|
PR VULVECTOMY RADICAL PARTIAL
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 56630
|
| Min. Negotiated Rate |
$649.20 |
| Max. Negotiated Rate |
$1,698.48 |
| Rate for Payer: Aetna Commercial |
$1,230.25
|
| Rate for Payer: Aetna Medicare |
$954.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.25
|
| Rate for Payer: BCBS Complete |
$649.20
|
| Rate for Payer: BCBS MAPPO |
$918.10
|
| Rate for Payer: BCN Medicare Advantage |
$918.10
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$1,322.06
|
| Rate for Payer: Cofinity Commercial |
$1,230.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.10
|
| Rate for Payer: Healthscope Commercial |
$1,468.96
|
| Rate for Payer: Healthscope Commercial |
$1,698.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,054.95
|
| Rate for Payer: Nomi Health Commercial |
$1,101.72
|
| Rate for Payer: PACE SWMI |
$918.10
|
| Rate for Payer: PHP Medicare Advantage |
$918.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.95
|
| Rate for Payer: Priority Health Medicare |
$918.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.10
|
| Rate for Payer: UHC Medicare Advantage |
$918.10
|
|
|
PR VULVECTOMY SIMPLE PARTIAL
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 56620
|
| Min. Negotiated Rate |
$555.20 |
| Max. Negotiated Rate |
$1,027.12 |
| Rate for Payer: Aetna Commercial |
$743.97
|
| Rate for Payer: Aetna Medicare |
$577.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$799.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$743.97
|
| Rate for Payer: BCBS Complete |
$628.40
|
| Rate for Payer: BCBS MAPPO |
$555.20
|
| Rate for Payer: BCN Medicare Advantage |
$555.20
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$799.49
|
| Rate for Payer: Cofinity Commercial |
$743.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.20
|
| Rate for Payer: Healthscope Commercial |
$888.32
|
| Rate for Payer: Healthscope Commercial |
$1,027.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$582.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,021.15
|
| Rate for Payer: Nomi Health Commercial |
$666.24
|
| Rate for Payer: PACE SWMI |
$555.20
|
| Rate for Payer: PHP Medicare Advantage |
$555.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.15
|
| Rate for Payer: Priority Health Medicare |
$555.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.20
|
| Rate for Payer: UHC Medicare Advantage |
$555.20
|
|
|
PR WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 11765
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Aetna Commercial |
$117.20
|
| Rate for Payer: Aetna Medicare |
$90.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.20
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS MAPPO |
$87.46
|
| Rate for Payer: BCN Medicare Advantage |
$87.46
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$125.94
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.46
|
| Rate for Payer: Healthscope Commercial |
$139.94
|
| Rate for Payer: Healthscope Commercial |
$161.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.80
|
| Rate for Payer: Nomi Health Commercial |
$104.95
|
| Rate for Payer: PACE SWMI |
$87.46
|
| Rate for Payer: PHP Medicare Advantage |
$87.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health Medicare |
$87.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.46
|
| Rate for Payer: UHC Medicare Advantage |
$87.46
|
|
|
PR WEDGE RESCJ/BISCTJ OVARY UNI/BI
|
Professional
|
Both
|
$1,929.00
|
|
|
Service Code
|
HCPCS 58920
|
| Min. Negotiated Rate |
$684.91 |
| Max. Negotiated Rate |
$1,267.08 |
| Rate for Payer: Aetna Commercial |
$917.78
|
| Rate for Payer: Aetna Medicare |
$712.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.78
|
| Rate for Payer: BCBS Complete |
$771.60
|
| Rate for Payer: BCBS MAPPO |
$684.91
|
| Rate for Payer: BCN Medicare Advantage |
$684.91
|
| Rate for Payer: Cash Price |
$1,543.20
|
| Rate for Payer: Cash Price |
$1,543.20
|
| Rate for Payer: Cofinity Commercial |
$986.27
|
| Rate for Payer: Cofinity Commercial |
$917.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.91
|
| Rate for Payer: Healthscope Commercial |
$1,267.08
|
| Rate for Payer: Healthscope Commercial |
$1,095.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,253.85
|
| Rate for Payer: Nomi Health Commercial |
$821.89
|
| Rate for Payer: PACE SWMI |
$684.91
|
| Rate for Payer: PHP Medicare Advantage |
$684.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.85
|
| Rate for Payer: Priority Health Medicare |
$684.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.91
|
| Rate for Payer: UHC Medicare Advantage |
$684.91
|
|
|
PR WEDGING CAST EXCEPT CLUBFOOT CASTS
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 29740
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$122.27 |
| Rate for Payer: Aetna Commercial |
$88.56
|
| Rate for Payer: Aetna Medicare |
$68.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.56
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$66.09
|
| Rate for Payer: BCN Medicare Advantage |
$66.09
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$95.17
|
| Rate for Payer: Cofinity Commercial |
$88.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.09
|
| Rate for Payer: Healthscope Commercial |
$105.74
|
| Rate for Payer: Healthscope Commercial |
$122.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.10
|
| Rate for Payer: Nomi Health Commercial |
$79.31
|
| Rate for Payer: PACE SWMI |
$66.09
|
| Rate for Payer: PHP Medicare Advantage |
