|
PR TRANSFER ANY PEDICLE FLAP ANY LOCATION
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 15650
|
| Min. Negotiated Rate |
$75.69 |
| Max. Negotiated Rate |
$794.59 |
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: Aetna Medicare |
$399.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.18
|
| Rate for Payer: BCBS Complete |
$275.54
|
| Rate for Payer: BCBS MAPPO |
$384.15
|
| Rate for Payer: BCBS Trust/PPO |
$75.69
|
| Rate for Payer: BCN Commercial |
$794.59
|
| Rate for Payer: BCN Medicare Advantage |
$384.15
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$514.76
|
| Rate for Payer: Cofinity Commercial |
$553.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.36
|
| Rate for Payer: Meridian Medicaid |
$275.54
|
| Rate for Payer: Nomi Health Commercial |
$460.98
|
| Rate for Payer: PACE SWMI |
$384.15
|
| Rate for Payer: PHP Commercial |
$537.81
|
| Rate for Payer: PHP Medicare Advantage |
$384.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$262.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.85
|
| Rate for Payer: Priority Health Medicare |
$384.15
|
| Rate for Payer: Priority Health Narrow Network |
$550.85
|
| Rate for Payer: Priority Health SBD |
$550.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$384.15
|
| Rate for Payer: UHC Medicare Advantage |
$384.15
|
| Rate for Payer: UHCCP Medicaid |
$262.42
|
| Rate for Payer: UMR Bronson Commercial |
$339.02
|
|
|
PR TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR
|
Professional
|
Both
|
$6,949.00
|
|
|
Service Code
|
HCPCS 27110
|
| Min. Negotiated Rate |
$630.91 |
| Max. Negotiated Rate |
$4,516.85 |
| Rate for Payer: Aetna Commercial |
$1,254.51
|
| Rate for Payer: Aetna Medicare |
$973.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,254.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,348.13
|
| Rate for Payer: BCBS Complete |
$662.46
|
| Rate for Payer: BCBS MAPPO |
$936.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,040.22
|
| Rate for Payer: BCN Commercial |
$1,425.47
|
| Rate for Payer: BCN Medicare Advantage |
$936.20
|
| Rate for Payer: Cash Price |
$5,559.20
|
| Rate for Payer: Cash Price |
$5,559.20
|
| Rate for Payer: Cofinity Commercial |
$1,254.51
|
| Rate for Payer: Cofinity Commercial |
$1,348.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$936.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$983.01
|
| Rate for Payer: Meridian Medicaid |
$662.46
|
| Rate for Payer: Nomi Health Commercial |
$1,123.44
|
| Rate for Payer: PACE SWMI |
$936.20
|
| Rate for Payer: PHP Commercial |
$1,310.68
|
| Rate for Payer: PHP Medicare Advantage |
$936.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,516.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,495.54
|
| Rate for Payer: Priority Health Medicare |
$936.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,495.54
|
| Rate for Payer: Priority Health SBD |
$1,495.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$936.20
|
| Rate for Payer: UHC Medicare Advantage |
$936.20
|
| Rate for Payer: UHCCP Medicaid |
$630.91
|
| Rate for Payer: UMR Bronson Commercial |
$3,196.54
|
|
|
PR TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH
|
Professional
|
Both
|
$2,666.00
|
|
|
Service Code
|
HCPCS 26485
|
| Min. Negotiated Rate |
$538.89 |
| Max. Negotiated Rate |
$1,732.90 |
| Rate for Payer: Aetna Commercial |
$1,046.14
|
| Rate for Payer: Aetna Medicare |
$811.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,046.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,124.21
|
| Rate for Payer: BCBS Complete |
$565.83
|
| Rate for Payer: BCBS MAPPO |
$780.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,205.05
|
| Rate for Payer: BCN Commercial |
$1,242.71
|
| Rate for Payer: BCN Medicare Advantage |
$780.70
|
| Rate for Payer: Cash Price |
$2,132.80
|
| Rate for Payer: Cash Price |
$2,132.80
|
| Rate for Payer: Cofinity Commercial |
$1,046.14
|
| Rate for Payer: Cofinity Commercial |
$1,124.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$780.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$819.74
|
| Rate for Payer: Meridian Medicaid |
$565.83
|
| Rate for Payer: Nomi Health Commercial |
$936.84
|
| Rate for Payer: PACE SWMI |
$780.70
|
| Rate for Payer: PHP Commercial |
$1,092.98
|
| Rate for Payer: PHP Medicare Advantage |
$780.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$538.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,292.50
|
| Rate for Payer: Priority Health Medicare |
$780.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,292.50
|
| Rate for Payer: Priority Health SBD |
