|
PROPAFENONE ER 425 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 64380018601
|
| Hospital Charge Code |
37645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$214.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.10
|
| Rate for Payer: UHC Core |
$139.54
|
| Rate for Payer: UHC Exchange |
$105.26
|
| Rate for Payer: UMR Bronson Commercial |
$99.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
PROPAFENONE ER 425 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$3,151.07
|
|
|
Service Code
|
NDC 00173082618
|
| Hospital Charge Code |
37645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,165.90 |
| Max. Negotiated Rate |
$2,835.96 |
| Rate for Payer: Aetna American Axle |
$2,048.20
|
| Rate for Payer: Aetna Commercial |
$2,678.41
|
| Rate for Payer: Aetna Medicare |
$1,575.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,048.20
|
| Rate for Payer: BCBS Complete |
$1,260.43
|
| Rate for Payer: Cash Price |
$2,520.86
|
| Rate for Payer: Cofinity Advantage |
$2,205.75
|
| Rate for Payer: Cofinity Commercial |
$2,709.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,520.86
|
| Rate for Payer: Healthscope Commercial |
$2,835.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,205.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,363.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,520.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,678.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,363.30
|
| Rate for Payer: PHP Commercial |
$2,678.41
|
| Rate for Payer: Priority Health SBD |
$1,985.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,048.20
|
| Rate for Payer: UHC Core |
$1,641.71
|
| Rate for Payer: UHC Exchange |
$1,238.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,165.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,363.30
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$8.69
|
|
|
Service Code
|
NDC 09900000394
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna American Axle |
$5.65
|
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.65
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cofinity Advantage |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.95
|
| Rate for Payer: Healthscope Commercial |
$7.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.52
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health SBD |
$5.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.52
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$8.69
|
|
|
Service Code
|
NDC 09900000394
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna American Axle |
$5.65
|
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna Medicare |
$4.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.65
|
| Rate for Payer: BCBS Complete |
$3.48
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cofinity Advantage |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.95
|
| Rate for Payer: Healthscope Commercial |
$7.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.52
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health SBD |
$5.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.65
|
| Rate for Payer: UHC Core |
$4.53
|
| Rate for Payer: UHC Exchange |
$3.42
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.52
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$99.54
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.83 |
| Max. Negotiated Rate |
$89.59 |
| Rate for Payer: Aetna American Axle |
$64.70
|
| Rate for Payer: Aetna Commercial |
$84.61
|
| Rate for Payer: Aetna Medicare |
$49.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.70
|
| Rate for Payer: BCBS Complete |
$39.82
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Cofinity Advantage |
$69.68
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.63
|
| Rate for Payer: Healthscope Commercial |
$89.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.66
|
| Rate for Payer: PHP Commercial |
$84.61
|
| Rate for Payer: Priority Health SBD |
$62.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.70
|
| Rate for Payer: UHC Core |
$51.86
|
| Rate for Payer: UHC Exchange |
$39.12
|
| Rate for Payer: UMR Bronson Commercial |
$36.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.66
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$114.19
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.24 |
| Max. Negotiated Rate |
$102.77 |
| Rate for Payer: Aetna American Axle |
