|
PR GI TRANSIT & PRES MEAS WIRELESS CAPSULE W/INTERP
|
Professional
|
Both
|
$3,417.00
|
|
|
Service Code
|
HCPCS 91112
|
| Min. Negotiated Rate |
$1,353.19 |
| Max. Negotiated Rate |
$2,503.40 |
| Rate for Payer: Aetna Commercial |
$1,813.27
|
| Rate for Payer: Aetna Commercial |
$1,813.27
|
| Rate for Payer: Aetna Medicare |
$1,407.32
|
| Rate for Payer: Aetna Medicare |
$1,407.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,948.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,948.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,813.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,813.27
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS Complete |
$1,366.80
|
| Rate for Payer: BCBS MAPPO |
$1,353.19
|
| Rate for Payer: BCBS MAPPO |
$1,353.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,353.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,353.19
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$2,733.60
|
| Rate for Payer: Cofinity Commercial |
$1,813.27
|
| Rate for Payer: Cofinity Commercial |
$1,813.27
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Cofinity Commercial |
$1,948.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,353.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,353.19
|
| Rate for Payer: Healthscope Commercial |
$2,503.40
|
| Rate for Payer: Healthscope Commercial |
$2,503.40
|
| Rate for Payer: Healthscope Commercial |
$2,165.10
|
| Rate for Payer: Healthscope Commercial |
$2,165.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,420.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,420.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,221.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.40
|
| Rate for Payer: Nomi Health Commercial |
$1,623.83
|
| Rate for Payer: Nomi Health Commercial |
$1,623.83
|
| Rate for Payer: PACE SWMI |
$1,353.19
|
| Rate for Payer: PACE SWMI |
$1,353.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,353.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,353.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,221.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health Medicare |
$1,353.19
|
| Rate for Payer: Priority Health Medicare |
$1,353.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,353.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,353.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,353.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,353.19
|
|
|
PR GI TRC IMG INTRALUMINAL ESOPHAGUS-ILEUM W/I&R
|
Professional
|
Both
|
$1,618.00
|
|
|
Service Code
|
HCPCS 91110
|
| Min. Negotiated Rate |
$622.62 |
| Max. Negotiated Rate |
$1,151.85 |
| Rate for Payer: Aetna Commercial |
$834.31
|
| Rate for Payer: Aetna Medicare |
$647.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$896.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$834.31
|
| Rate for Payer: BCBS Complete |
$647.20
|
| Rate for Payer: BCBS MAPPO |
$622.62
|
| Rate for Payer: BCN Medicare Advantage |
$622.62
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cash Price |
$1,294.40
|
| Rate for Payer: Cofinity Commercial |
$896.57
|
| Rate for Payer: Cofinity Commercial |
$834.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$622.62
|
| Rate for Payer: Healthscope Commercial |
$996.19
|
| Rate for Payer: Healthscope Commercial |
$1,151.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$653.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,051.70
|
| Rate for Payer: Nomi Health Commercial |
$747.14
|
| Rate for Payer: PACE SWMI |
$622.62
|
| Rate for Payer: PHP Medicare Advantage |
$622.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,051.70
|
| Rate for Payer: Priority Health Medicare |
$622.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$622.62
|
| Rate for Payer: UHC Medicare Advantage |
$622.62
|
|
|
PR GLOSSECTOMY HEMIGLOSSECTOMY
|
Professional
|
Both
|
$2,388.00
|
|
|
Service Code
|
HCPCS 41130
|
| Min. Negotiated Rate |
$955.20 |
| Max. Negotiated Rate |
$2,256.50 |
| Rate for Payer: Aetna Commercial |
$1,634.44
|
| Rate for Payer: Aetna Medicare |
$1,268.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,756.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,634.44
|
| Rate for Payer: BCBS Complete |
$955.20
|
