|
PR OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM
|
Professional
|
Both
|
$2,716.00
|
|
|
Service Code
|
HCPCS 22216
|
| Min. Negotiated Rate |
$204.48 |
| Max. Negotiated Rate |
$2,037.00 |
| Rate for Payer: Aetna Commercial |
$432.30
|
| Rate for Payer: Aetna Medicare |
$335.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$432.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.56
|
| Rate for Payer: BCBS Complete |
$214.70
|
| Rate for Payer: BCBS MAPPO |
$322.61
|
| Rate for Payer: BCN Commercial |
$596.31
|
| Rate for Payer: BCN Medicare Advantage |
$322.61
|
| Rate for Payer: Cash Price |
$2,172.80
|
| Rate for Payer: Cash Price |
$2,172.80
|
| Rate for Payer: Cofinity Commercial |
$464.56
|
| Rate for Payer: Cofinity Commercial |
$432.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.61
|
| Rate for Payer: Healthscope Commercial |
$596.83
|
| Rate for Payer: Healthscope Commercial |
$516.18
|
| Rate for Payer: Mclaren Medicaid |
$204.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.74
|
| Rate for Payer: Meridian Medicaid |
$214.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$354.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$649.17
|
| Rate for Payer: Nomi Health Commercial |
$387.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,037.00
|
| Rate for Payer: PACE SWMI |
$322.61
|
| Rate for Payer: PHP Medicare Advantage |
$322.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$580.24
|
| Rate for Payer: Priority Health Medicare |
$322.61
|
| Rate for Payer: Priority Health SBD |
$580.24
|
| Rate for Payer: Priority Health Tiered Network |
$580.24
|
| Rate for Payer: Railroad Medicare Medicare |
$322.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.44
|
| Rate for Payer: UHC Core |
$647.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$322.61
|
| Rate for Payer: UHC Exchange |
$647.44
|
| Rate for Payer: UHC Medicaid |
$204.48
|
| Rate for Payer: UHCCP Medicaid |
$204.48
|
|
|
PR OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT
|
Professional
|
Both
|
$1,774.00
|
|
|
Service Code
|
HCPCS 28305
|
| Min. Negotiated Rate |
$398.74 |
| Max. Negotiated Rate |
$1,330.50 |
| Rate for Payer: Aetna Commercial |
$820.54
|
| Rate for Payer: Aetna Medicare |
$636.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$820.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.77
|
| Rate for Payer: BCBS Complete |
$418.68
|
| Rate for Payer: BCBS MAPPO |
$612.34
|
| Rate for Payer: BCN Commercial |
$1,019.86
|
| Rate for Payer: BCN Medicare Advantage |
$612.34
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cofinity Commercial |
$881.77
|
| Rate for Payer: Cofinity Commercial |
$820.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$612.34
|
| Rate for Payer: Healthscope Commercial |
$979.74
|
| Rate for Payer: Healthscope Commercial |
$1,132.83
|
| Rate for Payer: Mclaren Medicaid |
$398.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$642.96
|
| Rate for Payer: Meridian Medicaid |
$418.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$673.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,186.04
|
| Rate for Payer: Nomi Health Commercial |
$734.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,330.50
|
| Rate for Payer: PACE SWMI |
$612.34
|
| Rate for Payer: PHP Medicare Advantage |
$612.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,090.21
|
| Rate for Payer: Priority Health Medicare |
$612.34
|
| Rate for Payer: Priority Health SBD |
$1,090.21
|
| Rate for Payer: Priority Health Tiered Network |
$1,090.21
|
| Rate for Payer: Railroad Medicare Medicare |
$612.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,173.39
|
| Rate for Payer: UHC Core |
$1,173.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$612.34
|
| Rate for Payer: UHC Exchange |
$1,173.39
|
| Rate for Payer: UHC Medicaid |
$398.74
|
| Rate for Payer: UHCCP Medicaid |
$398.74
|
|
|
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
|
Professional
|
Both
|
$4,081.00
|
|
|
Service Code
|
HCPCS 28309
|
| Min. Negotiated Rate |
$532.93 |
| Max. Negotiated Rate |
$3,060.75 |
| Rate for Payer: Aetna Commercial |
$1,097.93
|
| Rate for Payer: Aetna Medicare |
$852.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,097.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,179.86
|
| Rate for Payer: BCBS Complete |
$559.58
|
| Rate for Payer: BCBS MAPPO |
$819.35
|
| Rate for Payer: BCN Commercial |
