|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
HCPCS 95819
|
| Min. Negotiated Rate |
$317.60 |
| Max. Negotiated Rate |
$744.75 |
| Rate for Payer: Aetna Commercial |
$539.44
|
| Rate for Payer: Aetna Commercial |
$539.44
|
| Rate for Payer: Aetna Medicare |
$418.67
|
| Rate for Payer: Aetna Medicare |
$418.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$579.70
|
| Rate for Payer: BCBS Complete |
$317.60
|
| Rate for Payer: BCBS Complete |
$82.40
|
| Rate for Payer: BCBS MAPPO |
$402.57
|
| Rate for Payer: BCBS MAPPO |
$402.57
|
| Rate for Payer: BCN Medicare Advantage |
$402.57
|
| Rate for Payer: BCN Medicare Advantage |
$402.57
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$539.44
|
| Rate for Payer: Cofinity Commercial |
$579.70
|
| Rate for Payer: Cofinity Commercial |
$539.44
|
| Rate for Payer: Cofinity Commercial |
$579.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.57
|
| Rate for Payer: Healthscope Commercial |
$744.75
|
| Rate for Payer: Healthscope Commercial |
$744.75
|
| Rate for Payer: Healthscope Commercial |
$644.11
|
| Rate for Payer: Healthscope Commercial |
$644.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$422.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$422.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$516.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.90
|
| Rate for Payer: Nomi Health Commercial |
$483.08
|
| Rate for Payer: Nomi Health Commercial |
$483.08
|
| Rate for Payer: PACE SWMI |
$402.57
|
| Rate for Payer: PACE SWMI |
$402.57
|
| Rate for Payer: PHP Medicare Advantage |
$402.57
|
| Rate for Payer: PHP Medicare Advantage |
$402.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health Medicare |
$402.57
|
| Rate for Payer: Priority Health Medicare |
$402.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.57
|
| Rate for Payer: UHC Medicare Advantage |
$402.57
|
| Rate for Payer: UHC Medicare Advantage |
$402.57
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$692.00
|
|
|
Service Code
|
HCPCS 95816
|
| Min. Negotiated Rate |
$276.80 |
| Max. Negotiated Rate |
$640.47 |
| Rate for Payer: Aetna Commercial |
$463.91
|
| Rate for Payer: Aetna Commercial |
$463.91
|
| Rate for Payer: Aetna Medicare |
$360.05
|
| Rate for Payer: Aetna Medicare |
$360.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.53
|
| Rate for Payer: BCBS Complete |
$276.80
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS MAPPO |
$346.20
|
| Rate for Payer: BCBS MAPPO |
$346.20
|
| Rate for Payer: BCN Medicare Advantage |
$346.20
|
| Rate for Payer: BCN Medicare Advantage |
$346.20
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cash Price |
$553.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$463.91
|
| Rate for Payer: Cofinity Commercial |
$498.53
|
| Rate for Payer: Cofinity Commercial |
$463.91
|
| Rate for Payer: Cofinity Commercial |
$498.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$346.20
|
| Rate for Payer: Healthscope Commercial |
$640.47
|
| Rate for Payer: Healthscope Commercial |
$640.47
|
| Rate for Payer: Healthscope Commercial |
$553.92
|
| Rate for Payer: Healthscope Commercial |
$553.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$363.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$449.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$415.44
|
| Rate for Payer: Nomi Health Commercial |
$415.44
|
| Rate for Payer: PACE SWMI |
$346.20
|
| Rate for Payer: PACE SWMI |
$346.20
|
| Rate for Payer: PHP Medicare Advantage |
$346.20
|
| Rate for Payer: PHP Medicare Advantage |
$346.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$449.80
|
| Rate for Payer: Priority Health Medicare |
$346.20
|
| Rate for Payer: Priority Health Medicare |
$346.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$346.20
|
| Rate for Payer: UHC Medicare Advantage |
$346.20
|
| Rate for Payer: UHC Medicare Advantage |
$346.20
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUTANEOUS
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 91132
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$685.22 |
| Rate for Payer: Aetna Commercial |
$496.32
|
| Rate for Payer: Aetna Medicare |
$385.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$496.32
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS MAPPO |
$370.39
|
| Rate for Payer: BCN Medicare Advantage |
$370.39
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$533.36
|
| Rate for Payer: Cofinity Commercial |
