|
PR IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 96523
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$30.84 |
| Rate for Payer: Aetna Commercial |
$28.70
|
| Rate for Payer: Aetna Medicare |
$22.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.84
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$21.42
|
| Rate for Payer: BCN Medicare Advantage |
$21.42
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$28.70
|
| Rate for Payer: Cofinity Commercial |
$30.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.49
|
| Rate for Payer: Nomi Health Commercial |
$25.70
|
| Rate for Payer: PACE SWMI |
$21.42
|
| Rate for Payer: PHP Commercial |
$29.99
|
| Rate for Payer: PHP Medicare Advantage |
$21.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$21.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.42
|
| Rate for Payer: UHC Medicare Advantage |
$21.42
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR IRRIGATION CORPORA CAVERNOSA PRIAPISM
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 54220
|
| Min. Negotiated Rate |
$129.03 |
| Max. Negotiated Rate |
$291.20 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Medicare |
$134.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.90
|
| Rate for Payer: BCBS Complete |
$179.20
|
| Rate for Payer: BCBS MAPPO |
$129.03
|
| Rate for Payer: BCN Medicare Advantage |
$129.03
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cofinity Commercial |
$185.80
|
| Rate for Payer: Cofinity Commercial |
$172.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.48
|
| Rate for Payer: Nomi Health Commercial |
$154.84
|
| Rate for Payer: PACE SWMI |
$129.03
|
| Rate for Payer: PHP Commercial |
$180.64
|
| Rate for Payer: PHP Medicare Advantage |
$129.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.20
|
| Rate for Payer: Priority Health Medicare |
$129.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.03
|
| Rate for Payer: UHC Medicare Advantage |
$129.03
|
| Rate for Payer: UMR Bronson Commercial |
$206.08
|
|
|
PR IRRIGATION TRAY
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4320
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$9.89 |
| Rate for Payer: Aetna Commercial |
$9.21
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.21
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$6.87
|
| Rate for Payer: BCN Medicare Advantage |
$6.87
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$9.89
|
| Rate for Payer: Cofinity Commercial |
$9.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.21
|
| Rate for Payer: Nomi Health Commercial |
$8.24
|
| Rate for Payer: PACE SWMI |
$6.87
|
| Rate for Payer: PHP Commercial |
$9.62
|
| Rate for Payer: PHP Medicare Advantage |
$6.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$6.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.87
|
| Rate for Payer: UHC Medicare Advantage |
$6.87
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 57150
|
| Min. Negotiated Rate |
$24.43 |
| Max. Negotiated Rate |
$78.00 |
| Rate for Payer: Aetna Commercial |
$32.74
|
| Rate for Payer: Aetna Medicare |
$25.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.74
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$24.43
|
| Rate for Payer: BCN Medicare Advantage |
$24.43
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$35.18
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.65
|
| Rate for Payer: Nomi Health Commercial |
$29.32
|
| Rate for Payer: PACE SWMI |
$24.43
|
| Rate for Payer: PHP Commercial |
$34.20
|
| Rate for Payer: PHP Medicare Advantage |
$24.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$24.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.43
|
| Rate for Payer: UHC Medicare Advantage |
$24.43
|
| Rate for Payer: UMR Bronson Commercial |
$55.20
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 93571
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna Medicare |
$100.00
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.00
|
| Rate for Payer: UMR Bronson Commercial |
$92.00
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 93572
|
| 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 IV INFUSION HYDRATION EACH ADDITIONAL HOUR
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 96361
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Commercial |
$14.67
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.67
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$10.95
|
| Rate for Payer: BCN Medicare Advantage |
$10.95
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Cofinity Commercial |
$14.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.50
|
| Rate for Payer: Nomi Health Commercial |
$13.14
|
| Rate for Payer: PACE SWMI |
$10.95
|
| Rate for Payer: PHP Commercial |
$15.33
|
| Rate for Payer: PHP Medicare Advantage |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$10.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.95
|
