|
PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW LOW MDM 30 MIN
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 98001
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$154.05 |
| Rate for Payer: Aetna Medicare |
$118.50
|
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.05
|
| Rate for Payer: UMR Bronson Commercial |
$109.02
|
|
|
PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW MOD MDM 45 MIN
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 98002
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$230.75 |
| Rate for Payer: Aetna Medicare |
$177.50
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: UMR Bronson Commercial |
$163.30
|
|
|
PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW SF MDM 15 MIN
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 98000
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$82.55 |
| Rate for Payer: Aetna Medicare |
$63.50
|
| Rate for Payer: BCBS Complete |
$50.80
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.55
|
| Rate for Payer: UMR Bronson Commercial |
$58.42
|
|
|
PR SYNCHRONOUS AUDIO-VIDEO VST EST HIGH MDM 40 MIN
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 98007
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$230.75 |
| Rate for Payer: Aetna Medicare |
$177.50
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
| Rate for Payer: UMR Bronson Commercial |
$163.30
|
|
|
PR SYNCHRONOUS AUDIO-VIDEO VST NEW HIGH MDM 60 MIN
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
HCPCS 98003
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$310.05 |
| Rate for Payer: Aetna Medicare |
$238.50
|
| Rate for Payer: BCBS Complete |
$190.80
|
| Rate for Payer: Cash Price |
$381.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.05
|
| Rate for Payer: UMR Bronson Commercial |
$219.42
|
|
|
PR SYNDACTYLIZATION TOES
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 28280
|
| Min. Negotiated Rate |
$221.31 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$436.73
|
| Rate for Payer: Aetna Medicare |
$338.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$436.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$469.32
|
| Rate for Payer: BCBS Complete |
$232.38
|
| Rate for Payer: BCBS MAPPO |
$325.92
|
| Rate for Payer: BCBS Trust/PPO |
$756.00
|
| Rate for Payer: BCN Commercial |
$741.32
|
| Rate for Payer: BCN Medicare Advantage |
$325.92
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cofinity Commercial |
$436.73
|
| Rate for Payer: Cofinity Commercial |
$469.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$342.22
|
| Rate for Payer: Meridian Medicaid |
$232.38
|
| Rate for Payer: Nomi Health Commercial |
$391.10
|
| Rate for Payer: PACE SWMI |
$325.92
|
| Rate for Payer: PHP Commercial |
$456.29
|
| Rate for Payer: PHP Medicare Advantage |
$325.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$221.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$531.25
|
| Rate for Payer: Priority Health Medicare |
$325.92
|
| Rate for Payer: Priority Health Narrow Network |
$531.25
|
| Rate for Payer: Priority Health SBD |
$531.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.92
|
| Rate for Payer: UHC Medicare Advantage |
$325.92
|
| Rate for Payer: UHCCP Medicaid |
$221.31
|
| Rate for Payer: UMR Bronson Commercial |
$391.92
|
|
|
PR SYNOVECTOMY CARPOMETACARPAL JOINT
|
Professional
|
Both
|
$1,182.00
|
|
|
Service Code
|
HCPCS 26130
|
| Min. Negotiated Rate |
$310.13 |
| Max. Negotiated Rate |
$768.30 |
| Rate for Payer: Aetna Commercial |
$609.55
|
| Rate for Payer: Aetna Medicare |
$473.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$655.04
|
| Rate for Payer: BCBS Complete |
$325.64
|
| Rate for Payer: BCBS MAPPO |
$454.89
|
| Rate for Payer: BCN Commercial |
$696.86
|
| Rate for Payer: BCN Medicare Advantage |
$454.89
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cofinity Commercial |
$609.55
|
| Rate for Payer: Cofinity Commercial |
$655.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$454.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$477.63
|
| Rate for Payer: Meridian Medicaid |
$325.64
|
| Rate for Payer: Nomi Health Commercial |
$545.87
|
| Rate for Payer: PACE SWMI |
$454.89
|
