|
PR ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 96381
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Commercial |
$24.07
|
| Rate for Payer: Aetna Medicare |
$18.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.07
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$17.96
|
| Rate for Payer: BCN Medicare Advantage |
$17.96
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cofinity Commercial |
$25.86
|
| Rate for Payer: Cofinity Commercial |
$24.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$33.23
|
| Rate for Payer: Healthscope Commercial |
$28.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.25
|
| Rate for Payer: Nomi Health Commercial |
$21.55
|
| Rate for Payer: PACE SWMI |
$17.96
|
| Rate for Payer: PHP Medicare Advantage |
$17.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: Priority Health Medicare |
$17.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.96
|
| Rate for Payer: UHC Medicare Advantage |
$17.96
|
|
|
PR ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR
|
Professional
|
Both
|
$4,437.00
|
|
|
Service Code
|
HCPCS 60545
|
| Min. Negotiated Rate |
$1,203.22 |
| Max. Negotiated Rate |
$2,884.05 |
| Rate for Payer: Aetna Commercial |
$1,612.31
|
| Rate for Payer: Aetna Medicare |
$1,251.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,732.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,612.31
|
| Rate for Payer: BCBS Complete |
$1,774.80
|
| Rate for Payer: BCBS MAPPO |
$1,203.22
|
| Rate for Payer: BCN Medicare Advantage |
$1,203.22
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cash Price |
$3,549.60
|
| Rate for Payer: Cofinity Commercial |
$1,732.64
|
| Rate for Payer: Cofinity Commercial |
$1,612.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,203.22
|
| Rate for Payer: Healthscope Commercial |
$1,925.15
|
| Rate for Payer: Healthscope Commercial |
$2,225.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,263.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,884.05
|
| Rate for Payer: Nomi Health Commercial |
$1,443.86
|
| Rate for Payer: PACE SWMI |
$1,203.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,203.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,884.05
|
| Rate for Payer: Priority Health Medicare |
$1,203.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,203.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,203.22
|
|
|
PR ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX
|
Professional
|
Both
|
$3,369.00
|
|
|
Service Code
|
HCPCS 60540
|
| Min. Negotiated Rate |
$1,042.49 |
| Max. Negotiated Rate |
$2,189.85 |
| Rate for Payer: Aetna Commercial |
$1,396.94
|
| Rate for Payer: Aetna Medicare |
$1,084.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,501.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,396.94
|
| Rate for Payer: BCBS Complete |
$1,347.60
|
| Rate for Payer: BCBS MAPPO |
$1,042.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,042.49
|
| Rate for Payer: Cash Price |
$2,695.20
|
| Rate for Payer: Cash Price |
$2,695.20
|
| Rate for Payer: Cofinity Commercial |
$1,501.19
|
| Rate for Payer: Cofinity Commercial |
$1,396.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,042.49
|
| Rate for Payer: Healthscope Commercial |
$1,667.98
|
| Rate for Payer: Healthscope Commercial |
$1,928.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,094.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,189.85
|
| Rate for Payer: Nomi Health Commercial |
$1,250.99
|
| Rate for Payer: PACE SWMI |
$1,042.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,042.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,189.85
|
| Rate for Payer: Priority Health Medicare |
$1,042.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,042.49
|
| Rate for Payer: UHC Medicare Advantage |
$1,042.49
|
|
|
PR ADRENALIN EPINEPHRINE INJECT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J0171
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 99498
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$124.60 |
| Rate for Payer: Aetna Commercial |
$90.25
|
| Rate for Payer: Aetna Medicare |
$70.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.98
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$67.35
|
| Rate for Payer: BCN Medicare Advantage |
$67.35
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$90.25
|
| Rate for Payer: Cofinity Commercial |
$96.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.35
|
| Rate for Payer: Healthscope Commercial |
$107.76
|
| Rate for Payer: Healthscope Commercial |
$124.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Nomi Health Commercial |
$80.82
|
| Rate for Payer: PACE SWMI |
$67.35
|
| Rate for Payer: PHP Medicare Advantage |
$67.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$67.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.35
|
| Rate for Payer: UHC Medicare Advantage |
$67.35
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$131.66 |
| Rate for Payer: Aetna Commercial |
$95.37
|
| Rate for Payer: Aetna Medicare |
$74.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.48
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$71.17
|
| Rate for Payer: BCN Medicare Advantage |
$71.17
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$95.37
|
| Rate for Payer: Cofinity Commercial |
$102.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.17
|
| Rate for Payer: Healthscope Commercial |
$131.66
|
| Rate for Payer: Healthscope Commercial |
