|
PR PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 45309
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$291.00 |
| Rate for Payer: Aetna Commercial |
$114.34
|
| Rate for Payer: Aetna Medicare |
$88.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.88
|
| Rate for Payer: BCBS Complete |
$57.70
|
| Rate for Payer: BCBS MAPPO |
$85.33
|
| Rate for Payer: BCN Commercial |
$135.45
|
| Rate for Payer: BCN Medicare Advantage |
$85.33
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$122.88
|
| Rate for Payer: Cofinity Commercial |
$114.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.33
|
| Rate for Payer: Healthscope Commercial |
$157.86
|
| Rate for Payer: Healthscope Commercial |
$136.53
|
| Rate for Payer: Mclaren Medicaid |
$54.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.60
|
| Rate for Payer: Meridian Medicaid |
$57.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$93.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.50
|
| Rate for Payer: Nomi Health Commercial |
$102.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.00
|
| Rate for Payer: PACE SWMI |
$85.33
|
| Rate for Payer: PHP Medicare Advantage |
$85.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$165.03
|
| Rate for Payer: Priority Health Medicare |
$85.33
|
| Rate for Payer: Priority Health SBD |
$165.03
|
| Rate for Payer: Priority Health Tiered Network |
$165.03
|
| Rate for Payer: Railroad Medicare Medicare |
$85.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.65
|
| Rate for Payer: UHC Core |
$158.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$85.33
|
| Rate for Payer: UHC Exchange |
$158.65
|
| Rate for Payer: UHC Medicaid |
$54.95
|
| Rate for Payer: UHCCP Medicaid |
$54.95
|
|
|
PR PROCTOSGMDSC RIGID RMVL MULT TUMOR CAUTERY/SNARE
|
Professional
|
Both
|
$496.00
|
|
|
Service Code
|
HCPCS 45315
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$133.21
|
| Rate for Payer: Aetna Medicare |
$103.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.15
|
| Rate for Payer: BCBS Complete |
$67.09
|
| Rate for Payer: BCBS MAPPO |
$99.41
|
| Rate for Payer: BCN Commercial |
$159.85
|
| Rate for Payer: BCN Medicare Advantage |
$99.41
|
| Rate for Payer: Cash Price |
$396.80
|
| Rate for Payer: Cash Price |
$396.80
|
| Rate for Payer: Cofinity Commercial |
$143.15
|
| Rate for Payer: Cofinity Commercial |
$133.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.41
|
| Rate for Payer: Healthscope Commercial |
$183.91
|
| Rate for Payer: Healthscope Commercial |
$159.06
|
| Rate for Payer: Mclaren Medicaid |
$63.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.38
|
| Rate for Payer: Meridian Medicaid |
$67.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.60
|
| Rate for Payer: Nomi Health Commercial |
$119.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.00
|
| Rate for Payer: PACE SWMI |
$99.41
|
| Rate for Payer: PHP Medicare Advantage |
$99.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$194.76
|
| Rate for Payer: Priority Health Medicare |
$99.41
|
| Rate for Payer: Priority Health SBD |
$194.76
|
| Rate for Payer: Priority Health Tiered Network |
$194.76
|
| Rate for Payer: Railroad Medicare Medicare |
$99.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.27
|
| Rate for Payer: UHC Core |
$188.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$99.41
|
| Rate for Payer: UHC Exchange |
$188.27
|
| Rate for Payer: UHC Medicaid |
$63.90
|
| Rate for Payer: UHCCP Medicaid |
$63.90
|
|
|
PR PROCTOSGMDSC RIGID TNDSC STENT PLMT
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 45327
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$215.40 |
| Rate for Payer: Aetna Commercial |
$146.29
|
| Rate for Payer: Aetna Medicare |
$113.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.20
|
| Rate for Payer: BCBS Complete |
$73.58
|
| Rate for Payer: BCBS MAPPO |
$109.17
|
| Rate for Payer: BCN Commercial |
$176.78
|
| Rate for Payer: BCN Medicare Advantage |
$109.17
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$157.20
|
| Rate for Payer: Cofinity Commercial |
$146.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.17
|
| Rate for Payer: Healthscope Commercial |
$201.96
|
| Rate for Payer: Healthscope Commercial |
$174.67
|
| Rate for Payer: Mclaren Medicaid |
$70.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.63
|
| Rate for Payer: Meridian Medicaid |
$73.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$120.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.86
|
| Rate for Payer: Nomi Health Commercial |
$131.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.25
|
| Rate for Payer: PACE SWMI |
$109.17
|
| Rate for Payer: PHP Medicare Advantage |
$109.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$215.40
|
| Rate for Payer: Priority Health Medicare |
$109.17
|
