|
PR ASPIRATION BLADDER TROCAR/INTRACATHETER
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 51101
|
| Min. Negotiated Rate |
$48.83 |
| Max. Negotiated Rate |
$251.55 |
| Rate for Payer: Aetna Commercial |
$65.43
|
| Rate for Payer: Aetna Medicare |
$50.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.43
|
| Rate for Payer: BCBS Complete |
$154.80
|
| Rate for Payer: BCBS MAPPO |
$48.83
|
| Rate for Payer: BCN Medicare Advantage |
$48.83
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cofinity Commercial |
$70.32
|
| Rate for Payer: Cofinity Commercial |
$65.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.27
|
| Rate for Payer: Nomi Health Commercial |
$58.60
|
| Rate for Payer: PACE SWMI |
$48.83
|
| Rate for Payer: PHP Commercial |
$68.36
|
| Rate for Payer: PHP Medicare Advantage |
$48.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.55
|
| Rate for Payer: Priority Health Medicare |
$48.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.83
|
| Rate for Payer: UHC Medicare Advantage |
$48.83
|
| Rate for Payer: UMR Bronson Commercial |
$178.02
|
|
|
PR ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 20612
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Aetna Commercial |
$52.80
|
| Rate for Payer: Aetna Medicare |
$40.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.80
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS MAPPO |
$39.40
|
| Rate for Payer: BCN Medicare Advantage |
$39.40
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$56.74
|
| Rate for Payer: Cofinity Commercial |
$52.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.37
|
| Rate for Payer: Nomi Health Commercial |
$47.28
|
| Rate for Payer: PACE SWMI |
$39.40
|
| Rate for Payer: PHP Commercial |
$55.16
|
| Rate for Payer: PHP Medicare Advantage |
$39.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health Medicare |
$39.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.40
|
| Rate for Payer: UHC Medicare Advantage |
$39.40
|
| Rate for Payer: UMR Bronson Commercial |
$62.10
|
|
|
PR ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 96105
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna Commercial |
$121.94
|
| Rate for Payer: Aetna Medicare |
$94.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.94
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$91.00
|
| Rate for Payer: BCN Medicare Advantage |
$91.00
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$121.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.55
|
| Rate for Payer: Nomi Health Commercial |
$109.20
|
| Rate for Payer: PACE SWMI |
$91.00
|
| Rate for Payer: PHP Commercial |
$127.40
|
| Rate for Payer: PHP Medicare Advantage |
$91.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health Medicare |
$91.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.00
|
| Rate for Payer: UHC Medicare Advantage |
$91.00
|
| Rate for Payer: UMR Bronson Commercial |
$93.38
|
|
|
PR ASSESSMENT FOR HEARING AID
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS V5010
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: UMR Bronson Commercial |
$65.78
|
|
|
PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 99483
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$263.20 |
| Rate for Payer: Aetna Commercial |
$244.93
|
| Rate for Payer: Aetna Medicare |
$190.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.20
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$182.78
|
| Rate for Payer: BCN Medicare Advantage |
$182.78
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$244.93
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.92
|
| Rate for Payer: Nomi Health Commercial |
$219.34
|
| Rate for Payer: PACE SWMI |
$182.78
|
| Rate for Payer: PHP Commercial |
$255.89
|
| Rate for Payer: PHP Medicare Advantage |
$182.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Medicare |
$182.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.78
|
| Rate for Payer: UHC Medicare Advantage |
$182.78
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$133.92
|
|
|
Service Code
|
NDC 00378518693
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.92 |
| Max. Negotiated Rate |
$120.53 |
| Rate for Payer: Aetna American Axle |
$87.05
|
| Rate for Payer: Aetna Commercial |
$113.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| Rate for Payer: Cash Price |
$107.14
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.14
|
| Rate for Payer: Healthscope Commercial |
$120.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.83
|
| Rate for Payer: PHP Commercial |
$113.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.05
|
| Rate for Payer: Priority Health SBD |
$84.37
|
| Rate for Payer: UMR Bronson Commercial |
$58.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.44
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
OP
|
$52.83
|
|
|
Service Code
|
NDC 00002512301
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$47.55 |
| Rate for Payer: Aetna American Axle |
$34.34
|
| Rate for Payer: Aetna Commercial |
$44.91
|
| Rate for Payer: Aetna Medicare |
$26.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.34
|
| Rate for Payer: BCBS Complete |
$21.13
|
| Rate for Payer: Cash Price |
$42.26
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Commercial |
$45.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$47.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.91
|
| Rate for Payer: PHP Commercial |
$44.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.34
|
| Rate for Payer: Priority Health SBD |
$33.28
|
| Rate for Payer: UMR Bronson Commercial |
$19.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.62
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