$1,292.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$780.70
|
| Rate for Payer: UHC Medicare Advantage |
$780.70
|
| Rate for Payer: UHCCP Medicaid |
$538.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,226.36
|
|
|
PR TRANSFUSION BLOOD/BLOOD COMPONENTS
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 36430
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$795.09 |
| Rate for Payer: Aetna Commercial |
$51.28
|
| Rate for Payer: Aetna Medicare |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.11
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCBS MAPPO |
$38.27
|
| Rate for Payer: BCBS Trust/PPO |
$795.09
|
| Rate for Payer: BCN Commercial |
$57.17
|
| Rate for Payer: BCN Medicare Advantage |
$38.27
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.18
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: PACE SWMI |
$38.27
|
| Rate for Payer: PHP Commercial |
$53.58
|
| Rate for Payer: PHP Medicare Advantage |
$38.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.55
|
| Rate for Payer: Priority Health Medicare |
$38.27
|
| Rate for Payer: Priority Health Narrow Network |
$67.55
|
| Rate for Payer: Priority Health SBD |
$67.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.27
|
| Rate for Payer: UHC Medicare Advantage |
$38.27
|
| Rate for Payer: UMR Bronson Commercial |
$38.64
|
|
|
PR TRANSFUSION INTRAUTERINE FETAL
|
Professional
|
Both
|
$1,416.00
|
|
|
Service Code
|
HCPCS 36460
|
| Min. Negotiated Rate |
$217.90 |
| Max. Negotiated Rate |
$1,124.75 |
| Rate for Payer: Aetna Commercial |
$441.93
|
| Rate for Payer: Aetna Medicare |
$342.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.93
|
| Rate for Payer: BCBS Complete |
$228.80
|
| Rate for Payer: BCBS MAPPO |
$329.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,124.75
|
| Rate for Payer: BCN Commercial |
$499.92
|
| Rate for Payer: BCN Medicare Advantage |
$329.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cofinity Commercial |
$474.91
|
| Rate for Payer: Cofinity Commercial |
$441.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$346.29
|
| Rate for Payer: Meridian Medicaid |
$228.80
|
| Rate for Payer: Nomi Health Commercial |
$395.76
|
| Rate for Payer: PACE SWMI |
$329.80
|
| Rate for Payer: PHP Commercial |
$461.72
|
| Rate for Payer: PHP Medicare Advantage |
$329.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$920.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$544.58
|
| Rate for Payer: Priority Health Medicare |
$329.80
|
| Rate for Payer: Priority Health Narrow Network |
$544.58
|
| Rate for Payer: Priority Health SBD |
$544.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.80
|
| Rate for Payer: UHC Medicare Advantage |
$329.80
|
| Rate for Payer: UHCCP Medicaid |
$217.90
|
| Rate for Payer: UMR Bronson Commercial |
$651.36
|
|
|
PR TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 99496
|
| Min. Negotiated Rate |
$120.13 |
| Max. Negotiated Rate |
$294.12 |
| Rate for Payer: Aetna Commercial |
$240.05
|
| Rate for Payer: Aetna Medicare |
$186.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.96
|
| Rate for Payer: BCBS Complete |
$126.14
|
| Rate for Payer: BCBS MAPPO |
$179.14
|
| Rate for Payer: BCBS Trust/PPO |
$204.98
|
| Rate for Payer: BCN Commercial |
$294.12
|
| Rate for Payer: BCN Medicare Advantage |
$179.14
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cofinity Commercial |
$240.05
|
| Rate for Payer: Cofinity Commercial |
$257.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.10
|
| Rate for Payer: Meridian Medicaid |
$126.14
|
| Rate for Payer: Nomi Health Commercial |
$214.97
|
| Rate for Payer: PACE SWMI |
$179.14
|
| Rate for Payer: PHP Commercial |
$250.80
|
| Rate for Payer: PHP Medicare Advantage |
$179.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.51
|
| Rate for Payer: Priority Health Medicare |
$179.14
|
| Rate for Payer: Priority Health Narrow Network |
$253.51
|
| Rate for Payer: Priority Health SBD |
$253.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.14
|
| Rate for Payer: UHC Medicare Advantage |
$179.14
|
| Rate for Payer: UHCCP Medicaid |
$120.13
|
| Rate for Payer: UMR Bronson Commercial |
$162.84
|
|
|
PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 99495
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$935.09 |
| Rate for Payer: Aetna Commercial |
$176.52
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.69
|
| Rate for Payer: BCBS Complete |
$92.82
|
| Rate for Payer: BCBS MAPPO |
$131.73
|
| Rate for Payer: BCBS Trust/PPO |
$935.09
|
| Rate for Payer: BCN Commercial |
$217.10
|
| Rate for Payer: BCN Medicare Advantage |
