|
PR URETERONEOCYSTOSTOMY ANAST DUPLICATE URETER BLDR
|
Professional
|
Both
|
$2,236.00
|
|
|
Service Code
|
HCPCS 50782
|
| Min. Negotiated Rate |
$685.43 |
| Max. Negotiated Rate |
$2,758.25 |
| Rate for Payer: Aetna Commercial |
$1,373.55
|
| Rate for Payer: Aetna Medicare |
$1,066.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,373.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,476.06
|
| Rate for Payer: BCBS Complete |
$719.70
|
| Rate for Payer: BCBS MAPPO |
$1,025.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,758.25
|
| Rate for Payer: BCN Commercial |
$1,544.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,025.04
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cash Price |
$1,788.80
|
| Rate for Payer: Cofinity Commercial |
$1,373.55
|
| Rate for Payer: Cofinity Commercial |
$1,476.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,025.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,076.29
|
| Rate for Payer: Meridian Medicaid |
$719.70
|
| Rate for Payer: Nomi Health Commercial |
$1,230.05
|
| Rate for Payer: PACE SWMI |
$1,025.04
|
| Rate for Payer: PHP Commercial |
$1,435.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,025.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$685.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,453.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,702.72
|
| Rate for Payer: Priority Health Medicare |
$1,025.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,702.72
|
| Rate for Payer: Priority Health SBD |
$1,702.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,025.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,025.04
|
| Rate for Payer: UHCCP Medicaid |
$685.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,028.56
|
|
|
PR URETERONEOCYSTOSTOMY W/URETERAL TAILORING
|
Professional
|
Both
|
$2,345.00
|
|
|
Service Code
|
HCPCS 50783
|
| Min. Negotiated Rate |
$717.81 |
| Max. Negotiated Rate |
$3,020.82 |
| Rate for Payer: Aetna Commercial |
$1,438.72
|
| Rate for Payer: Aetna Medicare |
$1,116.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,438.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,546.08
|
| Rate for Payer: BCBS Complete |
$753.70
|
| Rate for Payer: BCBS MAPPO |
$1,073.67
|
| Rate for Payer: BCBS Trust/PPO |
$3,020.82
|
| Rate for Payer: BCN Commercial |
$1,618.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,073.67
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cash Price |
$1,876.00
|
| Rate for Payer: Cofinity Commercial |
$1,438.72
|
| Rate for Payer: Cofinity Commercial |
$1,546.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,073.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,127.35
|
| Rate for Payer: Meridian Medicaid |
$753.70
|
| Rate for Payer: Nomi Health Commercial |
$1,288.40
|
| Rate for Payer: PACE SWMI |
$1,073.67
|
| Rate for Payer: PHP Commercial |
$1,503.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,073.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$717.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,524.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,784.74
|
| Rate for Payer: Priority Health Medicare |
$1,073.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,784.74
|
| Rate for Payer: Priority Health SBD |
$1,784.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,073.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,073.67
|
| Rate for Payer: UHCCP Medicaid |
$717.81
|
| Rate for Payer: UMR Bronson Commercial |
$1,078.70
|
|
|
PR URETEROPYELOSTOMY ANAST URETER RENAL PELVIS
|
Professional
|
Both
|
$2,563.00
|
|
|
Service Code
|
HCPCS 50740
|
| Min. Negotiated Rate |
$788.74 |
| Max. Negotiated Rate |
$2,670.03 |
| Rate for Payer: Aetna Commercial |
$1,597.64
|
| Rate for Payer: Aetna Medicare |
$1,239.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,597.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,716.87
|
| Rate for Payer: BCBS Complete |
$828.18
|
| Rate for Payer: BCBS MAPPO |
$1,192.27
|
| Rate for Payer: BCBS Trust/PPO |
$2,670.03
|
| Rate for Payer: BCN Commercial |
$1,788.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.27
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cash Price |
$2,050.40
|
| Rate for Payer: Cofinity Commercial |
$1,597.64
|
| Rate for Payer: Cofinity Commercial |
$1,716.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,251.88
|
| Rate for Payer: Meridian Medicaid |
$828.18
|
| Rate for Payer: Nomi Health Commercial |
$1,430.72
|
| Rate for Payer: PACE SWMI |
$1,192.27
|
| Rate for Payer: PHP Commercial |
