|
PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 47542
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Aetna Commercial |
$157.45
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.20
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCN Commercial |
$197.20
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Cofinity Commercial |
$157.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Healthscope Commercial |
$217.38
|
| Rate for Payer: Healthscope Commercial |
$188.00
|
| Rate for Payer: Mclaren Medicaid |
$74.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.45
|
| Rate for Payer: Nomi Health Commercial |
$141.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$240.27
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health SBD |
$240.27
|
| Rate for Payer: Priority Health Tiered Network |
$240.27
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.12
|
| Rate for Payer: UHC Core |
$244.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$117.50
|
| Rate for Payer: UHC Exchange |
$244.12
|
| Rate for Payer: UHC Medicaid |
$74.76
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 61640
|
| Min. Negotiated Rate |
$406.40 |
| Max. Negotiated Rate |
$879.66 |
| Rate for Payer: Aetna Commercial |
$633.90
|
| Rate for Payer: Aetna Medicare |
$508.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.90
|
| Rate for Payer: BCBS Complete |
$406.40
|
| Rate for Payer: BCN Commercial |
$697.67
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$862.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$810.32
|
| Rate for Payer: Priority Health SBD |
$810.32
|
| Rate for Payer: Priority Health Tiered Network |
$810.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.66
|
| Rate for Payer: UHC Core |
$879.66
|
| Rate for Payer: UHC Exchange |
$879.66
|
|
|
PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
HCPCS 50706
|
| Min. Negotiated Rate |
$99.05 |
| Max. Negotiated Rate |
$1,484.25 |
| Rate for Payer: Aetna Commercial |
$208.42
|
| Rate for Payer: Aetna Medicare |
$161.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.98
|
| Rate for Payer: BCBS Complete |
$104.00
|
| Rate for Payer: BCBS MAPPO |
$155.54
|
| Rate for Payer: BCN Commercial |
$263.44
|
| Rate for Payer: BCN Medicare Advantage |
$155.54
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cofinity Commercial |
$223.98
|
| Rate for Payer: Cofinity Commercial |
$208.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.54
|
| Rate for Payer: Healthscope Commercial |
$287.75
|
| Rate for Payer: Healthscope Commercial |
$248.86
|
| Rate for Payer: Mclaren Medicaid |
$99.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$104.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$171.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$316.75
|
| Rate for Payer: Nomi Health Commercial |
$186.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,484.25
|
| Rate for Payer: PACE SWMI |
$155.54
|
| Rate for Payer: PHP Medicare Advantage |
$155.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$286.96
|
| Rate for Payer: Priority Health Medicare |
$155.54
|
| Rate for Payer: Priority Health SBD |
$286.96
|
| Rate for Payer: Priority Health Tiered Network |
$286.96
|
| Rate for Payer: Railroad Medicare Medicare |
$155.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.60
|
| Rate for Payer: UHC Core |
$326.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.54
|
| Rate for Payer: UHC Exchange |
$326.60
|
| Rate for Payer: UHC Medicaid |
$99.05
|
| Rate for Payer: UHCCP Medicaid |
$99.05
|
|
|
PR BCG LIVE INTRAVESICAL 1MG
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J9030
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Aetna Commercial |
$4.54
|
| Rate for Payer: Aetna Medicare |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.88
|
| Rate for Payer: BCBS MAPPO |
$3.39
|
| Rate for Payer: BCBS Trust/PPO |
$3.34
|
| Rate for Payer: BCN Commercial |
$3.19
|
| Rate for Payer: BCN Medicare Advantage |
$3.39
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$4.88
|
| Rate for Payer: Cofinity Commercial |
$4.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.39
|
| Rate for Payer: Healthscope Commercial |
$6.27
|
| Rate for Payer: Healthscope Commercial |
$5.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: Nomi Health Commercial |
$4.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PACE SWMI |
