|
PR ELEC STIM OTHER THAN WOUND
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS G0283
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$22.53 |
| Rate for Payer: Aetna Commercial |
$16.32
|
| Rate for Payer: Aetna Medicare |
$12.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.54
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$12.18
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: BCN Medicare Advantage |
$12.18
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$17.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.18
|
| Rate for Payer: Healthscope Commercial |
$22.53
|
| Rate for Payer: Healthscope Commercial |
$19.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.57
|
| Rate for Payer: Nomi Health Commercial |
$14.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: PACE SWMI |
$12.18
|
| Rate for Payer: PHP Medicare Advantage |
$12.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.99
|
| Rate for Payer: Priority Health Medicare |
$12.18
|
| Rate for Payer: Priority Health SBD |
$11.99
|
| Rate for Payer: Priority Health Tiered Network |
$11.99
|
| Rate for Payer: Railroad Medicare Medicare |
$12.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.67
|
| Rate for Payer: UHC Core |
$21.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12.18
|
| Rate for Payer: UHC Exchange |
$21.67
|
|
|
PR ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 62368
|
| Min. Negotiated Rate |
$18.74 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna Commercial |
$39.17
|
| Rate for Payer: Aetna Medicare |
$30.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.09
|
| Rate for Payer: BCBS Complete |
$19.68
|
| Rate for Payer: BCBS MAPPO |
$29.23
|
| Rate for Payer: BCN Commercial |
$50.80
|
| Rate for Payer: BCN Medicare Advantage |
$29.23
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$42.09
|
| Rate for Payer: Cofinity Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.23
|
| Rate for Payer: Healthscope Commercial |
$54.08
|
| Rate for Payer: Healthscope Commercial |
$46.77
|
| Rate for Payer: Mclaren Medicaid |
$18.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.69
|
| Rate for Payer: Meridian Medicaid |
$19.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.13
|
| Rate for Payer: Nomi Health Commercial |
$35.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.00
|
| Rate for Payer: PACE SWMI |
$29.23
|
| Rate for Payer: PHP Medicare Advantage |
$29.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$58.99
|
| Rate for Payer: Priority Health Medicare |
$29.23
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: Priority Health Tiered Network |
$58.99
|
| Rate for Payer: Railroad Medicare Medicare |
$29.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.23
|
| Rate for Payer: UHC Core |
$63.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.23
|
| Rate for Payer: UHC Exchange |
$63.23
|
| Rate for Payer: UHC Medicaid |
$18.74
|
| Rate for Payer: UHCCP Medicaid |
$18.74
|
|
|
PR ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
HCPCS 62367
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$295.50 |
| Rate for Payer: Aetna Commercial |
$28.46
|
| Rate for Payer: Aetna Medicare |
$22.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.59
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCBS MAPPO |
$21.24
|
| Rate for Payer: BCN Commercial |
$36.35
|
| Rate for Payer: BCN Medicare Advantage |
$21.24
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cofinity Commercial |
$30.59
|
| Rate for Payer: Cofinity Commercial |
$28.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.24
|
| Rate for Payer: Healthscope Commercial |
$39.29
|
| Rate for Payer: Healthscope Commercial |
$33.98
|
| Rate for Payer: Mclaren Medicaid |
$13.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.30
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.78
|
| Rate for Payer: Nomi Health Commercial |
$25.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.50
|
| Rate for Payer: PACE SWMI |
$21.24
|
| Rate for Payer: PHP Medicare Advantage |
$21.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42.22
|
| Rate for Payer: Priority Health Medicare |
$21.24
|
| Rate for Payer: Priority Health SBD |
$42.22
|
| Rate for Payer: Priority Health Tiered Network |
$42.22
|
| Rate for Payer: Railroad Medicare Medicare |
$21.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.82
|
| Rate for Payer: UHC Core |
$44.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.24
|
| Rate for Payer: UHC Exchange |
$44.82
|
| Rate for Payer: UHC Medicaid |
$13.63
|
| Rate for Payer: UHCCP Medicaid |
$13.63
|
|
|
PR ELECTROACOUS EVAL HEARING AID BINAURAL
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 92595
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$65.76 |
| Rate for Payer: Aetna Commercial |
$49.30
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.30
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCN Commercial |
$65.00
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
|
|
PR ELECTROACOUS EVAL HEARING AID MONAURAL
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 92594
