|
PR SALPINGOSTOMY
|
Professional
|
Both
|
$2,727.00
|
|
|
Service Code
|
HCPCS 58770
|
| Min. Negotiated Rate |
$826.88 |
| Max. Negotiated Rate |
$1,772.55 |
| Rate for Payer: Aetna Commercial |
$1,108.02
|
| Rate for Payer: Aetna Medicare |
$859.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,108.02
|
| Rate for Payer: BCBS Complete |
$1,090.80
|
| Rate for Payer: BCBS MAPPO |
$826.88
|
| Rate for Payer: BCN Medicare Advantage |
$826.88
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cofinity Commercial |
$1,190.71
|
| Rate for Payer: Cofinity Commercial |
$1,108.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$826.88
|
| Rate for Payer: Healthscope Commercial |
$1,323.01
|
| Rate for Payer: Healthscope Commercial |
$1,529.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$868.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,772.55
|
| Rate for Payer: Nomi Health Commercial |
$992.26
|
| Rate for Payer: PACE SWMI |
$826.88
|
| Rate for Payer: PHP Medicare Advantage |
$826.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,772.55
|
| Rate for Payer: Priority Health Medicare |
$826.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$826.88
|
| Rate for Payer: UHC Medicare Advantage |
$826.88
|
|
|
PR SARSCOV2 VACC 10MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 91319
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$175.38 |
| Rate for Payer: Aetna Commercial |
$127.03
|
| Rate for Payer: Aetna Medicare |
$98.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.03
|
| Rate for Payer: BCBS Complete |
$87.60
|
| Rate for Payer: BCBS MAPPO |
$94.80
|
| Rate for Payer: BCN Medicare Advantage |
$94.80
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$136.51
|
| Rate for Payer: Cofinity Commercial |
$127.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.80
|
| Rate for Payer: Healthscope Commercial |
$175.38
|
| Rate for Payer: Healthscope Commercial |
$151.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$142.35
|
| Rate for Payer: Nomi Health Commercial |
$113.76
|
| Rate for Payer: PACE SWMI |
$94.80
|
| Rate for Payer: PHP Medicare Advantage |
$94.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.35
|
| Rate for Payer: Priority Health Medicare |
$94.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.80
|
| Rate for Payer: UHC Medicare Advantage |
$94.80
|
|
|
PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 91320
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$311.48 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$175.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.62
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS MAPPO |
$168.37
|
| Rate for Payer: BCN Medicare Advantage |
$168.37
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$242.45
|
| Rate for Payer: Cofinity Commercial |
$225.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.37
|
| Rate for Payer: Healthscope Commercial |
$269.39
|
| Rate for Payer: Healthscope Commercial |
$311.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.55
|
| Rate for Payer: Nomi Health Commercial |
$202.04
|
| Rate for Payer: PACE SWMI |
$168.37
|
| Rate for Payer: PHP Medicare Advantage |
$168.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health Medicare |
$168.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.37
|
| Rate for Payer: UHC Medicare Advantage |
$168.37
|
|
|
PR SARSCOV2 VACC 3MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 91318
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Medicare |
$82.00
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 99233
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$207.35 |
| Rate for Payer: Aetna Commercial |
$150.19
|
| Rate for Payer: Aetna Medicare |
$116.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.40
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$112.08
|
| Rate for Payer: BCN Medicare Advantage |
$112.08
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$161.40
|
| Rate for Payer: Cofinity Commercial |
$150.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.08
|
| Rate for Payer: Healthscope Commercial |
$207.35
|
| Rate for Payer: Healthscope Commercial |
$179.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.60
|
| Rate for Payer: Nomi Health Commercial |
$134.50
|
| Rate for Payer: PACE SWMI |
$112.08
|
| Rate for Payer: PHP Medicare Advantage |
$112.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$112.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.08
|
| Rate for Payer: UHC Medicare Advantage |
$112.08
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$139.16 |
| Rate for Payer: Aetna Commercial |
$100.79
|
| Rate for Payer: Aetna Medicare |
$78.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.32
