|
PR SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 30140
|
| Min. Negotiated Rate |
$114.38 |
| Max. Negotiated Rate |
$855.85 |
| Rate for Payer: Aetna Commercial |
$228.62
|
| Rate for Payer: Aetna Medicare |
$177.43
|
| Rate for Payer: BCBS Complete |
$120.10
|
| Rate for Payer: BCBS MAPPO |
$170.61
|
| Rate for Payer: BCBS Trust/PPO |
$855.85
|
| Rate for Payer: BCN Commercial |
$437.37
|
| Rate for Payer: BCN Medicare Advantage |
$170.61
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$245.68
|
| Rate for Payer: Cofinity Commercial |
$228.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.61
|
| Rate for Payer: Mclaren Medicaid |
$114.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.14
|
| Rate for Payer: Meridian Medicaid |
$120.10
|
| Rate for Payer: Nomi Health Commercial |
$204.73
|
| Rate for Payer: PACE SWMI |
$170.61
|
| Rate for Payer: PHP Medicare Advantage |
$170.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$744.25
|
| Rate for Payer: Priority Health HMO/PPO |
$247.02
|
| Rate for Payer: Priority Health Medicare |
$172.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.61
|
| Rate for Payer: UHC Exchange |
$170.61
|
| Rate for Payer: UHC Medicare Advantage |
$170.61
|
| Rate for Payer: UHCCP Medicaid |
$114.38
|
|
|
PR SUBQ HOSPITAL CARE PER DAY E/M NORMAL NEWBORN
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99462
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$1,469.20 |
| Rate for Payer: Aetna Commercial |
$50.80
|
| Rate for Payer: Aetna Medicare |
$39.43
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS MAPPO |
$37.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.20
|
| Rate for Payer: BCN Commercial |
$59.13
|
| Rate for Payer: BCN Medicare Advantage |
$37.91
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$54.59
|
| Rate for Payer: Cofinity Commercial |
$50.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.91
|
| Rate for Payer: Mclaren Medicaid |
$25.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.81
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: Nomi Health Commercial |
$45.49
|
| Rate for Payer: PACE SWMI |
$37.91
|
| Rate for Payer: PHP Medicare Advantage |
$37.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO |
$54.30
|
| Rate for Payer: Priority Health Medicare |
$38.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.91
|
| Rate for Payer: UHC Exchange |
$37.91
|
| Rate for Payer: UHC Medicare Advantage |
$37.91
|
| Rate for Payer: UHCCP Medicaid |
$25.35
|
|
|
PR SUBQ I/P CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$793.00
|
|
|
Service Code
|
HCPCS 99469
|
| Min. Negotiated Rate |
$250.94 |
| Max. Negotiated Rate |
$598.52 |
| Rate for Payer: Aetna Commercial |
$487.49
|
| Rate for Payer: Aetna Medicare |
$378.35
|
| Rate for Payer: BCBS Complete |
$381.99
|
| Rate for Payer: BCBS MAPPO |
$363.80
|
| Rate for Payer: BCBS Trust/PPO |
$250.94
|
| Rate for Payer: BCN Commercial |
$558.56
|
| Rate for Payer: BCN Medicare Advantage |
$363.80
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cash Price |
$634.40
|
| Rate for Payer: Cofinity Commercial |
$523.87
|
| Rate for Payer: Cofinity Commercial |
$487.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.80
|
| Rate for Payer: Mclaren Medicaid |
$363.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.99
|
| Rate for Payer: Meridian Medicaid |
$381.99
|
| Rate for Payer: Nomi Health Commercial |
$436.56
|
| Rate for Payer: PACE SWMI |
$363.80
|
| Rate for Payer: PHP Medicare Advantage |
$363.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$515.45
|
| Rate for Payer: Priority Health HMO/PPO |
$598.52
|
| Rate for Payer: Priority Health Medicare |
$367.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$598.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.80
|
| Rate for Payer: UHC Exchange |
$363.80
|
| Rate for Payer: UHC Medicare Advantage |
$363.80
|
| Rate for Payer: UHCCP Medicaid |
$363.80
|
|
|
PR SUBSEQUENT INJECTION, PLATELET RICH PLASMA, ANY SITE, INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00672
|
|
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 SUBSEQUENT INTENSIVE CARE INFANT 1500-2500 GRAMS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99479
