|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 11-20 MIN
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 99447
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$62.99 |
| Rate for Payer: Aetna Commercial |
$45.63
|
| Rate for Payer: Aetna Medicare |
$35.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.63
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS MAPPO |
$34.05
|
| Rate for Payer: BCN Medicare Advantage |
$34.05
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$49.03
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.05
|
| Rate for Payer: Healthscope Commercial |
$54.48
|
| Rate for Payer: Healthscope Commercial |
$62.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.10
|
| Rate for Payer: Nomi Health Commercial |
$40.86
|
| Rate for Payer: PACE SWMI |
$34.05
|
| Rate for Payer: PHP Medicare Advantage |
$34.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health Medicare |
$34.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.05
|
| Rate for Payer: UHC Medicare Advantage |
$34.05
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 99448
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$93.52 |
| Rate for Payer: Aetna Commercial |
$67.74
|
| Rate for Payer: Aetna Medicare |
$52.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.74
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS MAPPO |
$50.55
|
| Rate for Payer: BCN Medicare Advantage |
$50.55
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$72.79
|
| Rate for Payer: Cofinity Commercial |
$67.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.55
|
| Rate for Payer: Healthscope Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$80.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.80
|
| Rate for Payer: Nomi Health Commercial |
$60.66
|
| Rate for Payer: PACE SWMI |
$50.55
|
| Rate for Payer: PHP Medicare Advantage |
$50.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Medicare |
$50.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.55
|
| Rate for Payer: UHC Medicare Advantage |
$50.55
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 99449
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$126.54 |
| Rate for Payer: Aetna Commercial |
$91.66
|
| Rate for Payer: Aetna Medicare |
$71.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.66
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: BCBS MAPPO |
$68.40
|
| Rate for Payer: BCN Medicare Advantage |
$68.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$98.50
|
| Rate for Payer: Cofinity Commercial |
$91.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.40
|
| Rate for Payer: Healthscope Commercial |
$109.44
|
| Rate for Payer: Healthscope Commercial |
$126.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.20
|
| Rate for Payer: Nomi Health Commercial |
$82.08
|
| Rate for Payer: PACE SWMI |
$68.40
|
| Rate for Payer: PHP Medicare Advantage |
$68.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health Medicare |
$68.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.40
|
| Rate for Payer: UHC Medicare Advantage |
$68.40
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99446
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$31.23 |
| Rate for Payer: Aetna Commercial |
$22.62
|
| Rate for Payer: Aetna Medicare |
$17.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.62
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$16.88
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$24.31
|
| Rate for Payer: Cofinity Commercial |
$22.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.88
|
| Rate for Payer: Healthscope Commercial |
$31.23
|
| Rate for Payer: Healthscope Commercial |
$27.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.05
|
| Rate for Payer: Nomi Health Commercial |
$20.26
|
| Rate for Payer: PACE SWMI |
$16.88
|
| Rate for Payer: PHP Medicare Advantage |
$16.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health Medicare |
$16.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.88
|
| Rate for Payer: UHC Medicare Advantage |
$16.88
|
|
|
PR NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS
|
Professional
|
Both
|
$7,109.00
|
|
|
Service Code
|
HCPCS 62161
|
| Min. Negotiated Rate |
$1,512.00 |
| Max. Negotiated Rate |
$4,620.85 |
| Rate for Payer: Aetna Commercial |
$2,026.08
|
| Rate for Payer: Aetna Medicare |
$1,572.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,177.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,026.08
|
| Rate for Payer: BCBS Complete |
$2,843.60
|
| Rate for Payer: BCBS MAPPO |
$1,512.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,512.00
|
| Rate for Payer: Cash Price |
$5,687.20
|
| Rate for Payer: Cash Price |
$5,687.20
|
| Rate for Payer: Cofinity Commercial |
$2,177.28
|
| Rate for Payer: Cofinity Commercial |
$2,026.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,512.00
|
| Rate for Payer: Healthscope Commercial |
$2,419.20
|
| Rate for Payer: Healthscope Commercial |
$2,797.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,587.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,620.85
|
| Rate for Payer: Nomi Health Commercial |