$496.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$370.39
|
| Rate for Payer: Healthscope Commercial |
$685.22
|
| Rate for Payer: Healthscope Commercial |
$592.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$388.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$444.47
|
| Rate for Payer: PACE SWMI |
$370.39
|
| Rate for Payer: PHP Medicare Advantage |
$370.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health Medicare |
$370.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$370.39
|
| Rate for Payer: UHC Medicare Advantage |
$370.39
|
|
|
PR ELECTRONIC ALYS ANTITACHYCARDIA PACEMAKER SYS
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
HCPCS 93724
|
| Min. Negotiated Rate |
$228.40 |
| Max. Negotiated Rate |
$481.68 |
| Rate for Payer: Aetna Commercial |
$348.90
|
| Rate for Payer: Aetna Medicare |
$270.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.90
|
| Rate for Payer: BCBS Complete |
$228.40
|
| Rate for Payer: BCBS MAPPO |
$260.37
|
| Rate for Payer: BCN Medicare Advantage |
$260.37
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cash Price |
$456.80
|
| Rate for Payer: Cofinity Commercial |
$374.93
|
| Rate for Payer: Cofinity Commercial |
$348.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.37
|
| Rate for Payer: Healthscope Commercial |
$416.59
|
| Rate for Payer: Healthscope Commercial |
$481.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.15
|
| Rate for Payer: Nomi Health Commercial |
$312.44
|
| Rate for Payer: PACE SWMI |
$260.37
|
| Rate for Payer: PHP Medicare Advantage |
$260.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$371.15
|
| Rate for Payer: Priority Health Medicare |
$260.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.37
|
| Rate for Payer: UHC Medicare Advantage |
$260.37
|
|
|
PR ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL
|
Professional
|
Both
|
$4,144.00
|
|
|
Service Code
|
HCPCS 62000
|
| Min. Negotiated Rate |
$1,028.09 |
| Max. Negotiated Rate |
$2,693.60 |
| Rate for Payer: Aetna Commercial |
$1,377.64
|
| Rate for Payer: Aetna Medicare |
$1,069.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,480.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,377.64
|
| Rate for Payer: BCBS Complete |
$1,657.60
|
| Rate for Payer: BCBS MAPPO |
$1,028.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,028.09
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: Cash Price |
$3,315.20
|
| Rate for Payer: Cofinity Commercial |
$1,480.45
|
| Rate for Payer: Cofinity Commercial |
$1,377.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,028.09
|
| Rate for Payer: Healthscope Commercial |
$1,901.97
|
| Rate for Payer: Healthscope Commercial |
$1,644.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,079.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,693.60
|
| Rate for Payer: Nomi Health Commercial |
$1,233.71
|
| Rate for Payer: PACE SWMI |
$1,028.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,028.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,693.60
|
| Rate for Payer: Priority Health Medicare |
$1,028.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,028.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,028.09
|
|
|
PR ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL
|
Professional
|
Both
|
$5,239.00
|
|
|
Service Code
|
HCPCS 62005
|
| Min. Negotiated Rate |
$1,264.76 |
| Max. Negotiated Rate |
$3,405.35 |
| Rate for Payer: Aetna Commercial |
$1,694.78
|
| Rate for Payer: Aetna Medicare |
$1,315.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,821.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,694.78
|
| Rate for Payer: BCBS Complete |
$2,095.60
|
| Rate for Payer: BCBS MAPPO |
$1,264.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,264.76
|
| Rate for Payer: Cash Price |
$4,191.20
|
| Rate for Payer: Cash Price |
$4,191.20
|
| Rate for Payer: Cofinity Commercial |
$1,821.25
|
| Rate for Payer: Cofinity Commercial |
$1,694.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,264.76
|
| Rate for Payer: Healthscope Commercial |
$2,023.62
|
| Rate for Payer: Healthscope Commercial |
$2,339.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,328.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,405.35
|
| Rate for Payer: Nomi Health Commercial |
$1,517.71
|
| Rate for Payer: PACE SWMI |
$1,264.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,264.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,405.35
