|
PR PCV20 VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
HCPCS 90677
|
| Min. Negotiated Rate |
$158.00 |
| Max. Negotiated Rate |
$578.87 |
| Rate for Payer: Aetna Commercial |
$419.29
|
| Rate for Payer: Aetna Medicare |
$325.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.29
|
| Rate for Payer: BCBS Complete |
$158.00
|
| Rate for Payer: BCBS MAPPO |
$312.90
|
| Rate for Payer: BCN Medicare Advantage |
$312.90
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cash Price |
$316.00
|
| Rate for Payer: Cofinity Commercial |
$450.58
|
| Rate for Payer: Cofinity Commercial |
$419.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.90
|
| Rate for Payer: Healthscope Commercial |
$578.87
|
| Rate for Payer: Healthscope Commercial |
$500.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$256.75
|
| Rate for Payer: Nomi Health Commercial |
$375.48
|
| Rate for Payer: PACE SWMI |
$312.90
|
| Rate for Payer: PHP Medicare Advantage |
$312.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.75
|
| Rate for Payer: Priority Health Medicare |
$312.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$312.90
|
| Rate for Payer: UHC Medicare Advantage |
$312.90
|
|
|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ BY PHYS/QHP
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 96573
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$361.58 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Medicare |
$203.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.90
|
| Rate for Payer: BCBS Complete |
$146.00
|
| Rate for Payer: BCBS MAPPO |
$195.45
|
| Rate for Payer: BCN Medicare Advantage |
$195.45
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cofinity Commercial |
$281.45
|
| Rate for Payer: Cofinity Commercial |
$261.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.45
|
| Rate for Payer: Healthscope Commercial |
$312.72
|
| Rate for Payer: Healthscope Commercial |
$361.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$205.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.25
|
| Rate for Payer: Nomi Health Commercial |
$234.54
|
| Rate for Payer: PACE SWMI |
$195.45
|
| Rate for Payer: PHP Medicare Advantage |
$195.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.25
|
| Rate for Payer: Priority Health Medicare |
$195.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$195.45
|
| Rate for Payer: UHC Medicare Advantage |
$195.45
|
|
|
PR PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ PER DAY
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 96567
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$215.49 |
| Rate for Payer: Aetna Commercial |
$156.08
|
| Rate for Payer: Aetna Medicare |
$121.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.08
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: BCBS MAPPO |
$116.48
|
| Rate for Payer: BCN Medicare Advantage |
$116.48
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$167.73
|
| Rate for Payer: Cofinity Commercial |
$156.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.48
|
| Rate for Payer: Healthscope Commercial |
$215.49
|
| Rate for Payer: Healthscope Commercial |
$186.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.70
|
| Rate for Payer: Nomi Health Commercial |
$139.78
|
| Rate for Payer: PACE SWMI |
$116.48
|
| Rate for Payer: PHP Medicare Advantage |
$116.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
| Rate for Payer: Priority Health Medicare |
$116.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.48
|
| Rate for Payer: UHC Medicare Advantage |
$116.48
|
|
|
PR PEL LMPHADEC W/XTRNL ILIAC HYPOGSTR&OBTURATOR
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
HCPCS 38770
|
| Min. Negotiated Rate |
$519.20 |
| Max. Negotiated Rate |
$1,429.18 |
| Rate for Payer: Aetna Commercial |
$1,035.19
|
| Rate for Payer: Aetna Medicare |
$803.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.19
|
| Rate for Payer: BCBS Complete |
$519.20
|
| Rate for Payer: BCBS MAPPO |
$772.53
|
| Rate for Payer: BCN Medicare Advantage |
$772.53
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cofinity Commercial |
$1,112.44
|
| Rate for Payer: Cofinity Commercial |
$1,035.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.53
|
| Rate for Payer: Healthscope Commercial |
$1,236.05
|
| Rate for Payer: Healthscope Commercial |
$1,429.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$843.70
|
| Rate for Payer: Nomi Health Commercial |
$927.04
|
| Rate for Payer: PACE SWMI |
$772.53
|
| Rate for Payer: PHP Medicare Advantage |