$1,814.40
|
| Rate for Payer: PACE SWMI |
$1,512.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,512.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,620.85
|
| Rate for Payer: Priority Health Medicare |
$1,512.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,512.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,512.00
|
|
|
PR NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID
|
Professional
|
Both
|
$2,824.00
|
|
|
Service Code
|
HCPCS 62165
|
| Min. Negotiated Rate |
$1,129.60 |
| Max. Negotiated Rate |
$2,740.20 |
| Rate for Payer: Aetna Commercial |
$1,984.79
|
| Rate for Payer: Aetna Medicare |
$1,540.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,132.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.79
|
| Rate for Payer: BCBS Complete |
$1,129.60
|
| Rate for Payer: BCBS MAPPO |
$1,481.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,481.19
|
| Rate for Payer: Cash Price |
$2,259.20
|
| Rate for Payer: Cash Price |
$2,259.20
|
| Rate for Payer: Cofinity Commercial |
$2,132.91
|
| Rate for Payer: Cofinity Commercial |
$1,984.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,481.19
|
| Rate for Payer: Healthscope Commercial |
$2,740.20
|
| Rate for Payer: Healthscope Commercial |
$2,369.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,555.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,835.60
|
| Rate for Payer: Nomi Health Commercial |
$1,777.43
|
| Rate for Payer: PACE SWMI |
$1,481.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,481.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.60
|
| Rate for Payer: Priority Health Medicare |
$1,481.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,481.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,481.19
|
|
|
PR NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG
|
Professional
|
Both
|
$7,834.00
|
|
|
Service Code
|
HCPCS 62162
|
| Min. Negotiated Rate |
$1,875.84 |
| Max. Negotiated Rate |
$5,092.10 |
| Rate for Payer: Aetna Commercial |
$2,513.63
|
| Rate for Payer: Aetna Medicare |
$1,950.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,701.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,513.63
|
| Rate for Payer: BCBS Complete |
$3,133.60
|
| Rate for Payer: BCBS MAPPO |
$1,875.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,875.84
|
| Rate for Payer: Cash Price |
$6,267.20
|
| Rate for Payer: Cash Price |
$6,267.20
|
| Rate for Payer: Cofinity Commercial |
$2,701.21
|
| Rate for Payer: Cofinity Commercial |
$2,513.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,875.84
|
| Rate for Payer: Healthscope Commercial |
$3,001.34
|
| Rate for Payer: Healthscope Commercial |
$3,470.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,969.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,092.10
|
| Rate for Payer: Nomi Health Commercial |
$2,251.01
|
| Rate for Payer: PACE SWMI |
$1,875.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,875.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,092.10
|
| Rate for Payer: Priority Health Medicare |
$1,875.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,875.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,875.84
|
|
|
PR NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 62160
|
| Min. Negotiated Rate |
$186.44 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Commercial |
$249.83
|
| Rate for Payer: Aetna Medicare |
$193.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.83
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$186.44
|
| Rate for Payer: BCN Medicare Advantage |
$186.44
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$268.47
|
| Rate for Payer: Cofinity Commercial |
$249.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.44
|
| Rate for Payer: Healthscope Commercial |
$344.91
|
| Rate for Payer: Healthscope Commercial |
$298.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$530.40
|
| Rate for Payer: Nomi Health Commercial |
$223.73
|
| Rate for Payer: PACE SWMI |
$186.44
|
| Rate for Payer: PHP Medicare Advantage |
$186.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$186.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.44
|
| Rate for Payer: UHC Medicare Advantage |
$186.44
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99316
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$227.88 |
| Rate for Payer: Aetna Commercial |
$165.06
|
| Rate for Payer: Aetna Medicare |
$128.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.06
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$123.18
|
| Rate for Payer: BCN Medicare Advantage |
$123.18
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$177.38
|
| Rate for Payer: Cofinity Commercial |
$165.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.18
|
| Rate for Payer: Healthscope Commercial |
$197.09
|
| Rate for Payer: Healthscope Commercial |
$227.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.70
|
| Rate for Payer: Nomi Health Commercial |
$147.82
|
| Rate for Payer: PACE SWMI |
$123.18
|
| Rate for Payer: PHP Medicare Advantage |
$123.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$123.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.18
