|
PR NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS
|
Professional
|
Both
|
$7,109.00
|
|
|
Service Code
|
HCPCS 62161
|
| Min. Negotiated Rate |
$214.49 |
| Max. Negotiated Rate |
$275,713.00 |
| Rate for Payer: Aetna Commercial |
$2,026.08
|
| Rate for Payer: Aetna Medicare |
$1,572.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,026.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,177.28
|
| Rate for Payer: BCBS Complete |
$1,045.34
|
| Rate for Payer: BCBS MAPPO |
$1,512.00
|
| Rate for Payer: BCBS Trust/PPO |
$214.49
|
| Rate for Payer: BCN Commercial |
$3,118.49
|
| 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 |
$2,797.20
|
| Rate for Payer: Healthscope Commercial |
$2,419.20
|
| Rate for Payer: Mclaren Medicaid |
$995.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,587.60
|
| Rate for Payer: Meridian Medicaid |
$1,045.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275,713.00
|
| 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 Choice Medicaid |
$995.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,620.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,649.64
|
| Rate for Payer: Priority Health Medicare |
$1,512.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,649.64
|
| Rate for Payer: Priority Health SBD |
$2,649.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,474.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,512.00
|
| Rate for Payer: UHC Exchange |
$1,474.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,512.00
|
| Rate for Payer: UHCCP Medicaid |
$995.56
|
|
|
PR NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID
|
Professional
|
Both
|
$2,824.00
|
|
|
Service Code
|
HCPCS 62165
|
| Min. Negotiated Rate |
$981.50 |
| Max. Negotiated Rate |
$273,397.00 |
| Rate for Payer: Aetna Commercial |
$1,984.79
|
| Rate for Payer: Aetna Medicare |
$1,540.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,132.91
|
| Rate for Payer: BCBS Complete |
$1,030.58
|
| Rate for Payer: BCBS MAPPO |
$1,481.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.62
|
| Rate for Payer: BCN Commercial |
$2,234.73
|
| 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: Mclaren Medicaid |
$981.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,555.25
|
| Rate for Payer: Meridian Medicaid |
$1,030.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$273,397.00
|
| 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 Choice Medicaid |
$981.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,613.25
|
| Rate for Payer: Priority Health Medicare |
$1,481.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,613.25
|
| Rate for Payer: Priority Health SBD |
$2,613.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,592.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,481.19
|
| Rate for Payer: UHC Exchange |
$1,592.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,481.19
|
| Rate for Payer: UHCCP Medicaid |
$981.50
|
|
|
PR NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG
|
Professional
|
Both
|
$7,834.00
|
|
|
Service Code
|
HCPCS 62162
|
| Min. Negotiated Rate |
$757.05 |
| Max. Negotiated Rate |
$342,707.00 |
| Rate for Payer: Aetna Commercial |
$2,513.63
|
| Rate for Payer: Aetna Medicare |
$1,950.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,513.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,701.21
|
| Rate for Payer: BCBS Complete |
$1,294.26
|
| Rate for Payer: BCBS MAPPO |
$1,875.84
|
| Rate for Payer: BCBS Trust/PPO |
$757.05
|
| Rate for Payer: BCN Commercial |
$2,789.86
|
| 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 |
$3,470.30
|
| Rate for Payer: Healthscope Commercial |
$3,001.34
|
| Rate for Payer: Mclaren Medicaid |
$1,232.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,969.63
|
| Rate for Payer: Meridian Medicaid |
$1,294.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342,707.00
|
| 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 Choice Medicaid |
$1,232.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,092.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,276.95
|
| Rate for Payer: Priority Health Medicare |
$1,875.84
|
| Rate for Payer: Priority Health Narrow Network |
$3,276.95
|
| Rate for Payer: Priority Health SBD |
$3,276.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,920.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,875.84
|
| Rate for Payer: UHC Exchange |
$1,920.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,875.84
|
| Rate for Payer: UHCCP Medicaid |
$1,232.63
|
|
|
PR NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 62160
|
| Min. Negotiated Rate |
$120.98 |
| Max. Negotiated Rate |
$34,121.00 |
| Rate for Payer: Aetna Commercial |
$249.83
|
| Rate for Payer: Aetna Medicare |
$193.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.47
|
| Rate for Payer: BCBS Complete |
$127.03
|
| Rate for Payer: BCBS MAPPO |
$186.44
