|
PR IP/OBS CONSLTJ NEW/EST PT HIGH MDM 80 MINUTES
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 99255
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$269.75 |
| Rate for Payer: Aetna Commercial |
$208.05
|
| Rate for Payer: Aetna Medicare |
$174.00
|
| Rate for Payer: BCBS Complete |
$123.46
|
| Rate for Payer: BCBS Trust/PPO |
$75.02
|
| Rate for Payer: BCN Commercial |
$269.75
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Mclaren Medicaid |
$117.58
|
| Rate for Payer: Meridian Medicaid |
$123.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health HMO/PPO |
$248.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.14
|
| Rate for Payer: UHCCP Medicaid |
$117.58
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 99253
|
| Min. Negotiated Rate |
$63.26 |
| Max. Negotiated Rate |
$286.87 |
| Rate for Payer: Aetna Commercial |
$119.14
|
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: BCBS Complete |
$66.42
|
| Rate for Payer: BCBS Trust/PPO |
$286.87
|
| Rate for Payer: BCN Commercial |
$144.65
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Mclaren Medicaid |
$63.26
|
| Rate for Payer: Meridian Medicaid |
$66.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO |
$132.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.81
|
| Rate for Payer: UHCCP Medicaid |
$63.26
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 99254
|
| Min. Negotiated Rate |
$87.54 |
| Max. Negotiated Rate |
$245.66 |
| Rate for Payer: Aetna Commercial |
$172.55
|
| Rate for Payer: Aetna Medicare |
$133.00
|
| Rate for Payer: BCBS Complete |
$91.92
|
| Rate for Payer: BCBS Trust/PPO |
$245.66
|
| Rate for Payer: BCN Commercial |
$201.34
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Mclaren Medicaid |
$87.54
|
| Rate for Payer: Meridian Medicaid |
$91.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health HMO/PPO |
$184.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.42
|
| Rate for Payer: UHCCP Medicaid |
$87.54
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT SF MDM 35 MINUTES
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 99252
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$77.71
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: BCBS Complete |
$46.97
|
| Rate for Payer: BCBS Trust/PPO |
$176.98
|
| Rate for Payer: BCN Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Mclaren Medicaid |
$44.73
|
| Rate for Payer: Meridian Medicaid |
$46.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO |
$94.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$94.68
|
| Rate for Payer: UHCCP Medicaid |
$44.73
|
|
|
PR IPRATROPIUM BROMIDE NON-COMP
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J7644
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Commercial |
$0.53
|
| Rate for Payer: Aetna Medicare |
$0.41
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$0.39
|
| Rate for Payer: BCN Commercial |
$0.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.39
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$0.53
|
| Rate for Payer: Cofinity Commercial |
$0.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.41
|
| Rate for Payer: Nomi Health Commercial |
$0.47
|
| Rate for Payer: PACE SWMI |
$0.39
|
| Rate for Payer: PHP Medicare Advantage |
$0.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: Priority Health Medicare |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.39
|
| Rate for Payer: UHC Exchange |
$0.39
|
| Rate for Payer: UHC Medicare Advantage |
$0.39
|
|
|
PR IR DEEP HEAT PAIN RELIEF 15MIN
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00099
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 96523
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$1,469.20 |
| Rate for Payer: Aetna Commercial |
$28.70
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.20
|
| Rate for Payer: BCN Commercial |
$37.14
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Nomi Health Commercial |
$25.70
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO |
$33.93
|
| Rate for Payer: Priority Health Medicare |
$21.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Exchange |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
|
|
PR IRRIGATION CORPORA CAVERNOSA PRIAPISM
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 54220
|
| Min. Negotiated Rate |
$85.84 |
| Max. Negotiated Rate |
$460.68 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Medicare |
$134.19
|
| Rate for Payer: BCBS Complete |
$90.13
|
| Rate for Payer: BCBS MAPPO |
$129.03
|
| Rate for Payer: BCBS Trust/PPO |
$460.68
|
| Rate for Payer: BCN Commercial |
$321.55
|
| Rate for Payer: BCN Medicare Advantage |
$129.03
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cofinity Commercial |
$185.80
|
| Rate for Payer: Cofinity Commercial |
$172.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.03
|
| Rate for Payer: Mclaren Medicaid |
$85.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.48
|
| Rate for Payer: Meridian Medicaid |
$90.13
|
| Rate for Payer: Nomi Health Commercial |
$154.84
|
| Rate for Payer: PACE SWMI |
$129.03
|
| Rate for Payer: PHP Medicare Advantage |
$129.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.20
|
| Rate for Payer: Priority Health HMO/PPO |
$214.11
|
| Rate for Payer: Priority Health Medicare |
$130.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.03
|
| Rate for Payer: UHC Exchange |
$129.03
|
| Rate for Payer: UHC Medicare Advantage |
$129.03
|
| Rate for Payer: UHCCP Medicaid |
$85.84
|
|
|
PR IRRIGATION TRAY
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4320