|
| Min. Negotiated Rate |
$113.46 |
| Max. Negotiated Rate |
$248.95 |
| Rate for Payer: Aetna Commercial |
$152.04
|
| Rate for Payer: Aetna Medicare |
$118.00
|
| Rate for Payer: BCBS Complete |
$119.13
|
| Rate for Payer: BCBS MAPPO |
$113.46
|
| Rate for Payer: BCBS Trust/PPO |
$233.51
|
| Rate for Payer: BCN Commercial |
$175.44
|
| Rate for Payer: BCN Medicare Advantage |
$113.46
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$163.38
|
| Rate for Payer: Cofinity Commercial |
$152.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.46
|
| Rate for Payer: Mclaren Medicaid |
$113.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.13
|
| Rate for Payer: Meridian Medicaid |
$119.13
|
| Rate for Payer: Nomi Health Commercial |
$136.15
|
| Rate for Payer: PACE SWMI |
$113.46
|
| Rate for Payer: PHP Medicare Advantage |
$113.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO |
$161.08
|
| Rate for Payer: Priority Health Medicare |
$114.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.46
|
| Rate for Payer: UHC Exchange |
$113.46
|
| Rate for Payer: UHC Medicare Advantage |
$113.46
|
| Rate for Payer: UHCCP Medicaid |
$113.46
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT < 1500 GRAMS
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 99478
|
| Min. Negotiated Rate |
$124.96 |
| Max. Negotiated Rate |
$192.54 |
| Rate for Payer: Aetna Commercial |
$167.45
|
| Rate for Payer: Aetna Medicare |
$129.96
|
| Rate for Payer: BCBS Complete |
$131.21
|
| Rate for Payer: BCBS MAPPO |
$124.96
|
| Rate for Payer: BCBS Trust/PPO |
$188.05
|
| Rate for Payer: BCN Commercial |
$192.54
|
| Rate for Payer: BCN Medicare Advantage |
$124.96
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$179.94
|
| Rate for Payer: Cofinity Commercial |
$167.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.96
|
| Rate for Payer: Mclaren Medicaid |
$124.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.21
|
| Rate for Payer: Meridian Medicaid |
$131.21
|
| Rate for Payer: Nomi Health Commercial |
$149.95
|
| Rate for Payer: PACE SWMI |
$124.96
|
| Rate for Payer: PHP Medicare Advantage |
$124.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO |
$177.25
|
| Rate for Payer: Priority Health Medicare |
$126.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.96
|
| Rate for Payer: UHC Exchange |
$124.96
|
| Rate for Payer: UHC Medicare Advantage |
$124.96
|
| Rate for Payer: UHCCP Medicaid |
$124.96
|
|
|
PR SUBSEQUENT INTENSIVE CARE INFANT 2501-5000 GRAMS
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS 99480
|
| Min. Negotiated Rate |
$109.34 |
| Max. Negotiated Rate |
$471.24 |
| Rate for Payer: Aetna Commercial |
$146.52
|
| Rate for Payer: Aetna Medicare |
$113.71
|
| Rate for Payer: BCBS Complete |
$114.81
|
| Rate for Payer: BCBS MAPPO |
$109.34
|
| Rate for Payer: BCBS Trust/PPO |
$471.24
|
| Rate for Payer: BCN Commercial |
$169.08
|
| Rate for Payer: BCN Medicare Advantage |
$109.34
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cash Price |
$306.40
|
| Rate for Payer: Cofinity Commercial |
$157.45
|
| Rate for Payer: Cofinity Commercial |
$146.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.34
|
| Rate for Payer: Mclaren Medicaid |
$109.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.81
|
| Rate for Payer: Meridian Medicaid |
$114.81
|
| Rate for Payer: Nomi Health Commercial |
$131.21
|
| Rate for Payer: PACE SWMI |
$109.34
|
| Rate for Payer: PHP Medicare Advantage |
$109.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.95
|
| Rate for Payer: Priority Health HMO/PPO |
$154.80
|
| Rate for Payer: Priority Health Medicare |
$110.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.34
|
| Rate for Payer: UHC Exchange |
$109.34
|
| Rate for Payer: UHC Medicare Advantage |
$109.34
|
| Rate for Payer: UHCCP Medicaid |
$109.34
|
|
|
PR SUBSEQUENT PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
HCPCS 99476
|
| Min. Negotiated Rate |
$139.66 |
| Max. Negotiated Rate |
$609.70 |
| Rate for Payer: Aetna Commercial |
$429.86
|
| Rate for Payer: Aetna Medicare |
$333.62
|
| Rate for Payer: BCBS Complete |
