|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS G0439
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$163.28
|
| Rate for Payer: Aetna Medicare |
$126.72
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$121.85
|
| Rate for Payer: BCBS Trust/PPO |
$728.00
|
| Rate for Payer: BCN Commercial |
$187.65
|
| Rate for Payer: BCN Medicare Advantage |
$121.85
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$175.46
|
| Rate for Payer: Cofinity Commercial |
$163.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.94
|
| Rate for Payer: Nomi Health Commercial |
$146.22
|
| Rate for Payer: PACE SWMI |
$121.85
|
| Rate for Payer: PHP Medicare Advantage |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health HMO/PPO |
$171.48
|
| Rate for Payer: Priority Health Medicare |
$123.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.85
|
| Rate for Payer: UHC Exchange |
$121.85
|
| Rate for Payer: UHC Medicare Advantage |
$121.85
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 90732
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$218.03 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: Aetna Medicare |
$138.81
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS MAPPO |
$133.47
|
| Rate for Payer: BCBS Trust/PPO |
$138.56
|
| Rate for Payer: BCN Commercial |
$218.03
|
| Rate for Payer: BCN Medicare Advantage |
$133.47
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$178.85
|
| Rate for Payer: Cofinity Commercial |
$192.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.15
|
| Rate for Payer: Nomi Health Commercial |
$160.17
|
| Rate for Payer: PACE SWMI |
$133.47
|
| Rate for Payer: PHP Medicare Advantage |
$133.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.90
|
| Rate for Payer: Priority Health Medicare |
$134.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.47
|
| Rate for Payer: UHC Exchange |
$133.47
|
| Rate for Payer: UHC Medicare Advantage |
$133.47
|
|
|
PR PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX
|
Professional
|
Both
|
$4,652.00
|
|
|
Service Code
|
HCPCS 45112
|
| Min. Negotiated Rate |
$234.04 |
| Max. Negotiated Rate |
$3,211.47 |
| Rate for Payer: Aetna Commercial |
$2,313.01
|
| Rate for Payer: Aetna Medicare |
$1,795.18
|
| Rate for Payer: BCBS Complete |
$1,208.83
|
| Rate for Payer: BCBS MAPPO |
$1,726.13
|
| Rate for Payer: BCBS Trust/PPO |
$234.04
|
| Rate for Payer: BCN Commercial |
$2,621.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,726.13
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$2,485.63
|
| Rate for Payer: Cofinity Commercial |
$2,313.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,726.13
|
| Rate for Payer: Mclaren Medicaid |
$1,151.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,812.44
|
| Rate for Payer: Meridian Medicaid |
$1,208.83
|
| Rate for Payer: Nomi Health Commercial |
$2,071.36
|
| Rate for Payer: PACE SWMI |
$1,726.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,726.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,151.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health HMO/PPO |
$3,211.47
|
| Rate for Payer: Priority Health Medicare |
$1,743.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,211.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,726.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,726.13
|
| Rate for Payer: UHC Exchange |
$1,726.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,726.13
|
| Rate for Payer: UHCCP Medicaid |
$1,151.27
|
|
|
PR PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST
|
Professional
|
Both
|
$4,725.00
|
|
|
Service Code
|
HCPCS 45110
|
| Min. Negotiated Rate |
$389.36 |
| Max. Negotiated Rate |
$3,226.98 |
| Rate for Payer: Aetna Commercial |
$2,319.65
|
| Rate for Payer: Aetna Medicare |
$1,800.32
|
| Rate for Payer: BCBS Complete |
$1,211.96
|
| Rate for Payer: BCBS MAPPO |
$1,731.08
|
| Rate for Payer: BCBS Trust/PPO |
$389.36
|
| Rate for Payer: BCN Commercial |
$2,639.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,731.08
|
| Rate for Payer: Cash Price |
$3,780.00
|
| Rate for Payer: Cash Price |
$3,780.00
|
| Rate for Payer: Cofinity Commercial |
$2,492.76
|
| Rate for Payer: Cofinity Commercial |
$2,319.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,731.08
|
| Rate for Payer: Mclaren Medicaid |
$1,154.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,817.63
|
| Rate for Payer: Meridian Medicaid |
$1,211.96
|
| Rate for Payer: Nomi Health Commercial |
$2,077.30
|
| Rate for Payer: PACE SWMI |
$1,731.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,731.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,154.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,071.25