$1,371.44
|
| Rate for Payer: BCN Medicare Advantage |
$819.35
|
| Rate for Payer: Cash Price |
$3,264.80
|
| Rate for Payer: Cash Price |
$3,264.80
|
| Rate for Payer: Cofinity Commercial |
$1,179.86
|
| Rate for Payer: Cofinity Commercial |
$1,097.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.35
|
| Rate for Payer: Healthscope Commercial |
$1,515.80
|
| Rate for Payer: Healthscope Commercial |
$1,310.96
|
| Rate for Payer: Mclaren Medicaid |
$532.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$860.32
|
| Rate for Payer: Meridian Medicaid |
$559.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$901.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,593.95
|
| Rate for Payer: Nomi Health Commercial |
$983.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,060.75
|
| Rate for Payer: PACE SWMI |
$819.35
|
| Rate for Payer: PHP Medicare Advantage |
$819.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$532.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,466.03
|
| Rate for Payer: Priority Health Medicare |
$819.35
|
| Rate for Payer: Priority Health SBD |
$1,466.03
|
| Rate for Payer: Priority Health Tiered Network |
$1,466.03
|
| Rate for Payer: Railroad Medicare Medicare |
$819.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,550.06
|
| Rate for Payer: UHC Core |
$1,550.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$819.35
|
| Rate for Payer: UHC Exchange |
$1,550.06
|
| Rate for Payer: UHC Medicaid |
$532.93
|
| Rate for Payer: UHCCP Medicaid |
$532.93
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 28306
|
| Min. Negotiated Rate |
$246.02 |
| Max. Negotiated Rate |
$1,095.00 |
| Rate for Payer: Aetna Commercial |
$502.67
|
| Rate for Payer: Aetna Medicare |
$390.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$540.19
|
| Rate for Payer: BCBS Complete |
$258.32
|
| Rate for Payer: BCBS MAPPO |
$375.13
|
| Rate for Payer: BCN Commercial |
$618.99
|
| Rate for Payer: BCN Medicare Advantage |
$375.13
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cofinity Commercial |
$540.19
|
| Rate for Payer: Cofinity Commercial |
$502.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$375.13
|
| Rate for Payer: Healthscope Commercial |
$693.99
|
| Rate for Payer: Healthscope Commercial |
$600.21
|
| Rate for Payer: Mclaren Medicaid |
$246.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.89
|
| Rate for Payer: Meridian Medicaid |
$258.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$412.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.92
|
| Rate for Payer: Nomi Health Commercial |
$450.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,095.00
|
| Rate for Payer: PACE SWMI |
$375.13
|
| Rate for Payer: PHP Medicare Advantage |
$375.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$246.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$661.69
|
| Rate for Payer: Priority Health Medicare |
$375.13
|
| Rate for Payer: Priority Health SBD |
$661.69
|
| Rate for Payer: Priority Health Tiered Network |
$661.69
|
| Rate for Payer: Railroad Medicare Medicare |
$375.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.67
|
| Rate for Payer: UHC Core |
$699.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$375.13
|
| Rate for Payer: UHC Exchange |
$699.67
|
| Rate for Payer: UHC Medicaid |
$246.02
|
| Rate for Payer: UHCCP Medicaid |
$246.02
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA
|
Professional
|
Both
|
$1,120.00
|
|
|
Service Code
|
HCPCS 28308
|
| Min. Negotiated Rate |
$237.07 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$482.17
|
| Rate for Payer: Aetna Medicare |
$374.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$482.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.16
|
| Rate for Payer: BCBS Complete |
$248.92
|
| Rate for Payer: BCBS MAPPO |
$359.83
|
| Rate for Payer: BCN Commercial |
$591.11
|
| Rate for Payer: BCN Medicare Advantage |
$359.83
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cofinity Commercial |
$518.16
|
| Rate for Payer: Cofinity Commercial |
$482.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.83
|
| Rate for Payer: Healthscope Commercial |
$665.69
|
| Rate for Payer: Healthscope Commercial |
$575.73
|
| Rate for Payer: Mclaren Medicaid |
$237.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$377.82
|
| Rate for Payer: Meridian Medicaid |
$248.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$395.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$677.56
