|
PR TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 38207
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
|
|
PR TR PARASPI MUSC HIP FASC/TDN XTN GRF
|
Professional
|
Both
|
$6,317.00
|
|
|
Service Code
|
HCPCS 27105
|
| Min. Negotiated Rate |
$840.06 |
| Max. Negotiated Rate |
$4,106.05 |
| Rate for Payer: Aetna Commercial |
$1,125.68
|
| Rate for Payer: Aetna Medicare |
$873.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,125.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.69
|
| Rate for Payer: BCBS Complete |
$2,526.80
|
| Rate for Payer: BCBS MAPPO |
$840.06
|
| Rate for Payer: BCN Medicare Advantage |
$840.06
|
| Rate for Payer: Cash Price |
$5,053.60
|
| Rate for Payer: Cash Price |
$5,053.60
|
| Rate for Payer: Cofinity Commercial |
$1,209.69
|
| Rate for Payer: Cofinity Commercial |
$1,125.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$840.06
|
| Rate for Payer: Healthscope Commercial |
$1,554.11
|
| Rate for Payer: Healthscope Commercial |
$1,344.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$882.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,106.05
|
| Rate for Payer: Nomi Health Commercial |
$1,008.07
|
| Rate for Payer: PACE SWMI |
$840.06
|
| Rate for Payer: PHP Medicare Advantage |
$840.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,106.05
|
| Rate for Payer: Priority Health Medicare |
$840.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$840.06
|
| Rate for Payer: UHC Medicare Advantage |
$840.06
|
|
|
PR TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART
|
Professional
|
Both
|
$2,076.00
|
|
|
Service Code
|
HCPCS 35695
|
| Min. Negotiated Rate |
$830.40 |
| Max. Negotiated Rate |
$1,829.00 |
| Rate for Payer: Aetna Commercial |
$1,324.79
|
| Rate for Payer: Aetna Medicare |
$1,028.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,324.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,423.66
|
| Rate for Payer: BCBS Complete |
$830.40
|
| Rate for Payer: BCBS MAPPO |
$988.65
|
| Rate for Payer: BCN Medicare Advantage |
$988.65
|
| Rate for Payer: Cash Price |
$1,660.80
|
| Rate for Payer: Cash Price |
$1,660.80
|
| Rate for Payer: Cofinity Commercial |
$1,324.79
|
| Rate for Payer: Cofinity Commercial |
$1,423.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$988.65
|
| Rate for Payer: Healthscope Commercial |
$1,581.84
|
| Rate for Payer: Healthscope Commercial |
$1,829.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,038.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,349.40
|
| Rate for Payer: Nomi Health Commercial |
$1,186.38
|
| Rate for Payer: PACE SWMI |
$988.65
|
| Rate for Payer: PHP Medicare Advantage |
$988.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,349.40
|
| Rate for Payer: Priority Health Medicare |
$988.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$988.65
|
| Rate for Payer: UHC Medicare Advantage |
$988.65
|
|
|
PR TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 35694
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$1,762.46 |
| Rate for Payer: Aetna Commercial |
$1,276.59
|
| Rate for Payer: Aetna Medicare |
$990.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,371.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,276.59
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: BCBS MAPPO |
$952.68
|
| Rate for Payer: BCN Medicare Advantage |
$952.68
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cofinity Commercial |
$1,371.86
|
| Rate for Payer: Cofinity Commercial |
$1,276.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$952.68
|
| Rate for Payer: Healthscope Commercial |
$1,762.46
|
| Rate for Payer: Healthscope Commercial |
$1,524.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,000.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,392.30
|
| Rate for Payer: Nomi Health Commercial |
$1,143.22
|
| Rate for Payer: PACE SWMI |
$952.68
|
| Rate for Payer: PHP Medicare Advantage |
$952.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
| Rate for Payer: Priority Health Medicare |
$952.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$952.68
|
| Rate for Payer: UHC Medicare Advantage |
$952.68
|
|
|
PR TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART
