|
PR ARYTENOIDECTOMY/ARYTENOIDOPEXY XTRNL APPROACH
|
Professional
|
Both
|
$2,087.00
|
|
|
Service Code
|
HCPCS 31400
|
| Min. Negotiated Rate |
$652.21 |
| Max. Negotiated Rate |
$1,845.88 |
| Rate for Payer: Aetna Commercial |
$1,272.91
|
| Rate for Payer: Aetna Medicare |
$987.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,272.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,367.90
|
| Rate for Payer: BCBS Complete |
$684.82
|
| Rate for Payer: BCBS MAPPO |
$949.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.88
|
| Rate for Payer: BCN Commercial |
$1,491.93
|
| Rate for Payer: BCN Medicare Advantage |
$949.93
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cofinity Commercial |
$1,272.91
|
| Rate for Payer: Cofinity Commercial |
$1,367.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$949.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$997.43
|
| Rate for Payer: Meridian Medicaid |
$684.82
|
| Rate for Payer: Nomi Health Commercial |
$1,139.92
|
| Rate for Payer: PACE SWMI |
$949.93
|
| Rate for Payer: PHP Commercial |
$1,329.90
|
| Rate for Payer: PHP Medicare Advantage |
$949.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$652.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,356.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,413.11
|
| Rate for Payer: Priority Health Medicare |
$949.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,413.11
|
| Rate for Payer: Priority Health SBD |
$1,413.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$949.93
|
| Rate for Payer: UHC Medicare Advantage |
$949.93
|
| Rate for Payer: UHCCP Medicaid |
$652.21
|
| Rate for Payer: UMR Bronson Commercial |
$960.02
|
|
|
PR AS-AORT GRF W/CARD BYP & AORTIC ROOT RPLCMT
|
Professional
|
Both
|
$6,622.00
|
|
|
Service Code
|
HCPCS 33863
|
| Min. Negotiated Rate |
$745.43 |
| Max. Negotiated Rate |
$4,902.36 |
| Rate for Payer: Aetna Commercial |
$4,036.09
|
| Rate for Payer: Aetna Medicare |
$3,132.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,036.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,337.29
|
| Rate for Payer: BCBS Complete |
$2,068.09
|
| Rate for Payer: BCBS MAPPO |
$3,012.01
|
| Rate for Payer: BCBS Trust/PPO |
$745.43
|
| Rate for Payer: BCN Commercial |
$4,494.37
|
| Rate for Payer: BCN Medicare Advantage |
$3,012.01
|
| Rate for Payer: Cash Price |
$5,297.60
|
| Rate for Payer: Cash Price |
$5,297.60
|
| Rate for Payer: Cofinity Commercial |
$4,036.09
|
| Rate for Payer: Cofinity Commercial |
$4,337.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,012.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,162.61
|
| Rate for Payer: Meridian Medicaid |
$2,068.09
|
| Rate for Payer: Nomi Health Commercial |
$3,614.41
|
| Rate for Payer: PACE SWMI |
$3,012.01
|
| Rate for Payer: PHP Commercial |
$4,216.81
|
| Rate for Payer: PHP Medicare Advantage |
$3,012.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,969.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,304.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,902.36
|
| Rate for Payer: Priority Health Medicare |
$3,012.01
|
| Rate for Payer: Priority Health Narrow Network |
$4,902.36
|
| Rate for Payer: Priority Health SBD |
$4,902.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,012.01
|
| Rate for Payer: UHC Medicare Advantage |
$3,012.01
|
| Rate for Payer: UHCCP Medicaid |
$1,969.61
|
| Rate for Payer: UMR Bronson Commercial |
$3,046.12
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DISSECTION
|
Professional
|
Both
|
$7,125.00
|
|
|
Service Code
|
HCPCS 33858
|
| Min. Negotiated Rate |
$313.81 |
| Max. Negotiated Rate |
$5,288.99 |
| Rate for Payer: Aetna Commercial |
$4,356.31
|
| Rate for Payer: Aetna Medicare |
$3,381.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,356.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,681.41
|
| Rate for Payer: BCBS Complete |
$2,231.81
|
| Rate for Payer: BCBS MAPPO |
$3,250.98
|
| Rate for Payer: BCBS Trust/PPO |
$313.81
|
| Rate for Payer: BCN Commercial |
$4,851.59
|
| Rate for Payer: BCN Medicare Advantage |
$3,250.98
|
| Rate for Payer: Cash Price |
$5,700.00
|
| Rate for Payer: Cash Price |
$5,700.00
|
| Rate for Payer: Cofinity Commercial |
$4,356.31
|
| Rate for Payer: Cofinity Commercial |
$4,681.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,250.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,413.53
|
| Rate for Payer: Meridian Medicaid |
$2,231.81
|
| Rate for Payer: Nomi Health Commercial |
$3,901.18
|
| Rate for Payer: PACE SWMI |
$3,250.98
|
| Rate for Payer: PHP Commercial |
$4,551.37
|
| Rate for Payer: PHP Medicare Advantage |
$3,250.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,125.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,631.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,288.99
|
| Rate for Payer: Priority Health Medicare |
$3,250.98
|
| Rate for Payer: Priority Health Narrow Network |
$5,288.99
|
| Rate for Payer: Priority Health SBD |
$5,288.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,250.98
|
| Rate for Payer: UHC Medicare Advantage |
$3,250.98
|
| Rate for Payer: UHCCP Medicaid |
$2,125.53
|
| Rate for Payer: UMR Bronson Commercial |
$3,277.50
|
|
|
PR AS-AORT GRF W/CARD BYP F/AORTIC DS OTH/THN DSJ
|
Professional
|
Both
|
$5,111.00
|
|
