|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$1,262.00
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$322.70 |
| Max. Negotiated Rate |
$998.98 |
| Rate for Payer: Aetna Commercial |
$657.40
|
| Rate for Payer: Aetna Medicare |
$510.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$706.46
|
| Rate for Payer: BCBS Complete |
$338.83
|
| Rate for Payer: BCBS MAPPO |
$490.60
|
| Rate for Payer: BCN Commercial |
$862.50
|
| Rate for Payer: BCN Medicare Advantage |
$490.60
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cash Price |
$1,009.60
|
| Rate for Payer: Cofinity Commercial |
$706.46
|
| Rate for Payer: Cofinity Commercial |
$657.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$490.60
|
| Rate for Payer: Healthscope Commercial |
$907.61
|
| Rate for Payer: Healthscope Commercial |
$784.96
|
| Rate for Payer: Mclaren Medicaid |
$322.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$515.13
|
| Rate for Payer: Meridian Medicaid |
$338.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$539.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$998.98
|
| Rate for Payer: Nomi Health Commercial |
$588.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$946.50
|
| Rate for Payer: PACE SWMI |
$490.60
|
| Rate for Payer: PHP Medicare Advantage |
$490.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$322.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$921.99
|
| Rate for Payer: Priority Health Medicare |
$490.60
|
| Rate for Payer: Priority Health SBD |
$921.99
|
| Rate for Payer: Priority Health Tiered Network |
$921.99
|
| Rate for Payer: Railroad Medicare Medicare |
$490.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$971.32
|
| Rate for Payer: UHC Core |
$971.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$490.60
|
| Rate for Payer: UHC Exchange |
$971.32
|
| Rate for Payer: UHC Medicaid |
$322.70
|
| Rate for Payer: UHCCP Medicaid |
$322.70
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$1,203.00
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$289.68 |
| Max. Negotiated Rate |
$902.25 |
| Rate for Payer: Aetna Commercial |
$592.51
|
| Rate for Payer: Aetna Medicare |
$459.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$636.72
|
| Rate for Payer: BCBS Complete |
$304.16
|
| Rate for Payer: BCBS MAPPO |
$442.17
|
| Rate for Payer: BCN Commercial |
$760.42
|
| Rate for Payer: BCN Medicare Advantage |
$442.17
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cash Price |
$962.40
|
| Rate for Payer: Cofinity Commercial |
$636.72
|
| Rate for Payer: Cofinity Commercial |
$592.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.17
|
| Rate for Payer: Healthscope Commercial |
$818.01
|
| Rate for Payer: Healthscope Commercial |
$707.47
|
| Rate for Payer: Mclaren Medicaid |
$289.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$464.28
|
| Rate for Payer: Meridian Medicaid |
$304.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$486.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$880.96
|
| Rate for Payer: Nomi Health Commercial |
$530.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$902.25
|
| Rate for Payer: PACE SWMI |
$442.17
|
| Rate for Payer: PHP Medicare Advantage |
$442.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$695.98
|
| Rate for Payer: Priority Health Medicare |
$442.17
|
| Rate for Payer: Priority Health SBD |
$695.98
|
| Rate for Payer: Priority Health Tiered Network |
$695.98
|
| Rate for Payer: Railroad Medicare Medicare |
$442.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.76
|
| Rate for Payer: UHC Core |
$841.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$442.17
|
| Rate for Payer: UHC Exchange |
$841.76
|
| Rate for Payer: UHC Medicaid |
$289.68
|
| Rate for Payer: UHCCP Medicaid |
$289.68
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$1,192.00
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$302.03 |
| Max. Negotiated Rate |
$894.00 |
| Rate for Payer: Aetna Commercial |
$616.88
|
| Rate for Payer: Aetna Medicare |
$478.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$662.92
|
| Rate for Payer: BCBS Complete |
$317.13
|
| Rate for Payer: BCBS MAPPO |
$460.36
|
| Rate for Payer: BCN Commercial |
$777.35
|
| Rate for Payer: BCN Medicare Advantage |