|
Professional
|
Both
|
$4,566.00
|
|
|
Service Code
|
HCPCS 35691
|
| Min. Negotiated Rate |
$911.39 |
| Max. Negotiated Rate |
$2,967.90 |
| Rate for Payer: Aetna Commercial |
$1,221.26
|
| Rate for Payer: Aetna Medicare |
$947.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,312.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,221.26
|
| Rate for Payer: BCBS Complete |
$1,826.40
|
| Rate for Payer: BCBS MAPPO |
$911.39
|
| Rate for Payer: BCN Medicare Advantage |
$911.39
|
| Rate for Payer: Cash Price |
$3,652.80
|
| Rate for Payer: Cash Price |
$3,652.80
|
| Rate for Payer: Cofinity Commercial |
$1,312.40
|
| Rate for Payer: Cofinity Commercial |
$1,221.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$911.39
|
| Rate for Payer: Healthscope Commercial |
$1,458.22
|
| Rate for Payer: Healthscope Commercial |
$1,686.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$956.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,967.90
|
| Rate for Payer: Nomi Health Commercial |
$1,093.67
|
| Rate for Payer: PACE SWMI |
$911.39
|
| Rate for Payer: PHP Medicare Advantage |
$911.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,967.90
|
| Rate for Payer: Priority Health Medicare |
$911.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$911.39
|
| Rate for Payer: UHC Medicare Advantage |
$911.39
|
|
|
PR TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
HCPCS 35693
|
| Min. Negotiated Rate |
$702.40 |
| Max. Negotiated Rate |
$1,490.82 |
| Rate for Payer: Aetna Commercial |
$1,079.84
|
| Rate for Payer: Aetna Medicare |
$838.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,160.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,079.84
|
| Rate for Payer: BCBS Complete |
$702.40
|
| Rate for Payer: BCBS MAPPO |
$805.85
|
| Rate for Payer: BCN Medicare Advantage |
$805.85
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Cofinity Commercial |
$1,160.42
|
| Rate for Payer: Cofinity Commercial |
$1,079.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$805.85
|
| Rate for Payer: Healthscope Commercial |
$1,490.82
|
| Rate for Payer: Healthscope Commercial |
$1,289.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$846.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,141.40
|
| Rate for Payer: Nomi Health Commercial |
$967.02
|
| Rate for Payer: PACE SWMI |
$805.85
|
| Rate for Payer: PHP Medicare Advantage |
$805.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.40
|
| Rate for Payer: Priority Health Medicare |
$805.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$805.85
|
| Rate for Payer: UHC Medicare Advantage |
$805.85
|
|
|
PR TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 26497
|
| Min. Negotiated Rate |
$853.26 |
| Max. Negotiated Rate |
$1,803.75 |
| Rate for Payer: Aetna Commercial |
$1,143.37
|
| Rate for Payer: Aetna Medicare |
$887.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,228.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,143.37
|
| Rate for Payer: BCBS Complete |
$1,110.00
|
| Rate for Payer: BCBS MAPPO |
$853.26
|
| Rate for Payer: BCN Medicare Advantage |
$853.26
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cofinity Commercial |
$1,228.69
|
| Rate for Payer: Cofinity Commercial |
$1,143.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$853.26
|
| Rate for Payer: Healthscope Commercial |
$1,365.22
|
| Rate for Payer: Healthscope Commercial |
$1,578.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,803.75
|
| Rate for Payer: Nomi Health Commercial |
$1,023.91
|
| Rate for Payer: PACE SWMI |
$853.26
|
| Rate for Payer: PHP Medicare Advantage |
$853.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.75
|
| Rate for Payer: Priority Health Medicare |
$853.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$853.26
|
| Rate for Payer: UHC Medicare Advantage |
$853.26
|
|
|
PR TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND
|
Professional
|
Both
|
$5,615.00
|
|
|
Service Code
|
HCPCS 26551
|
| Min. Negotiated Rate |
$2,246.00 |
| Max. Negotiated Rate |
$5,818.36 |
| Rate for Payer: Aetna Commercial |
$4,214.38
|
| Rate for Payer: Aetna Medicare |