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Commercial |
$22.43
|
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.43
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCN Commercial |
$65.00
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
|
|
PR ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 95824
|
| Min. Negotiated Rate |
$56.28 |
| Max. Negotiated Rate |
$403.76 |
| Rate for Payer: Aetna Commercial |
$106.88
|
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.88
|
| Rate for Payer: BCN Commercial |
$56.28
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$133.17
|
| Rate for Payer: Priority Health SBD |
$133.17
|
| Rate for Payer: Priority Health Tiered Network |
$133.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$403.76
|
| Rate for Payer: UHC Core |
$403.76
|
| Rate for Payer: UHC Exchange |
$403.76
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$776.00
|
|
|
Service Code
|
HCPCS 95812
|
| Min. Negotiated Rate |
$353.57 |
| Max. Negotiated Rate |
$654.10 |
| Rate for Payer: Aetna Commercial |
$473.78
|
| Rate for Payer: Aetna Medicare |
$367.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.78
|
| Rate for Payer: BCBS MAPPO |
$353.57
|
| Rate for Payer: BCN Commercial |
$518.90
|
| Rate for Payer: BCN Medicare Advantage |
$353.57
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cash Price |
$620.80
|
| Rate for Payer: Cofinity Commercial |
$509.14
|
| Rate for Payer: Cofinity Commercial |
$473.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.57
|
| Rate for Payer: Healthscope Commercial |
$654.10
|
| Rate for Payer: Healthscope Commercial |
$565.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$388.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$483.45
|
| Rate for Payer: Nomi Health Commercial |
$424.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$582.00
|
| Rate for Payer: PACE SWMI |
$353.57
|
| Rate for Payer: PHP Medicare Advantage |
$353.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$478.53
|
| Rate for Payer: Priority Health Medicare |
$353.57
|
| Rate for Payer: Priority Health SBD |
$478.53
|
| Rate for Payer: Priority Health Tiered Network |
$478.53
|
| Rate for Payer: Railroad Medicare Medicare |
$353.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$499.63
|
| Rate for Payer: UHC Core |
$499.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$353.57
|
| Rate for Payer: UHC Exchange |
$499.63
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 95822
|
| Min. Negotiated Rate |
$283.50 |
| Max. Negotiated Rate |
$761.83 |
| Rate for Payer: Aetna Commercial |
$551.81
|
| Rate for Payer: Aetna Medicare |
$428.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$551.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.99
|
| Rate for Payer: BCBS MAPPO |
$411.80
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$411.80
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$592.99
|
| Rate for Payer: Cofinity Commercial |
$551.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$411.80
|
| Rate for Payer: Healthscope Commercial |
$761.83
|
| Rate for Payer: Healthscope Commercial |
$658.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$432.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$452.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$581.15
|
| Rate for Payer: Nomi Health Commercial |
$494.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.50
|
| Rate for Payer: PACE SWMI |
$411.80
|
| Rate for Payer: PHP Medicare Advantage |
$411.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$574.51
|
| Rate for Payer: Priority Health Medicare |
$411.80
|
| Rate for Payer: Priority Health SBD |
$574.51
|
| Rate for Payer: Priority Health Tiered Network |
$574.51
|
| Rate for Payer: Railroad Medicare Medicare |
$411.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.43
|
| Rate for Payer: UHC Core |
$595.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$411.80
|
| Rate for Payer: UHC Exchange |
$595.43
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 95819
|
| Min. Negotiated Rate |
$444.19 |
| Max. Negotiated Rate |
$821.75 |
| Rate for Payer: Aetna Commercial |
$595.21
|
| Rate for Payer: Aetna Commercial |
$595.21
|
| Rate for Payer: Aetna Medicare |
$461.96
|
| Rate for Payer: Aetna Medicare |
$461.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.21
|
| Rate for Payer: BCBS MAPPO |
$444.19
|
| Rate for Payer: BCBS MAPPO |
$444.19
|
| Rate for Payer: BCN Commercial |
$673.77
|
| Rate for Payer: BCN Commercial |
$673.77
|
| Rate for Payer: BCN Medicare Advantage |
$444.19
|
| Rate for Payer: BCN Medicare Advantage |
$444.19
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$639.63
|
| Rate for Payer: Cofinity Commercial |
$595.21
|
| Rate for Payer: Cofinity Commercial |
$595.21
|
| Rate for Payer: Cofinity Commercial |
$639.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.19
|
| Rate for Payer: Healthscope Commercial |
$821.75
|
| Rate for Payer: Healthscope Commercial |
$821.75
|
| Rate for Payer: Healthscope Commercial |
$710.70
|
| Rate for Payer: Healthscope Commercial |
