|
PR RPR UMBILICAL HERNIA < 5 YRS INCARCERATED
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 49582
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Aetna Medicare |
$731.50
|
| Rate for Payer: BCBS Complete |
$585.20
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,268.00
|
|
|
Service Code
|
HCPCS 49580
|
| Min. Negotiated Rate |
$507.20 |
| Max. Negotiated Rate |
$824.20 |
| Rate for Payer: Aetna Medicare |
$634.00
|
| Rate for Payer: BCBS Complete |
$507.20
|
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$824.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.20
|
|
|
PR RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,685.00
|
|
|
Service Code
|
HCPCS 49587
|
| Min. Negotiated Rate |
$674.00 |
| Max. Negotiated Rate |
$1,095.25 |
| Rate for Payer: Aetna Medicare |
$842.50
|
| Rate for Payer: BCBS Complete |
$674.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,095.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,095.25
|
|
|
PR RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 49585
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Aetna Medicare |
$731.50
|
| Rate for Payer: BCBS Complete |
$585.20
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$950.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
|
|
PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC
|
Professional
|
Both
|
$8,041.00
|
|
|
Service Code
|
HCPCS 33414
|
| Min. Negotiated Rate |
$2,061.73 |
| Max. Negotiated Rate |
$5,226.65 |
| Rate for Payer: Aetna Commercial |
$2,762.72
|
| Rate for Payer: Aetna Medicare |
$2,144.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,762.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,968.89
|
| Rate for Payer: BCBS Complete |
$3,216.40
|
| Rate for Payer: BCBS MAPPO |
$2,061.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,061.73
|
| Rate for Payer: Cash Price |
$6,432.80
|
| Rate for Payer: Cash Price |
$6,432.80
|
| Rate for Payer: Cofinity Commercial |
$2,968.89
|
| Rate for Payer: Cofinity Commercial |
$2,762.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,061.73
|
| Rate for Payer: Healthscope Commercial |
$3,298.77
|
| Rate for Payer: Healthscope Commercial |
$3,814.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,164.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,226.65
|
| Rate for Payer: Nomi Health Commercial |
$2,474.08
|
| Rate for Payer: PACE SWMI |
$2,061.73
|
| Rate for Payer: PHP Medicare Advantage |
$2,061.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,226.65
|
| Rate for Payer: Priority Health Medicare |
$2,061.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,061.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,061.73
|
|
|
PR RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER
|
Professional
|
Both
|
$2,823.00
|
|
|
Service Code
|
HCPCS 26428
|
| Min. Negotiated Rate |
$744.65 |
| Max. Negotiated Rate |
$1,834.95 |
| Rate for Payer: Aetna Commercial |
$997.83
|
| Rate for Payer: Aetna Medicare |
$774.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,072.30
|
| Rate for Payer: BCBS Complete |
$1,129.20
|
| Rate for Payer: BCBS MAPPO |
$744.65
|
| Rate for Payer: BCN Medicare Advantage |
$744.65
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Cofinity Commercial |
$997.83
|
| Rate for Payer: Cofinity Commercial |
$1,072.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.65
|
| Rate for Payer: Healthscope Commercial |
$1,377.60
|
| Rate for Payer: Healthscope Commercial |
$1,191.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$781.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,834.95
|
| Rate for Payer: Nomi Health Commercial |
$893.58
|
| Rate for Payer: PACE SWMI |
$744.65
|
| Rate for Payer: PHP Medicare Advantage |
$744.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,834.95
|
| Rate for Payer: Priority Health Medicare |
$744.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.65
|
| Rate for Payer: UHC Medicare Advantage |
$744.65
|
|
|
PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 26426
|
| Min. Negotiated Rate |
$488.18 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$654.16
|
| Rate for Payer: Aetna Medicare |
$507.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.16
|
| Rate for Payer: BCBS Complete |
$793.20
|
| Rate for Payer: BCBS MAPPO |
$488.18
|
| Rate for Payer: BCN Medicare Advantage |
$488.18
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$702.98
|
| Rate for Payer: Cofinity Commercial |
$654.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.18
|
| Rate for Payer: Healthscope Commercial |
$781.09
|
| Rate for Payer: Healthscope Commercial |
$903.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,288.95
|
| Rate for Payer: Nomi Health Commercial |
$585.82
|
| Rate for Payer: PACE SWMI |
$488.18
|
| Rate for Payer: PHP Medicare Advantage |
$488.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health Medicare |
$488.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$488.18
|
| Rate for Payer: UHC Medicare Advantage |
$488.18
|
|
|
PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 33226
|
| Min. Negotiated Rate |
$466.10 |
| Max. Negotiated Rate |
$862.28 |
| Rate for Payer: Aetna Commercial |
$624.57
|
| Rate for Payer: Aetna Medicare |
$484.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.57
|
| Rate for Payer: BCBS Complete |
$518.80
|
| Rate for Payer: BCBS MAPPO |
