|
PR PERQ TRLUML REVSC CHRNC TOT OCCLS 1 C ART ANTGRD
|
Professional
|
Both
|
$1,434.00
|
|
|
Service Code
|
HCPCS 92943
|
| Min. Negotiated Rate |
$404.27 |
| Max. Negotiated Rate |
$1,098.57 |
| Rate for Payer: Aetna Commercial |
$857.73
|
| Rate for Payer: Aetna Medicare |
$665.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.74
|
| Rate for Payer: BCBS Complete |
$424.48
|
| Rate for Payer: BCBS MAPPO |
$640.10
|
| Rate for Payer: BCN Commercial |
$963.10
|
| Rate for Payer: BCN Medicare Advantage |
$640.10
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cash Price |
$1,147.20
|
| Rate for Payer: Cofinity Commercial |
$857.73
|
| Rate for Payer: Cofinity Commercial |
$921.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.11
|
| Rate for Payer: Meridian Medicaid |
$424.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$704.11
|
| Rate for Payer: Nomi Health Commercial |
$768.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,075.50
|
| Rate for Payer: PACE SWMI |
$640.10
|
| Rate for Payer: PHP Commercial |
$896.14
|
| Rate for Payer: PHP Medicare Advantage |
$640.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$404.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$915.37
|
| Rate for Payer: Priority Health Medicare |
$640.10
|
| Rate for Payer: Priority Health SBD |
$915.37
|
| Rate for Payer: Priority Health Tiered Network |
$915.37
|
| Rate for Payer: Railroad Medicare Medicare |
$640.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,098.57
|
| Rate for Payer: UHC Core |
$1,098.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$640.10
|
| Rate for Payer: UHC Exchange |
$1,098.57
|
| Rate for Payer: UHC Medicaid |
$404.27
|
| Rate for Payer: UHCCP Medicaid |
$404.27
|
| Rate for Payer: UMR Bronson Commercial |
$659.64
|
|
|
PR PERQ TRLUML REVSC OF/-CAB GRF 1 MAJ C ART&/BRNCH
|
Professional
|
Both
|
$1,280.00
|
|
|
Service Code
|
HCPCS 92937
|
| Min. Negotiated Rate |
$333.98 |
| Max. Negotiated Rate |
$976.03 |
| Rate for Payer: Aetna Commercial |
$708.69
|
| Rate for Payer: Aetna Medicare |
$550.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.57
|
| Rate for Payer: BCBS Complete |
$350.68
|
| Rate for Payer: BCBS MAPPO |
$528.87
|
| Rate for Payer: BCN Commercial |
$856.53
|
| Rate for Payer: BCN Medicare Advantage |
$528.87
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cash Price |
$1,024.00
|
| Rate for Payer: Cofinity Commercial |
$708.69
|
| Rate for Payer: Cofinity Commercial |
$761.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.31
|
| Rate for Payer: Meridian Medicaid |
$350.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$581.76
|
| Rate for Payer: Nomi Health Commercial |
$634.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$960.00
|
| Rate for Payer: PACE SWMI |
$528.87
|
| Rate for Payer: PHP Commercial |
$740.42
|
| Rate for Payer: PHP Medicare Advantage |
$528.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$333.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$814.09
|
| Rate for Payer: Priority Health Medicare |
$528.87
|
| Rate for Payer: Priority Health SBD |
$814.09
|
| Rate for Payer: Priority Health Tiered Network |
$814.09
|
| Rate for Payer: Railroad Medicare Medicare |
$528.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$976.03
|
| Rate for Payer: UHC Core |
$976.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$528.87
|
| Rate for Payer: UHC Exchange |
$976.03
|
| Rate for Payer: UHC Medicaid |
$333.98
|
| Rate for Payer: UHCCP Medicaid |
$333.98
|
| Rate for Payer: UMR Bronson Commercial |
$588.80
|
|
|
PR PERQ TRLUML REVSC TOT/STOT OCCLS AMI 1MAJ C ART
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 92941
|
| Min. Negotiated Rate |
$375.95 |
| Max. Negotiated Rate |
$1,098.57 |
| Rate for Payer: Aetna Commercial |
$797.55
|
| Rate for Payer: Aetna Medicare |
$619.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$797.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.07
|
| Rate for Payer: BCBS Complete |
$394.75
|
| Rate for Payer: BCBS MAPPO |
$595.19
|
| Rate for Payer: BCN Commercial |
$963.10
|
| Rate for Payer: BCN Medicare Advantage |
$595.19
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cofinity Commercial |
$797.55
|
| Rate for Payer: Cofinity Commercial |
$857.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$624.95