$1,669.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$788.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,665.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,961.57
|
| Rate for Payer: Priority Health Medicare |
$1,192.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,961.57
|
| Rate for Payer: Priority Health SBD |
$1,961.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,192.27
|
| Rate for Payer: UHCCP Medicaid |
$788.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,178.98
|
|
|
PR URETERORRHAPHY SUTURE URETER SEPARATE PROCEDURE
|
Professional
|
Both
|
$1,769.00
|
|
|
Service Code
|
HCPCS 50900
|
| Min. Negotiated Rate |
$539.32 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,078.26
|
| Rate for Payer: Aetna Medicare |
$836.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,158.72
|
| Rate for Payer: BCBS Complete |
$566.29
|
| Rate for Payer: BCBS MAPPO |
$804.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.84
|
| Rate for Payer: BCN Commercial |
$1,214.37
|
| Rate for Payer: BCN Medicare Advantage |
$804.67
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cash Price |
$1,415.20
|
| Rate for Payer: Cofinity Commercial |
$1,078.26
|
| Rate for Payer: Cofinity Commercial |
$1,158.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$804.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$844.90
|
| Rate for Payer: Meridian Medicaid |
$566.29
|
| Rate for Payer: Nomi Health Commercial |
$965.60
|
| Rate for Payer: PACE SWMI |
$804.67
|
| Rate for Payer: PHP Commercial |
$1,126.54
|
| Rate for Payer: PHP Medicare Advantage |
$804.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,149.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,340.02
|
| Rate for Payer: Priority Health Medicare |
$804.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,340.02
|
| Rate for Payer: Priority Health SBD |
$1,340.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$804.67
|
| Rate for Payer: UHC Medicare Advantage |
$804.67
|
| Rate for Payer: UHCCP Medicaid |
$539.32
|
| Rate for Payer: UMR Bronson Commercial |
$813.74
|
|
|
PR URETEROTOMY INSERTION INDWELLING STENT ALL TYPES
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 50605
|
| Min. Negotiated Rate |
$646.03 |
| Max. Negotiated Rate |
$1,609.52 |
| Rate for Payer: Aetna Commercial |
$1,305.32
|
| Rate for Payer: Aetna Medicare |
$1,013.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,305.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,402.73
|
| Rate for Payer: BCBS Complete |
$678.33
|
| Rate for Payer: BCBS MAPPO |
$974.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.98
|
| Rate for Payer: BCN Commercial |
$1,464.57
|
| Rate for Payer: BCN Medicare Advantage |
$974.12
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,305.32
|
| Rate for Payer: Cofinity Commercial |
$1,402.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,022.83
|
| Rate for Payer: Meridian Medicaid |
$678.33
|
| Rate for Payer: Nomi Health Commercial |
$1,168.94
|
| Rate for Payer: PACE SWMI |
$974.12
|
| Rate for Payer: PHP Commercial |
$1,363.77
|
| Rate for Payer: PHP Medicare Advantage |
$974.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$646.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,609.52
|
| Rate for Payer: Priority Health Medicare |
$974.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,609.52
|
| Rate for Payer: Priority Health SBD |
$1,609.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.12
|
| Rate for Payer: UHC Medicare Advantage |
$974.12
|
| Rate for Payer: UHCCP Medicaid |
$646.03
|
| Rate for Payer: UMR Bronson Commercial |
$935.64
|
|
|
PR URETEROURETEROSTOMY
|
Professional
|
Both
|
$2,110.00
|
|
|
Service Code
|
HCPCS 50760
|
| Min. Negotiated Rate |
$720.79 |
| Max. Negotiated Rate |
$2,592.37 |
| Rate for Payer: Aetna Commercial |
$1,448.86
|
| Rate for Payer: Aetna Medicare |
$1,124.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,448.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.99
|
| Rate for Payer: BCBS Complete |
$756.83
|
| Rate for Payer: BCBS MAPPO |
$1,081.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,592.37
|
| Rate for Payer: BCN Commercial |
$1,637.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,081.24
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cash Price |
$1,688.00
|
| Rate for Payer: Cofinity Commercial |
$1,448.86
|
| Rate for Payer: Cofinity Commercial |
$1,556.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,081.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,135.30
|
| Rate for Payer: Meridian Medicaid |
$756.83
|
| Rate for Payer: Nomi Health Commercial |
