|
PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 53410
|
| Min. Negotiated Rate |
$813.20 |
| Max. Negotiated Rate |
$1,344.83 |
| Rate for Payer: Aetna Commercial |
$1,251.44
|
| Rate for Payer: Aetna Medicare |
$971.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.44
|
| Rate for Payer: BCBS Complete |
$813.20
|
| Rate for Payer: BCBS MAPPO |
$933.91
|
| Rate for Payer: BCN Medicare Advantage |
$933.91
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,344.83
|
| Rate for Payer: Cofinity Commercial |
$1,251.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.61
|
| Rate for Payer: Nomi Health Commercial |
$1,120.69
|
| Rate for Payer: PACE SWMI |
$933.91
|
| Rate for Payer: PHP Commercial |
$1,307.47
|
| Rate for Payer: PHP Medicare Advantage |
$933.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.45
|
| Rate for Payer: Priority Health Medicare |
$933.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.91
|
| Rate for Payer: UHC Medicare Advantage |
$933.91
|
| Rate for Payer: UMR Bronson Commercial |
$935.18
|
|
|
PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 53400
|
| Min. Negotiated Rate |
$609.60 |
| Max. Negotiated Rate |
$1,103.00 |
| Rate for Payer: Aetna Commercial |
$1,026.40
|
| Rate for Payer: Aetna Medicare |
$796.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.40
|
| Rate for Payer: BCBS Complete |
$609.60
|
| Rate for Payer: BCBS MAPPO |
$765.97
|
| Rate for Payer: BCN Medicare Advantage |
$765.97
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,103.00
|
| Rate for Payer: Cofinity Commercial |
$1,026.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.27
|
| Rate for Payer: Nomi Health Commercial |
$919.16
|
| Rate for Payer: PACE SWMI |
$765.97
|
| Rate for Payer: PHP Commercial |
$1,072.36
|
| Rate for Payer: PHP Medicare Advantage |
$765.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health Medicare |
$765.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.97
|
| Rate for Payer: UHC Medicare Advantage |
$765.97
|
| Rate for Payer: UMR Bronson Commercial |
$701.04
|
|
|
PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 53405
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$1,201.13 |
| Rate for Payer: Aetna Commercial |
$1,117.72
|
| Rate for Payer: Aetna Medicare |
$867.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,201.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,117.72
|
| Rate for Payer: BCBS Complete |
$725.60
|
| Rate for Payer: BCBS MAPPO |
$834.12
|
| Rate for Payer: BCN Medicare Advantage |
$834.12
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cofinity Commercial |
$1,201.13
|
| Rate for Payer: Cofinity Commercial |
$1,117.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$834.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$875.83
|
| Rate for Payer: Nomi Health Commercial |
$1,000.94
|
| Rate for Payer: PACE SWMI |
$834.12
|
| Rate for Payer: PHP Commercial |
$1,167.77
|
| Rate for Payer: PHP Medicare Advantage |
$834.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health Medicare |
$834.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$834.12
|
| Rate for Payer: UHC Medicare Advantage |
$834.12
|
| Rate for Payer: UMR Bronson Commercial |
$834.44
|
|
|
PR URETHROPLASTY RCNSTJ FEMALE URETHRA
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS 53430
|
| Min. Negotiated Rate |
$705.60 |
| Max. Negotiated Rate |
$1,340.65 |
| Rate for Payer: Aetna Commercial |
$1,247.55
|
| Rate for Payer: Aetna Medicare |
$968.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,340.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.55
|
| Rate for Payer: BCBS Complete |
$705.60
|
| Rate for Payer: BCBS MAPPO |
$931.01
|
| Rate for Payer: BCN Medicare Advantage |
$931.01
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cofinity Commercial |
$1,340.65
|
| Rate for Payer: Cofinity Commercial |
$1,247.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.56
|
| Rate for Payer: Nomi Health Commercial |
$1,117.21
|
| Rate for Payer: PACE SWMI |
$931.01
|
| Rate for Payer: PHP Commercial |
$1,303.41
|
| Rate for Payer: PHP Medicare Advantage |
$931.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,146.60
|
| Rate for Payer: Priority Health Medicare |
$931.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.01
|
| Rate for Payer: UHC Medicare Advantage |
$931.01
|
| Rate for Payer: UMR Bronson Commercial |
$811.44
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
HCPCS 53502
|
| Min. Negotiated Rate |
$390.80 |
| Max. Negotiated Rate |
$670.77 |
| Rate for Payer: Aetna Commercial |
$624.19
|
