|
PR DESTRUCTION VAGINAL LESIONS SIMPLE
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
HCPCS 57061
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$2,929.42 |
| Rate for Payer: Aetna Commercial |
$145.20
|
| Rate for Payer: Aetna Medicare |
$112.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.04
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS MAPPO |
$108.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,929.42
|
| Rate for Payer: BCN Commercial |
$199.08
|
| Rate for Payer: BCN Medicare Advantage |
$108.36
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$145.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.78
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Nomi Health Commercial |
$130.03
|
| Rate for Payer: PACE SWMI |
$108.36
|
| Rate for Payer: PHP Commercial |
$151.70
|
| Rate for Payer: PHP Medicare Advantage |
$108.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$173.62
|
| Rate for Payer: Priority Health Medicare |
$108.36
|
| Rate for Payer: Priority Health Narrow Network |
$173.62
|
| Rate for Payer: Priority Health SBD |
$173.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.36
|
| Rate for Payer: UHC Medicare Advantage |
$108.36
|
| Rate for Payer: UHCCP Medicaid |
$74.34
|
| Rate for Payer: UMR Bronson Commercial |
$166.52
|
|
|
PR DETERMINATION REFRACTIVE STATE
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 92015
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$1,164.90 |
| Rate for Payer: Aetna Commercial |
$21.33
|
| Rate for Payer: Aetna Medicare |
$48.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.33
|
| Rate for Payer: BCBS Complete |
$12.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,164.90
|
| Rate for Payer: BCN Commercial |
$20.42
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Meridian Medicaid |
$12.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.84
|
| Rate for Payer: Priority Health Narrow Network |
$22.84
|
| Rate for Payer: Priority Health SBD |
$22.84
|
| Rate for Payer: UHCCP Medicaid |
$11.72
|
| Rate for Payer: UMR Bronson Commercial |
$44.16
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 96110
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$974.19 |
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.35
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$974.19
|
| Rate for Payer: BCN Commercial |
$15.64
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.83
|
| Rate for Payer: Priority Health Narrow Network |
$15.83
|
| Rate for Payer: Priority Health SBD |
$15.83
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
PR DEVELOPMENTAL TESTING W/INTERP & REPORT
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 96111
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: UMR Bronson Commercial |
$111.32
|
|
|
PR DEXAMETHASONE SODIUM PHOS
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1100
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$0.16
|
| Rate for Payer: Aetna Medicare |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.16
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$0.12
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.12
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$0.17
|
| Rate for Payer: Cofinity Commercial |
$0.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.12
|
| Rate for Payer: Nomi Health Commercial |
$0.14
|
| Rate for Payer: PACE SWMI |
$0.12
|
| Rate for Payer: PHP Commercial |
$0.17
|
| Rate for Payer: PHP Medicare Advantage |
$0.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$0.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.12
|
| Rate for Payer: UHC Medicare Advantage |
$0.12
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR DIABETES PREVENTION PROGRAM
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 00268
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
PR DIABETES PREVENTION PROG STANDARDIZED CURRICULUM
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 0403T
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$131.11 |
| Rate for Payer: Aetna Commercial |
$32.06
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.06
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$131.11
|