| Rate for Payer: BCBS MAPPO |
$1,219.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,219.73
|
| Rate for Payer: Cash Price |
$1,910.40
|
| Rate for Payer: Cash Price |
$1,910.40
|
| Rate for Payer: Cofinity Commercial |
$1,756.41
|
| Rate for Payer: Cofinity Commercial |
$1,634.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,219.73
|
| Rate for Payer: Healthscope Commercial |
$1,951.57
|
| Rate for Payer: Healthscope Commercial |
$2,256.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,280.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,552.20
|
| Rate for Payer: Nomi Health Commercial |
$1,463.68
|
| Rate for Payer: PACE SWMI |
$1,219.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,219.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,552.20
|
| Rate for Payer: Priority Health Medicare |
$1,219.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,219.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,219.73
|
|
|
PR GLOSSECTOMY <ONE-HALF TONGUE
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 41120
|
| Min. Negotiated Rate |
$760.00 |
| Max. Negotiated Rate |
$1,811.08 |
| Rate for Payer: Aetna Commercial |
$1,311.81
|
| Rate for Payer: Aetna Medicare |
$1,018.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,409.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,311.81
|
| Rate for Payer: BCBS Complete |
$760.00
|
| Rate for Payer: BCBS MAPPO |
$978.96
|
| Rate for Payer: BCN Medicare Advantage |
$978.96
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cofinity Commercial |
$1,409.70
|
| Rate for Payer: Cofinity Commercial |
$1,311.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$978.96
|
| Rate for Payer: Healthscope Commercial |
$1,811.08
|
| Rate for Payer: Healthscope Commercial |
$1,566.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,027.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,235.00
|
| Rate for Payer: Nomi Health Commercial |
$1,174.75
|
| Rate for Payer: PACE SWMI |
$978.96
|
| Rate for Payer: PHP Medicare Advantage |
$978.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,235.00
|
| Rate for Payer: Priority Health Medicare |
$978.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$978.96
|
| Rate for Payer: UHC Medicare Advantage |
$978.96
|
|
|
PR GLOSSECTOMY PRTL W/UNI RADICAL NECK DSJ
|
Professional
|
Both
|
$3,945.00
|
|
|
Service Code
|
HCPCS 41135
|
| Min. Negotiated Rate |
$1,578.00 |
| Max. Negotiated Rate |
$3,748.84 |
| Rate for Payer: Aetna Commercial |
$2,715.38
|
| Rate for Payer: Aetna Medicare |
$2,107.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,918.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,715.38
|
| Rate for Payer: BCBS Complete |
$1,578.00
|
| Rate for Payer: BCBS MAPPO |
$2,026.40
|
| Rate for Payer: BCN Medicare Advantage |
$2,026.40
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cofinity Commercial |
$2,918.02
|
| Rate for Payer: Cofinity Commercial |
$2,715.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,026.40
|
| Rate for Payer: Healthscope Commercial |
$3,242.24
|
| Rate for Payer: Healthscope Commercial |
$3,748.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,127.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,564.25
|
| Rate for Payer: Nomi Health Commercial |
$2,431.68
|
| Rate for Payer: PACE SWMI |
$2,026.40
|
| Rate for Payer: PHP Medicare Advantage |
$2,026.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,564.25
|
| Rate for Payer: Priority Health Medicare |
$2,026.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,026.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,026.40
|
|
|
PR GLSSC COMPOSIT W/RESCJ FLOOR & MANDIBULAR RESCJ
|
Professional
|
Both
|
$4,098.00
|
|
|
Service Code
|
HCPCS 41150
|
| Min. Negotiated Rate |
$1,639.20 |
| Max. Negotiated Rate |
$3,798.12 |
| Rate for Payer: Aetna Commercial |
$2,751.07
|
| Rate for Payer: Aetna Medicare |
$2,135.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,956.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,751.07
|
| Rate for Payer: BCBS Complete |
$1,639.20
|
| Rate for Payer: BCBS MAPPO |
$2,053.04
|
| Rate for Payer: BCN Medicare Advantage |
$2,053.04
|
| Rate for Payer: Cash Price |
$3,278.40
|
| Rate for Payer: Cash Price |
$3,278.40
|
