|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 58605
|
| Min. Negotiated Rate |
$216.62 |
| Max. Negotiated Rate |
$562.25 |
| Rate for Payer: Aetna Commercial |
$431.94
|
| Rate for Payer: Aetna Medicare |
$335.23
|
| Rate for Payer: BCBS Complete |
$227.45
|
| Rate for Payer: BCBS MAPPO |
$322.34
|
| Rate for Payer: BCBS Trust/PPO |
$264.15
|
| Rate for Payer: BCN Commercial |
$496.00
|
| Rate for Payer: BCN Medicare Advantage |
$322.34
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$431.94
|
| Rate for Payer: Cofinity Commercial |
$464.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.34
|
| Rate for Payer: Mclaren Medicaid |
$216.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.46
|
| Rate for Payer: Meridian Medicaid |
$227.45
|
| Rate for Payer: Nomi Health Commercial |
$386.81
|
| Rate for Payer: PACE SWMI |
$322.34
|
| Rate for Payer: PHP Medicare Advantage |
$322.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$216.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health HMO/PPO |
$506.47
|
| Rate for Payer: Priority Health Medicare |
$325.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$506.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.34
|
| Rate for Payer: UHC Exchange |
$322.34
|
| Rate for Payer: UHC Medicare Advantage |
$322.34
|
| Rate for Payer: UHCCP Medicaid |
$216.62
|
|
|
PR LILETTA, 52 MG
|
Professional
|
Both
|
$880.00
|
|
|
Service Code
|
HCPCS J7297
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$1,037.01 |
| Rate for Payer: Aetna Commercial |
$845.10
|
| Rate for Payer: Aetna Medicare |
$440.00
|
| Rate for Payer: BCBS Complete |
$1,037.01
|
| Rate for Payer: BCBS Trust/PPO |
$856.93
|
| Rate for Payer: BCN Commercial |
$856.93
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Cash Price |
$704.00
|
| Rate for Payer: Mclaren Medicaid |
$987.63
|
| Rate for Payer: Meridian Medicaid |
$1,037.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$987.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$572.00
|
| Rate for Payer: UHCCP Medicaid |
$987.63
|
|
|
PR LIMITED VISUAL FIELD XM UNI/BI I&R
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 92081
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$1,007.47 |
| Rate for Payer: Aetna Commercial |
$40.87
|
| Rate for Payer: Aetna Medicare |
$31.72
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCBS MAPPO |
$30.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.47
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: BCN Medicare Advantage |
$30.50
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$43.92
|
| Rate for Payer: Cofinity Commercial |
$40.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.50
|
| Rate for Payer: Mclaren Medicaid |
$10.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.02
|
| Rate for Payer: Meridian Medicaid |
$10.51
|
| Rate for Payer: Nomi Health Commercial |
$36.60
|
| Rate for Payer: PACE SWMI |
$30.50
|
| Rate for Payer: PHP Medicare Advantage |
$30.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health HMO/PPO |
$19.52
|
| Rate for Payer: Priority Health Medicare |
$30.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.50
|
| Rate for Payer: UHC Exchange |
$30.50
|
| Rate for Payer: UHC Medicare Advantage |
$30.50
|
| Rate for Payer: UHCCP Medicaid |
$10.01
|
|
|
PR LINCOMYCIN INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J2010
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Medicare |
$5.83
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$5.61
|
| Rate for Payer: BCBS Trust/PPO |
$7.48
|
| Rate for Payer: BCN Commercial |
$7.86
|
| Rate for Payer: BCN Medicare Advantage |
$5.61
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$8.08
|
| Rate for Payer: Cofinity Commercial |
$7.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.89
|
| Rate for Payer: Nomi Health Commercial |
$6.73
|
| Rate for Payer: PACE SWMI |
$5.61
|
| Rate for Payer: PHP Medicare Advantage |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.61
|
| Rate for Payer: UHC Exchange |
$5.61
|
| Rate for Payer: UHC Medicare Advantage |
$5.61
|
|
|
PR LITHOLAPAXY COMP/LG > 2.5 CM
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
HCPCS 52318
|
| Min. Negotiated Rate |
$298.63 |
| Max. Negotiated Rate |
$1,353.50 |
| Rate for Payer: Aetna Commercial |
$601.74
|
| Rate for Payer: Aetna Medicare |
$467.02
|
| Rate for Payer: BCBS Complete |
$313.56
|
| Rate for Payer: BCBS MAPPO |
$449.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.50
|
| Rate for Payer: BCN Commercial |
$674.37
|
| Rate for Payer: BCN Medicare Advantage |
$449.06
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cash Price |
$748.80
|
| Rate for Payer: Cofinity Commercial |
$646.65
|
| Rate for Payer: Cofinity Commercial |
$601.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.06
|
| Rate for Payer: Mclaren Medicaid |
$298.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$471.51
|
| Rate for Payer: Meridian Medicaid |
$313.56
|
| Rate for Payer: Nomi Health Commercial |
$538.87
|
| Rate for Payer: PACE SWMI |
$449.06
|
| Rate for Payer: PHP Medicare Advantage |
$449.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$298.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$608.40
|
| Rate for Payer: Priority Health HMO/PPO |
$742.45
|
| Rate for Payer: Priority Health Medicare |
$453.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$742.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$449.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$449.06
|
| Rate for Payer: UHC Exchange |
$449.06
|
| Rate for Payer: UHC Medicare Advantage |
$449.06
|
| Rate for Payer: UHCCP Medicaid |
$298.63
|
|
|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,658.00
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$218.96 |
| Max. Negotiated Rate |
$1,298.41 |
| Rate for Payer: Aetna Commercial |
$441.11
|
| Rate for Payer: Aetna Medicare |
$342.36
|
| 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: 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: 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 |