$3.39
|
| Rate for Payer: PHP Medicare Advantage |
$3.39
|
| Rate for Payer: Priority Health Medicare |
$3.39
|
| Rate for Payer: Railroad Medicare Medicare |
$3.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.28
|
| Rate for Payer: UHC Core |
$3.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.39
|
| Rate for Payer: UHC Exchange |
$3.28
|
|
|
PR BCG LIVE INTRAVESICAL VAC
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS J9031
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$138.75 |
| Rate for Payer: Aetna Medicare |
$92.50
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.75
|
|
|
PR BCN APNEALINK PLUS
|
Professional
|
Both
|
$776.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$310.40 |
| Max. Negotiated Rate |
$582.00 |
| Rate for Payer: Aetna Medicare |
$388.00
|
| Rate for Payer: BCBS Complete |
$310.40
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$504.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$582.00
|
|
|
PR BCN WATCHPAT
|
Professional
|
Both
|
$576.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Medicare |
$288.00
|
| Rate for Payer: BCBS Complete |
$230.40
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$432.00
|
|
|
PR BEDSIDE DRAINAGE BAG
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS A4357
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Medicare |
$14.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.93
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$13.84
|
| Rate for Payer: BCN Commercial |
$13.25
|
| Rate for Payer: BCN Medicare Advantage |
$13.84
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$19.93
|
| Rate for Payer: Cofinity Commercial |
$18.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.84
|
| Rate for Payer: Healthscope Commercial |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$22.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.91
|
| Rate for Payer: Nomi Health Commercial |
$16.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.25
|
| Rate for Payer: PACE SWMI |
$13.84
|
| Rate for Payer: PHP Medicare Advantage |
$13.84
|
| Rate for Payer: Priority Health Medicare |
$13.84
|
| Rate for Payer: Railroad Medicare Medicare |
$13.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.51
|
| Rate for Payer: UHC Core |
$4.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$13.84
|
| Rate for Payer: UHC Exchange |
$4.51
|
|
|
PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS 96127
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna Commercial |
$6.23
|
| Rate for Payer: Aetna Medicare |
$4.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.70
|
| Rate for Payer: BCBS MAPPO |
$4.65
|
| Rate for Payer: BCN Commercial |
$6.98
|
| Rate for Payer: BCN Medicare Advantage |
$4.65
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$6.23
|
| Rate for Payer: Cofinity Commercial |
$6.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$7.44
|
| Rate for Payer: Healthscope Commercial |
$8.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.57
|
| Rate for Payer: Nomi Health Commercial |
$5.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.25
|
| Rate for Payer: PACE SWMI |
$4.65
|
| Rate for Payer: PHP Medicare Advantage |
$4.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8.89
|
| Rate for Payer: Priority Health Medicare |
$4.65
|
| Rate for Payer: Priority Health SBD |
$8.89
|
| Rate for Payer: Priority Health Tiered Network |
$8.89
|
| Rate for Payer: Railroad Medicare Medicare |
$4.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.49
|
| Rate for Payer: UHC Core |
$7.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.65
|
| Rate for Payer: UHC Exchange |
$7.49
|
|
|
PR BEHAV HLTH DAY TREAT, PER HR
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
HCPCS H2012
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$425.25 |
| Rate for Payer: Aetna Commercial |
$39.28
|
| Rate for Payer: Aetna Medicare |
$283.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.28
|
| Rate for Payer: BCBS Complete |
$226.80
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Cash Price |
$453.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$368.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$425.25
|
|
|
PR BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 92524
|
| Min. Negotiated Rate |
$105.82 |
| Max. Negotiated Rate |
$195.77 |
| Rate for Payer: Aetna Commercial |
$141.80
