|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
HCPCS 41006
|
| Min. Negotiated Rate |
$222.01 |
| Max. Negotiated Rate |
$410.72 |
| Rate for Payer: Aetna Commercial |
$297.49
|
| Rate for Payer: Aetna Medicare |
$230.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.49
|
| Rate for Payer: BCBS Complete |
$240.40
|
| Rate for Payer: BCBS MAPPO |
$222.01
|
| Rate for Payer: BCN Medicare Advantage |
$222.01
|
| Rate for Payer: Cash Price |
$480.80
|
| Rate for Payer: Cash Price |
$480.80
|
| Rate for Payer: Cofinity Commercial |
$319.69
|
| Rate for Payer: Cofinity Commercial |
$297.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$222.01
|
| Rate for Payer: Healthscope Commercial |
$355.22
|
| Rate for Payer: Healthscope Commercial |
$410.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.65
|
| Rate for Payer: Nomi Health Commercial |
$266.41
|
| Rate for Payer: PACE SWMI |
$222.01
|
| Rate for Payer: PHP Medicare Advantage |
$222.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.65
|
| Rate for Payer: Priority Health Medicare |
$222.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.01
|
| Rate for Payer: UHC Medicare Advantage |
$222.01
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 41005
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$148.12
|
| Rate for Payer: Aetna Medicare |
$114.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.12
|
| Rate for Payer: BCBS Complete |
$156.80
|
| Rate for Payer: BCBS MAPPO |
$110.54
|
| Rate for Payer: BCN Medicare Advantage |
$110.54
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$159.18
|
| Rate for Payer: Cofinity Commercial |
$148.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.54
|
| Rate for Payer: Healthscope Commercial |
$204.50
|
| Rate for Payer: Healthscope Commercial |
$176.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$254.80
|
| Rate for Payer: Nomi Health Commercial |
$132.65
|
| Rate for Payer: PACE SWMI |
$110.54
|
| Rate for Payer: PHP Medicare Advantage |
$110.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health Medicare |
$110.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.54
|
| Rate for Payer: UHC Medicare Advantage |
$110.54
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
HCPCS 41008
|
| Min. Negotiated Rate |
$249.48 |
| Max. Negotiated Rate |
$461.54 |
| Rate for Payer: Aetna Commercial |
$334.30
|
| Rate for Payer: Aetna Medicare |
$259.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.30
|
| Rate for Payer: BCBS Complete |
$282.80
|
| Rate for Payer: BCBS MAPPO |
$249.48
|
| Rate for Payer: BCN Medicare Advantage |
$249.48
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cofinity Commercial |
$359.25
|
| Rate for Payer: Cofinity Commercial |
$334.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$249.48
|
| Rate for Payer: Healthscope Commercial |
$399.17
|
| Rate for Payer: Healthscope Commercial |
$461.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$459.55
|
| Rate for Payer: Nomi Health Commercial |
$299.38
|
| Rate for Payer: PACE SWMI |
$249.48
|
| Rate for Payer: PHP Medicare Advantage |
$249.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.55
|
| Rate for Payer: Priority Health Medicare |
$249.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.48
|
| Rate for Payer: UHC Medicare Advantage |
$249.48
|
|
|
PR INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 94610
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$97.22 |
| Rate for Payer: Aetna Commercial |
$70.42
|
| Rate for Payer: Aetna Medicare |
$54.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.42
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$52.55
|
| Rate for Payer: BCN Medicare Advantage |
$52.55
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$75.67
|
| Rate for Payer: Cofinity Commercial |
$70.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.55
|
| Rate for Payer: Healthscope Commercial |
$84.08
|
| Rate for Payer: Healthscope Commercial |
$97.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.80
|
| Rate for Payer: Nomi Health Commercial |
$63.06
|
| Rate for Payer: PACE SWMI |
$52.55
|
| Rate for Payer: PHP Medicare Advantage |
$52.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$52.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.55
|
| Rate for Payer: UHC Medicare Advantage |
$52.55
|
|
|
PR INTRAUT COPPER CONTRACEPTIVE
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
HCPCS J7300
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$879.45 |
| Rate for Payer: Aetna Medicare |
$676.50
|