| Rate for Payer: Cofinity Commercial |
$2,956.38
|
| Rate for Payer: Cofinity Commercial |
$2,751.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,053.04
|
| Rate for Payer: Healthscope Commercial |
$3,798.12
|
| Rate for Payer: Healthscope Commercial |
$3,284.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,155.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,663.70
|
| Rate for Payer: Nomi Health Commercial |
$2,463.65
|
| Rate for Payer: PACE SWMI |
$2,053.04
|
| Rate for Payer: PHP Medicare Advantage |
$2,053.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,663.70
|
| Rate for Payer: Priority Health Medicare |
$2,053.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,053.04
|
| Rate for Payer: UHC Medicare Advantage |
$2,053.04
|
|
|
PR GONIOSCOPY SEPARATE PROCEDURE
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 92020
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna Commercial |
$25.23
|
| Rate for Payer: Aetna Medicare |
$19.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.23
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$18.83
|
| Rate for Payer: BCN Medicare Advantage |
$18.83
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$27.12
|
| Rate for Payer: Cofinity Commercial |
$25.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$30.13
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.80
|
| Rate for Payer: Nomi Health Commercial |
$22.60
|
| Rate for Payer: PACE SWMI |
$18.83
|
| Rate for Payer: PHP Medicare Advantage |
$18.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health Medicare |
$18.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.83
|
| Rate for Payer: UHC Medicare Advantage |
$18.83
|
|
|
PR GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA
|
Professional
|
Both
|
$1,703.00
|
|
|
Service Code
|
HCPCS 15760
|
| Min. Negotiated Rate |
$662.35 |
| Max. Negotiated Rate |
$1,225.35 |
| Rate for Payer: Aetna Commercial |
$887.55
|
| Rate for Payer: Aetna Medicare |
$688.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$953.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$887.55
|
| Rate for Payer: BCBS Complete |
$681.20
|
| Rate for Payer: BCBS MAPPO |
$662.35
|
| Rate for Payer: BCN Medicare Advantage |
$662.35
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Cash Price |
$1,362.40
|
| Rate for Payer: Cofinity Commercial |
$953.78
|
| Rate for Payer: Cofinity Commercial |
$887.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$662.35
|
| Rate for Payer: Healthscope Commercial |
$1,225.35
|
| Rate for Payer: Healthscope Commercial |
$1,059.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$695.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,106.95
|
| Rate for Payer: Nomi Health Commercial |
$794.82
|
| Rate for Payer: PACE SWMI |
$662.35
|
| Rate for Payer: PHP Medicare Advantage |
$662.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,106.95
|
| Rate for Payer: Priority Health Medicare |
$662.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$662.35
|
| Rate for Payer: UHC Medicare Advantage |
$662.35
|
|
|
PR GRAFT DERMA-FAT-FASCIA
|
Professional
|
Both
|
$1,469.00
|
|
|
Service Code
|
HCPCS 15770
|
| Min. Negotiated Rate |
$587.60 |
| Max. Negotiated Rate |
$1,186.15 |
| Rate for Payer: Aetna Commercial |
$859.15
|
| Rate for Payer: Aetna Medicare |
$666.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.15
|
| Rate for Payer: BCBS Complete |
$587.60
|
| Rate for Payer: BCBS MAPPO |
$641.16
|
| Rate for Payer: BCN Medicare Advantage |
$641.16
|
| Rate for Payer: Cash Price |
$1,175.20
|
| Rate for Payer: Cash Price |
$1,175.20
|
| Rate for Payer: Cofinity Commercial |
$923.27
|
| Rate for Payer: Cofinity Commercial |
$859.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.16
|
| Rate for Payer: Healthscope Commercial |
$1,025.86
|
| Rate for Payer: Healthscope Commercial |
$1,186.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$954.85
|
| Rate for Payer: Nomi Health Commercial |
$769.39
|
| Rate for Payer: PACE SWMI |
$641.16
|
| Rate for Payer: PHP Medicare Advantage |
$641.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$954.85
|
| Rate for Payer: Priority Health Medicare |
$641.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.16
|
| Rate for Payer: UHC Medicare Advantage |