$1,297.49
|
| Rate for Payer: PACE SWMI |
$1,081.24
|
| Rate for Payer: PHP Commercial |
$1,513.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,081.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,371.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,795.92
|
| Rate for Payer: Priority Health Medicare |
$1,081.24
|
| Rate for Payer: Priority Health Narrow Network |
$1,795.92
|
| Rate for Payer: Priority Health SBD |
$1,795.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,081.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,081.24
|
| Rate for Payer: UHCCP Medicaid |
$720.79
|
| Rate for Payer: UMR Bronson Commercial |
$970.60
|
|
|
PR URETHRECTOMY TOT W/CYSTOST MALE
|
Professional
|
Both
|
$1,928.00
|
|
|
Service Code
|
HCPCS 53215
|
| Min. Negotiated Rate |
$397.81 |
| Max. Negotiated Rate |
$1,469.98 |
| Rate for Payer: Aetna Commercial |
$1,186.92
|
| Rate for Payer: Aetna Medicare |
$921.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,186.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,275.49
|
| Rate for Payer: BCBS Complete |
$622.20
|
| Rate for Payer: BCBS MAPPO |
$885.76
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: BCN Commercial |
$1,335.55
|
| Rate for Payer: BCN Medicare Advantage |
$885.76
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cash Price |
$1,542.40
|
| Rate for Payer: Cofinity Commercial |
$1,186.92
|
| Rate for Payer: Cofinity Commercial |
$1,275.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$885.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$930.05
|
| Rate for Payer: Meridian Medicaid |
$622.20
|
| Rate for Payer: Nomi Health Commercial |
$1,062.91
|
| Rate for Payer: PACE SWMI |
$885.76
|
| Rate for Payer: PHP Commercial |
$1,240.06
|
| Rate for Payer: PHP Medicare Advantage |
$885.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$592.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,469.98
|
| Rate for Payer: Priority Health Medicare |
$885.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,469.98
|
| Rate for Payer: Priority Health SBD |
$1,469.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$885.76
|
| Rate for Payer: UHC Medicare Advantage |
$885.76
|
| Rate for Payer: UHCCP Medicaid |
$592.57
|
| Rate for Payer: UMR Bronson Commercial |
$886.88
|
|
|
PR URETHROLSS TRVG SEC OPN W/CSTO
|
Professional
|
Both
|
$1,363.00
|
|
|
Service Code
|
HCPCS 53500
|
| Min. Negotiated Rate |
$479.25 |
| Max. Negotiated Rate |
$1,194.10 |
| Rate for Payer: Aetna Commercial |
$960.06
|
| Rate for Payer: Aetna Medicare |
$745.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,031.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.06
|
| Rate for Payer: BCBS Complete |
$503.21
|
| Rate for Payer: BCBS MAPPO |
$716.46
|
| Rate for Payer: BCBS Trust/PPO |
$556.83
|
| Rate for Payer: BCN Commercial |
$1,086.33
|
| Rate for Payer: BCN Medicare Advantage |
$716.46
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cash Price |
$1,090.40
|
| Rate for Payer: Cofinity Commercial |
$1,031.70
|
| Rate for Payer: Cofinity Commercial |
$960.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.28
|
| Rate for Payer: Meridian Medicaid |
$503.21
|
| Rate for Payer: Nomi Health Commercial |
$859.75
|
| Rate for Payer: PACE SWMI |
$716.46
|
| Rate for Payer: PHP Commercial |
$1,003.04
|
| Rate for Payer: PHP Medicare Advantage |
$716.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,194.10
|
| Rate for Payer: Priority Health Medicare |
$716.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,194.10
|
| Rate for Payer: Priority Health SBD |
$1,194.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.46
|
| Rate for Payer: UHC Medicare Advantage |
$716.46
|
| Rate for Payer: UHCCP Medicaid |
$479.25
|
| Rate for Payer: UMR Bronson Commercial |
$626.98
|
|
|
PR URETHROMEATOPLASTY W/MUCOSAL ADVANCEMENT
|
Professional
|
Both
|
$774.00
|
|
|
Service Code
|
HCPCS 53450
|
| Min. Negotiated Rate |
$264.33 |
| Max. Negotiated Rate |
$1,193.96 |
| Rate for Payer: Aetna Commercial |
$525.45
|
| Rate for Payer: Aetna Medicare |
$407.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.67
|
| Rate for Payer: BCBS Complete |
$277.55
|
| Rate for Payer: BCBS MAPPO |
$392.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,193.96
|
| Rate for Payer: BCN Commercial |
$592.28
|
| Rate for Payer: BCN Medicare Advantage |
$392.13
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cash Price |
$619.20
|
| Rate for Payer: Cofinity Commercial |
$525.45
|
| Rate for Payer: Cofinity Commercial |
$564.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.74