$66.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$66.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.09
|
| Rate for Payer: UHC Medicare Advantage |
$66.09
|
|
|
PR WESTONE MUSICIAN EAR PLUGS
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 00591
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
|
|
PR WET MOUNTS/ W PREPARATIONS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS Q0111
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$33.65 |
| Rate for Payer: Aetna Commercial |
$24.37
|
| Rate for Payer: Aetna Medicare |
$18.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.19
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$18.19
|
| Rate for Payer: BCN Medicare Advantage |
$18.19
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Cofinity Commercial |
$24.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.19
|
| Rate for Payer: Healthscope Commercial |
$33.65
|
| Rate for Payer: Healthscope Commercial |
$29.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$21.83
|
| Rate for Payer: PACE SWMI |
$18.19
|
| Rate for Payer: PHP Medicare Advantage |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$18.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.19
|
| Rate for Payer: UHC Medicare Advantage |
$18.19
|
|
|
PR WHFO, RIGID W/O JOINTS
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS L3808
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$722.65 |
| Rate for Payer: Aetna Commercial |
$523.43
|
| Rate for Payer: Aetna Medicare |
$406.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.49
|
| Rate for Payer: BCBS Complete |
$133.20
|
| Rate for Payer: BCBS MAPPO |
$390.62
|
| Rate for Payer: BCN Medicare Advantage |
$390.62
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$523.43
|
| Rate for Payer: Cofinity Commercial |
$562.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$624.99
|
| Rate for Payer: Healthscope Commercial |
$722.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.45
|
| Rate for Payer: Nomi Health Commercial |
$468.74
|
| Rate for Payer: PACE SWMI |
$390.62
|
| Rate for Payer: PHP Medicare Advantage |
$390.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
| Rate for Payer: Priority Health Medicare |
$390.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.62
|
| Rate for Payer: UHC Medicare Advantage |
$390.62
|
|
|
PR WHFO W/O JOINTS PRE CST
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS L3807
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$507.25 |
| Rate for Payer: Aetna Commercial |
$367.41
|
| Rate for Payer: Aetna Medicare |
$285.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.41
|
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: BCBS MAPPO |
$274.19
|
| Rate for Payer: BCN Medicare Advantage |
$274.19
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$394.83
|
| Rate for Payer: Cofinity Commercial |
$367.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.19
|
| Rate for Payer: Healthscope Commercial |
$507.25
|
| Rate for Payer: Healthscope Commercial |
$438.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.10
|
| Rate for Payer: Nomi Health Commercial |
$329.03
|
| Rate for Payer: PACE SWMI |
$274.19
|
| Rate for Payer: PHP Medicare Advantage |
$274.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.10
|
| Rate for Payer: Priority Health Medicare |
$274.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.19
|
| Rate for Payer: UHC Medicare Advantage |
$274.19
|
|
|
PR WHO COCK-UP NONMOLDE PRE OTS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS L3908
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$148.72 |
| Rate for Payer: Aetna Commercial |
$107.72
|
| Rate for Payer: Aetna Medicare |
$83.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.72
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$80.39
|
| Rate for Payer: BCN Medicare Advantage |
$80.39
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$115.76
|
| Rate for Payer: Cofinity Commercial |
$107.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.39
|
| Rate for Payer: Healthscope Commercial |
$128.62
|
| Rate for Payer: Healthscope Commercial |
$148.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.85
|
| Rate for Payer: Nomi Health Commercial |
$96.47
|
| Rate for Payer: PACE SWMI |
$80.39
|
| Rate for Payer: PHP Medicare Advantage |
$80.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health Medicare |
$80.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.39
|
| Rate for Payer: UHC Medicare Advantage |
$80.39
|
|
|
PR WHO W/NONTORSION JNT(S) CF
|
Professional
|
Both
|
$926.00
|
|
|
Service Code
|
HCPCS L3905
|
| Min. Negotiated Rate |
$370.40 |
| Max. Negotiated Rate |
$2,011.71 |
| Rate for Payer: Aetna Commercial |
$1,457.13
|
| Rate for Payer: Aetna Medicare |
$1,130.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,565.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,457.13
|
| Rate for Payer: BCBS Complete |
$370.40
|
| Rate for Payer: BCBS MAPPO |
$1,087.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,087.41
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cofinity Commercial |
$1,565.87
|
| Rate for Payer: Cofinity Commercial |
$1,457.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,087.41
|
| Rate for Payer: Healthscope Commercial |
$2,011.71
|
| Rate for Payer: Healthscope Commercial |
$1,739.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,141.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$601.90
|
| Rate for Payer: Nomi Health Commercial |
$1,304.89
|
| Rate for Payer: PACE SWMI |
