|
PR LOCM 250-299MG/ML IODINE,1ML
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q9948
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna Medicare |
$2.50
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
|
|
PR LORAZEPAM INJECTION
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J2060
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Commercial |
$2.22
|
| Rate for Payer: Aetna Medicare |
$1.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$1.66
|
| Rate for Payer: BCBS Trust/PPO |
$0.47
|
| Rate for Payer: BCN Commercial |
$0.52
|
| Rate for Payer: BCN Medicare Advantage |
$1.66
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Cofinity Commercial |
$2.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.66
|
| Rate for Payer: Healthscope Commercial |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$3.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.01
|
| Rate for Payer: Nomi Health Commercial |
$1.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.25
|
| Rate for Payer: PACE SWMI |
$1.66
|
| Rate for Payer: PHP Medicare Advantage |
$1.66
|
| Rate for Payer: Priority Health Medicare |
$1.66
|
| Rate for Payer: Railroad Medicare Medicare |
$1.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.41
|
| Rate for Payer: UHC Core |
$1.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.66
|
| Rate for Payer: UHC Exchange |
$1.41
|
|
|
PR LOWER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$2,704.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,081.60 |
| Max. Negotiated Rate |
$2,028.00 |
| Rate for Payer: Aetna Medicare |
$1,352.00
|
| Rate for Payer: BCBS Complete |
$1,081.60
|
| Rate for Payer: Cash Price |
$2,163.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,757.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,028.00
|
|
|
PR LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 20979
|
| Min. Negotiated Rate |
$26.34 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: Aetna Commercial |
$35.30
|
| Rate for Payer: Aetna Medicare |
$27.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.93
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: BCBS MAPPO |
$26.34
|
| Rate for Payer: BCN Commercial |
$46.31
|
| Rate for Payer: BCN Medicare Advantage |
$26.34
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cofinity Commercial |
$35.30
|
| Rate for Payer: Cofinity Commercial |
$37.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.34
|
| Rate for Payer: Healthscope Commercial |
$42.14
|
| Rate for Payer: Healthscope Commercial |
$48.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.73
|
| Rate for Payer: Nomi Health Commercial |
$31.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.25
|
| Rate for Payer: PACE SWMI |
$26.34
|
| Rate for Payer: PHP Medicare Advantage |
$26.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$49.50
|
| Rate for Payer: Priority Health Medicare |
$26.34
|
| Rate for Payer: Priority Health SBD |
$49.50
|
| Rate for Payer: Priority Health Tiered Network |
$49.50
|
| Rate for Payer: Railroad Medicare Medicare |
$26.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.23
|
| Rate for Payer: UHC Core |
$57.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.34
|
| Rate for Payer: UHC Exchange |
$57.23
|
|
|
PR LT COMPRES BAND >=3"" <5""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6449
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna Medicare |
$2.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$2.50
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Medicare Advantage |
$2.50
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Healthscope Commercial |
$4.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Nomi Health Commercial |
$3.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: PACE SWMI |
$2.50
|
| Rate for Payer: PHP Medicare Advantage |
$2.50
|
| Rate for Payer: Priority Health Medicare |
$2.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.82
|
| Rate for Payer: UHC Core |
$0.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.50
|
| Rate for Payer: UHC Exchange |
$0.82
|
|
|
PR LT COMPRES BAND <3""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6448
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.36
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$1.64
|
| Rate for Payer: BCN Commercial |
$1.57
|
| Rate for Payer: BCN Medicare Advantage |
$1.64
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.53
|
| Rate for Payer: Nomi Health Commercial |
$1.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: PACE SWMI |
$1.64
|
| Rate for Payer: PHP Medicare Advantage |
$1.64
|
| Rate for Payer: Priority Health Medicare |
$1.64
|
| Rate for Payer: Railroad Medicare Medicare |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.54
|
| Rate for Payer: UHC Core |
