|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
64624
|
| Min. Negotiated Rate |
$516.10 |
| Max. Negotiated Rate |
$714.60 |
| Rate for Payer: Aetna Commercial |
$674.90
|
| Rate for Payer: BCBS Trust/PPO |
$648.14
|
| Rate for Payer: BCN Commercial |
$613.60
|
| Rate for Payer: Cash Price |
$635.20
|
| Rate for Payer: Cofinity Commercial |
$682.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.20
|
| Rate for Payer: Healthscope Commercial |
$714.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$595.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$674.90
|
| Rate for Payer: Nomi Health Commercial |
$651.08
|
| Rate for Payer: PHP Commercial |
$674.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.10
|
| Rate for Payer: Priority Health HMO/PPO |
$690.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$531.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.72
|
| Rate for Payer: UHC Core |
$662.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$595.50
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 15/>
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 17004
|
| Min. Negotiated Rate |
$93.11 |
| Max. Negotiated Rate |
$202.15 |
| Rate for Payer: Aetna Commercial |
$124.77
|
| Rate for Payer: Aetna Medicare |
$96.83
|
| Rate for Payer: BCBS Complete |
$124.40
|
| Rate for Payer: BCBS MAPPO |
$93.11
|
| Rate for Payer: BCN Medicare Advantage |
$93.11
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$134.08
|
| Rate for Payer: Cofinity Commercial |
$124.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.77
|
| Rate for Payer: Nomi Health Commercial |
$111.73
|
| Rate for Payer: PACE SWMI |
$93.11
|
| Rate for Payer: PHP Medicare Advantage |
$93.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.15
|
| Rate for Payer: Priority Health Medicare |
$94.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.11
|
| Rate for Payer: UHC Exchange |
$93.11
|
| Rate for Payer: UHC Medicare Advantage |
$93.11
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 1ST
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 17000
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Aetna Commercial |
$68.47
|
| Rate for Payer: Aetna Medicare |
$53.14
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS MAPPO |
$51.10
|
| Rate for Payer: BCN Medicare Advantage |
$51.10
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$73.58
|
| Rate for Payer: Cofinity Commercial |
$68.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.66
|
| Rate for Payer: Nomi Health Commercial |
$61.32
|
| Rate for Payer: PACE SWMI |
$51.10
|
| Rate for Payer: PHP Medicare Advantage |
$51.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health Medicare |
$51.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.10
|
| Rate for Payer: UHC Exchange |
$51.10
|
| Rate for Payer: UHC Medicare Advantage |
$51.10
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 17003
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$1.96
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$1.88
|
| Rate for Payer: BCN Medicare Advantage |
$1.88
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.97
|
| Rate for Payer: Nomi Health Commercial |
$2.26
|
| Rate for Payer: PACE SWMI |
$1.88
|
| Rate for Payer: PHP Medicare Advantage |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Medicare |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.88
|
| Rate for Payer: UHC Exchange |
$1.88
|
| Rate for Payer: UHC Medicare Advantage |
$1.88
|
|
|
PR DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH
|
Professional
|
Both
|
$1,565.00
|
|
|
Service Code
|
HCPCS 45190
|
| Min. Negotiated Rate |
$626.00 |
| Max. Negotiated Rate |
$1,017.25 |
| Rate for Payer: Aetna Commercial |
$889.33
|
| Rate for Payer: Aetna Medicare |
$690.23
|
| Rate for Payer: BCBS Complete |
$626.00
|
| Rate for Payer: BCBS MAPPO |
$663.68
|
| Rate for Payer: BCN Medicare Advantage |
$663.68
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cash Price |
$1,252.00
|
| Rate for Payer: Cofinity Commercial |
$955.70
|
| Rate for Payer: Cofinity Commercial |
$889.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$663.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$696.86
|
| Rate for Payer: Nomi Health Commercial |
$796.42
|
| Rate for Payer: PACE SWMI |
$663.68
|
| Rate for Payer: PHP Medicare Advantage |
$663.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,017.25