| Rate for Payer: UHC Medicare Advantage |
$10.95
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 96360
|
| Min. Negotiated Rate |
$27.98 |
| Max. Negotiated Rate |
$70.85 |
| Rate for Payer: Aetna Commercial |
$37.49
|
| Rate for Payer: Aetna Medicare |
$29.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.49
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS MAPPO |
$27.98
|
| Rate for Payer: BCN Medicare Advantage |
$27.98
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$40.29
|
| Rate for Payer: Cofinity Commercial |
$37.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.38
|
| Rate for Payer: Nomi Health Commercial |
$33.58
|
| Rate for Payer: PACE SWMI |
$27.98
|
| Rate for Payer: PHP Commercial |
$39.17
|
| Rate for Payer: PHP Medicare Advantage |
$27.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.85
|
| Rate for Payer: Priority Health Medicare |
$27.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.98
|
| Rate for Payer: UHC Medicare Advantage |
$27.98
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
|
|
PR IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 96365
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$85.80 |
| Rate for Payer: Aetna Commercial |
$71.94
|
| Rate for Payer: Aetna Medicare |
$55.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.94
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$53.69
|
| Rate for Payer: BCN Medicare Advantage |
$53.69
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$71.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.37
|
| Rate for Payer: Nomi Health Commercial |
$64.43
|
| Rate for Payer: PACE SWMI |
$53.69
|
| Rate for Payer: PHP Commercial |
$75.17
|
| Rate for Payer: PHP Medicare Advantage |
$53.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$53.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.69
|
| Rate for Payer: UHC Medicare Advantage |
$53.69
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
PR IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 96366
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$26.32 |
| Rate for Payer: Aetna Commercial |
$24.50
|
| Rate for Payer: Aetna Medicare |
$19.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.50
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$18.28
|
| Rate for Payer: BCN Medicare Advantage |
$18.28
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$26.32
|
| Rate for Payer: Cofinity Commercial |
$24.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.19
|
| Rate for Payer: Nomi Health Commercial |
$21.94
|
| Rate for Payer: PACE SWMI |
$18.28
|
| Rate for Payer: PHP Commercial |
$25.59
|
| Rate for Payer: PHP Medicare Advantage |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Medicare |
$18.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.28
|
| Rate for Payer: UHC Medicare Advantage |
$18.28
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
|
|
PR IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 96367
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Aetna Commercial |
$33.23
|
| Rate for Payer: Aetna Medicare |
$25.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.23
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS MAPPO |
$24.80
|
| Rate for Payer: BCN Medicare Advantage |
$24.80
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$35.71
|
| Rate for Payer: Cofinity Commercial |
$33.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.04
|
| Rate for Payer: Nomi Health Commercial |
$29.76
|
| Rate for Payer: PACE SWMI |
$24.80
|
| Rate for Payer: PHP Commercial |
$34.72
|
| Rate for Payer: PHP Medicare Advantage |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health Medicare |
$24.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.80
|
| Rate for Payer: UHC Medicare Advantage |
$24.80
|
| Rate for Payer: UMR Bronson Commercial |
$26.68
|
|
|
PR IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 15860
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Commercial |
$137.81
|
| Rate for Payer: Aetna Medicare |
$106.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.81
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$102.84
|
| Rate for Payer: BCN Medicare Advantage |
$102.84
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$148.09
|
| Rate for Payer: Cofinity Commercial |
$137.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.98
|
| Rate for Payer: Nomi Health Commercial |
$123.41
|
| Rate for Payer: PACE SWMI |
$102.84
|
| Rate for Payer: PHP Commercial |
$143.98
|
| Rate for Payer: PHP Medicare Advantage |
$102.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health Medicare |
$102.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.84
|
| Rate for Payer: UHC Medicare Advantage |
$102.84
|
| Rate for Payer: UMR Bronson Commercial |
$105.80
|
|
|
PR IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 96368
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna Commercial |
$23.28