$0.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.64
|
| Rate for Payer: UHC Exchange |
$0.54
|
|
|
PR LT COMPRES BAND >=5""/YD
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A6450
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna Medicare |
$2.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$2.50
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Medicare Advantage |
$2.50
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Cofinity Commercial |
$3.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$4.62
|
| Rate for Payer: Healthscope Commercial |
$4.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.33
|
| Rate for Payer: Nomi Health Commercial |
$3.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.75
|
| Rate for Payer: PACE SWMI |
$2.50
|
| Rate for Payer: PHP Medicare Advantage |
$2.50
|
| Rate for Payer: Priority Health Medicare |
$2.50
|
| Rate for Payer: Railroad Medicare Medicare |
$2.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.82
|
| Rate for Payer: UHC Core |
$0.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.50
|
| Rate for Payer: UHC Exchange |
$0.82
|
|
|
PR LUX IR ABD/BACK
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
|
|
PR LUX IR ARMS
|
Professional
|
Both
|
$132.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
|
|
PR LUX IR BUTTOCKS
|
Professional
|
Both
|
$158.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
|
|
PR LUX IR CHEST
|
Professional
|
Both
|
$158.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$118.50 |
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.50
|
|
|
PR LUX IR FACE & NECK
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
|
|
PR LUX IR UP LEGS
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
|
|
PR LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 38308
|
| Min. Negotiated Rate |
$285.42 |
| Max. Negotiated Rate |
$950.18 |
| Rate for Payer: Aetna Commercial |
$588.02
|
| Rate for Payer: Aetna Medicare |
$456.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$588.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$631.90
|
| Rate for Payer: BCBS Complete |
$299.69
|
| Rate for Payer: BCBS MAPPO |
$438.82
|
| Rate for Payer: BCN Commercial |
$714.11
|
| Rate for Payer: BCN Medicare Advantage |
$438.82
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Cofinity Commercial |
$631.90
|
| Rate for Payer: Cofinity Commercial |
$588.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$438.82
|
| Rate for Payer: Healthscope Commercial |
$811.82
|
| Rate for Payer: Healthscope Commercial |
$702.11
|
| Rate for Payer: Mclaren Medicaid |
$285.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$460.76
|
| Rate for Payer: Meridian Medicaid |
$299.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$482.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$827.75
|
| Rate for Payer: Nomi Health Commercial |
$526.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$718.50
|
| Rate for Payer: PACE SWMI |
$438.82
|
| Rate for Payer: PHP Medicare Advantage |
$438.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$285.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$950.18
|
| Rate for Payer: Priority Health Medicare |
$438.82
|
| Rate for Payer: Priority Health SBD |
$950.18
|
| Rate for Payer: Priority Health Tiered Network |
$950.18
|
| Rate for Payer: Railroad Medicare Medicare |
$438.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$800.99
|
| Rate for Payer: UHC Core |
$800.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$438.82
|
| Rate for Payer: UHC Exchange |
$800.99
|
| Rate for Payer: UHC Medicaid |
$285.42
|
| Rate for Payer: UHCCP Medicaid |
$285.42
|
|
|
PR LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
HCPCS 54162
|
| Min. Negotiated Rate |
$117.58 |
| Max. Negotiated Rate |
$402.75 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Medicare |
$188.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.32
|
| Rate for Payer: BCBS Complete |
$123.46
|
| Rate for Payer: BCBS MAPPO |
$180.78
|
| Rate for Payer: BCN Commercial |
$301.78
|
| Rate for Payer: BCN Medicare Advantage |
$180.78
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cash Price |
$429.60
|
| Rate for Payer: Cofinity Commercial |
$260.32
|
| Rate for Payer: Cofinity Commercial |
$242.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.78
|
| Rate for Payer: Healthscope Commercial |
$334.44
|
| Rate for Payer: Healthscope Commercial |
$289.25
|
| Rate for Payer: Mclaren Medicaid |
$117.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.82
|
| Rate for Payer: Meridian Medicaid |
$123.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$198.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.12
|
| Rate for Payer: Nomi Health Commercial |
$216.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$402.75
|
| Rate for Payer: PACE SWMI |
$180.78
