|
PR FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
HCPCS 59076
|
| Min. Negotiated Rate |
$426.40 |
| Max. Negotiated Rate |
$733.52 |
| Rate for Payer: Aetna Commercial |
$682.58
|
| Rate for Payer: Aetna Medicare |
$529.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$733.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$682.58
|
| Rate for Payer: BCBS Complete |
$426.40
|
| Rate for Payer: BCBS MAPPO |
$509.39
|
| Rate for Payer: BCN Medicare Advantage |
$509.39
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Cofinity Commercial |
$733.52
|
| Rate for Payer: Cofinity Commercial |
$682.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$509.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$534.86
|
| Rate for Payer: Nomi Health Commercial |
$611.27
|
| Rate for Payer: PACE SWMI |
$509.39
|
| Rate for Payer: PHP Commercial |
$713.15
|
| Rate for Payer: PHP Medicare Advantage |
$509.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.90
|
| Rate for Payer: Priority Health Medicare |
$509.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$509.39
|
| Rate for Payer: UHC Medicare Advantage |
$509.39
|
| Rate for Payer: UMR Bronson Commercial |
$490.36
|
|
|
PR FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE
|
Professional
|
Both
|
$1,293.00
|
|
|
Service Code
|
HCPCS 14350
|
| Min. Negotiated Rate |
$517.20 |
| Max. Negotiated Rate |
$912.25 |
| Rate for Payer: Aetna Commercial |
$848.90
|
| Rate for Payer: Aetna Medicare |
$658.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$848.90
|
| Rate for Payer: BCBS Complete |
$517.20
|
| Rate for Payer: BCBS MAPPO |
$633.51
|
| Rate for Payer: BCN Medicare Advantage |
$633.51
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Cofinity Commercial |
$912.25
|
| Rate for Payer: Cofinity Commercial |
$848.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$633.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$665.19
|
| Rate for Payer: Nomi Health Commercial |
$760.21
|
| Rate for Payer: PACE SWMI |
$633.51
|
| Rate for Payer: PHP Commercial |
$886.91
|
| Rate for Payer: PHP Medicare Advantage |
$633.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$840.45
|
| Rate for Payer: Priority Health Medicare |
$633.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$633.51
|
| Rate for Payer: UHC Medicare Advantage |
$633.51
|
| Rate for Payer: UMR Bronson Commercial |
$594.78
|
|
|
PR FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION
|
Professional
|
Both
|
$736.00
|
|
|
Service Code
|
HCPCS 10009
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$478.40 |
| Rate for Payer: Aetna Commercial |
$137.97
|
| Rate for Payer: Aetna Commercial |
$137.97
|
| Rate for Payer: Aetna Medicare |
$107.08
|
| Rate for Payer: Aetna Medicare |
$107.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.26
|
| Rate for Payer: BCBS Complete |
$294.40
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$102.96
|
| Rate for Payer: BCBS MAPPO |
$102.96
|
| Rate for Payer: BCN Medicare Advantage |
$102.96
|
| Rate for Payer: BCN Medicare Advantage |
$102.96
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$588.80
|
| Rate for Payer: Cofinity Commercial |
$148.26
|
| Rate for Payer: Cofinity Commercial |
$148.26
|
| Rate for Payer: Cofinity Commercial |
$137.97
|
| Rate for Payer: Cofinity Commercial |
$137.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.11
|
| Rate for Payer: Nomi Health Commercial |
$123.55
|
| Rate for Payer: Nomi Health Commercial |
$123.55
|
| Rate for Payer: PACE SWMI |
$102.96
|
| Rate for Payer: PACE SWMI |
$102.96
|
| Rate for Payer: PHP Commercial |
$144.14
|
| Rate for Payer: PHP Commercial |
$144.14
|
| Rate for Payer: PHP Medicare Advantage |
$102.96
|
| Rate for Payer: PHP Medicare Advantage |
$102.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.40
|
| Rate for Payer: Priority Health Medicare |
$102.96
|
| Rate for Payer: Priority Health Medicare |
$102.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.96
|
| Rate for Payer: UHC Medicare Advantage |
$102.96
|
| Rate for Payer: UHC Medicare Advantage |
$102.96
|
| Rate for Payer: UMR Bronson Commercial |
$338.56
|
| Rate for Payer: UMR Bronson Commercial |
$121.90
|
|
|
PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 10021
|
| Min. Negotiated Rate |
$52.86 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Aetna Commercial |
$70.83
|
| Rate for Payer: Aetna Medicare |
$54.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.83
|
| Rate for Payer: BCBS Complete |
$95.20
|
| Rate for Payer: BCBS MAPPO |
$52.86
|
| Rate for Payer: BCN Medicare Advantage |
$52.86
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$76.12
