|
PR DSTRJ LESION PENIS SIMPLE ELECTRODESICCATION
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 54055
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$167.42 |
| Rate for Payer: Aetna Commercial |
$112.35
|
| Rate for Payer: Aetna Medicare |
$87.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.73
|
| Rate for Payer: BCBS Complete |
$58.15
|
| Rate for Payer: BCBS MAPPO |
$83.84
|
| Rate for Payer: BCN Commercial |
$146.91
|
| Rate for Payer: BCN Medicare Advantage |
$83.84
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$120.73
|
| Rate for Payer: Cofinity Commercial |
$112.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.84
|
| Rate for Payer: Healthscope Commercial |
$155.10
|
| Rate for Payer: Healthscope Commercial |
$134.14
|
| Rate for Payer: Mclaren Medicaid |
$55.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.03
|
| Rate for Payer: Meridian Medicaid |
$58.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.42
|
| Rate for Payer: Nomi Health Commercial |
$100.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.75
|
| Rate for Payer: PACE SWMI |
$83.84
|
| Rate for Payer: PHP Medicare Advantage |
$83.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$160.02
|
| Rate for Payer: Priority Health Medicare |
$83.84
|
| Rate for Payer: Priority Health SBD |
$160.02
|
| Rate for Payer: Priority Health Tiered Network |
$160.02
|
| Rate for Payer: Railroad Medicare Medicare |
$83.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.78
|
| Rate for Payer: UHC Core |
$160.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.84
|
| Rate for Payer: UHC Exchange |
$160.78
|
| Rate for Payer: UHC Medicaid |
$55.38
|
| Rate for Payer: UHCCP Medicaid |
$55.38
|
|
|
PR DSTRJ LESION PENIS SIMPLE LASER
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 54057
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$118.01
|
| Rate for Payer: Aetna Medicare |
$91.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.82
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS MAPPO |
$88.07
|
| Rate for Payer: BCN Commercial |
$145.91
|
| Rate for Payer: BCN Medicare Advantage |
$88.07
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$126.82
|
| Rate for Payer: Cofinity Commercial |
$118.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.07
|
| Rate for Payer: Healthscope Commercial |
$162.93
|
| Rate for Payer: Healthscope Commercial |
$140.91
|
| Rate for Payer: Mclaren Medicaid |
$58.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.47
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.98
|
| Rate for Payer: Nomi Health Commercial |
$105.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.00
|
| Rate for Payer: PACE SWMI |
$88.07
|
| Rate for Payer: PHP Medicare Advantage |
$88.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$158.95
|
| Rate for Payer: Priority Health Medicare |
$88.07
|
| Rate for Payer: Priority Health SBD |
$158.95
|
| Rate for Payer: Priority Health Tiered Network |
$158.95
|
| Rate for Payer: Railroad Medicare Medicare |
$88.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.86
|
| Rate for Payer: UHC Core |
$163.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$88.07
|
| Rate for Payer: UHC Exchange |
$163.86
|
| Rate for Payer: UHC Medicaid |
$58.15
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
|
|
PR DSTRJ LESION PENIS SIMPLE SURG EXCISION
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 54060
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna Commercial |
$159.81
|
| Rate for Payer: Aetna Medicare |
$124.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.73
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: BCBS MAPPO |
$119.26
|
| Rate for Payer: BCN Commercial |
$199.69
|
| Rate for Payer: BCN Medicare Advantage |
$119.26
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$171.73
|
| Rate for Payer: Cofinity Commercial |
$159.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.26
|
| Rate for Payer: Healthscope Commercial |
$220.63
|
| Rate for Payer: Healthscope Commercial |
$190.82
|
| Rate for Payer: Mclaren Medicaid |
$78.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.22
|
| Rate for Payer: Meridian Medicaid |
$82.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$131.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.23
|
| Rate for Payer: Nomi Health Commercial |
$143.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.50
|
| Rate for Payer: PACE SWMI |
$119.26
|
| Rate for Payer: PHP Medicare Advantage |
