|
PR UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 91299
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR UNLISTED EVALUATION AND MANAGEMENT SERVICE
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 99499
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
|
|
PR UNLISTED PSYCHIATRIC SERVICE/PROCEDURE
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 90899
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 33214
|
| Min. Negotiated Rate |
$397.20 |
| Max. Negotiated Rate |
$654.58 |
| Rate for Payer: Aetna Commercial |
$609.12
|
| Rate for Payer: Aetna Medicare |
$472.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.58
|
| Rate for Payer: BCBS Complete |
$397.20
|
| Rate for Payer: BCBS MAPPO |
$454.57
|
| Rate for Payer: BCN Medicare Advantage |
$454.57
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cofinity Commercial |
$609.12
|
| Rate for Payer: Cofinity Commercial |
$654.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$454.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$477.30
|
| Rate for Payer: Nomi Health Commercial |
$545.48
|
| Rate for Payer: PACE SWMI |
$454.57
|
| Rate for Payer: PHP Commercial |
$636.40
|
| Rate for Payer: PHP Medicare Advantage |
$454.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$645.45
|
| Rate for Payer: Priority Health Medicare |
$454.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$454.57
|
| Rate for Payer: UHC Medicare Advantage |
$454.57
|
| Rate for Payer: UMR Bronson Commercial |
$456.78
|
|
|
PR UPPER EXT FX ORTHOSIS RAD/UL
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS L3982
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$620.27 |
| Rate for Payer: Aetna Commercial |
$577.19
|
| Rate for Payer: Aetna Medicare |
$447.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$620.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.19
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS MAPPO |
$430.74
|
| Rate for Payer: BCN Medicare Advantage |
$430.74
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$620.27
|
| Rate for Payer: Cofinity Commercial |
$577.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$430.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$452.28
|
| Rate for Payer: Nomi Health Commercial |
$516.89
|
| Rate for Payer: PACE SWMI |
$430.74
|
| Rate for Payer: PHP Commercial |
$603.04
|
| Rate for Payer: PHP Medicare Advantage |
$430.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health Medicare |
$430.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$430.74
|
| Rate for Payer: UHC Medicare Advantage |
$430.74
|
| Rate for Payer: UMR Bronson Commercial |
$161.00
|
|
|
PR UPPER EXT FX ORTHOSIS WRIST
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS L3984
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$546.39 |
| Rate for Payer: Aetna Commercial |
$508.45
|
| Rate for Payer: Aetna Medicare |
$394.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.45
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$379.44
|
| Rate for Payer: BCN Medicare Advantage |
$379.44
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$546.39
|
| Rate for Payer: Cofinity Commercial |
$508.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.41
|
| Rate for Payer: Nomi Health Commercial |
$455.33
|
| Rate for Payer: PACE SWMI |
$379.44
|
| Rate for Payer: PHP Commercial |
$531.22
|
| Rate for Payer: PHP Medicare Advantage |
$379.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$379.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.44
|
| Rate for Payer: UHC Medicare Advantage |
$379.44
|
| Rate for Payer: UMR Bronson Commercial |
$141.68
|
|
|
PR UPPER GI ENDOSCOPY,STENT PLACEMENT
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 43256
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$720.85 |
| Rate for Payer: Aetna Medicare |
$554.50
|
| Rate for Payer: BCBS Complete |
$443.60
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: UMR Bronson Commercial |
$510.14
|
|
|
PR UPPER GI ENDOSCOPY,TUMOR ABLATN
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43258
|
| Min. Negotiated Rate |
$488.00 |
| Max. Negotiated Rate |
$793.00 |
| Rate for Payer: Aetna Medicare |
$610.00
|
| Rate for Payer: BCBS Complete |
$488.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.00
|
| Rate for Payer: UMR Bronson Commercial |
$561.20
|
|
|
PR UPPER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 00530
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Medicare |
$918.00
|
| Rate for Payer: BCBS Complete |
$734.40
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,193.40
