|
PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 19285
|
| Min. Negotiated Rate |
$79.33 |
| Max. Negotiated Rate |
$146.76 |
| Rate for Payer: Aetna Commercial |
$106.30
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.30
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$79.33
|
| Rate for Payer: BCN Medicare Advantage |
$79.33
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Cofinity Commercial |
$114.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.33
|
| Rate for Payer: Healthscope Commercial |
$146.76
|
| Rate for Payer: Healthscope Commercial |
$126.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.60
|
| Rate for Payer: Nomi Health Commercial |
$95.20
|
| Rate for Payer: PACE SWMI |
$79.33
|
| Rate for Payer: PHP Medicare Advantage |
$79.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$79.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.33
|
| Rate for Payer: UHC Medicare Advantage |
$79.33
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 19286
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$73.37 |
| Rate for Payer: Aetna Commercial |
$53.14
|
| Rate for Payer: Aetna Medicare |
$41.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.14
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$39.66
|
| Rate for Payer: BCN Medicare Advantage |
$39.66
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$57.11
|
| Rate for Payer: Cofinity Commercial |
$53.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.66
|
| Rate for Payer: Healthscope Commercial |
$73.37
|
| Rate for Payer: Healthscope Commercial |
$63.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.20
|
| Rate for Payer: Nomi Health Commercial |
$47.59
|
| Rate for Payer: PACE SWMI |
$39.66
|
| Rate for Payer: PHP Medicare Advantage |
$39.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health Medicare |
$39.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.66
|
| Rate for Payer: UHC Medicare Advantage |
$39.66
|
|
|
PR PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT
|
Professional
|
Both
|
$1,663.00
|
|
|
Service Code
|
HCPCS 33340
|
| Min. Negotiated Rate |
$665.20 |
| Max. Negotiated Rate |
$1,370.55 |
| Rate for Payer: Aetna Commercial |
$992.73
|
| Rate for Payer: Aetna Medicare |
$770.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$992.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,066.81
|
| Rate for Payer: BCBS Complete |
$665.20
|
| Rate for Payer: BCBS MAPPO |
$740.84
|
| Rate for Payer: BCN Medicare Advantage |
$740.84
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cofinity Commercial |
$992.73
|
| Rate for Payer: Cofinity Commercial |
$1,066.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$740.84
|
| Rate for Payer: Healthscope Commercial |
$1,185.34
|
| Rate for Payer: Healthscope Commercial |
$1,370.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$777.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,080.95
|
| Rate for Payer: Nomi Health Commercial |
$889.01
|
| Rate for Payer: PACE SWMI |
$740.84
|
| Rate for Payer: PHP Medicare Advantage |
$740.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.95
|
| Rate for Payer: Priority Health Medicare |
$740.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$740.84
|
| Rate for Payer: UHC Medicare Advantage |
$740.84
|
|
|
PR PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 19281
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Aetna Commercial |
$124.15
|
| Rate for Payer: Aetna Medicare |
$96.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.15
|
| Rate for Payer: BCBS Complete |
$146.40
|
| Rate for Payer: BCBS MAPPO |
$92.65
|
| Rate for Payer: BCN Medicare Advantage |
$92.65
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$133.42
|
| Rate for Payer: Cofinity Commercial |
$124.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.65
|
| Rate for Payer: Healthscope Commercial |
$171.40
|
| Rate for Payer: Healthscope Commercial |
$148.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.90
|
| Rate for Payer: Nomi Health Commercial |
$111.18
|
| Rate for Payer: PACE SWMI |
$92.65
|
| Rate for Payer: PHP Medicare Advantage |
$92.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health Medicare |
$92.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.65
|
| Rate for Payer: UHC Medicare Advantage |
$92.65
|
|
|
PR PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 19282
