|
PR HEAL & BEHAV ASSESS,EA 15 MIN,RE-ASSESS
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 96151
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
|
PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/O PT
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 96155
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
|
|
PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 96154
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
|
|
PR HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 96152
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
|
|
PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 96156
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$12,531.00 |
| Rate for Payer: Aetna Commercial |
$115.37
|
| Rate for Payer: Aetna Medicare |
$89.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.98
|
| Rate for Payer: BCBS Complete |
$59.93
|
| Rate for Payer: BCBS MAPPO |
$86.10
|
| Rate for Payer: BCBS Trust/PPO |
$135.77
|
| Rate for Payer: BCN Commercial |
$137.32
|
| Rate for Payer: BCN Medicare Advantage |
$86.10
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$123.98
|
| Rate for Payer: Cofinity Commercial |
$115.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.10
|
| Rate for Payer: Healthscope Commercial |
$159.28
|
| Rate for Payer: Healthscope Commercial |
$137.76
|
| Rate for Payer: Mclaren Medicaid |
$57.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.40
|
| Rate for Payer: Meridian Medicaid |
$59.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,531.00
|
| Rate for Payer: Nomi Health Commercial |
$103.32
|
| Rate for Payer: PACE SWMI |
$86.10
|
| Rate for Payer: PHP Medicare Advantage |
$86.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.96
|
| Rate for Payer: Priority Health Medicare |
$86.10
|
| Rate for Payer: Priority Health Narrow Network |
$118.96
|
| Rate for Payer: Priority Health SBD |
$118.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.10
|
| Rate for Payer: UHC Medicare Advantage |
$86.10
|
| Rate for Payer: UHCCP Medicaid |
$57.08
|
|
|
PR HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST 30 MIN
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 96170
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$10,857.00 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.24
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS Trust/PPO |
$66.04
|
| Rate for Payer: BCN Commercial |
$113.38
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,857.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.15
|
| Rate for Payer: Priority Health Narrow Network |
$98.15
|
| Rate for Payer: Priority Health SBD |
$98.15
|
|
|
PR HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F EA ADDL 15
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 96171
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$3,936.00 |
| Rate for Payer: Aetna Commercial |
$30.11
|
| Rate for Payer: Aetna Medicare |
$28.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.11
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$102.49
|
| Rate for Payer: BCN Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,936.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.27
|
| Rate for Payer: Priority Health Narrow Network |
$35.27
|
| Rate for Payer: Priority Health SBD |
$35.27
|
|
|
PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 96167
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$9,024.00 |
| Rate for Payer: Aetna Commercial |
$84.00
|
| Rate for Payer: Aetna Medicare |
$65.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.00
|
| Rate for Payer: BCBS Complete |
$43.62
|
| Rate for Payer: BCBS MAPPO |
$62.69
|
| Rate for Payer: BCBS Trust/PPO |
$115.70
|
| Rate for Payer: BCN Commercial |
$99.69
|
| Rate for Payer: BCN Medicare Advantage |
$62.69
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$90.27
|
| Rate for Payer: Cofinity Commercial |
$84.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.69
|
| Rate for Payer: Healthscope Commercial |
$100.30
|
| Rate for Payer: Healthscope Commercial |
$115.98
|
| Rate for Payer: Mclaren Medicaid |
$41.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.82
|
| Rate for Payer: Meridian Medicaid |
$43.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,024.00
|
| Rate for Payer: Nomi Health Commercial |
$75.23
|
| Rate for Payer: PACE SWMI |
$62.69
|
| Rate for Payer: PHP Medicare Advantage |
$62.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.12
|
| Rate for Payer: Priority Health Medicare |
$62.69
|
| Rate for Payer: Priority Health Narrow Network |
$84.12
|
| Rate for Payer: Priority Health SBD |
$84.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.69
|
| Rate for Payer: UHC Medicare Advantage |
$62.69
|
| Rate for Payer: UHCCP Medicaid |
$41.54
|
|
|
PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 96168
