|
PR LILETTA, 52 MG
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS J7297
|
| Min. Negotiated Rate |
$352.00 |
| Max. Negotiated Rate |
$572.00 |
| Rate for Payer: Aetna Medicare |
$440.00
|
| Rate for Payer: BCBS Complete |
$352.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$572.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.00
|
|
|
PR LIMITED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 92081
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$56.42 |
| Rate for Payer: Aetna Commercial |
$40.87
|
| Rate for Payer: Aetna Medicare |
$31.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.92
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$30.50
|
| Rate for Payer: BCN Medicare Advantage |
$30.50
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$43.92
|
| Rate for Payer: Cofinity Commercial |
$40.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.50
|
| Rate for Payer: Healthscope Commercial |
$56.42
|
| Rate for Payer: Healthscope Commercial |
$48.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.70
|
| Rate for Payer: Nomi Health Commercial |
$36.60
|
| Rate for Payer: PACE SWMI |
$30.50
|
| Rate for Payer: PHP Medicare Advantage |
$30.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health Medicare |
$30.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.50
|
| Rate for Payer: UHC Medicare Advantage |
$30.50
|
|
|
PR LINCOMYCIN INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J2010
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$6.03
|
| Rate for Payer: Aetna Medicare |
$4.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.48
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$4.50
|
| Rate for Payer: BCN Medicare Advantage |
$4.50
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$6.03
|
| Rate for Payer: Cofinity Commercial |
$6.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.50
|
| Rate for Payer: Healthscope Commercial |
$7.20
|
| Rate for Payer: Healthscope Commercial |
$8.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.00
|
| Rate for Payer: Nomi Health Commercial |
$5.40
|
| Rate for Payer: PACE SWMI |
$4.50
|
| Rate for Payer: PHP Medicare Advantage |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$4.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.50
|
|
|
PR LITHOLAPAXY COMP/LG > 2.5 CM
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
HCPCS 52318
|
| Min. Negotiated Rate |
$374.40 |
| Max. Negotiated Rate |
$830.76 |
| Rate for Payer: Aetna Commercial |
$601.74
|
| Rate for Payer: Aetna Medicare |
$467.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$646.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$601.74
|
| Rate for Payer: BCBS Complete |
$374.40
|
| Rate for Payer: BCBS MAPPO |
$449.06
|
| Rate for Payer: BCN Medicare Advantage |
$449.06
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cofinity Commercial |
$646.65
|
| Rate for Payer: Cofinity Commercial |
$601.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.06
|
| Rate for Payer: Healthscope Commercial |
$830.76
|
| Rate for Payer: Healthscope Commercial |
$718.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$608.40
|
| Rate for Payer: Nomi Health Commercial |
$538.87
|
| Rate for Payer: PACE SWMI |
$449.06
|
| Rate for Payer: PHP Medicare Advantage |
$449.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.40
|
| Rate for Payer: Priority Health Medicare |
$449.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.06
|
| Rate for Payer: UHC Medicare Advantage |
$449.06
|
|
|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$329.19 |
| Max. Negotiated Rate |
$1,077.70 |
| Rate for Payer: Aetna Commercial |
$441.11
|
| Rate for Payer: Aetna Medicare |
$342.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.11
|
| Rate for Payer: BCBS Complete |
$663.20
|
| Rate for Payer: BCBS MAPPO |
$329.19
|
| Rate for Payer: BCN Medicare Advantage |
$329.19
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cash Price |
$1,326.40
|
| Rate for Payer: Cofinity Commercial |
$474.03
|
| Rate for Payer: Cofinity Commercial |
$441.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.19
|
| Rate for Payer: Healthscope Commercial |
$526.70
|
| Rate for Payer: Healthscope Commercial |
$609.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.70
|
| Rate for Payer: Nomi Health Commercial |
$395.03
|
| Rate for Payer: PACE SWMI |
$329.19
|
| Rate for Payer: PHP Medicare Advantage |
$329.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health Medicare |
$329.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.19
|
| Rate for Payer: UHC Medicare Advantage |
$329.19
|
|
|
PR LITHOTRIPSY XTRCORP SHOCK WAVE
|
Professional
|
Both
|
$1,547.00
|
|
|
Service Code
|
HCPCS 50590
|
| Min. Negotiated Rate |
$546.36 |
| Max. Negotiated Rate |
$1,010.77 |
| Rate for Payer: Aetna Commercial |
