|
PR TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 27606
|
| Min. Negotiated Rate |
$175.94 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Aetna Commercial |
$349.45
|
| Rate for Payer: Aetna Medicare |
$271.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$375.52
|
| Rate for Payer: BCBS Complete |
$184.74
|
| Rate for Payer: BCBS MAPPO |
$260.78
|
| Rate for Payer: BCBS Trust/PPO |
$852.15
|
| Rate for Payer: BCN Commercial |
$396.32
|
| Rate for Payer: BCN Medicare Advantage |
$260.78
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$349.45
|
| Rate for Payer: Cofinity Commercial |
$375.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$260.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$273.82
|
| Rate for Payer: Meridian Medicaid |
$184.74
|
| Rate for Payer: Nomi Health Commercial |
$312.94
|
| Rate for Payer: PACE SWMI |
$260.78
|
| Rate for Payer: PHP Commercial |
$365.09
|
| Rate for Payer: PHP Medicare Advantage |
$260.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$563.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$414.21
|
| Rate for Payer: Priority Health Medicare |
$260.78
|
| Rate for Payer: Priority Health Narrow Network |
$414.21
|
| Rate for Payer: Priority Health SBD |
$414.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$260.78
|
| Rate for Payer: UHC Medicare Advantage |
$260.78
|
| Rate for Payer: UHCCP Medicaid |
$175.94
|
| Rate for Payer: UMR Bronson Commercial |
$398.82
|
|
|
PR TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES
|
Professional
|
Both
|
$762.00
|
|
|
Service Code
|
HCPCS 27605
|
| Min. Negotiated Rate |
$118.64 |
| Max. Negotiated Rate |
$832.60 |
| Rate for Payer: Aetna Commercial |
$234.50
|
| Rate for Payer: Aetna Medicare |
$182.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.00
|
| Rate for Payer: BCBS Complete |
$124.57
|
| Rate for Payer: BCBS MAPPO |
$175.00
|
| Rate for Payer: BCBS Trust/PPO |
$832.60
|
| Rate for Payer: BCN Commercial |
$481.83
|
| Rate for Payer: BCN Medicare Advantage |
$175.00
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cash Price |
$609.60
|
| Rate for Payer: Cofinity Commercial |
$234.50
|
| Rate for Payer: Cofinity Commercial |
$252.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.75
|
| Rate for Payer: Meridian Medicaid |
$124.57
|
| Rate for Payer: Nomi Health Commercial |
$210.00
|
| Rate for Payer: PACE SWMI |
$175.00
|
| Rate for Payer: PHP Commercial |
$245.00
|
| Rate for Payer: PHP Medicare Advantage |
$175.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$280.90
|
| Rate for Payer: Priority Health Medicare |
$175.00
|
| Rate for Payer: Priority Health Narrow Network |
$280.90
|
| Rate for Payer: Priority Health SBD |
$280.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.00
|
| Rate for Payer: UHC Medicare Advantage |
$175.00
|
| Rate for Payer: UHCCP Medicaid |
$118.64
|
| Rate for Payer: UMR Bronson Commercial |
$350.52
|
|
|
PR TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX
|
Professional
|
Both
|
$1,181.00
|
|
|
Service Code
|
HCPCS 27306
|
| Min. Negotiated Rate |
$225.35 |
| Max. Negotiated Rate |
$767.65 |
| Rate for Payer: Aetna Commercial |
$441.73
|
| Rate for Payer: Aetna Medicare |
$342.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$474.70
|
| Rate for Payer: BCBS Complete |
$236.62
|
| Rate for Payer: BCBS MAPPO |
$329.65
|
| Rate for Payer: BCN Commercial |
$494.05
|
| Rate for Payer: BCN Medicare Advantage |
$329.65
|
| Rate for Payer: Cash Price |
$944.80
|
| Rate for Payer: Cash Price |
$944.80
|
| Rate for Payer: Cofinity Commercial |
$441.73
|
| Rate for Payer: Cofinity Commercial |
$474.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$329.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$346.13
|
| Rate for Payer: Meridian Medicaid |
$236.62
|
| Rate for Payer: Nomi Health Commercial |
$395.58
|
| Rate for Payer: PACE SWMI |
$329.65
|
| Rate for Payer: PHP Commercial |
$461.51
|
| Rate for Payer: PHP Medicare Advantage |
$329.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$767.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$533.28
|
| Rate for Payer: Priority Health Medicare |
$329.65
|
| Rate for Payer: Priority Health Narrow Network |
$533.28
|
| Rate for Payer: Priority Health SBD |
$533.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$329.65
|
| Rate for Payer: UHC Medicare Advantage |
$329.65
|
| Rate for Payer: UHCCP Medicaid |
$225.35
|
| Rate for Payer: UMR Bronson Commercial |
$543.26
|
|
|
PR TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 27307
|
| Min. Negotiated Rate |
$268.81 |
| Max. Negotiated Rate |
$2,244.75 |
| Rate for Payer: Aetna Commercial |
$528.86
|
| Rate for Payer: Aetna Medicare |
$410.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.32
|
| Rate for Payer: BCBS Complete |
$282.25
|
| Rate for Payer: BCBS MAPPO |
$394.67
|