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$75.22
|
| Rate for Payer: BCN Medicare Advantage |
$75.22
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$100.79
|
| Rate for Payer: Cofinity Commercial |
$108.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.22
|
| Rate for Payer: Healthscope Commercial |
$120.35
|
| Rate for Payer: Healthscope Commercial |
$139.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.85
|
| Rate for Payer: Nomi Health Commercial |
$90.26
|
| Rate for Payer: PACE SWMI |
$75.22
|
| Rate for Payer: PHP Medicare Advantage |
$75.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health Medicare |
$75.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.22
|
| Rate for Payer: UHC Medicare Advantage |
$75.22
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$86.17 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$48.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.42
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$46.58
|
| Rate for Payer: BCN Medicare Advantage |
$46.58
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$86.17
|
| Rate for Payer: Healthscope Commercial |
$74.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.70
|
| Rate for Payer: Nomi Health Commercial |
$55.90
|
| Rate for Payer: PACE SWMI |
$46.58
|
| Rate for Payer: PHP Medicare Advantage |
$46.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health Medicare |
$46.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.58
|
| Rate for Payer: UHC Medicare Advantage |
$46.58
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$268.27 |
| Rate for Payer: Aetna Commercial |
$194.31
|
| Rate for Payer: Aetna Medicare |
$150.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.31
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$145.01
|
| Rate for Payer: BCN Medicare Advantage |
$145.01
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$208.81
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.01
|
| Rate for Payer: Healthscope Commercial |
$232.02
|
| Rate for Payer: Healthscope Commercial |
$268.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Nomi Health Commercial |
$174.01
|
| Rate for Payer: PACE SWMI |
$145.01
|
| Rate for Payer: PHP Medicare Advantage |
$145.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$145.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.01
|
| Rate for Payer: UHC Medicare Advantage |
$145.01
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna Commercial |
$93.59
|
| Rate for Payer: Aetna Medicare |
$72.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.57
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$69.84
|
| Rate for Payer: BCN Medicare Advantage |
$69.84
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$93.59
|
| Rate for Payer: Cofinity Commercial |
$100.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.84
|
| Rate for Payer: Healthscope Commercial |
$129.20
|
| Rate for Payer: Healthscope Commercial |
$111.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.95
|
| Rate for Payer: Nomi Health Commercial |
$83.81
|
| Rate for Payer: PACE SWMI |
$69.84
|
| Rate for Payer: PHP Medicare Advantage |
$69.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$69.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.84
|
| Rate for Payer: UHC Medicare Advantage |
$69.84
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$187.79 |
| Rate for Payer: Aetna Commercial |
$136.02
|
| Rate for Payer: Aetna Medicare |
$105.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.02
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$101.51
|
| Rate for Payer: BCN Medicare Advantage |
$101.51
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$146.17
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.51
|
| Rate for Payer: Healthscope Commercial |
$162.42
|
| Rate for Payer: Healthscope Commercial |
$187.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.05
|
| Rate for Payer: Nomi Health Commercial |
$121.81
|
| Rate for Payer: PACE SWMI |
$101.51
|
| Rate for Payer: PHP Medicare Advantage |
$101.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health Medicare |
$101.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.51
|
| Rate for Payer: UHC Medicare Advantage |
$101.51
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 99307
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$69.23 |
| Rate for Payer: Aetna Commercial |
$50.14
|
| Rate for Payer: Aetna Medicare |
$38.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.14
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS MAPPO |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$37.42
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$53.88
|
| Rate for Payer: Cofinity Commercial |
