|
PR DIR RPR RUPTD ANEURYSM & GRAFT ILIAC ARTERY
|
Professional
|
Both
|
$3,556.00
|
|
|
Service Code
|
HCPCS 35132
|
| Min. Negotiated Rate |
$947.42 |
| Max. Negotiated Rate |
$2,943.84 |
| Rate for Payer: Aetna Commercial |
$2,019.77
|
| Rate for Payer: Aetna Medicare |
$1,567.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,019.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,170.50
|
| Rate for Payer: BCBS Complete |
$994.79
|
| Rate for Payer: BCBS MAPPO |
$1,507.29
|
| Rate for Payer: BCN Commercial |
$2,388.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,507.29
|
| Rate for Payer: Cash Price |
$2,844.80
|
| Rate for Payer: Cash Price |
$2,844.80
|
| Rate for Payer: Cofinity Commercial |
$2,170.50
|
| Rate for Payer: Cofinity Commercial |
$2,019.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,507.29
|
| Rate for Payer: Healthscope Commercial |
$2,788.49
|
| Rate for Payer: Healthscope Commercial |
$2,411.66
|
| Rate for Payer: Mclaren Medicaid |
$947.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,582.65
|
| Rate for Payer: Meridian Medicaid |
$994.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,658.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,904.16
|
| Rate for Payer: Nomi Health Commercial |
$1,808.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,667.00
|
| Rate for Payer: PACE SWMI |
$1,507.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,507.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$947.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,568.34
|
| Rate for Payer: Priority Health Medicare |
$1,507.29
|
| Rate for Payer: Priority Health SBD |
$2,568.34
|
| Rate for Payer: Priority Health Tiered Network |
$2,568.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,507.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,943.84
|
| Rate for Payer: UHC Core |
$2,943.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,507.29
|
| Rate for Payer: UHC Exchange |
$2,943.84
|
| Rate for Payer: UHC Medicaid |
$947.42
|
| Rate for Payer: UHCCP Medicaid |
$947.42
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF COMMON FEMORAL ART
|
Professional
|
Both
|
$2,688.00
|
|
|
Service Code
|
HCPCS 35142
|
| Min. Negotiated Rate |
$761.90 |
| Max. Negotiated Rate |
$2,386.50 |
| Rate for Payer: Aetna Commercial |
$1,617.43
|
| Rate for Payer: Aetna Medicare |
$1,255.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,617.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,738.14
|
| Rate for Payer: BCBS Complete |
$800.00
|
| Rate for Payer: BCBS MAPPO |
$1,207.04
|
| Rate for Payer: BCN Commercial |
$1,927.18
|
| Rate for Payer: BCN Medicare Advantage |
$1,207.04
|
| Rate for Payer: Cash Price |
$2,150.40
|
| Rate for Payer: Cash Price |
$2,150.40
|
| Rate for Payer: Cofinity Commercial |
$1,738.14
|
| Rate for Payer: Cofinity Commercial |
$1,617.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,207.04
|
| Rate for Payer: Healthscope Commercial |
$2,233.02
|
| Rate for Payer: Healthscope Commercial |
$1,931.26
|
| Rate for Payer: Mclaren Medicaid |
$761.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,267.39
|
| Rate for Payer: Meridian Medicaid |
$800.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,327.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,340.18
|
| Rate for Payer: Nomi Health Commercial |
$1,448.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,016.00
|
| Rate for Payer: PACE SWMI |
$1,207.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,207.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$761.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,072.45
|
| Rate for Payer: Priority Health Medicare |
$1,207.04
|
| Rate for Payer: Priority Health SBD |
$2,072.45
|
| Rate for Payer: Priority Health Tiered Network |
$2,072.45
|
| Rate for Payer: Railroad Medicare Medicare |
$1,207.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,386.50
|
| Rate for Payer: UHC Core |
$2,386.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,207.04
|
| Rate for Payer: UHC Exchange |
$2,386.50
|
| Rate for Payer: UHC Medicaid |
$761.90
|
| Rate for Payer: UHCCP Medicaid |
$761.90
|
|
|
PR DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY
|
Professional
|
Both
|
$2,819.00
|
|
|
Service Code
|
HCPCS 35152
|
| Min. Negotiated Rate |
$810.47 |
| Max. Negotiated Rate |
$2,514.94 |
| Rate for Payer: Aetna Commercial |
$1,726.28
|
| Rate for Payer: Aetna Medicare |
