|
PR MICRONEEDLING PIN UPPER OR LOWER FACE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00106
|
|
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 MICRONEEDLING SCARS - UP TO 4 INCHES
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00109
|
|
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 MICRONEEDLING TAT RMVL 4-6 SQ INCHES
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 00122
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$298.35 |
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$183.60
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.35
|
|
|
PR MICRONEEDLING TAT RMVL 6-9 SQ INCHES
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00123
|
|
Hospital Revenue Code
|
990
|
| 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 MICRONEEDLING TAT RMVL 9-12 SQ INCHES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00124
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR MICRONEEDLING TAT RMVL UP TO 2 SQ INCH
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00110
|
|
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 MICROSURG TQS REQ USE OPERATING MICROSCOPE
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 69990
|
| Min. Negotiated Rate |
$200.40 |
| Max. Negotiated Rate |
$325.65 |
| Rate for Payer: Aetna Commercial |
$287.76
|
| Rate for Payer: Aetna Medicare |
$223.34
|
| Rate for Payer: BCBS Complete |
$200.40
|
| Rate for Payer: BCBS MAPPO |
$214.75
|
| Rate for Payer: BCN Medicare Advantage |
$214.75
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cofinity Commercial |
$287.76
|
| Rate for Payer: Cofinity Commercial |
$309.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$225.49
|
| Rate for Payer: Nomi Health Commercial |
$257.70
|
| Rate for Payer: PACE SWMI |
$214.75
|
| Rate for Payer: PHP Medicare Advantage |
$214.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health Medicare |
$216.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.75
|
| Rate for Payer: UHC Exchange |
$214.75
|
| Rate for Payer: UHC Medicare Advantage |
$214.75
|
|
|
PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC
|
Professional
|
Both
|
$1,704.00
|
|
|
Service Code
|
HCPCS 69440
|
| Min. Negotiated Rate |
$641.96 |
| Max. Negotiated Rate |
$1,107.60 |
| Rate for Payer: Aetna Commercial |
$860.23
|
| Rate for Payer: Aetna Medicare |
$667.64
|
| Rate for Payer: BCBS Complete |
$681.60
|
| Rate for Payer: BCBS MAPPO |
$641.96
|
| Rate for Payer: BCN Medicare Advantage |
$641.96
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cash Price |
$1,363.20
|
| Rate for Payer: Cofinity Commercial |
$924.42
|
| Rate for Payer: Cofinity Commercial |
$860.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$674.06
|
| Rate for Payer: Nomi Health Commercial |
$770.35
|
| Rate for Payer: PACE SWMI |
$641.96
|
| Rate for Payer: PHP Medicare Advantage |
$641.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,107.60
|
| Rate for Payer: Priority Health Medicare |
$648.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.96
|
| Rate for Payer: UHC Exchange |
$641.96
|
| Rate for Payer: UHC Medicare Advantage |
$641.96
|
|
|
PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES
|
Professional
|
Both
|
$2,972.00
|
|
|
Service Code
|
HCPCS 15730
|
| Min. Negotiated Rate |
$860.72 |
| Max. Negotiated Rate |
$1,931.80 |
| Rate for Payer: Aetna Commercial |
$1,153.36
|
| Rate for Payer: Aetna Medicare |
$895.15
|
| Rate for Payer: BCBS Complete |
$1,188.80
|
| Rate for Payer: BCBS MAPPO |
$860.72
|
| Rate for Payer: BCN Medicare Advantage |
$860.72
|
| Rate for Payer: Cash Price |
$2,377.60
|
| Rate for Payer: Cash Price |
$2,377.60
|
| Rate for Payer: Cofinity Commercial |
$1,153.36
|
| Rate for Payer: Cofinity Commercial |
$1,239.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$860.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$903.76
|
| Rate for Payer: Nomi Health Commercial |
$1,032.86
|
| Rate for Payer: PACE SWMI |
$860.72
|
| Rate for Payer: PHP Medicare Advantage |
$860.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,931.80
|
| Rate for Payer: Priority Health Medicare |
$869.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$860.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$860.72
|
| Rate for Payer: UHC Exchange |
$860.72
|
| Rate for Payer: UHC Medicare Advantage |
$860.72
|
|
|
PR MIRENA, 52 MG
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7298
|
| Min. Negotiated Rate |
$588.80 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: BCBS Complete |
$588.80
