|
PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 93291
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$7,085.00 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Medicare |
$45.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.88
|
| Rate for Payer: BCBS Complete |
$11.63
|
| Rate for Payer: BCBS MAPPO |
$43.67
|
| Rate for Payer: BCBS Trust/PPO |
$313.28
|
| Rate for Payer: BCN Commercial |
$72.82
|
| Rate for Payer: BCN Medicare Advantage |
$43.67
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$62.88
|
| Rate for Payer: Cofinity Commercial |
$58.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.67
|
| Rate for Payer: Healthscope Commercial |
$69.87
|
| Rate for Payer: Healthscope Commercial |
$80.79
|
| Rate for Payer: Mclaren Medicaid |
$11.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.85
|
| Rate for Payer: Meridian Medicaid |
$11.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,085.00
|
| Rate for Payer: Nomi Health Commercial |
$52.40
|
| Rate for Payer: PACE SWMI |
$43.67
|
| Rate for Payer: PHP Medicare Advantage |
$43.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.74
|
| Rate for Payer: Priority Health Medicare |
$43.67
|
| Rate for Payer: Priority Health Narrow Network |
$68.74
|
| Rate for Payer: Priority Health SBD |
$24.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.67
|
| Rate for Payer: UHC Medicare Advantage |
$43.67
|
| Rate for Payer: UHCCP Medicaid |
$11.08
|
|
|
PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 93289
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$10,476.00 |
| Rate for Payer: Aetna Commercial |
$87.06
|
| Rate for Payer: Aetna Medicare |
$67.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.56
|
| Rate for Payer: BCBS Complete |
$23.71
|
| Rate for Payer: BCBS MAPPO |
$64.97
|
| Rate for Payer: BCBS Trust/PPO |
$120.45
|
| Rate for Payer: BCN Commercial |
$106.53
|
| Rate for Payer: BCN Medicare Advantage |
$64.97
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$93.56
|
| Rate for Payer: Cofinity Commercial |
$87.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.97
|
| Rate for Payer: Healthscope Commercial |
$103.95
|
| Rate for Payer: Healthscope Commercial |
$120.19
|
| Rate for Payer: Mclaren Medicaid |
$22.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.22
|
| Rate for Payer: Meridian Medicaid |
$23.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,476.00
|
| Rate for Payer: Nomi Health Commercial |
$77.96
|
| Rate for Payer: PACE SWMI |
$64.97
|
| Rate for Payer: PHP Medicare Advantage |
$64.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.23
|
| Rate for Payer: Priority Health Medicare |
$64.97
|
| Rate for Payer: Priority Health Narrow Network |
$101.23
|
| Rate for Payer: Priority Health SBD |
$49.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.97
|
| Rate for Payer: UHC Medicare Advantage |
$64.97
|
| Rate for Payer: UHCCP Medicaid |
$22.58
|
|
|
PR INTERTHORACOSCAPULAR AMPUTATION
|
Professional
|
Both
|
$5,989.00
|
|
|
Service Code
|
HCPCS 23900
|
| Min. Negotiated Rate |
$354.88 |
| Max. Negotiated Rate |
$245,675.00 |
| Rate for Payer: Aetna Commercial |
$1,787.43
|
| Rate for Payer: Aetna Medicare |
$1,387.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,787.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,920.82
|
| Rate for Payer: BCBS Complete |
$939.78
|
| Rate for Payer: BCBS MAPPO |
$1,333.90
|
| Rate for Payer: BCBS Trust/PPO |
$354.88
|
| Rate for Payer: BCN Commercial |
$2,024.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,333.90
|
| Rate for Payer: Cash Price |
$4,791.20
|
| Rate for Payer: Cash Price |
$4,791.20
|
| Rate for Payer: Cofinity Commercial |
$1,920.82
|
| Rate for Payer: Cofinity Commercial |
$1,787.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,333.90
|
| Rate for Payer: Healthscope Commercial |
$2,467.72
|
| Rate for Payer: Healthscope Commercial |
$2,134.24
|
| Rate for Payer: Mclaren Medicaid |
$895.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,400.60
|
| Rate for Payer: Meridian Medicaid |
$939.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245,675.00
|
| Rate for Payer: Nomi Health Commercial |
$1,600.68
|
| Rate for Payer: PACE SWMI |
$1,333.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,333.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$895.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,892.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,121.45
|
| Rate for Payer: Priority Health Medicare |
$1,333.90
|
| Rate for Payer: Priority Health Narrow Network |
$2,121.45
|
| Rate for Payer: Priority Health SBD |
$2,121.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,614.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,333.90