$710.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$488.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$488.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$620.06
|
| Rate for Payer: Nomi Health Commercial |
$533.03
|
| Rate for Payer: Nomi Health Commercial |
$533.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$613.50
|
| Rate for Payer: PACE SWMI |
$444.19
|
| Rate for Payer: PACE SWMI |
$444.19
|
| Rate for Payer: PHP Medicare Advantage |
$444.19
|
| Rate for Payer: PHP Medicare Advantage |
$444.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$621.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$621.36
|
| Rate for Payer: Priority Health Medicare |
$444.19
|
| Rate for Payer: Priority Health Medicare |
$444.19
|
| Rate for Payer: Priority Health SBD |
$621.36
|
| Rate for Payer: Priority Health SBD |
$621.36
|
| Rate for Payer: Priority Health Tiered Network |
$621.36
|
| Rate for Payer: Priority Health Tiered Network |
$621.36
|
| Rate for Payer: Railroad Medicare Medicare |
$444.19
|
| Rate for Payer: Railroad Medicare Medicare |
$444.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$656.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$656.04
|
| Rate for Payer: UHC Core |
$656.04
|
| Rate for Payer: UHC Core |
$656.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$444.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$444.19
|
| Rate for Payer: UHC Exchange |
$656.04
|
| Rate for Payer: UHC Exchange |
$656.04
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$713.00
|
|
|
Service Code
|
HCPCS 95816
|
| Min. Negotiated Rate |
$381.30 |
| Max. Negotiated Rate |
$705.40 |
| Rate for Payer: Aetna Commercial |
$510.94
|
| Rate for Payer: Aetna Commercial |
$510.94
|
| Rate for Payer: Aetna Medicare |
$396.55
|
| Rate for Payer: Aetna Medicare |
$396.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$510.94
|
| Rate for Payer: BCBS MAPPO |
$381.30
|
| Rate for Payer: BCBS MAPPO |
$381.30
|
| Rate for Payer: BCN Commercial |
$578.65
|
| Rate for Payer: BCN Commercial |
$578.65
|
| Rate for Payer: BCN Medicare Advantage |
$381.30
|
| Rate for Payer: BCN Medicare Advantage |
$381.30
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$570.40
|
| Rate for Payer: Cash Price |
$570.40
|
| Rate for Payer: Cofinity Commercial |
$549.07
|
| Rate for Payer: Cofinity Commercial |
$510.94
|
| Rate for Payer: Cofinity Commercial |
$510.94
|
| Rate for Payer: Cofinity Commercial |
$549.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.30
|
| Rate for Payer: Healthscope Commercial |
$705.40
|
| Rate for Payer: Healthscope Commercial |
$705.40
|
| Rate for Payer: Healthscope Commercial |
$610.08
|
| Rate for Payer: Healthscope Commercial |
$610.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$419.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$419.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$535.31
|
| Rate for Payer: Nomi Health Commercial |
$457.56
|
| Rate for Payer: Nomi Health Commercial |
$457.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.75
|
| Rate for Payer: PACE SWMI |
$381.30
|
| Rate for Payer: PACE SWMI |
$381.30
|
| Rate for Payer: PHP Medicare Advantage |
$381.30
|
| Rate for Payer: PHP Medicare Advantage |
$381.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$533.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$533.65
|
| Rate for Payer: Priority Health Medicare |
$381.30
|
| Rate for Payer: Priority Health Medicare |
$381.30
|
| Rate for Payer: Priority Health SBD |
$533.65
|
| Rate for Payer: Priority Health SBD |
$533.65
|
| Rate for Payer: Priority Health Tiered Network |
$533.65
|
| Rate for Payer: Priority Health Tiered Network |
$533.65
|
| Rate for Payer: Railroad Medicare Medicare |
$381.30
|
| Rate for Payer: Railroad Medicare Medicare |
$381.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$553.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$553.32
|
| Rate for Payer: UHC Core |
$553.32
|
| Rate for Payer: UHC Core |
$553.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$381.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$381.30
|
| Rate for Payer: UHC Exchange |
$553.32
|
| Rate for Payer: UHC Exchange |
$553.32
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUTANEOUS
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 91132
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$823.43 |
| Rate for Payer: Aetna Commercial |
$596.43
|
| Rate for Payer: Aetna Medicare |
$462.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$640.94
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS MAPPO |
$445.10
|
| Rate for Payer: BCN Commercial |
$622.97
|
| Rate for Payer: BCN Medicare Advantage |
$445.10
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$640.94
|
| Rate for Payer: Cofinity Commercial |
$596.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$445.10
|
| Rate for Payer: Healthscope Commercial |
$823.43
|
| Rate for Payer: Healthscope Commercial |
$712.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$467.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$489.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.27
