|
PR FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 SQ CM/<
|
Professional
|
Both
|
$1,370.00
|
|
|
Service Code
|
HCPCS 15200
|
| Min. Negotiated Rate |
$548.00 |
| Max. Negotiated Rate |
$1,184.52 |
| Rate for Payer: Aetna Commercial |
$857.98
|
| Rate for Payer: Aetna Medicare |
$665.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$922.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.98
|
| Rate for Payer: BCBS Complete |
$548.00
|
| Rate for Payer: BCBS MAPPO |
$640.28
|
| Rate for Payer: BCN Medicare Advantage |
$640.28
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cash Price |
$1,096.00
|
| Rate for Payer: Cofinity Commercial |
$922.00
|
| Rate for Payer: Cofinity Commercial |
$857.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.28
|
| Rate for Payer: Healthscope Commercial |
$1,184.52
|
| Rate for Payer: Healthscope Commercial |
$1,024.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$890.50
|
| Rate for Payer: Nomi Health Commercial |
$768.34
|
| Rate for Payer: PACE SWMI |
$640.28
|
| Rate for Payer: PHP Medicare Advantage |
$640.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$890.50
|
| Rate for Payer: Priority Health Medicare |
$640.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.28
|
| Rate for Payer: UHC Medicare Advantage |
$640.28
|
|
|
PR FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA ADDL
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 15241
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$230.75 |
| Rate for Payer: Aetna Commercial |
$136.43
|
| Rate for Payer: Aetna Medicare |
$105.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.43
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: BCBS MAPPO |
$101.81
|
| Rate for Payer: BCN Medicare Advantage |
$101.81
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cofinity Commercial |
$146.61
|
| Rate for Payer: Cofinity Commercial |
$136.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.81
|
| Rate for Payer: Healthscope Commercial |
$162.90
|
| Rate for Payer: Healthscope Commercial |
$188.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.75
|
| Rate for Payer: Nomi Health Commercial |
$122.17
|
| Rate for Payer: PACE SWMI |
$101.81
|
| Rate for Payer: PHP Medicare Advantage |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: Priority Health Medicare |
$101.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.81
|
| Rate for Payer: UHC Medicare Advantage |
$101.81
|
|
|
PR FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 SQ CM
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 15221
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$184.60 |
| Rate for Payer: Aetna Commercial |
$88.32
|
| Rate for Payer: Aetna Medicare |
$68.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.32
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: BCBS MAPPO |
$65.91
|
| Rate for Payer: BCN Medicare Advantage |
$65.91
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cofinity Commercial |
$94.91
|
| Rate for Payer: Cofinity Commercial |
$88.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.91
|
| Rate for Payer: Healthscope Commercial |
$121.93
|
| Rate for Payer: Healthscope Commercial |
$105.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.60
|
| Rate for Payer: Nomi Health Commercial |
$79.09
|
| Rate for Payer: PACE SWMI |
$65.91
|
| Rate for Payer: PHP Medicare Advantage |
$65.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
| Rate for Payer: Priority Health Medicare |
$65.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.91
|
| Rate for Payer: UHC Medicare Advantage |
$65.91
|
|
|
PR FT INSERT UCB BERKELEY SHELL
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS L3000
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$700.21 |
| Rate for Payer: Aetna Commercial |
$507.18
|
| Rate for Payer: Aetna Medicare |
$393.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$545.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.18
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$378.49
|
| Rate for Payer: BCN Medicare Advantage |
$378.49
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$545.03
|
| Rate for Payer: Cofinity Commercial |
$507.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.49
|
| Rate for Payer: Healthscope Commercial |
$605.58
|
| Rate for Payer: Healthscope Commercial |
$700.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Nomi Health Commercial |
