|
PR PENICILLIN G BENZATHINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0561
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$45.32 |
| Rate for Payer: Aetna Commercial |
$42.17
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.32
|
| Rate for Payer: BCBS MAPPO |
$31.47
|
| Rate for Payer: BCBS Trust/PPO |
$33.85
|
| Rate for Payer: BCN Commercial |
$27.98
|
| Rate for Payer: BCN Medicare Advantage |
$31.47
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$45.32
|
| Rate for Payer: Cofinity Commercial |
$42.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.62
|
| Rate for Payer: Nomi Health Commercial |
$37.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
| Rate for Payer: PACE SWMI |
$31.47
|
| Rate for Payer: PHP Commercial |
$44.06
|
| Rate for Payer: PHP Medicare Advantage |
$31.47
|
| Rate for Payer: Priority Health Medicare |
$31.47
|
| Rate for Payer: Railroad Medicare Medicare |
$31.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.97
|
| Rate for Payer: UHC Core |
$31.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.47
|
| Rate for Payer: UHC Exchange |
$31.97
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR PENILE PLETHYSMOGRAPHY
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 54240
|
| Min. Negotiated Rate |
$89.24 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Aetna Commercial |
$145.44
|
| Rate for Payer: Aetna Medicare |
$112.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.30
|
| Rate for Payer: BCBS MAPPO |
$108.54
|
| Rate for Payer: BCN Commercial |
$162.84
|
| Rate for Payer: BCN Medicare Advantage |
$108.54
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Cofinity Commercial |
$156.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$119.39
|
| Rate for Payer: Nomi Health Commercial |
$130.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.50
|
| Rate for Payer: PACE SWMI |
$108.54
|
| Rate for Payer: PHP Commercial |
$151.96
|
| Rate for Payer: PHP Medicare Advantage |
$108.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$177.38
|
| Rate for Payer: Priority Health Medicare |
$108.54
|
| Rate for Payer: Priority Health SBD |
$177.38
|
| Rate for Payer: Priority Health Tiered Network |
$177.38
|
| Rate for Payer: Railroad Medicare Medicare |
$108.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.66
|
| Rate for Payer: UHC Core |
$176.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$108.54
|
| Rate for Payer: UHC Exchange |
$176.66
|
| Rate for Payer: UMR Bronson Commercial |
$89.24
|
|
|
PR PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR
|
Professional
|
Both
|
$5,356.00
|
|
|
Service Code
|
HCPCS 54304
|
| Min. Negotiated Rate |
$431.11 |
| Max. Negotiated Rate |
$4,017.00 |
| Rate for Payer: Aetna Commercial |
$893.55
|
| Rate for Payer: Aetna Medicare |
$693.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$893.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$960.24
|
| Rate for Payer: BCBS Complete |
$452.67
|
| Rate for Payer: BCBS MAPPO |
$666.83
|
| Rate for Payer: BCN Commercial |
$1,119.46
|
| Rate for Payer: BCN Medicare Advantage |
$666.83
|
| Rate for Payer: Cash Price |
$4,284.80
|
| Rate for Payer: Cash Price |
$4,284.80
|
| Rate for Payer: Cofinity Commercial |
$960.24
|
| Rate for Payer: Cofinity Commercial |
$893.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$666.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$700.17
|
| Rate for Payer: Meridian Medicaid |
$452.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$733.51
|
| Rate for Payer: Nomi Health Commercial |
$800.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,017.00
|
| Rate for Payer: PACE SWMI |
$666.83
|
| Rate for Payer: PHP Commercial |
$933.56
|
| Rate for Payer: PHP Medicare Advantage |
$666.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$431.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,219.46
|
| Rate for Payer: Priority Health Medicare |
$666.83
|
| Rate for Payer: Priority Health SBD |
$1,219.46
|
| Rate for Payer: Priority Health Tiered Network |
$1,219.46
|
| Rate for Payer: Railroad Medicare Medicare |
$666.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,321.67
|
| Rate for Payer: UHC Core |
$1,321.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$666.83
|