$732.12
|
| Rate for Payer: Aetna Medicare |
$568.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.12
|
| Rate for Payer: BCBS Complete |
$618.80
|
| Rate for Payer: BCBS MAPPO |
$546.36
|
| Rate for Payer: BCN Medicare Advantage |
$546.36
|
| Rate for Payer: Cash Price |
$1,237.60
|
| Rate for Payer: Cash Price |
$1,237.60
|
| Rate for Payer: Cofinity Commercial |
$786.76
|
| Rate for Payer: Cofinity Commercial |
$732.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$546.36
|
| Rate for Payer: Healthscope Commercial |
$874.18
|
| Rate for Payer: Healthscope Commercial |
$1,010.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$573.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,005.55
|
| Rate for Payer: Nomi Health Commercial |
$655.63
|
| Rate for Payer: PACE SWMI |
$546.36
|
| Rate for Payer: PHP Medicare Advantage |
$546.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.55
|
| Rate for Payer: Priority Health Medicare |
$546.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$546.36
|
| Rate for Payer: UHC Medicare Advantage |
$546.36
|
|
|
PR LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC
|
Professional
|
Both
|
$3,942.00
|
|
|
Service Code
|
HCPCS 38562
|
| Min. Negotiated Rate |
$680.79 |
| Max. Negotiated Rate |
$2,562.30 |
| Rate for Payer: Aetna Commercial |
$912.26
|
| Rate for Payer: Aetna Medicare |
$708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$980.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.26
|
| Rate for Payer: BCBS Complete |
$1,576.80
|
| Rate for Payer: BCBS MAPPO |
$680.79
|
| Rate for Payer: BCN Medicare Advantage |
$680.79
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cash Price |
$3,153.60
|
| Rate for Payer: Cofinity Commercial |
$980.34
|
| Rate for Payer: Cofinity Commercial |
$912.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.79
|
| Rate for Payer: Healthscope Commercial |
$1,089.26
|
| Rate for Payer: Healthscope Commercial |
$1,259.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,562.30
|
| Rate for Payer: Nomi Health Commercial |
$816.95
|
| Rate for Payer: PACE SWMI |
$680.79
|
| Rate for Payer: PHP Medicare Advantage |
$680.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,562.30
|
| Rate for Payer: Priority Health Medicare |
$680.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.79
|
| Rate for Payer: UHC Medicare Advantage |
$680.79
|
|
|
PR LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC
|
Professional
|
Both
|
$2,831.00
|
|
|
Service Code
|
HCPCS 38564
|
| Min. Negotiated Rate |
$680.01 |
| Max. Negotiated Rate |
$1,840.15 |
| Rate for Payer: Aetna Commercial |
$911.21
|
| Rate for Payer: Aetna Medicare |
$707.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.21
|
| Rate for Payer: BCBS Complete |
$1,132.40
|
| Rate for Payer: BCBS MAPPO |
$680.01
|
| Rate for Payer: BCN Medicare Advantage |
$680.01
|
| Rate for Payer: Cash Price |
$2,264.80
|
| Rate for Payer: Cash Price |
$2,264.80
|
| Rate for Payer: Cofinity Commercial |
$979.21
|
| Rate for Payer: Cofinity Commercial |
$911.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.01
|
| Rate for Payer: Healthscope Commercial |
$1,258.02
|
| Rate for Payer: Healthscope Commercial |
$1,088.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,840.15
|
| Rate for Payer: Nomi Health Commercial |
$816.01
|
| Rate for Payer: PACE SWMI |
$680.01
|
| Rate for Payer: PHP Medicare Advantage |
$680.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,840.15
|
| Rate for Payer: Priority Health Medicare |
$680.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.01
|
| Rate for Payer: UHC Medicare Advantage |
$680.01
|
|
|
PR LMTD OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 92019
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$126.06 |
| Rate for Payer: Aetna Commercial |
$91.31
|
| Rate for Payer: Aetna Medicare |
$70.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.31
|
| Rate for Payer: BCBS Complete |
$58.80
|
| Rate for Payer: BCBS MAPPO |
$68.14
|
| Rate for Payer: BCN Medicare Advantage |
$68.14
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$98.12
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.14
|
| Rate for Payer: Healthscope Commercial |
$109.02
|
| Rate for Payer: Healthscope Commercial |
$126.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.55
|
| Rate for Payer: Nomi Health Commercial |
$81.77
|
| Rate for Payer: PACE SWMI |
$68.14
|
| Rate for Payer: PHP Medicare Advantage |
$68.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health Medicare |
$68.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.14
|
| Rate for Payer: UHC Medicare Advantage |
$68.14
|
|
|
PR LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 25280
|
| Min. Negotiated Rate |
$548.44 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Aetna Commercial |
