|
PR IR DEEP HEAT PAIN RELIEF 15MIN
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00099
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 96523
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$3,546.00 |
| Rate for Payer: Aetna Commercial |
$28.70
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.84
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.20
|
| Rate for Payer: BCN Commercial |
$37.14
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$30.84
|
| Rate for Payer: Cofinity Commercial |
$28.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Healthscope Commercial |
$34.27
|
| Rate for Payer: Healthscope Commercial |
$39.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,546.00
|
| Rate for Payer: Nomi Health Commercial |
$25.70
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.93
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: Priority Health Narrow Network |
$33.93
|
| Rate for Payer: Priority Health SBD |
$33.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$27.74
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
|
|
PR IRRIGATION CORPORA CAVERNOSA PRIAPISM
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 54220
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$23,580.00 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Medicare |
$134.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.80
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$129.03
|
| Rate for Payer: BCBS Trust/PPO |
$460.68
|
| Rate for Payer: BCN Commercial |
$321.55
|
| Rate for Payer: BCN Medicare Advantage |
$129.03
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cofinity Commercial |
$185.80
|
| Rate for Payer: Cofinity Commercial |
$172.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.03
|
| Rate for Payer: Healthscope Commercial |
$238.71
|
| Rate for Payer: Healthscope Commercial |
$206.45
|
| Rate for Payer: Mclaren Medicaid |
$85.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.48
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,580.00
|
| Rate for Payer: Nomi Health Commercial |
$154.84
|
| Rate for Payer: PACE SWMI |
$129.03
|
| Rate for Payer: PHP Medicare Advantage |
$129.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.11
|
| Rate for Payer: Priority Health Medicare |
$129.03
|
| Rate for Payer: Priority Health Narrow Network |
$214.11
|
| Rate for Payer: Priority Health SBD |
$214.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.03
|
| Rate for Payer: UHC Exchange |
$258.84
|
| Rate for Payer: UHC Medicare Advantage |
$129.03
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
|
|
PR IRRIGATION TRAY
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4320
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$654.00 |
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$654.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 57150
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$4,631.00 |
| Rate for Payer: Aetna Commercial |
$32.74
|
| Rate for Payer: Aetna Medicare |
$25.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$24.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,018.63
|
| Rate for Payer: BCN Commercial |
$85.52
|
| Rate for Payer: BCN Medicare Advantage |
$24.43
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$35.18
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.43
|
| Rate for Payer: Healthscope Commercial |
$39.09
|
| Rate for Payer: Healthscope Commercial |
$45.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,631.00
|
| Rate for Payer: Nomi Health Commercial |
$29.32
|
| Rate for Payer: PACE SWMI |
$24.43
|
| Rate for Payer: PHP Medicare Advantage |
$24.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.19
|
| Rate for Payer: Priority Health Medicare |
$24.43
|
| Rate for Payer: Priority Health Narrow Network |
$38.19
|
| Rate for Payer: Priority Health SBD |
$38.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.43
|
| Rate for Payer: UHC Exchange |
$68.47
|
| Rate for Payer: UHC Medicare Advantage |
$24.43
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 93571
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$28,925.00 |
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.31
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,925.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,925.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$282.98
|
| Rate for Payer: Priority Health Narrow Network |
$282.98
|
| Rate for Payer: Priority Health Narrow Network |
$282.98
|
| Rate for Payer: Priority Health SBD |
$98.87
|
| Rate for Payer: Priority Health SBD |
$98.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.07
|
| Rate for Payer: UHC Exchange |
$294.07
|
| Rate for Payer: UHC Exchange |
$294.07
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 93572
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$15,783.00 |
| Rate for Payer: Aetna Commercial |