$1,339.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,726.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,855.11
|
| Rate for Payer: BCBS Complete |
$850.99
|
| Rate for Payer: BCBS MAPPO |
$1,288.27
|
| Rate for Payer: BCN Commercial |
$2,044.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,288.27
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Cofinity Commercial |
$1,855.11
|
| Rate for Payer: Cofinity Commercial |
$1,726.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,288.27
|
| Rate for Payer: Healthscope Commercial |
$2,383.30
|
| Rate for Payer: Healthscope Commercial |
$2,061.23
|
| Rate for Payer: Mclaren Medicaid |
$810.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,352.68
|
| Rate for Payer: Meridian Medicaid |
$850.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,417.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,483.21
|
| Rate for Payer: Nomi Health Commercial |
$1,545.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,114.25
|
| Rate for Payer: PACE SWMI |
$1,288.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,288.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$810.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,198.83
|
| Rate for Payer: Priority Health Medicare |
$1,288.27
|
| Rate for Payer: Priority Health SBD |
$2,198.83
|
| Rate for Payer: Priority Health Tiered Network |
$2,198.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1,288.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,514.94
|
| Rate for Payer: UHC Core |
$2,514.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,288.27
|
| Rate for Payer: UHC Exchange |
$2,514.94
|
| Rate for Payer: UHC Medicaid |
$810.47
|
| Rate for Payer: UHCCP Medicaid |
$810.47
|
|
|
PR DIR RPR RUPTD ANEURYSM INNOMINATE/SUBCLAVIAN
|
Professional
|
Both
|
$3,022.00
|
|
|
Service Code
|
HCPCS 35022
|
| Min. Negotiated Rate |
$877.35 |
| Max. Negotiated Rate |
$2,563.63 |
| Rate for Payer: Priority Health SBD |
$2,279.69
|
| Rate for Payer: Aetna Commercial |
$1,838.84
|
| Rate for Payer: Aetna Medicare |
$1,427.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,838.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,976.07
|
| Rate for Payer: BCBS Complete |
$921.22
|
| Rate for Payer: BCBS MAPPO |
$1,372.27
|
| Rate for Payer: BCN Commercial |
$2,119.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,372.27
|
| Rate for Payer: Cash Price |
$2,417.60
|
| Rate for Payer: Cash Price |
$2,417.60
|
| Rate for Payer: Cofinity Commercial |
$1,976.07
|
| Rate for Payer: Cofinity Commercial |
$1,838.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,372.27
|
| Rate for Payer: Healthscope Commercial |
$2,538.70
|
| Rate for Payer: Healthscope Commercial |
$2,195.63
|
| Rate for Payer: Mclaren Medicaid |
$877.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,440.88
|
| Rate for Payer: Meridian Medicaid |
$921.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,509.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,546.57
|
| Rate for Payer: Nomi Health Commercial |
$1,646.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,266.50
|
| Rate for Payer: PACE SWMI |
$1,372.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,372.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$877.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,279.69
|
| Rate for Payer: Priority Health Medicare |
$1,372.27
|
| Rate for Payer: Priority Health Tiered Network |
$2,279.69
|
| Rate for Payer: Railroad Medicare Medicare |
$1,372.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,563.63
|
| Rate for Payer: UHC Core |
$2,563.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,372.27
|
| Rate for Payer: UHC Exchange |
$2,563.63
|
| Rate for Payer: UHC Medicaid |
$877.35
|
| Rate for Payer: UHCCP Medicaid |
$877.35
|
|
|
PR DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY
|
Professional
|
Both
|
$3,527.00
|
|
|
Service Code
|
HCPCS 35045
|
| Min. Negotiated Rate |
$555.50 |
| Max. Negotiated Rate |
$2,645.25 |
| Rate for Payer: Aetna Commercial |
$1,176.63
|
| Rate for Payer: Aetna Medicare |
$913.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,176.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,264.44
|
| Rate for Payer: BCBS Complete |
$583.27
|
| Rate for Payer: BCBS MAPPO |
$878.08
|
| Rate for Payer: BCN Commercial |
$1,418.75
|
| Rate for Payer: BCN Medicare Advantage |
$878.08
|
| Rate for Payer: Cash Price |