| Rate for Payer: PHP Commercial |
$636.85
|
| Rate for Payer: PHP Medicare Advantage |
$454.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$310.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$734.29
|
| Rate for Payer: Priority Health Medicare |
$454.89
|
| Rate for Payer: Priority Health Narrow Network |
$734.29
|
| Rate for Payer: Priority Health SBD |
$734.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$454.89
|
| Rate for Payer: UHC Medicare Advantage |
$454.89
|
| Rate for Payer: UHCCP Medicaid |
$310.13
|
| Rate for Payer: UMR Bronson Commercial |
$543.72
|
|
|
PR SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT
|
Professional
|
Both
|
$1,276.00
|
|
|
Service Code
|
HCPCS 25118
|
| Min. Negotiated Rate |
$145.28 |
| Max. Negotiated Rate |
$829.40 |
| Rate for Payer: Aetna Commercial |
$497.90
|
| Rate for Payer: Aetna Medicare |
$386.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$535.06
|
| Rate for Payer: BCBS Complete |
$266.82
|
| Rate for Payer: BCBS MAPPO |
$371.57
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$568.82
|
| Rate for Payer: BCN Medicare Advantage |
$371.57
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cofinity Commercial |
$497.90
|
| Rate for Payer: Cofinity Commercial |
$535.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$390.15
|
| Rate for Payer: Meridian Medicaid |
$266.82
|
| Rate for Payer: Nomi Health Commercial |
$445.88
|
| Rate for Payer: PACE SWMI |
$371.57
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: PHP Medicare Advantage |
$371.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$829.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.45
|
| Rate for Payer: Priority Health Medicare |
$371.57
|
| Rate for Payer: Priority Health Narrow Network |
$600.45
|
| Rate for Payer: Priority Health SBD |
$600.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.57
|
| Rate for Payer: UHC Medicare Advantage |
$371.57
|
| Rate for Payer: UHCCP Medicaid |
$254.11
|
| Rate for Payer: UMR Bronson Commercial |
$586.96
|
|
|
PR SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 28072
|
| Min. Negotiated Rate |
$212.15 |
| Max. Negotiated Rate |
$712.98 |
| Rate for Payer: Aetna Commercial |
$417.74
|
| Rate for Payer: Aetna Medicare |
$324.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.92
|
| Rate for Payer: BCBS Complete |
$222.76
|
| Rate for Payer: BCBS MAPPO |
$311.75
|
| Rate for Payer: BCBS Trust/PPO |
$567.39
|
| Rate for Payer: BCN Commercial |
$712.98
|
| Rate for Payer: BCN Medicare Advantage |
$311.75
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cofinity Commercial |
$417.74
|
| Rate for Payer: Cofinity Commercial |
$448.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$327.34
|
| Rate for Payer: Meridian Medicaid |
$222.76
|
| Rate for Payer: Nomi Health Commercial |
$374.10
|
| Rate for Payer: PACE SWMI |
$311.75
|
| Rate for Payer: PHP Commercial |
$436.45
|
| Rate for Payer: PHP Medicare Advantage |
$311.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$502.25
|
| Rate for Payer: Priority Health Medicare |
$311.75
|
| Rate for Payer: Priority Health Narrow Network |
$502.25
|
| Rate for Payer: Priority Health SBD |
$502.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.75
|
| Rate for Payer: UHC Medicare Advantage |
$311.75
|
| Rate for Payer: UHCCP Medicaid |
$212.15
|
| Rate for Payer: UMR Bronson Commercial |
$467.36
|
|
|
PR SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD
|
Professional
|
Both
|
$1,726.00
|
|
|
Service Code
|
HCPCS 26135
|
| Min. Negotiated Rate |
$295.85 |
| Max. Negotiated Rate |
$1,121.90 |
| Rate for Payer: Aetna Commercial |
$720.04
|
| Rate for Payer: Aetna Medicare |
$558.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$773.77
|
| Rate for Payer: BCBS Complete |
$383.56
|
| Rate for Payer: BCBS MAPPO |
$537.34
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Commercial |
$820.97
|
| Rate for Payer: BCN Medicare Advantage |
$537.34
|
| Rate for Payer: Cash Price |
$1,380.80
|
| Rate for Payer: Cash Price |
$1,380.80
|
| Rate for Payer: Cofinity Commercial |
$720.04
|
| Rate for Payer: Cofinity Commercial |
$773.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$537.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$564.21