|
| Rate for Payer: Meridian Medicaid |
$277.55
|
| Rate for Payer: Nomi Health Commercial |
$470.56
|
| Rate for Payer: PACE SWMI |
$392.13
|
| Rate for Payer: PHP Commercial |
$548.98
|
| Rate for Payer: PHP Medicare Advantage |
$392.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$503.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$655.10
|
| Rate for Payer: Priority Health Medicare |
$392.13
|
| Rate for Payer: Priority Health Narrow Network |
$655.10
|
| Rate for Payer: Priority Health SBD |
$655.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.13
|
| Rate for Payer: UHC Medicare Advantage |
$392.13
|
| Rate for Payer: UHCCP Medicaid |
$264.33
|
| Rate for Payer: UMR Bronson Commercial |
$356.04
|
|
|
PR URETHROMEATOPLASTY W/PRTL EXC DSTL URTL SGM
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS 53460
|
| Min. Negotiated Rate |
$294.58 |
| Max. Negotiated Rate |
$1,023.75 |
| Rate for Payer: Aetna Commercial |
$586.45
|
| Rate for Payer: Aetna Medicare |
$455.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.22
|
| Rate for Payer: BCBS Complete |
$309.31
|
| Rate for Payer: BCBS MAPPO |
$437.65
|
| Rate for Payer: BCBS Trust/PPO |
$758.64
|
| Rate for Payer: BCN Commercial |
$661.67
|
| Rate for Payer: BCN Medicare Advantage |
$437.65
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cash Price |
$1,260.00
|
| Rate for Payer: Cofinity Commercial |
$586.45
|
| Rate for Payer: Cofinity Commercial |
$630.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$437.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$459.53
|
| Rate for Payer: Meridian Medicaid |
$309.31
|
| Rate for Payer: Nomi Health Commercial |
$525.18
|
| Rate for Payer: PACE SWMI |
$437.65
|
| Rate for Payer: PHP Commercial |
$612.71
|
| Rate for Payer: PHP Medicare Advantage |
$437.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,023.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$732.86
|
| Rate for Payer: Priority Health Medicare |
$437.65
|
| Rate for Payer: Priority Health Narrow Network |
$732.86
|
| Rate for Payer: Priority Health SBD |
$732.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$437.65
|
| Rate for Payer: UHC Medicare Advantage |
$437.65
|
| Rate for Payer: UHCCP Medicaid |
$294.58
|
| Rate for Payer: UMR Bronson Commercial |
$724.50
|
|
|
PR URETHROPLASTY 1 STG RECNST MALE ANTERIOR URETHRA
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 53410
|
| Min. Negotiated Rate |
$625.16 |
| Max. Negotiated Rate |
$1,732.82 |
| Rate for Payer: Aetna Commercial |
$1,251.44
|
| Rate for Payer: Aetna Medicare |
$971.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,251.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.83
|
| Rate for Payer: BCBS Complete |
$656.42
|
| Rate for Payer: BCBS MAPPO |
$933.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,732.82
|
| Rate for Payer: BCN Commercial |
$1,409.35
|
| Rate for Payer: BCN Medicare Advantage |
$933.91
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,251.44
|
| Rate for Payer: Cofinity Commercial |
$1,344.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$933.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$980.61
|
| Rate for Payer: Meridian Medicaid |
$656.42
|
| Rate for Payer: Nomi Health Commercial |
$1,120.69
|
| Rate for Payer: PACE SWMI |
$933.91
|
| Rate for Payer: PHP Commercial |
$1,307.47
|
| Rate for Payer: PHP Medicare Advantage |
$933.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$625.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,555.20
|
| Rate for Payer: Priority Health Medicare |
$933.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,555.20
|
| Rate for Payer: Priority Health SBD |
$1,555.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$933.91
|
| Rate for Payer: UHC Medicare Advantage |
$933.91
|
| Rate for Payer: UHCCP Medicaid |
$625.16
|
| Rate for Payer: UMR Bronson Commercial |
$935.18
|
|
|
PR URETHROPLASTY 1ST STG FISTULA/DIVERTICULUM/STRIX
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 53400
|
| Min. Negotiated Rate |
$513.54 |
| Max. Negotiated Rate |
$2,001.20 |
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Aetna Commercial |
$1,026.40
|
| Rate for Payer: Aetna Medicare |
$796.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,026.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.00
|
| Rate for Payer: BCBS Complete |
$539.22
|
| Rate for Payer: BCBS MAPPO |
$765.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,001.20
|
| Rate for Payer: BCN Commercial |
$1,154.25
|
| Rate for Payer: BCN Medicare Advantage |
$765.97