$145.84
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.84
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$165.66
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Mclaren Medicaid |
$32.59
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15,783.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.50
|
| Rate for Payer: Priority Health Narrow Network |
$153.50
|
| Rate for Payer: Priority Health SBD |
$72.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.07
|
| Rate for Payer: UHC Exchange |
$253.07
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
|
|
PR IV INFUSION HYDRATION EACH ADDITIONAL HOUR
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 96361
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$1,809.00 |
| Rate for Payer: Aetna Commercial |
$14.67
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.77
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$10.95
|
| Rate for Payer: BCBS Trust/PPO |
$22.72
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: BCN Medicare Advantage |
$10.95
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.95
|
| Rate for Payer: Healthscope Commercial |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$17.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,809.00
|
| Rate for Payer: Nomi Health Commercial |
$13.14
|
| Rate for Payer: PACE SWMI |
$10.95
|
| Rate for Payer: PHP Medicare Advantage |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.74
|
| Rate for Payer: Priority Health Medicare |
$10.95
|
| Rate for Payer: Priority Health Narrow Network |
$16.74
|
| Rate for Payer: Priority Health SBD |
$16.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.95
|
| Rate for Payer: UHC Medicare Advantage |
$10.95
|
|
|
PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 96360
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$4,577.00 |
| Rate for Payer: Aetna Commercial |
$37.49
|
| Rate for Payer: Aetna Medicare |
$29.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.29
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS MAPPO |
$27.98
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: BCN Medicare Advantage |
$27.98
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Cofinity Commercial |
$37.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.98
|
| Rate for Payer: Healthscope Commercial |
$44.77
|
| Rate for Payer: Healthscope Commercial |
$51.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,577.00
|
| Rate for Payer: Nomi Health Commercial |
$33.58
|
| Rate for Payer: PACE SWMI |
$27.98
|
| Rate for Payer: PHP Medicare Advantage |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.88
|
| Rate for Payer: Priority Health Medicare |
$27.98
|
| Rate for Payer: Priority Health Narrow Network |
$43.88
|
| Rate for Payer: Priority Health SBD |
$43.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.98
|
| Rate for Payer: UHC Medicare Advantage |
$27.98
|
|
|
PR IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 96365
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$8,973.00 |
| Rate for Payer: Aetna Commercial |
$71.94
|
| Rate for Payer: Aetna Medicare |
$55.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.31
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$53.69
|
| Rate for Payer: BCBS Trust/PPO |
$168.00
|
| Rate for Payer: BCN Commercial |
$93.34
|
| Rate for Payer: BCN Medicare Advantage |
$53.69
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$71.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.69
|
| Rate for Payer: Healthscope Commercial |
$85.90
|
| Rate for Payer: Healthscope Commercial |
$99.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8,973.00
|
| Rate for Payer: Nomi Health Commercial |
$64.43
|
| Rate for Payer: PACE SWMI |
$53.69
|
| Rate for Payer: PHP Medicare Advantage |
$53.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.03
|
| Rate for Payer: Priority Health Medicare |
$53.69
|
| Rate for Payer: Priority Health Narrow Network |
$85.03
|
| Rate for Payer: Priority Health SBD |
$85.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.69
|
| Rate for Payer: UHC Medicare Advantage |
$53.69
|
|
|
PR IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 96366
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: Aetna Commercial |
$24.50
|
| Rate for Payer: Aetna Medicare |
$19.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$18.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.94
|
| Rate for Payer: BCN Commercial |
$29.81
|
| Rate for Payer: BCN Medicare Advantage |
$18.28
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.28
|
| Rate for Payer: Healthscope Commercial |
$29.25
|
| Rate for Payer: Healthscope Commercial |
$33.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,915.00
|
| Rate for Payer: Nomi Health Commercial |
$21.94
|
| Rate for Payer: PACE SWMI |
$18.28
|