|
| Rate for Payer: Meridian Medicaid |
$383.56
|
| Rate for Payer: Nomi Health Commercial |
$644.81
|
| Rate for Payer: PACE SWMI |
$537.34
|
| Rate for Payer: PHP Commercial |
$752.28
|
| Rate for Payer: PHP Medicare Advantage |
$537.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,121.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$862.01
|
| Rate for Payer: Priority Health Medicare |
$537.34
|
| Rate for Payer: Priority Health Narrow Network |
$862.01
|
| Rate for Payer: Priority Health SBD |
$862.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$537.34
|
| Rate for Payer: UHC Medicare Advantage |
$537.34
|
| Rate for Payer: UHCCP Medicaid |
$365.30
|
| Rate for Payer: UMR Bronson Commercial |
$793.96
|
|
|
PR SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT
|
Professional
|
Both
|
$1,476.00
|
|
|
Service Code
|
HCPCS 26140
|
| Min. Negotiated Rate |
$335.05 |
| Max. Negotiated Rate |
$959.40 |
| Rate for Payer: Aetna Commercial |
$658.76
|
| Rate for Payer: Aetna Medicare |
$511.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$658.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$707.92
|
| Rate for Payer: BCBS Complete |
$351.80
|
| Rate for Payer: BCBS MAPPO |
$491.61
|
| Rate for Payer: BCBS Trust/PPO |
$497.66
|
| Rate for Payer: BCN Commercial |
$752.56
|
| Rate for Payer: BCN Medicare Advantage |
$491.61
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cash Price |
$1,180.80
|
| Rate for Payer: Cofinity Commercial |
$658.76
|
| Rate for Payer: Cofinity Commercial |
$707.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$491.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$516.19
|
| Rate for Payer: Meridian Medicaid |
$351.80
|
| Rate for Payer: Nomi Health Commercial |
$589.93
|
| Rate for Payer: PACE SWMI |
$491.61
|
| Rate for Payer: PHP Commercial |
$688.25
|
| Rate for Payer: PHP Medicare Advantage |
$491.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$335.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$959.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$793.31
|
| Rate for Payer: Priority Health Medicare |
$491.61
|
| Rate for Payer: Priority Health Narrow Network |
$793.31
|
| Rate for Payer: Priority Health SBD |
$793.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$491.61
|
| Rate for Payer: UHC Medicare Advantage |
$491.61
|
| Rate for Payer: UHCCP Medicaid |
$335.05
|
| Rate for Payer: UMR Bronson Commercial |
$678.96
|
|
|
PR SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN
|
Professional
|
Both
|
$1,680.00
|
|
|
Service Code
|
HCPCS 26145
|
| Min. Negotiated Rate |
$273.13 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$670.79
|
| Rate for Payer: Aetna Medicare |
$520.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$670.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$720.85
|
| Rate for Payer: BCBS Complete |
$357.84
|
| Rate for Payer: BCBS MAPPO |
$500.59
|
| Rate for Payer: BCBS Trust/PPO |
$273.13
|
| Rate for Payer: BCN Commercial |
$764.78
|
| Rate for Payer: BCN Medicare Advantage |
$500.59
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cash Price |
$1,344.00
|
| Rate for Payer: Cofinity Commercial |
$670.79
|
| Rate for Payer: Cofinity Commercial |
$720.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$500.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$525.62
|
| Rate for Payer: Meridian Medicaid |
$357.84
|
| Rate for Payer: Nomi Health Commercial |
$600.71
|
| Rate for Payer: PACE SWMI |
$500.59
|
| Rate for Payer: PHP Commercial |
$700.83
|
| Rate for Payer: PHP Medicare Advantage |
$500.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$340.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.02
|
| Rate for Payer: Priority Health Medicare |
$500.59
|
| Rate for Payer: Priority Health Narrow Network |
$805.02
|
| Rate for Payer: Priority Health SBD |
$805.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$500.59
|
| Rate for Payer: UHC Medicare Advantage |
$500.59
|
| Rate for Payer: UHCCP Medicaid |
$340.80
|
| Rate for Payer: UMR Bronson Commercial |
$772.80
|
|
|
PR SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA
|
Professional
|
Both
|
$1,796.00