$74.22
|
| Rate for Payer: Aetna Commercial |
$97.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.22
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cofinity Advantage |
$79.93
|
| Rate for Payer: Cofinity Commercial |
$98.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.35
|
| Rate for Payer: Healthscope Commercial |
$102.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.64
|
| Rate for Payer: PHP Commercial |
$97.06
|
| Rate for Payer: Priority Health SBD |
$71.94
|
| Rate for Payer: UMR Bronson Commercial |
$50.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.64
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$131.10
|
|
|
Service Code
|
NDC 00998001615
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna American Axle |
$85.22
|
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.22
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Advantage |
$91.77
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.33
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health SBD |
$82.59
|
| Rate for Payer: UMR Bronson Commercial |
$57.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.33
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna American Axle |
$73.92
|
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Advantage |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.29
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health SBD |
$71.64
|
| Rate for Payer: UMR Bronson Commercial |
$50.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna American Axle |
$73.92
|
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna Medicare |
$56.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Advantage |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.29
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health SBD |
$71.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.92
|
| Rate for Payer: UHC Core |
$59.25
|
| Rate for Payer: UHC Exchange |
$44.69
|
| Rate for Payer: UMR Bronson Commercial |
$42.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$114.19
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$102.77 |
| Rate for Payer: Aetna American Axle |
$74.22
|
| Rate for Payer: Aetna Commercial |
$97.06
|
| Rate for Payer: Aetna Medicare |
$57.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.22
|
| Rate for Payer: BCBS Complete |
$45.68
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cofinity Advantage |
$79.93
|
| Rate for Payer: Cofinity Commercial |
$98.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.35
|
| Rate for Payer: Healthscope Commercial |
$102.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.64
|
| Rate for Payer: PHP Commercial |
$97.06
|
| Rate for Payer: Priority Health SBD |
$71.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.22
|
| Rate for Payer: UHC Core |
$59.49
|
| Rate for Payer: UHC Exchange |
$44.88
|
| Rate for Payer: UMR Bronson Commercial |
$42.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.64
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$131.10
|
|
|
Service Code
|
NDC 00998001615
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna American Axle |
$85.22
|
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna Medicare |
$65.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.22
|
| Rate for Payer: BCBS Complete |
$52.44
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Advantage |
$91.77
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.33
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health SBD |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.22
|
| Rate for Payer: UHC Core |
$68.30
|
| Rate for Payer: UHC Exchange |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$48.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.33
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$99.54
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.80 |
| Max. Negotiated Rate |
$89.59 |
| Rate for Payer: Aetna American Axle |
$64.70
|
| Rate for Payer: Aetna Commercial |
$84.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.70
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Cofinity Advantage |
$69.68
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.63
|
| Rate for Payer: Healthscope Commercial |
$89.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.66
|
| Rate for Payer: PHP Commercial |
$84.61
|
| Rate for Payer: Priority Health SBD |