|
| Rate for Payer: UHC Medicare Advantage |
$123.18
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99315
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$142.02 |
| Rate for Payer: Aetna Commercial |
$102.87
|
| Rate for Payer: Aetna Medicare |
$79.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.87
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$76.77
|
| Rate for Payer: BCN Medicare Advantage |
$76.77
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$110.55
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.77
|
| Rate for Payer: Healthscope Commercial |
$142.02
|
| Rate for Payer: Healthscope Commercial |
$122.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.50
|
| Rate for Payer: Nomi Health Commercial |
$92.12
|
| Rate for Payer: PACE SWMI |
$76.77
|
| Rate for Payer: PHP Medicare Advantage |
$76.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$76.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.77
|
| Rate for Payer: UHC Medicare Advantage |
$76.77
|
|
|
PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 94690
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare |
$44.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.75
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$43.10
|
| Rate for Payer: BCN Medicare Advantage |
$43.10
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$62.06
|
| Rate for Payer: Cofinity Commercial |
$57.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.10
|
| Rate for Payer: Healthscope Commercial |
$68.96
|
| Rate for Payer: Healthscope Commercial |
$79.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.50
|
| Rate for Payer: Nomi Health Commercial |
$51.72
|
| Rate for Payer: PACE SWMI |
$43.10
|
| Rate for Payer: PHP Medicare Advantage |
$43.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$43.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.10
|
| Rate for Payer: UHC Medicare Advantage |
$43.10
|
|
|
PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 94680
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$88.15 |
| Rate for Payer: Aetna Commercial |
$63.85
|
| Rate for Payer: Aetna Medicare |
$49.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.85
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$47.65
|
| Rate for Payer: BCN Medicare Advantage |
$47.65
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$68.62
|
| Rate for Payer: Cofinity Commercial |
$63.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.65
|
| Rate for Payer: Healthscope Commercial |
$88.15
|
| Rate for Payer: Healthscope Commercial |
$76.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.10
|
| Rate for Payer: Nomi Health Commercial |
$57.18
|
| Rate for Payer: PACE SWMI |
$47.65
|
| Rate for Payer: PHP Medicare Advantage |
$47.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$47.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.65
|
| Rate for Payer: UHC Medicare Advantage |
$47.65
|
|
|
PROAIR HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$50.40
|
|
|
Service Code
|
NDC 69097014260
|
| Hospital Charge Code |
76821
|
|
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 Commercial |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.28
|
| 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: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.76
|
| Rate for Payer: Priority Health SBD |
$31.75
|
|
|
PROAIR HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
NDC 69097014260
|
| Hospital Charge Code |
76821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.16 |
| 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 Commercial |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.28
|
| 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: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.76
|
| Rate for Payer: Priority Health SBD |
$31.75
|
|
|
PROAIR HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
NDC 59310057922
|
| Hospital Charge Code |
76821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna Medicare |
$94.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health SBD |
$119.07
|
|
|
PROAIR HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
NDC 59310057922
|
| Hospital Charge Code |
76821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Aetna Commercial |
$160.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.85
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$132.30
|
| Rate for Payer: Cofinity Commercial |
$162.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$132.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$151.20
|
| Rate for Payer: Healthscope Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.65
|
| Rate for Payer: PHP Commercial |
$160.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health SBD |
$119.07
|
|
|
PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM
|
Professional
|
Both
|
$4,249.00
|
|
|
Service Code
|
HCPCS 59510
|
| Min. Negotiated Rate |
$1,699.60 |
| Max. Negotiated Rate |
$4,821.21 |
| Rate for Payer: Aetna Commercial |
$3,492.12
|
| Rate for Payer: Aetna Medicare |
