|
PR EDUCATION&TRAINING PT SELF-MGMT NQHP 5-8 PTS
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 98962
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$15.15 |
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: Aetna Medicare |
$9.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCN Commercial |
$10.66
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$15.15
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: Priority Health Tiered Network |
$15.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.41
|
| Rate for Payer: UHC Core |
$14.41
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UMR Bronson Commercial |
$8.28
|
|
|
PR EDUCATION&TRAINING PT SELF-MGMT NQHP INDIV PT
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 98960
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$46.81 |
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.53
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCN Commercial |
$46.81
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$43.18
|
| Rate for Payer: Priority Health SBD |
$43.18
|
| Rate for Payer: Priority Health Tiered Network |
$43.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.04
|
| Rate for Payer: UHC Core |
$41.04
|
| Rate for Payer: UHC Exchange |
$41.04
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
|
|
PR EEG,ALL NIGHT RECORD
|
Professional
|
Both
|
$1,385.00
|
|
|
Service Code
|
HCPCS 95827
|
| Min. Negotiated Rate |
$554.00 |
| Max. Negotiated Rate |
$1,038.75 |
| Rate for Payer: Aetna Medicare |
$692.50
|
| Rate for Payer: BCBS Complete |
$554.00
|
| Rate for Payer: Cash Price |
$1,108.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,038.75
|
| Rate for Payer: UMR Bronson Commercial |
$637.10
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
HCPCS 95721
|
| Min. Negotiated Rate |
$112.68 |
| Max. Negotiated Rate |
$335.17 |
| Rate for Payer: Aetna Commercial |
$234.39
|
| Rate for Payer: Aetna Medicare |
$181.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.88
|
| Rate for Payer: BCBS Complete |
$118.31
|
| Rate for Payer: BCBS MAPPO |
$174.92
|
| Rate for Payer: BCN Commercial |
$302.77
|
| Rate for Payer: BCN Medicare Advantage |
$174.92
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cofinity Commercial |
$251.88
|
| Rate for Payer: Cofinity Commercial |
$234.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.67
|
| Rate for Payer: Meridian Medicaid |
$118.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.41
|
| Rate for Payer: Nomi Health Commercial |
$209.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.75
|
| Rate for Payer: PACE SWMI |
$174.92
|
| Rate for Payer: PHP Commercial |
$244.89
|
| Rate for Payer: PHP Medicare Advantage |
$174.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$279.23
|
| Rate for Payer: Priority Health Medicare |
$174.92
|
| Rate for Payer: Priority Health SBD |
$279.23
|
| Rate for Payer: Priority Health Tiered Network |
$279.23
|
| Rate for Payer: Railroad Medicare Medicare |
$174.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.17
|
| Rate for Payer: UHC Core |
$335.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.92
|
| Rate for Payer: UHC Exchange |
$335.17
|
| Rate for Payer: UHC Medicaid |
$112.68
|
| Rate for Payer: UHCCP Medicaid |
$112.68
|
| Rate for Payer: UMR Bronson Commercial |
$202.86
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG
|
Professional
|
Both
|
$536.00
|
|
|
Service Code
|
HCPCS 95722
|
| Min. Negotiated Rate |
$136.53 |
| Max. Negotiated Rate |
$407.72 |
| Rate for Payer: Aetna Commercial |
$283.91
|
| Rate for Payer: Aetna Medicare |
$220.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.09
|
| Rate for Payer: BCBS Complete |
$143.36
|
| Rate for Payer: BCBS MAPPO |
$211.87
|
| Rate for Payer: BCN Commercial |
$368.50
|
| Rate for Payer: BCN Medicare Advantage |
$211.87
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cash Price |
$428.80
|
| Rate for Payer: Cofinity Commercial |
$283.91
|
| Rate for Payer: Cofinity Commercial |
$305.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$222.46
|
| Rate for Payer: Meridian Medicaid |
$143.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.06
|
| Rate for Payer: Nomi Health Commercial |
$254.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$402.00
|
| Rate for Payer: PACE SWMI |
$211.87
|
| Rate for Payer: PHP Commercial |
$296.62
|
| Rate for Payer: PHP Medicare Advantage |
$211.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$339.83
|
| Rate for Payer: Priority Health Medicare |
$211.87
|
| Rate for Payer: Priority Health SBD |
$339.83
|
| Rate for Payer: Priority Health Tiered Network |