|
|
|
Service Code
|
HCPCS 25119
|
| Min. Negotiated Rate |
$39.09 |
| Max. Negotiated Rate |
$1,167.40 |
| Rate for Payer: Aetna Commercial |
$652.79
|
| Rate for Payer: Aetna Medicare |
$506.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$652.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$701.51
|
| Rate for Payer: BCBS Complete |
$348.00
|
| Rate for Payer: BCBS MAPPO |
$487.16
|
| Rate for Payer: BCBS Trust/PPO |
$39.09
|
| Rate for Payer: BCN Commercial |
$745.24
|
| Rate for Payer: BCN Medicare Advantage |
$487.16
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cash Price |
$1,436.80
|
| Rate for Payer: Cofinity Commercial |
$701.51
|
| Rate for Payer: Cofinity Commercial |
$652.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.52
|
| Rate for Payer: Meridian Medicaid |
$348.00
|
| Rate for Payer: Nomi Health Commercial |
$584.59
|
| Rate for Payer: PACE SWMI |
$487.16
|
| Rate for Payer: PHP Commercial |
$682.02
|
| Rate for Payer: PHP Medicare Advantage |
$487.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$331.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$784.15
|
| Rate for Payer: Priority Health Medicare |
$487.16
|
| Rate for Payer: Priority Health Narrow Network |
$784.15
|
| Rate for Payer: Priority Health SBD |
$784.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.16
|
| Rate for Payer: UHC Medicare Advantage |
$487.16
|
| Rate for Payer: UHCCP Medicaid |
$331.43
|
| Rate for Payer: UMR Bronson Commercial |
$826.16
|
|
|
PR SYNVISC OR SYNVISC-ONE
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS J7325
|
| Min. Negotiated Rate |
$9.09 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Commercial |
$12.18
|
| Rate for Payer: Aetna Medicare |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.09
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$9.09
|
| Rate for Payer: BCBS Trust/PPO |
$9.29
|
| Rate for Payer: BCN Commercial |
$10.87
|
| Rate for Payer: BCN Medicare Advantage |
$9.09
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$13.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.54
|
| Rate for Payer: Nomi Health Commercial |
$10.91
|
| Rate for Payer: PACE SWMI |
$9.09
|
| Rate for Payer: PHP Commercial |
$12.73
|
| Rate for Payer: PHP Medicare Advantage |
$9.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$9.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.09
|
| Rate for Payer: UHC Medicare Advantage |
$9.09
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
|
|
PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 11103
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$27.59
|
| Rate for Payer: Aetna Medicare |
$21.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.65
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS MAPPO |
$20.59
|
| Rate for Payer: BCBS Trust/PPO |
$562.50
|
| Rate for Payer: BCN Commercial |
$59.29
|
| Rate for Payer: BCN Medicare Advantage |
$20.59
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$27.59
|
| Rate for Payer: Cofinity Commercial |
$29.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.62
|
| Rate for Payer: Meridian Medicaid |
$14.54
|
| Rate for Payer: Nomi Health Commercial |
$24.71
|
| Rate for Payer: PACE SWMI |
$20.59
|
| Rate for Payer: PHP Commercial |
$28.83
|
| Rate for Payer: PHP Medicare Advantage |
$20.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.35
|
| Rate for Payer: Priority Health Medicare |
$20.59
|
| Rate for Payer: Priority Health Narrow Network |
$29.35
|
| Rate for Payer: Priority Health SBD |
$29.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.59
|
| Rate for Payer: UHC Medicare Advantage |
$20.59
|
| Rate for Payer: UHCCP Medicaid |
$13.85
|
| Rate for Payer: UMR Bronson Commercial |
$48.30
|
|
|
PR TANGENTIAL BIOPSY SKIN SINGLE LESION
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 11102
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$285.54 |
| Rate for Payer: Aetna Commercial |
$47.45
|
| Rate for Payer: Aetna Medicare |
$36.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.99
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$35.41
|
| Rate for Payer: BCBS Trust/PPO |
$285.54
|
| Rate for Payer: BCN Commercial |
$119.76
|