|
| Rate for Payer: Nomi Health Commercial |
$534.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.50
|
| Rate for Payer: PACE SWMI |
$445.10
|
| Rate for Payer: PHP Medicare Advantage |
$445.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$574.51
|
| Rate for Payer: Priority Health Medicare |
$445.10
|
| Rate for Payer: Priority Health SBD |
$574.51
|
| Rate for Payer: Priority Health Tiered Network |
$574.51
|
| Rate for Payer: Railroad Medicare Medicare |
$445.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$489.71
|
| Rate for Payer: UHC Core |
$489.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$445.10
|
| Rate for Payer: UHC Exchange |
$489.71
|
|
|
PR ELECTRONIC ALYS ANTITACHYCARDIA PACEMAKER SYS
|
Professional
|
Both
|
$588.00
|
|
|
Service Code
|
HCPCS 93724
|
| Min. Negotiated Rate |
$268.17 |
| Max. Negotiated Rate |
$496.11 |
| Rate for Payer: Aetna Commercial |
$359.35
|
| Rate for Payer: Aetna Medicare |
$278.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.16
|
| Rate for Payer: BCBS MAPPO |
$268.17
|
| Rate for Payer: BCN Commercial |
$413.82
|
| Rate for Payer: BCN Medicare Advantage |
$268.17
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cofinity Commercial |
$386.16
|
| Rate for Payer: Cofinity Commercial |
$359.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.17
|
| Rate for Payer: Healthscope Commercial |
$429.07
|
| Rate for Payer: Healthscope Commercial |
$496.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$294.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.65
|
| Rate for Payer: Nomi Health Commercial |
$321.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$441.00
|
| Rate for Payer: PACE SWMI |
$268.17
|
| Rate for Payer: PHP Medicare Advantage |
$268.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$393.32
|
| Rate for Payer: Priority Health Medicare |
$268.17
|
| Rate for Payer: Priority Health SBD |
$393.32
|
| Rate for Payer: Priority Health Tiered Network |
$393.32
|
| Rate for Payer: Railroad Medicare Medicare |
$268.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$452.38
|
| Rate for Payer: UHC Core |
$452.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$268.17
|
| Rate for Payer: UHC Exchange |
$452.38
|
|
|
PR ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL
|
Professional
|
Both
|
$4,268.00
|
|
|
Service Code
|
HCPCS 62000
|
| Min. Negotiated Rate |
$663.71 |
| Max. Negotiated Rate |
$3,201.00 |
| Rate for Payer: Aetna Commercial |
$1,381.47
|
| Rate for Payer: Aetna Medicare |
$1,072.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,381.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,484.57
|
| Rate for Payer: BCBS Complete |
$696.90
|
| Rate for Payer: BCBS MAPPO |
$1,030.95
|
| Rate for Payer: BCN Commercial |
$1,587.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,030.95
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cash Price |
$3,414.40
|
| Rate for Payer: Cofinity Commercial |
$1,484.57
|
| Rate for Payer: Cofinity Commercial |
$1,381.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,030.95
|
| Rate for Payer: Healthscope Commercial |
$1,907.26
|
| Rate for Payer: Healthscope Commercial |
$1,649.52
|
| Rate for Payer: Mclaren Medicaid |
$663.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,082.50
|
| Rate for Payer: Meridian Medicaid |
$696.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,134.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,876.12
|
| Rate for Payer: Nomi Health Commercial |
$1,237.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,201.00
|
| Rate for Payer: PACE SWMI |
$1,030.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,030.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$663.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,843.93
|
| Rate for Payer: Priority Health Medicare |
$1,030.95
|
| Rate for Payer: Priority Health SBD |
$1,843.93
|
| Rate for Payer: Priority Health Tiered Network |
$1,843.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,030.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,810.80
|
| Rate for Payer: UHC Core |
$1,810.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,030.95
|
| Rate for Payer: UHC Exchange |
$1,810.80
|
| Rate for Payer: UHC Medicaid |
$663.71
|
| Rate for Payer: UHCCP Medicaid |
$663.71
|
|
|
PR ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL
|
Professional
|
Both
|
$5,396.00
|
|
|
Service Code
|
HCPCS 62005
|
| Min. Negotiated Rate |
$805.78 |
| Max. Negotiated Rate |
$4,047.00 |
| Rate for Payer: Aetna Commercial |
$1,682.99
|
| Rate for Payer: Aetna Medicare |
$1,306.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,682.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,808.58
|
| Rate for Payer: BCBS Complete |
$846.07
|
| Rate for Payer: BCBS MAPPO |
$1,255.96
|
| Rate for Payer: BCN Commercial |
$2,690.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,255.96
|
| Rate for Payer: Cash Price |
$4,316.80
|
| Rate for Payer: Cash Price |
$4,316.80
|
| Rate for Payer: Cofinity Commercial |
$1,808.58
|
| Rate for Payer: Cofinity Commercial |