| Rate for Payer: BCBS Complete |
$541.20
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$879.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$879.45
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL
|
Professional
|
Both
|
$424.00
|
|
|
Service Code
|
HCPCS 37253
|
| Min. Negotiated Rate |
$67.81 |
| Max. Negotiated Rate |
$275.60 |
| Rate for Payer: Aetna Commercial |
$90.87
|
| Rate for Payer: Aetna Medicare |
$70.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.65
|
| Rate for Payer: BCBS Complete |
$169.60
|
| Rate for Payer: BCBS MAPPO |
$67.81
|
| Rate for Payer: BCN Medicare Advantage |
$67.81
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cash Price |
$339.20
|
| Rate for Payer: Cofinity Commercial |
$90.87
|
| Rate for Payer: Cofinity Commercial |
$97.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.81
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Healthscope Commercial |
$125.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.60
|
| Rate for Payer: Nomi Health Commercial |
$81.37
|
| Rate for Payer: PACE SWMI |
$67.81
|
| Rate for Payer: PHP Medicare Advantage |
$67.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.60
|
| Rate for Payer: Priority Health Medicare |
$67.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.81
|
| Rate for Payer: UHC Medicare Advantage |
$67.81
|
|
|
PR INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS 37252
|
| Min. Negotiated Rate |
$77.20 |
| Max. Negotiated Rate |
$157.51 |
| Rate for Payer: Aetna Commercial |
$114.09
|
| Rate for Payer: Aetna Medicare |
$88.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.09
|
| Rate for Payer: BCBS Complete |
$77.20
|
| Rate for Payer: BCBS MAPPO |
$85.14
|
| Rate for Payer: BCN Medicare Advantage |
$85.14
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Cofinity Commercial |
$122.60
|
| Rate for Payer: Cofinity Commercial |
$114.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.14
|
| Rate for Payer: Healthscope Commercial |
$136.22
|
| Rate for Payer: Healthscope Commercial |
$157.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125.45
|
| Rate for Payer: Nomi Health Commercial |
$102.17
|
| Rate for Payer: PACE SWMI |
$85.14
|
| Rate for Payer: PHP Medicare Advantage |
$85.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.45
|
| Rate for Payer: Priority Health Medicare |
$85.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.14
|
| Rate for Payer: UHC Medicare Advantage |
$85.14
|
|
|
PR INTRAVASC US DURING DX EVAL/ INTERVENTION,EA ADDN VESSEL
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 37251
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
|
|
PR INTRA-VNTR MAPG TACHYCARDIA SITES W/CATH MNPJ
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 93609
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$379.60 |
| Rate for Payer: Aetna Medicare |
$292.00
|
| Rate for Payer: BCBS Complete |
$233.60
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.60
|
|
|
PR INTRO ANY HEMOSTATIC AGENT/PACK VAG HEMRRG SPX
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 57180
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$212.05 |
| Rate for Payer: Aetna Commercial |
$153.59
|
| Rate for Payer: Aetna Medicare |
$119.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.59
|
| Rate for Payer: BCBS Complete |
$88.40
|
| Rate for Payer: BCBS MAPPO |
$114.62
|
| Rate for Payer: BCN Medicare Advantage |
$114.62
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cofinity Commercial |
$165.05
|
| Rate for Payer: Cofinity Commercial |
$153.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.62
|
| Rate for Payer: Healthscope Commercial |
$212.05
|
| Rate for Payer: Healthscope Commercial |
$183.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.65
|
| Rate for Payer: Nomi Health Commercial |
$137.54
|
| Rate for Payer: PACE SWMI |
$114.62
|
| Rate for Payer: PHP Medicare Advantage |
$114.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health Medicare |
$114.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.62
|
| Rate for Payer: UHC Medicare Advantage |
$114.62
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 36901
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$295.35 |
| Rate for Payer: Aetna Commercial |
$213.93
|
| Rate for Payer: Aetna Medicare |
$166.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.93
|
| Rate for Payer: BCBS Complete |
$151.20
|
| Rate for Payer: BCBS MAPPO |
$159.65
|
| Rate for Payer: BCN Medicare Advantage |
$159.65
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$229.90
|