|
| Rate for Payer: UHC Exchange |
$1,614.20
|
| Rate for Payer: UHC Medicare Advantage |
$1,333.90
|
| Rate for Payer: UHCCP Medicaid |
$895.03
|
|
|
PR INTESTINAL PLICATION SEPARATE PROCEDURE
|
Professional
|
Both
|
$2,967.00
|
|
|
Service Code
|
HCPCS 44680
|
| Min. Negotiated Rate |
$305.89 |
| Max. Negotiated Rate |
$193,108.00 |
| Rate for Payer: Aetna Commercial |
$1,405.00
|
| Rate for Payer: Aetna Medicare |
$1,090.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,405.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,509.85
|
| Rate for Payer: BCBS Complete |
$727.08
|
| Rate for Payer: BCBS MAPPO |
$1,048.51
|
| Rate for Payer: BCBS Trust/PPO |
$305.89
|
| Rate for Payer: BCN Commercial |
$1,572.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.51
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cofinity Commercial |
$1,509.85
|
| Rate for Payer: Cofinity Commercial |
$1,405.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.51
|
| Rate for Payer: Healthscope Commercial |
$1,939.74
|
| Rate for Payer: Healthscope Commercial |
$1,677.62
|
| Rate for Payer: Mclaren Medicaid |
$692.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,100.94
|
| Rate for Payer: Meridian Medicaid |
$727.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193,108.00
|
| Rate for Payer: Nomi Health Commercial |
$1,258.21
|
| Rate for Payer: PACE SWMI |
$1,048.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$692.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,928.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,927.60
|
| Rate for Payer: Priority Health Medicare |
$1,048.51
|
| Rate for Payer: Priority Health Narrow Network |
$1,927.60
|
| Rate for Payer: Priority Health SBD |
$1,927.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,135.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,048.51
|
| Rate for Payer: UHC Exchange |
$1,135.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,048.51
|
| Rate for Payer: UHCCP Medicaid |
$692.46
|
|
|
PR INT HRHC BY LIGATION 2+ HROID W/O IMG GDN
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 46946
|
| Min. Negotiated Rate |
$246.44 |
| Max. Negotiated Rate |
$66,683.00 |
| Rate for Payer: Aetna Commercial |
$482.28
|
| Rate for Payer: Aetna Medicare |
$374.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.27
|
| Rate for Payer: BCBS Complete |
$258.76
|
| Rate for Payer: BCBS MAPPO |
$359.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,392.60
|
| Rate for Payer: BCN Commercial |
$558.56
|
| Rate for Payer: BCN Medicare Advantage |
$359.91
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$518.27
|
| Rate for Payer: Cofinity Commercial |
$482.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.91
|
| Rate for Payer: Healthscope Commercial |
$665.83
|
| Rate for Payer: Healthscope Commercial |
$575.86
|
| Rate for Payer: Mclaren Medicaid |
$246.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.91
|
| Rate for Payer: Meridian Medicaid |
$258.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66,683.00
|
| Rate for Payer: Nomi Health Commercial |
$431.89
|
| Rate for Payer: PACE SWMI |
$359.91
|
| Rate for Payer: PHP Medicare Advantage |
$359.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$684.89
|
| Rate for Payer: Priority Health Medicare |
$359.91
|
| Rate for Payer: Priority Health Narrow Network |
$684.89
|
| Rate for Payer: Priority Health SBD |
$684.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$359.91
|
| Rate for Payer: UHC Exchange |
$313.06
|
| Rate for Payer: UHC Medicare Advantage |
$359.91
|
| Rate for Payer: UHCCP Medicaid |
$246.44
|
|
|
PR INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 46945
|
| Min. Negotiated Rate |
$221.52 |
| Max. Negotiated Rate |
$59,222.00 |
| Rate for Payer: Aetna Commercial |
$432.06
|
| Rate for Payer: Aetna Medicare |
$335.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.30
|
| Rate for Payer: BCBS Complete |
$232.60
|
| Rate for Payer: BCBS MAPPO |
$322.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,245.20
|
| Rate for Payer: BCN Commercial |
$497.96
|
| Rate for Payer: BCN Medicare Advantage |
$322.43
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$464.30
|
| Rate for Payer: Cofinity Commercial |
$432.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.43
|
| Rate for Payer: Healthscope Commercial |
$596.50
|
| Rate for Payer: Healthscope Commercial |
$515.89
|
| Rate for Payer: Mclaren Medicaid |
$221.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.55
|
| Rate for Payer: Meridian Medicaid |
$232.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59,222.00
|
| Rate for Payer: Nomi Health Commercial |
$386.92
|
| Rate for Payer: PACE SWMI |
$322.43
|