$772.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.70
|
| Rate for Payer: Priority Health Medicare |
$772.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.53
|
| Rate for Payer: UHC Medicare Advantage |
$772.53
|
|
|
PR PELVIC EXAMINATION
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 99459
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$34.89 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Medicare |
$19.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.27
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$18.86
|
| Rate for Payer: BCN Medicare Advantage |
$18.86
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$27.16
|
| Rate for Payer: Cofinity Commercial |
$25.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.86
|
| Rate for Payer: Healthscope Commercial |
$34.89
|
| Rate for Payer: Healthscope Commercial |
$30.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.20
|
| Rate for Payer: Nomi Health Commercial |
$22.63
|
| Rate for Payer: PACE SWMI |
$18.86
|
| Rate for Payer: PHP Medicare Advantage |
$18.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Medicare |
$18.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.86
|
| Rate for Payer: UHC Medicare Advantage |
$18.86
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 57410
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$187.61 |
| Rate for Payer: Aetna Commercial |
$135.89
|
| Rate for Payer: Aetna Medicare |
$105.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.89
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS MAPPO |
$101.41
|
| Rate for Payer: BCN Medicare Advantage |
$101.41
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$146.03
|
| Rate for Payer: Cofinity Commercial |
$135.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.41
|
| Rate for Payer: Healthscope Commercial |
$162.26
|
| Rate for Payer: Healthscope Commercial |
$187.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.40
|
| Rate for Payer: Nomi Health Commercial |
$121.69
|
| Rate for Payer: PACE SWMI |
$101.41
|
| Rate for Payer: PHP Medicare Advantage |
$101.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$101.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.41
|
| Rate for Payer: UHC Medicare Advantage |
$101.41
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health SBD |
$123.48
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$8,728.81 |
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna Medicare |
$3,224.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,876.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,876.16
|
| Rate for Payer: BCBS Complete |
$1,745.20
|
| Rate for Payer: BCBS MAPPO |
$3,100.93
|
| Rate for Payer: BCN Medicare Advantage |
$3,100.93
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,100.93
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Mclaren Medicaid |
$1,662.10
|
| Rate for Payer: Mclaren Medicare |
$3,100.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,255.98
|
| Rate for Payer: Meridian Medicaid |
$1,745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,566.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: PACE Medicare |
$2,945.88
|
| Rate for Payer: PACE SWMI |
$3,100.93
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,662.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$3,100.93
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,728.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,100.93
|
| Rate for Payer: UHC Medicare Advantage |
$3,100.93
|
| Rate for Payer: UHCCP Medicaid |
$1,745.82
|
| Rate for Payer: VA VA |
$3,100.93
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$187.61 |
| Rate for Payer: Aetna Commercial |
$135.89
|
| Rate for Payer: Aetna Medicare |
$105.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.03
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS MAPPO |
$101.41
|
| Rate for Payer: BCN Medicare Advantage |
$101.41
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$146.03
|
| Rate for Payer: Cofinity Commercial |
$135.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.41
|
| Rate for Payer: Healthscope Commercial |
$162.26
|
| Rate for Payer: Healthscope Commercial |
$187.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.40
|
| Rate for Payer: Nomi Health Commercial |
$121.69
|
| Rate for Payer: PACE SWMI |
$101.41
|
| Rate for Payer: PHP Medicare Advantage |
$101.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$101.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.41
|
| Rate for Payer: UHC Medicare Advantage |