|
| Rate for Payer: Meridian Medicaid |
$394.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$654.71
|
| Rate for Payer: Nomi Health Commercial |
$714.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,080.00
|
| Rate for Payer: PACE SWMI |
$595.19
|
| Rate for Payer: PHP Commercial |
$833.27
|
| Rate for Payer: PHP Medicare Advantage |
$595.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$915.37
|
| Rate for Payer: Priority Health Medicare |
$595.19
|
| Rate for Payer: Priority Health SBD |
$915.37
|
| Rate for Payer: Priority Health Tiered Network |
$915.37
|
| Rate for Payer: Railroad Medicare Medicare |
$595.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,098.57
|
| Rate for Payer: UHC Core |
$1,098.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$595.19
|
| Rate for Payer: UHC Exchange |
$1,098.57
|
| Rate for Payer: UHC Medicaid |
$375.95
|
| Rate for Payer: UHCCP Medicaid |
$375.95
|
| Rate for Payer: UMR Bronson Commercial |
$662.40
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION
|
Professional
|
Both
|
$1,592.00
|
|
|
Service Code
|
HCPCS 22513
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$1,194.00 |
| Rate for Payer: Aetna Commercial |
$602.93
|
| Rate for Payer: Aetna Medicare |
$467.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$602.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$647.93
|
| Rate for Payer: BCBS Complete |
$303.71
|
| Rate for Payer: BCBS MAPPO |
$449.95
|
| Rate for Payer: BCN Commercial |
$759.43
|
| Rate for Payer: BCN Medicare Advantage |
$449.95
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Cash Price |
$1,273.60
|
| Rate for Payer: Cofinity Commercial |
$602.93
|
| Rate for Payer: Cofinity Commercial |
$647.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$449.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$472.45
|
| Rate for Payer: Meridian Medicaid |
$303.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$494.94
|
| Rate for Payer: Nomi Health Commercial |
$539.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,194.00
|
| Rate for Payer: PACE SWMI |
$449.95
|
| Rate for Payer: PHP Commercial |
$629.93
|
| Rate for Payer: PHP Medicare Advantage |
$449.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$811.79
|
| Rate for Payer: Priority Health Medicare |
$449.95
|
| Rate for Payer: Priority Health SBD |
$811.79
|
| Rate for Payer: Priority Health Tiered Network |
$811.79
|
| Rate for Payer: Railroad Medicare Medicare |
$449.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$906.09
|
| Rate for Payer: UHC Core |
$906.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$449.95
|
| Rate for Payer: UHC Exchange |
$906.09
|
| Rate for Payer: UHC Medicaid |
$289.25
|
| Rate for Payer: UHCCP Medicaid |
$289.25
|
| Rate for Payer: UMR Bronson Commercial |
$732.32
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH
|
Professional
|
Both
|
$830.00
|
|
|
Service Code
|
HCPCS 22515
|
| Min. Negotiated Rate |
$120.56 |
| Max. Negotiated Rate |
$622.50 |
| Rate for Payer: Aetna Commercial |
$254.10
|
| Rate for Payer: Aetna Medicare |
$197.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.07
|
| Rate for Payer: BCBS Complete |
$126.59
|
| Rate for Payer: BCBS MAPPO |
$189.63
|
| Rate for Payer: BCN Commercial |
$322.69
|
| Rate for Payer: BCN Medicare Advantage |
$189.63
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cash Price |
$664.00
|
| Rate for Payer: Cofinity Commercial |
$254.10
|
| Rate for Payer: Cofinity Commercial |
$273.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.11
|
| Rate for Payer: Meridian Medicaid |
$126.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$208.59
|
| Rate for Payer: Nomi Health Commercial |
$227.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$622.50
|
| Rate for Payer: PACE SWMI |
$189.63
|
| Rate for Payer: PHP Commercial |
$265.48
|
| Rate for Payer: PHP Medicare Advantage |
$189.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$344.96
|
| Rate for Payer: Priority Health Medicare |
$189.63
|
| Rate for Payer: Priority Health SBD |
$344.96
|
| Rate for Payer: Priority Health Tiered Network |
$344.96
|
| Rate for Payer: Railroad Medicare Medicare |
$189.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.35
|
| Rate for Payer: UHC Core |
