|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 10160
|
| Hospital Charge Code |
10160
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$168.89 |
| Rate for Payer: Aetna Commercial |
$122.33
|
| Rate for Payer: Aetna Medicare |
$94.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.46
|
| Rate for Payer: BCBS Complete |
$86.00
|
| Rate for Payer: BCBS MAPPO |
$91.29
|
| Rate for Payer: BCN Medicare Advantage |
$91.29
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$122.33
|
| Rate for Payer: Cofinity Commercial |
$131.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.29
|
| Rate for Payer: Healthscope Commercial |
$168.89
|
| Rate for Payer: Healthscope Commercial |
$146.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.75
|
| Rate for Payer: Nomi Health Commercial |
$109.55
|
| Rate for Payer: PACE SWMI |
$91.29
|
| Rate for Payer: PHP Medicare Advantage |
$91.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health Medicare |
$91.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.29
|
| Rate for Payer: UHC Medicare Advantage |
$91.29
|
|
|
PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
10160
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$135.45 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health SBD |
$135.45
|
|
|
PR PUNCTURE ASPIRATION CYST BREAST EACH ADDL CYST
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 19001
|
| Min. Negotiated Rate |
$19.52 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$26.16
|
| Rate for Payer: Aetna Medicare |
$20.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.16
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$19.52
|
| Rate for Payer: BCN Medicare Advantage |
$19.52
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$28.11
|
| Rate for Payer: Cofinity Commercial |
$26.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.52
|
| Rate for Payer: Healthscope Commercial |
$31.23
|
| Rate for Payer: Healthscope Commercial |
$36.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.75
|
| Rate for Payer: Nomi Health Commercial |
$23.42
|
| Rate for Payer: PACE SWMI |
$19.52
|
| Rate for Payer: PHP Medicare Advantage |
$19.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health Medicare |
$19.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.52
|
| Rate for Payer: UHC Medicare Advantage |
$19.52
|
|
|
PR PUNCTURE ASPIRATION CYST OF BREAST
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 19000
|
| Min. Negotiated Rate |
$40.86 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Aetna Commercial |
$54.75
|
| Rate for Payer: Aetna Medicare |
$42.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.75
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: BCBS MAPPO |
$40.86
|
| Rate for Payer: BCN Medicare Advantage |
$40.86
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cofinity Commercial |
$58.84
|
| Rate for Payer: Cofinity Commercial |
$54.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.86
|
| Rate for Payer: Healthscope Commercial |
$75.59
|
| Rate for Payer: Healthscope Commercial |
$65.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.15
|
| Rate for Payer: Nomi Health Commercial |
$49.03
|
| Rate for Payer: PACE SWMI |
$40.86
|
| Rate for Payer: PHP Medicare Advantage |
$40.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
| Rate for Payer: Priority Health Medicare |
$40.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.86
|
| Rate for Payer: UHC Medicare Advantage |
$40.86
|
|
|
PR PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
HCPCS 61070
|
| Min. Negotiated Rate |
$53.72 |
| Max. Negotiated Rate |
$260.65 |
| Rate for Payer: Aetna Commercial |
$71.98
|
| Rate for Payer: Aetna Medicare |
$55.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.98
|
| Rate for Payer: BCBS Complete |
$160.40
|
| Rate for Payer: BCBS MAPPO |
$53.72
|
| Rate for Payer: BCN Medicare Advantage |
$53.72
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cash Price |
$320.80
|
| Rate for Payer: Cofinity Commercial |
$77.36
|
| Rate for Payer: Cofinity Commercial |
$71.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.72
|
| Rate for Payer: Healthscope Commercial |
$85.95
|
| Rate for Payer: Healthscope Commercial |
$99.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.65
|
| Rate for Payer: Nomi Health Commercial |
$64.46
|
| Rate for Payer: PACE SWMI |
$53.72
|
| Rate for Payer: PHP Medicare Advantage |
$53.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.65
