|
PR MITOMYCIN INJECTION
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS J9280
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Aetna Commercial |
$37.88
|
| Rate for Payer: Aetna Medicare |
$29.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.88
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$28.27
|
| Rate for Payer: BCBS Trust/PPO |
$10.36
|
| Rate for Payer: BCN Commercial |
$3.72
|
| Rate for Payer: BCN Medicare Advantage |
$28.27
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$40.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.69
|
| Rate for Payer: Nomi Health Commercial |
$33.93
|
| Rate for Payer: PACE SWMI |
$28.27
|
| Rate for Payer: PHP Commercial |
$39.58
|
| Rate for Payer: PHP Medicare Advantage |
$28.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$28.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.27
|
| Rate for Payer: UHC Medicare Advantage |
$28.27
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG
|
Professional
|
Both
|
$995.00
|
|
|
Service Code
|
HCPCS 95805
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$646.75 |
| Rate for Payer: Aetna Commercial |
$526.20
|
| Rate for Payer: Aetna Commercial |
$526.20
|
| Rate for Payer: Aetna Medicare |
$408.40
|
| Rate for Payer: Aetna Medicare |
$408.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$565.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.20
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCBS MAPPO |
$392.69
|
| Rate for Payer: BCBS MAPPO |
$392.69
|
| Rate for Payer: BCBS Trust/PPO |
$639.77
|
| Rate for Payer: BCBS Trust/PPO |
$639.77
|
| Rate for Payer: BCN Commercial |
$610.36
|
| Rate for Payer: BCN Commercial |
$610.36
|
| Rate for Payer: BCN Medicare Advantage |
$392.69
|
| Rate for Payer: BCN Medicare Advantage |
$392.69
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Cofinity Commercial |
$526.20
|
| Rate for Payer: Cofinity Commercial |
$565.47
|
| Rate for Payer: Cofinity Commercial |
$565.47
|
| Rate for Payer: Cofinity Commercial |
$526.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.32
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: Nomi Health Commercial |
$471.23
|
| Rate for Payer: Nomi Health Commercial |
$471.23
|
| Rate for Payer: PACE SWMI |
$392.69
|
| Rate for Payer: PACE SWMI |
$392.69
|
| Rate for Payer: PHP Commercial |
$549.77
|
| Rate for Payer: PHP Commercial |
$549.77
|
| Rate for Payer: PHP Medicare Advantage |
$392.69
|
| Rate for Payer: PHP Medicare Advantage |
$392.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$586.20
|
| Rate for Payer: Priority Health Medicare |
$392.69
|
| Rate for Payer: Priority Health Medicare |
$392.69
|
| Rate for Payer: Priority Health Narrow Network |
$586.20
|
| Rate for Payer: Priority Health Narrow Network |
$586.20
|
| Rate for Payer: Priority Health SBD |
$75.98
|
| Rate for Payer: Priority Health SBD |
$75.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$392.69
|
| Rate for Payer: UHC Medicare Advantage |
$392.69
|
| Rate for Payer: UHCCP Medicaid |
$35.78
|
| Rate for Payer: UHCCP Medicaid |
$35.78
|
| Rate for Payer: UMR Bronson Commercial |
$112.70
|
| Rate for Payer: UMR Bronson Commercial |
$457.70
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$405.24 |
| Max. Negotiated Rate |
$828.90 |
| Rate for Payer: Aetna American Axle |
$598.65
|
| Rate for Payer: Aetna Commercial |
$782.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.65
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$644.70
|
| Rate for Payer: Cofinity Commercial |
$792.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$644.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.80
|
| Rate for Payer: Healthscope Commercial |
$828.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$644.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.85
|
| Rate for Payer: PHP Commercial |
$782.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health SBD |
$580.23
|
| Rate for Payer: UMR Bronson Commercial |
$405.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.75
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$189.57 |
| Max. Negotiated Rate |
$4,928.37 |
| Rate for Payer: Aetna American Axle |
$598.65
|
| Rate for Payer: Aetna Commercial |
$782.85
|
| Rate for Payer: Aetna Medicare |
$1,630.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,960.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,960.06
|
| Rate for Payer: BCBS Complete |
$882.50
|
| Rate for Payer: BCBS MAPPO |
$1,568.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,263.77
|
| Rate for Payer: BCN Commercial |
$1,263.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.05
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$792.06
|
| Rate for Payer: Cofinity Commercial |
$644.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$644.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.05
|
| Rate for Payer: Healthscope Commercial |
$828.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$644.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$690.75