| Rate for Payer: UHC Exchange |
$1,321.67
|
| Rate for Payer: UHC Medicaid |
$431.11
|
| Rate for Payer: UHCCP Medicaid |
$431.11
|
| Rate for Payer: UMR Bronson Commercial |
$2,463.76
|
|
|
PR PENIS STRAIGHTENING CHORDEE
|
Professional
|
Both
|
$1,376.00
|
|
|
Service Code
|
HCPCS 54300
|
| Min. Negotiated Rate |
$375.31 |
| Max. Negotiated Rate |
$1,136.46 |
| Rate for Payer: Aetna Commercial |
$776.36
|
| Rate for Payer: Aetna Medicare |
$602.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$776.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$834.29
|
| Rate for Payer: BCBS Complete |
$394.08
|
| Rate for Payer: BCBS MAPPO |
$579.37
|
| Rate for Payer: BCN Commercial |
$968.58
|
| Rate for Payer: BCN Medicare Advantage |
$579.37
|
| Rate for Payer: Cash Price |
$1,100.80
|
| Rate for Payer: Cash Price |
$1,100.80
|
| Rate for Payer: Cofinity Commercial |
$776.36
|
| Rate for Payer: Cofinity Commercial |
$834.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$579.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$608.34
|
| Rate for Payer: Meridian Medicaid |
$394.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$637.31
|
| Rate for Payer: Nomi Health Commercial |
$695.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,032.00
|
| Rate for Payer: PACE SWMI |
$579.37
|
| Rate for Payer: PHP Commercial |
$811.12
|
| Rate for Payer: PHP Medicare Advantage |
$579.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,055.09
|
| Rate for Payer: Priority Health Medicare |
$579.37
|
| Rate for Payer: Priority Health SBD |
$1,055.09
|
| Rate for Payer: Priority Health Tiered Network |
$1,055.09
|
| Rate for Payer: Railroad Medicare Medicare |
$579.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,136.46
|
| Rate for Payer: UHC Core |
$1,136.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$579.37
|
| Rate for Payer: UHC Exchange |
$1,136.46
|
| Rate for Payer: UHC Medicaid |
$375.31
|
| Rate for Payer: UHCCP Medicaid |
$375.31
|
| Rate for Payer: UMR Bronson Commercial |
$632.96
|
|
|
PR PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 94642
|
| Min. Negotiated Rate |
$18.04 |
| Max. Negotiated Rate |
$190.17 |
| Rate for Payer: Aetna Commercial |
$46.35
|
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.35
|
| Rate for Payer: BCBS Complete |
$18.94
|
| Rate for Payer: BCN Commercial |
$190.17
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Meridian Medicaid |
$18.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$59.25
|
| Rate for Payer: Priority Health SBD |
$59.25
|
| Rate for Payer: Priority Health Tiered Network |
$59.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.22
|
| Rate for Payer: UHC Core |
$47.22
|
| Rate for Payer: UHC Exchange |
$47.22
|
| Rate for Payer: UHC Medicaid |
$18.04
|
| Rate for Payer: UHCCP Medicaid |
$18.04
|
| Rate for Payer: UMR Bronson Commercial |
$90.16
|
|
|
PR PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 92972
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$243.43 |
| Rate for Payer: Aetna Commercial |
$162.88
|
| Rate for Payer: Aetna Medicare |
$126.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.03
|
| Rate for Payer: BCBS Complete |
$81.86
|
| Rate for Payer: BCBS MAPPO |
$121.55
|
| Rate for Payer: BCN Commercial |
$214.63
|
| Rate for Payer: BCN Medicare Advantage |
$121.55
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$175.03
|
| Rate for Payer: Cofinity Commercial |
$162.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.63
|
| Rate for Payer: Meridian Medicaid |
$81.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.71
|
| Rate for Payer: Nomi Health Commercial |
$145.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.00
|
| Rate for Payer: PACE SWMI |
$121.55
|
| Rate for Payer: PHP Commercial |
$170.17
|
| Rate for Payer: PHP Medicare Advantage |
$121.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$203.99
|
| Rate for Payer: Priority Health Medicare |
$121.55
|
| Rate for Payer: Priority Health SBD |
$203.99
|
| Rate for Payer: Priority Health Tiered Network |
$203.99
|
| Rate for Payer: Railroad Medicare Medicare |
$121.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.43
|
| Rate for Payer: UHC Core |
$243.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$121.55
|