$3,270.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,528.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,214.38
|
| Rate for Payer: BCBS Complete |
$2,246.00
|
| Rate for Payer: BCBS MAPPO |
$3,145.06
|
| Rate for Payer: BCN Medicare Advantage |
$3,145.06
|
| Rate for Payer: Cash Price |
$4,492.00
|
| Rate for Payer: Cash Price |
$4,492.00
|
| Rate for Payer: Cofinity Commercial |
$4,528.89
|
| Rate for Payer: Cofinity Commercial |
$4,214.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,145.06
|
| Rate for Payer: Healthscope Commercial |
$5,818.36
|
| Rate for Payer: Healthscope Commercial |
$5,032.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,302.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,649.75
|
| Rate for Payer: Nomi Health Commercial |
$3,774.07
|
| Rate for Payer: PACE SWMI |
$3,145.06
|
| Rate for Payer: PHP Medicare Advantage |
$3,145.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,649.75
|
| Rate for Payer: Priority Health Medicare |
$3,145.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,145.06
|
| Rate for Payer: UHC Medicare Advantage |
$3,145.06
|
|
|
PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP
|
Professional
|
Both
|
$2,819.00
|
|
|
Service Code
|
HCPCS 27691
|
| Min. Negotiated Rate |
$714.66 |
| Max. Negotiated Rate |
$1,832.35 |
| Rate for Payer: Aetna Commercial |
$957.64
|
| Rate for Payer: Aetna Medicare |
$743.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.11
|
| Rate for Payer: BCBS Complete |
$1,127.60
|
| Rate for Payer: BCBS MAPPO |
$714.66
|
| Rate for Payer: BCN Medicare Advantage |
$714.66
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Cofinity Commercial |
$957.64
|
| Rate for Payer: Cofinity Commercial |
$1,029.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$714.66
|
| Rate for Payer: Healthscope Commercial |
$1,143.46
|
| Rate for Payer: Healthscope Commercial |
$1,322.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$750.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,832.35
|
| Rate for Payer: Nomi Health Commercial |
$857.59
|
| Rate for Payer: PACE SWMI |
$714.66
|
| Rate for Payer: PHP Medicare Advantage |
$714.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,832.35
|
| Rate for Payer: Priority Health Medicare |
$714.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$714.66
|
| Rate for Payer: UHC Medicare Advantage |
$714.66
|
|
|
PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 27692
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$331.50 |
| Rate for Payer: Aetna Commercial |
$132.19
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.19
|
| Rate for Payer: BCBS Complete |
$204.00
|
| Rate for Payer: BCBS MAPPO |
$98.65
|
| Rate for Payer: BCN Medicare Advantage |
$98.65
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$142.06
|
| Rate for Payer: Cofinity Commercial |
$132.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.65
|
| Rate for Payer: Healthscope Commercial |
$182.50
|
| Rate for Payer: Healthscope Commercial |
$157.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.50
|
| Rate for Payer: Nomi Health Commercial |
$118.38
|
| Rate for Payer: PACE SWMI |
$98.65
|
| Rate for Payer: PHP Medicare Advantage |
$98.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.50
|
| Rate for Payer: Priority Health Medicare |
$98.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.65
|
| Rate for Payer: UHC Medicare Advantage |
$98.65
|
|
|
PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC
|
Professional
|
Both
|
$1,995.00
|
|
|
Service Code
|
HCPCS 27690
|
| Min. Negotiated Rate |
$613.89 |
| Max. Negotiated Rate |
$1,296.75 |
| Rate for Payer: Aetna Commercial |
$822.61
|
| Rate for Payer: Aetna Medicare |
$638.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$822.61
|
| Rate for Payer: BCBS Complete |
$798.00
|
| Rate for Payer: BCBS MAPPO |
$613.89
|
| Rate for Payer: BCN Medicare Advantage |
$613.89
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cofinity Commercial |
$884.00
|
| Rate for Payer: Cofinity Commercial |
$822.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$613.89
|
| Rate for Payer: Healthscope Commercial |
$1,135.70
|
| Rate for Payer: Healthscope Commercial |
