|
PR MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99150
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 99143
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Medicare |
$93.00
|
| Rate for Payer: BCBS Complete |
$74.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.90
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 99144
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Medicare |
$69.00
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 99145
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
|
|
PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 99157
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$9,132.00 |
| Rate for Payer: Aetna Commercial |
$73.82
|
| Rate for Payer: Aetna Medicare |
$57.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.82
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCBS MAPPO |
$55.09
|
| Rate for Payer: BCBS Trust/PPO |
$660.90
|
| Rate for Payer: BCN Commercial |
$98.47
|
| Rate for Payer: BCN Medicare Advantage |
$55.09
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$79.33
|
| Rate for Payer: Cofinity Commercial |
$73.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.09
|
| Rate for Payer: Healthscope Commercial |
$101.92
|
| Rate for Payer: Healthscope Commercial |
$88.14
|
| Rate for Payer: Mclaren Medicaid |
$36.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.84
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,132.00
|
| Rate for Payer: Nomi Health Commercial |
$66.11
|
| Rate for Payer: PACE SWMI |
$55.09
|
| Rate for Payer: PHP Medicare Advantage |
$55.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.91
|
| Rate for Payer: Priority Health Medicare |
$55.09
|
| Rate for Payer: Priority Health Narrow Network |
$169.91
|
| Rate for Payer: Priority Health SBD |
$169.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.09
|
| Rate for Payer: UHC Medicare Advantage |
$55.09
|
| Rate for Payer: UHCCP Medicaid |
$36.42
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 99155
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$12,326.00 |
| Rate for Payer: Aetna Commercial |
$106.85
|
| Rate for Payer: Aetna Medicare |
$82.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.83
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS MAPPO |
$79.74
|
| Rate for Payer: BCBS Trust/PPO |
$880.15
|
| Rate for Payer: BCN Commercial |
$131.29
|
| Rate for Payer: BCN Medicare Advantage |
$79.74
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$114.83
|
| Rate for Payer: Cofinity Commercial |
$106.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$127.58
|
| Rate for Payer: Healthscope Commercial |
$147.52
|
| Rate for Payer: Mclaren Medicaid |
$52.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.73
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,326.00
|
| Rate for Payer: Nomi Health Commercial |
$95.69
|
| Rate for Payer: PACE SWMI |
$79.74
|
| Rate for Payer: PHP Medicare Advantage |
$79.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.50
|
| Rate for Payer: Priority Health Medicare |
$79.74
|
| Rate for Payer: Priority Health Narrow Network |
$236.50
|
| Rate for Payer: Priority Health SBD |
$236.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.74
|
| Rate for Payer: UHC Medicare Advantage |
$79.74
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99156
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$11,270.00 |
| Rate for Payer: Aetna Commercial |
$95.05
|
| Rate for Payer: Aetna Medicare |
$73.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.05
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$70.93
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.53
|
| Rate for Payer: BCN Medicare Advantage |
$70.93
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Cofinity Commercial |
$102.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.93
|
| Rate for Payer: Healthscope Commercial |
$113.49
|
| Rate for Payer: Healthscope Commercial |
$131.22
|
| Rate for Payer: Mclaren Medicaid |
$46.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.48
|
| Rate for Payer: Meridian Medicaid |
$49.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,270.00
|
| Rate for Payer: Nomi Health Commercial |
$85.12
|
| Rate for Payer: PACE SWMI |
$70.93
|
| Rate for Payer: PHP Medicare Advantage |
$70.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.31
|
| Rate for Payer: Priority Health Medicare |
$70.93
|
| Rate for Payer: Priority Health Narrow Network |
$214.31
|
| Rate for Payer: Priority Health SBD |
$214.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.93