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Commercial |
$62.02
|
| Rate for Payer: Aetna Medicare |
$48.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.02
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS MAPPO |
$46.28
|
| Rate for Payer: BCN Medicare Advantage |
$46.28
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$66.64
|
| Rate for Payer: Cofinity Commercial |
$62.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.28
|
| Rate for Payer: Healthscope Commercial |
$74.05
|
| Rate for Payer: Healthscope Commercial |
$85.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Nomi Health Commercial |
$55.54
|
| Rate for Payer: PACE SWMI |
$46.28
|
| Rate for Payer: PHP Medicare Advantage |
$46.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.28
|
| Rate for Payer: UHC Medicare Advantage |
$46.28
|
|
|
PR PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 50436
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$264.12 |
| Rate for Payer: Aetna Commercial |
$191.31
|
| Rate for Payer: Aetna Medicare |
$148.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.31
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS MAPPO |
$142.77
|
| Rate for Payer: BCN Medicare Advantage |
$142.77
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$205.59
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.77
|
| Rate for Payer: Healthscope Commercial |
$264.12
|
| Rate for Payer: Healthscope Commercial |
$228.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.25
|
| Rate for Payer: Nomi Health Commercial |
$171.32
|
| Rate for Payer: PACE SWMI |
$142.77
|
| Rate for Payer: PHP Medicare Advantage |
$142.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health Medicare |
$142.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.77
|
| Rate for Payer: UHC Medicare Advantage |
$142.77
|
|
|
PR PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 50437
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$553.15 |
| Rate for Payer: Aetna Commercial |
$319.19
|
| Rate for Payer: Aetna Medicare |
$247.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.19
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$238.20
|
| Rate for Payer: BCN Medicare Advantage |
$238.20
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$343.01
|
| Rate for Payer: Cofinity Commercial |
$319.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.20
|
| Rate for Payer: Healthscope Commercial |
$381.12
|
| Rate for Payer: Healthscope Commercial |
$440.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.15
|
| Rate for Payer: Nomi Health Commercial |
$285.84
|
| Rate for Payer: PACE SWMI |
$238.20
|
| Rate for Payer: PHP Medicare Advantage |
$238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health Medicare |
$238.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.20
|
| Rate for Payer: UHC Medicare Advantage |
$238.20
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Professional
|
Both
|
$984.00
|
|
|
Service Code
|
HCPCS 32557
|
| Min. Negotiated Rate |
$140.51 |
| Max. Negotiated Rate |
$639.60 |
| Rate for Payer: Aetna Commercial |
$188.28
|
| Rate for Payer: Aetna Medicare |
$146.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.28
|
| Rate for Payer: BCBS Complete |
$393.60
|
| Rate for Payer: BCBS MAPPO |
$140.51
|
| Rate for Payer: BCN Medicare Advantage |
$140.51
|
| Rate for Payer: Cash Price |
$787.20
|
| Rate for Payer: Cash Price |
$787.20
|
| Rate for Payer: Cofinity Commercial |
$202.33
|
| Rate for Payer: Cofinity Commercial |
$188.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.51
|
| Rate for Payer: Healthscope Commercial |
$259.94
|
| Rate for Payer: Healthscope Commercial |
$224.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$639.60
|
| Rate for Payer: Nomi Health Commercial |
$168.61
|
| Rate for Payer: PACE SWMI |
$140.51
|
| Rate for Payer: PHP Medicare Advantage |
$140.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.60
|
| Rate for Payer: Priority Health Medicare |
$140.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.51
|
| Rate for Payer: UHC Medicare Advantage |
$140.51
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 32556
|
| Min. Negotiated Rate |
$119.15 |
| Max. Negotiated Rate |
$574.60 |
| Rate for Payer: Aetna Commercial |
$159.66
|
| Rate for Payer: Aetna Medicare |