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.80
|
|
|
PR MISC VISION ITEM OR SERVICE
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS V2799
|
| 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 MISOPROSTOL, ORAL, 200 MCG
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS S0191
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
|
|
PR MITOMYCIN INJECTION
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS J9280
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$27.27
|
| Rate for Payer: Aetna Medicare |
$21.16
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$20.35
|
| Rate for Payer: BCN Medicare Advantage |
$20.35
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$29.30
|
| Rate for Payer: Cofinity Commercial |
$27.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.37
|
| Rate for Payer: Nomi Health Commercial |
$24.42
|
| Rate for Payer: PACE SWMI |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$20.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.35
|
| Rate for Payer: UHC Exchange |
$20.35
|
| Rate for Payer: UHC Medicare Advantage |
$20.35
|
|
|
PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 95805
|
| Min. Negotiated Rate |
$392.69 |
| Max. Negotiated Rate |
$646.75 |
| Rate for Payer: Aetna Commercial |
$526.20
|
| Rate for Payer: Aetna Commercial |
$526.20
|
| Rate for Payer: Aetna Medicare |
$408.40
|
| Rate for Payer: Aetna Medicare |
$408.40
|
| Rate for Payer: BCBS Complete |
$398.00
|
| Rate for Payer: BCBS Complete |
$98.00
|
| Rate for Payer: BCBS MAPPO |
$392.69
|
| Rate for Payer: BCBS MAPPO |
$392.69
|
| Rate for Payer: BCN Medicare Advantage |
$392.69
|
| Rate for Payer: BCN Medicare Advantage |
$392.69
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cofinity Commercial |
$565.47
|
| Rate for Payer: Cofinity Commercial |
$565.47
|
| Rate for Payer: Cofinity Commercial |
$526.20
|
| Rate for Payer: Cofinity Commercial |
$526.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.32
|
| Rate for Payer: Nomi Health Commercial |
$471.23
|
| Rate for Payer: Nomi Health Commercial |
$471.23
|
| Rate for Payer: PACE SWMI |
$392.69
|
| Rate for Payer: PACE SWMI |
$392.69
|
| Rate for Payer: PHP Medicare Advantage |
$392.69
|
| Rate for Payer: PHP Medicare Advantage |
$392.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health Medicare |
$396.62
|
| Rate for Payer: Priority Health Medicare |
$396.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.69
|
| Rate for Payer: UHC Exchange |
$392.69
|
| Rate for Payer: UHC Exchange |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$392.69
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 23700
|
| Min. Negotiated Rate |
$189.03 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Commercial |
$253.30
|
| Rate for Payer: Aetna Medicare |
$196.59
|
| Rate for Payer: BCBS Complete |
$368.40
|
| Rate for Payer: BCBS MAPPO |
$189.03
|
| Rate for Payer: BCN Medicare Advantage |
$189.03
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$272.20
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.48
|
| Rate for Payer: Nomi Health Commercial |
$226.84
|
| Rate for Payer: PACE SWMI |
$189.03
|
| Rate for Payer: PHP Medicare Advantage |
$189.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health Medicare |
$190.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.03
|
| Rate for Payer: UHC Exchange |
$189.03
|
| Rate for Payer: UHC Medicare Advantage |
$189.03
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$598.65 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Aetna Commercial |
$782.85
|
| Rate for Payer: BCBS Trust/PPO |
$751.81
|
| Rate for Payer: BCN Commercial |
$711.75
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$792.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.80
|
| Rate for Payer: Healthscope Commercial |
$828.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.85
|
| Rate for Payer: Nomi Health Commercial |
$755.22
|
| Rate for Payer: PHP Commercial |
$782.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO |
$801.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.48
|
| Rate for Payer: UHC Core |
$769.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.75
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$189.03 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Commercial |
$253.30
|
| Rate for Payer: Aetna Medicare |
$196.59
|
| Rate for Payer: BCBS Complete |
$368.40
|
| Rate for Payer: BCBS MAPPO |
$189.03
|
| Rate for Payer: BCN Medicare Advantage |
$189.03
