|
PR IMM ADMN SARSCOV2 BIVALENT 30 MCG/0.3 ML 1 DOSE
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0121A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR IMM ADMN SARSCOV2 BIVALENT 30 MCG/0.3 ML ADDL
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0124A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$122.97 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$122.97
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR IMM ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML 1ST
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0171A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR IMM ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML 2ND
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0172A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR IMM ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML 3RD
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0173A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$2,756.25 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,756.25
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR IMM ADMN SARSCOV2 BIVALENT 3 MCG/0.2 ML ADDL
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0174A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR IMM ADMN SARSCOV2 BIVALENT 50 MCG/0.5 ML ADDL
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0134A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$1,882.66 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,882.66
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR IMM ADMN SARSCOV2 VACCINE SINGLE DOSE
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 90480
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$58.80 |
| Rate for Payer: Aetna Commercial |
$40.00
|
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.00
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.80
|
| Rate for Payer: Priority Health Narrow Network |
$58.80
|
| Rate for Payer: Priority Health SBD |
$58.80
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
|
|
PR IMMUNIZE COUNS < 21YR 5-15 M
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0312
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR IMMUNIZE COUNS < 21YR 6-30 M
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS G0313
|
| 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 IMMUNIZE COUNSEL 16-30 MINS
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS G0311
|
| 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 IMMUNIZE COUNSEL 5-15 MIN
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS G0310
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR IMPL ABSRB MESH/PRSTH DLYD CLSR DFCT INFCTJ/TRMA
|
Professional
|
Both
|
$802.00
|
|
|
Service Code
|
HCPCS 15778
|
| Min. Negotiated Rate |
$250.49 |
| Max. Negotiated Rate |
$559.05 |
| Rate for Payer: Aetna Commercial |
$511.09
|
| Rate for Payer: Aetna Medicare |
$396.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$549.23
|
| Rate for Payer: BCBS Complete |
$263.01
|
| Rate for Payer: BCBS MAPPO |
$381.41
|
| Rate for Payer: BCN Commercial |
$559.05
|
| Rate for Payer: BCN Medicare Advantage |
$381.41
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cash Price |
$641.60
|
| Rate for Payer: Cofinity Commercial |
$549.23
|
| Rate for Payer: Cofinity Commercial |
$511.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$381.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$400.48
|
| Rate for Payer: Meridian Medicaid |
$263.01
|
| Rate for Payer: Nomi Health Commercial |
$457.69
|
| Rate for Payer: PACE SWMI |
$381.41
|
| Rate for Payer: PHP Commercial |
$533.97
|
| Rate for Payer: PHP Medicare Advantage |
$381.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$250.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.79
|
| Rate for Payer: Priority Health Medicare |
$381.41
|
| Rate for Payer: Priority Health Narrow Network |
$518.79
|
| Rate for Payer: Priority Health SBD |
$518.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$381.41
|
| Rate for Payer: UHC Medicare Advantage |
$381.41
|
| Rate for Payer: UHCCP Medicaid |
$250.49
|
| Rate for Payer: UMR Bronson Commercial |
$368.92
|
|
|
PR IMPLANTABLE TISSUE MARKER
|
Professional
|
Both