|
| Rate for Payer: Nomi Health Commercial |
$431.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$840.00
|
| Rate for Payer: PACE SWMI |
$359.83
|
| Rate for Payer: PHP Medicare Advantage |
$359.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$631.87
|
| Rate for Payer: Priority Health Medicare |
$359.83
|
| Rate for Payer: Priority Health SBD |
$631.87
|
| Rate for Payer: Priority Health Tiered Network |
$631.87
|
| Rate for Payer: Railroad Medicare Medicare |
$359.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$662.84
|
| Rate for Payer: UHC Core |
$662.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$359.83
|
| Rate for Payer: UHC Exchange |
$662.84
|
| Rate for Payer: UHC Medicaid |
$237.07
|
| Rate for Payer: UHCCP Medicaid |
$237.07
|
|
|
PR OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX
|
Professional
|
Both
|
$1,308.00
|
|
|
Service Code
|
HCPCS 63295
|
| Min. Negotiated Rate |
$192.98 |
| Max. Negotiated Rate |
$981.00 |
| Rate for Payer: Aetna Commercial |
$410.94
|
| Rate for Payer: Aetna Medicare |
$318.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$410.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$441.60
|
| Rate for Payer: BCBS Complete |
$202.63
|
| Rate for Payer: BCBS MAPPO |
$306.67
|
| Rate for Payer: BCN Commercial |
$496.98
|
| Rate for Payer: BCN Medicare Advantage |
$306.67
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cash Price |
$1,046.40
|
| Rate for Payer: Cofinity Commercial |
$441.60
|
| Rate for Payer: Cofinity Commercial |
$410.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$306.67
|
| Rate for Payer: Healthscope Commercial |
$567.34
|
| Rate for Payer: Healthscope Commercial |
$490.67
|
| Rate for Payer: Mclaren Medicaid |
$192.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$322.00
|
| Rate for Payer: Meridian Medicaid |
$202.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$337.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$599.20
|
| Rate for Payer: Nomi Health Commercial |
$368.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$981.00
|
| Rate for Payer: PACE SWMI |
$306.67
|
| Rate for Payer: PHP Medicare Advantage |
$306.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$577.24
|
| Rate for Payer: Priority Health Medicare |
$306.67
|
| Rate for Payer: Priority Health SBD |
$577.24
|
| Rate for Payer: Priority Health Tiered Network |
$577.24
|
| Rate for Payer: Railroad Medicare Medicare |
$306.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$586.55
|
| Rate for Payer: UHC Core |
$586.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$306.67
|
| Rate for Payer: UHC Exchange |
$586.55
|
| Rate for Payer: UHC Medicaid |
$192.98
|
| Rate for Payer: UHCCP Medicaid |
$192.98
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$45.08
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$40.57 |
| Rate for Payer: Aetna Commercial |
$38.32
|
| Rate for Payer: Aetna Commercial |
$115.09
|
| Rate for Payer: Aetna Medicare |
$67.70
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: BCBS Complete |
$54.16
|
| Rate for Payer: BCBS Complete |
$18.03
|
| Rate for Payer: BCBS Trust/PPO |
$3.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.94
|
| Rate for Payer: BCN Commercial |
$3.94
|
| Rate for Payer: BCN Commercial |
$3.94
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cofinity Advantage |
$31.56
|
| Rate for Payer: Cofinity Advantage |
$94.78
|
| Rate for Payer: Cofinity Commercial |
$38.77
|
| Rate for Payer: Cofinity Commercial |
$116.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.06
|
| Rate for Payer: Healthscope Commercial |
$121.86
|
| Rate for Payer: Healthscope Commercial |
$40.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.55
|
| Rate for Payer: PHP Commercial |
$38.32
|
| Rate for Payer: PHP Commercial |
$115.09
|
| Rate for Payer: Priority Health SBD |
$28.40
|
| Rate for Payer: Priority Health SBD |
$85.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.59
|
| Rate for Payer: UHC Core |
$2.59
|
| Rate for Payer: UHC Core |
$2.59
|
| Rate for Payer: UHC Exchange |
$2.59
|
| Rate for Payer: UHC Exchange |
$2.59
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$45.08
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$40.57 |
| Rate for Payer: Aetna Commercial |
$38.32
|
| Rate for Payer: Aetna Commercial |
$115.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cofinity Advantage |