$460.36
|
| Rate for Payer: Cash Price |
$953.60
|
| Rate for Payer: Cash Price |
$953.60
|
| Rate for Payer: Cofinity Commercial |
$662.92
|
| Rate for Payer: Cofinity Commercial |
$616.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.36
|
| Rate for Payer: Healthscope Commercial |
$851.67
|
| Rate for Payer: Healthscope Commercial |
$736.58
|
| Rate for Payer: Mclaren Medicaid |
$302.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.38
|
| Rate for Payer: Meridian Medicaid |
$317.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$506.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$893.86
|
| Rate for Payer: Nomi Health Commercial |
$552.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$894.00
|
| Rate for Payer: PACE SWMI |
$460.36
|
| Rate for Payer: PHP Medicare Advantage |
$460.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$711.48
|
| Rate for Payer: Priority Health Medicare |
$460.36
|
| Rate for Payer: Priority Health SBD |
$711.48
|
| Rate for Payer: Priority Health Tiered Network |
$711.48
|
| Rate for Payer: Railroad Medicare Medicare |
$460.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$832.61
|
| Rate for Payer: UHC Core |
$832.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$460.36
|
| Rate for Payer: UHC Exchange |
$832.61
|
| Rate for Payer: UHC Medicaid |
$302.03
|
| Rate for Payer: UHCCP Medicaid |
$302.03
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$77.53 |
| Max. Negotiated Rate |
$275.25 |
| Rate for Payer: Aetna Commercial |
$162.05
|
| Rate for Payer: Aetna Medicare |
$125.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.14
|
| Rate for Payer: BCBS Complete |
$81.41
|
| Rate for Payer: BCBS MAPPO |
$120.93
|
| Rate for Payer: BCN Commercial |
$215.63
|
| Rate for Payer: BCN Medicare Advantage |
$120.93
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$174.14
|
| Rate for Payer: Cofinity Commercial |
$162.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.93
|
| Rate for Payer: Healthscope Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$193.49
|
| Rate for Payer: Mclaren Medicaid |
$77.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.98
|
| Rate for Payer: Meridian Medicaid |
$81.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.35
|
| Rate for Payer: Nomi Health Commercial |
$145.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.25
|
| Rate for Payer: PACE SWMI |
$120.93
|
| Rate for Payer: PHP Medicare Advantage |
$120.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$197.35
|
| Rate for Payer: Priority Health Medicare |
$120.93
|
| Rate for Payer: Priority Health SBD |
$197.35
|
| Rate for Payer: Priority Health Tiered Network |
$197.35
|
| Rate for Payer: Railroad Medicare Medicare |
$120.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.63
|
| Rate for Payer: UHC Core |
$239.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$120.93
|
| Rate for Payer: UHC Exchange |
$239.63
|
| Rate for Payer: UHC Medicaid |
$77.53
|
| Rate for Payer: UHCCP Medicaid |
$77.53
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$80.51 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna Commercial |
$168.32
|
| Rate for Payer: Aetna Medicare |
$130.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.88
|
| Rate for Payer: BCBS Complete |
$84.54
|
| Rate for Payer: BCBS MAPPO |
$125.61
|
| Rate for Payer: BCN Commercial |
$222.60
|
| Rate for Payer: BCN Medicare Advantage |
$125.61
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$180.88
|
| Rate for Payer: Cofinity Commercial |
$168.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.61
|
| Rate for Payer: Healthscope Commercial |
$232.38
|
| Rate for Payer: Healthscope Commercial |
$200.98
|
| Rate for Payer: Mclaren Medicaid |
$80.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.89
|
| Rate for Payer: Meridian Medicaid |
$84.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$262.49
|
| Rate for Payer: Nomi Health Commercial |
$150.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.50
|
| Rate for Payer: PACE SWMI |
$125.61
|
| Rate for Payer: PHP Medicare Advantage |
$125.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$203.74
|
| Rate for Payer: Priority Health Medicare |
$125.61
|
| Rate for Payer: Priority Health SBD |