$123.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.66
|
| Rate for Payer: BCBS Complete |
$353.60
|
| Rate for Payer: BCBS MAPPO |
$119.15
|
| Rate for Payer: BCN Medicare Advantage |
$119.15
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$171.58
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.15
|
| Rate for Payer: Healthscope Commercial |
$190.64
|
| Rate for Payer: Healthscope Commercial |
$220.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.60
|
| Rate for Payer: Nomi Health Commercial |
$142.98
|
| Rate for Payer: PACE SWMI |
$119.15
|
| Rate for Payer: PHP Medicare Advantage |
$119.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health Medicare |
$119.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.15
|
| Rate for Payer: UHC Medicare Advantage |
$119.15
|
|
|
PR PERQ NL/PL LITHOTRP COMPLEX >2 CM MLT LOCATIONS
|
Professional
|
Both
|
$2,448.00
|
|
|
Service Code
|
HCPCS 50081
|
| Min. Negotiated Rate |
$979.20 |
| Max. Negotiated Rate |
$1,983.51 |
| Rate for Payer: Aetna Commercial |
$1,436.71
|
| Rate for Payer: Aetna Medicare |
$1,115.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,543.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,436.71
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS MAPPO |
$1,072.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,072.17
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,543.92
|
| Rate for Payer: Cofinity Commercial |
$1,436.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,072.17
|
| Rate for Payer: Healthscope Commercial |
$1,983.51
|
| Rate for Payer: Healthscope Commercial |
$1,715.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,125.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,591.20
|
| Rate for Payer: Nomi Health Commercial |
$1,286.60
|
| Rate for Payer: PACE SWMI |
$1,072.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,072.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health Medicare |
$1,072.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,072.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,072.17
|
|
|
PR PERQ NL/PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION
|
Professional
|
Both
|
$1,664.00
|
|
|
Service Code
|
HCPCS 50080
|
| Min. Negotiated Rate |
$665.28 |
| Max. Negotiated Rate |
$1,230.77 |
| Rate for Payer: Aetna Commercial |
$891.48
|
| Rate for Payer: Aetna Medicare |
$691.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.48
|
| Rate for Payer: BCBS Complete |
$665.60
|
| Rate for Payer: BCBS MAPPO |
$665.28
|
| Rate for Payer: BCN Medicare Advantage |
$665.28
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cofinity Commercial |
$958.00
|
| Rate for Payer: Cofinity Commercial |
$891.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$665.28
|
| Rate for Payer: Healthscope Commercial |
$1,064.45
|
| Rate for Payer: Healthscope Commercial |
$1,230.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$698.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,081.60
|
| Rate for Payer: Nomi Health Commercial |
$798.34
|
| Rate for Payer: PACE SWMI |
$665.28
|
| Rate for Payer: PHP Medicare Advantage |
$665.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.60
|
| Rate for Payer: Priority Health Medicare |
$665.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$665.28
|
| Rate for Payer: UHC Medicare Advantage |
$665.28
|
|
|
PR PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 33017
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$435.84 |
| Rate for Payer: Aetna Commercial |
$315.69
|
| Rate for Payer: Aetna Medicare |
$245.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.69
|
| Rate for Payer: BCBS Complete |
$203.20
|
| Rate for Payer: BCBS MAPPO |
$235.59
|
| Rate for Payer: BCN Medicare Advantage |
$235.59
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cofinity Commercial |
$339.25
|
| Rate for Payer: Cofinity Commercial |
$315.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.59
|
| Rate for Payer: Healthscope Commercial |
$435.84
|
| Rate for Payer: Healthscope Commercial |
$376.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.20
|
| Rate for Payer: Nomi Health Commercial |
$282.71
|
| Rate for Payer: PACE SWMI |
$235.59
|
| Rate for Payer: PHP Medicare Advantage |
$235.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.20
|
| Rate for Payer: Priority Health Medicare |
