|
PR WEDGING CAST EXCEPT CLUBFOOT CASTS
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 29740
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$12,220.00 |
| Rate for Payer: Aetna Commercial |
$88.56
|
| Rate for Payer: Aetna Medicare |
$68.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.17
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS MAPPO |
$66.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.43
|
| Rate for Payer: BCN Commercial |
$144.65
|
| 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 |
$122.27
|
| Rate for Payer: Healthscope Commercial |
$105.74
|
| Rate for Payer: Mclaren Medicaid |
$44.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.39
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,220.00
|
| 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 Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.82
|
| Rate for Payer: Priority Health Medicare |
$66.09
|
| Rate for Payer: Priority Health Narrow Network |
$104.82
|
| Rate for Payer: Priority Health SBD |
$104.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.09
|
| Rate for Payer: UHC Exchange |
$95.91
|
| Rate for Payer: UHC Medicare Advantage |
$66.09
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
|
|
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 |
$2,597.00 |
| 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: BCBS Trust/PPO |
$703.47
|
| Rate for Payer: BCN Commercial |
$12.01
|
| 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 |
$24.37
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| 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 |
$2,597.00
|
| 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 All Payor (Choice/PPO) |
$10.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.19
|
| Rate for Payer: UHC Exchange |
$10.14
|
| 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 |
$37,179.00 |
| Rate for Payer: BCBS Complete |
$133.20
|
| Rate for Payer: BCN Commercial |
$307.83
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37,179.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
|
|
PR WHFO W/O JOINTS PRE CST
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS L3807
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$26,097.00 |
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: BCN Commercial |
$216.07
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,097.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.10
|
|
|
PR WHO COCK-UP NONMOLDE PRE OTS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS L3908
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$7,652.00 |
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCN Commercial |
$63.36
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,652.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
|
|
PR WHO W/NONTORSION JNT(S) CF
|
Professional
|
Both
|
$926.00
|
|
|
Service Code
|
HCPCS L3905
|
| Min. Negotiated Rate |
$370.40 |
| Max. Negotiated Rate |
$103,501.00 |
| Rate for Payer: BCBS Complete |
$370.40
|
| Rate for Payer: BCN Commercial |
$856.95
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103,501.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.90
|
|
|
PR WHO W/O JOINTS CF
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS L3906
|
| Min. Negotiated Rate |
$189.20 |
| Max. Negotiated Rate |
$52,891.00 |
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCN Commercial |
$437.92
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52,891.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
|
|
PR WINDOWING CAST
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 29730
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$7,862.00 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.56
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.26
|
| Rate for Payer: BCN Commercial |
$93.34
|
| 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 |
$79.09
|
| Rate for Payer: Healthscope Commercial |
$68.40
|
| Rate for Payer: Mclaren Medicaid |
$28.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,862.00
|
| 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 Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.19
|
| Rate for Payer: Priority Health Medicare |
$42.75
|
| Rate for Payer: Priority Health Narrow Network |
$68.19
|
| Rate for Payer: Priority Health SBD |
$68.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.75
|
| Rate for Payer: UHC Exchange |
$65.49
|
| Rate for Payer: UHC Medicare Advantage |
$42.75
|
| Rate for Payer: UHCCP Medicaid |
$28.54
|
|
|
PR WORK HARDENING/CONDITIONING 1ST 2 HR
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 97545
|
| Min. Negotiated Rate |
$77.25 |
| Max. Negotiated Rate |
$24,102.00 |
| Rate for Payer: Aetna Commercial |
$119.94
|
| Rate for Payer: Aetna Medicare |
$99.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.94
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: BCBS Trust/PPO |
$116.23
|
| Rate for Payer: BCN Commercial |
$187.39
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,102.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.00
|
| Rate for Payer: UHC Exchange |
$131.00
|
|
|
PR WORK HARDENING/CONDITIONING EACH HOUR
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 97546
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$9,600.00 |
| Rate for Payer: Aetna Commercial |
$47.77
|
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.77
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS Trust/PPO |
$328.07
|
| Rate for Payer: BCN Commercial |
$93.43
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,600.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.50
|
| Rate for Payer: UHC Exchange |
$65.50
|
|
|
PR WORK RELATED/MED DBLT XM TREATING PHYS
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99455
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$165.89 |
| Rate for Payer: Aetna Commercial |
$84.95
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.95
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS Trust/PPO |
$165.89
|
| Rate for Payer: Cash Price |
$89.60
|
| 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 |
$9.16 |
| Max. Negotiated Rate |
$2,228.00 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Medicare |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.15
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS MAPPO |
$13.99
|
| Rate for Payer: BCBS Trust/PPO |
$63.68
|
| Rate for Payer: BCN Commercial |