$203.74
|
| Rate for Payer: Priority Health Tiered Network |
$203.74
|
| Rate for Payer: Railroad Medicare Medicare |
$125.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.46
|
| Rate for Payer: UHC Core |
$249.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.61
|
| Rate for Payer: UHC Exchange |
$249.46
|
| Rate for Payer: UHC Medicaid |
$80.51
|
| Rate for Payer: UHCCP Medicaid |
$80.51
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$1,004.00
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$289.89 |
| Max. Negotiated Rate |
$848.57 |
| Rate for Payer: Aetna Commercial |
$594.36
|
| Rate for Payer: Aetna Medicare |
$461.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.71
|
| Rate for Payer: BCBS Complete |
$304.38
|
| Rate for Payer: BCBS MAPPO |
$443.55
|
| Rate for Payer: BCN Commercial |
$726.55
|
| Rate for Payer: BCN Medicare Advantage |
$443.55
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cash Price |
$803.20
|
| Rate for Payer: Cofinity Commercial |
$638.71
|
| Rate for Payer: Cofinity Commercial |
$594.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.55
|
| Rate for Payer: Healthscope Commercial |
$820.57
|
| Rate for Payer: Healthscope Commercial |
$709.68
|
| Rate for Payer: Mclaren Medicaid |
$289.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$465.73
|
| Rate for Payer: Meridian Medicaid |
$304.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$487.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$848.57
|
| Rate for Payer: Nomi Health Commercial |
$532.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$753.00
|
| Rate for Payer: PACE SWMI |
$443.55
|
| Rate for Payer: PHP Medicare Advantage |
$443.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$664.99
|
| Rate for Payer: Priority Health Medicare |
$443.55
|
| Rate for Payer: Priority Health SBD |
$664.99
|
| Rate for Payer: Priority Health Tiered Network |
$664.99
|
| Rate for Payer: Railroad Medicare Medicare |
$443.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$838.04
|
| Rate for Payer: UHC Core |
$838.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$443.55
|
| Rate for Payer: UHC Exchange |
$838.04
|
| Rate for Payer: UHC Medicaid |
$289.89
|
| Rate for Payer: UHCCP Medicaid |
$289.89
|
|
|
PR GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE
|
Professional
|
Both
|
$1,236.00
|
|
|
Service Code
|
HCPCS 46753
|
| Min. Negotiated Rate |
$391.92 |
| Max. Negotiated Rate |
$1,145.55 |
| Rate for Payer: Aetna Commercial |
$808.17
|
| Rate for Payer: Aetna Medicare |
$627.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.48
|
| Rate for Payer: BCBS Complete |
$411.52
|
| Rate for Payer: BCBS MAPPO |
$603.11
|
| Rate for Payer: BCN Commercial |
$940.19
|
| Rate for Payer: BCN Medicare Advantage |
$603.11
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cofinity Commercial |
$868.48
|
| Rate for Payer: Cofinity Commercial |
$808.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$603.11
|
| Rate for Payer: Healthscope Commercial |
$964.98
|
| Rate for Payer: Healthscope Commercial |
$1,115.75
|
| Rate for Payer: Mclaren Medicaid |
$391.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.27
|
| Rate for Payer: Meridian Medicaid |
$411.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$663.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.60
|
| Rate for Payer: Nomi Health Commercial |
$723.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$927.00
|
| Rate for Payer: PACE SWMI |
$603.11
|
| Rate for Payer: PHP Medicare Advantage |
$603.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$391.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,145.55
|
| Rate for Payer: Priority Health Medicare |
$603.11
|
| Rate for Payer: Priority Health SBD |
$1,145.55
|
| Rate for Payer: Priority Health Tiered Network |
$1,145.55
|
| Rate for Payer: Railroad Medicare Medicare |
$603.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,089.69
|
| Rate for Payer: UHC Core |
$1,089.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$603.11
|
| Rate for Payer: UHC Exchange |
$1,089.69
|
| Rate for Payer: UHC Medicaid |
$391.92
|
| Rate for Payer: UHCCP Medicaid |
$391.92
|
|
|
PR GROUP BEHAVE COUNS 2-10
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0473
