|
PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 99463
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$16,017.00 |
| Rate for Payer: Aetna Commercial |
$136.79
|
| Rate for Payer: Aetna Medicare |
$106.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.00
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS MAPPO |
$102.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,537.35
|
| Rate for Payer: BCN Commercial |
$157.35
|
| Rate for Payer: BCN Medicare Advantage |
$102.08
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$136.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.08
|
| Rate for Payer: Healthscope Commercial |
$163.33
|
| Rate for Payer: Healthscope Commercial |
$188.85
|
| Rate for Payer: Mclaren Medicaid |
$68.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.18
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,017.00
|
| Rate for Payer: Nomi Health Commercial |
$122.50
|
| Rate for Payer: PACE SWMI |
$102.08
|
| Rate for Payer: PHP Medicare Advantage |
$102.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.03
|
| Rate for Payer: Priority Health Medicare |
$102.08
|
| Rate for Payer: Priority Health Narrow Network |
$144.03
|
| Rate for Payer: Priority Health SBD |
$144.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.08
|
| Rate for Payer: UHC Medicare Advantage |
$102.08
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 99223
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$25,557.00 |
| Rate for Payer: Aetna Commercial |
$220.83
|
| Rate for Payer: Aetna Medicare |
$171.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.31
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS MAPPO |
$164.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,363.01
|
| Rate for Payer: BCN Commercial |
$183.78
|
| Rate for Payer: BCN Medicare Advantage |
$164.80
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$237.31
|
| Rate for Payer: Cofinity Commercial |
$220.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.80
|
| Rate for Payer: Healthscope Commercial |
$304.88
|
| Rate for Payer: Healthscope Commercial |
$263.68
|
| Rate for Payer: Mclaren Medicaid |
$110.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.04
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,557.00
|
| Rate for Payer: Nomi Health Commercial |
$197.76
|
| Rate for Payer: PACE SWMI |
$164.80
|
| Rate for Payer: PHP Medicare Advantage |
$164.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.64
|
| Rate for Payer: Priority Health Medicare |
$164.80
|
| Rate for Payer: Priority Health Narrow Network |
$230.64
|
| Rate for Payer: Priority Health SBD |
$230.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.80
|
| Rate for Payer: UHC Exchange |
$183.50
|
| Rate for Payer: UHC Medicare Advantage |
$164.80
|
| Rate for Payer: UHCCP Medicaid |
$110.12
|
|
|
PR 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 99222
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$19,190.00 |
| Rate for Payer: Aetna Commercial |
$165.73
|
| Rate for Payer: Aetna Medicare |
$128.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.10
|
| Rate for Payer: BCBS Complete |
$86.77
|
| Rate for Payer: BCBS MAPPO |
$123.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,113.20
|
| Rate for Payer: BCN Commercial |
$137.93
|
| Rate for Payer: BCN Medicare Advantage |
$123.68
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$178.10
|
| Rate for Payer: Cofinity Commercial |
$165.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.68
|
| Rate for Payer: Healthscope Commercial |
$228.81
|
| Rate for Payer: Healthscope Commercial |
$197.89
|
| Rate for Payer: Mclaren Medicaid |
$82.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.86
|
| Rate for Payer: Meridian Medicaid |
$86.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,190.00
|
| Rate for Payer: Nomi Health Commercial |
$148.42
|
| Rate for Payer: PACE SWMI |
$123.68
|
| Rate for Payer: PHP Medicare Advantage |
$123.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.11
|
| Rate for Payer: Priority Health Medicare |
$123.68
|
| Rate for Payer: Priority Health Narrow Network |
$174.11
|
| Rate for Payer: Priority Health SBD |
$174.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.68
|
| Rate for Payer: UHC Exchange |
$131.96
|
| Rate for Payer: UHC Medicare Advantage |
$123.68
|
| Rate for Payer: UHCCP Medicaid |
$82.64
|
|
|
PR 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 99221
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$12,281.00 |
| Rate for Payer: Aetna Commercial |
$105.35
|
| Rate for Payer: Aetna Medicare |
$81.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.21
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS MAPPO |