|
| Rate for Payer: Priority Health Medicare |
$1,264.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,264.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,264.76
|
|
|
PR ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN
|
Professional
|
Both
|
$6,878.00
|
|
|
Service Code
|
HCPCS 62010
|
| Min. Negotiated Rate |
$1,526.64 |
| Max. Negotiated Rate |
$4,470.70 |
| Rate for Payer: Aetna Commercial |
$2,045.70
|
| Rate for Payer: Aetna Medicare |
$1,587.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,198.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,045.70
|
| Rate for Payer: BCBS Complete |
$2,751.20
|
| Rate for Payer: BCBS MAPPO |
$1,526.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,526.64
|
| Rate for Payer: Cash Price |
$5,502.40
|
| Rate for Payer: Cash Price |
$5,502.40
|
| Rate for Payer: Cofinity Commercial |
$2,198.36
|
| Rate for Payer: Cofinity Commercial |
$2,045.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,526.64
|
| Rate for Payer: Healthscope Commercial |
$2,442.62
|
| Rate for Payer: Healthscope Commercial |
$2,824.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,602.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,470.70
|
| Rate for Payer: Nomi Health Commercial |
$1,831.97
|
| Rate for Payer: PACE SWMI |
$1,526.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,526.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,470.70
|
| Rate for Payer: Priority Health Medicare |
$1,526.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,526.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,526.64
|
|
|
PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 99318
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
|
|
PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART
|
Professional
|
Both
|
$2,337.00
|
|
|
Service Code
|
HCPCS 34101
|
| Min. Negotiated Rate |
$571.84 |
| Max. Negotiated Rate |
$1,519.05 |
| Rate for Payer: Aetna Commercial |
$766.27
|
| Rate for Payer: Aetna Medicare |
$594.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$766.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.45
|
| Rate for Payer: BCBS Complete |
$934.80
|
| Rate for Payer: BCBS MAPPO |
$571.84
|
| Rate for Payer: BCN Medicare Advantage |
$571.84
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Cofinity Commercial |
$766.27
|
| Rate for Payer: Cofinity Commercial |
$823.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.84
|
| Rate for Payer: Healthscope Commercial |
$1,057.90
|
| Rate for Payer: Healthscope Commercial |
$914.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$600.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,519.05
|
| Rate for Payer: Nomi Health Commercial |
$686.21
|
| Rate for Payer: PACE SWMI |
$571.84
|
| Rate for Payer: PHP Medicare Advantage |
$571.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,519.05
|
| Rate for Payer: Priority Health Medicare |
$571.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.84
|
| Rate for Payer: UHC Medicare Advantage |
$571.84
|
|
|
PR EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 34001
|
| Min. Negotiated Rate |
$813.60 |
| Max. Negotiated Rate |
$1,631.22 |
| Rate for Payer: Aetna Commercial |
$1,181.53
|
| Rate for Payer: Aetna Medicare |
$917.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,181.53
|
| Rate for Payer: BCBS Complete |
$813.60
|
| Rate for Payer: BCBS MAPPO |
$881.74
|
| Rate for Payer: BCN Medicare Advantage |
$881.74
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,269.71
|
| Rate for Payer: Cofinity Commercial |
$1,181.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.74
|
| Rate for Payer: Healthscope Commercial |
$1,631.22
|
| Rate for Payer: Healthscope Commercial |
$1,410.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,322.10
|
| Rate for Payer: Nomi Health Commercial |
$1,058.09
|
| Rate for Payer: PACE SWMI |
$881.74
|
| Rate for Payer: PHP Medicare Advantage |
$881.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health Medicare |
$881.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$881.74
|
| Rate for Payer: UHC Medicare Advantage |
$881.74
|
|
|
PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART
|
Professional
|
Both
|
$1,995.00
|
|
|
Service Code
|
HCPCS 34201
|
| Min. Negotiated Rate |
$798.00 |
| Max. Negotiated Rate |
$1,811.26 |
| Rate for Payer: Aetna Commercial |
$1,311.94
|
| Rate for Payer: Aetna Medicare |