|
| Rate for Payer: Priority Health HMO/PPO |
$3,226.98
|
| Rate for Payer: Priority Health Medicare |
$1,748.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,226.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,731.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,731.08
|
| Rate for Payer: UHC Exchange |
$1,731.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,731.08
|
| Rate for Payer: UHCCP Medicaid |
$1,154.25
|
|
|
PR PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS
|
Professional
|
Both
|
$4,993.00
|
|
|
Service Code
|
HCPCS 45120
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$3,245.45 |
| Rate for Payer: Aetna Commercial |
$2,084.18
|
| Rate for Payer: Aetna Medicare |
$1,617.57
|
| Rate for Payer: BCBS Complete |
$1,079.56
|
| Rate for Payer: BCBS MAPPO |
$1,555.36
|
| Rate for Payer: BCBS Trust/PPO |
$234.57
|
| Rate for Payer: BCN Commercial |
$2,334.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,555.36
|
| Rate for Payer: Cash Price |
$3,994.40
|
| Rate for Payer: Cash Price |
$3,994.40
|
| Rate for Payer: Cofinity Commercial |
$2,239.72
|
| Rate for Payer: Cofinity Commercial |
$2,084.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,555.36
|
| Rate for Payer: Mclaren Medicaid |
$1,028.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,633.13
|
| Rate for Payer: Meridian Medicaid |
$1,079.56
|
| Rate for Payer: Nomi Health Commercial |
$1,866.43
|
| Rate for Payer: PACE SWMI |
$1,555.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,555.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,028.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,245.45
|
| Rate for Payer: Priority Health HMO/PPO |
$2,864.24
|
| Rate for Payer: Priority Health Medicare |
$1,570.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,864.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,555.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,555.36
|
| Rate for Payer: UHC Exchange |
$1,555.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.36
|
| Rate for Payer: UHCCP Medicaid |
$1,028.15
|
|
|
PR PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS
|
Professional
|
Both
|
$4,900.00
|
|
|
Service Code
|
HCPCS 45121
|
| Min. Negotiated Rate |
$188.07 |
| Max. Negotiated Rate |
$3,185.00 |
| Rate for Payer: Aetna Commercial |
$2,273.89
|
| Rate for Payer: Aetna Medicare |
$1,764.81
|
| Rate for Payer: BCBS Complete |
$1,176.85
|
| Rate for Payer: BCBS MAPPO |
$1,696.93
|
| Rate for Payer: BCBS Trust/PPO |
$188.07
|
| Rate for Payer: BCN Commercial |
$2,547.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,696.93
|
| Rate for Payer: Cash Price |
$3,920.00
|
| Rate for Payer: Cash Price |
$3,920.00
|
| Rate for Payer: Cofinity Commercial |
$2,443.58
|
| Rate for Payer: Cofinity Commercial |
$2,273.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,696.93
|
| Rate for Payer: Mclaren Medicaid |
$1,120.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,781.78
|
| Rate for Payer: Meridian Medicaid |
$1,176.85
|
| Rate for Payer: Nomi Health Commercial |
$2,036.32
|
| Rate for Payer: PACE SWMI |
$1,696.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,696.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,120.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,185.00
|
| Rate for Payer: Priority Health HMO/PPO |
$3,125.55
|
| Rate for Payer: Priority Health Medicare |
$1,713.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,125.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,696.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,696.93
|
| Rate for Payer: UHC Exchange |
$1,696.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,696.93
|
| Rate for Payer: UHCCP Medicaid |
$1,120.81
|
|
|
PR PRCTECT PRTL RESCJ RECTUM TABDL APPR
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
HCPCS 45111
|
| Min. Negotiated Rate |
$283.70 |
| Max. Negotiated Rate |
$1,941.92 |
| Rate for Payer: Aetna Commercial |
$1,396.43
|
| Rate for Payer: Aetna Medicare |
$1,083.79
|
| Rate for Payer: BCBS Complete |
$728.88
|
| Rate for Payer: BCBS MAPPO |
$1,042.11
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$1,575.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,042.11
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cofinity Commercial |
$1,500.64
|
| Rate for Payer: Cofinity Commercial |
$1,396.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,042.11
|
| Rate for Payer: Mclaren Medicaid |
$694.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,094.22
|
| Rate for Payer: Meridian Medicaid |
$728.88
|
| Rate for Payer: Nomi Health Commercial |