|
| Rate for Payer: UMR Bronson Commercial |
$844.56
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROSTOMY
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 50951
|
| Min. Negotiated Rate |
$287.20 |
| Max. Negotiated Rate |
$466.70 |
| Rate for Payer: Aetna Commercial |
$389.89
|
| Rate for Payer: Aetna Medicare |
$302.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.89
|
| Rate for Payer: BCBS Complete |
$287.20
|
| Rate for Payer: BCBS MAPPO |
$290.96
|
| Rate for Payer: BCN Medicare Advantage |
$290.96
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cofinity Commercial |
$418.98
|
| Rate for Payer: Cofinity Commercial |
$389.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.51
|
| Rate for Payer: Nomi Health Commercial |
$349.15
|
| Rate for Payer: PACE SWMI |
$290.96
|
| Rate for Payer: PHP Commercial |
$407.34
|
| Rate for Payer: PHP Medicare Advantage |
$290.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.70
|
| Rate for Payer: Priority Health Medicare |
$290.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.96
|
| Rate for Payer: UHC Medicare Advantage |
$290.96
|
| Rate for Payer: UMR Bronson Commercial |
$330.28
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 50961
|
| Min. Negotiated Rate |
$298.93 |
| Max. Negotiated Rate |
$499.85 |
| Rate for Payer: Aetna Commercial |
$400.57
|
| Rate for Payer: Aetna Medicare |
$310.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.57
|
| Rate for Payer: BCBS Complete |
$307.60
|
| Rate for Payer: BCBS MAPPO |
$298.93
|
| Rate for Payer: BCN Medicare Advantage |
$298.93
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$430.46
|
| Rate for Payer: Cofinity Commercial |
$400.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.88
|
| Rate for Payer: Nomi Health Commercial |
$358.72
|
| Rate for Payer: PACE SWMI |
$298.93
|
| Rate for Payer: PHP Commercial |
$418.50
|
| Rate for Payer: PHP Medicare Advantage |
$298.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health Medicare |
$298.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.93
|
| Rate for Payer: UHC Medicare Advantage |
$298.93
|
| Rate for Payer: UMR Bronson Commercial |
$353.74
|
|
|
PR URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS
|
Professional
|
Both
|
$3,457.00
|
|
|
Service Code
|
HCPCS 50820
|
| Min. Negotiated Rate |
$1,253.27 |
| Max. Negotiated Rate |
$2,247.05 |
| Rate for Payer: Aetna Commercial |
$1,679.38
|
| Rate for Payer: Aetna Medicare |
$1,303.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,804.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,679.38
|
| Rate for Payer: BCBS Complete |
$1,382.80
|
| Rate for Payer: BCBS MAPPO |
$1,253.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,253.27
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cofinity Commercial |
$1,804.71
|
| Rate for Payer: Cofinity Commercial |
$1,679.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,253.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,315.93
|
| Rate for Payer: Nomi Health Commercial |
$1,503.92
|
| Rate for Payer: PACE SWMI |
$1,253.27
|
| Rate for Payer: PHP Commercial |
$1,754.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,253.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.05
|
| Rate for Payer: Priority Health Medicare |
$1,253.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,253.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,253.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,590.22
|
|
|
PR URETEROLYSIS FOR OVARIAN VEIN SYNDROME
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 50722
|
| Min. Negotiated Rate |
$979.99 |
| Max. Negotiated Rate |
$1,711.45 |
| Rate for Payer: Aetna Commercial |
$1,313.19
|
| Rate for Payer: Aetna Medicare |
$1,019.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,411.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,313.19
|
| Rate for Payer: BCBS Complete |
$1,053.20
|
| Rate for Payer: BCBS MAPPO |
$979.99
|
| Rate for Payer: BCN Medicare Advantage |
$979.99
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cofinity Commercial |
$1,411.19
|
| Rate for Payer: Cofinity Commercial |
$1,313.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,028.99
|
| Rate for Payer: Nomi Health Commercial |
$1,175.99
|
| Rate for Payer: PACE SWMI |
$979.99
|
| Rate for Payer: PHP Commercial |
$1,371.99
|
| Rate for Payer: PHP Medicare Advantage |
$979.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health Medicare |
$979.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.99
|
| Rate for Payer: UHC Medicare Advantage |