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$3,174.00 |
| Rate for Payer: Aetna Commercial |
$30.18
|
| Rate for Payer: Aetna Medicare |
$23.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.43
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS MAPPO |
$22.52
|
| Rate for Payer: BCBS Trust/PPO |
$168.53
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Medicare Advantage |
$22.52
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$32.43
|
| Rate for Payer: Cofinity Commercial |
$30.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.52
|
| Rate for Payer: Healthscope Commercial |
$36.03
|
| Rate for Payer: Healthscope Commercial |
$41.66
|
| Rate for Payer: Mclaren Medicaid |
$14.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.65
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,174.00
|
| Rate for Payer: Nomi Health Commercial |
$27.02
|
| Rate for Payer: PACE SWMI |
$22.52
|
| Rate for Payer: PHP Medicare Advantage |
$22.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.85
|
| Rate for Payer: Priority Health Medicare |
$22.52
|
| Rate for Payer: Priority Health Narrow Network |
$29.85
|
| Rate for Payer: Priority Health SBD |
$29.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.52
|
| Rate for Payer: UHC Medicare Advantage |
$22.52
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
|
|
PR HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 96158
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$8,516.00 |
| Rate for Payer: Aetna Commercial |
$79.25
|
| Rate for Payer: Aetna Medicare |
$61.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.16
|
| Rate for Payer: BCBS Complete |
$41.15
|
| Rate for Payer: BCBS MAPPO |
$59.14
|
| Rate for Payer: BCBS Trust/PPO |
$831.54
|
| Rate for Payer: BCN Commercial |
$93.82
|
| Rate for Payer: BCN Medicare Advantage |
$59.14
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$85.16
|
| Rate for Payer: Cofinity Commercial |
$79.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.14
|
| Rate for Payer: Healthscope Commercial |
$109.41
|
| Rate for Payer: Healthscope Commercial |
$94.62
|
| Rate for Payer: Mclaren Medicaid |
$39.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.10
|
| Rate for Payer: Meridian Medicaid |
$41.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,516.00
|
| Rate for Payer: Nomi Health Commercial |
$70.97
|
| Rate for Payer: PACE SWMI |
$59.14
|
| Rate for Payer: PHP Medicare Advantage |
$59.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.61
|
| Rate for Payer: Priority Health Medicare |
$59.14
|
| Rate for Payer: Priority Health Narrow Network |
$79.61
|
| Rate for Payer: Priority Health SBD |
$79.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.14
|
| Rate for Payer: UHC Medicare Advantage |
$59.14
|
| Rate for Payer: UHCCP Medicaid |
$39.19
|
|
|
PR HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 96159
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$2,921.00 |
| Rate for Payer: Aetna Commercial |
$27.11
|
| Rate for Payer: Aetna Medicare |
$21.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.13
|
| Rate for Payer: BCBS Complete |
$14.09
|
| Rate for Payer: BCBS MAPPO |
$20.23
|
| Rate for Payer: BCBS Trust/PPO |
$208.15
|
| Rate for Payer: BCN Commercial |
$32.25
|
| Rate for Payer: BCN Medicare Advantage |
$20.23
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$29.13
|
| Rate for Payer: Cofinity Commercial |
$27.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.23
|
| Rate for Payer: Healthscope Commercial |
$32.37
|
| Rate for Payer: Healthscope Commercial |
$37.43
|
| Rate for Payer: Mclaren Medicaid |
$13.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.24
|
| Rate for Payer: Meridian Medicaid |
$14.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,921.00
|
| Rate for Payer: Nomi Health Commercial |
$24.28
|
| Rate for Payer: PACE SWMI |
$20.23
|
| Rate for Payer: PHP Medicare Advantage |
$20.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.69
|
| Rate for Payer: Priority Health Medicare |
$20.23
|
| Rate for Payer: Priority Health Narrow Network |
$26.69
|
| Rate for Payer: Priority Health SBD |
$26.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.23
|
| Rate for Payer: UHC Medicare Advantage |
$20.23
|
| Rate for Payer: UHCCP Medicaid |
$13.42
|
|
|
PR HEALTH RISK ASSESSMENT TEST
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 99420
|
| 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 HEARING AID CHECK BINAURAL
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 92593
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$5,282.00 |
| Rate for Payer: Aetna Commercial |
$39.35
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.35
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$392.83
|
| Rate for Payer: BCN Commercial |
$47.99