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$13.25
|
| Rate for Payer: Aetna Medicare |
$10.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.24
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$9.89
|
| Rate for Payer: BCN Commercial |
$16.93
|
| Rate for Payer: BCN Medicare Advantage |
$9.89
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$14.24
|
| Rate for Payer: Cofinity Commercial |
$13.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.89
|
| Rate for Payer: Healthscope Commercial |
$18.30
|
| Rate for Payer: Healthscope Commercial |
$15.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$10.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.88
|
| Rate for Payer: Nomi Health Commercial |
$11.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$9.89
|
| Rate for Payer: PHP Medicare Advantage |
$9.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.10
|
| Rate for Payer: Priority Health Medicare |
$9.89
|
| Rate for Payer: Priority Health SBD |
$15.10
|
| Rate for Payer: Priority Health Tiered Network |
$15.10
|
| Rate for Payer: Railroad Medicare Medicare |
$9.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.72
|
| Rate for Payer: UHC Core |
$18.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9.89
|
| Rate for Payer: UHC Exchange |
$18.72
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 90853
|
| Min. Negotiated Rate |
$16.44 |
| Max. Negotiated Rate |
$44.92 |
| Rate for Payer: Aetna Commercial |
$32.54
|
| Rate for Payer: Aetna Medicare |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.96
|
| Rate for Payer: BCBS Complete |
$17.26
|
| Rate for Payer: BCBS MAPPO |
$24.28
|
| Rate for Payer: BCN Commercial |
$29.45
|
| Rate for Payer: BCN Medicare Advantage |
$24.28
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$34.96
|
| Rate for Payer: Cofinity Commercial |
$32.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.28
|
| Rate for Payer: Healthscope Commercial |
$44.92
|
| Rate for Payer: Healthscope Commercial |
$38.85
|
| Rate for Payer: Mclaren Medicaid |
$16.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.49
|
| Rate for Payer: Meridian Medicaid |
$17.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.79
|
| Rate for Payer: Nomi Health Commercial |
$29.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.75
|
| Rate for Payer: PACE SWMI |
$24.28
|
| Rate for Payer: PHP Medicare Advantage |
$24.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.48
|
| Rate for Payer: Priority Health Medicare |
$24.28
|
| Rate for Payer: Priority Health SBD |
$33.48
|
| Rate for Payer: Priority Health Tiered Network |
$33.48
|
| Rate for Payer: Railroad Medicare Medicare |
$24.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.23
|
| Rate for Payer: UHC Core |
$40.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.28
|
| Rate for Payer: UHC Exchange |
$40.23
|
| Rate for Payer: UHC Medicaid |
$16.44
|
| Rate for Payer: UHCCP Medicaid |
$16.44
|
|
|
PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,686.00
|
|
|
Service Code
|
HCPCS 43631
|
| Min. Negotiated Rate |
$864.57 |
| Max. Negotiated Rate |
$2,655.78 |
| Rate for Payer: Aetna Commercial |
$1,811.06
|
| Rate for Payer: Aetna Medicare |
$1,405.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,811.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,946.22
|
| Rate for Payer: BCBS Complete |
$907.80
|
| Rate for Payer: BCBS MAPPO |
$1,351.54
|
| Rate for Payer: BCN Commercial |
$2,179.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,351.54
|
| Rate for Payer: Cash Price |
$2,148.80
|
| Rate for Payer: Cash Price |
$2,148.80
|
| Rate for Payer: Cofinity Commercial |
$1,946.22
|
| Rate for Payer: Cofinity Commercial |
$1,811.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,351.54
|
| Rate for Payer: Healthscope Commercial |
$2,500.35
|
| Rate for Payer: Healthscope Commercial |
$2,162.46
|
| Rate for Payer: Mclaren Medicaid |
$864.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,419.12
|
| Rate for Payer: Meridian Medicaid |
$907.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,486.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,591.12
|
| Rate for Payer: Nomi Health Commercial |
$1,621.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,014.50