| Rate for Payer: Cofinity Commercial |
$213.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.65
|
| Rate for Payer: Healthscope Commercial |
$255.44
|
| Rate for Payer: Healthscope Commercial |
$295.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.70
|
| Rate for Payer: Nomi Health Commercial |
$191.58
|
| Rate for Payer: PACE SWMI |
$159.65
|
| Rate for Payer: PHP Medicare Advantage |
$159.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.70
|
| Rate for Payer: Priority Health Medicare |
$159.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.65
|
| Rate for Payer: UHC Medicare Advantage |
$159.65
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT
|
Professional
|
Both
|
$771.00
|
|
|
Service Code
|
HCPCS 36903
|
| Min. Negotiated Rate |
$298.73 |
| Max. Negotiated Rate |
$552.65 |
| Rate for Payer: Aetna Commercial |
$400.30
|
| Rate for Payer: Aetna Medicare |
$310.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.30
|
| Rate for Payer: BCBS Complete |
$308.40
|
| Rate for Payer: BCBS MAPPO |
$298.73
|
| Rate for Payer: BCN Medicare Advantage |
$298.73
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cofinity Commercial |
$430.17
|
| Rate for Payer: Cofinity Commercial |
$400.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.73
|
| Rate for Payer: Healthscope Commercial |
$552.65
|
| Rate for Payer: Healthscope Commercial |
$477.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$501.15
|
| Rate for Payer: Nomi Health Commercial |
$358.48
|
| Rate for Payer: PACE SWMI |
$298.73
|
| Rate for Payer: PHP Medicare Advantage |
$298.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.15
|
| Rate for Payer: Priority Health Medicare |
$298.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.73
|
| Rate for Payer: UHC Medicare Advantage |
$298.73
|
|
|
PR INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 36902
|
| Min. Negotiated Rate |
$225.20 |
| Max. Negotiated Rate |
$419.01 |
| Rate for Payer: Aetna Commercial |
$303.50
|
| Rate for Payer: Aetna Medicare |
$235.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.50
|
| Rate for Payer: BCBS Complete |
$225.20
|
| Rate for Payer: BCBS MAPPO |
$226.49
|
| Rate for Payer: BCN Medicare Advantage |
$226.49
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$326.15
|
| Rate for Payer: Cofinity Commercial |
$303.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.49
|
| Rate for Payer: Healthscope Commercial |
$362.38
|
| Rate for Payer: Healthscope Commercial |
$419.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$237.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.95
|
| Rate for Payer: Nomi Health Commercial |
$271.79
|
| Rate for Payer: PACE SWMI |
$226.49
|
| Rate for Payer: PHP Medicare Advantage |
$226.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.95
|
| Rate for Payer: Priority Health Medicare |
$226.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.49
|
| Rate for Payer: UHC Medicare Advantage |
$226.49
|
|
|
PR INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 36013
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$485.55 |
| Rate for Payer: Aetna Commercial |
$159.79
|
| Rate for Payer: Aetna Medicare |
$124.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.79
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: BCBS MAPPO |
$119.25
|
| Rate for Payer: BCN Medicare Advantage |
$119.25
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cofinity Commercial |
$171.72
|
| Rate for Payer: Cofinity Commercial |
$159.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.25
|
| Rate for Payer: Healthscope Commercial |
$220.61
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$485.55
|
| Rate for Payer: Nomi Health Commercial |
$143.10
|
| Rate for Payer: PACE SWMI |
$119.25
|
| Rate for Payer: PHP Medicare Advantage |
$119.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$485.55
|
| Rate for Payer: Priority Health Medicare |
$119.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.25
|
| Rate for Payer: UHC Medicare Advantage |
$119.25
|
|
|
PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA
|
Professional
|
Both
|
$974.00
|
|
|
Service Code
|
HCPCS 36010
|
| Min. Negotiated Rate |
$102.70 |
| Max. Negotiated Rate |
$633.10 |
| Rate for Payer: Aetna Commercial |
$137.62
|
| Rate for Payer: Aetna Medicare |
$106.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.62
|
| Rate for Payer: BCBS Complete |
$389.60
|
| Rate for Payer: BCBS MAPPO |
$102.70
|
| Rate for Payer: BCN Medicare Advantage |
$102.70
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cofinity Commercial |