|
| Rate for Payer: BCBS Trust/PPO |
$437.96
|
| Rate for Payer: BCN Commercial |
$381.67
|
| 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: Mclaren Medicaid |
$120.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.76
|
| Rate for Payer: Meridian Medicaid |
$127.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,121.00
|
| 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 Choice Medicaid |
$120.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.32
|
| Rate for Payer: Priority Health Medicare |
$186.44
|
| Rate for Payer: Priority Health Narrow Network |
$321.32
|
| Rate for Payer: Priority Health SBD |
$321.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.44
|
| Rate for Payer: UHC Exchange |
$207.12
|
| Rate for Payer: UHC Medicare Advantage |
$186.44
|
| Rate for Payer: UHCCP Medicaid |
$120.98
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99316
|
| Min. Negotiated Rate |
$82.86 |
| Max. Negotiated Rate |
$19,250.00 |
| Rate for Payer: Aetna Commercial |
$165.06
|
| Rate for Payer: Aetna Medicare |
$128.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.38
|
| Rate for Payer: BCBS Complete |
$87.00
|
| Rate for Payer: BCBS MAPPO |
$123.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,849.05
|
| Rate for Payer: BCN Commercial |
$189.61
|
| 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 |
$227.88
|
| Rate for Payer: Healthscope Commercial |
$197.09
|
| Rate for Payer: Mclaren Medicaid |
$82.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.34
|
| Rate for Payer: Meridian Medicaid |
$87.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,250.00
|
| 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 Choice Medicaid |
$82.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.99
|
| Rate for Payer: Priority Health Medicare |
$123.18
|
| Rate for Payer: Priority Health Narrow Network |
$174.99
|
| Rate for Payer: Priority Health SBD |
$174.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.18
|
| Rate for Payer: UHC Exchange |
$110.19
|
| Rate for Payer: UHC Medicare Advantage |
$123.18
|
| Rate for Payer: UHCCP Medicaid |
$82.86
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99315
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$11,922.00 |
| Rate for Payer: Aetna Commercial |
$102.87
|
| Rate for Payer: Aetna Medicare |
$79.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.55
|
| Rate for Payer: BCBS Complete |
$54.35
|
| Rate for Payer: BCBS MAPPO |
$76.77
|
| Rate for Payer: BCBS Trust/PPO |
$402.56
|
| Rate for Payer: BCN Commercial |
$117.77
|
| 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: Mclaren Medicaid |
$51.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.61
|
| Rate for Payer: Meridian Medicaid |
$54.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,922.00
|
| 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 Choice Medicaid |
$51.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.04
|
| Rate for Payer: Priority Health Medicare |
$76.77
|
| Rate for Payer: Priority Health Narrow Network |
$109.04
|
| Rate for Payer: Priority Health SBD |
$109.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.77
|
| Rate for Payer: UHC Exchange |
$84.42
|
| Rate for Payer: UHC Medicare Advantage |
$76.77
|
| Rate for Payer: UHCCP Medicaid |
$51.76
|
|
|
PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 94690
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$6,624.00 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare |
$44.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: BCBS Complete |
$2.46
|
| Rate for Payer: BCBS MAPPO |
$43.10
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: BCN Commercial |
$69.39
|
| 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 |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$68.96
|
| Rate for Payer: Mclaren Medicaid |
$2.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.26
|
| Rate for Payer: Meridian Medicaid |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,624.00
|
| 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 Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.04
|
| Rate for Payer: Priority Health Medicare |
$43.10
|
| Rate for Payer: Priority Health Narrow Network |
$66.04
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.10
|
| Rate for Payer: UHC Exchange |
$87.77
|
| Rate for Payer: UHC Medicare Advantage |
$43.10
|
| Rate for Payer: UHCCP Medicaid |
$2.34
|
|
|
PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 94680
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$7,422.00 |
| Rate for Payer: Aetna Commercial |
$63.85
|
| Rate for Payer: Aetna Medicare |
$49.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.62
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$47.65
|
| Rate for Payer: BCBS Trust/PPO |
$444.83
|
| Rate for Payer: BCN Commercial |
$76.72
|