$454.19
|
| Rate for Payer: PACE SWMI |
$378.49
|
| Rate for Payer: PHP Medicare Advantage |
$378.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$378.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.49
|
| Rate for Payer: UHC Medicare Advantage |
$378.49
|
|
|
PR FUNCJAL CORT&SUBCORT MAPG PHYS/QHP ATTND INIT HR
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 95961
|
| Min. Negotiated Rate |
$205.60 |
| Max. Negotiated Rate |
$556.55 |
| Rate for Payer: Aetna Commercial |
$403.13
|
| Rate for Payer: Aetna Medicare |
$312.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$433.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.13
|
| Rate for Payer: BCBS Complete |
$205.60
|
| Rate for Payer: BCBS MAPPO |
$300.84
|
| Rate for Payer: BCN Medicare Advantage |
$300.84
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cofinity Commercial |
$433.21
|
| Rate for Payer: Cofinity Commercial |
$403.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$300.84
|
| Rate for Payer: Healthscope Commercial |
$556.55
|
| Rate for Payer: Healthscope Commercial |
$481.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$315.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$334.10
|
| Rate for Payer: Nomi Health Commercial |
$361.01
|
| Rate for Payer: PACE SWMI |
$300.84
|
| Rate for Payer: PHP Medicare Advantage |
$300.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.10
|
| Rate for Payer: Priority Health Medicare |
$300.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$300.84
|
| Rate for Payer: UHC Medicare Advantage |
$300.84
|
|
|
PR FUNDUS PHOTOGRAPHY W/INTERPRETATION & REPORT
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 92250
|
| Min. Negotiated Rate |
$33.74 |
| Max. Negotiated Rate |
$80.60 |
| Rate for Payer: Aetna Commercial |
$45.21
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.21
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS MAPPO |
$33.74
|
| Rate for Payer: BCN Medicare Advantage |
$33.74
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$48.59
|
| Rate for Payer: Cofinity Commercial |
$45.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.74
|
| Rate for Payer: Healthscope Commercial |
$53.98
|
| Rate for Payer: Healthscope Commercial |
$62.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.60
|
| Rate for Payer: Nomi Health Commercial |
$40.49
|
| Rate for Payer: PACE SWMI |
$33.74
|
| Rate for Payer: PHP Medicare Advantage |
$33.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health Medicare |
$33.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.74
|
| Rate for Payer: UHC Medicare Advantage |
$33.74
|
|
|
PR F-UP/LIMITED TTHRC ECHO CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 93304
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$252.12 |
| Rate for Payer: Aetna Commercial |
$182.62
|
| Rate for Payer: Aetna Medicare |
$141.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.62
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS MAPPO |
$136.28
|
| Rate for Payer: BCN Medicare Advantage |
$136.28
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$196.24
|
| Rate for Payer: Cofinity Commercial |
$182.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.28
|
| Rate for Payer: Healthscope Commercial |
$218.05
|
| Rate for Payer: Healthscope Commercial |
$252.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.55
|
| Rate for Payer: Nomi Health Commercial |
$163.54
|
| Rate for Payer: PACE SWMI |
$136.28
|
| Rate for Payer: PHP Medicare Advantage |
$136.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health Medicare |
$136.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.28
|
| Rate for Payer: UHC Medicare Advantage |
$136.28
|
|
|
PR FUROSEMIDE INJECTION
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1940
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
|
|
PR GARAMYCIN GENTAMICIN INJ
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J1580
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Medicare |
$2.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.18
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$2.21
|
| Rate for Payer: BCN Medicare Advantage |
$2.21
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$2.96
|
| Rate for Payer: Cofinity Commercial |
$3.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$4.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.60
|
| Rate for Payer: Nomi Health Commercial |
$2.65