$101.41
|
|
|
PR PELVIC FIXATION OTHER THAN SACRUM
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
HCPCS 22848
|
| Min. Negotiated Rate |
$349.78 |
| Max. Negotiated Rate |
$1,164.15 |
| Rate for Payer: Aetna Commercial |
$468.71
|
| Rate for Payer: Aetna Medicare |
$363.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.71
|
| Rate for Payer: BCBS Complete |
$716.40
|
| Rate for Payer: BCBS MAPPO |
$349.78
|
| Rate for Payer: BCN Medicare Advantage |
$349.78
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Cofinity Commercial |
$503.68
|
| Rate for Payer: Cofinity Commercial |
$468.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.78
|
| Rate for Payer: Healthscope Commercial |
$647.09
|
| Rate for Payer: Healthscope Commercial |
$559.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,164.15
|
| Rate for Payer: Nomi Health Commercial |
$419.74
|
| Rate for Payer: PACE SWMI |
$349.78
|
| Rate for Payer: PHP Medicare Advantage |
$349.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,164.15
|
| Rate for Payer: Priority Health Medicare |
$349.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.78
|
| Rate for Payer: UHC Medicare Advantage |
$349.78
|
|
|
PR PELVIC RING FRACTURE UNI/BIL
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS G0413
|
| Min. Negotiated Rate |
$1,026.10 |
| Max. Negotiated Rate |
$2,061.80 |
| Rate for Payer: Aetna Commercial |
$1,374.97
|
| Rate for Payer: Aetna Medicare |
$1,067.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,477.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.97
|
| Rate for Payer: BCBS Complete |
$1,268.80
|
| Rate for Payer: BCBS MAPPO |
$1,026.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,026.10
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Cofinity Commercial |
$1,477.58
|
| Rate for Payer: Cofinity Commercial |
$1,374.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,026.10
|
| Rate for Payer: Healthscope Commercial |
$1,641.76
|
| Rate for Payer: Healthscope Commercial |
$1,898.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,077.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,061.80
|
| Rate for Payer: Nomi Health Commercial |
$1,231.32
|
| Rate for Payer: PACE SWMI |
$1,026.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,026.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health Medicare |
$1,026.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,026.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.10
|
|
|
PR PELVIC RING FX TREAT INT FIX
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS G0414
|
| Min. Negotiated Rate |
$968.55 |
| Max. Negotiated Rate |
$2,037.10 |
| Rate for Payer: Aetna Commercial |
$1,297.86
|
| Rate for Payer: Aetna Medicare |
$1,007.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.86
|
| Rate for Payer: BCBS Complete |
$1,253.60
|
| Rate for Payer: BCBS MAPPO |
$968.55
|
| Rate for Payer: BCN Medicare Advantage |
$968.55
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cofinity Commercial |
$1,394.71
|
| Rate for Payer: Cofinity Commercial |
$1,297.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$968.55
|
| Rate for Payer: Healthscope Commercial |
$1,791.82
|
| Rate for Payer: Healthscope Commercial |
$1,549.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,016.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,037.10
|
| Rate for Payer: Nomi Health Commercial |
$1,162.26
|
| Rate for Payer: PACE SWMI |
$968.55
|
| Rate for Payer: PHP Medicare Advantage |
$968.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
| Rate for Payer: Priority Health Medicare |
$968.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$968.55
|
| Rate for Payer: UHC Medicare Advantage |
$968.55
|
|
|
PR PENG BENZATHINE/PROCAINE INJ
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J0558
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$36.11 |
| Rate for Payer: Aetna Commercial |
$26.16
|
| Rate for Payer: Aetna Medicare |
$20.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.16
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$19.52
|
| Rate for Payer: BCN Medicare Advantage |
$19.52
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$28.11
|
| Rate for Payer: Cofinity Commercial |
$26.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$31.23
|
| Rate for Payer: Healthscope Commercial |
$36.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$23.42
|
| Rate for Payer: PACE SWMI |
$19.52
|