| Rate for Payer: Priority Health SBD |
$215.40
|
| Rate for Payer: Priority Health Tiered Network |
$215.40
|
| Rate for Payer: Railroad Medicare Medicare |
$109.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.56
|
| Rate for Payer: UHC Core |
$208.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$109.17
|
| Rate for Payer: UHC Exchange |
$208.56
|
| Rate for Payer: UHC Medicaid |
$70.08
|
| Rate for Payer: UHCCP Medicaid |
$70.08
|
|
|
PR PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 45305
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$229.50 |
| Rate for Payer: Aetna Commercial |
$90.88
|
| Rate for Payer: Aetna Medicare |
$70.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.66
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS MAPPO |
$67.82
|
| Rate for Payer: BCN Commercial |
$109.55
|
| Rate for Payer: BCN Medicare Advantage |
$67.82
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$97.66
|
| Rate for Payer: Cofinity Commercial |
$90.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.82
|
| Rate for Payer: Healthscope Commercial |
$125.47
|
| Rate for Payer: Healthscope Commercial |
$108.51
|
| Rate for Payer: Mclaren Medicaid |
$44.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.21
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.18
|
| Rate for Payer: Nomi Health Commercial |
$81.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$229.50
|
| Rate for Payer: PACE SWMI |
$67.82
|
| Rate for Payer: PHP Medicare Advantage |
$67.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$133.48
|
| Rate for Payer: Priority Health Medicare |
$67.82
|
| Rate for Payer: Priority Health SBD |
$133.48
|
| Rate for Payer: Priority Health Tiered Network |
$133.48
|
| Rate for Payer: Railroad Medicare Medicare |
$67.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.80
|
| Rate for Payer: UHC Core |
$127.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$67.82
|
| Rate for Payer: UHC Exchange |
$127.80
|
| Rate for Payer: UHC Medicaid |
$44.09
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
|
|
PR PROCTOSGMDSC RIGID W/DILATION
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 45303
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$160.50 |
| Rate for Payer: Aetna Commercial |
$105.63
|
| Rate for Payer: Aetna Medicare |
$81.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.52
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS MAPPO |
$78.83
|
| Rate for Payer: BCN Commercial |
$127.49
|
| Rate for Payer: BCN Medicare Advantage |
$78.83
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$113.52
|
| Rate for Payer: Cofinity Commercial |
$105.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.83
|
| Rate for Payer: Healthscope Commercial |
$145.84
|
| Rate for Payer: Healthscope Commercial |
$126.13
|
| Rate for Payer: Mclaren Medicaid |
$51.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.77
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.50
|
| Rate for Payer: Nomi Health Commercial |
$94.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$160.50
|
| Rate for Payer: PACE SWMI |
$78.83
|
| Rate for Payer: PHP Medicare Advantage |
$78.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$155.34
|
| Rate for Payer: Priority Health Medicare |
$78.83
|
| Rate for Payer: Priority Health SBD |
$155.34
|
| Rate for Payer: Priority Health Tiered Network |
$155.34
|
| Rate for Payer: Railroad Medicare Medicare |
$78.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.36
|
| Rate for Payer: UHC Core |
$149.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$78.83
|
| Rate for Payer: UHC Exchange |
$149.36
|
| Rate for Payer: UHC Medicaid |
$51.12
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
|
|
PR PROCTOSGMDSC RIGID W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 45307
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$261.75 |
| Rate for Payer: Aetna Commercial |
$127.41
|
| Rate for Payer: Aetna Medicare |
$98.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.92
|
| Rate for Payer: BCBS Complete |
$64.19
|
| Rate for Payer: BCBS MAPPO |
$95.08
|
| Rate for Payer: BCN Commercial |
$151.39
|
| Rate for Payer: BCN Medicare Advantage |
$95.08
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$136.92
|
| Rate for Payer: Cofinity Commercial |
$127.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.08
|
| Rate for Payer: Healthscope Commercial |
$175.90
|
| Rate for Payer: Healthscope Commercial |
$152.13
|
| Rate for Payer: Mclaren Medicaid |
$61.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.83
|
| Rate for Payer: Meridian Medicaid |
$64.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.31
|
| Rate for Payer: Nomi Health Commercial |
$114.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.75
|
| Rate for Payer: PACE SWMI |
$95.08
