|
PR VAGINAL DELIVERY AFTER CESAREAN DELIVERY
|
Professional
|
Both
|
$2,145.00
|
|
|
Service Code
|
HCPCS 59612
|
| Min. Negotiated Rate |
$858.00 |
| Max. Negotiated Rate |
$1,394.25 |
| Rate for Payer: Aetna Commercial |
$1,191.25
|
| Rate for Payer: Aetna Medicare |
$924.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,280.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,191.25
|
| Rate for Payer: BCBS Complete |
$858.00
|
| Rate for Payer: BCBS MAPPO |
$888.99
|
| Rate for Payer: BCN Medicare Advantage |
$888.99
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cofinity Commercial |
$1,280.15
|
| Rate for Payer: Cofinity Commercial |
$1,191.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$888.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.44
|
| Rate for Payer: Nomi Health Commercial |
$1,066.79
|
| Rate for Payer: PACE SWMI |
$888.99
|
| Rate for Payer: PHP Commercial |
$1,244.59
|
| Rate for Payer: PHP Medicare Advantage |
$888.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,394.25
|
| Rate for Payer: Priority Health Medicare |
$888.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$888.99
|
| Rate for Payer: UHC Medicare Advantage |
$888.99
|
| Rate for Payer: UMR Bronson Commercial |
$986.70
|
|
|
PR VAGINAL DELIVERY ONLY
|
Professional
|
Both
|
$1,970.00
|
|
|
Service Code
|
HCPCS 59409
|
| Min. Negotiated Rate |
$781.01 |
| Max. Negotiated Rate |
$1,280.50 |
| Rate for Payer: Aetna Commercial |
$1,046.55
|
| Rate for Payer: Aetna Medicare |
$812.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,124.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,046.55
|
| Rate for Payer: BCBS Complete |
$788.00
|
| Rate for Payer: BCBS MAPPO |
$781.01
|
| Rate for Payer: BCN Medicare Advantage |
$781.01
|
| Rate for Payer: Cash Price |
$1,576.00
|
| Rate for Payer: Cash Price |
$1,576.00
|
| Rate for Payer: Cofinity Commercial |
$1,124.65
|
| Rate for Payer: Cofinity Commercial |
$1,046.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$781.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$820.06
|
| Rate for Payer: Nomi Health Commercial |
$937.21
|
| Rate for Payer: PACE SWMI |
$781.01
|
| Rate for Payer: PHP Commercial |
$1,093.41
|
| Rate for Payer: PHP Medicare Advantage |
$781.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,280.50
|
| Rate for Payer: Priority Health Medicare |
$781.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$781.01
|
| Rate for Payer: UHC Medicare Advantage |
$781.01
|
| Rate for Payer: UMR Bronson Commercial |
$906.20
|
|
|
PR VAGINAL DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,242.00
|
|
|
Service Code
|
HCPCS 59410
|
| Min. Negotiated Rate |
$896.80 |
| Max. Negotiated Rate |
$1,518.91 |
| Rate for Payer: Aetna Commercial |
$1,413.43
|
| Rate for Payer: Aetna Medicare |
$1,096.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.43
|
| Rate for Payer: BCBS Complete |
$896.80
|
| Rate for Payer: BCBS MAPPO |
$1,054.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,054.80
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cash Price |
$1,793.60
|
| Rate for Payer: Cofinity Commercial |
$1,518.91
|
| Rate for Payer: Cofinity Commercial |
$1,413.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,054.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,107.54
|
| Rate for Payer: Nomi Health Commercial |
$1,265.76
|
| Rate for Payer: PACE SWMI |
$1,054.80
|
| Rate for Payer: PHP Commercial |
$1,476.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,054.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.30
|
| Rate for Payer: Priority Health Medicare |
$1,054.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,054.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,054.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.32
|
|
|
PR VAGINAL DELIVERY & POSTPARTUM CARE VBAC
|
Professional
|
Both
|
$2,417.00
|
|
|
Service Code
|
HCPCS 59614
|
| Min. Negotiated Rate |
$966.80 |
| Max. Negotiated Rate |
$1,652.04 |
| Rate for Payer: Aetna Commercial |
$1,537.32
|
| Rate for Payer: Aetna Medicare |
$1,193.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,652.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,537.32
|