$543.25
|
| Rate for Payer: Priority Health Medicare |
$332.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$543.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.19
|
| Rate for Payer: UHC Exchange |
$329.19
|
| 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 |
$1,184.30 |
| Rate for Payer: Aetna Commercial |
$732.12
|
| Rate for Payer: Aetna Medicare |
$568.21
|
| 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: 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: 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 |
$913.41
|
| Rate for Payer: Priority Health Medicare |
$551.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$913.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$546.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$546.36
|
| Rate for Payer: UHC Exchange |
$546.36
|
| 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 |
$2,562.30 |
| Rate for Payer: Aetna Commercial |
$912.26
|
| Rate for Payer: Aetna Medicare |
$708.02
|
| 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: 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: 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 |
$1,416.72
|
| Rate for Payer: Priority Health Medicare |
$687.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,416.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$680.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.79
|
| Rate for Payer: UHC Exchange |
$680.79
|
| 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 |
$1,840.15 |
| Rate for Payer: Aetna Commercial |
$911.21
|
| Rate for Payer: Aetna Medicare |
$707.21
|
| 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: 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: 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 |
$1,402.06
|
| Rate for Payer: Priority Health Medicare |
$686.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,402.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$680.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.01
|
| Rate for Payer: UHC Exchange |
$680.01
|
| 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 |
$1,793.58 |
| Rate for Payer: Aetna Commercial |
$91.31
|
| Rate for Payer: Aetna Medicare |
$70.87
|
| 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: 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: 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 |
$89.28
|
| Rate for Payer: Priority Health Medicare |
$68.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.14
|
| Rate for Payer: UHC Exchange |
$68.14
|
| 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 |
$1,053.00 |
| Rate for Payer: Aetna Commercial |
$734.91
|
| Rate for Payer: Aetna Medicare |
$570.38
|
| 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: 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: 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 |
$881.35
|
| Rate for Payer: Priority Health Medicare |
$553.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$881.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$548.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$548.44
|
| Rate for Payer: UHC Exchange |
$548.44
|
| 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 |
$2,402.18 |
| Rate for Payer: Aetna Commercial |
$683.83
|
| Rate for Payer: Aetna Medicare |
$530.73
|
| 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: 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: 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 |
$822.33
|
| Rate for Payer: Priority Health Medicare |
$515.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$822.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$510.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.32
|
| Rate for Payer: UHC Exchange |
$510.32
|
| 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 |
$3,119.66 |
| Rate for Payer: Aetna Commercial |
$598.99
|
| Rate for Payer: Aetna Medicare |
$464.89
|
| 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: 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: 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 |
$721.05
|
| Rate for Payer: Priority Health Medicare |
$451.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$721.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.01
|
| Rate for Payer: UHC Exchange |
$447.01
|
| 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: 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 |
$4.55 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.37
|
| 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 |
$1.89
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.38
|
| 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 |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.32
|
| Rate for Payer: UHC Exchange |
$1.32
|
| 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: 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 |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$39.91
|
| Rate for Payer: Aetna Medicare |
$30.97
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.27
|
| 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 |
$48.34
|
| Rate for Payer: Priority Health Medicare |
$30.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.78
|
| Rate for Payer: UHC Exchange |
$29.78
|
| Rate for Payer: UHC Medicare Advantage |
$29.78
|
|
|
PR LT COMPRES BAND >=3"" <5""/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6449
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.95 |
| 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: 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 |
$1.95 |
| 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: 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 |
$3.25 |
| 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: 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: 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: 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: 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: 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: Priority Health Cigna Priority Health |
$165.75
|
|
