|
PR FERN TEST
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS Q0114
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$18.02 |
| Rate for Payer: Aetna Commercial |
$13.05
|
| Rate for Payer: Aetna Medicare |
$10.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.05
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$9.74
|
| Rate for Payer: BCN Medicare Advantage |
$9.74
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$13.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.74
|
| Rate for Payer: Healthscope Commercial |
$18.02
|
| Rate for Payer: Healthscope Commercial |
$15.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.90
|
| Rate for Payer: Nomi Health Commercial |
$11.69
|
| Rate for Payer: PACE SWMI |
$9.74
|
| Rate for Payer: PHP Medicare Advantage |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$9.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.74
|
| Rate for Payer: UHC Medicare Advantage |
$9.74
|
|
|
PR FETAL CONTRACTION STRESS TEST
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 59020
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$122.45 |
| Rate for Payer: Aetna Commercial |
$88.69
|
| Rate for Payer: Aetna Medicare |
$68.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.69
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS MAPPO |
$66.19
|
| Rate for Payer: BCN Medicare Advantage |
$66.19
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$95.31
|
| Rate for Payer: Cofinity Commercial |
$88.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.19
|
| Rate for Payer: Healthscope Commercial |
$105.90
|
| Rate for Payer: Healthscope Commercial |
$122.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.60
|
| Rate for Payer: Nomi Health Commercial |
$79.43
|
| Rate for Payer: PACE SWMI |
$66.19
|
| Rate for Payer: PHP Medicare Advantage |
$66.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health Medicare |
$66.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.19
|
| Rate for Payer: UHC Medicare Advantage |
$66.19
|
|
|
PR FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$842.00
|
|
|
Service Code
|
HCPCS 59074
|
| Min. Negotiated Rate |
$301.73 |
| Max. Negotiated Rate |
$558.20 |
| Rate for Payer: Aetna Commercial |
$404.32
|
| Rate for Payer: Aetna Medicare |
$313.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$434.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.32
|
| Rate for Payer: BCBS Complete |
$336.80
|
| Rate for Payer: BCBS MAPPO |
$301.73
|
| Rate for Payer: BCN Medicare Advantage |
$301.73
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cash Price |
$673.60
|
| Rate for Payer: Cofinity Commercial |
$434.49
|
| Rate for Payer: Cofinity Commercial |
$404.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.73
|
| Rate for Payer: Healthscope Commercial |
$558.20
|
| Rate for Payer: Healthscope Commercial |
$482.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$316.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$547.30
|
| Rate for Payer: Nomi Health Commercial |
$362.08
|
| Rate for Payer: PACE SWMI |
$301.73
|
| Rate for Payer: PHP Medicare Advantage |
$301.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$547.30
|
| Rate for Payer: Priority Health Medicare |
$301.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.73
|
| Rate for Payer: UHC Medicare Advantage |
$301.73
|
|
|
PR FETAL NONSTRESS TEST
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 59025
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$85.69 |
| Rate for Payer: Aetna Commercial |
$62.07
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.07
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$46.32
|
| Rate for Payer: BCN Medicare Advantage |
$46.32
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$66.70
|
| Rate for Payer: Cofinity Commercial |
$62.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.32
|
| Rate for Payer: Healthscope Commercial |
$74.11
|
| Rate for Payer: Healthscope Commercial |
$85.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Nomi Health Commercial |
$55.58
|
| Rate for Payer: PACE SWMI |
$46.32
|
| Rate for Payer: PHP Medicare Advantage |
$46.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Medicare |
$46.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.32
|
| Rate for Payer: UHC Medicare Advantage |
$46.32
|
|
|
PR FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
HCPCS 59076
|
| Min. Negotiated Rate |
$426.40 |
| Max. Negotiated Rate |
$942.37 |
| Rate for Payer: Aetna Commercial |
$682.58
|
| Rate for Payer: Aetna Medicare |
$529.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$682.58
