|
PR INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT
|
Professional
|
Both
|
$1,829.00
|
|
|
Service Code
|
HCPCS 59857
|
| Min. Negotiated Rate |
$373.82 |
| Max. Negotiated Rate |
$1,188.85 |
| Rate for Payer: Aetna Commercial |
$761.01
|
| Rate for Payer: Aetna Medicare |
$590.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.80
|
| Rate for Payer: BCBS Complete |
$392.51
|
| Rate for Payer: BCBS MAPPO |
$567.92
|
| Rate for Payer: BCBS Trust/PPO |
$756.53
|
| Rate for Payer: BCN Commercial |
$854.70
|
| Rate for Payer: BCN Medicare Advantage |
$567.92
|
| Rate for Payer: Cash Price |
$1,463.20
|
| Rate for Payer: Cash Price |
$1,463.20
|
| Rate for Payer: Cofinity Commercial |
$761.01
|
| Rate for Payer: Cofinity Commercial |
$817.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.32
|
| Rate for Payer: Meridian Medicaid |
$392.51
|
| Rate for Payer: Nomi Health Commercial |
$681.50
|
| Rate for Payer: PACE SWMI |
$567.92
|
| Rate for Payer: PHP Commercial |
$795.09
|
| Rate for Payer: PHP Medicare Advantage |
$567.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$373.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,188.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$818.34
|
| Rate for Payer: Priority Health Medicare |
$567.92
|
| Rate for Payer: Priority Health Narrow Network |
$818.34
|
| Rate for Payer: Priority Health SBD |
$818.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.92
|
| Rate for Payer: UHC Medicare Advantage |
$567.92
|
| Rate for Payer: UHCCP Medicaid |
$373.82
|
| Rate for Payer: UMR Bronson Commercial |
$841.34
|
|
|
PR INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 59855
|
| Min. Negotiated Rate |
$274.13 |
| Max. Negotiated Rate |
$1,169.13 |
| Rate for Payer: Aetna Commercial |
$555.15
|
| Rate for Payer: Aetna Medicare |
$430.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$555.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.58
|
| Rate for Payer: BCBS Complete |
$287.84
|
| Rate for Payer: BCBS MAPPO |
$414.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,169.13
|
| Rate for Payer: BCN Commercial |
$627.46
|
| Rate for Payer: BCN Medicare Advantage |
$414.29
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$555.15
|
| Rate for Payer: Cofinity Commercial |
$596.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$435.00
|
| Rate for Payer: Meridian Medicaid |
$287.84
|
| Rate for Payer: Nomi Health Commercial |
$497.15
|
| Rate for Payer: PACE SWMI |
$414.29
|
| Rate for Payer: PHP Commercial |
$580.01
|
| Rate for Payer: PHP Medicare Advantage |
$414.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$600.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$601.76
|
| Rate for Payer: Priority Health Medicare |
$414.29
|
| Rate for Payer: Priority Health Narrow Network |
$601.76
|
| Rate for Payer: Priority Health SBD |
$601.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$414.29
|
| Rate for Payer: UHC Medicare Advantage |
$414.29
|
| Rate for Payer: UHCCP Medicaid |
$274.13
|
| Rate for Payer: UMR Bronson Commercial |
$425.04
|
|
|
PR INDUCED ABORTION DILATION AND CURETTAGE
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 59840
|
| Min. Negotiated Rate |
$142.71 |
| Max. Negotiated Rate |
$1,030.71 |
| Rate for Payer: Aetna Commercial |
$286.40
|
| Rate for Payer: Aetna Medicare |
$222.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.77
|
| Rate for Payer: BCBS Complete |
$149.85
|
| Rate for Payer: BCBS MAPPO |
$213.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,030.71
|
| Rate for Payer: BCN Commercial |
$369.44
|
| Rate for Payer: BCN Medicare Advantage |
$213.73
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$286.40
|
| Rate for Payer: Cofinity Commercial |
$307.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$213.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$224.42
|
| Rate for Payer: Meridian Medicaid |
$149.85
|
| Rate for Payer: Nomi Health Commercial |
$256.48
|
| Rate for Payer: PACE SWMI |
$213.73
|
| Rate for Payer: PHP Commercial |
$299.22
|
| Rate for Payer: PHP Medicare Advantage |
$213.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.85
|
| Rate for Payer: Priority Health Medicare |
$213.73
|
| Rate for Payer: Priority Health Narrow Network |
$314.85
|
| Rate for Payer: Priority Health SBD |