| Rate for Payer: Aetna Medicare |
$484.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.19
|
| Rate for Payer: BCBS Complete |
$390.80
|
| Rate for Payer: BCBS MAPPO |
$465.81
|
| Rate for Payer: BCN Medicare Advantage |
$465.81
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cofinity Commercial |
$670.77
|
| Rate for Payer: Cofinity Commercial |
$624.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.10
|
| Rate for Payer: Nomi Health Commercial |
$558.97
|
| Rate for Payer: PACE SWMI |
$465.81
|
| Rate for Payer: PHP Commercial |
$652.13
|
| Rate for Payer: PHP Medicare Advantage |
$465.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.05
|
| Rate for Payer: Priority Health Medicare |
$465.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.81
|
| Rate for Payer: UHC Medicare Advantage |
$465.81
|
| Rate for Payer: UMR Bronson Commercial |
$449.42
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 53505
|
| Min. Negotiated Rate |
$369.20 |
| Max. Negotiated Rate |
$670.33 |
| Rate for Payer: Aetna Commercial |
$623.78
|
| Rate for Payer: Aetna Medicare |
$484.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.78
|
| Rate for Payer: BCBS Complete |
$369.20
|
| Rate for Payer: BCBS MAPPO |
$465.51
|
| Rate for Payer: BCN Medicare Advantage |
$465.51
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$670.33
|
| Rate for Payer: Cofinity Commercial |
$623.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.79
|
| Rate for Payer: Nomi Health Commercial |
$558.61
|
| Rate for Payer: PACE SWMI |
$465.51
|
| Rate for Payer: PHP Commercial |
$651.71
|
| Rate for Payer: PHP Medicare Advantage |
$465.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.95
|
| Rate for Payer: Priority Health Medicare |
$465.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.51
|
| Rate for Payer: UHC Medicare Advantage |
$465.51
|
| Rate for Payer: UMR Bronson Commercial |
$424.58
|
|
|
PR URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 53010
|
| Min. Negotiated Rate |
$221.20 |
| Max. Negotiated Rate |
$409.61 |
| Rate for Payer: Aetna Commercial |
$381.16
|
| Rate for Payer: Aetna Medicare |
$295.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.16
|
| Rate for Payer: BCBS Complete |
$221.20
|
| Rate for Payer: BCBS MAPPO |
$284.45
|
| Rate for Payer: BCN Medicare Advantage |
$284.45
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cofinity Commercial |
$409.61
|
| Rate for Payer: Cofinity Commercial |
$381.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.67
|
| Rate for Payer: Nomi Health Commercial |
$341.34
|
| Rate for Payer: PACE SWMI |
$284.45
|
| Rate for Payer: PHP Commercial |
$398.23
|
| Rate for Payer: PHP Medicare Advantage |
$284.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.45
|
| Rate for Payer: Priority Health Medicare |
$284.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.45
|
| Rate for Payer: UHC Medicare Advantage |
$284.45
|
| Rate for Payer: UMR Bronson Commercial |
$254.38
|
|
|
PR URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,350.00
|
|
|
Service Code
|
HCPCS 50650
|
| Min. Negotiated Rate |
$990.46 |
| Max. Negotiated Rate |
$2,177.50 |
| Rate for Payer: Aetna Commercial |
$1,327.22
|
| Rate for Payer: Aetna Medicare |
$1,030.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,426.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,327.22
|
| Rate for Payer: BCBS Complete |
$1,340.00
|
| Rate for Payer: BCBS MAPPO |
$990.46
|
| Rate for Payer: BCN Medicare Advantage |
$990.46
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cofinity Commercial |
$1,426.26
|
| Rate for Payer: Cofinity Commercial |
$1,327.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$990.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,039.98
|
| Rate for Payer: Nomi Health Commercial |
$1,188.55
|
| Rate for Payer: PACE SWMI |
$990.46
|
| Rate for Payer: PHP Commercial |
$1,386.64
|
| Rate for Payer: PHP Medicare Advantage |
$990.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,177.50
|
| Rate for Payer: Priority Health Medicare |
$990.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$990.46
|
| Rate for Payer: UHC Medicare Advantage |
$990.46
|
| Rate for Payer: UMR Bronson Commercial |
$1,541.00
|
|
|
PR URINARY LEG OR ABDOMEN BAG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS A4358
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$11.79 |
| Rate for Payer: Aetna Commercial |
$10.97
|
| Rate for Payer: Aetna Medicare |
$8.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$8.19
|
| Rate for Payer: BCN Medicare Advantage |
$8.19