|
| Rate for Payer: BCBS Complete |
$426.40
|
| Rate for Payer: BCBS MAPPO |
$509.39
|
| Rate for Payer: BCN Medicare Advantage |
$509.39
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cofinity Commercial |
$733.52
|
| Rate for Payer: Cofinity Commercial |
$682.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.39
|
| Rate for Payer: Healthscope Commercial |
$942.37
|
| Rate for Payer: Healthscope Commercial |
$815.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$692.90
|
| Rate for Payer: Nomi Health Commercial |
$611.27
|
| Rate for Payer: PACE SWMI |
$509.39
|
| Rate for Payer: PHP Medicare Advantage |
$509.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.90
|
| Rate for Payer: Priority Health Medicare |
$509.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.39
|
| Rate for Payer: UHC Medicare Advantage |
$509.39
|
|
|
PR FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE
|
Professional
|
Both
|
$1,293.00
|
|
|
Service Code
|
HCPCS 14350
|
| Min. Negotiated Rate |
$517.20 |
| Max. Negotiated Rate |
$1,171.99 |
| Rate for Payer: Aetna Commercial |
$848.90
|
| Rate for Payer: Aetna Medicare |
$658.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.90
|
| Rate for Payer: BCBS Complete |
$517.20
|
| Rate for Payer: BCBS MAPPO |
$633.51
|
| Rate for Payer: BCN Medicare Advantage |
$633.51
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Cofinity Commercial |
$912.25
|
| Rate for Payer: Cofinity Commercial |
$848.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$633.51
|
| Rate for Payer: Healthscope Commercial |
$1,013.62
|
| Rate for Payer: Healthscope Commercial |
$1,171.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$665.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$840.45
|
| Rate for Payer: Nomi Health Commercial |
$760.21
|
| Rate for Payer: PACE SWMI |
$633.51
|
| Rate for Payer: PHP Medicare Advantage |
$633.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.45
|
| Rate for Payer: Priority Health Medicare |
$633.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$633.51
|
| Rate for Payer: UHC Medicare Advantage |
$633.51
|
|
|
PR FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 10009
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$478.40 |
| Rate for Payer: Aetna Commercial |
$137.97
|
| Rate for Payer: Aetna Commercial |
$137.97
|
| Rate for Payer: Aetna Medicare |
$107.08
|
| Rate for Payer: Aetna Medicare |
$107.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.26
|
| Rate for Payer: BCBS Complete |
$294.40
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$102.96
|
| Rate for Payer: BCBS MAPPO |
$102.96
|
| Rate for Payer: BCN Medicare Advantage |
$102.96
|
| Rate for Payer: BCN Medicare Advantage |
$102.96
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$137.97
|
| Rate for Payer: Cofinity Commercial |
$148.26
|
| Rate for Payer: Cofinity Commercial |
$137.97
|
| Rate for Payer: Cofinity Commercial |
$148.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.96
|
| Rate for Payer: Healthscope Commercial |
$190.48
|
| Rate for Payer: Healthscope Commercial |
$190.48
|
| Rate for Payer: Healthscope Commercial |
$164.74
|
| Rate for Payer: Healthscope Commercial |
$164.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$478.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.25
|
| Rate for Payer: Nomi Health Commercial |
$123.55
|
| Rate for Payer: Nomi Health Commercial |
$123.55
|
| Rate for Payer: PACE SWMI |
$102.96
|
| Rate for Payer: PACE SWMI |
$102.96
|
| Rate for Payer: PHP Medicare Advantage |
$102.96
|
| Rate for Payer: PHP Medicare Advantage |
$102.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.40
|
| Rate for Payer: Priority Health Medicare |
$102.96
|
| Rate for Payer: Priority Health Medicare |
$102.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.96
|
| Rate for Payer: UHC Medicare Advantage |
$102.96
|
| Rate for Payer: UHC Medicare Advantage |
$102.96
|
|
|
PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 10021
|
| Min. Negotiated Rate |
$52.86 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Aetna Commercial |
$70.83
|
| Rate for Payer: Aetna Medicare |
$54.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.83
|
| Rate for Payer: BCBS Complete |
$95.20
|
| Rate for Payer: BCBS MAPPO |
$52.86
|
| Rate for Payer: BCN Medicare Advantage |
$52.86
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$76.12
|
| Rate for Payer: Cofinity Commercial |
$70.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.86
|
| Rate for Payer: Healthscope Commercial |
$97.79
|
