|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 69645
|
| Min. Negotiated Rate |
$947.00 |
| Max. Negotiated Rate |
$2,184.39 |
| Rate for Payer: Aetna Commercial |
$1,847.98
|
| Rate for Payer: Aetna Medicare |
$1,434.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,847.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,985.89
|
| Rate for Payer: BCBS Complete |
$994.35
|
| Rate for Payer: BCBS MAPPO |
$1,379.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,502.49
|
| Rate for Payer: BCN Commercial |
$2,184.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,379.09
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,847.98
|
| Rate for Payer: Cofinity Commercial |
$1,985.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,379.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,448.04
|
| Rate for Payer: Meridian Medicaid |
$994.35
|
| Rate for Payer: Nomi Health Commercial |
$1,654.91
|
| Rate for Payer: PACE SWMI |
$1,379.09
|
| Rate for Payer: PHP Commercial |
$1,930.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,379.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$947.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,161.93
|
| Rate for Payer: Priority Health Medicare |
$1,379.09
|
| Rate for Payer: Priority Health Narrow Network |
$2,161.93
|
| Rate for Payer: Priority Health SBD |
$2,161.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,379.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,379.09
|
| Rate for Payer: UHCCP Medicaid |
$947.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,219.92
|
|
|
PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 69633
|
| Min. Negotiated Rate |
$134.72 |
| Max. Negotiated Rate |
$1,553.99 |
| Rate for Payer: Aetna Commercial |
$1,314.88
|
| Rate for Payer: Aetna Medicare |
$1,020.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,314.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.00
|
| Rate for Payer: BCBS Complete |
$705.62
|
| Rate for Payer: BCBS MAPPO |
$981.25
|
| Rate for Payer: BCBS Trust/PPO |
$134.72
|
| Rate for Payer: BCN Commercial |
$1,553.99
|
| Rate for Payer: BCN Medicare Advantage |
$981.25
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$1,314.88
|
| Rate for Payer: Cofinity Commercial |
$1,413.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.31
|
| Rate for Payer: Meridian Medicaid |
$705.62
|
| Rate for Payer: Nomi Health Commercial |
$1,177.50
|
| Rate for Payer: PACE SWMI |
$981.25
|
| Rate for Payer: PHP Commercial |
$1,373.75
|
| Rate for Payer: PHP Medicare Advantage |
$981.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$672.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,545.20
|
| Rate for Payer: Priority Health Medicare |
$981.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,545.20
|
| Rate for Payer: Priority Health SBD |
$1,545.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.25
|
| Rate for Payer: UHC Medicare Advantage |
$981.25
|
| Rate for Payer: UHCCP Medicaid |
$672.02
|
| Rate for Payer: UMR Bronson Commercial |
$868.48
|
|
|
PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
|
Professional
|
Both
|
$3,145.00
|
|
|
Service Code
|
HCPCS 69631
|
| Min. Negotiated Rate |
$567.01 |
| Max. Negotiated Rate |
$2,248.97 |
| Rate for Payer: Meridian Medicaid |
$595.36
|
| Rate for Payer: Aetna Commercial |
$1,106.60
|
| Rate for Payer: Aetna Medicare |
$858.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,106.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,189.18
|
| Rate for Payer: BCBS Complete |
$595.36
|
| Rate for Payer: BCBS MAPPO |
$825.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,248.97
|
| Rate for Payer: BCN Commercial |
$1,316.99
|
| Rate for Payer: BCN Medicare Advantage |
$825.82
|
| Rate for Payer: Cash Price |
$2,516.00
|
| Rate for Payer: Cash Price |
$2,516.00
|
| Rate for Payer: Cofinity Commercial |
$1,106.60
|
| Rate for Payer: Cofinity Commercial |
$1,189.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$825.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$867.11
|
| Rate for Payer: Nomi Health Commercial |
$990.98
|
| Rate for Payer: PACE SWMI |
$825.82
|
| Rate for Payer: PHP Commercial |
$1,156.15
|
| Rate for Payer: PHP Medicare Advantage |
$825.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,307.86
|
| Rate for Payer: Priority Health Medicare |
$825.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,307.86