$31.56
|
| Rate for Payer: Cofinity Advantage |
$94.78
|
| Rate for Payer: Cofinity Commercial |
$116.44
|
| Rate for Payer: Cofinity Commercial |
$38.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.32
|
| Rate for Payer: Healthscope Commercial |
$40.57
|
| Rate for Payer: Healthscope Commercial |
$121.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.81
|
| Rate for Payer: PHP Commercial |
$115.09
|
| Rate for Payer: PHP Commercial |
$38.32
|
| Rate for Payer: Priority Health SBD |
$28.40
|
| Rate for Payer: Priority Health SBD |
$85.30
|
|
|
PROTEIN SUPPLEMENT ORAL
|
Facility
|
OP
|
$3.52
|
|
|
Service Code
|
NDC 43900028430
|
| Hospital Charge Code |
150950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna Commercial |
$2.99
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Advantage |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$3.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.64
|
| Rate for Payer: PHP Commercial |
$2.99
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.29
|
| Rate for Payer: UHC Core |
$1.83
|
| Rate for Payer: UHC Exchange |
$1.38
|
|
|
PROTEIN SUPPLEMENT ORAL
|
Facility
|
IP
|
$3.52
|
|
|
Service Code
|
NDC 43900028430
|
| Hospital Charge Code |
150950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna Commercial |
$2.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Advantage |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$3.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.64
|
| Rate for Payer: PHP Commercial |
$2.99
|
| Rate for Payer: Priority Health SBD |
$2.22
|
|
|
PR OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA
|
Professional
|
Both
|
$4,616.00
|
|
|
Service Code
|
HCPCS 61345
|
| Min. Negotiated Rate |
$1,268.84 |
| Max. Negotiated Rate |
$4,299.83 |
| Rate for Payer: Aetna Commercial |
$2,661.60
|
| Rate for Payer: Aetna Medicare |
$2,065.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,661.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,860.23
|
| Rate for Payer: BCBS Complete |
$1,332.28
|
| Rate for Payer: BCBS MAPPO |
$1,986.27
|
| Rate for Payer: BCN Commercial |
$4,299.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,986.27
|
| Rate for Payer: Cash Price |
$3,692.80
|
| Rate for Payer: Cash Price |
$3,692.80
|
| Rate for Payer: Cofinity Commercial |
$2,860.23
|
| Rate for Payer: Cofinity Commercial |
$2,661.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,986.27
|
| Rate for Payer: Healthscope Commercial |
$3,674.60
|
| Rate for Payer: Healthscope Commercial |
$3,178.03
|
| Rate for Payer: Mclaren Medicaid |
$1,268.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,085.58
|
| Rate for Payer: Meridian Medicaid |
$1,332.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,184.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,705.19
|
| Rate for Payer: Nomi Health Commercial |
$2,383.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,462.00
|
| Rate for Payer: PACE SWMI |
$1,986.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,986.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,268.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,614.98
|
| Rate for Payer: Priority Health Medicare |
$1,986.27
|
| Rate for Payer: Priority Health SBD |
$3,614.98
|
| Rate for Payer: Priority Health Tiered Network |
$3,614.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,986.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,600.20
|
| Rate for Payer: UHC Core |
$3,600.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,986.27
|
| Rate for Payer: UHC Exchange |
$3,600.20
|
| Rate for Payer: UHC Medicaid |
$1,268.84
|
| Rate for Payer: UHCCP Medicaid |
$1,268.84
|
|
|
PR OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$343.00
|
|
|
Service Code
|
HCPCS 92502
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$257.25 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Medicare |
$87.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.03
|
| Rate for Payer: BCBS Complete |
$57.93
|
| Rate for Payer: BCBS MAPPO |
$84.05
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: BCN Medicare Advantage |
$84.05
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cash Price |
$274.40
|
| Rate for Payer: Cofinity Commercial |
$121.03
|
| Rate for Payer: Cofinity Commercial |
$112.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.05
|
| Rate for Payer: Healthscope Commercial |