|
Service Code
|
HCPCS 33859
|
| Min. Negotiated Rate |
$1,128.45 |
| Max. Negotiated Rate |
$3,802.01 |
| Rate for Payer: Aetna Commercial |
$3,128.78
|
| Rate for Payer: Aetna Medicare |
$2,428.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,128.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,362.27
|
| Rate for Payer: BCBS Complete |
$1,604.69
|
| Rate for Payer: BCBS MAPPO |
$2,334.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.45
|
| Rate for Payer: BCN Commercial |
$3,484.76
|
| Rate for Payer: BCN Medicare Advantage |
$2,334.91
|
| Rate for Payer: Cash Price |
$4,088.80
|
| Rate for Payer: Cash Price |
$4,088.80
|
| Rate for Payer: Cofinity Commercial |
$3,128.78
|
| Rate for Payer: Cofinity Commercial |
$3,362.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,334.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,451.66
|
| Rate for Payer: Meridian Medicaid |
$1,604.69
|
| Rate for Payer: Nomi Health Commercial |
$2,801.89
|
| Rate for Payer: PACE SWMI |
$2,334.91
|
| Rate for Payer: PHP Commercial |
$3,268.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,334.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,528.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,322.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,802.01
|
| Rate for Payer: Priority Health Medicare |
$2,334.91
|
| Rate for Payer: Priority Health Narrow Network |
$3,802.01
|
| Rate for Payer: Priority Health SBD |
$3,802.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,334.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,334.91
|
| Rate for Payer: UHCCP Medicaid |
$1,528.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,351.06
|
|
|
PR ASCEND AORTA GRAFT INCL VAVLE SUSPENSION
|
Professional
|
Both
|
$10,055.00
|
|
|
Service Code
|
HCPCS 33860
|
| Min. Negotiated Rate |
$4,022.00 |
| Max. Negotiated Rate |
$6,535.75 |
| Rate for Payer: Aetna Medicare |
$5,027.50
|
| Rate for Payer: BCBS Complete |
$4,022.00
|
| Rate for Payer: Cash Price |
$8,044.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,535.75
|
| Rate for Payer: UMR Bronson Commercial |
$4,625.30
|
|
|
PR ASCENDING AORTA GRF VALVE SPARE ROOT REMODEL
|
Professional
|
Both
|
$5,228.00
|
|
|
Service Code
|
HCPCS 33864
|
| Min. Negotiated Rate |
$1,166.49 |
| Max. Negotiated Rate |
$5,006.60 |
| Rate for Payer: Aetna Commercial |
$4,126.44
|
| Rate for Payer: Aetna Medicare |
$3,202.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,126.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,434.38
|
| Rate for Payer: BCBS Complete |
$2,113.94
|
| Rate for Payer: BCBS MAPPO |
$3,079.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,166.49
|
| Rate for Payer: BCN Commercial |
$4,594.06
|
| Rate for Payer: BCN Medicare Advantage |
$3,079.43
|
| Rate for Payer: Cash Price |
$4,182.40
|
| Rate for Payer: Cash Price |
$4,182.40
|
| Rate for Payer: Cofinity Commercial |
$4,126.44
|
| Rate for Payer: Cofinity Commercial |
$4,434.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,079.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,233.40
|
| Rate for Payer: Meridian Medicaid |
$2,113.94
|
| Rate for Payer: Nomi Health Commercial |
$3,695.32
|
| Rate for Payer: PACE SWMI |
$3,079.43
|
| Rate for Payer: PHP Commercial |
$4,311.20
|
| Rate for Payer: PHP Medicare Advantage |
$3,079.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,013.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,398.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,006.60
|
| Rate for Payer: Priority Health Medicare |
$3,079.43
|
| Rate for Payer: Priority Health Narrow Network |
$5,006.60
|
| Rate for Payer: Priority Health SBD |
$5,006.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,079.43
|
| Rate for Payer: UHC Medicare Advantage |
$3,079.43
|
| Rate for Payer: UHCCP Medicaid |
$2,013.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,404.88
|
|
|
PR ASPIRATION AND/OR INJECTION THYROID CYST
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 60300
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$3,338.86 |
| Rate for Payer: Aetna Commercial |
$61.73
|
| Rate for Payer: Aetna Medicare |
$47.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.34
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS MAPPO |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$3,338.86
|
| Rate for Payer: BCN Commercial |
$157.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.07
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Cofinity Commercial |
$66.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.37
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Nomi Health Commercial |
$55.28
|
| Rate for Payer: PACE SWMI |
$46.07
|
| Rate for Payer: PHP Commercial |
$64.50
|
| Rate for Payer: PHP Medicare Advantage |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.00
|
| Rate for Payer: Priority Health Medicare |
$46.07
|
| Rate for Payer: Priority Health Narrow Network |
$77.00
|
| Rate for Payer: Priority Health SBD |
$77.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.07
|
| Rate for Payer: UHC Medicare Advantage |
$46.07
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
| Rate for Payer: UMR Bronson Commercial |
$74.52
|
|
|
PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 51102