|
| Rate for Payer: Priority Health SBD |
$1,850.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$825.82
|
| Rate for Payer: UHC Medicare Advantage |
$825.82
|
| Rate for Payer: UHCCP Medicaid |
$567.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,446.70
|
|
|
PR TYMPANOSTOMY GENERAL ANESTHESIA
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 69436
|
| Min. Negotiated Rate |
$103.31 |
| Max. Negotiated Rate |
$2,059.84 |
| Rate for Payer: Aetna Commercial |
$202.55
|
| Rate for Payer: Aetna Medicare |
$157.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.67
|
| Rate for Payer: BCBS Complete |
$108.48
|
| Rate for Payer: BCBS MAPPO |
$151.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,059.84
|
| Rate for Payer: BCN Commercial |
$234.56
|
| Rate for Payer: BCN Medicare Advantage |
$151.16
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$202.55
|
| Rate for Payer: Cofinity Commercial |
$217.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.72
|
| Rate for Payer: Meridian Medicaid |
$108.48
|
| Rate for Payer: Nomi Health Commercial |
$181.39
|
| Rate for Payer: PACE SWMI |
$151.16
|
| Rate for Payer: PHP Commercial |
$211.62
|
| Rate for Payer: PHP Medicare Advantage |
$151.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.40
|
| Rate for Payer: Priority Health Medicare |
$151.16
|
| Rate for Payer: Priority Health Narrow Network |
$235.40
|
| Rate for Payer: Priority Health SBD |
$235.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.16
|
| Rate for Payer: UHC Medicare Advantage |
$151.16
|
| Rate for Payer: UHCCP Medicaid |
$103.31
|
| Rate for Payer: UMR Bronson Commercial |
$173.42
|
|
|
PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 69433
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$2,182.94 |
| Rate for Payer: Aetna Commercial |
$167.69
|
| Rate for Payer: Aetna Medicare |
$130.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.20
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$125.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,182.94
|
| Rate for Payer: BCN Commercial |
$239.92
|
| Rate for Payer: BCN Medicare Advantage |
$125.14
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$167.69
|
| Rate for Payer: Cofinity Commercial |
$180.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.40
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Nomi Health Commercial |
$150.17
|
| Rate for Payer: PACE SWMI |
$125.14
|
| Rate for Payer: PHP Commercial |
$175.20
|
| Rate for Payer: PHP Medicare Advantage |
$125.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.53
|
| Rate for Payer: Priority Health Medicare |
$125.14
|
| Rate for Payer: Priority Health Narrow Network |
$195.53
|
| Rate for Payer: Priority Health SBD |
$195.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.14
|
| Rate for Payer: UHC Medicare Advantage |
$125.14
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
| Rate for Payer: UMR Bronson Commercial |
$151.34
|
|
|
PR TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ
|
Professional
|
Both
|
$1,954.00
|
|
|
Service Code
|
HCPCS 69632
|
| Min. Negotiated Rate |
$124.68 |
| Max. Negotiated Rate |
$1,601.40 |
| Rate for Payer: Aetna Commercial |
$1,350.43
|
| Rate for Payer: Aetna Medicare |
$1,048.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,350.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,451.20
|
| Rate for Payer: BCBS Complete |
$724.41
|
| Rate for Payer: BCBS MAPPO |
$1,007.78
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$1,601.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.78
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cofinity Commercial |
$1,350.43
|
| Rate for Payer: Cofinity Commercial |
$1,451.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,058.17
|
| Rate for Payer: Meridian Medicaid |
$724.41
|
| Rate for Payer: Nomi Health Commercial |
$1,209.34
|
| Rate for Payer: PACE SWMI |
$1,007.78
|
| Rate for Payer: PHP Commercial |
$1,410.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,270.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,586.07
|
| Rate for Payer: Priority Health Medicare |
$1,007.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,586.07
|
| Rate for Payer: Priority Health SBD |
$1,586.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,007.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,007.78
|