$235.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.59
|
| Rate for Payer: UHC Medicare Advantage |
$235.59
|
|
|
PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 43762
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$280.15 |
| Rate for Payer: Aetna Commercial |
$48.82
|
| Rate for Payer: Aetna Medicare |
$37.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.82
|
| Rate for Payer: BCBS Complete |
$172.40
|
| Rate for Payer: BCBS MAPPO |
$36.43
|
| Rate for Payer: BCN Medicare Advantage |
$36.43
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Cofinity Commercial |
$48.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.43
|
| Rate for Payer: Healthscope Commercial |
$58.29
|
| Rate for Payer: Healthscope Commercial |
$67.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.15
|
| Rate for Payer: Nomi Health Commercial |
$43.72
|
| Rate for Payer: PACE SWMI |
$36.43
|
| Rate for Payer: PHP Medicare Advantage |
$36.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.15
|
| Rate for Payer: Priority Health Medicare |
$36.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.43
|
| Rate for Payer: UHC Medicare Advantage |
$36.43
|
|
|
PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
HCPCS 43763
|
| Min. Negotiated Rate |
$83.93 |
| Max. Negotiated Rate |
$417.95 |
| Rate for Payer: Aetna Commercial |
$112.47
|
| Rate for Payer: Aetna Medicare |
$87.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.47
|
| Rate for Payer: BCBS Complete |
$257.20
|
| Rate for Payer: BCBS MAPPO |
$83.93
|
| Rate for Payer: BCN Medicare Advantage |
$83.93
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cofinity Commercial |
$120.86
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.93
|
| Rate for Payer: Healthscope Commercial |
$134.29
|
| Rate for Payer: Healthscope Commercial |
$155.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$417.95
|
| Rate for Payer: Nomi Health Commercial |
$100.72
|
| Rate for Payer: PACE SWMI |
$83.93
|
| Rate for Payer: PHP Medicare Advantage |
$83.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.95
|
| Rate for Payer: Priority Health Medicare |
$83.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.93
|
| Rate for Payer: UHC Medicare Advantage |
$83.93
|
|
|
PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
HCPCS 0201T
|
| Min. Negotiated Rate |
$977.60 |
| Max. Negotiated Rate |
$1,588.60 |
| Rate for Payer: Aetna Medicare |
$1,222.00
|
| Rate for Payer: BCBS Complete |
$977.60
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,588.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.60
|
|
|
PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL
|
Professional
|
Both
|
$2,317.00
|
|
|
Service Code
|
HCPCS 0200T
|
| Min. Negotiated Rate |
$926.80 |
| Max. Negotiated Rate |
$1,506.05 |
| Rate for Payer: Aetna Medicare |
$1,158.50
|
| Rate for Payer: BCBS Complete |
$926.80
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,506.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,506.05
|
|
|
PR PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS 27216
|
| Min. Negotiated Rate |
$1,268.80 |
| Max. Negotiated Rate |
$2,061.80 |
| Rate for Payer: Aetna Medicare |
$1,586.00
|
| Rate for Payer: BCBS Complete |
$1,268.80
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,061.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
|
|
PR PERQ SKELETAL FIXATION ULNAR STYLOID FRACTURE
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 25651
|
| Min. Negotiated Rate |
$346.80 |
| Max. Negotiated Rate |
$878.97 |
| Rate for Payer: Aetna Commercial |
$636.66
|
| Rate for Payer: Aetna Medicare |
$494.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$636.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$684.17
|
| Rate for Payer: BCBS Complete |
$346.80
|
| Rate for Payer: BCBS MAPPO |
$475.12
|
| Rate for Payer: BCN Medicare Advantage |
$475.12
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$684.17
|
| Rate for Payer: Cofinity Commercial |
$636.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$475.12
|
| Rate for Payer: Healthscope Commercial |
$878.97
|
| Rate for Payer: Healthscope Commercial |
$760.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$498.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.55
|
| Rate for Payer: Nomi Health Commercial |
$570.14
|
| Rate for Payer: PACE SWMI |
$475.12
|