|
| Rate for Payer: UHC Medicare Advantage |
$70.93
|
| Rate for Payer: UHCCP Medicaid |
$46.86
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 99153
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$1,545.00 |
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Medicare |
$11.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.52
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$10.78
|
| Rate for Payer: BCBS Trust/PPO |
$674.11
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: BCN Medicare Advantage |
$10.78
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.78
|
| Rate for Payer: Healthscope Commercial |
$17.25
|
| Rate for Payer: Healthscope Commercial |
$19.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,545.00
|
| Rate for Payer: Nomi Health Commercial |
$12.94
|
| Rate for Payer: PACE SWMI |
$10.78
|
| Rate for Payer: PHP Medicare Advantage |
$10.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.20
|
| Rate for Payer: Priority Health Medicare |
$10.78
|
| Rate for Payer: Priority Health Narrow Network |
$19.20
|
| Rate for Payer: Priority Health SBD |
$19.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.78
|
| Rate for Payer: UHC Medicare Advantage |
$10.78
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99151
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$3,594.00 |
| Rate for Payer: Aetna Commercial |
$30.31
|
| Rate for Payer: Aetna Medicare |
$23.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.57
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$22.62
|
| Rate for Payer: BCBS Trust/PPO |
$726.41
|
| Rate for Payer: BCN Commercial |
$96.86
|
| Rate for Payer: BCN Medicare Advantage |
$22.62
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$32.57
|
| Rate for Payer: Cofinity Commercial |
$30.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.62
|
| Rate for Payer: Healthscope Commercial |
$36.19
|
| Rate for Payer: Healthscope Commercial |
$41.85
|
| Rate for Payer: Mclaren Medicaid |
$15.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.75
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,594.00
|
| Rate for Payer: Nomi Health Commercial |
$27.14
|
| Rate for Payer: PACE SWMI |
$22.62
|
| Rate for Payer: PHP Medicare Advantage |
$22.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.53
|
| Rate for Payer: Priority Health Medicare |
$22.62
|
| Rate for Payer: Priority Health Narrow Network |
$68.53
|
| Rate for Payer: Priority Health SBD |
$68.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.62
|
| Rate for Payer: UHC Medicare Advantage |
$22.62
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99152
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$1,860.00 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.68
|
| Rate for Payer: BCBS Complete |
$8.05
|
| Rate for Payer: BCBS MAPPO |
$11.58
|
| Rate for Payer: BCBS Trust/PPO |
$552.07
|
| Rate for Payer: BCN Commercial |
$80.72
|
| Rate for Payer: BCN Medicare Advantage |
$11.58
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.58
|
| Rate for Payer: Healthscope Commercial |
$18.53
|
| Rate for Payer: Healthscope Commercial |
$21.42
|
| Rate for Payer: Mclaren Medicaid |
$7.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.16
|
| Rate for Payer: Meridian Medicaid |
$8.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,860.00
|
| Rate for Payer: Nomi Health Commercial |
$13.90
|
| Rate for Payer: PACE SWMI |
$11.58
|
| Rate for Payer: PHP Medicare Advantage |
$11.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.51
|
| Rate for Payer: Priority Health Medicare |
$11.58
|
| Rate for Payer: Priority Health Narrow Network |
$39.51
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$11.58
|
| Rate for Payer: UHCCP Medicaid |
$7.67
|
|
|
PR MONALISA TOUCH, SERIES, UP TO 7 VISITS, LICHEN SCLEROSUS
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 00560
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Medicare |
$1,071.00
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
|
|
PR MONOVISC INJ PER DOSE
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS J7327
|
| Min. Negotiated Rate |
$376.40 |
| Max. Negotiated Rate |
$72,829.00 |
| Rate for Payer: Aetna Commercial |
$708.29
|
| Rate for Payer: Aetna Medicare |
$549.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.15
|
| Rate for Payer: BCBS Complete |
$376.40
|
| Rate for Payer: BCBS MAPPO |
$528.58
|
| Rate for Payer: BCBS Trust/PPO |
$727.84
|
| Rate for Payer: BCN Commercial |
$800.00
|
| Rate for Payer: BCN Medicare Advantage |
$528.58