$131.73
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$176.52
|
| Rate for Payer: Cofinity Commercial |
$189.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.32
|
| Rate for Payer: Meridian Medicaid |
$92.82
|
| Rate for Payer: Nomi Health Commercial |
$158.08
|
| Rate for Payer: PACE SWMI |
$131.73
|
| Rate for Payer: PHP Commercial |
$184.42
|
| Rate for Payer: PHP Medicare Advantage |
$131.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.67
|
| Rate for Payer: Priority Health Medicare |
$131.73
|
| Rate for Payer: Priority Health Narrow Network |
$186.67
|
| Rate for Payer: Priority Health SBD |
$186.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.73
|
| Rate for Payer: UHC Medicare Advantage |
$131.73
|
| Rate for Payer: UHCCP Medicaid |
$88.40
|
| Rate for Payer: UMR Bronson Commercial |
$115.46
|
|
|
PR TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 75962
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: UMR Bronson Commercial |
$53.36
|
|
|
PR TRANSMASTOID ANTROTOMY
|
Professional
|
Both
|
$1,780.00
|
|
|
Service Code
|
HCPCS 69501
|
| Min. Negotiated Rate |
$454.76 |
| Max. Negotiated Rate |
$3,498.40 |
| Rate for Payer: Aetna Commercial |
$893.78
|
| Rate for Payer: Aetna Medicare |
$693.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$893.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.48
|
| Rate for Payer: BCBS Complete |
$477.50
|
| Rate for Payer: BCBS MAPPO |
$667.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,498.40
|
| Rate for Payer: BCN Commercial |
$1,049.68
|
| Rate for Payer: BCN Medicare Advantage |
$667.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cofinity Commercial |
$960.48
|
| Rate for Payer: Cofinity Commercial |
$893.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$667.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$700.35
|
| Rate for Payer: Meridian Medicaid |
$477.50
|
| Rate for Payer: Nomi Health Commercial |
$800.40
|
| Rate for Payer: PACE SWMI |
$667.00
|
| Rate for Payer: PHP Commercial |
$933.80
|
| Rate for Payer: PHP Medicare Advantage |
$667.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,043.76
|
| Rate for Payer: Priority Health Medicare |
$667.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,043.76
|
| Rate for Payer: Priority Health SBD |
$1,043.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$667.00
|
| Rate for Payer: UHC Medicare Advantage |
$667.00
|
| Rate for Payer: UHCCP Medicaid |
$454.76
|
| Rate for Payer: UMR Bronson Commercial |
$818.80
|
|
|
PR TRANSMETACARPAL AMPUTATION RE-AMPUTATION
|
Professional
|
Both
|
$2,264.00
|
|
|
Service Code
|
HCPCS 25931
|
| Min. Negotiated Rate |
$125.23 |
| Max. Negotiated Rate |
$1,471.60 |
| Rate for Payer: Aetna Commercial |
$1,003.24
|
| Rate for Payer: Aetna Medicare |
$778.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.11
|
| Rate for Payer: BCBS Complete |
$540.12
|
| Rate for Payer: BCBS MAPPO |
$748.69
|
| Rate for Payer: BCBS Trust/PPO |
$125.23
|
| Rate for Payer: BCN Commercial |
$1,185.54
|
| Rate for Payer: BCN Medicare Advantage |
$748.69
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,003.24
|
| Rate for Payer: Cofinity Commercial |
$1,078.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$748.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$786.12
|
| Rate for Payer: Meridian Medicaid |
$540.12
|
| Rate for Payer: Nomi Health Commercial |
$898.43
|
| Rate for Payer: PACE SWMI |
$748.69
|
| Rate for Payer: PHP Commercial |
$1,048.17
|
| Rate for Payer: PHP Medicare Advantage |
$748.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$514.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,471.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,233.98
|
| Rate for Payer: Priority Health Medicare |
$748.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,233.98
|
| Rate for Payer: Priority Health SBD |
$1,233.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$748.69
|
| Rate for Payer: UHC Medicare Advantage |
$748.69
|
| Rate for Payer: UHCCP Medicaid |
$514.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,041.44
|
|
|
PR TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 25929
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$931.72 |
| Rate for Payer: Aetna Commercial |
$778.04
|
| Rate for Payer: Aetna Medicare |
$603.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.11
|
| Rate for Payer: BCBS Complete |
$413.30
|
| Rate for Payer: BCBS MAPPO |
$580.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.55
|
| Rate for Payer: BCN Commercial |
$885.48
|
| Rate for Payer: BCN Medicare Advantage |