|
| Rate for Payer: PHP Medicare Advantage |
$95.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$184.45
|
| Rate for Payer: Priority Health Medicare |
$95.08
|
| Rate for Payer: Priority Health SBD |
$184.45
|
| Rate for Payer: Priority Health Tiered Network |
$184.45
|
| Rate for Payer: Railroad Medicare Medicare |
$95.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.37
|
| Rate for Payer: UHC Core |
$171.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.08
|
| Rate for Payer: UHC Exchange |
$171.37
|
| Rate for Payer: UHC Medicaid |
$61.13
|
| Rate for Payer: UHCCP Medicaid |
$61.13
|
|
|
PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 95115
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$18.75 |
| Rate for Payer: Aetna Commercial |
$12.77
|
| Rate for Payer: Aetna Medicare |
$9.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.77
|
| Rate for Payer: BCBS MAPPO |
$9.53
|
| Rate for Payer: BCN Commercial |
$15.93
|
| Rate for Payer: BCN Medicare Advantage |
$9.53
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$13.72
|
| Rate for Payer: Cofinity Commercial |
$12.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.53
|
| Rate for Payer: Healthscope Commercial |
$17.63
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.98
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.75
|
| Rate for Payer: PACE SWMI |
$9.53
|
| Rate for Payer: PHP Medicare Advantage |
$9.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$13.72
|
| Rate for Payer: Priority Health Medicare |
$9.53
|
| Rate for Payer: Priority Health SBD |
$13.72
|
| Rate for Payer: Priority Health Tiered Network |
$13.72
|
| Rate for Payer: Railroad Medicare Medicare |
$9.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.88
|
| Rate for Payer: UHC Core |
$13.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.53
|
| Rate for Payer: UHC Exchange |
$13.88
|
|
|
PR PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS NJXS
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 95117
|
| Min. Negotiated Rate |
$11.36 |
| Max. Negotiated Rate |
$24.75 |
| Rate for Payer: Aetna Commercial |
$15.22
|
| Rate for Payer: Aetna Medicare |
$11.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.36
|
| Rate for Payer: BCBS MAPPO |
$11.36
|
| Rate for Payer: BCN Commercial |
$18.43
|
| Rate for Payer: BCN Medicare Advantage |
$11.36
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$15.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.36
|
| Rate for Payer: Healthscope Commercial |
$21.02
|
| Rate for Payer: Healthscope Commercial |
$18.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.29
|
| Rate for Payer: Nomi Health Commercial |
$13.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.75
|
| Rate for Payer: PACE SWMI |
$11.36
|
| Rate for Payer: PHP Medicare Advantage |
$11.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.65
|
| Rate for Payer: Priority Health Medicare |
$11.36
|
| Rate for Payer: Priority Health SBD |
$16.65
|
| Rate for Payer: Priority Health Tiered Network |
$16.65
|
| Rate for Payer: Railroad Medicare Medicare |
$11.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.00
|
| Rate for Payer: UHC Core |
$16.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11.36
|
| Rate for Payer: UHC Exchange |
$16.00
|
|
|
PR PROG DEVICE EVAL IN PERSON LEADLESS PM SYSTEM
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 0389T
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna Medicare |
$47.50
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 93280
|
| Min. Negotiated Rate |
$74.13 |
| Max. Negotiated Rate |
$170.25 |
| Rate for Payer: Aetna Commercial |
$99.33
|
| Rate for Payer: Aetna Medicare |
$77.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.33
|
| Rate for Payer: BCBS MAPPO |
$74.13
|
| Rate for Payer: BCN Commercial |
$115.53
|
| Rate for Payer: BCN Medicare Advantage |
$74.13
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$106.75
|
| Rate for Payer: Cofinity Commercial |
$99.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.13
|
| Rate for Payer: Healthscope Commercial |
$137.14
|
| Rate for Payer: Healthscope Commercial |
$118.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.94
|
| Rate for Payer: Nomi Health Commercial |
$88.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.25
|
| Rate for Payer: PACE SWMI |
$74.13
|
| Rate for Payer: PHP Medicare Advantage |
$74.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$109.80
|
| Rate for Payer: Priority Health Medicare |
$74.13
|
| Rate for Payer: Priority Health SBD |
$109.80
|
| Rate for Payer: Priority Health Tiered Network |
$109.80
|
| Rate for Payer: Railroad Medicare Medicare |
$74.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.93
|
| Rate for Payer: UHC Core |
$111.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.13