$62.71
|
| Rate for Payer: UMR Bronson Commercial |
$43.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.66
|
|
|
PR OPEN ABLATION 1/>RENAL MASS LESION CRYOSURGICAL
|
Professional
|
Both
|
$2,603.00
|
|
|
Service Code
|
HCPCS 50250
|
| Min. Negotiated Rate |
$693.95 |
| Max. Negotiated Rate |
$2,151.20 |
| Rate for Payer: Aetna Commercial |
$1,442.55
|
| Rate for Payer: Aetna Medicare |
$1,119.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,442.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,550.20
|
| Rate for Payer: BCBS Complete |
$728.65
|
| Rate for Payer: BCBS MAPPO |
$1,076.53
|
| Rate for Payer: BCN Commercial |
$1,812.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,076.53
|
| Rate for Payer: Cash Price |
$2,082.40
|
| Rate for Payer: Cash Price |
$2,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,442.55
|
| Rate for Payer: Cofinity Commercial |
$1,550.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,076.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,130.36
|
| Rate for Payer: Meridian Medicaid |
$728.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,184.18
|
| Rate for Payer: Nomi Health Commercial |
$1,291.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,952.25
|
| Rate for Payer: PACE SWMI |
$1,076.53
|
| Rate for Payer: PHP Commercial |
$1,507.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,076.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$693.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,974.03
|
| Rate for Payer: Priority Health Medicare |
$1,076.53
|
| Rate for Payer: Priority Health SBD |
$1,974.03
|
| Rate for Payer: Priority Health Tiered Network |
$1,974.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,076.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,151.20
|
| Rate for Payer: UHC Core |
$2,151.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,076.53
|
| Rate for Payer: UHC Exchange |
$2,151.20
|
| Rate for Payer: UHC Medicaid |
$693.95
|
| Rate for Payer: UHCCP Medicaid |
$693.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,197.38
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 38531
|
| Min. Negotiated Rate |
$275.84 |
| Max. Negotiated Rate |
$900.48 |
| Rate for Payer: Aetna Commercial |
$570.52
|
| Rate for Payer: Aetna Medicare |
$442.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.09
|
| Rate for Payer: BCBS Complete |
$289.63
|
| Rate for Payer: BCBS MAPPO |
$425.76
|
| Rate for Payer: BCN Commercial |
$676.75
|
| Rate for Payer: BCN Medicare Advantage |
$425.76
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$570.52
|
| Rate for Payer: Cofinity Commercial |
$613.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$447.05
|
| Rate for Payer: Meridian Medicaid |
$289.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$468.34
|
| Rate for Payer: Nomi Health Commercial |
$510.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.00
|
| Rate for Payer: PACE SWMI |
$425.76
|
| Rate for Payer: PHP Commercial |
$596.06
|
| Rate for Payer: PHP Medicare Advantage |
$425.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$900.48
|
| Rate for Payer: Priority Health Medicare |
$425.76
|
| Rate for Payer: Priority Health SBD |
$900.48
|
| Rate for Payer: Priority Health Tiered Network |
$900.48
|
| Rate for Payer: Railroad Medicare Medicare |
$425.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$761.22
|
| Rate for Payer: UHC Core |
$761.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$425.76
|
| Rate for Payer: UHC Exchange |
$761.22
|
| Rate for Payer: UHC Medicaid |
$275.84
|
| Rate for Payer: UHCCP Medicaid |
$275.84
|
| Rate for Payer: UMR Bronson Commercial |
$426.88
|
|
|
PR OPEN CLOSURE MAJOR BRONCHIAL FISTULA
|
Professional
|
Both
|
$4,925.00
|
|
|
Service Code
|
HCPCS 32815
|
| Min. Negotiated Rate |
$1,676.52 |
| Max. Negotiated Rate |
$4,976.17 |
| Rate for Payer: Aetna Commercial |
$3,525.41
|
| Rate for Payer: Aetna Medicare |
$2,736.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,525.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,788.50
|
| Rate for Payer: BCBS Complete |
$1,760.35
|
| Rate for Payer: BCBS MAPPO |
$2,630.90
|
| Rate for Payer: BCN Commercial |
$4,126.27
|
| Rate for Payer: BCN Medicare Advantage |
$2,630.90
|
| Rate for Payer: Cash Price |
$3,940.00
|
| Rate for Payer: Cash Price |
$3,940.00
|
| Rate for Payer: Cofinity Commercial |
$3,525.41