$392.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$189.63
|
| Rate for Payer: UHC Exchange |
$392.35
|
| Rate for Payer: UHC Medicaid |
$120.56
|
| Rate for Payer: UHCCP Medicaid |
$120.56
|
| Rate for Payer: UMR Bronson Commercial |
$381.80
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR
|
Professional
|
Both
|
$1,487.00
|
|
|
Service Code
|
HCPCS 22514
|
| Min. Negotiated Rate |
$270.51 |
| Max. Negotiated Rate |
$1,115.25 |
| Rate for Payer: Aetna Commercial |
$563.22
|
| Rate for Payer: Aetna Medicare |
$437.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$563.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$605.25
|
| Rate for Payer: BCBS Complete |
$284.04
|
| Rate for Payer: BCBS MAPPO |
$420.31
|
| Rate for Payer: BCN Commercial |
$709.63
|
| Rate for Payer: BCN Medicare Advantage |
$420.31
|
| Rate for Payer: Cash Price |
$1,189.60
|
| Rate for Payer: Cash Price |
$1,189.60
|
| Rate for Payer: Cofinity Commercial |
$563.22
|
| Rate for Payer: Cofinity Commercial |
$605.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$441.33
|
| Rate for Payer: Meridian Medicaid |
$284.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$462.34
|
| Rate for Payer: Nomi Health Commercial |
$504.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,115.25
|
| Rate for Payer: PACE SWMI |
$420.31
|
| Rate for Payer: PHP Commercial |
$588.43
|
| Rate for Payer: PHP Medicare Advantage |
$420.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$758.57
|
| Rate for Payer: Priority Health Medicare |
$420.31
|
| Rate for Payer: Priority Health SBD |
$758.57
|
| Rate for Payer: Priority Health Tiered Network |
$758.57
|
| Rate for Payer: Railroad Medicare Medicare |
$420.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$844.58
|
| Rate for Payer: UHC Core |
$844.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$420.31
|
| Rate for Payer: UHC Exchange |
$844.58
|
| Rate for Payer: UHC Medicaid |
$270.51
|
| Rate for Payer: UHCCP Medicaid |
$270.51
|
| Rate for Payer: UMR Bronson Commercial |
$684.02
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL
|
Professional
|
Both
|
$1,089.00
|
|
|
Service Code
|
HCPCS 22511
|
| Min. Negotiated Rate |
$230.47 |
| Max. Negotiated Rate |
$816.75 |
| Rate for Payer: Aetna Commercial |
$480.32
|
| Rate for Payer: Aetna Medicare |
$372.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$480.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.17
|
| Rate for Payer: BCBS Complete |
$241.99
|
| Rate for Payer: BCBS MAPPO |
$358.45
|
| Rate for Payer: BCN Commercial |
$606.04
|
| Rate for Payer: BCN Medicare Advantage |
$358.45
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cofinity Commercial |
$480.32
|
| Rate for Payer: Cofinity Commercial |
$516.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$358.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$376.37
|
| Rate for Payer: Meridian Medicaid |
$241.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$394.30
|
| Rate for Payer: Nomi Health Commercial |
$430.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$816.75
|
| Rate for Payer: PACE SWMI |
$358.45
|
| Rate for Payer: PHP Commercial |
$501.83
|
| Rate for Payer: PHP Medicare Advantage |
$358.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$647.85
|
| Rate for Payer: Priority Health Medicare |
$358.45
|
| Rate for Payer: Priority Health SBD |
$647.85
|
| Rate for Payer: Priority Health Tiered Network |
$647.85
|
| Rate for Payer: Railroad Medicare Medicare |
$358.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$717.02
|
| Rate for Payer: UHC Core |
$717.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$358.45
|
| Rate for Payer: UHC Exchange |
$717.02
|
| Rate for Payer: UHC Medicaid |
$230.47
|
| Rate for Payer: UHCCP Medicaid |
$230.47
|
| Rate for Payer: UMR Bronson Commercial |
$500.94
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC
|
Professional
|
Both
|
$3,524.00
|
|
|
Service Code
|
HCPCS 22510
|
| Min. Negotiated Rate |
$244.31 |
| Max. Negotiated Rate |
$2,643.00 |
| Rate for Payer: Aetna Commercial |
$509.90
|
| Rate for Payer: Aetna Medicare |
$395.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.95
|
| Rate for Payer: BCBS Complete |
$256.53
|
| Rate for Payer: BCBS MAPPO |
$380.52
|