| Rate for Payer: PHP Medicare Advantage |
$322.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.31
|
| Rate for Payer: Priority Health Medicare |
$322.43
|
| Rate for Payer: Priority Health Narrow Network |
$613.31
|
| Rate for Payer: Priority Health SBD |
$613.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.43
|
| Rate for Payer: UHC Exchange |
$238.46
|
| Rate for Payer: UHC Medicare Advantage |
$322.43
|
| Rate for Payer: UHCCP Medicaid |
$221.52
|
|
|
PR INTRACARD ECHOCARD W/THER/DX IVNTJ INCL IMG S&I
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 93662
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$14,055.00 |
| Rate for Payer: Aetna Commercial |
$195.64
|
| Rate for Payer: Aetna Commercial |
$195.64
|
| Rate for Payer: Aetna Medicare |
$146.50
|
| Rate for Payer: Aetna Medicare |
$279.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.64
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$68.15
|
| Rate for Payer: BCBS Trust/PPO |
$68.15
|
| Rate for Payer: BCN Commercial |
$211.11
|
| Rate for Payer: BCN Commercial |
$211.11
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Cash Price |
$447.20
|
| Rate for Payer: Mclaren Medicaid |
$43.88
|
| Rate for Payer: Mclaren Medicaid |
$43.88
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,055.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,055.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$363.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.53
|
| Rate for Payer: Priority Health Narrow Network |
$128.53
|
| Rate for Payer: Priority Health Narrow Network |
$128.53
|
| Rate for Payer: Priority Health SBD |
$96.52
|
| Rate for Payer: Priority Health SBD |
$96.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$374.48
|
| Rate for Payer: UHC Exchange |
$374.48
|
| Rate for Payer: UHC Exchange |
$374.48
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
|
|
PR INTRACARDIAC ELECTROPHYSIOLOGIC 3D MAPPING
|
Professional
|
Both
|
$1,201.00
|
|
|
Service Code
|
HCPCS 93613
|
| Min. Negotiated Rate |
$181.26 |
| Max. Negotiated Rate |
$43,155.00 |
| Rate for Payer: Aetna Commercial |
$369.49
|
| Rate for Payer: Aetna Medicare |
$286.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.07
|
| Rate for Payer: BCBS Complete |
$190.32
|
| Rate for Payer: BCBS MAPPO |
$275.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,339.77
|
| Rate for Payer: BCN Commercial |
$420.26
|
| Rate for Payer: BCN Medicare Advantage |
$275.74
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Cofinity Commercial |
$397.07
|
| Rate for Payer: Cofinity Commercial |
$369.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.74
|
| Rate for Payer: Healthscope Commercial |
$510.12
|
| Rate for Payer: Healthscope Commercial |
$441.18
|
| Rate for Payer: Mclaren Medicaid |
$181.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$289.53
|
| Rate for Payer: Meridian Medicaid |
$190.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43,155.00
|
| Rate for Payer: Nomi Health Commercial |
$330.89
|
| Rate for Payer: PACE SWMI |
$275.74
|
| Rate for Payer: PHP Medicare Advantage |
$275.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$401.15
|
| Rate for Payer: Priority Health Medicare |
$275.74
|
| Rate for Payer: Priority Health Narrow Network |
$401.15
|
| Rate for Payer: Priority Health SBD |
$288.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.74
|
| Rate for Payer: UHC Exchange |
$415.74
|
| Rate for Payer: UHC Medicare Advantage |
$275.74
|
| Rate for Payer: UHCCP Medicaid |
$181.26
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ DURAL CMPL
|
Professional
|
Both
|
$9,212.00
|
|
|
Service Code
|
HCPCS 61692
|
| Min. Negotiated Rate |
$784.00 |
| Max. Negotiated Rate |
$661,471.00 |
| Rate for Payer: Aetna Commercial |
$4,845.68
|
| Rate for Payer: Aetna Medicare |
$3,760.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,845.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,207.30
|
| Rate for Payer: BCBS Complete |
$2,480.95
|
| Rate for Payer: BCBS MAPPO |
$3,616.18
|
| Rate for Payer: BCBS Trust/PPO |
$784.00
|
| Rate for Payer: BCN Commercial |
$5,360.79
|
| Rate for Payer: BCN Medicare Advantage |
$3,616.18
|
| Rate for Payer: Cash Price |
$7,369.60
|
| Rate for Payer: Cash Price |
$7,369.60
|
| Rate for Payer: Cofinity Commercial |
$5,207.30
|
| Rate for Payer: Cofinity Commercial |
$4,845.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,616.18
|
| Rate for Payer: Healthscope Commercial |
$6,689.93
|
| Rate for Payer: Healthscope Commercial |
$5,785.89
|
| Rate for Payer: Mclaren Medicaid |
$2,362.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,796.99
|
| Rate for Payer: Meridian Medicaid |
$2,480.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$661,471.00