$1,250.53
|
| Rate for Payer: PACE SWMI |
$1,042.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,042.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$694.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,282.45
|
| Rate for Payer: Priority Health HMO/PPO |
$1,941.92
|
| Rate for Payer: Priority Health Medicare |
$1,052.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,941.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,042.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,042.11
|
| Rate for Payer: UHC Exchange |
$1,042.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,042.11
|
| Rate for Payer: UHCCP Medicaid |
$694.17
|
|
|
PR PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH
|
Professional
|
Both
|
$3,259.00
|
|
|
Service Code
|
HCPCS 45114
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$3,245.47 |
| Rate for Payer: Aetna Commercial |
$2,367.44
|
| Rate for Payer: Aetna Medicare |
$1,837.42
|
| Rate for Payer: BCBS Complete |
$1,223.14
|
| Rate for Payer: BCBS MAPPO |
$1,766.75
|
| Rate for Payer: BCBS Trust/PPO |
$86.17
|
| Rate for Payer: BCN Commercial |
$2,647.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,766.75
|
| Rate for Payer: Cash Price |
$2,607.20
|
| Rate for Payer: Cash Price |
$2,607.20
|
| Rate for Payer: Cofinity Commercial |
$2,544.12
|
| Rate for Payer: Cofinity Commercial |
$2,367.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,766.75
|
| Rate for Payer: Mclaren Medicaid |
$1,164.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,855.09
|
| Rate for Payer: Meridian Medicaid |
$1,223.14
|
| Rate for Payer: Nomi Health Commercial |
$2,120.10
|
| Rate for Payer: PACE SWMI |
$1,766.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,766.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,164.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,118.35
|
| Rate for Payer: Priority Health HMO/PPO |
$3,245.47
|
| Rate for Payer: Priority Health Medicare |
$1,784.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,245.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,766.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,766.75
|
| Rate for Payer: UHC Exchange |
$1,766.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,766.75
|
| Rate for Payer: UHCCP Medicaid |
$1,164.90
|
|
|
PR PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY
|
Professional
|
Both
|
$3,811.00
|
|
|
Service Code
|
HCPCS 45116
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$2,738.96 |
| Rate for Payer: Aetna Commercial |
$1,969.63
|
| Rate for Payer: Aetna Medicare |
$1,528.66
|
| Rate for Payer: BCBS Complete |
$1,031.03
|
| Rate for Payer: BCBS MAPPO |
$1,469.87
|
| Rate for Payer: BCBS Trust/PPO |
$187.02
|
| Rate for Payer: BCN Commercial |
$2,233.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,469.87
|
| Rate for Payer: Cash Price |
$3,048.80
|
| Rate for Payer: Cash Price |
$3,048.80
|
| Rate for Payer: Cofinity Commercial |
$2,116.61
|
| Rate for Payer: Cofinity Commercial |
$1,969.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,469.87
|
| Rate for Payer: Mclaren Medicaid |
$981.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,543.36
|
| Rate for Payer: Meridian Medicaid |
$1,031.03
|
| Rate for Payer: Nomi Health Commercial |
$1,763.84
|
| Rate for Payer: PACE SWMI |
$1,469.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,469.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$981.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,477.15
|
| Rate for Payer: Priority Health HMO/PPO |
$2,738.96
|
| Rate for Payer: Priority Health Medicare |
$1,484.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,738.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,469.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,469.87
|
| Rate for Payer: UHC Exchange |
$1,469.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,469.87
|
| Rate for Payer: UHCCP Medicaid |
$981.93
|
|
|
PR PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR
|
Professional
|
Both
|
$5,455.00
|
|
|
Service Code
|
HCPCS 45113
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$3,545.75 |
| Rate for Payer: Aetna Commercial |
$2,370.54
|
| Rate for Payer: Aetna Medicare |
$1,839.82
|
| Rate for Payer: BCBS Complete |
$1,241.26
|
| Rate for Payer: BCBS MAPPO |
$1,769.06
|
| Rate for Payer: BCBS Trust/PPO |
$234.57
|
| Rate for Payer: BCN Commercial |
$2,697.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,769.06
|
| Rate for Payer: Cash Price |
$4,364.00
|
| Rate for Payer: Cash Price |
$4,364.00
|
| Rate for Payer: Cofinity Commercial |
$2,547.45
|
| Rate for Payer: Cofinity Commercial |
