|
PR INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX
|
Professional
|
Both
|
$2,629.00
|
|
|
Service Code
|
HCPCS 38760
|
| Min. Negotiated Rate |
$539.10 |
| Max. Negotiated Rate |
$149,162.00 |
| Rate for Payer: Aetna Commercial |
$1,084.42
|
| Rate for Payer: Aetna Medicare |
$841.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.35
|
| Rate for Payer: BCBS Complete |
$566.06
|
| Rate for Payer: BCBS MAPPO |
$809.27
|
| Rate for Payer: BCBS Trust/PPO |
$689.96
|
| Rate for Payer: BCN Commercial |
$1,221.69
|
| 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 |
$1,497.15
|
| Rate for Payer: Healthscope Commercial |
$1,294.83
|
| Rate for Payer: Mclaren Medicaid |
$539.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$849.73
|
| Rate for Payer: Meridian Medicaid |
$566.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149,162.00
|
| 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 Choice Medicaid |
$539.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,675.70
|
| Rate for Payer: Priority Health Medicare |
$809.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,675.70
|
| Rate for Payer: Priority Health SBD |
$1,675.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$841.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$809.27
|
| Rate for Payer: UHC Exchange |
$841.50
|
| Rate for Payer: UHC Medicare Advantage |
$809.27
|
| Rate for Payer: UHCCP Medicaid |
$539.10
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC
|
Professional
|
Both
|
$2,707.00
|
|
|
Service Code
|
HCPCS 38765
|
| Min. Negotiated Rate |
$524.60 |
| Max. Negotiated Rate |
$233,654.00 |
| Rate for Payer: Aetna Commercial |
$1,698.80
|
| Rate for Payer: Aetna Medicare |
$1,318.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,698.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,825.57
|
| Rate for Payer: BCBS Complete |
$884.54
|
| Rate for Payer: BCBS MAPPO |
$1,267.76
|
| Rate for Payer: BCBS Trust/PPO |
$524.60
|
| Rate for Payer: BCN Commercial |
$1,909.76
|
| 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: Mclaren Medicaid |
$842.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,331.15
|
| Rate for Payer: Meridian Medicaid |
$884.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233,654.00
|
| 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 Choice Medicaid |
$842.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,759.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,613.06
|
| Rate for Payer: Priority Health Medicare |
$1,267.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,613.06
|
| Rate for Payer: Priority Health SBD |
$2,613.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,457.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,267.76
|
| Rate for Payer: UHC Exchange |
$1,457.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,267.76
|
| Rate for Payer: UHCCP Medicaid |
$842.42
|
|
|
PR INHLJ BRNCL CHALLENGE TSTG W/HISTAMINE/METHACHOL
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 95070
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$4,787.00 |
| Rate for Payer: Aetna Commercial |
$42.20
|
| Rate for Payer: Aetna Medicare |
$32.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.35
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS MAPPO |
$31.49
|
| Rate for Payer: BCBS Trust/PPO |
$302.19
|
| Rate for Payer: BCN Commercial |
$50.33
|
| 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 |
$4,787.00
|
| 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 HMO/PPO/Tiered Network |
$48.08
|
| Rate for Payer: Priority Health Medicare |
$31.49
|
| Rate for Payer: Priority Health Narrow Network |
$48.08
|
| Rate for Payer: Priority Health SBD |
$48.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.49
|
| Rate for Payer: UHC Exchange |
$91.43
|
| 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 |
$5,850.00 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Aetna Medicare |
$38.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.78
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS MAPPO |
$37.35
|
| Rate for Payer: BCBS Trust/PPO |
$90.34
|
| Rate for Payer: BCN Commercial |
$92.36
|
| 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 |
$59.76
|
| Rate for Payer: Healthscope Commercial |
$69.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,850.00
|
| 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 HMO/PPO/Tiered Network |
$44.13
|
| Rate for Payer: Priority Health Medicare |
$37.35
|
| Rate for Payer: Priority Health Narrow Network |
$44.13
|
| Rate for Payer: Priority Health SBD |
$44.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.35
|
| Rate for Payer: UHC Exchange |
$69.86
|
| 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 |
$177.51 |
| Max. Negotiated Rate |
$49,905.00 |
| Rate for Payer: Aetna Commercial |
$427.84
|
| Rate for Payer: Aetna Medicare |
$332.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.76
|
| Rate for Payer: BCBS Complete |
$335.24
|
| Rate for Payer: BCBS MAPPO |
$319.28
|
| Rate for Payer: BCBS Trust/PPO |
$177.51
|
| Rate for Payer: BCN Commercial |
$489.17
|
| 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: Mclaren Medicaid |
$319.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.24
|
| Rate for Payer: Meridian Medicaid |
$335.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49,905.00
|