$336.83
|
| Rate for Payer: BCBS MAPPO |
$320.79
|
| Rate for Payer: BCBS Trust/PPO |
$139.66
|
| Rate for Payer: BCN Commercial |
$485.26
|
| Rate for Payer: BCN Medicare Advantage |
$320.79
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cash Price |
$750.40
|
| Rate for Payer: Cofinity Commercial |
$461.94
|
| Rate for Payer: Cofinity Commercial |
$429.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.79
|
| Rate for Payer: Mclaren Medicaid |
$320.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.83
|
| Rate for Payer: Meridian Medicaid |
$336.83
|
| Rate for Payer: Nomi Health Commercial |
$384.95
|
| Rate for Payer: PACE SWMI |
$320.79
|
| Rate for Payer: PHP Medicare Advantage |
$320.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$320.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.70
|
| Rate for Payer: Priority Health HMO/PPO |
$446.47
|
| Rate for Payer: Priority Health Medicare |
$324.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$446.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.79
|
| Rate for Payer: UHC Exchange |
$320.79
|
| Rate for Payer: UHC Medicare Advantage |
$320.79
|
| Rate for Payer: UHCCP Medicaid |
$320.79
|
|
|
PR SUBSQ PED CRITICAL CARE 29 DAYS THRU 24 MO
|
Professional
|
Both
|
$723.00
|
|
|
Service Code
|
HCPCS 99472
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$619.98 |
| Rate for Payer: Aetna Commercial |
$508.22
|
| Rate for Payer: Aetna Medicare |
$394.44
|
| Rate for Payer: BCBS Complete |
$398.23
|
| Rate for Payer: BCBS MAPPO |
$379.27
|
| Rate for Payer: BCBS Trust/PPO |
$67.62
|
| Rate for Payer: BCN Commercial |
$566.38
|
| Rate for Payer: BCN Medicare Advantage |
$379.27
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cash Price |
$578.40
|
| Rate for Payer: Cofinity Commercial |
$546.15
|
| Rate for Payer: Cofinity Commercial |
$508.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.27
|
| Rate for Payer: Mclaren Medicaid |
$379.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.23
|
| Rate for Payer: Meridian Medicaid |
$398.23
|
| Rate for Payer: Nomi Health Commercial |
$455.12
|
| Rate for Payer: PACE SWMI |
$379.27
|
| Rate for Payer: PHP Medicare Advantage |
$379.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$379.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$469.95
|
| Rate for Payer: Priority Health HMO/PPO |
$619.98
|
| Rate for Payer: Priority Health Medicare |
$383.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$619.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.27
|
| Rate for Payer: UHC Exchange |
$379.27
|
| Rate for Payer: UHC Medicare Advantage |
$379.27
|
| Rate for Payer: UHCCP Medicaid |
$379.27
|
|
|
PR SUBTEMPORAL CRANIAL DECOMPRESSION
|
Professional
|
Both
|
$4,236.00
|
|
|
Service Code
|
HCPCS 61340
|
| Min. Negotiated Rate |
$470.19 |
| Max. Negotiated Rate |
$2,953.76 |
| Rate for Payer: Aetna Commercial |
$1,917.20
|
| Rate for Payer: Aetna Medicare |
$1,487.98
|
| Rate for Payer: BCBS Complete |
$988.75
|
| Rate for Payer: BCBS MAPPO |
$1,430.75
|
| Rate for Payer: BCBS Trust/PPO |
$470.19
|
| Rate for Payer: BCN Commercial |
$2,953.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,430.75
|
| Rate for Payer: Cash Price |
$3,388.80
|
| Rate for Payer: Cash Price |
$3,388.80
|
| Rate for Payer: Cofinity Commercial |
$2,060.28
|
| Rate for Payer: Cofinity Commercial |
$1,917.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,430.75
|
| Rate for Payer: Mclaren Medicaid |
$941.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,502.29
|
| Rate for Payer: Meridian Medicaid |
$988.75
|
| Rate for Payer: Nomi Health Commercial |
$1,716.90
|
| Rate for Payer: PACE SWMI |
$1,430.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,430.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$941.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,753.40
|
| Rate for Payer: Priority Health HMO/PPO |
$2,500.64
|
| Rate for Payer: Priority Health Medicare |
$1,445.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,500.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,430.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,430.75
|
| Rate for Payer: UHC Exchange |