$982.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$644.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.75
|
| Rate for Payer: Nomi Health Commercial |
$736.67
|
| Rate for Payer: PACE SWMI |
$613.89
|
| Rate for Payer: PHP Medicare Advantage |
$613.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.75
|
| Rate for Payer: Priority Health Medicare |
$613.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$613.89
|
| Rate for Payer: UHC Medicare Advantage |
$613.89
|
|
|
PR TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
HCPCS 26480
|
| Min. Negotiated Rate |
$687.64 |
| Max. Negotiated Rate |
$1,340.30 |
| Rate for Payer: Aetna Commercial |
$921.44
|
| Rate for Payer: Aetna Medicare |
$715.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$990.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.44
|
| Rate for Payer: BCBS Complete |
$824.80
|
| Rate for Payer: BCBS MAPPO |
$687.64
|
| Rate for Payer: BCN Medicare Advantage |
$687.64
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cofinity Commercial |
$990.20
|
| Rate for Payer: Cofinity Commercial |
$921.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$687.64
|
| Rate for Payer: Healthscope Commercial |
$1,272.13
|
| Rate for Payer: Healthscope Commercial |
$1,100.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$722.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,340.30
|
| Rate for Payer: Nomi Health Commercial |
$825.17
|
| Rate for Payer: PACE SWMI |
$687.64
|
| Rate for Payer: PHP Medicare Advantage |
$687.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,340.30
|
| Rate for Payer: Priority Health Medicare |
$687.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$687.64
|
| Rate for Payer: UHC Medicare Advantage |
$687.64
|
|
|
PR TRURL DRAINAGE PROSTATIC ABSCESS
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 52700
|
| Min. Negotiated Rate |
$330.80 |
| Max. Negotiated Rate |
$783.25 |
| Rate for Payer: Aetna Commercial |
$567.33
|
| Rate for Payer: Aetna Medicare |
$440.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.33
|
| Rate for Payer: BCBS Complete |
$330.80
|
| Rate for Payer: BCBS MAPPO |
$423.38
|
| Rate for Payer: BCN Medicare Advantage |
$423.38
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cofinity Commercial |
$609.67
|
| Rate for Payer: Cofinity Commercial |
$567.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$423.38
|
| Rate for Payer: Healthscope Commercial |
$677.41
|
| Rate for Payer: Healthscope Commercial |
$783.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$444.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$537.55
|
| Rate for Payer: Nomi Health Commercial |
$508.06
|
| Rate for Payer: PACE SWMI |
$423.38
|
| Rate for Payer: PHP Medicare Advantage |
$423.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$537.55
|
| Rate for Payer: Priority Health Medicare |
$423.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$423.38
|
| Rate for Payer: UHC Medicare Advantage |
$423.38
|
|
|
PR TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY
|
Professional
|
Both
|
$3,550.00
|
|
|
Service Code
|
HCPCS 53854
|
| Min. Negotiated Rate |
$363.73 |
| Max. Negotiated Rate |
$2,307.50 |
| Rate for Payer: Aetna Commercial |
$487.40
|
| Rate for Payer: Aetna Medicare |
$378.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.40
|
| Rate for Payer: BCBS Complete |
$1,420.00
|
| Rate for Payer: BCBS MAPPO |
$363.73
|
| Rate for Payer: BCN Medicare Advantage |
$363.73
|
| Rate for Payer: Cash Price |
$2,840.00
|
| Rate for Payer: Cash Price |
$2,840.00
|
| Rate for Payer: Cofinity Commercial |
$523.77
|
| Rate for Payer: Cofinity Commercial |
$487.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.73
|
| Rate for Payer: Healthscope Commercial |
$672.90
|
| Rate for Payer: Healthscope Commercial |
$581.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,307.50
|
| Rate for Payer: Nomi Health Commercial |
$436.48
|
| Rate for Payer: PACE SWMI |
$363.73
|
| Rate for Payer: PHP Medicare Advantage |
$363.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,307.50
|
| Rate for Payer: Priority Health Medicare |
$363.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.73
