|
PR MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 51798
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$3,662.70 |
| Rate for Payer: Aetna Commercial |
$14.04
|
| Rate for Payer: Aetna Medicare |
$10.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.04
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS MAPPO |
$10.48
|
| Rate for Payer: BCBS Trust/PPO |
$3,662.70
|
| Rate for Payer: BCN Commercial |
$15.64
|
| Rate for Payer: BCN Medicare Advantage |
$10.48
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$15.09
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.00
|
| Rate for Payer: Nomi Health Commercial |
$12.58
|
| Rate for Payer: PACE SWMI |
$10.48
|
| Rate for Payer: PHP Commercial |
$14.67
|
| Rate for Payer: PHP Medicare Advantage |
$10.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.11
|
| Rate for Payer: Priority Health Medicare |
$10.48
|
| Rate for Payer: Priority Health Narrow Network |
$18.11
|
| Rate for Payer: Priority Health SBD |
$18.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.48
|
| Rate for Payer: UHC Medicare Advantage |
$10.48
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
PR MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 53020
|
| Min. Negotiated Rate |
$61.56 |
| Max. Negotiated Rate |
$359.24 |
| Rate for Payer: Aetna Commercial |
$123.33
|
| Rate for Payer: Aetna Medicare |
$95.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.54
|
| Rate for Payer: BCBS Complete |
$64.64
|
| Rate for Payer: BCBS MAPPO |
$92.04
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: BCN Commercial |
$138.79
|
| Rate for Payer: BCN Medicare Advantage |
$92.04
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$123.33
|
| Rate for Payer: Cofinity Commercial |
$132.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.64
|
| Rate for Payer: Meridian Medicaid |
$64.64
|
| Rate for Payer: Nomi Health Commercial |
$110.45
|
| Rate for Payer: PACE SWMI |
$92.04
|
| Rate for Payer: PHP Commercial |
$128.86
|
| Rate for Payer: PHP Medicare Advantage |
$92.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.86
|
| Rate for Payer: Priority Health Medicare |
$92.04
|
| Rate for Payer: Priority Health Narrow Network |
$152.86
|
| Rate for Payer: Priority Health SBD |
$152.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.04
|
| Rate for Payer: UHC Medicare Advantage |
$92.04
|
| Rate for Payer: UHCCP Medicaid |
$61.56
|
| Rate for Payer: UMR Bronson Commercial |
$157.32
|
|
|
PR MEATOTOMY CUTTING MEATUS SPX INFANT
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 53025
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$718.49 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Medicare |
$68.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.78
|
| Rate for Payer: BCBS Complete |
$46.52
|
| Rate for Payer: BCBS MAPPO |
$65.82
|
| Rate for Payer: BCBS Trust/PPO |
$718.49
|
| Rate for Payer: BCN Commercial |
$98.72
|
| Rate for Payer: BCN Medicare Advantage |
$65.82
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$94.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.11
|
| Rate for Payer: Meridian Medicaid |
$46.52
|
| Rate for Payer: Nomi Health Commercial |
$78.98
|
| Rate for Payer: PACE SWMI |
$65.82
|
| Rate for Payer: PHP Commercial |
$92.15
|
| Rate for Payer: PHP Medicare Advantage |
$65.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.18
|
| Rate for Payer: Priority Health Medicare |
$65.82
|
| Rate for Payer: Priority Health Narrow Network |
$109.18
|
| Rate for Payer: Priority Health SBD |
$109.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.82
|
| Rate for Payer: UHC Medicare Advantage |
$65.82
|
| Rate for Payer: UHCCP Medicaid |
$44.30
|
| Rate for Payer: UMR Bronson Commercial |
$164.22
|
|
|
PR MEDIASTINOSCOPY INCL BIOPSIES WHEN PERFORMED
|
Professional
|
Both
|
$2,243.00
|
|
|
Service Code
|
HCPCS 39400
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$1,457.95 |
| Rate for Payer: Aetna Medicare |
$1,121.50
|
| Rate for Payer: BCBS Complete |
$897.20
|
| Rate for Payer: Cash Price |
$1,794.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,457.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,031.78
|
|
|
PR MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY
|
Professional
|
Both
|
$970.00
|
|
|
Service Code
|
HCPCS 39401
|
| Min. Negotiated Rate |
$195.53 |
| Max. Negotiated Rate |
$630.50 |
| Rate for Payer: Aetna Commercial |
$398.23
|
| Rate for Payer: Aetna Medicare |
