|
PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 93459
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$1,304.01
|
| Rate for Payer: Aetna Commercial |
$1,304.01
|
| Rate for Payer: Aetna Medicare |
$1,012.07
|
| Rate for Payer: Aetna Medicare |
$1,012.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,304.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,304.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,401.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,401.32
|
| Rate for Payer: BCBS Complete |
$880.00
|
| Rate for Payer: BCBS Complete |
$444.40
|
| Rate for Payer: BCBS MAPPO |
$973.14
|
| Rate for Payer: BCBS MAPPO |
$973.14
|
| Rate for Payer: BCN Medicare Advantage |
$973.14
|
| Rate for Payer: BCN Medicare Advantage |
$973.14
|
| Rate for Payer: Cash Price |
$888.80
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$888.80
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cofinity Commercial |
$1,401.32
|
| Rate for Payer: Cofinity Commercial |
$1,401.32
|
| Rate for Payer: Cofinity Commercial |
$1,304.01
|
| Rate for Payer: Cofinity Commercial |
$1,304.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$973.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$973.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,021.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,021.80
|
| Rate for Payer: Nomi Health Commercial |
$1,167.77
|
| Rate for Payer: Nomi Health Commercial |
$1,167.77
|
| Rate for Payer: PACE SWMI |
$973.14
|
| Rate for Payer: PACE SWMI |
$973.14
|
| Rate for Payer: PHP Commercial |
$1,362.40
|
| Rate for Payer: PHP Commercial |
$1,362.40
|
| Rate for Payer: PHP Medicare Advantage |
$973.14
|
| Rate for Payer: PHP Medicare Advantage |
$973.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.00
|
| Rate for Payer: Priority Health Medicare |
$973.14
|
| Rate for Payer: Priority Health Medicare |
$973.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$973.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$973.14
|
| Rate for Payer: UHC Medicare Advantage |
$973.14
|
| Rate for Payer: UHC Medicare Advantage |
$973.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,012.00
|
| Rate for Payer: UMR Bronson Commercial |
$511.06
|
|
|
PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 93458
|
| Min. Negotiated Rate |
$388.00 |
| Max. Negotiated Rate |
$1,299.76 |
| Rate for Payer: Aetna Commercial |
$1,209.50
|
| Rate for Payer: Aetna Commercial |
$1,209.50
|
| Rate for Payer: Aetna Medicare |
$938.71
|
| Rate for Payer: Aetna Medicare |
$938.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,209.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,299.76
|
| Rate for Payer: BCBS Complete |
$388.00
|
| Rate for Payer: BCBS Complete |
$793.60
|
| Rate for Payer: BCBS MAPPO |
$902.61
|
| Rate for Payer: BCBS MAPPO |
$902.61
|
| Rate for Payer: BCN Medicare Advantage |
$902.61
|
| Rate for Payer: BCN Medicare Advantage |
$902.61
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cash Price |
$1,587.20
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cofinity Commercial |
$1,299.76
|
| Rate for Payer: Cofinity Commercial |
$1,299.76
|
| Rate for Payer: Cofinity Commercial |
$1,209.50
|
| Rate for Payer: Cofinity Commercial |
$1,209.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$902.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$947.74
|
| Rate for Payer: Nomi Health Commercial |
$1,083.13
|
| Rate for Payer: Nomi Health Commercial |
$1,083.13
|
| Rate for Payer: PACE SWMI |
$902.61
|
| Rate for Payer: PACE SWMI |
$902.61
|
| Rate for Payer: PHP Commercial |
$1,263.65
|
| Rate for Payer: PHP Commercial |
$1,263.65
|
| Rate for Payer: PHP Medicare Advantage |
$902.61
|
| Rate for Payer: PHP Medicare Advantage |
$902.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,289.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.50
|
| Rate for Payer: Priority Health Medicare |
$902.61
|
| Rate for Payer: Priority Health Medicare |
$902.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$902.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$902.61
|
| Rate for Payer: UHC Medicare Advantage |
$902.61
|
| Rate for Payer: UHC Medicare Advantage |
$902.61
|
| Rate for Payer: UMR Bronson Commercial |
$446.20
|
| Rate for Payer: UMR Bronson Commercial |
$912.64
|
|
|
PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
HCPCS 93455
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$1,258.82 |
| Rate for Payer: Aetna Commercial |
$1,171.40
|
| Rate for Payer: Aetna Medicare |
$909.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.40
|
| Rate for Payer: BCBS Complete |
$232.80
|
| Rate for Payer: BCBS MAPPO |
$874.18
|
| Rate for Payer: BCN Medicare Advantage |
$874.18
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cofinity Commercial |
$1,258.82
|
| Rate for Payer: Cofinity Commercial |
$1,171.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$917.89
|
| Rate for Payer: Nomi Health Commercial |
$1,049.02
|
| Rate for Payer: PACE SWMI |
$874.18
|
| Rate for Payer: PHP Commercial |
$1,223.85
|
| Rate for Payer: PHP Medicare Advantage |
$874.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$378.30
|
| Rate for Payer: Priority Health Medicare |
$874.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.18
|
| Rate for Payer: UHC Medicare Advantage |
$874.18
|
| Rate for Payer: UMR Bronson Commercial |
$267.72
|
|
|
PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I
|
Professional
|
Both
|
$2,427.00
|
|
|
Service Code
|
HCPCS 93457
|
| Min. Negotiated Rate |
$970.80 |
| Max. Negotiated Rate |
$1,577.55 |
| Rate for Payer: Aetna Commercial |
$1,426.75
|
| Rate for Payer: Aetna Medicare |