| Rate for Payer: BCN Commercial |
$58.68
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$1,294.00
|
|
|
Service Code
|
HCPCS 29805
|
| Min. Negotiated Rate |
$308.64 |
| Max. Negotiated Rate |
$841.10 |
| Rate for Payer: Aetna Commercial |
$608.83
|
| Rate for Payer: Aetna Medicare |
$472.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.26
|
| Rate for Payer: BCBS Complete |
$324.07
|
| Rate for Payer: BCBS MAPPO |
$454.35
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$692.46
|
| Rate for Payer: BCN Medicare Advantage |
$454.35
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cash Price |
$1,035.20
|
| Rate for Payer: Cofinity Commercial |
$654.26
|
| Rate for Payer: Cofinity Commercial |
$608.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$454.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$477.07
|
| Rate for Payer: Meridian Medicaid |
$324.07
|
| Rate for Payer: Nomi Health Commercial |
$545.22
|
| Rate for Payer: PACE SWMI |
$454.35
|
| Rate for Payer: PHP Commercial |
$636.09
|
| Rate for Payer: PHP Medicare Advantage |
$454.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$308.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$725.64
|
| Rate for Payer: Priority Health Medicare |
$454.35
|
| Rate for Payer: Priority Health Narrow Network |
$725.64
|
| Rate for Payer: Priority Health SBD |
$725.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$454.35
|
| Rate for Payer: UHC Medicare Advantage |
$454.35
|
| Rate for Payer: UHCCP Medicaid |
$308.64
|
| Rate for Payer: UMR Bronson Commercial |
$595.24
|
|
|
PR DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 38220
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$437.96 |
| Rate for Payer: Aetna Commercial |
$85.13
|
| Rate for Payer: Aetna Medicare |
$66.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.48
|
| Rate for Payer: BCBS Complete |
$44.95
|
| Rate for Payer: BCBS MAPPO |
$63.53
|
| Rate for Payer: BCBS Trust/PPO |
$437.96
|
| Rate for Payer: BCN Commercial |
$226.75
|
| Rate for Payer: BCN Medicare Advantage |
$63.53
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$85.13
|
| Rate for Payer: Cofinity Commercial |
$91.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.71
|
| Rate for Payer: Meridian Medicaid |
$44.95
|
| Rate for Payer: Nomi Health Commercial |
$76.24
|
| Rate for Payer: PACE SWMI |
$63.53
|
| Rate for Payer: PHP Commercial |
$88.94
|
| Rate for Payer: PHP Medicare Advantage |
$63.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.48
|
| Rate for Payer: Priority Health Medicare |
$63.53
|
| Rate for Payer: Priority Health Narrow Network |
$132.48
|
| Rate for Payer: Priority Health SBD |
$132.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.53
|
| Rate for Payer: UHC Medicare Advantage |
$63.53
|
| Rate for Payer: UHCCP Medicaid |
$42.81
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS 38221
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$400.45 |
| Rate for Payer: Aetna Commercial |
$87.81
|
| Rate for Payer: Aetna Medicare |
$68.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.36
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS MAPPO |
$65.53
|
| Rate for Payer: BCBS Trust/PPO |
$400.45
|
| Rate for Payer: BCN Commercial |
$235.54
|
| Rate for Payer: BCN Medicare Advantage |
$65.53
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cash Price |
$293.60
|
| Rate for Payer: Cofinity Commercial |
$87.81
|
| Rate for Payer: Cofinity Commercial |
$94.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.81
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Nomi Health Commercial |
$78.64
|
| Rate for Payer: PACE SWMI |
$65.53
|
| Rate for Payer: PHP Commercial |
$91.74
|
| Rate for Payer: PHP Medicare Advantage |
$65.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.48
|
| Rate for Payer: Priority Health Medicare |
$65.53
|
| Rate for Payer: Priority Health Narrow Network |
$138.48
|
| Rate for Payer: Priority Health SBD |
$138.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.53
|
| Rate for Payer: UHC Medicare Advantage |
$65.53
|
| Rate for Payer: UHCCP Medicaid |
$44.09
|
| Rate for Payer: UMR Bronson Commercial |
$168.82
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 38222