|
| Rate for Payer: Nomi Health Commercial |
$4,339.42
|
| Rate for Payer: PACE SWMI |
$3,616.18
|
| Rate for Payer: PHP Medicare Advantage |
$3,616.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,362.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,987.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,284.31
|
| Rate for Payer: Priority Health Medicare |
$3,616.18
|
| Rate for Payer: Priority Health Narrow Network |
$6,284.31
|
| Rate for Payer: Priority Health SBD |
$6,284.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,007.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,616.18
|
| Rate for Payer: UHC Exchange |
$4,007.97
|
| Rate for Payer: UHC Medicare Advantage |
$3,616.18
|
| Rate for Payer: UHCCP Medicaid |
$2,362.81
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ DURAL SMPL
|
Professional
|
Both
|
$7,820.00
|
|
|
Service Code
|
HCPCS 61690
|
| Min. Negotiated Rate |
$331.77 |
| Max. Negotiated Rate |
$395,348.00 |
| Rate for Payer: Aetna Commercial |
$2,902.84
|
| Rate for Payer: Aetna Medicare |
$2,252.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,902.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,119.47
|
| Rate for Payer: BCBS Complete |
$1,492.64
|
| Rate for Payer: BCBS MAPPO |
$2,166.30
|
| Rate for Payer: BCBS Trust/PPO |
$331.77
|
| Rate for Payer: BCN Commercial |
$3,215.01
|
| Rate for Payer: BCN Medicare Advantage |
$2,166.30
|
| Rate for Payer: Cash Price |
$6,256.00
|
| Rate for Payer: Cash Price |
$6,256.00
|
| Rate for Payer: Cofinity Commercial |
$3,119.47
|
| Rate for Payer: Cofinity Commercial |
$2,902.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,166.30
|
| Rate for Payer: Healthscope Commercial |
$4,007.66
|
| Rate for Payer: Healthscope Commercial |
$3,466.08
|
| Rate for Payer: Mclaren Medicaid |
$1,421.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,274.62
|
| Rate for Payer: Meridian Medicaid |
$1,492.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395,348.00
|
| Rate for Payer: Nomi Health Commercial |
$2,599.56
|
| Rate for Payer: PACE SWMI |
$2,166.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,166.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,421.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,083.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,777.98
|
| Rate for Payer: Priority Health Medicare |
$2,166.30
|
| Rate for Payer: Priority Health Narrow Network |
$3,777.98
|
| Rate for Payer: Priority Health SBD |
$3,777.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,507.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,166.30
|
| Rate for Payer: UHC Exchange |
$2,507.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,166.30
|
| Rate for Payer: UHCCP Medicaid |
$1,421.56
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL CMPL
|
Professional
|
Both
|
$12,123.00
|
|
|
Service Code
|
HCPCS 61686
|
| Min. Negotiated Rate |
$191.24 |
| Max. Negotiated Rate |
$813,886.00 |
| Rate for Payer: Aetna Commercial |
$5,961.74
|
| Rate for Payer: Aetna Medicare |
$4,627.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,961.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,406.65
|
| Rate for Payer: BCBS Complete |
$3,050.59
|
| Rate for Payer: BCBS MAPPO |
$4,449.06
|
| Rate for Payer: BCBS Trust/PPO |
$191.24
|
| Rate for Payer: BCN Commercial |
$9,146.67
|
| Rate for Payer: BCN Medicare Advantage |
$4,449.06
|
| Rate for Payer: Cash Price |
$9,698.40
|
| Rate for Payer: Cash Price |
$9,698.40
|
| Rate for Payer: Cofinity Commercial |
$6,406.65
|
| Rate for Payer: Cofinity Commercial |
$5,961.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,449.06
|
| Rate for Payer: Healthscope Commercial |
$8,230.76
|
| Rate for Payer: Healthscope Commercial |
$7,118.50
|
| Rate for Payer: Mclaren Medicaid |
$2,905.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,671.51
|
| Rate for Payer: Meridian Medicaid |
$3,050.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$813,886.00
|
| Rate for Payer: Nomi Health Commercial |
$5,338.87
|
| Rate for Payer: PACE SWMI |
$4,449.06
|
| Rate for Payer: PHP Medicare Advantage |
$4,449.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,905.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,879.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,727.71
|
| Rate for Payer: Priority Health Medicare |
$4,449.06
|
| Rate for Payer: Priority Health Narrow Network |
$7,727.71
|
| Rate for Payer: Priority Health SBD |
$7,727.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,026.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,449.06
|
| Rate for Payer: UHC Exchange |
$5,026.51
|
| Rate for Payer: UHC Medicare Advantage |
$4,449.06
|
| Rate for Payer: UHCCP Medicaid |