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,026.40
|
| Rate for Payer: Cofinity Commercial |
$1,103.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$765.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.27
|
| Rate for Payer: Meridian Medicaid |
$539.22
|
| Rate for Payer: Nomi Health Commercial |
$919.16
|
| Rate for Payer: PACE SWMI |
$765.97
|
| Rate for Payer: PHP Commercial |
$1,072.36
|
| Rate for Payer: PHP Medicare Advantage |
$765.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$513.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,272.91
|
| Rate for Payer: Priority Health Medicare |
$765.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,272.91
|
| Rate for Payer: Priority Health SBD |
$1,272.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$765.97
|
| Rate for Payer: UHC Medicare Advantage |
$765.97
|
| Rate for Payer: UHCCP Medicaid |
$513.54
|
| Rate for Payer: UMR Bronson Commercial |
$701.04
|
|
|
PR URETHROPLASTY 2ND STAGE W/URINARY DIVERSION
|
Professional
|
Both
|
$1,814.00
|
|
|
Service Code
|
HCPCS 53405
|
| Min. Negotiated Rate |
$558.70 |
| Max. Negotiated Rate |
$2,435.99 |
| Rate for Payer: Aetna Commercial |
$1,117.72
|
| Rate for Payer: Aetna Medicare |
$867.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,117.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,201.13
|
| Rate for Payer: BCBS Complete |
$586.64
|
| Rate for Payer: BCBS MAPPO |
$834.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,435.99
|
| Rate for Payer: BCN Commercial |
$1,258.34
|
| Rate for Payer: BCN Medicare Advantage |
$834.12
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cash Price |
$1,451.20
|
| Rate for Payer: Cofinity Commercial |
$1,117.72
|
| Rate for Payer: Cofinity Commercial |
$1,201.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$834.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$875.83
|
| Rate for Payer: Meridian Medicaid |
$586.64
|
| Rate for Payer: Nomi Health Commercial |
$1,000.94
|
| Rate for Payer: PACE SWMI |
$834.12
|
| Rate for Payer: PHP Commercial |
$1,167.77
|
| Rate for Payer: PHP Medicare Advantage |
$834.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,179.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,387.42
|
| Rate for Payer: Priority Health Medicare |
$834.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,387.42
|
| Rate for Payer: Priority Health SBD |
$1,387.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$834.12
|
| Rate for Payer: UHC Medicare Advantage |
$834.12
|
| Rate for Payer: UHCCP Medicaid |
$558.70
|
| Rate for Payer: UMR Bronson Commercial |
$834.44
|
|
|
PR URETHROPLASTY RCNSTJ FEMALE URETHRA
|
Professional
|
Both
|
$1,764.00
|
|
|
Service Code
|
HCPCS 53430
|
| Min. Negotiated Rate |
$622.17 |
| Max. Negotiated Rate |
$2,049.80 |
| Rate for Payer: Aetna Commercial |
$1,247.55
|
| Rate for Payer: Aetna Medicare |
$968.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,340.65
|
| Rate for Payer: BCBS Complete |
$653.28
|
| Rate for Payer: BCBS MAPPO |
$931.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,049.80
|
| Rate for Payer: BCN Commercial |
$1,406.42
|
| Rate for Payer: BCN Medicare Advantage |
$931.01
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cash Price |
$1,411.20
|
| Rate for Payer: Cofinity Commercial |
$1,247.55
|
| Rate for Payer: Cofinity Commercial |
$1,340.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$977.56
|
| Rate for Payer: Meridian Medicaid |
$653.28
|
| Rate for Payer: Nomi Health Commercial |
$1,117.21
|
| Rate for Payer: PACE SWMI |
$931.01
|
| Rate for Payer: PHP Commercial |
$1,303.41
|
| Rate for Payer: PHP Medicare Advantage |
$931.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$622.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,146.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,548.80
|
| Rate for Payer: Priority Health Medicare |
$931.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.80
|
| Rate for Payer: Priority Health SBD |
$1,548.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$931.01
|
| Rate for Payer: UHC Medicare Advantage |
$931.01
|
| Rate for Payer: UHCCP Medicaid |
$622.17
|
| Rate for Payer: UMR Bronson Commercial |
$811.44
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ FEMALE
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
HCPCS 53502
|
| Min. Negotiated Rate |
$313.32 |
| Max. Negotiated Rate |
$778.13 |
| Rate for Payer: Aetna Commercial |
$624.19
|
| Rate for Payer: Aetna Medicare |
$484.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.77
|
| Rate for Payer: BCBS Complete |