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$761.15
|
| Rate for Payer: Cofinity Commercial |
$708.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.58
|
| Rate for Payer: Healthscope Commercial |
$845.72
|
| Rate for Payer: Healthscope Commercial |
$977.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72,829.00
|
| Rate for Payer: Nomi Health Commercial |
$634.29
|
| Rate for Payer: PACE SWMI |
$528.58
|
| Rate for Payer: PHP Medicare Advantage |
$528.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health Medicare |
$528.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$598.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.58
|
| Rate for Payer: UHC Exchange |
$598.53
|
| Rate for Payer: UHC Medicare Advantage |
$528.58
|
|
|
PR MORPHINE SULFATE INJECTION
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2270
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.54
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$4.54
|
| Rate for Payer: BCBS Trust/PPO |
$0.09
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.54
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Cofinity Commercial |
$6.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.54
|
| Rate for Payer: Healthscope Commercial |
$7.27
|
| Rate for Payer: Healthscope Commercial |
$8.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.00
|
| Rate for Payer: Nomi Health Commercial |
$5.45
|
| Rate for Payer: PACE SWMI |
$4.54
|
| Rate for Payer: PHP Medicare Advantage |
$4.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$4.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.54
|
| Rate for Payer: UHC Exchange |
$4.85
|
| Rate for Payer: UHC Medicare Advantage |
$4.54
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 95905
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4,809.00 |
| Rate for Payer: Aetna Commercial |
$39.11
|
| Rate for Payer: Aetna Medicare |
$30.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.03
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS MAPPO |
$29.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,790.41
|
| Rate for Payer: BCN Commercial |
$50.33
|
| Rate for Payer: BCN Medicare Advantage |
$29.19
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cofinity Commercial |
$42.03
|
| Rate for Payer: Cofinity Commercial |
$39.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.19
|
| Rate for Payer: Healthscope Commercial |
$46.70
|
| Rate for Payer: Healthscope Commercial |
$54.00
|
| Rate for Payer: Mclaren Medicaid |
$1.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.65
|
| Rate for Payer: Meridian Medicaid |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,809.00
|
| Rate for Payer: Nomi Health Commercial |
$35.03
|
| Rate for Payer: PACE SWMI |
$29.19
|
| Rate for Payer: PHP Medicare Advantage |
$29.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.68
|
| Rate for Payer: Priority Health Medicare |
$29.19
|
| Rate for Payer: Priority Health Narrow Network |
$45.68
|
| Rate for Payer: Priority Health SBD |
$3.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.19
|
| Rate for Payer: UHC Medicare Advantage |
$29.19
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
|
|
PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 90733
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$11,762.00 |
| Rate for Payer: Aetna Commercial |
$125.50
|
| Rate for Payer: Aetna Medicare |
$64.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.50
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS Trust/PPO |
$125.49
|
| Rate for Payer: BCN Commercial |
$123.17
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,762.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.51
|
| Rate for Payer: UHC Exchange |
$156.51
|
|
|
PR MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 97157
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$997.43 |
| Rate for Payer: Aetna Commercial |
$20.79
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.79
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$997.43
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.60
|
| Rate for Payer: Priority Health Narrow Network |
$27.60
|
| Rate for Payer: Priority Health SBD |
$27.60
|
|
|
PR MULTIPLE FAMILY GROUP PSYCHOTHERAPY
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 90849
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$4,220.00 |
| Rate for Payer: Aetna Commercial |
$38.67
|
| Rate for Payer: Aetna Medicare |
$30.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.56
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS MAPPO |
$28.86
|