|
| Rate for Payer: UHC Medicare Advantage |
$363.73
|
|
|
PR TRURL DSTRJ PRSTATE TISS RF THERMOTH
|
Professional
|
Both
|
$2,935.00
|
|
|
Service Code
|
HCPCS 53852
|
| Min. Negotiated Rate |
$363.73 |
| Max. Negotiated Rate |
$1,907.75 |
| Rate for Payer: Aetna Commercial |
$487.40
|
| Rate for Payer: Aetna Medicare |
$378.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.40
|
| Rate for Payer: BCBS Complete |
$1,174.00
|
| Rate for Payer: BCBS MAPPO |
$363.73
|
| Rate for Payer: BCN Medicare Advantage |
$363.73
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cash Price |
$2,348.00
|
| Rate for Payer: Cofinity Commercial |
$523.77
|
| Rate for Payer: Cofinity Commercial |
$487.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.73
|
| Rate for Payer: Healthscope Commercial |
$581.97
|
| Rate for Payer: Healthscope Commercial |
$672.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,907.75
|
| Rate for Payer: Nomi Health Commercial |
$436.48
|
| Rate for Payer: PACE SWMI |
$363.73
|
| Rate for Payer: PHP Medicare Advantage |
$363.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.75
|
| Rate for Payer: Priority Health Medicare |
$363.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.73
|
| Rate for Payer: UHC Medicare Advantage |
$363.73
|
|
|
PR TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE
|
Professional
|
Both
|
$1,590.00
|
|
|
Service Code
|
HCPCS 52601
|
| Min. Negotiated Rate |
$636.00 |
| Max. Negotiated Rate |
$1,286.71 |
| Rate for Payer: Aetna Commercial |
$932.00
|
| Rate for Payer: Aetna Medicare |
$723.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$932.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.55
|
| Rate for Payer: BCBS Complete |
$636.00
|
| Rate for Payer: BCBS MAPPO |
$695.52
|
| Rate for Payer: BCN Medicare Advantage |
$695.52
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cash Price |
$1,272.00
|
| Rate for Payer: Cofinity Commercial |
$932.00
|
| Rate for Payer: Cofinity Commercial |
$1,001.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.52
|
| Rate for Payer: Healthscope Commercial |
$1,286.71
|
| Rate for Payer: Healthscope Commercial |
$1,112.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,033.50
|
| Rate for Payer: Nomi Health Commercial |
$834.62
|
| Rate for Payer: PACE SWMI |
$695.52
|
| Rate for Payer: PHP Medicare Advantage |
$695.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,033.50
|
| Rate for Payer: Priority Health Medicare |
$695.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.52
|
| Rate for Payer: UHC Medicare Advantage |
$695.52
|
|
|
PR TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 52640
|
| Min. Negotiated Rate |
$289.60 |
| Max. Negotiated Rate |
$571.19 |
| Rate for Payer: Aetna Commercial |
$413.73
|
| Rate for Payer: Aetna Medicare |
$321.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.73
|
| Rate for Payer: BCBS Complete |
$289.60
|
| Rate for Payer: BCBS MAPPO |
$308.75
|
| Rate for Payer: BCN Medicare Advantage |
$308.75
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cofinity Commercial |
$444.60
|
| Rate for Payer: Cofinity Commercial |
$413.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.75
|
| Rate for Payer: Healthscope Commercial |
$494.00
|
| Rate for Payer: Healthscope Commercial |
$571.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$470.60
|
| Rate for Payer: Nomi Health Commercial |
$370.50
|
| Rate for Payer: PACE SWMI |
$308.75
|
| Rate for Payer: PHP Medicare Advantage |
$308.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health Medicare |
$308.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.75
|
| Rate for Payer: UHC Medicare Advantage |
$308.75
|
|
|
PR TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS
|
Professional
|
Both
|
$789.00
|
|
|
Service Code
|
HCPCS 52630
|
| Min. Negotiated Rate |
$315.60 |
| Max. Negotiated Rate |
$718.50 |
| Rate for Payer: Aetna Commercial |
$520.43
|
| Rate for Payer: Aetna Medicare |
$403.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.43
|
| Rate for Payer: BCBS Complete |
$315.60
|
| Rate for Payer: BCBS MAPPO |
$388.38
|
| Rate for Payer: BCN Medicare Advantage |
$388.38