| Rate for Payer: BCBS Trust/PPO |
$2,244.75
|
| Rate for Payer: BCN Commercial |
$602.05
|
| Rate for Payer: BCN Medicare Advantage |
$394.67
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$528.86
|
| Rate for Payer: Cofinity Commercial |
$568.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.40
|
| Rate for Payer: Meridian Medicaid |
$282.25
|
| Rate for Payer: Nomi Health Commercial |
$473.60
|
| Rate for Payer: PACE SWMI |
$394.67
|
| Rate for Payer: PHP Commercial |
$552.54
|
| Rate for Payer: PHP Medicare Advantage |
$394.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$268.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.51
|
| Rate for Payer: Priority Health Medicare |
$394.67
|
| Rate for Payer: Priority Health Narrow Network |
$632.51
|
| Rate for Payer: Priority Health SBD |
$632.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.67
|
| Rate for Payer: UHC Medicare Advantage |
$394.67
|
| Rate for Payer: UHCCP Medicaid |
$268.81
|
| Rate for Payer: UMR Bronson Commercial |
$388.70
|
|
|
PR TENOTOMY SHOULDER AREA 1 TENDON
|
Professional
|
Both
|
$1,732.00
|
|
|
Service Code
|
HCPCS 23405
|
| Min. Negotiated Rate |
$87.87 |
| Max. Negotiated Rate |
$1,125.80 |
| Rate for Payer: Aetna Commercial |
$793.07
|
| Rate for Payer: Aetna Medicare |
$615.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$793.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$852.25
|
| Rate for Payer: BCBS Complete |
$420.68
|
| Rate for Payer: BCBS MAPPO |
$591.84
|
| Rate for Payer: BCBS Trust/PPO |
$87.87
|
| Rate for Payer: BCN Commercial |
$908.45
|
| Rate for Payer: BCN Medicare Advantage |
$591.84
|
| Rate for Payer: Cash Price |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,385.60
|
| Rate for Payer: Cofinity Commercial |
$852.25
|
| Rate for Payer: Cofinity Commercial |
$793.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$591.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$621.43
|
| Rate for Payer: Meridian Medicaid |
$420.68
|
| Rate for Payer: Nomi Health Commercial |
$710.21
|
| Rate for Payer: PACE SWMI |
$591.84
|
| Rate for Payer: PHP Commercial |
$828.58
|
| Rate for Payer: PHP Medicare Advantage |
$591.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,125.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$952.08
|
| Rate for Payer: Priority Health Medicare |
$591.84
|
| Rate for Payer: Priority Health Narrow Network |
$952.08
|
| Rate for Payer: Priority Health SBD |
$952.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$591.84
|
| Rate for Payer: UHC Medicare Advantage |
$591.84
|
| Rate for Payer: UHCCP Medicaid |
$400.65
|
| Rate for Payer: UMR Bronson Commercial |
$796.72
|
|
|
PR TERBUTALINE SULFATE INJ
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS J3105
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.95
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$2.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.18
|
| Rate for Payer: BCN Medicare Advantage |
$2.74
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Cofinity Commercial |
$3.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$3.29
|
| Rate for Payer: PACE SWMI |
$2.74
|
| Rate for Payer: PHP Commercial |
$3.84
|
| Rate for Payer: PHP Medicare Advantage |
$2.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$2.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.74
|
| Rate for Payer: UHC Medicare Advantage |
$2.74
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
PR TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 95923
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$759.17 |
| Rate for Payer: Aetna Commercial |
$143.43
|
| Rate for Payer: Aetna Medicare |
$111.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.14
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS MAPPO |
$107.04
|
| Rate for Payer: BCBS Trust/PPO |
$759.17
|
| Rate for Payer: BCN Commercial |
$179.83
|
| Rate for Payer: BCN Medicare Advantage |
$107.04
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$154.14
|
| Rate for Payer: Cofinity Commercial |
$143.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.39
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Nomi Health Commercial |
$128.45
|
| Rate for Payer: PACE SWMI |
$107.04
|
| Rate for Payer: PHP Commercial |
$149.86
|
| Rate for Payer: PHP Medicare Advantage |
$107.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.54
|
| Rate for Payer: Priority Health Medicare |
$107.04
|
| Rate for Payer: Priority Health Narrow Network |
$165.54
|
| Rate for Payer: Priority Health SBD |
$59.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.04
|
| Rate for Payer: UHC Medicare Advantage |
$107.04
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
| Rate for Payer: UMR Bronson Commercial |
$201.94
|
|
|
PR TESTOSTERONE CYPIONAT 100 MG
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1070