$309.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.95
|
| Rate for Payer: BCBS Complete |
$205.31
|
| Rate for Payer: BCBS MAPPO |
$297.19
|
| Rate for Payer: BCBS Trust/PPO |
$207.62
|
| Rate for Payer: BCN Commercial |
$442.74
|
| Rate for Payer: BCN Medicare Advantage |
$297.19
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cash Price |
$776.00
|
| Rate for Payer: Cofinity Commercial |
$427.95
|
| Rate for Payer: Cofinity Commercial |
$398.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.05
|
| Rate for Payer: Meridian Medicaid |
$205.31
|
| Rate for Payer: Nomi Health Commercial |
$356.63
|
| Rate for Payer: PACE SWMI |
$297.19
|
| Rate for Payer: PHP Commercial |
$416.07
|
| Rate for Payer: PHP Medicare Advantage |
$297.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$195.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$484.49
|
| Rate for Payer: Priority Health Medicare |
$297.19
|
| Rate for Payer: Priority Health Narrow Network |
$484.49
|
| Rate for Payer: Priority Health SBD |
$484.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$297.19
|
| Rate for Payer: UHC Medicare Advantage |
$297.19
|
| Rate for Payer: UHCCP Medicaid |
$195.53
|
| Rate for Payer: UMR Bronson Commercial |
$446.20
|
|
|
PR MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES
|
Professional
|
Both
|
$845.00
|
|
|
Service Code
|
HCPCS 39402
|
| Min. Negotiated Rate |
$254.96 |
| Max. Negotiated Rate |
$632.34 |
| Rate for Payer: Aetna Commercial |
$520.72
|
| Rate for Payer: Aetna Medicare |
$404.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$520.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.58
|
| Rate for Payer: BCBS Complete |
$267.71
|
| Rate for Payer: BCBS MAPPO |
$388.60
|
| Rate for Payer: BCBS Trust/PPO |
$487.62
|
| Rate for Payer: BCN Commercial |
$578.11
|
| Rate for Payer: BCN Medicare Advantage |
$388.60
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cash Price |
$676.00
|
| Rate for Payer: Cofinity Commercial |
$520.72
|
| Rate for Payer: Cofinity Commercial |
$559.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.03
|
| Rate for Payer: Meridian Medicaid |
$267.71
|
| Rate for Payer: Nomi Health Commercial |
$466.32
|
| Rate for Payer: PACE SWMI |
$388.60
|
| Rate for Payer: PHP Commercial |
$544.04
|
| Rate for Payer: PHP Medicare Advantage |
$388.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$632.34
|
| Rate for Payer: Priority Health Medicare |
$388.60
|
| Rate for Payer: Priority Health Narrow Network |
$632.34
|
| Rate for Payer: Priority Health SBD |
$632.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$388.60
|
| Rate for Payer: UHC Medicare Advantage |
$388.60
|
| Rate for Payer: UHCCP Medicaid |
$254.96
|
| Rate for Payer: UMR Bronson Commercial |
$388.70
|
|
|
PR MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR
|
Professional
|
Both
|
$2,549.00
|
|
|
Service Code
|
HCPCS 39000
|
| Min. Negotiated Rate |
$323.97 |
| Max. Negotiated Rate |
$1,656.85 |
| Rate for Payer: Aetna Commercial |
$648.87
|
| Rate for Payer: Aetna Medicare |
$503.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$648.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$697.29
|
| Rate for Payer: BCBS Complete |
$340.17
|
| Rate for Payer: BCBS MAPPO |
$484.23
|
| Rate for Payer: BCBS Trust/PPO |
$418.94
|
| Rate for Payer: BCN Commercial |
$700.27
|
| Rate for Payer: BCN Medicare Advantage |
$484.23
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Cofinity Commercial |
$648.87
|
| Rate for Payer: Cofinity Commercial |
$697.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$484.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$508.44
|
| Rate for Payer: Meridian Medicaid |
$340.17
|
| Rate for Payer: Nomi Health Commercial |
$581.08
|
| Rate for Payer: PACE SWMI |
$484.23
|
| Rate for Payer: PHP Commercial |
$677.92
|
| Rate for Payer: PHP Medicare Advantage |
$484.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,656.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$805.72
|
| Rate for Payer: Priority Health Medicare |
$484.23
|
| Rate for Payer: Priority Health Narrow Network |
$805.72
|
| Rate for Payer: Priority Health SBD |
$805.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$484.23
|
| Rate for Payer: UHC Medicare Advantage |
$484.23
|
| Rate for Payer: UHCCP Medicaid |
$323.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,172.54
|
|
|
PR MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR
|
Professional
|
Both
|
$5,247.00