$113.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.95
|
| Rate for Payer: Nomi Health Commercial |
$85.40
|
| Rate for Payer: PACE SWMI |
$71.17
|
| Rate for Payer: PHP Medicare Advantage |
$71.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$71.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.17
|
| Rate for Payer: UHC Medicare Advantage |
$71.17
|
|
|
PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 92651
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$135.16 |
| Rate for Payer: Aetna Commercial |
$97.90
|
| Rate for Payer: Aetna Medicare |
$75.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.21
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$73.06
|
| Rate for Payer: BCN Medicare Advantage |
$73.06
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Cofinity Commercial |
$105.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.06
|
| Rate for Payer: Healthscope Commercial |
$116.90
|
| Rate for Payer: Healthscope Commercial |
$135.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.65
|
| Rate for Payer: Nomi Health Commercial |
$87.67
|
| Rate for Payer: PACE SWMI |
$73.06
|
| Rate for Payer: PHP Medicare Advantage |
$73.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Medicare |
$73.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.06
|
| Rate for Payer: UHC Medicare Advantage |
$73.06
|
|
|
PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 92653
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$138.84 |
| Rate for Payer: Aetna Commercial |
$100.57
|
| Rate for Payer: Aetna Medicare |
$78.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.57
|
| Rate for Payer: BCBS Complete |
$67.60
|
| Rate for Payer: BCBS MAPPO |
$75.05
|
| Rate for Payer: BCN Medicare Advantage |
$75.05
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cofinity Commercial |
$108.07
|
| Rate for Payer: Cofinity Commercial |
$100.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.05
|
| Rate for Payer: Healthscope Commercial |
$120.08
|
| Rate for Payer: Healthscope Commercial |
$138.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.85
|
| Rate for Payer: Nomi Health Commercial |
$90.06
|
| Rate for Payer: PACE SWMI |
$75.05
|
| Rate for Payer: PHP Medicare Advantage |
$75.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.85
|
| Rate for Payer: Priority Health Medicare |
$75.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.05
|
| Rate for Payer: UHC Medicare Advantage |
$75.05
|
|
|
PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 92650
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
|
|
PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 92652
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$186.26 |
| Rate for Payer: Aetna Commercial |
$134.91
|
| Rate for Payer: Aetna Medicare |
$104.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.98
|
| Rate for Payer: BCBS Complete |
$93.20
|
| Rate for Payer: BCBS MAPPO |
$100.68
|
| Rate for Payer: BCN Medicare Advantage |
$100.68
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$134.91
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.68
|
| Rate for Payer: Healthscope Commercial |
$161.09
|
| Rate for Payer: Healthscope Commercial |
$186.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.45
|
| Rate for Payer: Nomi Health Commercial |
$120.82
|
| Rate for Payer: PACE SWMI |
$100.68
|
| Rate for Payer: PHP Medicare Advantage |
$100.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health Medicare |
$100.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.68
|
| Rate for Payer: UHC Medicare Advantage |
$100.68
|
|
|
PR AFO ANKLE GAUNTLET PRE OTS
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS L1902
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$166.37 |
| Rate for Payer: Aetna Commercial |
$120.51
|
| Rate for Payer: Aetna Medicare |
$93.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.51
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$89.93
|
| Rate for Payer: BCN Medicare Advantage |
$89.93
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$129.50
|
| Rate for Payer: Cofinity Commercial |
$120.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.93
|
| Rate for Payer: Healthscope Commercial |
$166.37
|
| Rate for Payer: Healthscope Commercial |
$143.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.45
|
| Rate for Payer: Nomi Health Commercial |
$107.92
|
| Rate for Payer: PACE SWMI |
$89.93
|
| Rate for Payer: PHP Medicare Advantage |
$89.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health Medicare |
$89.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.93
|
| Rate for Payer: UHC Medicare Advantage |
$89.93
|
|
|
PR AFO MULTILIG ANK SUP PRE OTS
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS L1906
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$250.66 |
| Rate for Payer: Aetna Commercial |
$181.56
|
| Rate for Payer: Aetna Medicare |
$140.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.56
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$135.49
|
| Rate for Payer: BCN Medicare Advantage |
$135.49
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$195.11
|
| Rate for Payer: Cofinity Commercial |
$181.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.49
|
| Rate for Payer: Healthscope Commercial |
$216.78
|
| Rate for Payer: Healthscope Commercial |
$250.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.50
|
| Rate for Payer: Nomi Health Commercial |
$162.59
|
| Rate for Payer: PACE SWMI |