$2,821.60
|
| Rate for Payer: Cash Price |
$2,821.60
|
| Rate for Payer: Cofinity Commercial |
$1,264.44
|
| Rate for Payer: Cofinity Commercial |
$1,176.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$878.08
|
| Rate for Payer: Healthscope Commercial |
$1,624.45
|
| Rate for Payer: Healthscope Commercial |
$1,404.93
|
| Rate for Payer: Mclaren Medicaid |
$555.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$921.98
|
| Rate for Payer: Meridian Medicaid |
$583.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$965.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,720.55
|
| Rate for Payer: Nomi Health Commercial |
$1,053.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,645.25
|
| Rate for Payer: PACE SWMI |
$878.08
|
| Rate for Payer: PHP Medicare Advantage |
$878.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$555.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,525.68
|
| Rate for Payer: Priority Health Medicare |
$878.08
|
| Rate for Payer: Priority Health SBD |
$1,525.68
|
| Rate for Payer: Priority Health Tiered Network |
$1,525.68
|
| Rate for Payer: Railroad Medicare Medicare |
$878.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,752.23
|
| Rate for Payer: UHC Core |
$1,752.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$878.08
|
| Rate for Payer: UHC Exchange |
$1,752.23
|
| Rate for Payer: UHC Medicaid |
$555.50
|
| Rate for Payer: UHCCP Medicaid |
$555.50
|
|
|
PR DISARTICULATION HIP
|
Professional
|
Both
|
$5,595.00
|
|
|
Service Code
|
HCPCS 27295
|
| Min. Negotiated Rate |
$731.44 |
| Max. Negotiated Rate |
$4,196.25 |
| Rate for Payer: Aetna Commercial |
$1,518.88
|
| Rate for Payer: Aetna Medicare |
$1,178.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,632.23
|
| Rate for Payer: BCBS Complete |
$768.01
|
| Rate for Payer: BCBS MAPPO |
$1,133.49
|
| Rate for Payer: BCN Commercial |
$1,891.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.49
|
| Rate for Payer: Cash Price |
$4,476.00
|
| Rate for Payer: Cash Price |
$4,476.00
|
| Rate for Payer: Cofinity Commercial |
$1,632.23
|
| Rate for Payer: Cofinity Commercial |
$1,518.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.49
|
| Rate for Payer: Healthscope Commercial |
$2,096.96
|
| Rate for Payer: Healthscope Commercial |
$1,813.58
|
| Rate for Payer: Mclaren Medicaid |
$731.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,190.16
|
| Rate for Payer: Meridian Medicaid |
$768.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,246.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,236.81
|
| Rate for Payer: Nomi Health Commercial |
$1,360.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,196.25
|
| Rate for Payer: PACE SWMI |
$1,133.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,133.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$731.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,022.31
|
| Rate for Payer: Priority Health Medicare |
$1,133.49
|
| Rate for Payer: Priority Health SBD |
$2,022.31
|
| Rate for Payer: Priority Health Tiered Network |
$2,022.31
|
| Rate for Payer: Railroad Medicare Medicare |
$1,133.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,219.25
|
| Rate for Payer: UHC Core |
$2,219.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,133.49
|
| Rate for Payer: UHC Exchange |
$2,219.25
|
| Rate for Payer: UHC Medicaid |
$731.44
|
| Rate for Payer: UHCCP Medicaid |
$731.44
|
|
|
PR DISARTICULATION KNEE
|
Professional
|
Both
|
$3,021.00
|
|
|
Service Code
|
HCPCS 27598
|
| Min. Negotiated Rate |
$411.52 |
| Max. Negotiated Rate |
$2,265.75 |
| Rate for Payer: Aetna Commercial |
$857.89
|
| Rate for Payer: Aetna Medicare |
$665.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.92
|
| Rate for Payer: BCBS Complete |
$432.10
|
| Rate for Payer: BCBS MAPPO |
$640.22
|
| Rate for Payer: BCN Commercial |
$1,044.76
|
| Rate for Payer: BCN Medicare Advantage |
$640.22
|
| Rate for Payer: Cash Price |
$2,416.80
|
| Rate for Payer: Cash Price |
$2,416.80
|
| Rate for Payer: Cofinity Commercial |
$921.92
|
| Rate for Payer: Cofinity Commercial |
$857.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.22
|
| Rate for Payer: Healthscope Commercial |
$1,184.41
|
| Rate for Payer: Healthscope Commercial |
$1,024.35
|
| Rate for Payer: Mclaren Medicaid |
$411.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.23
|
| Rate for Payer: Meridian Medicaid |