| Rate for Payer: UHCCP Medicaid |
$689.91
|
| Rate for Payer: UMR Bronson Commercial |
$898.84
|
|
|
PR TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$3,636.00
|
|
|
Service Code
|
HCPCS 69635
|
| Min. Negotiated Rate |
$329.13 |
| Max. Negotiated Rate |
$2,363.40 |
| Rate for Payer: Aetna Commercial |
$1,597.91
|
| Rate for Payer: Aetna Medicare |
$1,240.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,597.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,717.16
|
| Rate for Payer: BCBS Complete |
$860.16
|
| Rate for Payer: BCBS MAPPO |
$1,192.47
|
| Rate for Payer: BCBS Trust/PPO |
$329.13
|
| Rate for Payer: BCN Commercial |
$1,893.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.47
|
| Rate for Payer: Cash Price |
$2,908.80
|
| Rate for Payer: Cash Price |
$2,908.80
|
| Rate for Payer: Cofinity Commercial |
$1,597.91
|
| Rate for Payer: Cofinity Commercial |
$1,717.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,252.09
|
| Rate for Payer: Meridian Medicaid |
$860.16
|
| Rate for Payer: Nomi Health Commercial |
$1,430.96
|
| Rate for Payer: PACE SWMI |
$1,192.47
|
| Rate for Payer: PHP Commercial |
$1,669.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$819.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,363.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,875.95
|
| Rate for Payer: Priority Health Medicare |
$1,192.47
|
| Rate for Payer: Priority Health Narrow Network |
$1,875.95
|
| Rate for Payer: Priority Health SBD |
$1,875.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,192.47
|
| Rate for Payer: UHCCP Medicaid |
$819.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,672.56
|
|
|
PR UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX
|
Professional
|
Both
|
$2,006.00
|
|
|
Service Code
|
HCPCS 49250
|
| Min. Negotiated Rate |
$385.96 |
| Max. Negotiated Rate |
$1,303.90 |
| Rate for Payer: Aetna Commercial |
$773.54
|
| Rate for Payer: Aetna Medicare |
$600.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.27
|
| Rate for Payer: BCBS Complete |
$405.26
|
| Rate for Payer: BCBS MAPPO |
$577.27
|
| Rate for Payer: BCBS Trust/PPO |
$996.37
|
| Rate for Payer: BCN Commercial |
$870.33
|
| Rate for Payer: BCN Medicare Advantage |
$577.27
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Cofinity Commercial |
$773.54
|
| Rate for Payer: Cofinity Commercial |
$831.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$577.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$606.13
|
| Rate for Payer: Meridian Medicaid |
$405.26
|
| Rate for Payer: Nomi Health Commercial |
$692.72
|
| Rate for Payer: PACE SWMI |
$577.27
|
| Rate for Payer: PHP Commercial |
$808.18
|
| Rate for Payer: PHP Medicare Advantage |
$577.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$385.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,303.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,071.48
|
| Rate for Payer: Priority Health Medicare |
$577.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,071.48
|
| Rate for Payer: Priority Health SBD |
$1,071.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$577.27
|
| Rate for Payer: UHC Medicare Advantage |
$577.27
|
| Rate for Payer: UHCCP Medicaid |
$385.96
|
| Rate for Payer: UMR Bronson Commercial |
$922.76
|
|
|
PR UNILATERAL BREAST AUGMENTATION GEL
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 00362
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,109.60 |
| Max. Negotiated Rate |
$1,803.10 |
| Rate for Payer: Aetna Medicare |
$1,387.00
|
| Rate for Payer: BCBS Complete |
$1,109.60
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,276.04
|
|
|
PR UNILATERAL BREAST AUGMENTATION SALINE
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
HCPCS 00363
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$1,405.30 |
| Rate for Payer: Aetna Medicare |
$1,081.00
|
| Rate for Payer: BCBS Complete |
$864.80
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.30
|
| Rate for Payer: UMR Bronson Commercial |
$994.52
|
|
|
PR UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 91299
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$749.66 |
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS Trust/PPO |
$749.66
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR UNLISTED EVALUATION AND MANAGEMENT SERVICE
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 99499