| Rate for Payer: BCBS Complete |
$966.80
|
| Rate for Payer: BCBS MAPPO |
$1,147.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,147.25
|
| Rate for Payer: Cash Price |
$1,933.60
|
| Rate for Payer: Cash Price |
$1,933.60
|
| Rate for Payer: Cofinity Commercial |
$1,652.04
|
| Rate for Payer: Cofinity Commercial |
$1,537.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,147.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,204.61
|
| Rate for Payer: Nomi Health Commercial |
$1,376.70
|
| Rate for Payer: PACE SWMI |
$1,147.25
|
| Rate for Payer: PHP Commercial |
$1,606.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,147.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,571.05
|
| Rate for Payer: Priority Health Medicare |
$1,147.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,147.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,147.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,111.82
|
|
|
PR VAGINAL HYSTERECTOMY >250 GM RPR ENTEROCELE
|
Professional
|
Both
|
$2,238.00
|
|
|
Service Code
|
HCPCS 58294
|
| Min. Negotiated Rate |
$895.20 |
| Max. Negotiated Rate |
$1,684.34 |
| Rate for Payer: Aetna Commercial |
$1,567.37
|
| Rate for Payer: Aetna Medicare |
$1,216.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,684.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,567.37
|
| Rate for Payer: BCBS Complete |
$895.20
|
| Rate for Payer: BCBS MAPPO |
$1,169.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,169.68
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cash Price |
$1,790.40
|
| Rate for Payer: Cofinity Commercial |
$1,684.34
|
| Rate for Payer: Cofinity Commercial |
$1,567.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,169.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,228.16
|
| Rate for Payer: Nomi Health Commercial |
$1,403.62
|
| Rate for Payer: PACE SWMI |
$1,169.68
|
| Rate for Payer: PHP Commercial |
$1,637.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,169.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,454.70
|
| Rate for Payer: Priority Health Medicare |
$1,169.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,169.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,169.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,029.48
|
|
|
PR VAGINAL HYSTERECTOMY 250 GM/< W/RPR ENTEROCELE
|
Professional
|
Both
|
$2,757.00
|
|
|
Service Code
|
HCPCS 58270
|
| Min. Negotiated Rate |
$858.59 |
| Max. Negotiated Rate |
$1,792.05 |
| Rate for Payer: Aetna Commercial |
$1,150.51
|
| Rate for Payer: Aetna Medicare |
$892.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.51
|
| Rate for Payer: BCBS Complete |
$1,102.80
|
| Rate for Payer: BCBS MAPPO |
$858.59
|
| Rate for Payer: BCN Medicare Advantage |
$858.59
|
| Rate for Payer: Cash Price |
$2,205.60
|
| Rate for Payer: Cash Price |
$2,205.60
|
| Rate for Payer: Cofinity Commercial |
$1,236.37
|
| Rate for Payer: Cofinity Commercial |
$1,150.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.52
|
| Rate for Payer: Nomi Health Commercial |
$1,030.31
|
| Rate for Payer: PACE SWMI |
$858.59
|
| Rate for Payer: PHP Commercial |
$1,202.03
|
| Rate for Payer: PHP Medicare Advantage |
$858.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,792.05
|
| Rate for Payer: Priority Health Medicare |
$858.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.59
|
| Rate for Payer: UHC Medicare Advantage |
$858.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,268.22
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS > 250 GM
|
Professional
|
Both
|
$2,917.00
|
|
|
Service Code
|
HCPCS 58290
|
| Min. Negotiated Rate |
$1,106.24 |
| Max. Negotiated Rate |
$1,896.05 |
| Rate for Payer: Aetna Commercial |
$1,482.36
|
| Rate for Payer: Aetna Medicare |
$1,150.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,592.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,482.36
|
| Rate for Payer: BCBS Complete |
$1,166.80
|
| Rate for Payer: BCBS MAPPO |
$1,106.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,106.24
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cash Price |
$2,333.60
|
| Rate for Payer: Cofinity Commercial |
$1,592.99
|
| Rate for Payer: Cofinity Commercial |