|
|
|
Service Code
|
HCPCS 39010
|
| Min. Negotiated Rate |
$502.68 |
| Max. Negotiated Rate |
$3,410.55 |
| Rate for Payer: Aetna Commercial |
$1,018.43
|
| Rate for Payer: Aetna Medicare |
$790.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,018.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,094.43
|
| Rate for Payer: BCBS Complete |
$527.81
|
| Rate for Payer: BCBS MAPPO |
$760.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,750.26
|
| Rate for Payer: BCN Commercial |
$1,138.13
|
| Rate for Payer: BCN Medicare Advantage |
$760.02
|
| Rate for Payer: Cash Price |
$4,197.60
|
| Rate for Payer: Cash Price |
$4,197.60
|
| Rate for Payer: Cofinity Commercial |
$1,094.43
|
| Rate for Payer: Cofinity Commercial |
$1,018.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$760.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$798.02
|
| Rate for Payer: Meridian Medicaid |
$527.81
|
| Rate for Payer: Nomi Health Commercial |
$912.02
|
| Rate for Payer: PACE SWMI |
$760.02
|
| Rate for Payer: PHP Commercial |
$1,064.03
|
| Rate for Payer: PHP Medicare Advantage |
$760.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$502.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,410.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,248.20
|
| Rate for Payer: Priority Health Medicare |
$760.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,248.20
|
| Rate for Payer: Priority Health SBD |
$1,248.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$760.02
|
| Rate for Payer: UHC Medicare Advantage |
$760.02
|
| Rate for Payer: UHCCP Medicaid |
$502.68
|
| Rate for Payer: UMR Bronson Commercial |
$2,413.62
|
|
|
PR MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 97802
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$1,112.07 |
| Rate for Payer: Aetna Commercial |
$40.45
|
| Rate for Payer: Aetna Medicare |
$31.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.47
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$30.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,112.07
|
| Rate for Payer: BCN Commercial |
$53.26
|
| Rate for Payer: BCN Medicare Advantage |
$30.19
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$43.47
|
| Rate for Payer: Cofinity Commercial |
$40.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.70
|
| Rate for Payer: Nomi Health Commercial |
$36.23
|
| Rate for Payer: PACE SWMI |
$30.19
|
| Rate for Payer: PHP Commercial |
$42.27
|
| Rate for Payer: PHP Medicare Advantage |
$30.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.34
|
| Rate for Payer: Priority Health Medicare |
$30.19
|
| Rate for Payer: Priority Health Narrow Network |
$33.34
|
| Rate for Payer: Priority Health SBD |
$33.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.19
|
| Rate for Payer: UHC Medicare Advantage |
$30.19
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
|
PR MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 97803
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$561.58 |
| Rate for Payer: Aetna Commercial |
$34.22
|
| Rate for Payer: Aetna Medicare |
$26.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.78
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$25.54
|
| Rate for Payer: BCBS Trust/PPO |
$561.58
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: BCN Medicare Advantage |
$25.54
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$34.22
|
| Rate for Payer: Cofinity Commercial |
$36.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.82
|
| Rate for Payer: Nomi Health Commercial |
$30.65
|
| Rate for Payer: PACE SWMI |
$25.54
|
| Rate for Payer: PHP Commercial |
$35.76
|
| Rate for Payer: PHP Medicare Advantage |
$25.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.82
|
| Rate for Payer: Priority Health Medicare |
$25.54
|
| Rate for Payer: Priority Health Narrow Network |
$29.82
|
| Rate for Payer: Priority Health SBD |
$29.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.54
|
| Rate for Payer: UHC Medicare Advantage |
$25.54
|
| Rate for Payer: UMR Bronson Commercial |
$23.00
|
|
|
PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 97804
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$641.36 |
| Rate for Payer: Aetna Commercial |
$19.24
|
| Rate for Payer: Aetna Medicare |
$14.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.68
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$14.36
|
| Rate for Payer: BCBS Trust/PPO |
$641.36
|
| Rate for Payer: BCN Commercial |
$24.44
|
