|
PR EXPLORATION PENETRATING WOUND SPX EXTREMITY
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 20103
|
| Min. Negotiated Rate |
$330.90 |
| Max. Negotiated Rate |
$1,181.05 |
| Rate for Payer: Aetna Commercial |
$443.41
|
| Rate for Payer: Aetna Medicare |
$344.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$443.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.50
|
| Rate for Payer: BCBS Complete |
$726.80
|
| Rate for Payer: BCBS MAPPO |
$330.90
|
| Rate for Payer: BCN Medicare Advantage |
$330.90
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cofinity Commercial |
$443.41
|
| Rate for Payer: Cofinity Commercial |
$476.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$330.90
|
| Rate for Payer: Healthscope Commercial |
$529.44
|
| Rate for Payer: Healthscope Commercial |
$612.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$347.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,181.05
|
| Rate for Payer: Nomi Health Commercial |
$397.08
|
| Rate for Payer: PACE SWMI |
$330.90
|
| Rate for Payer: PHP Medicare Advantage |
$330.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,181.05
|
| Rate for Payer: Priority Health Medicare |
$330.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$330.90
|
| Rate for Payer: UHC Medicare Advantage |
$330.90
|
|
|
PR EXPLORATION PENETRATING WOUND SPX NECK
|
Professional
|
Both
|
$1,939.00
|
|
|
Service Code
|
HCPCS 20100
|
| Min. Negotiated Rate |
$580.58 |
| Max. Negotiated Rate |
$1,260.35 |
| Rate for Payer: Aetna Commercial |
$777.98
|
| Rate for Payer: Aetna Medicare |
$603.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.98
|
| Rate for Payer: BCBS Complete |
$775.60
|
| Rate for Payer: BCBS MAPPO |
$580.58
|
| Rate for Payer: BCN Medicare Advantage |
$580.58
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cash Price |
$1,551.20
|
| Rate for Payer: Cofinity Commercial |
$836.04
|
| Rate for Payer: Cofinity Commercial |
$777.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$580.58
|
| Rate for Payer: Healthscope Commercial |
$1,074.07
|
| Rate for Payer: Healthscope Commercial |
$928.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$609.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,260.35
|
| Rate for Payer: Nomi Health Commercial |
$696.70
|
| Rate for Payer: PACE SWMI |
$580.58
|
| Rate for Payer: PHP Medicare Advantage |
$580.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.35
|
| Rate for Payer: Priority Health Medicare |
$580.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$580.58
|
| Rate for Payer: UHC Medicare Advantage |
$580.58
|
|
|
PR EXPLORATION POPLITEAL ARTERY
|
Professional
|
Both
|
$1,079.00
|
|
|
Service Code
|
HCPCS 35741
|
| Min. Negotiated Rate |
$431.60 |
| Max. Negotiated Rate |
$701.35 |
| Rate for Payer: Aetna Medicare |
$539.50
|
| Rate for Payer: BCBS Complete |
$431.60
|
| Rate for Payer: Cash Price |
$863.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$701.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$701.35
|
|
|
PR EXPLORATION SPINAL FUSION
|
Professional
|
Both
|
$5,175.00
|
|
|
Service Code
|
HCPCS 22830
|
| Min. Negotiated Rate |
$803.57 |
| Max. Negotiated Rate |
$3,363.75 |
| Rate for Payer: Aetna Commercial |
$1,076.78
|
| Rate for Payer: Aetna Medicare |
$835.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,076.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.14
|
| Rate for Payer: BCBS Complete |
$2,070.00
|
| Rate for Payer: BCBS MAPPO |
$803.57
|
| Rate for Payer: BCN Medicare Advantage |
$803.57
|
| Rate for Payer: Cash Price |
$4,140.00
|
| Rate for Payer: Cash Price |
$4,140.00
|
| Rate for Payer: Cofinity Commercial |
$1,076.78
|
| Rate for Payer: Cofinity Commercial |
$1,157.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$803.57
|
| Rate for Payer: Healthscope Commercial |
$1,285.71
|
| Rate for Payer: Healthscope Commercial |
$1,486.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$843.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,363.75
|
| Rate for Payer: Nomi Health Commercial |
$964.28
|
| Rate for Payer: PACE SWMI |
$803.57
|
| Rate for Payer: PHP Medicare Advantage |
$803.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,363.75
|
| Rate for Payer: Priority Health Medicare |
$803.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$803.57
|
| Rate for Payer: UHC Medicare Advantage |
$803.57
|
|
|
PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX
|
Professional
|
Both
|
$2,353.00
|
|
|
Service Code
|
HCPCS 49000
|
| Min. Negotiated Rate |
$746.43 |
| Max. Negotiated Rate |
$1,529.45 |
| Rate for Payer: Aetna Commercial |
$1,000.22
|
| Rate for Payer: Aetna Medicare |
$776.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,000.22
|
| Rate for Payer: BCBS Complete |
$941.20
|
| Rate for Payer: BCBS MAPPO |
$746.43
|
| Rate for Payer: BCN Medicare Advantage |
$746.43
|
| Rate for Payer: Cash Price |
$1,882.40
|
| Rate for Payer: Cash Price |
$1,882.40
|
| Rate for Payer: Cofinity Commercial |
$1,074.86
|
| Rate for Payer: Cofinity Commercial |
$1,000.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.43
|
| Rate for Payer: Healthscope Commercial |
$1,380.90
|
| Rate for Payer: Healthscope Commercial |
$1,194.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,529.45
|
| Rate for Payer: Nomi Health Commercial |
$895.72
|
| Rate for Payer: PACE SWMI |
$746.43
|
| Rate for Payer: PHP Medicare Advantage |
$746.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,529.45
|
| Rate for Payer: Priority Health Medicare |
$746.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.43
|
| Rate for Payer: UHC Medicare Advantage |
$746.43
|
|
|
PR EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 20102
|
| Min. Negotiated Rate |
$247.50 |
| Max. Negotiated Rate |
$1,322.10 |
| Rate for Payer: Aetna Commercial |
$331.65
|
| Rate for Payer: Aetna Medicare |
$257.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$356.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.65
|
| Rate for Payer: BCBS Complete |
$813.60
|
| Rate for Payer: BCBS MAPPO |
$247.50
|
| Rate for Payer: BCN Medicare Advantage |
$247.50
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cofinity Commercial |
$356.40
|
| Rate for Payer: Cofinity Commercial |
$331.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.50
|
| Rate for Payer: Healthscope Commercial |
$396.00
|
| Rate for Payer: Healthscope Commercial |
$457.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$259.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,322.10
|
| Rate for Payer: Nomi Health Commercial |
$297.00
|
| Rate for Payer: PACE SWMI |
$247.50
|
| Rate for Payer: PHP Medicare Advantage |
$247.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health Medicare |
$247.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$247.50
|
| Rate for Payer: UHC Medicare Advantage |
$247.50
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD
|
Professional
|
Both
|
$2,353.00
|
|
|
Service Code
|
HCPCS 35840
|
| Min. Negotiated Rate |
$941.20 |
| Max. Negotiated Rate |
$2,178.86 |
| Rate for Payer: Aetna Commercial |
$1,578.20
|
| Rate for Payer: Aetna Medicare |
$1,224.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,695.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,578.20
|
| Rate for Payer: BCBS Complete |
$941.20
|
| Rate for Payer: BCBS MAPPO |
$1,177.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,177.76
|
| Rate for Payer: Cash Price |
$1,882.40
|
| Rate for Payer: Cash Price |
$1,882.40
|
| Rate for Payer: Cofinity Commercial |
$1,695.97
|
| Rate for Payer: Cofinity Commercial |
$1,578.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,177.76
|
| Rate for Payer: Healthscope Commercial |
$2,178.86
|
| Rate for Payer: Healthscope Commercial |
$1,884.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,236.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,529.45
|
| Rate for Payer: Nomi Health Commercial |
$1,413.31
|
| Rate for Payer: PACE SWMI |
$1,177.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,177.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,529.45
|
| Rate for Payer: Priority Health Medicare |
$1,177.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,177.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,177.76
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ CH
|
Professional
|
Both
|
$5,591.00
|
|
|
Service Code
|
HCPCS 35820
|
| Min. Negotiated Rate |
$1,932.79 |
| Max. Negotiated Rate |
$3,634.15 |
| Rate for Payer: Aetna Commercial |
$2,589.94
|
| Rate for Payer: Aetna Medicare |
$2,010.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,783.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,589.94
|
| Rate for Payer: BCBS Complete |
$2,236.40
|
| Rate for Payer: BCBS MAPPO |
