|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$218.96 |
| Max. Negotiated Rate |
$60,617.00 |
| Rate for Payer: Aetna Commercial |
$441.11
|
| Rate for Payer: Aetna Medicare |
$342.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.03
|
| Rate for Payer: BCBS Complete |
$229.91
|
| Rate for Payer: BCBS MAPPO |
$329.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,148.52
|
| Rate for Payer: BCN Commercial |
$1,298.41
|
| 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 |
$609.00
|
| Rate for Payer: Healthscope Commercial |
$526.70
|
| Rate for Payer: Mclaren Medicaid |
$218.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$345.65
|
| Rate for Payer: Meridian Medicaid |
$229.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$60,617.00
|
| 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 Choice Medicaid |
$218.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,077.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$543.25
|
| Rate for Payer: Priority Health Medicare |
$329.19
|
| Rate for Payer: Priority Health Narrow Network |
$543.25
|
| Rate for Payer: Priority Health SBD |
$543.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$701.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.19
|
| Rate for Payer: UHC Exchange |
$701.22
|
| Rate for Payer: UHC Medicare Advantage |
$329.19
|
| Rate for Payer: UHCCP Medicaid |
$218.96
|
|
|
PR LITHOTRIPSY XTRCORP SHOCK WAVE
|
Professional
|
Both
|
$1,547.00
|
|
|
Service Code
|
HCPCS 50590
|
| Min. Negotiated Rate |
$367.43 |
| Max. Negotiated Rate |
$100,204.00 |
| Rate for Payer: Aetna Commercial |
$732.12
|
| Rate for Payer: Aetna Medicare |
$568.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$732.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$786.76
|
| Rate for Payer: BCBS Complete |
$385.80
|
| Rate for Payer: BCBS MAPPO |
$546.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.83
|
| Rate for Payer: BCN Commercial |
$1,184.30
|
| 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: Mclaren Medicaid |
$367.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$573.68
|
| Rate for Payer: Meridian Medicaid |
$385.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100,204.00
|
| 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 Choice Medicaid |
$367.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,005.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$913.41
|
| Rate for Payer: Priority Health Medicare |
$546.36
|
| Rate for Payer: Priority Health Narrow Network |
$913.41
|
| Rate for Payer: Priority Health SBD |
$913.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$904.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$546.36
|
| Rate for Payer: UHC Exchange |
$904.36
|
| Rate for Payer: UHC Medicare Advantage |
$546.36
|
| Rate for Payer: UHCCP Medicaid |
$367.43
|
|
|
PR LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC
|
Professional
|
Both
|
$3,942.00
|
|
|
Service Code
|
HCPCS 38562
|
| Min. Negotiated Rate |
$456.89 |
| Max. Negotiated Rate |
$124,952.00 |
| Rate for Payer: Aetna Commercial |
$912.26
|
| Rate for Payer: Aetna Medicare |
$708.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$980.34
|
| Rate for Payer: BCBS Complete |
$479.73
|
| Rate for Payer: BCBS MAPPO |
$680.79
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$1,029.16
|
| 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 |
$1,259.46
|
| Rate for Payer: Healthscope Commercial |
$1,089.26
|
| Rate for Payer: Mclaren Medicaid |
$456.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.83
|
| Rate for Payer: Meridian Medicaid |
$479.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124,952.00
|
| 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 Choice Medicaid |
$456.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,562.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,416.72
|
| Rate for Payer: Priority Health Medicare |
$680.79
|
| Rate for Payer: Priority Health Narrow Network |
$1,416.72
|
| Rate for Payer: Priority Health SBD |
$1,416.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$855.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.79
|
| Rate for Payer: UHC Exchange |
$855.33
|
| Rate for Payer: UHC Medicare Advantage |
$680.79
|
| Rate for Payer: UHCCP Medicaid |
$456.89
|
|
|
PR LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC
|
Professional
|
Both
|
$2,831.00
|
|
|
Service Code
|
HCPCS 38564
|
| Min. Negotiated Rate |
$452.84 |
| Max. Negotiated Rate |
$125,105.00 |
| Rate for Payer: Aetna Commercial |
$911.21
|
| Rate for Payer: Aetna Medicare |
$707.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$911.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$979.21
|
| Rate for Payer: BCBS Complete |
$475.48
|
| Rate for Payer: BCBS MAPPO |
$680.01
|
| Rate for Payer: BCBS Trust/PPO |
$543.62
|
| Rate for Payer: BCN Commercial |
$1,024.27
|
| 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: Mclaren Medicaid |
$452.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$714.01