$1,087.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,087.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.90
|
| Rate for Payer: Priority Health Medicare |
$1,087.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,087.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,087.41
|
|
|
PR WHO W/O JOINTS CF
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS L3906
|
| Min. Negotiated Rate |
$189.20 |
| Max. Negotiated Rate |
$1,028.01 |
| Rate for Payer: Aetna Commercial |
$744.61
|
| Rate for Payer: Aetna Medicare |
$577.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$800.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$744.61
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCBS MAPPO |
$555.68
|
| Rate for Payer: BCN Medicare Advantage |
$555.68
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$800.18
|
| Rate for Payer: Cofinity Commercial |
$744.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.68
|
| Rate for Payer: Healthscope Commercial |
$1,028.01
|
| Rate for Payer: Healthscope Commercial |
$889.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$583.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.45
|
| Rate for Payer: Nomi Health Commercial |
$666.82
|
| Rate for Payer: PACE SWMI |
$555.68
|
| Rate for Payer: PHP Medicare Advantage |
$555.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
| Rate for Payer: Priority Health Medicare |
$555.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.68
|
| Rate for Payer: UHC Medicare Advantage |
$555.68
|
|
|
PR WINDOWING CAST
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 29730
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$79.09 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.28
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCN Medicare Advantage |
$42.75
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$61.56
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$68.40
|
| Rate for Payer: Healthscope Commercial |
$79.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.10
|
| Rate for Payer: Nomi Health Commercial |
$51.30
|
| Rate for Payer: PACE SWMI |
$42.75
|
| Rate for Payer: PHP Medicare Advantage |
$42.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$42.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.75
|
| Rate for Payer: UHC Medicare Advantage |
$42.75
|
|
|
PR WORK HARDENING/CONDITIONING 1ST 2 HR
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 97545
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna Medicare |
$99.00
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
|
|
PR WORK HARDENING/CONDITIONING EACH HOUR
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 97546
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$64.35 |
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
|
|
PR WORK RELATED/MED DBLT XM TREATING PHYS
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99455
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
|
|
PR WOUND CLOSURE BY ADHESIVE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS G0168
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$131.30 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Medicare |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: BCBS Complete |
$80.80
|
| Rate for Payer: BCBS MAPPO |
$13.99
|
| Rate for Payer: BCN Medicare Advantage |
$13.99
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$18.75
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.99
|
| Rate for Payer: Healthscope Commercial |
$25.88
|
| Rate for Payer: Healthscope Commercial |
$22.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.30
|
| Rate for Payer: Nomi Health Commercial |
$16.79
|
| Rate for Payer: PACE SWMI |
$13.99
|
| Rate for Payer: PHP Medicare Advantage |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.30
|
| Rate for Payer: Priority Health Medicare |
$13.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.99
|
| Rate for Payer: UHC Medicare Advantage |
$13.99
|
|
|
PR XEOMIN
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 00085
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 94617
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$150.46 |
| Rate for Payer: Aetna Commercial |
$108.98
|
| Rate for Payer: Aetna Medicare |
$84.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.98
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS MAPPO |
$81.33
|
| Rate for Payer: BCN Medicare Advantage |
$81.33
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$117.12
|
| Rate for Payer: Cofinity Commercial |
$108.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.33
|
| Rate for Payer: Healthscope Commercial |
$150.46
|
| Rate for Payer: Healthscope Commercial |
$130.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.00
|
| Rate for Payer: Nomi Health Commercial |
$97.60
|
| Rate for Payer: PACE SWMI |
$81.33
|
| Rate for Payer: PHP Medicare Advantage |
$81.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.00
|
| Rate for Payer: Priority Health Medicare |
$81.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.33
|
| Rate for Payer: UHC Medicare Advantage |
$81.33
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 94619
|
| Min. Negotiated Rate |
$59.42 |
| Max. Negotiated Rate |
$109.93 |
| Rate for Payer: Aetna Commercial |
$79.62
|
| Rate for Payer: Aetna Medicare |
$61.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.62
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS MAPPO |
$59.42
|
| Rate for Payer: BCN Medicare Advantage |
$59.42
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$85.56