| 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 Choice Medicaid |
$319.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.05
|
| Rate for Payer: Priority Health Medicare |
$319.28
|
| Rate for Payer: Priority Health Narrow Network |
$450.05
|
| Rate for Payer: Priority Health SBD |
$450.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.28
|
| Rate for Payer: UHC Medicare Advantage |
$319.28
|
| Rate for Payer: UHCCP Medicaid |
$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 |
$113.98 |
| Max. Negotiated Rate |
$26,681.00 |
| 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 |
$121.22
|
| Rate for Payer: BCBS MAPPO |
$171.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,045.58
|
| Rate for Payer: BCN Commercial |
$262.91
|
| 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: Mclaren Medicaid |
$115.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.24
|
| Rate for Payer: Meridian Medicaid |
$121.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,681.00
|
| 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 Choice Medicaid |
$115.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.20
|
| Rate for Payer: Priority Health Medicare |
$171.66
|
| Rate for Payer: Priority Health Narrow Network |
$243.20
|
| Rate for Payer: Priority Health SBD |
$243.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.66
|
| Rate for Payer: UHC Exchange |
$113.98
|
| Rate for Payer: UHC Medicare Advantage |
$171.66
|
| Rate for Payer: UHCCP Medicaid |
$115.45
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 99305
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$19,527.00 |
| 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 |
$88.79
|
| Rate for Payer: BCBS MAPPO |
$125.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.96
|
| Rate for Payer: BCN Commercial |
$192.54
|
| 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 |
$180.78
|
| Rate for Payer: Cofinity Commercial |
$168.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.54
|
| Rate for Payer: Healthscope Commercial |
$232.25
|
| Rate for Payer: Healthscope Commercial |
$200.86
|
| Rate for Payer: Mclaren Medicaid |
$84.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.82
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,527.00
|
| 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 Choice Medicaid |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.13
|
| Rate for Payer: Priority Health Medicare |
$125.54
|
| Rate for Payer: Priority Health Narrow Network |
$178.13
|
| Rate for Payer: Priority Health SBD |
$178.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.54
|
| Rate for Payer: UHC Exchange |
$92.25
|
| Rate for Payer: UHC Medicare Advantage |
$125.54
|
| Rate for Payer: UHCCP Medicaid |
$84.56
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 99304
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$11,792.00 |
| Rate for Payer: Aetna Commercial |
$101.92
|
| Rate for Payer: Aetna Medicare |
$79.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.53
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS MAPPO |
$76.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.22
|
| Rate for Payer: BCN Commercial |
$116.31
|
| 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 |
$140.71
|
| Rate for Payer: Healthscope Commercial |
$121.70
|
| Rate for Payer: Mclaren Medicaid |
$51.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.86
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,792.00
|
| 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 Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.25
|
| Rate for Payer: Priority Health Medicare |
$76.06
|
| Rate for Payer: Priority Health Narrow Network |
$107.25
|
| Rate for Payer: Priority Health SBD |
$107.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.06
|
| Rate for Payer: UHC Exchange |
$69.39
|
| Rate for Payer: UHC Medicare Advantage |
$76.06
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
|
|
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 |
$288.45 |
| Max. Negotiated Rate |
$113,930.00 |
| 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 |
$764.47
|
| Rate for Payer: BCBS MAPPO |
$728.07
|
| Rate for Payer: BCBS Trust/PPO |
$288.45
|
| Rate for Payer: BCN Commercial |
$1,116.63
|
| 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: Mclaren Medicaid |
$728.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$764.47
|
| Rate for Payer: Meridian Medicaid |
$764.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113,930.00
|
| 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 Choice Medicaid |
$728.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,029.36
|
| Rate for Payer: Priority Health Medicare |
$728.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.36
|
| Rate for Payer: Priority Health SBD |
$1,029.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.07
|
| Rate for Payer: UHC Medicare Advantage |
$728.07
|
| Rate for Payer: UHCCP Medicaid |
$728.07
|
|
|
PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 99475
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$82,112.00 |
| 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 |
$555.42
|
| Rate for Payer: BCBS MAPPO |
$528.97
|
| Rate for Payer: BCBS Trust/PPO |
$94.66
|
| Rate for Payer: BCN Commercial |
$804.85
|
| 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 |
$761.72
|
| Rate for Payer: Cofinity Commercial |