$641.16
|
|
|
PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR
|
Professional
|
Both
|
$1,225.00
|
|
|
Service Code
|
HCPCS 21235
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$1,000.29 |
| Rate for Payer: Aetna Commercial |
$724.54
|
| Rate for Payer: Aetna Medicare |
$562.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$778.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$724.54
|
| Rate for Payer: BCBS Complete |
$490.00
|
| Rate for Payer: BCBS MAPPO |
$540.70
|
| Rate for Payer: BCN Medicare Advantage |
$540.70
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cash Price |
$980.00
|
| Rate for Payer: Cofinity Commercial |
$778.61
|
| Rate for Payer: Cofinity Commercial |
$724.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$540.70
|
| Rate for Payer: Healthscope Commercial |
$865.12
|
| Rate for Payer: Healthscope Commercial |
$1,000.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$567.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.25
|
| Rate for Payer: Nomi Health Commercial |
$648.84
|
| Rate for Payer: PACE SWMI |
$540.70
|
| Rate for Payer: PHP Medicare Advantage |
$540.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.25
|
| Rate for Payer: Priority Health Medicare |
$540.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$540.70
|
| Rate for Payer: UHC Medicare Advantage |
$540.70
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS
|
Professional
|
Both
|
$1,168.00
|
|
|
Service Code
|
HCPCS 15773
|
| Min. Negotiated Rate |
$467.20 |
| Max. Negotiated Rate |
$886.85 |
| Rate for Payer: Aetna Commercial |
$642.37
|
| Rate for Payer: Aetna Medicare |
$498.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$690.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$642.37
|
| Rate for Payer: BCBS Complete |
$467.20
|
| Rate for Payer: BCBS MAPPO |
$479.38
|
| Rate for Payer: BCN Medicare Advantage |
$479.38
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cash Price |
$934.40
|
| Rate for Payer: Cofinity Commercial |
$690.31
|
| Rate for Payer: Cofinity Commercial |
$642.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.38
|
| Rate for Payer: Healthscope Commercial |
$767.01
|
| Rate for Payer: Healthscope Commercial |
$886.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$503.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$759.20
|
| Rate for Payer: Nomi Health Commercial |
$575.26
|
| Rate for Payer: PACE SWMI |
$479.38
|
| Rate for Payer: PHP Medicare Advantage |
$479.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$759.20
|
| Rate for Payer: Priority Health Medicare |
$479.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$479.38
|
| Rate for Payer: UHC Medicare Advantage |
$479.38
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS
|
Professional
|
Both
|
$1,157.00
|
|
|
Service Code
|
HCPCS 15771
|
| Min. Negotiated Rate |
$462.80 |
| Max. Negotiated Rate |
$906.43 |
| Rate for Payer: Aetna Commercial |
$656.55
|
| Rate for Payer: Aetna Medicare |
$509.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$705.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$656.55
|
| Rate for Payer: BCBS Complete |
$462.80
|
| Rate for Payer: BCBS MAPPO |
$489.96
|
| Rate for Payer: BCN Medicare Advantage |
$489.96
|
| Rate for Payer: Cash Price |
$925.60
|
| Rate for Payer: Cash Price |
$925.60
|
| Rate for Payer: Cofinity Commercial |
$705.54
|
| Rate for Payer: Cofinity Commercial |
$656.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$489.96
|
| Rate for Payer: Healthscope Commercial |
$906.43
|
| Rate for Payer: Healthscope Commercial |
$783.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$514.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$752.05
|
| Rate for Payer: Nomi Health Commercial |
$587.95
|
| Rate for Payer: PACE SWMI |
$489.96
|
| Rate for Payer: PHP Medicare Advantage |
$489.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$752.05
|
| Rate for Payer: Priority Health Medicare |
$489.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$489.96
|
| Rate for Payer: UHC Medicare Advantage |
$489.96
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 15774
|
| Min. Negotiated Rate |
$138.52 |
| Max. Negotiated Rate |
$256.26 |
| Rate for Payer: Aetna Commercial |