$147.89
|
| Rate for Payer: Cofinity Commercial |
$137.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.70
|
| Rate for Payer: Healthscope Commercial |
$164.32
|
| Rate for Payer: Healthscope Commercial |
$190.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.10
|
| Rate for Payer: Nomi Health Commercial |
$123.24
|
| Rate for Payer: PACE SWMI |
$102.70
|
| Rate for Payer: PHP Medicare Advantage |
$102.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$633.10
|
| Rate for Payer: Priority Health Medicare |
$102.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.70
|
| Rate for Payer: UHC Medicare Advantage |
$102.70
|
|
|
PR INTRODUCTION CATHETER AORTA
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 36200
|
| Min. Negotiated Rate |
$134.13 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$179.73
|
| Rate for Payer: Aetna Medicare |
$139.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.73
|
| Rate for Payer: BCBS Complete |
$230.40
|
| Rate for Payer: BCBS MAPPO |
$134.13
|
| Rate for Payer: BCN Medicare Advantage |
$134.13
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cofinity Commercial |
$193.15
|
| Rate for Payer: Cofinity Commercial |
$179.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.13
|
| Rate for Payer: Healthscope Commercial |
$248.14
|
| Rate for Payer: Healthscope Commercial |
$214.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.40
|
| Rate for Payer: Nomi Health Commercial |
$160.96
|
| Rate for Payer: PACE SWMI |
$134.13
|
| Rate for Payer: PHP Medicare Advantage |
$134.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.40
|
| Rate for Payer: Priority Health Medicare |
$134.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.13
|
| Rate for Payer: UHC Medicare Advantage |
$134.13
|
|
|
PR INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 44500
|
| Min. Negotiated Rate |
$18.26 |
| Max. Negotiated Rate |
$90.35 |
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Medicare |
$18.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.47
|
| Rate for Payer: BCBS Complete |
$55.60
|
| Rate for Payer: BCBS MAPPO |
$18.26
|
| Rate for Payer: BCN Medicare Advantage |
$18.26
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$24.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$29.22
|
| Rate for Payer: Healthscope Commercial |
$33.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.35
|
| Rate for Payer: Nomi Health Commercial |
$21.91
|
| Rate for Payer: PACE SWMI |
$18.26
|
| Rate for Payer: PHP Medicare Advantage |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.35
|
| Rate for Payer: Priority Health Medicare |
$18.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.26
|
| Rate for Payer: UHC Medicare Advantage |
$18.26
|
|
|
PR INTRODUCTION NEEDLE/INTRACATHETER VEIN
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 36000
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
|
|
PR INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 36100
|
| Min. Negotiated Rate |
$146.56 |
| Max. Negotiated Rate |
$477.75 |
| Rate for Payer: Aetna Commercial |
$196.39
|
| Rate for Payer: Aetna Medicare |
$152.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.05
|
| Rate for Payer: BCBS Complete |
$294.00
|
| Rate for Payer: BCBS MAPPO |
$146.56
|
| Rate for Payer: BCN Medicare Advantage |
$146.56
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cofinity Commercial |
$211.05
|
| Rate for Payer: Cofinity Commercial |
$196.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.56
|
| Rate for Payer: Healthscope Commercial |
$271.14
|
| Rate for Payer: Healthscope Commercial |
$234.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$477.75
|
| Rate for Payer: Nomi Health Commercial |
$175.87
|
| Rate for Payer: PACE SWMI |
$146.56
|
| Rate for Payer: PHP Medicare Advantage |
$146.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.75
|
| Rate for Payer: Priority Health Medicare |
$146.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.56
|
| Rate for Payer: UHC Medicare Advantage |
$146.56
|
|
|
PR INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY
|
Professional
|
Both
|
$942.00
|
|
|
Service Code
|
HCPCS 36140
|
| Min. Negotiated Rate |
$84.73 |
| Max. Negotiated Rate |
$612.30 |
| Rate for Payer: Aetna Commercial |
$113.54
|
| Rate for Payer: Aetna Medicare |
$88.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.01
|
| Rate for Payer: BCBS Complete |
$376.80
|
| Rate for Payer: BCBS MAPPO |
$84.73
|
| Rate for Payer: BCN Medicare Advantage |
$84.73