| Rate for Payer: BCN Commercial |
$643.39
|
| Rate for Payer: BCN Medicare Advantage |
$380.52
|
| Rate for Payer: Cash Price |
$2,819.20
|
| Rate for Payer: Cash Price |
$2,819.20
|
| Rate for Payer: Cofinity Commercial |
$509.90
|
| Rate for Payer: Cofinity Commercial |
$547.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$399.55
|
| Rate for Payer: Meridian Medicaid |
$256.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$418.57
|
| Rate for Payer: Nomi Health Commercial |
$456.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,643.00
|
| Rate for Payer: PACE SWMI |
$380.52
|
| Rate for Payer: PHP Commercial |
$532.73
|
| Rate for Payer: PHP Medicare Advantage |
$380.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$687.77
|
| Rate for Payer: Priority Health Medicare |
$380.52
|
| Rate for Payer: Priority Health SBD |
$687.77
|
| Rate for Payer: Priority Health Tiered Network |
$687.77
|
| Rate for Payer: Railroad Medicare Medicare |
$380.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$765.15
|
| Rate for Payer: UHC Core |
$765.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$380.52
|
| Rate for Payer: UHC Exchange |
$765.15
|
| Rate for Payer: UHC Medicaid |
$244.31
|
| Rate for Payer: UHCCP Medicaid |
$244.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,621.04
|
|
|
PR PESSARY REUSABLE NONRUBBER
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS A4562
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna Commercial |
$97.24
|
| Rate for Payer: Aetna Medicare |
$75.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.50
|
| Rate for Payer: BCBS MAPPO |
$72.57
|
| Rate for Payer: BCN Commercial |
$69.48
|
| Rate for Payer: BCN Medicare Advantage |
$72.57
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$97.24
|
| Rate for Payer: Cofinity Commercial |
$104.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.83
|
| Rate for Payer: Nomi Health Commercial |
$87.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.25
|
| Rate for Payer: PACE SWMI |
$72.57
|
| Rate for Payer: PHP Commercial |
$101.60
|
| Rate for Payer: PHP Medicare Advantage |
$72.57
|
| Rate for Payer: Priority Health Medicare |
$72.57
|
| Rate for Payer: Railroad Medicare Medicare |
$72.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.66
|
| Rate for Payer: UHC Core |
$23.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$72.57
|
| Rate for Payer: UHC Exchange |
$23.66
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
PR PESSARY REUSABLE RUB ANYTYPE
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS A4561
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Aetna Commercial |
$39.14
|
| Rate for Payer: Aetna Medicare |
$30.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.06
|
| Rate for Payer: BCBS MAPPO |
$29.21
|
| Rate for Payer: BCN Commercial |
$27.97
|
| Rate for Payer: BCN Medicare Advantage |
$29.21
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$42.06
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.13
|
| Rate for Payer: Nomi Health Commercial |
$35.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.25
|
| Rate for Payer: PACE SWMI |
$29.21
|
| Rate for Payer: PHP Commercial |
$40.89
|
| Rate for Payer: PHP Medicare Advantage |
$29.21
|
| Rate for Payer: Priority Health Medicare |
$29.21
|
| Rate for Payer: Railroad Medicare Medicare |
$29.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.52
|
| Rate for Payer: UHC Core |
$9.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.21
|
| Rate for Payer: UHC Exchange |
$9.52
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
PR PHALANGECTOMY TOE EACH TOE
|
Professional
|
Both
|
$874.00
|
|
|
Service Code
|
HCPCS 28150
|
| Min. Negotiated Rate |
$169.34 |
| Max. Negotiated Rate |
$655.50 |
| Rate for Payer: Aetna Commercial |
$345.06
|
| Rate for Payer: Aetna Medicare |
$267.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$370.81
|
| Rate for Payer: BCBS Complete |
$177.81
|
| Rate for Payer: BCBS MAPPO |
$257.51
|
| Rate for Payer: BCN Commercial |
$425.77
|
| Rate for Payer: BCN Medicare Advantage |
$257.51
|
| Rate for Payer: Cash Price |
$699.20
|
| Rate for Payer: Cash Price |
$699.20
|
| Rate for Payer: Cofinity Commercial |
$345.06
|
| Rate for Payer: Cofinity Commercial |
$370.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$270.39