| Rate for Payer: BCN Medicare Advantage |
$14.36
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$20.68
|
| Rate for Payer: Cofinity Commercial |
$19.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.08
|
| Rate for Payer: Nomi Health Commercial |
$17.23
|
| Rate for Payer: PACE SWMI |
$14.36
|
| Rate for Payer: PHP Commercial |
$20.10
|
| Rate for Payer: PHP Medicare Advantage |
$14.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.57
|
| Rate for Payer: Priority Health Medicare |
$14.36
|
| Rate for Payer: Priority Health Narrow Network |
$15.57
|
| Rate for Payer: Priority Health SBD |
$15.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.36
|
| Rate for Payer: UHC Medicare Advantage |
$14.36
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
|
|
PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 93463
|
| Min. Negotiated Rate |
$61.13 |
| Max. Negotiated Rate |
$735.92 |
| Rate for Payer: Aetna Commercial |
$122.86
|
| Rate for Payer: Aetna Medicare |
$95.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.03
|
| Rate for Payer: BCBS Complete |
$64.19
|
| Rate for Payer: BCBS MAPPO |
$91.69
|
| Rate for Payer: BCBS Trust/PPO |
$735.92
|
| Rate for Payer: BCN Commercial |
$140.25
|
| Rate for Payer: BCN Medicare Advantage |
$91.69
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$132.03
|
| Rate for Payer: Cofinity Commercial |
$122.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.27
|
| Rate for Payer: Meridian Medicaid |
$64.19
|
| Rate for Payer: Nomi Health Commercial |
$110.03
|
| Rate for Payer: PACE SWMI |
$91.69
|
| Rate for Payer: PHP Commercial |
$128.37
|
| Rate for Payer: PHP Medicare Advantage |
$91.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.66
|
| Rate for Payer: Priority Health Medicare |
$91.69
|
| Rate for Payer: Priority Health Narrow Network |
$134.66
|
| Rate for Payer: Priority Health SBD |
$134.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.69
|
| Rate for Payer: UHC Medicare Advantage |
$91.69
|
| Rate for Payer: UHCCP Medicaid |
$61.13
|
| Rate for Payer: UMR Bronson Commercial |
$150.88
|
|
|
PR MEDICATION THERAPY EACH ADDITIONAL 15 MIN
|
Professional
|
Both
|
$13.00
|
|
|
Service Code
|
HCPCS 99607
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$370.34 |
| Rate for Payer: Aetna Commercial |
$45.29
|
| Rate for Payer: Aetna Medicare |
$6.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.29
|
| Rate for Payer: BCBS Complete |
$5.20
|
| Rate for Payer: BCBS Trust/PPO |
$370.34
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Cash Price |
$10.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.45
|
| Rate for Payer: UMR Bronson Commercial |
$5.98
|
|
|
PR MEDICATION THERAPY INITIAL 15 MIN ESTABLISHED PT
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 99606
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$62.87 |
| Rate for Payer: Aetna Commercial |
$33.89
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.89
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$62.87
|
| Rate for Payer: Cash Price |
$25.60
|
| 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 MEDICATION THERAPY INITIAL 15 MIN NEW PATIENT
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 99605
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$79.81 |
| Rate for Payer: Aetna Commercial |
$67.55
|
| Rate for Payer: Aetna Medicare |
$32.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.55
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS Trust/PPO |
$79.81
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: UMR Bronson Commercial |
$29.44
|
|
|
PR MEDROXYPROGESTERONE ACETATE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J1050
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.52
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.52
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.14
|
| Rate for Payer: BCN Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
|
|
PR MEDROXYPROGESTERONE INJ
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J1051
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR MEDRXYPROGESTER ACETATE INJ
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS J1055
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$53.30 |
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
PR MENACWYD/MENACWY-CRM CONJ VACC GRPS ACWY IM USE
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 90734
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$151.33 |
| Rate for Payer: Aetna Commercial |