OP
|
$133.92
|
|
|
Service Code
|
NDC 00378518693
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.55 |
| Max. Negotiated Rate |
$120.53 |
| Rate for Payer: Aetna American Axle |
$87.05
|
| Rate for Payer: Aetna Commercial |
$113.83
|
| Rate for Payer: Aetna Medicare |
$66.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
| Rate for Payer: BCBS Complete |
$53.57
|
| Rate for Payer: Cash Price |
$107.14
|
| Rate for Payer: Cofinity Commercial |
$115.17
|
| Rate for Payer: Cofinity Commercial |
$93.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.14
|
| Rate for Payer: Healthscope Commercial |
$120.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.83
|
| Rate for Payer: PHP Commercial |
$113.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.05
|
| Rate for Payer: Priority Health SBD |
$84.37
|
| Rate for Payer: UMR Bronson Commercial |
$49.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.44
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
OP
|
$86.26
|
|
|
Service Code
|
NDC 67877060530
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.92 |
| Max. Negotiated Rate |
$77.63 |
| Rate for Payer: Aetna American Axle |
$56.07
|
| Rate for Payer: Aetna Commercial |
$73.32
|
| Rate for Payer: Aetna Medicare |
$43.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.07
|
| Rate for Payer: BCBS Complete |
$34.50
|
| Rate for Payer: Cash Price |
$69.01
|
| Rate for Payer: Cofinity Commercial |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$74.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.01
|
| Rate for Payer: Healthscope Commercial |
$77.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.32
|
| Rate for Payer: PHP Commercial |
$73.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.07
|
| Rate for Payer: Priority Health SBD |
$54.34
|
| Rate for Payer: UMR Bronson Commercial |
$31.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.69
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$52.83
|
|
|
Service Code
|
NDC 00002512301
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$47.55 |
| Rate for Payer: Aetna American Axle |
$34.34
|
| Rate for Payer: Aetna Commercial |
$44.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.34
|
| Rate for Payer: Cash Price |
$42.26
|
| Rate for Payer: Cofinity Commercial |
$36.98
|
| Rate for Payer: Cofinity Commercial |
$45.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.26
|
| Rate for Payer: Healthscope Commercial |
$47.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.91
|
| Rate for Payer: PHP Commercial |
$44.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.34
|
| Rate for Payer: Priority Health SBD |
$33.28
|
| Rate for Payer: UMR Bronson Commercial |
$23.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.62
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$86.26
|
|
|
Service Code
|
NDC 67877060530
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.95 |
| Max. Negotiated Rate |
$77.63 |
| Rate for Payer: Aetna American Axle |
$56.07
|
| Rate for Payer: Aetna Commercial |
$73.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.07
|
| Rate for Payer: Cash Price |
$69.01
|
| Rate for Payer: Cofinity Commercial |
$60.38
|
| Rate for Payer: Cofinity Commercial |
$74.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.01
|
| Rate for Payer: Healthscope Commercial |
$77.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.32
|
| Rate for Payer: PHP Commercial |
$73.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.07
|
| Rate for Payer: Priority Health SBD |
$54.34
|
| Rate for Payer: UMR Bronson Commercial |
$37.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.69
|
|
|
PR ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 33257
|
| Min. Negotiated Rate |
$558.60 |
| Max. Negotiated Rate |
$991.25 |
| Rate for Payer: Aetna Commercial |
$748.52
|
| Rate for Payer: Aetna Medicare |
$580.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.52
|
| Rate for Payer: BCBS Complete |
$610.00
|
| Rate for Payer: BCBS MAPPO |
$558.60
|
| Rate for Payer: BCN Medicare Advantage |
$558.60
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Cofinity Commercial |
$804.38
|
| Rate for Payer: Cofinity Commercial |
$748.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$586.53
|
| Rate for Payer: Nomi Health Commercial |
$670.32
|
| Rate for Payer: PACE SWMI |
$558.60
|
| Rate for Payer: PHP Commercial |
$782.04
|
| Rate for Payer: PHP Medicare Advantage |
$558.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.25
|
| Rate for Payer: Priority Health Medicare |
$558.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.60
|
| Rate for Payer: UHC Medicare Advantage |
$558.60
|
| Rate for Payer: UMR Bronson Commercial |
$701.50
|
|
|
PR ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
HCPCS 33259
|
| Min. Negotiated Rate |
$811.34 |
| Max. Negotiated Rate |
$1,496.95 |
| Rate for Payer: Aetna Commercial |
$1,087.20
|
| Rate for Payer: Aetna Medicare |
$843.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,168.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,087.20
|
| Rate for Payer: BCBS Complete |
$921.20
|
| Rate for Payer: BCBS MAPPO |
$811.34
|
| Rate for Payer: BCN Medicare Advantage |
$811.34
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cofinity Commercial |
$1,168.33
|
| Rate for Payer: Cofinity Commercial |
$1,087.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$851.91
|
| Rate for Payer: Nomi Health Commercial |
$973.61
|
| Rate for Payer: PACE SWMI |
$811.34
|
| Rate for Payer: PHP Commercial |
$1,135.88
|
| Rate for Payer: PHP Medicare Advantage |
$811.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,496.95
|
| Rate for Payer: Priority Health Medicare |