| Rate for Payer: PHP Medicare Advantage |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.60
|
| Rate for Payer: Priority Health Medicare |
$18.28
|
| Rate for Payer: Priority Health Narrow Network |
$27.60
|
| Rate for Payer: Priority Health SBD |
$27.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.28
|
| Rate for Payer: UHC Medicare Advantage |
$18.28
|
|
|
PR IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 96367
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$4,077.00 |
| Rate for Payer: Aetna Commercial |
$33.23
|
| Rate for Payer: Aetna Medicare |
$25.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.71
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS MAPPO |
$24.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.43
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Medicare Advantage |
$24.80
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$35.71
|
| Rate for Payer: Cofinity Commercial |
$33.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.80
|
| Rate for Payer: Healthscope Commercial |
$39.68
|
| Rate for Payer: Healthscope Commercial |
$45.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,077.00
|
| Rate for Payer: Nomi Health Commercial |
$29.76
|
| Rate for Payer: PACE SWMI |
$24.80
|
| Rate for Payer: PHP Medicare Advantage |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.44
|
| Rate for Payer: Priority Health Medicare |
$24.80
|
| Rate for Payer: Priority Health Narrow Network |
$38.44
|
| Rate for Payer: Priority Health SBD |
$38.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.80
|
| Rate for Payer: UHC Medicare Advantage |
$24.80
|
|
|
PR IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 15860
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$18,981.00 |
| Rate for Payer: Aetna Commercial |
$137.81
|
| Rate for Payer: Aetna Medicare |
$106.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.09
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$102.84
|
| Rate for Payer: BCBS Trust/PPO |
$10,615.31
|
| Rate for Payer: BCN Commercial |
$154.42
|
| Rate for Payer: BCN Medicare Advantage |
$102.84
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$148.09
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.84
|
| Rate for Payer: Healthscope Commercial |
$190.25
|
| Rate for Payer: Healthscope Commercial |
$164.54
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.98
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,981.00
|
| Rate for Payer: Nomi Health Commercial |
$123.41
|
| Rate for Payer: PACE SWMI |
$102.84
|
| Rate for Payer: PHP Medicare Advantage |
$102.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.68
|
| Rate for Payer: Priority Health Medicare |
$102.84
|
| Rate for Payer: Priority Health Narrow Network |
$142.68
|
| Rate for Payer: Priority Health SBD |
$142.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.84
|
| Rate for Payer: UHC Exchange |
$144.00
|
| Rate for Payer: UHC Medicare Advantage |
$102.84
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
PR IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 96368
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$2,817.00 |
| Rate for Payer: Aetna Commercial |
$23.28
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.01
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$17.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.88
|
| Rate for Payer: BCN Commercial |
$28.83
|
| Rate for Payer: BCN Medicare Advantage |
$17.37
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$25.01
|
| Rate for Payer: Cofinity Commercial |
$23.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.37
|
| Rate for Payer: Healthscope Commercial |
$27.79
|
| Rate for Payer: Healthscope Commercial |
$32.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,817.00
|
| Rate for Payer: Nomi Health Commercial |
$20.84
|
| Rate for Payer: PACE SWMI |
$17.37
|
| Rate for Payer: PHP Medicare Advantage |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.69
|
| Rate for Payer: Priority Health Medicare |
$17.37
|
| Rate for Payer: Priority Health Narrow Network |
$26.69
|
| Rate for Payer: Priority Health SBD |
$26.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.37
|
| Rate for Payer: UHC Medicare Advantage |
$17.37
|
|
|
PR IV ULTRASOUND,FIRST VESSEL
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 37250
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$198.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR KETOROLAC TROMETHAMINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1885
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna Commercial |
$0.46
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.50
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$0.50
|
| Rate for Payer: Cofinity Commercial |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Healthscope Commercial |
$0.64
|
| Rate for Payer: Healthscope Commercial |