$466.10
|
| Rate for Payer: BCN Medicare Advantage |
$466.10
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$671.18
|
| Rate for Payer: Cofinity Commercial |
$624.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.10
|
| Rate for Payer: Healthscope Commercial |
$862.28
|
| Rate for Payer: Healthscope Commercial |
$745.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$843.05
|
| Rate for Payer: Nomi Health Commercial |
$559.32
|
| Rate for Payer: PACE SWMI |
$466.10
|
| Rate for Payer: PHP Medicare Advantage |
$466.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health Medicare |
$466.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.10
|
| Rate for Payer: UHC Medicare Advantage |
$466.10
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 33215
|
| Min. Negotiated Rate |
$295.05 |
| Max. Negotiated Rate |
$668.85 |
| Rate for Payer: Aetna Commercial |
$395.37
|
| Rate for Payer: Aetna Medicare |
$306.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.37
|
| Rate for Payer: BCBS Complete |
$411.60
|
| Rate for Payer: BCBS MAPPO |
$295.05
|
| Rate for Payer: BCN Medicare Advantage |
$295.05
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cofinity Commercial |
$424.87
|
| Rate for Payer: Cofinity Commercial |
$395.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.05
|
| Rate for Payer: Healthscope Commercial |
$472.08
|
| Rate for Payer: Healthscope Commercial |
$545.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$668.85
|
| Rate for Payer: Nomi Health Commercial |
$354.06
|
| Rate for Payer: PACE SWMI |
$295.05
|
| Rate for Payer: PHP Medicare Advantage |
$295.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$668.85
|
| Rate for Payer: Priority Health Medicare |
$295.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.05
|
| Rate for Payer: UHC Medicare Advantage |
$295.05
|
|
|
PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 36597
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Commercial |
$76.77
|
| Rate for Payer: Aetna Medicare |
$59.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.77
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$57.29
|
| Rate for Payer: BCN Medicare Advantage |
$57.29
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$82.50
|
| Rate for Payer: Cofinity Commercial |
$76.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.29
|
| Rate for Payer: Healthscope Commercial |
$105.99
|
| Rate for Payer: Healthscope Commercial |
$91.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.40
|
| Rate for Payer: Nomi Health Commercial |
$68.75
|
| Rate for Payer: PACE SWMI |
$57.29
|
| Rate for Payer: PHP Medicare Advantage |
$57.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$57.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.29
|
| Rate for Payer: UHC Medicare Advantage |
$57.29
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
HCPCS 90380
|
| Min. Negotiated Rate |
$521.20 |
| Max. Negotiated Rate |
$846.95 |
| Rate for Payer: Aetna Medicare |
$651.50
|
| Rate for Payer: BCBS Complete |
$521.20
|
| Rate for Payer: Cash Price |
$1,042.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$846.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.95
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
HCPCS 90381
|
| Min. Negotiated Rate |
$521.20 |
| Max. Negotiated Rate |
$846.95 |
| Rate for Payer: Aetna Medicare |
$651.50
|
| Rate for Payer: BCBS Complete |
$521.20
|
| Rate for Payer: Cash Price |
$1,042.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$846.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.95
|
|
|
PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 90678
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna Medicare |
$420.00
|
| Rate for Payer: BCBS Complete |
$336.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
|
|
PR RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 90679
|
| Min. Negotiated Rate |
$318.80 |
| Max. Negotiated Rate |
$518.05 |
| Rate for Payer: Aetna Medicare |
$398.50
|
| Rate for Payer: BCBS Complete |
$318.80
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$518.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.05
|
|
|
PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$2,946.00
|
|
|
Service Code
|
HCPCS 37193
|
| Min. Negotiated Rate |
$327.97 |
| Max. Negotiated Rate |
$1,914.90 |
| Rate for Payer: Aetna Commercial |
$439.48
|
| Rate for Payer: Aetna Medicare |
$341.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.48
|
| Rate for Payer: BCBS Complete |
$1,178.40
|
| Rate for Payer: BCBS MAPPO |
$327.97
|
| Rate for Payer: BCN Medicare Advantage |
$327.97
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cofinity Commercial |
$439.48
|
| Rate for Payer: Cofinity Commercial |
$472.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.97
|
| Rate for Payer: Healthscope Commercial |
$606.74
|
| Rate for Payer: Healthscope Commercial |
$524.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,914.90
|
| Rate for Payer: Nomi Health Commercial |
$393.56
|
| Rate for Payer: PACE SWMI |
$327.97
|
| Rate for Payer: PHP Medicare Advantage |
$327.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,914.90
|
| Rate for Payer: Priority Health Medicare |
$327.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.97
|
| Rate for Payer: UHC Medicare Advantage |
$327.97
|
|
|
PR RUBELLA IMMUNIZATION, SUBCUT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 90706