$580.63
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cofinity Commercial |
$778.04
|
| Rate for Payer: Cofinity Commercial |
$836.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.66
|
| Rate for Payer: Meridian Medicaid |
$413.30
|
| Rate for Payer: Nomi Health Commercial |
$696.76
|
| Rate for Payer: PACE SWMI |
$580.63
|
| Rate for Payer: PHP Commercial |
$812.88
|
| Rate for Payer: PHP Medicare Advantage |
$580.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$393.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$931.72
|
| Rate for Payer: Priority Health Medicare |
$580.63
|
| Rate for Payer: Priority Health Narrow Network |
$931.72
|
| Rate for Payer: Priority Health SBD |
$931.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$580.63
|
| Rate for Payer: UHC Medicare Advantage |
$580.63
|
| Rate for Payer: UHCCP Medicaid |
$393.62
|
| Rate for Payer: UMR Bronson Commercial |
$490.82
|
|
|
PR TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX
|
Professional
|
Both
|
$581.00
|
|
|
Service Code
|
HCPCS 33141
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$1,088.30 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Aetna Medicare |
$132.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.87
|
| Rate for Payer: BCBS Complete |
$86.77
|
| Rate for Payer: BCBS MAPPO |
$126.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,088.30
|
| Rate for Payer: BCN Commercial |
$188.15
|
| Rate for Payer: BCN Medicare Advantage |
$126.99
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cofinity Commercial |
$170.17
|
| Rate for Payer: Cofinity Commercial |
$182.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.34
|
| Rate for Payer: Meridian Medicaid |
$86.77
|
| Rate for Payer: Nomi Health Commercial |
$152.39
|
| Rate for Payer: PACE SWMI |
$126.99
|
| Rate for Payer: PHP Commercial |
$177.79
|
| Rate for Payer: PHP Medicare Advantage |
$126.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.28
|
| Rate for Payer: Priority Health Medicare |
$126.99
|
| Rate for Payer: Priority Health Narrow Network |
$205.28
|
| Rate for Payer: Priority Health SBD |
$205.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.99
|
| Rate for Payer: UHC Medicare Advantage |
$126.99
|
| Rate for Payer: UHCCP Medicaid |
$82.64
|
| Rate for Payer: UMR Bronson Commercial |
$267.26
|
|
|
PR TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR
|
Professional
|
Both
|
$2,474.00
|
|
|
Service Code
|
HCPCS 63057
|
| Min. Negotiated Rate |
$206.40 |
| Max. Negotiated Rate |
$1,608.10 |
| Rate for Payer: Aetna Commercial |
$423.32
|
| Rate for Payer: Aetna Medicare |
$328.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.91
|
| Rate for Payer: BCBS Complete |
$216.72
|
| Rate for Payer: BCBS MAPPO |
$315.91
|
| Rate for Payer: BCBS Trust/PPO |
$543.09
|
| Rate for Payer: BCN Commercial |
$515.47
|
| Rate for Payer: BCN Medicare Advantage |
$315.91
|
| Rate for Payer: Cash Price |
$1,979.20
|
| Rate for Payer: Cash Price |
$1,979.20
|
| Rate for Payer: Cofinity Commercial |
$423.32
|
| Rate for Payer: Cofinity Commercial |
$454.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.71
|
| Rate for Payer: Meridian Medicaid |
$216.72
|
| Rate for Payer: Nomi Health Commercial |
$379.09
|
| Rate for Payer: PACE SWMI |
$315.91
|
| Rate for Payer: PHP Commercial |
$442.27
|
| Rate for Payer: PHP Medicare Advantage |
$315.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$206.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$547.11
|
| Rate for Payer: Priority Health Medicare |
$315.91
|
| Rate for Payer: Priority Health Narrow Network |
$547.11
|
| Rate for Payer: Priority Health SBD |
$547.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.91
|
| Rate for Payer: UHC Medicare Advantage |
$315.91
|
| Rate for Payer: UHCCP Medicaid |
$206.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.04
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR
|
Professional
|
Both
|
$7,074.00
|
|
|
Service Code
|
HCPCS 63056
|
| Min. Negotiated Rate |
$545.21 |
| Max. Negotiated Rate |
$4,598.10 |
| Rate for Payer: Aetna Commercial |
$1,954.89
|
| Rate for Payer: Aetna Medicare |
$1,517.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,954.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,100.77
|
| Rate for Payer: BCBS Complete |
$1,013.81
|
| Rate for Payer: BCBS MAPPO |
$1,458.87
|
| Rate for Payer: BCBS Trust/PPO |
$545.21
|
| Rate for Payer: BCN Commercial |
$2,415.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,458.87
|
| Rate for Payer: Cash Price |
$5,659.20
|
| Rate for Payer: Cash Price |
$5,659.20