|
| Rate for Payer: Meridian Medicaid |
$177.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$283.26
|
| Rate for Payer: Nomi Health Commercial |
$309.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.50
|
| Rate for Payer: PACE SWMI |
$257.51
|
| Rate for Payer: PHP Commercial |
$360.51
|
| Rate for Payer: PHP Medicare Advantage |
$257.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$455.14
|
| Rate for Payer: Priority Health Medicare |
$257.51
|
| Rate for Payer: Priority Health SBD |
$455.14
|
| Rate for Payer: Priority Health Tiered Network |
$455.14
|
| Rate for Payer: Railroad Medicare Medicare |
$257.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$485.09
|
| Rate for Payer: UHC Core |
$485.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$257.51
|
| Rate for Payer: UHC Exchange |
$485.09
|
| Rate for Payer: UHC Medicaid |
$169.34
|
| Rate for Payer: UHCCP Medicaid |
$169.34
|
| Rate for Payer: UMR Bronson Commercial |
$402.04
|
|
|
PR PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 90863
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$66.00 |
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: Aetna Medicare |
$44.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.40
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCN Commercial |
$53.43
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36.18
|
| Rate for Payer: Priority Health SBD |
$36.18
|
| Rate for Payer: Priority Health Tiered Network |
$36.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.36
|
| Rate for Payer: UHC Core |
$40.36
|
| Rate for Payer: UHC Exchange |
$40.36
|
| Rate for Payer: UMR Bronson Commercial |
$40.48
|
|
|
PR PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX
|
Professional
|
Both
|
$1,484.00
|
|
|
Service Code
|
HCPCS 42950
|
| Min. Negotiated Rate |
$467.54 |
| Max. Negotiated Rate |
$1,451.37 |
| Rate for Payer: Aetna Commercial |
$939.93
|
| Rate for Payer: Aetna Medicare |
$729.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,010.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$939.93
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$701.44
|
| Rate for Payer: BCN Commercial |
$1,191.17
|
| Rate for Payer: BCN Medicare Advantage |
$701.44
|
| Rate for Payer: Cash Price |
$1,187.20
|
| Rate for Payer: Cash Price |
$1,187.20
|
| Rate for Payer: Cofinity Commercial |
$1,010.07
|
| Rate for Payer: Cofinity Commercial |
$939.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$701.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$736.51
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$771.58
|
| Rate for Payer: Nomi Health Commercial |
$841.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,113.00
|
| Rate for Payer: PACE SWMI |
$701.44
|
| Rate for Payer: PHP Commercial |
$982.02
|
| Rate for Payer: PHP Medicare Advantage |
$701.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,451.37
|
| Rate for Payer: Priority Health Medicare |
$701.44
|
| Rate for Payer: Priority Health SBD |
$1,451.37
|
| Rate for Payer: Priority Health Tiered Network |
$1,451.37
|
| Rate for Payer: Railroad Medicare Medicare |
$701.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,363.71
|
| Rate for Payer: UHC Core |
$1,363.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$701.44
|
| Rate for Payer: UHC Exchange |
$1,363.71
|
| Rate for Payer: UHC Medicaid |
$467.54
|
| Rate for Payer: UHCCP Medicaid |
$467.54
|
| Rate for Payer: UMR Bronson Commercial |
$682.64
|
|
|
PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 99195
|
| Min. Negotiated Rate |
$90.02 |
| Max. Negotiated Rate |
$151.81 |
| Rate for Payer: Aetna Commercial |
$120.63
|
| Rate for Payer: Aetna Medicare |
$93.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.63
|
| Rate for Payer: BCBS MAPPO |
$90.02
|
| Rate for Payer: BCN Commercial |
$133.96
|
| Rate for Payer: BCN Medicare Advantage |
$90.02
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$129.63
|
| Rate for Payer: Cofinity Commercial |
$120.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$99.02
|
| Rate for Payer: Nomi Health Commercial |
$108.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$151.50
|
| Rate for Payer: PACE SWMI |
$90.02
|
| Rate for Payer: PHP Commercial |
$126.03
|
| Rate for Payer: PHP Medicare Advantage |