$119.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$78.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$217.53
|
| Rate for Payer: Priority Health Medicare |
$119.26
|
| Rate for Payer: Priority Health SBD |
$217.53
|
| Rate for Payer: Priority Health Tiered Network |
$217.53
|
| Rate for Payer: Railroad Medicare Medicare |
$119.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.72
|
| Rate for Payer: UHC Core |
$226.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$119.26
|
| Rate for Payer: UHC Exchange |
$226.72
|
| Rate for Payer: UHC Medicaid |
$78.17
|
| Rate for Payer: UHCCP Medicaid |
$78.17
|
|
|
PR DSTRJ LES/SCAR VESTIBULE MOUTH PHYSICAL METHS
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 40820
|
| Min. Negotiated Rate |
$97.77 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Aetna Commercial |
$194.11
|
| Rate for Payer: Aetna Medicare |
$150.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.60
|
| Rate for Payer: BCBS Complete |
$102.66
|
| Rate for Payer: BCBS MAPPO |
$144.86
|
| Rate for Payer: BCN Commercial |
$247.49
|
| Rate for Payer: BCN Medicare Advantage |
$144.86
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$208.60
|
| Rate for Payer: Cofinity Commercial |
$194.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.86
|
| Rate for Payer: Healthscope Commercial |
$267.99
|
| Rate for Payer: Healthscope Commercial |
$231.78
|
| Rate for Payer: Mclaren Medicaid |
$97.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.10
|
| Rate for Payer: Meridian Medicaid |
$102.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$159.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.41
|
| Rate for Payer: Nomi Health Commercial |
$173.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.25
|
| Rate for Payer: PACE SWMI |
$144.86
|
| Rate for Payer: PHP Medicare Advantage |
$144.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$301.55
|
| Rate for Payer: Priority Health Medicare |
$144.86
|
| Rate for Payer: Priority Health SBD |
$301.55
|
| Rate for Payer: Priority Health Tiered Network |
$301.55
|
| Rate for Payer: Railroad Medicare Medicare |
$144.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.49
|
| Rate for Payer: UHC Core |
$282.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$144.86
|
| Rate for Payer: UHC Exchange |
$282.49
|
| Rate for Payer: UHC Medicaid |
$97.77
|
| Rate for Payer: UHCCP Medicaid |
$97.77
|
|
|
PR DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 17276
|
| Min. Negotiated Rate |
$106.93 |
| Max. Negotiated Rate |
$438.75 |
| Rate for Payer: Aetna Commercial |
$220.76
|
| Rate for Payer: Aetna Medicare |
$171.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.24
|
| Rate for Payer: BCBS Complete |
$112.28
|
| Rate for Payer: BCBS MAPPO |
$164.75
|
| Rate for Payer: BCN Commercial |
$239.15
|
| Rate for Payer: BCN Medicare Advantage |
$164.75
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cofinity Commercial |
$237.24
|
| Rate for Payer: Cofinity Commercial |
$220.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.75
|
| Rate for Payer: Healthscope Commercial |
$304.79
|
| Rate for Payer: Healthscope Commercial |
$263.60
|
| Rate for Payer: Mclaren Medicaid |
$106.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.99
|
| Rate for Payer: Meridian Medicaid |
$112.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$181.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.02
|
| Rate for Payer: Nomi Health Commercial |
$197.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.75
|
| Rate for Payer: PACE SWMI |
$164.75
|
| Rate for Payer: PHP Medicare Advantage |
$164.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$277.57
|
| Rate for Payer: Priority Health Medicare |
$164.75
|
| Rate for Payer: Priority Health SBD |
$277.57
|
| Rate for Payer: Priority Health Tiered Network |
$277.57
|
| Rate for Payer: Railroad Medicare Medicare |
$164.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$355.69
|
| Rate for Payer: UHC Core |
$355.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$164.75
|
| Rate for Payer: UHC Exchange |
$355.69
|
| Rate for Payer: UHC Medicaid |
$106.93
|
| Rate for Payer: UHCCP Medicaid |
$106.93
|
|
|
PR DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR
|
Professional
|
Both
|
$1,248.00
|
|
|
Service Code
|
HCPCS 64610
|
| Min. Negotiated Rate |
$286.49 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$598.22
|
| Rate for Payer: Aetna Medicare |
$464.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.86