$2,905.32
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ INFRATENTRL SMPL
|
Professional
|
Both
|
$5,987.00
|
|
|
Service Code
|
HCPCS 61684
|
| Min. Negotiated Rate |
$195.47 |
| Max. Negotiated Rate |
$515,405.00 |
| Rate for Payer: Aetna Commercial |
$3,777.47
|
| Rate for Payer: Aetna Medicare |
$2,931.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,777.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,059.37
|
| Rate for Payer: BCBS Complete |
$1,938.37
|
| Rate for Payer: BCBS MAPPO |
$2,819.01
|
| Rate for Payer: BCBS Trust/PPO |
$195.47
|
| Rate for Payer: BCN Commercial |
$5,805.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,819.01
|
| Rate for Payer: Cash Price |
$4,789.60
|
| Rate for Payer: Cash Price |
$4,789.60
|
| Rate for Payer: Cofinity Commercial |
$4,059.37
|
| Rate for Payer: Cofinity Commercial |
$3,777.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,819.01
|
| Rate for Payer: Healthscope Commercial |
$5,215.17
|
| Rate for Payer: Healthscope Commercial |
$4,510.42
|
| Rate for Payer: Mclaren Medicaid |
$1,846.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,959.96
|
| Rate for Payer: Meridian Medicaid |
$1,938.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$515,405.00
|
| Rate for Payer: Nomi Health Commercial |
$3,382.81
|
| Rate for Payer: PACE SWMI |
$2,819.01
|
| Rate for Payer: PHP Medicare Advantage |
$2,819.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,891.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,908.58
|
| Rate for Payer: Priority Health Medicare |
$2,819.01
|
| Rate for Payer: Priority Health Narrow Network |
$4,908.58
|
| Rate for Payer: Priority Health SBD |
$4,908.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,457.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,819.01
|
| Rate for Payer: UHC Exchange |
$3,457.59
|
| Rate for Payer: UHC Medicare Advantage |
$2,819.01
|
| Rate for Payer: UHCCP Medicaid |
$1,846.07
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL CMPL
|
Professional
|
Both
|
$8,916.00
|
|
|
Service Code
|
HCPCS 61682
|
| Min. Negotiated Rate |
$275.77 |
| Max. Negotiated Rate |
$753,332.00 |
| Rate for Payer: Aetna Commercial |
$5,499.37
|
| Rate for Payer: Aetna Medicare |
$4,268.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,499.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5,909.77
|
| Rate for Payer: BCBS Complete |
$2,811.73
|
| Rate for Payer: BCBS MAPPO |
$4,104.01
|
| Rate for Payer: BCBS Trust/PPO |
$275.77
|
| Rate for Payer: BCN Commercial |
$8,459.92
|
| Rate for Payer: BCN Medicare Advantage |
$4,104.01
|
| Rate for Payer: Cash Price |
$7,132.80
|
| Rate for Payer: Cash Price |
$7,132.80
|
| Rate for Payer: Cofinity Commercial |
$5,909.77
|
| Rate for Payer: Cofinity Commercial |
$5,499.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,104.01
|
| Rate for Payer: Healthscope Commercial |
$7,592.42
|
| Rate for Payer: Healthscope Commercial |
$6,566.42
|
| Rate for Payer: Mclaren Medicaid |
$2,677.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4,309.21
|
| Rate for Payer: Meridian Medicaid |
$2,811.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$753,332.00
|
| Rate for Payer: Nomi Health Commercial |
$4,924.81
|
| Rate for Payer: PACE SWMI |
$4,104.01
|
| Rate for Payer: PHP Medicare Advantage |
$4,104.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,677.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,795.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,176.62
|
| Rate for Payer: Priority Health Medicare |
$4,104.01
|
| Rate for Payer: Priority Health Narrow Network |
$7,176.62
|
| Rate for Payer: Priority Health SBD |
$7,176.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,789.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,104.01
|
| Rate for Payer: UHC Exchange |
$4,789.70
|
| Rate for Payer: UHC Medicare Advantage |
$4,104.01
|
| Rate for Payer: UHCCP Medicaid |
$2,677.84
|
|
|
PR INTRACRANIAL ARVEN MALFRMJ SUPRATENTRL SMPL
|
Professional
|
Both
|
$4,754.00
|
|
|
Service Code
|
HCPCS 61680
|
| Min. Negotiated Rate |
$373.51 |
| Max. Negotiated Rate |
$404,836.00 |
| Rate for Payer: Aetna Commercial |
$2,996.27
|
| Rate for Payer: Aetna Medicare |
$2,325.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,996.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,219.87
|
| Rate for Payer: BCBS Complete |
$1,541.62
|
| Rate for Payer: BCBS MAPPO |
$2,236.02
|
| Rate for Payer: BCBS Trust/PPO |
$373.51
|
| Rate for Payer: BCN Commercial |
$4,568.58
|
| Rate for Payer: BCN Medicare Advantage |
$2,236.02
|
| Rate for Payer: Cash Price |
$3,803.20
|
| Rate for Payer: Cash Price |
$3,803.20
|
| Rate for Payer: Cofinity Commercial |
$3,219.87
|
| Rate for Payer: Cofinity Commercial |