$1,482.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,106.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,161.55
|
| Rate for Payer: Nomi Health Commercial |
$1,327.49
|
| Rate for Payer: PACE SWMI |
$1,106.24
|
| Rate for Payer: PHP Commercial |
$1,548.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,106.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,896.05
|
| Rate for Payer: Priority Health Medicare |
$1,106.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,106.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,106.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,341.82
|
|
|
PR VAGINAL HYSTERECTOMY UTERUS 250 GM/<
|
Professional
|
Both
|
$2,684.00
|
|
|
Service Code
|
HCPCS 58260
|
| Min. Negotiated Rate |
$804.92 |
| Max. Negotiated Rate |
$1,744.60 |
| Rate for Payer: Aetna Commercial |
$1,078.59
|
| Rate for Payer: Aetna Medicare |
$837.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.59
|
| Rate for Payer: BCBS Complete |
$1,073.60
|
| Rate for Payer: BCBS MAPPO |
$804.92
|
| Rate for Payer: BCN Medicare Advantage |
$804.92
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cash Price |
$2,147.20
|
| Rate for Payer: Cofinity Commercial |
$1,159.08
|
| Rate for Payer: Cofinity Commercial |
$1,078.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$845.17
|
| Rate for Payer: Nomi Health Commercial |
$965.90
|
| Rate for Payer: PACE SWMI |
$804.92
|
| Rate for Payer: PHP Commercial |
$1,126.89
|
| Rate for Payer: PHP Medicare Advantage |
$804.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,744.60
|
| Rate for Payer: Priority Health Medicare |
$804.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$804.92
|
| Rate for Payer: UHC Medicare Advantage |
$804.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,234.64
|
|
|
PR VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY
|
Professional
|
Both
|
$2,416.00
|
|
|
Service Code
|
HCPCS 58275
|
| Min. Negotiated Rate |
$953.00 |
| Max. Negotiated Rate |
$1,570.40 |
| Rate for Payer: Aetna Commercial |
$1,277.02
|
| Rate for Payer: Aetna Medicare |
$991.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,372.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,277.02
|
| Rate for Payer: BCBS Complete |
$966.40
|
| Rate for Payer: BCBS MAPPO |
$953.00
|
| Rate for Payer: BCN Medicare Advantage |
$953.00
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cash Price |
$1,932.80
|
| Rate for Payer: Cofinity Commercial |
$1,372.32
|
| Rate for Payer: Cofinity Commercial |
$1,277.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$953.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,000.65
|
| Rate for Payer: Nomi Health Commercial |
$1,143.60
|
| Rate for Payer: PACE SWMI |
$953.00
|
| Rate for Payer: PHP Commercial |
$1,334.20
|
| Rate for Payer: PHP Medicare Advantage |
$953.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,570.40
|
| Rate for Payer: Priority Health Medicare |
$953.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$953.00
|
| Rate for Payer: UHC Medicare Advantage |
$953.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,111.36
|
|
|
PR VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 57110
|
| Min. Negotiated Rate |
$810.00 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$1,160.33
|
| Rate for Payer: Aetna Medicare |
$900.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,246.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,160.33
|
| Rate for Payer: BCBS Complete |
$810.00
|
| Rate for Payer: BCBS MAPPO |
$865.92
|
| Rate for Payer: BCN Medicare Advantage |
$865.92
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cofinity Commercial |
$1,246.92
|
| Rate for Payer: Cofinity Commercial |
$1,160.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$865.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$909.22
|
| Rate for Payer: Nomi Health Commercial |
$1,039.10
|
| Rate for Payer: PACE SWMI |
$865.92
|
| Rate for Payer: PHP Commercial |
$1,212.29
|
| Rate for Payer: PHP Medicare Advantage |
$865.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,316.25
|
| Rate for Payer: Priority Health Medicare |
$865.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$865.92
|