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 57150
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$2,018.63 |
| Rate for Payer: Aetna Commercial |
$32.74
|
| Rate for Payer: Aetna Medicare |
$25.41
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$24.43
|
| Rate for Payer: BCBS Trust/PPO |
$2,018.63
|
| Rate for Payer: BCN Commercial |
$85.52
|
| Rate for Payer: BCN Medicare Advantage |
$24.43
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$35.18
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.65
|
| Rate for Payer: Nomi Health Commercial |
$29.32
|
| Rate for Payer: PACE SWMI |
$24.43
|
| Rate for Payer: PHP Medicare Advantage |
$24.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO |
$38.19
|
| Rate for Payer: Priority Health Medicare |
$24.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.43
|
| Rate for Payer: UHC Exchange |
$24.43
|
| Rate for Payer: UHC Medicare Advantage |
$24.43
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 93571
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO |
$98.87
|
| Rate for Payer: Priority Health HMO/PPO |
$98.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.87
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 93572
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Commercial |
$145.84
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$165.66
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Mclaren Medicaid |
$32.59
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO |
$72.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.04
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
|
|
PR IV INFUSION HYDRATION EACH ADDITIONAL HOUR
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 96361
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$14.67
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$10.95
|
| Rate for Payer: BCBS Trust/PPO |
$22.72
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: BCN Medicare Advantage |
$10.95
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.50
|
| Rate for Payer: Nomi Health Commercial |
$13.14
|
| Rate for Payer: PACE SWMI |
$10.95
|
| Rate for Payer: PHP Medicare Advantage |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health HMO/PPO |
$16.74
|
| Rate for Payer: Priority Health Medicare |
$11.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.95
|
| Rate for Payer: UHC Exchange |
$10.95
|
| Rate for Payer: UHC Medicare Advantage |
$10.95
|
|
|
PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 96360
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$190.72 |
| Rate for Payer: Aetna Commercial |
$37.49
|
| Rate for Payer: Aetna Medicare |
$29.10
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS MAPPO |
$27.98
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: BCN Medicare Advantage |
$27.98
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Cofinity Commercial |
$37.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.38
|
| Rate for Payer: Nomi Health Commercial |
$33.58
|
| Rate for Payer: PACE SWMI |
$27.98
|
| Rate for Payer: PHP Medicare Advantage |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health HMO/PPO |
$43.88
|
| Rate for Payer: Priority Health Medicare |
$28.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.98
|
| Rate for Payer: UHC Exchange |
$27.98
|
| Rate for Payer: UHC Medicare Advantage |
$27.98
|
|
|
PR IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 96365
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$71.94
|
| Rate for Payer: Aetna Medicare |
$55.84
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$53.69
|
| Rate for Payer: BCBS Trust/PPO |
$168.00
|
| Rate for Payer: BCN Commercial |
$93.34
|
| Rate for Payer: BCN Medicare Advantage |
$53.69
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$71.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.37
|
| Rate for Payer: Nomi Health Commercial |
$64.43
|
| Rate for Payer: PACE SWMI |
$53.69
|
| Rate for Payer: PHP Medicare Advantage |
$53.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health HMO/PPO |
$85.03
|
| Rate for Payer: Priority Health Medicare |
$54.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.69
|
| Rate for Payer: UHC Exchange |
$53.69
|
| Rate for Payer: UHC Medicare Advantage |
$53.69
|
|
|
PR IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 96366
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$1,006.94 |
| Rate for Payer: Aetna Commercial |
$24.50
|
| Rate for Payer: Aetna Medicare |
$19.01
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$18.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.94
|
| Rate for Payer: BCN Commercial |
$29.81
|
| Rate for Payer: BCN Medicare Advantage |
$18.28
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$21.94
|
| Rate for Payer: PACE SWMI |
$18.28
|
| Rate for Payer: PHP Medicare Advantage |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO |
$27.60
|
| Rate for Payer: Priority Health Medicare |
$18.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.28
|
| Rate for Payer: UHC Exchange |
$18.28
|
| Rate for Payer: UHC Medicare Advantage |
$18.28
|
|
|
PR IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 96367
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$1,165.43 |
| Rate for Payer: Aetna Commercial |
$33.23
|
| Rate for Payer: Aetna Medicare |
$25.79
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS MAPPO |
$24.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.43
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Medicare Advantage |
$24.80
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$35.71