$151.33
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.33
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS Trust/PPO |
$150.00
|
| Rate for Payer: BCN Commercial |
$147.22
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: UMR Bronson Commercial |
$65.78
|
|
|
PR MENACWY-TT CONJ VACC SEROGROUPS ACWY FOR IM USE
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 90619
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$168.36 |
| Rate for Payer: Aetna Commercial |
$159.10
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.10
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS Trust/PPO |
$168.36
|
| Rate for Payer: BCN Commercial |
$168.36
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: UMR Bronson Commercial |
$84.64
|
|
|
PR MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 90620
|
| Min. Negotiated Rate |
$105.20 |
| Max. Negotiated Rate |
$215.42 |
| Rate for Payer: Aetna Commercial |
$215.42
|
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.42
|
| Rate for Payer: BCBS Complete |
$105.20
|
| Rate for Payer: BCBS Trust/PPO |
$198.55
|
| Rate for Payer: BCN Commercial |
$198.55
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.95
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
|
PR MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 90621
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$183.17 |
| Rate for Payer: Aetna Commercial |
$183.17
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.17
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS Trust/PPO |
$165.84
|
| Rate for Payer: BCN Commercial |
$165.84
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: UMR Bronson Commercial |
$84.64
|
|
|
PR MEPERIDINE HYDROCHL /100 MG
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J2175
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna Commercial |
$21.03
|
| Rate for Payer: Aetna Medicare |
$16.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.60
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$15.69
|
| Rate for Payer: BCBS Trust/PPO |
$1.87
|
| Rate for Payer: BCN Commercial |
$1.88
|
| Rate for Payer: BCN Medicare Advantage |
$15.69
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$21.03
|
| Rate for Payer: Cofinity Commercial |
$22.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.48
|
| Rate for Payer: Nomi Health Commercial |
$18.83
|
| Rate for Payer: PACE SWMI |
$15.69
|
| Rate for Payer: PHP Commercial |
$21.97
|
| Rate for Payer: PHP Medicare Advantage |
$15.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$15.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.69
|
| Rate for Payer: UHC Medicare Advantage |
$15.69
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR MEPERIDINE/PROMETHAZINE INJ
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J2180
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.58
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: UMR Bronson Commercial |
$5.06
|
|
|
PR METATARSECTOMY
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
HCPCS 28140
|
| Min. Negotiated Rate |
$274.34 |
| Max. Negotiated Rate |
$1,034.26 |
| Rate for Payer: Aetna Commercial |
$546.13
|
| Rate for Payer: Aetna Medicare |
$423.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$586.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.13
|
| Rate for Payer: BCBS Complete |
$288.06
|
| Rate for Payer: BCBS MAPPO |
$407.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,034.26
|
| Rate for Payer: BCN Commercial |
$830.26
|
| Rate for Payer: BCN Medicare Advantage |
$407.56
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cofinity Commercial |
$586.89
|
| Rate for Payer: Cofinity Commercial |
$546.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$427.94
|
| Rate for Payer: Meridian Medicaid |
$288.06
|
| Rate for Payer: Nomi Health Commercial |
$489.07
|
| Rate for Payer: PACE SWMI |
$407.56
|
| Rate for Payer: PHP Commercial |
$570.58
|
| Rate for Payer: PHP Medicare Advantage |
$407.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$696.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$653.37
|
| Rate for Payer: Priority Health Medicare |
$407.56
|
| Rate for Payer: Priority Health Narrow Network |
$653.37
|
| Rate for Payer: Priority Health SBD |
$653.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.56
|
| Rate for Payer: UHC Medicare Advantage |
$407.56
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
| Rate for Payer: UMR Bronson Commercial |
$492.66
|
|
