|
PR PL GLYCOLIC 35/70
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00067
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR PL ILLUMINIZE
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 00069
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
|
PR PL JESSNERS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00068
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 47541
|
| Min. Negotiated Rate |
$315.08 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Aetna Commercial |
$422.21
|
| Rate for Payer: Aetna Medicare |
$327.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.72
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: BCBS MAPPO |
$315.08
|
| Rate for Payer: BCN Medicare Advantage |
$315.08
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cofinity Commercial |
$422.21
|
| Rate for Payer: Cofinity Commercial |
$453.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.08
|
| Rate for Payer: Healthscope Commercial |
$582.90
|
| Rate for Payer: Healthscope Commercial |
$504.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,392.30
|
| Rate for Payer: Nomi Health Commercial |
$378.10
|
| Rate for Payer: PACE SWMI |
$315.08
|
| Rate for Payer: PHP Medicare Advantage |
$315.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
| Rate for Payer: Priority Health Medicare |
$315.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.08
|
| Rate for Payer: UHC Medicare Advantage |
$315.08
|
|
|
PR PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST
|
Professional
|
Both
|
$10,186.00
|
|
|
Service Code
|
HCPCS 19296
|
| Min. Negotiated Rate |
$204.23 |
| Max. Negotiated Rate |
$6,620.90 |
| Rate for Payer: Aetna Commercial |
$273.67
|
| Rate for Payer: Aetna Medicare |
$212.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.67
|
| Rate for Payer: BCBS Complete |
$4,074.40
|
| Rate for Payer: BCBS MAPPO |
$204.23
|
| Rate for Payer: BCN Medicare Advantage |
$204.23
|
| Rate for Payer: Cash Price |
$8,148.80
|
| Rate for Payer: Cash Price |
$8,148.80
|
| Rate for Payer: Cofinity Commercial |
$294.09
|
| Rate for Payer: Cofinity Commercial |
$273.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.23
|
| Rate for Payer: Healthscope Commercial |
$377.83
|
| Rate for Payer: Healthscope Commercial |
$326.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,620.90
|
| Rate for Payer: Nomi Health Commercial |
$245.08
|
| Rate for Payer: PACE SWMI |
$204.23
|
| Rate for Payer: PHP Medicare Advantage |
$204.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,620.90
|
| Rate for Payer: Priority Health Medicare |
$204.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.23
|
| Rate for Payer: UHC Medicare Advantage |
$204.23
|
|
|
PR PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR
|
Professional
|
Both
|
$1,219.00
|
|
|
Service Code
|
HCPCS 34813
|
| Min. Negotiated Rate |
$225.47 |
| Max. Negotiated Rate |
$792.35 |
| Rate for Payer: Aetna Commercial |
$302.13
|
| Rate for Payer: Aetna Medicare |
$234.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.13
|
| Rate for Payer: BCBS Complete |
$487.60
|
| Rate for Payer: BCBS MAPPO |
$225.47
|
| Rate for Payer: BCN Medicare Advantage |
$225.47
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cash Price |
$975.20
|
| Rate for Payer: Cofinity Commercial |
$324.68
|
| Rate for Payer: Cofinity Commercial |
$302.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.47
|
| Rate for Payer: Healthscope Commercial |
$360.75
|
| Rate for Payer: Healthscope Commercial |
$417.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$792.35
|
| Rate for Payer: Nomi Health Commercial |
$270.56
|
| Rate for Payer: PACE SWMI |
$225.47
|
| Rate for Payer: PHP Medicare Advantage |
$225.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$792.35
|
| Rate for Payer: Priority Health Medicare |
$225.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.47
|
| Rate for Payer: UHC Medicare Advantage |
$225.47
|
|
|
PR PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 55876
|
| Min. Negotiated Rate |
$96.89 |
| Max. Negotiated Rate |
$180.05 |
| Rate for Payer: Aetna Commercial |
$129.83
|
| Rate for Payer: Aetna Medicare |
$100.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.83
|
| Rate for Payer: BCBS Complete |
$110.80
|
| Rate for Payer: BCBS MAPPO |
$96.89
|
| Rate for Payer: BCN Medicare Advantage |
$96.89
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$139.52
|
| Rate for Payer: Cofinity Commercial |
