|
PR VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL
|
Professional
|
Both
|
$1,757.00
|
|
|
Service Code
|
HCPCS 22512
|
| Min. Negotiated Rate |
$199.05 |
| Max. Negotiated Rate |
$1,142.05 |
| Rate for Payer: Aetna Commercial |
$266.73
|
| Rate for Payer: Aetna Medicare |
$207.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.73
|
| Rate for Payer: BCBS Complete |
$702.80
|
| Rate for Payer: BCBS MAPPO |
$199.05
|
| Rate for Payer: BCN Medicare Advantage |
$199.05
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cofinity Commercial |
$286.63
|
| Rate for Payer: Cofinity Commercial |
$266.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.05
|
| Rate for Payer: Healthscope Commercial |
$368.24
|
| Rate for Payer: Healthscope Commercial |
$318.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,142.05
|
| Rate for Payer: Nomi Health Commercial |
$238.86
|
| Rate for Payer: PACE SWMI |
$199.05
|
| Rate for Payer: PHP Medicare Advantage |
$199.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,142.05
|
| Rate for Payer: Priority Health Medicare |
$199.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.05
|
| Rate for Payer: UHC Medicare Advantage |
$199.05
|
|
|
PR VESICULOTOMY COMPLICATED
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 55605
|
| Min. Negotiated Rate |
$332.00 |
| Max. Negotiated Rate |
$926.63 |
| Rate for Payer: Aetna Commercial |
$671.18
|
| Rate for Payer: Aetna Medicare |
$520.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.18
|
| Rate for Payer: BCBS Complete |
$332.00
|
| Rate for Payer: BCBS MAPPO |
$500.88
|
| Rate for Payer: BCN Medicare Advantage |
$500.88
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cofinity Commercial |
$721.27
|
| Rate for Payer: Cofinity Commercial |
$671.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.88
|
| Rate for Payer: Healthscope Commercial |
$801.41
|
| Rate for Payer: Healthscope Commercial |
$926.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$525.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$539.50
|
| Rate for Payer: Nomi Health Commercial |
$601.06
|
| Rate for Payer: PACE SWMI |
$500.88
|
| Rate for Payer: PHP Medicare Advantage |
$500.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$539.50
|
| Rate for Payer: Priority Health Medicare |
$500.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$500.88
|
| Rate for Payer: UHC Medicare Advantage |
$500.88
|
|
|
PR VESSEL MAPPING HEMO ACCESS
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS G0365
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Aetna Medicare |
$183.00
|
| Rate for Payer: BCBS Complete |
$146.40
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
|
|
PR VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV
|
Professional
|
Both
|
$3,629.00
|
|
|
Service Code
|
HCPCS 43640
|
| Min. Negotiated Rate |
$1,160.40 |
| Max. Negotiated Rate |
$2,358.85 |
| Rate for Payer: Aetna Commercial |
$1,554.94
|
| Rate for Payer: Aetna Medicare |
$1,206.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,670.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,554.94
|
| Rate for Payer: BCBS Complete |
$1,451.60
|
| Rate for Payer: BCBS MAPPO |
$1,160.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,160.40
|
| Rate for Payer: Cash Price |
$2,903.20
|
| Rate for Payer: Cash Price |
$2,903.20
|
| Rate for Payer: Cofinity Commercial |
$1,554.94
|
| Rate for Payer: Cofinity Commercial |
$1,670.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,160.40
|
| Rate for Payer: Healthscope Commercial |
$2,146.74
|
| Rate for Payer: Healthscope Commercial |
$1,856.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,218.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,358.85
|
| Rate for Payer: Nomi Health Commercial |
$1,392.48
|
| Rate for Payer: PACE SWMI |
$1,160.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,160.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,358.85
|
| Rate for Payer: Priority Health Medicare |
$1,160.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,160.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,160.40
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 34845
|
| Min. Negotiated Rate |
$348.40 |
| Max. Negotiated Rate |
$566.15 |
| Rate for Payer: Aetna Medicare |
$435.50
|
| Rate for Payer: BCBS Complete |
$348.40
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.15
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS
|
Professional
|
Both
|
$3,060.00
|
|
|
Service Code
|
HCPCS 34846
|
| Min. Negotiated Rate |
$1,224.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Aetna Medicare |
