|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
HCPCS 28455
|
| Min. Negotiated Rate |
$220.37 |
| Max. Negotiated Rate |
$525.20 |
| Rate for Payer: Aetna Commercial |
$295.30
|
| Rate for Payer: Aetna Medicare |
$229.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.30
|
| Rate for Payer: BCBS Complete |
$323.20
|
| Rate for Payer: BCBS MAPPO |
$220.37
|
| Rate for Payer: BCN Medicare Advantage |
$220.37
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cofinity Commercial |
$317.33
|
| Rate for Payer: Cofinity Commercial |
$295.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.37
|
| Rate for Payer: Healthscope Commercial |
$352.59
|
| Rate for Payer: Healthscope Commercial |
$407.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$525.20
|
| Rate for Payer: Nomi Health Commercial |
$264.44
|
| Rate for Payer: PACE SWMI |
$220.37
|
| Rate for Payer: PHP Medicare Advantage |
$220.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.20
|
| Rate for Payer: Priority Health Medicare |
$220.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.37
|
| Rate for Payer: UHC Medicare Advantage |
$220.37
|
|
|
PR TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 28450
|
| Min. Negotiated Rate |
$185.02 |
| Max. Negotiated Rate |
$378.95 |
| Rate for Payer: Aetna Commercial |
$247.93
|
| Rate for Payer: Aetna Medicare |
$192.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.93
|
| Rate for Payer: BCBS Complete |
$233.20
|
| Rate for Payer: BCBS MAPPO |
$185.02
|
| Rate for Payer: BCN Medicare Advantage |
$185.02
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$266.43
|
| Rate for Payer: Cofinity Commercial |
$247.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$185.02
|
| Rate for Payer: Healthscope Commercial |
$342.29
|
| Rate for Payer: Healthscope Commercial |
$296.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$194.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$378.95
|
| Rate for Payer: Nomi Health Commercial |
$222.02
|
| Rate for Payer: PACE SWMI |
$185.02
|
| Rate for Payer: PHP Medicare Advantage |
$185.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.95
|
| Rate for Payer: Priority Health Medicare |
$185.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$185.02
|
| Rate for Payer: UHC Medicare Advantage |
$185.02
|
|
|
PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA
|
Professional
|
Both
|
$4,265.00
|
|
|
Service Code
|
HCPCS 27759
|
| Min. Negotiated Rate |
$961.87 |
| Max. Negotiated Rate |
$2,772.25 |
| Rate for Payer: Aetna Commercial |
$1,288.91
|
| Rate for Payer: Aetna Medicare |
$1,000.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,385.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,288.91
|
| Rate for Payer: BCBS Complete |
$1,706.00
|
| Rate for Payer: BCBS MAPPO |
$961.87
|
| Rate for Payer: BCN Medicare Advantage |
$961.87
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cash Price |
$3,412.00
|
| Rate for Payer: Cofinity Commercial |
$1,385.09
|
| Rate for Payer: Cofinity Commercial |
$1,288.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$961.87
|
| Rate for Payer: Healthscope Commercial |
$1,538.99
|
| Rate for Payer: Healthscope Commercial |
$1,779.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,009.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,772.25
|
| Rate for Payer: Nomi Health Commercial |
$1,154.24
|
| Rate for Payer: PACE SWMI |
$961.87
|
| Rate for Payer: PHP Medicare Advantage |
$961.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,772.25
|
| Rate for Payer: Priority Health Medicare |
$961.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$961.87
|
| Rate for Payer: UHC Medicare Advantage |
$961.87
|
|
|
PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
HCPCS 69610
|
| Min. Negotiated Rate |
$267.20 |
| Max. Negotiated Rate |
$506.49 |
| Rate for Payer: Aetna Commercial |
$366.87
|
| Rate for Payer: Aetna Medicare |
$284.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.87
|
| Rate for Payer: BCBS Complete |
$267.20
|
| Rate for Payer: BCBS MAPPO |
$273.78
|
| Rate for Payer: BCN Medicare Advantage |
$273.78
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Cash Price |
$534.40
|
| Rate for Payer: Cofinity Commercial |
$394.24
|
| Rate for Payer: Cofinity Commercial |
$366.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.78
|
| Rate for Payer: Healthscope Commercial |
$506.49
|
| Rate for Payer: Healthscope Commercial |
$438.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.20
|
| Rate for Payer: Nomi Health Commercial |
$328.54
|
| Rate for Payer: PACE SWMI |
$273.78
|
| Rate for Payer: PHP Medicare Advantage |
$273.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.20
|
| Rate for Payer: Priority Health Medicare |
$273.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.78
|