$1,682.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,255.96
|
| Rate for Payer: Healthscope Commercial |
$2,323.53
|
| Rate for Payer: Healthscope Commercial |
$2,009.54
|
| Rate for Payer: Mclaren Medicaid |
$805.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,318.76
|
| Rate for Payer: Meridian Medicaid |
$846.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,381.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,309.17
|
| Rate for Payer: Nomi Health Commercial |
$1,507.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,047.00
|
| Rate for Payer: PACE SWMI |
$1,255.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,255.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$805.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,262.10
|
| Rate for Payer: Priority Health Medicare |
$1,255.96
|
| Rate for Payer: Priority Health SBD |
$2,262.10
|
| Rate for Payer: Priority Health Tiered Network |
$2,262.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,255.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,234.75
|
| Rate for Payer: UHC Core |
$2,234.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,255.96
|
| Rate for Payer: UHC Exchange |
$2,234.75
|
| Rate for Payer: UHC Medicaid |
$805.78
|
| Rate for Payer: UHCCP Medicaid |
$805.78
|
|
|
PR ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN
|
Professional
|
Both
|
$7,084.00
|
|
|
Service Code
|
HCPCS 62010
|
| Min. Negotiated Rate |
$967.87 |
| Max. Negotiated Rate |
$5,313.00 |
| Rate for Payer: Aetna Commercial |
$2,023.35
|
| Rate for Payer: Aetna Medicare |
$1,570.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,023.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,174.34
|
| Rate for Payer: BCBS Complete |
$1,016.26
|
| Rate for Payer: BCBS MAPPO |
$1,509.96
|
| Rate for Payer: BCN Commercial |
$3,245.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,509.96
|
| Rate for Payer: Cash Price |
$5,667.20
|
| Rate for Payer: Cash Price |
$5,667.20
|
| Rate for Payer: Cofinity Commercial |
$2,174.34
|
| Rate for Payer: Cofinity Commercial |
$2,023.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,509.96
|
| Rate for Payer: Healthscope Commercial |
$2,793.43
|
| Rate for Payer: Healthscope Commercial |
$2,415.94
|
| Rate for Payer: Mclaren Medicaid |
$967.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,585.46
|
| Rate for Payer: Meridian Medicaid |
$1,016.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,660.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,789.19
|
| Rate for Payer: Nomi Health Commercial |
$1,811.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,313.00
|
| Rate for Payer: PACE SWMI |
$1,509.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,509.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$967.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,728.87
|
| Rate for Payer: Priority Health Medicare |
$1,509.96
|
| Rate for Payer: Priority Health SBD |
$2,728.87
|
| Rate for Payer: Priority Health Tiered Network |
$2,728.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,509.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,700.31
|
| Rate for Payer: UHC Core |
$2,700.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,509.96
|
| Rate for Payer: UHC Exchange |
$2,700.31
|
| Rate for Payer: UHC Medicaid |
$967.87
|
| Rate for Payer: UHCCP Medicaid |
$967.87
|
|
|
PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 99318
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Aetna Medicare |
$74.50
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.75
|
|
|
PREMATURITY WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$66,161.70
|
|
|
Service Code
|
MSDRG 791
|
| Min. Negotiated Rate |
$30,350.48 |
| Max. Negotiated Rate |
$66,161.70 |
| Rate for Payer: Aetna Medicare |
$33,225.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,934.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,934.84
|
| Rate for Payer: BCBS MAPPO |
$31,947.87
|
| Rate for Payer: BCBS Trust/PPO |
$45,853.93
|
| Rate for Payer: BCN Commercial |
$45,853.93
|
| Rate for Payer: BCN Medicare Advantage |
$31,947.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,947.87
|
| Rate for Payer: Mclaren Medicare |
$31,947.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33,545.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,740.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$35,142.66
|
| Rate for Payer: Nomi Health Commercial |
$52,361.10
|
| Rate for Payer: PACE Medicare |
$30,350.48
|
| Rate for Payer: PACE SWMI |
$31,947.87
|
| Rate for Payer: PHP Medicare Advantage |
$31,947.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44,629.31
|
| Rate for Payer: Priority Health Medicare |
$31,947.87
|
| Rate for Payer: Priority Health Tiered Network |
$35,703.44
|
| Rate for Payer: Railroad Medicare Medicare |
$31,947.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66,161.70
|
| Rate for Payer: UHC Core |
$55,352.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31,947.87
|
| Rate for Payer: UHC Exchange |
$45,205.08
|
| Rate for Payer: VA VA |
$31,947.87
|
|
|
PREMATURITY WITHOUT MAJOR PROBLEMS