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$11.79
|
| Rate for Payer: Cofinity Commercial |
$10.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.60
|
| Rate for Payer: Nomi Health Commercial |
$9.83
|
| Rate for Payer: PACE SWMI |
$8.19
|
| Rate for Payer: PHP Commercial |
$11.47
|
| Rate for Payer: PHP Medicare Advantage |
$8.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$8.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.19
|
| Rate for Payer: UHC Medicare Advantage |
$8.19
|
| Rate for Payer: UMR Bronson Commercial |
$3.68
|
|
|
PR URINARY SUSPENSORY
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS A5105
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$82.04 |
| Rate for Payer: Aetna Commercial |
$76.34
|
| Rate for Payer: Aetna Medicare |
$59.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.34
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS MAPPO |
$56.97
|
| Rate for Payer: BCN Medicare Advantage |
$56.97
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$82.04
|
| Rate for Payer: Cofinity Commercial |
$76.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.82
|
| Rate for Payer: Nomi Health Commercial |
$68.36
|
| Rate for Payer: PACE SWMI |
$56.97
|
| Rate for Payer: PHP Commercial |
$79.76
|
| Rate for Payer: PHP Medicare Advantage |
$56.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$56.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.97
|
| Rate for Payer: UHC Medicare Advantage |
$56.97
|
| Rate for Payer: UMR Bronson Commercial |
$30.36
|
|
|
PR URTP W/TUBULARIZATION POST URT&/LWR BLDR
|
Professional
|
Both
|
$2,206.00
|
|
|
Service Code
|
HCPCS 53431
|
| Min. Negotiated Rate |
$882.40 |
| Max. Negotiated Rate |
$1,582.57 |
| Rate for Payer: Aetna Commercial |
$1,472.67
|
| Rate for Payer: Aetna Medicare |
$1,142.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.67
|
| Rate for Payer: BCBS Complete |
$882.40
|
| Rate for Payer: BCBS MAPPO |
$1,099.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.01
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Cofinity Commercial |
$1,582.57
|
| Rate for Payer: Cofinity Commercial |
$1,472.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,153.96
|
| Rate for Payer: Nomi Health Commercial |
$1,318.81
|
| Rate for Payer: PACE SWMI |
$1,099.01
|
| Rate for Payer: PHP Commercial |
$1,538.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,433.90
|
| Rate for Payer: Priority Health Medicare |
$1,099.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,014.76
|
|
|
PR URTROLITHOTOMY MIDDLE ONE-THIRD URETER
|
Professional
|
Both
|
$1,626.00
|
|
|
Service Code
|
HCPCS 50620
|
| Min. Negotiated Rate |
$650.40 |
| Max. Negotiated Rate |
$1,240.95 |
| Rate for Payer: Aetna Commercial |
$1,154.77
|
| Rate for Payer: Aetna Medicare |
$896.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,240.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,154.77
|
| Rate for Payer: BCBS Complete |
$650.40
|
| Rate for Payer: BCBS MAPPO |
$861.77
|
| Rate for Payer: BCN Medicare Advantage |
$861.77
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cofinity Commercial |
$1,240.95
|
| Rate for Payer: Cofinity Commercial |
$1,154.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$861.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$904.86
|
| Rate for Payer: Nomi Health Commercial |
$1,034.12
|
| Rate for Payer: PACE SWMI |
$861.77
|
| Rate for Payer: PHP Commercial |
$1,206.48
|
| Rate for Payer: PHP Medicare Advantage |
$861.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,056.90
|
| Rate for Payer: Priority Health Medicare |
$861.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$861.77
|
| Rate for Payer: UHC Medicare Advantage |
$861.77
|
| Rate for Payer: UMR Bronson Commercial |
$747.96
|
|
|
PR URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP
|
Professional
|
Both
|
$4,652.00
|
|
|
Service Code
|
HCPCS 50785
|
| Min. Negotiated Rate |
$1,161.58 |
| Max. Negotiated Rate |
$3,023.80 |
| Rate for Payer: Aetna Commercial |
$1,556.52
|
| Rate for Payer: Aetna Medicare |
$1,208.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,672.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.52
|
| Rate for Payer: BCBS Complete |
$1,860.80
|
| Rate for Payer: BCBS MAPPO |
$1,161.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,161.58
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,672.68
|
| Rate for Payer: Cofinity Commercial |
$1,556.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,161.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,219.66
|
| Rate for Payer: Nomi Health Commercial |
$1,393.90
|