|
| Rate for Payer: Mclaren Medicaid |
$840.47
|
| Rate for Payer: Mclaren Medicare |
$1,568.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,646.45
|
| Rate for Payer: Meridian Medicaid |
$882.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,803.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$782.85
|
| Rate for Payer: Nomi Health Commercial |
$3,292.90
|
| Rate for Payer: PACE Medicare |
$1,489.65
|
| Rate for Payer: PACE SWMI |
$1,568.05
|
| Rate for Payer: PHP Commercial |
$782.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$840.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,928.37
|
| Rate for Payer: Priority Health Medicare |
$1,568.05
|
| Rate for Payer: Priority Health Narrow Network |
$3,942.70
|
| Rate for Payer: Priority Health SBD |
$580.23
|
| Rate for Payer: Railroad Medicare Medicare |
$1,568.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.53
|
| Rate for Payer: UHC Core |
$2,014.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,568.05
|
| Rate for Payer: UHC Exchange |
$189.57
|
| Rate for Payer: UHC Medicare Advantage |
$1,568.05
|
| Rate for Payer: UHCCP Medicaid |
$840.47
|
| Rate for Payer: UMR Bronson Commercial |
$340.77
|
| Rate for Payer: VA VA |
$1,568.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$690.75
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Medicare |
$196.59
|
| Rate for Payer: Aetna Commercial |
$253.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.20
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$189.03
|
| Rate for Payer: BCBS Trust/PPO |
$286.11
|
| Rate for Payer: BCN Commercial |
$288.81
|
| Rate for Payer: BCN Medicare Advantage |
$189.03
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Cofinity Commercial |
$272.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.48
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Nomi Health Commercial |
$226.84
|
| Rate for Payer: PACE SWMI |
$189.03
|
| Rate for Payer: PHP Commercial |
$264.64
|
| Rate for Payer: PHP Medicare Advantage |
$189.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.28
|
| Rate for Payer: Priority Health Medicare |
$189.03
|
| Rate for Payer: Priority Health Narrow Network |
$303.28
|
| Rate for Payer: Priority Health SBD |
$303.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.03
|
| Rate for Payer: UHC Medicare Advantage |
$189.03
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
| Rate for Payer: UMR Bronson Commercial |
$423.66
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$921.00
|
|
|
Service Code
|
HCPCS 23700
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$598.65 |
| Rate for Payer: Aetna Commercial |
$253.30
|
| Rate for Payer: Aetna Medicare |
$196.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.20
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$189.03
|
| Rate for Payer: BCBS Trust/PPO |
$286.11
|
| Rate for Payer: BCN Commercial |
$288.81
|
| Rate for Payer: BCN Medicare Advantage |
$189.03
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cash Price |
$736.80
|
| Rate for Payer: Cofinity Commercial |
$272.20
|
| Rate for Payer: Cofinity Commercial |
$253.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.48
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Nomi Health Commercial |
$226.84
|
| Rate for Payer: PACE SWMI |
$189.03
|
| Rate for Payer: PHP Commercial |
$264.64
|
| Rate for Payer: PHP Medicare Advantage |
$189.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$303.28
|
| Rate for Payer: Priority Health Medicare |
$189.03
|
| Rate for Payer: Priority Health Narrow Network |
$303.28
|
| Rate for Payer: Priority Health SBD |
$303.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.03
|
| Rate for Payer: UHC Medicare Advantage |
$189.03
|
| Rate for Payer: UHCCP Medicaid |
$128.23
|
| Rate for Payer: UMR Bronson Commercial |
$423.66
|
|
|
PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 20950
|
| Min. Negotiated Rate |
$84.84 |
| Max. Negotiated Rate |
$29,358.48 |
| Rate for Payer: Aetna Commercial |
$113.69
|
| Rate for Payer: Aetna Medicare |
$88.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.17
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$84.84
|
| Rate for Payer: BCBS Trust/PPO |
$29,358.48
|
| Rate for Payer: BCN Commercial |
$387.52
|
| Rate for Payer: BCN Medicare Advantage |
$84.84
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$122.17
|
| Rate for Payer: Cofinity Commercial |
$113.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$89.08
|
| Rate for Payer: Nomi Health Commercial |
$101.81
|
| Rate for Payer: PACE SWMI |
$84.84
|
| Rate for Payer: PHP Commercial |
$118.78
|
| Rate for Payer: PHP Medicare Advantage |
$84.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.35
|
| Rate for Payer: Priority Health Medicare |
$84.84
|
| Rate for Payer: Priority Health Narrow Network |
$135.35
|
| Rate for Payer: Priority Health SBD |
$135.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.84
|