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Cofinity Commercial |
$559.27
|
| Rate for Payer: Cofinity Commercial |
$520.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.38
|
| Rate for Payer: Healthscope Commercial |
$718.50
|
| Rate for Payer: Healthscope Commercial |
$621.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$512.85
|
| Rate for Payer: Nomi Health Commercial |
$466.06
|
| Rate for Payer: PACE SWMI |
$388.38
|
| Rate for Payer: PHP Medicare Advantage |
$388.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.85
|
| Rate for Payer: Priority Health Medicare |
$388.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$388.38
|
| Rate for Payer: UHC Medicare Advantage |
$388.38
|
|
|
PR TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 95921
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$146.61 |
| Rate for Payer: Aetna Commercial |
$106.19
|
| Rate for Payer: Aetna Medicare |
$82.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.19
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: BCBS MAPPO |
$79.25
|
| Rate for Payer: BCN Medicare Advantage |
$79.25
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$114.12
|
| Rate for Payer: Cofinity Commercial |
$106.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.25
|
| Rate for Payer: Healthscope Commercial |
$126.80
|
| Rate for Payer: Healthscope Commercial |
$146.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.10
|
| Rate for Payer: Nomi Health Commercial |
$95.10
|
| Rate for Payer: PACE SWMI |
$79.25
|
| Rate for Payer: PHP Medicare Advantage |
$79.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$79.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.25
|
| Rate for Payer: UHC Medicare Advantage |
$79.25
|
|
|
PR TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 95924
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$251.19 |
| Rate for Payer: Aetna Commercial |
$181.95
|
| Rate for Payer: Aetna Medicare |
$141.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.95
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$135.78
|
| Rate for Payer: BCN Medicare Advantage |
$135.78
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$195.52
|
| Rate for Payer: Cofinity Commercial |
$181.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.78
|
| Rate for Payer: Healthscope Commercial |
$251.19
|
| Rate for Payer: Healthscope Commercial |
$217.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.65
|
| Rate for Payer: Nomi Health Commercial |
$162.94
|
| Rate for Payer: PACE SWMI |
$135.78
|
| Rate for Payer: PHP Medicare Advantage |
$135.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$135.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.78
|
| Rate for Payer: UHC Medicare Advantage |
$135.78
|
|
|
PR TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 95922
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$151.07 |
| Rate for Payer: Aetna Commercial |
$109.42
|
| Rate for Payer: Aetna Medicare |
$84.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.42
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS MAPPO |
$81.66
|
| Rate for Payer: BCN Medicare Advantage |
$81.66
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$117.59
|
| Rate for Payer: Cofinity Commercial |
$109.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.66
|
| Rate for Payer: Healthscope Commercial |
$130.66
|
| Rate for Payer: Healthscope Commercial |
$151.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.25
|
| Rate for Payer: Nomi Health Commercial |
$97.99
|
| Rate for Payer: PACE SWMI |
$81.66
|
| Rate for Payer: PHP Medicare Advantage |
$81.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| Rate for Payer: Priority Health Medicare |
$81.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.66
|
| Rate for Payer: UHC Medicare Advantage |
$81.66
|
|
|
PR TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 31730
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$267.18 |
| Rate for Payer: Aetna Commercial |
$193.52
|
| Rate for Payer: Aetna Medicare |
$150.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.52
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS MAPPO |