$185.62
|
| Rate for Payer: Aetna Medicare |
$144.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.62
|
| Rate for Payer: BCBS Complete |
$142.40
|
| Rate for Payer: BCBS MAPPO |
$138.52
|
| Rate for Payer: BCN Medicare Advantage |
$138.52
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$199.47
|
| Rate for Payer: Cofinity Commercial |
$185.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.52
|
| Rate for Payer: Healthscope Commercial |
$221.63
|
| Rate for Payer: Healthscope Commercial |
$256.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.40
|
| Rate for Payer: Nomi Health Commercial |
$166.22
|
| Rate for Payer: PACE SWMI |
$138.52
|
| Rate for Payer: PHP Medicare Advantage |
$138.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.40
|
| Rate for Payer: Priority Health Medicare |
$138.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.52
|
| Rate for Payer: UHC Medicare Advantage |
$138.52
|
|
|
PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 15772
|
| Min. Negotiated Rate |
$142.99 |
| Max. Negotiated Rate |
$264.53 |
| Rate for Payer: Aetna Commercial |
$191.61
|
| Rate for Payer: Aetna Medicare |
$148.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.61
|
| Rate for Payer: BCBS Complete |
$146.80
|
| Rate for Payer: BCBS MAPPO |
$142.99
|
| Rate for Payer: BCN Medicare Advantage |
$142.99
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$205.91
|
| Rate for Payer: Cofinity Commercial |
$191.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.99
|
| Rate for Payer: Healthscope Commercial |
$264.53
|
| Rate for Payer: Healthscope Commercial |
$228.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$150.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.55
|
| Rate for Payer: Nomi Health Commercial |
$171.59
|
| Rate for Payer: PACE SWMI |
$142.99
|
| Rate for Payer: PHP Medicare Advantage |
$142.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health Medicare |
$142.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.99
|
| Rate for Payer: UHC Medicare Advantage |
$142.99
|
|
|
PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 15769
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$850.39 |
| Rate for Payer: Aetna Commercial |
$615.96
|
| Rate for Payer: Aetna Medicare |
$478.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$661.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$615.96
|
| Rate for Payer: BCBS Complete |
$390.00
|
| Rate for Payer: BCBS MAPPO |
$459.67
|
| Rate for Payer: BCN Medicare Advantage |
$459.67
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cofinity Commercial |
$661.92
|
| Rate for Payer: Cofinity Commercial |
$615.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.67
|
| Rate for Payer: Healthscope Commercial |
$735.47
|
| Rate for Payer: Healthscope Commercial |
$850.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$482.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.75
|
| Rate for Payer: Nomi Health Commercial |
$551.60
|
| Rate for Payer: PACE SWMI |
$459.67
|
| Rate for Payer: PHP Medicare Advantage |
$459.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.75
|
| Rate for Payer: Priority Health Medicare |
$459.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.67
|
| Rate for Payer: UHC Medicare Advantage |
$459.67
|
|
|
PR GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE
|
Professional
|
Both
|
$1,200.00
|
|
|
Service Code
|
HCPCS 46753
|
| Min. Negotiated Rate |
$480.00 |
| Max. Negotiated Rate |
$1,111.87 |
| Rate for Payer: Aetna Commercial |
$805.35
|
| Rate for Payer: Aetna Medicare |
$625.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$865.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$805.35
|
| Rate for Payer: BCBS Complete |
$480.00
|
| Rate for Payer: BCBS MAPPO |
$601.01
|
| Rate for Payer: BCN Medicare Advantage |
$601.01
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cash Price |
$960.00
|
| Rate for Payer: Cofinity Commercial |
$865.45
|
| Rate for Payer: Cofinity Commercial |
$805.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$601.01
|
| Rate for Payer: Healthscope Commercial |
$961.62
|
| Rate for Payer: Healthscope Commercial |
$1,111.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$631.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$780.00