$328.99
|
| Rate for Payer: BCBS MAPPO |
$465.81
|
| Rate for Payer: BCBS Trust/PPO |
$701.05
|
| Rate for Payer: BCN Commercial |
$702.72
|
| Rate for Payer: BCN Medicare Advantage |
$465.81
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cofinity Commercial |
$624.19
|
| Rate for Payer: Cofinity Commercial |
$670.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.10
|
| Rate for Payer: Meridian Medicaid |
$328.99
|
| Rate for Payer: Nomi Health Commercial |
$558.97
|
| Rate for Payer: PACE SWMI |
$465.81
|
| Rate for Payer: PHP Commercial |
$652.13
|
| Rate for Payer: PHP Medicare Advantage |
$465.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$635.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$778.13
|
| Rate for Payer: Priority Health Medicare |
$465.81
|
| Rate for Payer: Priority Health Narrow Network |
$778.13
|
| Rate for Payer: Priority Health SBD |
$778.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.81
|
| Rate for Payer: UHC Medicare Advantage |
$465.81
|
| Rate for Payer: UHCCP Medicaid |
$313.32
|
| Rate for Payer: UMR Bronson Commercial |
$449.42
|
|
|
PR URETHRORRHAPHY SUTR URETHRAL WOUND/INJ PENILE
|
Professional
|
Both
|
$923.00
|
|
|
Service Code
|
HCPCS 53505
|
| Min. Negotiated Rate |
$288.98 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna Commercial |
$623.78
|
| Rate for Payer: Aetna Medicare |
$484.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$623.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.33
|
| Rate for Payer: BCBS Complete |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$465.51
|
| Rate for Payer: BCBS Trust/PPO |
$288.98
|
| Rate for Payer: BCN Commercial |
$702.23
|
| Rate for Payer: BCN Medicare Advantage |
$465.51
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cash Price |
$738.40
|
| Rate for Payer: Cofinity Commercial |
$623.78
|
| Rate for Payer: Cofinity Commercial |
$670.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$465.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$488.79
|
| Rate for Payer: Meridian Medicaid |
$328.77
|
| Rate for Payer: Nomi Health Commercial |
$558.61
|
| Rate for Payer: PACE SWMI |
$465.51
|
| Rate for Payer: PHP Commercial |
$651.71
|
| Rate for Payer: PHP Medicare Advantage |
$465.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$599.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$777.60
|
| Rate for Payer: Priority Health Medicare |
$465.51
|
| Rate for Payer: Priority Health Narrow Network |
$777.60
|
| Rate for Payer: Priority Health SBD |
$777.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$465.51
|
| Rate for Payer: UHC Medicare Advantage |
$465.51
|
| Rate for Payer: UHCCP Medicaid |
$313.11
|
| Rate for Payer: UMR Bronson Commercial |
$424.58
|
|
|
PR URETHROTOMY/URETHROSTOMY XT SPX PERINEAL URETHRA
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
HCPCS 53010
|
| Min. Negotiated Rate |
$192.98 |
| Max. Negotiated Rate |
$478.27 |
| Rate for Payer: Aetna Commercial |
$381.16
|
| Rate for Payer: Aetna Medicare |
$295.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.61
|
| Rate for Payer: BCBS Complete |
$202.63
|
| Rate for Payer: BCBS MAPPO |
$284.45
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: BCN Commercial |
$430.52
|
| Rate for Payer: BCN Medicare Advantage |
$284.45
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cofinity Commercial |
$381.16
|
| Rate for Payer: Cofinity Commercial |
$409.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.67
|
| Rate for Payer: Meridian Medicaid |
$202.63
|
| Rate for Payer: Nomi Health Commercial |
$341.34
|
| Rate for Payer: PACE SWMI |
$284.45
|
| Rate for Payer: PHP Commercial |
$398.23
|
| Rate for Payer: PHP Medicare Advantage |
$284.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$478.27
|
| Rate for Payer: Priority Health Medicare |
$284.45
|
| Rate for Payer: Priority Health Narrow Network |
$478.27
|
| Rate for Payer: Priority Health SBD |
$478.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.45
|
| Rate for Payer: UHC Medicare Advantage |
$284.45
|
| Rate for Payer: UHCCP Medicaid |
$192.98
|
| Rate for Payer: UMR Bronson Commercial |
$254.38
|
|
|
PR URETRECECTOMY W/BLADDER CUFF SEPARATE PROCEDURE
|
Professional
|
Both
|
$3,350.00
|
|
|
Service Code
|
HCPCS 50650
|
| Min. Negotiated Rate |
$662.43 |
| Max. Negotiated Rate |
$2,177.50 |
| Rate for Payer: Aetna Commercial |
$1,327.22
|
| Rate for Payer: Aetna Medicare |
$1,030.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,327.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,426.26
|
| Rate for Payer: BCBS Complete |