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,282.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.21
|
| Rate for Payer: Priority Health Narrow Network |
$50.21
|
| Rate for Payer: Priority Health SBD |
$50.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.00
|
| Rate for Payer: UHC Exchange |
$50.00
|
|
|
PR HEARING AID CHECK MONAURAL
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 92592
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$3,215.00 |
| Rate for Payer: Aetna Commercial |
$23.53
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.53
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,403.24
|
| Rate for Payer: BCN Commercial |
$47.99
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,215.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.30
|
| Rate for Payer: Priority Health Narrow Network |
$30.30
|
| Rate for Payer: Priority Health SBD |
$30.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.00
|
| Rate for Payer: UHC Exchange |
$20.00
|
|
|
PR HEARING AID EXAMINATION & SELECTION BINAURAL
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 92591
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$10,275.00 |
| Rate for Payer: Aetna Commercial |
$76.88
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.88
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS Trust/PPO |
$864.19
|
| Rate for Payer: BCN Commercial |
$98.85
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,275.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.70
|
| Rate for Payer: Priority Health Narrow Network |
$97.70
|
| Rate for Payer: Priority Health SBD |
$97.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.94
|
| Rate for Payer: UHC Exchange |
$84.94
|
|
|
PR HEARING AID EXAMINATION & SELECTION MONAURAL
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 92590
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$8,066.00 |
| Rate for Payer: Aetna Commercial |
$59.96
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.96
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.47
|
| Rate for Payer: BCN Commercial |
$98.85
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,066.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.89
|
| Rate for Payer: Priority Health Narrow Network |
$76.89
|
| Rate for Payer: Priority Health SBD |
$76.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.44
|
| Rate for Payer: UHC Exchange |
$57.44
|
|
|
PR HEARING AID, PROG, BIN, BTE
|
Professional
|
Both
|
$5,516.00
|
|
|
Service Code
|
HCPCS V5253
|
| Min. Negotiated Rate |
$1,350.00 |
| Max. Negotiated Rate |
$3,585.40 |
| Rate for Payer: Aetna Commercial |
$1,350.00
|
| Rate for Payer: Aetna Medicare |
$2,758.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,350.00
|
| Rate for Payer: BCBS Complete |
$2,206.40
|
| Rate for Payer: Cash Price |
$4,412.80
|
| Rate for Payer: Cash Price |
$4,412.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,585.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,585.40
|
|
|
PR HEARING AID REPAIR/MODIFYING
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS V5014
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$12,920.00 |
| Rate for Payer: Aetna Commercial |
$88.69
|
| Rate for Payer: Aetna Commercial |
$88.69
|
| Rate for Payer: Aetna Commercial |
$88.69
|
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: Aetna Medicare |
$217.00
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.69
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS Complete |
$173.60
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,920.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,920.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,920.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR HEMIARTHROPLASTY HIP PARTIAL
|
Professional
|
Both
|
$2,333.00
|
|
|
Service Code
|
HCPCS 27125
|
| Min. Negotiated Rate |
$732.93 |
| Max. Negotiated Rate |
$200,630.00 |
| Rate for Payer: Aetna Commercial |
$1,461.31
|
| Rate for Payer: Aetna Medicare |
$1,134.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,461.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,570.36
|
| Rate for Payer: BCBS Complete |
$769.58
|
| Rate for Payer: BCBS MAPPO |
$1,090.53
|
| Rate for Payer: BCBS Trust/PPO |
$984.22
|
| Rate for Payer: BCN Commercial |
$1,655.64
|
| Rate for Payer: BCN Medicare Advantage |
$1,090.53
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cofinity Commercial |
$1,570.36
|
| Rate for Payer: Cofinity Commercial |
$1,461.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,090.53
|
| Rate for Payer: Healthscope Commercial |
$2,017.48
|
| Rate for Payer: Healthscope Commercial |
$1,744.85
|
| Rate for Payer: Mclaren Medicaid |
$732.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,145.06
|
| Rate for Payer: Meridian Medicaid |