|
| Rate for Payer: Cofinity Commercial |
$1,954.89
|
| Rate for Payer: Cofinity Commercial |
$2,100.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,458.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,531.81
|
| Rate for Payer: Meridian Medicaid |
$1,013.81
|
| Rate for Payer: Nomi Health Commercial |
$1,750.64
|
| Rate for Payer: PACE SWMI |
$1,458.87
|
| Rate for Payer: PHP Commercial |
$2,042.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,458.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$965.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,598.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,569.46
|
| Rate for Payer: Priority Health Medicare |
$1,458.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,569.46
|
| Rate for Payer: Priority Health SBD |
$2,569.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,458.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,458.87
|
| Rate for Payer: UHCCP Medicaid |
$965.53
|
| Rate for Payer: UMR Bronson Commercial |
$3,254.04
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC
|
Professional
|
Both
|
$7,455.00
|
|
|
Service Code
|
HCPCS 63055
|
| Min. Negotiated Rate |
$470.19 |
| Max. Negotiated Rate |
$4,845.75 |
| Rate for Payer: Aetna Commercial |
$2,146.09
|
| Rate for Payer: Aetna Medicare |
$1,665.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,146.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,306.25
|
| Rate for Payer: BCBS Complete |
$1,109.08
|
| Rate for Payer: BCBS MAPPO |
$1,601.56
|
| Rate for Payer: BCBS Trust/PPO |
$470.19
|
| Rate for Payer: BCN Commercial |
$2,636.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,601.56
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: Cofinity Commercial |
$2,146.09
|
| Rate for Payer: Cofinity Commercial |
$2,306.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,601.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,681.64
|
| Rate for Payer: Meridian Medicaid |
$1,109.08
|
| Rate for Payer: Nomi Health Commercial |
$1,921.87
|
| Rate for Payer: PACE SWMI |
$1,601.56
|
| Rate for Payer: PHP Commercial |
$2,242.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,601.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,056.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,845.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,808.32
|
| Rate for Payer: Priority Health Medicare |
$1,601.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,808.32
|
| Rate for Payer: Priority Health SBD |
$2,808.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,601.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,601.56
|
| Rate for Payer: UHCCP Medicaid |
$1,056.27
|
| Rate for Payer: UMR Bronson Commercial |
$3,429.30
|
|
|
PR TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX
|
Professional
|
Both
|
$6,685.00
|
|
|
Service Code
|
HCPCS 55874
|
| Min. Negotiated Rate |
$104.58 |
| Max. Negotiated Rate |
$4,345.25 |
| Rate for Payer: Aetna Commercial |
$208.97
|
| Rate for Payer: Aetna Medicare |
$162.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.57
|
| Rate for Payer: BCBS Complete |
$109.81
|
| Rate for Payer: BCBS MAPPO |
$155.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,585.43
|
| Rate for Payer: BCN Commercial |
$4,253.94
|
| Rate for Payer: BCN Medicare Advantage |
$155.95
|
| Rate for Payer: Cash Price |
$5,348.00
|
| Rate for Payer: Cash Price |
$5,348.00
|
| Rate for Payer: Cofinity Commercial |
$208.97
|
| Rate for Payer: Cofinity Commercial |
$224.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.75
|
| Rate for Payer: Meridian Medicaid |
$109.81
|
| Rate for Payer: Nomi Health Commercial |
$187.14
|
| Rate for Payer: PACE SWMI |
$155.95
|
| Rate for Payer: PHP Commercial |
$218.33
|
| Rate for Payer: PHP Medicare Advantage |
$155.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,345.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.38
|
| Rate for Payer: Priority Health Medicare |
$155.95
|
| Rate for Payer: Priority Health Narrow Network |
$259.38
|
| Rate for Payer: Priority Health SBD |
$259.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.95
|
| Rate for Payer: UHC Medicare Advantage |
$155.95
|
| Rate for Payer: UHCCP Medicaid |
$104.58
|
| Rate for Payer: UMR Bronson Commercial |
$3,075.10
|
|
|
PR TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ
|
Professional
|
Both
|
$2,721.00
|
|
|
Service Code
|
HCPCS 55875
|
| Min. Negotiated Rate |
$502.47 |
| Max. Negotiated Rate |
$2,345.12 |
| Rate for Payer: Aetna Commercial |
$999.43
|
| Rate for Payer: Aetna Medicare |