| Rate for Payer: Healthscope Commercial |
$84.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.70
|
| Rate for Payer: Nomi Health Commercial |
$63.43
|
| Rate for Payer: PACE SWMI |
$52.86
|
| Rate for Payer: PHP Medicare Advantage |
$52.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.70
|
| Rate for Payer: Priority Health Medicare |
$52.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.86
|
| Rate for Payer: UHC Medicare Advantage |
$52.86
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 10005
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$93.13
|
| Rate for Payer: Aetna Medicare |
$72.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.08
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS MAPPO |
$69.50
|
| Rate for Payer: BCN Medicare Advantage |
$69.50
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$93.13
|
| Rate for Payer: Cofinity Commercial |
$100.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.50
|
| Rate for Payer: Healthscope Commercial |
$111.20
|
| Rate for Payer: Healthscope Commercial |
$128.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.80
|
| Rate for Payer: Nomi Health Commercial |
$83.40
|
| Rate for Payer: PACE SWMI |
$69.50
|
| Rate for Payer: PHP Medicare Advantage |
$69.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health Medicare |
$69.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.50
|
| Rate for Payer: UHC Medicare Advantage |
$69.50
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 10006
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$87.58 |
| Rate for Payer: Aetna Commercial |
$63.44
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.44
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS MAPPO |
$47.34
|
| Rate for Payer: BCN Medicare Advantage |
$47.34
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$68.17
|
| Rate for Payer: Cofinity Commercial |
$63.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.34
|
| Rate for Payer: Healthscope Commercial |
$75.74
|
| Rate for Payer: Healthscope Commercial |
$87.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: Nomi Health Commercial |
$56.81
|
| Rate for Payer: PACE SWMI |
$47.34
|
| Rate for Payer: PHP Medicare Advantage |
$47.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$47.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.34
|
| Rate for Payer: UHC Medicare Advantage |
$47.34
|
|
|
PR FINE NEEDLE ASP;W/IMAGING GUIDANCE
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 10022
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$174.85 |
| Rate for Payer: Aetna Medicare |
$134.50
|
| Rate for Payer: BCBS Complete |
$107.60
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.85
|
|
|
PR FINGER SPLINT, STATIC
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Aetna Medicare |
$2.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.79
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$2.63
|
| Rate for Payer: BCN Medicare Advantage |
$2.63
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$4.21
|
| Rate for Payer: Healthscope Commercial |
$4.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$3.16
|
| Rate for Payer: PACE SWMI |
$2.63
|
| Rate for Payer: PHP Medicare Advantage |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$2.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.63
|
| Rate for Payer: UHC Medicare Advantage |
$2.63
|
|
|
PR FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 46200
|
| Min. Negotiated Rate |
$320.70 |
| Max. Negotiated Rate |
$625.30 |
| Rate for Payer: Aetna Commercial |
$429.74
|
| Rate for Payer: Aetna Medicare |
$333.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.74
|
| Rate for Payer: BCBS Complete |
$384.80
|
| Rate for Payer: BCBS MAPPO |
$320.70
|
| Rate for Payer: BCN Medicare Advantage |
$320.70
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cofinity Commercial |
$461.81
|
| Rate for Payer: Cofinity Commercial |
$429.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.70
|
| Rate for Payer: Healthscope Commercial |
$593.29
|
| Rate for Payer: Healthscope Commercial |
$513.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.30
|
| Rate for Payer: Nomi Health Commercial |
$384.84
|
| Rate for Payer: PACE SWMI |
$320.70
|
| Rate for Payer: PHP Medicare Advantage |
$320.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.30
|
| Rate for Payer: Priority Health Medicare |
$320.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.70
|
| Rate for Payer: UHC Medicare Advantage |
$320.70
|
|
|
PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 92071