|
| Rate for Payer: Nomi Health Commercial |
$721.21
|
| Rate for Payer: PACE SWMI |
$601.01
|
| Rate for Payer: PHP Medicare Advantage |
$601.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.00
|
| Rate for Payer: Priority Health Medicare |
$601.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$601.01
|
| Rate for Payer: UHC Medicare Advantage |
$601.01
|
|
|
PR GROUP BEHAVE COUNS 2-10
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0473
|
| Min. Negotiated Rate |
$10.77 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$14.43
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.43
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$10.77
|
| Rate for Payer: BCN Medicare Advantage |
$10.77
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$15.51
|
| Rate for Payer: Cofinity Commercial |
$14.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.77
|
| Rate for Payer: Healthscope Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$19.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Nomi Health Commercial |
$12.92
|
| Rate for Payer: PACE SWMI |
$10.77
|
| Rate for Payer: PHP Medicare Advantage |
$10.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$10.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.77
|
| Rate for Payer: UHC Medicare Advantage |
$10.77
|
|
|
PR GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 90853
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$44.66 |
| Rate for Payer: Aetna Commercial |
$32.35
|
| Rate for Payer: Aetna Medicare |
$25.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.35
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS MAPPO |
$24.14
|
| Rate for Payer: BCN Medicare Advantage |
$24.14
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$34.76
|
| Rate for Payer: Cofinity Commercial |
$32.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.14
|
| Rate for Payer: Healthscope Commercial |
$44.66
|
| Rate for Payer: Healthscope Commercial |
$38.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.75
|
| Rate for Payer: Nomi Health Commercial |
$28.97
|
| Rate for Payer: PACE SWMI |
$24.14
|
| Rate for Payer: PHP Medicare Advantage |
$24.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health Medicare |
$24.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.14
|
| Rate for Payer: UHC Medicare Advantage |
$24.14
|
|
|
PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY
|
Professional
|
Both
|
$2,608.00
|
|
|
Service Code
|
HCPCS 43631
|
| Min. Negotiated Rate |
$1,043.20 |
| Max. Negotiated Rate |
$2,611.37 |
| Rate for Payer: Aetna Commercial |
$1,891.48
|
| Rate for Payer: Aetna Medicare |
$1,468.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,032.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,891.48
|
| Rate for Payer: BCBS Complete |
$1,043.20
|
| Rate for Payer: BCBS MAPPO |
$1,411.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,411.55
|
| Rate for Payer: Cash Price |
$2,086.40
|
| Rate for Payer: Cash Price |
$2,086.40
|
| Rate for Payer: Cofinity Commercial |
$2,032.63
|
| Rate for Payer: Cofinity Commercial |
$1,891.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,411.55
|
| Rate for Payer: Healthscope Commercial |
$2,258.48
|
| Rate for Payer: Healthscope Commercial |
$2,611.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,482.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,695.20
|
| Rate for Payer: Nomi Health Commercial |
$1,693.86
|
| Rate for Payer: PACE SWMI |
$1,411.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,411.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,695.20
|
| Rate for Payer: Priority Health Medicare |
$1,411.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,411.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,411.55
|
|
|
PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY
|
Professional
|
Both
|
$3,761.00
|
|
|
Service Code
|
HCPCS 43632
|
| Min. Negotiated Rate |
$1,504.40 |
| Max. Negotiated Rate |
$3,662.37 |
| Rate for Payer: Aetna Commercial |
$2,652.74
|
| Rate for Payer: Aetna Medicare |
$2,058.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,850.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,652.74
|