$181.79
|
| 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 |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$18.75
|
| 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: Mclaren Medicaid |
$9.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.69
|
| Rate for Payer: Meridian Medicaid |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,228.00
|
| 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 Choice Medicaid |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.87
|
| Rate for Payer: Priority Health Medicare |
$13.99
|
| Rate for Payer: Priority Health Narrow Network |
$19.87
|
| Rate for Payer: Priority Health SBD |
$19.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.99
|
| Rate for Payer: UHC Exchange |
$89.70
|
| Rate for Payer: UHC Medicare Advantage |
$13.99
|
| Rate for Payer: UHCCP Medicaid |
$9.16
|
|
|
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 |
$19.81 |
| Max. Negotiated Rate |
$12,381.00 |
| Rate for Payer: Aetna Commercial |
$108.98
|
| Rate for Payer: Aetna Medicare |
$84.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.12
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$81.33
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$127.06
|
| 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 |
$130.13
|
| Rate for Payer: Healthscope Commercial |
$150.46
|
| Rate for Payer: Mclaren Medicaid |
$19.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.40
|
| Rate for Payer: Meridian Medicaid |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,381.00
|
| 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 Choice Medicaid |
$19.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.77
|
| Rate for Payer: Priority Health Medicare |
$81.33
|
| Rate for Payer: Priority Health Narrow Network |
$120.77
|
| Rate for Payer: Priority Health SBD |
$42.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.33
|
| Rate for Payer: UHC Medicare Advantage |
$81.33
|
| Rate for Payer: UHCCP Medicaid |
$19.81
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 94619
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$10,814.00 |
| Rate for Payer: Aetna Commercial |
$79.62
|
| Rate for Payer: Aetna Medicare |
$61.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.56
|
| Rate for Payer: BCBS Complete |
$14.09
|
| Rate for Payer: BCBS MAPPO |
$59.42
|
| Rate for Payer: BCBS Trust/PPO |
$225.12
|
| Rate for Payer: BCN Commercial |
$111.42
|
| 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: Mclaren Medicaid |
$13.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.39
|
| Rate for Payer: Meridian Medicaid |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,814.00
|
| 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 Choice Medicaid |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.20
|
| Rate for Payer: Priority Health Medicare |
$59.42
|
| Rate for Payer: Priority Health Narrow Network |
$88.20
|
| Rate for Payer: Priority Health SBD |
$28.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.42
|
| Rate for Payer: UHC Medicare Advantage |
$59.42
|
| Rate for Payer: UHCCP Medicaid |
$13.42
|
|
|
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 |
$36,797.00 |
| Rate for Payer: Aetna Commercial |
$319.46
|
| Rate for Payer: Aetna Medicare |
$247.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.30
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$238.40
|
| Rate for Payer: BCBS Trust/PPO |
$485.51
|
| Rate for Payer: BCN Commercial |
$309.81
|
| 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 |
$381.44
|
| Rate for Payer: Healthscope Commercial |
$441.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,797.00
|
| 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 HMO/PPO/Tiered Network |
$364.90
|
| Rate for Payer: Priority Health Medicare |
$238.40
|
| Rate for Payer: Priority Health Narrow Network |
$364.90
|
| Rate for Payer: Priority Health SBD |
$364.90
|
| 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 |
$2,556.00 |
| 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: BCBS Trust/PPO |
$2,547.99
|
| Rate for Payer: BCN Commercial |
$26.88
|
| 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 |
$2,556.00
|
| 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 HMO/PPO/Tiered Network |
$25.90
|
| Rate for Payer: Priority Health Medicare |
$16.00
|
| Rate for Payer: Priority Health Narrow Network |
$25.90
|
| Rate for Payer: Priority Health SBD |
$25.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.00
|
| Rate for Payer: UHC Exchange |
$68.91
|
| 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 |
$10,250.00 |
| Rate for Payer: Aetna Commercial |
$85.16
|
| Rate for Payer: Aetna Medicare |
$66.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.51
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$63.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.30
|
| Rate for Payer: BCN Commercial |
$106.04
|
| 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 |
$101.68
|
| Rate for Payer: Healthscope Commercial |
$117.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,250.00
|
| 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 HMO/PPO/Tiered Network |
$101.70
|
| Rate for Payer: Priority Health Medicare |
$63.55
|
| Rate for Payer: Priority Health Narrow Network |
$101.70
|
| Rate for Payer: Priority Health SBD |
$101.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.55
|
| Rate for Payer: UHC Exchange |
$300.37
|
| 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 |
$11.50 |
| Max. Negotiated Rate |
$2,685.00 |
| Rate for Payer: Aetna Commercial |
$22.94
|
| Rate for Payer: Aetna Medicare |
$17.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.65
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$17.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,081.50
|
| Rate for Payer: BCN Commercial |
$26.39
|
| 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 |
$31.67
|
| Rate for Payer: Healthscope Commercial |
$27.39
|
| Rate for Payer: Mclaren Medicaid |
$11.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.98
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,685.00
|
| 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 Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.43
|
| Rate for Payer: Priority Health Medicare |
$17.12
|
| Rate for Payer: Priority Health Narrow Network |
$25.43
|
| Rate for Payer: Priority Health SBD |