| Rate for Payer: PHP Medicare Advantage |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$19.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.52
|
| Rate for Payer: UHC Medicare Advantage |
$19.52
|
|
|
PR PENICILLIN G BENZATHINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0561
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$55.52 |
| Rate for Payer: Aetna Commercial |
$40.21
|
| Rate for Payer: Aetna Medicare |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.21
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$30.01
|
| Rate for Payer: BCN Medicare Advantage |
$30.01
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$43.21
|
| Rate for Payer: Cofinity Commercial |
$40.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.01
|
| Rate for Payer: Healthscope Commercial |
$55.52
|
| Rate for Payer: Healthscope Commercial |
$48.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Nomi Health Commercial |
$36.01
|
| Rate for Payer: PACE SWMI |
$30.01
|
| Rate for Payer: PHP Medicare Advantage |
$30.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$30.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.01
|
| Rate for Payer: UHC Medicare Advantage |
$30.01
|
|
|
PR PENILE PLETHYSMOGRAPHY
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 54240
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$187.90 |
| Rate for Payer: Aetna Commercial |
$136.10
|
| Rate for Payer: Aetna Medicare |
$105.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.10
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$101.57
|
| Rate for Payer: BCN Medicare Advantage |
$101.57
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$146.26
|
| Rate for Payer: Cofinity Commercial |
$136.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.57
|
| Rate for Payer: Healthscope Commercial |
$162.51
|
| Rate for Payer: Healthscope Commercial |
$187.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.20
|
| Rate for Payer: Nomi Health Commercial |
$121.88
|
| Rate for Payer: PACE SWMI |
$101.57
|
| Rate for Payer: PHP Medicare Advantage |
$101.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Medicare |
$101.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.57
|
| Rate for Payer: UHC Medicare Advantage |
$101.57
|
|
|
PR PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR
|
Professional
|
Both
|
$5,200.00
|
|
|
Service Code
|
HCPCS 54304
|
| Min. Negotiated Rate |
$714.22 |
| Max. Negotiated Rate |
$3,380.00 |
| Rate for Payer: Aetna Commercial |
$957.05
|
| Rate for Payer: Aetna Medicare |
$742.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,028.48
|
| Rate for Payer: BCBS Complete |
$2,080.00
|
| Rate for Payer: BCBS MAPPO |
$714.22
|
| Rate for Payer: BCN Medicare Advantage |
$714.22
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Cash Price |
$4,160.00
|
| Rate for Payer: Cofinity Commercial |
$957.05
|
| Rate for Payer: Cofinity Commercial |
$1,028.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$714.22
|
| Rate for Payer: Healthscope Commercial |
$1,321.31
|
| Rate for Payer: Healthscope Commercial |
$1,142.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$749.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,380.00
|
| Rate for Payer: Nomi Health Commercial |
$857.06
|
| Rate for Payer: PACE SWMI |
$714.22
|
| Rate for Payer: PHP Medicare Advantage |
$714.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,380.00
|
| Rate for Payer: Priority Health Medicare |
$714.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$714.22
|
| Rate for Payer: UHC Medicare Advantage |
$714.22
|
|
|
PR PENIS STRAIGHTENING CHORDEE
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS 54300
|
| Min. Negotiated Rate |
$534.40 |
| Max. Negotiated Rate |
$1,141.45 |
| Rate for Payer: Aetna Commercial |
$826.78
|
| Rate for Payer: Aetna Medicare |
$641.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.78
|
| Rate for Payer: BCBS Complete |
$534.40
|
| Rate for Payer: BCBS MAPPO |
$617.00
|
| Rate for Payer: BCN Medicare Advantage |
$617.00
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cash Price |
$1,068.80
|
| Rate for Payer: Cofinity Commercial |
$888.48
|
| Rate for Payer: Cofinity Commercial |
$826.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$617.00
|
| Rate for Payer: Healthscope Commercial |
$1,141.45
|
| Rate for Payer: Healthscope Commercial |
$987.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$868.40
|
| Rate for Payer: Nomi Health Commercial |
$740.40
|
| Rate for Payer: PACE SWMI |
$617.00
|
| Rate for Payer: PHP Medicare Advantage |
