|
PR INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI
|
Professional
|
Both
|
$10,965.00
|
|
|
Service Code
|
HCPCS 61591
|
| Min. Negotiated Rate |
$2,958.07 |
| Max. Negotiated Rate |
$7,127.25 |
| Rate for Payer: Aetna Commercial |
$3,963.81
|
| Rate for Payer: Aetna Medicare |
$3,076.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,259.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,963.81
|
| Rate for Payer: BCBS Complete |
$4,386.00
|
| Rate for Payer: BCBS MAPPO |
$2,958.07
|
| Rate for Payer: BCN Medicare Advantage |
$2,958.07
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cofinity Commercial |
$4,259.62
|
| Rate for Payer: Cofinity Commercial |
$3,963.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,958.07
|
| Rate for Payer: Healthscope Commercial |
$4,732.91
|
| Rate for Payer: Healthscope Commercial |
$5,472.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,105.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,127.25
|
| Rate for Payer: Nomi Health Commercial |
$3,549.68
|
| Rate for Payer: PACE SWMI |
$2,958.07
|
| Rate for Payer: PHP Medicare Advantage |
$2,958.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,127.25
|
| Rate for Payer: Priority Health Medicare |
$2,958.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,958.07
|
| Rate for Payer: UHC Medicare Advantage |
$2,958.07
|
|
|
PR INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN
|
Professional
|
Both
|
$6,572.00
|
|
|
Service Code
|
HCPCS 61590
|
| Min. Negotiated Rate |
$2,628.80 |
| Max. Negotiated Rate |
$5,320.80 |
| Rate for Payer: Aetna Commercial |
$3,853.99
|
| Rate for Payer: Aetna Medicare |
$2,991.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,141.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,853.99
|
| Rate for Payer: BCBS Complete |
$2,628.80
|
| Rate for Payer: BCBS MAPPO |
$2,876.11
|
| Rate for Payer: BCN Medicare Advantage |
$2,876.11
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Cofinity Commercial |
$4,141.60
|
| Rate for Payer: Cofinity Commercial |
$3,853.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,876.11
|
| Rate for Payer: Healthscope Commercial |
$5,320.80
|
| Rate for Payer: Healthscope Commercial |
$4,601.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,019.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,271.80
|
| Rate for Payer: Nomi Health Commercial |
$3,451.33
|
| Rate for Payer: PACE SWMI |
$2,876.11
|
| Rate for Payer: PHP Medicare Advantage |
$2,876.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,271.80
|
| Rate for Payer: Priority Health Medicare |
$2,876.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,876.11
|
| Rate for Payer: UHC Medicare Advantage |
$2,876.11
|
|
|
PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 95079
|
| Min. Negotiated Rate |
$63.92 |
| Max. Negotiated Rate |
$118.25 |
| Rate for Payer: Aetna Commercial |
$85.65
|
| Rate for Payer: Aetna Medicare |
$66.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.65
|
| Rate for Payer: BCBS Complete |
$68.00
|
| Rate for Payer: BCBS MAPPO |
$63.92
|
| Rate for Payer: BCN Medicare Advantage |
$63.92
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$92.04
|
| Rate for Payer: Cofinity Commercial |
$85.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.92
|
| Rate for Payer: Healthscope Commercial |
$102.27
|
| Rate for Payer: Healthscope Commercial |
$118.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110.50
|
| Rate for Payer: Nomi Health Commercial |
$76.70
|
| Rate for Payer: PACE SWMI |
$63.92
|
| Rate for Payer: PHP Medicare Advantage |
$63.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health Medicare |
$63.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.92
|
| Rate for Payer: UHC Medicare Advantage |
$63.92
|
|
|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 95076
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$92.84
|
| Rate for Payer: Aetna Medicare |
$72.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.84
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS MAPPO |
$69.28
|
| Rate for Payer: BCN Medicare Advantage |
$69.28
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$99.76
|
| Rate for Payer: Cofinity Commercial |
$92.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.28
|
| Rate for Payer: Healthscope Commercial |
$128.17
|
| Rate for Payer: Healthscope Commercial |
$110.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.95
|
| Rate for Payer: Nomi Health Commercial |
$83.14
|
| Rate for Payer: PACE SWMI |
$69.28
|
| Rate for Payer: PHP Medicare Advantage |
$69.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Medicare |
$69.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.28