| Rate for Payer: BCBS Complete |
$1,504.40
|
| Rate for Payer: BCBS MAPPO |
$1,979.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,979.66
|
| Rate for Payer: Cash Price |
$3,008.80
|
| Rate for Payer: Cash Price |
$3,008.80
|
| Rate for Payer: Cofinity Commercial |
$2,850.71
|
| Rate for Payer: Cofinity Commercial |
$2,652.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,979.66
|
| Rate for Payer: Healthscope Commercial |
$3,662.37
|
| Rate for Payer: Healthscope Commercial |
$3,167.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,078.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,444.65
|
| Rate for Payer: Nomi Health Commercial |
$2,375.59
|
| Rate for Payer: PACE SWMI |
$1,979.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,979.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,444.65
|
| Rate for Payer: Priority Health Medicare |
$1,979.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,979.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,979.66
|
|
|
PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ
|
Professional
|
Both
|
$3,446.00
|
|
|
Service Code
|
HCPCS 43633
|
| Min. Negotiated Rate |
$1,378.40 |
| Max. Negotiated Rate |
$3,462.11 |
| Rate for Payer: Aetna Commercial |
$2,507.69
|
| Rate for Payer: Aetna Medicare |
$1,946.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,694.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,507.69
|
| Rate for Payer: BCBS Complete |
$1,378.40
|
| Rate for Payer: BCBS MAPPO |
$1,871.41
|
| Rate for Payer: BCN Medicare Advantage |
$1,871.41
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cash Price |
$2,756.80
|
| Rate for Payer: Cofinity Commercial |
$2,694.83
|
| Rate for Payer: Cofinity Commercial |
$2,507.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,871.41
|
| Rate for Payer: Healthscope Commercial |
$2,994.26
|
| Rate for Payer: Healthscope Commercial |
$3,462.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,964.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,239.90
|
| Rate for Payer: Nomi Health Commercial |
$2,245.69
|
| Rate for Payer: PACE SWMI |
$1,871.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,871.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,239.90
|
| Rate for Payer: Priority Health Medicare |
$1,871.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,871.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,871.41
|
|
|
PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY
|
Professional
|
Both
|
$6,616.00
|
|
|
Service Code
|
HCPCS 43620
|
| Min. Negotiated Rate |
$1,928.33 |
| Max. Negotiated Rate |
$4,300.40 |
| Rate for Payer: Aetna Commercial |
$2,583.96
|
| Rate for Payer: Aetna Medicare |
$2,005.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,776.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,583.96
|
| Rate for Payer: BCBS Complete |
$2,646.40
|
| Rate for Payer: BCBS MAPPO |
$1,928.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,928.33
|
| Rate for Payer: Cash Price |
$5,292.80
|
| Rate for Payer: Cash Price |
$5,292.80
|
| Rate for Payer: Cofinity Commercial |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$2,583.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,928.33
|
| Rate for Payer: Healthscope Commercial |
$3,085.33
|
| Rate for Payer: Healthscope Commercial |
$3,567.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,024.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,300.40
|
| Rate for Payer: Nomi Health Commercial |
$2,314.00
|
| Rate for Payer: PACE SWMI |
$1,928.33
|
| Rate for Payer: PHP Medicare Advantage |
$1,928.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,300.40
|
| Rate for Payer: Priority Health Medicare |
$1,928.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,928.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,928.33
|
|
|
PR HAIR REDUC 1/2 LEGS
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00060
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR HAIR REDUC ABD TRAIL
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00052
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR HAIR REDUC BACK
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00054
|
|
Hospital Revenue Code
|
990
|
| 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
|
|