| Rate for Payer: UHC Medicare Advantage |
$273.78
|
|
|
PR TYMPANOMETRY
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 92567
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$13.52
|
| Rate for Payer: Aetna Medicare |
$10.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.52
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$10.09
|
| Rate for Payer: BCN Medicare Advantage |
$10.09
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$14.53
|
| Rate for Payer: Cofinity Commercial |
$13.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.09
|
| Rate for Payer: Healthscope Commercial |
$16.14
|
| Rate for Payer: Healthscope Commercial |
$18.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Nomi Health Commercial |
$12.11
|
| Rate for Payer: PACE SWMI |
$10.09
|
| Rate for Payer: PHP Medicare Advantage |
$10.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$10.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.09
|
| Rate for Payer: UHC Medicare Advantage |
$10.09
|
|
|
PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 92550
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$37.46 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Medicare |
$21.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.14
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$20.25
|
| Rate for Payer: BCN Medicare Advantage |
$20.25
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$29.16
|
| Rate for Payer: Cofinity Commercial |
$27.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$37.46
|
| Rate for Payer: Healthscope Commercial |
$32.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Nomi Health Commercial |
$24.30
|
| Rate for Payer: PACE SWMI |
$20.25
|
| Rate for Payer: PHP Medicare Advantage |
$20.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Medicare |
$20.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.25
|
| Rate for Payer: UHC Medicare Advantage |
$20.25
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR
|
Professional
|
Both
|
$2,793.00
|
|
|
Service Code
|
HCPCS 69646
|
| Min. Negotiated Rate |
$1,117.20 |
| Max. Negotiated Rate |
$2,703.07 |
| Rate for Payer: Aetna Commercial |
$1,957.90
|
| Rate for Payer: Aetna Medicare |
$1,519.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,104.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,957.90
|
| Rate for Payer: BCBS Complete |
$1,117.20
|
| Rate for Payer: BCBS MAPPO |
$1,461.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,461.12
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cash Price |
$2,234.40
|
| Rate for Payer: Cofinity Commercial |
$2,104.01
|
| Rate for Payer: Cofinity Commercial |
$1,957.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,461.12
|
| Rate for Payer: Healthscope Commercial |
$2,337.79
|
| Rate for Payer: Healthscope Commercial |
$2,703.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,534.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,815.45
|
| Rate for Payer: Nomi Health Commercial |
$1,753.34
|
| Rate for Payer: PACE SWMI |
$1,461.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,461.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,815.45
|
| Rate for Payer: Priority Health Medicare |
$1,461.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,461.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,461.12
|
|
|
PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 69645
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$2,551.32 |
| Rate for Payer: Aetna Commercial |
$1,847.98
|
| Rate for Payer: Aetna Medicare |
$1,434.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,985.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,847.98
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: BCBS MAPPO |
$1,379.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,379.09
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,985.89
|
| Rate for Payer: Cofinity Commercial |
$1,847.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,379.09
|
| Rate for Payer: Healthscope Commercial |
$2,551.32
|
| Rate for Payer: Healthscope Commercial |
$2,206.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,448.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,723.80
|
| Rate for Payer: Nomi Health Commercial |
$1,654.91
|
| Rate for Payer: PACE SWMI |
$1,379.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,379.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$1,379.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,379.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,379.09
|
|
|
PR TYMPANOPLASTY W/O MASTOIDEC 1ST/REVJ PROSTH TORP
|
Professional
|
Both
|
$1,888.00
|
|
|
Service Code
|
HCPCS 69633
|
| Min. Negotiated Rate |
$755.20 |
| Max. Negotiated Rate |
$1,815.31 |
| Rate for Payer: Aetna Commercial |
$1,314.88
|
| Rate for Payer: Aetna Medicare |