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$75.02 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$75.02
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
|
|
PR UNLISTED PSYCHIATRIC SERVICE/PROCEDURE
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 90899
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$681.51 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS Trust/PPO |
$681.51
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 33214
|
| Min. Negotiated Rate |
$302.25 |
| Max. Negotiated Rate |
$1,455.47 |
| Rate for Payer: Aetna Commercial |
$609.12
|
| Rate for Payer: Aetna Medicare |
$472.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.58
|
| Rate for Payer: BCBS Complete |
$317.36
|
| Rate for Payer: BCBS MAPPO |
$454.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,455.47
|
| Rate for Payer: BCN Commercial |
$693.44
|
| Rate for Payer: BCN Medicare Advantage |
$454.57
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cofinity Commercial |
$609.12
|
| Rate for Payer: Cofinity Commercial |
$654.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$454.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$477.30
|
| Rate for Payer: Meridian Medicaid |
$317.36
|
| Rate for Payer: Nomi Health Commercial |
$545.48
|
| Rate for Payer: PACE SWMI |
$454.57
|
| Rate for Payer: PHP Commercial |
$636.40
|
| Rate for Payer: PHP Medicare Advantage |
$454.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$645.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$751.46
|
| Rate for Payer: Priority Health Medicare |
$454.57
|
| Rate for Payer: Priority Health Narrow Network |
$751.46
|
| Rate for Payer: Priority Health SBD |
$751.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$454.57
|
| Rate for Payer: UHC Medicare Advantage |
$454.57
|
| Rate for Payer: UHCCP Medicaid |
$302.25
|
| Rate for Payer: UMR Bronson Commercial |
$456.78
|
|
|
PR UPPER EXT FX ORTHOSIS RAD/UL
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS L3982
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$339.45 |
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCN Commercial |
$339.45
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: UMR Bronson Commercial |
$161.00
|
|
|
PR UPPER EXT FX ORTHOSIS WRIST
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS L3984
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$299.03 |
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCN Commercial |
$299.03
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: UMR Bronson Commercial |
$141.68
|
|
|
PR UPPER GI ENDOSCOPY,STENT PLACEMENT
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 43256
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$720.85 |
| Rate for Payer: Aetna Medicare |
$554.50
|
| Rate for Payer: BCBS Complete |
$443.60
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
| Rate for Payer: UMR Bronson Commercial |
$510.14
|
|
|
PR UPPER GI ENDOSCOPY,TUMOR ABLATN
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43258
|
| Min. Negotiated Rate |
$488.00 |
| Max. Negotiated Rate |
$793.00 |
| Rate for Payer: Aetna Medicare |
$610.00
|
| Rate for Payer: BCBS Complete |
$488.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.00
|
| Rate for Payer: UMR Bronson Commercial |
$561.20
|
|
|
PR UPPER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 00530
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Medicare |
$918.00
|
| Rate for Payer: BCBS Complete |
$734.40
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,193.40
|
| Rate for Payer: UMR Bronson Commercial |
$844.56
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROSTOMY
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
HCPCS 50951
|
| Min. Negotiated Rate |
$193.83 |
| Max. Negotiated Rate |
$2,683.76 |
| Rate for Payer: Aetna Commercial |
$389.89
|
| Rate for Payer: Aetna Medicare |
$302.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.89
|
| Rate for Payer: BCBS Complete |
$203.52
|
| Rate for Payer: BCBS MAPPO |
$290.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,683.76
|
| Rate for Payer: BCN Commercial |
$546.34
|
| Rate for Payer: BCN Medicare Advantage |
$290.96
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cofinity Commercial |
$418.98
|
| Rate for Payer: Cofinity Commercial |
$389.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.51
|
| Rate for Payer: Meridian Medicaid |
$203.52
|