$339.83
|
| Rate for Payer: Railroad Medicare Medicare |
$211.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.72
|
| Rate for Payer: UHC Core |
$407.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$211.87
|
| Rate for Payer: UHC Exchange |
$407.72
|
| Rate for Payer: UHC Medicaid |
$136.53
|
| Rate for Payer: UHCCP Medicaid |
$136.53
|
| Rate for Payer: UMR Bronson Commercial |
$246.56
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
HCPCS 95723
|
| Min. Negotiated Rate |
$137.17 |
| Max. Negotiated Rate |
$414.96 |
| Rate for Payer: Aetna Commercial |
$285.14
|
| Rate for Payer: Aetna Medicare |
$221.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.42
|
| Rate for Payer: BCBS Complete |
$144.03
|
| Rate for Payer: BCBS MAPPO |
$212.79
|
| Rate for Payer: BCN Commercial |
$371.99
|
| Rate for Payer: BCN Medicare Advantage |
$212.79
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cash Price |
$437.60
|
| Rate for Payer: Cofinity Commercial |
$285.14
|
| Rate for Payer: Cofinity Commercial |
$306.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.43
|
| Rate for Payer: Meridian Medicaid |
$144.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$234.07
|
| Rate for Payer: Nomi Health Commercial |
$255.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$410.25
|
| Rate for Payer: PACE SWMI |
$212.79
|
| Rate for Payer: PHP Commercial |
$297.91
|
| Rate for Payer: PHP Medicare Advantage |
$212.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$343.06
|
| Rate for Payer: Priority Health Medicare |
$212.79
|
| Rate for Payer: Priority Health SBD |
$343.06
|
| Rate for Payer: Priority Health Tiered Network |
$343.06
|
| Rate for Payer: Railroad Medicare Medicare |
$212.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.96
|
| Rate for Payer: UHC Core |
$414.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.79
|
| Rate for Payer: UHC Exchange |
$414.96
|
| Rate for Payer: UHC Medicaid |
$137.17
|
| Rate for Payer: UHCCP Medicaid |
$137.17
|
| Rate for Payer: UMR Bronson Commercial |
$251.62
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
HCPCS 95724
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$519.84 |
| Rate for Payer: Aetna Commercial |
$360.43
|
| Rate for Payer: Aetna Medicare |
$279.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$360.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$387.33
|
| Rate for Payer: BCBS Complete |
$182.05
|
| Rate for Payer: BCBS MAPPO |
$268.98
|
| Rate for Payer: BCN Commercial |
$467.60
|
| Rate for Payer: BCN Medicare Advantage |
$268.98
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cofinity Commercial |
$360.43
|
| Rate for Payer: Cofinity Commercial |
$387.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$268.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$282.43
|
| Rate for Payer: Meridian Medicaid |
$182.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$295.88
|
| Rate for Payer: Nomi Health Commercial |
$322.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$513.00
|
| Rate for Payer: PACE SWMI |
$268.98
|
| Rate for Payer: PHP Commercial |
$376.57
|
| Rate for Payer: PHP Medicare Advantage |
$268.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$173.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$431.23
|
| Rate for Payer: Priority Health Medicare |
$268.98
|
| Rate for Payer: Priority Health SBD |
$431.23
|
| Rate for Payer: Priority Health Tiered Network |
$431.23
|
| Rate for Payer: Railroad Medicare Medicare |
$268.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$519.84
|
| Rate for Payer: UHC Core |
$519.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$268.98
|
| Rate for Payer: UHC Exchange |
$519.84
|
| Rate for Payer: UHC Medicaid |
$173.38
|
| Rate for Payer: UHCCP Medicaid |
$173.38
|
| Rate for Payer: UMR Bronson Commercial |
$314.64
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/O VID
|
Professional
|
Both
|
$625.00
|
|
|
Service Code
|
HCPCS 95725
|
| Min. Negotiated Rate |
$157.41 |
| Max. Negotiated Rate |
$472.12 |
| Rate for Payer: Aetna Commercial |
$327.16
|
| Rate for Payer: Aetna Medicare |
$253.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.58
|
| Rate for Payer: BCBS Complete |
$165.28
|
| Rate for Payer: BCBS MAPPO |
$244.15
|
| Rate for Payer: BCN Commercial |
$426.28
|
| Rate for Payer: BCN Medicare Advantage |
$244.15
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cash Price |
$500.00
|
| Rate for Payer: Cofinity Commercial |
$327.16
|
| Rate for Payer: Cofinity Commercial |
$351.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$244.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$256.36