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$367.17 |
| Rate for Payer: PACE SWMI |
$70.67
|
| Rate for Payer: Aetna Commercial |
$94.70
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$70.67
|
| Rate for Payer: BCBS Trust/PPO |
$367.17
|
| Rate for Payer: BCN Commercial |
$255.58
|
| Rate for Payer: BCN Medicare Advantage |
$70.67
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$101.76
|
| Rate for Payer: Cofinity Commercial |
$94.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.20
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Nomi Health Commercial |
$84.80
|
| Rate for Payer: PHP Commercial |
$98.94
|
| Rate for Payer: PHP Medicare Advantage |
$70.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.80
|
| Rate for Payer: Priority Health Medicare |
$70.67
|
| Rate for Payer: Priority Health Narrow Network |
$147.80
|
| Rate for Payer: Priority Health SBD |
$147.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.67
|
| Rate for Payer: UHC Medicare Advantage |
$70.67
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
| Rate for Payer: UMR Bronson Commercial |
$178.48
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
HCPCS 62270
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$874.34 |
| Rate for Payer: Aetna Commercial |
$84.10
|
| Rate for Payer: Aetna Medicare |
$65.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.37
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS MAPPO |
$62.76
|
| Rate for Payer: BCBS Trust/PPO |
$874.34
|
| Rate for Payer: BCN Commercial |
$194.49
|
| Rate for Payer: BCN Medicare Advantage |
$62.76
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cash Price |
$452.80
|
| Rate for Payer: Cofinity Commercial |
$84.10
|
| Rate for Payer: Cofinity Commercial |
$90.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.90
|
| Rate for Payer: Meridian Medicaid |
$43.17
|
| Rate for Payer: Nomi Health Commercial |
$75.31
|
| Rate for Payer: PACE SWMI |
$62.76
|
| Rate for Payer: PHP Commercial |
$87.86
|
| Rate for Payer: PHP Medicare Advantage |
$62.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.06
|
| Rate for Payer: Priority Health Medicare |
$62.76
|
| Rate for Payer: Priority Health Narrow Network |
$108.06
|
| Rate for Payer: Priority Health SBD |
$108.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.76
|
| Rate for Payer: UHC Medicare Advantage |
$62.76
|
| Rate for Payer: UHCCP Medicaid |
$41.11
|
| Rate for Payer: UMR Bronson Commercial |
$260.36
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 62328
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$1,578.56 |
| Rate for Payer: Aetna Commercial |
$108.39
|
| Rate for Payer: Aetna Medicare |
$84.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.48
|
| Rate for Payer: BCBS Complete |
$56.58
|
| Rate for Payer: BCBS MAPPO |
$80.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,578.56
|
| Rate for Payer: BCN Commercial |
$339.63
|
| Rate for Payer: BCN Medicare Advantage |
$80.89
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$108.39
|
| Rate for Payer: Cofinity Commercial |
$116.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.93
|
| Rate for Payer: Meridian Medicaid |
$56.58
|
| Rate for Payer: Nomi Health Commercial |
$97.07
|
| Rate for Payer: PACE SWMI |
$80.89
|
| Rate for Payer: PHP Commercial |
$113.25
|
| Rate for Payer: PHP Medicare Advantage |
$80.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$143.31
|
| Rate for Payer: Priority Health Medicare |
$80.89
|
| Rate for Payer: Priority Health Narrow Network |
$143.31
|
| Rate for Payer: Priority Health SBD |
$143.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.89
|
| Rate for Payer: UHC Medicare Advantage |
$80.89
|
| Rate for Payer: UHCCP Medicaid |
$53.89
|
| Rate for Payer: UMR Bronson Commercial |
$81.42
|
|
|
PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
|
Professional
|
Both
|
$1,542.00
|
|
|
Service Code
|
HCPCS 36909
|
| Min. Negotiated Rate |
$124.82 |
| Max. Negotiated Rate |
$2,818.21 |
| Rate for Payer: Aetna Commercial |
$254.77
|
| Rate for Payer: Aetna Medicare |
$197.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.79
|
| Rate for Payer: BCBS Complete |