|
| Rate for Payer: Cofinity Commercial |
$70.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.50
|
| Rate for Payer: Nomi Health Commercial |
$63.43
|
| Rate for Payer: PACE SWMI |
$52.86
|
| Rate for Payer: PHP Commercial |
$74.00
|
| Rate for Payer: PHP Medicare Advantage |
$52.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.70
|
| Rate for Payer: Priority Health Medicare |
$52.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.86
|
| Rate for Payer: UHC Medicare Advantage |
$52.86
|
| Rate for Payer: UMR Bronson Commercial |
$109.48
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 10005
|
| Min. Negotiated Rate |
$69.50 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$93.13
|
| Rate for Payer: Aetna Medicare |
$72.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.08
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS MAPPO |
$69.50
|
| Rate for Payer: BCN Medicare Advantage |
$69.50
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$93.13
|
| Rate for Payer: Cofinity Commercial |
$100.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.97
|
| Rate for Payer: Nomi Health Commercial |
$83.40
|
| Rate for Payer: PACE SWMI |
$69.50
|
| Rate for Payer: PHP Commercial |
$97.30
|
| Rate for Payer: PHP Medicare Advantage |
$69.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health Medicare |
$69.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.50
|
| Rate for Payer: UHC Medicare Advantage |
$69.50
|
| Rate for Payer: UMR Bronson Commercial |
$115.92
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 10006
|
| Min. Negotiated Rate |
$47.34 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Commercial |
$63.44
|
| Rate for Payer: Aetna Medicare |
$49.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.44
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS MAPPO |
$47.34
|
| Rate for Payer: BCN Medicare Advantage |
$47.34
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$68.17
|
| Rate for Payer: Cofinity Commercial |
$63.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.71
|
| Rate for Payer: Nomi Health Commercial |
$56.81
|
| Rate for Payer: PACE SWMI |
$47.34
|
| Rate for Payer: PHP Commercial |
$66.28
|
| Rate for Payer: PHP Medicare Advantage |
$47.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$47.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.34
|
| Rate for Payer: UHC Medicare Advantage |
$47.34
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
|
PR FINE NEEDLE ASP;W/IMAGING GUIDANCE
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 10022
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$174.85 |
| Rate for Payer: Aetna Medicare |
$134.50
|
| Rate for Payer: BCBS Complete |
$107.60
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.85
|
| Rate for Payer: UMR Bronson Commercial |
$123.74
|
|
|
PR FINGER SPLINT, STATIC
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Aetna Medicare |
$2.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.79
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$2.63
|
| Rate for Payer: BCN Medicare Advantage |
$2.63
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.76
|
| Rate for Payer: Nomi Health Commercial |
$3.16
|
| Rate for Payer: PACE SWMI |
$2.63
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: PHP Medicare Advantage |
$2.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$2.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.63
|
| Rate for Payer: UHC Medicare Advantage |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
HCPCS 46200
|
| Min. Negotiated Rate |
$320.70 |
| Max. Negotiated Rate |
$625.30 |
| Rate for Payer: Aetna Commercial |
$429.74
|
| Rate for Payer: Aetna Medicare |
$333.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.74
|
| Rate for Payer: BCBS Complete |
$384.80
|
| Rate for Payer: BCBS MAPPO |
$320.70
|
| Rate for Payer: BCN Medicare Advantage |
$320.70
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cash Price |
$769.60
|
| Rate for Payer: Cofinity Commercial |
$461.81
|
| Rate for Payer: Cofinity Commercial |
$429.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$336.74
|
| Rate for Payer: Nomi Health Commercial |
$384.84
|
| Rate for Payer: PACE SWMI |
$320.70
|
| Rate for Payer: PHP Commercial |
$448.98
|
| Rate for Payer: PHP Medicare Advantage |
$320.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$625.30
|
| Rate for Payer: Priority Health Medicare |
$320.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.70
|
| Rate for Payer: UHC Medicare Advantage |
$320.70
|
| Rate for Payer: UMR Bronson Commercial |
$442.52
|
|
|
PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 92071