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 90681
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$103.35 |
| Rate for Payer: Aetna Medicare |
$79.50
|
| Rate for Payer: BCBS Complete |
$63.60
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.35
|
|
|
PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 90680
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Medicare |
$48.00
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
|
|
PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY
|
Professional
|
Both
|
$3,142.00
|
|
|
Service Code
|
HCPCS 33476
|
| Min. Negotiated Rate |
$1,256.80 |
| Max. Negotiated Rate |
$2,710.77 |
| Rate for Payer: Aetna Commercial |
$1,963.48
|
| Rate for Payer: Aetna Medicare |
$1,523.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,963.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,110.00
|
| Rate for Payer: BCBS Complete |
$1,256.80
|
| Rate for Payer: BCBS MAPPO |
$1,465.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,465.28
|
| Rate for Payer: Cash Price |
$2,513.60
|
| Rate for Payer: Cash Price |
$2,513.60
|
| Rate for Payer: Cofinity Commercial |
$1,963.48
|
| Rate for Payer: Cofinity Commercial |
$2,110.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,465.28
|
| Rate for Payer: Healthscope Commercial |
$2,710.77
|
| Rate for Payer: Healthscope Commercial |
$2,344.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,538.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,042.30
|
| Rate for Payer: Nomi Health Commercial |
$1,758.34
|
| Rate for Payer: PACE SWMI |
$1,465.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,465.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,042.30
|
| Rate for Payer: Priority Health Medicare |
$1,465.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,465.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,465.28
|
|
|
PR RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 92310
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
|
|
PR RX&FITG C-LENS TECH CRNL LENS OU XCPT APHAKIA
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 92314
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Aetna Medicare |
$68.50
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
|
|
PR RX RIB FRACTURE W EXTERN FIXATN
|
Professional
|
Both
|
$1,317.00
|
|
|
Service Code
|
HCPCS 21810
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$856.05 |
| Rate for Payer: Aetna Medicare |
$658.50
|
| Rate for Payer: BCBS Complete |
$526.80
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$856.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.05
|
|
|
PR SACRAL NERVE STIM TEST LEAD
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS A4290
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$105.95 |
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
|
|
PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$1,749.00
|
|
|
Service Code
|
HCPCS 58700
|
| Min. Negotiated Rate |
$699.60 |
| Max. Negotiated Rate |
$1,426.41 |
| Rate for Payer: Aetna Commercial |
$1,033.18
|
| Rate for Payer: Aetna Medicare |
$801.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,110.28
|
| Rate for Payer: BCBS Complete |
$699.60
|
| Rate for Payer: BCBS MAPPO |
$771.03
|
| Rate for Payer: BCN Medicare Advantage |
$771.03
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cofinity Commercial |
$1,110.28
|
| Rate for Payer: Cofinity Commercial |
$1,033.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$771.03
|
| Rate for Payer: Healthscope Commercial |
$1,233.65
|
| Rate for Payer: Healthscope Commercial |
$1,426.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,136.85
|
| Rate for Payer: Nomi Health Commercial |
$925.24
|
| Rate for Payer: PACE SWMI |
$771.03
|
| Rate for Payer: PHP Medicare Advantage |
$771.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.85
|
| Rate for Payer: Priority Health Medicare |
$771.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$771.03
|
| Rate for Payer: UHC Medicare Advantage |
$771.03
|
|
|
PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX
|
Professional
|
Both
|
$2,041.00
|
|
|
Service Code
|
HCPCS 58720
|
| Min. Negotiated Rate |
$729.64 |
| Max. Negotiated Rate |
$1,349.83 |
| Rate for Payer: Aetna Commercial |
$977.72
|
| Rate for Payer: Aetna Medicare |
$758.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$977.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,050.68
|
| Rate for Payer: BCBS Complete |
$816.40
|
| Rate for Payer: BCBS MAPPO |
$729.64
|
| Rate for Payer: BCN Medicare Advantage |
$729.64
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cofinity Commercial |
$977.72
|
| Rate for Payer: Cofinity Commercial |
$1,050.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$729.64
|
| Rate for Payer: Healthscope Commercial |
$1,349.83
|
| Rate for Payer: Healthscope Commercial |
$1,167.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$766.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,326.65
|
| Rate for Payer: Nomi Health Commercial |
$875.57
|
| Rate for Payer: PACE SWMI |
$729.64
|
| Rate for Payer: PHP Medicare Advantage |
$729.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.65
|
| Rate for Payer: Priority Health Medicare |
$729.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$729.64
|
| Rate for Payer: UHC Medicare Advantage |
$729.64
|
|
