|
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 HMO/PPO/Tiered Network |
$30.52
|
| Rate for Payer: Priority Health Medicare |
$18.86
|
| Rate for Payer: Priority Health Narrow Network |
$30.52
|
| Rate for Payer: Priority Health SBD |
$30.52
|
| 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 |
$67.95 |
| Max. Negotiated Rate |
$18,670.00 |
| 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 |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$101.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.90
|
| Rate for Payer: BCN Commercial |
$153.45
|
| 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 |
$187.61
|
| Rate for Payer: Healthscope Commercial |
$162.26
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.48
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,670.00
|
| 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 Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.24
|
| Rate for Payer: Priority Health Medicare |
$101.41
|
| Rate for Payer: Priority Health Narrow Network |
$158.24
|
| Rate for Payer: Priority Health SBD |
$158.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.41
|
| Rate for Payer: UHC Exchange |
$184.30
|
| Rate for Payer: UHC Medicare Advantage |
$101.41
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
PR PELVIC EXAMINATION W/ANESTHESIA OTHER THAN LOCAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$113.02 |
| Max. Negotiated Rate |
$9,791.14 |
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna Medicare |
$3,239.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,894.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,894.05
|
| Rate for Payer: BCBS Complete |
$1,753.26
|
| Rate for Payer: BCBS MAPPO |
$3,115.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,620.97
|
| Rate for Payer: BCN Commercial |
$1,620.97
|
| Rate for Payer: BCN Medicare Advantage |
$3,115.24
|
| Rate for Payer: Cash Price |
$156.80
|
| 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 |
$3,115.24
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Mclaren Medicaid |
$1,669.77
|
| Rate for Payer: Mclaren Medicare |
$3,115.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,271.00
|
| Rate for Payer: Meridian Medicaid |
$1,753.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,582.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: Nomi Health Commercial |
$6,542.00
|
| Rate for Payer: PACE Medicare |
$2,959.48
|
| Rate for Payer: PACE SWMI |
$3,115.24
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,115.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,669.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,791.14
|
| Rate for Payer: Priority Health Medicare |
$3,115.24
|
| Rate for Payer: Priority Health Narrow Network |
$7,832.91
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: Railroad Medicare Medicare |
$3,115.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.02
|
| Rate for Payer: UHC Core |
$4,155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,115.24
|
| Rate for Payer: UHC Medicare Advantage |
$3,115.24
|
| Rate for Payer: UHCCP Medicaid |
$1,753.88
|
| Rate for Payer: VA VA |
$3,115.24
|
|
|
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
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
57410
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$18,670.00 |
| 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 |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$101.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,808.90
|
| Rate for Payer: BCN Commercial |
$153.45
|
| 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 |
$187.61
|
| Rate for Payer: Healthscope Commercial |
$162.26
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.48
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,670.00
|
| 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 Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.24
|
| Rate for Payer: Priority Health Medicare |
$101.41
|
| Rate for Payer: Priority Health Narrow Network |
$158.24
|
| Rate for Payer: Priority Health SBD |
$158.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.41
|
| Rate for Payer: UHC Exchange |
$184.30
|
| Rate for Payer: UHC Medicare Advantage |
$101.41
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
PR PELVIC FIXATION OTHER THAN SACRUM
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
HCPCS 22848
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$64,355.00 |
| Rate for Payer: Aetna Commercial |
$468.71
|
| Rate for Payer: Aetna Medicare |
$363.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.68
|
| Rate for Payer: BCBS Complete |
$241.32
|
| Rate for Payer: BCBS MAPPO |
$349.78
|
| Rate for Payer: BCBS Trust/PPO |
$65.80
|
| Rate for Payer: BCN Commercial |
$575.20
|
| 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: Mclaren Medicaid |
$229.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.27
|
| Rate for Payer: Meridian Medicaid |
$241.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64,355.00
|
| 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 Choice Medicaid |
$229.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,164.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.52
|