|
| Rate for Payer: Meridian Medicaid |
$165.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$268.56
|
| Rate for Payer: Nomi Health Commercial |
$292.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$468.75
|
| Rate for Payer: PACE SWMI |
$244.15
|
| Rate for Payer: PHP Commercial |
$341.81
|
| Rate for Payer: PHP Medicare Advantage |
$244.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$393.12
|
| Rate for Payer: Priority Health Medicare |
$244.15
|
| Rate for Payer: Priority Health SBD |
$393.12
|
| Rate for Payer: Priority Health Tiered Network |
$393.12
|
| Rate for Payer: Railroad Medicare Medicare |
$244.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$472.12
|
| Rate for Payer: UHC Core |
$472.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$244.15
|
| Rate for Payer: UHC Exchange |
$472.12
|
| Rate for Payer: UHC Medicaid |
$157.41
|
| Rate for Payer: UHCCP Medicaid |
$157.41
|
| Rate for Payer: UMR Bronson Commercial |
$287.50
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
HCPCS 95726
|
| Min. Negotiated Rate |
$220.46 |
| Max. Negotiated Rate |
$656.90 |
| Rate for Payer: Aetna Commercial |
$458.25
|
| Rate for Payer: Aetna Medicare |
$355.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.45
|
| Rate for Payer: BCBS Complete |
$231.48
|
| Rate for Payer: BCBS MAPPO |
$341.98
|
| Rate for Payer: BCN Commercial |
$594.09
|
| Rate for Payer: BCN Medicare Advantage |
$341.98
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cofinity Commercial |
$458.25
|
| Rate for Payer: Cofinity Commercial |
$492.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$359.08
|
| Rate for Payer: Meridian Medicaid |
$231.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$376.18
|
| Rate for Payer: Nomi Health Commercial |
$410.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.00
|
| Rate for Payer: PACE SWMI |
$341.98
|
| Rate for Payer: PHP Commercial |
$478.77
|
| Rate for Payer: PHP Medicare Advantage |
$341.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$220.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$547.87
|
| Rate for Payer: Priority Health Medicare |
$341.98
|
| Rate for Payer: Priority Health SBD |
$547.87
|
| Rate for Payer: Priority Health Tiered Network |
$547.87
|
| Rate for Payer: Railroad Medicare Medicare |
$341.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$656.90
|
| Rate for Payer: UHC Core |
$656.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$341.98
|
| Rate for Payer: UHC Exchange |
$656.90
|
| Rate for Payer: UHC Medicaid |
$220.46
|
| Rate for Payer: UHCCP Medicaid |
$220.46
|
| Rate for Payer: UMR Bronson Commercial |
$397.44
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$894.00
|
|
|
Service Code
|
HCPCS 95813
|
| Min. Negotiated Rate |
$411.24 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Aetna Commercial |
$594.30
|
| Rate for Payer: Aetna Medicare |
$461.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$638.65
|
| Rate for Payer: BCBS MAPPO |
$443.51
|
| Rate for Payer: BCN Commercial |
$661.82
|
| Rate for Payer: BCN Medicare Advantage |
$443.51
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cash Price |
$715.20
|
| Rate for Payer: Cofinity Commercial |
$638.65
|
| Rate for Payer: Cofinity Commercial |
$594.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$465.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$487.86
|
| Rate for Payer: Nomi Health Commercial |
$532.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$670.50
|
| Rate for Payer: PACE SWMI |
$443.51
|
| Rate for Payer: PHP Commercial |
$620.91
|
| Rate for Payer: PHP Medicare Advantage |
$443.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$610.33
|
| Rate for Payer: Priority Health Medicare |
$443.51
|
| Rate for Payer: Priority Health SBD |
$610.33
|
| Rate for Payer: Priority Health Tiered Network |
$610.33
|
| Rate for Payer: Railroad Medicare Medicare |
$443.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$622.75
|
| Rate for Payer: UHC Core |
$622.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$443.51
|
| Rate for Payer: UHC Exchange |
$622.75
|
| Rate for Payer: UMR Bronson Commercial |
$411.24
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED BY TECH/NURSE
|
Professional
|
Both
|
$2,976.00
|
|
|
Service Code
|
HCPCS 95956
|
| Min. Negotiated Rate |
$1,190.40 |
| Max. Negotiated Rate |
$2,232.00 |
| Rate for Payer: Aetna Medicare |
$1,488.00
|
| Rate for Payer: BCBS Complete |
$1,190.40
|
| Rate for Payer: Cash Price |
$2,380.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,232.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,368.96