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.28
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$17.37
|
| Rate for Payer: BCN Medicare Advantage |
$17.37
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$25.01
|
| Rate for Payer: Cofinity Commercial |
$23.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.24
|
| Rate for Payer: Nomi Health Commercial |
$20.84
|
| Rate for Payer: PACE SWMI |
$17.37
|
| Rate for Payer: PHP Commercial |
$24.32
|
| Rate for Payer: PHP Medicare Advantage |
$17.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health Medicare |
$17.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.37
|
| Rate for Payer: UHC Medicare Advantage |
$17.37
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
|
|
PR IV ULTRASOUND,FIRST VESSEL
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 37250
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna Medicare |
$153.00
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
PR KETOROLAC TROMETHAMINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1885
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Commercial |
$0.40
|
| Rate for Payer: Aetna Medicare |
$0.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.43
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$0.30
|
| Rate for Payer: BCN Medicare Advantage |
$0.30
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$0.40
|
| Rate for Payer: Cofinity Commercial |
$0.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.32
|
| Rate for Payer: Nomi Health Commercial |
$0.36
|
| Rate for Payer: PACE SWMI |
$0.30
|
| Rate for Payer: PHP Commercial |
$0.42
|
| Rate for Payer: PHP Medicare Advantage |
$0.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$0.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.30
|
| Rate for Payer: UHC Medicare Advantage |
$0.30
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR KO IMMOB CANVAS LONG PRE OTS
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS L1830
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$99.20 |
| Rate for Payer: Aetna Commercial |
$92.31
|
| Rate for Payer: Aetna Medicare |
$71.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.31
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$68.89
|
| Rate for Payer: BCN Medicare Advantage |
$68.89
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$92.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.33
|
| Rate for Payer: Nomi Health Commercial |
$82.67
|
| Rate for Payer: PACE SWMI |
$68.89
|
| Rate for Payer: PHP Commercial |
$96.45
|
| Rate for Payer: PHP Medicare Advantage |
$68.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$68.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.89
|
| Rate for Payer: UHC Medicare Advantage |
$68.89
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
PR KYBELLA
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00086
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: UMR Bronson Commercial |
$281.52
|
|
|
PR KYLEENA, 19.5 MG
|
Professional
|
Both
|
$877.00
|
|
|
Service Code
|
HCPCS Q9984
|
| Min. Negotiated Rate |
$350.80 |
| Max. Negotiated Rate |
$570.05 |
| Rate for Payer: Aetna Medicare |
$438.50
|
| Rate for Payer: BCBS Complete |
$350.80
|
| Rate for Payer: Cash Price |
$701.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.05
|
| Rate for Payer: UMR Bronson Commercial |
$403.42
|
|
|
PR KYLEENA, 19.5 MG
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
HCPCS J7296
|
| Min. Negotiated Rate |
$588.80 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Medicare |
$736.00
|
| Rate for Payer: BCBS Complete |
$588.80
|
| Rate for Payer: Cash Price |
$1,177.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$956.80
|
| Rate for Payer: UMR Bronson Commercial |
$677.12
|
|
|
PR KYPHECTOMY SINGLE OR TWO SEGMENTS
|
Professional
|
Both
|
$12,926.00
|
|
|
Service Code
|
HCPCS 22818
|
| Min. Negotiated Rate |
$2,070.19 |
| Max. Negotiated Rate |
$8,401.90 |
| Rate for Payer: Aetna Commercial |
$2,774.05
|
| Rate for Payer: Aetna Medicare |
$2,153.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,981.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,774.05
|
| Rate for Payer: BCBS Complete |
$5,170.40
|
| Rate for Payer: BCBS MAPPO |
$2,070.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,070.19
|
| Rate for Payer: Cash Price |
$10,340.80
|
| Rate for Payer: Cash Price |
$10,340.80
|
| Rate for Payer: Cofinity Commercial |
$2,981.07
|
| Rate for Payer: Cofinity Commercial |
$2,774.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,070.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,173.70
|
| Rate for Payer: Nomi Health Commercial |
$2,484.23
|
| Rate for Payer: PACE SWMI |
$2,070.19
|
| Rate for Payer: PHP Commercial |
$2,898.27
|
| Rate for Payer: PHP Medicare Advantage |
$2,070.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,401.90
|
| Rate for Payer: Priority Health Medicare |