$129.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.89
|
| Rate for Payer: Healthscope Commercial |
$179.25
|
| Rate for Payer: Healthscope Commercial |
$155.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.05
|
| Rate for Payer: Nomi Health Commercial |
$116.27
|
| Rate for Payer: PACE SWMI |
$96.89
|
| Rate for Payer: PHP Medicare Advantage |
$96.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health Medicare |
$96.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.89
|
| Rate for Payer: UHC Medicare Advantage |
$96.89
|
|
|
PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 50432
|
| Min. Negotiated Rate |
$192.01 |
| Max. Negotiated Rate |
$1,050.40 |
| Rate for Payer: Aetna Commercial |
$257.29
|
| Rate for Payer: Aetna Medicare |
$199.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.29
|
| Rate for Payer: BCBS Complete |
$646.40
|
| Rate for Payer: BCBS MAPPO |
$192.01
|
| Rate for Payer: BCN Medicare Advantage |
$192.01
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$276.49
|
| Rate for Payer: Cofinity Commercial |
$257.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.01
|
| Rate for Payer: Healthscope Commercial |
$307.22
|
| Rate for Payer: Healthscope Commercial |
$355.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,050.40
|
| Rate for Payer: Nomi Health Commercial |
$230.41
|
| Rate for Payer: PACE SWMI |
$192.01
|
| Rate for Payer: PHP Medicare Advantage |
$192.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health Medicare |
$192.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.01
|
| Rate for Payer: UHC Medicare Advantage |
$192.01
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA 1ST XTN
|
Professional
|
Both
|
$2,278.00
|
|
|
Service Code
|
HCPCS 33883
|
| Min. Negotiated Rate |
$911.20 |
| Max. Negotiated Rate |
$1,964.33 |
| Rate for Payer: Aetna Commercial |
$1,422.81
|
| Rate for Payer: Aetna Medicare |
$1,104.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,528.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,422.81
|
| Rate for Payer: BCBS Complete |
$911.20
|
| Rate for Payer: BCBS MAPPO |
$1,061.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,061.80
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cash Price |
$1,822.40
|
| Rate for Payer: Cofinity Commercial |
$1,528.99
|
| Rate for Payer: Cofinity Commercial |
$1,422.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,061.80
|
| Rate for Payer: Healthscope Commercial |
$1,964.33
|
| Rate for Payer: Healthscope Commercial |
$1,698.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,114.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,480.70
|
| Rate for Payer: Nomi Health Commercial |
$1,274.16
|
| Rate for Payer: PACE SWMI |
$1,061.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,061.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,480.70
|
| Rate for Payer: Priority Health Medicare |
$1,061.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,061.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,061.80
|
|
|
PR PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS 33884
|
| Min. Negotiated Rate |
$350.80 |
| Max. Negotiated Rate |
$704.44 |
| Rate for Payer: Aetna Commercial |
$510.25
|
| Rate for Payer: Aetna Medicare |
$396.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$548.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.25
|
| Rate for Payer: BCBS Complete |
$350.80
|
| Rate for Payer: BCBS MAPPO |
$380.78
|
| Rate for Payer: BCN Medicare Advantage |
$380.78
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Cofinity Commercial |
$548.32
|
| Rate for Payer: Cofinity Commercial |
$510.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.78
|
| Rate for Payer: Healthscope Commercial |
$609.25
|
| Rate for Payer: Healthscope Commercial |
$704.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.05
|
| Rate for Payer: Nomi Health Commercial |
$456.94
|
| Rate for Payer: PACE SWMI |
$380.78
|
| Rate for Payer: PHP Medicare Advantage |
$380.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.05
|
| Rate for Payer: Priority Health Medicare |
$380.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$380.78
|
| Rate for Payer: UHC Medicare Advantage |
$380.78
|
|
|
PR PLMT SFT TISS LOCLZJ DEV PERQ 1ST LESION
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 10035
|
| Min. Negotiated Rate |
$79.33 |
| Max. Negotiated Rate |
$154.05 |
| 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 |
$94.80
|
| Rate for Payer: BCBS MAPPO |
$79.33
|