$695.55
|
| Rate for Payer: BCBS MAPPO |
$990.46
|
| Rate for Payer: BCBS Trust/PPO |
$809.36
|
| Rate for Payer: BCN Commercial |
$1,491.44
|
| Rate for Payer: BCN Medicare Advantage |
$990.46
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cofinity Commercial |
$1,426.26
|
| Rate for Payer: Cofinity Commercial |
$1,327.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$990.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,039.98
|
| Rate for Payer: Meridian Medicaid |
$695.55
|
| Rate for Payer: Nomi Health Commercial |
$1,188.55
|
| Rate for Payer: PACE SWMI |
$990.46
|
| Rate for Payer: PHP Commercial |
$1,386.64
|
| Rate for Payer: PHP Medicare Advantage |
$990.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$662.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,177.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,648.40
|
| Rate for Payer: Priority Health Medicare |
$990.46
|
| Rate for Payer: Priority Health Narrow Network |
$1,648.40
|
| Rate for Payer: Priority Health SBD |
$1,648.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$990.46
|
| Rate for Payer: UHC Medicare Advantage |
$990.46
|
| Rate for Payer: UHCCP Medicaid |
$662.43
|
| Rate for Payer: UMR Bronson Commercial |
$1,541.00
|
|
|
PR URINARY LEG OR ABDOMEN BAG
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS A4358
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCN Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: UMR Bronson Commercial |
$3.68
|
|
|
PR URINARY SUSPENSORY
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS A5105
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCN Commercial |
$44.89
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: UMR Bronson Commercial |
$30.36
|
|
|
PR URTP W/TUBULARIZATION POST URT&/LWR BLDR
|
Professional
|
Both
|
$2,206.00
|
|
|
Service Code
|
HCPCS 53431
|
| Min. Negotiated Rate |
$734.64 |
| Max. Negotiated Rate |
$2,997.57 |
| Rate for Payer: Aetna Commercial |
$1,472.67
|
| Rate for Payer: Aetna Medicare |
$1,142.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,472.67
|
| Rate for Payer: BCBS Complete |
$771.37
|
| Rate for Payer: BCBS MAPPO |
$1,099.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,997.57
|
| Rate for Payer: BCN Commercial |
$1,656.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.01
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Cash Price |
$1,764.80
|
| Rate for Payer: Cofinity Commercial |
$1,472.67
|
| Rate for Payer: Cofinity Commercial |
$1,582.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,153.96
|
| Rate for Payer: Meridian Medicaid |
$771.37
|
| Rate for Payer: Nomi Health Commercial |
$1,318.81
|
| Rate for Payer: PACE SWMI |
$1,099.01
|
| Rate for Payer: PHP Commercial |
$1,538.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$734.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,433.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,825.76
|
| Rate for Payer: Priority Health Medicare |
$1,099.01
|
| 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 |
$1,099.01
|
| Rate for Payer: UHC Medicare Advantage |
$1,099.01
|
| Rate for Payer: UHCCP Medicaid |
$734.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,014.76
|
|
|
PR URTROLITHOTOMY MIDDLE ONE-THIRD URETER
|
Professional
|
Both
|
$1,626.00
|
|
|
Service Code
|
HCPCS 50620
|
| Min. Negotiated Rate |
$576.59 |
| Max. Negotiated Rate |
$1,432.69 |
| Rate for Payer: Aetna Commercial |
$1,154.77
|
| Rate for Payer: Aetna Medicare |
$896.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,154.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,240.95
|
| Rate for Payer: BCBS Complete |
$605.42
|
| Rate for Payer: BCBS MAPPO |
$861.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,273.73
|
| Rate for Payer: BCN Commercial |
$1,299.39
|
| Rate for Payer: BCN Medicare Advantage |
$861.77
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cash Price |
$1,300.80
|
| Rate for Payer: Cofinity Commercial |
$1,154.77
|
| Rate for Payer: Cofinity Commercial |
$1,240.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$861.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$904.86
|
| Rate for Payer: Meridian Medicaid |
$605.42
|
| Rate for Payer: Nomi Health Commercial |
$1,034.12
|
| Rate for Payer: PACE SWMI |
$861.77
|
| Rate for Payer: PHP Commercial |
$1,206.48
|
| Rate for Payer: PHP Medicare Advantage |
$861.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$576.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,056.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,432.69
|