$314.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$213.73
|
| Rate for Payer: UHC Medicare Advantage |
$213.73
|
| Rate for Payer: UHCCP Medicaid |
$142.71
|
| Rate for Payer: UMR Bronson Commercial |
$370.76
|
|
|
PR INDUCED ABORTION DILATION & EVACUATION
|
Professional
|
Both
|
$847.00
|
|
|
Service Code
|
HCPCS 59841
|
| Min. Negotiated Rate |
$240.69 |
| Max. Negotiated Rate |
$953.58 |
| Rate for Payer: Aetna Commercial |
$487.53
|
| Rate for Payer: Aetna Medicare |
$378.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.92
|
| Rate for Payer: BCBS Complete |
$252.72
|
| Rate for Payer: BCBS MAPPO |
$363.83
|
| Rate for Payer: BCBS Trust/PPO |
$953.58
|
| Rate for Payer: BCN Commercial |
$630.40
|
| Rate for Payer: BCN Medicare Advantage |
$363.83
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cofinity Commercial |
$487.53
|
| Rate for Payer: Cofinity Commercial |
$523.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$382.02
|
| Rate for Payer: Meridian Medicaid |
$252.72
|
| Rate for Payer: Nomi Health Commercial |
$436.60
|
| Rate for Payer: PACE SWMI |
$363.83
|
| Rate for Payer: PHP Commercial |
$509.36
|
| Rate for Payer: PHP Medicare Advantage |
$363.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$240.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$526.77
|
| Rate for Payer: Priority Health Medicare |
$363.83
|
| Rate for Payer: Priority Health Narrow Network |
$526.77
|
| Rate for Payer: Priority Health SBD |
$526.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.83
|
| Rate for Payer: UHC Medicare Advantage |
$363.83
|
| Rate for Payer: UHCCP Medicaid |
$240.69
|
| Rate for Payer: UMR Bronson Commercial |
$389.62
|
|
|
PR INDWELLING CATHETER SPECIAL
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS A4340
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCN Commercial |
$29.71
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR INFRATEMPO MID CRANIAL FOSSA W/WO DCOMPR&/MOBI
|
Professional
|
Both
|
$10,965.00
|
|
|
Service Code
|
HCPCS 61591
|
| Min. Negotiated Rate |
$366.64 |
| Max. Negotiated Rate |
$7,127.25 |
| Rate for Payer: Aetna Commercial |
$3,963.81
|
| Rate for Payer: Aetna Medicare |
$3,076.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,259.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,963.81
|
| Rate for Payer: BCBS Complete |
$2,073.91
|
| Rate for Payer: BCBS MAPPO |
$2,958.07
|
| Rate for Payer: BCBS Trust/PPO |
$366.64
|
| Rate for Payer: BCN Commercial |
$4,510.49
|
| Rate for Payer: BCN Medicare Advantage |
$2,958.07
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cash Price |
$8,772.00
|
| Rate for Payer: Cofinity Commercial |
$3,963.81
|
| Rate for Payer: Cofinity Commercial |
$4,259.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,958.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,105.97
|
| Rate for Payer: Meridian Medicaid |
$2,073.91
|
| Rate for Payer: Nomi Health Commercial |
$3,549.68
|
| Rate for Payer: PACE SWMI |
$2,958.07
|
| Rate for Payer: PHP Commercial |
$4,141.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,958.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,975.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,127.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,253.23
|
| Rate for Payer: Priority Health Medicare |
$2,958.07
|
| Rate for Payer: Priority Health Narrow Network |
$5,253.23
|
| Rate for Payer: Priority Health SBD |
$5,253.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,958.07
|
| Rate for Payer: UHC Medicare Advantage |
$2,958.07
|
| Rate for Payer: UHCCP Medicaid |
$1,975.15
|
| Rate for Payer: UMR Bronson Commercial |
$5,043.90
|
|
|
PR INFRATEMPORAL MID CRANIAL FOSSA W/WO DISARTICLTN
|
Professional
|
Both
|
$6,572.00
|
|
|
Service Code
|
HCPCS 61590
|
| Min. Negotiated Rate |
$514.56 |
| Max. Negotiated Rate |
$5,159.95 |
| Rate for Payer: Aetna Commercial |
$3,853.99
|
| Rate for Payer: Aetna Medicare |
$2,991.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,853.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,141.60
|
| Rate for Payer: BCBS Complete |
$2,022.92
|
| Rate for Payer: BCBS MAPPO |
$2,876.11
|
| Rate for Payer: BCBS Trust/PPO |
$514.56
|
| Rate for Payer: BCN Commercial |
$4,435.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,876.11