$1,530.00
|
| Rate for Payer: BCBS Complete |
$1,224.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,989.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,989.00
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS
|
Professional
|
Both
|
$5,100.00
|
|
|
Service Code
|
HCPCS 34847
|
| Min. Negotiated Rate |
$2,040.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Aetna Medicare |
$2,550.00
|
| Rate for Payer: BCBS Complete |
$2,040.00
|
| Rate for Payer: Cash Price |
$4,080.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,315.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,315.00
|
|
|
PR VISCO GEL SPACER - LARGE
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00039
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR VISCO GEL SPACER - MEDIUM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00038
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR VISCO GEL SPACER - SMALL
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00037
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR VISION EXAM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
PR VISION EXAM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna Commercial |
$43.35
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.15
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$35.70
|
| Rate for Payer: Cofinity Commercial |
$43.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.80
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.35
|
| Rate for Payer: PHP Commercial |
$43.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health SBD |
$32.13
|
|
|
PR VISIT TO DETERM LDCT ELIG
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS G0296
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$44.12 |
| Rate for Payer: Aetna Commercial |
$31.96
|
| Rate for Payer: Aetna Medicare |
$24.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.96
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$23.85
|
| Rate for Payer: BCN Medicare Advantage |
$23.85
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$34.34
|
| Rate for Payer: Cofinity Commercial |
$31.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.85
|
| Rate for Payer: Healthscope Commercial |
$44.12
|
| Rate for Payer: Healthscope Commercial |
$38.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.10
|
| Rate for Payer: Nomi Health Commercial |
$28.62
|
| Rate for Payer: PACE SWMI |
$23.85
|
| Rate for Payer: PHP Medicare Advantage |
$23.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health Medicare |
$23.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.85
|
| Rate for Payer: UHC Medicare Advantage |
$23.85
|
|
|
PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 95930
|
| Min. Negotiated Rate |
$59.52 |
| Max. Negotiated Rate |
$177.45 |
| Rate for Payer: Aetna Commercial |
$79.76
|
| Rate for Payer: Aetna Medicare |
$61.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.76
|
| Rate for Payer: BCBS Complete |
$109.20
|
| Rate for Payer: BCBS MAPPO |
$59.52
|
| Rate for Payer: BCN Medicare Advantage |
$59.52
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$85.71
|
| Rate for Payer: Cofinity Commercial |
$79.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.52
|
| Rate for Payer: Healthscope Commercial |
$95.23
|
| Rate for Payer: Healthscope Commercial |
$110.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.45
|
| Rate for Payer: Nomi Health Commercial |
$71.42
|
| Rate for Payer: PACE SWMI |
$59.52
|
| Rate for Payer: PHP Medicare Advantage |
$59.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health Medicare |
$59.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.52
|
| Rate for Payer: UHC Medicare Advantage |
$59.52
|
|
|
PR VISUAL REINFORCEMENT AUDIOMETRY
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 92579
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$64.01 |
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Aetna Medicare |
$35.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.36
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$34.60
|
| Rate for Payer: BCN Medicare Advantage |
$34.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$49.82
|
| Rate for Payer: Cofinity Commercial |
$46.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.60
|
| Rate for Payer: Healthscope Commercial |
$55.36
|
| Rate for Payer: Healthscope Commercial |
$64.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.05
|
| Rate for Payer: Nomi Health Commercial |
$41.52
|
| Rate for Payer: PACE SWMI |
$34.60
|
| Rate for Payer: PHP Medicare Advantage |
