|
PR VNPNXR 3 YEARS/> PHYS/QHP SKILL DX/THER PURPOSES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 36410
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$1,232.00 |
| Rate for Payer: Aetna Commercial |
$11.58
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$8.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,232.00
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Medicare Advantage |
$8.64
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$12.44
|
| Rate for Payer: Cofinity Commercial |
$11.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.07
|
| Rate for Payer: Nomi Health Commercial |
$10.37
|
| Rate for Payer: PACE SWMI |
$8.64
|
| Rate for Payer: PHP Medicare Advantage |
$8.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health HMO/PPO |
$14.36
|
| Rate for Payer: Priority Health Medicare |
$8.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.64
|
| Rate for Payer: UHC Exchange |
$8.64
|
| Rate for Payer: UHC Medicare Advantage |
$8.64
|
|
|
PR VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 36406
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$25.41 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Mclaren Medicaid |
$5.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health HMO/PPO |
$13.82
|
| Rate for Payer: Priority Health Medicare |
$8.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Exchange |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
|
|
PR VOID PRESSURE STUDIES INTRAABDOMINAL
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
HCPCS 51797
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$3,594.55 |
| Rate for Payer: Aetna Commercial |
$200.53
|
| Rate for Payer: Aetna Medicare |
$155.64
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS MAPPO |
$149.65
|
| Rate for Payer: BCBS Trust/PPO |
$3,594.55
|
| Rate for Payer: BCN Commercial |
$282.46
|
| Rate for Payer: BCN Medicare Advantage |
$149.65
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cash Price |
$414.40
|
| Rate for Payer: Cofinity Commercial |
$215.50
|
| Rate for Payer: Cofinity Commercial |
$200.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.65
|
| Rate for Payer: Mclaren Medicaid |
$24.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.13
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Nomi Health Commercial |
$179.58
|
| Rate for Payer: PACE SWMI |
$149.65
|
| Rate for Payer: PHP Medicare Advantage |
$149.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.70
|
| Rate for Payer: Priority Health HMO/PPO |
$62.32
|
| Rate for Payer: Priority Health Medicare |
$151.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.65
|
| Rate for Payer: UHC Exchange |
$149.65
|
| Rate for Payer: UHC Medicare Advantage |
$149.65
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
|
|
PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 92540
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$1,769.28 |
| Rate for Payer: Aetna Commercial |
$130.11
|
| Rate for Payer: Aetna Medicare |
$100.98
|
| Rate for Payer: BCBS Complete |
$50.77
|
| Rate for Payer: BCBS MAPPO |
$97.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,769.28
|
| Rate for Payer: BCN Commercial |
$158.33
|
| Rate for Payer: BCN Medicare Advantage |
$97.10
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$139.82
|
| Rate for Payer: Cofinity Commercial |
$130.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.10
|
| Rate for Payer: Mclaren Medicaid |
$48.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.96
|
| Rate for Payer: Meridian Medicaid |
$50.77
|
| Rate for Payer: Nomi Health Commercial |
$116.52
|
| Rate for Payer: PACE SWMI |
$97.10
|
| Rate for Payer: PHP Medicare Advantage |
$97.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health HMO/PPO |
$102.67
|
| Rate for Payer: Priority Health Medicare |
$98.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.10
|
| Rate for Payer: UHC Exchange |
$97.10
|
| Rate for Payer: UHC Medicare Advantage |
$97.10
|
| Rate for Payer: UHCCP Medicaid |
$48.35
|
|
|
PR VULVECTOMY RADICAL PARTIAL
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 56630
|
| Min. Negotiated Rate |
$617.70 |
| Max. Negotiated Rate |
$1,855.92 |
| Rate for Payer: Aetna Commercial |
$1,230.25
|
| Rate for Payer: Aetna Medicare |
$954.82
|
| Rate for Payer: BCBS Complete |
$648.58
|
| Rate for Payer: BCBS MAPPO |
$918.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,855.92
|
| Rate for Payer: BCN Commercial |
$1,408.37
|
| Rate for Payer: BCN Medicare Advantage |
$918.10
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$1,322.06
|
| Rate for Payer: Cofinity Commercial |
$1,230.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$918.10
|
| Rate for Payer: Mclaren Medicaid |
$617.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$964.00
|
| Rate for Payer: Meridian Medicaid |
$648.58
|
| Rate for Payer: Nomi Health Commercial |
$1,101.72
|
| Rate for Payer: PACE SWMI |
$918.10
|
| Rate for Payer: PHP Medicare Advantage |
$918.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$617.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,054.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,442.01
