|
PR HAIR REDUC BIKINI LN
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00055
|
|
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 BRAZ
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00056
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
PR HAIR REDUC BROW/NOSE/EARS/TOE/HND
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 00061
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR HAIR REDUC CHIN/NECK
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00057
|
|
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 FL FACE/SCALP/FL ABD
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 00058
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
|
|
PR HAIR REDUC FL LEGS
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 00059
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
PR HAIR REDUC HLF ARMS/CHEST/ABD/SHLDR
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00053
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
PR HAIR REDUC LIP
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 00062
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR HAIR REDUC LIP & CHIN
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 00063
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
|
|
PR HAIR REDUC UDR ARMS OR BUTTOCKS
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00064
|
|
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 UP/LOW LEGS
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00065
|
|
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 HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 28291
|
| Min. Negotiated Rate |
$456.65 |
| Max. Negotiated Rate |
$955.50 |
| Rate for Payer: Aetna Commercial |
$611.91
|
| Rate for Payer: Aetna Medicare |
$474.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$657.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.91
|
| Rate for Payer: BCBS Complete |
$588.00
|
| Rate for Payer: BCBS MAPPO |
$456.65
|
| Rate for Payer: BCN Medicare Advantage |
$456.65
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cofinity Commercial |
$657.58
|
| Rate for Payer: Cofinity Commercial |
$611.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$456.65
|
| Rate for Payer: Healthscope Commercial |
$844.80
|
| Rate for Payer: Healthscope Commercial |
$730.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$479.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$955.50
|
| Rate for Payer: Nomi Health Commercial |
$547.98
|
| Rate for Payer: PACE SWMI |
$456.65
|
| Rate for Payer: PHP Medicare Advantage |
$456.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$955.50
|
| Rate for Payer: Priority Health Medicare |
$456.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$456.65
|
| Rate for Payer: UHC Medicare Advantage |
$456.65
|
|
|
PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT
|
Professional
|
Both
|
$1,236.00
|
|
|
Service Code
|
HCPCS 28289
|
| Min. Negotiated Rate |
$442.81 |
| Max. Negotiated Rate |
$819.20 |
| Rate for Payer: Aetna Commercial |
$593.37
|
| Rate for Payer: Aetna Medicare |
$460.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$637.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.37
|
| Rate for Payer: BCBS Complete |
$494.40
|
| Rate for Payer: BCBS MAPPO |
$442.81
|
| Rate for Payer: BCN Medicare Advantage |
$442.81
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cofinity Commercial |
$637.65
|
| Rate for Payer: Cofinity Commercial |
$593.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.81
|
| Rate for Payer: Healthscope Commercial |
$708.50
|
| Rate for Payer: Healthscope Commercial |
$819.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$464.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$803.40
|
| Rate for Payer: Nomi Health Commercial |
$531.37
|
| Rate for Payer: PACE SWMI |
$442.81
|
| Rate for Payer: PHP Medicare Advantage |
$442.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$803.40
|
| Rate for Payer: Priority Health Medicare |
$442.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$442.81
|
| Rate for Payer: UHC Medicare Advantage |
$442.81
|
|
|
PR HAMMER TOE CREST FELT - LARGE LT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00044
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR HAMMER TOE CREST FELT - LARGE RT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00045
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR HAMMER TOE CREST FELT - MEDIUM LT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00042
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR HAMMER TOE CREST FELT - MEDIUM RT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00043
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR HAMMER TOE CREST FELT - SMALL LT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00040
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR HAMMER TOE CREST FELT - SMALL RT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00041
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR HAMMER TOE CREST FELT - XLARGE LT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00046
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR HAMMER TOE CREST FELT - XLARGE RT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00047
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
|
PR HAND-HELD PEFR METER
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS A4614
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$61.48 |
| Rate for Payer: Aetna Commercial |
$44.53
|
| Rate for Payer: Aetna Medicare |
$34.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.85
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$33.23
|
| Rate for Payer: BCN Medicare Advantage |
$33.23
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$44.53
|
| Rate for Payer: Cofinity Commercial |
$47.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.23
|
| Rate for Payer: Healthscope Commercial |
$53.17
|
| Rate for Payer: Healthscope Commercial |
$61.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Nomi Health Commercial |
$39.88
|
| Rate for Payer: PACE SWMI |
$33.23
|
| Rate for Payer: PHP Medicare Advantage |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$33.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.23
|
| Rate for Payer: UHC Medicare Advantage |
$33.23
|
|
|
PR HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 99000
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna Medicare |
$8.00
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
|
|
PR HAND MUSCLE TEST,MANUAL
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 95832
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$55.90 |
| Rate for Payer: Aetna Medicare |
$43.00
|
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
|
|
PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX
|
Professional
|
Both
|
$1,142.00
|
|
|
Service Code
|
HCPCS 35572
|
| Min. Negotiated Rate |
$329.15 |
| Max. Negotiated Rate |
$742.30 |
| Rate for Payer: Aetna Commercial |
$441.06
|
| Rate for Payer: Aetna Medicare |
$342.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.06
|
| Rate for Payer: BCBS Complete |
$456.80
|
| Rate for Payer: BCBS MAPPO |
$329.15
|
| Rate for Payer: BCN Medicare Advantage |
$329.15
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cash Price |
$913.60
|
| Rate for Payer: Cofinity Commercial |
$441.06
|
| Rate for Payer: Cofinity Commercial |
$473.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.15
|
| Rate for Payer: Healthscope Commercial |
$608.93
|
| Rate for Payer: Healthscope Commercial |
$526.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$742.30
|
| Rate for Payer: Nomi Health Commercial |
$394.98
|
| Rate for Payer: PACE SWMI |
$329.15
|
| Rate for Payer: PHP Medicare Advantage |
$329.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.30
|
| Rate for Payer: Priority Health Medicare |
$329.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.15
|
| Rate for Payer: UHC Medicare Advantage |
$329.15
|
|