|
| Rate for Payer: PACE SWMI |
$2.21
|
| Rate for Payer: PHP Medicare Advantage |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health Medicare |
$2.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.21
|
| Rate for Payer: UHC Medicare Advantage |
$2.21
|
|
|
PR GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&V
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 94727
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$79.95 |
| Rate for Payer: Aetna Commercial |
$54.54
|
| Rate for Payer: Aetna Medicare |
$42.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.54
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$40.70
|
| Rate for Payer: BCN Medicare Advantage |
$40.70
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Cofinity Commercial |
$54.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.70
|
| Rate for Payer: Healthscope Commercial |
$75.30
|
| Rate for Payer: Healthscope Commercial |
$65.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.95
|
| Rate for Payer: Nomi Health Commercial |
$48.84
|
| Rate for Payer: PACE SWMI |
$40.70
|
| Rate for Payer: PHP Medicare Advantage |
$40.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health Medicare |
$40.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.70
|
| Rate for Payer: UHC Medicare Advantage |
$40.70
|
|
|
PR GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 43753
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$38.39 |
| Rate for Payer: Aetna Commercial |
$27.80
|
| Rate for Payer: Aetna Medicare |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.80
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$20.75
|
| Rate for Payer: BCN Medicare Advantage |
$20.75
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$29.88
|
| Rate for Payer: Cofinity Commercial |
$27.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$33.20
|
| Rate for Payer: Healthscope Commercial |
$38.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.50
|
| Rate for Payer: Nomi Health Commercial |
$24.90
|
| Rate for Payer: PACE SWMI |
$20.75
|
| Rate for Payer: PHP Medicare Advantage |
$20.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Medicare |
$20.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.75
|
| Rate for Payer: UHC Medicare Advantage |
$20.75
|
|
|
PR GASTROCNEMIUS RECESSION
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
HCPCS 27687
|
| Min. Negotiated Rate |
$436.73 |
| Max. Negotiated Rate |
$986.70 |
| Rate for Payer: Aetna Commercial |
$585.22
|
| Rate for Payer: Aetna Medicare |
$454.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.22
|
| Rate for Payer: BCBS Complete |
$607.20
|
| Rate for Payer: BCBS MAPPO |
$436.73
|
| Rate for Payer: BCN Medicare Advantage |
$436.73
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cofinity Commercial |
$628.89
|
| Rate for Payer: Cofinity Commercial |
$585.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$436.73
|
| Rate for Payer: Healthscope Commercial |
$807.95
|
| Rate for Payer: Healthscope Commercial |
$698.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$458.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$986.70
|
| Rate for Payer: Nomi Health Commercial |
$524.08
|
| Rate for Payer: PACE SWMI |
$436.73
|
| Rate for Payer: PHP Medicare Advantage |
$436.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$986.70
|
| Rate for Payer: Priority Health Medicare |
$436.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$436.73
|
| Rate for Payer: UHC Medicare Advantage |
$436.73
|
|
|
PR GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,486.00
|
|
|
Service Code
|
HCPCS 43810
|
| Min. Negotiated Rate |
$991.25 |
| Max. Negotiated Rate |
$1,833.81 |
| Rate for Payer: Aetna Commercial |
$1,328.28
|
| Rate for Payer: Aetna Medicare |
$1,030.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,427.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,328.28
|
| Rate for Payer: BCBS Complete |
$994.40
|
| Rate for Payer: BCBS MAPPO |
$991.25
|
| Rate for Payer: BCN Medicare Advantage |
$991.25
|
| Rate for Payer: Cash Price |
$1,988.80
|
| Rate for Payer: Cash Price |
$1,988.80
|
| Rate for Payer: Cofinity Commercial |
$1,427.40
|
| Rate for Payer: Cofinity Commercial |
$1,328.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$991.25
|
| Rate for Payer: Healthscope Commercial |
$1,586.00
|
| Rate for Payer: Healthscope Commercial |