$1,107.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,533.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,426.75
|
| Rate for Payer: BCBS Complete |
$970.80
|
| Rate for Payer: BCBS MAPPO |
$1,064.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,064.74
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cash Price |
$1,941.60
|
| Rate for Payer: Cofinity Commercial |
$1,533.23
|
| Rate for Payer: Cofinity Commercial |
$1,426.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,064.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,117.98
|
| Rate for Payer: Nomi Health Commercial |
$1,277.69
|
| Rate for Payer: PACE SWMI |
$1,064.74
|
| Rate for Payer: PHP Commercial |
$1,490.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,064.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,577.55
|
| Rate for Payer: Priority Health Medicare |
$1,064.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,064.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,064.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,116.42
|
|
|
PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I
|
Professional
|
Both
|
$2,171.00
|
|
|
Service Code
|
HCPCS 93456
|
| Min. Negotiated Rate |
$868.40 |
| Max. Negotiated Rate |
$1,411.15 |
| Rate for Payer: Aetna Commercial |
$1,306.11
|
| Rate for Payer: Aetna Medicare |
$1,013.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,403.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,306.11
|
| Rate for Payer: BCBS Complete |
$868.40
|
| Rate for Payer: BCBS MAPPO |
$974.71
|
| Rate for Payer: BCN Medicare Advantage |
$974.71
|
| Rate for Payer: Cash Price |
$1,736.80
|
| Rate for Payer: Cash Price |
$1,736.80
|
| Rate for Payer: Cofinity Commercial |
$1,403.58
|
| Rate for Payer: Cofinity Commercial |
$1,306.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$974.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,023.45
|
| Rate for Payer: Nomi Health Commercial |
$1,169.65
|
| Rate for Payer: PACE SWMI |
$974.71
|
| Rate for Payer: PHP Commercial |
$1,364.59
|
| Rate for Payer: PHP Medicare Advantage |
$974.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,411.15
|
| Rate for Payer: Priority Health Medicare |
$974.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$974.71
|
| Rate for Payer: UHC Medicare Advantage |
$974.71
|
| Rate for Payer: UMR Bronson Commercial |
$998.66
|
|
|
PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI
|
Professional
|
Both
|
$644.00
|
|
|
Service Code
|
HCPCS 58340
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$418.60 |
| Rate for Payer: Aetna Commercial |
$74.20
|
| Rate for Payer: Aetna Medicare |
$57.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.20
|
| Rate for Payer: BCBS Complete |
$257.60
|
| Rate for Payer: BCBS MAPPO |
$55.37
|
| Rate for Payer: BCN Medicare Advantage |
$55.37
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cash Price |
$515.20
|
| Rate for Payer: Cofinity Commercial |
$79.73
|
| Rate for Payer: Cofinity Commercial |
$74.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.14
|
| Rate for Payer: Nomi Health Commercial |
$66.44
|
| Rate for Payer: PACE SWMI |
$55.37
|
| Rate for Payer: PHP Commercial |
$77.52
|
| Rate for Payer: PHP Medicare Advantage |
$55.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$418.60
|
| Rate for Payer: Priority Health Medicare |
$55.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.37
|
| Rate for Payer: UHC Medicare Advantage |
$55.37
|
| Rate for Payer: UMR Bronson Commercial |
$296.24
|
|
|
PR CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
HCPCS 57511
|
| Min. Negotiated Rate |
$139.54 |
| Max. Negotiated Rate |
$299.00 |
| Rate for Payer: Aetna Commercial |
$186.98
|
| Rate for Payer: Aetna Medicare |
$145.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.98
|
| Rate for Payer: BCBS Complete |
$184.00
|
| Rate for Payer: BCBS MAPPO |
$139.54
|
| Rate for Payer: BCN Medicare Advantage |
$139.54
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cash Price |
$368.00
|
| Rate for Payer: Cofinity Commercial |
$200.94
|
| Rate for Payer: Cofinity Commercial |
$186.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.52
|
| Rate for Payer: Nomi Health Commercial |
$167.45
|
| Rate for Payer: PACE SWMI |
$139.54
|
| Rate for Payer: PHP Commercial |
$195.36
|
| Rate for Payer: PHP Medicare Advantage |
$139.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.00
|
| Rate for Payer: Priority Health Medicare |
$139.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.54
|
| Rate for Payer: UHC Medicare Advantage |
$139.54
|
| Rate for Payer: UMR Bronson Commercial |
$211.60
|
|
|
PR CAUTERY CERVIX ELECTRO/THERMAL
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 57510
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$144.99
|
| Rate for Payer: Aetna Medicare |
$112.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.99
|
| Rate for Payer: BCBS Complete |
$192.00
|
| Rate for Payer: BCBS MAPPO |
$108.20
|
| Rate for Payer: BCN Medicare Advantage |
$108.20
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$155.81
|
| Rate for Payer: Cofinity Commercial |
$144.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.61
|
| Rate for Payer: Nomi Health Commercial |
$129.84
|
| Rate for Payer: PACE SWMI |
$108.20
|
| Rate for Payer: PHP Commercial |
$151.48
|
| Rate for Payer: PHP Medicare Advantage |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.00
|
| Rate for Payer: Priority Health Medicare |
$108.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.20
|
| Rate for Payer: UHC Medicare Advantage |
$108.20
|
| Rate for Payer: UMR Bronson Commercial |
$220.80
|
|
|