|
| Rate for Payer: Priority Health Medicare |
$53.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.72
|
| Rate for Payer: UHC Medicare Advantage |
$53.72
|
|
|
PR PURE TONE AUDIOMETRY AIR & BONE
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 92553
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna Commercial |
$57.37
|
| Rate for Payer: Aetna Medicare |
$44.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.37
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS MAPPO |
$42.81
|
| Rate for Payer: BCN Medicare Advantage |
$42.81
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$61.65
|
| Rate for Payer: Cofinity Commercial |
$57.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.81
|
| Rate for Payer: Healthscope Commercial |
$79.20
|
| Rate for Payer: Healthscope Commercial |
$68.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.25
|
| Rate for Payer: Nomi Health Commercial |
$51.37
|
| Rate for Payer: PACE SWMI |
$42.81
|
| Rate for Payer: PHP Medicare Advantage |
$42.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.25
|
| Rate for Payer: Priority Health Medicare |
$42.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.81
|
| Rate for Payer: UHC Medicare Advantage |
$42.81
|
|
|
PR PURE TONE AUDIOMETRY AIR ONLY
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 92552
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$65.58 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Medicare |
$36.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.50
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$35.45
|
| Rate for Payer: BCN Medicare Advantage |
$35.45
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$51.05
|
| Rate for Payer: Cofinity Commercial |
$47.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.45
|
| Rate for Payer: Healthscope Commercial |
$56.72
|
| Rate for Payer: Healthscope Commercial |
$65.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.10
|
| Rate for Payer: Nomi Health Commercial |
$42.54
|
| Rate for Payer: PACE SWMI |
$35.45
|
| Rate for Payer: PHP Medicare Advantage |
$35.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health Medicare |
$35.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.45
|
| Rate for Payer: UHC Medicare Advantage |
$35.45
|
|
|
PR PVB THORACIC CONT CATHETER INFUSION W/IMG GID
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 64463
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$104.71
|
| Rate for Payer: Aetna Medicare |
$81.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.71
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: BCBS MAPPO |
$78.14
|
| Rate for Payer: BCN Medicare Advantage |
$78.14
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$112.52
|
| Rate for Payer: Cofinity Commercial |
$104.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.14
|
| Rate for Payer: Healthscope Commercial |
$144.56
|
| Rate for Payer: Healthscope Commercial |
$125.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$206.05
|
| Rate for Payer: Nomi Health Commercial |
$93.77
|
| Rate for Payer: PACE SWMI |
$78.14
|
| Rate for Payer: PHP Medicare Advantage |
$78.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health Medicare |
$78.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.14
|
| Rate for Payer: UHC Medicare Advantage |
$78.14
|
|
|
PR PYELOPLASTY COMPLICATED
|
Professional
|
Both
|
$2,668.00
|
|
|
Service Code
|
HCPCS 50405
|
| Min. Negotiated Rate |
$1,067.20 |
| Max. Negotiated Rate |
$2,459.37 |
| Rate for Payer: Aetna Commercial |
$1,781.38
|
| Rate for Payer: Aetna Medicare |
$1,382.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,914.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,781.38
|
| Rate for Payer: BCBS Complete |
$1,067.20
|
| Rate for Payer: BCBS MAPPO |
$1,329.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,329.39
|
| Rate for Payer: Cash Price |
$2,134.40
|
| Rate for Payer: Cash Price |
$2,134.40
|
| Rate for Payer: Cofinity Commercial |
$1,914.32
|
| Rate for Payer: Cofinity Commercial |
$1,781.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,329.39
|
| Rate for Payer: Healthscope Commercial |
$2,127.02
|
| Rate for Payer: Healthscope Commercial |
$2,459.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,395.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,734.20
|
| Rate for Payer: Nomi Health Commercial |
$1,595.27
|
| Rate for Payer: PACE SWMI |