| Rate for Payer: PACE SWMI |
$1,161.58
|
| Rate for Payer: PHP Commercial |
$1,626.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,161.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health Medicare |
$1,161.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,161.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,161.58
|
| Rate for Payer: UMR Bronson Commercial |
$2,139.92
|
|
|
PR URTT/URTS XTRNL SPX PENDULOUS URETHRA
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 53000
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$203.60 |
| Rate for Payer: Aetna Commercial |
$189.46
|
| Rate for Payer: Aetna Medicare |
$147.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.46
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$141.39
|
| Rate for Payer: BCN Medicare Advantage |
$141.39
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$203.60
|
| Rate for Payer: Cofinity Commercial |
$189.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.46
|
| Rate for Payer: Nomi Health Commercial |
$169.67
|
| Rate for Payer: PACE SWMI |
$141.39
|
| Rate for Payer: PHP Commercial |
$197.95
|
| Rate for Payer: PHP Medicare Advantage |
$141.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$141.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.39
|
| Rate for Payer: UHC Medicare Advantage |
$141.39
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
PR USE OF ECHO CONTRAST AGENT DURING STRESS ECHO
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 93352
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Aetna Commercial |
$42.42
|
| Rate for Payer: Aetna Medicare |
$32.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.42
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS MAPPO |
$31.66
|
| Rate for Payer: BCN Medicare Advantage |
$31.66
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.59
|
| Rate for Payer: Cofinity Commercial |
$42.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.24
|
| Rate for Payer: Nomi Health Commercial |
$37.99
|
| Rate for Payer: PACE SWMI |
$31.66
|
| Rate for Payer: PHP Commercial |
$44.32
|
| Rate for Payer: PHP Medicare Advantage |
$31.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.25
|
| Rate for Payer: Priority Health Medicare |
$31.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.66
|
| Rate for Payer: UHC Medicare Advantage |
$31.66
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
|
|
PR USE VERTICAL ELECTRODES
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 92547
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Commercial |
$12.23
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.23
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$9.13
|
| Rate for Payer: BCN Medicare Advantage |
$9.13
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$13.15
|
| Rate for Payer: Cofinity Commercial |
$12.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.59
|
| Rate for Payer: Nomi Health Commercial |
$10.96
|
| Rate for Payer: PACE SWMI |
$9.13
|
| Rate for Payer: PHP Commercial |
$12.78
|
| Rate for Payer: PHP Medicare Advantage |
$9.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Medicare |
$9.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.13
|
| Rate for Payer: UHC Medicare Advantage |
$9.13
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
|
|
PR UTERINE EVACUATION & CURETTAGE HYDATIDIFORM MOLE
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
HCPCS 59870
|
| Min. Negotiated Rate |
$314.00 |
| Max. Negotiated Rate |
$738.52 |
| Rate for Payer: Aetna Commercial |
$687.23
|
| Rate for Payer: Aetna Medicare |
$533.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$738.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$687.23
|
| Rate for Payer: BCBS Complete |
$314.00
|
| Rate for Payer: BCBS MAPPO |
$512.86
|
| Rate for Payer: BCN Medicare Advantage |
$512.86
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cash Price |
$628.00
|
| Rate for Payer: Cofinity Commercial |
$738.52
|
| Rate for Payer: Cofinity Commercial |
$687.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$538.50
|
| Rate for Payer: Nomi Health Commercial |
$615.43
|
| Rate for Payer: PACE SWMI |
$512.86
|
| Rate for Payer: PHP Commercial |
$718.00
|
| Rate for Payer: PHP Medicare Advantage |
$512.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.25
|
| Rate for Payer: Priority Health Medicare |
$512.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$512.86
|
| Rate for Payer: UHC Medicare Advantage |
$512.86
|
| Rate for Payer: UMR Bronson Commercial |
$361.10
|
|
|
PR UTERINE SUSPENSION W/WO SHORTENING LIGAMENTS SPX