|
| Rate for Payer: Cofinity Commercial |
$33.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.04
|
| Rate for Payer: Nomi Health Commercial |
$29.76
|
| Rate for Payer: PACE SWMI |
$24.80
|
| Rate for Payer: PHP Medicare Advantage |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO |
$38.44
|
| Rate for Payer: Priority Health Medicare |
$25.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.80
|
| Rate for Payer: UHC Exchange |
$24.80
|
| Rate for Payer: UHC Medicare Advantage |
$24.80
|
|
|
PR IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 15860
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$10,615.31 |
| Rate for Payer: Aetna Commercial |
$137.81
|
| Rate for Payer: Aetna Medicare |
$106.95
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCBS MAPPO |
$102.84
|
| Rate for Payer: BCBS Trust/PPO |
$10,615.31
|
| Rate for Payer: BCN Commercial |
$154.42
|
| Rate for Payer: BCN Medicare Advantage |
$102.84
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Cofinity Commercial |
$148.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.84
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.98
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Nomi Health Commercial |
$123.41
|
| Rate for Payer: PACE SWMI |
$102.84
|
| Rate for Payer: PHP Medicare Advantage |
$102.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health HMO/PPO |
$142.68
|
| Rate for Payer: Priority Health Medicare |
$103.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.84
|
| Rate for Payer: UHC Exchange |
$102.84
|
| Rate for Payer: UHC Medicare Advantage |
$102.84
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
PR IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 96368
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$1,117.88 |
| Rate for Payer: Aetna Commercial |
$23.28
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$17.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.88
|
| Rate for Payer: BCN Commercial |
$28.83
|
| Rate for Payer: BCN Medicare Advantage |
$17.37
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$23.28
|
| Rate for Payer: Cofinity Commercial |
$25.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.24
|
| Rate for Payer: Nomi Health Commercial |
$20.84
|
| Rate for Payer: PACE SWMI |
$17.37
|
| Rate for Payer: PHP Medicare Advantage |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health HMO/PPO |
$26.69
|
| Rate for Payer: Priority Health Medicare |
$17.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.37
|
| Rate for Payer: UHC Exchange |
$17.37
|
| Rate for Payer: UHC Medicare Advantage |
$17.37
|
|
|
PR IV ULTRASOUND,FIRST VESSEL
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 37250
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
|
|
PR KETOROLAC TROMETHAMINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1885
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$0.46
|
| Rate for Payer: Aetna Medicare |
$0.36
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: BCN Medicare Advantage |
$0.35
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$0.50
|
| Rate for Payer: Cofinity Commercial |
$0.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.36
|
| Rate for Payer: Nomi Health Commercial |
$0.42
|
| Rate for Payer: PACE SWMI |
$0.35
|
| Rate for Payer: PHP Medicare Advantage |
$0.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$0.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.35
|
| Rate for Payer: UHC Exchange |
$0.35
|
| Rate for Payer: UHC Medicare Advantage |
$0.35
|
|
|
PR KO IMMOB CANVAS LONG PRE OTS
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS L1830
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$96.31 |
| Rate for Payer: Aetna Commercial |
$89.62
|
| Rate for Payer: Aetna Medicare |
$69.56
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$66.88
|
| Rate for Payer: BCN Commercial |
$64.89
|
| Rate for Payer: BCN Medicare Advantage |
$66.88
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$89.62
|
| Rate for Payer: Cofinity Commercial |
$96.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.22
|
| Rate for Payer: Nomi Health Commercial |
$80.26
|
| Rate for Payer: PACE SWMI |
$66.88
|
| Rate for Payer: PHP Medicare Advantage |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$67.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.88
|
| Rate for Payer: UHC Exchange |
$66.88
|
| Rate for Payer: UHC Medicare Advantage |
$66.88
|
|
|
PR KYBELLA
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00086
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
PR KYLEENA, 19.5 MG
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS Q9984
|
| Min. Negotiated Rate |
$350.80 |
| Max. Negotiated Rate |
$570.05 |
| Rate for Payer: Aetna Medicare |
$438.50
|
| Rate for Payer: BCBS Complete |
$350.80
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.05
|
|
|
PR KYLEENA, 19.5 MG
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7296
|
| Min. Negotiated Rate |
$736.00 |
| Max. Negotiated Rate |
$1,351.89 |
| Rate for Payer: Aetna Commercial |
$1,101.70
|
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: BCBS Complete |
$1,351.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.44
|
| Rate for Payer: BCN Commercial |
$1,121.75
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Mclaren Medicaid |
$1,287.51
|
| Rate for Payer: Meridian Medicaid |
$1,351.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,287.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.80
|
| Rate for Payer: UHCCP Medicaid |
$1,287.51
|
|