| Rate for Payer: UHC Exchange |
$243.43
|
| Rate for Payer: UHC Medicaid |
$77.96
|
| Rate for Payer: UHCCP Medicaid |
$77.96
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
|
|
PR PERCUTANEOUS TX MALAR AREA FRACTURE
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
HCPCS 21355
|
| Min. Negotiated Rate |
$187.65 |
| Max. Negotiated Rate |
$707.25 |
| Rate for Payer: Aetna Commercial |
$382.90
|
| Rate for Payer: Aetna Medicare |
$297.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.48
|
| Rate for Payer: BCBS Complete |
$197.03
|
| Rate for Payer: BCBS MAPPO |
$285.75
|
| Rate for Payer: BCN Commercial |
$497.49
|
| Rate for Payer: BCN Medicare Advantage |
$285.75
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cofinity Commercial |
$382.90
|
| Rate for Payer: Cofinity Commercial |
$411.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$300.04
|
| Rate for Payer: Meridian Medicaid |
$197.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$314.32
|
| Rate for Payer: Nomi Health Commercial |
$342.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.25
|
| Rate for Payer: PACE SWMI |
$285.75
|
| Rate for Payer: PHP Commercial |
$400.05
|
| Rate for Payer: PHP Medicare Advantage |
$285.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$531.79
|
| Rate for Payer: Priority Health Medicare |
$285.75
|
| Rate for Payer: Priority Health SBD |
$531.79
|
| Rate for Payer: Priority Health Tiered Network |
$531.79
|
| Rate for Payer: Railroad Medicare Medicare |
$285.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$554.38
|
| Rate for Payer: UHC Core |
$554.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$285.75
|
| Rate for Payer: UHC Exchange |
$554.38
|
| Rate for Payer: UHC Medicaid |
$187.65
|
| Rate for Payer: UHCCP Medicaid |
$187.65
|
| Rate for Payer: UMR Bronson Commercial |
$433.78
|
|
|
PR PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR
|
Professional
|
Both
|
$741.00
|
|
|
Service Code
|
HCPCS 22522
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$555.75 |
| Rate for Payer: Aetna Medicare |
$370.50
|
| Rate for Payer: BCBS Complete |
$296.40
|
| Rate for Payer: Cash Price |
$592.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$555.75
|
| Rate for Payer: UMR Bronson Commercial |
$340.86
|
|
|
PR PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX
|
Professional
|
Both
|
$5,916.00
|
|
|
Service Code
|
HCPCS 22521
|
| Min. Negotiated Rate |
$2,366.40 |
| Max. Negotiated Rate |
$4,437.00 |
| Rate for Payer: Aetna Medicare |
$2,958.00
|
| Rate for Payer: BCBS Complete |
$2,366.40
|
| Rate for Payer: Cash Price |
$4,732.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,437.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,721.36
|
|
|
PR PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX
|
Professional
|
Both
|
$8,076.00
|
|
|
Service Code
|
HCPCS 22520
|
| Min. Negotiated Rate |
$3,230.40 |
| Max. Negotiated Rate |
$6,057.00 |
| Rate for Payer: Aetna Medicare |
$4,038.00
|
| Rate for Payer: BCBS Complete |
$3,230.40
|
| Rate for Payer: Cash Price |
$6,460.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,057.00
|
| Rate for Payer: UMR Bronson Commercial |
$3,714.96
|
|
|
PR PERCUT DILATN RENAL TRACT
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 50395
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.75
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
PR PERCUT INSERT KIDNEY CATH/DRAIN
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
HCPCS 50392
|
| Min. Negotiated Rate |
$150.40 |
| Max. Negotiated Rate |
$282.00 |
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: UMR Bronson Commercial |
$172.96
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, EA ADD
|
Professional
|
Both
|
$520.00
|
|
|
Service Code
|
HCPCS 22525
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$390.00 |
| Rate for Payer: Aetna Medicare |
$260.00
|
| Rate for Payer: BCBS Complete |
$208.00
|
| Rate for Payer: Cash Price |
$416.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$390.00
|
| Rate for Payer: UMR Bronson Commercial |
$239.20
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, LUMBAR
|
Professional
|
Both
|
$1,107.00
|
|
|
Service Code
|
HCPCS 22524
|
| Min. Negotiated Rate |
$442.80 |
| Max. Negotiated Rate |
$830.25 |