$1,020.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,413.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,314.88
|
| Rate for Payer: BCBS Complete |
$755.20
|
| Rate for Payer: BCBS MAPPO |
$981.25
|
| Rate for Payer: BCN Medicare Advantage |
$981.25
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cash Price |
$1,510.40
|
| Rate for Payer: Cofinity Commercial |
$1,413.00
|
| Rate for Payer: Cofinity Commercial |
$1,314.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$981.25
|
| Rate for Payer: Healthscope Commercial |
$1,570.00
|
| Rate for Payer: Healthscope Commercial |
$1,815.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,030.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,227.20
|
| Rate for Payer: Nomi Health Commercial |
$1,177.50
|
| Rate for Payer: PACE SWMI |
$981.25
|
| Rate for Payer: PHP Medicare Advantage |
$981.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.20
|
| Rate for Payer: Priority Health Medicare |
$981.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$981.25
|
| Rate for Payer: UHC Medicare Advantage |
$981.25
|
|
|
PR TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
|
Professional
|
Both
|
$3,145.00
|
|
|
Service Code
|
HCPCS 69631
|
| Min. Negotiated Rate |
$825.82 |
| Max. Negotiated Rate |
$2,044.25 |
| Rate for Payer: Aetna Commercial |
$1,106.60
|
| Rate for Payer: Aetna Medicare |
$858.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,189.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,106.60
|
| Rate for Payer: BCBS Complete |
$1,258.00
|
| Rate for Payer: BCBS MAPPO |
$825.82
|
| Rate for Payer: BCN Medicare Advantage |
$825.82
|
| Rate for Payer: Cash Price |
$2,516.00
|
| Rate for Payer: Cash Price |
$2,516.00
|
| Rate for Payer: Cofinity Commercial |
$1,189.18
|
| Rate for Payer: Cofinity Commercial |
$1,106.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$825.82
|
| Rate for Payer: Healthscope Commercial |
$1,527.77
|
| Rate for Payer: Healthscope Commercial |
$1,321.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$867.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,044.25
|
| Rate for Payer: Nomi Health Commercial |
$990.98
|
| Rate for Payer: PACE SWMI |
$825.82
|
| Rate for Payer: PHP Medicare Advantage |
$825.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,044.25
|
| Rate for Payer: Priority Health Medicare |
$825.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$825.82
|
| Rate for Payer: UHC Medicare Advantage |
$825.82
|
|
|
PR TYMPANOSTOMY GENERAL ANESTHESIA
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 69436
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$279.65 |
| Rate for Payer: Aetna Commercial |
$202.55
|
| Rate for Payer: Aetna Medicare |
$157.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.55
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$151.16
|
| Rate for Payer: BCN Medicare Advantage |
$151.16
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$217.67
|
| Rate for Payer: Cofinity Commercial |
$202.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.16
|
| Rate for Payer: Healthscope Commercial |
$241.86
|
| Rate for Payer: Healthscope Commercial |
$279.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.05
|
| Rate for Payer: Nomi Health Commercial |
$181.39
|
| Rate for Payer: PACE SWMI |
$151.16
|
| Rate for Payer: PHP Medicare Advantage |
$151.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$151.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.16
|
| Rate for Payer: UHC Medicare Advantage |
$151.16
|
|
|
PR TYMPANOSTOMY LOCAL/TOPICAL ANESTHESIA
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
HCPCS 69433
|
| Min. Negotiated Rate |
$125.14 |
| Max. Negotiated Rate |
$231.51 |
| Rate for Payer: Aetna Commercial |
$167.69
|
| Rate for Payer: Aetna Medicare |
$130.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.69
|
| Rate for Payer: BCBS Complete |
$131.60
|
| Rate for Payer: BCBS MAPPO |
$125.14
|
| Rate for Payer: BCN Medicare Advantage |
$125.14
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$180.20
|
| Rate for Payer: Cofinity Commercial |
$167.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.14
|
| Rate for Payer: Healthscope Commercial |
$231.51
|
| Rate for Payer: Healthscope Commercial |
$200.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.85
|
| Rate for Payer: Nomi Health Commercial |
$150.17
|
| Rate for Payer: PACE SWMI |
$125.14
|
| Rate for Payer: PHP Medicare Advantage |
$125.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health Medicare |
$125.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.14
|
| Rate for Payer: UHC Medicare Advantage |
$125.14
|
|
|
PR TYMPNOPLSTY W/O MSTDC 1ST/REVJ W/OSICLE RECNSTJ
|
Professional
|
Both
|
$1,954.00
|
|
|
Service Code
|
HCPCS 69632
|
| Min. Negotiated Rate |
$781.60 |
| Max. Negotiated Rate |