|
| Rate for Payer: BCBS Complete |
$300.81
|
| Rate for Payer: BCBS MAPPO |
$446.43
|
| Rate for Payer: BCN Commercial |
$726.55
|
| Rate for Payer: BCN Medicare Advantage |
$446.43
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cash Price |
$998.40
|
| Rate for Payer: Cofinity Commercial |
$642.86
|
| Rate for Payer: Cofinity Commercial |
$598.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$446.43
|
| Rate for Payer: Healthscope Commercial |
$825.90
|
| Rate for Payer: Healthscope Commercial |
$714.29
|
| Rate for Payer: Mclaren Medicaid |
$286.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$468.75
|
| Rate for Payer: Meridian Medicaid |
$300.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$491.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$867.87
|
| Rate for Payer: Nomi Health Commercial |
$535.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$936.00
|
| Rate for Payer: PACE SWMI |
$446.43
|
| Rate for Payer: PHP Medicare Advantage |
$446.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$843.89
|
| Rate for Payer: Priority Health Medicare |
$446.43
|
| Rate for Payer: Priority Health SBD |
$843.89
|
| Rate for Payer: Priority Health Tiered Network |
$843.89
|
| Rate for Payer: Railroad Medicare Medicare |
$446.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$853.71
|
| Rate for Payer: UHC Core |
$853.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$446.43
|
| Rate for Payer: UHC Exchange |
$853.71
|
| Rate for Payer: UHC Medicaid |
$286.49
|
| Rate for Payer: UHCCP Medicaid |
$286.49
|
|
|
PR DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE
|
Professional
|
Both
|
$795.00
|
|
|
Service Code
|
HCPCS 64620
|
| Min. Negotiated Rate |
$106.71 |
| Max. Negotiated Rate |
$596.25 |
| Rate for Payer: Aetna Commercial |
$219.18
|
| Rate for Payer: Aetna Medicare |
$170.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.54
|
| Rate for Payer: BCBS Complete |
$112.05
|
| Rate for Payer: BCBS MAPPO |
$163.57
|
| Rate for Payer: BCN Commercial |
$267.91
|
| Rate for Payer: BCN Medicare Advantage |
$163.57
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cash Price |
$636.00
|
| Rate for Payer: Cofinity Commercial |
$235.54
|
| Rate for Payer: Cofinity Commercial |
$219.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.57
|
| Rate for Payer: Healthscope Commercial |
$302.60
|
| Rate for Payer: Healthscope Commercial |
$261.71
|
| Rate for Payer: Mclaren Medicaid |
$106.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.75
|
| Rate for Payer: Meridian Medicaid |
$112.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$179.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.40
|
| Rate for Payer: Nomi Health Commercial |
$196.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$596.25
|
| Rate for Payer: PACE SWMI |
$163.57
|
| Rate for Payer: PHP Medicare Advantage |
$163.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$311.17
|
| Rate for Payer: Priority Health Medicare |
$163.57
|
| Rate for Payer: Priority Health SBD |
$311.17
|
| Rate for Payer: Priority Health Tiered Network |
$311.17
|
| Rate for Payer: Railroad Medicare Medicare |
$163.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.91
|
| Rate for Payer: UHC Core |
$305.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.57
|
| Rate for Payer: UHC Exchange |
$305.91
|
| Rate for Payer: UHC Medicaid |
$106.71
|
| Rate for Payer: UHCCP Medicaid |
$106.71
|
|
|
PR DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 64640
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$469.50 |
| Rate for Payer: Aetna Commercial |
$146.13
|
| Rate for Payer: Aetna Medicare |
$113.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.03
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS MAPPO |
$109.05
|
| Rate for Payer: BCN Commercial |
$180.27
|
| Rate for Payer: BCN Medicare Advantage |
$109.05
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cofinity Commercial |
$157.03
|
| Rate for Payer: Cofinity Commercial |
$146.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.05
|
| Rate for Payer: Healthscope Commercial |
$201.74
|
| Rate for Payer: Healthscope Commercial |
$174.48
|
| Rate for Payer: Mclaren Medicaid |
$71.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.50
|
| Rate for Payer: Meridian Medicaid |
$74.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$119.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.14
|
| Rate for Payer: Nomi Health Commercial |