$979.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,211.18
|
|
|
PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 50715
|
| Min. Negotiated Rate |
$908.00 |
| Max. Negotiated Rate |
$1,675.18 |
| Rate for Payer: Aetna Commercial |
$1,558.85
|
| Rate for Payer: Aetna Medicare |
$1,209.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,675.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,558.85
|
| Rate for Payer: BCBS Complete |
$908.00
|
| Rate for Payer: BCBS MAPPO |
$1,163.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,163.32
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cofinity Commercial |
$1,675.18
|
| Rate for Payer: Cofinity Commercial |
$1,558.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,163.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,221.49
|
| Rate for Payer: Nomi Health Commercial |
$1,395.98
|
| Rate for Payer: PACE SWMI |
$1,163.32
|
| Rate for Payer: PHP Commercial |
$1,628.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,163.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.50
|
| Rate for Payer: Priority Health Medicare |
$1,163.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,163.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,163.32
|
| Rate for Payer: UMR Bronson Commercial |
$1,044.20
|
|
|
PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 50780
|
| Min. Negotiated Rate |
$837.20 |
| Max. Negotiated Rate |
$1,535.31 |
| Rate for Payer: Aetna Commercial |
$1,428.69
|
| Rate for Payer: Aetna Medicare |
$1,108.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,535.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,428.69
|
| Rate for Payer: BCBS Complete |
$837.20
|
| Rate for Payer: BCBS MAPPO |
$1,066.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,066.19
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cofinity Commercial |
$1,535.31
|
| Rate for Payer: Cofinity Commercial |
$1,428.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,066.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,119.50
|
| Rate for Payer: Nomi Health Commercial |
$1,279.43
|
| Rate for Payer: PACE SWMI |
$1,066.19
|
| Rate for Payer: PHP Commercial |
$1,492.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,066.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,360.45
|
| Rate for Payer: Priority Health Medicare |
$1,066.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,066.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,066.19
|
| Rate for Payer: UMR Bronson Commercial |
$962.78
|
|
|
PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR
|
Professional
|
Both
|
$2,236.00
|
|
|
Service Code
|
HCPCS 50782
|
| Min. Negotiated Rate |
$894.40 |
| Max. Negotiated Rate |
$1,476.06 |
| Rate for Payer: Aetna Commercial |
$1,373.55
|
| Rate for Payer: Aetna Medicare |
$1,066.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,476.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.55
|
| Rate for Payer: BCBS Complete |
$894.40
|
| Rate for Payer: BCBS MAPPO |
$1,025.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,025.04
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cofinity Commercial |
$1,476.06
|
| Rate for Payer: Cofinity Commercial |
$1,373.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,025.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,076.29
|
| Rate for Payer: Nomi Health Commercial |
$1,230.05
|
| Rate for Payer: PACE SWMI |
$1,025.04
|
| Rate for Payer: PHP Commercial |
$1,435.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,025.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,453.40
|
| Rate for Payer: Priority Health Medicare |
$1,025.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,025.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,025.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,028.56
|
|
|
PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING
|
Professional
|
Both
|
$2,345.00
|
|
|
Service Code
|
HCPCS 50783
|
| Min. Negotiated Rate |
$938.00 |
| Max. Negotiated Rate |
$1,546.08 |
| Rate for Payer: Aetna Commercial |
$1,438.72
|
| Rate for Payer: Aetna Medicare |
$1,116.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,546.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,438.72
|
| Rate for Payer: BCBS Complete |
$938.00
|
| Rate for Payer: BCBS MAPPO |
$1,073.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,073.67
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cofinity Commercial |
$1,546.08
|
| Rate for Payer: Cofinity Commercial |
$1,438.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,073.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,127.35