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Cash Price |
$5,257.60
|
| Rate for Payer: Cofinity Commercial |
$3,853.99
|
| Rate for Payer: Cofinity Commercial |
$4,141.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,876.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,019.92
|
| Rate for Payer: Meridian Medicaid |
$2,022.92
|
| Rate for Payer: Nomi Health Commercial |
$3,451.33
|
| Rate for Payer: PACE SWMI |
$2,876.11
|
| Rate for Payer: PHP Commercial |
$4,026.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,876.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,926.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,271.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,159.95
|
| Rate for Payer: Priority Health Medicare |
$2,876.11
|
| Rate for Payer: Priority Health Narrow Network |
$5,159.95
|
| Rate for Payer: Priority Health SBD |
$5,159.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,876.11
|
| Rate for Payer: UHC Medicare Advantage |
$2,876.11
|
| Rate for Payer: UHCCP Medicaid |
$1,926.59
|
| Rate for Payer: UMR Bronson Commercial |
$3,023.12
|
|
|
PR INGESTION CHALLENGE TEST EACH ADDL 60 MINUTES
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 95079
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$376.15 |
| Rate for Payer: Aetna Commercial |
$85.65
|
| Rate for Payer: Aetna Medicare |
$66.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.04
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS MAPPO |
$63.92
|
| Rate for Payer: BCBS Trust/PPO |
$376.15
|
| Rate for Payer: BCN Commercial |
$122.66
|
| Rate for Payer: BCN Medicare Advantage |
$63.92
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$85.65
|
| Rate for Payer: Cofinity Commercial |
$92.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.12
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Nomi Health Commercial |
$76.70
|
| Rate for Payer: PACE SWMI |
$63.92
|
| Rate for Payer: PHP Commercial |
$89.49
|
| Rate for Payer: PHP Medicare Advantage |
$63.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.05
|
| Rate for Payer: Priority Health Medicare |
$63.92
|
| Rate for Payer: Priority Health Narrow Network |
$92.05
|
| Rate for Payer: Priority Health SBD |
$92.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.92
|
| Rate for Payer: UHC Medicare Advantage |
$63.92
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
| Rate for Payer: UMR Bronson Commercial |
$78.20
|
|
|
PR INGESTION CHALLENGE TEST INITIAL 120 MINUTES
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 95076
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$262.04 |
| Rate for Payer: Aetna Commercial |
$92.84
|
| Rate for Payer: Aetna Medicare |
$72.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.76
|
| Rate for Payer: BCBS Complete |
$48.98
|
| Rate for Payer: BCBS MAPPO |
$69.28
|
| Rate for Payer: BCBS Trust/PPO |
$262.04
|
| Rate for Payer: BCN Commercial |
$175.93
|
| Rate for Payer: BCN Medicare Advantage |
$69.28
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$92.84
|
| Rate for Payer: Cofinity Commercial |
$99.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.74
|
| Rate for Payer: Meridian Medicaid |
$48.98
|
| Rate for Payer: Nomi Health Commercial |
$83.14
|
| Rate for Payer: PACE SWMI |
$69.28
|
| Rate for Payer: PHP Commercial |
$96.99
|
| Rate for Payer: PHP Medicare Advantage |
$69.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.83
|
| Rate for Payer: Priority Health Medicare |
$69.28
|
| Rate for Payer: Priority Health Narrow Network |
$99.83
|
| Rate for Payer: Priority Health SBD |
$99.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.28
|
| Rate for Payer: UHC Medicare Advantage |
$69.28
|
| Rate for Payer: UHCCP Medicaid |
$46.65
|
| Rate for Payer: UMR Bronson Commercial |
$111.78
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX
|
Professional
|
Both
|
$2,629.00
|
|
|
Service Code
|
HCPCS 38760
|
| Min. Negotiated Rate |
$539.10 |
| Max. Negotiated Rate |
$1,708.85 |
| Rate for Payer: Aetna Commercial |
$1,084.42
|
| Rate for Payer: Aetna Medicare |
$841.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,084.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,165.35
|
| Rate for Payer: BCBS Complete |
$566.06
|
| Rate for Payer: BCBS MAPPO |
$809.27
|
| Rate for Payer: BCBS Trust/PPO |
$689.96
|