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Medicare |
$31.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.09
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS MAPPO |
$29.92
|
| Rate for Payer: BCN Medicare Advantage |
$29.92
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Commercial |
$40.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.42
|
| Rate for Payer: Nomi Health Commercial |
$35.90
|
| Rate for Payer: PACE SWMI |
$29.92
|
| Rate for Payer: PHP Commercial |
$41.89
|
| Rate for Payer: PHP Medicare Advantage |
$29.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health Medicare |
$29.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.92
|
| Rate for Payer: UHC Medicare Advantage |
$29.92
|
| Rate for Payer: UMR Bronson Commercial |
$30.82
|
|
|
PR FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 57160
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Commercial |
$59.63
|
| Rate for Payer: Aetna Medicare |
$46.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.63
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS MAPPO |
$44.50
|
| Rate for Payer: BCN Medicare Advantage |
$44.50
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$64.08
|
| Rate for Payer: Cofinity Commercial |
$59.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.73
|
| Rate for Payer: Nomi Health Commercial |
$53.40
|
| Rate for Payer: PACE SWMI |
$44.50
|
| Rate for Payer: PHP Commercial |
$62.30
|
| Rate for Payer: PHP Medicare Advantage |
$44.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: Priority Health Medicare |
$44.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.50
|
| Rate for Payer: UHC Medicare Advantage |
$44.50
|
| Rate for Payer: UMR Bronson Commercial |
$58.88
|
|
|
PR FITTING CONTACT LENS FOR MGMT OF KERATOCONUS 1ST
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 92072
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Aetna Commercial |
$116.02
|
| Rate for Payer: Aetna Medicare |
$90.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.02
|
| Rate for Payer: BCBS Complete |
$88.40
|
| Rate for Payer: BCBS MAPPO |
$86.58
|
| Rate for Payer: BCN Medicare Advantage |
$86.58
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cofinity Commercial |
$124.68
|
| Rate for Payer: Cofinity Commercial |
$116.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.91
|
| Rate for Payer: Nomi Health Commercial |
$103.90
|
| Rate for Payer: PACE SWMI |
$86.58
|
| Rate for Payer: PHP Commercial |
$121.21
|
| Rate for Payer: PHP Medicare Advantage |
$86.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health Medicare |
$86.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.58
|
| Rate for Payer: UHC Medicare Advantage |
$86.58
|
| Rate for Payer: UMR Bronson Commercial |
$101.66
|
|
|
PR FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 54620
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$410.76 |
| Rate for Payer: Aetna Commercial |
$382.24
|
| Rate for Payer: Aetna Medicare |
$296.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.24
|
| Rate for Payer: BCBS Complete |
$229.60
|
| Rate for Payer: BCBS MAPPO |
$285.25
|
| Rate for Payer: BCN Medicare Advantage |
$285.25
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$410.76
|
| Rate for Payer: Cofinity Commercial |
$382.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.51
|
| Rate for Payer: Nomi Health Commercial |
$342.30
|
| Rate for Payer: PACE SWMI |
$285.25
|
| Rate for Payer: PHP Commercial |
$399.35
|
| Rate for Payer: PHP Medicare Advantage |
$285.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health Medicare |
$285.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$285.25
|
| Rate for Payer: UHC Medicare Advantage |
$285.25
|
| Rate for Payer: UMR Bronson Commercial |
$264.04
|
|
|
PR FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY
|
Professional
|
Both
|
$1,733.00
|
|
|
Service Code
|
HCPCS 15740
|
| Min. Negotiated Rate |
$693.20 |
| Max. Negotiated Rate |
$1,154.64 |
| Rate for Payer: Aetna Commercial |
$1,074.45
|
| Rate for Payer: Aetna Medicare |
$833.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,154.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,074.45
|
| Rate for Payer: BCBS Complete |
$693.20
|
| Rate for Payer: BCBS MAPPO |
$801.83
|
| Rate for Payer: BCN Medicare Advantage |
$801.83
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cash Price |
$1,386.40
|
| Rate for Payer: Cofinity Commercial |
$1,154.64
|
| Rate for Payer: Cofinity Commercial |
$1,074.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$801.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$841.92
|