$34.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$34.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.60
|
| Rate for Payer: UHC Medicare Advantage |
$34.60
|
|
|
PR VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 94150
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
|
|
PR VITAMIN B12 INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3420
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.45
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$1.01
|
| Rate for Payer: BCN Medicare Advantage |
$1.01
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$1.45
|
| Rate for Payer: Cofinity Commercial |
$1.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.01
|
| Rate for Payer: Healthscope Commercial |
$1.87
|
| Rate for Payer: Healthscope Commercial |
$1.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$1.21
|
| Rate for Payer: PACE SWMI |
$1.01
|
| Rate for Payer: PHP Medicare Advantage |
$1.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$1.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.01
|
| Rate for Payer: UHC Medicare Advantage |
$1.01
|
|
|
PR VITAMIN K PHYTONADIONE INJ
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3430
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$5.05 |
| Rate for Payer: Aetna Commercial |
$3.66
|
| Rate for Payer: Aetna Medicare |
$2.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.93
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$2.73
|
| Rate for Payer: BCN Medicare Advantage |
$2.73
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.66
|
| Rate for Payer: Cofinity Commercial |
$3.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.73
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Commercial |
$5.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.28
|
| Rate for Payer: PACE SWMI |
$2.73
|
| Rate for Payer: PHP Medicare Advantage |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$2.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.73
|
| Rate for Payer: UHC Medicare Advantage |
$2.73
|
|
|
PR VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING
|
Professional
|
Both
|
$5,124.00
|
|
|
Service Code
|
HCPCS 33427
|
| Min. Negotiated Rate |
$2,049.60 |
| Max. Negotiated Rate |
$4,319.49 |
| Rate for Payer: Aetna Commercial |
$3,128.71
|
| Rate for Payer: Aetna Medicare |
$2,428.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,362.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,128.71
|
| Rate for Payer: BCBS Complete |
$2,049.60
|
| Rate for Payer: BCBS MAPPO |
$2,334.86
|
| Rate for Payer: BCN Medicare Advantage |
$2,334.86
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Cash Price |
$4,099.20
|
| Rate for Payer: Cofinity Commercial |
$3,362.20
|
| Rate for Payer: Cofinity Commercial |
$3,128.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,334.86
|
| Rate for Payer: Healthscope Commercial |
$4,319.49
|
| Rate for Payer: Healthscope Commercial |
$3,735.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,451.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,330.60
|
| Rate for Payer: Nomi Health Commercial |
$2,801.83
|
| Rate for Payer: PACE SWMI |
$2,334.86
|
| Rate for Payer: PHP Medicare Advantage |
$2,334.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,330.60
|
| Rate for Payer: Priority Health Medicare |
$2,334.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,334.86
|
| Rate for Payer: UHC Medicare Advantage |
$2,334.86
|
|
|
PR VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING
|
Professional
|
Both
|
$8,903.00
|
|
|
Service Code
|
HCPCS 33426
|
| Min. Negotiated Rate |
$2,284.56 |
| Max. Negotiated Rate |
$5,786.95 |
| Rate for Payer: Aetna Commercial |
$3,061.31
|
| Rate for Payer: Aetna Medicare |
$2,375.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,289.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,061.31
|
| Rate for Payer: BCBS Complete |
$3,561.20
|
| Rate for Payer: BCBS MAPPO |
$2,284.56
|
| Rate for Payer: BCN Medicare Advantage |
$2,284.56
|
| Rate for Payer: Cash Price |
$7,122.40
|
| Rate for Payer: Cash Price |
$7,122.40
|
| Rate for Payer: Cofinity Commercial |
$3,289.77
|
| Rate for Payer: Cofinity Commercial |
$3,061.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,284.56
|
| Rate for Payer: Healthscope Commercial |
$3,655.30
|
| Rate for Payer: Healthscope Commercial |
$4,226.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,398.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,786.95
|
| Rate for Payer: Nomi Health Commercial |
$2,741.47
|
| Rate for Payer: PACE SWMI |
$2,284.56
|
| Rate for Payer: PHP Medicare Advantage |