$2,996.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,236.02
|
| Rate for Payer: Healthscope Commercial |
$4,136.64
|
| Rate for Payer: Healthscope Commercial |
$3,577.63
|
| Rate for Payer: Mclaren Medicaid |
$1,468.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,347.82
|
| Rate for Payer: Meridian Medicaid |
$1,541.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$404,836.00
|
| Rate for Payer: Nomi Health Commercial |
$2,683.22
|
| Rate for Payer: PACE SWMI |
$2,236.02
|
| Rate for Payer: PHP Medicare Advantage |
$2,236.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,468.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,090.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,928.68
|
| Rate for Payer: Priority Health Medicare |
$2,236.02
|
| Rate for Payer: Priority Health Narrow Network |
$3,928.68
|
| Rate for Payer: Priority Health SBD |
$3,928.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,745.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,236.02
|
| Rate for Payer: UHC Exchange |
$2,745.11
|
| Rate for Payer: UHC Medicare Advantage |
$2,236.02
|
| Rate for Payer: UHCCP Medicaid |
$1,468.21
|
|
|
PR INTRAFRACTION TRACK MOTION
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS G6017
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$11,438.00 |
| Rate for Payer: Aetna Commercial |
$94.22
|
| Rate for Payer: Aetna Medicare |
$88.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.22
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,256.83
|
| Rate for Payer: BCN Commercial |
$104.62
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,438.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.52
|
| Rate for Payer: Priority Health Narrow Network |
$136.52
|
| Rate for Payer: Priority Health SBD |
$136.52
|
|
|
PR INTRAOPERATIVE COLONIC LAVAGE
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 44701
|
| Min. Negotiated Rate |
$107.99 |
| Max. Negotiated Rate |
$30,362.00 |
| Rate for Payer: Aetna Commercial |
$221.25
|
| Rate for Payer: Aetna Medicare |
$171.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.76
|
| Rate for Payer: BCBS Complete |
$113.39
|
| Rate for Payer: BCBS MAPPO |
$165.11
|
| Rate for Payer: BCBS Trust/PPO |
$226.64
|
| Rate for Payer: BCN Commercial |
$245.32
|
| Rate for Payer: BCN Medicare Advantage |
$165.11
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$221.25
|
| Rate for Payer: Cofinity Commercial |
$237.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.11
|
| Rate for Payer: Healthscope Commercial |
$305.45
|
| Rate for Payer: Healthscope Commercial |
$264.18
|
| Rate for Payer: Mclaren Medicaid |
$107.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.37
|
| Rate for Payer: Meridian Medicaid |
$113.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30,362.00
|
| Rate for Payer: Nomi Health Commercial |
$198.13
|
| Rate for Payer: PACE SWMI |
$165.11
|
| Rate for Payer: PHP Medicare Advantage |
$165.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.09
|
| Rate for Payer: Priority Health Medicare |
$165.11
|
| Rate for Payer: Priority Health Narrow Network |
$300.09
|
| Rate for Payer: Priority Health SBD |
$300.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.11
|
| Rate for Payer: UHC Exchange |
$177.76
|
| Rate for Payer: UHC Medicare Advantage |
$165.11
|
| Rate for Payer: UHCCP Medicaid |
$107.99
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$192.15 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 38900
|
| Min. Negotiated Rate |
$87.54 |
| Max. Negotiated Rate |
$24,502.00 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Aetna Medicare |
$138.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.97
|
| Rate for Payer: BCBS Complete |
$91.92
|
| Rate for Payer: BCBS MAPPO |
$133.31
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: BCN Medicare Advantage |
$133.31
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$191.97
|
| Rate for Payer: Cofinity Commercial |
$178.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.31
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Healthscope Commercial |
$246.62
|
| Rate for Payer: Mclaren Medicaid |
$87.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.98
|
| Rate for Payer: Meridian Medicaid |
$91.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,502.00
|
| Rate for Payer: Nomi Health Commercial |
$159.97
|
| Rate for Payer: PACE SWMI |
$133.31
|
| Rate for Payer: PHP Medicare Advantage |
$133.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.30
|
| Rate for Payer: Priority Health Medicare |
$133.31
|
| Rate for Payer: Priority Health Narrow Network |
$272.30
|
| Rate for Payer: Priority Health SBD |
$272.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.31