$2,370.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,769.06
|
| Rate for Payer: Mclaren Medicaid |
$1,182.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,857.51
|
| Rate for Payer: Meridian Medicaid |
$1,241.26
|
| Rate for Payer: Nomi Health Commercial |
$2,122.87
|
| Rate for Payer: PACE SWMI |
$1,769.06
|
| Rate for Payer: PHP Medicare Advantage |
$1,769.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,182.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,545.75
|
| Rate for Payer: Priority Health HMO/PPO |
$3,301.55
|
| Rate for Payer: Priority Health Medicare |
$1,786.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,301.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,769.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,769.06
|
| Rate for Payer: UHC Exchange |
$1,769.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,769.06
|
| Rate for Payer: UHCCP Medicaid |
$1,182.15
|
|
|
PR PRCTECT PRTL W/O ANAST PRNL APPR
|
Professional
|
Both
|
$3,047.00
|
|
|
Service Code
|
HCPCS 45123
|
| Min. Negotiated Rate |
$710.78 |
| Max. Negotiated Rate |
$2,046.11 |
| Rate for Payer: Aetna Commercial |
$1,426.31
|
| Rate for Payer: Aetna Medicare |
$1,106.99
|
| Rate for Payer: BCBS Complete |
$746.32
|
| Rate for Payer: BCBS MAPPO |
$1,064.41
|
| Rate for Payer: BCBS Trust/PPO |
$2,046.11
|
| Rate for Payer: BCN Commercial |
$1,621.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,064.41
|
| Rate for Payer: Cash Price |
$2,437.60
|
| Rate for Payer: Cash Price |
$2,437.60
|
| Rate for Payer: Cofinity Commercial |
$1,532.75
|
| Rate for Payer: Cofinity Commercial |
$1,426.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,064.41
|
| Rate for Payer: Mclaren Medicaid |
$710.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,117.63
|
| Rate for Payer: Meridian Medicaid |
$746.32
|
| Rate for Payer: Nomi Health Commercial |
$1,277.29
|
| Rate for Payer: PACE SWMI |
$1,064.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,064.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$710.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,980.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,981.88
|
| Rate for Payer: Priority Health Medicare |
$1,075.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,981.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,064.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,064.41
|
| Rate for Payer: UHC Exchange |
$1,064.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,064.41
|
| Rate for Payer: UHCCP Medicaid |
$710.78
|
|
|
PR PREDNISONE IR OR DR ORAL 1MG
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.00
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.00
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.00
|
| Rate for Payer: Nomi Health Commercial |
$0.00
|
| Rate for Payer: PACE SWMI |
$0.00
|
| Rate for Payer: PHP Medicare Advantage |
$0.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.00
|
| Rate for Payer: UHC Exchange |
$0.00
|
| Rate for Payer: UHC Medicare Advantage |
$0.00
|
|
|
PR PREDNISONE ORAL
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J7506
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
|
|
PR PREPARE FECAL MICROBIOTA FOR INSTILLATION
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 44705
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$96.49
|
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$252.00
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Mclaren Medicaid |
$45.58
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO |
$126.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.48
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA
|
Professional
|
Both
|
$942.00
|
|
|
Service Code
|
HCPCS 49013
|
| Min. Negotiated Rate |
$290.11 |
| Max. Negotiated Rate |
$808.98 |
| Rate for Payer: Aetna Commercial |
$594.21
|
| Rate for Payer: Aetna Medicare |
$461.18
|
| Rate for Payer: BCBS Complete |
$304.62
|
| Rate for Payer: BCBS MAPPO |
$443.44
|
| Rate for Payer: BCBS Trust/PPO |
$562.11
|
| Rate for Payer: BCN Commercial |
$660.20
|
| Rate for Payer: BCN Medicare Advantage |
$443.44
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cofinity Commercial |
$638.55
|
| Rate for Payer: Cofinity Commercial |
$594.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.44
|
| Rate for Payer: Mclaren Medicaid |
$290.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$465.61
|
| Rate for Payer: Meridian Medicaid |
$304.62
|
| Rate for Payer: Nomi Health Commercial |
$532.13
|
| Rate for Payer: PACE SWMI |
$443.44
|
| Rate for Payer: PHP Medicare Advantage |