$1,018.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,409.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,311.94
|
| Rate for Payer: BCBS Complete |
$798.00
|
| Rate for Payer: BCBS MAPPO |
$979.06
|
| Rate for Payer: BCN Medicare Advantage |
$979.06
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cofinity Commercial |
$1,409.85
|
| Rate for Payer: Cofinity Commercial |
$1,311.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.06
|
| Rate for Payer: Healthscope Commercial |
$1,566.50
|
| Rate for Payer: Healthscope Commercial |
$1,811.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,028.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,296.75
|
| Rate for Payer: Nomi Health Commercial |
$1,174.87
|
| Rate for Payer: PACE SWMI |
$979.06
|
| Rate for Payer: PHP Medicare Advantage |
$979.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.75
|
| Rate for Payer: Priority Health Medicare |
$979.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.06
|
| Rate for Payer: UHC Medicare Advantage |
$979.06
|
|
|
PR EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 34051
|
| Min. Negotiated Rate |
$804.00 |
| Max. Negotiated Rate |
$1,757.19 |
| Rate for Payer: Aetna Commercial |
$1,272.77
|
| Rate for Payer: Aetna Medicare |
$987.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,367.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,272.77
|
| Rate for Payer: BCBS Complete |
$804.00
|
| Rate for Payer: BCBS MAPPO |
$949.83
|
| Rate for Payer: BCN Medicare Advantage |
$949.83
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cofinity Commercial |
$1,367.76
|
| Rate for Payer: Cofinity Commercial |
$1,272.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$949.83
|
| Rate for Payer: Healthscope Commercial |
$1,757.19
|
| Rate for Payer: Healthscope Commercial |
$1,519.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$997.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,306.50
|
| Rate for Payer: Nomi Health Commercial |
$1,139.80
|
| Rate for Payer: PACE SWMI |
$949.83
|
| Rate for Payer: PHP Medicare Advantage |
$949.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.50
|
| Rate for Payer: Priority Health Medicare |
$949.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$949.83
|
| Rate for Payer: UHC Medicare Advantage |
$949.83
|
|
|
PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC
|
Professional
|
Both
|
$1,977.00
|
|
|
Service Code
|
HCPCS 34203
|
| Min. Negotiated Rate |
$790.80 |
| Max. Negotiated Rate |
$1,683.28 |
| Rate for Payer: Aetna Commercial |
$1,219.24
|
| Rate for Payer: Aetna Medicare |
$946.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,219.24
|
| Rate for Payer: BCBS Complete |
$790.80
|
| Rate for Payer: BCBS MAPPO |
$909.88
|
| Rate for Payer: BCN Medicare Advantage |
$909.88
|
| Rate for Payer: Cash Price |
$1,581.60
|
| Rate for Payer: Cash Price |
$1,581.60
|
| Rate for Payer: Cofinity Commercial |
$1,310.23
|
| Rate for Payer: Cofinity Commercial |
$1,219.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$909.88
|
| Rate for Payer: Healthscope Commercial |
$1,455.81
|
| Rate for Payer: Healthscope Commercial |
$1,683.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$955.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,285.05
|
| Rate for Payer: Nomi Health Commercial |
$1,091.86
|
| Rate for Payer: PACE SWMI |
$909.88
|
| Rate for Payer: PHP Medicare Advantage |
$909.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.05
|
| Rate for Payer: Priority Health Medicare |
$909.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$909.88
|
| Rate for Payer: UHC Medicare Advantage |
$909.88
|
|
|
PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART
|
Professional
|
Both
|
$2,730.00
|
|
|
Service Code
|
HCPCS 34151
|
| Min. Negotiated Rate |
$1,092.00 |
| Max. Negotiated Rate |
$2,470.56 |
| Rate for Payer: Aetna Commercial |
$1,789.49
|
| Rate for Payer: Aetna Medicare |
$1,388.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,923.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,789.49
|
| Rate for Payer: BCBS Complete |
$1,092.00
|
| Rate for Payer: BCBS MAPPO |
$1,335.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,335.44
|
| Rate for Payer: Cash Price |
$2,184.00
|
| Rate for Payer: Cash Price |
$2,184.00
|
| Rate for Payer: Cofinity Commercial |
$1,923.03
|
| Rate for Payer: Cofinity Commercial |
$1,789.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,335.44