| Rate for Payer: PHP Medicare Advantage |
$475.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health Medicare |
$475.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$475.12
|
| Rate for Payer: UHC Medicare Advantage |
$475.12
|
|
|
PR PERQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION
|
Professional
|
Both
|
$1,428.00
|
|
|
Service Code
|
HCPCS 25671
|
| Min. Negotiated Rate |
$519.45 |
| Max. Negotiated Rate |
$960.98 |
| Rate for Payer: Aetna Commercial |
$696.06
|
| Rate for Payer: Aetna Medicare |
$540.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$696.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.01
|
| Rate for Payer: BCBS Complete |
$571.20
|
| Rate for Payer: BCBS MAPPO |
$519.45
|
| Rate for Payer: BCN Medicare Advantage |
$519.45
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cofinity Commercial |
$696.06
|
| Rate for Payer: Cofinity Commercial |
$748.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$519.45
|
| Rate for Payer: Healthscope Commercial |
$831.12
|
| Rate for Payer: Healthscope Commercial |
$960.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$545.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.20
|
| Rate for Payer: Nomi Health Commercial |
$623.34
|
| Rate for Payer: PACE SWMI |
$519.45
|
| Rate for Payer: PHP Medicare Advantage |
$519.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$928.20
|
| Rate for Payer: Priority Health Medicare |
$519.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$519.45
|
| Rate for Payer: UHC Medicare Advantage |
$519.45
|
|
|
PR PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,944.00
|
|
|
Service Code
|
HCPCS 25606
|
| Min. Negotiated Rate |
$647.59 |
| Max. Negotiated Rate |
$1,263.60 |
| Rate for Payer: Aetna Commercial |
$867.77
|
| Rate for Payer: Aetna Medicare |
$673.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$867.77
|
| Rate for Payer: BCBS Complete |
$777.60
|
| Rate for Payer: BCBS MAPPO |
$647.59
|
| Rate for Payer: BCN Medicare Advantage |
$647.59
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cofinity Commercial |
$932.53
|
| Rate for Payer: Cofinity Commercial |
$867.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$647.59
|
| Rate for Payer: Healthscope Commercial |
$1,198.04
|
| Rate for Payer: Healthscope Commercial |
$1,036.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,263.60
|
| Rate for Payer: Nomi Health Commercial |
$777.11
|
| Rate for Payer: PACE SWMI |
$647.59
|
| Rate for Payer: PHP Medicare Advantage |
$647.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,263.60
|
| Rate for Payer: Priority Health Medicare |
$647.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$647.59
|
| Rate for Payer: UHC Medicare Advantage |
$647.59
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 36906
|
| Min. Negotiated Rate |
$482.07 |
| Max. Negotiated Rate |
$1,002.30 |
| Rate for Payer: Aetna Commercial |
$645.97
|
| Rate for Payer: Aetna Medicare |
$501.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$694.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$645.97
|
| Rate for Payer: BCBS Complete |
$616.80
|
| Rate for Payer: BCBS MAPPO |
$482.07
|
| Rate for Payer: BCN Medicare Advantage |
$482.07
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cofinity Commercial |
$694.18
|
| Rate for Payer: Cofinity Commercial |
$645.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$482.07
|
| Rate for Payer: Healthscope Commercial |
$771.31
|
| Rate for Payer: Healthscope Commercial |
$891.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$506.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,002.30
|
| Rate for Payer: Nomi Health Commercial |
$578.48
|
| Rate for Payer: PACE SWMI |
$482.07
|
| Rate for Payer: PHP Medicare Advantage |
$482.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.30
|
| Rate for Payer: Priority Health Medicare |
$482.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$482.07
|
| Rate for Payer: UHC Medicare Advantage |
$482.07
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 36905
|
| Min. Negotiated Rate |
$418.19 |
| Max. Negotiated Rate |
$859.30 |
| Rate for Payer: Aetna Commercial |
$560.37
|
| Rate for Payer: Aetna Medicare |
$434.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.37
|
| Rate for Payer: BCBS Complete |
$528.80
|
| Rate for Payer: BCBS MAPPO |
$418.19
|