$155.49
|
| Rate for Payer: Healthscope Commercial |
$134.48
|
| Rate for Payer: Mclaren Medicaid |
$55.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.25
|
| Rate for Payer: Meridian Medicaid |
$57.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.79
|
| Rate for Payer: Nomi Health Commercial |
$100.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.25
|
| Rate for Payer: PACE SWMI |
$84.05
|
| Rate for Payer: PHP Medicare Advantage |
$84.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$131.34
|
| Rate for Payer: Priority Health Medicare |
$84.05
|
| Rate for Payer: Priority Health SBD |
$131.34
|
| Rate for Payer: Priority Health Tiered Network |
$131.34
|
| Rate for Payer: Railroad Medicare Medicare |
$84.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.91
|
| Rate for Payer: UHC Core |
$150.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$84.05
|
| Rate for Payer: UHC Exchange |
$150.91
|
| Rate for Payer: UHC Medicaid |
$55.17
|
| Rate for Payer: UHCCP Medicaid |
$55.17
|
|
|
PR OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ
|
Professional
|
Both
|
$1,628.00
|
|
|
Service Code
|
HCPCS 69300
|
| Min. Negotiated Rate |
$272.43 |
| Max. Negotiated Rate |
$1,221.00 |
| Rate for Payer: Aetna Commercial |
$556.70
|
| Rate for Payer: Aetna Medicare |
$432.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.25
|
| Rate for Payer: BCBS Complete |
$286.05
|
| Rate for Payer: BCBS MAPPO |
$415.45
|
| Rate for Payer: BCN Commercial |
$711.11
|
| Rate for Payer: BCN Medicare Advantage |
$415.45
|
| Rate for Payer: Cash Price |
$1,302.40
|
| Rate for Payer: Cash Price |
$1,302.40
|
| Rate for Payer: Cofinity Commercial |
$598.25
|
| Rate for Payer: Cofinity Commercial |
$556.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.45
|
| Rate for Payer: Healthscope Commercial |
$768.58
|
| Rate for Payer: Healthscope Commercial |
$664.72
|
| Rate for Payer: Mclaren Medicaid |
$272.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.22
|
| Rate for Payer: Meridian Medicaid |
$286.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$457.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$825.97
|
| Rate for Payer: Nomi Health Commercial |
$498.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,221.00
|
| Rate for Payer: PACE SWMI |
$415.45
|
| Rate for Payer: PHP Medicare Advantage |
$415.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$272.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$702.66
|
| Rate for Payer: Priority Health Medicare |
$415.45
|
| Rate for Payer: Priority Health SBD |
$702.66
|
| Rate for Payer: Priority Health Tiered Network |
$702.66
|
| Rate for Payer: Railroad Medicare Medicare |
$415.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$793.44
|
| Rate for Payer: UHC Core |
$793.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$415.45
|
| Rate for Payer: UHC Exchange |
$793.44
|
| Rate for Payer: UHC Medicaid |
$272.43
|
| Rate for Payer: UHCCP Medicaid |
$272.43
|
|
|
PR OVARIAN CYSTECTOMY UNI/BI
|
Professional
|
Both
|
$2,457.00
|
|
|
Service Code
|
HCPCS 58925
|
| Min. Negotiated Rate |
$445.17 |
| Max. Negotiated Rate |
$1,842.75 |
| Rate for Payer: Aetna Commercial |
$924.53
|
| Rate for Payer: Aetna Medicare |
$717.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.53
|
| Rate for Payer: BCBS Complete |
$467.43
|
| Rate for Payer: BCBS MAPPO |
$689.95
|
| Rate for Payer: BCN Commercial |
$1,156.31
|
| Rate for Payer: BCN Medicare Advantage |
$689.95
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,965.60
|
| Rate for Payer: Cofinity Commercial |
$993.53
|
| Rate for Payer: Cofinity Commercial |
$924.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.95
|
| Rate for Payer: Healthscope Commercial |
$1,276.41
|
| Rate for Payer: Healthscope Commercial |
$1,103.92
|
| Rate for Payer: Mclaren Medicaid |
$445.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$724.45
|
| Rate for Payer: Meridian Medicaid |
$467.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$758.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,371.73
|
| Rate for Payer: Nomi Health Commercial |
$827.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,842.75
|
| Rate for Payer: PACE SWMI |
$689.95
|
| Rate for Payer: PHP Medicare Advantage |
$689.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,171.10
|
| Rate for Payer: Priority Health Medicare |
$689.95
|
| Rate for Payer: Priority Health SBD |