$50.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.42
|
| Rate for Payer: Healthscope Commercial |
$59.87
|
| Rate for Payer: Healthscope Commercial |
$69.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.55
|
| Rate for Payer: Nomi Health Commercial |
$44.90
|
| Rate for Payer: PACE SWMI |
$37.42
|
| Rate for Payer: PHP Medicare Advantage |
$37.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health Medicare |
$37.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.42
|
| Rate for Payer: UHC Medicare Advantage |
$37.42
|
|
|
PR SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 99224
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
|
|
PR SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99225
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
|
|
PR SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 99226
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
|
|
PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 99493
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$180.08 |
| Rate for Payer: Aetna Commercial |
$130.44
|
| Rate for Payer: Aetna Medicare |
$101.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS MAPPO |
$97.34
|
| Rate for Payer: BCN Medicare Advantage |
$97.34
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$140.17
|
| Rate for Payer: Cofinity Commercial |
$130.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.34
|
| Rate for Payer: Healthscope Commercial |
$180.08
|
| Rate for Payer: Healthscope Commercial |
$155.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.80
|
| Rate for Payer: Nomi Health Commercial |
$116.81
|
| Rate for Payer: PACE SWMI |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health Medicare |
$97.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.34
|
| Rate for Payer: UHC Medicare Advantage |
$97.34
|
|
|
PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 49185
|
| Min. Negotiated Rate |
$113.45 |
| Max. Negotiated Rate |
$1,473.55 |
| Rate for Payer: Aetna Commercial |
$152.02
|
| Rate for Payer: Aetna Medicare |
$117.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.37
|
| Rate for Payer: BCBS Complete |
$906.80
|
| Rate for Payer: BCBS MAPPO |
$113.45
|
| Rate for Payer: BCN Medicare Advantage |
$113.45
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cofinity Commercial |
$152.02
|
| Rate for Payer: Cofinity Commercial |
$163.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.45
|
| Rate for Payer: Healthscope Commercial |
$181.52
|
| Rate for Payer: Healthscope Commercial |
$209.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,473.55
|
| Rate for Payer: Nomi Health Commercial |
$136.14
|
| Rate for Payer: PACE SWMI |
$113.45
|
| Rate for Payer: PHP Medicare Advantage |
$113.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.55
|
| Rate for Payer: Priority Health Medicare |
$113.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.45
|
| Rate for Payer: UHC Medicare Advantage |
$113.45
|
|
|
PR SCREENING PAP SMEAR BY PHYS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS P3001
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$42.42 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$23.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.73
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS MAPPO |
$22.93
|
| Rate for Payer: BCN Medicare Advantage |
$22.93
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Cofinity Commercial |
$30.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.93
|
| Rate for Payer: Healthscope Commercial |
$36.69
|
| Rate for Payer: Healthscope Commercial |
$42.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.60
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: PACE SWMI |
$22.93
|
| Rate for Payer: PHP Medicare Advantage |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Medicare |
$22.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.93
|
| Rate for Payer: UHC Medicare Advantage |
$22.93
|
|
|
PR SCREENING PROCTOSCOPY
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS S0601
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Aetna Medicare |
$77.00
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
|
|
PR SCREENING TEST PURE TONE AIR ONLY
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 92551
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
|
|
PR SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 99173
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
|
|
PR SCR MAMMO BI INCL CAD
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS G0202
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
|
|
PR SCROTAL EXPLORATION
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 55110
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$690.40 |