|
| Rate for Payer: Aetna Medicare |
$110.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.38
|
| Rate for Payer: BCBS MAPPO |
$105.82
|
| Rate for Payer: BCN Commercial |
$164.34
|
| Rate for Payer: BCN Medicare Advantage |
$105.82
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$152.38
|
| Rate for Payer: Cofinity Commercial |
$141.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.82
|
| Rate for Payer: Healthscope Commercial |
$195.77
|
| Rate for Payer: Healthscope Commercial |
$169.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.70
|
| Rate for Payer: Nomi Health Commercial |
$126.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.75
|
| Rate for Payer: PACE SWMI |
$105.82
|
| Rate for Payer: PHP Medicare Advantage |
$105.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$151.55
|
| Rate for Payer: Priority Health Medicare |
$105.82
|
| Rate for Payer: Priority Health SBD |
$151.55
|
| Rate for Payer: Priority Health Tiered Network |
$151.55
|
| Rate for Payer: Railroad Medicare Medicare |
$105.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.90
|
| Rate for Payer: UHC Core |
$143.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$105.82
|
| Rate for Payer: UHC Exchange |
$143.90
|
|
|
PR BEHAVIORAL VERIFICATION OF AMPLIFICATION
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 92638
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
|
|
PR BEHAVIOR COUNSEL OBESITY 15M
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS G0447
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$48.32 |
| Rate for Payer: Aetna Commercial |
$35.00
|
| Rate for Payer: Aetna Medicare |
$27.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.61
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS MAPPO |
$26.12
|
| Rate for Payer: BCN Commercial |
$44.81
|
| Rate for Payer: BCN Medicare Advantage |
$26.12
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$37.61
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.12
|
| Rate for Payer: Healthscope Commercial |
$48.32
|
| Rate for Payer: Healthscope Commercial |
$41.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.86
|
| Rate for Payer: Nomi Health Commercial |
$31.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: PACE SWMI |
$26.12
|
| Rate for Payer: PHP Medicare Advantage |
$26.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$27.23
|
| Rate for Payer: Priority Health Medicare |
$26.12
|
| Rate for Payer: Priority Health SBD |
$27.23
|
| Rate for Payer: Priority Health Tiered Network |
$27.23
|
| Rate for Payer: Railroad Medicare Medicare |
$26.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.00
|
| Rate for Payer: UHC Core |
$38.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.12
|
| Rate for Payer: UHC Exchange |
$38.00
|
|
|
PR BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 97151
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$79.55 |
| Rate for Payer: Aetna Commercial |
$20.79
|
| Rate for Payer: Aetna Medicare |
$32.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.79
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCN Commercial |
$42.82
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$67.51
|
| Rate for Payer: Priority Health SBD |
$67.51
|
| Rate for Payer: Priority Health Tiered Network |
$67.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.55
|
| Rate for Payer: UHC Core |
$79.55
|
| Rate for Payer: UHC Exchange |
$79.55
|
|
|
PR BETAMETHASONE ACET&SOD PHOSP
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0702
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: Aetna Commercial |
$9.34
|
| Rate for Payer: Aetna Medicare |
$7.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.34
|
| Rate for Payer: BCBS MAPPO |
$6.97
|
| Rate for Payer: BCBS Trust/PPO |
$1.61
|
| Rate for Payer: BCN Commercial |
$4.80
|
| Rate for Payer: BCN Medicare Advantage |
$6.97
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$9.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.97
|
| Rate for Payer: Healthscope Commercial |
$12.89
|
| Rate for Payer: Healthscope Commercial |
$11.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.41
|
| Rate for Payer: Nomi Health Commercial |
$8.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
| Rate for Payer: PACE SWMI |
$6.97
|
| Rate for Payer: PHP Medicare Advantage |
$6.97
|
| Rate for Payer: Priority Health Medicare |
