|
PR TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 93892
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$485.62 |
| Rate for Payer: Aetna Commercial |
$351.75
|
| Rate for Payer: Aetna Medicare |
$273.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.75
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$262.50
|
| Rate for Payer: BCN Medicare Advantage |
$262.50
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$378.00
|
| Rate for Payer: Cofinity Commercial |
$351.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.50
|
| Rate for Payer: Healthscope Commercial |
$420.00
|
| Rate for Payer: Healthscope Commercial |
$485.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.95
|
| Rate for Payer: Nomi Health Commercial |
$315.00
|
| Rate for Payer: PACE SWMI |
$262.50
|
| Rate for Payer: PHP Medicare Advantage |
$262.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health Medicare |
$262.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$262.50
|
| Rate for Payer: UHC Medicare Advantage |
$262.50
|
|
|
PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
HCPCS 93886
|
| Min. Negotiated Rate |
$229.50 |
| Max. Negotiated Rate |
$424.57 |
| Rate for Payer: Aetna Commercial |
$307.53
|
| Rate for Payer: Aetna Commercial |
$307.53
|
| Rate for Payer: Aetna Medicare |
$238.68
|
| Rate for Payer: Aetna Medicare |
$238.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$330.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.53
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS Complete |
$252.80
|
| Rate for Payer: BCBS MAPPO |
$229.50
|
| Rate for Payer: BCBS MAPPO |
$229.50
|
| Rate for Payer: BCN Medicare Advantage |
$229.50
|
| Rate for Payer: BCN Medicare Advantage |
$229.50
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$505.60
|
| Rate for Payer: Cofinity Commercial |
$307.53
|
| Rate for Payer: Cofinity Commercial |
$307.53
|
| Rate for Payer: Cofinity Commercial |
$330.48
|
| Rate for Payer: Cofinity Commercial |
$330.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$229.50
|
| Rate for Payer: Healthscope Commercial |
$424.57
|
| Rate for Payer: Healthscope Commercial |
$424.57
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$275.40
|
| Rate for Payer: Nomi Health Commercial |
$275.40
|
| Rate for Payer: PACE SWMI |
$229.50
|
| Rate for Payer: PACE SWMI |
$229.50
|
| Rate for Payer: PHP Medicare Advantage |
$229.50
|
| Rate for Payer: PHP Medicare Advantage |
$229.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$410.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$229.50
|
| Rate for Payer: Priority Health Medicare |
$229.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$229.50
|
| Rate for Payer: UHC Medicare Advantage |
$229.50
|
| Rate for Payer: UHC Medicare Advantage |
$229.50
|
|
|
PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS 93888
|
| Min. Negotiated Rate |
$144.94 |
| Max. Negotiated Rate |
$268.14 |
| Rate for Payer: Aetna Commercial |
$194.22
|
| Rate for Payer: Aetna Medicare |
$150.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.22
|
| Rate for Payer: BCBS Complete |
$147.20
|
| Rate for Payer: BCBS MAPPO |
$144.94
|
| Rate for Payer: BCN Medicare Advantage |
$144.94
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$208.71
|
| Rate for Payer: Cofinity Commercial |
$194.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.94
|
| Rate for Payer: Healthscope Commercial |
$268.14
|
| Rate for Payer: Healthscope Commercial |
$231.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.20
|
| Rate for Payer: Nomi Health Commercial |
$173.93
|
| Rate for Payer: PACE SWMI |
$144.94
|
| Rate for Payer: PHP Medicare Advantage |
$144.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.20
|
| Rate for Payer: Priority Health Medicare |
$144.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.94
|
| Rate for Payer: UHC Medicare Advantage |
$144.94
|
|
|
PR TRANSECTION/AVULSION GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 64744
|
| Min. Negotiated Rate |
$346.80 |
| Max. Negotiated Rate |
$921.41 |
| Rate for Payer: Aetna Commercial |
$667.40
|
| Rate for Payer: Aetna Medicare |
$517.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$717.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$667.40
|
| Rate for Payer: BCBS Complete |
$346.80
|
| Rate for Payer: BCBS MAPPO |
$498.06
|
| Rate for Payer: BCN Medicare Advantage |