$1,171.10
|
| Rate for Payer: Priority Health Tiered Network |
$1,171.10
|
| Rate for Payer: Railroad Medicare Medicare |
$689.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,340.72
|
| Rate for Payer: UHC Core |
$1,340.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$689.95
|
| Rate for Payer: UHC Exchange |
$1,340.72
|
| Rate for Payer: UHC Medicaid |
$445.17
|
| Rate for Payer: UHCCP Medicaid |
$445.17
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$102.90
|
|
|
Service Code
|
NDC 66993001968
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Aetna Commercial |
$87.47
|
| Rate for Payer: Aetna Medicare |
$51.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.89
|
| Rate for Payer: BCBS Complete |
$41.16
|
| Rate for Payer: Cash Price |
$82.32
|
| Rate for Payer: Cofinity Advantage |
$72.03
|
| Rate for Payer: Cofinity Commercial |
$88.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.32
|
| Rate for Payer: Healthscope Commercial |
$92.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.17
|
| Rate for Payer: PHP Commercial |
$87.47
|
| Rate for Payer: Priority Health SBD |
$64.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.89
|
| Rate for Payer: UHC Core |
$53.61
|
| Rate for Payer: UHC Exchange |
$40.44
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$102.90
|
|
|
Service Code
|
NDC 66993001968
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Aetna Commercial |
$87.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.89
|
| Rate for Payer: Cash Price |
$82.32
|
| Rate for Payer: Cofinity Advantage |
$72.03
|
| Rate for Payer: Cofinity Commercial |
$88.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.32
|
| Rate for Payer: Healthscope Commercial |
$92.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.17
|
| Rate for Payer: PHP Commercial |
$87.47
|
| Rate for Payer: Priority Health SBD |
$64.83
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$116.90
|
|
|
Service Code
|
NDC 00781729685
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.65 |
| Max. Negotiated Rate |
$105.21 |
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.98
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Advantage |
$81.83
|
| Rate for Payer: Cofinity Commercial |
$100.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$105.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.67
|
| Rate for Payer: PHP Commercial |
$99.36
|
| Rate for Payer: Priority Health SBD |
$73.65
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
NDC 69097014260
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Cofinity Advantage |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.32
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.80
|
| Rate for Payer: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health SBD |
$31.75
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
NDC 69097014260
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna Medicare |
$25.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Cofinity Advantage |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.32
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.80
|
| Rate for Payer: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health SBD |
$31.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.76
|
| Rate for Payer: UHC Core |
$26.26
|
| Rate for Payer: UHC Exchange |
$19.81
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$116.90
|
|
|
Service Code
|
NDC 00781729685
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.94 |
| Max. Negotiated Rate |
$105.21 |
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: Aetna Medicare |
$58.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.98
|
| Rate for Payer: BCBS Complete |
$46.76
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Advantage |
$81.83
|
| Rate for Payer: Cofinity Commercial |
$100.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$105.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.67
|
| Rate for Payer: PHP Commercial |
$99.36
|
| Rate for Payer: Priority Health SBD |
$73.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.98
|
| Rate for Payer: UHC Core |
$60.90
|
| Rate for Payer: UHC Exchange |
$45.94
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
NDC 69097014260
|
| Hospital Charge Code |
17934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.81 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna Medicare |