$131.06
|
| Rate for Payer: BCBS MAPPO |
$190.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.28
|
| Rate for Payer: BCN Commercial |
$2,818.21
|
| Rate for Payer: BCN Medicare Advantage |
$190.13
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cash Price |
$1,233.60
|
| Rate for Payer: Cofinity Commercial |
$254.77
|
| Rate for Payer: Cofinity Commercial |
$273.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.64
|
| Rate for Payer: Meridian Medicaid |
$131.06
|
| Rate for Payer: Nomi Health Commercial |
$228.16
|
| Rate for Payer: PACE SWMI |
$190.13
|
| Rate for Payer: PHP Commercial |
$266.18
|
| Rate for Payer: PHP Medicare Advantage |
$190.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,002.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$311.11
|
| Rate for Payer: Priority Health Medicare |
$190.13
|
| Rate for Payer: Priority Health Narrow Network |
$311.11
|
| Rate for Payer: Priority Health SBD |
$311.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$190.13
|
| Rate for Payer: UHC Medicare Advantage |
$190.13
|
| Rate for Payer: UHCCP Medicaid |
$124.82
|
| Rate for Payer: UMR Bronson Commercial |
$709.32
|
|
|
PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 90945
|
| Min. Negotiated Rate |
$54.74 |
| Max. Negotiated Rate |
$370.34 |
| Rate for Payer: Aetna Commercial |
$108.63
|
| Rate for Payer: Aetna Medicare |
$84.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.74
|
| Rate for Payer: BCBS Complete |
$57.48
|
| Rate for Payer: BCBS MAPPO |
$81.07
|
| Rate for Payer: BCBS Trust/PPO |
$370.34
|
| Rate for Payer: BCN Commercial |
$123.15
|
| Rate for Payer: BCN Medicare Advantage |
$81.07
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$108.63
|
| Rate for Payer: Cofinity Commercial |
$116.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.12
|
| Rate for Payer: Meridian Medicaid |
$57.48
|
| Rate for Payer: Nomi Health Commercial |
$97.28
|
| Rate for Payer: PACE SWMI |
$81.07
|
| Rate for Payer: PHP Commercial |
$113.50
|
| Rate for Payer: PHP Medicare Advantage |
$81.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.89
|
| Rate for Payer: Priority Health Medicare |
$81.07
|
| Rate for Payer: Priority Health Narrow Network |
$114.89
|
| Rate for Payer: Priority Health SBD |
$114.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.07
|
| Rate for Payer: UHC Medicare Advantage |
$81.07
|
| Rate for Payer: UHCCP Medicaid |
$54.74
|
| Rate for Payer: UMR Bronson Commercial |
$96.14
|
|
|
PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 90947
|
| Min. Negotiated Rate |
$77.32 |
| Max. Negotiated Rate |
$319.62 |
| Rate for Payer: Aetna Commercial |
$154.98
|
| Rate for Payer: Aetna Medicare |
$120.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.55
|
| Rate for Payer: BCBS Complete |
$81.19
|
| Rate for Payer: BCBS MAPPO |
$115.66
|
| Rate for Payer: BCBS Trust/PPO |
$319.62
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: BCN Medicare Advantage |
$115.66
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$154.98
|
| Rate for Payer: Cofinity Commercial |
$166.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.44
|
| Rate for Payer: Meridian Medicaid |
$81.19
|
| Rate for Payer: Nomi Health Commercial |
$138.79
|
| Rate for Payer: PACE SWMI |
$115.66
|
| Rate for Payer: PHP Commercial |
$161.92
|
| Rate for Payer: PHP Medicare Advantage |
$115.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.74
|
| Rate for Payer: Priority Health Medicare |
$115.66
|
| Rate for Payer: Priority Health Narrow Network |
$163.74
|
| Rate for Payer: Priority Health SBD |
$163.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.66
|
| Rate for Payer: UHC Medicare Advantage |
$115.66
|
| Rate for Payer: UHCCP Medicaid |
$77.32
|
| Rate for Payer: UMR Bronson Commercial |
$152.72
|
|
|
PR DIAPHRAGM
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS A4266
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.28
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCN Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
| Rate for Payer: UMR Bronson Commercial |
$32.66
|
|
|
PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 57170
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$2,039.77 |