|
$1,224.00
|
|
|
Service Code
|
HCPCS A4648
|
| Min. Negotiated Rate |
$102.14 |
| Max. Negotiated Rate |
$795.60 |
| Rate for Payer: Aetna Commercial |
$102.14
|
| Rate for Payer: Aetna Medicare |
$612.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.14
|
| Rate for Payer: BCBS Complete |
$489.60
|
| Rate for Payer: BCN Commercial |
$136.96
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$795.60
|
| Rate for Payer: UMR Bronson Commercial |
$563.04
|
|
|
PR IMPLANTATION NERVE END BONE/MUSCLE
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 64787
|
| Min. Negotiated Rate |
$136.83 |
| Max. Negotiated Rate |
$1,204.45 |
| Rate for Payer: Aetna Commercial |
$302.42
|
| Rate for Payer: Aetna Medicare |
$234.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$324.99
|
| Rate for Payer: BCBS Complete |
$157.23
|
| Rate for Payer: BCBS MAPPO |
$225.69
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: BCN Commercial |
$341.58
|
| Rate for Payer: BCN Medicare Advantage |
$225.69
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$302.42
|
| Rate for Payer: Cofinity Commercial |
$324.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.97
|
| Rate for Payer: Meridian Medicaid |
$157.23
|
| Rate for Payer: Nomi Health Commercial |
$270.83
|
| Rate for Payer: PACE SWMI |
$225.69
|
| Rate for Payer: PHP Commercial |
$315.97
|
| Rate for Payer: PHP Medicare Advantage |
$225.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.70
|
| Rate for Payer: Priority Health Medicare |
$225.69
|
| Rate for Payer: Priority Health Narrow Network |
$394.70
|
| Rate for Payer: Priority Health SBD |
$394.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.69
|
| Rate for Payer: UHC Medicare Advantage |
$225.69
|
| Rate for Payer: UHCCP Medicaid |
$149.74
|
| Rate for Payer: UMR Bronson Commercial |
$852.38
|
|
|
PR IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 33282
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Aetna Medicare |
$315.00
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: UMR Bronson Commercial |
$289.80
|
|
|
PR IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE
|
Professional
|
Both
|
$1,010.00
|
|
|
Service Code
|
HCPCS 49568
|
| Min. Negotiated Rate |
$404.00 |
| Max. Negotiated Rate |
$656.50 |
| Rate for Payer: Aetna Medicare |
$505.00
|
| Rate for Payer: BCBS Complete |
$404.00
|
| Rate for Payer: Cash Price |
$808.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$656.50
|
| Rate for Payer: UMR Bronson Commercial |
$464.60
|
|
|
PR IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 15777
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$311.29 |
| Rate for Payer: Aetna Commercial |
$275.42
|
| Rate for Payer: Aetna Medicare |
$213.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.98
|
| Rate for Payer: BCBS Complete |
$143.59
|
| Rate for Payer: BCBS MAPPO |
$205.54
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: BCN Commercial |
$311.29
|
| Rate for Payer: BCN Medicare Advantage |
$205.54
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cofinity Commercial |
$275.42
|
| Rate for Payer: Cofinity Commercial |
$295.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$215.82
|
| Rate for Payer: Meridian Medicaid |
$143.59
|
| Rate for Payer: Nomi Health Commercial |
$246.65
|
| Rate for Payer: PACE SWMI |
$205.54
|
| Rate for Payer: PHP Commercial |
$287.76
|
| Rate for Payer: PHP Medicare Advantage |
$205.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$287.61
|
| Rate for Payer: Priority Health Medicare |
$205.54
|
| Rate for Payer: Priority Health Narrow Network |
$287.61
|
| Rate for Payer: Priority Health SBD |
$287.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.54
|
| Rate for Payer: UHC Medicare Advantage |
$205.54
|
| Rate for Payer: UHCCP Medicaid |
$136.75
|
| Rate for Payer: UMR Bronson Commercial |
$206.08
|
|
|
PR IMPL OI IMPLT SKULL MAG TC ATTACHMENT ESP<100
|
Professional
|
Both
|
$1,343.00
|
|
|
Service Code
|
HCPCS 69716
|
| Min. Negotiated Rate |
$176.45 |
| Max. Negotiated Rate |
$910.40 |
| Rate for Payer: Aetna Commercial |
$787.60
|
| Rate for Payer: Aetna Medicare |