$130.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$469.50
|
| Rate for Payer: PACE SWMI |
$109.05
|
| Rate for Payer: PHP Medicare Advantage |
$109.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$209.37
|
| Rate for Payer: Priority Health Medicare |
$109.05
|
| Rate for Payer: Priority Health SBD |
$209.37
|
| Rate for Payer: Priority Health Tiered Network |
$209.37
|
| Rate for Payer: Railroad Medicare Medicare |
$109.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.72
|
| Rate for Payer: UHC Core |
$205.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$109.05
|
| Rate for Payer: UHC Exchange |
$205.72
|
| Rate for Payer: UHC Medicaid |
$71.14
|
| Rate for Payer: UHCCP Medicaid |
$71.14
|
|
|
PR DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 64632
|
| Min. Negotiated Rate |
$39.41 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna Commercial |
$81.14
|
| Rate for Payer: Aetna Medicare |
$62.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.19
|
| Rate for Payer: BCBS Complete |
$41.38
|
| Rate for Payer: BCBS MAPPO |
$60.55
|
| Rate for Payer: BCN Commercial |
$101.59
|
| Rate for Payer: BCN Medicare Advantage |
$60.55
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$81.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.55
|
| Rate for Payer: Healthscope Commercial |
$96.88
|
| Rate for Payer: Healthscope Commercial |
$112.02
|
| Rate for Payer: Mclaren Medicaid |
$39.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.58
|
| Rate for Payer: Meridian Medicaid |
$41.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.70
|
| Rate for Payer: Nomi Health Commercial |
$72.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.25
|
| Rate for Payer: PACE SWMI |
$60.55
|
| Rate for Payer: PHP Medicare Advantage |
$60.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$118.00
|
| Rate for Payer: Priority Health Medicare |
$60.55
|
| Rate for Payer: Priority Health SBD |
$118.00
|
| Rate for Payer: Priority Health Tiered Network |
$118.00
|
| Rate for Payer: Railroad Medicare Medicare |
$60.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.51
|
| Rate for Payer: UHC Core |
$118.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60.55
|
| Rate for Payer: UHC Exchange |
$118.51
|
| Rate for Payer: UHC Medicaid |
$39.41
|
| Rate for Payer: UHCCP Medicaid |
$39.41
|
|
|
PR DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
HCPCS 64680
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$530.25 |
| Rate for Payer: Aetna Commercial |
$192.02
|
| Rate for Payer: Aetna Medicare |
$149.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.35
|
| Rate for Payer: BCBS Complete |
$98.19
|
| Rate for Payer: BCBS MAPPO |
$143.30
|
| Rate for Payer: BCN Commercial |
$241.52
|
| Rate for Payer: BCN Medicare Advantage |
$143.30
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cofinity Commercial |
$206.35
|
| Rate for Payer: Cofinity Commercial |
$192.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$143.30
|
| Rate for Payer: Healthscope Commercial |
$265.11
|
| Rate for Payer: Healthscope Commercial |
$229.28
|
| Rate for Payer: Mclaren Medicaid |
$93.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.47
|
| Rate for Payer: Meridian Medicaid |
$98.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$157.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.28
|
| Rate for Payer: Nomi Health Commercial |
$171.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.25
|
| Rate for Payer: PACE SWMI |
$143.30
|
| Rate for Payer: PHP Medicare Advantage |
$143.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.52
|
| Rate for Payer: Priority Health Medicare |
$143.30
|
| Rate for Payer: Priority Health SBD |
$280.52
|
| Rate for Payer: Priority Health Tiered Network |
$280.52
|
| Rate for Payer: Railroad Medicare Medicare |
$143.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.38
|
| Rate for Payer: UHC Core |
$283.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$143.30
|
| Rate for Payer: UHC Exchange |
$283.38
|
| Rate for Payer: UHC Medicaid |
$93.51
|
| Rate for Payer: UHCCP Medicaid |
$93.51
|
|
|
PR DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 64681
|
| Min. Negotiated Rate |
$123.11 |
| Max. Negotiated Rate |
$705.00 |
| Rate for Payer: Aetna Commercial |
$253.46
|
| Rate for Payer: Aetna Medicare |
$196.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.38
|
| Rate for Payer: BCBS Complete |
$129.27
|
| Rate for Payer: BCBS MAPPO |
$189.15
|
| Rate for Payer: BCN Commercial |
$331.16
|