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 58400
|
| Min. Negotiated Rate |
$345.60 |
| Max. Negotiated Rate |
$633.08 |
| Rate for Payer: Aetna Commercial |
$589.12
|
| Rate for Payer: Aetna Medicare |
$457.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$589.12
|
| Rate for Payer: BCBS Complete |
$345.60
|
| Rate for Payer: BCBS MAPPO |
$439.64
|
| Rate for Payer: BCN Medicare Advantage |
$439.64
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$633.08
|
| Rate for Payer: Cofinity Commercial |
$589.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$439.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$461.62
|
| Rate for Payer: Nomi Health Commercial |
$527.57
|
| Rate for Payer: PACE SWMI |
$439.64
|
| Rate for Payer: PHP Commercial |
$615.50
|
| Rate for Payer: PHP Medicare Advantage |
$439.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$561.60
|
| Rate for Payer: Priority Health Medicare |
$439.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$439.64
|
| Rate for Payer: UHC Medicare Advantage |
$439.64
|
| Rate for Payer: UMR Bronson Commercial |
$397.44
|
|
|
PR U-TUBE HEPATICOENTEROSTOMY
|
Professional
|
Both
|
$2,734.00
|
|
|
Service Code
|
HCPCS 47802
|
| Min. Negotiated Rate |
$1,093.60 |
| Max. Negotiated Rate |
$1,777.10 |
| Rate for Payer: Aetna Medicare |
$1,367.00
|
| Rate for Payer: BCBS Complete |
$1,093.60
|
| Rate for Payer: Cash Price |
$2,187.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,777.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,257.64
|
|
|
PR UVULECTOMY EXCISION UVULA
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
HCPCS 42140
|
| Min. Negotiated Rate |
$153.68 |
| Max. Negotiated Rate |
$372.45 |
| Rate for Payer: Aetna Commercial |
$205.93
|
| Rate for Payer: Aetna Medicare |
$159.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.30
|
| Rate for Payer: BCBS Complete |
$229.20
|
| Rate for Payer: BCBS MAPPO |
$153.68
|
| Rate for Payer: BCN Medicare Advantage |
$153.68
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cash Price |
$458.40
|
| Rate for Payer: Cofinity Commercial |
$205.93
|
| Rate for Payer: Cofinity Commercial |
$221.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.36
|
| Rate for Payer: Nomi Health Commercial |
$184.42
|
| Rate for Payer: PACE SWMI |
$153.68
|
| Rate for Payer: PHP Commercial |
$215.15
|
| Rate for Payer: PHP Medicare Advantage |
$153.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$372.45
|
| Rate for Payer: Priority Health Medicare |
$153.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.68
|
| Rate for Payer: UHC Medicare Advantage |
$153.68
|
| Rate for Payer: UMR Bronson Commercial |
$263.58
|
|
|
PR VAG HYST > 250 GM RMVL TUBE&/OVARY
|
Professional
|
Both
|
$3,124.00
|
|
|
Service Code
|
HCPCS 58291
|
| Min. Negotiated Rate |
$1,195.10 |
| Max. Negotiated Rate |
$2,030.60 |
| Rate for Payer: Aetna Commercial |
$1,601.43
|
| Rate for Payer: Aetna Medicare |
$1,242.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,720.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,601.43
|
| Rate for Payer: BCBS Complete |
$1,249.60
|
| Rate for Payer: BCBS MAPPO |
$1,195.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,195.10
|
| Rate for Payer: Cash Price |
$2,499.20
|
| Rate for Payer: Cash Price |
$2,499.20
|
| Rate for Payer: Cofinity Commercial |
$1,720.94
|
| Rate for Payer: Cofinity Commercial |
$1,601.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,195.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,254.86
|
| Rate for Payer: Nomi Health Commercial |
$1,434.12
|
| Rate for Payer: PACE SWMI |
$1,195.10
|
| Rate for Payer: PHP Commercial |
$1,673.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,195.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,030.60
|
| Rate for Payer: Priority Health Medicare |
$1,195.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,195.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,195.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,437.04
|
|
|
PR VAG HYST > 250 GM RMVL TUBE&/OVARY W/RPR ENTRCLE
|
Professional
|
Both
|
$3,457.00
|
|
|
Service Code
|
HCPCS 58292
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$2,247.05 |
| Rate for Payer: Aetna Commercial |
$1,687.26
|
| Rate for Payer: Aetna Medicare |
$1,309.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,813.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,687.26
|
| Rate for Payer: BCBS Complete |
$1,382.80
|
| Rate for Payer: BCBS MAPPO |
$1,259.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,259.15
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cofinity Commercial |