$2,284.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,786.95
|
| Rate for Payer: Priority Health Medicare |
$2,284.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,284.56
|
| Rate for Payer: UHC Medicare Advantage |
$2,284.56
|
|
|
PR VNPNXR <3 YEARS PHY/QHP SKILL FEMORAL/JUGULAR VN
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 36400
|
| Min. Negotiated Rate |
$17.56 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna Commercial |
$23.53
|
| Rate for Payer: Aetna Medicare |
$18.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.53
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$17.56
|
| Rate for Payer: BCN Medicare Advantage |
$17.56
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$25.29
|
| Rate for Payer: Cofinity Commercial |
$23.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.56
|
| Rate for Payer: Healthscope Commercial |
$32.49
|
| Rate for Payer: Healthscope Commercial |
$28.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.95
|
| Rate for Payer: Nomi Health Commercial |
$21.07
|
| Rate for Payer: PACE SWMI |
$17.56
|
| Rate for Payer: PHP Medicare Advantage |
$17.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health Medicare |
$17.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.56
|
| Rate for Payer: UHC Medicare Advantage |
$17.56
|
|
|
PR VNPNXR 3 YEARS/> PHYS/QHP SKILL DX/THER PURPOSES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 36410
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Commercial |
$11.58
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.58
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$8.64
|
| Rate for Payer: BCN Medicare Advantage |
$8.64
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Cofinity Commercial |
$11.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.64
|
| Rate for Payer: Healthscope Commercial |
$13.82
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.75
|
| Rate for Payer: Nomi Health Commercial |
$10.37
|
| Rate for Payer: PACE SWMI |
$8.64
|
| Rate for Payer: PHP Medicare Advantage |
$8.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health Medicare |
$8.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.64
|
| Rate for Payer: UHC Medicare Advantage |
$8.64
|
|
|
PR VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 36406
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$13.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.05
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
|
|
PR VOID PRESSURE STUDIES INTRAABDOMINAL
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 51797
|
| Min. Negotiated Rate |
$149.65 |
| Max. Negotiated Rate |
$336.70 |
| Rate for Payer: Aetna Commercial |
$200.53
|
| Rate for Payer: Aetna Medicare |
$155.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.53
|
| Rate for Payer: BCBS Complete |
$207.20
|
| Rate for Payer: BCBS MAPPO |
$149.65
|
| Rate for Payer: BCN Medicare Advantage |
$149.65
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$215.50
|
| Rate for Payer: Cofinity Commercial |
$200.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.65
|
| Rate for Payer: Healthscope Commercial |
$239.44
|
| Rate for Payer: Healthscope Commercial |
$276.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.70
|
| Rate for Payer: Nomi Health Commercial |
$179.58
|
| Rate for Payer: PACE SWMI |
$149.65
|
| Rate for Payer: PHP Medicare Advantage |
$149.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health Medicare |
$149.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.65
|
| Rate for Payer: UHC Medicare Advantage |
$149.65
|
|
|
PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 92540
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$179.63 |
| Rate for Payer: Aetna Commercial |
$130.11
|
| Rate for Payer: Aetna Medicare |
$100.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.11
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS MAPPO |
$97.10
|
| Rate for Payer: BCN Medicare Advantage |
$97.10
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$130.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.10
|
| Rate for Payer: Healthscope Commercial |
$179.63
|
| Rate for Payer: Healthscope Commercial |
$155.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.00
|
| Rate for Payer: Nomi Health Commercial |
$116.52
|
| Rate for Payer: PACE SWMI |
$97.10
|
| Rate for Payer: PHP Medicare Advantage |
$97.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health Medicare |
$97.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.10
|
| Rate for Payer: UHC Medicare Advantage |
$97.10
|
|