$2,710.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,752.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,492.12
|
| Rate for Payer: BCBS Complete |
$1,699.60
|
| Rate for Payer: BCBS MAPPO |
$2,606.06
|
| Rate for Payer: BCN Medicare Advantage |
$2,606.06
|
| Rate for Payer: Cash Price |
$3,399.20
|
| Rate for Payer: Cash Price |
$3,399.20
|
| Rate for Payer: Cofinity Commercial |
$3,752.73
|
| Rate for Payer: Cofinity Commercial |
$3,492.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,606.06
|
| Rate for Payer: Healthscope Commercial |
$4,169.70
|
| Rate for Payer: Healthscope Commercial |
$4,821.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,736.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,761.85
|
| Rate for Payer: Nomi Health Commercial |
$3,127.27
|
| Rate for Payer: PACE SWMI |
$2,606.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,606.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,761.85
|
| Rate for Payer: Priority Health Medicare |
$2,606.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,606.06
|
| Rate for Payer: UHC Medicare Advantage |
$2,606.06
|
|
|
PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM
|
Professional
|
Both
|
$3,830.00
|
|
|
Service Code
|
HCPCS 59400
|
| Min. Negotiated Rate |
$1,532.00 |
| Max. Negotiated Rate |
$4,324.58 |
| Rate for Payer: Aetna Commercial |
$3,132.40
|
| Rate for Payer: Aetna Medicare |
$2,431.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,366.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,132.40
|
| Rate for Payer: BCBS Complete |
$1,532.00
|
| Rate for Payer: BCBS MAPPO |
$2,337.61
|
| Rate for Payer: BCN Medicare Advantage |
$2,337.61
|
| Rate for Payer: Cash Price |
$3,064.00
|
| Rate for Payer: Cash Price |
$3,064.00
|
| Rate for Payer: Cofinity Commercial |
$3,366.16
|
| Rate for Payer: Cofinity Commercial |
$3,132.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,337.61
|
| Rate for Payer: Healthscope Commercial |
$3,740.18
|
| Rate for Payer: Healthscope Commercial |
$4,324.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,454.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,489.50
|
| Rate for Payer: Nomi Health Commercial |
$2,805.13
|
| Rate for Payer: PACE SWMI |
$2,337.61
|
| Rate for Payer: PHP Medicare Advantage |
$2,337.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,489.50
|
| Rate for Payer: Priority Health Medicare |
$2,337.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,337.61
|
| Rate for Payer: UHC Medicare Advantage |
$2,337.61
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 33813
|
| Min. Negotiated Rate |
$962.40 |
| Max. Negotiated Rate |
$1,563.90 |
| Rate for Payer: Aetna Medicare |
$1,203.00
|
| Rate for Payer: BCBS Complete |
$962.40
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,563.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,563.90
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DFCT W/CARD BYPASS
|
Professional
|
Both
|
$3,091.00
|
|
|
Service Code
|
HCPCS 33814
|
| Min. Negotiated Rate |
$1,236.40 |
| Max. Negotiated Rate |
$2,712.41 |
| Rate for Payer: Aetna Commercial |
$1,964.67
|
| Rate for Payer: Aetna Medicare |
$1,524.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,964.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,111.28
|
| Rate for Payer: BCBS Complete |
$1,236.40
|
| Rate for Payer: BCBS MAPPO |
$1,466.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,466.17
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cofinity Commercial |
$1,964.67
|
| Rate for Payer: Cofinity Commercial |
$2,111.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.17
|
| Rate for Payer: Healthscope Commercial |
$2,345.87
|
| Rate for Payer: Healthscope Commercial |
$2,712.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,539.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,009.15
|
| Rate for Payer: Nomi Health Commercial |
$1,759.40
|
| Rate for Payer: PACE SWMI |
$1,466.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,466.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,009.15
|
| Rate for Payer: Priority Health Medicare |
$1,466.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,466.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.17
|
|
|
PR OBSERVATION CARE DISCHARGE MANAGEMENT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99217
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Commercial |
$22.98
|
| Rate for Payer: Aetna Medicare |
$17.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.70
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$17.15
|
| Rate for Payer: BCN Medicare Advantage |
$17.15
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.15
|
| Rate for Payer: Healthscope Commercial |
$31.73
|
| Rate for Payer: Healthscope Commercial |
$27.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.45
|
| Rate for Payer: Nomi Health Commercial |
$20.58
|
| Rate for Payer: PACE SWMI |
$17.15
|
| Rate for Payer: PHP Medicare Advantage |
$17.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health Medicare |
$17.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.15
|
| Rate for Payer: UHC Medicare Advantage |