|
| Rate for Payer: UHC Medicare Advantage |
$69.28
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX
|
Professional
|
Both
|
$2,629.00
|
|
|
Service Code
|
HCPCS 38760
|
| Min. Negotiated Rate |
$809.27 |
| Max. Negotiated Rate |
$1,708.85 |
| Rate for Payer: Aetna Commercial |
$1,084.42
|
| Rate for Payer: Aetna Medicare |
$841.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.42
|
| Rate for Payer: BCBS Complete |
$1,051.60
|
| Rate for Payer: BCBS MAPPO |
$809.27
|
| Rate for Payer: BCN Medicare Advantage |
$809.27
|
| Rate for Payer: Cash Price |
$2,103.20
|
| Rate for Payer: Cash Price |
$2,103.20
|
| Rate for Payer: Cofinity Commercial |
$1,165.35
|
| Rate for Payer: Cofinity Commercial |
$1,084.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$809.27
|
| Rate for Payer: Healthscope Commercial |
$1,294.83
|
| Rate for Payer: Healthscope Commercial |
$1,497.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$849.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,708.85
|
| Rate for Payer: Nomi Health Commercial |
$971.12
|
| Rate for Payer: PACE SWMI |
$809.27
|
| Rate for Payer: PHP Medicare Advantage |
$809.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.85
|
| Rate for Payer: Priority Health Medicare |
$809.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$809.27
|
| Rate for Payer: UHC Medicare Advantage |
$809.27
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC
|
Professional
|
Both
|
$2,707.00
|
|
|
Service Code
|
HCPCS 38765
|
| Min. Negotiated Rate |
$1,082.80 |
| Max. Negotiated Rate |
$2,345.36 |
| Rate for Payer: Aetna Commercial |
$1,698.80
|
| Rate for Payer: Aetna Medicare |
$1,318.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,825.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,698.80
|
| Rate for Payer: BCBS Complete |
$1,082.80
|
| Rate for Payer: BCBS MAPPO |
$1,267.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,267.76
|
| Rate for Payer: Cash Price |
$2,165.60
|
| Rate for Payer: Cash Price |
$2,165.60
|
| Rate for Payer: Cofinity Commercial |
$1,825.57
|
| Rate for Payer: Cofinity Commercial |
$1,698.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,267.76
|
| Rate for Payer: Healthscope Commercial |
$2,345.36
|
| Rate for Payer: Healthscope Commercial |
$2,028.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,331.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,759.55
|
| Rate for Payer: Nomi Health Commercial |
$1,521.31
|
| Rate for Payer: PACE SWMI |
$1,267.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,267.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,759.55
|
| Rate for Payer: Priority Health Medicare |
$1,267.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,267.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,267.76
|
|
|
PR INHLJ BRNCL CHALLENGE TSTG W/HISTAMINE/METHACHOL
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 95070
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Aetna Commercial |
$42.20
|
| Rate for Payer: Aetna Medicare |
$32.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.20
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS MAPPO |
$31.49
|
| Rate for Payer: BCN Medicare Advantage |
$31.49
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$45.35
|
| Rate for Payer: Cofinity Commercial |
$42.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.49
|
| Rate for Payer: Healthscope Commercial |
$50.38
|
| Rate for Payer: Healthscope Commercial |
$58.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.85
|
| Rate for Payer: Nomi Health Commercial |
$37.79
|
| Rate for Payer: PACE SWMI |
$31.49
|
| Rate for Payer: PHP Medicare Advantage |
$31.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health Medicare |
$31.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.49
|
| Rate for Payer: UHC Medicare Advantage |
$31.49
|
|
|
PR INITIAL FOOT EXAM PT LOPS
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS G0245
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$69.10 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Aetna Medicare |
$38.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS MAPPO |
$37.35
|
| Rate for Payer: BCN Medicare Advantage |
$37.35
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$53.78
|
| Rate for Payer: Cofinity Commercial |
$50.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.35
|
| Rate for Payer: Healthscope Commercial |
$69.10
|
| Rate for Payer: Healthscope Commercial |
$59.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.70
|
| Rate for Payer: Nomi Health Commercial |
$44.82
|
| Rate for Payer: PACE SWMI |
$37.35
|
| Rate for Payer: PHP Medicare Advantage |
$37.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.70