| Rate for Payer: BCN Medicare Advantage |
$189.15
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cofinity Commercial |
$272.38
|
| Rate for Payer: Cofinity Commercial |
$253.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.15
|
| Rate for Payer: Healthscope Commercial |
$349.93
|
| Rate for Payer: Healthscope Commercial |
$302.64
|
| Rate for Payer: Mclaren Medicaid |
$123.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.61
|
| Rate for Payer: Meridian Medicaid |
$129.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$208.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.55
|
| Rate for Payer: Nomi Health Commercial |
$226.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$705.00
|
| Rate for Payer: PACE SWMI |
$189.15
|
| Rate for Payer: PHP Medicare Advantage |
$189.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$384.63
|
| Rate for Payer: Priority Health Medicare |
$189.15
|
| Rate for Payer: Priority Health SBD |
$384.63
|
| Rate for Payer: Priority Health Tiered Network |
$384.63
|
| Rate for Payer: Railroad Medicare Medicare |
$189.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.71
|
| Rate for Payer: UHC Core |
$455.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$189.15
|
| Rate for Payer: UHC Exchange |
$455.71
|
| Rate for Payer: UHC Medicaid |
$123.11
|
| Rate for Payer: UHCCP Medicaid |
$123.11
|
|
|
PR DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH
|
Professional
|
Both
|
$926.00
|
|
|
Service Code
|
HCPCS 64600
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$694.50 |
| Rate for Payer: Aetna Commercial |
$300.00
|
| Rate for Payer: Aetna Medicare |
$232.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.39
|
| Rate for Payer: BCBS Complete |
$152.08
|
| Rate for Payer: BCBS MAPPO |
$223.88
|
| Rate for Payer: BCN Commercial |
$363.03
|
| Rate for Payer: BCN Medicare Advantage |
$223.88
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cofinity Commercial |
$322.39
|
| Rate for Payer: Cofinity Commercial |
$300.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.88
|
| Rate for Payer: Healthscope Commercial |
$414.18
|
| Rate for Payer: Healthscope Commercial |
$358.21
|
| Rate for Payer: Mclaren Medicaid |
$144.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$235.07
|
| Rate for Payer: Meridian Medicaid |
$152.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$246.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.17
|
| Rate for Payer: Nomi Health Commercial |
$268.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$694.50
|
| Rate for Payer: PACE SWMI |
$223.88
|
| Rate for Payer: PHP Medicare Advantage |
$223.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$421.66
|
| Rate for Payer: Priority Health Medicare |
$223.88
|
| Rate for Payer: Priority Health SBD |
$421.66
|
| Rate for Payer: Priority Health Tiered Network |
$421.66
|
| Rate for Payer: Railroad Medicare Medicare |
$223.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.86
|
| Rate for Payer: UHC Core |
$400.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$223.88
|
| Rate for Payer: UHC Exchange |
$400.86
|
| Rate for Payer: UHC Medicaid |
$144.84
|
| Rate for Payer: UHCCP Medicaid |
$144.84
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 64634
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$76.88
|
| Rate for Payer: Aetna Medicare |
$59.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.61
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$57.37
|
| Rate for Payer: BCN Commercial |
$99.60
|
| Rate for Payer: BCN Medicare Advantage |
$57.37
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$82.61
|
| Rate for Payer: Cofinity Commercial |
$76.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.37
|
| Rate for Payer: Healthscope Commercial |
$91.79
|
| Rate for Payer: Healthscope Commercial |
$106.13
|
| Rate for Payer: Mclaren Medicaid |
$36.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.24
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.85
|
| Rate for Payer: Nomi Health Commercial |
$68.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.00
|
| Rate for Payer: PACE SWMI |
$57.37
|
| Rate for Payer: PHP Medicare Advantage |
$57.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$115.67
|
| Rate for Payer: Priority Health Medicare |
$57.37
|
| Rate for Payer: Priority Health SBD |
$115.67
|
| Rate for Payer: Priority Health Tiered Network |
$115.67
|
| Rate for Payer: Railroad Medicare Medicare |
$57.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.30