| Rate for Payer: Aetna Commercial |
$61.40
|
| Rate for Payer: Aetna Medicare |
$47.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.98
|
| Rate for Payer: BCBS Complete |
$31.76
|
| Rate for Payer: BCBS MAPPO |
$45.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,039.77
|
| Rate for Payer: BCN Commercial |
$115.33
|
| Rate for Payer: BCN Medicare Advantage |
$45.82
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$61.40
|
| Rate for Payer: Cofinity Commercial |
$65.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.11
|
| Rate for Payer: Meridian Medicaid |
$31.76
|
| Rate for Payer: Nomi Health Commercial |
$54.98
|
| Rate for Payer: PACE SWMI |
$45.82
|
| Rate for Payer: PHP Commercial |
$64.15
|
| Rate for Payer: PHP Medicare Advantage |
$45.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.95
|
| Rate for Payer: Priority Health Medicare |
$45.82
|
| Rate for Payer: Priority Health Narrow Network |
$69.95
|
| Rate for Payer: Priority Health SBD |
$69.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.82
|
| Rate for Payer: UHC Medicare Advantage |
$45.82
|
| Rate for Payer: UHCCP Medicaid |
$30.25
|
| Rate for Payer: UMR Bronson Commercial |
$104.42
|
|
|
PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS 95957
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$505.70 |
| Rate for Payer: Aetna Commercial |
$352.82
|
| Rate for Payer: Aetna Medicare |
$273.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$379.15
|
| Rate for Payer: BCBS Complete |
$66.64
|
| Rate for Payer: BCBS MAPPO |
$263.30
|
| Rate for Payer: BCBS Trust/PPO |
$346.56
|
| Rate for Payer: BCN Commercial |
$401.69
|
| Rate for Payer: BCN Medicare Advantage |
$263.30
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cofinity Commercial |
$352.82
|
| Rate for Payer: Cofinity Commercial |
$379.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$263.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$276.46
|
| Rate for Payer: Meridian Medicaid |
$66.64
|
| Rate for Payer: Nomi Health Commercial |
$315.96
|
| Rate for Payer: PACE SWMI |
$263.30
|
| Rate for Payer: PHP Commercial |
$368.62
|
| Rate for Payer: PHP Medicare Advantage |
$263.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$398.04
|
| Rate for Payer: Priority Health Medicare |
$263.30
|
| Rate for Payer: Priority Health Narrow Network |
$398.04
|
| Rate for Payer: Priority Health SBD |
$135.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.30
|
| Rate for Payer: UHC Medicare Advantage |
$263.30
|
| Rate for Payer: UHCCP Medicaid |
$63.47
|
| Rate for Payer: UMR Bronson Commercial |
$357.88
|
|
|
PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 45905
|
| Min. Negotiated Rate |
$110.33 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Aetna Commercial |
$218.49
|
| Rate for Payer: Aetna Medicare |
$169.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.79
|
| Rate for Payer: BCBS Complete |
$115.85
|
| Rate for Payer: BCBS MAPPO |
$163.05
|
| Rate for Payer: BCBS Trust/PPO |
$585.88
|
| Rate for Payer: BCN Commercial |
$249.22
|
| Rate for Payer: BCN Medicare Advantage |
$163.05
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$218.49
|
| Rate for Payer: Cofinity Commercial |
$234.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.20
|
| Rate for Payer: Meridian Medicaid |
$115.85
|
| Rate for Payer: Nomi Health Commercial |
$195.66
|
| Rate for Payer: PACE SWMI |
$163.05
|
| Rate for Payer: PHP Commercial |
$228.27
|
| Rate for Payer: PHP Medicare Advantage |
$163.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.65
|
| Rate for Payer: Priority Health Medicare |
$163.05
|
| Rate for Payer: Priority Health Narrow Network |
$306.65
|
| Rate for Payer: Priority Health SBD |
$306.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$163.05
|
| Rate for Payer: UHC Medicare Advantage |
$163.05
|
| Rate for Payer: UHCCP Medicaid |
$110.33
|
| Rate for Payer: UMR Bronson Commercial |
$165.14
|
|
|
PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
HCPCS 42660
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$1,102.03 |
| Rate for Payer: Aetna Commercial |
$100.55
|
| Rate for Payer: Aetna Medicare |