| Rate for Payer: UHC Medicare Advantage |
$865.92
|
| Rate for Payer: UMR Bronson Commercial |
$931.50
|
|
|
PR VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
HCPCS 57106
|
| Min. Negotiated Rate |
$510.28 |
| Max. Negotiated Rate |
$1,295.45 |
| Rate for Payer: Aetna Commercial |
$683.78
|
| Rate for Payer: Aetna Medicare |
$530.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.78
|
| Rate for Payer: BCBS Complete |
$797.20
|
| Rate for Payer: BCBS MAPPO |
$510.28
|
| Rate for Payer: BCN Medicare Advantage |
$510.28
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cofinity Commercial |
$734.80
|
| Rate for Payer: Cofinity Commercial |
$683.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.79
|
| Rate for Payer: Nomi Health Commercial |
$612.34
|
| Rate for Payer: PACE SWMI |
$510.28
|
| Rate for Payer: PHP Commercial |
$714.39
|
| Rate for Payer: PHP Medicare Advantage |
$510.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.45
|
| Rate for Payer: Priority Health Medicare |
$510.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.28
|
| Rate for Payer: UHC Medicare Advantage |
$510.28
|
| Rate for Payer: UMR Bronson Commercial |
$916.78
|
|
|
PR VAGINOPLASTY INTERSEX STATE
|
Professional
|
Both
|
$2,533.00
|
|
|
Service Code
|
HCPCS 57335
|
| Min. Negotiated Rate |
$1,013.20 |
| Max. Negotiated Rate |
$1,646.45 |
| Rate for Payer: Aetna Commercial |
$1,511.52
|
| Rate for Payer: Aetna Medicare |
$1,173.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,511.52
|
| Rate for Payer: BCBS Complete |
$1,013.20
|
| Rate for Payer: BCBS MAPPO |
$1,128.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,128.00
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cash Price |
$2,026.40
|
| Rate for Payer: Cofinity Commercial |
$1,624.32
|
| Rate for Payer: Cofinity Commercial |
$1,511.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,128.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,184.40
|
| Rate for Payer: Nomi Health Commercial |
$1,353.60
|
| Rate for Payer: PACE SWMI |
$1,128.00
|
| Rate for Payer: PHP Commercial |
$1,579.20
|
| Rate for Payer: PHP Medicare Advantage |
$1,128.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,646.45
|
| Rate for Payer: Priority Health Medicare |
$1,128.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,128.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,128.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,165.18
|
|
|
PR VAGNC PRTL RMVL VAG WALL W/RMVL PARAVAGINAL TISS
|
Professional
|
Both
|
$2,571.00
|
|
|
Service Code
|
HCPCS 57107
|
| Min. Negotiated Rate |
$1,028.40 |
| Max. Negotiated Rate |
$2,014.62 |
| Rate for Payer: Aetna Commercial |
$1,874.71
|
| Rate for Payer: Aetna Medicare |
$1,455.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,014.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,874.71
|
| Rate for Payer: BCBS Complete |
$1,028.40
|
| Rate for Payer: BCBS MAPPO |
$1,399.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,399.04
|
| Rate for Payer: Cash Price |
$2,056.80
|
| Rate for Payer: Cash Price |
$2,056.80
|
| Rate for Payer: Cofinity Commercial |
$2,014.62
|
| Rate for Payer: Cofinity Commercial |
$1,874.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,399.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,468.99
|
| Rate for Payer: Nomi Health Commercial |
$1,678.85
|
| Rate for Payer: PACE SWMI |
$1,399.04
|
| Rate for Payer: PHP Commercial |
$1,958.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,399.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,671.15
|
| Rate for Payer: Priority Health Medicare |
$1,399.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,399.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,399.04
|
| Rate for Payer: UMR Bronson Commercial |
$1,182.66
|
|
|
PR VAGOTOMY PFRMD W/PRTL DSTL GSTRCT
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 43635
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$157.46 |
| Rate for Payer: Aetna Commercial |
$146.53
|
| Rate for Payer: Aetna Medicare |
$113.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.53
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$109.35
|
| Rate for Payer: BCN Medicare Advantage |
$109.35