| Rate for Payer: UHC Medicare Advantage |
$84.84
|
| Rate for Payer: UMR Bronson Commercial |
$223.10
|
|
|
PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
HCPCS 44139
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$1,085.13 |
| Rate for Payer: Aetna Commercial |
$155.64
|
| Rate for Payer: Aetna Medicare |
$120.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.26
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS MAPPO |
$116.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.13
|
| Rate for Payer: BCN Commercial |
$173.96
|
| Rate for Payer: BCN Medicare Advantage |
$116.15
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cash Price |
$329.60
|
| Rate for Payer: Cofinity Commercial |
$155.64
|
| Rate for Payer: Cofinity Commercial |
$167.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.96
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Nomi Health Commercial |
$139.38
|
| Rate for Payer: PACE SWMI |
$116.15
|
| Rate for Payer: PHP Commercial |
$162.61
|
| Rate for Payer: PHP Medicare Advantage |
$116.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.38
|
| Rate for Payer: Priority Health Medicare |
$116.15
|
| Rate for Payer: Priority Health Narrow Network |
$212.38
|
| Rate for Payer: Priority Health SBD |
$212.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.15
|
| Rate for Payer: UHC Medicare Advantage |
$116.15
|
| Rate for Payer: UHCCP Medicaid |
$76.25
|
| Rate for Payer: UMR Bronson Commercial |
$189.52
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 99149
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$87.10 |
| Rate for Payer: Aetna Medicare |
$67.00
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
| Rate for Payer: UMR Bronson Commercial |
$61.64
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99150
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 99143
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$120.90 |
| Rate for Payer: Aetna Medicare |
$93.00
|
| Rate for Payer: BCBS Complete |
$74.40
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.90
|
| Rate for Payer: UMR Bronson Commercial |
$85.56
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 99144
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Medicare |
$69.00
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: UMR Bronson Commercial |
$63.48
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 99145
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
|
|
PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 99157
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$660.90 |
| Rate for Payer: Aetna Commercial |
$73.82
|
| Rate for Payer: Aetna Medicare |
$57.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.33
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCBS MAPPO |
$55.09
|
| Rate for Payer: BCBS Trust/PPO |
$660.90
|
| Rate for Payer: BCN Commercial |
$98.47
|
| Rate for Payer: BCN Medicare Advantage |
$55.09
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$79.33
|
| Rate for Payer: Cofinity Commercial |
$73.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.84
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Nomi Health Commercial |
$66.11
|
| Rate for Payer: PACE SWMI |
$55.09
|
| Rate for Payer: PHP Commercial |
$77.13
|
| Rate for Payer: PHP Medicare Advantage |
$55.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.91
|
| Rate for Payer: Priority Health Medicare |
$55.09
|
| Rate for Payer: Priority Health Narrow Network |
$169.91
|
| Rate for Payer: Priority Health SBD |
$169.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.09
|
| Rate for Payer: UHC Medicare Advantage |
$55.09
|
| Rate for Payer: UHCCP Medicaid |
$36.42
|
| Rate for Payer: UMR Bronson Commercial |
$53.82
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS 99155
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$880.15 |
| Rate for Payer: Aetna Commercial |
$106.85
|
| Rate for Payer: Aetna Medicare |
$82.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.83
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS MAPPO |
$79.74
|
| Rate for Payer: BCBS Trust/PPO |
$880.15
|
| Rate for Payer: BCN Commercial |
$131.29
|
| Rate for Payer: BCN Medicare Advantage |
$79.74
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$106.85
|
| Rate for Payer: Cofinity Commercial |
$114.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.73
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Nomi Health Commercial |
$95.69
|
| Rate for Payer: PACE SWMI |
$79.74
|
| Rate for Payer: PHP Commercial |
$111.64
|
| Rate for Payer: PHP Medicare Advantage |
$79.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.50
|
| Rate for Payer: Priority Health Medicare |
$79.74
|
| Rate for Payer: Priority Health Narrow Network |
$236.50
|
| Rate for Payer: Priority Health SBD |
$236.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.74
|
| Rate for Payer: UHC Medicare Advantage |
$79.74
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
| Rate for Payer: UMR Bronson Commercial |