$498.06
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$717.21
|
| Rate for Payer: Cofinity Commercial |
$667.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.06
|
| Rate for Payer: Healthscope Commercial |
$796.90
|
| Rate for Payer: Healthscope Commercial |
$921.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$522.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$563.55
|
| Rate for Payer: Nomi Health Commercial |
$597.67
|
| Rate for Payer: PACE SWMI |
$498.06
|
| Rate for Payer: PHP Medicare Advantage |
$498.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health Medicare |
$498.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.06
|
| Rate for Payer: UHC Medicare Advantage |
$498.06
|
|
|
PR TRANSECTION/AVULSION OTH SPINAL NRV XDRL
|
Professional
|
Both
|
$1,307.00
|
|
|
Service Code
|
HCPCS 64772
|
| Min. Negotiated Rate |
$522.80 |
| Max. Negotiated Rate |
$991.95 |
| Rate for Payer: Aetna Commercial |
$718.49
|
| Rate for Payer: Aetna Medicare |
$557.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$772.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$718.49
|
| Rate for Payer: BCBS Complete |
$522.80
|
| Rate for Payer: BCBS MAPPO |
$536.19
|
| Rate for Payer: BCN Medicare Advantage |
$536.19
|
| Rate for Payer: Cash Price |
$1,045.60
|
| Rate for Payer: Cash Price |
$1,045.60
|
| Rate for Payer: Cofinity Commercial |
$772.11
|
| Rate for Payer: Cofinity Commercial |
$718.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$536.19
|
| Rate for Payer: Healthscope Commercial |
$991.95
|
| Rate for Payer: Healthscope Commercial |
$857.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$563.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$849.55
|
| Rate for Payer: Nomi Health Commercial |
$643.43
|
| Rate for Payer: PACE SWMI |
$536.19
|
| Rate for Payer: PHP Medicare Advantage |
$536.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.55
|
| Rate for Payer: Priority Health Medicare |
$536.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$536.19
|
| Rate for Payer: UHC Medicare Advantage |
$536.19
|
|
|
PR TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL
|
Professional
|
Both
|
$1,061.00
|
|
|
Service Code
|
HCPCS 64760
|
| Min. Negotiated Rate |
$424.40 |
| Max. Negotiated Rate |
$936.38 |
| Rate for Payer: Aetna Commercial |
$678.24
|
| Rate for Payer: Aetna Medicare |
$526.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$678.24
|
| Rate for Payer: BCBS Complete |
$424.40
|
| Rate for Payer: BCBS MAPPO |
$506.15
|
| Rate for Payer: BCN Medicare Advantage |
$506.15
|
| Rate for Payer: Cash Price |
$848.80
|
| Rate for Payer: Cash Price |
$848.80
|
| Rate for Payer: Cofinity Commercial |
$728.86
|
| Rate for Payer: Cofinity Commercial |
$678.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$506.15
|
| Rate for Payer: Healthscope Commercial |
$809.84
|
| Rate for Payer: Healthscope Commercial |
$936.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$689.65
|
| Rate for Payer: Nomi Health Commercial |
$607.38
|
| Rate for Payer: PACE SWMI |
$506.15
|
| Rate for Payer: PHP Medicare Advantage |
$506.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.65
|
| Rate for Payer: Priority Health Medicare |
$506.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$506.15
|
| Rate for Payer: UHC Medicare Advantage |
$506.15
|
|
|
PR TRANSFER ADDUCTOR ISCHIUM
|
Professional
|
Both
|
$2,657.00
|
|
|
Service Code
|
HCPCS 27098
|
| Min. Negotiated Rate |
$673.33 |
| Max. Negotiated Rate |
$1,727.05 |
| Rate for Payer: Aetna Commercial |
$902.26
|
| Rate for Payer: Aetna Medicare |
$700.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$969.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$902.26
|
| Rate for Payer: BCBS Complete |
$1,062.80
|
| Rate for Payer: BCBS MAPPO |
$673.33
|
| Rate for Payer: BCN Medicare Advantage |
$673.33
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cash Price |
$2,125.60
|
| Rate for Payer: Cofinity Commercial |
$969.60
|
| Rate for Payer: Cofinity Commercial |
$902.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$673.33
|
| Rate for Payer: Healthscope Commercial |
$1,245.66
|
| Rate for Payer: Healthscope Commercial |
$1,077.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$707.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,727.05
|
| Rate for Payer: Nomi Health Commercial |