|
| Rate for Payer: Cofinity Commercial |
$79.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.42
|
| Rate for Payer: Healthscope Commercial |
$109.93
|
| Rate for Payer: Healthscope Commercial |
$95.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.00
|
| Rate for Payer: Nomi Health Commercial |
$71.30
|
| Rate for Payer: PACE SWMI |
$59.42
|
| Rate for Payer: PHP Medicare Advantage |
$59.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health Medicare |
$59.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.42
|
| Rate for Payer: UHC Medicare Advantage |
$59.42
|
|
|
PR XTRNL ECG REC>48HR<7D RECORDING SCAN A/R R&I
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 93241
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$441.04 |
| Rate for Payer: Aetna Commercial |
$319.46
|
| Rate for Payer: Aetna Medicare |
$247.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.46
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$238.40
|
| Rate for Payer: BCN Medicare Advantage |
$238.40
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$343.30
|
| Rate for Payer: Cofinity Commercial |
$319.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.40
|
| Rate for Payer: Healthscope Commercial |
$441.04
|
| Rate for Payer: Healthscope Commercial |
$381.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.80
|
| Rate for Payer: Nomi Health Commercial |
$286.08
|
| Rate for Payer: PACE SWMI |
$238.40
|
| Rate for Payer: PHP Medicare Advantage |
$238.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Medicare |
$238.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.40
|
| Rate for Payer: UHC Medicare Advantage |
$238.40
|
|
|
PR XTRNL ECG REC<48 HRS RECORDING
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 93225
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$21.44
|
| Rate for Payer: Aetna Medicare |
$16.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.44
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$16.00
|
| Rate for Payer: BCN Medicare Advantage |
$16.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$23.04
|
| Rate for Payer: Cofinity Commercial |
$21.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$29.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.00
|
| Rate for Payer: Nomi Health Commercial |
$19.20
|
| Rate for Payer: PACE SWMI |
$16.00
|
| Rate for Payer: PHP Medicare Advantage |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$16.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.00
|
| Rate for Payer: UHC Medicare Advantage |
$16.00
|
|
|
PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 93224
|
| Min. Negotiated Rate |
$63.55 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$85.16
|
| Rate for Payer: Aetna Medicare |
$66.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.16
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$63.55
|
| Rate for Payer: BCN Medicare Advantage |
$63.55
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$91.51
|
| Rate for Payer: Cofinity Commercial |
$85.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.55
|
| Rate for Payer: Healthscope Commercial |
$117.57
|
| Rate for Payer: Healthscope Commercial |
$101.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.75
|
| Rate for Payer: Nomi Health Commercial |
$76.26
|
| Rate for Payer: PACE SWMI |
$63.55
|
| Rate for Payer: PHP Medicare Advantage |
$63.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health Medicare |
$63.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.55
|
| Rate for Payer: UHC Medicare Advantage |
$63.55
|
|
|
PR XTRNL ECG REC<48 HRS RVW&INTERPJ PHYS/QHP
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 93227
|
| Min. Negotiated Rate |
$17.12 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Commercial |
$22.94
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.94
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS MAPPO |
$17.12
|
| Rate for Payer: BCN Medicare Advantage |
$17.12
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$24.65
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$27.39
|
| Rate for Payer: Healthscope Commercial |
$31.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.00
|
| Rate for Payer: Nomi Health Commercial |
$20.54
|
| Rate for Payer: PACE SWMI |
$17.12
|
| Rate for Payer: PHP Medicare Advantage |
$17.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health Medicare |
$17.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.12
|
| Rate for Payer: UHC Medicare Advantage |
$17.12
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 93228
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$43.92 |
| Rate for Payer: Aetna Commercial |
$31.81
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.81
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS MAPPO |
$23.74
|
| Rate for Payer: BCN Medicare Advantage |
$23.74
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$34.19
|
| Rate for Payer: Cofinity Commercial |
$31.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.74
|
| Rate for Payer: Healthscope Commercial |
$43.92
|
| Rate for Payer: Healthscope Commercial |
$37.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.70
|
| Rate for Payer: Nomi Health Commercial |
$28.49
|
| Rate for Payer: PACE SWMI |
$23.74
|
| Rate for Payer: PHP Medicare Advantage |
$23.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health Medicare |
$23.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.74
|
| Rate for Payer: UHC Medicare Advantage |
$23.74
|
|