| 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: Mclaren Medicaid |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.03
|
| Rate for Payer: Meridian Medicaid |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,422.00
|
| 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 Choice Medicaid |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.28
|
| Rate for Payer: Priority Health Medicare |
$47.65
|
| Rate for Payer: Priority Health Narrow Network |
$73.28
|
| Rate for Payer: Priority Health SBD |
$16.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.65
|
| Rate for Payer: UHC Exchange |
$88.38
|
| Rate for Payer: UHC Medicare Advantage |
$47.65
|
| Rate for Payer: UHCCP Medicaid |
$7.88
|
|
|
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
|
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
|
|
|
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
|
|
|
PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM
|
Professional
|
Both
|
$4,249.00
|
|
|
Service Code
|
HCPCS 59510
|
| Min. Negotiated Rate |
$69.21 |
| Max. Negotiated Rate |
$475,907.00 |
| Rate for Payer: Aetna Commercial |
$3,492.12
|
| Rate for Payer: Aetna Medicare |
$2,710.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,492.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,752.73
|
| Rate for Payer: BCBS Complete |
$2,599.55
|
| Rate for Payer: BCBS MAPPO |
$2,606.06
|
| Rate for Payer: BCBS Trust/PPO |
$69.21
|
| Rate for Payer: BCN Commercial |
$3,201.80
|
| 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 |
$4,821.21
|
| Rate for Payer: Healthscope Commercial |
$4,169.70
|
| Rate for Payer: Mclaren Medicaid |
$2,475.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,736.36
|
| Rate for Payer: Meridian Medicaid |
$2,599.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$475,907.00
|
| 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 Choice Medicaid |
$2,475.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,761.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,780.59
|
| Rate for Payer: Priority Health Medicare |
$2,606.06
|
| Rate for Payer: Priority Health Narrow Network |
$3,780.59
|
| Rate for Payer: Priority Health SBD |
$3,780.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,078.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,606.06
|
| Rate for Payer: UHC Exchange |
$2,078.58
|
| Rate for Payer: UHC Medicare Advantage |
$2,606.06
|
| Rate for Payer: UHCCP Medicaid |
$2,475.76
|
|
|
PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM
|
Professional
|
Both
|
$3,830.00
|
|
|
Service Code
|
HCPCS 59400
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$429,167.00 |
| Rate for Payer: Aetna Commercial |
$3,132.40
|
| Rate for Payer: Aetna Medicare |
$2,431.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,132.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,366.16
|
| Rate for Payer: BCBS Complete |
$2,331.77
|
| Rate for Payer: BCBS MAPPO |
$2,337.61
|
| Rate for Payer: BCBS Trust/PPO |
$42.26
|
| Rate for Payer: BCN Commercial |
$3,201.80
|
| 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 |
$4,324.58
|
| Rate for Payer: Healthscope Commercial |
$3,740.18
|
| Rate for Payer: Mclaren Medicaid |
$2,220.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,454.49
|
| Rate for Payer: Meridian Medicaid |
$2,331.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$429,167.00
|
| 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 Choice Medicaid |
$2,220.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,489.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,400.06
|
| Rate for Payer: Priority Health Medicare |
$2,337.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,400.06
|
| Rate for Payer: Priority Health SBD |
$3,400.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,063.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,337.61
|
| Rate for Payer: UHC Exchange |
$2,063.19
|
| Rate for Payer: UHC Medicare Advantage |
$2,337.61
|
| Rate for Payer: UHCCP Medicaid |
$2,220.73
|
|
|
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 |
$219,982.00 |
| Rate for Payer: Aetna Commercial |
$1,663.43
|
| Rate for Payer: Aetna Medicare |
$1,203.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,663.43
|
| Rate for Payer: BCBS Complete |
$962.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.52
|
| Rate for Payer: BCN Commercial |
$1,787.09
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219,982.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,563.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,233.33
|
| Rate for Payer: UHC Exchange |
$2,233.33
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DFCT W/CARD BYPASS
|
Professional
|
Both
|
$3,091.00
|
|
|
Service Code
|
HCPCS 33814
|
| Min. Negotiated Rate |
$964.68 |
| Max. Negotiated Rate |
$270,200.00 |
| 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 |
$1,012.91
|
| Rate for Payer: BCBS MAPPO |