|
| Rate for Payer: PHP Medicare Advantage |
$180.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$328.73
|
| Rate for Payer: Priority Health Medicare |
$180.78
|
| Rate for Payer: Priority Health SBD |
$328.73
|
| Rate for Payer: Priority Health Tiered Network |
$328.73
|
| Rate for Payer: Railroad Medicare Medicare |
$180.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.16
|
| Rate for Payer: UHC Core |
$350.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$180.78
|
| Rate for Payer: UHC Exchange |
$350.16
|
| Rate for Payer: UHC Medicaid |
$117.58
|
| Rate for Payer: UHCCP Medicaid |
$117.58
|
|
|
PR LYSIS INTRANASAL SYNECHIA
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
HCPCS 30560
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$398.25 |
| Rate for Payer: Aetna Commercial |
$177.63
|
| Rate for Payer: Aetna Medicare |
$137.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.89
|
| Rate for Payer: BCBS Complete |
$93.48
|
| Rate for Payer: BCBS MAPPO |
$132.56
|
| Rate for Payer: BCN Commercial |
$226.08
|
| Rate for Payer: BCN Medicare Advantage |
$132.56
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cash Price |
$424.80
|
| Rate for Payer: Cofinity Commercial |
$190.89
|
| Rate for Payer: Cofinity Commercial |
$177.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.56
|
| Rate for Payer: Healthscope Commercial |
$245.24
|
| Rate for Payer: Healthscope Commercial |
$212.10
|
| Rate for Payer: Mclaren Medicaid |
$89.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.19
|
| Rate for Payer: Meridian Medicaid |
$93.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.86
|
| Rate for Payer: Nomi Health Commercial |
$159.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$398.25
|
| Rate for Payer: PACE SWMI |
$132.56
|
| Rate for Payer: PHP Medicare Advantage |
$132.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$212.90
|
| Rate for Payer: Priority Health Medicare |
$132.56
|
| Rate for Payer: Priority Health SBD |
$212.90
|
| Rate for Payer: Priority Health Tiered Network |
$212.90
|
| Rate for Payer: Railroad Medicare Medicare |
$132.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.92
|
| Rate for Payer: UHC Core |
$238.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.56
|
| Rate for Payer: UHC Exchange |
$238.92
|
| Rate for Payer: UHC Medicaid |
$89.03
|
| Rate for Payer: UHCCP Medicaid |
$89.03
|
|
|
PR LYSIS LABIAL ADHESIONS
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 56441
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$380.25 |
| Rate for Payer: Aetna Commercial |
$182.99
|
| Rate for Payer: Aetna Medicare |
$142.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.65
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS MAPPO |
$136.56
|
| Rate for Payer: BCN Commercial |
$233.06
|
| Rate for Payer: BCN Medicare Advantage |
$136.56
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cofinity Commercial |
$196.65
|
| Rate for Payer: Cofinity Commercial |
$182.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.56
|
| Rate for Payer: Healthscope Commercial |
$252.64
|
| Rate for Payer: Healthscope Commercial |
$218.50
|
| Rate for Payer: Mclaren Medicaid |
$89.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.39
|
| Rate for Payer: Meridian Medicaid |
$94.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$150.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.38
|
| Rate for Payer: Nomi Health Commercial |
$163.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$380.25
|
| Rate for Payer: PACE SWMI |
$136.56
|
| Rate for Payer: PHP Medicare Advantage |
$136.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$236.03
|
| Rate for Payer: Priority Health Medicare |
$136.56
|
| Rate for Payer: Priority Health SBD |
$236.03
|
| Rate for Payer: Priority Health Tiered Network |
$236.03
|
| Rate for Payer: Railroad Medicare Medicare |
$136.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.88
|
| Rate for Payer: UHC Core |
$255.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$136.56
|
| Rate for Payer: UHC Exchange |
$255.88
|
| Rate for Payer: UHC Medicaid |
$89.67
|
| Rate for Payer: UHCCP Medicaid |
$89.67
|
|
|
PR LYSIS OF ADHESIONS SALPINX/OVARY
|
Professional
|
Both
|
$2,501.00
|
|
|
Service Code
|
HCPCS 58740
|
| Min. Negotiated Rate |
$526.11 |
| Max. Negotiated Rate |
$1,875.75 |
| Rate for Payer: Aetna Commercial |
$1,094.14
|
| Rate for Payer: Aetna Medicare |
$849.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,094.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.79
|
| Rate for Payer: BCBS Complete |
$552.42
|
| Rate for Payer: BCBS MAPPO |
$816.52
|
| Rate for Payer: BCN Commercial |
$1,359.49
|
| Rate for Payer: BCN Medicare Advantage |
$816.52
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cofinity Commercial |
$1,175.79