$1,329.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,329.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,734.20
|
| Rate for Payer: Priority Health Medicare |
$1,329.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,329.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,329.39
|
|
|
PR PYELOPLASTY SIMPLE
|
Professional
|
Both
|
$1,795.00
|
|
|
Service Code
|
HCPCS 50400
|
| Min. Negotiated Rate |
$718.00 |
| Max. Negotiated Rate |
$2,037.46 |
| Rate for Payer: Aetna Commercial |
$1,475.78
|
| Rate for Payer: Aetna Medicare |
$1,145.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,585.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,475.78
|
| Rate for Payer: BCBS Complete |
$718.00
|
| Rate for Payer: BCBS MAPPO |
$1,101.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,101.33
|
| Rate for Payer: Cash Price |
$1,436.00
|
| Rate for Payer: Cash Price |
$1,436.00
|
| Rate for Payer: Cofinity Commercial |
$1,585.92
|
| Rate for Payer: Cofinity Commercial |
$1,475.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,101.33
|
| Rate for Payer: Healthscope Commercial |
$2,037.46
|
| Rate for Payer: Healthscope Commercial |
$1,762.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,156.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.75
|
| Rate for Payer: Nomi Health Commercial |
$1,321.60
|
| Rate for Payer: PACE SWMI |
$1,101.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,101.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,166.75
|
| Rate for Payer: Priority Health Medicare |
$1,101.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,101.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,101.33
|
|
|
PR PYLOROMYOTOMY CUTTING PYLORIC MUSC
|
Professional
|
Both
|
$2,256.00
|
|
|
Service Code
|
HCPCS 43520
|
| Min. Negotiated Rate |
$694.38 |
| Max. Negotiated Rate |
$1,466.40 |
| Rate for Payer: Aetna Commercial |
$930.47
|
| Rate for Payer: Aetna Medicare |
$722.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$930.47
|
| Rate for Payer: BCBS Complete |
$902.40
|
| Rate for Payer: BCBS MAPPO |
$694.38
|
| Rate for Payer: BCN Medicare Advantage |
$694.38
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cofinity Commercial |
$999.91
|
| Rate for Payer: Cofinity Commercial |
$930.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.38
|
| Rate for Payer: Healthscope Commercial |
$1,111.01
|
| Rate for Payer: Healthscope Commercial |
$1,284.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$729.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,466.40
|
| Rate for Payer: Nomi Health Commercial |
$833.26
|
| Rate for Payer: PACE SWMI |
$694.38
|
| Rate for Payer: PHP Medicare Advantage |
$694.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,466.40
|
| Rate for Payer: Priority Health Medicare |
$694.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$694.38
|
| Rate for Payer: UHC Medicare Advantage |
$694.38
|
|
|
PR PYLOROPLASTY
|
Professional
|
Both
|
$2,557.00
|
|
|
Service Code
|
HCPCS 43800
|
| Min. Negotiated Rate |
$904.63 |
| Max. Negotiated Rate |
$1,673.57 |
| Rate for Payer: Aetna Commercial |
$1,212.20
|
| Rate for Payer: Aetna Medicare |
$940.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,302.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,212.20
|
| Rate for Payer: BCBS Complete |
$1,022.80
|
| Rate for Payer: BCBS MAPPO |
$904.63
|
| Rate for Payer: BCN Medicare Advantage |
$904.63
|
| Rate for Payer: Cash Price |
$2,045.60
|
| Rate for Payer: Cash Price |
$2,045.60
|
| Rate for Payer: Cofinity Commercial |
$1,302.67
|
| Rate for Payer: Cofinity Commercial |
$1,212.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$904.63
|
| Rate for Payer: Healthscope Commercial |
$1,673.57
|
| Rate for Payer: Healthscope Commercial |
$1,447.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$949.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,662.05
|
| Rate for Payer: Nomi Health Commercial |
$1,085.56
|
| Rate for Payer: PACE SWMI |
$904.63
|
| Rate for Payer: PHP Medicare Advantage |
$904.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,662.05
|
| Rate for Payer: Priority Health Medicare |
$904.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$904.63
|
| Rate for Payer: UHC Medicare Advantage |
$904.63
|
|
|
PR QUADRICEPSPLASTY
|
Professional
|
Both
|
$2,049.00
|
|
|
Service Code
|
HCPCS 27430
|
| Min. Negotiated Rate |
$716.80 |
| Max. Negotiated Rate |
$1,331.85 |
| Rate for Payer: Aetna Commercial |
$960.51
|
| Rate for Payer: Aetna Medicare |