| Rate for Payer: Priority Health Medicare |
$349.78
|
| Rate for Payer: Priority Health Narrow Network |
$546.52
|
| Rate for Payer: Priority Health SBD |
$546.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$575.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.78
|
| Rate for Payer: UHC Exchange |
$575.61
|
| Rate for Payer: UHC Medicare Advantage |
$349.78
|
| Rate for Payer: UHCCP Medicaid |
$229.83
|
|
|
PR PELVIC RING FRACTURE UNI/BIL
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS G0413
|
| Min. Negotiated Rate |
$238.26 |
| Max. Negotiated Rate |
$157,385.00 |
| Rate for Payer: Aetna Commercial |
$1,374.97
|
| Rate for Payer: Aetna Medicare |
$1,067.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,374.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,477.58
|
| Rate for Payer: BCBS Complete |
$723.95
|
| Rate for Payer: BCBS MAPPO |
$1,026.10
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$1,557.90
|
| 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 |
$1,898.28
|
| Rate for Payer: Mclaren Medicaid |
$689.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,077.40
|
| Rate for Payer: Meridian Medicaid |
$723.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157,385.00
|
| 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 Choice Medicaid |
$689.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,634.45
|
| Rate for Payer: Priority Health Medicare |
$1,026.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,634.45
|
| Rate for Payer: Priority Health SBD |
$1,634.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,026.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,026.10
|
| Rate for Payer: UHCCP Medicaid |
$689.48
|
|
|
PR PELVIC RING FX TREAT INT FIX
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS G0414
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$148,329.00 |
| Rate for Payer: Aetna Commercial |
$1,297.86
|
| Rate for Payer: Aetna Medicare |
$1,007.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,297.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,394.71
|
| Rate for Payer: BCBS Complete |
$683.92
|
| Rate for Payer: BCBS MAPPO |
$968.55
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: BCN Commercial |
$1,469.46
|
| 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 |
$1,549.68
|
| Rate for Payer: Healthscope Commercial |
$1,791.82
|
| Rate for Payer: Mclaren Medicaid |
$651.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,016.98
|
| Rate for Payer: Meridian Medicaid |
$683.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148,329.00
|
| 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 Choice Medicaid |
$651.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,542.35
|
| Rate for Payer: Priority Health Medicare |
$968.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,542.35
|
| Rate for Payer: Priority Health SBD |
$1,542.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$968.55
|
| Rate for Payer: UHC Medicare Advantage |
$968.55
|
| Rate for Payer: UHCCP Medicaid |
$651.35
|
|
|
PR PENG BENZATHINE/PROCAINE INJ
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J0558
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$1,574.00 |
| Rate for Payer: Aetna Commercial |
$23.27
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.01
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$17.37
|
| Rate for Payer: BCBS Trust/PPO |
$17.90
|
| Rate for Payer: BCN Commercial |
$14.68
|
| Rate for Payer: BCN Medicare Advantage |
$17.37
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$23.27
|
| Rate for Payer: Cofinity Commercial |
$25.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.37
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Healthscope Commercial |
$27.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,574.00
|
| Rate for Payer: Nomi Health Commercial |
$20.84
|
| Rate for Payer: PACE SWMI |
$17.37
|
| Rate for Payer: PHP Medicare Advantage |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$17.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.37
|
| Rate for Payer: UHC Exchange |
$18.41
|
| Rate for Payer: UHC Medicare Advantage |
$17.37
|
|
|
PR PENICILLIN G BENZATHINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0561
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$39.26
|
| Rate for Payer: Aetna Medicare |
$30.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.19
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$21.19
|
| Rate for Payer: BCN Commercial |
$16.84
|
| Rate for Payer: BCN Medicare Advantage |
$29.30
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$42.19
|
| Rate for Payer: Cofinity Commercial |
$39.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.30
|
| Rate for Payer: Healthscope Commercial |
$46.88
|
| Rate for Payer: Healthscope Commercial |
$54.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,016.00
|
| Rate for Payer: Nomi Health Commercial |
$35.16
|
| Rate for Payer: PACE SWMI |
$29.30
|
| Rate for Payer: PHP Medicare Advantage |
$29.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$29.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.30
|
| Rate for Payer: UHC Exchange |
$28.43
|
| Rate for Payer: UHC Medicare Advantage |