$25.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.12
|
| Rate for Payer: UHC Exchange |
$60.79
|
| Rate for Payer: UHC Medicare Advantage |
$17.12
|
| Rate for Payer: UHCCP Medicaid |
$11.50
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 93228
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$3,723.00 |
| Rate for Payer: Aetna Commercial |
$31.81
|
| Rate for Payer: Aetna Medicare |
$24.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.19
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$23.74
|
| Rate for Payer: BCBS Trust/PPO |
$454.34
|
| Rate for Payer: BCN Commercial |
$36.65
|
| 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 |
$37.98
|
| Rate for Payer: Healthscope Commercial |
$43.92
|
| Rate for Payer: Mclaren Medicaid |
$15.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.93
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,723.00
|
| 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 Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.84
|
| Rate for Payer: Priority Health Medicare |
$23.74
|
| Rate for Payer: Priority Health Narrow Network |
$34.84
|
| Rate for Payer: Priority Health SBD |
$34.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.74
|
| Rate for Payer: UHC Medicare Advantage |
$23.74
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
HCPCS 93271
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$20,244.00 |
| Rate for Payer: Aetna Commercial |
$162.01
|
| Rate for Payer: Aetna Medicare |
$125.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$261.60
|
| Rate for Payer: BCBS MAPPO |
$120.90
|
| Rate for Payer: BCBS Trust/PPO |
$867.47
|
| Rate for Payer: BCN Commercial |
$213.55
|
| Rate for Payer: BCN Medicare Advantage |
$120.90
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cofinity Commercial |
$174.10
|
| Rate for Payer: Cofinity Commercial |
$162.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.90
|
| Rate for Payer: Healthscope Commercial |
$193.44
|
| Rate for Payer: Healthscope Commercial |
$223.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,244.00
|
| Rate for Payer: Nomi Health Commercial |
$145.08
|
| Rate for Payer: PACE SWMI |
$120.90
|
| Rate for Payer: PHP Medicare Advantage |
$120.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.98
|
| Rate for Payer: Priority Health Medicare |
$120.90
|
| Rate for Payer: Priority Health Narrow Network |
$201.98
|
| Rate for Payer: Priority Health SBD |
$201.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.90
|
| Rate for Payer: UHC Exchange |
$246.17
|
| Rate for Payer: UHC Medicare Advantage |
$120.90
|
|
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 93270
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$1,166.00 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Medicare |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.59
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,098.86
|
| Rate for Payer: BCN Commercial |
$12.22
|
| Rate for Payer: BCN Medicare Advantage |
$7.16
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Cofinity Commercial |
$10.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.16
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Healthscope Commercial |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,166.00
|
| Rate for Payer: Nomi Health Commercial |
$8.59
|
| Rate for Payer: PACE SWMI |
$7.16
|
| Rate for Payer: PHP Medicare Advantage |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health Medicare |
$7.16
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: Priority Health SBD |
$11.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.16
|
| Rate for Payer: UHC Exchange |
$52.25
|
| Rate for Payer: UHC Medicare Advantage |
$7.16
|
|
|
PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 93268
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$24,951.00 |
| Rate for Payer: Aetna Commercial |
$201.87
|
| Rate for Payer: Aetna Medicare |
$156.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.94
|
| Rate for Payer: BCBS Complete |
$348.40
|
| Rate for Payer: BCBS MAPPO |
$150.65
|
| Rate for Payer: BCBS Trust/PPO |
$869.58
|
| Rate for Payer: BCN Commercial |
$260.46
|
| Rate for Payer: BCN Medicare Advantage |
$150.65
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cofinity Commercial |
$216.94
|
| Rate for Payer: Cofinity Commercial |
$201.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.65
|
| Rate for Payer: Healthscope Commercial |
$241.04
|
| Rate for Payer: Healthscope Commercial |
$278.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,951.00
|
| Rate for Payer: Nomi Health Commercial |
$180.78
|
| Rate for Payer: PACE SWMI |
$150.65
|
| Rate for Payer: PHP Medicare Advantage |
$150.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.19
|
| Rate for Payer: Priority Health Medicare |
$150.65
|
| Rate for Payer: Priority Health Narrow Network |
$247.19
|
| Rate for Payer: Priority Health SBD |
$247.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.65
|
| Rate for Payer: UHC Exchange |
$327.31
|
| Rate for Payer: UHC Medicare Advantage |
$150.65
|
|
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 93272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$30.27
|
| Rate for Payer: Aetna Medicare |
$23.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.53
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$22.59
|
| Rate for Payer: BCBS Trust/PPO |
$934.03
|
| Rate for Payer: BCN Commercial |
$34.70
|
| Rate for Payer: BCN Medicare Advantage |
$22.59
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Commercial |
$30.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.59
|
| Rate for Payer: Healthscope Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$36.14
|
| Rate for Payer: Mclaren Medicaid |
$15.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.72
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,540.00
|
| Rate for Payer: Nomi Health Commercial |
$27.11
|
| Rate for Payer: PACE SWMI |
$22.59
|
| Rate for Payer: PHP Medicare Advantage |
$22.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.42
|
| Rate for Payer: Priority Health Medicare |
$22.59
|
| Rate for Payer: Priority Health Narrow Network |
$33.42
|
| Rate for Payer: Priority Health SBD |
$33.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.59
|
| Rate for Payer: UHC Exchange |
$49.91
|
| Rate for Payer: UHC Medicare Advantage |
$22.59
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
|