$1,932.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,932.79
|
| Rate for Payer: Cash Price |
$4,472.80
|
| Rate for Payer: Cash Price |
$4,472.80
|
| Rate for Payer: Cofinity Commercial |
$2,783.22
|
| Rate for Payer: Cofinity Commercial |
$2,589.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,932.79
|
| Rate for Payer: Healthscope Commercial |
$3,092.46
|
| Rate for Payer: Healthscope Commercial |
$3,575.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,029.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,634.15
|
| Rate for Payer: Nomi Health Commercial |
$2,319.35
|
| Rate for Payer: PACE SWMI |
$1,932.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,932.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,634.15
|
| Rate for Payer: Priority Health Medicare |
$1,932.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,932.79
|
| Rate for Payer: UHC Medicare Advantage |
$1,932.79
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK
|
Professional
|
Both
|
$1,513.00
|
|
|
Service Code
|
HCPCS 35800
|
| Min. Negotiated Rate |
$605.20 |
| Max. Negotiated Rate |
$1,301.88 |
| Rate for Payer: Aetna Commercial |
$942.98
|
| Rate for Payer: Aetna Medicare |
$731.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$942.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,013.36
|
| Rate for Payer: BCBS Complete |
$605.20
|
| Rate for Payer: BCBS MAPPO |
$703.72
|
| Rate for Payer: BCN Medicare Advantage |
$703.72
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cash Price |
$1,210.40
|
| Rate for Payer: Cofinity Commercial |
$942.98
|
| Rate for Payer: Cofinity Commercial |
$1,013.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$703.72
|
| Rate for Payer: Healthscope Commercial |
$1,301.88
|
| Rate for Payer: Healthscope Commercial |
$1,125.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$738.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$983.45
|
| Rate for Payer: Nomi Health Commercial |
$844.46
|
| Rate for Payer: PACE SWMI |
$703.72
|
| Rate for Payer: PHP Medicare Advantage |
$703.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$983.45
|
| Rate for Payer: Priority Health Medicare |
$703.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$703.72
|
| Rate for Payer: UHC Medicare Advantage |
$703.72
|
|
|
PR EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR
|
Professional
|
Both
|
$1,524.00
|
|
|
Service Code
|
HCPCS 35860
|
| Min. Negotiated Rate |
$609.60 |
| Max. Negotiated Rate |
$1,498.91 |
| Rate for Payer: Aetna Commercial |
$1,085.69
|
| Rate for Payer: Aetna Medicare |
$842.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,166.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,085.69
|
| Rate for Payer: BCBS Complete |
$609.60
|
| Rate for Payer: BCBS MAPPO |
$810.22
|
| Rate for Payer: BCN Medicare Advantage |
$810.22
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cofinity Commercial |
$1,166.72
|
| Rate for Payer: Cofinity Commercial |
$1,085.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.22
|
| Rate for Payer: Healthscope Commercial |
$1,296.35
|
| Rate for Payer: Healthscope Commercial |
$1,498.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$850.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.60
|
| Rate for Payer: Nomi Health Commercial |
$972.26
|
| Rate for Payer: PACE SWMI |
$810.22
|
| Rate for Payer: PHP Medicare Advantage |
$810.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$990.60
|
| Rate for Payer: Priority Health Medicare |
$810.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.22
|
| Rate for Payer: UHC Medicare Advantage |
$810.22
|
|
|
PR EXPL RETROPERITONEUM W/WO BX SPX
|
Professional
|
Both
|
$2,032.00
|
|
|
Service Code
|
HCPCS 49010
|
| Min. Negotiated Rate |
$812.80 |
| Max. Negotiated Rate |
$1,663.28 |
| Rate for Payer: Aetna Commercial |
$1,204.75
|
| Rate for Payer: Aetna Medicare |
$935.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,294.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,204.75
|
| Rate for Payer: BCBS Complete |
$812.80
|
| Rate for Payer: BCBS MAPPO |
$899.07
|
| Rate for Payer: BCN Medicare Advantage |
$899.07
|
| Rate for Payer: Cash Price |
$1,625.60
|
| Rate for Payer: Cash Price |
$1,625.60
|
| Rate for Payer: Cofinity Commercial |
$1,294.66
|
| Rate for Payer: Cofinity Commercial |
$1,204.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$899.07
|