| Rate for Payer: Aetna Medicare |
$553.50
|
| Rate for Payer: BCBS Complete |
$442.80
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$830.25
|
| Rate for Payer: UMR Bronson Commercial |
$509.22
|
|
|
PR PERC VERTEB AUGMENT/ KYPHOPLAST, THOR
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 22523
|
| Min. Negotiated Rate |
$470.00 |
| Max. Negotiated Rate |
$881.25 |
| Rate for Payer: Aetna Medicare |
$587.50
|
| Rate for Payer: BCBS Complete |
$470.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$881.25
|
| Rate for Payer: UMR Bronson Commercial |
$540.50
|
|
|
PR PEREYRA PX W/ANTERIOR COLPORRHAPHY
|
Professional
|
Both
|
$2,279.00
|
|
|
Service Code
|
HCPCS 57289
|
| Min. Negotiated Rate |
$446.24 |
| Max. Negotiated Rate |
$1,709.25 |
| Rate for Payer: Aetna Commercial |
$925.86
|
| Rate for Payer: Aetna Medicare |
$718.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$925.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$994.95
|
| Rate for Payer: BCBS Complete |
$468.55
|
| Rate for Payer: BCBS MAPPO |
$690.94
|
| Rate for Payer: BCN Commercial |
$1,188.18
|
| Rate for Payer: BCN Medicare Advantage |
$690.94
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Cash Price |
$1,823.20
|
| Rate for Payer: Cofinity Commercial |
$994.95
|
| Rate for Payer: Cofinity Commercial |
$925.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$690.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$725.49
|
| Rate for Payer: Meridian Medicaid |
$468.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$760.03
|
| Rate for Payer: Nomi Health Commercial |
$829.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,709.25
|
| Rate for Payer: PACE SWMI |
$690.94
|
| Rate for Payer: PHP Commercial |
$967.32
|
| Rate for Payer: PHP Medicare Advantage |
$690.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,203.38
|
| Rate for Payer: Priority Health Medicare |
$690.94
|
| Rate for Payer: Priority Health SBD |
$1,203.38
|
| Rate for Payer: Priority Health Tiered Network |
$1,203.38
|
| Rate for Payer: Railroad Medicare Medicare |
$690.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,380.31
|
| Rate for Payer: UHC Core |
$1,380.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$690.94
|
| Rate for Payer: UHC Exchange |
$1,380.31
|
| Rate for Payer: UHC Medicaid |
$446.24
|
| Rate for Payer: UHCCP Medicaid |
$446.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,048.34
|
|
|
PR PERICARDIOCENTESIS INITIAL
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 33010
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$348.75 |
| Rate for Payer: Aetna Medicare |
$232.50
|
| Rate for Payer: BCBS Complete |
$186.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.75
|
| Rate for Payer: UMR Bronson Commercial |
$213.90
|
|
|
PR PERICARDIOCENTESIS SUBSEQUENT
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 33011
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Medicare |
$232.00
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$348.00
|
| Rate for Payer: UMR Bronson Commercial |
$213.44
|
|
|
PR PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 33016
|
| Min. Negotiated Rate |
$130.14 |
| Max. Negotiated Rate |
$421.93 |
| Rate for Payer: Aetna Commercial |
$275.95
|
| Rate for Payer: Aetna Medicare |
$214.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.54
|
| Rate for Payer: BCBS Complete |
$136.65
|
| Rate for Payer: BCBS MAPPO |
$205.93
|
| Rate for Payer: BCN Commercial |
$343.11
|
| Rate for Payer: BCN Medicare Advantage |
$205.93
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cofinity Commercial |
$275.95
|
| Rate for Payer: Cofinity Commercial |
$296.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.23
|
| Rate for Payer: Meridian Medicaid |
$136.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$226.52
|
| Rate for Payer: Nomi Health Commercial |
$247.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$382.50
|
| Rate for Payer: PACE SWMI |
$205.93
|
| Rate for Payer: PHP Commercial |
$288.30
|
| Rate for Payer: PHP Medicare Advantage |
$205.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$368.97
|
| Rate for Payer: Priority Health Medicare |
$205.93
|
| Rate for Payer: Priority Health SBD |
$368.97
|
| Rate for Payer: Priority Health Tiered Network |
$368.97