| Rate for Payer: BCN Commercial |
$1,221.69
|
| Rate for Payer: BCN Medicare Advantage |
$809.27
|
| Rate for Payer: Cash Price |
$2,103.20
|
| Rate for Payer: Cash Price |
$2,103.20
|
| Rate for Payer: Cofinity Commercial |
$1,084.42
|
| Rate for Payer: Cofinity Commercial |
$1,165.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$809.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$849.73
|
| Rate for Payer: Meridian Medicaid |
$566.06
|
| Rate for Payer: Nomi Health Commercial |
$971.12
|
| Rate for Payer: PACE SWMI |
$809.27
|
| Rate for Payer: PHP Commercial |
$1,132.98
|
| Rate for Payer: PHP Medicare Advantage |
$809.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,708.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,675.70
|
| Rate for Payer: Priority Health Medicare |
$809.27
|
| Rate for Payer: Priority Health Narrow Network |
$1,675.70
|
| Rate for Payer: Priority Health SBD |
$1,675.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$809.27
|
| Rate for Payer: UHC Medicare Advantage |
$809.27
|
| Rate for Payer: UHCCP Medicaid |
$539.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,209.34
|
|
|
PR INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC
|
Professional
|
Both
|
$2,707.00
|
|
|
Service Code
|
HCPCS 38765
|
| Min. Negotiated Rate |
$524.60 |
| Max. Negotiated Rate |
$2,613.06 |
| Rate for Payer: Aetna Commercial |
$1,698.80
|
| Rate for Payer: Aetna Medicare |
$1,318.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,698.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,825.57
|
| Rate for Payer: BCBS Complete |
$884.54
|
| Rate for Payer: BCBS MAPPO |
$1,267.76
|
| Rate for Payer: BCBS Trust/PPO |
$524.60
|
| Rate for Payer: BCN Commercial |
$1,909.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,267.76
|
| Rate for Payer: Cash Price |
$2,165.60
|
| Rate for Payer: Cash Price |
$2,165.60
|
| Rate for Payer: Cofinity Commercial |
$1,825.57
|
| Rate for Payer: Cofinity Commercial |
$1,698.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,267.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,331.15
|
| Rate for Payer: Meridian Medicaid |
$884.54
|
| Rate for Payer: Nomi Health Commercial |
$1,521.31
|
| Rate for Payer: PACE SWMI |
$1,267.76
|
| Rate for Payer: PHP Commercial |
$1,774.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,267.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$842.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,759.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,613.06
|
| Rate for Payer: Priority Health Medicare |
$1,267.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,613.06
|
| Rate for Payer: Priority Health SBD |
$2,613.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,267.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,267.76
|
| Rate for Payer: UHCCP Medicaid |
$842.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,245.22
|
|
|
PR INHLJ BRNCL CHALLENGE TSTG W/HISTAMINE/METHACHOL
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 95070
|
| Min. Negotiated Rate |
$31.49 |
| Max. Negotiated Rate |
$302.19 |
| Rate for Payer: Aetna Commercial |
$42.20
|
| Rate for Payer: Aetna Medicare |
$32.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.35
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS MAPPO |
$31.49
|
| Rate for Payer: BCBS Trust/PPO |
$302.19
|
| Rate for Payer: BCN Commercial |
$50.33
|
| Rate for Payer: BCN Medicare Advantage |
$31.49
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$45.35
|
| Rate for Payer: Cofinity Commercial |
$42.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.06
|
| Rate for Payer: Nomi Health Commercial |
$37.79
|
| Rate for Payer: PACE SWMI |
$31.49
|
| Rate for Payer: PHP Commercial |
$44.09
|
| Rate for Payer: PHP Medicare Advantage |
$31.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.08
|
| Rate for Payer: Priority Health Medicare |
$31.49
|
| Rate for Payer: Priority Health Narrow Network |
$48.08
|
| Rate for Payer: Priority Health SBD |
$48.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.49
|
| Rate for Payer: UHC Medicare Advantage |
$31.49
|
| Rate for Payer: UMR Bronson Commercial |
$114.54
|
|
|
PR INITIAL FOOT EXAM PT LOPS
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS G0245
|
| Min. Negotiated Rate |
$37.35 |
| Max. Negotiated Rate |
$92.36 |