$29.30
|
|
|
PR PENILE PLETHYSMOGRAPHY
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 54240
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$18,628.00 |
| Rate for Payer: Aetna Commercial |
$136.10
|
| Rate for Payer: Aetna Medicare |
$105.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.26
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS MAPPO |
$101.57
|
| Rate for Payer: BCBS Trust/PPO |
$680.45
|
| Rate for Payer: BCN Commercial |
$155.89
|
| 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 |
$187.90
|
| Rate for Payer: Healthscope Commercial |
$162.51
|
| Rate for Payer: Mclaren Medicaid |
$41.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.65
|
| Rate for Payer: Meridian Medicaid |
$43.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,628.00
|
| 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 Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.50
|
| Rate for Payer: Priority Health Medicare |
$101.57
|
| Rate for Payer: Priority Health Narrow Network |
$171.50
|
| Rate for Payer: Priority Health SBD |
$101.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.57
|
| Rate for Payer: UHC Exchange |
$133.72
|
| Rate for Payer: UHC Medicare Advantage |
$101.57
|
| Rate for Payer: UHCCP Medicaid |
$41.11
|
|
|
PR PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR
|
Professional
|
Both
|
$5,200.00
|
|
|
Service Code
|
HCPCS 54304
|
| Min. Negotiated Rate |
$316.45 |
| Max. Negotiated Rate |
$131,373.00 |
| Rate for Payer: Aetna Commercial |
$957.05
|
| Rate for Payer: Aetna Medicare |
$742.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,028.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.05
|
| Rate for Payer: BCBS Complete |
$502.76
|
| Rate for Payer: BCBS MAPPO |
$714.22
|
| Rate for Payer: BCBS Trust/PPO |
$316.45
|
| Rate for Payer: BCN Commercial |
$1,078.02
|
| 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: Mclaren Medicaid |
$478.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$749.93
|
| Rate for Payer: Meridian Medicaid |
$502.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131,373.00
|
| 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 Choice Medicaid |
$478.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,380.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.82
|
| Rate for Payer: Priority Health Medicare |
$714.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.82
|
| Rate for Payer: Priority Health SBD |
$1,189.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,031.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$714.22
|
| Rate for Payer: UHC Exchange |
$1,031.91
|
| Rate for Payer: UHC Medicare Advantage |
$714.22
|
| Rate for Payer: UHCCP Medicaid |
$478.82
|
|
|
PR PENIS STRAIGHTENING CHORDEE
|
Professional
|
Both
|
$1,336.00
|
|
|
Service Code
|
HCPCS 54300
|
| Min. Negotiated Rate |
$311.17 |
| Max. Negotiated Rate |
$113,342.00 |
| Rate for Payer: Aetna Commercial |
$826.78
|
| Rate for Payer: Aetna Medicare |
$641.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$888.48
|
| Rate for Payer: BCBS Complete |
$435.00
|
| Rate for Payer: BCBS MAPPO |
$617.00
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: BCN Commercial |
$931.42
|
| 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 |
$987.20
|
| Rate for Payer: Healthscope Commercial |
$1,141.45
|
| Rate for Payer: Mclaren Medicaid |
$414.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$647.85
|
| Rate for Payer: Meridian Medicaid |
$435.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113,342.00
|
| 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 Choice Medicaid |
$414.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$868.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,028.98
|
| Rate for Payer: Priority Health Medicare |
$617.00
|
| Rate for Payer: Priority Health Narrow Network |
$1,028.98
|
| Rate for Payer: Priority Health SBD |
$1,028.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$845.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$617.00
|
| Rate for Payer: UHC Exchange |
$845.40
|
| Rate for Payer: UHC Medicare Advantage |
$617.00
|
| Rate for Payer: UHCCP Medicaid |
$414.29
|
|
|
PR PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 94642
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$5,999.00 |
| Rate for Payer: Aetna Commercial |
$46.35
|
| Rate for Payer: Aetna Medicare |
$95.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.35
|
| Rate for Payer: BCBS Complete |
$18.94
|
| Rate for Payer: BCBS Trust/PPO |
$217.66
|
| Rate for Payer: BCN Commercial |
$177.14
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Mclaren Medicaid |
$18.04
|
| Rate for Payer: Meridian Medicaid |
$18.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,999.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.35
|
| Rate for Payer: Priority Health Narrow Network |
$58.35
|
| Rate for Payer: Priority Health SBD |
$58.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.00
|
| Rate for Payer: UHC Exchange |
$50.00
|
| Rate for Payer: UHCCP Medicaid |
$18.04
|
|
|
PR PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 92972
|
| Min. Negotiated Rate |
$91.80 |
| 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 |