$0.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.00
|
| Rate for Payer: Nomi Health Commercial |
$0.42
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.80
|
| Rate for Payer: UHC Medicare Advantage |
$0.35
|
|
|
PR KO IMMOB CANVAS LONG PRE OTS
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS L1830
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$7,401.00 |
| Rate for Payer: Aetna Commercial |
$89.62
|
| Rate for Payer: Aetna Medicare |
$69.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.31
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$66.88
|
| Rate for Payer: BCN Commercial |
$64.89
|
| Rate for Payer: BCN Medicare Advantage |
$66.88
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$89.62
|
| Rate for Payer: Cofinity Commercial |
$96.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.88
|
| Rate for Payer: Healthscope Commercial |
$123.73
|
| Rate for Payer: Healthscope Commercial |
$107.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,401.00
|
| Rate for Payer: Nomi Health Commercial |
$80.26
|
| Rate for Payer: PACE SWMI |
$66.88
|
| Rate for Payer: PHP Medicare Advantage |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$66.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.88
|
| Rate for Payer: UHC Medicare Advantage |
$66.88
|
|
|
PR KYBELLA
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00086
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
PR KYLEENA, 19.5 MG
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7296
|
| Min. Negotiated Rate |
$736.00 |
| Max. Negotiated Rate |
$112,373.00 |
| Rate for Payer: Aetna Commercial |
$1,101.70
|
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,101.70
|
| Rate for Payer: BCBS Complete |
$1,351.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.44
|
| Rate for Payer: BCN Commercial |
$1,121.75
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Mclaren Medicaid |
$1,287.51
|
| Rate for Payer: Meridian Medicaid |
$1,351.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112,373.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,287.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,262.98
|
| Rate for Payer: UHC Exchange |
$1,262.98
|
| Rate for Payer: UHCCP Medicaid |
$1,287.51
|
|
|
PR KYLEENA, 19.5 MG
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS Q9984
|
| Min. Negotiated Rate |
$350.80 |
| Max. Negotiated Rate |
$570.05 |
| Rate for Payer: Aetna Medicare |
$438.50
|
| Rate for Payer: BCBS Complete |
$350.80
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$570.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.05
|
|
|
PR KYPHECTOMY SINGLE OR TWO SEGMENTS
|
Professional
|
Both
|
$12,926.00
|
|
|
Service Code
|
HCPCS 22818
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$381,541.00 |
| Rate for Payer: Aetna Commercial |
$2,774.05
|
| Rate for Payer: Aetna Medicare |
$2,153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,774.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,981.07
|
| Rate for Payer: BCBS Complete |
$1,451.04
|
| Rate for Payer: BCBS MAPPO |
$2,070.19
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$3,130.47
|
| Rate for Payer: BCN Medicare Advantage |
$2,070.19
|
| Rate for Payer: Cash Price |
$10,340.80
|
| Rate for Payer: Cash Price |
$10,340.80
|
| Rate for Payer: Cofinity Commercial |
$2,981.07
|
| Rate for Payer: Cofinity Commercial |
$2,774.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,070.19
|
| Rate for Payer: Healthscope Commercial |
$3,829.85
|
| Rate for Payer: Healthscope Commercial |
$3,312.30
|
| Rate for Payer: Mclaren Medicaid |
$1,381.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,173.70
|
| Rate for Payer: Meridian Medicaid |
$1,451.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381,541.00
|
| Rate for Payer: Nomi Health Commercial |
$2,484.23
|
| Rate for Payer: PACE SWMI |
$2,070.19
|
| Rate for Payer: PHP Medicare Advantage |
$2,070.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,381.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,401.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,277.58
|
| Rate for Payer: Priority Health Medicare |
$2,070.19
|
| Rate for Payer: Priority Health Narrow Network |
$3,277.58
|
| Rate for Payer: Priority Health SBD |
$3,277.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,853.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,070.19
|
| Rate for Payer: UHC Exchange |
$2,853.40
|
| Rate for Payer: UHC Medicare Advantage |
$2,070.19
|
| Rate for Payer: UHCCP Medicaid |
$1,381.94
|
|
|
PR LABYRINTHOTOMY TRANSCANAL
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 69801
|
| Min. Negotiated Rate |
$79.88 |
| Max. Negotiated Rate |
$22,027.00 |
| Rate for Payer: Aetna Commercial |
$159.31
|
| Rate for Payer: Aetna Medicare |
$123.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.20
|
| Rate for Payer: BCBS Complete |