|
| Rate for Payer: Nomi Health Commercial |
$1,288.40
|
| Rate for Payer: PACE SWMI |
$1,073.67
|
| Rate for Payer: PHP Commercial |
$1,503.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,073.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,524.25
|
| Rate for Payer: Priority Health Medicare |
$1,073.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,073.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,073.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,078.70
|
|
|
PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 50740
|
| Min. Negotiated Rate |
$1,025.20 |
| Max. Negotiated Rate |
$1,716.87 |
| Rate for Payer: Aetna Commercial |
$1,597.64
|
| Rate for Payer: Aetna Medicare |
$1,239.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,597.64
|
| Rate for Payer: BCBS Complete |
$1,025.20
|
| Rate for Payer: BCBS MAPPO |
$1,192.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.27
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cofinity Commercial |
$1,716.87
|
| Rate for Payer: Cofinity Commercial |
$1,597.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.88
|
| Rate for Payer: Nomi Health Commercial |
$1,430.72
|
| Rate for Payer: PACE SWMI |
$1,192.27
|
| Rate for Payer: PHP Commercial |
$1,669.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.95
|
| Rate for Payer: Priority Health Medicare |
$1,192.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,192.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,178.98
|
|
|
PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 50900
|
| Min. Negotiated Rate |
$707.60 |
| Max. Negotiated Rate |
$1,158.72 |
| Rate for Payer: Aetna Commercial |
$1,078.26
|
| Rate for Payer: Aetna Medicare |
$836.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,158.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.26
|
| Rate for Payer: BCBS Complete |
$707.60
|
| Rate for Payer: BCBS MAPPO |
$804.67
|
| Rate for Payer: BCN Medicare Advantage |
$804.67
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cofinity Commercial |
$1,158.72
|
| Rate for Payer: Cofinity Commercial |
$1,078.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$844.90
|
| Rate for Payer: Nomi Health Commercial |
$965.60
|
| Rate for Payer: PACE SWMI |
$804.67
|
| Rate for Payer: PHP Commercial |
$1,126.54
|
| Rate for Payer: PHP Medicare Advantage |
$804.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.85
|
| Rate for Payer: Priority Health Medicare |
$804.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$804.67
|
| Rate for Payer: UHC Medicare Advantage |
$804.67
|
| Rate for Payer: UMR Bronson Commercial |
$813.74
|
|
|
PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 50605
|
| Min. Negotiated Rate |
$813.60 |
| Max. Negotiated Rate |
$1,402.73 |
| Rate for Payer: Aetna Commercial |
$1,305.32
|
| Rate for Payer: Aetna Medicare |
$1,013.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.32
|
| Rate for Payer: BCBS Complete |
$813.60
|
| Rate for Payer: BCBS MAPPO |
$974.12
|
| Rate for Payer: BCN Medicare Advantage |
$974.12
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,402.73
|
| Rate for Payer: Cofinity Commercial |
$1,305.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,022.83
|
| Rate for Payer: Nomi Health Commercial |
$1,168.94
|
| Rate for Payer: PACE SWMI |
$974.12
|
| Rate for Payer: PHP Commercial |
$1,363.77
|
| Rate for Payer: PHP Medicare Advantage |
$974.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health Medicare |
$974.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.12
|
| Rate for Payer: UHC Medicare Advantage |
$974.12
|
| Rate for Payer: UMR Bronson Commercial |
$935.64
|
|
|
PR URETEROURETEROSTOMY
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 50760
|
| Min. Negotiated Rate |
$844.00 |
| Max. Negotiated Rate |
$1,556.99 |
| Rate for Payer: Aetna Commercial |
$1,448.86
|
| Rate for Payer: Aetna Medicare |
$1,124.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,448.86
|
| Rate for Payer: BCBS Complete |
$844.00
|
| Rate for Payer: BCBS MAPPO |
$1,081.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,081.24
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,556.99
|
| Rate for Payer: Cofinity Commercial |
$1,448.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,081.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,135.30
|
| Rate for Payer: Nomi Health Commercial |
$1,297.49
|
| Rate for Payer: PACE SWMI |
$1,081.24
|
| Rate for Payer: PHP Commercial |
$1,513.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,081.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.50
