|
PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 92651
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$3,831.23 |
| Rate for Payer: Aetna Commercial |
$97.90
|
| Rate for Payer: Aetna Medicare |
$75.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.90
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$73.06
|
| Rate for Payer: BCBS Trust/PPO |
$3,831.23
|
| Rate for Payer: BCN Commercial |
$123.64
|
| Rate for Payer: BCN Medicare Advantage |
$73.06
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$105.21
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.71
|
| Rate for Payer: Nomi Health Commercial |
$87.67
|
| Rate for Payer: PACE SWMI |
$73.06
|
| Rate for Payer: PHP Commercial |
$102.28
|
| Rate for Payer: PHP Medicare Advantage |
$73.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.17
|
| Rate for Payer: Priority Health Medicare |
$73.06
|
| Rate for Payer: Priority Health Narrow Network |
$112.17
|
| Rate for Payer: Priority Health SBD |
$112.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.06
|
| Rate for Payer: UHC Medicare Advantage |
$73.06
|
| Rate for Payer: UMR Bronson Commercial |
$74.06
|
|
|
PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 92653
|
| Min. Negotiated Rate |
$67.60 |
| Max. Negotiated Rate |
$1,917.20 |
| Rate for Payer: Aetna Commercial |
$100.57
|
| Rate for Payer: Aetna Medicare |
$78.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.07
|
| Rate for Payer: BCBS Complete |
$67.60
|
| Rate for Payer: BCBS MAPPO |
$75.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,917.20
|
| Rate for Payer: BCN Commercial |
$123.15
|
| Rate for Payer: BCN Medicare Advantage |
$75.05
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cofinity Commercial |
$108.07
|
| Rate for Payer: Cofinity Commercial |
$100.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.80
|
| Rate for Payer: Nomi Health Commercial |
$90.06
|
| Rate for Payer: PACE SWMI |
$75.05
|
| Rate for Payer: PHP Commercial |
$105.07
|
| Rate for Payer: PHP Medicare Advantage |
$75.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.63
|
| Rate for Payer: Priority Health Medicare |
$75.05
|
| Rate for Payer: Priority Health Narrow Network |
$112.63
|
| Rate for Payer: Priority Health SBD |
$112.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.05
|
| Rate for Payer: UHC Medicare Advantage |
$75.05
|
| Rate for Payer: UMR Bronson Commercial |
$77.74
|
|
|
PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 92650
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$1,517.28 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.47
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.28
|
| Rate for Payer: BCN Commercial |
$40.56
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.63
|
| Rate for Payer: Priority Health Narrow Network |
$36.63
|
| Rate for Payer: Priority Health SBD |
$36.63
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
|
|
PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 92652
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$4,564.51 |
| Rate for Payer: Aetna Commercial |
$134.91
|
| Rate for Payer: Aetna Medicare |
$104.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.91
|
| Rate for Payer: BCBS Complete |
$93.20
|
| Rate for Payer: BCBS MAPPO |
$100.68
|
| Rate for Payer: BCBS Trust/PPO |
$4,564.51
|
| Rate for Payer: BCN Commercial |
$165.18
|
| Rate for Payer: BCN Medicare Advantage |
$100.68
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$134.91
|
| Rate for Payer: Cofinity Commercial |
$144.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.71
|
| Rate for Payer: Nomi Health Commercial |
$120.82
|
| Rate for Payer: PACE SWMI |
$100.68
|
| Rate for Payer: PHP Commercial |
$140.95
|
| Rate for Payer: PHP Medicare Advantage |
$100.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.98
|
| Rate for Payer: Priority Health Medicare |
$100.68
|
| Rate for Payer: Priority Health Narrow Network |
$151.98
|
| Rate for Payer: Priority Health SBD |
$151.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.68
|
| Rate for Payer: UHC Medicare Advantage |
$100.68
|
| Rate for Payer: UMR Bronson Commercial |
$107.18
|
|
|
PR AFO ANKLE GAUNTLET PRE OTS
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS L1902
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$70.88 |
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCN Commercial |
$70.88
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: UMR Bronson Commercial |
$33.58
|
|
|
PR AFO MULTILIG ANK SUP PRE OTS
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS L1906
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCN Commercial |
$106.78
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: UMR Bronson Commercial |
$50.60
|
|
|
PR AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 90694
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.36
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS Trust/PPO |
$77.36
|
| Rate for Payer: BCN Commercial |
$71.68
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: UMR Bronson Commercial |
$83.72
|
|
|
PR AK SLEEVE SUSP NEOPRENE/EQUA
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS L5695
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$171.39 |
| Rate for Payer: BCBS Complete |
$63.60
|
| Rate for Payer: BCN Commercial |
$171.39
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.35
|
| Rate for Payer: UMR Bronson Commercial |
$73.14
|
|
|
PRALATREXATE 20 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20,803.16
|
|
|
Service Code
|
HCPCS J9307
|
| Hospital Charge Code |
99982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.34 |