$811.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.34
|
| Rate for Payer: UHC Medicare Advantage |
$811.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,059.38
|
|
|
PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 99464
|
| Min. Negotiated Rate |
$68.23 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: Aetna Commercial |
$91.43
|
| Rate for Payer: Aetna Medicare |
$70.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.43
|
| Rate for Payer: BCBS Complete |
$164.00
|
| Rate for Payer: BCBS MAPPO |
$68.23
|
| Rate for Payer: BCN Medicare Advantage |
$68.23
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$98.25
|
| Rate for Payer: Cofinity Commercial |
$91.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.64
|
| Rate for Payer: Nomi Health Commercial |
$81.88
|
| Rate for Payer: PACE SWMI |
$68.23
|
| Rate for Payer: PHP Commercial |
$95.52
|
| Rate for Payer: PHP Medicare Advantage |
$68.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health Medicare |
$68.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.23
|
| Rate for Payer: UHC Medicare Advantage |
$68.23
|
| Rate for Payer: UMR Bronson Commercial |
$188.60
|
|
|
PR AUDIOMETRY FOR HEARING AID
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS S0618
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
PR AUDITORY EVOKED POTENTIAL
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 92585
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$221.65 |
| Rate for Payer: Aetna Medicare |
$170.50
|
| Rate for Payer: BCBS Complete |
$136.40
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.65
|
| Rate for Payer: UMR Bronson Commercial |
$156.86
|
|
|
PR AUDITORY EVOKED POTENTIAL, LIMITED
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 92586
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$178.44 |
| Max. Negotiated Rate |
$786.50 |
| Rate for Payer: Aetna Commercial |
$239.11
|
| Rate for Payer: Aetna Medicare |
$185.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.11
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$178.44
|
| Rate for Payer: BCN Medicare Advantage |
$178.44
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$256.95
|
| Rate for Payer: Cofinity Commercial |
$239.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.36
|
| Rate for Payer: Nomi Health Commercial |
$214.13
|
| Rate for Payer: PACE SWMI |
$178.44
|
| Rate for Payer: PHP Commercial |
$249.82
|
| Rate for Payer: PHP Medicare Advantage |
$178.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: Priority Health Medicare |
$178.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.44
|
| Rate for Payer: UHC Medicare Advantage |
$178.44
|
| Rate for Payer: UMR Bronson Commercial |
$556.60
|
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$483.60 |
| Rate for Payer: Aetna Medicare |
$372.00
|
| Rate for Payer: BCBS Complete |
$297.60
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.60
|
| Rate for Payer: UMR Bronson Commercial |
$342.24
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$162.74 |
| Max. Negotiated Rate |
$631.15 |
| Rate for Payer: Aetna Commercial |
$218.07
|
| Rate for Payer: Aetna Medicare |
$169.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.35
|
| Rate for Payer: BCBS Complete |
$388.40
|
| Rate for Payer: BCBS MAPPO |
$162.74
|
| Rate for Payer: BCN Medicare Advantage |
$162.74
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cofinity Commercial |
$218.07
|
| Rate for Payer: Cofinity Commercial |
$234.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.88
|
| Rate for Payer: Nomi Health Commercial |
$195.29
|
| Rate for Payer: PACE SWMI |
$162.74
|
| Rate for Payer: PHP Commercial |
$227.84
|
| Rate for Payer: PHP Medicare Advantage |
$162.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.15
|
| Rate for Payer: Priority Health Medicare |
$162.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.74
|
| Rate for Payer: UHC Medicare Advantage |
$162.74
|
| Rate for Payer: UMR Bronson Commercial |
$446.66
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,381.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$1,352.40 |
| Max. Negotiated Rate |
$2,285.25 |
| Rate for Payer: Aetna Commercial |
$2,126.55
|
| Rate for Payer: Aetna Medicare |
$1,650.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,285.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,126.55
|
| Rate for Payer: BCBS Complete |
$1,352.40
|
| Rate for Payer: BCBS MAPPO |
$1,586.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,586.98
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cofinity Commercial |
$2,285.25
|
| Rate for Payer: Cofinity Commercial |
$2,126.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,586.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.33
|
| Rate for Payer: Nomi Health Commercial |
$1,904.38
|
| Rate for Payer: PACE SWMI |
$1,586.98
|
| Rate for Payer: PHP Commercial |
$2,221.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,586.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,197.65
|
| Rate for Payer: Priority Health Medicare |
$1,586.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,586.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,586.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,555.26
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.51 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna Medicare |
$161.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$119.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$142.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 00093077198
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 00093077198
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