$443.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$290.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.30
|
| Rate for Payer: Priority Health HMO/PPO |
$808.98
|
| Rate for Payer: Priority Health Medicare |
$447.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$808.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$443.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$443.44
|
| Rate for Payer: UHC Exchange |
$443.44
|
| Rate for Payer: UHC Medicare Advantage |
$443.44
|
| Rate for Payer: UHCCP Medicaid |
$290.11
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$670.00
|
|
|
Service Code
|
HCPCS 15004
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$576.64 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Medicare |
$258.62
|
| Rate for Payer: BCBS Complete |
$174.67
|
| Rate for Payer: BCBS MAPPO |
$248.67
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$576.64
|
| Rate for Payer: BCN Medicare Advantage |
$248.67
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cash Price |
$536.00
|
| Rate for Payer: Cofinity Commercial |
$358.08
|
| Rate for Payer: Cofinity Commercial |
$333.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.67
|
| Rate for Payer: Mclaren Medicaid |
$166.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.10
|
| Rate for Payer: Meridian Medicaid |
$174.67
|
| Rate for Payer: Nomi Health Commercial |
$298.40
|
| Rate for Payer: PACE SWMI |
$248.67
|
| Rate for Payer: PHP Medicare Advantage |
$248.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$435.50
|
| Rate for Payer: Priority Health HMO/PPO |
$348.12
|
| Rate for Payer: Priority Health Medicare |
$251.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$348.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.67
|
| Rate for Payer: UHC Exchange |
$248.67
|
| Rate for Payer: UHC Medicare Advantage |
$248.67
|
| Rate for Payer: UHCCP Medicaid |
$166.35
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 15005
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$206.12 |
| Rate for Payer: Aetna Commercial |
$115.86
|
| Rate for Payer: Aetna Medicare |
$89.92
|
| Rate for Payer: BCBS Complete |
$59.93
|
| Rate for Payer: BCBS MAPPO |
$86.46
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$169.57
|
| Rate for Payer: BCN Medicare Advantage |
$86.46
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$124.50
|
| Rate for Payer: Cofinity Commercial |
$115.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.46
|
| Rate for Payer: Mclaren Medicaid |
$57.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.78
|
| Rate for Payer: Meridian Medicaid |
$59.93
|
| Rate for Payer: Nomi Health Commercial |
$103.75
|
| Rate for Payer: PACE SWMI |
$86.46
|
| Rate for Payer: PHP Medicare Advantage |
$86.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO |
$120.10
|
| Rate for Payer: Priority Health Medicare |
$87.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$120.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.46
|
| Rate for Payer: UHC Exchange |
$86.46
|
| Rate for Payer: UHC Medicare Advantage |
$86.46
|
| Rate for Payer: UHCCP Medicaid |
$57.08
|
|
|
PR PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
HCPCS 15002
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$505.78 |
| Rate for Payer: Aetna Commercial |
$282.07
|
| Rate for Payer: Aetna Medicare |
$218.92
|
| Rate for Payer: BCBS Complete |
$147.61
|
| Rate for Payer: BCBS MAPPO |
$210.50
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$505.78
|
| Rate for Payer: BCN Medicare Advantage |
$210.50
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$303.12
|
| Rate for Payer: Cofinity Commercial |
$282.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.50
|
| Rate for Payer: Mclaren Medicaid |
$140.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.02
|
| Rate for Payer: Meridian Medicaid |
$147.61
|
| Rate for Payer: Nomi Health Commercial |
$252.60
|
| Rate for Payer: PACE SWMI |
$210.50
|
| Rate for Payer: PHP Medicare Advantage |
$210.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$140.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.30
|
| Rate for Payer: Priority Health HMO/PPO |
$294.84
|
| Rate for Payer: Priority Health Medicare |
$212.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.50
|
| Rate for Payer: UHC Exchange |
$210.50
|
| Rate for Payer: UHC Medicare Advantage |
$210.50
|
| Rate for Payer: UHCCP Medicaid |
$140.58
|
|
|
PR PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 15003
|
| Min. Negotiated Rate |
$28.33 |
| Max. Negotiated Rate |
$138.90 |
| Rate for Payer: Aetna Commercial |
$57.54
|
| Rate for Payer: Aetna Medicare |
$44.66
|
| Rate for Payer: BCBS Complete |