$78.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,817.88
|
| Rate for Payer: BCN Commercial |
$88.13
|
| Rate for Payer: BCN Medicare Advantage |
$78.62
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$113.21
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.62
|
| Rate for Payer: Healthscope Commercial |
$145.45
|
| Rate for Payer: Healthscope Commercial |
$125.79
|
| Rate for Payer: Mclaren Medicaid |
$52.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.55
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,281.00
|
| Rate for Payer: Nomi Health Commercial |
$94.34
|
| Rate for Payer: PACE SWMI |
$78.62
|
| Rate for Payer: PHP Medicare Advantage |
$78.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.39
|
| Rate for Payer: Priority Health Medicare |
$78.62
|
| Rate for Payer: Priority Health Narrow Network |
$110.39
|
| Rate for Payer: Priority Health SBD |
$110.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.62
|
| Rate for Payer: UHC Exchange |
$81.11
|
| Rate for Payer: UHC Medicare Advantage |
$78.62
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
|
|
PR 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 99468
|
| Min. Negotiated Rate |
$127.77 |
| Max. Negotiated Rate |
$131,688.00 |
| Rate for Payer: Aetna Commercial |
$1,126.78
|
| Rate for Payer: Aetna Medicare |
$874.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,126.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,210.87
|
| Rate for Payer: BCBS Complete |
$882.92
|
| Rate for Payer: BCBS MAPPO |
$840.88
|
| Rate for Payer: BCBS Trust/PPO |
$127.77
|
| Rate for Payer: BCN Commercial |
$1,290.60
|
| Rate for Payer: BCN Medicare Advantage |
$840.88
|
| Rate for Payer: Cash Price |
$1,340.00
|
| Rate for Payer: Cash Price |
$1,340.00
|
| Rate for Payer: Cofinity Commercial |
$1,210.87
|
| Rate for Payer: Cofinity Commercial |
$1,126.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$840.88
|
| Rate for Payer: Healthscope Commercial |
$1,345.41
|
| Rate for Payer: Healthscope Commercial |
$1,555.63
|
| Rate for Payer: Mclaren Medicaid |
$840.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$882.92
|
| Rate for Payer: Meridian Medicaid |
$882.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131,688.00
|
| Rate for Payer: Nomi Health Commercial |
$1,009.06
|
| Rate for Payer: PACE SWMI |
$840.88
|
| Rate for Payer: PHP Medicare Advantage |
$840.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,088.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,188.19
|
| Rate for Payer: Priority Health Medicare |
$840.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,188.19
|
| Rate for Payer: Priority Health SBD |
$1,188.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$840.88
|
| Rate for Payer: UHC Medicare Advantage |
$840.88
|
| Rate for Payer: UHCCP Medicaid |
$840.88
|
|
|
PR 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 99492
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$13,640.00 |
| Rate for Payer: Aetna Commercial |
$119.69
|
| Rate for Payer: Aetna Medicare |
$92.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.62
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: BCBS MAPPO |
$89.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,323.39
|
| Rate for Payer: BCN Commercial |
$193.46
|
| Rate for Payer: BCN Medicare Advantage |
$89.32
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$128.62
|
| Rate for Payer: Cofinity Commercial |
$119.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$142.91
|
| Rate for Payer: Healthscope Commercial |
$165.24
|
| Rate for Payer: Mclaren Medicaid |
$59.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.79
|
| Rate for Payer: Meridian Medicaid |
$62.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,640.00
|
| Rate for Payer: Nomi Health Commercial |
$107.18
|
| Rate for Payer: PACE SWMI |
$89.32
|
| Rate for Payer: PHP Medicare Advantage |
$89.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$172.40
|
| Rate for Payer: Priority Health Medicare |
$89.32
|
| Rate for Payer: Priority Health Narrow Network |
$172.40
|
| Rate for Payer: Priority Health SBD |
$172.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.32
|
| Rate for Payer: UHC Medicare Advantage |
$89.32
|
| Rate for Payer: UHCCP Medicaid |
$59.85
|
|
|
PR 1ST/SBSQ PSYCH COLLAB CARE MGMT EA ADDL 30 MINS
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 99494
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$5,978.00 |
| Rate for Payer: Aetna Commercial |
$51.00
|
| Rate for Payer: Aetna Medicare |
$39.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.81
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCBS MAPPO |
$38.06
|
| Rate for Payer: BCBS Trust/PPO |
$984.75
|