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, UNATTENDED
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 95953
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$576.75 |
| Rate for Payer: Aetna Medicare |
$384.50
|
| Rate for Payer: BCBS Complete |
$307.60
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$576.75
|
| Rate for Payer: UMR Bronson Commercial |
$353.74
|
|
|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$1,603.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$641.20 |
| Max. Negotiated Rate |
$1,202.25 |
| Rate for Payer: Aetna Medicare |
$801.50
|
| Rate for Payer: Aetna Medicare |
$1,597.50
|
| Rate for Payer: BCBS Complete |
$641.20
|
| Rate for Payer: BCBS Complete |
$1,278.00
|
| Rate for Payer: Cash Price |
$1,282.40
|
| Rate for Payer: Cash Price |
$2,556.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,396.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,202.25
|
| Rate for Payer: UMR Bronson Commercial |
$737.38
|
| Rate for Payer: UMR Bronson Commercial |
$1,469.70
|
|
|
PR EEG PHYS/QHP 2-12 HR WITHOUT VIDEO
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 95717
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$164.64 |
| Rate for Payer: Aetna Commercial |
$118.24
|
| Rate for Payer: Aetna Medicare |
$91.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.07
|
| Rate for Payer: BCBS Complete |
$59.71
|
| Rate for Payer: BCBS MAPPO |
$88.24
|
| Rate for Payer: BCN Commercial |
$157.36
|
| Rate for Payer: BCN Medicare Advantage |
$88.24
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$118.24
|
| Rate for Payer: Cofinity Commercial |
$127.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.65
|
| Rate for Payer: Meridian Medicaid |
$59.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$97.06
|
| Rate for Payer: Nomi Health Commercial |
$105.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PACE SWMI |
$88.24
|
| Rate for Payer: PHP Commercial |
$123.54
|
| Rate for Payer: PHP Medicare Advantage |
$88.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$145.11
|
| Rate for Payer: Priority Health Medicare |
$88.24
|
| Rate for Payer: Priority Health SBD |
$145.11
|
| Rate for Payer: Priority Health Tiered Network |
$145.11
|
| Rate for Payer: Railroad Medicare Medicare |
$88.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.64
|
| Rate for Payer: UHC Core |
$164.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$88.24
|
| Rate for Payer: UHC Exchange |
$164.64
|
| Rate for Payer: UHC Medicaid |
$56.87
|
| Rate for Payer: UHCCP Medicaid |
$56.87
|
| Rate for Payer: UMR Bronson Commercial |
$98.90
|
|
|
PR EEG PHYS/QHP 2-12 HR WITH VEEG
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 95718
|
| Min. Negotiated Rate |
$71.14 |
| Max. Negotiated Rate |
$215.79 |
| Rate for Payer: Aetna Commercial |
$147.92
|
| Rate for Payer: Aetna Medicare |
$114.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.96
|
| Rate for Payer: BCBS Complete |
$74.70
|
| Rate for Payer: BCBS MAPPO |
$110.39
|
| Rate for Payer: BCN Commercial |
$197.70
|
| Rate for Payer: BCN Medicare Advantage |
$110.39
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$147.92
|
| Rate for Payer: Cofinity Commercial |
$158.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.91
|
| Rate for Payer: Meridian Medicaid |
$74.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.43
|
| Rate for Payer: Nomi Health Commercial |
$132.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PACE SWMI |
$110.39
|
| Rate for Payer: PHP Commercial |
$154.55
|
| Rate for Payer: PHP Medicare Advantage |
$110.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$182.33
|
| Rate for Payer: Priority Health Medicare |
$110.39
|
| Rate for Payer: Priority Health SBD |
$182.33
|
| Rate for Payer: Priority Health Tiered Network |
$182.33
|
| Rate for Payer: Railroad Medicare Medicare |
$110.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.79
|
| Rate for Payer: UHC Core |
$215.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$110.39
|
| Rate for Payer: UHC Exchange |
$215.79
|
| Rate for Payer: UHC Medicaid |
$71.14
|
| Rate for Payer: UHCCP Medicaid |
$71.14
|
| Rate for Payer: UMR Bronson Commercial |
$129.72
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR WO VID
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 95719
|
| Min. Negotiated Rate |
$85.41 |
| Max. Negotiated Rate |
$255.09 |
| Rate for Payer: Aetna Commercial |
$177.50
|
| Rate for Payer: Aetna Medicare |
$137.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.74
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: BCBS MAPPO |
$132.46
|
| Rate for Payer: BCN Commercial |