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$55.35 |
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Medicare |
$31.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.09
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS MAPPO |
$29.92
|
| Rate for Payer: BCN Medicare Advantage |
$29.92
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Commercial |
$40.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$47.87
|
| Rate for Payer: Healthscope Commercial |
$55.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.55
|
| Rate for Payer: Nomi Health Commercial |
$35.90
|
| Rate for Payer: PACE SWMI |
$29.92
|
| Rate for Payer: PHP Medicare Advantage |
$29.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health Medicare |
$29.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.92
|
| Rate for Payer: UHC Medicare Advantage |
$29.92
|
|
|
PR FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 57160
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$59.63
|
| Rate for Payer: Aetna Medicare |
$46.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.63
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS MAPPO |
$44.50
|
| Rate for Payer: BCN Medicare Advantage |
$44.50
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$64.08
|
| Rate for Payer: Cofinity Commercial |
$59.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.50
|
| Rate for Payer: Healthscope Commercial |
$82.33
|
| Rate for Payer: Healthscope Commercial |
$71.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.20
|
| Rate for Payer: Nomi Health Commercial |
$53.40
|
| Rate for Payer: PACE SWMI |
$44.50
|
| Rate for Payer: PHP Medicare Advantage |
$44.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health Medicare |
$44.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.50
|
| Rate for Payer: UHC Medicare Advantage |
$44.50
|
|
|
PR FITTING CONTACT LENS FOR MGMT OF KERATOCONUS 1ST
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 92072
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$160.17 |
| Rate for Payer: Aetna Commercial |
$116.02
|
| Rate for Payer: Aetna Medicare |
$90.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.02
|
| Rate for Payer: BCBS Complete |
$88.40
|
| Rate for Payer: BCBS MAPPO |
$86.58
|
| Rate for Payer: BCN Medicare Advantage |
$86.58
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cofinity Commercial |
$124.68
|
| Rate for Payer: Cofinity Commercial |
$116.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.58
|
| Rate for Payer: Healthscope Commercial |
$138.53
|
| Rate for Payer: Healthscope Commercial |
$160.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.65
|
| Rate for Payer: Nomi Health Commercial |
$103.90
|
| Rate for Payer: PACE SWMI |
$86.58
|
| Rate for Payer: PHP Medicare Advantage |
$86.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health Medicare |
$86.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.58
|
| Rate for Payer: UHC Medicare Advantage |
$86.58
|
|
|
PR FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 54620
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$527.71 |
| Rate for Payer: Aetna Commercial |
$382.24
|
| Rate for Payer: Aetna Medicare |
$296.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.24
|
| Rate for Payer: BCBS Complete |
$229.60
|
| Rate for Payer: BCBS MAPPO |
$285.25
|
| Rate for Payer: BCN Medicare Advantage |
$285.25
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$410.76
|
| Rate for Payer: Cofinity Commercial |
$382.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.25
|
| Rate for Payer: Healthscope Commercial |
$527.71
|
| Rate for Payer: Healthscope Commercial |
$456.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.10
|
| Rate for Payer: Nomi Health Commercial |
$342.30
|
| Rate for Payer: PACE SWMI |
$285.25
|
| Rate for Payer: PHP Medicare Advantage |
$285.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health Medicare |
$285.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.25
|
| Rate for Payer: UHC Medicare Advantage |
$285.25
|
|
|
PR FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY
|
Professional
|
Both
|
$1,733.00
|
|
|
Service Code
|
HCPCS 15740
|
| Min. Negotiated Rate |
$693.20 |
| Max. Negotiated Rate |
$1,483.39 |
| Rate for Payer: Aetna Commercial |
$1,074.45
|
| Rate for Payer: Aetna Medicare |
$833.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,154.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.45
|
| Rate for Payer: BCBS Complete |
$693.20
|
| Rate for Payer: BCBS MAPPO |
$801.83
|
| Rate for Payer: BCN Medicare Advantage |
$801.83