$611.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$787.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$846.37
|
| Rate for Payer: BCBS Complete |
$418.00
|
| Rate for Payer: BCBS MAPPO |
$587.76
|
| Rate for Payer: BCBS Trust/PPO |
$176.45
|
| Rate for Payer: BCN Commercial |
$910.40
|
| Rate for Payer: BCN Medicare Advantage |
$587.76
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cash Price |
$1,074.40
|
| Rate for Payer: Cofinity Commercial |
$787.60
|
| Rate for Payer: Cofinity Commercial |
$846.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$587.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$617.15
|
| Rate for Payer: Meridian Medicaid |
$418.00
|
| Rate for Payer: Nomi Health Commercial |
$705.31
|
| Rate for Payer: PACE SWMI |
$587.76
|
| Rate for Payer: PHP Commercial |
$822.86
|
| Rate for Payer: PHP Medicare Advantage |
$587.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$908.55
|
| Rate for Payer: Priority Health Medicare |
$587.76
|
| Rate for Payer: Priority Health Narrow Network |
$908.55
|
| Rate for Payer: Priority Health SBD |
$908.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$587.76
|
| Rate for Payer: UHC Medicare Advantage |
$587.76
|
| Rate for Payer: UHCCP Medicaid |
$398.10
|
| Rate for Payer: UMR Bronson Commercial |
$617.78
|
|
|
PR IMPL OI IMPLT SKULL PERQ ATTACHMENT ESP
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
HCPCS 69714
|
| Min. Negotiated Rate |
$318.01 |
| Max. Negotiated Rate |
$3,343.08 |
| Rate for Payer: Aetna Commercial |
$626.44
|
| Rate for Payer: Aetna Medicare |
$486.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$626.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$673.19
|
| Rate for Payer: BCBS Complete |
$333.91
|
| Rate for Payer: BCBS MAPPO |
$467.49
|
| Rate for Payer: BCBS Trust/PPO |
$3,343.08
|
| Rate for Payer: BCN Commercial |
$725.20
|
| Rate for Payer: BCN Medicare Advantage |
$467.49
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cash Price |
$1,562.40
|
| Rate for Payer: Cofinity Commercial |
$626.44
|
| Rate for Payer: Cofinity Commercial |
$673.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$467.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$490.86
|
| Rate for Payer: Meridian Medicaid |
$333.91
|
| Rate for Payer: Nomi Health Commercial |
$560.99
|
| Rate for Payer: PACE SWMI |
$467.49
|
| Rate for Payer: PHP Commercial |
$654.49
|
| Rate for Payer: PHP Medicare Advantage |
$467.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$318.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,269.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$726.15
|
| Rate for Payer: Priority Health Medicare |
$467.49
|
| Rate for Payer: Priority Health Narrow Network |
$726.15
|
| Rate for Payer: Priority Health SBD |
$726.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$467.49
|
| Rate for Payer: UHC Medicare Advantage |
$467.49
|
| Rate for Payer: UHCCP Medicaid |
$318.01
|
| Rate for Payer: UMR Bronson Commercial |
$898.38
|
|
|
PR IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT
|
Professional
|
Both
|
$419.00
|
|
|
Service Code
|
HCPCS 61517
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$975.77 |
| Rate for Payer: Aetna Commercial |
$116.15
|
| Rate for Payer: Aetna Medicare |
$90.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.82
|
| Rate for Payer: BCBS Complete |
$59.04
|
| Rate for Payer: BCBS MAPPO |
$86.68
|
| Rate for Payer: BCBS Trust/PPO |
$975.77
|
| Rate for Payer: BCN Commercial |
$127.06
|
| Rate for Payer: BCN Medicare Advantage |
$86.68
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cofinity Commercial |
$124.82
|
| Rate for Payer: Cofinity Commercial |
$116.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.01
|
| Rate for Payer: Meridian Medicaid |
$59.04
|
| Rate for Payer: Nomi Health Commercial |
$104.02
|
| Rate for Payer: PACE SWMI |
$86.68
|
| Rate for Payer: PHP Commercial |
$121.35
|
| Rate for Payer: PHP Medicare Advantage |
$86.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.00
|
| Rate for Payer: Priority Health Medicare |
$86.68
|
| Rate for Payer: Priority Health Narrow Network |
$149.00
|
| Rate for Payer: Priority Health SBD |
$149.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.68