|
| Rate for Payer: PACE SWMI |
$1,351.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,351.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$864.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,655.78
|
| Rate for Payer: Priority Health Medicare |
$1,351.54
|
| Rate for Payer: Priority Health SBD |
$2,655.78
|
| Rate for Payer: Priority Health Tiered Network |
$2,655.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,351.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,591.70
|
| Rate for Payer: UHC Core |
$2,591.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,351.54
|
| Rate for Payer: UHC Exchange |
$2,591.70
|
| Rate for Payer: UHC Medicaid |
$864.57
|
| Rate for Payer: UHCCP Medicaid |
$864.57
|
|
|
PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY
|
Professional
|
Both
|
$3,874.00
|
|
|
Service Code
|
HCPCS 43632
|
| Min. Negotiated Rate |
$1,196.00 |
| Max. Negotiated Rate |
$3,715.78 |
| Rate for Payer: Aetna Commercial |
$2,512.18
|
| Rate for Payer: Aetna Medicare |
$1,949.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,512.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,699.65
|
| Rate for Payer: BCBS Complete |
$1,255.80
|
| Rate for Payer: BCBS MAPPO |
$1,874.76
|
| Rate for Payer: BCN Commercial |
$3,049.63
|
| Rate for Payer: BCN Medicare Advantage |
$1,874.76
|
| Rate for Payer: Cash Price |
$3,099.20
|
| Rate for Payer: Cash Price |
$3,099.20
|
| Rate for Payer: Cofinity Commercial |
$2,699.65
|
| Rate for Payer: Cofinity Commercial |
$2,512.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,874.76
|
| Rate for Payer: Healthscope Commercial |
$3,468.31
|
| Rate for Payer: Healthscope Commercial |
$2,999.62
|
| Rate for Payer: Mclaren Medicaid |
$1,196.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,968.50
|
| Rate for Payer: Meridian Medicaid |
$1,255.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,062.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,646.98
|
| Rate for Payer: Nomi Health Commercial |
$2,249.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,905.50
|
| Rate for Payer: PACE SWMI |
$1,874.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,874.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,196.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,715.78
|
| Rate for Payer: Priority Health Medicare |
$1,874.76
|
| Rate for Payer: Priority Health SBD |
$3,715.78
|
| Rate for Payer: Priority Health Tiered Network |
$3,715.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1,874.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,641.65
|
| Rate for Payer: UHC Core |
$3,641.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,874.76
|
| Rate for Payer: UHC Exchange |
$3,641.65
|
| Rate for Payer: UHC Medicaid |
$1,196.00
|
| Rate for Payer: UHCCP Medicaid |
$1,196.00
|
|
|
PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$3,549.00
|
|
|
Service Code
|
HCPCS 43633
|
| Min. Negotiated Rate |
$1,132.52 |
| Max. Negotiated Rate |
$3,514.34 |
| Rate for Payer: Aetna Commercial |
$2,377.88
|
| Rate for Payer: Aetna Medicare |
$1,845.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,377.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,555.34
|
| Rate for Payer: BCBS Complete |
$1,189.15
|
| Rate for Payer: BCBS MAPPO |
$1,774.54
|
| Rate for Payer: BCN Commercial |
$2,884.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,774.54
|
| Rate for Payer: Cash Price |
$2,839.20
|
| Rate for Payer: Cash Price |
$2,839.20
|
| Rate for Payer: Cofinity Commercial |
$2,555.34
|
| Rate for Payer: Cofinity Commercial |
$2,377.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,774.54
|
| Rate for Payer: Healthscope Commercial |
$3,282.90
|
| Rate for Payer: Healthscope Commercial |
$2,839.26
|
| Rate for Payer: Mclaren Medicaid |
$1,132.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,863.27
|
| Rate for Payer: Meridian Medicaid |
$1,189.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,951.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,443.87
|
| Rate for Payer: Nomi Health Commercial |
$2,129.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,661.75
|
| Rate for Payer: PACE SWMI |