| Rate for Payer: Priority Health Medicare |
$861.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,432.69
|
| Rate for Payer: Priority Health SBD |
$1,432.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$861.77
|
| Rate for Payer: UHC Medicare Advantage |
$861.77
|
| Rate for Payer: UHCCP Medicaid |
$576.59
|
| Rate for Payer: UMR Bronson Commercial |
$747.96
|
|
|
PR URTRONEOCSTOST W/VESICO-PSOAS HITCH/BLDR FLAP
|
Professional
|
Both
|
$4,652.00
|
|
|
Service Code
|
HCPCS 50785
|
| Min. Negotiated Rate |
$775.11 |
| Max. Negotiated Rate |
$3,101.12 |
| Rate for Payer: Aetna Commercial |
$1,556.52
|
| Rate for Payer: Aetna Medicare |
$1,208.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,556.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,672.68
|
| Rate for Payer: BCBS Complete |
$813.87
|
| Rate for Payer: BCBS MAPPO |
$1,161.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,101.12
|
| Rate for Payer: BCN Commercial |
$1,747.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,161.58
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$1,556.52
|
| Rate for Payer: Cofinity Commercial |
$1,672.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,161.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,219.66
|
| Rate for Payer: Meridian Medicaid |
$813.87
|
| Rate for Payer: Nomi Health Commercial |
$1,393.90
|
| Rate for Payer: PACE SWMI |
$1,161.58
|
| Rate for Payer: PHP Commercial |
$1,626.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,161.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$775.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,920.56
|
| Rate for Payer: Priority Health Medicare |
$1,161.58
|
| Rate for Payer: Priority Health Narrow Network |
$1,920.56
|
| Rate for Payer: Priority Health SBD |
$1,920.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,161.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,161.58
|
| Rate for Payer: UHCCP Medicaid |
$775.11
|
| Rate for Payer: UMR Bronson Commercial |
$2,139.92
|
|
|
PR URTT/URTS XTRNL SPX PENDULOUS URETHRA
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 53000
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$283.70 |
| Rate for Payer: Aetna Commercial |
$189.46
|
| Rate for Payer: Aetna Medicare |
$147.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.60
|
| Rate for Payer: BCBS Complete |
$100.42
|
| Rate for Payer: BCBS MAPPO |
$141.39
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$214.53
|
| Rate for Payer: BCN Medicare Advantage |
$141.39
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$203.60
|
| Rate for Payer: Cofinity Commercial |
$189.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.46
|
| Rate for Payer: Meridian Medicaid |
$100.42
|
| Rate for Payer: Nomi Health Commercial |
$169.67
|
| Rate for Payer: PACE SWMI |
$141.39
|
| Rate for Payer: PHP Commercial |
$197.95
|
| Rate for Payer: PHP Medicare Advantage |
$141.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.08
|
| Rate for Payer: Priority Health Medicare |
$141.39
|
| Rate for Payer: Priority Health Narrow Network |
$238.08
|
| Rate for Payer: Priority Health SBD |
$238.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.39
|
| Rate for Payer: UHC Medicare Advantage |
$141.39
|
| Rate for Payer: UHCCP Medicaid |
$95.64
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
PR USE OF ECHO CONTRAST AGENT DURING STRESS ECHO
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 93352
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$1,312.83 |
| Rate for Payer: Aetna Commercial |
$42.42
|
| Rate for Payer: Aetna Medicare |
$32.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.59
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS MAPPO |
$31.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,312.83
|
| Rate for Payer: BCN Commercial |
$49.36
|
| Rate for Payer: BCN Medicare Advantage |
$31.66
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$45.59
|
| Rate for Payer: Cofinity Commercial |
$42.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.24
|
| Rate for Payer: Nomi Health Commercial |
$37.99
|
| Rate for Payer: PACE SWMI |
$31.66
|
| Rate for Payer: PHP Commercial |
$44.32
|
| Rate for Payer: PHP Medicare Advantage |
$31.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.97
|
| Rate for Payer: Priority Health Medicare |
$31.66
|
| Rate for Payer: Priority Health Narrow Network |
$48.97
|
| Rate for Payer: Priority Health SBD |
$48.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.66
|
| Rate for Payer: UHC Medicare Advantage |
$31.66
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
|