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$5.03
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR TESTOSTERONE CYPIONAT 200 MG
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS J1080
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCN Commercial |
$5.07
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR TESTOSTERONE CYPIONATE 1 ML
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J1060
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: UMR Bronson Commercial |
$2.76
|
|
|
PR TESTOSTERONE ENANTHATE INJ
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS J3130
|
| Min. Negotiated Rate |
$9.08 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCN Commercial |
$9.08
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR TESTOSTERONE PELLET 75 MG
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS S0189
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$106.79 |
| Rate for Payer: Aetna Commercial |
$100.93
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.93
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS Trust/PPO |
$106.47
|
| Rate for Payer: BCN Commercial |
$106.79
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
|
PR TESTOSTERONE UNDECANOATE 1MG
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3145
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$3.25 |
| Rate for Payer: Aetna Commercial |
$2.67
|
| Rate for Payer: Aetna Medicare |
$2.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.87
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$1.99
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.87
|
| Rate for Payer: BCN Medicare Advantage |
$1.99
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Cofinity Commercial |
$2.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.09
|
| Rate for Payer: Nomi Health Commercial |
$2.39
|
| Rate for Payer: PACE SWMI |
$1.99
|
| Rate for Payer: PHP Commercial |
$2.79
|
| Rate for Payer: PHP Medicare Advantage |
$1.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$1.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.99
|
| Rate for Payer: UHC Medicare Advantage |
$1.99
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
PR TETANUS IMMUNIZATION, IM
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 90703
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: UMR Bronson Commercial |
$20.70
|
|
|
PR THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 97530
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$3,205.12 |
| Rate for Payer: Aetna Commercial |
$44.06
|
| Rate for Payer: Aetna Medicare |
$34.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$32.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,205.12
|
| Rate for Payer: BCN Commercial |
$36.21
|
| Rate for Payer: BCN Medicare Advantage |
$32.88
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$44.06
|
| Rate for Payer: Cofinity Commercial |
$47.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.52
|
| Rate for Payer: Nomi Health Commercial |
$39.46
|
| Rate for Payer: PACE SWMI |
$32.88
|
| Rate for Payer: PHP Commercial |
$46.03
|
| Rate for Payer: PHP Medicare Advantage |
$32.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$32.88
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.88
|
| Rate for Payer: UHC Medicare Advantage |
$32.88
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
PR THERAPEUTIC APHERESIS PLASMA PHERESIS
|
Professional
|
Both
|
$869.00
|
|
|
Service Code
|
HCPCS 36514
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$1,024.37 |
| Rate for Payer: Aetna Commercial |
$118.17
|
| Rate for Payer: Aetna Medicare |
$91.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.99
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCBS MAPPO |
$88.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.37
|
| Rate for Payer: BCN Commercial |
$823.91
|
| Rate for Payer: BCN Medicare Advantage |
$88.19
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cash Price |
$695.20
|
| Rate for Payer: Cofinity Commercial |
$126.99
|
| Rate for Payer: Cofinity Commercial |
$118.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.60
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Nomi Health Commercial |
$105.83
|
| Rate for Payer: PACE SWMI |
$88.19
|
| Rate for Payer: PHP Commercial |
$123.47
|
| Rate for Payer: PHP Medicare Advantage |
$88.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$564.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.25
|
| Rate for Payer: Priority Health Medicare |
$88.19
|
| Rate for Payer: Priority Health Narrow Network |
$146.25
|
| Rate for Payer: Priority Health SBD |
$146.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.19
|
| Rate for Payer: UHC Medicare Advantage |
$88.19
|
| Rate for Payer: UHCCP Medicaid |
$59.00
|
| Rate for Payer: UMR Bronson Commercial |
$399.74
|
|
|
PR THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 97150