| Rate for Payer: BCBS Trust/PPO |
$58.11
|
| Rate for Payer: BCN Commercial |
$53.75
|
| Rate for Payer: BCN Medicare Advantage |
$28.86
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$41.56
|
| Rate for Payer: Cofinity Commercial |
$38.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.86
|
| Rate for Payer: Healthscope Commercial |
$53.39
|
| Rate for Payer: Healthscope Commercial |
$46.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,220.00
|
| Rate for Payer: Nomi Health Commercial |
$34.63
|
| Rate for Payer: PACE SWMI |
$28.86
|
| Rate for Payer: PHP Medicare Advantage |
$28.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.14
|
| Rate for Payer: Priority Health Medicare |
$28.86
|
| Rate for Payer: Priority Health Narrow Network |
$38.14
|
| Rate for Payer: Priority Health SBD |
$38.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.86
|
| Rate for Payer: UHC Exchange |
$36.79
|
| Rate for Payer: UHC Medicare Advantage |
$28.86
|
|
|
PR MUSCLE-SKIN FLAP,HEAD/NECK
|
Professional
|
Both
|
$3,247.00
|
|
|
Service Code
|
HCPCS 15732
|
| Min. Negotiated Rate |
$1,298.80 |
| Max. Negotiated Rate |
$2,110.55 |
| Rate for Payer: Aetna Medicare |
$1,623.50
|
| Rate for Payer: BCBS Complete |
$1,298.80
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,110.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,110.55
|
|
|
PR MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE
|
Professional
|
Both
|
$1,140.00
|
|
|
Service Code
|
HCPCS 24301
|
| Min. Negotiated Rate |
$114.64 |
| Max. Negotiated Rate |
$133,859.00 |
| Rate for Payer: Aetna Commercial |
$972.37
|
| Rate for Payer: Aetna Medicare |
$754.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,044.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$972.37
|
| Rate for Payer: BCBS Complete |
$514.62
|
| Rate for Payer: BCBS MAPPO |
$725.65
|
| Rate for Payer: BCBS Trust/PPO |
$114.64
|
| Rate for Payer: BCN Commercial |
$1,109.30
|
| Rate for Payer: BCN Medicare Advantage |
$725.65
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cash Price |
$912.00
|
| Rate for Payer: Cofinity Commercial |
$972.37
|
| Rate for Payer: Cofinity Commercial |
$1,044.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$725.65
|
| Rate for Payer: Healthscope Commercial |
$1,342.45
|
| Rate for Payer: Healthscope Commercial |
$1,161.04
|
| Rate for Payer: Mclaren Medicaid |
$490.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$761.93
|
| Rate for Payer: Meridian Medicaid |
$514.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133,859.00
|
| Rate for Payer: Nomi Health Commercial |
$870.78
|
| Rate for Payer: PACE SWMI |
$725.65
|
| Rate for Payer: PHP Medicare Advantage |
$725.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$741.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,161.22
|
| Rate for Payer: Priority Health Medicare |
$725.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,161.22
|
| Rate for Payer: Priority Health SBD |
$1,161.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$909.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$725.65
|
| Rate for Payer: UHC Exchange |
$909.69
|
| Rate for Payer: UHC Medicare Advantage |
$725.65
|
| Rate for Payer: UHCCP Medicaid |
$490.11
|
|
|
PR MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE
|
Professional
|
Both
|
$3,065.00
|
|
|
Service Code
|
HCPCS 23397
|
| Min. Negotiated Rate |
$78.96 |
| Max. Negotiated Rate |
$202,160.00 |
| Rate for Payer: Aetna Commercial |
$1,468.88
|
| Rate for Payer: Aetna Medicare |
$1,140.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,468.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,578.50
|
| Rate for Payer: BCBS Complete |
$773.61
|
| Rate for Payer: BCBS MAPPO |
$1,096.18
|
| Rate for Payer: BCBS Trust/PPO |
$78.96
|
| Rate for Payer: BCN Commercial |
$1,668.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,096.18
|
| Rate for Payer: Cash Price |
$2,452.00
|
| Rate for Payer: Cash Price |
$2,452.00
|
| Rate for Payer: Cofinity Commercial |
$1,578.50
|
| Rate for Payer: Cofinity Commercial |
$1,468.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,096.18
|
| Rate for Payer: Healthscope Commercial |
$2,027.93
|
| Rate for Payer: Healthscope Commercial |
$1,753.89
|
| Rate for Payer: Mclaren Medicaid |
$736.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,150.99
|
| Rate for Payer: Meridian Medicaid |
$773.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202,160.00
|
| Rate for Payer: Nomi Health Commercial |
$1,315.42
|
| Rate for Payer: PACE SWMI |