$6.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.91
|
| Rate for Payer: UHC Core |
$6.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6.97
|
| Rate for Payer: UHC Exchange |
$6.91
|
|
|
PR BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 90912
|
| Min. Negotiated Rate |
$37.13 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Aetna Commercial |
$49.75
|
| Rate for Payer: Aetna Medicare |
$38.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.47
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS MAPPO |
$37.13
|
| Rate for Payer: BCN Commercial |
$62.75
|
| Rate for Payer: BCN Medicare Advantage |
$37.13
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$53.47
|
| Rate for Payer: Cofinity Commercial |
$49.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.13
|
| Rate for Payer: Healthscope Commercial |
$68.69
|
| Rate for Payer: Healthscope Commercial |
$59.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.76
|
| Rate for Payer: Nomi Health Commercial |
$44.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.75
|
| Rate for Payer: PACE SWMI |
$37.13
|
| Rate for Payer: PHP Medicare Advantage |
$37.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$65.04
|
| Rate for Payer: Priority Health Medicare |
$37.13
|
| Rate for Payer: Priority Health SBD |
$65.04
|
| Rate for Payer: Priority Health Tiered Network |
$65.04
|
| Rate for Payer: Railroad Medicare Medicare |
$37.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.68
|
| Rate for Payer: UHC Core |
$71.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.13
|
| Rate for Payer: UHC Exchange |
$71.68
|
|
|
PR BIA WHOLE BODY COMPOSITION ASSESSMENT W/I&R
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 0358T
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$215.22 |
| Rate for Payer: Aetna Commercial |
$29.66
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.66
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCN Commercial |
$22.90
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.22
|
| Rate for Payer: UHC Core |
$215.22
|
| Rate for Payer: UHC Exchange |
$215.22
|
|
|
PR BILATERAL GYNECOMASTIA
|
Professional
|
Both
|
$4,506.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,802.40 |
| Max. Negotiated Rate |
$3,379.50 |
| Rate for Payer: Aetna Medicare |
$2,253.00
|
| Rate for Payer: BCBS Complete |
$1,802.40
|
| Rate for Payer: Cash Price |
$3,604.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,928.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,379.50
|
|
|
PR BILATERAL MASTOPEXY
|
Professional
|
Both
|
$5,408.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,163.20 |
| Max. Negotiated Rate |
$4,056.00 |
| Rate for Payer: Aetna Medicare |
$2,704.00
|
| Rate for Payer: BCBS Complete |
$2,163.20
|
| Rate for Payer: Cash Price |
$4,326.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,515.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,056.00
|
|
|
PR BILATERAL OTOPLASTY
|
Professional
|
Both
|
$4,506.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,802.40 |
| Max. Negotiated Rate |
$3,379.50 |
| Rate for Payer: Aetna Medicare |
$2,253.00
|
| Rate for Payer: BCBS Complete |
$1,802.40
|
| Rate for Payer: Cash Price |
$3,604.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,928.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,379.50
|
|
|
PR BILATERAL REDUCTION MAMMOPLASTY
|
Professional
|
Both
|
$3,992.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,596.80 |
| Max. Negotiated Rate |
$2,994.00 |
| Rate for Payer: Aetna Medicare |
$1,996.00
|
| Rate for Payer: BCBS Complete |
$1,596.80
|
| Rate for Payer: Cash Price |
$3,193.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,994.00
|
|
|
PR BILATERAL THORACIC ROLL EXCISION
|
Professional
|
Both
|
$3,605.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,442.00 |
| Max. Negotiated Rate |
$2,703.75 |
| Rate for Payer: Aetna Medicare |
$1,802.50
|
| Rate for Payer: BCBS Complete |
$1,442.00
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,343.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,703.75
|
|
|
PR BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
HCPCS 47554
|
| Min. Negotiated Rate |
$252.83 |
| Max. Negotiated Rate |
$923.51 |
| Rate for Payer: Aetna Commercial |
$531.47
|
| Rate for Payer: Aetna Medicare |
$412.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$531.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$571.13