|
| Rate for Payer: Meridian Medicaid |
$475.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125,105.00
|
| 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 Choice Medicaid |
$452.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,840.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,402.06
|
| Rate for Payer: Priority Health Medicare |
$680.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,402.06
|
| Rate for Payer: Priority Health SBD |
$1,402.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$917.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.01
|
| Rate for Payer: UHC Exchange |
$917.28
|
| Rate for Payer: UHC Medicare Advantage |
$680.01
|
| Rate for Payer: UHCCP Medicaid |
$452.84
|
|
|
PR LMTD OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 92019
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$10,397.00 |
| Rate for Payer: Aetna Commercial |
$91.31
|
| Rate for Payer: Aetna Medicare |
$70.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.12
|
| Rate for Payer: BCBS Complete |
$48.53
|
| Rate for Payer: BCBS MAPPO |
$68.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,793.58
|
| Rate for Payer: BCN Commercial |
$75.59
|
| 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 |
$126.06
|
| Rate for Payer: Healthscope Commercial |
$109.02
|
| Rate for Payer: Mclaren Medicaid |
$46.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.55
|
| Rate for Payer: Meridian Medicaid |
$48.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,397.00
|
| 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 Choice Medicaid |
$46.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.28
|
| Rate for Payer: Priority Health Medicare |
$68.14
|
| Rate for Payer: Priority Health Narrow Network |
$89.28
|
| Rate for Payer: Priority Health SBD |
$89.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.14
|
| Rate for Payer: UHC Exchange |
$78.16
|
| Rate for Payer: UHC Medicare Advantage |
$68.14
|
| Rate for Payer: UHCCP Medicaid |
$46.22
|
|
|
PR LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN
|
Professional
|
Both
|
$1,620.00
|
|
|
Service Code
|
HCPCS 25280
|
| Min. Negotiated Rate |
$372.54 |
| Max. Negotiated Rate |
$100,548.00 |
| Rate for Payer: Aetna Commercial |
$734.91
|
| Rate for Payer: Aetna Medicare |
$570.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.75
|
| Rate for Payer: BCBS Complete |
$391.17
|
| Rate for Payer: BCBS MAPPO |
$548.44
|
| Rate for Payer: BCBS Trust/PPO |
$760.22
|
| Rate for Payer: BCN Commercial |
$837.11
|
| 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: Mclaren Medicaid |
$372.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$575.86
|
| Rate for Payer: Meridian Medicaid |
$391.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100,548.00
|
| 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 Choice Medicaid |
$372.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,053.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$881.35
|
| Rate for Payer: Priority Health Medicare |
$548.44
|
| Rate for Payer: Priority Health Narrow Network |
$881.35
|
| Rate for Payer: Priority Health SBD |
$881.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$932.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$548.44
|
| Rate for Payer: UHC Exchange |
$932.24
|
| Rate for Payer: UHC Medicare Advantage |
$548.44
|
| Rate for Payer: UHCCP Medicaid |
$372.54
|
|
|
PR LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA
|
Professional
|
Both
|
$1,362.00
|
|
|
Service Code
|
HCPCS 27686
|
| Min. Negotiated Rate |
$345.70 |
| Max. Negotiated Rate |
$93,263.00 |
| Rate for Payer: Aetna Commercial |
$683.83
|
| Rate for Payer: Aetna Medicare |
$530.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.86
|
| Rate for Payer: BCBS Complete |
$362.98
|
| Rate for Payer: BCBS MAPPO |
$510.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,402.18
|
| Rate for Payer: BCN Commercial |
$773.09
|
| 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 |
$944.09
|
| Rate for Payer: Healthscope Commercial |
$816.51
|
| Rate for Payer: Mclaren Medicaid |
$345.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.84
|
| Rate for Payer: Meridian Medicaid |
$362.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93,263.00
|
| 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 Choice Medicaid |
$345.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$885.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$822.33
|
| Rate for Payer: Priority Health Medicare |
$510.32
|
| Rate for Payer: Priority Health Narrow Network |
$822.33
|
| Rate for Payer: Priority Health SBD |
$822.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$906.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.32
|
| Rate for Payer: UHC Exchange |
$906.99
|
| Rate for Payer: UHC Medicare Advantage |
$510.32
|
| Rate for Payer: UHCCP Medicaid |
$345.70
|
|
|
PR LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX
|
Professional
|
Both
|
$1,821.00
|
|
|
Service Code
|
HCPCS 27685
|