$617.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.40
|
| Rate for Payer: Priority Health Medicare |
$617.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$617.00
|
| Rate for Payer: UHC Medicare Advantage |
$617.00
|
|
|
PR PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 94642
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Medicare |
$95.00
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
|
|
PR PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 92972
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$255.17 |
| Rate for Payer: Aetna Commercial |
$184.83
|
| Rate for Payer: Aetna Medicare |
$143.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.62
|
| Rate for Payer: BCBS Complete |
$93.20
|
| Rate for Payer: BCBS MAPPO |
$137.93
|
| Rate for Payer: BCN Medicare Advantage |
$137.93
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$198.62
|
| Rate for Payer: Cofinity Commercial |
$184.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.93
|
| Rate for Payer: Healthscope Commercial |
$255.17
|
| Rate for Payer: Healthscope Commercial |
$220.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.45
|
| Rate for Payer: Nomi Health Commercial |
$165.52
|
| Rate for Payer: PACE SWMI |
$137.93
|
| Rate for Payer: PHP Medicare Advantage |
$137.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health Medicare |
$137.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.93
|
| Rate for Payer: UHC Medicare Advantage |
$137.93
|
|
|
PR PERCUTANEOUS TX MALAR AREA FRACTURE
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 21355
|
| Min. Negotiated Rate |
$312.53 |
| Max. Negotiated Rate |
$595.40 |
| Rate for Payer: Aetna Commercial |
$418.79
|
| Rate for Payer: Aetna Medicare |
$325.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.04
|
| Rate for Payer: BCBS Complete |
$366.40
|
| Rate for Payer: BCBS MAPPO |
$312.53
|
| Rate for Payer: BCN Medicare Advantage |
$312.53
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$418.79
|
| Rate for Payer: Cofinity Commercial |
$450.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.53
|
| Rate for Payer: Healthscope Commercial |
$500.05
|
| Rate for Payer: Healthscope Commercial |
$578.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$595.40
|
| Rate for Payer: Nomi Health Commercial |
$375.04
|
| Rate for Payer: PACE SWMI |
$312.53
|
| Rate for Payer: PHP Medicare Advantage |
$312.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.40
|
| Rate for Payer: Priority Health Medicare |
$312.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$312.53
|
| Rate for Payer: UHC Medicare Advantage |
$312.53
|
|
|
PR PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
HCPCS 22522
|
| Min. Negotiated Rate |
$287.60 |
| Max. Negotiated Rate |
$467.35 |
| Rate for Payer: Aetna Medicare |
$359.50
|
| Rate for Payer: BCBS Complete |
$287.60
|
| Rate for Payer: Cash Price |
$575.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$467.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$467.35
|
|
|
PR PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX
|
Professional
|
Both
|
$5,744.00
|
|
|
Service Code
|
HCPCS 22521
|
| Min. Negotiated Rate |
$2,297.60 |
| Max. Negotiated Rate |
$3,733.60 |
| Rate for Payer: Aetna Medicare |
$2,872.00
|
| Rate for Payer: BCBS Complete |
$2,297.60
|
| Rate for Payer: Cash Price |
$4,595.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,733.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,733.60
|
|
|
PR PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX
|
Professional
|
Both
|
$7,841.00
|
|
|
Service Code
|
HCPCS 22520
|
| Min. Negotiated Rate |
$3,136.40 |
| Max. Negotiated Rate |
$5,096.65 |
| Rate for Payer: Aetna Medicare |
$3,920.50
|
| Rate for Payer: BCBS Complete |
$3,136.40
|
| Rate for Payer: Cash Price |
$6,272.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,096.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,096.65
|
|
|
PR PERCUT DILATN RENAL TRACT
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 50395
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$225.55 |
| Rate for Payer: Aetna Medicare |
$173.50
|
| Rate for Payer: BCBS Complete |
$138.80
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.55
|
|
|
PR PERCUT INSERT KIDNEY CATH/DRAIN
|
Professional
|
Both
|
$365.00
|
|
|
Service Code
|
HCPCS 50392
|
| Min. Negotiated Rate |
$146.00 |
| Max. Negotiated Rate |
$237.25 |
| Rate for Payer: Aetna Medicare |
$182.50
|
| Rate for Payer: BCBS Complete |
$146.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.25
|
|