$29.75
|
| Rate for Payer: BCBS MAPPO |
$42.94
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$101.65
|
| Rate for Payer: BCN Medicare Advantage |
$42.94
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$61.83
|
| Rate for Payer: Cofinity Commercial |
$57.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.94
|
| Rate for Payer: Mclaren Medicaid |
$28.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.09
|
| Rate for Payer: Meridian Medicaid |
$29.75
|
| Rate for Payer: Nomi Health Commercial |
$51.53
|
| Rate for Payer: PACE SWMI |
$42.94
|
| Rate for Payer: PHP Medicare Advantage |
$42.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health HMO/PPO |
$60.51
|
| Rate for Payer: Priority Health Medicare |
$43.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.94
|
| Rate for Payer: UHC Exchange |
$42.94
|
| Rate for Payer: UHC Medicare Advantage |
$42.94
|
| Rate for Payer: UHCCP Medicaid |
$28.33
|
|
|
PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 94640
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$255.17 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Medicare |
$7.45
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$255.17
|
| Rate for Payer: BCN Commercial |
$13.19
|
| Rate for Payer: BCN Medicare Advantage |
$7.16
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Cofinity Commercial |
$10.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.52
|
| Rate for Payer: Nomi Health Commercial |
$8.59
|
| Rate for Payer: PACE SWMI |
$7.16
|
| Rate for Payer: PHP Medicare Advantage |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO |
$10.86
|
| Rate for Payer: Priority Health Medicare |
$7.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.16
|
| Rate for Payer: UHC Exchange |
$7.16
|
| Rate for Payer: UHC Medicare Advantage |
$7.16
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 15 MIN
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 99401
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$1,234.11 |
| Rate for Payer: Aetna Commercial |
$25.12
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,234.11
|
| Rate for Payer: BCN Commercial |
$56.19
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Mclaren Medicaid |
$14.91
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health HMO/PPO |
$31.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.41
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 30 MIN
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 99402
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$1,381.50 |
| Rate for Payer: Aetna Commercial |
$51.32
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: BCBS Complete |
$31.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,381.50
|
| Rate for Payer: BCN Commercial |
$90.89
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Mclaren Medicaid |
$30.03
|
| Rate for Payer: Meridian Medicaid |
$31.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO |
$63.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.72
|
| Rate for Payer: UHCCP Medicaid |
$30.03
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 45 MIN
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 99403
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$393.06 |
| Rate for Payer: Aetna Commercial |
$76.44
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$393.06
|
| Rate for Payer: BCN Commercial |
$125.10
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health HMO/PPO |
$95.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.13
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
|
|
PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 60 MIN
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 99404
|
| Min. Negotiated Rate |
$60.71 |
| Max. Negotiated Rate |
$805.13 |
| Rate for Payer: Aetna Commercial |
$101.22
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: BCBS Complete |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$805.13
|
| Rate for Payer: BCN Commercial |
$159.31
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Mclaren Medicaid |
$60.71
|
| Rate for Payer: Meridian Medicaid |
$63.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO |
$126.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.98
|
| Rate for Payer: UHCCP Medicaid |
$60.71
|
|
|
PR PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 99412
|
| Min. Negotiated Rate |
$13.09 |
| Max. Negotiated Rate |
$1,314.41 |
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,314.41
|
| Rate for Payer: BCN Commercial |
$36.65
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO |
$16.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.61
|
|