$236.55
|
| Rate for Payer: BCN Medicare Advantage |
$132.46
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$177.50
|
| Rate for Payer: Cofinity Commercial |
$190.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.08
|
| Rate for Payer: Meridian Medicaid |
$89.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$145.71
|
| Rate for Payer: Nomi Health Commercial |
$158.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$249.75
|
| Rate for Payer: PACE SWMI |
$132.46
|
| Rate for Payer: PHP Commercial |
$185.44
|
| Rate for Payer: PHP Medicare Advantage |
$132.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$218.15
|
| Rate for Payer: Priority Health Medicare |
$132.46
|
| Rate for Payer: Priority Health SBD |
$218.15
|
| Rate for Payer: Priority Health Tiered Network |
$218.15
|
| Rate for Payer: Railroad Medicare Medicare |
$132.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.09
|
| Rate for Payer: UHC Core |
$255.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.46
|
| Rate for Payer: UHC Exchange |
$255.09
|
| Rate for Payer: UHC Medicaid |
$85.41
|
| Rate for Payer: UHCCP Medicaid |
$85.41
|
| Rate for Payer: UMR Bronson Commercial |
$153.18
|
|
|
PR EEG PHYS/QHP EA INCR>12HR<26HR AFTER 24HR W/VEEG
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 95720
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$334.11 |
| Rate for Payer: Aetna Commercial |
$227.57
|
| Rate for Payer: Aetna Medicare |
$176.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.56
|
| Rate for Payer: BCBS Complete |
$114.95
|
| Rate for Payer: BCBS MAPPO |
$169.83
|
| Rate for Payer: BCN Commercial |
$303.77
|
| Rate for Payer: BCN Medicare Advantage |
$169.83
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cash Price |
$350.40
|
| Rate for Payer: Cofinity Commercial |
$227.57
|
| Rate for Payer: Cofinity Commercial |
$244.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.32
|
| Rate for Payer: Meridian Medicaid |
$114.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.81
|
| Rate for Payer: Nomi Health Commercial |
$203.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$328.50
|
| Rate for Payer: PACE SWMI |
$169.83
|
| Rate for Payer: PHP Commercial |
$237.76
|
| Rate for Payer: PHP Medicare Advantage |
$169.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$280.13
|
| Rate for Payer: Priority Health Medicare |
$169.83
|
| Rate for Payer: Priority Health SBD |
$280.13
|
| Rate for Payer: Priority Health Tiered Network |
$280.13
|
| Rate for Payer: Railroad Medicare Medicare |
$169.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.11
|
| Rate for Payer: UHC Core |
$334.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$169.83
|
| Rate for Payer: UHC Exchange |
$334.11
|
| Rate for Payer: UHC Medicaid |
$109.48
|
| Rate for Payer: UHCCP Medicaid |
$109.48
|
| Rate for Payer: UMR Bronson Commercial |
$201.48
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
NDC 60687050601
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Aetna American Axle |
$195.00
|
| Rate for Payer: Aetna Commercial |
$255.00
|
| Rate for Payer: Aetna Medicare |
$150.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Advantage |
$210.00
|
| Rate for Payer: Cofinity Commercial |
$258.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.00
|
| Rate for Payer: Healthscope Commercial |
$270.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$240.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PHP Commercial |
$255.00
|
| Rate for Payer: Priority Health SBD |
$189.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.00
|
| Rate for Payer: UHC Core |
$156.30
|
| Rate for Payer: UHC Exchange |
$117.90
|
| Rate for Payer: UMR Bronson Commercial |
$111.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.00
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$203.04
|
|
|
Service Code
|
NDC 67877046590
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.34 |
| Max. Negotiated Rate |
$182.74 |
| Rate for Payer: Aetna American Axle |
$131.98
|
| Rate for Payer: Aetna Commercial |
$172.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.98
|
| Rate for Payer: Cash Price |
$162.43
|
| Rate for Payer: Cofinity Advantage |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$174.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.43
|
| Rate for Payer: Healthscope Commercial |
$182.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.28
|
| Rate for Payer: PHP Commercial |
$172.58
|
| Rate for Payer: Priority Health SBD |
$127.92
|
| Rate for Payer: UMR Bronson Commercial |
$89.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.28