| Rate for Payer: Nomi Health Commercial |
$962.20
|
| Rate for Payer: PACE SWMI |
$801.83
|
| Rate for Payer: PHP Commercial |
$1,122.56
|
| Rate for Payer: PHP Medicare Advantage |
$801.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,126.45
|
| Rate for Payer: Priority Health Medicare |
$801.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$801.83
|
| Rate for Payer: UHC Medicare Advantage |
$801.83
|
| Rate for Payer: UMR Bronson Commercial |
$797.18
|
|
|
PR FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 92230
|
| Min. Negotiated Rate |
$29.77 |
| Max. Negotiated Rate |
$76.70 |
| Rate for Payer: Aetna Commercial |
$39.89
|
| Rate for Payer: Aetna Medicare |
$30.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.89
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$29.77
|
| Rate for Payer: BCN Medicare Advantage |
$29.77
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$42.87
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.26
|
| Rate for Payer: Nomi Health Commercial |
$35.72
|
| Rate for Payer: PACE SWMI |
$29.77
|
| Rate for Payer: PHP Commercial |
$41.68
|
| Rate for Payer: PHP Medicare Advantage |
$29.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.70
|
| Rate for Payer: Priority Health Medicare |
$29.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.77
|
| Rate for Payer: UHC Medicare Advantage |
$29.77
|
| Rate for Payer: UMR Bronson Commercial |
$54.28
|
|
|
PR FLUPHENAZINE DECANOATE 25 MG
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS J2680
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Aetna Commercial |
$9.80
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.53
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$7.31
|
| Rate for Payer: BCN Medicare Advantage |
$7.31
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$9.80
|
| Rate for Payer: Cofinity Commercial |
$10.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.68
|
| Rate for Payer: Nomi Health Commercial |
$8.77
|
| Rate for Payer: PACE SWMI |
$7.31
|
| Rate for Payer: PHP Commercial |
$10.23
|
| Rate for Payer: PHP Medicare Advantage |
$7.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.60
|
| Rate for Payer: Priority Health Medicare |
$7.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.31
|
| Rate for Payer: UHC Medicare Advantage |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
|
|
PR FLUVIRIN VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q2037
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR FLUZONE VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
PR FOLLOW-UP/REASSESSMENT
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS S0316
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR FO NONTORSION JOINT CF
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS L3935
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$348.81 |
| Rate for Payer: Aetna Commercial |
$324.59
|
| Rate for Payer: Aetna Medicare |
$251.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.59
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS MAPPO |
$242.23
|
| Rate for Payer: BCN Medicare Advantage |
$242.23
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$348.81
|
| Rate for Payer: Cofinity Commercial |
$324.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$242.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$254.34
|
| Rate for Payer: Nomi Health Commercial |
$290.68
|
| Rate for Payer: PACE SWMI |
$242.23
|
| Rate for Payer: PHP Commercial |
$339.12
|
| Rate for Payer: PHP Medicare Advantage |
$242.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$242.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$242.23
|
| Rate for Payer: UHC Medicare Advantage |
$242.23
|
| Rate for Payer: UMR Bronson Commercial |
$95.22
|
|
|
PR FOOT ARCH SUPP LONGITUD/META
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS L3060
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$127.97 |
| Rate for Payer: Aetna Commercial |
$119.09
|
| Rate for Payer: Aetna Medicare |
$92.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.09
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$88.87
|
| Rate for Payer: BCN Medicare Advantage |
$88.87
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$127.97
|
| Rate for Payer: Cofinity Commercial |
$119.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.31
|
| Rate for Payer: Nomi Health Commercial |
$106.64
|
| Rate for Payer: PACE SWMI |
$88.87
|
| Rate for Payer: PHP Commercial |
$124.42
|
| Rate for Payer: PHP Medicare Advantage |
$88.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$88.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.87
|
| Rate for Payer: UHC Medicare Advantage |