| Min. Negotiated Rate |
$303.74 |
| Max. Negotiated Rate |
$82,222.00 |
| Rate for Payer: Aetna Commercial |
$598.99
|
| Rate for Payer: Aetna Medicare |
$464.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.69
|
| Rate for Payer: BCBS Complete |
$318.93
|
| Rate for Payer: BCBS MAPPO |
$447.01
|
| Rate for Payer: BCBS Trust/PPO |
$3,119.66
|
| Rate for Payer: BCN Commercial |
$962.69
|
| 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 |
$826.97
|
| Rate for Payer: Healthscope Commercial |
$715.22
|
| Rate for Payer: Mclaren Medicaid |
$303.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.36
|
| Rate for Payer: Meridian Medicaid |
$318.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82,222.00
|
| 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 Choice Medicaid |
$303.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,183.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$721.05
|
| Rate for Payer: Priority Health Medicare |
$447.01
|
| Rate for Payer: Priority Health Narrow Network |
$721.05
|
| Rate for Payer: Priority Health SBD |
$721.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$692.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.01
|
| Rate for Payer: UHC Exchange |
$692.48
|
| Rate for Payer: UHC Medicare Advantage |
$447.01
|
| Rate for Payer: UHCCP Medicaid |
$303.74
|
|
|
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 |
$0.45 |
| Max. Negotiated Rate |
$101.00 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.89
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$1.32
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.32
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.32
|
| Rate for Payer: Healthscope Commercial |
$2.43
|
| Rate for Payer: Healthscope Commercial |
$2.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.00
|
| Rate for Payer: Nomi Health Commercial |
$1.58
|
| Rate for Payer: PACE SWMI |
$1.32
|
| Rate for Payer: PHP Medicare Advantage |
$1.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health Medicare |
$1.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.32
|
| Rate for Payer: UHC Exchange |
$1.43
|
| Rate for Payer: UHC Medicare Advantage |
$1.32
|
|
|
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 |
$5,773.00 |
| 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: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$82.58
|
| 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 |
$47.65
|
| Rate for Payer: Healthscope Commercial |
$55.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,773.00
|
| 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 HMO/PPO/Tiered Network |
$48.34
|
| Rate for Payer: Priority Health Medicare |
$29.78
|
| Rate for Payer: Priority Health Narrow Network |
$48.34
|
| Rate for Payer: Priority Health SBD |
$48.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.78
|
| Rate for Payer: UHC Exchange |
$60.29
|
| 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 |
$233.00 |
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCN Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
|
|
PR LT COMPRES BAND <3""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6448
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCN Commercial |
$1.27
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.95
|
|
|
PR LT COMPRES BAND >=5""/YD
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A6450
|
| Min. Negotiated Rate |
$1.93 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCN Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
|
|
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
|
|
|
PR LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
HCPCS 38308
|
| Min. Negotiated Rate |
$305.44 |
| Max. Negotiated Rate |
$82,775.00 |
| Rate for Payer: Aetna Commercial |
$610.45
|
| Rate for Payer: Aetna Medicare |
$473.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$610.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$656.01
|
| Rate for Payer: BCBS Complete |
$320.71
|
| Rate for Payer: BCBS MAPPO |
$455.56
|
| Rate for Payer: BCBS Trust/PPO |
$635.54
|
| Rate for Payer: BCN Commercial |
$681.71
|
| Rate for Payer: BCN Medicare Advantage |
$455.56
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cofinity Commercial |
$656.01
|
| Rate for Payer: Cofinity Commercial |
$610.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.56
|
| Rate for Payer: Healthscope Commercial |
$842.79
|
| Rate for Payer: Healthscope Commercial |
$728.90
|
| Rate for Payer: Mclaren Medicaid |
$305.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$478.34
|
| Rate for Payer: Meridian Medicaid |
$320.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82,775.00
|
| Rate for Payer: Nomi Health Commercial |
$546.67
|
| Rate for Payer: PACE SWMI |
$455.56
|
| Rate for Payer: PHP Medicare Advantage |
$455.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$305.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$945.36
|
| Rate for Payer: Priority Health Medicare |
$455.56
|
| Rate for Payer: Priority Health Narrow Network |