|
| Rate for Payer: Priority Health Medicare |
$927.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,442.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$918.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$918.10
|
| Rate for Payer: UHC Exchange |
$918.10
|
| Rate for Payer: UHC Medicare Advantage |
$918.10
|
| Rate for Payer: UHCCP Medicaid |
$617.70
|
|
|
PR VULVECTOMY SIMPLE PARTIAL
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 56620
|
| Min. Negotiated Rate |
$377.86 |
| Max. Negotiated Rate |
$1,725.43 |
| Rate for Payer: Aetna Commercial |
$743.97
|
| Rate for Payer: Aetna Medicare |
$577.41
|
| Rate for Payer: BCBS Complete |
$396.75
|
| Rate for Payer: BCBS MAPPO |
$555.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,725.43
|
| Rate for Payer: BCN Commercial |
$862.52
|
| Rate for Payer: BCN Medicare Advantage |
$555.20
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$799.49
|
| Rate for Payer: Cofinity Commercial |
$743.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$555.20
|
| Rate for Payer: Mclaren Medicaid |
$377.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$582.96
|
| Rate for Payer: Meridian Medicaid |
$396.75
|
| Rate for Payer: Nomi Health Commercial |
$666.24
|
| Rate for Payer: PACE SWMI |
$555.20
|
| Rate for Payer: PHP Medicare Advantage |
$555.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,021.15
|
| Rate for Payer: Priority Health HMO/PPO |
$883.46
|
| Rate for Payer: Priority Health Medicare |
$560.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$883.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$555.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$555.20
|
| Rate for Payer: UHC Exchange |
$555.20
|
| Rate for Payer: UHC Medicare Advantage |
$555.20
|
| Rate for Payer: UHCCP Medicaid |
$377.86
|
|
|
PR WEDGE EXCISION SKIN NAIL FOLD
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 11765
|
| Min. Negotiated Rate |
$60.07 |
| Max. Negotiated Rate |
$267.10 |
| Rate for Payer: Aetna Commercial |
$117.20
|
| Rate for Payer: Aetna Medicare |
$90.96
|
| Rate for Payer: BCBS Complete |
$63.07
|
| Rate for Payer: BCBS MAPPO |
$87.46
|
| Rate for Payer: BCBS Trust/PPO |
$267.10
|
| Rate for Payer: BCN Commercial |
$194.37
|
| Rate for Payer: BCN Medicare Advantage |
$87.46
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$125.94
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.46
|
| Rate for Payer: Mclaren Medicaid |
$60.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.83
|
| Rate for Payer: Meridian Medicaid |
$63.07
|
| Rate for Payer: Nomi Health Commercial |
$104.95
|
| Rate for Payer: PACE SWMI |
$87.46
|
| Rate for Payer: PHP Medicare Advantage |
$87.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO |
$126.43
|
| Rate for Payer: Priority Health Medicare |
$88.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.46
|
| Rate for Payer: UHC Exchange |
$87.46
|
| Rate for Payer: UHC Medicare Advantage |
$87.46
|
| Rate for Payer: UHCCP Medicaid |
$60.07
|
|
|
PR WEDGE RESCJ/BISCTJ OVARY UNI/BI
|
Professional
|
Both
|
$1,929.00
|
|
|
Service Code
|
HCPCS 58920
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$1,253.85 |
| Rate for Payer: Aetna Commercial |
$917.78
|
| Rate for Payer: Aetna Medicare |
$712.31
|
| Rate for Payer: BCBS Complete |
$480.85
|
| Rate for Payer: BCBS MAPPO |
$684.91
|
| Rate for Payer: BCBS Trust/PPO |
$165.36
|
| Rate for Payer: BCN Commercial |
$1,050.17
|
| Rate for Payer: BCN Medicare Advantage |
$684.91
|
| Rate for Payer: Cash Price |
$1,543.20
|
| Rate for Payer: Cash Price |
$1,543.20
|
| Rate for Payer: Cofinity Commercial |
$986.27
|
| Rate for Payer: Cofinity Commercial |
$917.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.91
|
| Rate for Payer: Mclaren Medicaid |
$457.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.16
|
| Rate for Payer: Meridian Medicaid |
$480.85
|
| Rate for Payer: Nomi Health Commercial |
$821.89
|
| Rate for Payer: PACE SWMI |
$684.91
|
| Rate for Payer: PHP Medicare Advantage |
$684.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,253.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,069.48
|
| Rate for Payer: Priority Health Medicare |
$691.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,069.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.91
|
| Rate for Payer: UHC Exchange |
$684.91
|
| Rate for Payer: UHC Medicare Advantage |
$684.91
|
| Rate for Payer: UHCCP Medicaid |
$457.95
|
|
|
PR WEDGING CAST EXCEPT CLUBFOOT CASTS
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 29740
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$1,753.43 |
| Rate for Payer: Aetna Commercial |
$88.56
|
| Rate for Payer: Aetna Medicare |
$68.73
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS MAPPO |
$66.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,753.43
|
| Rate for Payer: BCN Commercial |
$144.65
|
| Rate for Payer: BCN Medicare Advantage |
$66.09
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$95.17
|
| Rate for Payer: Cofinity Commercial |
$88.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.09
|