| Rate for Payer: Healthscope Commercial |
$1,663.28
|
| Rate for Payer: Healthscope Commercial |
$1,438.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$944.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,320.80
|
| Rate for Payer: Nomi Health Commercial |
$1,078.88
|
| Rate for Payer: PACE SWMI |
$899.07
|
| Rate for Payer: PHP Medicare Advantage |
$899.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,320.80
|
| Rate for Payer: Priority Health Medicare |
$899.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$899.07
|
| Rate for Payer: UHC Medicare Advantage |
$899.07
|
|
|
PR EXPL RPR & PRESACRAL DRG RECTAL INJURY
|
Professional
|
Both
|
$3,078.00
|
|
|
Service Code
|
HCPCS 45562
|
| Min. Negotiated Rate |
$1,133.14 |
| Max. Negotiated Rate |
$2,096.31 |
| Rate for Payer: Aetna Commercial |
$1,518.41
|
| Rate for Payer: Aetna Medicare |
$1,178.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,631.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,518.41
|
| Rate for Payer: BCBS Complete |
$1,231.20
|
| Rate for Payer: BCBS MAPPO |
$1,133.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,133.14
|
| Rate for Payer: Cash Price |
$2,462.40
|
| Rate for Payer: Cash Price |
$2,462.40
|
| Rate for Payer: Cofinity Commercial |
$1,631.72
|
| Rate for Payer: Cofinity Commercial |
$1,518.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,133.14
|
| Rate for Payer: Healthscope Commercial |
$1,813.02
|
| Rate for Payer: Healthscope Commercial |
$2,096.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,189.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,000.70
|
| Rate for Payer: Nomi Health Commercial |
$1,359.77
|
| Rate for Payer: PACE SWMI |
$1,133.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,133.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,000.70
|
| Rate for Payer: Priority Health Medicare |
$1,133.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,133.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.14
|
|
|
PR EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 54560
|
| Min. Negotiated Rate |
$519.60 |
| Max. Negotiated Rate |
$1,215.95 |
| Rate for Payer: Aetna Commercial |
$880.74
|
| Rate for Payer: Aetna Medicare |
$683.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$880.74
|
| Rate for Payer: BCBS Complete |
$519.60
|
| Rate for Payer: BCBS MAPPO |
$657.27
|
| Rate for Payer: BCN Medicare Advantage |
$657.27
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$946.47
|
| Rate for Payer: Cofinity Commercial |
$880.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.27
|
| Rate for Payer: Healthscope Commercial |
$1,215.95
|
| Rate for Payer: Healthscope Commercial |
$1,051.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$844.35
|
| Rate for Payer: Nomi Health Commercial |
$788.72
|
| Rate for Payer: PACE SWMI |
$657.27
|
| Rate for Payer: PHP Medicare Advantage |
$657.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$844.35
|
| Rate for Payer: Priority Health Medicare |
$657.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.27
|
| Rate for Payer: UHC Medicare Advantage |
$657.27
|
|
|
PR EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 54550
|
| Min. Negotiated Rate |
$371.20 |
| Max. Negotiated Rate |
$870.87 |
| Rate for Payer: Aetna Commercial |
$630.79
|
| Rate for Payer: Aetna Medicare |
$489.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$630.79
|
| Rate for Payer: BCBS Complete |
$371.20
|
| Rate for Payer: BCBS MAPPO |
$470.74
|
| Rate for Payer: BCN Medicare Advantage |
$470.74
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$677.87
|
| Rate for Payer: Cofinity Commercial |
$630.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$470.74
|
| Rate for Payer: Healthscope Commercial |
$753.18
|
| Rate for Payer: Healthscope Commercial |
$870.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$494.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.20
|
| Rate for Payer: Nomi Health Commercial |
$564.89
|
| Rate for Payer: PACE SWMI |
$470.74
|
| Rate for Payer: PHP Medicare Advantage |
$470.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$603.20
|
| Rate for Payer: Priority Health Medicare |
$470.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$470.74
|
| Rate for Payer: UHC Medicare Advantage |
$470.74
|
|
|
PR EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST
|
Professional
|
Both
|
$820.00
|