|
| Rate for Payer: Healthscope Commercial |
$2,470.56
|
| Rate for Payer: Healthscope Commercial |
$2,136.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,402.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,774.50
|
| Rate for Payer: Nomi Health Commercial |
$1,602.53
|
| Rate for Payer: PACE SWMI |
$1,335.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,335.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,774.50
|
| Rate for Payer: Priority Health Medicare |
$1,335.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,335.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,335.44
|
|
|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$1,258.00
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$503.20 |
| Max. Negotiated Rate |
$1,055.72 |
| Rate for Payer: Aetna Commercial |
$764.68
|
| Rate for Payer: Aetna Medicare |
$593.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.68
|
| Rate for Payer: BCBS Complete |
$503.20
|
| Rate for Payer: BCBS MAPPO |
$570.66
|
| Rate for Payer: BCN Medicare Advantage |
$570.66
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cofinity Commercial |
$821.75
|
| Rate for Payer: Cofinity Commercial |
$764.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.66
|
| Rate for Payer: Healthscope Commercial |
$1,055.72
|
| Rate for Payer: Healthscope Commercial |
$913.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$817.70
|
| Rate for Payer: Nomi Health Commercial |
$684.79
|
| Rate for Payer: PACE SWMI |
$570.66
|
| Rate for Payer: PHP Medicare Advantage |
$570.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.70
|
| Rate for Payer: Priority Health Medicare |
$570.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.66
|
| Rate for Payer: UHC Medicare Advantage |
$570.66
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$312.61 |
| Rate for Payer: Aetna Commercial |
$226.43
|
| Rate for Payer: Aetna Medicare |
$175.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.43
|
| Rate for Payer: BCBS Complete |
$148.40
|
| Rate for Payer: BCBS MAPPO |
$168.98
|
| Rate for Payer: BCN Medicare Advantage |
$168.98
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$243.33
|
| Rate for Payer: Cofinity Commercial |
$226.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.98
|
| Rate for Payer: Healthscope Commercial |
$312.61
|
| Rate for Payer: Healthscope Commercial |
$270.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.15
|
| Rate for Payer: Nomi Health Commercial |
$202.78
|
| Rate for Payer: PACE SWMI |
$168.98
|
| Rate for Payer: PHP Medicare Advantage |
$168.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.15
|
| Rate for Payer: Priority Health Medicare |
$168.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.98
|
| Rate for Payer: UHC Medicare Advantage |
$168.98
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$126.06 |
| Rate for Payer: Aetna Commercial |
$91.31
|
| Rate for Payer: Aetna Medicare |
$70.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.31
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS MAPPO |
$68.14
|
| Rate for Payer: BCN Medicare Advantage |
$68.14
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$98.12
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.14
|
| Rate for Payer: Healthscope Commercial |
$109.02
|
| Rate for Payer: Healthscope Commercial |
$126.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.45
|
| Rate for Payer: Nomi Health Commercial |
$81.77
|
| Rate for Payer: PACE SWMI |
$68.14
|
| Rate for Payer: PHP Medicare Advantage |
$68.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health Medicare |
$68.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.14
|
| Rate for Payer: UHC Medicare Advantage |
$68.14
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$10.99 |
| Max. Negotiated Rate |
$60.45 |
| Rate for Payer: Aetna Commercial |
$14.73
|
| Rate for Payer: Aetna Medicare |
$11.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.73
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS MAPPO |
$10.99
|
| Rate for Payer: BCN Medicare Advantage |
$10.99
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Cofinity Commercial |
$14.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.99
|
| Rate for Payer: Healthscope Commercial |
$20.33
|
| Rate for Payer: Healthscope Commercial |
$17.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60.45
|
| Rate for Payer: Nomi Health Commercial |
$13.19
|