| Rate for Payer: Mclaren Medicaid |
$44.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.39
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Nomi Health Commercial |
$79.31
|
| Rate for Payer: PACE SWMI |
$66.09
|
| Rate for Payer: PHP Medicare Advantage |
$66.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO |
$104.82
|
| Rate for Payer: Priority Health Medicare |
$66.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.09
|
| Rate for Payer: UHC Exchange |
$66.09
|
| Rate for Payer: UHC Medicare Advantage |
$66.09
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
|
|
PR WESTONE MUSICIAN EAR PLUGS
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 00591
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna Medicare |
$148.00
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.40
|
|
|
PR WET MOUNTS/ W PREPARATIONS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS Q0111
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$703.47 |
| Rate for Payer: Aetna Commercial |
$24.37
|
| Rate for Payer: Aetna Medicare |
$18.92
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$18.19
|
| Rate for Payer: BCBS Trust/PPO |
$703.47
|
| Rate for Payer: BCN Commercial |
$12.01
|
| Rate for Payer: BCN Medicare Advantage |
$18.19
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$26.19
|
| Rate for Payer: Cofinity Commercial |
$24.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$21.83
|
| Rate for Payer: PACE SWMI |
$18.19
|
| Rate for Payer: PHP Medicare Advantage |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$18.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.19
|
| Rate for Payer: UHC Exchange |
$18.19
|
| Rate for Payer: UHC Medicare Advantage |
$18.19
|
|
|
PR WHFO, RIGID W/O JOINTS
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS L3808
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$307.83 |
| Rate for Payer: BCBS Complete |
$133.20
|
| Rate for Payer: BCN Commercial |
$307.83
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
|
|
PR WHFO W/O JOINTS PRE CST
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS L3807
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: BCN Commercial |
$216.07
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.10
|
|
|
PR WHO COCK-UP NONMOLDE PRE OTS
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS L3908
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$63.36 |
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCN Commercial |
$63.36
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
|
|
PR WHO W/NONTORSION JNT(S) CF
|
Professional
|
Both
|
$926.00
|
|
|
Service Code
|
HCPCS L3905
|
| Min. Negotiated Rate |
$370.40 |
| Max. Negotiated Rate |
$856.95 |
| Rate for Payer: BCBS Complete |
$370.40
|
| Rate for Payer: BCN Commercial |
$856.95
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Cash Price |
$740.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$601.90
|
|
|
PR WHO W/O JOINTS CF
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS L3906
|
| Min. Negotiated Rate |
$189.20 |
| Max. Negotiated Rate |
$437.92 |
| Rate for Payer: BCBS Complete |
$189.20
|
| Rate for Payer: BCN Commercial |
$437.92
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.45
|
|
|
PR WINDOWING CAST
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 29730
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$1,134.26 |
| Rate for Payer: Aetna Commercial |
$57.28
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,134.26
|
| Rate for Payer: BCN Commercial |
$93.34
|
| Rate for Payer: BCN Medicare Advantage |
$42.75
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$61.56
|
| Rate for Payer: Cofinity Commercial |
$57.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.75
|
| Rate for Payer: Mclaren Medicaid |
$28.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Nomi Health Commercial |
$51.30
|
| Rate for Payer: PACE SWMI |
$42.75
|
| Rate for Payer: PHP Medicare Advantage |
$42.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO |
$68.19
|
| Rate for Payer: Priority Health Medicare |
$43.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.75
|
| Rate for Payer: UHC Exchange |
$42.75
|
| Rate for Payer: UHC Medicare Advantage |
$42.75
|
| Rate for Payer: UHCCP Medicaid |
$28.54
|
|
|
PR WORK HARDENING/CONDITIONING 1ST 2 HR
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 97545
|
| Min. Negotiated Rate |
$77.25 |
| Max. Negotiated Rate |
$187.39 |
| Rate for Payer: Aetna Commercial |
$119.94
|
| Rate for Payer: Aetna Medicare |
$99.00
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: BCBS Trust/PPO |
$116.23
|
| Rate for Payer: BCN Commercial |
$187.39
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health HMO/PPO |
$77.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.25
|
|
|
PR WORK HARDENING/CONDITIONING EACH HOUR
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 97546
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$328.07 |
| Rate for Payer: Aetna Commercial |
$47.77
|
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS Trust/PPO |
$328.07
|
| Rate for Payer: BCN Commercial |
$93.43