| Rate for Payer: Aetna Commercial |
$50.05
|
| Rate for Payer: Aetna Medicare |
$38.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.78
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS MAPPO |
$37.35
|
| Rate for Payer: BCBS Trust/PPO |
$90.34
|
| Rate for Payer: BCN Commercial |
$92.36
|
| Rate for Payer: BCN Medicare Advantage |
$37.35
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cofinity Commercial |
$53.78
|
| Rate for Payer: Cofinity Commercial |
$50.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.22
|
| Rate for Payer: Nomi Health Commercial |
$44.82
|
| Rate for Payer: PACE SWMI |
$37.35
|
| Rate for Payer: PHP Commercial |
$52.29
|
| Rate for Payer: PHP Medicare Advantage |
$37.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.13
|
| Rate for Payer: Priority Health Medicare |
$37.35
|
| Rate for Payer: Priority Health Narrow Network |
$44.13
|
| Rate for Payer: Priority Health SBD |
$44.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.35
|
| Rate for Payer: UHC Medicare Advantage |
$37.35
|
| Rate for Payer: UMR Bronson Commercial |
$45.08
|
|
|
PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL
|
Professional
|
Both
|
$1,065.00
|
|
|
Service Code
|
HCPCS 99477
|
| Min. Negotiated Rate |
$177.51 |
| Max. Negotiated Rate |
$692.25 |
| Rate for Payer: Aetna Commercial |
$427.84
|
| Rate for Payer: Aetna Medicare |
$332.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$459.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.84
|
| Rate for Payer: BCBS Complete |
$335.24
|
| Rate for Payer: BCBS MAPPO |
$319.28
|
| Rate for Payer: BCBS Trust/PPO |
$177.51
|
| Rate for Payer: BCN Commercial |
$489.17
|
| Rate for Payer: BCN Medicare Advantage |
$319.28
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cash Price |
$852.00
|
| Rate for Payer: Cofinity Commercial |
$459.76
|
| Rate for Payer: Cofinity Commercial |
$427.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.24
|
| Rate for Payer: Meridian Medicaid |
$335.24
|
| Rate for Payer: Nomi Health Commercial |
$383.14
|
| Rate for Payer: PACE SWMI |
$319.28
|
| Rate for Payer: PHP Commercial |
$446.99
|
| Rate for Payer: PHP Medicare Advantage |
$319.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$319.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$450.05
|
| Rate for Payer: Priority Health Medicare |
$319.28
|
| Rate for Payer: Priority Health Narrow Network |
$450.05
|
| Rate for Payer: Priority Health SBD |
$450.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.28
|
| Rate for Payer: UHC Medicare Advantage |
$319.28
|
| Rate for Payer: UHCCP Medicaid |
$319.28
|
| Rate for Payer: UMR Bronson Commercial |
$489.90
|
|
|
PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 99251
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Medicare |
$67.00
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
| Rate for Payer: UMR Bronson Commercial |
$61.64
|
|
|
PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS 99306
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$2,045.58 |
| Rate for Payer: Aetna Commercial |
$230.02
|
| Rate for Payer: Aetna Medicare |
$178.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.19
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: BCBS MAPPO |
$171.66
|
| Rate for Payer: BCBS Trust/PPO |
$2,045.58
|
| Rate for Payer: BCN Commercial |
$262.91
|
| Rate for Payer: BCN Medicare Advantage |
$171.66
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cash Price |
$200.80
|
| Rate for Payer: Cofinity Commercial |
$247.19
|
| Rate for Payer: Cofinity Commercial |
$230.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$171.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.24
|
| Rate for Payer: Meridian Medicaid |
$121.22
|
| Rate for Payer: Nomi Health Commercial |
$205.99
|
| Rate for Payer: PACE SWMI |
$171.66
|
| Rate for Payer: PHP Commercial |
$240.32
|
| Rate for Payer: PHP Medicare Advantage |
$171.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$243.20
|
| Rate for Payer: Priority Health Medicare |
$171.66
|
| Rate for Payer: Priority Health Narrow Network |
$243.20
|
| Rate for Payer: Priority Health SBD |
$243.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$171.66
|
| Rate for Payer: UHC Medicare Advantage |
$171.66
|
| Rate for Payer: UHCCP Medicaid |
$115.45
|