$808.00
|
| Rate for Payer: PACE SWMI |
$673.33
|
| Rate for Payer: PHP Medicare Advantage |
$673.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,727.05
|
| Rate for Payer: Priority Health Medicare |
$673.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$673.33
|
| Rate for Payer: UHC Medicare Advantage |
$673.33
|
|
|
PR TRANSFER ANY PEDICLE FLAP ANY LOCATION
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 15650
|
| Min. Negotiated Rate |
$294.80 |
| Max. Negotiated Rate |
$710.68 |
| Rate for Payer: Aetna Commercial |
$514.76
|
| Rate for Payer: Aetna Medicare |
$399.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$553.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.76
|
| Rate for Payer: BCBS Complete |
$294.80
|
| Rate for Payer: BCBS MAPPO |
$384.15
|
| Rate for Payer: BCN Medicare Advantage |
$384.15
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$553.18
|
| Rate for Payer: Cofinity Commercial |
$514.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$384.15
|
| Rate for Payer: Healthscope Commercial |
$614.64
|
| Rate for Payer: Healthscope Commercial |
$710.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$403.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$479.05
|
| Rate for Payer: Nomi Health Commercial |
$460.98
|
| Rate for Payer: PACE SWMI |
$384.15
|
| Rate for Payer: PHP Medicare Advantage |
$384.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.05
|
| Rate for Payer: Priority Health Medicare |
$384.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$384.15
|
| Rate for Payer: UHC Medicare Advantage |
$384.15
|
|
|
PR TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR
|
Professional
|
Both
|
$6,949.00
|
|
|
Service Code
|
HCPCS 27110
|
| Min. Negotiated Rate |
$936.20 |
| Max. Negotiated Rate |
$4,516.85 |
| Rate for Payer: Aetna Commercial |
$1,254.51
|
| Rate for Payer: Aetna Medicare |
$973.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,348.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,254.51
|
| Rate for Payer: BCBS Complete |
$2,779.60
|
| Rate for Payer: BCBS MAPPO |
$936.20
|
| Rate for Payer: BCN Medicare Advantage |
$936.20
|
| Rate for Payer: Cash Price |
$5,559.20
|
| Rate for Payer: Cash Price |
$5,559.20
|
| Rate for Payer: Cofinity Commercial |
$1,348.13
|
| Rate for Payer: Cofinity Commercial |
$1,254.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$936.20
|
| Rate for Payer: Healthscope Commercial |
$1,731.97
|
| Rate for Payer: Healthscope Commercial |
$1,497.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$983.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,516.85
|
| Rate for Payer: Nomi Health Commercial |
$1,123.44
|
| Rate for Payer: PACE SWMI |
$936.20
|
| Rate for Payer: PHP Medicare Advantage |
$936.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,516.85
|
| Rate for Payer: Priority Health Medicare |
$936.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$936.20
|
| Rate for Payer: UHC Medicare Advantage |
$936.20
|
|
|
PR TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH
|
Professional
|
Both
|
$2,666.00
|
|
|
Service Code
|
HCPCS 26485
|
| Min. Negotiated Rate |
$780.70 |
| Max. Negotiated Rate |
$1,732.90 |
| Rate for Payer: Aetna Commercial |
$1,046.14
|
| Rate for Payer: Aetna Medicare |
$811.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,124.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,046.14
|
| Rate for Payer: BCBS Complete |
$1,066.40
|
| Rate for Payer: BCBS MAPPO |
$780.70
|
| Rate for Payer: BCN Medicare Advantage |
$780.70
|
| Rate for Payer: Cash Price |
$2,132.80
|
| Rate for Payer: Cash Price |
$2,132.80
|
| Rate for Payer: Cofinity Commercial |
$1,124.21
|
| Rate for Payer: Cofinity Commercial |
$1,046.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$780.70
|
| Rate for Payer: Healthscope Commercial |
$1,249.12
|
| Rate for Payer: Healthscope Commercial |
$1,444.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$819.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,732.90
|
| Rate for Payer: Nomi Health Commercial |
$936.84
|
| Rate for Payer: PACE SWMI |
$780.70
|
| Rate for Payer: PHP Medicare Advantage |
$780.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,732.90
|
| Rate for Payer: Priority Health Medicare |
$780.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$780.70
|
| Rate for Payer: UHC Medicare Advantage |
