|
PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 90744
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$2,753.00 |
| Rate for Payer: Aetna Commercial |
$42.44
|
| Rate for Payer: Aetna Medicare |
$32.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.61
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$31.67
|
| Rate for Payer: BCBS Trust/PPO |
$31.03
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: BCN Medicare Advantage |
$31.67
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$45.61
|
| Rate for Payer: Cofinity Commercial |
$42.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.67
|
| Rate for Payer: Healthscope Commercial |
$50.67
|
| Rate for Payer: Healthscope Commercial |
$58.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,753.00
|
| Rate for Payer: Nomi Health Commercial |
$38.01
|
| Rate for Payer: PACE SWMI |
$31.67
|
| Rate for Payer: PHP Medicare Advantage |
$31.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$31.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.67
|
| Rate for Payer: UHC Exchange |
$33.57
|
| Rate for Payer: UHC Medicare Advantage |
$31.67
|
|
|
PR HFO FLEXION GLOVE PRE OTS
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS L3912
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$10,996.00 |
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCN Commercial |
$91.04
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,996.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
|
|
PR HFO NONTORSION JNTS PRE CST
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS L3929
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$9,533.00 |
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: BCN Commercial |
$78.93
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,533.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
|
|
PR HFO W/JOINT(S) CF
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS L3921
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$33,526.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCN Commercial |
$277.59
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,526.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
|
|
PR HFO W/O JOINTS CF
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS L3913
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$28,265.00 |
| Rate for Payer: BCBS Complete |
$101.20
|
| Rate for Payer: BCN Commercial |
$234.03
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,265.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.45
|
|
|
PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 90748
|
| Min. Negotiated Rate |
$42.06 |
| Max. Negotiated Rate |
$6,576.00 |
| Rate for Payer: Aetna Commercial |
$42.90
|
| Rate for Payer: Aetna Medicare |
$132.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.90
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.85
|
| Rate for Payer: BCN Commercial |
$42.06
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,576.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.50
|
| Rate for Payer: UHC Exchange |
$53.50
|
|
|
PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90647
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$3,018.00 |
| Rate for Payer: Aetna Commercial |
$30.53
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.53
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$28.36
|
| Rate for Payer: BCN Commercial |
$28.36
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,018.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.41
|
| Rate for Payer: UHC Exchange |
$32.41
|
|
|
PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90648
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$1,257.00 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$18.57
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,257.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.28
|
| Rate for Payer: UHC Exchange |
$13.28
|
|
|
PR HIB VACCINE, HBOC, IM
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90645
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
|
|
PR HIB VACCINE, PRP-D, IM
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90646
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR HINGE EXTENSION/FLEX WRIST/F
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
HCPCS L3900
|
| Min. Negotiated Rate |
$604.80 |
| Max. Negotiated Rate |
$169,073.00 |
| Rate for Payer: BCBS Complete |
$604.80
|
| Rate for Payer: BCN Commercial |
$1,399.87
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169,073.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$982.80
|
|
|
PR HOME HEALTH CARE SUPERVISION
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS G0181
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$15,138.00 |
| Rate for Payer: Aetna Commercial |
$132.93
|
| Rate for Payer: Aetna Medicare |