$83.87
|
| Rate for Payer: BCBS MAPPO |
$118.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,908.82
|
| Rate for Payer: BCN Commercial |
$336.70
|
| Rate for Payer: BCN Medicare Advantage |
$118.89
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$159.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.89
|
| Rate for Payer: Healthscope Commercial |
$219.95
|
| Rate for Payer: Healthscope Commercial |
$190.22
|
| Rate for Payer: Mclaren Medicaid |
$79.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.83
|
| Rate for Payer: Meridian Medicaid |
$83.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,027.00
|
| Rate for Payer: Nomi Health Commercial |
$142.67
|
| Rate for Payer: PACE SWMI |
$118.89
|
| Rate for Payer: PHP Medicare Advantage |
$118.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.41
|
| Rate for Payer: Priority Health Medicare |
$118.89
|
| Rate for Payer: Priority Health Narrow Network |
$181.41
|
| Rate for Payer: Priority Health SBD |
$181.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$804.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.89
|
| Rate for Payer: UHC Exchange |
$804.87
|
| Rate for Payer: UHC Medicare Advantage |
$118.89
|
| Rate for Payer: UHCCP Medicaid |
$79.88
|
|
|
PR LAIV3 VACCINE LIVE FOR INTRANASAL USE
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 90660
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$2,361.00 |
| Rate for Payer: Aetna Commercial |
$38.69
|
| Rate for Payer: Aetna Medicare |
$30.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.69
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$28.87
|
| Rate for Payer: BCN Medicare Advantage |
$28.87
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$41.57
|
| Rate for Payer: Cofinity Commercial |
$38.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.87
|
| Rate for Payer: Healthscope Commercial |
$53.41
|
| Rate for Payer: Healthscope Commercial |
$46.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,361.00
|
| Rate for Payer: Nomi Health Commercial |
$34.65
|
| Rate for Payer: PACE SWMI |
$28.87
|
| Rate for Payer: PHP Medicare Advantage |
$28.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health Medicare |
$28.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.87
|
| Rate for Payer: UHC Exchange |
$30.60
|
| Rate for Payer: UHC Medicare Advantage |
$28.87
|
|
|
PR LAIV4 VACCINE FOR INTRANASAL USE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90672
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$2,486.00 |
| Rate for Payer: Aetna Commercial |
$27.79
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.79
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$27.54
|
| Rate for Payer: BCN Commercial |
$27.54
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,486.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.46
|
| Rate for Payer: UHC Exchange |
$29.46
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED CERVICAL
|
Professional
|
Both
|
$8,260.00
|
|
|
Service Code
|
HCPCS 63285
|
| Min. Negotiated Rate |
$381.43 |
| Max. Negotiated Rate |
$474,246.00 |
| Rate for Payer: Aetna Commercial |
$3,477.64
|
| Rate for Payer: Aetna Medicare |
$2,699.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,477.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,737.16
|
| Rate for Payer: BCBS Complete |
$1,785.85
|
| Rate for Payer: BCBS MAPPO |
$2,595.25
|
| Rate for Payer: BCBS Trust/PPO |
$381.43
|
| Rate for Payer: BCN Commercial |
$4,242.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,595.25
|
| Rate for Payer: Cash Price |
$6,608.00
|
| Rate for Payer: Cash Price |
$6,608.00
|
| Rate for Payer: Cofinity Commercial |
$3,737.16
|
| Rate for Payer: Cofinity Commercial |
$3,477.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,595.25
|
| Rate for Payer: Healthscope Commercial |
$4,801.21
|
| Rate for Payer: Healthscope Commercial |
$4,152.40
|
| Rate for Payer: Mclaren Medicaid |
$1,700.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,725.01
|
| Rate for Payer: Meridian Medicaid |
$1,785.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$474,246.00
|
| Rate for Payer: Nomi Health Commercial |
$3,114.30
|
| Rate for Payer: PACE SWMI |
$2,595.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,595.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,700.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,369.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,521.86
|
| Rate for Payer: Priority Health Medicare |
$2,595.25
|
| Rate for Payer: Priority Health Narrow Network |
$4,521.86
|
| Rate for Payer: Priority Health SBD |
$4,521.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,055.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,595.25
|
| Rate for Payer: UHC Exchange |
$3,055.13
|
| Rate for Payer: UHC Medicare Advantage |
$2,595.25
|
| Rate for Payer: UHCCP Medicaid |
$1,700.81
|
|