|
| Rate for Payer: Priority Health Medicare |
$670.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$663.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$663.68
|
| Rate for Payer: UHC Exchange |
$663.68
|
| Rate for Payer: UHC Medicare Advantage |
$663.68
|
|
|
PR DESTRUCTION VAGINAL LESIONS EXTENSIVE
|
Professional
|
Both
|
$728.00
|
|
|
Service Code
|
HCPCS 57065
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$473.20 |
| Rate for Payer: Aetna Commercial |
$236.78
|
| Rate for Payer: Aetna Medicare |
$183.77
|
| Rate for Payer: BCBS Complete |
$291.20
|
| Rate for Payer: BCBS MAPPO |
$176.70
|
| Rate for Payer: BCN Medicare Advantage |
$176.70
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cash Price |
$582.40
|
| Rate for Payer: Cofinity Commercial |
$254.45
|
| Rate for Payer: Cofinity Commercial |
$236.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.53
|
| Rate for Payer: Nomi Health Commercial |
$212.04
|
| Rate for Payer: PACE SWMI |
$176.70
|
| Rate for Payer: PHP Medicare Advantage |
$176.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.20
|
| Rate for Payer: Priority Health Medicare |
$178.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.70
|
| Rate for Payer: UHC Exchange |
$176.70
|
| Rate for Payer: UHC Medicare Advantage |
$176.70
|
|
|
PR DESTRUCTION VAGINAL LESIONS SIMPLE
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 57061
|
| Min. Negotiated Rate |
$108.36 |
| Max. Negotiated Rate |
$235.30 |
| Rate for Payer: Aetna Commercial |
$145.20
|
| Rate for Payer: Aetna Medicare |
$112.69
|
| Rate for Payer: BCBS Complete |
$144.80
|
| Rate for Payer: BCBS MAPPO |
$108.36
|
| Rate for Payer: BCN Medicare Advantage |
$108.36
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cofinity Commercial |
$145.20
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.78
|
| Rate for Payer: Nomi Health Commercial |
$130.03
|
| Rate for Payer: PACE SWMI |
$108.36
|
| Rate for Payer: PHP Medicare Advantage |
$108.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.30
|
| Rate for Payer: Priority Health Medicare |
$109.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.36
|
| Rate for Payer: UHC Exchange |
$108.36
|
| Rate for Payer: UHC Medicare Advantage |
$108.36
|
|
|
PR DETERMINATION REFRACTIVE STATE
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 92015
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Medicare |
$48.00
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 96110
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
|
|
PR DEVELOPMENTAL TESTING W/INTERP & REPORT
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 96111
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
|
|
PR DEXAMETHASONE SODIUM PHOS
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1100
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Nomi Health Commercial |
$0.11
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
|
|
PR DIABETES PREVENTION PROGRAM
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 00268
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
|
|
PR DIABETES PREVENTION PROG STANDARDIZED CURRICULUM
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 0403T
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
|
|
PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$1,294.00
|
|
|
Service Code
|
HCPCS 29805
|
| Min. Negotiated Rate |
$454.35 |
| Max. Negotiated Rate |
$841.10 |
| Rate for Payer: Aetna Commercial |
$608.83
|
| Rate for Payer: Aetna Medicare |
$472.52
|
| Rate for Payer: BCBS Complete |
$517.60
|
| Rate for Payer: BCBS MAPPO |
$454.35
|
| Rate for Payer: BCN Medicare Advantage |
$454.35
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cofinity Commercial |
$608.83
|
| Rate for Payer: Cofinity Commercial |
$654.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$454.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$477.07
|
| Rate for Payer: Nomi Health Commercial |
$545.22
|
| Rate for Payer: PACE SWMI |
$454.35
|
| Rate for Payer: PHP Medicare Advantage |
$454.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.10
|
| Rate for Payer: Priority Health Medicare |
$458.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$454.35
|
| Rate for Payer: UHC Exchange |
$454.35
|
| Rate for Payer: UHC Medicare Advantage |
$454.35
|
|
|
PR DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 38220