$103.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.85
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$99.20
|
| Rate for Payer: BCBS Trust/PPO |
$90.87
|
| Rate for Payer: BCN Commercial |
$150.52
|
| Rate for Payer: BCN Medicare Advantage |
$99.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$142.85
|
| Rate for Payer: Cofinity Commercial |
$132.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.20
|
| Rate for Payer: Healthscope Commercial |
$158.72
|
| Rate for Payer: Healthscope Commercial |
$183.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,138.00
|
| Rate for Payer: Nomi Health Commercial |
$119.04
|
| Rate for Payer: PACE SWMI |
$99.20
|
| Rate for Payer: PHP Medicare Advantage |
$99.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.02
|
| Rate for Payer: Priority Health Medicare |
$99.20
|
| Rate for Payer: Priority Health Narrow Network |
$142.02
|
| Rate for Payer: Priority Health SBD |
$142.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.20
|
| Rate for Payer: UHC Exchange |
$129.18
|
| Rate for Payer: UHC Medicare Advantage |
$99.20
|
|
|
PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 99350
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$27,308.00 |
| Rate for Payer: Aetna Commercial |
$233.68
|
| Rate for Payer: Aetna Medicare |
$181.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.12
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$174.39
|
| Rate for Payer: BCBS Trust/PPO |
$507.70
|
| Rate for Payer: BCN Commercial |
$268.78
|
| Rate for Payer: BCN Medicare Advantage |
$174.39
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$251.12
|
| Rate for Payer: Cofinity Commercial |
$233.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.39
|
| Rate for Payer: Healthscope Commercial |
$279.02
|
| Rate for Payer: Healthscope Commercial |
$322.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,308.00
|
| Rate for Payer: Nomi Health Commercial |
$209.27
|
| Rate for Payer: PACE SWMI |
$174.39
|
| Rate for Payer: PHP Medicare Advantage |
$174.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.70
|
| Rate for Payer: Priority Health Medicare |
$174.39
|
| Rate for Payer: Priority Health Narrow Network |
$247.70
|
| Rate for Payer: Priority Health SBD |
$247.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$202.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.39
|
| Rate for Payer: UHC Exchange |
$202.60
|
| Rate for Payer: UHC Medicare Advantage |
$174.39
|
|
|
PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99348
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$11,165.00 |
| Rate for Payer: Aetna Commercial |
$97.12
|
| Rate for Payer: Aetna Medicare |
$75.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.12
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$72.48
|
| Rate for Payer: BCBS Trust/PPO |
$125.21
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: BCN Medicare Advantage |
$72.48
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$97.12
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.48
|
| Rate for Payer: Healthscope Commercial |
$115.97
|
| Rate for Payer: Healthscope Commercial |
$134.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,165.00
|
| Rate for Payer: Nomi Health Commercial |
$86.98
|
| Rate for Payer: PACE SWMI |
$72.48
|
| Rate for Payer: PHP Medicare Advantage |
$72.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.31
|
| Rate for Payer: Priority Health Medicare |
$72.48
|
| Rate for Payer: Priority Health Narrow Network |
$102.31
|
| Rate for Payer: Priority Health SBD |
$102.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.48
|
| Rate for Payer: UHC Exchange |
$89.75
|
| Rate for Payer: UHC Medicare Advantage |
$72.48
|
|
|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99349
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$18,704.00 |
| Rate for Payer: Aetna Commercial |
$160.88
|
| Rate for Payer: Aetna Medicare |
$124.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.89
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS MAPPO |
$120.06
|
| Rate for Payer: BCBS Trust/PPO |
$288.45
|
| Rate for Payer: BCN Commercial |
$184.23
|
| Rate for Payer: BCN Medicare Advantage |
$120.06
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$172.89
|
| Rate for Payer: Cofinity Commercial |
$160.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.06
|
| Rate for Payer: Healthscope Commercial |
$192.10
|
| Rate for Payer: Healthscope Commercial |
$222.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,704.00
|
| Rate for Payer: Nomi Health Commercial |
$144.07
|
| Rate for Payer: PACE SWMI |
$120.06
|
| Rate for Payer: PHP Medicare Advantage |
$120.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.06
|
| Rate for Payer: Priority Health Medicare |
$120.06