$780.70
|
|
|
PR TRANSFUSION BLOOD/BLOOD COMPONENTS
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 36430
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$51.28
|
| Rate for Payer: Aetna Medicare |
$39.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.28
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCBS MAPPO |
$38.27
|
| Rate for Payer: BCN Medicare Advantage |
$38.27
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.27
|
| Rate for Payer: Healthscope Commercial |
$70.80
|
| Rate for Payer: Healthscope Commercial |
$61.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.60
|
| Rate for Payer: Nomi Health Commercial |
$45.92
|
| Rate for Payer: PACE SWMI |
$38.27
|
| Rate for Payer: PHP Medicare Advantage |
$38.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health Medicare |
$38.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.27
|
| Rate for Payer: UHC Medicare Advantage |
$38.27
|
|
|
PR TRANSFUSION INTRAUTERINE FETAL
|
Professional
|
Both
|
$1,416.00
|
|
|
Service Code
|
HCPCS 36460
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$920.40 |
| Rate for Payer: Aetna Commercial |
$441.93
|
| Rate for Payer: Aetna Medicare |
$342.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.93
|
| Rate for Payer: BCBS Complete |
$566.40
|
| Rate for Payer: BCBS MAPPO |
$329.80
|
| Rate for Payer: BCN Medicare Advantage |
$329.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cofinity Commercial |
$474.91
|
| Rate for Payer: Cofinity Commercial |
$441.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.80
|
| Rate for Payer: Healthscope Commercial |
$527.68
|
| Rate for Payer: Healthscope Commercial |
$610.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$346.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$920.40
|
| Rate for Payer: Nomi Health Commercial |
$395.76
|
| Rate for Payer: PACE SWMI |
$329.80
|
| Rate for Payer: PHP Medicare Advantage |
$329.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$920.40
|
| Rate for Payer: Priority Health Medicare |
$329.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.80
|
| Rate for Payer: UHC Medicare Advantage |
$329.80
|
|
|
PR TRANSJ CARE MGMT HIGH MDM F2F 7 CAL D DISCHARGE
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
HCPCS 99496
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$331.41 |
| Rate for Payer: Aetna Commercial |
$240.05
|
| Rate for Payer: Aetna Medicare |
$186.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.05
|
| Rate for Payer: BCBS Complete |
$141.60
|
| Rate for Payer: BCBS MAPPO |
$179.14
|
| Rate for Payer: BCN Medicare Advantage |
$179.14
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cash Price |
$283.20
|
| Rate for Payer: Cofinity Commercial |
$257.96
|
| Rate for Payer: Cofinity Commercial |
$240.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.14
|
| Rate for Payer: Healthscope Commercial |
$331.41
|
| Rate for Payer: Healthscope Commercial |
$286.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.10
|
| Rate for Payer: Nomi Health Commercial |
$214.97
|
| Rate for Payer: PACE SWMI |
$179.14
|
| Rate for Payer: PHP Medicare Advantage |
$179.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.10
|
| Rate for Payer: Priority Health Medicare |
$179.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.14
|
| Rate for Payer: UHC Medicare Advantage |
$179.14
|
|
|
PR TRANSJ CARE MGMT MOD MDM F2F 14 CAL D DISCHARGE
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 99495
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$243.70 |
| Rate for Payer: Aetna Commercial |
$176.52
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.52
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: BCBS MAPPO |
$131.73
|
| Rate for Payer: BCN Medicare Advantage |
$131.73
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$189.69
|
| Rate for Payer: Cofinity Commercial |
$176.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.73
|
| Rate for Payer: Healthscope Commercial |
$210.77
|
| Rate for Payer: Healthscope Commercial |
$243.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.15
|
| Rate for Payer: Nomi Health Commercial |
$158.08
|
| Rate for Payer: PACE SWMI |
$131.73
|
| Rate for Payer: PHP Medicare Advantage |
$131.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health Medicare |
$131.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.73
|