|
| Rate for Payer: Cofinity Commercial |
$1,094.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.52
|
| Rate for Payer: Healthscope Commercial |
$1,510.56
|
| Rate for Payer: Healthscope Commercial |
$1,306.43
|
| Rate for Payer: Mclaren Medicaid |
$526.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$857.35
|
| Rate for Payer: Meridian Medicaid |
$552.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$898.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,612.55
|
| Rate for Payer: Nomi Health Commercial |
$979.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,875.75
|
| Rate for Payer: PACE SWMI |
$816.52
|
| Rate for Payer: PHP Medicare Advantage |
$816.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$526.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,376.87
|
| Rate for Payer: Priority Health Medicare |
$816.52
|
| Rate for Payer: Priority Health SBD |
$1,376.87
|
| Rate for Payer: Priority Health Tiered Network |
$1,376.87
|
| Rate for Payer: Railroad Medicare Medicare |
$816.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,584.76
|
| Rate for Payer: UHC Core |
$1,584.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$816.52
|
| Rate for Payer: UHC Exchange |
$1,584.76
|
| Rate for Payer: UHC Medicaid |
$526.11
|
| Rate for Payer: UHCCP Medicaid |
$526.11
|
|
|
PR MA/EC CONTRACEPTIVEINJECTION
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS J1056
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
|
|
PR MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC
|
Professional
|
Both
|
$3,448.00
|
|
|
Service Code
|
HCPCS 32820
|
| Min. Negotiated Rate |
$837.94 |
| Max. Negotiated Rate |
$2,586.00 |
| Rate for Payer: Aetna Commercial |
$1,746.11
|
| Rate for Payer: Aetna Medicare |
$1,355.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,746.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,876.42
|
| Rate for Payer: BCBS Complete |
$879.84
|
| Rate for Payer: BCBS MAPPO |
$1,303.07
|
| Rate for Payer: BCN Commercial |
$2,074.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,303.07
|
| Rate for Payer: Cash Price |
$2,758.40
|
| Rate for Payer: Cash Price |
$2,758.40
|
| Rate for Payer: Cofinity Commercial |
$1,876.42
|
| Rate for Payer: Cofinity Commercial |
$1,746.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,303.07
|
| Rate for Payer: Healthscope Commercial |
$2,084.91
|
| Rate for Payer: Healthscope Commercial |
$2,410.68
|
| Rate for Payer: Mclaren Medicaid |
$837.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,368.22
|
| Rate for Payer: Meridian Medicaid |
$879.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,433.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,359.57
|
| Rate for Payer: Nomi Health Commercial |
$1,563.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,586.00
|
| Rate for Payer: PACE SWMI |
$1,303.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,303.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,953.18
|
| Rate for Payer: Priority Health Medicare |
$1,303.07
|
| Rate for Payer: Priority Health SBD |
$1,953.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,953.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1,303.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,353.04
|
| Rate for Payer: UHC Core |
$2,353.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,303.07
|
| Rate for Payer: UHC Exchange |
$2,353.04
|
| Rate for Payer: UHC Medicaid |
$837.94
|
| Rate for Payer: UHCCP Medicaid |
$837.94
|
|
|
PR MAKENA, 10 MG
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS J1726
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$20.62 |
| Rate for Payer: Aetna Commercial |
$19.41
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.41
|
| Rate for Payer: BCN Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.65
|
| Rate for Payer: UHC Core |
$19.65
|
| Rate for Payer: UHC Exchange |
$19.65
|
|
|
PR MAMMAPLASTY AUGMENTATION - GEL
|
Professional
|
Both
|
$3,605.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,442.00 |
| Max. Negotiated Rate |
$2,703.75 |
| Rate for Payer: Aetna Medicare |
$1,802.50
|
| Rate for Payer: BCBS Complete |
$1,442.00
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,343.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,703.75
|
|
|
PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 26341
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$94.60
|
| Rate for Payer: Aetna Medicare |
$73.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.60
|
| Rate for Payer: BCBS Complete |
$48.98
|
| Rate for Payer: BCBS MAPPO |
$70.60
|
| Rate for Payer: BCN Commercial |
$119.02
|
| Rate for Payer: BCN Medicare Advantage |
$70.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$94.60
|
| Rate for Payer: Cofinity Commercial |
$101.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.60