| Rate for Payer: BCN Medicare Advantage |
$35.41
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$47.45
|
| Rate for Payer: Cofinity Commercial |
$50.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.18
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Nomi Health Commercial |
$42.49
|
| Rate for Payer: PACE SWMI |
$35.41
|
| Rate for Payer: PHP Commercial |
$49.57
|
| Rate for Payer: PHP Medicare Advantage |
$35.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.57
|
| Rate for Payer: Priority Health Medicare |
$35.41
|
| Rate for Payer: Priority Health Narrow Network |
$50.57
|
| Rate for Payer: Priority Health SBD |
$50.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.41
|
| Rate for Payer: UHC Medicare Advantage |
$35.41
|
| Rate for Payer: UHCCP Medicaid |
$23.86
|
| Rate for Payer: UMR Bronson Commercial |
$89.24
|
|
|
PR TAP BLOCK UNILATERAL BY INJECTION(S)
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 64486
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$164.20 |
| Rate for Payer: Aetna Commercial |
$66.97
|
| Rate for Payer: Aetna Medicare |
$51.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.97
|
| Rate for Payer: BCBS Complete |
$34.67
|
| Rate for Payer: BCBS MAPPO |
$49.98
|
| Rate for Payer: BCBS Trust/PPO |
$92.98
|
| Rate for Payer: BCN Commercial |
$164.20
|
| Rate for Payer: BCN Medicare Advantage |
$49.98
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$66.97
|
| Rate for Payer: Cofinity Commercial |
$71.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.48
|
| Rate for Payer: Meridian Medicaid |
$34.67
|
| Rate for Payer: Nomi Health Commercial |
$59.98
|
| Rate for Payer: PACE SWMI |
$49.98
|
| Rate for Payer: PHP Commercial |
$69.97
|
| Rate for Payer: PHP Medicare Advantage |
$49.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.70
|
| Rate for Payer: Priority Health Medicare |
$49.98
|
| Rate for Payer: Priority Health Narrow Network |
$92.70
|
| Rate for Payer: Priority Health SBD |
$92.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.98
|
| Rate for Payer: UHC Medicare Advantage |
$49.98
|
| Rate for Payer: UHCCP Medicaid |
$33.02
|
| Rate for Payer: UMR Bronson Commercial |
$52.44
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.0 CM/<
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 11920
|
| Min. Negotiated Rate |
$73.27 |
| Max. Negotiated Rate |
$630.49 |
| Rate for Payer: Aetna Commercial |
$145.34
|
| Rate for Payer: Aetna Medicare |
$112.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.18
|
| Rate for Payer: BCBS Complete |
$76.93
|
| Rate for Payer: BCBS MAPPO |
$108.46
|
| Rate for Payer: BCBS Trust/PPO |
$630.49
|
| Rate for Payer: BCN Commercial |
$281.97
|
| Rate for Payer: BCN Medicare Advantage |
$108.46
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$145.34
|
| Rate for Payer: Cofinity Commercial |
$156.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.88
|
| Rate for Payer: Meridian Medicaid |
$76.93
|
| Rate for Payer: Nomi Health Commercial |
$130.15
|
| Rate for Payer: PACE SWMI |
$108.46
|
| Rate for Payer: PHP Commercial |
$151.84
|
| Rate for Payer: PHP Medicare Advantage |
$108.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.97
|
| Rate for Payer: Priority Health Medicare |
$108.46
|
| Rate for Payer: Priority Health Narrow Network |
$153.97
|
| Rate for Payer: Priority Health SBD |
$153.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.46
|
| Rate for Payer: UHC Medicare Advantage |
$108.46
|
| Rate for Payer: UHCCP Medicaid |
$73.27
|
| Rate for Payer: UMR Bronson Commercial |
$148.58
|
|
|
PR TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 11921
|
| Min. Negotiated Rate |
$83.92 |
| Max. Negotiated Rate |
$2,064.94 |
| Rate for Payer: Aetna Commercial |
$166.99
|
| Rate for Payer: Aetna Medicare |
$129.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.45
|
| Rate for Payer: BCBS Complete |
$88.12
|
| Rate for Payer: BCBS MAPPO |
$124.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,064.94
|
| Rate for Payer: BCN Commercial |
$327.90
|
| Rate for Payer: BCN Medicare Advantage |
$124.62
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$166.99
|
| Rate for Payer: Cofinity Commercial |