$769.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200,630.00
|
| Rate for Payer: Nomi Health Commercial |
$1,308.64
|
| Rate for Payer: PACE SWMI |
$1,090.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,090.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$732.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,516.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,736.74
|
| Rate for Payer: Priority Health Medicare |
$1,090.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,736.74
|
| Rate for Payer: Priority Health SBD |
$1,736.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,388.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,090.53
|
| Rate for Payer: UHC Exchange |
$1,388.02
|
| Rate for Payer: UHC Medicare Advantage |
$1,090.53
|
| Rate for Payer: UHCCP Medicaid |
$732.93
|
|
|
PR HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
HCPCS 28160
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$46,534.00 |
| Rate for Payer: Aetna Commercial |
$342.29
|
| Rate for Payer: Aetna Medicare |
$265.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$342.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.83
|
| Rate for Payer: BCBS Complete |
$182.94
|
| Rate for Payer: BCBS MAPPO |
$255.44
|
| Rate for Payer: BCBS Trust/PPO |
$888.60
|
| Rate for Payer: BCN Commercial |
$592.77
|
| Rate for Payer: BCN Medicare Advantage |
$255.44
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cash Price |
$557.60
|
| Rate for Payer: Cofinity Commercial |
$367.83
|
| Rate for Payer: Cofinity Commercial |
$342.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.44
|
| Rate for Payer: Healthscope Commercial |
$472.56
|
| Rate for Payer: Healthscope Commercial |
$408.70
|
| Rate for Payer: Mclaren Medicaid |
$174.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$268.21
|
| Rate for Payer: Meridian Medicaid |
$182.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46,534.00
|
| Rate for Payer: Nomi Health Commercial |
$306.53
|
| Rate for Payer: PACE SWMI |
$255.44
|
| Rate for Payer: PHP Medicare Advantage |
$255.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$174.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$453.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$412.18
|
| Rate for Payer: Priority Health Medicare |
$255.44
|
| Rate for Payer: Priority Health Narrow Network |
$412.18
|
| Rate for Payer: Priority Health SBD |
$412.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.44
|
| Rate for Payer: UHC Exchange |
$490.45
|
| Rate for Payer: UHC Medicare Advantage |
$255.44
|
| Rate for Payer: UHCCP Medicaid |
$174.23
|
|
|
PR HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 90935
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$10,524.00 |
| Rate for Payer: Aetna Commercial |
$89.54
|
| Rate for Payer: Aetna Medicare |
$69.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.22
|
| Rate for Payer: BCBS Complete |
$46.97
|
| Rate for Payer: BCBS MAPPO |
$66.82
|
| Rate for Payer: BCBS Trust/PPO |
$293.73
|
| Rate for Payer: BCN Commercial |
$103.11
|
| Rate for Payer: BCN Medicare Advantage |
$66.82
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$96.22
|
| Rate for Payer: Cofinity Commercial |
$89.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.82
|
| Rate for Payer: Healthscope Commercial |
$123.62
|
| Rate for Payer: Healthscope Commercial |
$106.91
|
| Rate for Payer: Mclaren Medicaid |
$44.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.16
|
| Rate for Payer: Meridian Medicaid |
$46.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,524.00
|
| Rate for Payer: Nomi Health Commercial |
$80.18
|
| Rate for Payer: PACE SWMI |
$66.82
|
| Rate for Payer: PHP Medicare Advantage |
$66.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.98
|
| Rate for Payer: Priority Health Medicare |
$66.82
|
| Rate for Payer: Priority Health Narrow Network |
$94.98
|
| Rate for Payer: Priority Health SBD |
$94.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.82
|
| Rate for Payer: UHC Exchange |
$133.55
|
| Rate for Payer: UHC Medicare Advantage |
$66.82
|
| Rate for Payer: UHCCP Medicaid |
$44.73
|
|
|
PR HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
HCPCS 90937
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$14,948.00 |
| Rate for Payer: Aetna Commercial |
$129.66
|
| Rate for Payer: Aetna Medicare |
$100.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.33
|
| Rate for Payer: BCBS Complete |
$67.99
|
| Rate for Payer: BCBS MAPPO |
$96.76
|
| Rate for Payer: BCBS Trust/PPO |
$314.34
|
| Rate for Payer: BCN Commercial |
$146.60
|
| Rate for Payer: BCN Medicare Advantage |
$96.76
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cash Price |
$476.80
|
| Rate for Payer: Cofinity Commercial |
$139.33
|
| Rate for Payer: Cofinity Commercial |
$129.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.76