| Rate for Payer: BCN Medicare Advantage |
$79.33
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| 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 |
$154.05
|
| 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 |
$154.05
|
| 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 PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 50693
|
| Min. Negotiated Rate |
$191.01 |
| Max. Negotiated Rate |
$365.95 |
| Rate for Payer: Aetna Commercial |
$255.95
|
| Rate for Payer: Aetna Medicare |
$198.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.95
|
| Rate for Payer: BCBS Complete |
$225.20
|
| Rate for Payer: BCBS MAPPO |
$191.01
|
| Rate for Payer: BCN Medicare Advantage |
$191.01
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$275.05
|
| Rate for Payer: Cofinity Commercial |
$255.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.01
|
| Rate for Payer: Healthscope Commercial |
$305.62
|
| Rate for Payer: Healthscope Commercial |
$353.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.95
|
| Rate for Payer: Nomi Health Commercial |
$229.21
|
| Rate for Payer: PACE SWMI |
$191.01
|
| Rate for Payer: PHP Medicare Advantage |
$191.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.95
|
| Rate for Payer: Priority Health Medicare |
$191.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.01
|
| Rate for Payer: UHC Medicare Advantage |
$191.01
|
|
|
PR PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 35685
|
| Min. Negotiated Rate |
$177.20 |
| Max. Negotiated Rate |
$352.83 |
| Rate for Payer: Aetna Commercial |
$255.56
|
| Rate for Payer: Aetna Medicare |
$198.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.56
|
| Rate for Payer: BCBS Complete |
$177.20
|
| Rate for Payer: BCBS MAPPO |
$190.72
|
| Rate for Payer: BCN Medicare Advantage |
$190.72
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$274.64
|
| Rate for Payer: Cofinity Commercial |
$255.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.72
|
| Rate for Payer: Healthscope Commercial |
$305.15
|
| Rate for Payer: Healthscope Commercial |
$352.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$287.95
|
| Rate for Payer: Nomi Health Commercial |
$228.86
|
| Rate for Payer: PACE SWMI |
$190.72
|
| Rate for Payer: PHP Medicare Advantage |
$190.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.95
|
| Rate for Payer: Priority Health Medicare |
$190.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.72
|
| Rate for Payer: UHC Medicare Advantage |
$190.72
|
|
|
PR PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 34839
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR PL REJUV/PERFECT
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 00071
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
|
|
PR PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL
|
Professional
|
Both
|
$1,883.00
|
|
|
Service Code
|
HCPCS 40720
|
| Min. Negotiated Rate |
$753.20 |
| Max. Negotiated Rate |
$1,815.83 |
| Rate for Payer: Aetna Commercial |
$1,315.25
|
| Rate for Payer: Aetna Medicare |
$1,020.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,315.25
|
| Rate for Payer: BCBS Complete |
$753.20
|
| Rate for Payer: BCBS MAPPO |
$981.53
|
| Rate for Payer: BCN Medicare Advantage |
$981.53
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cofinity Commercial |
$1,413.40
|
| Rate for Payer: Cofinity Commercial |
$1,315.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.53
|
| Rate for Payer: Healthscope Commercial |
$1,815.83
|
| Rate for Payer: Healthscope Commercial |
$1,570.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,223.95
|
| Rate for Payer: Nomi Health Commercial |
$1,177.84
|
| Rate for Payer: PACE SWMI |
$981.53
|
| Rate for Payer: PHP Medicare Advantage |
$981.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,223.95
|
| Rate for Payer: Priority Health Medicare |
$981.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.53
|
| Rate for Payer: UHC Medicare Advantage |
$981.53
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 42500
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$606.06 |
| Rate for Payer: Aetna Commercial |
$438.98
|
| Rate for Payer: Aetna Medicare |
$340.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.98
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: BCBS MAPPO |
$327.60
|
| Rate for Payer: BCN Medicare Advantage |
$327.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$471.74
|
| Rate for Payer: Cofinity Commercial |
$438.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.60