$775.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.43
|
| Rate for Payer: BCBS Complete |
$527.59
|
| Rate for Payer: BCBS MAPPO |
$745.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,345.12
|
| Rate for Payer: BCN Commercial |
$1,124.94
|
| Rate for Payer: BCN Medicare Advantage |
$745.84
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cofinity Commercial |
$1,074.01
|
| Rate for Payer: Cofinity Commercial |
$999.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.13
|
| Rate for Payer: Meridian Medicaid |
$527.59
|
| Rate for Payer: Nomi Health Commercial |
$895.01
|
| Rate for Payer: PACE SWMI |
$745.84
|
| Rate for Payer: PHP Commercial |
$1,044.18
|
| Rate for Payer: PHP Medicare Advantage |
$745.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$502.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,768.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,241.49
|
| Rate for Payer: Priority Health Medicare |
$745.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,241.49
|
| Rate for Payer: Priority Health SBD |
$1,241.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.84
|
| Rate for Payer: UHC Medicare Advantage |
$745.84
|
| Rate for Payer: UHCCP Medicaid |
$502.47
|
| Rate for Payer: UMR Bronson Commercial |
$1,251.66
|
|
|
PR TRANSPLANTATION TESTIS TO THIGH
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 54680
|
| Min. Negotiated Rate |
$504.38 |
| Max. Negotiated Rate |
$2,125.35 |
| Rate for Payer: Aetna Commercial |
$1,008.62
|
| Rate for Payer: Aetna Medicare |
$782.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,083.89
|
| Rate for Payer: BCBS Complete |
$529.60
|
| Rate for Payer: BCBS MAPPO |
$752.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,125.35
|
| Rate for Payer: BCN Commercial |
$1,135.69
|
| Rate for Payer: BCN Medicare Advantage |
$752.70
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$1,008.62
|
| Rate for Payer: Cofinity Commercial |
$1,083.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$752.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$790.34
|
| Rate for Payer: Meridian Medicaid |
$529.60
|
| Rate for Payer: Nomi Health Commercial |
$903.24
|
| Rate for Payer: PACE SWMI |
$752.70
|
| Rate for Payer: PHP Commercial |
$1,053.78
|
| Rate for Payer: PHP Medicare Advantage |
$752.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$504.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,252.67
|
| Rate for Payer: Priority Health Medicare |
$752.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,252.67
|
| Rate for Payer: Priority Health SBD |
$1,252.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$752.70
|
| Rate for Payer: UHC Medicare Advantage |
$752.70
|
| Rate for Payer: UHCCP Medicaid |
$504.38
|
| Rate for Payer: UMR Bronson Commercial |
$653.20
|
|
|
PR TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR MULT TDN
|
Professional
|
Both
|
$1,880.00
|
|
|
Service Code
|
HCPCS 27397
|
| Min. Negotiated Rate |
$597.04 |
| Max. Negotiated Rate |
$1,413.62 |
| Rate for Payer: Aetna Commercial |
$1,185.06
|
| Rate for Payer: Aetna Medicare |
$919.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,185.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,273.49
|
| Rate for Payer: BCBS Complete |
$626.89
|
| Rate for Payer: BCBS MAPPO |
$884.37
|
| Rate for Payer: BCBS Trust/PPO |
$629.21
|
| Rate for Payer: BCN Commercial |
$1,344.35
|
| Rate for Payer: BCN Medicare Advantage |
$884.37
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cash Price |
$1,504.00
|
| Rate for Payer: Cofinity Commercial |
$1,185.06
|
| Rate for Payer: Cofinity Commercial |
$1,273.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$884.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$928.59
|
| Rate for Payer: Meridian Medicaid |
$626.89
|
| Rate for Payer: Nomi Health Commercial |
$1,061.24
|
| Rate for Payer: PACE SWMI |
$884.37
|
| Rate for Payer: PHP Commercial |
$1,238.12
|
| Rate for Payer: PHP Medicare Advantage |
$884.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,222.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,413.62
|
| Rate for Payer: Priority Health Medicare |
$884.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,413.62
|
| Rate for Payer: Priority Health SBD |
$1,413.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$884.37
|
| Rate for Payer: UHC Medicare Advantage |
$884.37
|
| Rate for Payer: UHCCP Medicaid |
$597.04
|
| Rate for Payer: UMR Bronson Commercial |
$864.80
|
|
|
PR TRANSPOSITION OVARY
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 58825
|
| Min. Negotiated Rate |
$82.94 |
| Max. Negotiated Rate |