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cofinity Commercial |
$1,154.64
|
| Rate for Payer: Cofinity Commercial |
$1,074.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$801.83
|
| Rate for Payer: Healthscope Commercial |
$1,282.93
|
| Rate for Payer: Healthscope Commercial |
$1,483.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$841.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,126.45
|
| Rate for Payer: Nomi Health Commercial |
$962.20
|
| Rate for Payer: PACE SWMI |
$801.83
|
| Rate for Payer: PHP Medicare Advantage |
$801.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health Medicare |
$801.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$801.83
|
| Rate for Payer: UHC Medicare Advantage |
$801.83
|
|
|
PR FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 92230
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Aetna Commercial |
$39.89
|
| Rate for Payer: Aetna Medicare |
$30.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.89
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$29.77
|
| Rate for Payer: BCN Medicare Advantage |
$29.77
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$42.87
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.77
|
| Rate for Payer: Healthscope Commercial |
$55.07
|
| Rate for Payer: Healthscope Commercial |
$47.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.70
|
| Rate for Payer: Nomi Health Commercial |
$35.72
|
| Rate for Payer: PACE SWMI |
$29.77
|
| Rate for Payer: PHP Medicare Advantage |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.70
|
| Rate for Payer: Priority Health Medicare |
$29.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.77
|
| Rate for Payer: UHC Medicare Advantage |
$29.77
|
|
|
PR FLUPHENAZINE DECANOATE 25 MG
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS J2680
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$9.80
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Healthscope Commercial |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$13.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.60
|
| Rate for Payer: Nomi Health Commercial |
$8.77
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.31
|
| Rate for Payer: UHC Medicare Advantage |
$7.31
|
|
|
PR FLUVIRIN VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q2037
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
|
|
PR FLUZONE VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
|
|
PR FOLLOW-UP/REASSESSMENT
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS S0316
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR FO NONTORSION JOINT CF
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS L3935
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$448.13 |
| Rate for Payer: Aetna Commercial |
$324.59
|
| Rate for Payer: Aetna Medicare |
$251.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.81
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS MAPPO |
$242.23
|
| Rate for Payer: BCN Medicare Advantage |
$242.23
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$324.59
|
| Rate for Payer: Cofinity Commercial |
$348.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.23
|
| Rate for Payer: Healthscope Commercial |
$448.13
|
| Rate for Payer: Healthscope Commercial |
$387.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.55
|
| Rate for Payer: Nomi Health Commercial |
$290.68
|
| Rate for Payer: PACE SWMI |
$242.23
|
| Rate for Payer: PHP Medicare Advantage |
$242.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$242.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.23
|
| Rate for Payer: UHC Medicare Advantage |
$242.23
|
|
|
PR FOOT ARCH SUPP LONGITUD/META
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS L3060
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$164.41 |
| Rate for Payer: Aetna Commercial |
$119.09
|
| Rate for Payer: Aetna Medicare |
$92.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.09
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$88.87
|
| Rate for Payer: BCN Medicare Advantage |
$88.87
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$127.97
|
| Rate for Payer: Cofinity Commercial |
$119.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.87
|
| Rate for Payer: Healthscope Commercial |
$164.41
|
| Rate for Payer: Healthscope Commercial |
$142.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: PACE SWMI |
$88.87
|
| Rate for Payer: PHP Medicare Advantage |
$88.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$88.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.87
|
| Rate for Payer: UHC Medicare Advantage |
$88.87
|
|