|
| Rate for Payer: Healthscope Commercial |
$524.16
|
| Rate for Payer: Healthscope Commercial |
$606.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.80
|
| Rate for Payer: Nomi Health Commercial |
$393.12
|
| Rate for Payer: PACE SWMI |
$327.60
|
| Rate for Payer: PHP Medicare Advantage |
$327.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health Medicare |
$327.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.60
|
| Rate for Payer: UHC Medicare Advantage |
$327.60
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP
|
Professional
|
Both
|
$1,112.00
|
|
|
Service Code
|
HCPCS 42505
|
| Min. Negotiated Rate |
$435.25 |
| Max. Negotiated Rate |
$805.21 |
| Rate for Payer: Aetna Commercial |
$583.24
|
| Rate for Payer: Aetna Medicare |
$452.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$583.24
|
| Rate for Payer: BCBS Complete |
$444.80
|
| Rate for Payer: BCBS MAPPO |
$435.25
|
| Rate for Payer: BCN Medicare Advantage |
$435.25
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cofinity Commercial |
$626.76
|
| Rate for Payer: Cofinity Commercial |
$583.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.25
|
| Rate for Payer: Healthscope Commercial |
$696.40
|
| Rate for Payer: Healthscope Commercial |
$805.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$457.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$722.80
|
| Rate for Payer: Nomi Health Commercial |
$522.30
|
| Rate for Payer: PACE SWMI |
$435.25
|
| Rate for Payer: PHP Medicare Advantage |
$435.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health Medicare |
$435.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$435.25
|
| Rate for Payer: UHC Medicare Advantage |
$435.25
|
|
|
PR PL VITALIZE
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00070
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
PR PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$3,664.00
|
|
|
Service Code
|
HCPCS 48140
|
| Min. Negotiated Rate |
$1,465.60 |
| Max. Negotiated Rate |
$2,815.13 |
| Rate for Payer: Aetna Commercial |
$2,039.06
|
| Rate for Payer: Aetna Medicare |
$1,582.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,039.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,191.23
|
| Rate for Payer: BCBS Complete |
$1,465.60
|
| Rate for Payer: BCBS MAPPO |
$1,521.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,521.69
|
| Rate for Payer: Cash Price |
$2,931.20
|
| Rate for Payer: Cash Price |
$2,931.20
|
| Rate for Payer: Cofinity Commercial |
$2,039.06
|
| Rate for Payer: Cofinity Commercial |
$2,191.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,521.69
|
| Rate for Payer: Healthscope Commercial |
$2,434.70
|
| Rate for Payer: Healthscope Commercial |
$2,815.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,597.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,381.60
|
| Rate for Payer: Nomi Health Commercial |
$1,826.03
|
| Rate for Payer: PACE SWMI |
$1,521.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,521.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,381.60
|
| Rate for Payer: Priority Health Medicare |
$1,521.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,521.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,521.69
|
|
|
PR PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$5,562.00
|
|
|
Service Code
|
HCPCS 48150
|
| Min. Negotiated Rate |
$2,224.80 |
| Max. Negotiated Rate |
$5,587.17 |
| Rate for Payer: Aetna Commercial |
$4,046.92
|
| Rate for Payer: Aetna Medicare |
$3,140.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,348.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,046.92
|
| Rate for Payer: BCBS Complete |
$2,224.80
|
| Rate for Payer: BCBS MAPPO |
$3,020.09
|
| Rate for Payer: BCN Medicare Advantage |
$3,020.09
|
| Rate for Payer: Cash Price |
$4,449.60
|
| Rate for Payer: Cash Price |
$4,449.60
|
| Rate for Payer: Cofinity Commercial |
$4,348.93
|
| Rate for Payer: Cofinity Commercial |
$4,046.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,020.09
|
| Rate for Payer: Healthscope Commercial |
$5,587.17
|
| Rate for Payer: Healthscope Commercial |
$4,832.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,171.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,615.30
|
| Rate for Payer: Nomi Health Commercial |
$3,624.11
|
| Rate for Payer: PACE SWMI |
$3,020.09
|
| Rate for Payer: PHP Medicare Advantage |
$3,020.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,615.30
|