$708.82
|
| 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: Mclaren Medicaid |
$528.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.42
|
| Rate for Payer: Meridian Medicaid |
$555.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82,112.00
|
| 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 Choice Medicaid |
$528.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$741.72
|
| Rate for Payer: Priority Health Medicare |
$528.97
|
| Rate for Payer: Priority Health Narrow Network |
$741.72
|
| Rate for Payer: Priority Health SBD |
$741.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.97
|
| Rate for Payer: UHC Medicare Advantage |
$528.97
|
| Rate for Payer: UHCCP Medicaid |
$528.97
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS G0402
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$19,295.00 |
| Rate for Payer: Aetna Commercial |
$165.45
|
| Rate for Payer: Aetna Medicare |
$128.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.80
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: BCBS MAPPO |
$123.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,427.47
|
| Rate for Payer: BCN Commercial |
$240.43
|
| 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 |
$228.42
|
| Rate for Payer: Healthscope Commercial |
$197.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,295.00
|
| 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 HMO/PPO/Tiered Network |
$171.05
|
| Rate for Payer: Priority Health Medicare |
$123.47
|
| Rate for Payer: Priority Health Narrow Network |
$171.05
|
| Rate for Payer: Priority Health SBD |
$171.05
|
| 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 |
$53.49 |
| Max. Negotiated Rate |
$10,857.00 |
| Rate for Payer: Aetna Commercial |
$78.23
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| Rate for Payer: BCBS Complete |
$56.16
|
| Rate for Payer: BCBS Trust/PPO |
$275.77
|
| Rate for Payer: BCN Commercial |
$157.84
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Mclaren Medicaid |
$53.49
|
| Rate for Payer: Meridian Medicaid |
$56.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,857.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.94
|
| Rate for Payer: Priority Health Narrow Network |
$162.94
|
| Rate for Payer: Priority Health SBD |
$162.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.18
|
| Rate for Payer: UHC Exchange |
$122.18
|
| Rate for Payer: UHCCP Medicaid |
$53.49
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 99386
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$16,778.00 |
| Rate for Payer: Aetna Commercial |
$121.06
|
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.06
|
| Rate for Payer: BCBS Complete |
$88.74
|
| Rate for Payer: BCBS Trust/PPO |
$72.38
|
| Rate for Payer: BCN Commercial |
$157.99
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Mclaren Medicaid |
$84.51
|
| Rate for Payer: Meridian Medicaid |
$88.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,778.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.80
|
| Rate for Payer: Priority Health Narrow Network |
$147.80
|
| Rate for Payer: Priority Health SBD |
$147.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.39
|
| Rate for Payer: UHC Exchange |
$164.39
|
| Rate for Payer: UHCCP Medicaid |
$84.51
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 99387
|
| Min. Negotiated Rate |
$75.55 |
| Max. Negotiated Rate |
$18,083.00 |
| Rate for Payer: Aetna Commercial |
$130.25
|
| Rate for Payer: Aetna Medicare |
$120.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.25
|
| Rate for Payer: BCBS Complete |
$97.04
|
| Rate for Payer: BCBS Trust/PPO |
$75.55
|
| Rate for Payer: BCN Commercial |
$171.96
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Mclaren Medicaid |
$92.42
|
| Rate for Payer: Meridian Medicaid |
$97.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,083.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.76
|
| Rate for Payer: Priority Health Narrow Network |
$158.76
|
| Rate for Payer: Priority Health SBD |
$158.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.16
|
| Rate for Payer: UHC Exchange |
$178.16
|
| Rate for Payer: UHCCP Medicaid |
$92.42
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 99384
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$14,388.00 |
| Rate for Payer: Aetna Commercial |
$103.72
|
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.72
|
| Rate for Payer: BCBS Complete |
$72.45
|
| Rate for Payer: BCBS Trust/PPO |
$445.89
|
| Rate for Payer: BCN Commercial |
$141.16
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Mclaren Medicaid |
$69.00
|
| Rate for Payer: Meridian Medicaid |
$72.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,388.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.19
|
| Rate for Payer: Priority Health Narrow Network |
$127.19
|
| Rate for Payer: Priority Health SBD |
$127.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.95
|
| Rate for Payer: UHC Exchange |
$139.95
|
| Rate for Payer: UHCCP Medicaid |
$69.00
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 99382
|
| Min. Negotiated Rate |
$61.08 |
| Max. Negotiated Rate |
$11,552.00 |
| Rate for Payer: Aetna Commercial |
$83.18
|
| Rate for Payer: Aetna Medicare |
$89.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.18
|
| Rate for Payer: BCBS Complete |
$64.13
|
| Rate for Payer: BCBS Trust/PPO |