$1,466.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,770.33
|
| Rate for Payer: BCN Commercial |
$2,192.69
|
| 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 |
$2,111.28
|
| Rate for Payer: Cofinity Commercial |
$1,964.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.17
|
| Rate for Payer: Healthscope Commercial |
$2,712.41
|
| Rate for Payer: Healthscope Commercial |
$2,345.87
|
| Rate for Payer: Mclaren Medicaid |
$964.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,539.48
|
| Rate for Payer: Meridian Medicaid |
$1,012.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270,200.00
|
| 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 Choice Medicaid |
$964.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,009.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,399.59
|
| Rate for Payer: Priority Health Medicare |
$1,466.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,399.59
|
| Rate for Payer: Priority Health SBD |
$2,399.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,918.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,466.17
|
| Rate for Payer: UHC Exchange |
$2,918.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.17
|
| Rate for Payer: UHCCP Medicaid |
$964.68
|
|
|
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 |
$11.50 |
| Max. Negotiated Rate |
$2,685.00 |
| 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 |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$17.15
|
| Rate for Payer: BCBS Trust/PPO |
$308.53
|
| Rate for Payer: BCN Commercial |
$42.50
|
| 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: Mclaren Medicaid |
$11.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.01
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,685.00
|
| 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 Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.38
|
| Rate for Payer: Priority Health Medicare |
$17.15
|
| Rate for Payer: Priority Health Narrow Network |
$23.38
|
| Rate for Payer: Priority Health SBD |
$23.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.15
|
| Rate for Payer: UHC Exchange |
$41.16
|
| Rate for Payer: UHC Medicare Advantage |
$17.15
|
| Rate for Payer: UHCCP Medicaid |
$11.50
|
|
|
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
|
|
|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$210.73
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
6562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.10 |
| Max. Negotiated Rate |
$1,571.58 |
| Rate for Payer: Aetna Commercial |
$179.12
|
| Rate for Payer: Aetna Commercial |
$1,441.87
|
| Rate for Payer: Aetna Medicare |
$190.35
|
| Rate for Payer: Aetna Medicare |
$190.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$228.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$228.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$228.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$228.79
|
| Rate for Payer: BCBS Complete |
$103.01
|
| Rate for Payer: BCBS Complete |
$103.01
|
| Rate for Payer: BCBS MAPPO |
$183.03
|
| Rate for Payer: BCBS MAPPO |
$183.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,542.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,542.51
|
| Rate for Payer: BCN Commercial |
$1,542.51
|
| Rate for Payer: BCN Commercial |
$1,542.51
|
| Rate for Payer: BCN Medicare Advantage |
$183.03
|
| Rate for Payer: BCN Medicare Advantage |
$183.03
|
| Rate for Payer: Cash Price |
$1,357.06
|
| Rate for Payer: Cash Price |
$1,357.06
|
| Rate for Payer: Cash Price |
$168.58
|
| Rate for Payer: Cash Price |
$168.58
|
| Rate for Payer: Cofinity Commercial |
$147.51
|
| Rate for Payer: Cofinity Commercial |
$1,187.42
|
| Rate for Payer: Cofinity Commercial |
$181.23
|
| Rate for Payer: Cofinity Commercial |
$1,458.84
|
| 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 |
$183.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.03
|
| Rate for Payer: Healthscope Commercial |
$189.66
|
| Rate for Payer: Healthscope Commercial |
$1,526.69
|
| Rate for Payer: Mclaren Medicaid |
$98.10
|
| Rate for Payer: Mclaren Medicaid |
$98.10
|
| Rate for Payer: Mclaren Medicare |
$183.03
|
| Rate for Payer: Mclaren Medicare |
$183.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.18
|
| Rate for Payer: Meridian Medicaid |
$103.01
|
| Rate for Payer: Meridian Medicaid |
$103.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,441.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.12
|
| Rate for Payer: Nomi Health Commercial |
$549.09
|
| Rate for Payer: Nomi Health Commercial |
$549.09
|
| Rate for Payer: PACE Medicare |
$173.88
|
| Rate for Payer: PACE Medicare |
$173.88
|
| Rate for Payer: PACE SWMI |
$183.03
|
| Rate for Payer: PACE SWMI |
$183.03
|
| Rate for Payer: PHP Commercial |
$179.12
|
| Rate for Payer: PHP Commercial |
$1,441.87
|
| Rate for Payer: PHP Medicare Advantage |
$183.03
|