$17.15
|
|
|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$1,696.32
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
6562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$157.95 |
| Max. Negotiated Rate |
$1,526.69 |
| Rate for Payer: Aetna Commercial |
$1,441.87
|
| Rate for Payer: Aetna Commercial |
$179.12
|
| Rate for Payer: Aetna Medicare |
$306.48
|
| Rate for Payer: Aetna Medicare |
$306.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.36
|
| Rate for Payer: BCBS Complete |
$165.85
|
| Rate for Payer: BCBS Complete |
$165.85
|
| Rate for Payer: BCBS MAPPO |
$294.69
|
| Rate for Payer: BCBS MAPPO |
$294.69
|
| Rate for Payer: BCN Medicare Advantage |
$294.69
|
| Rate for Payer: BCN Medicare Advantage |
$294.69
|
| Rate for Payer: Cash Price |
$168.58
|
| Rate for Payer: Cash Price |
$168.58
|
| Rate for Payer: Cash Price |
$1,357.06
|
| Rate for Payer: Cash Price |
$1,357.06
|
| Rate for Payer: Cofinity Commercial |
$147.51
|
| Rate for Payer: Cofinity Commercial |
$181.23
|
| Rate for Payer: Cofinity Commercial |
$1,458.84
|
| Rate for Payer: Cofinity Commercial |
$1,187.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,187.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.69
|
| Rate for Payer: Healthscope Commercial |
$1,526.69
|
| Rate for Payer: Healthscope Commercial |
$189.66
|
| Rate for Payer: Mclaren Medicaid |
$157.95
|
| Rate for Payer: Mclaren Medicaid |
$157.95
|
| Rate for Payer: Mclaren Medicare |
$294.69
|
| Rate for Payer: Mclaren Medicare |
$294.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.42
|
| Rate for Payer: Meridian Medicaid |
$165.85
|
| Rate for Payer: Meridian Medicaid |
$165.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,441.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.12
|
| Rate for Payer: PACE Medicare |
$279.96
|
| Rate for Payer: PACE Medicare |
$279.96
|
| Rate for Payer: PACE SWMI |
$294.69
|
| Rate for Payer: PACE SWMI |
$294.69
|
| Rate for Payer: PHP Commercial |
$179.12
|
| Rate for Payer: PHP Commercial |
$1,441.87
|
| Rate for Payer: PHP Medicare Advantage |
$294.69
|
| Rate for Payer: PHP Medicare Advantage |
$294.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,102.61
|
| Rate for Payer: Priority Health Medicare |
$294.69
|
| Rate for Payer: Priority Health Medicare |
$294.69
|
| Rate for Payer: Priority Health SBD |
$132.76
|
| Rate for Payer: Priority Health SBD |
$1,068.68
|
| Rate for Payer: Railroad Medicare Medicare |
$294.69
|
| Rate for Payer: Railroad Medicare Medicare |
$294.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.69
|
| Rate for Payer: UHC Medicare Advantage |
$294.69
|
| Rate for Payer: UHC Medicare Advantage |
$294.69
|
| Rate for Payer: UHCCP Medicaid |
$165.91
|
| Rate for Payer: UHCCP Medicaid |
$165.91
|
| Rate for Payer: VA VA |
$294.69
|
| Rate for Payer: VA VA |
$294.69
|
|
|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,696.32
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
6562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,068.68 |
| Max. Negotiated Rate |
$1,526.69 |
| Rate for Payer: Aetna Commercial |
$1,441.87
|
| Rate for Payer: Aetna Commercial |
$179.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.97
|
| Rate for Payer: Cash Price |
$1,357.06
|
| Rate for Payer: Cash Price |
$168.58
|
| Rate for Payer: Cofinity Commercial |
$1,187.42
|
| Rate for Payer: Cofinity Commercial |
$147.51
|
| Rate for Payer: Cofinity Commercial |
$181.23
|
| Rate for Payer: Cofinity Commercial |
$1,458.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,187.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.58
|
| Rate for Payer: Healthscope Commercial |
$1,526.69
|
| Rate for Payer: Healthscope Commercial |
$189.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,441.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.12
|
| Rate for Payer: PHP Commercial |
$1,441.87
|
| Rate for Payer: PHP Commercial |
$179.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,102.61
|
| Rate for Payer: Priority Health SBD |
$132.76
|
| Rate for Payer: Priority Health SBD |
$1,068.68
|
|
|
PR OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 58615
|
| Min. Negotiated Rate |
$179.60 |
| Max. Negotiated Rate |
$446.57 |
| Rate for Payer: Aetna Commercial |
$323.46
|
| Rate for Payer: Aetna Medicare |
$251.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: BCBS Complete |
$179.60
|
| Rate for Payer: BCBS MAPPO |
$241.39
|
| Rate for Payer: BCN Medicare Advantage |
$241.39
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$323.46
|
| Rate for Payer: Cofinity Commercial |
$347.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.39
|
| Rate for Payer: Healthscope Commercial |
$386.22
|
| Rate for Payer: Healthscope Commercial |
$446.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.85
|
| Rate for Payer: Nomi Health Commercial |
$289.67
|
| Rate for Payer: PACE SWMI |
$241.39
|
| Rate for Payer: PHP Medicare Advantage |
$241.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$241.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.39
|
| Rate for Payer: UHC Medicare Advantage |
$241.39
|
|