|
| Rate for Payer: Priority Health Medicare |
$1,081.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,081.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.24
|
| Rate for Payer: UMR Bronson Commercial |
$970.60
|
|
|
PR URETHRECTOMY TOT W/CYSTOST MALE
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 53215
|
| Min. Negotiated Rate |
$771.20 |
| Max. Negotiated Rate |
$1,275.49 |
| Rate for Payer: Aetna Commercial |
$1,186.92
|
| Rate for Payer: Aetna Medicare |
$921.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,186.92
|
| Rate for Payer: BCBS Complete |
$771.20
|
| Rate for Payer: BCBS MAPPO |
$885.76
|
| Rate for Payer: BCN Medicare Advantage |
$885.76
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cofinity Commercial |
$1,275.49
|
| Rate for Payer: Cofinity Commercial |
$1,186.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$930.05
|
| Rate for Payer: Nomi Health Commercial |
$1,062.91
|
| Rate for Payer: PACE SWMI |
$885.76
|
| Rate for Payer: PHP Commercial |
$1,240.06
|
| Rate for Payer: PHP Medicare Advantage |
$885.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health Medicare |
$885.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.76
|
| Rate for Payer: UHC Medicare Advantage |
$885.76
|
| Rate for Payer: UMR Bronson Commercial |
$886.88
|
|
|
PR URETHROLSS TRVG SEC OPN W/CSTO
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 53500
|
| Min. Negotiated Rate |
$545.20 |
| Max. Negotiated Rate |
$1,031.70 |
| Rate for Payer: Aetna Commercial |
$960.06
|
| Rate for Payer: Aetna Medicare |
$745.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.70
|
| Rate for Payer: BCBS Complete |
$545.20
|
| Rate for Payer: BCBS MAPPO |
$716.46
|
| Rate for Payer: BCN Medicare Advantage |
$716.46
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$960.06
|
| Rate for Payer: Cofinity Commercial |
$1,031.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.28
|
| Rate for Payer: Nomi Health Commercial |
$859.75
|
| Rate for Payer: PACE SWMI |
$716.46
|
| Rate for Payer: PHP Commercial |
$1,003.04
|
| Rate for Payer: PHP Medicare Advantage |
$716.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health Medicare |
$716.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.46
|
| Rate for Payer: UHC Medicare Advantage |
$716.46
|
| Rate for Payer: UMR Bronson Commercial |
$626.98
|
|
|
PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 53450
|
| Min. Negotiated Rate |
$309.60 |
| Max. Negotiated Rate |
$564.67 |
| Rate for Payer: Aetna Commercial |
$525.45
|
| Rate for Payer: Aetna Medicare |
$407.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.45
|
| Rate for Payer: BCBS Complete |
$309.60
|
| Rate for Payer: BCBS MAPPO |
$392.13
|
| Rate for Payer: BCN Medicare Advantage |
$392.13
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$564.67
|
| Rate for Payer: Cofinity Commercial |
$525.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.74
|
| Rate for Payer: Nomi Health Commercial |
$470.56
|
| Rate for Payer: PACE SWMI |
$392.13
|
| Rate for Payer: PHP Commercial |
$548.98
|
| Rate for Payer: PHP Medicare Advantage |
$392.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.10
|
| Rate for Payer: Priority Health Medicare |
$392.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.13
|
| Rate for Payer: UHC Medicare Advantage |
$392.13
|
| Rate for Payer: UMR Bronson Commercial |
$356.04
|
|
|
PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 53460
|
| Min. Negotiated Rate |
$437.65 |
| Max. Negotiated Rate |
$1,023.75 |
| Rate for Payer: Aetna Commercial |
$586.45
|
| Rate for Payer: Aetna Medicare |
$455.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.45
|
| Rate for Payer: BCBS Complete |
$630.00
|
| Rate for Payer: BCBS MAPPO |
$437.65
|
| Rate for Payer: BCN Medicare Advantage |
$437.65
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cofinity Commercial |
$630.22
|
| Rate for Payer: Cofinity Commercial |
$586.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$437.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$459.53
|
| Rate for Payer: Nomi Health Commercial |
$525.18
|
| Rate for Payer: PACE SWMI |
$437.65
|
| Rate for Payer: PHP Commercial |
$612.71
|
| Rate for Payer: PHP Medicare Advantage |
$437.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.75
|
| Rate for Payer: Priority Health Medicare |
$437.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$437.65
|
| Rate for Payer: UHC Medicare Advantage |
$437.65
|
| Rate for Payer: UMR Bronson Commercial |
$724.50
|
|