$25.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Cofinity Advantage |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.32
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.80
|
| Rate for Payer: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health SBD |
$31.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.76
|
| Rate for Payer: UHC Core |
$26.26
|
| Rate for Payer: UHC Exchange |
$19.81
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
NDC 69097014260
|
| Hospital Charge Code |
17934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.75 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Cofinity Advantage |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.32
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.80
|
| Rate for Payer: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health SBD |
$31.75
|
|
|
PR OVINE, UP TO 999 USP UNITS
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J3471
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.51
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.51
|
| Rate for Payer: BCBS Trust/PPO |
$0.50
|
| Rate for Payer: BCN Commercial |
$0.50
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.50
|
| Rate for Payer: UHC Core |
$0.50
|
| Rate for Payer: UHC Exchange |
$0.50
|
|
|
PR PACKING STRIPS, NON-IMPREG
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS A6407
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$4.92 |
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Aetna Medicare |
$2.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.56
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$2.66
|
| Rate for Payer: BCN Commercial |
$2.55
|
| Rate for Payer: BCN Medicare Advantage |
$2.66
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$3.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.66
|
| Rate for Payer: Healthscope Commercial |
$4.92
|
| Rate for Payer: Healthscope Commercial |
$4.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.49
|
| Rate for Payer: Nomi Health Commercial |
$3.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.50
|
| Rate for Payer: PACE SWMI |
$2.66
|
| Rate for Payer: PHP Medicare Advantage |
$2.66
|
| Rate for Payer: Priority Health Medicare |
$2.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.87
|
| Rate for Payer: UHC Core |
$0.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2.66
|
| Rate for Payer: UHC Exchange |
$0.87
|
|
|
PR PALATOPHARYNGOPLASTY
|
Professional
|
Both
|
$2,546.00
|
|
|
Service Code
|
HCPCS 42145
|
| Min. Negotiated Rate |
$388.09 |
| Max. Negotiated Rate |
$1,909.50 |
| Rate for Payer: Aetna Commercial |
$795.12
|
| Rate for Payer: Aetna Medicare |
$617.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$795.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$854.45
|
| Rate for Payer: BCBS Complete |
$407.49
|
| Rate for Payer: BCBS MAPPO |
$593.37
|
| Rate for Payer: BCN Commercial |
$1,035.31
|
| Rate for Payer: BCN Medicare Advantage |
$593.37
|
| Rate for Payer: Cash Price |
$2,036.80
|
| Rate for Payer: Cash Price |
$2,036.80
|
| Rate for Payer: Cofinity Commercial |
$854.45
|
| Rate for Payer: Cofinity Commercial |
$795.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$593.37
|
| Rate for Payer: Healthscope Commercial |
$949.39
|
| Rate for Payer: Healthscope Commercial |
$1,097.73
|
| Rate for Payer: Mclaren Medicaid |
$388.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$623.04
|
| Rate for Payer: Meridian Medicaid |
$407.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$652.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,216.69
|
| Rate for Payer: Nomi Health Commercial |
$712.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,909.50
|
| Rate for Payer: PACE SWMI |
$593.37
|
| Rate for Payer: PHP Medicare Advantage |
$593.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$388.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,261.44
|
| Rate for Payer: Priority Health Medicare |
$593.37
|
| Rate for Payer: Priority Health SBD |
$1,261.44
|
| Rate for Payer: Priority Health Tiered Network |
$1,261.44
|
| Rate for Payer: Railroad Medicare Medicare |
$593.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,196.84
|
| Rate for Payer: UHC Core |
$1,196.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$593.37
|
| Rate for Payer: UHC Exchange |
$1,196.84
|
| Rate for Payer: UHC Medicaid |
$388.09
|
| Rate for Payer: UHCCP Medicaid |
$388.09
|
|