|
| Rate for Payer: Cofinity Commercial |
$3,788.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,630.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,762.45
|
| Rate for Payer: Meridian Medicaid |
$1,760.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,893.99
|
| Rate for Payer: Nomi Health Commercial |
$3,157.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,693.75
|
| Rate for Payer: PACE SWMI |
$2,630.90
|
| Rate for Payer: PHP Commercial |
$3,683.26
|
| Rate for Payer: PHP Medicare Advantage |
$2,630.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,676.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,885.72
|
| Rate for Payer: Priority Health Medicare |
$2,630.90
|
| Rate for Payer: Priority Health SBD |
$3,885.72
|
| Rate for Payer: Priority Health Tiered Network |
$3,885.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2,630.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,976.17
|
| Rate for Payer: UHC Core |
$4,976.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,630.90
|
| Rate for Payer: UHC Exchange |
$4,976.17
|
| Rate for Payer: UHC Medicaid |
$1,676.52
|
| Rate for Payer: UHCCP Medicaid |
$1,676.52
|
| Rate for Payer: UMR Bronson Commercial |
$2,265.50
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 10.1-20 CM
|
Professional
|
Both
|
$4,192.00
|
|
|
Service Code
|
HCPCS 49188
|
| Min. Negotiated Rate |
$1,181.30 |
| Max. Negotiated Rate |
$3,686.71 |
| Rate for Payer: Aetna Commercial |
$2,469.22
|
| Rate for Payer: Aetna Medicare |
$1,916.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,469.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,653.49
|
| Rate for Payer: BCBS Complete |
$1,240.37
|
| Rate for Payer: BCBS MAPPO |
$1,842.70
|
| Rate for Payer: BCN Commercial |
$3,003.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,842.70
|
| Rate for Payer: Cash Price |
$3,353.60
|
| Rate for Payer: Cash Price |
$3,353.60
|
| Rate for Payer: Cofinity Commercial |
$2,469.22
|
| Rate for Payer: Cofinity Commercial |
$2,653.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,842.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,934.84
|
| Rate for Payer: Meridian Medicaid |
$1,240.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,026.97
|
| Rate for Payer: Nomi Health Commercial |
$2,211.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,144.00
|
| Rate for Payer: PACE SWMI |
$1,842.70
|
| Rate for Payer: PHP Commercial |
$2,579.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,842.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,181.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,659.96
|
| Rate for Payer: Priority Health Medicare |
$1,842.70
|
| Rate for Payer: Priority Health SBD |
$3,659.96
|
| Rate for Payer: Priority Health Tiered Network |
$3,659.96
|
| Rate for Payer: Railroad Medicare Medicare |
$1,842.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,686.71
|
| Rate for Payer: UHC Core |
$3,686.71
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,842.70
|
| Rate for Payer: UHC Exchange |
$3,686.71
|
| Rate for Payer: UHC Medicaid |
$1,181.30
|
| Rate for Payer: UHCCP Medicaid |
$1,181.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,928.32
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5 CM OR LESS
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 49186
|
| Min. Negotiated Rate |
$778.94 |
| Max. Negotiated Rate |
$2,410.23 |
| Rate for Payer: Aetna Commercial |
$1,624.68
|
| Rate for Payer: Aetna Medicare |
$1,260.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,624.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,745.93
|
| Rate for Payer: BCBS Complete |
$817.89
|
| Rate for Payer: BCBS MAPPO |
$1,212.45
|
| Rate for Payer: BCN Commercial |
$1,967.02
|
| Rate for Payer: BCN Medicare Advantage |
$1,212.45
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cofinity Commercial |
$1,624.68
|
| Rate for Payer: Cofinity Commercial |
$1,745.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,212.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,273.07
|
| Rate for Payer: Meridian Medicaid |
$817.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,333.69
|
| Rate for Payer: Nomi Health Commercial |
$1,454.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,081.25
|
| Rate for Payer: PACE SWMI |
$1,212.45
|
| Rate for Payer: PHP Commercial |