$179.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.85
|
| Rate for Payer: Meridian Medicaid |
$88.12
|
| Rate for Payer: Nomi Health Commercial |
$149.54
|
| Rate for Payer: PACE SWMI |
$124.62
|
| Rate for Payer: PHP Commercial |
$174.47
|
| Rate for Payer: PHP Medicare Advantage |
$124.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.54
|
| Rate for Payer: Priority Health Medicare |
$124.62
|
| Rate for Payer: Priority Health Narrow Network |
$176.54
|
| Rate for Payer: Priority Health SBD |
$176.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.62
|
| Rate for Payer: UHC Medicare Advantage |
$124.62
|
| Rate for Payer: UHCCP Medicaid |
$83.92
|
| Rate for Payer: UMR Bronson Commercial |
$171.12
|
|
|
PR TATTOOING INCL MICROPIGMENTATION EA 20.0 CM
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 11922
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$89.43 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: Aetna Medicare |
$28.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.08
|
| Rate for Payer: BCBS Complete |
$19.02
|
| Rate for Payer: BCBS MAPPO |
$27.14
|
| Rate for Payer: BCBS Trust/PPO |
$62.82
|
| Rate for Payer: BCN Commercial |
$89.43
|
| Rate for Payer: BCN Medicare Advantage |
$27.14
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cofinity Commercial |
$36.37
|
| Rate for Payer: Cofinity Commercial |
$39.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.50
|
| Rate for Payer: Meridian Medicaid |
$19.02
|
| Rate for Payer: Nomi Health Commercial |
$32.57
|
| Rate for Payer: PACE SWMI |
$27.14
|
| Rate for Payer: PHP Commercial |
$38.00
|
| Rate for Payer: PHP Medicare Advantage |
$27.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.83
|
| Rate for Payer: Priority Health Medicare |
$27.14
|
| Rate for Payer: Priority Health Narrow Network |
$38.83
|
| Rate for Payer: Priority Health SBD |
$38.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.14
|
| Rate for Payer: UHC Medicare Advantage |
$27.14
|
| Rate for Payer: UHCCP Medicaid |
$18.11
|
| Rate for Payer: UMR Bronson Commercial |
$55.66
|
|
|
PR TC99M DISOFENIN
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS A9510
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$1,959.99 |
| Rate for Payer: Aetna Commercial |
$67.20
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.20
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,959.99
|
| Rate for Payer: BCN Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
PR TC99M MEBROFENIN
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS A9537
|
| Min. Negotiated Rate |
$53.10 |
| Max. Negotiated Rate |
$2,874.48 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Medicare |
$121.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.10
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,874.48
|
| Rate for Payer: BCN Commercial |
$69.79
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: UMR Bronson Commercial |
$111.78
|
|
|
PR TC99M MEDRONATE
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS A9503
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$1,603.92 |
| Rate for Payer: Aetna Commercial |
$12.48
|
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.48
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,603.92
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: UMR Bronson Commercial |
$42.32
|
|
|
PR TC99M PERTECHNETATE
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS A9512
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1,517.81 |
| Rate for Payer: Aetna Commercial |
$1.50
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.50
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.81
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$16.00
|
| 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 TC99M SESTAMIBI
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS A9500
|
| Min. Negotiated Rate |
$102.48 |
| Max. Negotiated Rate |
$1,830.03 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$160.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.48
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,830.03
|
| Rate for Payer: BCN Commercial |
$128.10
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: UMR Bronson Commercial |
$147.20
|
|