|
| Rate for Payer: Railroad Medicare Medicare |
$205.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.93
|
| Rate for Payer: UHC Core |
$421.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$205.93
|
| Rate for Payer: UHC Exchange |
$421.93
|
| Rate for Payer: UHC Medicaid |
$130.14
|
| Rate for Payer: UHCCP Medicaid |
$130.14
|
| Rate for Payer: UMR Bronson Commercial |
$234.60
|
|
|
PR PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY
|
Professional
|
Both
|
$2,737.00
|
|
|
Service Code
|
HCPCS 33020
|
| Min. Negotiated Rate |
$499.70 |
| Max. Negotiated Rate |
$2,052.75 |
| Rate for Payer: Aetna Commercial |
$1,045.94
|
| Rate for Payer: Aetna Medicare |
$811.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,045.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,123.99
|
| Rate for Payer: BCBS Complete |
$524.68
|
| Rate for Payer: BCBS MAPPO |
$780.55
|
| Rate for Payer: BCN Commercial |
$1,226.52
|
| Rate for Payer: BCN Medicare Advantage |
$780.55
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cash Price |
$2,189.60
|
| Rate for Payer: Cofinity Commercial |
$1,045.94
|
| Rate for Payer: Cofinity Commercial |
$1,123.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$780.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$819.58
|
| Rate for Payer: Meridian Medicaid |
$524.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$858.61
|
| Rate for Payer: Nomi Health Commercial |
$936.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,052.75
|
| Rate for Payer: PACE SWMI |
$780.55
|
| Rate for Payer: PHP Commercial |
$1,092.77
|
| Rate for Payer: PHP Medicare Advantage |
$780.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$499.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,318.97
|
| Rate for Payer: Priority Health Medicare |
$780.55
|
| Rate for Payer: Priority Health SBD |
$1,318.97
|
| Rate for Payer: Priority Health Tiered Network |
$1,318.97
|
| Rate for Payer: Railroad Medicare Medicare |
$780.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.26
|
| Rate for Payer: UHC Core |
$1,466.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$780.55
|
| Rate for Payer: UHC Exchange |
$1,466.26
|
| Rate for Payer: UHC Medicaid |
$499.70
|
| Rate for Payer: UHCCP Medicaid |
$499.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,259.02
|
|
|
PR PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE
|
Professional
|
Both
|
$2,217.00
|
|
|
Service Code
|
HCPCS 19371
|
| Min. Negotiated Rate |
$414.07 |
| Max. Negotiated Rate |
$1,662.75 |
| Rate for Payer: Aetna Commercial |
$850.06
|
| Rate for Payer: Aetna Medicare |
$659.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$850.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.49
|
| Rate for Payer: BCBS Complete |
$434.77
|
| Rate for Payer: BCBS MAPPO |
$634.37
|
| Rate for Payer: BCN Commercial |
$1,080.12
|
| Rate for Payer: BCN Medicare Advantage |
$634.37
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cash Price |
$1,773.60
|
| Rate for Payer: Cofinity Commercial |
$850.06
|
| Rate for Payer: Cofinity Commercial |
$913.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$634.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$666.09
|
| Rate for Payer: Meridian Medicaid |
$434.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$697.81
|
| Rate for Payer: Nomi Health Commercial |
$761.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,662.75
|
| Rate for Payer: PACE SWMI |
$634.37
|
| Rate for Payer: PHP Commercial |
$888.12
|
| Rate for Payer: PHP Medicare Advantage |
$634.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$988.60
|
| Rate for Payer: Priority Health Medicare |
$634.37
|
| Rate for Payer: Priority Health SBD |
$988.60
|
| Rate for Payer: Priority Health Tiered Network |
$988.60
|
| Rate for Payer: Railroad Medicare Medicare |
$634.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,374.41
|
| Rate for Payer: UHC Core |
$1,374.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$634.37
|
| Rate for Payer: UHC Exchange |
$1,374.41
|
| Rate for Payer: UHC Medicaid |
$414.07
|
| Rate for Payer: UHCCP Medicaid |
$414.07
|
| Rate for Payer: UMR Bronson Commercial |
$1,019.82
|
|
|
PR PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
HCPCS 56810
|
| Min. Negotiated Rate |