$88.87
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR FOOT PLAS HEEL STABI PRE OTS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS L3170
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$88.26 |
| Rate for Payer: Aetna Commercial |
$82.13
|
| Rate for Payer: Aetna Medicare |
$63.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.13
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$61.29
|
| Rate for Payer: BCN Medicare Advantage |
$61.29
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$88.26
|
| Rate for Payer: Cofinity Commercial |
$82.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.35
|
| Rate for Payer: Nomi Health Commercial |
$73.55
|
| Rate for Payer: PACE SWMI |
$61.29
|
| Rate for Payer: PHP Commercial |
$85.81
|
| Rate for Payer: PHP Medicare Advantage |
$61.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Medicare |
$61.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.29
|
| Rate for Payer: UHC Medicare Advantage |
$61.29
|
| Rate for Payer: UMR Bronson Commercial |
$23.00
|
|
|
PR FO PIP DIP JNT/SPRNG PRE OTS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS L3925
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$103.72 |
| Rate for Payer: Aetna Commercial |
$96.52
|
| Rate for Payer: Aetna Medicare |
$74.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.72
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$72.03
|
| Rate for Payer: BCN Medicare Advantage |
$72.03
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$96.52
|
| Rate for Payer: Cofinity Commercial |
$103.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.63
|
| Rate for Payer: Nomi Health Commercial |
$86.44
|
| Rate for Payer: PACE SWMI |
$72.03
|
| Rate for Payer: PHP Commercial |
$100.84
|
| Rate for Payer: PHP Medicare Advantage |
$72.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health Medicare |
$72.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.03
|
| Rate for Payer: UHC Medicare Advantage |
$72.03
|
| Rate for Payer: UMR Bronson Commercial |
$28.52
|
|
|
PR FOREARM/ARM CUFFS FREE MOTIO
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
HCPCS L3720
|
| Min. Negotiated Rate |
$255.20 |
| Max. Negotiated Rate |
$1,078.91 |
| Rate for Payer: Aetna Commercial |
$1,003.98
|
| Rate for Payer: Aetna Medicare |
$779.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,078.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,003.98
|
| Rate for Payer: BCBS Complete |
$255.20
|
| Rate for Payer: BCBS MAPPO |
$749.24
|
| Rate for Payer: BCN Medicare Advantage |
$749.24
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cash Price |
$510.40
|
| Rate for Payer: Cofinity Commercial |
$1,078.91
|
| Rate for Payer: Cofinity Commercial |
$1,003.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$749.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$786.70
|
| Rate for Payer: Nomi Health Commercial |
$899.09
|
| Rate for Payer: PACE SWMI |
$749.24
|
| Rate for Payer: PHP Commercial |
$1,048.94
|
| Rate for Payer: PHP Medicare Advantage |
$749.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$414.70
|
| Rate for Payer: Priority Health Medicare |
$749.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$749.24
|
| Rate for Payer: UHC Medicare Advantage |
$749.24
|
| Rate for Payer: UMR Bronson Commercial |
$293.48
|
|
|
PR FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE
|
Professional
|
Both
|
$2,259.00
|
|
|
Service Code
|
HCPCS 15731
|
| Min. Negotiated Rate |
$903.60 |
| Max. Negotiated Rate |
$1,468.35 |
| Rate for Payer: Aetna Commercial |
$1,268.04
|
| Rate for Payer: Aetna Medicare |
$984.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,362.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,268.04
|
| Rate for Payer: BCBS Complete |
$903.60
|
| Rate for Payer: BCBS MAPPO |
$946.30
|
| Rate for Payer: BCN Medicare Advantage |
$946.30
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cash Price |
$1,807.20
|
| Rate for Payer: Cofinity Commercial |
$1,362.67
|
| Rate for Payer: Cofinity Commercial |
$1,268.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$946.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$993.62
|
| Rate for Payer: Nomi Health Commercial |
$1,135.56
|
| Rate for Payer: PACE SWMI |
$946.30
|
| Rate for Payer: PHP Commercial |
$1,324.82
|
| Rate for Payer: PHP Medicare Advantage |
$946.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,468.35
|
| Rate for Payer: Priority Health Medicare |
$946.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$946.30
|
| Rate for Payer: UHC Medicare Advantage |
$946.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,039.14
|
|