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$831.02 |
| Rate for Payer: Aetna Commercial |
$22.55
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.24
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS MAPPO |
$16.83
|
| Rate for Payer: BCBS Trust/PPO |
$831.02
|
| Rate for Payer: BCN Commercial |
$17.29
|
| Rate for Payer: BCN Medicare Advantage |
$16.83
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$24.24
|
| Rate for Payer: Cofinity Commercial |
$22.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.67
|
| Rate for Payer: Nomi Health Commercial |
$20.20
|
| Rate for Payer: PACE SWMI |
$16.83
|
| Rate for Payer: PHP Commercial |
$23.56
|
| Rate for Payer: PHP Medicare Advantage |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$16.83
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.83
|
| Rate for Payer: UHC Medicare Advantage |
$16.83
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 96372
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$1,275.84 |
| Rate for Payer: Aetna Commercial |
$17.76
|
| Rate for Payer: Aetna Medicare |
$13.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.08
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$13.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,275.84
|
| Rate for Payer: BCN Commercial |
$13.70
|
| Rate for Payer: BCN Medicare Advantage |
$13.25
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$17.76
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.91
|
| Rate for Payer: Nomi Health Commercial |
$15.90
|
| Rate for Payer: PACE SWMI |
$13.25
|
| Rate for Payer: PHP Commercial |
$18.55
|
| Rate for Payer: PHP Medicare Advantage |
$13.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.44
|
| Rate for Payer: Priority Health Medicare |
$13.25
|
| Rate for Payer: Priority Health Narrow Network |
$19.44
|
| Rate for Payer: Priority Health SBD |
$19.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.25
|
| Rate for Payer: UHC Medicare Advantage |
$13.25
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 97110
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$1,141.13 |
| Rate for Payer: Aetna Commercial |
$37.00
|
| Rate for Payer: Aetna Medicare |
$28.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.76
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS MAPPO |
$27.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,141.13
|
| Rate for Payer: BCN Commercial |
$28.71
|
| Rate for Payer: BCN Medicare Advantage |
$27.61
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$39.76
|
| Rate for Payer: Cofinity Commercial |
$37.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.99
|
| Rate for Payer: Nomi Health Commercial |
$33.13
|
| Rate for Payer: PACE SWMI |
$27.61
|
| Rate for Payer: PHP Commercial |
$38.65
|
| Rate for Payer: PHP Medicare Advantage |
$27.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$27.61
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.61
|
| Rate for Payer: UHC Medicare Advantage |
$27.61
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
PR THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 62329
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$1,621.88 |
| Rate for Payer: Aetna Commercial |
$133.93
|
| Rate for Payer: Aetna Medicare |
$103.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.93
|
| Rate for Payer: BCBS Complete |
$69.55
|
| Rate for Payer: BCBS MAPPO |
$99.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,621.88
|
| Rate for Payer: BCN Commercial |
$419.77
|
| Rate for Payer: BCN Medicare Advantage |
$99.95
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$133.93
|
| Rate for Payer: Cofinity Commercial |
$143.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.95
|
| Rate for Payer: Meridian Medicaid |
$69.55
|
| Rate for Payer: Nomi Health Commercial |
$119.94
|
| Rate for Payer: PACE SWMI |
$99.95
|
| Rate for Payer: PHP Commercial |
$139.93
|
| Rate for Payer: PHP Medicare Advantage |
$99.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.74
|
| Rate for Payer: Priority Health Medicare |
$99.95
|
| Rate for Payer: Priority Health Narrow Network |
$175.74
|
| Rate for Payer: Priority Health SBD |
$175.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.95
|
| Rate for Payer: UHC Medicare Advantage |
$99.95
|
| Rate for Payer: UHCCP Medicaid |
$66.24
|
| Rate for Payer: UMR Bronson Commercial |
$104.88
|
|
|
PR THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF
|
Professional
|
Both
|
$471.00
|
|
|
Service Code
|
HCPCS 62272
|
| Min. Negotiated Rate |
$59.85 |
| Max. Negotiated Rate |
$996.90 |
| Rate for Payer: Aetna Commercial |
$122.73
|
| Rate for Payer: Aetna Medicare |
$95.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.89
|
| Rate for Payer: BCBS Complete |
$62.84
|
| Rate for Payer: BCBS MAPPO |
$91.59
|
| Rate for Payer: BCBS Trust/PPO |
$996.90
|
| Rate for Payer: BCN Commercial |
$261.44
|