|
| Min. Negotiated Rate |
$63.53 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna Medicare |
$66.07
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$63.53
|
| Rate for Payer: BCN Medicare Advantage |
$63.53
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$91.48
|
| Rate for Payer: Cofinity Commercial |
$85.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.71
|
| Rate for Payer: Nomi Health Commercial |
$76.24
|
| Rate for Payer: PACE SWMI |
$63.53
|
| Rate for Payer: PHP Medicare Advantage |
$63.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$64.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.53
|
| Rate for Payer: UHC Exchange |
$63.53
|
| Rate for Payer: UHC Medicare Advantage |
$63.53
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 38221
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$238.55 |
| Rate for Payer: Aetna Commercial |
$87.81
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: BCBS Complete |
$146.80
|
| Rate for Payer: BCBS MAPPO |
$65.53
|
| Rate for Payer: BCN Medicare Advantage |
$65.53
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$94.36
|
| Rate for Payer: Cofinity Commercial |
$87.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.81
|
| Rate for Payer: Nomi Health Commercial |
$78.64
|
| Rate for Payer: PACE SWMI |
$65.53
|
| Rate for Payer: PHP Medicare Advantage |
$65.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health Medicare |
$66.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.53
|
| Rate for Payer: UHC Exchange |
$65.53
|
| Rate for Payer: UHC Medicare Advantage |
$65.53
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 38222
|
| Min. Negotiated Rate |
$70.67 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: Aetna Commercial |
$94.70
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: BCBS Complete |
$155.20
|
| Rate for Payer: BCBS MAPPO |
$70.67
|
| Rate for Payer: BCN Medicare Advantage |
$70.67
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$94.70
|
| Rate for Payer: Cofinity Commercial |
$101.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.20
|
| Rate for Payer: Nomi Health Commercial |
$84.80
|
| Rate for Payer: PACE SWMI |
$70.67
|
| Rate for Payer: PHP Medicare Advantage |
$70.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.20
|
| Rate for Payer: Priority Health Medicare |
$71.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.67
|
| Rate for Payer: UHC Exchange |
$70.67
|
| Rate for Payer: UHC Medicare Advantage |
$70.67
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 62270
|
| Min. Negotiated Rate |
$62.76 |
| Max. Negotiated Rate |
$367.90 |
| Rate for Payer: Aetna Commercial |
$84.10
|
| Rate for Payer: Aetna Medicare |
$65.27
|
| Rate for Payer: BCBS Complete |
$226.40
|
| Rate for Payer: BCBS MAPPO |
$62.76
|
| Rate for Payer: BCN Medicare Advantage |
$62.76
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Cofinity Commercial |
$84.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.90
|
| Rate for Payer: Nomi Health Commercial |
$75.31
|
| Rate for Payer: PACE SWMI |
$62.76
|
| Rate for Payer: PHP Medicare Advantage |
$62.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.90
|
| Rate for Payer: Priority Health Medicare |
$63.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.76
|
| Rate for Payer: UHC Exchange |
$62.76
|
| Rate for Payer: UHC Medicare Advantage |
$62.76
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 62328
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$116.48 |
| Rate for Payer: Aetna Commercial |
$108.39
|
| Rate for Payer: Aetna Medicare |
$84.13
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$80.89
|
| Rate for Payer: BCN Medicare Advantage |
$80.89
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$116.48
|
| Rate for Payer: Cofinity Commercial |
$108.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.93
|
| Rate for Payer: Nomi Health Commercial |
$97.07
|
| Rate for Payer: PACE SWMI |
$80.89
|
| Rate for Payer: PHP Medicare Advantage |
$80.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Medicare |
$81.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.89
|
| Rate for Payer: UHC Exchange |
$80.89
|
| Rate for Payer: UHC Medicare Advantage |
$80.89
|
|
|
PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 36909
|
| Min. Negotiated Rate |
$190.13 |
| Max. Negotiated Rate |
$1,002.30 |