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$1,872.30 |
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: Aetna Commercial |
$179.95
|
| Rate for Payer: Aetna Medicare |
$139.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.38
|
| Rate for Payer: BCBS MAPPO |
$134.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.30
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: BCN Medicare Advantage |
$134.29
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$179.95
|
| Rate for Payer: Cofinity Commercial |
$193.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.00
|
| Rate for Payer: Meridian Medicaid |
$94.15
|
| Rate for Payer: Nomi Health Commercial |
$161.15
|
| Rate for Payer: PACE SWMI |
$134.29
|
| Rate for Payer: PHP Commercial |
$188.01
|
| Rate for Payer: PHP Medicare Advantage |
$134.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.75
|
| Rate for Payer: Priority Health Medicare |
$134.29
|
| Rate for Payer: Priority Health Narrow Network |
$224.75
|
| Rate for Payer: Priority Health SBD |
$224.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.29
|
| Rate for Payer: UHC Medicare Advantage |
$134.29
|
| Rate for Payer: UHCCP Medicaid |
$89.67
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
|
|
PR ASPIRATION BLADDER NEEDLE
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 51100
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$2,925.20 |
| Rate for Payer: Aetna Commercial |
$49.96
|
| Rate for Payer: Aetna Medicare |
$38.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.68
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS MAPPO |
$37.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.20
|
| Rate for Payer: BCN Commercial |
$107.02
|
| Rate for Payer: BCN Medicare Advantage |
$37.28
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$49.96
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.14
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Nomi Health Commercial |
$44.74
|
| Rate for Payer: PACE SWMI |
$37.28
|
| Rate for Payer: PHP Commercial |
$52.19
|
| Rate for Payer: PHP Medicare Advantage |
$37.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.78
|
| Rate for Payer: Priority Health Medicare |
$37.28
|
| Rate for Payer: Priority Health Narrow Network |
$61.78
|
| Rate for Payer: Priority Health SBD |
$61.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.28
|
| Rate for Payer: UHC Medicare Advantage |
$37.28
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
| Rate for Payer: UMR Bronson Commercial |
$57.04
|
|
|
PR ASPIRATION BLADDER TROCAR/INTRACATHETER
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 51101
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$2,914.10 |
| Rate for Payer: Aetna Commercial |
$65.43
|
| Rate for Payer: Aetna Medicare |
$50.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.32
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$48.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,914.10
|
| Rate for Payer: BCN Commercial |
$226.26
|
| 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 |
$65.43
|
| Rate for Payer: Cofinity Commercial |
$70.32
|
| 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: Meridian Medicaid |
$34.00
|
| 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 Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.42
|
| Rate for Payer: Priority Health Medicare |
$48.83
|
| Rate for Payer: Priority Health Narrow Network |
$80.42
|
| Rate for Payer: Priority Health SBD |
$80.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.83
|
| Rate for Payer: UHC Medicare Advantage |
$48.83
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
| 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 |
$26.41 |
| Max. Negotiated Rate |
$2,114.22 |
| Rate for Payer: Aetna Commercial |
$52.80
|
| Rate for Payer: Aetna Medicare |
$40.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.74
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$39.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,114.22
|
| Rate for Payer: BCN Commercial |
$93.82
|
| 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 |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$56.74
|
| 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: Meridian Medicaid |
$27.73
|
| 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 Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.58
|
| Rate for Payer: Priority Health Medicare |
$39.40
|
| Rate for Payer: Priority Health Narrow Network |
$62.58
|
| Rate for Payer: Priority Health SBD |
$62.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.40
|
| Rate for Payer: UHC Medicare Advantage |
$39.40
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
| 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 |
$332.30 |
| Rate for Payer: Aetna Commercial |
$121.94
|
| Rate for Payer: Aetna Medicare |
$94.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.04
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$91.00
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$141.72
|
| 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 HMO/PPO/Tiered Network |
$130.27
|
| Rate for Payer: Priority Health Medicare |
$91.00
|
| Rate for Payer: Priority Health Narrow Network |
$130.27
|
| Rate for Payer: Priority Health SBD |
$130.27
|