$1,430.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,430.75
|
| Rate for Payer: UHCCP Medicaid |
$941.67
|
|
|
PR SUCTION ASSISTED LIPECTOMY HEAD & NECK
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 15876
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Commercial |
$367.50
|
| Rate for Payer: Aetna Medicare |
$1,020.00
|
| Rate for Payer: BCBS Complete |
$542.13
|
| Rate for Payer: BCBS Trust/PPO |
$438.68
|
| Rate for Payer: BCN Commercial |
$873.51
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Mclaren Medicaid |
$516.31
|
| Rate for Payer: Meridian Medicaid |
$542.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
| Rate for Payer: Priority Health HMO/PPO |
$217.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.36
|
| Rate for Payer: UHCCP Medicaid |
$516.31
|
|
|
PR SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY
|
Professional
|
Both
|
$3,162.00
|
|
|
Service Code
|
HCPCS 15879
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$656.25
|
| Rate for Payer: Aetna Medicare |
$1,581.00
|
| Rate for Payer: BCBS Complete |
$1,264.80
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$890.53
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Cash Price |
$2,529.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,055.30
|
| Rate for Payer: Priority Health HMO/PPO |
$217.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.36
|
|
|
PR SUCTION ASSISTED LIPECTOMY TRUNK
|
Professional
|
Both
|
$2,754.00
|
|
|
Service Code
|
HCPCS 15877
|
| Min. Negotiated Rate |
$217.36 |
| Max. Negotiated Rate |
$1,790.10 |
| Rate for Payer: Aetna Commercial |
$656.25
|
| Rate for Payer: Aetna Medicare |
$1,377.00
|
| Rate for Payer: BCBS Complete |
$1,101.60
|
| Rate for Payer: BCBS Trust/PPO |
$438.68
|
| Rate for Payer: BCN Commercial |
$882.90
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Cash Price |
$2,203.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,790.10
|
| Rate for Payer: Priority Health HMO/PPO |
$217.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.36
|
|
|
PR SUMATRIPTAN SUCCINATE / 6 MG
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS J3030
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Commercial |
$60.24
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.09
|
| Rate for Payer: BCN Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
|
|
PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99377
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$1,432.75 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,432.75
|
| Rate for Payer: BCN Commercial |
$98.23
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: Priority Health HMO/PPO |
$71.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.80
|
|
|
PR SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 99485
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$106.53 |
| Rate for Payer: Aetna Commercial |
$75.97
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCN Commercial |
$106.53
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO |
$97.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.37
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99379
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$2,731.31 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,731.31
|
| Rate for Payer: BCN Commercial |
$98.23
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: Priority Health HMO/PPO |
$71.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.80
|
|
|
PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99380
|
| Min. Negotiated Rate |
$69.20 |
| Max. Negotiated Rate |
$843.17 |
| Rate for Payer: Aetna Commercial |
$87.31
|
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: BCBS Complete |
$69.20
|
| Rate for Payer: BCBS Trust/PPO |
$843.17
|
| Rate for Payer: BCN Commercial |
$146.11
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health HMO/PPO |
$112.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.18
|
|
|
PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 99375
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$2,731.31 |
| Rate for Payer: Aetna Commercial |
$87.31
|
| Rate for Payer: Aetna Medicare |
$92.50