| Max. Negotiated Rate |
$18,722.84 |
| Rate for Payer: Aetna American Axle |
$13,522.05
|
| Rate for Payer: Aetna Commercial |
$17,682.69
|
| Rate for Payer: Aetna Medicare |
$388.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,522.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$467.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$467.21
|
| Rate for Payer: BCBS Complete |
$210.36
|
| Rate for Payer: BCBS MAPPO |
$373.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.80
|
| Rate for Payer: BCN Commercial |
$1,007.80
|
| Rate for Payer: BCN Medicare Advantage |
$373.77
|
| Rate for Payer: Cash Price |
$16,642.53
|
| Rate for Payer: Cash Price |
$16,642.53
|
| Rate for Payer: Cofinity Commercial |
$17,890.72
|
| Rate for Payer: Cofinity Commercial |
$14,562.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,562.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,642.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.77
|
| Rate for Payer: Healthscope Commercial |
$18,722.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,562.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,602.37
|
| Rate for Payer: Mclaren Medicaid |
$200.34
|
| Rate for Payer: Mclaren Medicare |
$373.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.46
|
| Rate for Payer: Meridian Medicaid |
$210.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,682.69
|
| Rate for Payer: Nomi Health Commercial |
$1,121.31
|
| Rate for Payer: PACE Medicare |
$355.08
|
| Rate for Payer: PACE SWMI |
$373.77
|
| Rate for Payer: PHP Commercial |
$17,682.69
|
| Rate for Payer: PHP Medicare Advantage |
$373.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,522.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,075.72
|
| Rate for Payer: Priority Health Medicare |
$373.77
|
| Rate for Payer: Priority Health Narrow Network |
$860.58
|
| Rate for Payer: Priority Health SBD |
$13,105.99
|
| Rate for Payer: Railroad Medicare Medicare |
$373.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,052.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.77
|
| Rate for Payer: UHC Exchange |
$714.31
|
| Rate for Payer: UHC Medicare Advantage |
$373.77
|
| Rate for Payer: UHCCP Medicaid |
$200.34
|
| Rate for Payer: UMR Bronson Commercial |
$7,697.17
|
| Rate for Payer: VA VA |
$373.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,602.37
|
|
|
PRALATREXATE 40 MG/2 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$41,606.37
|
|
|
Service Code
|
HCPCS J9307
|
| Hospital Charge Code |
119254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$200.34 |
| Max. Negotiated Rate |
$37,445.73 |
| Rate for Payer: Aetna American Axle |
$27,044.14
|
| Rate for Payer: Aetna American Axle |
$42,822.75
|
| Rate for Payer: Aetna Commercial |
$55,998.98
|
| Rate for Payer: Aetna Commercial |
$35,365.41
|
| Rate for Payer: Aetna Medicare |
$388.72
|
| Rate for Payer: Aetna Medicare |
$388.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,044.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42,822.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$467.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$467.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$467.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$467.21
|
| Rate for Payer: BCBS Complete |
$210.36
|
| Rate for Payer: BCBS Complete |
$210.36
|
| Rate for Payer: BCBS MAPPO |
$373.77
|
| Rate for Payer: BCBS MAPPO |
$373.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.80
|
| Rate for Payer: BCN Commercial |
$1,007.80
|
| Rate for Payer: BCN Commercial |
$1,007.80
|
| Rate for Payer: BCN Medicare Advantage |
$373.77
|
| Rate for Payer: BCN Medicare Advantage |
$373.77
|
| Rate for Payer: Cash Price |
$52,704.92
|
| Rate for Payer: Cash Price |
$33,285.10
|
| Rate for Payer: Cash Price |
$52,704.92
|
| Rate for Payer: Cash Price |
$33,285.10
|
| Rate for Payer: Cofinity Commercial |
$46,116.80
|
| Rate for Payer: Cofinity Commercial |
$29,124.46
|
| Rate for Payer: Cofinity Commercial |
$35,781.48
|
| Rate for Payer: Cofinity Commercial |
$56,657.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29,124.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$46,116.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,285.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52,704.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.77
|
| Rate for Payer: Healthscope Commercial |
$37,445.73
|
| Rate for Payer: Healthscope Commercial |
$59,293.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46,116.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,124.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,204.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49,410.86
|
| Rate for Payer: Mclaren Medicaid |
$200.34
|
| Rate for Payer: Mclaren Medicaid |
$200.34
|
| Rate for Payer: Mclaren Medicare |
$373.77
|
| Rate for Payer: Mclaren Medicare |
$373.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$392.46
|
| Rate for Payer: Meridian Medicaid |
$210.36
|
| Rate for Payer: Meridian Medicaid |
$210.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$429.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,365.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55,998.98
|
| Rate for Payer: Nomi Health Commercial |
$1,121.31
|
| Rate for Payer: Nomi Health Commercial |
$1,121.31
|
| Rate for Payer: PACE Medicare |
$355.08
|
| Rate for Payer: PACE Medicare |
$355.08
|
| Rate for Payer: PACE SWMI |
$373.77
|
| Rate for Payer: PACE SWMI |
$373.77
|
| Rate for Payer: PHP Commercial |
$35,365.41
|
| Rate for Payer: PHP Commercial |
$55,998.98
|
| Rate for Payer: PHP Medicare Advantage |
$373.77