| Rate for Payer: UMR Bronson Commercial |
$115.46
|
|
|
PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 99305
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$1,949.96 |
| Rate for Payer: Aetna Commercial |
$168.22
|
| Rate for Payer: Aetna Medicare |
$130.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.78
|
| Rate for Payer: BCBS Complete |
$88.79
|
| Rate for Payer: BCBS MAPPO |
$125.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,949.96
|
| Rate for Payer: BCN Commercial |
$192.54
|
| Rate for Payer: BCN Medicare Advantage |
$125.54
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$168.22
|
| Rate for Payer: Cofinity Commercial |
$180.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.82
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Nomi Health Commercial |
$150.65
|
| Rate for Payer: PACE SWMI |
$125.54
|
| Rate for Payer: PHP Commercial |
$175.76
|
| Rate for Payer: PHP Medicare Advantage |
$125.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.13
|
| Rate for Payer: Priority Health Medicare |
$125.54
|
| Rate for Payer: Priority Health Narrow Network |
$178.13
|
| Rate for Payer: Priority Health SBD |
$178.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.54
|
| Rate for Payer: UHC Medicare Advantage |
$125.54
|
| Rate for Payer: UHCCP Medicaid |
$84.56
|
| Rate for Payer: UMR Bronson Commercial |
$90.62
|
|
|
PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 99304
|
| Min. Negotiated Rate |
$51.12 |
| Max. Negotiated Rate |
$2,272.22 |
| Rate for Payer: Aetna Commercial |
$101.92
|
| Rate for Payer: Aetna Medicare |
$79.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.53
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: BCBS MAPPO |
$76.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,272.22
|
| Rate for Payer: BCN Commercial |
$116.31
|
| Rate for Payer: BCN Medicare Advantage |
$76.06
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cofinity Commercial |
$101.92
|
| Rate for Payer: Cofinity Commercial |
$109.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.86
|
| Rate for Payer: Meridian Medicaid |
$53.68
|
| Rate for Payer: Nomi Health Commercial |
$91.27
|
| Rate for Payer: PACE SWMI |
$76.06
|
| Rate for Payer: PHP Commercial |
$106.48
|
| Rate for Payer: PHP Medicare Advantage |
$76.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.25
|
| Rate for Payer: Priority Health Medicare |
$76.06
|
| Rate for Payer: Priority Health Narrow Network |
$107.25
|
| Rate for Payer: Priority Health SBD |
$107.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.06
|
| Rate for Payer: UHC Medicare Advantage |
$76.06
|
| Rate for Payer: UHCCP Medicaid |
$51.12
|
| Rate for Payer: UMR Bronson Commercial |
$63.48
|
|
|
PR INITIAL OBSERVATION CARE/DAY 30 MINUTES
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 99218
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$98.15 |
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: UMR Bronson Commercial |
$69.46
|
|
|
PR INITIAL OBSERVATION CARE/DAY 50 MINUTES
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 99219
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$133.25 |
| Rate for Payer: Aetna Medicare |
$102.50
|
| Rate for Payer: BCBS Complete |
$82.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.25
|
| Rate for Payer: UMR Bronson Commercial |
$94.30
|
|
|
PR INITIAL OBSERVATION CARE/DAY 70 MINUTES
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 99220
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$182.65 |
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS
|
Professional
|
Both
|
$1,467.00
|
|
|
Service Code
|
HCPCS 99471
|
| Min. Negotiated Rate |
$288.45 |
| Max. Negotiated Rate |
$1,116.63 |
| Rate for Payer: Aetna Commercial |
$975.61
|
| Rate for Payer: Aetna Medicare |
$757.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,048.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$975.61
|
| Rate for Payer: BCBS Complete |
$764.47
|
| Rate for Payer: BCBS MAPPO |
$728.07
|
| Rate for Payer: BCBS Trust/PPO |
$288.45
|
| Rate for Payer: BCN Commercial |
$1,116.63
|
| Rate for Payer: BCN Medicare Advantage |
$728.07
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cash Price |
$1,173.60
|
| Rate for Payer: Cofinity Commercial |
$975.61
|
| Rate for Payer: Cofinity Commercial |