|
| Rate for Payer: UHC Exchange |
$111.93
|
|
|
PR PROGRAM EVAL IMPLANTABLE IN PRSN MULTI LD PACER
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 93281
|
| Min. Negotiated Rate |
$78.33 |
| Max. Negotiated Rate |
$177.75 |
| Rate for Payer: Aetna Commercial |
$104.96
|
| Rate for Payer: Aetna Medicare |
$81.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.80
|
| Rate for Payer: BCBS MAPPO |
$78.33
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$78.33
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$104.96
|
| Rate for Payer: Cofinity Commercial |
$112.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.33
|
| Rate for Payer: Healthscope Commercial |
$144.91
|
| Rate for Payer: Healthscope Commercial |
$125.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.89
|
| Rate for Payer: Nomi Health Commercial |
$94.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.75
|
| Rate for Payer: PACE SWMI |
$78.33
|
| Rate for Payer: PHP Medicare Advantage |
$78.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$116.91
|
| Rate for Payer: Priority Health Medicare |
$78.33
|
| Rate for Payer: Priority Health SBD |
$116.91
|
| Rate for Payer: Priority Health Tiered Network |
$116.91
|
| Rate for Payer: Railroad Medicare Medicare |
$78.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.77
|
| Rate for Payer: UHC Core |
$119.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$78.33
|
| Rate for Payer: UHC Exchange |
$119.77
|
|
|
PR PROGRAMMED STIMJ & PACG AFTER IV DRUG INFUSION
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 93623
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$1,619.31 |
| Rate for Payer: Aetna Commercial |
$217.76
|
| Rate for Payer: Aetna Commercial |
$217.76
|
| Rate for Payer: Aetna Medicare |
$125.00
|
| Rate for Payer: Aetna Medicare |
$171.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.76
|
| Rate for Payer: BCN Commercial |
$1,619.31
|
| Rate for Payer: BCN Commercial |
$1,619.31
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$100.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$100.82
|
| Rate for Payer: Priority Health SBD |
$100.82
|
| Rate for Payer: Priority Health SBD |
$100.82
|
| Rate for Payer: Priority Health Tiered Network |
$100.82
|
| Rate for Payer: Priority Health Tiered Network |
$100.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$657.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$657.94
|
| Rate for Payer: UHC Core |
$657.94
|
| Rate for Payer: UHC Core |
$657.94
|
| Rate for Payer: UHC Exchange |
$657.94
|
| Rate for Payer: UHC Exchange |
$657.94
|
|
|
PR PROGRAMMING DEV EVAL ICDS W/SS ELTRD IN PERSON
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS 0575T
|
| Min. Negotiated Rate |
$34.87 |
| Max. Negotiated Rate |
$120.37 |
| Rate for Payer: Aetna Commercial |
$65.51
|
| Rate for Payer: Aetna Medicare |
$49.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.51
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCN Commercial |
$34.87
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$73.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.10
|
| Rate for Payer: UHC Core |
$90.10
|
| Rate for Payer: UHC Exchange |
$90.10
|
|
|
PR PRO HEALTH BACK SCREEN
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$88.95 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$88.95
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$88.95
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.15
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Exchange |
$20.04
|
|
|
PR PRO HEALTH BACK SCREEN
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000022
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
PR PRO HEALTH FIT FOR DUTY EXAM
|
Facility
|
IP
|
$229.50
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.59 |
| Max. Negotiated Rate |
$206.55 |
| Rate for Payer: Aetna Commercial |
$195.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Advantage |
$160.65
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.12
|
| Rate for Payer: PHP Commercial |
$195.07
|
| Rate for Payer: Priority Health SBD |
$144.59
|
|
|
PR PRO HEALTH FIT FOR DUTY EXAM
|
Facility
|
OP
|
$229.50
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
51000038
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.19 |
| Max. Negotiated Rate |
$211.09 |
| Rate for Payer: Aetna Commercial |
$195.07
|
| Rate for Payer: Aetna Medicare |
$114.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.18
|
| Rate for Payer: BCBS Complete |
$91.80
|
| Rate for Payer: BCBS Trust/PPO |
$211.09
|
| Rate for Payer: BCN Commercial |
$211.09
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cofinity Advantage |
$160.65
|
| Rate for Payer: Cofinity Commercial |
$197.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.60
|
| Rate for Payer: Healthscope Commercial |