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health HMO/PPO |
$77.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.25
|
|
|
PR WORK RELATED/MED DBLT XM TREATING PHYS
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99455
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$165.89 |
| Rate for Payer: Aetna Commercial |
$84.95
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS Trust/PPO |
$165.89
|
| 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 WOUND CLOSURE BY ADHESIVE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS G0168
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Medicare |
$14.55
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS MAPPO |
$13.99
|
| Rate for Payer: BCBS Trust/PPO |
$63.68
|
| Rate for Payer: BCN Commercial |
$181.79
|
| Rate for Payer: BCN Medicare Advantage |
$13.99
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$18.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.99
|
| Rate for Payer: Mclaren Medicaid |
$9.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.69
|
| Rate for Payer: Meridian Medicaid |
$9.62
|
| Rate for Payer: Nomi Health Commercial |
$16.79
|
| Rate for Payer: PACE SWMI |
$13.99
|
| Rate for Payer: PHP Medicare Advantage |
$13.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.30
|
| Rate for Payer: Priority Health HMO/PPO |
$19.87
|
| Rate for Payer: Priority Health Medicare |
$14.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.99
|
| Rate for Payer: UHC Exchange |
$13.99
|
| Rate for Payer: UHC Medicare Advantage |
$13.99
|
| Rate for Payer: UHCCP Medicaid |
$9.16
|
|
|
PR XEOMIN
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS 00085
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 94617
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$127.06 |
| Rate for Payer: Aetna Commercial |
$108.98
|
| Rate for Payer: Aetna Medicare |
$84.58
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$81.33
|
| Rate for Payer: BCBS Trust/PPO |
$124.68
|
| Rate for Payer: BCN Commercial |
$127.06
|
| Rate for Payer: BCN Medicare Advantage |
$81.33
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$117.12
|
| Rate for Payer: Cofinity Commercial |
$108.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.33
|
| Rate for Payer: Mclaren Medicaid |
$19.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.40
|
| Rate for Payer: Meridian Medicaid |
$20.80
|
| Rate for Payer: Nomi Health Commercial |
$97.60
|
| Rate for Payer: PACE SWMI |
$81.33
|
| Rate for Payer: PHP Medicare Advantage |
$81.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.00
|
| Rate for Payer: Priority Health HMO/PPO |
$42.07
|
| Rate for Payer: Priority Health Medicare |
$82.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.33
|
| Rate for Payer: UHC Exchange |
$81.33
|
| Rate for Payer: UHC Medicare Advantage |
$81.33
|
| Rate for Payer: UHCCP Medicaid |
$19.81
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 94619
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$225.12 |
| Rate for Payer: Aetna Commercial |
$79.62
|
| Rate for Payer: Aetna Medicare |
$61.80
|
| Rate for Payer: BCBS Complete |
$14.09
|
| Rate for Payer: BCBS MAPPO |
$59.42
|
| Rate for Payer: BCBS Trust/PPO |
$225.12
|
| Rate for Payer: BCN Commercial |
$111.42
|
| Rate for Payer: BCN Medicare Advantage |
$59.42
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$85.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.42
|
| Rate for Payer: Mclaren Medicaid |
$13.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.39
|
| Rate for Payer: Meridian Medicaid |
$14.09
|
| Rate for Payer: Nomi Health Commercial |
$71.30
|
| Rate for Payer: PACE SWMI |
$59.42
|
| Rate for Payer: PHP Medicare Advantage |
$59.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health HMO/PPO |
$28.49
|
| Rate for Payer: Priority Health Medicare |
$60.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.42
|
| Rate for Payer: UHC Exchange |
$59.42
|
| Rate for Payer: UHC Medicare Advantage |
$59.42
|
| Rate for Payer: UHCCP Medicaid |
$13.42
|
|
|
PR XTRNL ECG REC>48HR<7D RECORDING SCAN A/R R&I
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 93241
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$485.51 |
| Rate for Payer: Aetna Commercial |
$319.46
|
| Rate for Payer: Aetna Medicare |
$247.94
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$238.40
|
| Rate for Payer: BCBS Trust/PPO |
$485.51
|
| Rate for Payer: BCN Commercial |
$309.81
|
| Rate for Payer: BCN Medicare Advantage |
$238.40
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$319.46
|
| Rate for Payer: Cofinity Commercial |
$343.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.32
|
| Rate for Payer: Nomi Health Commercial |
$286.08
|
| Rate for Payer: PACE SWMI |
$238.40
|
| Rate for Payer: PHP Medicare Advantage |
$238.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health HMO/PPO |
$364.90
|
| Rate for Payer: Priority Health Medicare |
$240.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$364.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.40
|
| Rate for Payer: UHC Exchange |
$238.40
|
| Rate for Payer: UHC Medicare Advantage |
$238.40
|
|