$1,062.53 |
| Rate for Payer: Aetna Commercial |
$911.36
|
| Rate for Payer: Aetna Medicare |
$707.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.37
|
| Rate for Payer: BCBS Complete |
$477.72
|
| Rate for Payer: BCBS MAPPO |
$680.12
|
| Rate for Payer: BCBS Trust/PPO |
$82.94
|
| Rate for Payer: BCN Commercial |
$1,042.35
|
| Rate for Payer: BCN Medicare Advantage |
$680.12
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Cofinity Commercial |
$911.36
|
| Rate for Payer: Cofinity Commercial |
$979.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.13
|
| Rate for Payer: Meridian Medicaid |
$477.72
|
| Rate for Payer: Nomi Health Commercial |
$816.14
|
| Rate for Payer: PACE SWMI |
$680.12
|
| Rate for Payer: PHP Commercial |
$952.17
|
| Rate for Payer: PHP Medicare Advantage |
$680.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,062.53
|
| Rate for Payer: Priority Health Medicare |
$680.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,062.53
|
| Rate for Payer: Priority Health SBD |
$1,062.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.12
|
| Rate for Payer: UHC Medicare Advantage |
$680.12
|
| Rate for Payer: UHCCP Medicaid |
$454.97
|
| Rate for Payer: UMR Bronson Commercial |
$672.98
|
|
|
PR TRANSPTRSAL POST CRNL FOSSA CLIVUS/FORAMN MAGNUM
|
Professional
|
Both
|
$5,079.00
|
|
|
Service Code
|
HCPCS 61598
|
| Min. Negotiated Rate |
$1,835.31 |
| Max. Negotiated Rate |
$4,923.37 |
| Rate for Payer: Aetna Commercial |
$3,725.74
|
| Rate for Payer: Aetna Medicare |
$2,891.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,725.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,003.78
|
| Rate for Payer: BCBS Complete |
$1,933.68
|
| Rate for Payer: BCBS MAPPO |
$2,780.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,835.31
|
| Rate for Payer: BCN Commercial |
$4,216.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,780.40
|
| Rate for Payer: Cash Price |
$4,063.20
|
| Rate for Payer: Cash Price |
$4,063.20
|
| Rate for Payer: Cofinity Commercial |
$3,725.74
|
| Rate for Payer: Cofinity Commercial |
$4,003.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,780.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,919.42
|
| Rate for Payer: Meridian Medicaid |
$1,933.68
|
| Rate for Payer: Nomi Health Commercial |
$3,336.48
|
| Rate for Payer: PACE SWMI |
$2,780.40
|
| Rate for Payer: PHP Commercial |
$3,892.56
|
| Rate for Payer: PHP Medicare Advantage |
$2,780.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,841.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,301.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,923.37
|
| Rate for Payer: Priority Health Medicare |
$2,780.40
|
| Rate for Payer: Priority Health Narrow Network |
$4,923.37
|
| Rate for Payer: Priority Health SBD |
$4,923.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,780.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,780.40
|
| Rate for Payer: UHCCP Medicaid |
$1,841.60
|
| Rate for Payer: UMR Bronson Commercial |
$2,336.34
|
|
|
PR TRANSRECTAL DRAINAGE OF PELVIC ABSCESS
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 45000
|
| Min. Negotiated Rate |
$277.11 |
| Max. Negotiated Rate |
$2,674.78 |
| Rate for Payer: Aetna Commercial |
$550.86
|
| Rate for Payer: Aetna Medicare |
$427.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$550.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$591.97
|
| Rate for Payer: BCBS Complete |
$290.97
|
| Rate for Payer: BCBS MAPPO |
$411.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,674.78
|
| Rate for Payer: BCN Commercial |
$627.46
|
| Rate for Payer: BCN Medicare Advantage |
$411.09
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$550.86
|
| Rate for Payer: Cofinity Commercial |
$591.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$431.64
|
| Rate for Payer: Meridian Medicaid |
$290.97
|
| Rate for Payer: Nomi Health Commercial |
$493.31
|
| Rate for Payer: PACE SWMI |
$411.09
|
| Rate for Payer: PHP Commercial |
$575.53
|
| Rate for Payer: PHP Medicare Advantage |
$411.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$277.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$531.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$772.58
|
| Rate for Payer: Priority Health Medicare |
$411.09
|
| Rate for Payer: Priority Health Narrow Network |
$772.58
|
| Rate for Payer: Priority Health SBD |
$772.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$411.09
|
| Rate for Payer: UHC Medicare Advantage |
$411.09
|
| Rate for Payer: UHCCP Medicaid |
$277.11
|
| Rate for Payer: UMR Bronson Commercial |
$376.28
|
|
|