| Rate for Payer: BCN Commercial |
$79.98
|
| Rate for Payer: BCN Medicare Advantage |
$38.06
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$54.81
|
| Rate for Payer: Cofinity Commercial |
$51.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.06
|
| Rate for Payer: Healthscope Commercial |
$60.90
|
| Rate for Payer: Healthscope Commercial |
$70.41
|
| Rate for Payer: Mclaren Medicaid |
$25.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.96
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,978.00
|
| Rate for Payer: Nomi Health Commercial |
$45.67
|
| Rate for Payer: PACE SWMI |
$38.06
|
| Rate for Payer: PHP Medicare Advantage |
$38.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.71
|
| Rate for Payer: Priority Health Medicare |
$38.06
|
| Rate for Payer: Priority Health Narrow Network |
$82.71
|
| Rate for Payer: Priority Health SBD |
$82.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.06
|
| Rate for Payer: UHC Medicare Advantage |
$38.06
|
| Rate for Payer: UHCCP Medicaid |
$25.56
|
|
|
PR 2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 90650
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$181.35 |
| Rate for Payer: Aetna Commercial |
$141.25
|
| Rate for Payer: Aetna Medicare |
$139.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.25
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: BCBS Trust/PPO |
$133.16
|
| Rate for Payer: BCN Commercial |
$133.16
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.50
|
| Rate for Payer: UHC Exchange |
$168.50
|
|
|
PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 90649
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$14,912.00 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.24
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: BCBS Trust/PPO |
$160.17
|
| Rate for Payer: BCN Commercial |
$160.17
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,912.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.88
|
| Rate for Payer: UHC Exchange |
$174.88
|
|
|
PR 5% DEXTROSE IN LAC RINGERS
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J7121
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$789.00 |
| Rate for Payer: Aetna Commercial |
$7.42
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.42
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$1.86
|
| Rate for Payer: BCN Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$789.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.46
|
| Rate for Payer: UHC Exchange |
$8.46
|
|
|
PR 9VHPV VACC 2/3 DOSE SCHED IM USE
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 90651
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$29,316.00 |
| Rate for Payer: Aetna Commercial |
$293.16
|
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.16
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: BCBS Trust/PPO |
$277.00
|
| Rate for Payer: BCN Commercial |
$265.15
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,316.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.85
|
| Rate for Payer: UHC Exchange |
$335.85
|
|
|
PR AAA REPAIR,AORTO-AORTIC TUBE PROSTH
|
Professional
|
Both
|
$3,937.00
|
|
|
Service Code
|
HCPCS 34800
|
| Min. Negotiated Rate |
$1,574.80 |
| Max. Negotiated Rate |
$2,559.05 |
| Rate for Payer: Aetna Medicare |
$1,968.50
|
| Rate for Payer: BCBS Complete |
$1,574.80
|
| Rate for Payer: Cash Price |
$3,149.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,559.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,559.05
|
|
|
PR AAA REPAIR,MODULR BIFURCATED PROSTH
|
Professional
|
Both
|
$2,555.00
|
|
|
Service Code
|
HCPCS 34802
|
| Min. Negotiated Rate |
$1,022.00 |
| Max. Negotiated Rate |
$1,660.75 |
| Rate for Payer: Aetna Medicare |
$1,277.50
|
| Rate for Payer: BCBS Complete |
$1,022.00
|
| Rate for Payer: Cash Price |
$2,044.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,660.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.75
|
|
|
PR AAA REPAIR,MODULR BIFUR PROSTH,2-DOCK
|
Professional
|
Both
|
$2,622.00
|
|
|
Service Code
|
HCPCS 34803
|
| Min. Negotiated Rate |
$1,048.80 |
| Max. Negotiated Rate |
$1,704.30 |
| Rate for Payer: Aetna Medicare |
$1,311.00
|
| Rate for Payer: BCBS Complete |
$1,048.80
|
| Rate for Payer: Cash Price |
$2,097.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,704.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,704.30
|
|
|
PR AAA REPAIR,UNIBODY BIFURCATED PROSTH
|
Professional
|
Both
|
$5,512.00
|
|
|
Service Code
|
HCPCS 34804
|
| Min. Negotiated Rate |
$2,204.80 |
| Max. Negotiated Rate |
$3,582.80 |
| Rate for Payer: Aetna Medicare |
$2,756.00
|
| Rate for Payer: BCBS Complete |
$2,204.80
|
| Rate for Payer: Cash Price |
$4,409.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,582.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,582.80