$2,070.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,070.19
|
| Rate for Payer: UHC Medicare Advantage |
$2,070.19
|
| Rate for Payer: UMR Bronson Commercial |
$5,945.96
|
|
|
PR LABYRINTHOTOMY TRANSCANAL
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 69801
|
| Min. Negotiated Rate |
$118.89 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Commercial |
$159.31
|
| Rate for Payer: Aetna Medicare |
$123.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.31
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$118.89
|
| Rate for Payer: BCN Medicare Advantage |
$118.89
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$159.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.83
|
| Rate for Payer: Nomi Health Commercial |
$142.67
|
| Rate for Payer: PACE SWMI |
$118.89
|
| Rate for Payer: PHP Commercial |
$166.45
|
| Rate for Payer: PHP Medicare Advantage |
$118.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health Medicare |
$118.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.89
|
| Rate for Payer: UHC Medicare Advantage |
$118.89
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PR LAIV3 VACCINE LIVE FOR INTRANASAL USE
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 90660
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$44.85 |
| Rate for Payer: Aetna Commercial |
$39.81
|
| Rate for Payer: Aetna Medicare |
$30.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.81
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$29.71
|
| Rate for Payer: BCN Medicare Advantage |
$29.71
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$42.78
|
| Rate for Payer: Cofinity Commercial |
$39.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.20
|
| Rate for Payer: Nomi Health Commercial |
$35.65
|
| Rate for Payer: PACE SWMI |
$29.71
|
| Rate for Payer: PHP Commercial |
$41.59
|
| Rate for Payer: PHP Medicare Advantage |
$29.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health Medicare |
$29.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.71
|
| Rate for Payer: UHC Medicare Advantage |
$29.71
|
| Rate for Payer: UMR Bronson Commercial |
$31.74
|
|
|
PR LAIV4 VACCINE FOR INTRANASAL USE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90672
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED CERVICAL
|
Professional
|
Both
|
$8,260.00
|
|
|
Service Code
|
HCPCS 63285
|
| Min. Negotiated Rate |
$2,595.25 |
| Max. Negotiated Rate |
$5,369.00 |
| Rate for Payer: Aetna Commercial |
$3,477.64
|
| Rate for Payer: Aetna Medicare |
$2,699.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,477.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,737.16
|
| Rate for Payer: BCBS Complete |
$3,304.00
|
| Rate for Payer: BCBS MAPPO |
$2,595.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,595.25
|
| Rate for Payer: Cash Price |
$6,608.00
|
| Rate for Payer: Cash Price |
$6,608.00
|
| Rate for Payer: Cofinity Commercial |
$3,477.64
|
| Rate for Payer: Cofinity Commercial |
$3,737.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,595.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,725.01
|
| Rate for Payer: Nomi Health Commercial |
$3,114.30
|
| Rate for Payer: PACE SWMI |
$2,595.25
|
| Rate for Payer: PHP Commercial |
$3,633.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,595.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,369.00
|
| Rate for Payer: Priority Health Medicare |
$2,595.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,595.25
|
| Rate for Payer: UHC Medicare Advantage |
$2,595.25
|
| Rate for Payer: UMR Bronson Commercial |
$3,799.60
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED THORACIC
|
Professional
|
Both
|
$8,278.00
|
|
|
Service Code
|
HCPCS 63286
|
| Min. Negotiated Rate |
$2,564.91 |
| Max. Negotiated Rate |
$5,380.70 |
| Rate for Payer: Aetna Commercial |
$3,436.98
|
| Rate for Payer: Aetna Medicare |
$2,667.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,693.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,436.98
|
| Rate for Payer: BCBS Complete |
$3,311.20
|
| Rate for Payer: BCBS MAPPO |
$2,564.91
|
| Rate for Payer: BCN Medicare Advantage |
$2,564.91
|
| Rate for Payer: Cash Price |
$6,622.40
|
| Rate for Payer: Cash Price |
$6,622.40
|
| Rate for Payer: Cofinity Commercial |
$3,693.47
|
| Rate for Payer: Cofinity Commercial |
$3,436.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,564.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,693.16
|
| Rate for Payer: Nomi Health Commercial |
$3,077.89
|
| Rate for Payer: PACE SWMI |
$2,564.91
|
| Rate for Payer: PHP Commercial |
$3,590.87
|
| Rate for Payer: PHP Medicare Advantage |
$2,564.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,380.70
|
| Rate for Payer: Priority Health Medicare |
$2,564.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,564.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,564.91
|
| Rate for Payer: UMR Bronson Commercial |
$3,807.88
|
|