$1,048.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$728.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$764.47
|
| Rate for Payer: Meridian Medicaid |
$764.47
|
| Rate for Payer: Nomi Health Commercial |
$873.68
|
| Rate for Payer: PACE SWMI |
$728.07
|
| Rate for Payer: PHP Commercial |
$1,019.30
|
| Rate for Payer: PHP Medicare Advantage |
$728.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$728.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$953.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,029.36
|
| Rate for Payer: Priority Health Medicare |
$728.07
|
| Rate for Payer: Priority Health Narrow Network |
$1,029.36
|
| Rate for Payer: Priority Health SBD |
$1,029.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$728.07
|
| Rate for Payer: UHC Medicare Advantage |
$728.07
|
| Rate for Payer: UHCCP Medicaid |
$728.07
|
| Rate for Payer: UMR Bronson Commercial |
$674.82
|
|
|
PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
HCPCS 99475
|
| Min. Negotiated Rate |
$94.66 |
| Max. Negotiated Rate |
$807.95 |
| Rate for Payer: Aetna Commercial |
$708.82
|
| Rate for Payer: Aetna Medicare |
$550.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.72
|
| Rate for Payer: BCBS Complete |
$555.42
|
| Rate for Payer: BCBS MAPPO |
$528.97
|
| Rate for Payer: BCBS Trust/PPO |
$94.66
|
| Rate for Payer: BCN Commercial |
$804.85
|
| Rate for Payer: BCN Medicare Advantage |
$528.97
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cofinity Commercial |
$761.72
|
| Rate for Payer: Cofinity Commercial |
$708.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.42
|
| Rate for Payer: Meridian Medicaid |
$555.42
|
| Rate for Payer: Nomi Health Commercial |
$634.76
|
| Rate for Payer: PACE SWMI |
$528.97
|
| Rate for Payer: PHP Commercial |
$740.56
|
| Rate for Payer: PHP Medicare Advantage |
$528.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$528.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$807.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$741.72
|
| Rate for Payer: Priority Health Medicare |
$528.97
|
| Rate for Payer: Priority Health Narrow Network |
$741.72
|
| Rate for Payer: Priority Health SBD |
$741.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.97
|
| Rate for Payer: UHC Medicare Advantage |
$528.97
|
| Rate for Payer: UHCCP Medicaid |
$528.97
|
| Rate for Payer: UMR Bronson Commercial |
$571.78
|
|
|
PR INITIAL PREVENTIVE EXAM
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS G0402
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$1,427.47 |
| Rate for Payer: Aetna Commercial |
$165.45
|
| Rate for Payer: Aetna Medicare |
$128.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.80
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: BCBS MAPPO |
$123.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,427.47
|
| Rate for Payer: BCN Commercial |
$240.43
|
| Rate for Payer: BCN Medicare Advantage |
$123.47
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cofinity Commercial |
$177.80
|
| Rate for Payer: Cofinity Commercial |
$165.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.64
|
| Rate for Payer: Nomi Health Commercial |
$148.16
|
| Rate for Payer: PACE SWMI |
$123.47
|
| Rate for Payer: PHP Commercial |
$172.86
|
| Rate for Payer: PHP Medicare Advantage |
$123.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.05
|
| Rate for Payer: Priority Health Medicare |
$123.47
|
| Rate for Payer: Priority Health Narrow Network |
$171.05
|
| Rate for Payer: Priority Health SBD |
$171.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.47
|
| Rate for Payer: UHC Medicare Advantage |
$123.47
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 99381
|
| Min. Negotiated Rate |
$53.49 |
| Max. Negotiated Rate |
$275.77 |
| Rate for Payer: Aetna Commercial |
$78.23
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.23
|
| Rate for Payer: BCBS Complete |
$56.16
|
| Rate for Payer: BCBS Trust/PPO |
$275.77
|
| Rate for Payer: BCN Commercial |
$157.84
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Meridian Medicaid |
$56.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.94
|
| Rate for Payer: Priority Health Narrow Network |
$162.94
|
| Rate for Payer: Priority Health SBD |
$162.94
|
| Rate for Payer: UHCCP Medicaid |
$53.49
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