$1,697.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,212.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,396.70
|
| Rate for Payer: Priority Health Medicare |
$1,212.45
|
| Rate for Payer: Priority Health SBD |
$2,396.70
|
| Rate for Payer: Priority Health Tiered Network |
$2,396.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1,212.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,410.23
|
| Rate for Payer: UHC Core |
$2,410.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,212.45
|
| Rate for Payer: UHC Exchange |
$2,410.23
|
| Rate for Payer: UHC Medicaid |
$778.94
|
| Rate for Payer: UHCCP Medicaid |
$778.94
|
| Rate for Payer: UMR Bronson Commercial |
$1,276.50
|
|
|
PR OPEN HARVEST UPPER EXTREMITY ART 1 SEGMENT CAB
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 35600
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Commercial |
$228.71
|
| Rate for Payer: Aetna Medicare |
$177.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.78
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCBS MAPPO |
$170.68
|
| Rate for Payer: BCN Commercial |
$271.40
|
| Rate for Payer: BCN Medicare Advantage |
$170.68
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cofinity Commercial |
$228.71
|
| Rate for Payer: Cofinity Commercial |
$245.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.21
|
| Rate for Payer: Meridian Medicaid |
$113.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$187.75
|
| Rate for Payer: Nomi Health Commercial |
$204.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$994.50
|
| Rate for Payer: PACE SWMI |
$170.68
|
| Rate for Payer: PHP Commercial |
$238.95
|
| Rate for Payer: PHP Medicare Advantage |
$170.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$291.86
|
| Rate for Payer: Priority Health Medicare |
$170.68
|
| Rate for Payer: Priority Health SBD |
$291.86
|
| Rate for Payer: Priority Health Tiered Network |
$291.86
|
| Rate for Payer: Railroad Medicare Medicare |
$170.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.76
|
| Rate for Payer: UHC Core |
$459.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$170.68
|
| Rate for Payer: UHC Exchange |
$459.76
|
| Rate for Payer: UHC Medicaid |
$107.78
|
| Rate for Payer: UHCCP Medicaid |
$107.78
|
| Rate for Payer: UMR Bronson Commercial |
$609.96
|
|
|
PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
HCPCS 64568
|
| Min. Negotiated Rate |
$420.89 |
| Max. Negotiated Rate |
$1,497.00 |
| Rate for Payer: Aetna Commercial |
$871.62
|
| Rate for Payer: Aetna Medicare |
$676.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$871.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$936.66
|
| Rate for Payer: BCBS Complete |
$441.93
|
| Rate for Payer: BCBS MAPPO |
$650.46
|
| Rate for Payer: BCN Commercial |
$913.79
|
| Rate for Payer: BCN Medicare Advantage |
$650.46
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cofinity Commercial |
$871.62
|
| Rate for Payer: Cofinity Commercial |
$936.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$682.98
|
| Rate for Payer: Meridian Medicaid |
$441.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$715.51
|
| Rate for Payer: Nomi Health Commercial |
$780.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.00
|
| Rate for Payer: PACE SWMI |
$650.46
|
| Rate for Payer: PHP Commercial |
$910.64
|
| Rate for Payer: PHP Medicare Advantage |
$650.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,061.36
|
| Rate for Payer: Priority Health Medicare |
$650.46
|
| Rate for Payer: Priority Health SBD |
$1,061.36
|
| Rate for Payer: Priority Health Tiered Network |
$1,061.36
|
| Rate for Payer: Railroad Medicare Medicare |
$650.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,098.03
|
| Rate for Payer: UHC Core |
$1,098.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$650.46
|
| Rate for Payer: UHC Exchange |
$1,098.03
|
| Rate for Payer: UHC Medicaid |
$420.89
|
| Rate for Payer: UHCCP Medicaid |
$420.89
|
| Rate for Payer: UMR Bronson Commercial |
$918.16
|
|
|
PR OPEN IMPLANTATION NEA PERIPHERAL NERVE
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 64575
|
| Min. Negotiated Rate |
$187.23 |
| Max. Negotiated Rate |
$768.75 |
| Rate for Payer: Aetna Commercial |
$382.64
|
| Rate for Payer: Aetna Medicare |
$296.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$382.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$411.19
|
| Rate for Payer: BCBS Complete |