$1,833.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,040.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,615.90
|
| Rate for Payer: Nomi Health Commercial |
$1,189.50
|
| Rate for Payer: PACE SWMI |
$991.25
|
| Rate for Payer: PHP Medicare Advantage |
$991.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,615.90
|
| Rate for Payer: Priority Health Medicare |
$991.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$991.25
|
| Rate for Payer: UHC Medicare Advantage |
$991.25
|
|
|
PR GASTROESOPHAG REFLX TEST W/CATH PH ELTRD PLCMT
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 91034
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$311.54 |
| Rate for Payer: Aetna Commercial |
$225.66
|
| Rate for Payer: Aetna Commercial |
$225.66
|
| Rate for Payer: Aetna Medicare |
$175.14
|
| Rate for Payer: Aetna Medicare |
$175.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.50
|
| Rate for Payer: BCBS Complete |
$137.20
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS MAPPO |
$168.40
|
| Rate for Payer: BCBS MAPPO |
$168.40
|
| Rate for Payer: BCN Medicare Advantage |
$168.40
|
| Rate for Payer: BCN Medicare Advantage |
$168.40
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$225.66
|
| Rate for Payer: Cofinity Commercial |
$242.50
|
| Rate for Payer: Cofinity Commercial |
$225.66
|
| Rate for Payer: Cofinity Commercial |
$242.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.40
|
| Rate for Payer: Healthscope Commercial |
$311.54
|
| Rate for Payer: Healthscope Commercial |
$311.54
|
| Rate for Payer: Healthscope Commercial |
$269.44
|
| Rate for Payer: Healthscope Commercial |
$269.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.60
|
| Rate for Payer: Nomi Health Commercial |
$202.08
|
| Rate for Payer: Nomi Health Commercial |
$202.08
|
| Rate for Payer: PACE SWMI |
$168.40
|
| Rate for Payer: PACE SWMI |
$168.40
|
| Rate for Payer: PHP Medicare Advantage |
$168.40
|
| Rate for Payer: PHP Medicare Advantage |
$168.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.95
|
| Rate for Payer: Priority Health Medicare |
$168.40
|
| Rate for Payer: Priority Health Medicare |
$168.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.40
|
| Rate for Payer: UHC Medicare Advantage |
$168.40
|
| Rate for Payer: UHC Medicare Advantage |
$168.40
|
|
|
PR GASTROESOPHAG REFLX TEST W/INTRLUML IMPED ELTRD
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 91037
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$275.96 |
| Rate for Payer: Aetna Commercial |
$199.89
|
| Rate for Payer: Aetna Commercial |
$199.89
|
| Rate for Payer: Aetna Medicare |
$155.14
|
| Rate for Payer: Aetna Medicare |
$155.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.80
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$149.17
|
| Rate for Payer: BCBS MAPPO |
$149.17
|
| Rate for Payer: BCN Medicare Advantage |
$149.17
|
| Rate for Payer: BCN Medicare Advantage |
$149.17
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$199.89
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Cofinity Commercial |
$199.89
|
| Rate for Payer: Cofinity Commercial |
$214.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.17
|
| Rate for Payer: Healthscope Commercial |
$275.96
|
| Rate for Payer: Healthscope Commercial |
$275.96
|
| Rate for Payer: Healthscope Commercial |
$238.67
|
| Rate for Payer: Healthscope Commercial |
$238.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.80
|
| Rate for Payer: Nomi Health Commercial |
$179.00
|
| Rate for Payer: Nomi Health Commercial |
$179.00
|
| Rate for Payer: PACE SWMI |
$149.17
|
| Rate for Payer: PACE SWMI |
$149.17
|
| Rate for Payer: PHP Medicare Advantage |
$149.17
|
| Rate for Payer: PHP Medicare Advantage |
$149.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health Medicare |
$149.17
|
| Rate for Payer: Priority Health Medicare |
$149.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.17
|
| Rate for Payer: UHC Medicare Advantage |
$149.17
|
| Rate for Payer: UHC Medicare Advantage |
$149.17
|
|
|
PR GASTROESOPHAG REFLX TEST W/TELEMTRY PH ELTRD
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 91035
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$725.51 |
| Rate for Payer: Aetna Commercial |
$525.51
|
| Rate for Payer: Aetna Commercial |
$525.51
|
| Rate for Payer: Aetna Medicare |
$407.86
|
| Rate for Payer: Aetna Medicare |
$407.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.72
|
| Rate for Payer: BCBS Complete |