$90.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$123.53
|
| Rate for Payer: Priority Health Medicare |
$90.02
|
| Rate for Payer: Priority Health SBD |
$123.53
|
| Rate for Payer: Priority Health Tiered Network |
$123.53
|
| Rate for Payer: Railroad Medicare Medicare |
$90.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.81
|
| Rate for Payer: UHC Core |
$151.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$90.02
|
| Rate for Payer: UHC Exchange |
$151.81
|
| Rate for Payer: UMR Bronson Commercial |
$92.92
|
|
|
PR PHTFAC ARMS
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
|
PR PHTFAC CHEST/SHLD
|
Professional
|
Both
|
$132.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
PR PHTFAC FACE & NECK/ FL ARMS
|
Professional
|
Both
|
$263.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
|
PR PHTFAC FL LEGS
|
Professional
|
Both
|
$368.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$147.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Medicare |
$184.00
|
| Rate for Payer: BCBS Complete |
$147.20
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.00
|
| Rate for Payer: UMR Bronson Commercial |
$169.28
|
|
|
PR PHTFAC HANDS
|
Professional
|
Both
|
$53.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$39.75 |
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
PR PHTFAC HEMANGIOMAS/WARTS
|
Professional
|
Both
|
$37.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR PHTFAC NASAL VEIN
|
Professional
|
Both
|
$47.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$35.25 |
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR PHTFAC SNGL PIGMENT
|
Professional
|
Both
|
$37.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 97750
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna Medicare |
$33.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.34
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$32.18
|
| Rate for Payer: BCN Commercial |
$34.38
|
| Rate for Payer: BCN Medicare Advantage |
$32.18
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$46.34
|
| Rate for Payer: Cofinity Commercial |
$43.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.40
|
| Rate for Payer: Nomi Health Commercial |
$38.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: PACE SWMI |
$32.18
|
| Rate for Payer: PHP Commercial |
$45.05
|
| Rate for Payer: PHP Medicare Advantage |
$32.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$32.18
|
| Rate for Payer: Priority Health SBD |
$89.48
|
| Rate for Payer: Priority Health Tiered Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$32.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.72
|
| Rate for Payer: UHC Core |
$30.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.18
|
| Rate for Payer: UHC Exchange |
$30.72
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 93464
|
| Min. Negotiated Rate |
$86.48 |
| Max. Negotiated Rate |
$375.69 |
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare |
$217.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.44
|
| Rate for Payer: BCBS MAPPO |
$209.33
|
| Rate for Payer: BCN Commercial |
$320.20
|
| Rate for Payer: BCN Medicare Advantage |
$209.33
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$280.50
|
| Rate for Payer: Cofinity Commercial |
$301.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.26
|
| Rate for Payer: Nomi Health Commercial |
$251.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PACE SWMI |
$209.33
|
| Rate for Payer: PHP Commercial |
$293.06
|
| Rate for Payer: PHP Medicare Advantage |
$209.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$304.34
|
| Rate for Payer: Priority Health Medicare |
$209.33
|
| Rate for Payer: Priority Health SBD |
$304.34
|
| Rate for Payer: Priority Health Tiered Network |
$304.34
|
| Rate for Payer: Railroad Medicare Medicare |
$209.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.69
|
| Rate for Payer: UHC Core |
$375.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$209.33
|
| Rate for Payer: UHC Exchange |
$375.69
|
| Rate for Payer: UMR Bronson Commercial |
$86.48
|
|
|
PR PHYSIOL SUPPORT HARVEST ORGAN FROM BRAIN-DEAD PT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 01990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.25
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