$1,864.39 |
| Rate for Payer: Aetna Commercial |
$1,350.43
|
| Rate for Payer: Aetna Medicare |
$1,048.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,451.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,350.43
|
| Rate for Payer: BCBS Complete |
$781.60
|
| Rate for Payer: BCBS MAPPO |
$1,007.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.78
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cash Price |
$1,563.20
|
| Rate for Payer: Cofinity Commercial |
$1,451.20
|
| Rate for Payer: Cofinity Commercial |
$1,350.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.78
|
| Rate for Payer: Healthscope Commercial |
$1,612.45
|
| Rate for Payer: Healthscope Commercial |
$1,864.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,058.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,270.10
|
| Rate for Payer: Nomi Health Commercial |
$1,209.34
|
| Rate for Payer: PACE SWMI |
$1,007.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,270.10
|
| Rate for Payer: Priority Health Medicare |
$1,007.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,007.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,007.78
|
|
|
PR TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ
|
Professional
|
Both
|
$3,636.00
|
|
|
Service Code
|
HCPCS 69635
|
| Min. Negotiated Rate |
$1,192.47 |
| Max. Negotiated Rate |
$2,363.40 |
| Rate for Payer: Aetna Commercial |
$1,597.91
|
| Rate for Payer: Aetna Medicare |
$1,240.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,717.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,597.91
|
| Rate for Payer: BCBS Complete |
$1,454.40
|
| Rate for Payer: BCBS MAPPO |
$1,192.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,192.47
|
| Rate for Payer: Cash Price |
$2,908.80
|
| Rate for Payer: Cash Price |
$2,908.80
|
| Rate for Payer: Cofinity Commercial |
$1,717.16
|
| Rate for Payer: Cofinity Commercial |
$1,597.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,192.47
|
| Rate for Payer: Healthscope Commercial |
$2,206.07
|
| Rate for Payer: Healthscope Commercial |
$1,907.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,252.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,363.40
|
| Rate for Payer: Nomi Health Commercial |
$1,430.96
|
| Rate for Payer: PACE SWMI |
$1,192.47
|
| Rate for Payer: PHP Medicare Advantage |
$1,192.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,363.40
|
| Rate for Payer: Priority Health Medicare |
$1,192.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,192.47
|
| Rate for Payer: UHC Medicare Advantage |
$1,192.47
|
|
|
PR UMBILECTOMY OMPHALECTOMY EXC UMBILICUS SPX
|
Professional
|
Both
|
$2,006.00
|
|
|
Service Code
|
HCPCS 49250
|
| Min. Negotiated Rate |
$577.27 |
| Max. Negotiated Rate |
$1,303.90 |
| Rate for Payer: Aetna Commercial |
$773.54
|
| Rate for Payer: Aetna Medicare |
$600.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$831.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.54
|
| Rate for Payer: BCBS Complete |
$802.40
|
| Rate for Payer: BCBS MAPPO |
$577.27
|
| Rate for Payer: BCN Medicare Advantage |
$577.27
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Cash Price |
$1,604.80
|
| Rate for Payer: Cofinity Commercial |
$831.27
|
| Rate for Payer: Cofinity Commercial |
$773.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$577.27
|
| Rate for Payer: Healthscope Commercial |
$1,067.95
|
| Rate for Payer: Healthscope Commercial |
$923.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$606.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,303.90
|
| Rate for Payer: Nomi Health Commercial |
$692.72
|
| Rate for Payer: PACE SWMI |
$577.27
|
| Rate for Payer: PHP Medicare Advantage |
$577.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,303.90
|
| Rate for Payer: Priority Health Medicare |
$577.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$577.27
|
| Rate for Payer: UHC Medicare Advantage |
$577.27
|
|
|
PR UNILATERAL BREAST AUGMENTATION GEL
|
Professional
|
Both
|
$2,774.00
|
|
|
Service Code
|
HCPCS 00362
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,109.60 |
| Max. Negotiated Rate |
$1,803.10 |
| Rate for Payer: Aetna Medicare |
$1,387.00
|
| Rate for Payer: BCBS Complete |
$1,109.60
|
| Rate for Payer: Cash Price |
$2,219.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,803.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,803.10
|
|
|
PR UNILATERAL BREAST AUGMENTATION SALINE
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
HCPCS 00363
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$864.80 |
| Max. Negotiated Rate |
$1,405.30 |
| Rate for Payer: Aetna Medicare |
$1,081.00
|
| Rate for Payer: BCBS Complete |
$864.80
|
| Rate for Payer: Cash Price |
$1,729.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,405.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,405.30