$144.42
|
| Rate for Payer: BCN Medicare Advantage |
$144.42
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$207.96
|
| Rate for Payer: Cofinity Commercial |
$193.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.42
|
| Rate for Payer: Healthscope Commercial |
$267.18
|
| Rate for Payer: Healthscope Commercial |
$231.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.25
|
| Rate for Payer: Nomi Health Commercial |
$173.30
|
| Rate for Payer: PACE SWMI |
$144.42
|
| Rate for Payer: PHP Medicare Advantage |
$144.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health Medicare |
$144.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.42
|
| Rate for Payer: UHC Medicare Advantage |
$144.42
|
|
|
PR TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 44015
|
| Min. Negotiated Rate |
$136.65 |
| Max. Negotiated Rate |
$807.95 |
| Rate for Payer: Aetna Commercial |
$183.11
|
| Rate for Payer: Aetna Medicare |
$142.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.11
|
| Rate for Payer: BCBS Complete |
$497.20
|
| Rate for Payer: BCBS MAPPO |
$136.65
|
| Rate for Payer: BCN Medicare Advantage |
$136.65
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cofinity Commercial |
$196.78
|
| Rate for Payer: Cofinity Commercial |
$183.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.65
|
| Rate for Payer: Healthscope Commercial |
$218.64
|
| Rate for Payer: Healthscope Commercial |
$252.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$807.95
|
| Rate for Payer: Nomi Health Commercial |
$163.98
|
| Rate for Payer: PACE SWMI |
$136.65
|
| Rate for Payer: PHP Medicare Advantage |
$136.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health Medicare |
$136.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.65
|
| Rate for Payer: UHC Medicare Advantage |
$136.65
|
|
|
PR TUBE THORACOSTOMY INCLUDES WATER SEAL
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 32551
|
| Min. Negotiated Rate |
$149.09 |
| Max. Negotiated Rate |
$391.30 |
| Rate for Payer: Aetna Commercial |
$199.78
|
| Rate for Payer: Aetna Medicare |
$155.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.78
|
| Rate for Payer: BCBS Complete |
$240.80
|
| Rate for Payer: BCBS MAPPO |
$149.09
|
| Rate for Payer: BCN Medicare Advantage |
$149.09
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cofinity Commercial |
$214.69
|
| Rate for Payer: Cofinity Commercial |
$199.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.09
|
| Rate for Payer: Healthscope Commercial |
$275.82
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.30
|
| Rate for Payer: Nomi Health Commercial |
$178.91
|
| Rate for Payer: PACE SWMI |
$149.09
|
| Rate for Payer: PHP Medicare Advantage |
$149.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.30
|
| Rate for Payer: Priority Health Medicare |
$149.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.09
|
| Rate for Payer: UHC Medicare Advantage |
$149.09
|
|
|
PR TUBOTUBAL ANASTATOMOSIS
|
Professional
|
Both
|
$1,653.00
|
|
|
Service Code
|
HCPCS 58750
|
| Min. Negotiated Rate |
$661.20 |
| Max. Negotiated Rate |
$1,616.60 |
| Rate for Payer: Aetna Commercial |
$1,170.95
|
| Rate for Payer: Aetna Medicare |
$908.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,170.95
|
| Rate for Payer: BCBS Complete |
$661.20
|
| Rate for Payer: BCBS MAPPO |
$873.84
|
| Rate for Payer: BCN Medicare Advantage |
$873.84
|
| Rate for Payer: Cash Price |
$1,322.40
|
| Rate for Payer: Cash Price |
$1,322.40
|
| Rate for Payer: Cofinity Commercial |
$1,258.33
|
| Rate for Payer: Cofinity Commercial |
$1,170.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$873.84
|
| Rate for Payer: Healthscope Commercial |
$1,398.14
|
| Rate for Payer: Healthscope Commercial |
$1,616.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,074.45
|
| Rate for Payer: Nomi Health Commercial |
$1,048.61
|
| Rate for Payer: PACE SWMI |
$873.84
|
| Rate for Payer: PHP Medicare Advantage |
$873.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,074.45
|
| Rate for Payer: Priority Health Medicare |
$873.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$873.84
|
| Rate for Payer: UHC Medicare Advantage |
$873.84
|
|