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cofinity Commercial |
$113.54
|
| Rate for Payer: Cofinity Commercial |
$122.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.73
|
| Rate for Payer: Healthscope Commercial |
$135.57
|
| Rate for Payer: Healthscope Commercial |
$156.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$612.30
|
| Rate for Payer: Nomi Health Commercial |
$101.68
|
| Rate for Payer: PACE SWMI |
$84.73
|
| Rate for Payer: PHP Medicare Advantage |
$84.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.30
|
| Rate for Payer: Priority Health Medicare |
$84.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.73
|
| Rate for Payer: UHC Medicare Advantage |
$84.73
|
|
|
PR INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ
|
Professional
|
Both
|
$2,967.00
|
|
|
Service Code
|
HCPCS 44615
|
| Min. Negotiated Rate |
$1,037.74 |
| Max. Negotiated Rate |
$1,928.55 |
| Rate for Payer: Aetna Commercial |
$1,390.57
|
| Rate for Payer: Aetna Medicare |
$1,079.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,494.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,390.57
|
| Rate for Payer: BCBS Complete |
$1,186.80
|
| Rate for Payer: BCBS MAPPO |
$1,037.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,037.74
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cofinity Commercial |
$1,494.35
|
| Rate for Payer: Cofinity Commercial |
$1,390.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,037.74
|
| Rate for Payer: Healthscope Commercial |
$1,919.82
|
| Rate for Payer: Healthscope Commercial |
$1,660.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,089.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,928.55
|
| Rate for Payer: Nomi Health Commercial |
$1,245.29
|
| Rate for Payer: PACE SWMI |
$1,037.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,037.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,928.55
|
| Rate for Payer: Priority Health Medicare |
$1,037.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,037.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,037.74
|
|
|
PR INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 31500
|
| Min. Negotiated Rate |
$137.27 |
| Max. Negotiated Rate |
$253.95 |
| Rate for Payer: Aetna Commercial |
$183.94
|
| Rate for Payer: Aetna Medicare |
$142.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.94
|
| Rate for Payer: BCBS Complete |
$145.60
|
| Rate for Payer: BCBS MAPPO |
$137.27
|
| Rate for Payer: BCN Medicare Advantage |
$137.27
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$197.67
|
| Rate for Payer: Cofinity Commercial |
$183.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.27
|
| Rate for Payer: Healthscope Commercial |
$219.63
|
| Rate for Payer: Healthscope Commercial |
$253.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.60
|
| Rate for Payer: Nomi Health Commercial |
$164.72
|
| Rate for Payer: PACE SWMI |
$137.27
|
| Rate for Payer: PHP Medicare Advantage |
$137.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.60
|
| Rate for Payer: Priority Health Medicare |
$137.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.27
|
| Rate for Payer: UHC Medicare Advantage |
$137.27
|
|
|
PR IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 95940
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$56.17 |
| Rate for Payer: Aetna Commercial |
$40.68
|
| Rate for Payer: Aetna Medicare |
$31.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.68
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$30.36
|
| Rate for Payer: BCN Medicare Advantage |
$30.36
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$43.72
|
| Rate for Payer: Cofinity Commercial |
$40.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.36
|
| Rate for Payer: Healthscope Commercial |
$48.58
|
| Rate for Payer: Healthscope Commercial |
$56.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.40
|
| Rate for Payer: Nomi Health Commercial |
$36.43
|
| Rate for Payer: PACE SWMI |
$30.36
|
| Rate for Payer: PHP Medicare Advantage |
$30.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Medicare |
$30.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.36
|
| Rate for Payer: UHC Medicare Advantage |
$30.36
|
|
|
PR IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 95941
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT HIGH MDM 80 MINUTES
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 99255
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$226.20 |
| Rate for Payer: Aetna Medicare |
$174.00
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
|