|
|
Service Code
|
HCPCS 25248
|
| Min. Negotiated Rate |
$328.00 |
| Max. Negotiated Rate |
$748.45 |
| Rate for Payer: Aetna Commercial |
$542.12
|
| Rate for Payer: Aetna Medicare |
$420.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$582.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.12
|
| Rate for Payer: BCBS Complete |
$328.00
|
| Rate for Payer: BCBS MAPPO |
$404.57
|
| Rate for Payer: BCN Medicare Advantage |
$404.57
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cash Price |
$656.00
|
| Rate for Payer: Cofinity Commercial |
$582.58
|
| Rate for Payer: Cofinity Commercial |
$542.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$404.57
|
| Rate for Payer: Healthscope Commercial |
$748.45
|
| Rate for Payer: Healthscope Commercial |
$647.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$424.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$533.00
|
| Rate for Payer: Nomi Health Commercial |
$485.48
|
| Rate for Payer: PACE SWMI |
$404.57
|
| Rate for Payer: PHP Medicare Advantage |
$404.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.00
|
| Rate for Payer: Priority Health Medicare |
$404.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$404.57
|
| Rate for Payer: UHC Medicare Advantage |
$404.57
|
|
|
PR EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST
|
Professional
|
Both
|
$1,673.00
|
|
|
Service Code
|
HCPCS 55860
|
| Min. Negotiated Rate |
$669.20 |
| Max. Negotiated Rate |
$1,544.79 |
| Rate for Payer: Aetna Commercial |
$1,118.93
|
| Rate for Payer: Aetna Medicare |
$868.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.93
|
| Rate for Payer: BCBS Complete |
$669.20
|
| Rate for Payer: BCBS MAPPO |
$835.02
|
| Rate for Payer: BCN Medicare Advantage |
$835.02
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cash Price |
$1,338.40
|
| Rate for Payer: Cofinity Commercial |
$1,202.43
|
| Rate for Payer: Cofinity Commercial |
$1,118.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.02
|
| Rate for Payer: Healthscope Commercial |
$1,336.03
|
| Rate for Payer: Healthscope Commercial |
$1,544.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$876.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,087.45
|
| Rate for Payer: Nomi Health Commercial |
$1,002.02
|
| Rate for Payer: PACE SWMI |
$835.02
|
| Rate for Payer: PHP Medicare Advantage |
$835.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,087.45
|
| Rate for Payer: Priority Health Medicare |
$835.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$835.02
|
| Rate for Payer: UHC Medicare Advantage |
$835.02
|
|
|
PR EXPRESS FACIAL REFINEMENT OR RELAXATION
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00126
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 0296T
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$122.85 |
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
|
|
PR EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 0298T
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
|
|
PR EXTENDED ABDOMINOPLASTY
|
Professional
|
Both
|
$5,304.00
|
|
|
Service Code
|
HCPCS 00366
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,121.60 |
| Max. Negotiated Rate |
$3,447.60 |
| Rate for Payer: Aetna Medicare |
$2,652.00
|
| Rate for Payer: BCBS Complete |
$2,121.60
|
| Rate for Payer: Cash Price |
$4,243.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,447.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,447.60
|
|
|
PR EXTENDED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 92083
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$76.78
|
| Rate for Payer: Aetna Medicare |
$59.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.51
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$57.30
|
| Rate for Payer: BCN Medicare Advantage |
$57.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$82.51
|
| Rate for Payer: Cofinity Commercial |
$76.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.30
|
| Rate for Payer: Healthscope Commercial |
$106.00
|
| Rate for Payer: Healthscope Commercial |
$91.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.05
|
| Rate for Payer: Nomi Health Commercial |
$68.76
|
| Rate for Payer: PACE SWMI |
$57.30
|
| Rate for Payer: PHP Medicare Advantage |
$57.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$57.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.30
|
| Rate for Payer: UHC Medicare Advantage |