$734.91
|
| Rate for Payer: Aetna Medicare |
$570.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.91
|
| Rate for Payer: BCBS Complete |
$648.00
|
| Rate for Payer: BCBS MAPPO |
$548.44
|
| Rate for Payer: BCN Medicare Advantage |
$548.44
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,296.00
|
| Rate for Payer: Cofinity Commercial |
$789.75
|
| Rate for Payer: Cofinity Commercial |
$734.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$548.44
|
| Rate for Payer: Healthscope Commercial |
$877.50
|
| Rate for Payer: Healthscope Commercial |
$1,014.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$575.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,053.00
|
| Rate for Payer: Nomi Health Commercial |
$658.13
|
| Rate for Payer: PACE SWMI |
$548.44
|
| Rate for Payer: PHP Medicare Advantage |
$548.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,053.00
|
| Rate for Payer: Priority Health Medicare |
$548.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$548.44
|
| Rate for Payer: UHC Medicare Advantage |
$548.44
|
|
|
PR LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
HCPCS 27686
|
| Min. Negotiated Rate |
$510.32 |
| Max. Negotiated Rate |
$944.09 |
| Rate for Payer: Aetna Commercial |
$683.83
|
| Rate for Payer: Aetna Medicare |
$530.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.83
|
| Rate for Payer: BCBS Complete |
$544.80
|
| Rate for Payer: BCBS MAPPO |
$510.32
|
| Rate for Payer: BCN Medicare Advantage |
$510.32
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cofinity Commercial |
$734.86
|
| Rate for Payer: Cofinity Commercial |
$683.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.32
|
| Rate for Payer: Healthscope Commercial |
$816.51
|
| Rate for Payer: Healthscope Commercial |
$944.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$885.30
|
| Rate for Payer: Nomi Health Commercial |
$612.38
|
| Rate for Payer: PACE SWMI |
$510.32
|
| Rate for Payer: PHP Medicare Advantage |
$510.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.30
|
| Rate for Payer: Priority Health Medicare |
$510.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.32
|
| Rate for Payer: UHC Medicare Advantage |
$510.32
|
|
|
PR LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX
|
Professional
|
Both
|
$1,821.00
|
|
|
Service Code
|
HCPCS 27685
|
| Min. Negotiated Rate |
$447.01 |
| Max. Negotiated Rate |
$1,183.65 |
| Rate for Payer: Aetna Commercial |
$598.99
|
| Rate for Payer: Aetna Medicare |
$464.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.99
|
| Rate for Payer: BCBS Complete |
$728.40
|
| Rate for Payer: BCBS MAPPO |
$447.01
|
| Rate for Payer: BCN Medicare Advantage |
$447.01
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cash Price |
$1,456.80
|
| Rate for Payer: Cofinity Commercial |
$643.69
|
| Rate for Payer: Cofinity Commercial |
$598.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.01
|
| Rate for Payer: Healthscope Commercial |
$715.22
|
| Rate for Payer: Healthscope Commercial |
$826.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,183.65
|
| Rate for Payer: Nomi Health Commercial |
$536.41
|
| Rate for Payer: PACE SWMI |
$447.01
|
| Rate for Payer: PHP Medicare Advantage |
$447.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.65
|
| Rate for Payer: Priority Health Medicare |
$447.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.01
|
| Rate for Payer: UHC Medicare Advantage |
$447.01
|
|
|
PR LOCM 250-299MG/ML IODINE,1ML
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q9948
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.25 |
| 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: Priority Health Cigna Priority Health |
$3.25
|
|
|
PR LORAZEPAM INJECTION
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J2060
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$1.85
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.99
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$1.38
|
| Rate for Payer: BCN Medicare Advantage |
$1.38
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$1.85
|
| Rate for Payer: Cofinity Commercial |
$1.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.38
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$2.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.55
|
| Rate for Payer: Nomi Health Commercial |
$1.66
|
| Rate for Payer: PACE SWMI |
$1.38
|
| Rate for Payer: PHP Medicare Advantage |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health Medicare |
$1.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.38
|
| Rate for Payer: UHC Medicare Advantage |
$1.38
|
|
|
PR LOWER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$1,836.00
|
|
|
Service Code
|
HCPCS 00531
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$734.40 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna Medicare |