|
|
|
PR UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 91299
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
|
|
PR UNLISTED EVALUATION AND MANAGEMENT SERVICE
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 99499
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
|
|
PR UNLISTED PSYCHIATRIC SERVICE/PROCEDURE
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 90899
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
|
|
PR UPG PACEMAKER SYS CONVERT 1CHMBR SYS 2CHMBR SYS
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 33214
|
| Min. Negotiated Rate |
$397.20 |
| Max. Negotiated Rate |
$840.95 |
| Rate for Payer: Aetna Commercial |
$609.12
|
| Rate for Payer: Aetna Medicare |
$472.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.12
|
| Rate for Payer: BCBS Complete |
$397.20
|
| Rate for Payer: BCBS MAPPO |
$454.57
|
| Rate for Payer: BCN Medicare Advantage |
$454.57
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cofinity Commercial |
$654.58
|
| Rate for Payer: Cofinity Commercial |
$609.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$454.57
|
| Rate for Payer: Healthscope Commercial |
$840.95
|
| Rate for Payer: Healthscope Commercial |
$727.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$477.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$645.45
|
| Rate for Payer: Nomi Health Commercial |
$545.48
|
| Rate for Payer: PACE SWMI |
$454.57
|
| Rate for Payer: PHP Medicare Advantage |
$454.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$645.45
|
| Rate for Payer: Priority Health Medicare |
$454.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$454.57
|
| Rate for Payer: UHC Medicare Advantage |
$454.57
|
|
|
PR UPPER EXT FX ORTHOSIS RAD/UL
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS L3982
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$796.87 |
| Rate for Payer: Aetna Commercial |
$577.19
|
| Rate for Payer: Aetna Medicare |
$447.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$620.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$577.19
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS MAPPO |
$430.74
|
| Rate for Payer: BCN Medicare Advantage |
$430.74
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$620.27
|
| Rate for Payer: Cofinity Commercial |
$577.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$430.74
|
| Rate for Payer: Healthscope Commercial |
$796.87
|
| Rate for Payer: Healthscope Commercial |
$689.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$452.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.50
|
| Rate for Payer: Nomi Health Commercial |
$516.89
|
| Rate for Payer: PACE SWMI |
$430.74
|
| Rate for Payer: PHP Medicare Advantage |
$430.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health Medicare |
$430.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$430.74
|
| Rate for Payer: UHC Medicare Advantage |
$430.74
|
|
|
PR UPPER EXT FX ORTHOSIS WRIST
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS L3984
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$701.96 |
| Rate for Payer: Aetna Commercial |
$508.45
|
| Rate for Payer: Aetna Medicare |
$394.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.45
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$379.44
|
| Rate for Payer: BCN Medicare Advantage |
$379.44
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$546.39
|
| Rate for Payer: Cofinity Commercial |
$508.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.44
|
| Rate for Payer: Healthscope Commercial |
$607.10
|
| Rate for Payer: Healthscope Commercial |
$701.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.20
|
| Rate for Payer: Nomi Health Commercial |
$455.33
|
| Rate for Payer: PACE SWMI |
$379.44
|
| Rate for Payer: PHP Medicare Advantage |
$379.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$379.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.44
|
| Rate for Payer: UHC Medicare Advantage |
$379.44
|
|
|
PR UPPER GI ENDOSCOPY,STENT PLACEMENT
|
Professional
|
Both
|
$1,109.00
|
|
|
Service Code
|
HCPCS 43256
|
| Min. Negotiated Rate |
$443.60 |
| Max. Negotiated Rate |
$720.85 |
| Rate for Payer: Aetna Medicare |
$554.50
|
| Rate for Payer: BCBS Complete |
$443.60
|
| Rate for Payer: Cash Price |
$887.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$720.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$720.85
|
|
|
PR UPPER GI ENDOSCOPY,TUMOR ABLATN
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
HCPCS 43258
|
| Min. Negotiated Rate |
$488.00 |
| Max. Negotiated Rate |
$793.00 |
| Rate for Payer: Aetna Medicare |
$610.00
|
| Rate for Payer: BCBS Complete |
$488.00
|
| Rate for Payer: Cash Price |
$976.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$793.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$793.00
|
|