$350.00
|
| Rate for Payer: BCBS Complete |
$67.60
|
| Rate for Payer: BCBS MAPPO |
$392.17
|
| Rate for Payer: BCBS MAPPO |
$392.17
|
| Rate for Payer: BCN Medicare Advantage |
$392.17
|
| Rate for Payer: BCN Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cofinity Commercial |
$525.51
|
| Rate for Payer: Cofinity Commercial |
$564.72
|
| Rate for Payer: Cofinity Commercial |
$525.51
|
| Rate for Payer: Cofinity Commercial |
$564.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.17
|
| Rate for Payer: Healthscope Commercial |
$725.51
|
| Rate for Payer: Healthscope Commercial |
$725.51
|
| Rate for Payer: Healthscope Commercial |
$627.47
|
| Rate for Payer: Healthscope Commercial |
$627.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$568.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.85
|
| Rate for Payer: Nomi Health Commercial |
$470.60
|
| Rate for Payer: Nomi Health Commercial |
$470.60
|
| Rate for Payer: PACE SWMI |
$392.17
|
| Rate for Payer: PACE SWMI |
$392.17
|
| Rate for Payer: PHP Medicare Advantage |
$392.17
|
| Rate for Payer: PHP Medicare Advantage |
$392.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.75
|
| Rate for Payer: Priority Health Medicare |
$392.17
|
| Rate for Payer: Priority Health Medicare |
$392.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.17
|
| Rate for Payer: UHC Medicare Advantage |
$392.17
|
| Rate for Payer: UHC Medicare Advantage |
$392.17
|
|
|
PR GASTROJEJUNOSTOMY W/O VAGOTOMY
|
Professional
|
Both
|
$2,621.00
|
|
|
Service Code
|
HCPCS 43820
|
| Min. Negotiated Rate |
$1,048.40 |
| Max. Negotiated Rate |
$2,420.00 |
| Rate for Payer: Aetna Commercial |
$1,752.87
|
| Rate for Payer: Aetna Medicare |
$1,360.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,883.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,752.87
|
| Rate for Payer: BCBS Complete |
$1,048.40
|
| Rate for Payer: BCBS MAPPO |
$1,308.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.11
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cash Price |
$2,096.80
|
| Rate for Payer: Cofinity Commercial |
$1,883.68
|
| Rate for Payer: Cofinity Commercial |
$1,752.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.11
|
| Rate for Payer: Healthscope Commercial |
$2,420.00
|
| Rate for Payer: Healthscope Commercial |
$2,092.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,373.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,703.65
|
| Rate for Payer: Nomi Health Commercial |
$1,569.73
|
| Rate for Payer: PACE SWMI |
$1,308.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,703.65
|
| Rate for Payer: Priority Health Medicare |
$1,308.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.11
|
|
|
PR GASTROJEJUNOSTOMY W/VAGOTOMY ANY TYPE
|
Professional
|
Both
|
$2,581.00
|
|
|
Service Code
|
HCPCS 43825
|
| Min. Negotiated Rate |
$1,032.40 |
| Max. Negotiated Rate |
$2,362.95 |
| Rate for Payer: Aetna Commercial |
$1,711.54
|
| Rate for Payer: Aetna Medicare |
$1,328.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,839.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,711.54
|
| Rate for Payer: BCBS Complete |
$1,032.40
|
| Rate for Payer: BCBS MAPPO |
$1,277.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,277.27
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cash Price |
$2,064.80
|
| Rate for Payer: Cofinity Commercial |
$1,839.27
|
| Rate for Payer: Cofinity Commercial |
$1,711.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,277.27
|
| Rate for Payer: Healthscope Commercial |
$2,043.63
|
| Rate for Payer: Healthscope Commercial |
$2,362.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,341.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,677.65
|
| Rate for Payer: Nomi Health Commercial |
$1,532.72
|
| Rate for Payer: PACE SWMI |
$1,277.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,277.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.65
|
| Rate for Payer: Priority Health Medicare |
$1,277.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,277.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,277.27
|
|
|
PR GASTRORRHAPHY SUTR PRF8 DUOL/GSTR ULCER WND/INJ
|
Professional
|
Both
|
$2,821.00
|
|
|
Service Code
|
HCPCS 43840
|
| Min. Negotiated Rate |
$1,128.40 |
| Max. Negotiated Rate |
$2,446.85 |
| Rate for Payer: Aetna Commercial |
$1,772.31
|
| Rate for Payer: Aetna Medicare |