$918.00
|
| Rate for Payer: BCBS Complete |
$734.40
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,193.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,193.40
|
|
|
PR LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 20979
|
| Min. Negotiated Rate |
$29.78 |
| Max. Negotiated Rate |
$67.60 |
| Rate for Payer: Aetna Commercial |
$39.91
|
| Rate for Payer: Aetna Medicare |
$30.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.88
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS MAPPO |
$29.78
|
| Rate for Payer: BCN Medicare Advantage |
$29.78
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$42.88
|
| Rate for Payer: Cofinity Commercial |
$39.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.78
|
| Rate for Payer: Healthscope Commercial |
$55.09
|
| Rate for Payer: Healthscope Commercial |
$47.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.60
|
| Rate for Payer: Nomi Health Commercial |
$35.74
|
| Rate for Payer: PACE SWMI |
$29.78
|
| Rate for Payer: PHP Medicare Advantage |
$29.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
| Rate for Payer: Priority Health Medicare |
$29.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.78
|
| Rate for Payer: UHC Medicare Advantage |
$29.78
|
|
|
PR LT COMPRES BAND >=3"" <5""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6449
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Aetna Medicare |
$2.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.53
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$2.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.45
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.45
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Healthscope Commercial |
$4.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.95
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: PACE SWMI |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health Medicare |
$2.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.45
|
| Rate for Payer: UHC Medicare Advantage |
$2.45
|
|
|
PR LT COMPRES BAND <3""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6448
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.98 |
| Rate for Payer: Aetna Commercial |
$2.16
|
| Rate for Payer: Aetna Medicare |
$1.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.16
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$1.61
|
| Rate for Payer: BCN Medicare Advantage |
$1.61
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.32
|
| Rate for Payer: Cofinity Commercial |
$2.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.61
|
| Rate for Payer: Healthscope Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$2.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.95
|
| Rate for Payer: Nomi Health Commercial |
$1.93
|
| Rate for Payer: PACE SWMI |
$1.61
|
| Rate for Payer: PHP Medicare Advantage |
$1.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
| Rate for Payer: Priority Health Medicare |
$1.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.61
|
| Rate for Payer: UHC Medicare Advantage |
$1.61
|
|
|
PR LT COMPRES BAND >=5""/YD
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A6450
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.53 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Aetna Medicare |
$2.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.28
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$2.45
|
| Rate for Payer: BCN Medicare Advantage |
$2.45
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Cofinity Commercial |
$3.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.45
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Healthscope Commercial |
$4.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.25
|
| Rate for Payer: Nomi Health Commercial |
$2.94
|
| Rate for Payer: PACE SWMI |
$2.45
|
| Rate for Payer: PHP Medicare Advantage |
$2.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$2.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.45
|
| Rate for Payer: UHC Medicare Advantage |
$2.45
|
|
|
PR LUX IR ABD/BACK
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00097
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR LUX IR ARMS
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00095
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
PR LUX IR BUTTOCKS
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00098
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR LUX IR CHEST
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00094
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
|
|
PR LUX IR FACE & NECK
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00093
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR LUX IR UP LEGS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00096
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