|
| Rate for Payer: Priority Health Medicare |
$37.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.35
|
| Rate for Payer: UHC Medicare Advantage |
$37.35
|
|
|
PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 99477
|
| Min. Negotiated Rate |
$319.28 |
| Max. Negotiated Rate |
$692.25 |
| Rate for Payer: Aetna Commercial |
$427.84
|
| Rate for Payer: Aetna Medicare |
$332.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.84
|
| Rate for Payer: BCBS Complete |
$426.00
|
| Rate for Payer: BCBS MAPPO |
$319.28
|
| Rate for Payer: BCN Medicare Advantage |
$319.28
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cofinity Commercial |
$459.76
|
| Rate for Payer: Cofinity Commercial |
$427.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.28
|
| Rate for Payer: Healthscope Commercial |
$510.85
|
| Rate for Payer: Healthscope Commercial |
$590.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$692.25
|
| Rate for Payer: Nomi Health Commercial |
$383.14
|
| Rate for Payer: PACE SWMI |
$319.28
|
| Rate for Payer: PHP Medicare Advantage |
$319.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.25
|
| Rate for Payer: Priority Health Medicare |
$319.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.28
|
| Rate for Payer: UHC Medicare Advantage |
$319.28
|
|
|
PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 99251
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Medicare |
$67.00
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
|
|
PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 99306
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$317.57 |
| Rate for Payer: Aetna Commercial |
$230.02
|
| Rate for Payer: Aetna Medicare |
$178.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.19
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: BCBS MAPPO |
$171.66
|
| Rate for Payer: BCN Medicare Advantage |
$171.66
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$247.19
|
| Rate for Payer: Cofinity Commercial |
$230.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.66
|
| Rate for Payer: Healthscope Commercial |
$317.57
|
| Rate for Payer: Healthscope Commercial |
$274.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.15
|
| Rate for Payer: Nomi Health Commercial |
$205.99
|
| Rate for Payer: PACE SWMI |
$171.66
|
| Rate for Payer: PHP Medicare Advantage |
$171.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health Medicare |
$171.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.66
|
| Rate for Payer: UHC Medicare Advantage |
$171.66
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 99305
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$232.25 |
| Rate for Payer: Aetna Commercial |
$168.22
|
| Rate for Payer: Aetna Medicare |
$130.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.78
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS MAPPO |
$125.54
|
| Rate for Payer: BCN Medicare Advantage |
$125.54
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$168.22
|
| Rate for Payer: Cofinity Commercial |
$180.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.54
|
| Rate for Payer: Healthscope Commercial |
$200.86
|
| Rate for Payer: Healthscope Commercial |
$232.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.05
|
| Rate for Payer: Nomi Health Commercial |
$150.65
|
| Rate for Payer: PACE SWMI |
$125.54
|
| Rate for Payer: PHP Medicare Advantage |
$125.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health Medicare |
$125.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.54
|
| Rate for Payer: UHC Medicare Advantage |
$125.54
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 99304
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$140.71 |
| Rate for Payer: Aetna Commercial |
$101.92
|
| Rate for Payer: Aetna Medicare |
$79.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.92
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: BCBS MAPPO |
$76.06
|
| Rate for Payer: BCN Medicare Advantage |
$76.06
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cofinity Commercial |
$109.53
|
| Rate for Payer: Cofinity Commercial |
$101.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.06
|
| Rate for Payer: Healthscope Commercial |
$121.70
|
| Rate for Payer: Healthscope Commercial |
$140.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.70
|
| Rate for Payer: Nomi Health Commercial |
$91.27
|
| Rate for Payer: PACE SWMI |
$76.06
|
| Rate for Payer: PHP Medicare Advantage |
$76.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health Medicare |
$76.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.06
|
| Rate for Payer: UHC Medicare Advantage |
$76.06
|
|
|
PR INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 99218