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,731.31
|
| Rate for Payer: BCN Commercial |
$146.11
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| Rate for Payer: Priority Health HMO/PPO |
$112.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.18
|
|
|
PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY
|
Professional
|
Both
|
$3,240.00
|
|
|
Service Code
|
HCPCS 58180
|
| Min. Negotiated Rate |
$161.66 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna Commercial |
$1,239.65
|
| Rate for Payer: Aetna Medicare |
$962.11
|
| Rate for Payer: BCBS Complete |
$647.91
|
| Rate for Payer: BCBS MAPPO |
$925.11
|
| Rate for Payer: BCBS Trust/PPO |
$161.66
|
| Rate for Payer: BCN Commercial |
$1,403.97
|
| Rate for Payer: BCN Medicare Advantage |
$925.11
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cofinity Commercial |
$1,332.16
|
| Rate for Payer: Cofinity Commercial |
$1,239.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$925.11
|
| Rate for Payer: Mclaren Medicaid |
$617.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$971.37
|
| Rate for Payer: Meridian Medicaid |
$647.91
|
| Rate for Payer: Nomi Health Commercial |
$1,110.13
|
| Rate for Payer: PACE SWMI |
$925.11
|
| Rate for Payer: PHP Medicare Advantage |
$925.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$617.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,106.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,436.56
|
| Rate for Payer: Priority Health Medicare |
$934.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,436.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$925.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$925.11
|
| Rate for Payer: UHC Exchange |
$925.11
|
| Rate for Payer: UHC Medicare Advantage |
$925.11
|
| Rate for Payer: UHCCP Medicaid |
$617.06
|
|
|
PR SUPRAHYOID LYMPHADENECTOMY
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 38700
|
| Min. Negotiated Rate |
$494.49 |
| Max. Negotiated Rate |
$1,615.78 |
| Rate for Payer: Aetna Commercial |
$1,034.59
|
| Rate for Payer: Aetna Medicare |
$802.96
|
| Rate for Payer: BCBS Complete |
$545.71
|
| Rate for Payer: BCBS MAPPO |
$772.08
|
| Rate for Payer: BCBS Trust/PPO |
$494.49
|
| Rate for Payer: BCN Commercial |
$1,182.60
|
| Rate for Payer: BCN Medicare Advantage |
$772.08
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cofinity Commercial |
$1,111.80
|
| Rate for Payer: Cofinity Commercial |
$1,034.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.08
|
| Rate for Payer: Mclaren Medicaid |
$519.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$810.68
|
| Rate for Payer: Meridian Medicaid |
$545.71
|
| Rate for Payer: Nomi Health Commercial |
$926.50
|
| Rate for Payer: PACE SWMI |
$772.08
|
| Rate for Payer: PHP Medicare Advantage |
$772.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$519.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$949.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,615.78
|
| Rate for Payer: Priority Health Medicare |
$779.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,615.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$772.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$772.08
|
| Rate for Payer: UHC Exchange |
$772.08
|
| Rate for Payer: UHC Medicare Advantage |
$772.08
|
| Rate for Payer: UHCCP Medicaid |
$519.72
|
|
|
PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
HCPCS 36253
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$2,962.36 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Medicare |
$346.54
|
| Rate for Payer: BCBS Complete |
$231.48
|
| Rate for Payer: BCBS MAPPO |
$333.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,416.90
|
| Rate for Payer: BCN Commercial |
$2,962.36
|
| Rate for Payer: BCN Medicare Advantage |
$333.21
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cash Price |
$572.80
|
| Rate for Payer: Cofinity Commercial |
$446.50
|
| Rate for Payer: Cofinity Commercial |
$479.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$333.21
|
| Rate for Payer: Mclaren Medicaid |
$220.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$349.87
|
| Rate for Payer: Meridian Medicaid |
$231.48
|