| 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 |
$47.05 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Aetna Commercial |
$47.05
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.05
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: Cash Price |
$114.40
|
| 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 |
$122.48 |
| Max. Negotiated Rate |
$405.21 |
| 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 |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$182.78
|
| Rate for Payer: BCBS Trust/PPO |
$405.21
|
| Rate for Payer: BCN Commercial |
$288.40
|
| 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: Meridian Medicaid |
$128.60
|
| 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 Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.57
|
| Rate for Payer: Priority Health Medicare |
$182.78
|
| Rate for Payer: Priority Health Narrow Network |
$257.57
|
| Rate for Payer: Priority Health SBD |
$257.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.78
|
| Rate for Payer: UHC Medicare Advantage |
$182.78
|
| Rate for Payer: UHCCP Medicaid |
$122.48
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
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 |
$64.70
|
| 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 |
$64.70
|
|
|
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
|
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 |
$64.70
|
| 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 |
$64.70
|
|
|
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 |
$26.42
|
| 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
|
|
|
PR ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 33257
|
| Min. Negotiated Rate |
$369.77 |
| Max. Negotiated Rate |
$2,631.46 |
| Rate for Payer: Aetna Commercial |
$748.52
|
| Rate for Payer: Aetna Medicare |
$580.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$804.38
|
| Rate for Payer: BCBS Complete |
$388.26
|
| Rate for Payer: BCBS MAPPO |
$558.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,631.46
|
| Rate for Payer: BCN Commercial |
$838.57
|
| 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 |
$748.52
|
| Rate for Payer: Cofinity Commercial |
$804.38
|
| 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: Meridian Medicaid |
$388.26
|
| 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 Choice Medicaid |
$369.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$917.40
|
| Rate for Payer: Priority Health Medicare |
$558.60
|
| Rate for Payer: Priority Health Narrow Network |
$917.40
|
| Rate for Payer: Priority Health SBD |
$917.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.60
|
| Rate for Payer: UHC Medicare Advantage |
$558.60
|
| Rate for Payer: UHCCP Medicaid |
$369.77
|
| 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 |
$536.76 |
| Max. Negotiated Rate |
$5,209.57 |
| Rate for Payer: Aetna Commercial |
$1,087.20
|
| Rate for Payer: Aetna Medicare |
$843.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,087.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,168.33
|
| Rate for Payer: BCBS Complete |
$563.60
|
| Rate for Payer: BCBS MAPPO |
$811.34
|
| Rate for Payer: BCBS Trust/PPO |
$5,209.57
|
| Rate for Payer: BCN Commercial |
$1,216.32
|
| 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 |
$1,087.20
|
| Rate for Payer: Cofinity Commercial |
$1,168.33
|
| 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: Meridian Medicaid |
$563.60
|
| 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 Choice Medicaid |
$536.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,496.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,332.74
|
| Rate for Payer: Priority Health Medicare |
$811.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,332.74
|
| Rate for Payer: Priority Health SBD |
$1,332.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.34
|
| Rate for Payer: UHC Medicare Advantage |
$811.34
|
| Rate for Payer: UHCCP Medicaid |
$536.76
|
| 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 |
$45.58 |
| Max. Negotiated Rate |
$1,378.86 |
| Rate for Payer: Aetna Commercial |
$91.43
|
| Rate for Payer: Aetna Medicare |
$70.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.25
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS MAPPO |
$68.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,378.86
|
| Rate for Payer: BCN Commercial |
$105.06
|
| 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 |
$91.43
|
| Rate for Payer: Cofinity Commercial |
$98.25
|
| 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: Meridian Medicaid |
$47.86
|
| 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 Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.47
|
| Rate for Payer: Priority Health Medicare |
$68.23
|
| Rate for Payer: Priority Health Narrow Network |
$96.47
|
| Rate for Payer: Priority Health SBD |
$96.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.23
|
| Rate for Payer: UHC Medicare Advantage |
$68.23
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
| 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 Commercial |
$43.02
|
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.02
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: Cash Price |
$63.20
|
| 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
|
|