$1,096.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,096.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$736.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,992.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,753.02
|
| Rate for Payer: Priority Health Medicare |
$1,096.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,753.02
|
| Rate for Payer: Priority Health SBD |
$1,753.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,298.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,096.18
|
| Rate for Payer: UHC Exchange |
$1,298.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,096.18
|
| Rate for Payer: UHCCP Medicaid |
$736.77
|
|
|
PR MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE
|
Professional
|
Both
|
$3,414.00
|
|
|
Service Code
|
HCPCS 23395
|
| Min. Negotiated Rate |
$61.98 |
| Max. Negotiated Rate |
$226,939.00 |
| Rate for Payer: Aetna Commercial |
$1,656.45
|
| Rate for Payer: Aetna Medicare |
$1,285.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,656.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,780.07
|
| Rate for Payer: BCBS Complete |
$874.02
|
| Rate for Payer: BCBS MAPPO |
$1,236.16
|
| Rate for Payer: BCBS Trust/PPO |
$61.98
|
| Rate for Payer: BCN Commercial |
$1,875.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,236.16
|
| Rate for Payer: Cash Price |
$2,731.20
|
| Rate for Payer: Cash Price |
$2,731.20
|
| Rate for Payer: Cofinity Commercial |
$1,780.07
|
| Rate for Payer: Cofinity Commercial |
$1,656.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,236.16
|
| Rate for Payer: Healthscope Commercial |
$2,286.90
|
| Rate for Payer: Healthscope Commercial |
$1,977.86
|
| Rate for Payer: Mclaren Medicaid |
$832.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,297.97
|
| Rate for Payer: Meridian Medicaid |
$874.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226,939.00
|
| Rate for Payer: Nomi Health Commercial |
$1,483.39
|
| Rate for Payer: PACE SWMI |
$1,236.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,236.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$832.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,219.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,972.34
|
| Rate for Payer: Priority Health Medicare |
$1,236.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,972.34
|
| Rate for Payer: Priority Health SBD |
$1,972.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,317.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,236.16
|
| Rate for Payer: UHC Exchange |
$1,317.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,236.16
|
| Rate for Payer: UHCCP Medicaid |
$832.40
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 15738
|
| Min. Negotiated Rate |
$75.69 |
| Max. Negotiated Rate |
$224,375.00 |
| Rate for Payer: Aetna Commercial |
$1,620.13
|
| Rate for Payer: Aetna Medicare |
$1,257.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,620.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,741.03
|
| Rate for Payer: BCBS Complete |
$852.56
|
| Rate for Payer: BCBS MAPPO |
$1,209.05
|
| Rate for Payer: BCBS Trust/PPO |
$75.69
|
| Rate for Payer: BCN Commercial |
$1,850.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,209.05
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cofinity Commercial |
$1,741.03
|
| Rate for Payer: Cofinity Commercial |
$1,620.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,209.05
|
| Rate for Payer: Healthscope Commercial |
$2,236.74
|
| Rate for Payer: Healthscope Commercial |
$1,934.48
|
| Rate for Payer: Mclaren Medicaid |
$811.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,269.50
|
| Rate for Payer: Meridian Medicaid |
$852.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224,375.00
|
| Rate for Payer: Nomi Health Commercial |
$1,450.86
|
| Rate for Payer: PACE SWMI |
$1,209.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,209.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$811.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,715.31
|
| Rate for Payer: Priority Health Medicare |
$1,209.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,715.31
|
| Rate for Payer: Priority Health SBD |
$1,715.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,510.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,209.05
|
| Rate for Payer: UHC Exchange |
$1,510.68
|
| Rate for Payer: UHC Medicare Advantage |
$1,209.05
|
| Rate for Payer: UHCCP Medicaid |
$811.96
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Professional
|
Both
|
$4,600.00
|
|
|
Service Code
|
HCPCS 15734
|
| Min. Negotiated Rate |
$75.69 |