$206.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$183.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$172.12
|
| Rate for Payer: PHP Commercial |
$195.07
|
| Rate for Payer: Priority Health SBD |
$144.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.18
|
| Rate for Payer: UHC Core |
$119.57
|
| Rate for Payer: UHC Exchange |
$90.19
|
|
|
PR PRO HEALTH LIFT TEST
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
PR PRO HEALTH LIFT TEST
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
51000023
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.04 |
| Max. Negotiated Rate |
$88.95 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$88.95
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$88.95
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Advantage |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.25
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health SBD |
$32.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.15
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Exchange |
$20.04
|
|
|
PR PRO HEALTH NURSE VISIT
|
Facility
|
OP
|
$32.64
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.83 |
| Max. Negotiated Rate |
$49.51 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna Medicare |
$16.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: BCBS Complete |
$13.06
|
| Rate for Payer: BCBS Trust/PPO |
$49.51
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$49.51
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Advantage |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.48
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health SBD |
$20.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.22
|
| Rate for Payer: UHC Core |
$17.01
|
| Rate for Payer: UHC Exchange |
$12.83
|
|
|
PR PRO HEALTH NURSE VISIT
|
Facility
|
IP
|
$32.64
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000017
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.56 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Aetna Commercial |
$27.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.22
|
| Rate for Payer: Cash Price |
$26.11
|
| Rate for Payer: Cofinity Advantage |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$28.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.11
|
| Rate for Payer: Healthscope Commercial |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.48
|
| Rate for Payer: PHP Commercial |
$27.74
|
| Rate for Payer: Priority Health SBD |
$20.56
|
|
|
PR PRO HEALTH PHYSICAL AGILITY TEST
|
Facility
|
IP
|
$71.40
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$64.26 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Advantage |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.55
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health SBD |
$44.98
|
|
|
PR PRO HEALTH PHYSICAL AGILITY TEST
|
Facility
|
OP
|
$71.40
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
51000028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$119.83 |
| Rate for Payer: Aetna Commercial |
$60.69
|
| Rate for Payer: Aetna Medicare |
$35.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.41
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS Trust/PPO |
$119.83
|
| Rate for Payer: BCCCP Commercial |
$87.68
|
| Rate for Payer: BCN Commercial |
$119.83
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Advantage |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.12
|
| Rate for Payer: Healthscope Commercial |
$64.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.55
|
| Rate for Payer: PHP Commercial |
$60.69
|
| Rate for Payer: Priority Health SBD |
$44.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.41
|
| Rate for Payer: UHC Core |
$37.20
|
| Rate for Payer: UHC Exchange |
$28.06
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Advantage |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health SBD |
$16.07
|
|
|
PR PRO HEALTH VISION TESTING
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
51000018
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$49.51 |
| Rate for Payer: Aetna Commercial |
$21.68
|
| Rate for Payer: Aetna Medicare |
$12.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.57
|
| Rate for Payer: BCBS Complete |
$10.20
|
| Rate for Payer: BCBS Trust/PPO |
$49.51
|
| Rate for Payer: BCCCP Commercial |
$21.87
|
| Rate for Payer: BCN Commercial |
$49.51
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cofinity Advantage |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.40
|
| Rate for Payer: Healthscope Commercial |
$22.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.12
|
| Rate for Payer: PHP Commercial |
$21.68
|
| Rate for Payer: Priority Health SBD |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.57
|
| Rate for Payer: UHC Core |
$13.29
|
| Rate for Payer: UHC Exchange |
$10.02
|
|