|
| Rate for Payer: Priority Health Narrow Network |
$170.06
|
| Rate for Payer: Priority Health SBD |
$170.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.06
|
| Rate for Payer: UHC Exchange |
$139.07
|
| Rate for Payer: UHC Medicare Advantage |
$120.06
|
|
|
PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 99347
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$6,554.00 |
| Rate for Payer: Aetna Commercial |
$57.23
|
| Rate for Payer: Aetna Medicare |
$44.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.50
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$42.71
|
| Rate for Payer: BCBS Trust/PPO |
$728.53
|
| Rate for Payer: BCN Commercial |
$64.51
|
| Rate for Payer: BCN Medicare Advantage |
$42.71
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$61.50
|
| Rate for Payer: Cofinity Commercial |
$57.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.71
|
| Rate for Payer: Healthscope Commercial |
$68.34
|
| Rate for Payer: Healthscope Commercial |
$79.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,554.00
|
| Rate for Payer: Nomi Health Commercial |
$51.25
|
| Rate for Payer: PACE SWMI |
$42.71
|
| Rate for Payer: PHP Medicare Advantage |
$42.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.57
|
| Rate for Payer: Priority Health Medicare |
$42.71
|
| Rate for Payer: Priority Health Narrow Network |
$60.57
|
| Rate for Payer: Priority Health SBD |
$60.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.71
|
| Rate for Payer: UHC Exchange |
$56.43
|
| Rate for Payer: UHC Medicare Advantage |
$42.71
|
|
|
PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 99345
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$29,657.00 |
| Rate for Payer: Aetna Commercial |
$254.33
|
| Rate for Payer: Aetna Medicare |
$197.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.31
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: BCBS MAPPO |
$189.80
|
| Rate for Payer: BCBS Trust/PPO |
$321.73
|
| Rate for Payer: BCN Commercial |
$292.23
|
| Rate for Payer: BCN Medicare Advantage |
$189.80
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$273.31
|
| Rate for Payer: Cofinity Commercial |
$254.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.80
|
| Rate for Payer: Healthscope Commercial |
$303.68
|
| Rate for Payer: Healthscope Commercial |
$351.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,657.00
|
| Rate for Payer: Nomi Health Commercial |
$227.76
|
| Rate for Payer: PACE SWMI |
$189.80
|
| Rate for Payer: PHP Medicare Advantage |
$189.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.68
|
| Rate for Payer: Priority Health Medicare |
$189.80
|
| Rate for Payer: Priority Health Narrow Network |
$269.68
|
| Rate for Payer: Priority Health SBD |
$269.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$254.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.80
|
| Rate for Payer: UHC Exchange |
$254.14
|
| Rate for Payer: UHC Medicare Advantage |
$189.80
|
|
|
PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 99342
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$11,465.00 |
| Rate for Payer: Aetna Commercial |
$99.56
|
| Rate for Payer: Aetna Medicare |
$77.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.56
|
| Rate for Payer: BCBS Complete |
$64.80
|
| Rate for Payer: BCBS MAPPO |
$74.30
|
| Rate for Payer: BCBS Trust/PPO |
$133.13
|
| Rate for Payer: BCN Commercial |
$112.40
|
| Rate for Payer: BCN Medicare Advantage |
$74.30
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$99.56
|
| Rate for Payer: Cofinity Commercial |
$106.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.30
|
| Rate for Payer: Healthscope Commercial |
$118.88
|
| Rate for Payer: Healthscope Commercial |
$137.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,465.00
|
| Rate for Payer: Nomi Health Commercial |
$89.16
|
| Rate for Payer: PACE SWMI |
$74.30
|
| Rate for Payer: PHP Medicare Advantage |
$74.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.55
|
| Rate for Payer: Priority Health Medicare |
$74.30
|
| Rate for Payer: Priority Health Narrow Network |
$104.55
|
| Rate for Payer: Priority Health SBD |
$104.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.30
|
| Rate for Payer: UHC Exchange |
$107.52
|
| Rate for Payer: UHC Medicare Advantage |
$74.30
|
|
|
PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 99344
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$21,131.00 |
| Rate for Payer: Aetna Commercial |
$179.92
|
| Rate for Payer: Aetna Medicare |
$139.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.35
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: BCBS MAPPO |
$134.27
|
| Rate for Payer: BCBS Trust/PPO |
$178.57
|
| Rate for Payer: BCN Commercial |
$207.69
|
| Rate for Payer: BCN Medicare Advantage |
$134.27