|
| Rate for Payer: UHC Medicare Advantage |
$133.31
|
| Rate for Payer: UHCCP Medicaid |
$87.54
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$878.00 |
| Rate for Payer: Aetna Commercial |
$259.25
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.25
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS Trust/PPO |
$290.78
|
| Rate for Payer: BCN Commercial |
$290.78
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$213.50
|
| Rate for Payer: Cofinity Commercial |
$262.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$213.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.00
|
| Rate for Payer: Healthscope Commercial |
$274.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$259.25
|
| Rate for Payer: PHP Commercial |
$259.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health SBD |
$192.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.78
|
| Rate for Payer: UHC Core |
$878.00
|
|
|
PR INTRAOP SENTINEL LYMPH NODE ID W/DYE INJECTION
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 38900
|
| Hospital Charge Code |
38900
|
| Min. Negotiated Rate |
$87.54 |
| Max. Negotiated Rate |
$24,502.00 |
| Rate for Payer: Aetna Commercial |
$178.64
|
| Rate for Payer: Aetna Medicare |
$138.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.97
|
| Rate for Payer: BCBS Complete |
$91.92
|
| Rate for Payer: BCBS MAPPO |
$133.31
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: BCN Commercial |
$198.40
|
| Rate for Payer: BCN Medicare Advantage |
$133.31
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$191.97
|
| Rate for Payer: Cofinity Commercial |
$178.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.31
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Healthscope Commercial |
$246.62
|
| Rate for Payer: Mclaren Medicaid |
$87.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.98
|
| Rate for Payer: Meridian Medicaid |
$91.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,502.00
|
| Rate for Payer: Nomi Health Commercial |
$159.97
|
| Rate for Payer: PACE SWMI |
$133.31
|
| Rate for Payer: PHP Medicare Advantage |
$133.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$272.30
|
| Rate for Payer: Priority Health Medicare |
$133.31
|
| Rate for Payer: Priority Health Narrow Network |
$272.30
|
| Rate for Payer: Priority Health SBD |
$272.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.31
|
| Rate for Payer: UHC Medicare Advantage |
$133.31
|
| Rate for Payer: UHCCP Medicaid |
$87.54
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR MASTICATOR SPACE
|
Professional
|
Both
|
$683.00
|
|
|
Service Code
|
HCPCS 41009
|
| Min. Negotiated Rate |
$185.95 |
| Max. Negotiated Rate |
$49,660.00 |
| Rate for Payer: Aetna Commercial |
$364.02
|
| Rate for Payer: Aetna Medicare |
$282.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$391.19
|
| Rate for Payer: BCBS Complete |
$195.25
|
| Rate for Payer: BCBS MAPPO |
$271.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.60
|
| Rate for Payer: BCN Commercial |
$621.60
|
| Rate for Payer: BCN Medicare Advantage |
$271.66
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cash Price |
$546.40
|
| Rate for Payer: Cofinity Commercial |
$391.19
|
| Rate for Payer: Cofinity Commercial |
$364.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.66
|
| Rate for Payer: Healthscope Commercial |
$502.57
|
| Rate for Payer: Healthscope Commercial |
$434.66
|
| Rate for Payer: Mclaren Medicaid |
$185.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$285.24
|
| Rate for Payer: Meridian Medicaid |
$195.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49,660.00
|
| Rate for Payer: Nomi Health Commercial |
$325.99
|
| Rate for Payer: PACE SWMI |
$271.66
|
| Rate for Payer: PHP Medicare Advantage |
$271.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$185.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.07
|
| Rate for Payer: Priority Health Medicare |
$271.66
|
| Rate for Payer: Priority Health Narrow Network |
$513.07
|
| Rate for Payer: Priority Health SBD |
$513.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.66
|
| Rate for Payer: UHC Exchange |
$345.91
|
| Rate for Payer: UHC Medicare Advantage |
$271.66
|
| Rate for Payer: UHCCP Medicaid |
$185.95
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL DP SPRMLHYD
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
HCPCS 41006
|
| Min. Negotiated Rate |
$151.44 |
| Max. Negotiated Rate |
$40,442.00 |
| Rate for Payer: Aetna Commercial |
$297.49
|
| Rate for Payer: Aetna Medicare |
$230.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.69
|
| Rate for Payer: BCBS Complete |
$159.01
|
| Rate for Payer: BCBS MAPPO |
$222.01
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$499.43