$432.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$704.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,239.71
|
| Rate for Payer: Nomi Health Commercial |
$768.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,265.75
|
| Rate for Payer: PACE SWMI |
$640.22
|
| Rate for Payer: PHP Medicare Advantage |
$640.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,116.82
|
| Rate for Payer: Priority Health Medicare |
$640.22
|
| Rate for Payer: Priority Health SBD |
$1,116.82
|
| Rate for Payer: Priority Health Tiered Network |
$1,116.82
|
| Rate for Payer: Railroad Medicare Medicare |
$640.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,256.82
|
| Rate for Payer: UHC Core |
$1,256.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$640.22
|
| Rate for Payer: UHC Exchange |
$1,256.82
|
| Rate for Payer: UHC Medicaid |
$411.52
|
| Rate for Payer: UHCCP Medicaid |
$411.52
|
|
|
PR DISARTICULATION SHOULDER
|
Professional
|
Both
|
$2,056.00
|
|
|
Service Code
|
HCPCS 23920
|
| Min. Negotiated Rate |
$659.66 |
| Max. Negotiated Rate |
$1,991.45 |
| Rate for Payer: Aetna Commercial |
$1,359.62
|
| Rate for Payer: Aetna Medicare |
$1,055.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,359.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.08
|
| Rate for Payer: BCBS Complete |
$692.64
|
| Rate for Payer: BCBS MAPPO |
$1,014.64
|
| Rate for Payer: BCN Commercial |
$1,704.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,014.64
|
| Rate for Payer: Cash Price |
$1,644.80
|
| Rate for Payer: Cash Price |
$1,644.80
|
| Rate for Payer: Cofinity Commercial |
$1,461.08
|
| Rate for Payer: Cofinity Commercial |
$1,359.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,014.64
|
| Rate for Payer: Healthscope Commercial |
$1,877.08
|
| Rate for Payer: Healthscope Commercial |
$1,623.42
|
| Rate for Payer: Mclaren Medicaid |
$659.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,065.37
|
| Rate for Payer: Meridian Medicaid |
$692.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,116.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,991.45
|
| Rate for Payer: Nomi Health Commercial |
$1,217.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,542.00
|
| Rate for Payer: PACE SWMI |
$1,014.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,014.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,821.63
|
| Rate for Payer: Priority Health Medicare |
$1,014.64
|
| Rate for Payer: Priority Health SBD |
$1,821.63
|
| Rate for Payer: Priority Health Tiered Network |
$1,821.63
|
| Rate for Payer: Railroad Medicare Medicare |
$1,014.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,969.28
|
| Rate for Payer: UHC Core |
$1,969.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,014.64
|
| Rate for Payer: UHC Exchange |
$1,969.28
|
| Rate for Payer: UHC Medicaid |
$659.66
|
| Rate for Payer: UHCCP Medicaid |
$659.66
|
|
|
PR DISARTICULATION THROUGH WRIST
|
Professional
|
Both
|
$1,475.00
|
|
|
Service Code
|
HCPCS 25920
|
| Min. Negotiated Rate |
$444.74 |
| Max. Negotiated Rate |
$1,294.74 |
| Rate for Payer: Aetna Commercial |
$905.57
|
| Rate for Payer: Aetna Medicare |
$702.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$905.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$973.15
|
| Rate for Payer: BCBS Complete |
$466.98
|
| Rate for Payer: BCBS MAPPO |
$675.80
|
| Rate for Payer: BCN Commercial |
$1,112.49
|
| Rate for Payer: BCN Medicare Advantage |
$675.80
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cash Price |
$1,180.00
|
| Rate for Payer: Cofinity Commercial |
$973.15
|
| Rate for Payer: Cofinity Commercial |
$905.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.80
|
| Rate for Payer: Healthscope Commercial |
$1,250.23
|
| Rate for Payer: Healthscope Commercial |
$1,081.28
|
| Rate for Payer: Mclaren Medicaid |
$444.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.59
|
| Rate for Payer: Meridian Medicaid |
$466.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$743.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,294.74
|
| Rate for Payer: Nomi Health Commercial |
$810.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,106.25
|
| Rate for Payer: PACE SWMI |
$675.80
|
| Rate for Payer: PHP Medicare Advantage |
$675.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,189.22
|
| Rate for Payer: Priority Health Medicare |
$675.80
|
| Rate for Payer: Priority Health SBD |
$1,189.22
|
| Rate for Payer: Priority Health Tiered Network |