|
Facility
|
IP
|
$39,921.96
|
|
|
Service Code
|
MSDRG 792
|
| Min. Negotiated Rate |
$7,093.74 |
| Max. Negotiated Rate |
$39,921.96 |
| Rate for Payer: Aetna Medicare |
$20,287.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24,383.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24,383.70
|
| Rate for Payer: BCBS MAPPO |
$19,506.96
|
| Rate for Payer: BCBS Trust/PPO |
$15,973.62
|
| Rate for Payer: BCN Commercial |
$15,973.62
|
| Rate for Payer: BCN Medicare Advantage |
$19,506.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19,506.96
|
| Rate for Payer: Mclaren Medicare |
$19,506.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20,482.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22,433.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$21,457.66
|
| Rate for Payer: Nomi Health Commercial |
$31,594.68
|
| Rate for Payer: PACE Medicare |
$18,531.61
|
| Rate for Payer: PACE SWMI |
$19,506.96
|
| Rate for Payer: PHP Medicare Advantage |
$19,506.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$8,867.18
|
| Rate for Payer: Priority Health Medicare |
$19,506.96
|
| Rate for Payer: Priority Health Tiered Network |
$7,093.74
|
| Rate for Payer: Railroad Medicare Medicare |
$19,506.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39,921.96
|
| Rate for Payer: UHC Core |
$33,399.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$19,506.96
|
| Rate for Payer: UHC Exchange |
$27,276.74
|
| Rate for Payer: VA VA |
$19,506.96
|
|
|
PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART
|
Professional
|
Both
|
$2,407.00
|
|
|
Service Code
|
HCPCS 34101
|
| Min. Negotiated Rate |
$346.76 |
| Max. Negotiated Rate |
$1,805.25 |
| Rate for Payer: Aetna Commercial |
$733.06
|
| Rate for Payer: Aetna Medicare |
$568.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.77
|
| Rate for Payer: BCBS Complete |
$364.10
|
| Rate for Payer: BCBS MAPPO |
$547.06
|
| Rate for Payer: BCN Commercial |
$874.95
|
| Rate for Payer: BCN Medicare Advantage |
$547.06
|
| Rate for Payer: Cash Price |
$1,925.60
|
| Rate for Payer: Cash Price |
$1,925.60
|
| Rate for Payer: Cofinity Commercial |
$787.77
|
| Rate for Payer: Cofinity Commercial |
$733.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.06
|
| Rate for Payer: Healthscope Commercial |
$875.30
|
| Rate for Payer: Healthscope Commercial |
$1,012.06
|
| Rate for Payer: Mclaren Medicaid |
$346.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$574.41
|
| Rate for Payer: Meridian Medicaid |
$364.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$601.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,057.90
|
| Rate for Payer: Nomi Health Commercial |
$656.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,805.25
|
| Rate for Payer: PACE SWMI |
$547.06
|
| Rate for Payer: PHP Medicare Advantage |
$547.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$940.90
|
| Rate for Payer: Priority Health Medicare |
$547.06
|
| Rate for Payer: Priority Health SBD |
$940.90
|
| Rate for Payer: Priority Health Tiered Network |
$940.90
|
| Rate for Payer: Railroad Medicare Medicare |
$547.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,070.67
|
| Rate for Payer: UHC Core |
$1,070.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$547.06
|
| Rate for Payer: UHC Exchange |
$1,070.67
|
| Rate for Payer: UHC Medicaid |
$346.76
|
| Rate for Payer: UHCCP Medicaid |
$346.76
|
|
|
PR EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART
|
Professional
|
Both
|
$2,095.00
|
|
|
Service Code
|
HCPCS 34001
|
| Min. Negotiated Rate |
$532.50 |
| Max. Negotiated Rate |
$1,644.16 |
| Rate for Payer: Aetna Commercial |
$1,132.57
|
| Rate for Payer: Aetna Medicare |
$879.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,132.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,217.09
|
| Rate for Payer: BCBS Complete |
$559.12
|
| Rate for Payer: BCBS MAPPO |
$845.20
|
| Rate for Payer: BCN Commercial |
$1,340.07
|
| Rate for Payer: BCN Medicare Advantage |
$845.20
|
| Rate for Payer: Cash Price |
$1,676.00
|
| Rate for Payer: Cash Price |
$1,676.00
|
| Rate for Payer: Cofinity Commercial |
$1,217.09
|
| Rate for Payer: Cofinity Commercial |
$1,132.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$845.20
|
| Rate for Payer: Healthscope Commercial |
$1,563.62
|
| Rate for Payer: Healthscope Commercial |
$1,352.32
|
| Rate for Payer: Mclaren Medicaid |
$532.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$887.46
|
| Rate for Payer: Meridian Medicaid |
$559.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$929.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,624.88
|
| Rate for Payer: Nomi Health Commercial |
$1,014.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,571.25
|
| Rate for Payer: PACE SWMI |
$845.20
|
| Rate for Payer: PHP Medicare Advantage |
$845.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$532.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,441.07
|
| Rate for Payer: Priority Health Medicare |
$845.20
|
| Rate for Payer: Priority Health SBD |
$1,441.07
|
| Rate for Payer: Priority Health Tiered Network |
$1,441.07