$196.59
|
| Rate for Payer: BCBS MAPPO |
$285.55
|
| Rate for Payer: BCN Commercial |
$474.58
|
| Rate for Payer: BCN Medicare Advantage |
$285.55
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cofinity Commercial |
$382.64
|
| Rate for Payer: Cofinity Commercial |
$411.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$299.83
|
| Rate for Payer: Meridian Medicaid |
$196.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$314.11
|
| Rate for Payer: Nomi Health Commercial |
$342.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$768.75
|
| Rate for Payer: PACE SWMI |
$285.55
|
| Rate for Payer: PHP Commercial |
$399.77
|
| Rate for Payer: PHP Medicare Advantage |
$285.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$551.21
|
| Rate for Payer: Priority Health Medicare |
$285.55
|
| Rate for Payer: Priority Health SBD |
$551.21
|
| Rate for Payer: Priority Health Tiered Network |
$551.21
|
| Rate for Payer: Railroad Medicare Medicare |
$285.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$592.33
|
| Rate for Payer: UHC Core |
$592.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$285.55
|
| Rate for Payer: UHC Exchange |
$592.33
|
| Rate for Payer: UHC Medicaid |
$187.23
|
| Rate for Payer: UHCCP Medicaid |
$187.23
|
| Rate for Payer: UMR Bronson Commercial |
$471.50
|
|
|
PR OPEN IMPLANTATION NEA SACRAL NERVE
|
Professional
|
Both
|
$1,563.00
|
|
|
Service Code
|
HCPCS 64581
|
| Min. Negotiated Rate |
$374.88 |
| Max. Negotiated Rate |
$1,174.88 |
| Rate for Payer: Aetna Commercial |
$782.25
|
| Rate for Payer: Aetna Medicare |
$607.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$782.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$840.63
|
| Rate for Payer: BCBS Complete |
$393.62
|
| Rate for Payer: BCBS MAPPO |
$583.77
|
| Rate for Payer: BCN Commercial |
$982.02
|
| Rate for Payer: BCN Medicare Advantage |
$583.77
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Cofinity Commercial |
$782.25
|
| Rate for Payer: Cofinity Commercial |
$840.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$583.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$612.96
|
| Rate for Payer: Meridian Medicaid |
$393.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$642.15
|
| Rate for Payer: Nomi Health Commercial |
$700.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,172.25
|
| Rate for Payer: PACE SWMI |
$583.77
|
| Rate for Payer: PHP Commercial |
$817.28
|
| Rate for Payer: PHP Medicare Advantage |
$583.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,140.59
|
| Rate for Payer: Priority Health Medicare |
$583.77
|
| Rate for Payer: Priority Health SBD |
$1,140.59
|
| Rate for Payer: Priority Health Tiered Network |
$1,140.59
|
| Rate for Payer: Railroad Medicare Medicare |
$583.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,174.88
|
| Rate for Payer: UHC Core |
$1,174.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$583.77
|
| Rate for Payer: UHC Exchange |
$1,174.88
|
| Rate for Payer: UHC Medicaid |
$374.88
|
| Rate for Payer: UHCCP Medicaid |
$374.88
|
| Rate for Payer: UMR Bronson Commercial |
$718.98
|
|
|
PR OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR
|
Professional
|
Both
|
$1,804.00
|
|
|
Service Code
|
HCPCS 64582
|
| Min. Negotiated Rate |
$460.93 |
| Max. Negotiated Rate |
$1,563.56 |
| Rate for Payer: Aetna Commercial |
$956.67
|
| Rate for Payer: Aetna Medicare |
$742.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,028.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$956.67
|
| Rate for Payer: BCBS Complete |
$483.98
|
| Rate for Payer: BCBS MAPPO |
$713.93
|
| Rate for Payer: BCN Commercial |
$1,255.91
|
| Rate for Payer: BCN Medicare Advantage |
$713.93
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cofinity Commercial |
$1,028.06
|
| Rate for Payer: Cofinity Commercial |
$956.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$713.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$749.63
|
| Rate for Payer: Meridian Medicaid |
$483.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$785.32
|
| Rate for Payer: Nomi Health Commercial |
$856.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.00
|
| Rate for Payer: PACE SWMI |
$713.93
|
| Rate for Payer: PHP Commercial |
$999.50
|
| Rate for Payer: PHP Medicare Advantage |
$713.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,458.72
|
| Rate for Payer: Priority Health Medicare |