| Rate for Payer: Priority Health Medicare |
$3,020.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,020.09
|
| Rate for Payer: UHC Medicare Advantage |
$3,020.09
|
|
|
PR PNCRTECT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$8,303.00
|
|
|
Service Code
|
HCPCS 48153
|
| Min. Negotiated Rate |
$3,004.75 |
| Max. Negotiated Rate |
$5,558.79 |
| Rate for Payer: Aetna Commercial |
$4,026.36
|
| Rate for Payer: Aetna Medicare |
$3,124.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,326.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,026.36
|
| Rate for Payer: BCBS Complete |
$3,321.20
|
| Rate for Payer: BCBS MAPPO |
$3,004.75
|
| Rate for Payer: BCN Medicare Advantage |
$3,004.75
|
| Rate for Payer: Cash Price |
$6,642.40
|
| Rate for Payer: Cash Price |
$6,642.40
|
| Rate for Payer: Cofinity Commercial |
$4,326.84
|
| Rate for Payer: Cofinity Commercial |
$4,026.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,004.75
|
| Rate for Payer: Healthscope Commercial |
$4,807.60
|
| Rate for Payer: Healthscope Commercial |
$5,558.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,154.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,396.95
|
| Rate for Payer: Nomi Health Commercial |
$3,605.70
|
| Rate for Payer: PACE SWMI |
$3,004.75
|
| Rate for Payer: PHP Medicare Advantage |
$3,004.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,396.95
|
| Rate for Payer: Priority Health Medicare |
$3,004.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,004.75
|
| Rate for Payer: UHC Medicare Advantage |
$3,004.75
|
|
|
PR PNEUMOCOCCAL CONJ VACCINE 7 VALENT IM
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 90669
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$75.40 |
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
|
|
PR PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
HCPCS 32940
|
| Min. Negotiated Rate |
$1,029.60 |
| Max. Negotiated Rate |
$2,194.03 |
| Rate for Payer: Aetna Commercial |
$1,589.19
|
| Rate for Payer: Aetna Medicare |
$1,233.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,589.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,707.78
|
| Rate for Payer: BCBS Complete |
$1,029.60
|
| Rate for Payer: BCBS MAPPO |
$1,185.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,185.96
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cofinity Commercial |
$1,707.78
|
| Rate for Payer: Cofinity Commercial |
$1,589.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,185.96
|
| Rate for Payer: Healthscope Commercial |
$2,194.03
|
| Rate for Payer: Healthscope Commercial |
$1,897.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,245.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,673.10
|
| Rate for Payer: Nomi Health Commercial |
$1,423.15
|
| Rate for Payer: PACE SWMI |
$1,185.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,185.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,673.10
|
| Rate for Payer: Priority Health Medicare |
$1,185.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,185.96
|
| Rate for Payer: UHC Medicare Advantage |
$1,185.96
|
|
|
PR PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST
|
Professional
|
Both
|
$2,729.00
|
|
|
Service Code
|
HCPCS 32200
|
| Min. Negotiated Rate |
$1,091.60 |
| Max. Negotiated Rate |
$2,027.77 |
| Rate for Payer: Aetna Commercial |
$1,468.76
|
| Rate for Payer: Aetna Medicare |
$1,139.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,468.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,578.37
|
| Rate for Payer: BCBS Complete |
$1,091.60
|
| Rate for Payer: BCBS MAPPO |
$1,096.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,096.09
|
| Rate for Payer: Cash Price |
$2,183.20
|
| Rate for Payer: Cash Price |
$2,183.20
|
| Rate for Payer: Cofinity Commercial |
$1,468.76
|
| Rate for Payer: Cofinity Commercial |
$1,578.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,096.09
|
| Rate for Payer: Healthscope Commercial |
$1,753.74
|
| Rate for Payer: Healthscope Commercial |
$2,027.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,150.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,773.85
|
| Rate for Payer: Nomi Health Commercial |
$1,315.31
|
| Rate for Payer: PACE SWMI |
$1,096.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,096.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,773.85
|
| Rate for Payer: Priority Health Medicare |
$1,096.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,096.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,096.09
|
|