$1,813.18
|
| Rate for Payer: Cofinity Commercial |
$1,687.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,259.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,322.11
|
| Rate for Payer: Nomi Health Commercial |
$1,510.98
|
| Rate for Payer: PACE SWMI |
$1,259.15
|
| Rate for Payer: PHP Commercial |
$1,762.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,259.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.05
|
| Rate for Payer: Priority Health Medicare |
$1,259.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,259.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,259.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,590.22
|
|
|
PR VAG HYST 250 GM/< W/RMVL TUBE&/OVARY
|
Professional
|
Both
|
$2,973.00
|
|
|
Service Code
|
HCPCS 58262
|
| Min. Negotiated Rate |
$890.83 |
| Max. Negotiated Rate |
$1,932.45 |
| Rate for Payer: Aetna Commercial |
$1,193.71
|
| Rate for Payer: Aetna Medicare |
$926.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,282.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,193.71
|
| Rate for Payer: BCBS Complete |
$1,189.20
|
| Rate for Payer: BCBS MAPPO |
$890.83
|
| Rate for Payer: BCN Medicare Advantage |
$890.83
|
| Rate for Payer: Cash Price |
$2,378.40
|
| Rate for Payer: Cash Price |
$2,378.40
|
| Rate for Payer: Cofinity Commercial |
$1,282.80
|
| Rate for Payer: Cofinity Commercial |
$1,193.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$935.37
|
| Rate for Payer: Nomi Health Commercial |
$1,069.00
|
| Rate for Payer: PACE SWMI |
$890.83
|
| Rate for Payer: PHP Commercial |
$1,247.16
|
| Rate for Payer: PHP Medicare Advantage |
$890.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,932.45
|
| Rate for Payer: Priority Health Medicare |
$890.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.83
|
| Rate for Payer: UHC Medicare Advantage |
$890.83
|
| Rate for Payer: UMR Bronson Commercial |
$1,367.58
|
|
|
PR VAG HYST 250 GM/< W/RMVL TUBE OVARY W/RPR NTRCL
|
Professional
|
Both
|
$3,245.00
|
|
|
Service Code
|
HCPCS 58263
|
| Min. Negotiated Rate |
$956.48 |
| Max. Negotiated Rate |
$2,109.25 |
| Rate for Payer: Aetna Commercial |
$1,281.68
|
| Rate for Payer: Aetna Medicare |
$994.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,377.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,281.68
|
| Rate for Payer: BCBS Complete |
$1,298.00
|
| Rate for Payer: BCBS MAPPO |
$956.48
|
| Rate for Payer: BCN Medicare Advantage |
$956.48
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cash Price |
$2,596.00
|
| Rate for Payer: Cofinity Commercial |
$1,377.33
|
| Rate for Payer: Cofinity Commercial |
$1,281.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$956.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,004.30
|
| Rate for Payer: Nomi Health Commercial |
$1,147.78
|
| Rate for Payer: PACE SWMI |
$956.48
|
| Rate for Payer: PHP Commercial |
$1,339.07
|
| Rate for Payer: PHP Medicare Advantage |
$956.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,109.25
|
| Rate for Payer: Priority Health Medicare |
$956.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$956.48
|
| Rate for Payer: UHC Medicare Advantage |
$956.48
|
| Rate for Payer: UMR Bronson Commercial |
$1,492.70
|
|
|
PR VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE
|
Professional
|
Both
|
$3,732.00
|
|
|
Service Code
|
HCPCS 58280
|
| Min. Negotiated Rate |
$1,017.16 |
| Max. Negotiated Rate |
$2,425.80 |
| Rate for Payer: Aetna Commercial |
$1,362.99
|
| Rate for Payer: Aetna Medicare |
$1,057.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,464.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,362.99
|
| Rate for Payer: BCBS Complete |
$1,492.80
|
| Rate for Payer: BCBS MAPPO |
$1,017.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,017.16
|
| Rate for Payer: Cash Price |
$2,985.60
|
| Rate for Payer: Cash Price |
$2,985.60
|
| Rate for Payer: Cofinity Commercial |
$1,464.71
|
| Rate for Payer: Cofinity Commercial |
$1,362.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,017.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.02
|
| Rate for Payer: Nomi Health Commercial |
$1,220.59
|
| Rate for Payer: PACE SWMI |
$1,017.16
|
| Rate for Payer: PHP Commercial |
$1,424.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,017.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,425.80
|
| Rate for Payer: Priority Health Medicare |
$1,017.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,017.16
|
| Rate for Payer: UHC Medicare Advantage |
$1,017.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,716.72
|
|