$135.49
|
| Rate for Payer: PHP Medicare Advantage |
$135.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$135.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.49
|
| Rate for Payer: UHC Medicare Advantage |
$135.49
|
|
|
PR AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 90694
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
|
|
PR AK SLEEVE SUSP NEOPRENE/EQUA
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS L5695
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$362.10 |
| Rate for Payer: Aetna Commercial |
$262.28
|
| Rate for Payer: Aetna Medicare |
$203.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.85
|
| Rate for Payer: BCBS Complete |
$63.60
|
| Rate for Payer: BCBS MAPPO |
$195.73
|
| Rate for Payer: BCN Medicare Advantage |
$195.73
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$281.85
|
| Rate for Payer: Cofinity Commercial |
$262.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.73
|
| Rate for Payer: Healthscope Commercial |
$362.10
|
| Rate for Payer: Healthscope Commercial |
$313.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$205.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.35
|
| Rate for Payer: Nomi Health Commercial |
$234.88
|
| Rate for Payer: PACE SWMI |
$195.73
|
| Rate for Payer: PHP Medicare Advantage |
$195.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.35
|
| Rate for Payer: Priority Health Medicare |
$195.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$195.73
|
| Rate for Payer: UHC Medicare Advantage |
$195.73
|
|
|
PR ALBUTEROL IPRATROP NON-COMP
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7620
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.27
|
| Rate for Payer: Aetna Medicare |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.29
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.20
|
| Rate for Payer: BCN Medicare Advantage |
$0.20
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.27
|
| Rate for Payer: Cofinity Commercial |
$0.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.32
|
| Rate for Payer: Healthscope Commercial |
$0.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.30
|
| Rate for Payer: Nomi Health Commercial |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.20
|
| Rate for Payer: UHC Medicare Advantage |
$0.20
|
|
|
PR ALBUTEROL NON-COMP CON
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7611
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.23
|
| Rate for Payer: Aetna Medicare |
$0.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.17
|
| Rate for Payer: BCN Medicare Advantage |
$0.17
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.24
|
| Rate for Payer: Cofinity Commercial |
$0.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.17
|
| Rate for Payer: Healthscope Commercial |
$0.31
|
| Rate for Payer: Healthscope Commercial |
$0.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.30
|
| Rate for Payer: Nomi Health Commercial |
$0.20
|
| Rate for Payer: PACE SWMI |
$0.17
|
| Rate for Payer: PHP Medicare Advantage |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.17
|
| Rate for Payer: UHC Medicare Advantage |
$0.17
|
|
|
PR ALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7613
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.11
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.11
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.08
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Cofinity Commercial |
$0.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.08
|
| Rate for Payer: Healthscope Commercial |
$0.13
|
| Rate for Payer: Healthscope Commercial |
$0.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.30
|
| Rate for Payer: Nomi Health Commercial |
$0.10
|
| Rate for Payer: PACE SWMI |
$0.08
|
| Rate for Payer: PHP Medicare Advantage |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.08
|
| Rate for Payer: UHC Medicare Advantage |
$0.08
|
|
|
PR ALCOHOL AND/OR DRUG SERVICES
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS H0015
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 99408
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 99409
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$67.60 |
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR IM INJECTION
|
Facility
|
IP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
151068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.34 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR IM INJECTION
|
Facility
|
OP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
151068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.50 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna Medicare |
$143.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: BCBS Complete |
$114.50
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
6462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.50 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna Medicare |
$143.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: BCBS Complete |
$114.50
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
6462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$180.34 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 20930
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$317.85 |
| Rate for Payer: Aetna Medicare |
$244.50
|
| Rate for Payer: BCBS Complete |
$195.60
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$317.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.85
|
|