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$98.15 |
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
|
|
PR INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 99219
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Medicare |
$102.50
|
| Rate for Payer: BCBS Complete |
$82.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.25
|
|
|
PR INITIAL OBSERVATION CARE/DAY 70 MINUTES
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 99220
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
|
|
PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS
|
Professional
|
Both
|
$1,467.00
|
|
|
Service Code
|
HCPCS 99471
|
| Min. Negotiated Rate |
$586.80 |
| Max. Negotiated Rate |
$1,346.93 |
| Rate for Payer: Aetna Commercial |
$975.61
|
| Rate for Payer: Aetna Medicare |
$757.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.61
|
| Rate for Payer: BCBS Complete |
$586.80
|
| Rate for Payer: BCBS MAPPO |
$728.07
|
| Rate for Payer: BCN Medicare Advantage |
$728.07
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cofinity Commercial |
$975.61
|
| Rate for Payer: Cofinity Commercial |
$1,048.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.07
|
| Rate for Payer: Healthscope Commercial |
$1,346.93
|
| Rate for Payer: Healthscope Commercial |
$1,164.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$764.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$953.55
|
| Rate for Payer: Nomi Health Commercial |
$873.68
|
| Rate for Payer: PACE SWMI |
$728.07
|
| Rate for Payer: PHP Medicare Advantage |
$728.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.55
|
| Rate for Payer: Priority Health Medicare |
$728.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.07
|
| Rate for Payer: UHC Medicare Advantage |
$728.07
|
|
|
PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 99475
|
| Min. Negotiated Rate |
$497.20 |
| Max. Negotiated Rate |
$978.59 |
| Rate for Payer: Aetna Commercial |
$708.82
|
| Rate for Payer: Aetna Medicare |
$550.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.72
|
| Rate for Payer: BCBS Complete |
$497.20
|
| Rate for Payer: BCBS MAPPO |
$528.97
|
| Rate for Payer: BCN Medicare Advantage |
$528.97
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cofinity Commercial |
$708.82
|
| Rate for Payer: Cofinity Commercial |
$761.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.97
|
| Rate for Payer: Healthscope Commercial |
$846.35
|
| Rate for Payer: Healthscope Commercial |
$978.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$807.95
|
| Rate for Payer: Nomi Health Commercial |
$634.76
|
| Rate for Payer: PACE SWMI |
$528.97
|
| Rate for Payer: PHP Medicare Advantage |
$528.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health Medicare |
$528.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.97
|
| Rate for Payer: UHC Medicare Advantage |
$528.97
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS G0402
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$228.42 |
| Rate for Payer: Aetna Commercial |
$165.45
|
| Rate for Payer: Aetna Medicare |
$128.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.45
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: BCBS MAPPO |
$123.47
|
| Rate for Payer: BCN Medicare Advantage |
$123.47
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cofinity Commercial |
$177.80
|
| Rate for Payer: Cofinity Commercial |
$165.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.47
|
| Rate for Payer: Healthscope Commercial |
$197.55
|
| Rate for Payer: Healthscope Commercial |
$228.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.95
|
| Rate for Payer: Nomi Health Commercial |
$148.16
|
| Rate for Payer: PACE SWMI |
$123.47
|
| Rate for Payer: PHP Medicare Advantage |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.95
|
| Rate for Payer: Priority Health Medicare |
$123.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.47
|
| Rate for Payer: UHC Medicare Advantage |
$123.47
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 99381
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 99386
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: BCBS Complete |
$88.40
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 99387
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Medicare |
$120.00
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 99384
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 99382
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Aetna Medicare |
$89.50
|
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 99385
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Aetna Medicare |
$95.50
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
|