$745.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,032.19
|
| Rate for Payer: BCBS Complete |
$819.60
|
| Rate for Payer: BCBS MAPPO |
$716.80
|
| Rate for Payer: BCN Medicare Advantage |
$716.80
|
| Rate for Payer: Cash Price |
$1,639.20
|
| Rate for Payer: Cash Price |
$1,639.20
|
| Rate for Payer: Cofinity Commercial |
$960.51
|
| Rate for Payer: Cofinity Commercial |
$1,032.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$716.80
|
| Rate for Payer: Healthscope Commercial |
$1,146.88
|
| Rate for Payer: Healthscope Commercial |
$1,326.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$752.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,331.85
|
| Rate for Payer: Nomi Health Commercial |
$860.16
|
| Rate for Payer: PACE SWMI |
$716.80
|
| Rate for Payer: PHP Medicare Advantage |
$716.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,331.85
|
| Rate for Payer: Priority Health Medicare |
$716.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$716.80
|
| Rate for Payer: UHC Medicare Advantage |
$716.80
|
|
|
PR QUAL NONMD EST PT 11-20M
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2062
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR QUAL NONMD EST PT 21>MIN
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2063
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR QUAL NONMD EST PT 5-10M
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G2061
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 90375
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$517.72 |
| Rate for Payer: Aetna Commercial |
$375.00
|
| Rate for Payer: Aetna Medicare |
$291.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.98
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS MAPPO |
$279.85
|
| Rate for Payer: BCN Medicare Advantage |
$279.85
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$375.00
|
| Rate for Payer: Cofinity Commercial |
$402.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.85
|
| Rate for Payer: Healthscope Commercial |
$517.72
|
| Rate for Payer: Healthscope Commercial |
$447.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.00
|
| Rate for Payer: Nomi Health Commercial |
$335.82
|
| Rate for Payer: PACE SWMI |
$279.85
|
| Rate for Payer: PHP Medicare Advantage |
$279.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.00
|
| Rate for Payer: Priority Health Medicare |
$279.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.85
|
| Rate for Payer: UHC Medicare Advantage |
$279.85
|
|
|
PR RABIES VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 90675
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$580.31 |
| Rate for Payer: Aetna Commercial |
$420.33
|
| Rate for Payer: Aetna Medicare |
$326.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$451.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$420.33
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS MAPPO |
$313.68
|
| Rate for Payer: BCN Medicare Advantage |
$313.68
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$451.70
|
| Rate for Payer: Cofinity Commercial |
$420.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.68
|
| Rate for Payer: Healthscope Commercial |
$580.31
|
| Rate for Payer: Healthscope Commercial |
$501.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.20
|
| Rate for Payer: Nomi Health Commercial |
$376.42
|
| Rate for Payer: PACE SWMI |
$313.68
|
| Rate for Payer: PHP Medicare Advantage |
$313.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.20
|
| Rate for Payer: Priority Health Medicare |
$313.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$313.68
|
| Rate for Payer: UHC Medicare Advantage |
$313.68
|
|
|
PR RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY
|
Professional
|
Both
|
$6,028.00
|
|
|
Service Code
|
HCPCS 58210
|
| Min. Negotiated Rate |
$1,749.98 |
| Max. Negotiated Rate |
$3,918.20 |
| Rate for Payer: Aetna Commercial |
$2,344.97
|
| Rate for Payer: Aetna Medicare |
$1,819.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,519.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,344.97
|
| Rate for Payer: BCBS Complete |
$2,411.20
|
| Rate for Payer: BCBS MAPPO |
$1,749.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,749.98
|
| Rate for Payer: Cash Price |
$4,822.40
|
| Rate for Payer: Cash Price |
$4,822.40
|
| Rate for Payer: Cofinity Commercial |
$2,519.97
|
| Rate for Payer: Cofinity Commercial |
$2,344.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,749.98