$713.93
|
| Rate for Payer: Priority Health SBD |
$1,458.72
|
| Rate for Payer: Priority Health Tiered Network |
$1,458.72
|
| Rate for Payer: Railroad Medicare Medicare |
$713.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,563.56
|
| Rate for Payer: UHC Core |
$1,563.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$713.93
|
| Rate for Payer: UHC Exchange |
$1,563.56
|
| Rate for Payer: UHC Medicaid |
$460.93
|
| Rate for Payer: UHCCP Medicaid |
$460.93
|
| Rate for Payer: UMR Bronson Commercial |
$829.84
|
|
|
PR OPEN INSJ/RPLCMT INTEGRATED NSTIMJ SYS PTN SUBQ
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 0816T
|
| Min. Negotiated Rate |
$223.05 |
| Max. Negotiated Rate |
$20,050.50 |
| Rate for Payer: Aetna Medicare |
$396.00
|
| Rate for Payer: BCBS Complete |
$316.80
|
| Rate for Payer: BCN Commercial |
$20,050.50
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.05
|
| Rate for Payer: UHC Core |
$223.05
|
| Rate for Payer: UHC Exchange |
$223.05
|
| Rate for Payer: UMR Bronson Commercial |
$364.32
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL
|
Professional
|
Both
|
$659.00
|
|
|
Service Code
|
HCPCS 37239
|
| Min. Negotiated Rate |
$83.92 |
| Max. Negotiated Rate |
$494.25 |
| Rate for Payer: Aetna Commercial |
$177.99
|
| Rate for Payer: Aetna Medicare |
$138.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.28
|
| Rate for Payer: BCBS Complete |
$88.12
|
| Rate for Payer: BCBS MAPPO |
$132.83
|
| Rate for Payer: BCN Commercial |
$220.11
|
| Rate for Payer: BCN Medicare Advantage |
$132.83
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Cofinity Commercial |
$177.99
|
| Rate for Payer: Cofinity Commercial |
$191.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$139.47
|
| Rate for Payer: Meridian Medicaid |
$88.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$146.11
|
| Rate for Payer: Nomi Health Commercial |
$159.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.25
|
| Rate for Payer: PACE SWMI |
$132.83
|
| Rate for Payer: PHP Commercial |
$185.96
|
| Rate for Payer: PHP Medicare Advantage |
$132.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$236.70
|
| Rate for Payer: Priority Health Medicare |
$132.83
|
| Rate for Payer: Priority Health SBD |
$236.70
|
| Rate for Payer: Priority Health Tiered Network |
$236.70
|
| Rate for Payer: Railroad Medicare Medicare |
$132.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.56
|
| Rate for Payer: UHC Core |
$273.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$132.83
|
| Rate for Payer: UHC Exchange |
$273.56
|
| Rate for Payer: UHC Medicaid |
$83.92
|
| Rate for Payer: UHCCP Medicaid |
$83.92
|
| Rate for Payer: UMR Bronson Commercial |
$303.14
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
HCPCS 37237
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$392.25 |
| Rate for Payer: Aetna Commercial |
$255.44
|
| Rate for Payer: Aetna Medicare |
$198.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.51
|
| Rate for Payer: BCBS Complete |
$125.70
|
| Rate for Payer: BCBS MAPPO |
$190.63
|
| Rate for Payer: BCN Commercial |
$307.25
|
| Rate for Payer: BCN Medicare Advantage |
$190.63
|
| Rate for Payer: Cash Price |
$418.40
|
| Rate for Payer: Cash Price |
$418.40
|
| Rate for Payer: Cofinity Commercial |
$255.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$190.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.16
|
| Rate for Payer: Meridian Medicaid |
$125.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$209.69
|
| Rate for Payer: Nomi Health Commercial |
$228.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$392.25
|
| Rate for Payer: PACE SWMI |
$190.63
|
| Rate for Payer: PHP Commercial |
$266.88
|
| Rate for Payer: PHP Medicare Advantage |
$190.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$330.42
|
| Rate for Payer: Priority Health Medicare |
$190.63
|
| Rate for Payer: Priority Health SBD |
$330.42
|
| Rate for Payer: Priority Health Tiered Network |
$330.42
|
| Rate for Payer: Railroad Medicare Medicare |
$190.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$382.52
|
| Rate for Payer: UHC Core |
$382.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$190.63
|
| Rate for Payer: UHC Exchange |
$382.52
|
| Rate for Payer: UHC Medicaid |
$119.71
|
| Rate for Payer: UHCCP Medicaid |
$119.71
|
| Rate for Payer: UMR Bronson Commercial |
$240.58
|
|