|
| Rate for Payer: UHC Core |
$120.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.37
|
| Rate for Payer: UHC Exchange |
$120.30
|
| Rate for Payer: UHC Medicaid |
$36.85
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 64636
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$259.50 |
| Rate for Payer: Aetna Commercial |
$67.58
|
| Rate for Payer: Aetna Medicare |
$52.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.62
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$50.43
|
| Rate for Payer: BCN Commercial |
$87.65
|
| Rate for Payer: BCN Medicare Advantage |
$50.43
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$72.62
|
| Rate for Payer: Cofinity Commercial |
$67.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.43
|
| Rate for Payer: Healthscope Commercial |
$93.30
|
| Rate for Payer: Healthscope Commercial |
$80.69
|
| Rate for Payer: Mclaren Medicaid |
$32.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.95
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.09
|
| Rate for Payer: Nomi Health Commercial |
$60.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.50
|
| Rate for Payer: PACE SWMI |
$50.43
|
| Rate for Payer: PHP Medicare Advantage |
$50.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$101.80
|
| Rate for Payer: Priority Health Medicare |
$50.43
|
| Rate for Payer: Priority Health SBD |
$101.80
|
| Rate for Payer: Priority Health Tiered Network |
$101.80
|
| Rate for Payer: Railroad Medicare Medicare |
$50.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.60
|
| Rate for Payer: UHC Core |
$105.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$50.43
|
| Rate for Payer: UHC Exchange |
$105.60
|
| Rate for Payer: UHC Medicaid |
$32.38
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
HCPCS 64633
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$480.75 |
| Rate for Payer: Aetna Commercial |
$226.78
|
| Rate for Payer: Aetna Medicare |
$176.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.71
|
| Rate for Payer: BCBS Complete |
$115.63
|
| Rate for Payer: BCBS MAPPO |
$169.24
|
| Rate for Payer: BCN Commercial |
$287.33
|
| Rate for Payer: BCN Medicare Advantage |
$169.24
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cash Price |
$512.80
|
| Rate for Payer: Cofinity Commercial |
$243.71
|
| Rate for Payer: Cofinity Commercial |
$226.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.24
|
| Rate for Payer: Healthscope Commercial |
$313.09
|
| Rate for Payer: Healthscope Commercial |
$270.78
|
| Rate for Payer: Mclaren Medicaid |
$110.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.70
|
| Rate for Payer: Meridian Medicaid |
$115.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.00
|
| Rate for Payer: Nomi Health Commercial |
$203.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$480.75
|
| Rate for Payer: PACE SWMI |
$169.24
|
| Rate for Payer: PHP Medicare Advantage |
$169.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$333.74
|
| Rate for Payer: Priority Health Medicare |
$169.24
|
| Rate for Payer: Priority Health SBD |
$333.74
|
| Rate for Payer: Priority Health Tiered Network |
$333.74
|
| Rate for Payer: Railroad Medicare Medicare |
$169.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$393.62
|
| Rate for Payer: UHC Core |
$393.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.24
|
| Rate for Payer: UHC Exchange |
$393.62
|
| Rate for Payer: UHC Medicaid |
$110.12
|
| Rate for Payer: UHCCP Medicaid |
$110.12
|
|
|
PR DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
HCPCS 64635
|
| Min. Negotiated Rate |
$110.33 |
| Max. Negotiated Rate |
$474.75 |
| Rate for Payer: Aetna Commercial |
$227.09
|
| Rate for Payer: Aetna Medicare |
$176.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.04
|
| Rate for Payer: BCBS Complete |
$115.85
|
| Rate for Payer: BCBS MAPPO |
$169.47
|
| Rate for Payer: BCN Commercial |
$287.33
|
| Rate for Payer: BCN Medicare Advantage |
$169.47
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cofinity Commercial |
$244.04
|
| Rate for Payer: Cofinity Commercial |
$227.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.47
|
| Rate for Payer: Healthscope Commercial |
$313.52
|
| Rate for Payer: Healthscope Commercial |
$271.15
|
| Rate for Payer: Mclaren Medicaid |
$110.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.94
|
| Rate for Payer: Meridian Medicaid |
$115.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.56
|
| Rate for Payer: Nomi Health Commercial |