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$193.35
|
| Rate for Payer: Cofinity Commercial |
$179.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.27
|
| Rate for Payer: Healthscope Commercial |
$214.83
|
| Rate for Payer: Healthscope Commercial |
$248.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,131.00
|
| Rate for Payer: Nomi Health Commercial |
$161.12
|
| Rate for Payer: PACE SWMI |
$134.27
|
| Rate for Payer: PHP Medicare Advantage |
$134.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.81
|
| Rate for Payer: Priority Health Medicare |
$134.27
|
| Rate for Payer: Priority Health Narrow Network |
$189.81
|
| Rate for Payer: Priority Health SBD |
$189.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.27
|
| Rate for Payer: UHC Exchange |
$207.93
|
| Rate for Payer: UHC Medicare Advantage |
$134.27
|
|
|
PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 99341
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$7,154.00 |
| Rate for Payer: Aetna Commercial |
$62.36
|
| Rate for Payer: Aetna Medicare |
$48.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.02
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$46.54
|
| Rate for Payer: BCBS Trust/PPO |
$431.62
|
| Rate for Payer: BCN Commercial |
$70.37
|
| Rate for Payer: BCN Medicare Advantage |
$46.54
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$67.02
|
| Rate for Payer: Cofinity Commercial |
$62.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.54
|
| Rate for Payer: Healthscope Commercial |
$74.46
|
| Rate for Payer: Healthscope Commercial |
$86.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,154.00
|
| Rate for Payer: Nomi Health Commercial |
$55.85
|
| Rate for Payer: PACE SWMI |
$46.54
|
| Rate for Payer: PHP Medicare Advantage |
$46.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.96
|
| Rate for Payer: Priority Health Medicare |
$46.54
|
| Rate for Payer: Priority Health Narrow Network |
$65.96
|
| Rate for Payer: Priority Health SBD |
$65.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.54
|
| Rate for Payer: UHC Exchange |
$71.53
|
| Rate for Payer: UHC Medicare Advantage |
$46.54
|
|
|
PR HOME SLEEP TEST/TYPE 3 PORTA
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS G0399
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$14,031.00 |
| Rate for Payer: Aetna Commercial |
$187.42
|
| Rate for Payer: Aetna Medicare |
$177.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.42
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.51
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,031.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.05
|
| Rate for Payer: Priority Health Narrow Network |
$137.05
|
| Rate for Payer: Priority Health SBD |
$58.80
|
|
|
PR HOME SLEEP TEST/TYPE 4 PORTA
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS G0400
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$14,912.00 |
| Rate for Payer: Aetna Commercial |
$162.24
|
| Rate for Payer: Aetna Commercial |
$162.24
|
| Rate for Payer: Aetna Commercial |
$162.24
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna Medicare |
$177.50
|
| Rate for Payer: Aetna Medicare |
$73.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.24
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.05
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,912.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,912.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,912.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.65
|
| Rate for Payer: Priority Health Narrow Network |
$145.65
|
| Rate for Payer: Priority Health Narrow Network |
$145.65
|
| Rate for Payer: Priority Health Narrow Network |
$145.65
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: Priority Health SBD |
$64.23
|
| Rate for Payer: Priority Health SBD |
$64.23
|
|
|
PR HOME VENTILATOR MGMT CARE OVERSIGHT 30 MIN/>
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 94005
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$13,127.00 |
| Rate for Payer: Aetna Commercial |
$100.62
|
| Rate for Payer: Aetna Medicare |
$95.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.62
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,127.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.13
|
| Rate for Payer: Priority Health Narrow Network |
$122.13
|
| Rate for Payer: Priority Health SBD |
$122.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.83
|
| Rate for Payer: UHC Exchange |
$92.83
|
|
|
PR HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 99343
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Aetna Medicare |
$119.50
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
|
|
PR HOPD MNTL HLT, 15-29 MIN
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS C7900
|
| 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
|
|