| Rate for Payer: Nomi Health Commercial |
$399.85
|
| Rate for Payer: PACE SWMI |
$333.21
|
| Rate for Payer: PHP Medicare Advantage |
$333.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$465.40
|
| Rate for Payer: Priority Health HMO/PPO |
$547.25
|
| Rate for Payer: Priority Health Medicare |
$336.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$547.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$333.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$333.21
|
| Rate for Payer: UHC Exchange |
$333.21
|
| Rate for Payer: UHC Medicare Advantage |
$333.21
|
| Rate for Payer: UHCCP Medicaid |
$220.46
|
|
|
PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 99374
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$2,302.33 |
| Rate for Payer: Aetna Commercial |
$55.68
|
| Rate for Payer: Aetna Medicare |
$68.00
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,302.33
|
| Rate for Payer: BCN Commercial |
$98.23
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.40
|
| Rate for Payer: Priority Health HMO/PPO |
$71.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.80
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR
|
Professional
|
Both
|
$734.00
|
|
|
Service Code
|
HCPCS 31820
|
| Min. Negotiated Rate |
$213.64 |
| Max. Negotiated Rate |
$1,141.66 |
| Rate for Payer: Aetna Commercial |
$421.56
|
| Rate for Payer: Aetna Medicare |
$327.18
|
| Rate for Payer: BCBS Complete |
$224.32
|
| Rate for Payer: BCBS MAPPO |
$314.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,141.66
|
| Rate for Payer: BCN Commercial |
$656.30
|
| Rate for Payer: BCN Medicare Advantage |
$314.60
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cash Price |
$587.20
|
| Rate for Payer: Cofinity Commercial |
$453.02
|
| Rate for Payer: Cofinity Commercial |
$421.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.60
|
| Rate for Payer: Mclaren Medicaid |
$213.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.33
|
| Rate for Payer: Meridian Medicaid |
$224.32
|
| Rate for Payer: Nomi Health Commercial |
$377.52
|
| Rate for Payer: PACE SWMI |
$314.60
|
| Rate for Payer: PHP Medicare Advantage |
$314.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$213.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$477.10
|
| Rate for Payer: Priority Health HMO/PPO |
$466.24
|
| Rate for Payer: Priority Health Medicare |
$317.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$466.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.60
|
| Rate for Payer: UHC Exchange |
$314.60
|
| Rate for Payer: UHC Medicare Advantage |
$314.60
|
| Rate for Payer: UHCCP Medicaid |
$213.64
|
|
|
PR SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR
|
Professional
|
Both
|
$1,031.00
|
|
|
Service Code
|
HCPCS 31825
|
| Min. Negotiated Rate |
$313.11 |
| Max. Negotiated Rate |
$1,118.94 |
| Rate for Payer: Aetna Commercial |
$619.66
|
| Rate for Payer: Aetna Medicare |
$480.93
|
| Rate for Payer: BCBS Complete |
$328.77
|
| Rate for Payer: BCBS MAPPO |
$462.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.94
|
| Rate for Payer: BCN Commercial |
$906.01
|
| Rate for Payer: BCN Medicare Advantage |
$462.43
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cash Price |
$824.80
|
| Rate for Payer: Cofinity Commercial |
$665.90
|
| Rate for Payer: Cofinity Commercial |
$619.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$462.43
|
| Rate for Payer: Mclaren Medicaid |
$313.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$485.55
|
| Rate for Payer: Meridian Medicaid |
$328.77
|
| Rate for Payer: Nomi Health Commercial |
$554.92
|
| Rate for Payer: PACE SWMI |
$462.43
|
| Rate for Payer: PHP Medicare Advantage |
$462.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$670.15
|
| Rate for Payer: Priority Health HMO/PPO |
$681.30
|
| Rate for Payer: Priority Health Medicare |
$467.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$681.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$462.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$462.43
|
| Rate for Payer: UHC Exchange |
$462.43
|
| Rate for Payer: UHC Medicare Advantage |
$462.43
|
| Rate for Payer: UHCCP Medicaid |
$313.11
|
|