PR CAUTERY CERVIX LASER ABLATION
|
Professional
|
Both
|
$554.00
|
|
|
Service Code
|
HCPCS 57513
|
| Min. Negotiated Rate |
$138.95 |
| Max. Negotiated Rate |
$360.10 |
| Rate for Payer: Aetna Commercial |
$186.19
|
| Rate for Payer: Aetna Medicare |
$144.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.19
|
| Rate for Payer: BCBS Complete |
$221.60
|
| Rate for Payer: BCBS MAPPO |
$138.95
|
| Rate for Payer: BCN Medicare Advantage |
$138.95
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cash Price |
$443.20
|
| Rate for Payer: Cofinity Commercial |
$200.09
|
| Rate for Payer: Cofinity Commercial |
$186.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.90
|
| Rate for Payer: Nomi Health Commercial |
$166.74
|
| Rate for Payer: PACE SWMI |
$138.95
|
| Rate for Payer: PHP Commercial |
$194.53
|
| Rate for Payer: PHP Medicare Advantage |
$138.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.10
|
| Rate for Payer: Priority Health Medicare |
$138.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.95
|
| Rate for Payer: UHC Medicare Advantage |
$138.95
|
| Rate for Payer: UMR Bronson Commercial |
$254.84
|
|
|
PR CBHC CONSULT FEE $150
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 00678
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR CBHC CONSULT FEE $300
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00585
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR CBHC IN HOUSE REPAIR
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 00580
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR CBHC IN-HOUSE REPAIR
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 00590
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$17.55 |
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
PR CBHC LOSS AND DAMAGE FEE
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 00581
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
PR CBHC MAILING CHARGE
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 00584
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
|
|
PR CBHC RECASE BTE
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 00582
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
|
PR CBHC RECASE ITE
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 00583
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$116.35 |
| Rate for Payer: Aetna Medicare |
$89.50
|
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
| Rate for Payer: UMR Bronson Commercial |
$82.34
|
|
|
PR CBHC REPAIR 5 YRS AND OLDER
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 00589
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$282.10 |
| Rate for Payer: Aetna Medicare |
$217.00
|
| Rate for Payer: BCBS Complete |
$173.60
|
| Rate for Payer: Cash Price |
$347.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.10
|
| Rate for Payer: UMR Bronson Commercial |
$199.64
|
|
|
PR CBHC REPAIR DIGITAL/CIC
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 00588
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR CBHC REPAIR RECEIVER
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00587
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
| Rate for Payer: UMR Bronson Commercial |
$58.88
|
|
|
PR CCIIV3 VACCINE ABX FREE 0.5 ML FOR IM USE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 90661
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$71.28 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$51.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.33
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$49.50
|
| Rate for Payer: BCN Medicare Advantage |
$49.50
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$66.33
|
| Rate for Payer: Cofinity Commercial |
$71.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.98
|
| Rate for Payer: Nomi Health Commercial |
$59.40
|
| Rate for Payer: PACE SWMI |
$49.50
|
| Rate for Payer: PHP Commercial |
$69.30
|
| Rate for Payer: PHP Medicare Advantage |
$49.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$49.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.50
|
| Rate for Payer: UHC Medicare Advantage |
$49.50
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
|
PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 90756
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: UMR Bronson Commercial |
$31.28
|
|
|
PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 90674
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: UMR Bronson Commercial |
$33.58
|
|
|
PR CCM/BHI BY RHC/FQHC 20MIN MO
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS G0511
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$163.15 |
| Rate for Payer: Aetna Medicare |
$125.50
|
| Rate for Payer: BCBS Complete |
$100.40
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: UMR Bronson Commercial |
$115.46
|
|
|
PR CEFTRIAXONE SODIUM INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0696
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$0.58
|
| Rate for Payer: Aetna Medicare |
$0.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.58
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.43
|
| Rate for Payer: BCN Medicare Advantage |
$0.43
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$0.62
|
| Rate for Payer: Cofinity Commercial |
$0.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.45
|
| Rate for Payer: Nomi Health Commercial |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.43
|
| Rate for Payer: PHP Commercial |
$0.60
|
| Rate for Payer: PHP Medicare Advantage |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$0.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.43
|
| Rate for Payer: UHC Medicare Advantage |
$0.43
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