$1,375.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,904.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,772.31
|
| Rate for Payer: BCBS Complete |
$1,128.40
|
| Rate for Payer: BCBS MAPPO |
$1,322.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,322.62
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Cash Price |
$2,256.80
|
| Rate for Payer: Cofinity Commercial |
$1,904.57
|
| Rate for Payer: Cofinity Commercial |
$1,772.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,322.62
|
| Rate for Payer: Healthscope Commercial |
$2,446.85
|
| Rate for Payer: Healthscope Commercial |
$2,116.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,388.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,833.65
|
| Rate for Payer: Nomi Health Commercial |
$1,587.14
|
| Rate for Payer: PACE SWMI |
$1,322.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,322.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,833.65
|
| Rate for Payer: Priority Health Medicare |
$1,322.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,322.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,322.62
|
|
|
PR GASTROSTOMY OPEN NEONATAL FOR FEEDING
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
HCPCS 43831
|
| Min. Negotiated Rate |
$588.99 |
| Max. Negotiated Rate |
$1,385.80 |
| Rate for Payer: Aetna Commercial |
$789.25
|
| Rate for Payer: Aetna Medicare |
$612.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.25
|
| Rate for Payer: BCBS Complete |
$852.80
|
| Rate for Payer: BCBS MAPPO |
$588.99
|
| Rate for Payer: BCN Medicare Advantage |
$588.99
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cofinity Commercial |
$848.15
|
| Rate for Payer: Cofinity Commercial |
$789.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$588.99
|
| Rate for Payer: Healthscope Commercial |
$1,089.63
|
| Rate for Payer: Healthscope Commercial |
$942.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$618.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.80
|
| Rate for Payer: Nomi Health Commercial |
$706.79
|
| Rate for Payer: PACE SWMI |
$588.99
|
| Rate for Payer: PHP Medicare Advantage |
$588.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.80
|
| Rate for Payer: Priority Health Medicare |
$588.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$588.99
|
| Rate for Payer: UHC Medicare Advantage |
$588.99
|
|
|
PR GASTROSTOMY OPEN W/CONSTJ GASTRIC TUBE
|
Professional
|
Both
|
$2,934.00
|
|
|
Service Code
|
HCPCS 43832
|
| Min. Negotiated Rate |
$1,018.08 |
| Max. Negotiated Rate |
$1,907.10 |
| Rate for Payer: Aetna Commercial |
$1,364.23
|
| Rate for Payer: Aetna Medicare |
$1,058.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,466.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,364.23
|
| Rate for Payer: BCBS Complete |
$1,173.60
|
| Rate for Payer: BCBS MAPPO |
$1,018.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,018.08
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cash Price |
$2,347.20
|
| Rate for Payer: Cofinity Commercial |
$1,466.04
|
| Rate for Payer: Cofinity Commercial |
$1,364.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,018.08
|
| Rate for Payer: Healthscope Commercial |
$1,883.45
|
| Rate for Payer: Healthscope Commercial |
$1,628.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,068.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,907.10
|
| Rate for Payer: Nomi Health Commercial |
$1,221.70
|
| Rate for Payer: PACE SWMI |
$1,018.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,018.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,907.10
|
| Rate for Payer: Priority Health Medicare |
$1,018.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,018.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,018.08
|
|
|
PR GASTROSTOMY OPEN W/O CONSTJ GASTRIC TUBE SPX
|
Professional
|
Both
|
$2,132.00
|
|
|
Service Code
|
HCPCS 43830
|
| Min. Negotiated Rate |
$680.98 |
| Max. Negotiated Rate |
$1,385.80 |
| Rate for Payer: Aetna Commercial |
$912.51
|
| Rate for Payer: Aetna Medicare |
$708.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$980.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.51
|
| Rate for Payer: BCBS Complete |
$852.80
|
| Rate for Payer: BCBS MAPPO |
$680.98
|
| Rate for Payer: BCN Medicare Advantage |
$680.98
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cash Price |
$1,705.60
|
| Rate for Payer: Cofinity Commercial |
$980.61
|
| Rate for Payer: Cofinity Commercial |