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$157.46
|
| Rate for Payer: Cofinity Commercial |
$146.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.82
|
| Rate for Payer: Nomi Health Commercial |
$131.22
|
| Rate for Payer: PACE SWMI |
$109.35
|
| Rate for Payer: PHP Commercial |
$153.09
|
| Rate for Payer: PHP Medicare Advantage |
$109.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$109.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.35
|
| Rate for Payer: UHC Medicare Advantage |
$109.35
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR VALVECTOMY TRICUSPID VALVE W/CARDIOPULMONARY BYP
|
Professional
|
Both
|
$4,859.00
|
|
|
Service Code
|
HCPCS 33460
|
| Min. Negotiated Rate |
$1,943.60 |
| Max. Negotiated Rate |
$3,298.91 |
| Rate for Payer: Aetna Commercial |
$3,069.82
|
| Rate for Payer: Aetna Medicare |
$2,382.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,298.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,069.82
|
| Rate for Payer: BCBS Complete |
$1,943.60
|
| Rate for Payer: BCBS MAPPO |
$2,290.91
|
| Rate for Payer: BCN Medicare Advantage |
$2,290.91
|
| Rate for Payer: Cash Price |
$3,887.20
|
| Rate for Payer: Cash Price |
$3,887.20
|
| Rate for Payer: Cofinity Commercial |
$3,298.91
|
| Rate for Payer: Cofinity Commercial |
$3,069.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,290.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,405.46
|
| Rate for Payer: Nomi Health Commercial |
$2,749.09
|
| Rate for Payer: PACE SWMI |
$2,290.91
|
| Rate for Payer: PHP Commercial |
$3,207.27
|
| Rate for Payer: PHP Medicare Advantage |
$2,290.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,158.35
|
| Rate for Payer: Priority Health Medicare |
$2,290.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,290.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,290.91
|
| Rate for Payer: UMR Bronson Commercial |
$2,235.14
|
|
|
PR VALVOTOMY MITRAL VALVE OPEN HEART W/BYPASS
|
Professional
|
Both
|
$8,923.00
|
|
|
Service Code
|
HCPCS 33422
|
| Min. Negotiated Rate |
$1,590.96 |
| Max. Negotiated Rate |
$5,799.95 |
| Rate for Payer: Aetna Commercial |
$2,131.89
|
| Rate for Payer: Aetna Medicare |
$1,654.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,290.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,131.89
|
| Rate for Payer: BCBS Complete |
$3,569.20
|
| Rate for Payer: BCBS MAPPO |
$1,590.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,590.96
|
| Rate for Payer: Cash Price |
$7,138.40
|
| Rate for Payer: Cash Price |
$7,138.40
|
| Rate for Payer: Cofinity Commercial |
$2,290.98
|
| Rate for Payer: Cofinity Commercial |
$2,131.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,590.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,670.51
|
| Rate for Payer: Nomi Health Commercial |
$1,909.15
|
| Rate for Payer: PACE SWMI |
$1,590.96
|
| Rate for Payer: PHP Commercial |
$2,227.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,590.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,799.95
|
| Rate for Payer: Priority Health Medicare |
$1,590.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,590.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,590.96
|
| Rate for Payer: UMR Bronson Commercial |
$4,104.58
|
|
|
PR VALVULOPLASTY MITRAL VALVE W/CARDIAC BYPASS
|
Professional
|
Both
|
$8,513.00
|
|
|
Service Code
|
HCPCS 33425
|
| Min. Negotiated Rate |
$2,612.40 |
| Max. Negotiated Rate |
$5,533.45 |
| Rate for Payer: Aetna Commercial |
$3,500.62
|
| Rate for Payer: Aetna Medicare |
$2,716.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,761.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,500.62
|
| Rate for Payer: BCBS Complete |
$3,405.20
|
| Rate for Payer: BCBS MAPPO |
$2,612.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,612.40
|
| Rate for Payer: Cash Price |
$6,810.40
|
| Rate for Payer: Cash Price |
$6,810.40
|
| Rate for Payer: Cofinity Commercial |
$3,761.86
|
| Rate for Payer: Cofinity Commercial |
$3,500.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,612.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,743.02
|
| Rate for Payer: Nomi Health Commercial |
$3,134.88
|
| Rate for Payer: PACE SWMI |
$2,612.40