| Rate for Payer: UHC Medicare Advantage |
$131.73
|
|
|
PR TRANSLUMINAL BALLOON ANGIOP PERIPHERAL ART RSI
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 75962
|
| 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 TRANSMASTOID ANTROTOMY
|
Professional
|
Both
|
$1,780.00
|
|
|
Service Code
|
HCPCS 69501
|
| Min. Negotiated Rate |
$667.00 |
| Max. Negotiated Rate |
$1,233.95 |
| Rate for Payer: Aetna Commercial |
$893.78
|
| Rate for Payer: Aetna Medicare |
$693.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$893.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.48
|
| Rate for Payer: BCBS Complete |
$712.00
|
| Rate for Payer: BCBS MAPPO |
$667.00
|
| Rate for Payer: BCN Medicare Advantage |
$667.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Cofinity Commercial |
$960.48
|
| Rate for Payer: Cofinity Commercial |
$893.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$667.00
|
| Rate for Payer: Healthscope Commercial |
$1,233.95
|
| Rate for Payer: Healthscope Commercial |
$1,067.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$700.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,157.00
|
| Rate for Payer: Nomi Health Commercial |
$800.40
|
| Rate for Payer: PACE SWMI |
$667.00
|
| Rate for Payer: PHP Medicare Advantage |
$667.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,157.00
|
| Rate for Payer: Priority Health Medicare |
$667.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$667.00
|
| Rate for Payer: UHC Medicare Advantage |
$667.00
|
|
|
PR TRANSMETACARPAL AMPUTATION RE-AMPUTATION
|
Professional
|
Both
|
$2,264.00
|
|
|
Service Code
|
HCPCS 25931
|
| Min. Negotiated Rate |
$748.69 |
| Max. Negotiated Rate |
$1,471.60 |
| Rate for Payer: Aetna Commercial |
$1,003.24
|
| Rate for Payer: Aetna Medicare |
$778.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.11
|
| Rate for Payer: BCBS Complete |
$905.60
|
| Rate for Payer: BCBS MAPPO |
$748.69
|
| Rate for Payer: BCN Medicare Advantage |
$748.69
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cash Price |
$1,811.20
|
| Rate for Payer: Cofinity Commercial |
$1,003.24
|
| Rate for Payer: Cofinity Commercial |
$1,078.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$748.69
|
| Rate for Payer: Healthscope Commercial |
$1,197.90
|
| Rate for Payer: Healthscope Commercial |
$1,385.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$786.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,471.60
|
| Rate for Payer: Nomi Health Commercial |
$898.43
|
| Rate for Payer: PACE SWMI |
$748.69
|
| Rate for Payer: PHP Medicare Advantage |
$748.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,471.60
|
| Rate for Payer: Priority Health Medicare |
$748.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$748.69
|
| Rate for Payer: UHC Medicare Advantage |
$748.69
|
|
|
PR TRANSMETACARPAL AMPUTATION SEC CLOSURE/SCAR REVJ
|
Professional
|
Both
|
$1,067.00
|
|
|
Service Code
|
HCPCS 25929
|
| Min. Negotiated Rate |
$426.80 |
| Max. Negotiated Rate |
$1,074.17 |
| Rate for Payer: Aetna Commercial |
$778.04
|
| Rate for Payer: Aetna Medicare |
$603.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.04
|
| Rate for Payer: BCBS Complete |
$426.80
|
| Rate for Payer: BCBS MAPPO |
$580.63
|
| Rate for Payer: BCN Medicare Advantage |
$580.63
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cash Price |
$853.60
|
| Rate for Payer: Cofinity Commercial |
$836.11
|
| Rate for Payer: Cofinity Commercial |
$778.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.63
|
| Rate for Payer: Healthscope Commercial |
$929.01
|
| Rate for Payer: Healthscope Commercial |
$1,074.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$693.55
|
| Rate for Payer: Nomi Health Commercial |
$696.76
|
| Rate for Payer: PACE SWMI |
$580.63
|
| Rate for Payer: PHP Medicare Advantage |
$580.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$693.55
|
| Rate for Payer: Priority Health Medicare |
$580.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$580.63
|
| Rate for Payer: UHC Medicare Advantage |
$580.63
|
|
|
PR TRANSMYOCRD LASER REVSC PFRMD TM OTH OPN CAR PX
|
Professional
|
Both
|
$581.00
|
|
|
Service Code
|
HCPCS 33141
|
| Min. Negotiated Rate |
$126.99 |
| Max. Negotiated Rate |
$377.65 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Aetna Medicare |
$132.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.17
|