|
| 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 |
$410.72
|
| Rate for Payer: Healthscope Commercial |
$355.22
|
| Rate for Payer: Mclaren Medicaid |
$151.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$233.11
|
| Rate for Payer: Meridian Medicaid |
$159.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40,442.00
|
| 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 Choice Medicaid |
$151.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$390.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.64
|
| Rate for Payer: Priority Health Medicare |
$222.01
|
| Rate for Payer: Priority Health Narrow Network |
$414.64
|
| Rate for Payer: Priority Health SBD |
$414.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$222.01
|
| Rate for Payer: UHC Exchange |
$313.45
|
| Rate for Payer: UHC Medicare Advantage |
$222.01
|
| Rate for Payer: UHCCP Medicaid |
$151.44
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBLNGL SUPFC
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 41005
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$20,831.00 |
| Rate for Payer: Aetna Commercial |
$148.12
|
| Rate for Payer: Aetna Medicare |
$114.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.18
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS MAPPO |
$110.54
|
| Rate for Payer: BCBS Trust/PPO |
$795.62
|
| Rate for Payer: BCN Commercial |
$353.31
|
| 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: Mclaren Medicaid |
$76.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.07
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20,831.00
|
| 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 Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.81
|
| Rate for Payer: Priority Health Medicare |
$110.54
|
| Rate for Payer: Priority Health Narrow Network |
$208.81
|
| Rate for Payer: Priority Health SBD |
$208.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.54
|
| Rate for Payer: UHC Exchange |
$159.89
|
| Rate for Payer: UHC Medicare Advantage |
$110.54
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
|
|
PR INTRAORAL I&D TONGUE/FLOOR SUBMNDBLR SPACE
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
HCPCS 41008
|
| Min. Negotiated Rate |
$170.19 |
| Max. Negotiated Rate |
$44,901.00 |
| Rate for Payer: Aetna Commercial |
$334.30
|
| Rate for Payer: Aetna Medicare |
$259.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$334.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.25
|
| Rate for Payer: BCBS Complete |
$178.70
|
| Rate for Payer: BCBS MAPPO |
$249.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.71
|
| Rate for Payer: BCN Commercial |
$575.17
|
| 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 |
$461.54
|
| Rate for Payer: Healthscope Commercial |
$399.17
|
| Rate for Payer: Mclaren Medicaid |
$170.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.95
|
| Rate for Payer: Meridian Medicaid |
$178.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44,901.00
|
| 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 Choice Medicaid |
$170.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$463.55
|
| Rate for Payer: Priority Health Medicare |
$249.48
|
| Rate for Payer: Priority Health Narrow Network |
$463.55
|
| Rate for Payer: Priority Health SBD |
$463.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$249.48
|
| Rate for Payer: UHC Exchange |
$323.75
|
| Rate for Payer: UHC Medicare Advantage |
$249.48
|
| Rate for Payer: UHCCP Medicaid |
$170.19
|
|
|
PR INTRAPULMONARY SURFACTANT ADMINISTJ PHYS/QHP
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 94610
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$8,279.00 |
| Rate for Payer: Aetna Commercial |
$70.42
|
| Rate for Payer: Aetna Medicare |
$54.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.67
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS MAPPO |
$52.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,160.68
|
| Rate for Payer: BCN Commercial |
$81.12
|
| 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 |
$97.22
|
| Rate for Payer: Healthscope Commercial |
$84.08
|
| Rate for Payer: Mclaren Medicaid |
$35.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.18
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,279.00
|
| 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 Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.54
|
| Rate for Payer: Priority Health Medicare |
$52.55
|
| Rate for Payer: Priority Health Narrow Network |
$75.54
|
| Rate for Payer: Priority Health SBD |
$75.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.55
|
| Rate for Payer: UHC Exchange |
$78.30
|
| Rate for Payer: UHC Medicare Advantage |
$52.55
|
| Rate for Payer: UHCCP Medicaid |
$35.15
|
|