|
| Rate for Payer: PHP Commercial |
$3,657.36
|
| Rate for Payer: PHP Medicare Advantage |
$2,612.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,533.45
|
| Rate for Payer: Priority Health Medicare |
$2,612.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,612.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,612.40
|
| Rate for Payer: UMR Bronson Commercial |
$3,915.98
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/O RING INSERTION
|
Professional
|
Both
|
$7,544.00
|
|
|
Service Code
|
HCPCS 33463
|
| Min. Negotiated Rate |
$2,943.26 |
| Max. Negotiated Rate |
$4,903.60 |
| Rate for Payer: Aetna Commercial |
$3,943.97
|
| Rate for Payer: Aetna Medicare |
$3,060.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,238.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,943.97
|
| Rate for Payer: BCBS Complete |
$3,017.60
|
| Rate for Payer: BCBS MAPPO |
$2,943.26
|
| Rate for Payer: BCN Medicare Advantage |
$2,943.26
|
| Rate for Payer: Cash Price |
$6,035.20
|
| Rate for Payer: Cash Price |
$6,035.20
|
| Rate for Payer: Cofinity Commercial |
$4,238.29
|
| Rate for Payer: Cofinity Commercial |
$3,943.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,943.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,090.42
|
| Rate for Payer: Nomi Health Commercial |
$3,531.91
|
| Rate for Payer: PACE SWMI |
$2,943.26
|
| Rate for Payer: PHP Commercial |
$4,120.56
|
| Rate for Payer: PHP Medicare Advantage |
$2,943.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,903.60
|
| Rate for Payer: Priority Health Medicare |
$2,943.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,943.26
|
| Rate for Payer: UHC Medicare Advantage |
$2,943.26
|
| Rate for Payer: UMR Bronson Commercial |
$3,470.24
|
|
|
PR VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION
|
Professional
|
Both
|
$5,116.00
|
|
|
Service Code
|
HCPCS 33464
|
| Min. Negotiated Rate |
$2,046.40 |
| Max. Negotiated Rate |
$3,359.20 |
| Rate for Payer: Aetna Commercial |
$3,125.93
|
| Rate for Payer: Aetna Medicare |
$2,426.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,359.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,125.93
|
| Rate for Payer: BCBS Complete |
$2,046.40
|
| Rate for Payer: BCBS MAPPO |
$2,332.78
|
| Rate for Payer: BCN Medicare Advantage |
$2,332.78
|
| Rate for Payer: Cash Price |
$4,092.80
|
| Rate for Payer: Cash Price |
$4,092.80
|
| Rate for Payer: Cofinity Commercial |
$3,359.20
|
| Rate for Payer: Cofinity Commercial |
$3,125.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,332.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,449.42
|
| Rate for Payer: Nomi Health Commercial |
$2,799.34
|
| Rate for Payer: PACE SWMI |
$2,332.78
|
| Rate for Payer: PHP Commercial |
$3,265.89
|
| Rate for Payer: PHP Medicare Advantage |
$2,332.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,325.40
|
| Rate for Payer: Priority Health Medicare |
$2,332.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,332.78
|
| Rate for Payer: UHC Medicare Advantage |
$2,332.78
|
| Rate for Payer: UMR Bronson Commercial |
$2,353.36
|
|
|
PR VANTAS IMPLANT
|
Professional
|
Both
|
$3,401.00
|
|
|
Service Code
|
HCPCS J9225
|
| Min. Negotiated Rate |
$1,360.40 |
| Max. Negotiated Rate |
$2,210.65 |
| Rate for Payer: Aetna Medicare |
$1,700.50
|
| Rate for Payer: BCBS Complete |
$1,360.40
|
| Rate for Payer: Cash Price |
$2,720.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,210.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,564.46
|
|
|
PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 90716
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
PR VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 37500
|
| Min. Negotiated Rate |
$534.00 |
| Max. Negotiated Rate |
$873.94 |
| Rate for Payer: Aetna Commercial |
$813.25
|
| Rate for Payer: Aetna Medicare |
$631.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$873.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$813.25
|
| Rate for Payer: BCBS Complete |
$534.00
|
| Rate for Payer: BCBS MAPPO |
$606.90
|
| Rate for Payer: BCN Medicare Advantage |
$606.90
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cofinity Commercial |
$813.25
|