|
|
|
PR AAA REPR,1ST VESSEL,EXTENSION PROSTH
|
Professional
|
Both
|
$2,698.00
|
|
|
Service Code
|
HCPCS 34825
|
| Min. Negotiated Rate |
$1,079.20 |
| Max. Negotiated Rate |
$1,753.70 |
| Rate for Payer: Aetna Medicare |
$1,349.00
|
| Rate for Payer: BCBS Complete |
$1,079.20
|
| Rate for Payer: Cash Price |
$2,158.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,753.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,753.70
|
|
|
PR AAA REPR,ADD VESSEL,EXTENSION PROSTH
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 34826
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$283.40 |
| Rate for Payer: Aetna Medicare |
$218.00
|
| Rate for Payer: BCBS Complete |
$174.40
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.40
|
|
|
PR ABATACEPT INJECTION
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS J0129
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$4,270.00 |
| Rate for Payer: Aetna Commercial |
$59.62
|
| Rate for Payer: Aetna Medicare |
$46.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.07
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$44.49
|
| Rate for Payer: BCBS Trust/PPO |
$52.16
|
| Rate for Payer: BCN Commercial |
$50.93
|
| Rate for Payer: BCN Medicare Advantage |
$44.49
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$59.62
|
| Rate for Payer: Cofinity Commercial |
$64.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.49
|
| Rate for Payer: Healthscope Commercial |
$82.31
|
| Rate for Payer: Healthscope Commercial |
$71.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,270.00
|
| Rate for Payer: Nomi Health Commercial |
$53.39
|
| Rate for Payer: PACE SWMI |
$44.49
|
| Rate for Payer: PHP Medicare Advantage |
$44.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$44.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.49
|
| Rate for Payer: UHC Exchange |
$46.43
|
| Rate for Payer: UHC Medicare Advantage |
$44.49
|
|
|
PR ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 38747
|
| Min. Negotiated Rate |
$168.91 |
| Max. Negotiated Rate |
$47,529.00 |
| Rate for Payer: Aetna Commercial |
$345.13
|
| Rate for Payer: Aetna Medicare |
$267.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.89
|
| Rate for Payer: BCBS Complete |
$177.36
|
| Rate for Payer: BCBS MAPPO |
$257.56
|
| Rate for Payer: BCBS Trust/PPO |
$784.00
|
| Rate for Payer: BCN Commercial |
$384.59
|
| Rate for Payer: BCN Medicare Advantage |
$257.56
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$370.89
|
| Rate for Payer: Cofinity Commercial |
$345.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.56
|
| Rate for Payer: Healthscope Commercial |
$476.49
|
| Rate for Payer: Healthscope Commercial |
$412.10
|
| Rate for Payer: Mclaren Medicaid |
$168.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.44
|
| Rate for Payer: Meridian Medicaid |
$177.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47,529.00
|
| Rate for Payer: Nomi Health Commercial |
$309.07
|
| Rate for Payer: PACE SWMI |
$257.56
|
| Rate for Payer: PHP Medicare Advantage |
$257.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.28
|
| Rate for Payer: Priority Health Medicare |
$257.56
|
| Rate for Payer: Priority Health Narrow Network |
$527.28
|
| Rate for Payer: Priority Health SBD |
$527.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$257.56
|
| Rate for Payer: UHC Exchange |
$346.97
|
| Rate for Payer: UHC Medicare Advantage |
$257.56
|
| Rate for Payer: UHCCP Medicaid |
$168.91
|
|
|
PR ABDOMINOPLASTY (2HRS)
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 00364
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,060.80 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Medicare |
$1,326.00
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,723.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
|
|
PR ABDOMINOPLASTY (3HRS)
|
Professional
|
Both
|
$4,284.00
|
|
|
Service Code
|
HCPCS 00365
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,713.60 |
| Max. Negotiated Rate |
$2,784.60 |
| Rate for Payer: Aetna Medicare |
$2,142.00
|
| Rate for Payer: BCBS Complete |
$1,713.60
|
| Rate for Payer: Cash Price |
$3,427.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,784.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,784.60
|
|
|
PR ABDOMINOPLASTY W/ BREAST AUGMENT
|
Professional
|
Both
|
$7,446.00
|
|
|
Service Code
|
HCPCS 00256
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,978.40 |
| Max. Negotiated Rate |
$4,839.90 |
| Rate for Payer: Aetna Medicare |
$3,723.00
|
| Rate for Payer: BCBS Complete |
$2,978.40
|
| Rate for Payer: Cash Price |
$5,956.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,839.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,839.90