| Rate for Payer: Aetna Commercial |
$500.07
|
| Rate for Payer: Aetna Medicare |
$388.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$500.07
|
| Rate for Payer: BCBS Complete |
$280.80
|
| Rate for Payer: BCBS MAPPO |
$373.19
|
| Rate for Payer: BCN Medicare Advantage |
$373.19
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$500.07
|
| Rate for Payer: Cofinity Commercial |
$537.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.19
|
| Rate for Payer: Healthscope Commercial |
$690.40
|
| Rate for Payer: Healthscope Commercial |
$597.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$456.30
|
| Rate for Payer: Nomi Health Commercial |
$447.83
|
| Rate for Payer: PACE SWMI |
$373.19
|
| Rate for Payer: PHP Medicare Advantage |
$373.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$456.30
|
| Rate for Payer: Priority Health Medicare |
$373.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.19
|
| Rate for Payer: UHC Medicare Advantage |
$373.19
|
|
|
PR SCROTOPLASTY COMPLICATED
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
HCPCS 55180
|
| Min. Negotiated Rate |
$565.60 |
| Max. Negotiated Rate |
$1,218.06 |
| Rate for Payer: Aetna Commercial |
$882.27
|
| Rate for Payer: Aetna Medicare |
$684.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$948.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$882.27
|
| Rate for Payer: BCBS Complete |
$565.60
|
| Rate for Payer: BCBS MAPPO |
$658.41
|
| Rate for Payer: BCN Medicare Advantage |
$658.41
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cash Price |
$1,131.20
|
| Rate for Payer: Cofinity Commercial |
$948.11
|
| Rate for Payer: Cofinity Commercial |
$882.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.41
|
| Rate for Payer: Healthscope Commercial |
$1,218.06
|
| Rate for Payer: Healthscope Commercial |
$1,053.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$691.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$919.10
|
| Rate for Payer: Nomi Health Commercial |
$790.09
|
| Rate for Payer: PACE SWMI |
$658.41
|
| Rate for Payer: PHP Medicare Advantage |
$658.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$919.10
|
| Rate for Payer: Priority Health Medicare |
$658.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.41
|
| Rate for Payer: UHC Medicare Advantage |
$658.41
|
|
|
PR SCROTOPLASTY SIMPLE
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 55175
|
| Min. Negotiated Rate |
$273.60 |
| Max. Negotiated Rate |
$647.13 |
| Rate for Payer: Aetna Commercial |
$468.73
|
| Rate for Payer: Aetna Medicare |
$363.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.73
|
| Rate for Payer: BCBS Complete |
$273.60
|
| Rate for Payer: BCBS MAPPO |
$349.80
|
| Rate for Payer: BCN Medicare Advantage |
$349.80
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Commercial |
$503.71
|
| Rate for Payer: Cofinity Commercial |
$468.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.80
|
| Rate for Payer: Healthscope Commercial |
$559.68
|
| Rate for Payer: Healthscope Commercial |
$647.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$444.60
|
| Rate for Payer: Nomi Health Commercial |
$419.76
|
| Rate for Payer: PACE SWMI |
$349.80
|
| Rate for Payer: PHP Medicare Advantage |
$349.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.60
|
| Rate for Payer: Priority Health Medicare |
$349.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.80
|
| Rate for Payer: UHC Medicare Advantage |
$349.80
|
|
|
PR SEC ABDOMINAL WALL SUTURE EVISCERATION/DEHSN
|
Professional
|
Both
|
$2,346.00
|
|
|
Service Code
|
HCPCS 49900
|
| Min. Negotiated Rate |
$798.93 |
| Max. Negotiated Rate |
$1,524.90 |
| Rate for Payer: Aetna Commercial |
$1,070.57
|
| Rate for Payer: Aetna Medicare |
$830.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,070.57
|
| Rate for Payer: BCBS Complete |
$938.40
|
| Rate for Payer: BCBS MAPPO |
$798.93
|
| Rate for Payer: BCN Medicare Advantage |
$798.93
|
| Rate for Payer: Cash Price |
$1,876.80
|
| Rate for Payer: Cash Price |
$1,876.80
|
| Rate for Payer: Cofinity Commercial |
$1,150.46
|
| Rate for Payer: Cofinity Commercial |
$1,070.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.93
|
| Rate for Payer: Healthscope Commercial |
$1,478.02
|
| Rate for Payer: Healthscope Commercial |
$1,278.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,524.90
|
| Rate for Payer: Nomi Health Commercial |
$958.72
|
| Rate for Payer: PACE SWMI |
$798.93
|
| Rate for Payer: PHP Medicare Advantage |
$798.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,524.90
|
| Rate for Payer: Priority Health Medicare |
$798.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.93
|
| Rate for Payer: UHC Medicare Advantage |
$798.93
|
|