|
| Rate for Payer: PHP Medicare Advantage |
$373.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,044.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42,822.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,075.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,075.72
|
| Rate for Payer: Priority Health Medicare |
$373.77
|
| Rate for Payer: Priority Health Medicare |
$373.77
|
| Rate for Payer: Priority Health Narrow Network |
$860.58
|
| Rate for Payer: Priority Health Narrow Network |
$860.58
|
| Rate for Payer: Priority Health SBD |
$26,212.01
|
| Rate for Payer: Priority Health SBD |
$41,505.12
|
| Rate for Payer: Railroad Medicare Medicare |
$373.77
|
| Rate for Payer: Railroad Medicare Medicare |
$373.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,052.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,052.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.77
|
| Rate for Payer: UHC Exchange |
$714.31
|
| Rate for Payer: UHC Exchange |
$714.31
|
| Rate for Payer: UHC Medicare Advantage |
$373.77
|
| Rate for Payer: UHC Medicare Advantage |
$373.77
|
| Rate for Payer: UHCCP Medicaid |
$200.34
|
| Rate for Payer: UHCCP Medicaid |
$200.34
|
| Rate for Payer: UMR Bronson Commercial |
$15,394.36
|
| Rate for Payer: UMR Bronson Commercial |
$24,376.03
|
| Rate for Payer: VA VA |
$373.77
|
| Rate for Payer: VA VA |
$373.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,204.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49,410.86
|
|
|
PR ALBUTEROL IPRATROP NON-COMP
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7620
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.27
|
| Rate for Payer: Aetna Medicare |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.29
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.20
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.20
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.27
|
| Rate for Payer: Cofinity Commercial |
$0.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.21
|
| Rate for Payer: Nomi Health Commercial |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.20
|
| Rate for Payer: UHC Medicare Advantage |
$0.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR ALBUTEROL NON-COMP CON
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7611
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.22
|
| Rate for Payer: Aetna Medicare |
$0.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.22
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.16
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Medicare Advantage |
$0.16
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.22
|
| Rate for Payer: Cofinity Commercial |
$0.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.17
|
| Rate for Payer: Nomi Health Commercial |
$0.19
|
| Rate for Payer: PACE SWMI |
$0.16
|
| Rate for Payer: PHP Commercial |
$0.23
|
| Rate for Payer: PHP Medicare Advantage |
$0.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.16
|
| Rate for Payer: UHC Medicare Advantage |
$0.16
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR ALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7613
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.10
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.11
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.08
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.11
|
| Rate for Payer: Cofinity Commercial |
$0.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.08
|
| Rate for Payer: Nomi Health Commercial |
$0.09
|
| Rate for Payer: PACE SWMI |
$0.08
|
| Rate for Payer: PHP Commercial |
$0.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.08
|
| Rate for Payer: UHC Medicare Advantage |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR ALCOHOL AND/OR DRUG SERVICES
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS H0015
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Commercial |
$134.33
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.33
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 99408
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$1,099.92 |
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.63
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.92
|
| Rate for Payer: BCN Commercial |
$50.33
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.18
|
| Rate for Payer: Priority Health Narrow Network |
$42.18
|
| Rate for Payer: Priority Health SBD |
$42.18
|
| Rate for Payer: UHCCP Medicaid |
$20.24
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 99409
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$1,109.43 |
| Rate for Payer: Aetna Commercial |
$67.61
|
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.61
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.43
|
| Rate for Payer: BCN Commercial |
$96.27
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Meridian Medicaid |
$42.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.36
|
| Rate for Payer: Priority Health Narrow Network |
$84.36
|
| Rate for Payer: Priority Health SBD |
$84.36
|
| Rate for Payer: UHCCP Medicaid |
$40.04
|
| Rate for Payer: UMR Bronson Commercial |
$47.84
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR IM INJECTION
|
Facility
|
IP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
151068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UMR Bronson Commercial |
$125.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR IM INJECTION
|
Facility
|
OP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
151068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.91 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna Medicare |