|
| Rate for Payer: Railroad Medicare Medicare |
$845.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,644.16
|
| Rate for Payer: UHC Core |
$1,644.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$845.20
|
| Rate for Payer: UHC Exchange |
$1,644.16
|
| Rate for Payer: UHC Medicaid |
$532.50
|
| Rate for Payer: UHCCP Medicaid |
$532.50
|
|
|
PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART
|
Professional
|
Both
|
$2,055.00
|
|
|
Service Code
|
HCPCS 34201
|
| Min. Negotiated Rate |
$591.29 |
| Max. Negotiated Rate |
$1,841.81 |
| Rate for Payer: Aetna Commercial |
$1,255.10
|
| Rate for Payer: Aetna Medicare |
$974.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,255.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,348.76
|
| Rate for Payer: BCBS Complete |
$620.85
|
| Rate for Payer: BCBS MAPPO |
$936.64
|
| Rate for Payer: BCN Commercial |
$1,491.46
|
| Rate for Payer: BCN Medicare Advantage |
$936.64
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cofinity Commercial |
$1,348.76
|
| Rate for Payer: Cofinity Commercial |
$1,255.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$936.64
|
| Rate for Payer: Healthscope Commercial |
$1,732.78
|
| Rate for Payer: Healthscope Commercial |
$1,498.62
|
| Rate for Payer: Mclaren Medicaid |
$591.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$983.47
|
| Rate for Payer: Meridian Medicaid |
$620.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,030.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,810.76
|
| Rate for Payer: Nomi Health Commercial |
$1,123.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,541.25
|
| Rate for Payer: PACE SWMI |
$936.64
|
| Rate for Payer: PHP Medicare Advantage |
$936.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$591.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,603.87
|
| Rate for Payer: Priority Health Medicare |
$936.64
|
| Rate for Payer: Priority Health SBD |
$1,603.87
|
| Rate for Payer: Priority Health Tiered Network |
$1,603.87
|
| Rate for Payer: Railroad Medicare Medicare |
$936.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,841.81
|
| Rate for Payer: UHC Core |
$1,841.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$936.64
|
| Rate for Payer: UHC Exchange |
$1,841.81
|
| Rate for Payer: UHC Medicaid |
$591.29
|
| Rate for Payer: UHCCP Medicaid |
$591.29
|
|
|
PR EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,070.00
|
|
|
Service Code
|
HCPCS 34051
|
| Min. Negotiated Rate |
$615.57 |
| Max. Negotiated Rate |
$1,772.36 |
| Rate for Payer: Aetna Commercial |
$1,283.76
|
| Rate for Payer: Aetna Medicare |
$996.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,283.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,379.56
|
| Rate for Payer: BCBS Complete |
$646.35
|
| Rate for Payer: BCBS MAPPO |
$958.03
|
| Rate for Payer: BCN Commercial |
$1,467.05
|
| Rate for Payer: BCN Medicare Advantage |
$958.03
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Cofinity Commercial |
$1,379.56
|
| Rate for Payer: Cofinity Commercial |
$1,283.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$958.03
|
| Rate for Payer: Healthscope Commercial |
$1,772.36
|
| Rate for Payer: Healthscope Commercial |
$1,532.85
|
| Rate for Payer: Mclaren Medicaid |
$615.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,005.93
|
| Rate for Payer: Meridian Medicaid |
$646.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,053.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,753.72
|
| Rate for Payer: Nomi Health Commercial |
$1,149.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,552.50
|
| Rate for Payer: PACE SWMI |
$958.03
|
| Rate for Payer: PHP Medicare Advantage |
$958.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$615.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,577.63
|
| Rate for Payer: Priority Health Medicare |
$958.03
|
| Rate for Payer: Priority Health SBD |
$1,577.63
|
| Rate for Payer: Priority Health Tiered Network |
$1,577.63
|
| Rate for Payer: Railroad Medicare Medicare |
$958.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,757.59
|
| Rate for Payer: UHC Core |
$1,757.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$958.03
|
| Rate for Payer: UHC Exchange |
$1,757.59
|
| Rate for Payer: UHC Medicaid |
$615.57
|
| Rate for Payer: UHCCP Medicaid |
$615.57
|
|
|
PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC
|
Professional
|
Both
|
$2,036.00
|
|
|
Service Code
|
HCPCS 34203
|
| Min. Negotiated Rate |
$549.97 |
| Max. Negotiated Rate |
$1,704.75 |
| Rate for Payer: Aetna Commercial |
$1,165.81
|
| Rate for Payer: Aetna Medicare |
$904.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,252.81
|
| Rate for Payer: BCBS Complete |
$577.47
|
| Rate for Payer: BCBS MAPPO |
$870.01
|
| Rate for Payer: BCN Commercial |
$1,387.88
|
| Rate for Payer: BCN Medicare Advantage |
$870.01
|
| Rate for Payer: Cash Price |
$1,628.80
|
| Rate for Payer: Cash Price |
$1,628.80
|
| Rate for Payer: Cofinity Commercial |
$1,252.81
|
| Rate for Payer: Cofinity Commercial |
$1,165.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.01
|