| Rate for Payer: BCN Medicare Advantage |
$91.59
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cofinity Commercial |
$122.73
|
| Rate for Payer: Cofinity Commercial |
$131.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.17
|
| Rate for Payer: Meridian Medicaid |
$62.84
|
| Rate for Payer: Nomi Health Commercial |
$109.91
|
| Rate for Payer: PACE SWMI |
$91.59
|
| Rate for Payer: PHP Commercial |
$128.23
|
| Rate for Payer: PHP Medicare Advantage |
$91.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$156.40
|
| Rate for Payer: Priority Health Medicare |
$91.59
|
| Rate for Payer: Priority Health Narrow Network |
$156.40
|
| Rate for Payer: Priority Health SBD |
$156.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.59
|
| Rate for Payer: UHC Medicare Advantage |
$91.59
|
| Rate for Payer: UHCCP Medicaid |
$59.85
|
| Rate for Payer: UMR Bronson Commercial |
$216.66
|
|
|
PR THER PROPH/DX NJX IV PUSH SINGLE/1ST SBST/DRUG
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 96374
|
| Min. Negotiated Rate |
$31.63 |
| Max. Negotiated Rate |
$1,546.86 |
| Rate for Payer: Aetna Commercial |
$42.38
|
| Rate for Payer: Aetna Medicare |
$32.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.55
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: BCBS MAPPO |
$31.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,546.86
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Medicare Advantage |
$31.63
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cofinity Commercial |
$42.38
|
| Rate for Payer: Cofinity Commercial |
$45.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.21
|
| Rate for Payer: Nomi Health Commercial |
$37.96
|
| Rate for Payer: PACE SWMI |
$31.63
|
| Rate for Payer: PHP Commercial |
$44.28
|
| Rate for Payer: PHP Medicare Advantage |
$31.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.76
|
| Rate for Payer: Priority Health Medicare |
$31.63
|
| Rate for Payer: Priority Health Narrow Network |
$49.76
|
| Rate for Payer: Priority Health SBD |
$49.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.63
|
| Rate for Payer: UHC Medicare Advantage |
$31.63
|
| Rate for Payer: UMR Bronson Commercial |
$49.22
|
|
|
PR THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 97112
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$1,233.58 |
| Rate for Payer: Aetna Commercial |
$41.14
|
| Rate for Payer: Aetna Medicare |
$31.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.21
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS MAPPO |
$30.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,233.58
|
| Rate for Payer: BCN Commercial |
$32.95
|
| Rate for Payer: BCN Medicare Advantage |
$30.70
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$44.21
|
| Rate for Payer: Cofinity Commercial |
$41.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.24
|
| Rate for Payer: Nomi Health Commercial |
$36.84
|
| Rate for Payer: PACE SWMI |
$30.70
|
| Rate for Payer: PHP Commercial |
$42.98
|
| Rate for Payer: PHP Medicare Advantage |
$30.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$30.70
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.70
|
| Rate for Payer: UHC Medicare Advantage |
$30.70
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
|
|
PR THER PX 1/> AREAS EACH 15 MINUTES MASSAGE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 97124
|
| Min. Negotiated Rate |
$14.23 |
| Max. Negotiated Rate |
$1,345.58 |
| Rate for Payer: Aetna Commercial |
$37.79
|
| Rate for Payer: Aetna Medicare |
$29.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.61
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$28.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,345.58
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: BCN Medicare Advantage |
$28.20
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$40.61
|
| Rate for Payer: Cofinity Commercial |
$37.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.61
|
| Rate for Payer: Nomi Health Commercial |
$33.84
|
| Rate for Payer: PACE SWMI |
$28.20
|
| Rate for Payer: PHP Commercial |
$39.48
|
| Rate for Payer: PHP Medicare Advantage |
$28.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$28.20
|
| Rate for Payer: Priority Health Narrow Network |
$77.25
|
| Rate for Payer: Priority Health SBD |
$77.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.20
|
| Rate for Payer: UHC Medicare Advantage |
$28.20
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
|
PR THIGHPLASTY
|
Professional
|
Both
|
$4,590.00
|
|
|
Service Code
|
HCPCS 00538
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,836.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Aetna Medicare |
$2,295.00
|
| Rate for Payer: BCBS Complete |
$1,836.00
|
| Rate for Payer: Cash Price |
$3,672.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,983.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,111.40
|
|