|
| Rate for Payer: Healthscope Commercial |
$2,799.97
|
| Rate for Payer: Healthscope Commercial |
$3,237.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,837.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,918.20
|
| Rate for Payer: Nomi Health Commercial |
$2,099.98
|
| Rate for Payer: PACE SWMI |
$1,749.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,749.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,918.20
|
| Rate for Payer: Priority Health Medicare |
$1,749.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,749.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,749.98
|
|
|
PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS
|
Professional
|
Both
|
$2,719.00
|
|
|
Service Code
|
HCPCS 25115
|
| Min. Negotiated Rate |
$732.84 |
| Max. Negotiated Rate |
$1,767.35 |
| Rate for Payer: Aetna Commercial |
$982.01
|
| Rate for Payer: Aetna Medicare |
$762.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$982.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,055.29
|
| Rate for Payer: BCBS Complete |
$1,087.60
|
| Rate for Payer: BCBS MAPPO |
$732.84
|
| Rate for Payer: BCN Medicare Advantage |
$732.84
|
| Rate for Payer: Cash Price |
$2,175.20
|
| Rate for Payer: Cash Price |
$2,175.20
|
| Rate for Payer: Cofinity Commercial |
$982.01
|
| Rate for Payer: Cofinity Commercial |
$1,055.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$732.84
|
| Rate for Payer: Healthscope Commercial |
$1,355.75
|
| Rate for Payer: Healthscope Commercial |
$1,172.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$769.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,767.35
|
| Rate for Payer: Nomi Health Commercial |
$879.41
|
| Rate for Payer: PACE SWMI |
$732.84
|
| Rate for Payer: PHP Medicare Advantage |
$732.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,767.35
|
| Rate for Payer: Priority Health Medicare |
$732.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$732.84
|
| Rate for Payer: UHC Medicare Advantage |
$732.84
|
|
|
PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS
|
Professional
|
Both
|
$2,330.00
|
|
|
Service Code
|
HCPCS 25116
|
| Min. Negotiated Rate |
$585.05 |
| Max. Negotiated Rate |
$1,514.50 |
| Rate for Payer: Aetna Commercial |
$783.97
|
| Rate for Payer: Aetna Medicare |
$608.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$842.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$783.97
|
| Rate for Payer: BCBS Complete |
$932.00
|
| Rate for Payer: BCBS MAPPO |
$585.05
|
| Rate for Payer: BCN Medicare Advantage |
$585.05
|
| Rate for Payer: Cash Price |
$1,864.00
|
| Rate for Payer: Cash Price |
$1,864.00
|
| Rate for Payer: Cofinity Commercial |
$842.47
|
| Rate for Payer: Cofinity Commercial |
$783.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$585.05
|
| Rate for Payer: Healthscope Commercial |
$1,082.34
|
| Rate for Payer: Healthscope Commercial |
$936.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$614.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,514.50
|
| Rate for Payer: Nomi Health Commercial |
$702.06
|
| Rate for Payer: PACE SWMI |
$585.05
|
| Rate for Payer: PHP Medicare Advantage |
$585.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,514.50
|
| Rate for Payer: Priority Health Medicare |
$585.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$585.05
|
| Rate for Payer: UHC Medicare Advantage |
$585.05
|
|
|
PR RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ
|
Professional
|
Both
|
$1,902.00
|
|
|
Service Code
|
HCPCS 69150
|
| Min. Negotiated Rate |
$760.80 |
| Max. Negotiated Rate |
$1,748.32 |
| Rate for Payer: Aetna Commercial |
$1,266.35
|
| Rate for Payer: Aetna Medicare |
$982.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,360.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,266.35
|
| Rate for Payer: BCBS Complete |
$760.80
|
| Rate for Payer: BCBS MAPPO |
$945.04
|
| Rate for Payer: BCN Medicare Advantage |
$945.04
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cash Price |
$1,521.60
|
| Rate for Payer: Cofinity Commercial |
$1,360.86
|
| Rate for Payer: Cofinity Commercial |
$1,266.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$945.04
|
| Rate for Payer: Healthscope Commercial |
$1,748.32
|
| Rate for Payer: Healthscope Commercial |
$1,512.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$992.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,236.30
|
| Rate for Payer: Nomi Health Commercial |
$1,134.05
|
| Rate for Payer: PACE SWMI |