| Rate for Payer: Cofinity Commercial |
$873.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$606.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.25
|
| Rate for Payer: Nomi Health Commercial |
$728.28
|
| Rate for Payer: PACE SWMI |
$606.90
|
| Rate for Payer: PHP Commercial |
$849.66
|
| Rate for Payer: PHP Medicare Advantage |
$606.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$867.75
|
| Rate for Payer: Priority Health Medicare |
$606.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$606.90
|
| Rate for Payer: UHC Medicare Advantage |
$606.90
|
| Rate for Payer: UMR Bronson Commercial |
$614.10
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I
|
Professional
|
Both
|
$1,515.00
|
|
|
Service Code
|
HCPCS 37242
|
| Min. Negotiated Rate |
$450.23 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$603.31
|
| Rate for Payer: Aetna Medicare |
$468.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.31
|
| Rate for Payer: BCBS Complete |
$606.00
|
| Rate for Payer: BCBS MAPPO |
$450.23
|
| Rate for Payer: BCN Medicare Advantage |
$450.23
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cash Price |
$1,212.00
|
| Rate for Payer: Cofinity Commercial |
$648.33
|
| Rate for Payer: Cofinity Commercial |
$603.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.74
|
| Rate for Payer: Nomi Health Commercial |
$540.28
|
| Rate for Payer: PACE SWMI |
$450.23
|
| Rate for Payer: PHP Commercial |
$630.32
|
| Rate for Payer: PHP Medicare Advantage |
$450.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$984.75
|
| Rate for Payer: Priority Health Medicare |
$450.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$450.23
|
| Rate for Payer: UHC Medicare Advantage |
$450.23
|
| Rate for Payer: UMR Bronson Commercial |
$696.90
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE
|
Professional
|
Both
|
$9,702.00
|
|
|
Service Code
|
HCPCS 37244
|
| Min. Negotiated Rate |
$620.47 |
| Max. Negotiated Rate |
$6,306.30 |
| Rate for Payer: Aetna Commercial |
$831.43
|
| Rate for Payer: Aetna Medicare |
$645.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$893.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.43
|
| Rate for Payer: BCBS Complete |
$3,880.80
|
| Rate for Payer: BCBS MAPPO |
$620.47
|
| Rate for Payer: BCN Medicare Advantage |
$620.47
|
| Rate for Payer: Cash Price |
$7,761.60
|
| Rate for Payer: Cash Price |
$7,761.60
|
| Rate for Payer: Cofinity Commercial |
$893.48
|
| Rate for Payer: Cofinity Commercial |
$831.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$620.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$651.49
|
| Rate for Payer: Nomi Health Commercial |
$744.56
|
| Rate for Payer: PACE SWMI |
$620.47
|
| Rate for Payer: PHP Commercial |
$868.66
|
| Rate for Payer: PHP Medicare Advantage |
$620.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,306.30
|
| Rate for Payer: Priority Health Medicare |
$620.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$620.47
|
| Rate for Payer: UHC Medicare Advantage |
$620.47
|
| Rate for Payer: UMR Bronson Commercial |
$4,462.92
|
|
|
PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 37241
|
| Min. Negotiated Rate |
$276.40 |
| Max. Negotiated Rate |
$581.21 |
| Rate for Payer: Aetna Commercial |
$540.85
|
| Rate for Payer: Aetna Medicare |
$419.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.85
|
| Rate for Payer: BCBS Complete |
$276.40
|
| Rate for Payer: BCBS MAPPO |
$403.62
|
| Rate for Payer: BCN Medicare Advantage |
$403.62
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cofinity Commercial |
$581.21
|
| Rate for Payer: Cofinity Commercial |
$540.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$403.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$423.80
|
| Rate for Payer: Nomi Health Commercial |
$484.34
|
| Rate for Payer: PACE SWMI |
$403.62
|
| Rate for Payer: PHP Commercial |
$565.07
|
| Rate for Payer: PHP Medicare Advantage |
$403.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.15
|
| Rate for Payer: Priority Health Medicare |
$403.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$403.62
|
| Rate for Payer: UHC Medicare Advantage |
$403.62
|
| Rate for Payer: UMR Bronson Commercial |
$317.86
|
|