| Rate for Payer: BCN Medicare Advantage |
$418.19
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cofinity Commercial |
$602.19
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$418.19
|
| Rate for Payer: Healthscope Commercial |
$773.65
|
| Rate for Payer: Healthscope Commercial |
$669.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$439.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$859.30
|
| Rate for Payer: Nomi Health Commercial |
$501.83
|
| Rate for Payer: PACE SWMI |
$418.19
|
| Rate for Payer: PHP Medicare Advantage |
$418.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.30
|
| Rate for Payer: Priority Health Medicare |
$418.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$418.19
|
| Rate for Payer: UHC Medicare Advantage |
$418.19
|
|
|
PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 36904
|
| Min. Negotiated Rate |
$347.99 |
| Max. Negotiated Rate |
$643.78 |
| Rate for Payer: Aetna Commercial |
$466.31
|
| Rate for Payer: Aetna Medicare |
$361.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$501.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$466.31
|
| Rate for Payer: BCBS Complete |
$354.80
|
| Rate for Payer: BCBS MAPPO |
$347.99
|
| Rate for Payer: BCN Medicare Advantage |
$347.99
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cofinity Commercial |
$501.11
|
| Rate for Payer: Cofinity Commercial |
$466.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.99
|
| Rate for Payer: Healthscope Commercial |
$556.78
|
| Rate for Payer: Healthscope Commercial |
$643.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$576.55
|
| Rate for Payer: Nomi Health Commercial |
$417.59
|
| Rate for Payer: PACE SWMI |
$347.99
|
| Rate for Payer: PHP Medicare Advantage |
$347.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.55
|
| Rate for Payer: Priority Health Medicare |
$347.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$347.99
|
| Rate for Payer: UHC Medicare Advantage |
$347.99
|
|
|
PR PERQ TRANSLUMINAL ANGIOPLASTY NATIVE/RECR COA
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 33897
|
| Min. Negotiated Rate |
$497.60 |
| Max. Negotiated Rate |
$1,022.90 |
| Rate for Payer: Aetna Commercial |
$740.91
|
| Rate for Payer: Aetna Medicare |
$575.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$796.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$740.91
|
| Rate for Payer: BCBS Complete |
$497.60
|
| Rate for Payer: BCBS MAPPO |
$552.92
|
| Rate for Payer: BCN Medicare Advantage |
$552.92
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cofinity Commercial |
$796.20
|
| Rate for Payer: Cofinity Commercial |
$740.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.92
|
| Rate for Payer: Healthscope Commercial |
$884.67
|
| Rate for Payer: Healthscope Commercial |
$1,022.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$580.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$808.60
|
| Rate for Payer: Nomi Health Commercial |
$663.50
|
| Rate for Payer: PACE SWMI |
$552.92
|
| Rate for Payer: PHP Medicare Advantage |
$552.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health Medicare |
$552.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.92
|
| Rate for Payer: UHC Medicare Advantage |
$552.92
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 22513
|
| Min. Negotiated Rate |
$487.67 |
| Max. Negotiated Rate |
$1,004.90 |
| Rate for Payer: Aetna Commercial |
$653.48
|
| Rate for Payer: Aetna Medicare |
$507.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.48
|
| Rate for Payer: BCBS Complete |
$618.40
|
| Rate for Payer: BCBS MAPPO |
$487.67
|
| Rate for Payer: BCN Medicare Advantage |
$487.67
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cofinity Commercial |
$702.24
|
| Rate for Payer: Cofinity Commercial |
$653.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.67
|
| Rate for Payer: Healthscope Commercial |
$780.27
|
| Rate for Payer: Healthscope Commercial |
$902.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,004.90
|
| Rate for Payer: Nomi Health Commercial |
$585.20
|
| Rate for Payer: PACE SWMI |
$487.67
|
| Rate for Payer: PHP Medicare Advantage |
$487.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.90
|
| Rate for Payer: Priority Health Medicare |
$487.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.67
|
| Rate for Payer: UHC Medicare Advantage |
$487.67
|
|
