58
|
| Rate for Payer: BCBS Complete |
$1,642.40
|
| Rate for Payer: BCBS MAPPO |
$1,181.03
|
| Rate for Payer: BCN Medicare Advantage |
$1,181.03
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cash Price |
$3,284.80
|
| Rate for Payer: Cofinity Commercial |
$1,700.68
|
| Rate for Payer: Cofinity Commercial |
$1,582.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,181.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,240.08
|
| Rate for Payer: Nomi Health Commercial |
$1,417.24
|
| Rate for Payer: PACE SWMI |
$1,181.03
|
| Rate for Payer: PHP Commercial |
$1,653.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,181.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,668.90
|
| Rate for Payer: Priority Health Medicare |
$1,181.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,181.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,181.03
|
| Rate for Payer: UMR Bronson Commercial |
$1,888.76
|
|
|
PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 27244
|
| Min. Negotiated Rate |
$1,182.67 |
| Max. Negotiated Rate |
$2,256.15 |
| Rate for Payer: Aetna Commercial |
$1,584.78
|
| Rate for Payer: Aetna Medicare |
$1,229.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,703.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,584.78
|
| Rate for Payer: BCBS Complete |
$1,388.40
|
| Rate for Payer: BCBS MAPPO |
$1,182.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,182.67
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$1,703.04
|
| Rate for Payer: Cofinity Commercial |
$1,584.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,182.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,241.80
|
| Rate for Payer: Nomi Health Commercial |
$1,419.20
|
| Rate for Payer: PACE SWMI |
$1,182.67
|
| Rate for Payer: PHP Commercial |
$1,655.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,182.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health Medicare |
$1,182.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,182.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,182.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,596.66
|
|
|
PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59820
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$535.75 |
| Rate for Payer: Aetna Commercial |
$498.55
|
| Rate for Payer: Aetna Medicare |
$386.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.55
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$372.05
|
| Rate for Payer: BCN Medicare Advantage |
$372.05
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$535.75
|
| Rate for Payer: Cofinity Commercial |
$498.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$372.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.65
|
| Rate for Payer: Nomi Health Commercial |
$446.46
|
| Rate for Payer: PACE SWMI |
$372.05
|
| Rate for Payer: PHP Commercial |
$520.87
|
| Rate for Payer: PHP Medicare Advantage |
$372.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$372.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$372.05
|
| Rate for Payer: UHC Medicare Advantage |
$372.05
|
| Rate for Payer: UMR Bronson Commercial |
$375.36
|
|
|
PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 59821
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Commercial |
$489.76
|
| Rate for Payer: Aetna Medicare |
$380.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.76
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$365.49
|
| Rate for Payer: BCN Medicare Advantage |
$365.49
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$526.31
|
| Rate for Payer: Cofinity Commercial |
$489.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$365.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$383.76
|
| Rate for Payer: Nomi Health Commercial |
$438.59
|
| Rate for Payer: PACE SWMI |
$365.49
|
| Rate for Payer: PHP Commercial |
$511.69
|
| Rate for Payer: PHP Medicare Advantage |
$365.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$365.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$365.49
|
| Rate for Payer: UHC Medicare Advantage |
$365.49
|
| Rate for Payer: UMR Bronson Commercial |
$375.36
|
|
|
PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 28232
|
| Min. Negotiated Rate |
$229.53 |
| Max. Negotiated Rate |
$412.75 |
| Rate for Payer: Aetna Commercial |
$307.57
|
| Rate for Payer: Aetna Medicare |
$238.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.57
|
| Rate for Payer: BCBS Complete |
$254.00
|
| Rate for Payer: BCBS MAPPO |
$229.53
|
| Rate for Payer: BCN Medicare Advantage |
$229.53
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cofinity Commercial |
$330.52
|
| Rate for Payer: Cofinity Commercial |
$307.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.01
|
| Rate for Payer: Nomi Health Commercial |
$275.44
|
| Rate for Payer: PACE SWMI |
$229.53
|
| Rate for Payer: PHP Commercial |
$321.34
|
| Rate for Payer: PHP Medicare Advantage |
$229.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$412.75
|
| Rate for Payer: Priority Health Medicare |
$229.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.53
|
| Rate for Payer: UHC Medicare Advantage |
$229.53
|
| Rate for Payer: UMR Bronson Commercial |
$292.10
|
|
|
PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
HCPCS 28230
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$403.65 |
| Rate for Payer: Aetna Commercial |
$366.42
|
| Rate for Payer: Aetna Medicare |
$284.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.42
|
| Rate for Payer: BCBS Complete |
$248.40
|
| Rate for Payer: BCBS MAPPO |
$273.45
|
| Rate for Payer: BCN Medicare Advantage |
$273.45
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cash Price |
$496.80
|
| Rate for Payer: Cofinity Commercial |
$393.77
|
| Rate for Payer: Cofinity Commercial |
$366.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.12
|
| Rate for Payer: Nomi Health Commercial |
$328.14
|
| Rate for Payer: PACE SWMI |
$273.45
|
| Rate for Payer: PHP Commercial |
$382.83
|
| Rate for Payer: PHP Medicare Advantage |
$273.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.65
|
| Rate for Payer: Priority Health Medicare |
$273.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.45
|
| Rate for Payer: UHC Medicare Advantage |
$273.45
|
| Rate for Payer: UMR Bronson Commercial |
$285.66
|
|