$1,189.22
|
| Rate for Payer: Railroad Medicare Medicare |
$675.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,240.76
|
| Rate for Payer: UHC Core |
$1,240.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$675.80
|
| Rate for Payer: UHC Exchange |
$1,240.76
|
| Rate for Payer: UHC Medicaid |
$444.74
|
| Rate for Payer: UHCCP Medicaid |
$444.74
|
|
|
PR DISARTICULATION THRU WRIST RE-AMPUTATION
|
Professional
|
Both
|
$2,430.00
|
|
|
Service Code
|
HCPCS 25924
|
| Min. Negotiated Rate |
$434.73 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Aetna Commercial |
$885.16
|
| Rate for Payer: Aetna Medicare |
$686.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$885.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$951.22
|
| Rate for Payer: BCBS Complete |
$456.47
|
| Rate for Payer: BCBS MAPPO |
$660.57
|
| Rate for Payer: BCN Commercial |
$1,085.60
|
| Rate for Payer: BCN Medicare Advantage |
$660.57
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,944.00
|
| Rate for Payer: Cofinity Commercial |
$951.22
|
| Rate for Payer: Cofinity Commercial |
$885.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$660.57
|
| Rate for Payer: Healthscope Commercial |
$1,222.05
|
| Rate for Payer: Healthscope Commercial |
$1,056.91
|
| Rate for Payer: Mclaren Medicaid |
$434.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$693.60
|
| Rate for Payer: Meridian Medicaid |
$456.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$726.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,264.70
|
| Rate for Payer: Nomi Health Commercial |
$792.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,822.50
|
| Rate for Payer: PACE SWMI |
$660.57
|
| Rate for Payer: PHP Medicare Advantage |
$660.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,160.47
|
| Rate for Payer: Priority Health Medicare |
$660.57
|
| Rate for Payer: Priority Health SBD |
$1,160.47
|
| Rate for Payer: Priority Health Tiered Network |
$1,160.47
|
| Rate for Payer: Railroad Medicare Medicare |
$660.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,210.54
|
| Rate for Payer: UHC Core |
$1,210.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$660.57
|
| Rate for Payer: UHC Exchange |
$1,210.54
|
| Rate for Payer: UHC Medicaid |
$434.73
|
| Rate for Payer: UHCCP Medicaid |
$434.73
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC
|
Professional
|
Both
|
$5,918.00
|
|
|
Service Code
|
HCPCS 63075
|
| Min. Negotiated Rate |
$821.54 |
| Max. Negotiated Rate |
$4,438.50 |
| Rate for Payer: Priority Health SBD |
$2,389.35
|
| Rate for Payer: Aetna Commercial |
$1,711.80
|
| Rate for Payer: Aetna Medicare |
$1,328.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,711.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,839.54
|
| Rate for Payer: BCBS Complete |
$862.62
|
| Rate for Payer: BCBS MAPPO |
$1,277.46
|
| Rate for Payer: BCN Commercial |
$2,259.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,277.46
|
| Rate for Payer: Cash Price |
$4,734.40
|
| Rate for Payer: Cash Price |
$4,734.40
|
| Rate for Payer: Cofinity Commercial |
$1,839.54
|
| Rate for Payer: Cofinity Commercial |
$1,711.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,277.46
|
| Rate for Payer: Healthscope Commercial |
$2,363.30
|
| Rate for Payer: Healthscope Commercial |
$2,043.94
|
| Rate for Payer: Mclaren Medicaid |
$821.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,341.33
|
| Rate for Payer: Meridian Medicaid |
$862.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,405.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,438.60
|
| Rate for Payer: Nomi Health Commercial |
$1,532.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,438.50
|
| Rate for Payer: PACE SWMI |
$1,277.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,277.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$821.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,389.35
|
| Rate for Payer: Priority Health Medicare |
$1,277.46
|
| Rate for Payer: Priority Health Tiered Network |
$2,389.35
|
| Rate for Payer: Railroad Medicare Medicare |
$1,277.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,381.47
|
| Rate for Payer: UHC Core |
$2,381.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,277.46
|
| Rate for Payer: UHC Exchange |
$2,381.47
|
| Rate for Payer: UHC Medicaid |
$821.54
|
| Rate for Payer: UHCCP Medicaid |
$821.54
|
|
|
PR DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC
|
Professional
|
Both
|
$1,986.00
|
|
|
Service Code
|
HCPCS 63076
|
| Min. Negotiated Rate |
$138.45 |
| Max. Negotiated Rate |
$1,489.50 |
| Rate for Payer: Aetna Commercial |
$293.14
|
| Rate for Payer: Aetna Medicare |
$227.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.01
|
| Rate for Payer: BCBS Complete |
$145.37
|
| Rate for Payer: BCBS MAPPO |
$218.76
|
| Rate for Payer: BCN Commercial |
$401.00
|
| Rate for Payer: BCN Medicare Advantage |
$218.76
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cofinity Commercial |
$315.01
|
| Rate for Payer: Cofinity Commercial |
$293.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.76
|
| Rate for Payer: Healthscope Commercial |
$404.71
|
| Rate for Payer: Healthscope Commercial |
$350.02
|
| Rate for Payer: Mclaren Medicaid |
$138.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$229.70
|
| Rate for Payer: Meridian Medicaid |
$145.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$240.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$435.47
|
| Rate for Payer: Nomi Health Commercial |
$262.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,489.50
|
| Rate for Payer: PACE SWMI |
$218.76
|
| Rate for Payer: PHP Medicare Advantage |
$218.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$423.96
|
| Rate for Payer: Priority Health Medicare |
$218.76
|
| Rate for Payer: Priority Health SBD |
$423.96
|
| Rate for Payer: Priority Health Tiered Network |
$423.96
|
| Rate for Payer: Railroad Medicare Medicare |
$218.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$437.99
|
| Rate for Payer: UHC Core |
$437.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$218.76
|
| Rate for Payer: UHC Exchange |
$437.99
|
| Rate for Payer: UHC Medicaid |
$138.45
|
| Rate for Payer: UHCCP Medicaid |
$138.45
|
|
|
PR DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC
|
Professional
|
Both
|
$5,863.00
|
|
|
Service Code
|
HCPCS 63077
|
| Min. Negotiated Rate |
$836.45 |
| Max. Negotiated Rate |
$4,397.25 |
| Rate for Payer: Aetna Commercial |
$1,737.50
|
| Rate for Payer: Aetna Medicare |
$1,348.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,737.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,867.16
|
| Rate for Payer: BCBS Complete |
$878.27
|
| Rate for Payer: BCBS MAPPO |
$1,296.64
|
| Rate for Payer: BCN Commercial |
$2,420.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,296.64
|
| Rate for Payer: Cash Price |
$4,690.40
|
| Rate for Payer: Cash Price |
$4,690.40
|
| Rate for Payer: Cofinity Commercial |
$1,867.16
|
| Rate for Payer: Cofinity Commercial |
$1,737.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,296.64
|
| Rate for Payer: Healthscope Commercial |
$2,398.78
|
| Rate for Payer: Healthscope Commercial |
$2,074.62
|
| Rate for Payer: Mclaren Medicaid |
$836.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,361.47
|
| Rate for Payer: Meridian Medicaid |
$878.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,426.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,748.11
|
| Rate for Payer: Nomi Health Commercial |
$1,555.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,397.25
|
| Rate for Payer: PACE SWMI |
$1,296.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,296.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,559.40
|
| Rate for Payer: Priority Health Medicare |
$1,296.64
|
| Rate for Payer: Priority Health SBD |
$2,559.40
|
| Rate for Payer: Priority Health Tiered Network |
$2,559.40
|
| Rate for Payer: Railroad Medicare Medicare |
$1,296.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,661.31
|
| Rate for Payer: UHC Core |
$2,661.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,296.64
|
| Rate for Payer: UHC Exchange |
$2,661.31
|
| Rate for Payer: UHC Medicaid |
$836.45
|
| Rate for Payer: UHCCP Medicaid |
$836.45
|
|
|
PR DISCHRG MEDS RECONCILED W/CURRENT MED LIST
|
Professional
|
Both
|
$0.01
|
|
|
Service Code
|
HCPCS 1111F
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.00
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.01
|
|
|
PR DISEASE MANAGEMENT PROGRAM
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS S0315
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$354.75 |
| Rate for Payer: Aetna Commercial |
$85.00
|
| Rate for Payer: Aetna Medicare |
$236.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.00
|
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.75