$143.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: BCBS Complete |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$226.72
|
| Rate for Payer: BCN Commercial |
$226.72
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UMR Bronson Commercial |
$105.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
6462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.91 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna Medicare |
$143.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: BCBS Complete |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$226.72
|
| Rate for Payer: BCN Commercial |
$226.72
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UMR Bronson Commercial |
$105.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
6462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UMR Bronson Commercial |
$125.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 20930
|
| Min. Negotiated Rate |
$135.79 |
| Max. Negotiated Rate |
$11,952.59 |
| Rate for Payer: Aetna Commercial |
$155.86
|
| Rate for Payer: Aetna Medicare |
$244.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.86
|
| Rate for Payer: BCBS Complete |
$195.60
|
| Rate for Payer: BCBS Trust/PPO |
$11,952.59
|
| Rate for Payer: BCN Commercial |
$135.79
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.11
|
| Rate for Payer: Priority Health Narrow Network |
$178.11
|
| Rate for Payer: Priority Health SBD |
$178.11
|
| Rate for Payer: UMR Bronson Commercial |
$224.94
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 20931
|
| Min. Negotiated Rate |
$70.93 |
| Max. Negotiated Rate |
$29,358.48 |
| Rate for Payer: Aetna Commercial |
$145.28
|
| Rate for Payer: Aetna Medicare |
$112.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.12
|
| Rate for Payer: BCBS Complete |
$74.48
|
| Rate for Payer: BCBS MAPPO |
$108.42
|
| Rate for Payer: BCBS Trust/PPO |
$29,358.48
|
| Rate for Payer: BCN Commercial |
$177.03
|
| Rate for Payer: BCN Medicare Advantage |
$108.42
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$156.12
|
| Rate for Payer: Cofinity Commercial |
$145.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.84
|
| Rate for Payer: Meridian Medicaid |
$74.48
|
| Rate for Payer: Nomi Health Commercial |
$130.10
|
| Rate for Payer: PACE SWMI |
$108.42
|
| Rate for Payer: PHP Commercial |
$151.79
|
| Rate for Payer: PHP Medicare Advantage |
$108.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.93
|
| Rate for Payer: Priority Health Medicare |
$108.42
|
| Rate for Payer: Priority Health Narrow Network |
$167.93
|
| Rate for Payer: Priority Health SBD |
$167.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.42
|
| Rate for Payer: UHC Medicare Advantage |
$108.42
|
| Rate for Payer: UHCCP Medicaid |
$70.93
|
| Rate for Payer: UMR Bronson Commercial |
$205.16
|
|
|
PR ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS J2997
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$135.58 |
| Rate for Payer: Aetna Commercial |
$126.16
|
| Rate for Payer: Aetna Medicare |
$97.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.58
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$94.15
|
| Rate for Payer: BCBS Trust/PPO |
$88.53
|
| Rate for Payer: BCN Commercial |
$87.12
|
| Rate for Payer: BCN Medicare Advantage |
$94.15
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$126.16
|
| Rate for Payer: Cofinity Commercial |
$135.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.86
|
| Rate for Payer: Nomi Health Commercial |
$112.98
|
| Rate for Payer: PACE SWMI |
$94.15
|
| Rate for Payer: PHP Commercial |
$131.81
|
| Rate for Payer: PHP Medicare Advantage |
$94.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$94.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.15
|
| Rate for Payer: UHC Medicare Advantage |
$94.15
|
| Rate for Payer: UMR Bronson Commercial |
$41.86
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 93784
|
| Min. Negotiated Rate |
$37.78 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Medicare |
$43.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.29
|
| Rate for Payer: BCBS Complete |
$102.80
|
| Rate for Payer: BCBS MAPPO |
$42.01
|
| Rate for Payer: BCBS Trust/PPO |
$37.78
|
| Rate for Payer: BCN Commercial |
$66.46
|
| Rate for Payer: BCN Medicare Advantage |
$42.01
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cofinity Commercial |
$60.49
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.11
|
| Rate for Payer: Nomi Health Commercial |
$50.41
|
| Rate for Payer: PACE SWMI |
$42.01
|
| Rate for Payer: PHP Commercial |
$58.81
|
| Rate for Payer: PHP Medicare Advantage |
$42.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.98
|
| Rate for Payer: Priority Health Medicare |
$42.01
|
| Rate for Payer: Priority Health Narrow Network |
$64.98
|
| Rate for Payer: Priority Health SBD |
$64.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.01
|
| Rate for Payer: UHC Medicare Advantage |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$118.22
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 93790
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.19
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$31.84
|
| Rate for Payer: BCN Commercial |
$25.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$24.19
|
| Rate for Payer: Cofinity Commercial |
$22.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Nomi Health Commercial |
$20.16
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.95
|
| Rate for Payer: Priority Health Medicare |
$16.80
|
| Rate for Payer: Priority Health Narrow Network |
$24.95
|
| Rate for Payer: Priority Health SBD |
$24.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