$912.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.98
|
| Rate for Payer: Healthscope Commercial |
$1,089.57
|
| Rate for Payer: Healthscope Commercial |
$1,259.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,385.80
|
| Rate for Payer: Nomi Health Commercial |
$817.18
|
| Rate for Payer: PACE SWMI |
$680.98
|
| Rate for Payer: PHP Medicare Advantage |
$680.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,385.80
|
| Rate for Payer: Priority Health Medicare |
$680.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.98
|
| Rate for Payer: UHC Medicare Advantage |
$680.98
|
|
|
PR GASTROTOMY W/EXPLORATION/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,256.00
|
|
|
Service Code
|
HCPCS 43500
|
| Min. Negotiated Rate |
$766.61 |
| Max. Negotiated Rate |
$1,466.40 |
| Rate for Payer: Aetna Commercial |
$1,027.26
|
| Rate for Payer: Aetna Medicare |
$797.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.26
|
| Rate for Payer: BCBS Complete |
$902.40
|
| Rate for Payer: BCBS MAPPO |
$766.61
|
| Rate for Payer: BCN Medicare Advantage |
$766.61
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cash Price |
$1,804.80
|
| Rate for Payer: Cofinity Commercial |
$1,103.92
|
| Rate for Payer: Cofinity Commercial |
$1,027.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.61
|
| Rate for Payer: Healthscope Commercial |
$1,418.23
|
| Rate for Payer: Healthscope Commercial |
$1,226.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,466.40
|
| Rate for Payer: Nomi Health Commercial |
$919.93
|
| Rate for Payer: PACE SWMI |
$766.61
|
| Rate for Payer: PHP Medicare Advantage |
$766.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,466.40
|
| Rate for Payer: Priority Health Medicare |
$766.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.61
|
| Rate for Payer: UHC Medicare Advantage |
$766.61
|
|
|
PR GASTROTOMY W/SUTURE REPAIR BLEEDING ULCER
|
Professional
|
Both
|
$3,976.00
|
|
|
Service Code
|
HCPCS 43501
|
| Min. Negotiated Rate |
$1,308.02 |
| Max. Negotiated Rate |
$2,584.40 |
| Rate for Payer: Aetna Commercial |
$1,752.75
|
| Rate for Payer: Aetna Medicare |
$1,360.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,883.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,752.75
|
| Rate for Payer: BCBS Complete |
$1,590.40
|
| Rate for Payer: BCBS MAPPO |
$1,308.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,308.02
|
| Rate for Payer: Cash Price |
$3,180.80
|
| Rate for Payer: Cash Price |
$3,180.80
|
| Rate for Payer: Cofinity Commercial |
$1,883.55
|
| Rate for Payer: Cofinity Commercial |
$1,752.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,308.02
|
| Rate for Payer: Healthscope Commercial |
$2,092.83
|
| Rate for Payer: Healthscope Commercial |
$2,419.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,373.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,584.40
|
| Rate for Payer: Nomi Health Commercial |
$1,569.62
|
| Rate for Payer: PACE SWMI |
$1,308.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,308.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,584.40
|
| Rate for Payer: Priority Health Medicare |
$1,308.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,308.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,308.02
|
|
|
PR GEL-ONE
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
HCPCS J7326
|
| Min. Negotiated Rate |
$529.26 |
| Max. Negotiated Rate |
$979.13 |
| Rate for Payer: Aetna Commercial |
$709.21
|
| Rate for Payer: Aetna Medicare |
$550.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.21
|
| Rate for Payer: BCBS Complete |
$546.80
|
| Rate for Payer: BCBS MAPPO |
$529.26
|
| Rate for Payer: BCN Medicare Advantage |
$529.26
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cash Price |
$1,093.60
|
| Rate for Payer: Cofinity Commercial |
$762.13
|
| Rate for Payer: Cofinity Commercial |
$709.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.26
|
| Rate for Payer: Healthscope Commercial |
$846.82
|
| Rate for Payer: Healthscope Commercial |
$979.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$888.55
|
| Rate for Payer: Nomi Health Commercial |
$635.11
|
| Rate for Payer: PACE SWMI |
$529.26
|
| Rate for Payer: PHP Medicare Advantage |
$529.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$888.55
|
| Rate for Payer: Priority Health Medicare |
$529.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$529.26
|
| Rate for Payer: UHC Medicare Advantage |
$529.26
|
|