| Rate for Payer: PHP Medicare Advantage |
$183.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,102.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,571.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,571.58
|
| Rate for Payer: Priority Health Medicare |
$183.03
|
| Rate for Payer: Priority Health Medicare |
$183.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,257.26
|
| Rate for Payer: Priority Health Narrow Network |
$1,257.26
|
| Rate for Payer: Priority Health SBD |
$132.76
|
| Rate for Payer: Priority Health SBD |
$1,068.68
|
| Rate for Payer: Railroad Medicare Medicare |
$183.03
|
| Rate for Payer: Railroad Medicare Medicare |
$183.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$515.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.03
|
| Rate for Payer: UHC Medicare Advantage |
$183.03
|
| Rate for Payer: UHC Medicare Advantage |
$183.03
|
| Rate for Payer: UHCCP Medicaid |
$103.05
|
| Rate for Payer: UHCCP Medicaid |
$103.05
|
| Rate for Payer: VA VA |
$183.03
|
| Rate for Payer: VA VA |
$183.03
|
|
|
PR OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 58615
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$45,191.00 |
| 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 |
$170.43
|
| Rate for Payer: BCBS MAPPO |
$241.39
|
| Rate for Payer: BCBS Trust/PPO |
$151.62
|
| Rate for Payer: BCN Commercial |
$372.86
|
| 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 |
$347.60
|
| Rate for Payer: Cofinity Commercial |
$323.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.39
|
| Rate for Payer: Healthscope Commercial |
$446.57
|
| Rate for Payer: Healthscope Commercial |
$386.22
|
| Rate for Payer: Mclaren Medicaid |
$162.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.46
|
| Rate for Payer: Meridian Medicaid |
$170.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45,191.00
|
| 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 Choice Medicaid |
$162.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$380.48
|
| Rate for Payer: Priority Health Medicare |
$241.39
|
| Rate for Payer: Priority Health Narrow Network |
$380.48
|
| Rate for Payer: Priority Health SBD |
$380.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$464.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.39
|
| Rate for Payer: UHC Exchange |
$464.88
|
| Rate for Payer: UHC Medicare Advantage |
$241.39
|
| Rate for Payer: UHCCP Medicaid |
$162.31
|
|
|
PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 97165
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$14,622.00 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.84
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$96.42
|
| Rate for Payer: BCBS Trust/PPO |
$648.75
|
| Rate for Payer: BCN Commercial |
$86.71
|
| Rate for Payer: BCN Medicare Advantage |
$96.42
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.42
|
| Rate for Payer: Healthscope Commercial |
$154.27
|
| Rate for Payer: Healthscope Commercial |
$178.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,622.00
|
| Rate for Payer: Nomi Health Commercial |
$115.70
|
| Rate for Payer: PACE SWMI |
$96.42
|
| Rate for Payer: PHP Medicare Advantage |
$96.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.70
|
| Rate for Payer: Priority Health Medicare |
$96.42
|
| Rate for Payer: Priority Health Narrow Network |
$92.70
|
| Rate for Payer: Priority Health SBD |
$92.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.42
|
| Rate for Payer: UHC Medicare Advantage |
$96.42
|
|
|
PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 97166
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$14,622.00 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.84
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS MAPPO |
$96.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.24
|
| Rate for Payer: BCN Commercial |
$86.38
|
| Rate for Payer: BCN Medicare Advantage |
$96.42
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.42
|
| Rate for Payer: Healthscope Commercial |
$154.27
|
| Rate for Payer: Healthscope Commercial |
$178.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,622.00
|
| Rate for Payer: Nomi Health Commercial |
$115.70
|
| Rate for Payer: PACE SWMI |
$96.42
|
| Rate for Payer: PHP Medicare Advantage |
$96.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.70
|
| Rate for Payer: Priority Health Medicare |
$96.42
|
| Rate for Payer: Priority Health Narrow Network |
$92.70
|
| Rate for Payer: Priority Health SBD |
$92.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.42
|
| Rate for Payer: UHC Medicare Advantage |
$96.42
|
|
|
PR OCCUPATIONAL THERAPY EVALUATION
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 97003
|
| 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 OCCUPATIONAL THERAPY RE-EVALUATION
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 97004
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
|