|
|
|
PR DISEASE MGMT PER DIEM
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS S0317
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$1,000.00 |
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Commercial |
$175.00
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.00
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: BCN Commercial |
$1,000.00
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
|
|
PR DISE DYN EVAL SLEEP DISORDERED BREATHING FLX DX
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 42975
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$202.22 |
| Rate for Payer: Aetna Commercial |
$110.19
|
| Rate for Payer: Aetna Medicare |
$85.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.41
|
| Rate for Payer: BCBS Complete |
$55.91
|
| Rate for Payer: BCBS MAPPO |
$82.23
|
| Rate for Payer: BCN Commercial |
$145.41
|
| Rate for Payer: BCN Medicare Advantage |
$82.23
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$118.41
|
| Rate for Payer: Cofinity Commercial |
$110.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.23
|
| Rate for Payer: Healthscope Commercial |
$152.13
|
| Rate for Payer: Healthscope Commercial |
$131.57
|
| Rate for Payer: Mclaren Medicaid |
$53.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$86.34
|
| Rate for Payer: Meridian Medicaid |
$55.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$90.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.72
|
| Rate for Payer: Nomi Health Commercial |
$98.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.50
|
| Rate for Payer: PACE SWMI |
$82.23
|
| Rate for Payer: PHP Medicare Advantage |
$82.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$177.17
|
| Rate for Payer: Priority Health Medicare |
$82.23
|
| Rate for Payer: Priority Health SBD |
$177.17
|
| Rate for Payer: Priority Health Tiered Network |
$177.17
|
| Rate for Payer: Railroad Medicare Medicare |
$82.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.22
|
| Rate for Payer: UHC Core |
$202.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$82.23
|
| Rate for Payer: UHC Exchange |
$202.22
|
| Rate for Payer: UHC Medicaid |
$53.25
|
| Rate for Payer: UHCCP Medicaid |
$53.25
|
|
|
PR DISPENSING FEE BINAURAL
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS V5160
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$484.34 |
| Rate for Payer: Aetna Commercial |
$289.59
|
| Rate for Payer: Aetna Medicare |
$250.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$289.59
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$421.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.34
|
| Rate for Payer: UHC Core |
$484.34
|
| Rate for Payer: UHC Exchange |
$484.34
|
|
|
PR DISPENSING FEE, MONAURAL
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS V5241
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.01
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
|
|
PR DISP FEE CONTRALATERAL BINAU
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS V5240
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$415.22 |
| Rate for Payer: Aetna Commercial |
$248.26
|
| Rate for Payer: Aetna Medicare |
$250.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.26
|
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.22
|
| Rate for Payer: UHC Core |
$415.22
|
| Rate for Payer: UHC Exchange |
$415.22
|
|
|
PR DISP FEE CONTRALATERAL MONAU
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS V5200
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$400.87 |
| Rate for Payer: Aetna Commercial |
$239.68
|
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.68
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.87
|
| Rate for Payer: UHC Core |
$400.87
|
| Rate for Payer: UHC Exchange |
$400.87
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
HCPCS 38542
|
| Min. Negotiated Rate |
$299.48 |
| Max. Negotiated Rate |
$1,050.90 |
| Rate for Payer: Aetna Commercial |
$617.58
|
| Rate for Payer: Aetna Medicare |
$479.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$617.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$663.67
|
| Rate for Payer: BCBS Complete |
$314.45
|
| Rate for Payer: BCBS MAPPO |
$460.88
|
| Rate for Payer: BCN Commercial |
$789.79
|
| Rate for Payer: BCN Medicare Advantage |
$460.88
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cofinity Commercial |
$663.67
|
| Rate for Payer: Cofinity Commercial |