| Rate for Payer: BCBS Complete |
$232.40
|
| Rate for Payer: BCBS MAPPO |
$126.99
|
| Rate for Payer: BCN Medicare Advantage |
$126.99
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cofinity Commercial |
$182.87
|
| Rate for Payer: Cofinity Commercial |
$170.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.99
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| Rate for Payer: Healthscope Commercial |
$234.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.65
|
| Rate for Payer: Nomi Health Commercial |
$152.39
|
| Rate for Payer: PACE SWMI |
$126.99
|
| Rate for Payer: PHP Medicare Advantage |
$126.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.65
|
| Rate for Payer: Priority Health Medicare |
$126.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.99
|
| Rate for Payer: UHC Medicare Advantage |
$126.99
|
|
|
PR TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR
|
Professional
|
Both
|
$2,474.00
|
|
|
Service Code
|
HCPCS 63057
|
| Min. Negotiated Rate |
$315.91 |
| Max. Negotiated Rate |
$1,608.10 |
| Rate for Payer: Aetna Commercial |
$423.32
|
| Rate for Payer: Aetna Medicare |
$328.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.32
|
| Rate for Payer: BCBS Complete |
$989.60
|
| Rate for Payer: BCBS MAPPO |
$315.91
|
| Rate for Payer: BCN Medicare Advantage |
$315.91
|
| Rate for Payer: Cash Price |
$1,979.20
|
| Rate for Payer: Cash Price |
$1,979.20
|
| Rate for Payer: Cofinity Commercial |
$454.91
|
| Rate for Payer: Cofinity Commercial |
$423.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.91
|
| Rate for Payer: Healthscope Commercial |
$584.43
|
| Rate for Payer: Healthscope Commercial |
$505.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,608.10
|
| Rate for Payer: Nomi Health Commercial |
$379.09
|
| Rate for Payer: PACE SWMI |
$315.91
|
| Rate for Payer: PHP Medicare Advantage |
$315.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.10
|
| Rate for Payer: Priority Health Medicare |
$315.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.91
|
| Rate for Payer: UHC Medicare Advantage |
$315.91
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR
|
Professional
|
Both
|
$7,074.00
|
|
|
Service Code
|
HCPCS 63056
|
| Min. Negotiated Rate |
$1,458.87 |
| Max. Negotiated Rate |
$4,598.10 |
| Rate for Payer: Aetna Commercial |
$1,954.89
|
| Rate for Payer: Aetna Medicare |
$1,517.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,100.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,954.89
|
| Rate for Payer: BCBS Complete |
$2,829.60
|
| Rate for Payer: BCBS MAPPO |
$1,458.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,458.87
|
| Rate for Payer: Cash Price |
$5,659.20
|
| Rate for Payer: Cash Price |
$5,659.20
|
| Rate for Payer: Cofinity Commercial |
$2,100.77
|
| Rate for Payer: Cofinity Commercial |
$1,954.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,458.87
|
| Rate for Payer: Healthscope Commercial |
$2,334.19
|
| Rate for Payer: Healthscope Commercial |
$2,698.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,531.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,598.10
|
| Rate for Payer: Nomi Health Commercial |
$1,750.64
|
| Rate for Payer: PACE SWMI |
$1,458.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,458.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,598.10
|
| Rate for Payer: Priority Health Medicare |
$1,458.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,458.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,458.87
|
|
|
PR TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC
|
Professional
|
Both
|
$7,455.00
|
|
|
Service Code
|
HCPCS 63055
|
| Min. Negotiated Rate |
$1,601.56 |
| Max. Negotiated Rate |
$4,845.75 |
| Rate for Payer: Aetna Commercial |
$2,146.09
|
| Rate for Payer: Aetna Medicare |
$1,665.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,306.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,146.09
|
| Rate for Payer: BCBS Complete |
$2,982.00
|
| Rate for Payer: BCBS MAPPO |
$1,601.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,601.56
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: Cash Price |
$5,964.00
|
| Rate for Payer: Cofinity Commercial |
$2,306.25
|
| Rate for Payer: Cofinity Commercial |
$2,146.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,601.56
|
| Rate for Payer: Healthscope Commercial |
$2,962.89
|
| Rate for Payer: Healthscope Commercial |