$1,774.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,774.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,132.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,514.34
|
| Rate for Payer: Priority Health Medicare |
$1,774.54
|
| Rate for Payer: Priority Health SBD |
$3,514.34
|
| Rate for Payer: Priority Health Tiered Network |
$3,514.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,774.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,443.53
|
| Rate for Payer: UHC Core |
$3,443.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,774.54
|
| Rate for Payer: UHC Exchange |
$3,443.53
|
| Rate for Payer: UHC Medicaid |
$1,132.52
|
| Rate for Payer: UHCCP Medicaid |
$1,132.52
|
|
|
PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY
|
Professional
|
Both
|
$6,814.00
|
|
|
Service Code
|
HCPCS 43620
|
| Min. Negotiated Rate |
$1,169.80 |
| Max. Negotiated Rate |
$5,110.50 |
| Rate for Payer: Aetna Commercial |
$2,459.40
|
| Rate for Payer: Aetna Medicare |
$1,908.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,459.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,642.93
|
| Rate for Payer: BCBS Complete |
$1,228.29
|
| Rate for Payer: BCBS MAPPO |
$1,835.37
|
| Rate for Payer: BCN Commercial |
$2,968.96
|
| Rate for Payer: BCN Medicare Advantage |
$1,835.37
|
| Rate for Payer: Cash Price |
$5,451.20
|
| Rate for Payer: Cash Price |
$5,451.20
|
| Rate for Payer: Cofinity Commercial |
$2,642.93
|
| Rate for Payer: Cofinity Commercial |
$2,459.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,835.37
|
| Rate for Payer: Healthscope Commercial |
$3,395.43
|
| Rate for Payer: Healthscope Commercial |
$2,936.59
|
| Rate for Payer: Mclaren Medicaid |
$1,169.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,927.14
|
| Rate for Payer: Meridian Medicaid |
$1,228.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,018.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,553.72
|
| Rate for Payer: Nomi Health Commercial |
$2,202.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,110.50
|
| Rate for Payer: PACE SWMI |
$1,835.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,835.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,169.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,617.49
|
| Rate for Payer: Priority Health Medicare |
$1,835.37
|
| Rate for Payer: Priority Health SBD |
$3,617.49
|
| Rate for Payer: Priority Health Tiered Network |
$3,617.49
|
| Rate for Payer: Railroad Medicare Medicare |
$1,835.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,551.46
|
| Rate for Payer: UHC Core |
$3,551.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,835.37
|
| Rate for Payer: UHC Exchange |
$3,551.46
|
| Rate for Payer: UHC Medicaid |
$1,169.80
|
| Rate for Payer: UHCCP Medicaid |
$1,169.80
|
|
|
PR HAIR REDUC 1/2 LEGS
|
Professional
|
Both
|
$210.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
|
|
PR HAIR REDUC ABD TRAIL
|
Professional
|
Both
|
$53.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
|
|
PR HAIR REDUC BACK
|
Professional
|
Both
|
$315.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
|
|
PR HAIR REDUC BIKINI LN
|
Professional
|
Both
|
$53.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
|
|
PR HAIR REDUC BRAZ
|
Professional
|
Both
|
$132.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
|
|
PR HAIR REDUC BROW/NOSE/EARS/TOE/HND
|
Professional
|
Both
|
$37.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
|
|
PR HAIR REDUC CHIN/NECK
|
Professional
|
Both
|
$53.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
|
|
PR HAIR REDUC FL FACE/SCALP/FL ABD
|
Professional
|
Both
|
$95.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna Medicare |
$47.50
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
|
|
PR HAIR REDUC FL LEGS
|
Professional
|
Both
|
$420.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Medicare |
$210.00
|
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
|
|
PR HAIR REDUC HLF ARMS/CHEST/ABD/SHLDR
|
Professional
|
Both
|
$105.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
|
|
PR HAIR REDUC LIP
|
Professional
|
Both
|
$37.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
|
|
PR HAIR REDUC LIP & CHIN
|
Professional
|
Both
|
$84.00
|
|
|
Hospital Revenue Code
|
990
|
| 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
|
|