$945.04
|
| Rate for Payer: PHP Medicare Advantage |
$945.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,236.30
|
| Rate for Payer: Priority Health Medicare |
$945.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$945.04
|
| Rate for Payer: UHC Medicare Advantage |
$945.04
|
|
|
PR RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP
|
Professional
|
Both
|
$3,040.00
|
|
|
Service Code
|
HCPCS 42844
|
| Min. Negotiated Rate |
$1,216.00 |
| Max. Negotiated Rate |
$2,382.65 |
| Rate for Payer: Aetna Commercial |
$1,725.81
|
| Rate for Payer: Aetna Medicare |
$1,339.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,854.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,725.81
|
| Rate for Payer: BCBS Complete |
$1,216.00
|
| Rate for Payer: BCBS MAPPO |
$1,287.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,287.92
|
| Rate for Payer: Cash Price |
$2,432.00
|
| Rate for Payer: Cash Price |
$2,432.00
|
| Rate for Payer: Cofinity Commercial |
$1,854.60
|
| Rate for Payer: Cofinity Commercial |
$1,725.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,287.92
|
| Rate for Payer: Healthscope Commercial |
$2,060.67
|
| Rate for Payer: Healthscope Commercial |
$2,382.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,352.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,976.00
|
| Rate for Payer: Nomi Health Commercial |
$1,545.50
|
| Rate for Payer: PACE SWMI |
$1,287.92
|
| Rate for Payer: PHP Medicare Advantage |
$1,287.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,976.00
|
| Rate for Payer: Priority Health Medicare |
$1,287.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,287.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,287.92
|
|
|
PR RADICAL RESECTION STERNUM
|
Professional
|
Both
|
$2,674.00
|
|
|
Service Code
|
HCPCS 21630
|
| Min. Negotiated Rate |
$1,069.60 |
| Max. Negotiated Rate |
$2,325.64 |
| Rate for Payer: Aetna Commercial |
$1,684.51
|
| Rate for Payer: Aetna Medicare |
$1,307.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,810.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,684.51
|
| Rate for Payer: BCBS Complete |
$1,069.60
|
| Rate for Payer: BCBS MAPPO |
$1,257.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,257.10
|
| Rate for Payer: Cash Price |
$2,139.20
|
| Rate for Payer: Cash Price |
$2,139.20
|
| Rate for Payer: Cofinity Commercial |
$1,810.22
|
| Rate for Payer: Cofinity Commercial |
$1,684.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,257.10
|
| Rate for Payer: Healthscope Commercial |
$2,325.64
|
| Rate for Payer: Healthscope Commercial |
$2,011.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,319.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,738.10
|
| Rate for Payer: Nomi Health Commercial |
$1,508.52
|
| Rate for Payer: PACE SWMI |
$1,257.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,257.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,738.10
|
| Rate for Payer: Priority Health Medicare |
$1,257.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,257.10
|
| Rate for Payer: UHC Medicare Advantage |
$1,257.10
|
|
|
PR RADICAL RESECTION TONSIL W/O CLOSURE
|
Professional
|
Both
|
$1,802.00
|
|
|
Service Code
|
HCPCS 42842
|
| Min. Negotiated Rate |
$720.80 |
| Max. Negotiated Rate |
$1,745.16 |
| Rate for Payer: Aetna Commercial |
$1,264.06
|
| Rate for Payer: Aetna Medicare |
$981.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,358.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,264.06
|
| Rate for Payer: BCBS Complete |
$720.80
|
| Rate for Payer: BCBS MAPPO |
$943.33
|
| Rate for Payer: BCN Medicare Advantage |
$943.33
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cash Price |
$1,441.60
|
| Rate for Payer: Cofinity Commercial |
$1,358.40
|
| Rate for Payer: Cofinity Commercial |
$1,264.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$943.33
|
| Rate for Payer: Healthscope Commercial |
$1,509.33
|
| Rate for Payer: Healthscope Commercial |
$1,745.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$990.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,171.30
|
| Rate for Payer: Nomi Health Commercial |
$1,132.00
|
| Rate for Payer: PACE SWMI |
$943.33
|
| Rate for Payer: PHP Medicare Advantage |
$943.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,171.30
|
| Rate for Payer: Priority Health Medicare |
$943.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$943.33
|
| Rate for Payer: UHC Medicare Advantage |
$943.33
|
|