$203.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.75
|
| Rate for Payer: PACE SWMI |
$169.47
|
| Rate for Payer: PHP Medicare Advantage |
$169.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$333.74
|
| Rate for Payer: Priority Health Medicare |
$169.47
|
| Rate for Payer: Priority Health SBD |
$333.74
|
| Rate for Payer: Priority Health Tiered Network |
$333.74
|
| Rate for Payer: Railroad Medicare Medicare |
$169.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.04
|
| Rate for Payer: UHC Core |
$388.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.47
|
| Rate for Payer: UHC Exchange |
$388.04
|
| Rate for Payer: UHC Medicaid |
$110.33
|
| Rate for Payer: UHCCP Medicaid |
$110.33
|
|
|
PR DTAP-HEPB-IPV VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 90723
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$103.62 |
| Rate for Payer: Aetna Commercial |
$95.50
|
| Rate for Payer: Aetna Medicare |
$63.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.50
|
| Rate for Payer: BCBS Trust/PPO |
$103.62
|
| Rate for Payer: BCN Commercial |
$101.34
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.62
|
| Rate for Payer: UHC Core |
$103.62
|
| Rate for Payer: UHC Exchange |
$103.62
|
|
|
PR DTAP-IPV-HIB-HEPB VACCINE INTRAMUSCULAR
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 90697
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$154.01
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.01
|
| Rate for Payer: BCBS Trust/PPO |
$167.36
|
| Rate for Payer: BCN Commercial |
$153.46
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.44
|
| Rate for Payer: UHC Core |
$167.44
|
| Rate for Payer: UHC Exchange |
$167.44
|
|
|
PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 90698
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$130.53 |
| Rate for Payer: Aetna Commercial |
$118.20
|
| Rate for Payer: Aetna Medicare |
$56.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.20
|
| Rate for Payer: BCBS Trust/PPO |
$130.53
|
| Rate for Payer: BCN Commercial |
$117.52
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.53
|
| Rate for Payer: UHC Core |
$130.53
|
| Rate for Payer: UHC Exchange |
$130.53
|
|
|
PR DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 90696
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$64.93 |
| Rate for Payer: Aetna Commercial |
$62.89
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.89
|
| Rate for Payer: BCBS Trust/PPO |
$62.82
|
| Rate for Payer: BCN Commercial |
$63.04
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.93
|
| Rate for Payer: UHC Core |
$64.93
|
| Rate for Payer: UHC Exchange |
$64.93
|
|
|
PR DTP/HIB VACCINE,IM
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 90720
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.00
|
|
|
PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 90702
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$79.01 |
| Rate for Payer: Aetna Commercial |
$67.16
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.16
|
| Rate for Payer: BCBS Trust/PPO |
$66.09
|
| Rate for Payer: BCN Commercial |
$79.01
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.09
|
| Rate for Payer: UHC Core |
$66.09
|
| Rate for Payer: UHC Exchange |
$66.09
|
|
|
PR DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 43756
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$375.00 |
| Rate for Payer: Aetna Commercial |
$61.21
|
| Rate for Payer: Aetna Medicare |
$47.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.21
|
| Rate for Payer: BCBS Complete |
$31.53
|
| Rate for Payer: BCBS MAPPO |
$45.68
|
| Rate for Payer: BCN Commercial |
$75.19
|
| Rate for Payer: BCN Medicare Advantage |
$45.68
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Cofinity Commercial |
$65.78
|
| Rate for Payer: Cofinity Commercial |
$61.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.68
|
| Rate for Payer: Healthscope Commercial |
$84.51
|
| Rate for Payer: Healthscope Commercial |
$73.09
|
| Rate for Payer: Mclaren Medicaid |
$30.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.96
|
| Rate for Payer: Meridian Medicaid |
$31.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.10
|
| Rate for Payer: Nomi Health Commercial |
$54.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$375.00
|
| Rate for Payer: PACE SWMI |
$45.68
|
| Rate for Payer: PHP Medicare Advantage |
$45.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$91.61
|
| Rate for Payer: Priority Health Medicare |
$45.68
|
| Rate for Payer: Priority Health SBD |