$945.36
|
| Rate for Payer: Priority Health SBD |
$945.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$455.56
|
| Rate for Payer: UHC Exchange |
$518.24
|
| Rate for Payer: UHC Medicare Advantage |
$455.56
|
| Rate for Payer: UHCCP Medicaid |
$305.44
|
|
|
PR LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 54162
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$35,212.00 |
| Rate for Payer: Aetna Commercial |
$256.64
|
| Rate for Payer: Aetna Medicare |
$199.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.79
|
| Rate for Payer: BCBS Complete |
$135.53
|
| Rate for Payer: BCBS MAPPO |
$191.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,225.13
|
| Rate for Payer: BCN Commercial |
$374.33
|
| Rate for Payer: BCN Medicare Advantage |
$191.52
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cofinity Commercial |
$275.79
|
| Rate for Payer: Cofinity Commercial |
$256.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$354.31
|
| Rate for Payer: Healthscope Commercial |
$306.43
|
| Rate for Payer: Mclaren Medicaid |
$129.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.10
|
| Rate for Payer: Meridian Medicaid |
$135.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,212.00
|
| Rate for Payer: Nomi Health Commercial |
$229.82
|
| Rate for Payer: PACE SWMI |
$191.52
|
| Rate for Payer: PHP Medicare Advantage |
$191.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$338.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$320.62
|
| Rate for Payer: Priority Health Medicare |
$191.52
|
| Rate for Payer: Priority Health Narrow Network |
$320.62
|
| Rate for Payer: Priority Health SBD |
$320.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$191.52
|
| Rate for Payer: UHC Exchange |
$249.92
|
| Rate for Payer: UHC Medicare Advantage |
$191.52
|
| Rate for Payer: UHCCP Medicaid |
$129.08
|
|
|
PR LYSIS INTRANASAL SYNECHIA
|
Professional
|
Both
|
$516.00
|
|
|
Service Code
|
HCPCS 30560
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$26,186.00 |
| Rate for Payer: Aetna Commercial |
$186.60
|
| Rate for Payer: Aetna Medicare |
$144.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.52
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$139.25
|
| Rate for Payer: BCBS Trust/PPO |
$805.66
|
| Rate for Payer: BCN Commercial |
$479.88
|
| Rate for Payer: BCN Medicare Advantage |
$139.25
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cofinity Commercial |
$200.52
|
| Rate for Payer: Cofinity Commercial |
$186.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.25
|
| Rate for Payer: Healthscope Commercial |
$257.61
|
| Rate for Payer: Healthscope Commercial |
$222.80
|
| Rate for Payer: Mclaren Medicaid |
$96.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.21
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,186.00
|
| Rate for Payer: Nomi Health Commercial |
$167.10
|
| Rate for Payer: PACE SWMI |
$139.25
|
| Rate for Payer: PHP Medicare Advantage |
$139.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$335.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.27
|
| Rate for Payer: Priority Health Medicare |
$139.25
|
| Rate for Payer: Priority Health Narrow Network |
$212.27
|
| Rate for Payer: Priority Health SBD |
$212.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.25
|
| Rate for Payer: UHC Exchange |
$248.94
|
| Rate for Payer: UHC Medicare Advantage |
$139.25
|
| Rate for Payer: UHCCP Medicaid |
$96.70
|
|
|
PR LYSIS LABIAL ADHESIONS
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 56441
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$27,238.00 |
| Rate for Payer: Aetna Commercial |
$196.00
|
| Rate for Payer: Aetna Medicare |
$152.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.63
|
| Rate for Payer: BCBS Complete |
$104.66
|
| Rate for Payer: BCBS MAPPO |
$146.27
|
| Rate for Payer: BCBS Trust/PPO |
$488.15
|
| Rate for Payer: BCN Commercial |
$270.24
|
| Rate for Payer: BCN Medicare Advantage |
$146.27
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$210.63
|
| Rate for Payer: Cofinity Commercial |
$196.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.27
|
| Rate for Payer: Healthscope Commercial |
$270.60
|
| Rate for Payer: Healthscope Commercial |
$234.03
|
| Rate for Payer: Mclaren Medicaid |
$99.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.58
|
| Rate for Payer: Meridian Medicaid |
$104.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,238.00
|
| Rate for Payer: Nomi Health Commercial |
$175.52
|
| Rate for Payer: PACE SWMI |
$146.27
|
| Rate for Payer: PHP Medicare Advantage |
$146.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$233.63
|
| Rate for Payer: Priority Health Medicare |
$146.27
|
| Rate for Payer: Priority Health Narrow Network |
$233.63
|
| Rate for Payer: Priority Health SBD |
$233.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.27
|
| Rate for Payer: UHC Exchange |
$186.84
|
| Rate for Payer: UHC Medicare Advantage |
$146.27
|
| Rate for Payer: UHCCP Medicaid |
$99.68
|
|