| Rate for Payer: PACE SWMI |
$10.99
|
| Rate for Payer: PHP Medicare Advantage |
$10.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
| Rate for Payer: Priority Health Medicare |
$10.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.99
|
| Rate for Payer: UHC Medicare Advantage |
$10.99
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$215.40 |
| Rate for Payer: Aetna Commercial |
$156.02
|
| Rate for Payer: Aetna Medicare |
$121.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.02
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS MAPPO |
$116.43
|
| Rate for Payer: BCN Medicare Advantage |
$116.43
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$167.66
|
| Rate for Payer: Cofinity Commercial |
$156.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.43
|
| Rate for Payer: Healthscope Commercial |
$186.29
|
| Rate for Payer: Healthscope Commercial |
$215.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.85
|
| Rate for Payer: Nomi Health Commercial |
$139.72
|
| Rate for Payer: PACE SWMI |
$116.43
|
| Rate for Payer: PHP Medicare Advantage |
$116.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health Medicare |
$116.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.43
|
| Rate for Payer: UHC Medicare Advantage |
$116.43
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Aetna Commercial |
$54.08
|
| Rate for Payer: Aetna Medicare |
$41.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.08
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$40.36
|
| Rate for Payer: BCN Medicare Advantage |
$40.36
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$58.12
|
| Rate for Payer: Cofinity Commercial |
$54.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.36
|
| Rate for Payer: Healthscope Commercial |
$74.67
|
| Rate for Payer: Healthscope Commercial |
$64.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.70
|
| Rate for Payer: Nomi Health Commercial |
$48.43
|
| Rate for Payer: PACE SWMI |
$40.36
|
| Rate for Payer: PHP Medicare Advantage |
$40.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.70
|
| Rate for Payer: Priority Health Medicare |
$40.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.36
|
| Rate for Payer: UHC Medicare Advantage |
$40.36
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$59.33 |
| Max. Negotiated Rate |
$255.45 |
| Rate for Payer: Aetna Commercial |
$79.50
|
| Rate for Payer: Aetna Medicare |
$61.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.50
|
| Rate for Payer: BCBS Complete |
$157.20
|
| Rate for Payer: BCBS MAPPO |
$59.33
|
| Rate for Payer: BCN Medicare Advantage |
$59.33
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cofinity Commercial |
$85.44
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.33
|
| Rate for Payer: Healthscope Commercial |
$109.76
|
| Rate for Payer: Healthscope Commercial |
$94.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.45
|
| Rate for Payer: Nomi Health Commercial |
$71.20
|
| Rate for Payer: PACE SWMI |
$59.33
|
| Rate for Payer: PHP Medicare Advantage |
$59.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.45
|
| Rate for Payer: Priority Health Medicare |
$59.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.33
|
| Rate for Payer: UHC Medicare Advantage |
$59.33
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
OP
|
$324.30
|
|
|
Service Code
|
NDC 77333071510
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Medicare |
$162.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.79
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$227.01
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.79
|
| Rate for Payer: Priority Health SBD |
$204.31
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
IP
|
$324.30
|
|
|
Service Code
|
NDC 77333071510
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.31 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.79
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$227.01
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.79
|
| Rate for Payer: Priority Health SBD |
$204.31
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
OP
|
$3.25
|
|
|
Service Code
|
NDC 77333071525
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$2.05
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
NDC 77333071525
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.27
|
| Rate for Payer: Cofinity Commercial |
$2.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$2.05
|
|