| Rate for Payer: Nomi Health Commercial |
$349.15
|
| Rate for Payer: PACE SWMI |
$290.96
|
| Rate for Payer: PHP Commercial |
$407.34
|
| Rate for Payer: PHP Medicare Advantage |
$290.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$482.00
|
| Rate for Payer: Priority Health Medicare |
$290.96
|
| Rate for Payer: Priority Health Narrow Network |
$482.00
|
| Rate for Payer: Priority Health SBD |
$482.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$290.96
|
| Rate for Payer: UHC Medicare Advantage |
$290.96
|
| Rate for Payer: UHCCP Medicaid |
$193.83
|
| Rate for Payer: UMR Bronson Commercial |
$330.28
|
|
|
PR URETERAL ENDOSCOPY VIA URETEROST W/RMVL FB/STONE
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 50961
|
| Min. Negotiated Rate |
$199.16 |
| Max. Negotiated Rate |
$2,814.78 |
| Rate for Payer: Aetna Commercial |
$400.57
|
| Rate for Payer: Aetna Medicare |
$310.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.46
|
| Rate for Payer: BCBS Complete |
$209.12
|
| Rate for Payer: BCBS MAPPO |
$298.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,814.78
|
| Rate for Payer: BCN Commercial |
$561.98
|
| Rate for Payer: BCN Medicare Advantage |
$298.93
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$400.57
|
| Rate for Payer: Cofinity Commercial |
$430.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.88
|
| Rate for Payer: Meridian Medicaid |
$209.12
|
| Rate for Payer: Nomi Health Commercial |
$358.72
|
| Rate for Payer: PACE SWMI |
$298.93
|
| Rate for Payer: PHP Commercial |
$418.50
|
| Rate for Payer: PHP Medicare Advantage |
$298.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$199.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.98
|
| Rate for Payer: Priority Health Medicare |
$298.93
|
| Rate for Payer: Priority Health Narrow Network |
$497.98
|
| Rate for Payer: Priority Health SBD |
$497.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.93
|
| Rate for Payer: UHC Medicare Advantage |
$298.93
|
| Rate for Payer: UHCCP Medicaid |
$199.16
|
| Rate for Payer: UMR Bronson Commercial |
$353.74
|
|
|
PR URETEROILEAL CONDUIT W/INTESTINE ANASTOMOSIS
|
Professional
|
Both
|
$3,457.00
|
|
|
Service Code
|
HCPCS 50820
|
| Min. Negotiated Rate |
$836.88 |
| Max. Negotiated Rate |
$3,097.95 |
| Rate for Payer: Aetna Commercial |
$1,679.38
|
| Rate for Payer: Aetna Medicare |
$1,303.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,679.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,804.71
|
| Rate for Payer: BCBS Complete |
$878.72
|
| Rate for Payer: BCBS MAPPO |
$1,253.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,097.95
|
| Rate for Payer: BCN Commercial |
$1,888.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,253.27
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cash Price |
$2,765.60
|
| Rate for Payer: Cofinity Commercial |
$1,679.38
|
| Rate for Payer: Cofinity Commercial |
$1,804.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,253.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,315.93
|
| Rate for Payer: Meridian Medicaid |
$878.72
|
| Rate for Payer: Nomi Health Commercial |
$1,503.92
|
| Rate for Payer: PACE SWMI |
$1,253.27
|
| Rate for Payer: PHP Commercial |
$1,754.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,253.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,247.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,078.74
|
| Rate for Payer: Priority Health Medicare |
$1,253.27
|
| Rate for Payer: Priority Health Narrow Network |
$2,078.74
|
| Rate for Payer: Priority Health SBD |
$2,078.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,253.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,253.27
|
| Rate for Payer: UHCCP Medicaid |
$836.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,590.22
|
|
|
PR URETEROLYSIS FOR OVARIAN VEIN SYNDROME
|
Professional
|
Both
|
$2,633.00
|
|
|
Service Code
|
HCPCS 50722
|
| Min. Negotiated Rate |
$652.63 |
| Max. Negotiated Rate |
$4,734.10 |
| Rate for Payer: Aetna Commercial |
$1,313.19
|
| Rate for Payer: Aetna Medicare |
$1,019.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,313.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,411.19
|
| Rate for Payer: BCBS Complete |
$685.26
|
| Rate for Payer: BCBS MAPPO |
$979.99
|
| Rate for Payer: BCBS Trust/PPO |
$4,734.10
|
| Rate for Payer: BCN Commercial |
$1,489.49
|
| Rate for Payer: BCN Medicare Advantage |