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$272.20
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.48
|
| Rate for Payer: Nomi Health Commercial |
$226.84
|
| Rate for Payer: PACE SWMI |
$189.03
|
| Rate for Payer: PHP Medicare Advantage |
$189.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health Medicare |
$190.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.03
|
| Rate for Payer: UHC Exchange |
$189.03
|
| Rate for Payer: UHC Medicare Advantage |
$189.03
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$218.74 |
| Max. Negotiated Rate |
$1,215.03 |
| Rate for Payer: Aetna Commercial |
$782.85
|
| Rate for Payer: Aetna Medicare |
$239.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$287.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$287.81
|
| Rate for Payer: BCBS Complete |
$1,215.03
|
| Rate for Payer: BCBS MAPPO |
$230.25
|
| Rate for Payer: BCBS Trust/PPO |
$757.15
|
| Rate for Payer: BCN Commercial |
$716.08
|
| Rate for Payer: BCN Medicare Advantage |
$230.25
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$792.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.25
|
| Rate for Payer: Healthscope Commercial |
$828.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.75
|
| Rate for Payer: Mclaren Medicaid |
$1,157.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$241.76
|
| Rate for Payer: Meridian Medicaid |
$1,215.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.85
|
| Rate for Payer: Nomi Health Commercial |
$755.22
|
| Rate for Payer: PACE Senior Care Partners |
$218.74
|
| Rate for Payer: PACE SWMI |
$230.25
|
| Rate for Payer: PHP Commercial |
$782.85
|
| Rate for Payer: PHP Medicare Advantage |
$230.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,157.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO |
$801.27
|
| Rate for Payer: Priority Health Medicare |
$232.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$617.07
|
| Rate for Payer: Railroad Medicare Medicare |
$230.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$810.48
|
| Rate for Payer: UHC Core |
$769.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.25
|
| Rate for Payer: UHC Exchange |
$230.25
|
| Rate for Payer: UHC Medicare Advantage |
$230.25
|
| Rate for Payer: UHCCP Medicaid |
$1,157.10
|
| Rate for Payer: VA VA |
$230.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.75
|
|
|
PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 20950
|
| Min. Negotiated Rate |
$84.84 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$113.69
|
| Rate for Payer: Aetna Medicare |
$88.23
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$84.84
|
| Rate for Payer: BCN Medicare Advantage |
$84.84
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$122.17
|
| Rate for Payer: Cofinity Commercial |
$113.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.08
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: PACE SWMI |
$84.84
|
| Rate for Payer: PHP Medicare Advantage |
$84.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health Medicare |
$85.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.84
|
| Rate for Payer: UHC Exchange |
$84.84
|
| Rate for Payer: UHC Medicare Advantage |
$84.84
|
|
|
PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 44139
|
| Min. Negotiated Rate |
$116.15 |
| Max. Negotiated Rate |
$267.80 |
| Rate for Payer: Aetna Commercial |
$155.64
|
| Rate for Payer: Aetna Medicare |
$120.80
|
| Rate for Payer: BCBS Complete |
$164.80
|
| Rate for Payer: BCBS MAPPO |
$116.15
|
| Rate for Payer: BCN Medicare Advantage |
$116.15
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$155.64
|
| Rate for Payer: Cofinity Commercial |
$167.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.96
|
| Rate for Payer: Nomi Health Commercial |
$139.38
|
| Rate for Payer: PACE SWMI |
$116.15
|
| Rate for Payer: PHP Medicare Advantage |
$116.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health Medicare |
$117.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.15
|
| Rate for Payer: UHC Exchange |
$116.15
|
| Rate for Payer: UHC Medicare Advantage |
$116.15
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 99149
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Medicare |
$67.00
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
|
|
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: 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: 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: 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: Priority Health Cigna Priority Health |
$35.75
|
|