|
| Rate for Payer: Healthscope Commercial |
$179.01
|
| Rate for Payer: Healthscope Commercial |
$154.82
|
| Rate for Payer: Mclaren Medicaid |
$64.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.60
|
| Rate for Payer: Meridian Medicaid |
$67.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,948.00
|
| Rate for Payer: Nomi Health Commercial |
$116.11
|
| Rate for Payer: PACE SWMI |
$96.76
|
| Rate for Payer: PHP Medicare Advantage |
$96.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$387.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.60
|
| Rate for Payer: Priority Health Medicare |
$96.76
|
| Rate for Payer: Priority Health Narrow Network |
$136.60
|
| Rate for Payer: Priority Health SBD |
$136.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.76
|
| Rate for Payer: UHC Exchange |
$196.11
|
| Rate for Payer: UHC Medicare Advantage |
$96.76
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
|
|
PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
46221
|
| Min. Negotiated Rate |
$261.45 |
| Max. Negotiated Rate |
$373.50 |
| Rate for Payer: Aetna Commercial |
$352.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.75
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cofinity Commercial |
$290.50
|
| Rate for Payer: Cofinity Commercial |
$356.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.00
|
| Rate for Payer: Healthscope Commercial |
$373.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.75
|
| Rate for Payer: PHP Commercial |
$352.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.75
|
| Rate for Payer: Priority Health SBD |
$261.45
|
|
|
PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 46221
|
| Hospital Charge Code |
46221
|
| Min. Negotiated Rate |
$125.46 |
| Max. Negotiated Rate |
$33,696.00 |
| Rate for Payer: Aetna Commercial |
$245.77
|
| Rate for Payer: Aetna Medicare |
$190.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.11
|
| Rate for Payer: BCBS Complete |
$131.73
|
| Rate for Payer: BCBS MAPPO |
$183.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,246.26
|
| Rate for Payer: BCN Commercial |
$335.33
|
| Rate for Payer: BCN Medicare Advantage |
$183.41
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cofinity Commercial |
$264.11
|
| Rate for Payer: Cofinity Commercial |
$245.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.41
|
| Rate for Payer: Healthscope Commercial |
$339.31
|
| Rate for Payer: Healthscope Commercial |
$293.46
|
| Rate for Payer: Mclaren Medicaid |
$125.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.58
|
| Rate for Payer: Meridian Medicaid |
$131.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,696.00
|
| Rate for Payer: Nomi Health Commercial |
$220.09
|
| Rate for Payer: PACE SWMI |
$183.41
|
| Rate for Payer: PHP Medicare Advantage |
$183.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.03
|
| Rate for Payer: Priority Health Medicare |
$183.41
|
| Rate for Payer: Priority Health Narrow Network |
$346.03
|
| Rate for Payer: Priority Health SBD |
$346.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.41
|
| Rate for Payer: UHC Exchange |
$193.88
|
| Rate for Payer: UHC Medicare Advantage |
$183.41
|
| Rate for Payer: UHCCP Medicaid |
$125.46
|
|
|
PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 46221
|
| Min. Negotiated Rate |
$125.46 |
| Max. Negotiated Rate |
$33,696.00 |
| Rate for Payer: Aetna Commercial |
$245.77
|
| Rate for Payer: Aetna Medicare |
$190.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.11
|
| Rate for Payer: BCBS Complete |
$131.73
|
| Rate for Payer: BCBS MAPPO |
$183.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,246.26
|
| Rate for Payer: BCN Commercial |
$335.33
|
| Rate for Payer: BCN Medicare Advantage |
$183.41
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cofinity Commercial |
$264.11
|
| Rate for Payer: Cofinity Commercial |
$245.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.41
|
| Rate for Payer: Healthscope Commercial |
$339.31
|
| Rate for Payer: Healthscope Commercial |
$293.46
|
| Rate for Payer: Mclaren Medicaid |
$125.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.58
|
| Rate for Payer: Meridian Medicaid |
$131.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,696.00
|
| Rate for Payer: Nomi Health Commercial |
$220.09
|
| Rate for Payer: PACE SWMI |
$183.41
|
| Rate for Payer: PHP Medicare Advantage |
$183.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$346.03
|
| Rate for Payer: Priority Health Medicare |
$183.41
|
| Rate for Payer: Priority Health Narrow Network |
$346.03
|
| Rate for Payer: Priority Health SBD |
$346.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.41
|
| Rate for Payer: UHC Exchange |
$193.88
|
| Rate for Payer: UHC Medicare Advantage |
$183.41
|
| Rate for Payer: UHCCP Medicaid |
$125.46
|
|