|
| Rate for Payer: UHC Medicare Advantage |
$86.68
|
| Rate for Payer: UHCCP Medicaid |
$56.23
|
| Rate for Payer: UMR Bronson Commercial |
$192.74
|
|
|
PR IMPLTJ NONBIOL/SYNTH IMPLT FASC RNFCMT ABDL WALL
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 0437T
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$318.50 |
| Rate for Payer: Aetna Commercial |
$294.80
|
| Rate for Payer: Aetna Medicare |
$245.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.80
|
| Rate for Payer: BCBS Complete |
$196.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: UMR Bronson Commercial |
$225.40
|
|
|
PR IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
HCPCS 62350
|
| Min. Negotiated Rate |
$258.58 |
| Max. Negotiated Rate |
$1,703.77 |
| Rate for Payer: Aetna Commercial |
$516.68
|
| Rate for Payer: Aetna Medicare |
$401.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.24
|
| Rate for Payer: BCBS Complete |
$271.51
|
| Rate for Payer: BCBS MAPPO |
$385.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.77
|
| Rate for Payer: BCN Commercial |
$581.53
|
| Rate for Payer: BCN Medicare Advantage |
$385.58
|
| Rate for Payer: Cash Price |
$656.80
|
| Rate for Payer: Cash Price |
$656.80
|
| Rate for Payer: Cofinity Commercial |
$516.68
|
| Rate for Payer: Cofinity Commercial |
$555.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$385.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$404.86
|
| Rate for Payer: Meridian Medicaid |
$271.51
|
| Rate for Payer: Nomi Health Commercial |
$462.70
|
| Rate for Payer: PACE SWMI |
$385.58
|
| Rate for Payer: PHP Commercial |
$539.81
|
| Rate for Payer: PHP Medicare Advantage |
$385.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$258.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$533.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$684.73
|
| Rate for Payer: Priority Health Medicare |
$385.58
|
| Rate for Payer: Priority Health Narrow Network |
$684.73
|
| Rate for Payer: Priority Health SBD |
$684.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$385.58
|
| Rate for Payer: UHC Medicare Advantage |
$385.58
|
| Rate for Payer: UHCCP Medicaid |
$258.58
|
| Rate for Payer: UMR Bronson Commercial |
$377.66
|
|
|
PR IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP
|
Professional
|
Both
|
$2,526.00
|
|
|
Service Code
|
HCPCS 62362
|
| Min. Negotiated Rate |
$250.06 |
| Max. Negotiated Rate |
$1,641.90 |
| Rate for Payer: Aetna Commercial |
$499.94
|
| Rate for Payer: Aetna Medicare |
$388.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$499.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$537.25
|
| Rate for Payer: BCBS Complete |
$262.56
|
| Rate for Payer: BCBS MAPPO |
$373.09
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: BCN Commercial |
$564.43
|
| Rate for Payer: BCN Medicare Advantage |
$373.09
|
| Rate for Payer: Cash Price |
$2,020.80
|
| Rate for Payer: Cash Price |
$2,020.80
|
| Rate for Payer: Cofinity Commercial |
$499.94
|
| Rate for Payer: Cofinity Commercial |
$537.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$373.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$391.74
|
| Rate for Payer: Meridian Medicaid |
$262.56
|
| Rate for Payer: Nomi Health Commercial |
$447.71
|
| Rate for Payer: PACE SWMI |
$373.09
|
| Rate for Payer: PHP Commercial |
$522.33
|
| Rate for Payer: PHP Medicare Advantage |
$373.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$250.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,641.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$664.26
|
| Rate for Payer: Priority Health Medicare |
$373.09
|
| Rate for Payer: Priority Health Narrow Network |
$664.26
|
| Rate for Payer: Priority Health SBD |
$664.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$373.09
|
| Rate for Payer: UHC Medicare Advantage |
$373.09
|
| Rate for Payer: UHCCP Medicaid |
$250.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,161.96
|
|
|
PR IMPREG GAUZE NO H20/SAL/YARD
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS A6266
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCN Commercial |
$2.11
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
|