|
|
|
PR ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL
|
Professional
|
Both
|
$2,628.00
|
|
|
Service Code
|
HCPCS 51845
|
| Min. Negotiated Rate |
$374.45 |
| Max. Negotiated Rate |
$102,406.00 |
| Rate for Payer: Aetna Commercial |
$747.41
|
| Rate for Payer: Aetna Medicare |
$580.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.19
|
| Rate for Payer: BCBS Complete |
$393.17
|
| Rate for Payer: BCBS MAPPO |
$557.77
|
| Rate for Payer: BCBS Trust/PPO |
$3,525.87
|
| Rate for Payer: BCN Commercial |
$841.50
|
| Rate for Payer: BCN Medicare Advantage |
$557.77
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cash Price |
$2,102.40
|
| Rate for Payer: Cofinity Commercial |
$803.19
|
| Rate for Payer: Cofinity Commercial |
$747.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.77
|
| Rate for Payer: Healthscope Commercial |
$892.43
|
| Rate for Payer: Healthscope Commercial |
$1,031.87
|
| Rate for Payer: Mclaren Medicaid |
$374.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.66
|
| Rate for Payer: Meridian Medicaid |
$393.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102,406.00
|
| Rate for Payer: Nomi Health Commercial |
$669.32
|
| Rate for Payer: PACE SWMI |
$557.77
|
| Rate for Payer: PHP Medicare Advantage |
$557.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$929.39
|
| Rate for Payer: Priority Health Medicare |
$557.77
|
| Rate for Payer: Priority Health Narrow Network |
$929.39
|
| Rate for Payer: Priority Health SBD |
$929.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$824.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.77
|
| Rate for Payer: UHC Exchange |
$824.89
|
| Rate for Payer: UHC Medicare Advantage |
$557.77
|
| Rate for Payer: UHCCP Medicaid |
$374.45
|
|
|
PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 49083
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$18,614.00 |
| Rate for Payer: Aetna Commercial |
$134.38
|
| Rate for Payer: Aetna Medicare |
$104.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.40
|
| Rate for Payer: BCBS Complete |
$70.46
|
| Rate for Payer: BCBS MAPPO |
$100.28
|
| Rate for Payer: BCBS Trust/PPO |
$759.70
|
| Rate for Payer: BCN Commercial |
$432.48
|
| Rate for Payer: BCN Medicare Advantage |
$100.28
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$144.40
|
| Rate for Payer: Cofinity Commercial |
$134.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.28
|
| Rate for Payer: Healthscope Commercial |
$160.45
|
| Rate for Payer: Healthscope Commercial |
$185.52
|
| Rate for Payer: Mclaren Medicaid |
$67.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.29
|
| Rate for Payer: Meridian Medicaid |
$70.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,614.00
|
| Rate for Payer: Nomi Health Commercial |
$120.34
|
| Rate for Payer: PACE SWMI |
$100.28
|
| Rate for Payer: PHP Medicare Advantage |
$100.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.14
|
| Rate for Payer: Priority Health Medicare |
$100.28
|
| Rate for Payer: Priority Health Narrow Network |
$186.14
|
| Rate for Payer: Priority Health SBD |
$186.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.28
|
| Rate for Payer: UHC Medicare Advantage |
$100.28
|
| Rate for Payer: UHCCP Medicaid |
$67.10
|
|
|
PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 49082
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$12,866.00 |
| Rate for Payer: Aetna Commercial |
$92.90
|
| Rate for Payer: Aetna Medicare |
$72.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.84
|
| Rate for Payer: BCBS Complete |
$48.75
|
| Rate for Payer: BCBS MAPPO |
$69.33
|
| Rate for Payer: BCBS Trust/PPO |
$721.66
|
| Rate for Payer: BCN Commercial |
$311.78
|
| Rate for Payer: BCN Medicare Advantage |
$69.33
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$99.84
|
| Rate for Payer: Cofinity Commercial |
$92.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.33
|
| Rate for Payer: Healthscope Commercial |
$110.93
|
| Rate for Payer: Healthscope Commercial |
$128.26
|
| Rate for Payer: Mclaren Medicaid |
$46.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.80
|
| Rate for Payer: Meridian Medicaid |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,866.00
|
| Rate for Payer: Nomi Health Commercial |
$83.20
|
| Rate for Payer: PACE SWMI |
$69.33
|
| Rate for Payer: PHP Medicare Advantage |
$69.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.06
|
| Rate for Payer: Priority Health Medicare |
$69.33
|
| Rate for Payer: Priority Health Narrow Network |
$130.06
|
| Rate for Payer: Priority Health SBD |
$130.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.33
|
| Rate for Payer: UHC Medicare Advantage |
$69.33
|
| Rate for Payer: UHCCP Medicaid |
$46.43
|
|