PR TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVAL
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 93293
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$525.66 |
| Rate for Payer: Aetna Commercial |
$50.38
|
| Rate for Payer: Aetna Medicare |
$39.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.14
|
| Rate for Payer: BCBS Complete |
$9.17
|
| Rate for Payer: BCBS MAPPO |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$525.66
|
| Rate for Payer: BCN Commercial |
$66.46
|
| Rate for Payer: BCN Medicare Advantage |
$37.60
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$50.38
|
| Rate for Payer: Cofinity Commercial |
$54.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.48
|
| Rate for Payer: Meridian Medicaid |
$9.17
|
| Rate for Payer: Nomi Health Commercial |
$45.12
|
| Rate for Payer: PACE SWMI |
$37.60
|
| Rate for Payer: PHP Commercial |
$52.64
|
| Rate for Payer: PHP Medicare Advantage |
$37.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.15
|
| Rate for Payer: Priority Health Medicare |
$37.60
|
| Rate for Payer: Priority Health Narrow Network |
$62.15
|
| Rate for Payer: Priority Health SBD |
$19.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.60
|
| Rate for Payer: UHC Medicare Advantage |
$37.60
|
| Rate for Payer: UHCCP Medicaid |
$8.73
|
| Rate for Payer: UMR Bronson Commercial |
$83.26
|
|
|
PR TRANSTEMP APPR POST CRAN FOSSA DCOMPR SINUS/NRV
|
Professional
|
Both
|
$6,249.00
|
|
|
Service Code
|
HCPCS 61595
|
| Min. Negotiated Rate |
$1,535.52 |
| Max. Negotiated Rate |
$4,103.86 |
| Rate for Payer: Aetna Commercial |
$3,075.43
|
| Rate for Payer: Aetna Medicare |
$2,386.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,075.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,304.94
|
| Rate for Payer: BCBS Complete |
$1,612.30
|
| Rate for Payer: BCBS MAPPO |
$2,295.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,960.52
|
| Rate for Payer: BCN Commercial |
$3,505.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,295.10
|
| Rate for Payer: Cash Price |
$4,999.20
|
| Rate for Payer: Cash Price |
$4,999.20
|
| Rate for Payer: Cofinity Commercial |
$3,075.43
|
| Rate for Payer: Cofinity Commercial |
$3,304.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,295.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,409.86
|
| Rate for Payer: Meridian Medicaid |
$1,612.30
|
| Rate for Payer: Nomi Health Commercial |
$2,754.12
|
| Rate for Payer: PACE SWMI |
$2,295.10
|
| Rate for Payer: PHP Commercial |
$3,213.14
|
| Rate for Payer: PHP Medicare Advantage |
$2,295.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,535.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,061.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,103.86
|
| Rate for Payer: Priority Health Medicare |
$2,295.10
|
| Rate for Payer: Priority Health Narrow Network |
$4,103.86
|
| Rate for Payer: Priority Health SBD |
$4,103.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,295.10
|
| Rate for Payer: UHC Medicare Advantage |
$2,295.10
|
| Rate for Payer: UHCCP Medicaid |
$1,535.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,874.54
|
|
|
PR TRANSURETEROURETEROSTOMY ANAST URETER CLAT URTR
|
Professional
|
Both
|
$2,160.00
|
|
|
Service Code
|
HCPCS 50770
|
| Min. Negotiated Rate |
$734.64 |
| Max. Negotiated Rate |
$2,761.42 |
| Rate for Payer: Aetna Commercial |
$1,472.82
|
| Rate for Payer: Aetna Medicare |
$1,143.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.73
|
| Rate for Payer: BCBS Complete |
$771.37
|
| Rate for Payer: BCBS MAPPO |
$1,099.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,761.42
|
| Rate for Payer: BCN Commercial |
$1,655.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.12
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Cofinity Commercial |
$1,472.82
|
| Rate for Payer: Cofinity Commercial |
$1,582.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,154.08
|
| Rate for Payer: Meridian Medicaid |
$771.37
|
| Rate for Payer: Nomi Health Commercial |
$1,318.94
|
| Rate for Payer: PACE SWMI |
$1,099.12
|
| Rate for Payer: PHP Commercial |
$1,538.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$734.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,404.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,825.76
|
| Rate for Payer: Priority Health Medicare |
$1,099.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,825.76
|
| Rate for Payer: Priority Health SBD |
$1,825.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.12
|
| Rate for Payer: UHCCP Medicaid |
$734.64
|
| Rate for Payer: UMR Bronson Commercial |
$993.60
|
|