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$179.78
|
|
|
Service Code
|
NDC 64980041309
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna Medicare |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: BCBS Complete |
$71.91
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Advantage |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.82
|
| Rate for Payer: Healthscope Commercial |
$161.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.84
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.86
|
| Rate for Payer: UHC Core |
$93.67
|
| Rate for Payer: UHC Exchange |
$70.65
|
| Rate for Payer: UMR Bronson Commercial |
$66.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687050611
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna American Axle |
$1.95
|
| Rate for Payer: Aetna Commercial |
$2.55
|
| Rate for Payer: Aetna Medicare |
$1.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.95
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Advantage |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$2.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: PHP Commercial |
$2.55
|
| Rate for Payer: Priority Health SBD |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.95
|
| Rate for Payer: UHC Core |
$1.56
|
| Rate for Payer: UHC Exchange |
$1.18
|
| Rate for Payer: UMR Bronson Commercial |
$1.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.25
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687050611
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Aetna American Axle |
$1.95
|
| Rate for Payer: Aetna Commercial |
$2.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.95
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cofinity Advantage |
$2.10
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.40
|
| Rate for Payer: Healthscope Commercial |
$2.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.25
|
| Rate for Payer: PHP Commercial |
$2.55
|
| Rate for Payer: Priority Health SBD |
$1.89
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.25
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$203.04
|
|
|
Service Code
|
NDC 67877046590
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.12 |
| Max. Negotiated Rate |
$182.74 |
| Rate for Payer: Aetna American Axle |
$131.98
|
| Rate for Payer: Aetna Commercial |
$172.58
|
| Rate for Payer: Aetna Medicare |
$101.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.98
|
| Rate for Payer: BCBS Complete |
$81.22
|
| Rate for Payer: Cash Price |
$162.43
|
| Rate for Payer: Cofinity Advantage |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$174.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.43
|
| Rate for Payer: Healthscope Commercial |
$182.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.28
|
| Rate for Payer: PHP Commercial |
$172.58
|
| Rate for Payer: Priority Health SBD |
$127.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.98
|
| Rate for Payer: UHC Core |
$105.78
|
| Rate for Payer: UHC Exchange |
$79.79
|
| Rate for Payer: UMR Bronson Commercial |
$75.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.28
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
OP
|
$272.84
|
|
|
Service Code
|
NDC 00228285909
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.95 |
| Max. Negotiated Rate |
$245.56 |
| Rate for Payer: Aetna American Axle |
$177.35
|
| Rate for Payer: Aetna Commercial |
$231.91
|
| Rate for Payer: Aetna Medicare |
$136.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.35
|
| Rate for Payer: BCBS Complete |
$109.14
|
| Rate for Payer: Cash Price |
$218.27
|
| Rate for Payer: Cofinity Advantage |
$190.99
|
| Rate for Payer: Cofinity Commercial |
$234.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.27
|
| Rate for Payer: Healthscope Commercial |
$245.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.63
|
| Rate for Payer: PHP Commercial |
$231.91
|
| Rate for Payer: Priority Health SBD |
$171.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.35
|
| Rate for Payer: UHC Core |
$142.15
|
| Rate for Payer: UHC Exchange |
$107.23
|
| Rate for Payer: UMR Bronson Commercial |
$100.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.63
|
|
|
PREGABALIN 100 MG CAPSULE
|
Facility
|
IP
|
$179.78
|
|
|
Service Code
|
NDC 64980041309
|
| Hospital Charge Code |
42165
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Advantage |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.82
|
| Rate for Payer: Healthscope Commercial |
$161.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.84
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UMR Bronson Commercial |
$79.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