$78.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.06
|
| Rate for Payer: BCBS Complete |
$53.46
|
| Rate for Payer: BCBS MAPPO |
$75.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,102.03
|
| Rate for Payer: BCN Commercial |
$172.01
|
| Rate for Payer: BCN Medicare Advantage |
$75.04
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cofinity Commercial |
$100.55
|
| Rate for Payer: Cofinity Commercial |
$108.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.79
|
| Rate for Payer: Meridian Medicaid |
$53.46
|
| Rate for Payer: Nomi Health Commercial |
$90.05
|
| Rate for Payer: PACE SWMI |
$75.04
|
| Rate for Payer: PHP Commercial |
$105.06
|
| Rate for Payer: PHP Medicare Advantage |
$75.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.12
|
| Rate for Payer: Priority Health Medicare |
$75.04
|
| Rate for Payer: Priority Health Narrow Network |
$155.12
|
| Rate for Payer: Priority Health SBD |
$155.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.04
|
| Rate for Payer: UHC Medicare Advantage |
$75.04
|
| Rate for Payer: UHCCP Medicaid |
$50.91
|
| Rate for Payer: UMR Bronson Commercial |
$104.42
|
|
|
PR DILATE ESOPHAGUS,BALLOON RETROGRADE
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
HCPCS 43456
|
| Min. Negotiated Rate |
$331.20 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.20
|
| Rate for Payer: UMR Bronson Commercial |
$380.88
|
|
|
PR DILATE ESOPH,BALLN,>30MM ACHALASIA
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 43458
|
| Min. Negotiated Rate |
$411.60 |
| Max. Negotiated Rate |
$668.85 |
| Rate for Payer: Aetna Medicare |
$514.50
|
| Rate for Payer: BCBS Complete |
$411.60
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$668.85
|
| Rate for Payer: UMR Bronson Commercial |
$473.34
|
|
|
PR DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 53665
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$59.65 |
| Rate for Payer: Aetna Commercial |
$47.68
|
| Rate for Payer: Aetna Medicare |
$37.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.24
|
| Rate for Payer: BCBS Complete |
$24.82
|
| Rate for Payer: BCBS MAPPO |
$35.58
|
| Rate for Payer: BCN Commercial |
$54.73
|
| Rate for Payer: BCN Medicare Advantage |
$35.58
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$51.24
|
| Rate for Payer: Cofinity Commercial |
$47.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.36
|
| Rate for Payer: Meridian Medicaid |
$24.82
|
| Rate for Payer: Nomi Health Commercial |
$42.70
|
| Rate for Payer: PACE SWMI |
$35.58
|
| Rate for Payer: PHP Commercial |
$49.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.65
|
| Rate for Payer: Priority Health Medicare |
$35.58
|
| Rate for Payer: Priority Health Narrow Network |
$59.65
|
| Rate for Payer: Priority Health SBD |
$59.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.58
|
| Rate for Payer: UHC Medicare Advantage |
$35.58
|
| Rate for Payer: UHCCP Medicaid |
$23.64
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 53660
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$927.17 |
| Rate for Payer: Aetna Commercial |
$52.61
|
| Rate for Payer: Aetna Medicare |
$40.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.53
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$39.26
|
| Rate for Payer: BCBS Trust/PPO |
$927.17
|
| Rate for Payer: BCN Commercial |
$110.45
|
| Rate for Payer: BCN Medicare Advantage |
$39.26
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$52.61
|
| Rate for Payer: Cofinity Commercial |
$56.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.22
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Nomi Health Commercial |
$47.11
|
| Rate for Payer: PACE SWMI |
$39.26
|
| Rate for Payer: PHP Commercial |
$54.96
|
| Rate for Payer: PHP Medicare Advantage |
$39.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.05
|
| Rate for Payer: Priority Health Medicare |
$39.26
|
| Rate for Payer: Priority Health Narrow Network |
$66.05
|
| Rate for Payer: Priority Health SBD |
$66.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.26
|
| Rate for Payer: UHC Medicare Advantage |
$39.26
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
| Rate for Payer: UMR Bronson Commercial |
$66.24
|
|