$91.61
|
| Rate for Payer: Priority Health Tiered Network |
$91.61
|
| Rate for Payer: Railroad Medicare Medicare |
$45.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.48
|
| Rate for Payer: UHC Core |
$88.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$45.68
|
| Rate for Payer: UHC Exchange |
$88.48
|
| Rate for Payer: UHC Medicaid |
$30.03
|
| Rate for Payer: UHCCP Medicaid |
$30.03
|
|
|
PR DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$3,024.00
|
|
|
Service Code
|
HCPCS 44010
|
| Min. Negotiated Rate |
$499.06 |
| Max. Negotiated Rate |
$2,268.00 |
| Rate for Payer: Aetna Commercial |
$1,037.08
|
| Rate for Payer: Aetna Medicare |
$804.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,037.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,114.47
|
| Rate for Payer: BCBS Complete |
$524.01
|
| Rate for Payer: BCBS MAPPO |
$773.94
|
| Rate for Payer: BCN Commercial |
$1,266.36
|
| Rate for Payer: BCN Medicare Advantage |
$773.94
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cash Price |
$2,419.20
|
| Rate for Payer: Cofinity Commercial |
$1,114.47
|
| Rate for Payer: Cofinity Commercial |
$1,037.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$773.94
|
| Rate for Payer: Healthscope Commercial |
$1,431.79
|
| Rate for Payer: Healthscope Commercial |
$1,238.30
|
| Rate for Payer: Mclaren Medicaid |
$499.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$812.64
|
| Rate for Payer: Meridian Medicaid |
$524.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$851.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,510.78
|
| Rate for Payer: Nomi Health Commercial |
$928.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,268.00
|
| Rate for Payer: PACE SWMI |
$773.94
|
| Rate for Payer: PHP Medicare Advantage |
$773.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$499.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,542.98
|
| Rate for Payer: Priority Health Medicare |
$773.94
|
| Rate for Payer: Priority Health SBD |
$1,542.98
|
| Rate for Payer: Priority Health Tiered Network |
$1,542.98
|
| Rate for Payer: Railroad Medicare Medicare |
$773.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,520.71
|
| Rate for Payer: UHC Core |
$1,520.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$773.94
|
| Rate for Payer: UHC Exchange |
$1,520.71
|
| Rate for Payer: UHC Medicaid |
$499.06
|
| Rate for Payer: UHCCP Medicaid |
$499.06
|
|
|
PR DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ
|
Professional
|
Both
|
$6,469.00
|
|
|
Service Code
|
HCPCS 48547
|
| Min. Negotiated Rate |
$1,061.81 |
| Max. Negotiated Rate |
$4,851.75 |
| Rate for Payer: Aetna Commercial |
$2,229.04
|
| Rate for Payer: Aetna Medicare |
$1,730.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,229.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,395.38
|
| Rate for Payer: BCBS Complete |
$1,114.90
|
| Rate for Payer: BCBS MAPPO |
$1,663.46
|
| Rate for Payer: BCN Commercial |
$2,685.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,663.46
|
| Rate for Payer: Cash Price |
$5,175.20
|
| Rate for Payer: Cash Price |
$5,175.20
|
| Rate for Payer: Cofinity Commercial |
$2,395.38
|
| Rate for Payer: Cofinity Commercial |
$2,229.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,663.46
|
| Rate for Payer: Healthscope Commercial |
$3,077.40
|
| Rate for Payer: Healthscope Commercial |
$2,661.54
|
| Rate for Payer: Mclaren Medicaid |
$1,061.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,746.63
|
| Rate for Payer: Meridian Medicaid |
$1,114.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,829.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,212.30
|
| Rate for Payer: Nomi Health Commercial |
$1,996.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,851.75
|
| Rate for Payer: PACE SWMI |
$1,663.46
|
| Rate for Payer: PHP Medicare Advantage |
$1,663.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,061.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,272.25
|
| Rate for Payer: Priority Health Medicare |
$1,663.46
|
| Rate for Payer: Priority Health SBD |
$3,272.25
|
| Rate for Payer: Priority Health Tiered Network |
$3,272.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,663.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,209.66
|
| Rate for Payer: UHC Core |
$3,209.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,663.46
|
| Rate for Payer: UHC Exchange |
$3,209.66
|
| Rate for Payer: UHC Medicaid |
$1,061.81
|
| Rate for Payer: UHCCP Medicaid |
$1,061.81
|
|