$153.79 |
| Max. Negotiated Rate |
$707.25 |
| Rate for Payer: Aetna Commercial |
$318.17
|
| Rate for Payer: Aetna Medicare |
$246.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.91
|
| Rate for Payer: BCBS Complete |
$161.48
|
| Rate for Payer: BCBS MAPPO |
$237.44
|
| Rate for Payer: BCN Commercial |
$407.85
|
| Rate for Payer: BCN Medicare Advantage |
$237.44
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cofinity Commercial |
$318.17
|
| Rate for Payer: Cofinity Commercial |
$341.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.31
|
| Rate for Payer: Meridian Medicaid |
$161.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$261.18
|
| Rate for Payer: Nomi Health Commercial |
$284.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.25
|
| Rate for Payer: PACE SWMI |
$237.44
|
| Rate for Payer: PHP Commercial |
$332.42
|
| Rate for Payer: PHP Medicare Advantage |
$237.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$153.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$413.06
|
| Rate for Payer: Priority Health Medicare |
$237.44
|
| Rate for Payer: Priority Health SBD |
$413.06
|
| Rate for Payer: Priority Health Tiered Network |
$413.06
|
| Rate for Payer: Railroad Medicare Medicare |
$237.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$469.85
|
| Rate for Payer: UHC Core |
$469.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$237.44
|
| Rate for Payer: UHC Exchange |
$469.85
|
| Rate for Payer: UHC Medicaid |
$153.79
|
| Rate for Payer: UHCCP Medicaid |
$153.79
|
| Rate for Payer: UMR Bronson Commercial |
$433.78
|
|
|
PR PERIODIC PREVENTIVE MED ESTABLISHED PATIENT <1Y
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 99391
|
| Min. Negotiated Rate |
$61.21 |
| Max. Negotiated Rate |
$146.80 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Medicare |
$79.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.14
|
| Rate for Payer: BCBS Complete |
$64.27
|
| Rate for Payer: BCN Commercial |
$146.40
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Meridian Medicaid |
$64.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$119.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$146.80
|
| Rate for Payer: Priority Health SBD |
$146.80
|
| Rate for Payer: Priority Health Tiered Network |
$146.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.69
|
| Rate for Payer: UHC Core |
$100.69
|
| Rate for Payer: UHC Exchange |
$100.69
|
| Rate for Payer: UHC Medicaid |
$61.21
|
| Rate for Payer: UHCCP Medicaid |
$61.21
|
| Rate for Payer: UMR Bronson Commercial |
$73.14
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 12-17YRS
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 99394
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.48
|
| Rate for Payer: BCBS Complete |
$79.30
|
| Rate for Payer: BCN Commercial |
$124.23
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Meridian Medicaid |
$79.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$107.58
|
| Rate for Payer: Priority Health SBD |
$107.58
|
| Rate for Payer: Priority Health Tiered Network |
$107.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.25
|
| Rate for Payer: UHC Core |
$124.25
|
| Rate for Payer: UHC Exchange |
$124.25
|
| Rate for Payer: UHC Medicaid |
$75.52
|
| Rate for Payer: UHCCP Medicaid |
$75.52
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
PR PERIODIC PREVENTIVE MED EST PATIENT 1-4YRS
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 99392
|
| Min. Negotiated Rate |
$66.69 |
| Max. Negotiated Rate |
$156.69 |
| Rate for Payer: Aetna Commercial |
$78.23
|
| Rate for Payer: Aetna Medicare |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| Rate for Payer: BCBS Complete |
$70.02
|
| Rate for Payer: BCN Commercial |
$155.86
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Meridian Medicaid |
$70.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$156.69
|
| Rate for Payer: Priority Health SBD |
$156.69
|
| Rate for Payer: Priority Health Tiered Network |
$156.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.70
|
| Rate for Payer: UHC Core |
$109.70
|
| Rate for Payer: UHC Exchange |
$109.70
|
| Rate for Payer: UHC Medicaid |
$66.69
|
| Rate for Payer: UHCCP Medicaid |
$66.69
|
| Rate for Payer: UMR Bronson Commercial |
$78.20
|
|