$96.39
|
| 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 |
$220.69
|
| Rate for Payer: Healthscope Commercial |
$255.17
|
| Rate for Payer: Mclaren Medicaid |
$91.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.83
|
| Rate for Payer: Meridian Medicaid |
$96.39
|
| 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 Choice Medicaid |
$91.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.52
|
| Rate for Payer: Priority Health Medicare |
$137.93
|
| Rate for Payer: Priority Health Narrow Network |
$201.52
|
| Rate for Payer: Priority Health SBD |
$201.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.93
|
| Rate for Payer: UHC Medicare Advantage |
$137.93
|
| Rate for Payer: UHCCP Medicaid |
$91.80
|
|
|
PR PERCUTANEOUS TX MALAR AREA FRACTURE
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 21355
|
| Min. Negotiated Rate |
$32.75 |
| Max. Negotiated Rate |
$58,138.00 |
| 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 |
$223.43
|
| Rate for Payer: BCBS MAPPO |
$312.53
|
| Rate for Payer: BCBS Trust/PPO |
$32.75
|
| Rate for Payer: BCN Commercial |
$661.18
|
| 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 |
$450.04
|
| Rate for Payer: Cofinity Commercial |
$418.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.53
|
| Rate for Payer: Healthscope Commercial |
$578.18
|
| Rate for Payer: Healthscope Commercial |
$500.05
|
| Rate for Payer: Mclaren Medicaid |
$212.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.16
|
| Rate for Payer: Meridian Medicaid |
$223.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58,138.00
|
| 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 Choice Medicaid |
$212.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.34
|
| Rate for Payer: Priority Health Medicare |
$312.53
|
| Rate for Payer: Priority Health Narrow Network |
$507.34
|
| Rate for Payer: Priority Health SBD |
$507.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$383.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$312.53
|
| Rate for Payer: UHC Exchange |
$383.56
|
| Rate for Payer: UHC Medicare Advantage |
$312.53
|
| Rate for Payer: UHCCP Medicaid |
$212.79
|
|
|
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
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, EA ADD
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 22525
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$328.25 |
| Rate for Payer: Aetna Medicare |
$252.50
|
| Rate for Payer: BCBS Complete |
$202.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$328.25
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, LUMBAR
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
HCPCS 22524
|
| Min. Negotiated Rate |
$430.00 |
| Max. Negotiated Rate |
$698.75 |
| Rate for Payer: Aetna Medicare |
$537.50
|
| Rate for Payer: BCBS Complete |
$430.00
|
| Rate for Payer: Cash Price |
$860.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$698.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$698.75
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, THOR
|
Professional
|
Both
|
$1,141.00
|
|
|
Service Code
|
HCPCS 22523
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$741.65 |
| Rate for Payer: Aetna Medicare |
$570.50
|
| Rate for Payer: BCBS Complete |
$456.40
|
| Rate for Payer: Cash Price |
$912.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$741.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.65
|
|
|
PR PEREYRA PX W/ANTERIOR COLPORRHAPHY
|
Professional
|
Both
|
$2,213.00
|
|
|
Service Code
|
HCPCS 57289
|
| Min. Negotiated Rate |
$508.22 |
| Max. Negotiated Rate |
$141,647.00 |
| Rate for Payer: Aetna Commercial |
$1,015.83
|
| Rate for Payer: Aetna Medicare |
$788.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,091.64
|
| Rate for Payer: BCBS Complete |
$533.63
|
| Rate for Payer: BCBS MAPPO |
$758.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,673.73
|
| Rate for Payer: BCN Commercial |
$1,165.98
|
| Rate for Payer: BCN Medicare Advantage |
$758.08
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cofinity Commercial |
$1,091.64
|
| Rate for Payer: Cofinity Commercial |
$1,015.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$758.08
|
| Rate for Payer: Healthscope Commercial |
$1,402.45
|
| Rate for Payer: Healthscope Commercial |
$1,212.93
|
| Rate for Payer: Mclaren Medicaid |
$508.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$795.98
|
| Rate for Payer: Meridian Medicaid |
$533.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141,647.00
|
| Rate for Payer: Nomi Health Commercial |
$909.70
|
| Rate for Payer: PACE SWMI |
$758.08
|
| Rate for Payer: PHP Medicare Advantage |
$758.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,438.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,189.02
|
| Rate for Payer: Priority Health Medicare |
$758.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,189.02
|
| Rate for Payer: Priority Health SBD |
$1,189.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,059.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$758.08
|
| Rate for Payer: UHC Exchange |
$1,059.99
|
| Rate for Payer: UHC Medicare Advantage |
$758.08
|
| Rate for Payer: UHCCP Medicaid |
$508.22
|
|