$617.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.88
|
| Rate for Payer: Healthscope Commercial |
$852.63
|
| Rate for Payer: Healthscope Commercial |
$737.41
|
| Rate for Payer: Mclaren Medicaid |
$299.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.92
|
| Rate for Payer: Meridian Medicaid |
$314.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$506.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$928.40
|
| Rate for Payer: Nomi Health Commercial |
$553.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$724.50
|
| Rate for Payer: PACE SWMI |
$460.88
|
| Rate for Payer: PHP Medicare Advantage |
$460.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,050.90
|
| Rate for Payer: Priority Health Medicare |
$460.88
|
| Rate for Payer: Priority Health SBD |
$1,050.90
|
| Rate for Payer: Priority Health Tiered Network |
$1,050.90
|
| Rate for Payer: Railroad Medicare Medicare |
$460.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$903.58
|
| Rate for Payer: UHC Core |
$903.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$460.88
|
| Rate for Payer: UHC Exchange |
$903.58
|
| Rate for Payer: UHC Medicaid |
$299.48
|
| Rate for Payer: UHCCP Medicaid |
$299.48
|
|
|
PR DIS SITE TELE SVCS RHC/FQHC
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS G2025
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Aetna Commercial |
$95.30
|
| Rate for Payer: Aetna Medicare |
$97.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.30
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCN Commercial |
$145.41
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.28
|
| Rate for Payer: UHC Core |
$126.28
|
| Rate for Payer: UHC Exchange |
$126.28
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 92587
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$66.75 |
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: Aetna Medicare |
$22.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.66
|
| Rate for Payer: BCBS MAPPO |
$21.29
|
| Rate for Payer: BCN Commercial |
$32.37
|
| Rate for Payer: BCN Medicare Advantage |
$21.29
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$30.66
|
| Rate for Payer: Cofinity Commercial |
$28.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.29
|
| Rate for Payer: Healthscope Commercial |
$34.06
|
| Rate for Payer: Healthscope Commercial |
$39.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.85
|
| Rate for Payer: Nomi Health Commercial |
$25.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.75
|
| Rate for Payer: PACE SWMI |
$21.29
|
| Rate for Payer: PHP Medicare Advantage |
$21.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29.86
|
| Rate for Payer: Priority Health Medicare |
$21.29
|
| Rate for Payer: Priority Health SBD |
$29.86
|
| Rate for Payer: Priority Health Tiered Network |
$29.86
|
| Rate for Payer: Railroad Medicare Medicare |
$21.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.32
|
| Rate for Payer: UHC Core |
$35.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.29
|
| Rate for Payer: UHC Exchange |
$35.32
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 92588
|
| Min. Negotiated Rate |
$32.54 |
| Max. Negotiated Rate |
$60.20 |
| Rate for Payer: Aetna Commercial |
$43.60
|
| Rate for Payer: Aetna Medicare |
$33.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.60
|
| Rate for Payer: BCBS MAPPO |
$32.54
|
| Rate for Payer: BCN Commercial |
$49.80
|
| Rate for Payer: BCN Medicare Advantage |
$32.54
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$46.86
|
| Rate for Payer: Cofinity Commercial |
$43.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.54
|
| Rate for Payer: Healthscope Commercial |
$52.06
|
| Rate for Payer: Healthscope Commercial |
$60.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.43
|
| Rate for Payer: Nomi Health Commercial |
$39.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
| Rate for Payer: PACE SWMI |
$32.54
|
| Rate for Payer: PHP Medicare Advantage |
$32.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$45.93
|
| Rate for Payer: Priority Health Medicare |
$32.54
|
| Rate for Payer: Priority Health SBD |
$45.93
|
| Rate for Payer: Priority Health Tiered Network |
$45.93
|
| Rate for Payer: Railroad Medicare Medicare |
$32.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.85
|
| Rate for Payer: UHC Core |
$53.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.54
|
| Rate for Payer: UHC Exchange |
$53.85
|
|