| Rate for Payer: Healthscope Commercial |
$1,609.52
|
| Rate for Payer: Healthscope Commercial |
$1,392.02
|
| Rate for Payer: Mclaren Medicaid |
$549.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$913.51
|
| Rate for Payer: Meridian Medicaid |
$577.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$957.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,679.11
|
| Rate for Payer: Nomi Health Commercial |
$1,044.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,527.00
|
| Rate for Payer: PACE SWMI |
$870.01
|
| Rate for Payer: PHP Medicare Advantage |
$870.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$549.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,492.49
|
| Rate for Payer: Priority Health Medicare |
$870.01
|
| Rate for Payer: Priority Health SBD |
$1,492.49
|
| Rate for Payer: Priority Health Tiered Network |
$1,492.49
|
| Rate for Payer: Railroad Medicare Medicare |
$870.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,704.75
|
| Rate for Payer: UHC Core |
$1,704.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$870.01
|
| Rate for Payer: UHC Exchange |
$1,704.75
|
| Rate for Payer: UHC Medicaid |
$549.97
|
| Rate for Payer: UHCCP Medicaid |
$549.97
|
|
|
PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
HCPCS 34151
|
| Min. Negotiated Rate |
$805.57 |
| Max. Negotiated Rate |
$2,496.73 |
| Rate for Payer: Priority Health SBD |
$2,187.57
|
| Rate for Payer: Aetna Commercial |
$1,709.57
|
| Rate for Payer: Aetna Medicare |
$1,326.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,709.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,837.15
|
| Rate for Payer: BCBS Complete |
$845.85
|
| Rate for Payer: BCBS MAPPO |
$1,275.80
|
| Rate for Payer: BCN Commercial |
$2,034.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,275.80
|
| Rate for Payer: Cash Price |
$2,249.60
|
| Rate for Payer: Cash Price |
$2,249.60
|
| Rate for Payer: Cofinity Commercial |
$1,837.15
|
| Rate for Payer: Cofinity Commercial |
$1,709.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,275.80
|
| Rate for Payer: Healthscope Commercial |
$2,360.23
|
| Rate for Payer: Healthscope Commercial |
$2,041.28
|
| Rate for Payer: Mclaren Medicaid |
$805.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,339.59
|
| Rate for Payer: Meridian Medicaid |
$845.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,403.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,468.20
|
| Rate for Payer: Nomi Health Commercial |
$1,530.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,109.00
|
| Rate for Payer: PACE SWMI |
$1,275.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,275.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$805.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,187.57
|
| Rate for Payer: Priority Health Medicare |
$1,275.80
|
| Rate for Payer: Priority Health Tiered Network |
$2,187.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1,275.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,496.73
|
| Rate for Payer: UHC Core |
$2,496.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,275.80
|
| Rate for Payer: UHC Exchange |
$2,496.73
|
| Rate for Payer: UHC Medicaid |
$805.57
|
| Rate for Payer: UHCCP Medicaid |
$805.57
|
|
|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$1,296.00
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$346.98 |
| Max. Negotiated Rate |
$1,075.63 |
| Rate for Payer: Aetna Commercial |
$733.27
|
| Rate for Payer: Aetna Medicare |
$569.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$788.00
|
| Rate for Payer: BCBS Complete |
$364.33
|
| Rate for Payer: BCBS MAPPO |
$547.22
|
| Rate for Payer: BCN Commercial |
$872.96
|
| Rate for Payer: BCN Medicare Advantage |
$547.22
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cofinity Commercial |
$788.00
|
| Rate for Payer: Cofinity Commercial |
$733.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.22
|
| Rate for Payer: Healthscope Commercial |
$875.55
|
| Rate for Payer: Healthscope Commercial |
$1,012.36
|
| Rate for Payer: Mclaren Medicaid |
$346.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$574.58
|
| Rate for Payer: Meridian Medicaid |
$364.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$601.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,061.03
|
| Rate for Payer: Nomi Health Commercial |
$656.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$972.00
|
| Rate for Payer: PACE SWMI |
$547.22
|
| Rate for Payer: PHP Medicare Advantage |
$547.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$346.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$938.75
|
| Rate for Payer: Priority Health Medicare |
$547.22
|
| Rate for Payer: Priority Health SBD |
$938.75
|
| Rate for Payer: Priority Health Tiered Network |
$938.75
|
| Rate for Payer: Railroad Medicare Medicare |
$547.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,075.63
|
| Rate for Payer: UHC Core |
$1,075.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$547.22
|
| Rate for Payer: UHC Exchange |
$1,075.63
|
| Rate for Payer: UHC Medicaid |
$346.98
|
| Rate for Payer: UHCCP Medicaid |
$346.98
|
|