|
| Rate for Payer: BCBS Complete |
$265.47
|
| Rate for Payer: BCBS MAPPO |
$396.62
|
| Rate for Payer: BCN Commercial |
$659.83
|
| Rate for Payer: BCN Medicare Advantage |
$396.62
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cofinity Commercial |
$571.13
|
| Rate for Payer: Cofinity Commercial |
$531.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.62
|
| Rate for Payer: Healthscope Commercial |
$634.59
|
| Rate for Payer: Healthscope Commercial |
$733.75
|
| Rate for Payer: Mclaren Medicaid |
$252.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$416.45
|
| Rate for Payer: Meridian Medicaid |
$265.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$436.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$791.93
|
| Rate for Payer: Nomi Health Commercial |
$475.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.25
|
| Rate for Payer: PACE SWMI |
$396.62
|
| Rate for Payer: PHP Medicare Advantage |
$396.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$803.95
|
| Rate for Payer: Priority Health Medicare |
$396.62
|
| Rate for Payer: Priority Health SBD |
$803.95
|
| Rate for Payer: Priority Health Tiered Network |
$803.95
|
| Rate for Payer: Railroad Medicare Medicare |
$396.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$923.51
|
| Rate for Payer: UHC Core |
$923.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$396.62
|
| Rate for Payer: UHC Exchange |
$923.51
|
| Rate for Payer: UHC Medicaid |
$252.83
|
| Rate for Payer: UHCCP Medicaid |
$252.83
|
|
|
PR BILIARY NDSC INTRAOPERATIVE
|
Professional
|
Both
|
$546.00
|
|
|
Service Code
|
HCPCS 47550
|
| Min. Negotiated Rate |
$92.44 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Aetna Commercial |
$195.65
|
| Rate for Payer: Aetna Medicare |
$151.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.25
|
| Rate for Payer: BCBS Complete |
$97.06
|
| Rate for Payer: BCBS MAPPO |
$146.01
|
| Rate for Payer: BCN Commercial |
$241.52
|
| Rate for Payer: BCN Medicare Advantage |
$146.01
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cofinity Commercial |
$210.25
|
| Rate for Payer: Cofinity Commercial |
$195.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.01
|
| Rate for Payer: Healthscope Commercial |
$270.12
|
| Rate for Payer: Healthscope Commercial |
$233.62
|
| Rate for Payer: Mclaren Medicaid |
$92.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.31
|
| Rate for Payer: Meridian Medicaid |
$97.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.71
|
| Rate for Payer: Nomi Health Commercial |
$175.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$409.50
|
| Rate for Payer: PACE SWMI |
$146.01
|
| Rate for Payer: PHP Medicare Advantage |
$146.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$294.28
|
| Rate for Payer: Priority Health Medicare |
$146.01
|
| Rate for Payer: Priority Health SBD |
$294.28
|
| Rate for Payer: Priority Health Tiered Network |
$294.28
|
| Rate for Payer: Railroad Medicare Medicare |
$146.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.18
|
| Rate for Payer: UHC Core |
$296.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$146.01
|
| Rate for Payer: UHC Exchange |
$296.18
|
| Rate for Payer: UHC Medicaid |
$92.44
|
| Rate for Payer: UHCCP Medicaid |
$92.44
|
|
|
PR BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 92504
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.96
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS MAPPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$11.00
|
| Rate for Payer: BCN Medicare Advantage |
$7.61
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.61
|
| Rate for Payer: Healthscope Commercial |
$14.08
|
| Rate for Payer: Healthscope Commercial |
$12.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Nomi Health Commercial |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: PACE SWMI |
$7.61
|
| Rate for Payer: PHP Medicare Advantage |
$7.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12.86
|
| Rate for Payer: Priority Health Medicare |
$7.61
|
| Rate for Payer: Priority Health SBD |
$12.86
|
| Rate for Payer: Priority Health Tiered Network |
$12.86
|
| Rate for Payer: Railroad Medicare Medicare |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.30
|
| Rate for Payer: UHC Core |
$15.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.61
|
| Rate for Payer: UHC Exchange |
$15.30
|
|