| Rate for Payer: Aetna Commercial |
$254.77
|
| Rate for Payer: Aetna Medicare |
$197.74
|
| Rate for Payer: BCBS Complete |
$616.80
|
| Rate for Payer: BCBS MAPPO |
$190.13
|
| Rate for Payer: BCN Medicare Advantage |
$190.13
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cofinity Commercial |
$273.79
|
| Rate for Payer: Cofinity Commercial |
$254.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.64
|
| Rate for Payer: Nomi Health Commercial |
$228.16
|
| Rate for Payer: PACE SWMI |
$190.13
|
| Rate for Payer: PHP Medicare Advantage |
$190.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.30
|
| Rate for Payer: Priority Health Medicare |
$192.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.13
|
| Rate for Payer: UHC Exchange |
$190.13
|
| Rate for Payer: UHC Medicare Advantage |
$190.13
|
|
|
PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 90945
|
| Min. Negotiated Rate |
$81.07 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Commercial |
$108.63
|
| Rate for Payer: Aetna Medicare |
$84.31
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$81.07
|
| Rate for Payer: BCN Medicare Advantage |
$81.07
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$116.74
|
| Rate for Payer: Cofinity Commercial |
$108.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.12
|
| Rate for Payer: Nomi Health Commercial |
$97.28
|
| Rate for Payer: PACE SWMI |
$81.07
|
| Rate for Payer: PHP Medicare Advantage |
$81.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Medicare |
$81.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.07
|
| Rate for Payer: UHC Exchange |
$81.07
|
| Rate for Payer: UHC Medicare Advantage |
$81.07
|
|
|
PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 90947
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$215.80 |
| Rate for Payer: Aetna Commercial |
$154.98
|
| Rate for Payer: Aetna Medicare |
$120.29
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS MAPPO |
$115.66
|
| Rate for Payer: BCN Medicare Advantage |
$115.66
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$166.55
|
| Rate for Payer: Cofinity Commercial |
$154.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.44
|
| Rate for Payer: Nomi Health Commercial |
$138.79
|
| Rate for Payer: PACE SWMI |
$115.66
|
| Rate for Payer: PHP Medicare Advantage |
$115.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health Medicare |
$116.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.66
|
| Rate for Payer: UHC Exchange |
$115.66
|
| Rate for Payer: UHC Medicare Advantage |
$115.66
|
|
|
PR DIAPHRAGM
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS A4266
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
|
|
PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 57170
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$147.55 |
| Rate for Payer: Aetna Commercial |
$61.40
|
| Rate for Payer: Aetna Medicare |
$47.65
|
| Rate for Payer: BCBS Complete |
$90.80
|
| Rate for Payer: BCBS MAPPO |
$45.82
|
| Rate for Payer: BCN Medicare Advantage |
$45.82
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$65.98
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.11
|
| Rate for Payer: Nomi Health Commercial |
$54.98
|
| Rate for Payer: PACE SWMI |
$45.82
|
| Rate for Payer: PHP Medicare Advantage |
$45.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.82
|
| Rate for Payer: UHC Exchange |
$45.82
|
| Rate for Payer: UHC Medicare Advantage |
$45.82
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 95957
|
| Min. Negotiated Rate |
$263.30 |
| Max. Negotiated Rate |
$505.70 |
| Rate for Payer: Aetna Commercial |
$352.82
|
| Rate for Payer: Aetna Medicare |
$273.83
|
| Rate for Payer: BCBS Complete |
$311.20
|
| Rate for Payer: BCBS MAPPO |
$263.30
|
| Rate for Payer: BCN Medicare Advantage |
$263.30
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cofinity Commercial |
$352.82
|
| Rate for Payer: Cofinity Commercial |
$379.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.46
|
| Rate for Payer: Nomi Health Commercial |
$315.96
|
| Rate for Payer: PACE SWMI |
$263.30
|
| Rate for Payer: PHP Medicare Advantage |
$263.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.70
|
| Rate for Payer: Priority Health Medicare |
$265.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.30
|
| Rate for Payer: UHC Exchange |
$263.30
|
| Rate for Payer: UHC Medicare Advantage |
$263.30
|
|