| Max. Negotiated Rate |
$266,202.00 |
| Rate for Payer: Aetna Commercial |
$1,934.76
|
| Rate for Payer: Aetna Medicare |
$1,501.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,934.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,079.14
|
| Rate for Payer: BCBS Complete |
$1,013.81
|
| Rate for Payer: BCBS MAPPO |
$1,443.85
|
| Rate for Payer: BCBS Trust/PPO |
$75.69
|
| Rate for Payer: BCN Commercial |
$2,188.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,443.85
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cofinity Commercial |
$2,079.14
|
| Rate for Payer: Cofinity Commercial |
$1,934.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,443.85
|
| Rate for Payer: Healthscope Commercial |
$2,671.12
|
| Rate for Payer: Healthscope Commercial |
$2,310.16
|
| Rate for Payer: Mclaren Medicaid |
$965.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.04
|
| Rate for Payer: Meridian Medicaid |
$1,013.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266,202.00
|
| Rate for Payer: Nomi Health Commercial |
$1,732.62
|
| Rate for Payer: PACE SWMI |
$1,443.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,443.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$965.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,990.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,032.28
|
| Rate for Payer: Priority Health Medicare |
$1,443.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,032.28
|
| Rate for Payer: Priority Health SBD |
$2,032.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,500.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,443.85
|
| Rate for Payer: UHC Exchange |
$1,500.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,443.85
|
| Rate for Payer: UHCCP Medicaid |
$965.53
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Professional
|
Both
|
$4,600.00
|
|
|
Service Code
|
HCPCS 15734
|
| Hospital Charge Code |
15734
|
| Min. Negotiated Rate |
$75.69 |
| Max. Negotiated Rate |
$266,202.00 |
| Rate for Payer: Aetna Commercial |
$1,934.76
|
| Rate for Payer: Aetna Medicare |
$1,501.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,934.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,079.14
|
| Rate for Payer: BCBS Complete |
$1,013.81
|
| Rate for Payer: BCBS MAPPO |
$1,443.85
|
| Rate for Payer: BCBS Trust/PPO |
$75.69
|
| Rate for Payer: BCN Commercial |
$2,188.30
|
| Rate for Payer: BCN Medicare Advantage |
$1,443.85
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cofinity Commercial |
$2,079.14
|
| Rate for Payer: Cofinity Commercial |
$1,934.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,443.85
|
| Rate for Payer: Healthscope Commercial |
$2,671.12
|
| Rate for Payer: Healthscope Commercial |
$2,310.16
|
| Rate for Payer: Mclaren Medicaid |
$965.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,516.04
|
| Rate for Payer: Meridian Medicaid |
$1,013.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$266,202.00
|
| Rate for Payer: Nomi Health Commercial |
$1,732.62
|
| Rate for Payer: PACE SWMI |
$1,443.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,443.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$965.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,990.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,032.28
|
| Rate for Payer: Priority Health Medicare |
$1,443.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,032.28
|
| Rate for Payer: Priority Health SBD |
$2,032.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,500.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,443.85
|
| Rate for Payer: UHC Exchange |
$1,500.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,443.85
|
| Rate for Payer: UHCCP Medicaid |
$965.53
|
|
|
PR MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK
|
Facility
|
IP
|
$4,600.00
|
|
|
Service Code
|
CPT 15734
|
| Hospital Charge Code |
15734
|
| Min. Negotiated Rate |
$2,898.00 |
| Max. Negotiated Rate |
$4,140.00 |
| Rate for Payer: Aetna Commercial |
$3,910.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,990.00
|
| Rate for Payer: Cash Price |
$3,680.00
|
| Rate for Payer: Cofinity Commercial |
$3,220.00
|
| Rate for Payer: Cofinity Commercial |
$3,956.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,220.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,680.00
|
| Rate for Payer: Healthscope Commercial |
$4,140.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,910.00
|
| Rate for Payer: PHP Commercial |
$3,910.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,990.00
|
| Rate for Payer: Priority Health SBD |
$2,898.00
|
|