$979.99
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cash Price |
$2,106.40
|
| Rate for Payer: Cofinity Commercial |
$1,313.19
|
| Rate for Payer: Cofinity Commercial |
$1,411.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,028.99
|
| Rate for Payer: Meridian Medicaid |
$685.26
|
| Rate for Payer: Nomi Health Commercial |
$1,175.99
|
| Rate for Payer: PACE SWMI |
$979.99
|
| Rate for Payer: PHP Commercial |
$1,371.99
|
| Rate for Payer: PHP Medicare Advantage |
$979.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,711.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,631.36
|
| Rate for Payer: Priority Health Medicare |
$979.99
|
| Rate for Payer: Priority Health Narrow Network |
$1,631.36
|
| Rate for Payer: Priority Health SBD |
$1,631.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.99
|
| Rate for Payer: UHC Medicare Advantage |
$979.99
|
| Rate for Payer: UHCCP Medicaid |
$652.63
|
| Rate for Payer: UMR Bronson Commercial |
$1,211.18
|
|
|
PR URETEROLYSIS W/WORPSG URETER RETROPERIT FIBROSIS
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 50715
|
| Min. Negotiated Rate |
$774.89 |
| Max. Negotiated Rate |
$4,058.93 |
| Rate for Payer: Aetna Commercial |
$1,558.85
|
| Rate for Payer: Aetna Medicare |
$1,209.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,558.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,675.18
|
| Rate for Payer: BCBS Complete |
$813.63
|
| Rate for Payer: BCBS MAPPO |
$1,163.32
|
| Rate for Payer: BCBS Trust/PPO |
$4,058.93
|
| Rate for Payer: BCN Commercial |
$1,749.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,163.32
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cofinity Commercial |
$1,558.85
|
| Rate for Payer: Cofinity Commercial |
$1,675.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,163.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,221.49
|
| Rate for Payer: Meridian Medicaid |
$813.63
|
| Rate for Payer: Nomi Health Commercial |
$1,395.98
|
| Rate for Payer: PACE SWMI |
$1,163.32
|
| Rate for Payer: PHP Commercial |
$1,628.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,163.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$774.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,925.89
|
| Rate for Payer: Priority Health Medicare |
$1,163.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,925.89
|
| Rate for Payer: Priority Health SBD |
$1,925.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,163.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,163.32
|
| Rate for Payer: UHCCP Medicaid |
$774.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,044.20
|
|
|
PR URETERONEOCYSTOSTOMY ANAST 1 URETER BLADDER
|
Professional
|
Both
|
$2,093.00
|
|
|
Service Code
|
HCPCS 50780
|
| Min. Negotiated Rate |
$711.21 |
| Max. Negotiated Rate |
$2,795.76 |
| Rate for Payer: Aetna Commercial |
$1,428.69
|
| Rate for Payer: Aetna Medicare |
$1,108.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,428.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,535.31
|
| Rate for Payer: BCBS Complete |
$746.77
|
| Rate for Payer: BCBS MAPPO |
$1,066.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,795.76
|
| Rate for Payer: BCN Commercial |
$1,600.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,066.19
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cash Price |
$1,674.40
|
| Rate for Payer: Cofinity Commercial |
$1,428.69
|
| Rate for Payer: Cofinity Commercial |
$1,535.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,066.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,119.50
|
| Rate for Payer: Meridian Medicaid |
$746.77
|
| Rate for Payer: Nomi Health Commercial |
$1,279.43
|
| Rate for Payer: PACE SWMI |
$1,066.19
|
| Rate for Payer: PHP Commercial |
$1,492.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,066.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$711.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,360.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,767.17
|
| Rate for Payer: Priority Health Medicare |
$1,066.19
|
| Rate for Payer: Priority Health Narrow Network |
$1,767.17
|
| Rate for Payer: Priority Health SBD |
$1,767.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,066.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,066.19
|
| Rate for Payer: UHCCP Medicaid |
$711.21
|
| Rate for Payer: UMR Bronson Commercial |
$962.78
|
|