$2,562.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,681.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,845.75
|
| Rate for Payer: Nomi Health Commercial |
$1,921.87
|
| Rate for Payer: PACE SWMI |
$1,601.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,601.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,845.75
|
| Rate for Payer: Priority Health Medicare |
$1,601.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,601.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,601.56
|
|
|
PR TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX
|
Professional
|
Both
|
$6,685.00
|
|
|
Service Code
|
HCPCS 55874
|
| Min. Negotiated Rate |
$155.95 |
| Max. Negotiated Rate |
$4,345.25 |
| Rate for Payer: Aetna Commercial |
$208.97
|
| Rate for Payer: Aetna Medicare |
$162.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.97
|
| Rate for Payer: BCBS Complete |
$2,674.00
|
| Rate for Payer: BCBS MAPPO |
$155.95
|
| Rate for Payer: BCN Medicare Advantage |
$155.95
|
| Rate for Payer: Cash Price |
$5,348.00
|
| Rate for Payer: Cash Price |
$5,348.00
|
| Rate for Payer: Cofinity Commercial |
$224.57
|
| Rate for Payer: Cofinity Commercial |
$208.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.95
|
| Rate for Payer: Healthscope Commercial |
$249.52
|
| Rate for Payer: Healthscope Commercial |
$288.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,345.25
|
| Rate for Payer: Nomi Health Commercial |
$187.14
|
| Rate for Payer: PACE SWMI |
$155.95
|
| Rate for Payer: PHP Medicare Advantage |
$155.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,345.25
|
| Rate for Payer: Priority Health Medicare |
$155.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.95
|
| Rate for Payer: UHC Medicare Advantage |
$155.95
|
|
|
PR TRANSPERINEAL PLMT NDL/CATHS PROSTATE RADJ INSJ
|
Professional
|
Both
|
$2,721.00
|
|
|
Service Code
|
HCPCS 55875
|
| Min. Negotiated Rate |
$745.84 |
| Max. Negotiated Rate |
$1,768.65 |
| Rate for Payer: Aetna Commercial |
$999.43
|
| Rate for Payer: Aetna Medicare |
$775.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.01
|
| Rate for Payer: BCBS Complete |
$1,088.40
|
| Rate for Payer: BCBS MAPPO |
$745.84
|
| Rate for Payer: BCN Medicare Advantage |
$745.84
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cash Price |
$2,176.80
|
| Rate for Payer: Cofinity Commercial |
$999.43
|
| Rate for Payer: Cofinity Commercial |
$1,074.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.84
|
| Rate for Payer: Healthscope Commercial |
$1,379.80
|
| Rate for Payer: Healthscope Commercial |
$1,193.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,768.65
|
| Rate for Payer: Nomi Health Commercial |
$895.01
|
| Rate for Payer: PACE SWMI |
$745.84
|
| Rate for Payer: PHP Medicare Advantage |
$745.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,768.65
|
| Rate for Payer: Priority Health Medicare |
$745.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.84
|
| Rate for Payer: UHC Medicare Advantage |
$745.84
|
|
|
PR TRANSPLANTATION TESTIS TO THIGH
|
Professional
|
Both
|
$1,420.00
|
|
|
Service Code
|
HCPCS 54680
|
| Min. Negotiated Rate |
$568.00 |
| Max. Negotiated Rate |
$1,392.49 |
| Rate for Payer: Aetna Commercial |
$1,008.62
|
| Rate for Payer: Aetna Medicare |
$782.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,083.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,008.62
|
| Rate for Payer: BCBS Complete |
$568.00
|
| Rate for Payer: BCBS MAPPO |
$752.70
|
| Rate for Payer: BCN Medicare Advantage |
$752.70
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cash Price |
$1,136.00
|
| Rate for Payer: Cofinity Commercial |
$1,083.89
|
| Rate for Payer: Cofinity Commercial |
$1,008.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$752.70
|
| Rate for Payer: Healthscope Commercial |
$1,204.32
|
| Rate for Payer: Healthscope Commercial |
$1,392.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$790.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$923.00
|
| Rate for Payer: Nomi Health Commercial |
$903.24
|
| Rate for Payer: PACE SWMI |
$752.70
|
| Rate for Payer: PHP Medicare Advantage |
$752.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.00
|
| Rate for Payer: Priority Health Medicare |
$752.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$752.70
|
| Rate for Payer: UHC Medicare Advantage |
$752.70
|
|