$57.30
|
|
|
PR EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 59412
|
| Min. Negotiated Rate |
$100.38 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Aetna Commercial |
$134.51
|
| Rate for Payer: Aetna Medicare |
$104.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.51
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS MAPPO |
$100.38
|
| Rate for Payer: BCN Medicare Advantage |
$100.38
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$144.55
|
| Rate for Payer: Cofinity Commercial |
$134.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.38
|
| Rate for Payer: Healthscope Commercial |
$185.70
|
| Rate for Payer: Healthscope Commercial |
$160.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.50
|
| Rate for Payer: Nomi Health Commercial |
$120.46
|
| Rate for Payer: PACE SWMI |
$100.38
|
| Rate for Payer: PHP Medicare Advantage |
$100.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health Medicare |
$100.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.38
|
| Rate for Payer: UHC Medicare Advantage |
$100.38
|
|
|
PR EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN
|
Professional
|
Both
|
$3,081.00
|
|
|
Service Code
|
HCPCS 48510
|
| Min. Negotiated Rate |
$1,063.54 |
| Max. Negotiated Rate |
$2,002.65 |
| Rate for Payer: Aetna Commercial |
$1,425.14
|
| Rate for Payer: Aetna Medicare |
$1,106.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,531.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,425.14
|
| Rate for Payer: BCBS Complete |
$1,232.40
|
| Rate for Payer: BCBS MAPPO |
$1,063.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,063.54
|
| Rate for Payer: Cash Price |
$2,464.80
|
| Rate for Payer: Cash Price |
$2,464.80
|
| Rate for Payer: Cofinity Commercial |
$1,531.50
|
| Rate for Payer: Cofinity Commercial |
$1,425.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,063.54
|
| Rate for Payer: Healthscope Commercial |
$1,701.66
|
| Rate for Payer: Healthscope Commercial |
$1,967.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,116.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,002.65
|
| Rate for Payer: Nomi Health Commercial |
$1,276.25
|
| Rate for Payer: PACE SWMI |
$1,063.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,063.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,002.65
|
| Rate for Payer: Priority Health Medicare |
$1,063.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,063.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,063.54
|
|
|
PR EXTERNAL ECG REC>48HR<7D RECORDING
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 93242
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$13.94
|
| Rate for Payer: Aetna Medicare |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.94
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$10.40
|
| Rate for Payer: BCN Medicare Advantage |
$10.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$14.98
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$19.24
|
| Rate for Payer: Healthscope Commercial |
$16.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Nomi Health Commercial |
$12.48
|
| Rate for Payer: PACE SWMI |
$10.40
|
| Rate for Payer: PHP Medicare Advantage |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$10.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.40
|
| Rate for Payer: UHC Medicare Advantage |
$10.40
|
|
|
PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 93244
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$40.05 |
| Rate for Payer: Aetna Commercial |
$29.01
|
| Rate for Payer: Aetna Medicare |
$22.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.01
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$21.65
|
| Rate for Payer: BCN Medicare Advantage |
$21.65
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$31.18
|
| Rate for Payer: Cofinity Commercial |
$29.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.65
|
| Rate for Payer: Healthscope Commercial |
$34.64
|
| Rate for Payer: Healthscope Commercial |
$40.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.85
|
| Rate for Payer: Nomi Health Commercial |
$25.98
|
| Rate for Payer: PACE SWMI |
$21.65
|
| Rate for Payer: PHP Medicare Advantage |
$21.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health Medicare |
$21.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.65
|
| Rate for Payer: UHC Medicare Advantage |
$21.65
|
|