|
| Rate for Payer: Healthscope Commercial |
$130.61
|
| Rate for Payer: Healthscope Commercial |
$112.96
|
| Rate for Payer: Mclaren Medicaid |
$46.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.13
|
| Rate for Payer: Meridian Medicaid |
$48.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.90
|
| Rate for Payer: Nomi Health Commercial |
$84.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PACE SWMI |
$70.60
|
| Rate for Payer: PHP Medicare Advantage |
$70.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$127.23
|
| Rate for Payer: Priority Health Medicare |
$70.60
|
| Rate for Payer: Priority Health SBD |
$127.23
|
| Rate for Payer: Priority Health Tiered Network |
$127.23
|
| Rate for Payer: Railroad Medicare Medicare |
$70.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.53
|
| Rate for Payer: UHC Core |
$131.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$70.60
|
| Rate for Payer: UHC Exchange |
$131.53
|
| Rate for Payer: UHC Medicaid |
$46.65
|
| Rate for Payer: UHCCP Medicaid |
$46.65
|
|
|
PR MANIPULATION ANKLE UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
HCPCS 27860
|
| Min. Negotiated Rate |
$98.62 |
| Max. Negotiated Rate |
$486.75 |
| Rate for Payer: Aetna Commercial |
$201.66
|
| Rate for Payer: Aetna Medicare |
$156.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.71
|
| Rate for Payer: BCBS Complete |
$103.55
|
| Rate for Payer: BCBS MAPPO |
$150.49
|
| Rate for Payer: BCN Commercial |
$249.49
|
| Rate for Payer: BCN Medicare Advantage |
$150.49
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cash Price |
$519.20
|
| Rate for Payer: Cofinity Commercial |
$216.71
|
| Rate for Payer: Cofinity Commercial |
$201.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.49
|
| Rate for Payer: Healthscope Commercial |
$278.41
|
| Rate for Payer: Healthscope Commercial |
$240.78
|
| Rate for Payer: Mclaren Medicaid |
$98.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.01
|
| Rate for Payer: Meridian Medicaid |
$103.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$165.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.34
|
| Rate for Payer: Nomi Health Commercial |
$180.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$486.75
|
| Rate for Payer: PACE SWMI |
$150.49
|
| Rate for Payer: PHP Medicare Advantage |
$150.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$266.70
|
| Rate for Payer: Priority Health Medicare |
$150.49
|
| Rate for Payer: Priority Health SBD |
$266.70
|
| Rate for Payer: Priority Health Tiered Network |
$266.70
|
| Rate for Payer: Railroad Medicare Medicare |
$150.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.88
|
| Rate for Payer: UHC Core |
$296.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$150.49
|
| Rate for Payer: UHC Exchange |
$296.88
|
| Rate for Payer: UHC Medicaid |
$98.62
|
| Rate for Payer: UHCCP Medicaid |
$98.62
|
|
|
PR MANIPULATION ELBOW UNDER ANESTHESIA
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
HCPCS 24300
|
| Min. Negotiated Rate |
$284.57 |
| Max. Negotiated Rate |
$785.05 |
| Rate for Payer: Aetna Commercial |
$568.63
|
| Rate for Payer: Aetna Medicare |
$441.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$611.06
|
| Rate for Payer: BCBS Complete |
$298.80
|
| Rate for Payer: BCBS MAPPO |
$424.35
|
| Rate for Payer: BCN Commercial |
$685.22
|
| Rate for Payer: BCN Medicare Advantage |
$424.35
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cash Price |
$589.60
|
| Rate for Payer: Cofinity Commercial |
$611.06
|
| Rate for Payer: Cofinity Commercial |
$568.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$424.35
|
| Rate for Payer: Healthscope Commercial |
$785.05
|
| Rate for Payer: Healthscope Commercial |
$678.96
|
| Rate for Payer: Mclaren Medicaid |
$284.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$445.57
|
| Rate for Payer: Meridian Medicaid |
$298.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$466.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$767.32
|
| Rate for Payer: Nomi Health Commercial |
$509.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$552.75
|
| Rate for Payer: PACE SWMI |
$424.35
|
| Rate for Payer: PHP Medicare Advantage |
$424.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$284.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$732.49
|
| Rate for Payer: Priority Health Medicare |
$424.35
|
| Rate for Payer: Priority Health SBD |
$732.49
|
| Rate for Payer: Priority Health Tiered Network |
$732.49
|
| Rate for Payer: Railroad Medicare Medicare |
$424.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.29
|
| Rate for Payer: UHC Core |
$729.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$424.35
|
| Rate for Payer: UHC Exchange |
$729.29
|
| Rate for Payer: UHC Medicaid |
$284.57
|
| Rate for Payer: UHCCP Medicaid |
$284.57
|
|