$299.02
|
| Rate for Payer: BCN Commercial |
$164.69
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Mclaren Medicaid |
$61.08
|
| Rate for Payer: Meridian Medicaid |
$64.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,552.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.75
|
| Rate for Payer: Priority Health Narrow Network |
$170.75
|
| Rate for Payer: Priority Health SBD |
$170.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.51
|
| Rate for Payer: UHC Exchange |
$131.51
|
| Rate for Payer: UHCCP Medicaid |
$61.08
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 99385
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$13,842.00 |
| Rate for Payer: Aetna Commercial |
$99.47
|
| Rate for Payer: Aetna Medicare |
$95.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.47
|
| Rate for Payer: BCBS Complete |
$72.45
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$137.21
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Mclaren Medicaid |
$69.00
|
| Rate for Payer: Meridian Medicaid |
$72.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,842.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.93
|
| Rate for Payer: Priority Health Narrow Network |
$121.93
|
| Rate for Payer: Priority Health SBD |
$121.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.95
|
| Rate for Payer: UHC Exchange |
$139.95
|
| Rate for Payer: UHCCP Medicaid |
$69.00
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99383
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$12,245.00 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.48
|
| Rate for Payer: BCBS Complete |
$64.13
|
| Rate for Payer: BCBS Trust/PPO |
$40.68
|
| Rate for Payer: BCN Commercial |
$125.39
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Mclaren Medicaid |
$61.08
|
| Rate for Payer: Meridian Medicaid |
$64.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,245.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.90
|
| Rate for Payer: Priority Health Narrow Network |
$107.90
|
| Rate for Payer: Priority Health SBD |
$107.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.85
|
| Rate for Payer: UHC Exchange |
$128.85
|
| Rate for Payer: UHCCP Medicaid |
$61.08
|
|
|
PR INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 16000
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$8,181.00 |
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna Medicare |
$45.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.65
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS MAPPO |
$44.20
|
| Rate for Payer: BCBS Trust/PPO |
$569.29
|
| Rate for Payer: BCN Commercial |
$92.28
|
| Rate for Payer: BCN Medicare Advantage |
$44.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$59.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.20
|
| Rate for Payer: Healthscope Commercial |
$81.77
|
| Rate for Payer: Healthscope Commercial |
$70.72
|
| Rate for Payer: Mclaren Medicaid |
$29.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.41
|
| Rate for Payer: Meridian Medicaid |
$30.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,181.00
|
| Rate for Payer: Nomi Health Commercial |
$53.04
|
| Rate for Payer: PACE SWMI |
$44.20
|
| Rate for Payer: PHP Medicare Advantage |
$44.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.40
|
| Rate for Payer: Priority Health Medicare |
$44.20
|
| Rate for Payer: Priority Health Narrow Network |
$61.40
|
| Rate for Payer: Priority Health SBD |
$61.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.20
|
| Rate for Payer: UHC Exchange |
$77.41
|
| Rate for Payer: UHC Medicare Advantage |
$44.20
|
| Rate for Payer: UHCCP Medicaid |
$29.18
|
|
|
PR INIT/SUB PSYCH CARE M 1ST 30
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS G2214
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$5,568.00 |
| Rate for Payer: Aetna Commercial |
$48.44
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.06
|
| Rate for Payer: BCBS Complete |
$25.49
|
| Rate for Payer: BCBS MAPPO |
$36.15
|
| Rate for Payer: BCBS Trust/PPO |
$590.64
|
| Rate for Payer: BCN Commercial |
$81.69
|
| Rate for Payer: BCN Medicare Advantage |
$36.15
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$48.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.15
|
| Rate for Payer: Healthscope Commercial |
$57.84
|
| Rate for Payer: Healthscope Commercial |
$66.88
|
| Rate for Payer: Mclaren Medicaid |
$24.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.96
|
| Rate for Payer: Meridian Medicaid |
$25.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,568.00
|
| Rate for Payer: Nomi Health Commercial |
$43.38
|
| Rate for Payer: PACE SWMI |
$36.15
|
| Rate for Payer: PHP Medicare Advantage |
$36.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.86
|
| Rate for Payer: Priority Health Medicare |
$36.15
|
| Rate for Payer: Priority Health Narrow Network |
$76.86
|
| Rate for Payer: Priority Health SBD |
$76.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.15
|
| Rate for Payer: UHC Medicare Advantage |
$36.15
|
| Rate for Payer: UHCCP Medicaid |
$24.28
|
|
|
PR INJ DEXAMETHASONE ACETATE
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J1094
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$47.00 |
| Rate for Payer: Aetna Commercial |
$0.27
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.80
|
| Rate for Payer: UHC Exchange |
$0.80
|
|