$86.94
|
|
|
PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99156
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$672.53 |
| Rate for Payer: Aetna Commercial |
$95.05
|
| Rate for Payer: Aetna Medicare |
$73.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.05
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$70.93
|
| Rate for Payer: BCBS Trust/PPO |
$672.53
|
| Rate for Payer: BCN Commercial |
$120.53
|
| Rate for Payer: BCN Medicare Advantage |
$70.93
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$102.14
|
| Rate for Payer: Cofinity Commercial |
$95.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.48
|
| Rate for Payer: Meridian Medicaid |
$49.20
|
| Rate for Payer: Nomi Health Commercial |
$85.12
|
| Rate for Payer: PACE SWMI |
$70.93
|
| Rate for Payer: PHP Commercial |
$99.30
|
| Rate for Payer: PHP Medicare Advantage |
$70.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.31
|
| Rate for Payer: Priority Health Medicare |
$70.93
|
| Rate for Payer: Priority Health Narrow Network |
$214.31
|
| Rate for Payer: Priority Health SBD |
$214.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.93
|
| Rate for Payer: UHC Medicare Advantage |
$70.93
|
| Rate for Payer: UHCCP Medicaid |
$46.86
|
| Rate for Payer: UMR Bronson Commercial |
$71.30
|
|
|
PR MOD SED SAME PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 99153
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$674.11 |
| Rate for Payer: Aetna Commercial |
$14.45
|
| Rate for Payer: Aetna Medicare |
$11.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.52
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$10.78
|
| Rate for Payer: BCBS Trust/PPO |
$674.11
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: BCN Medicare Advantage |
$10.78
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Cofinity Commercial |
$14.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.32
|
| Rate for Payer: Nomi Health Commercial |
$12.94
|
| Rate for Payer: PACE SWMI |
$10.78
|
| Rate for Payer: PHP Commercial |
$15.09
|
| Rate for Payer: PHP Medicare Advantage |
$10.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.20
|
| Rate for Payer: Priority Health Medicare |
$10.78
|
| Rate for Payer: Priority Health Narrow Network |
$19.20
|
| Rate for Payer: Priority Health SBD |
$19.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.78
|
| Rate for Payer: UHC Medicare Advantage |
$10.78
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99151
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$726.41 |
| Rate for Payer: Aetna Commercial |
$30.31
|
| Rate for Payer: Aetna Medicare |
$23.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.31
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$22.62
|
| Rate for Payer: BCBS Trust/PPO |
$726.41
|
| Rate for Payer: BCN Commercial |
$96.86
|
| Rate for Payer: BCN Medicare Advantage |
$22.62
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$32.57
|
| Rate for Payer: Cofinity Commercial |
$30.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.75
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Nomi Health Commercial |
$27.14
|
| Rate for Payer: PACE SWMI |
$22.62
|
| Rate for Payer: PHP Commercial |
$31.67
|
| Rate for Payer: PHP Medicare Advantage |
$22.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.53
|
| Rate for Payer: Priority Health Medicare |
$22.62
|
| Rate for Payer: Priority Health Narrow Network |
$68.53
|
| Rate for Payer: Priority Health SBD |
$68.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.62
|
| Rate for Payer: UHC Medicare Advantage |
$22.62
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
PR MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99152
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$15.52
|
| Rate for Payer: Aetna Medicare |
$12.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.68
|
| Rate for Payer: BCBS Complete |
$8.05
|
| Rate for Payer: BCBS MAPPO |
$11.58
|
| Rate for Payer: BCBS Trust/PPO |
$552.07
|
| Rate for Payer: BCN Commercial |
$80.72
|
| Rate for Payer: BCN Medicare Advantage |
$11.58
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$15.52
|
| Rate for Payer: Cofinity Commercial |
$16.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.16
|
| Rate for Payer: Meridian Medicaid |
$8.05
|
| Rate for Payer: Nomi Health Commercial |
$13.90
|
| Rate for Payer: PACE SWMI |
$11.58
|
| Rate for Payer: PHP Commercial |
$16.21
|
| Rate for Payer: PHP Medicare Advantage |
$11.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.51
|
| Rate for Payer: Priority Health Medicare |
$11.58
|
| Rate for Payer: Priority Health Narrow Network |
$39.51
|
| Rate for Payer: Priority Health SBD |
$39.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.58
|
| Rate for Payer: UHC Medicare Advantage |
$11.58
|
| Rate for Payer: UHCCP Medicaid |
$7.67
|
| Rate for Payer: UMR Bronson Commercial |
$71.30
|
|
|
PR MONALISA TOUCH, SERIES, UP TO 7 VISITS, LICHEN SCLEROSUS
|
Professional
|
Both
|
$2,142.00
|
|
|
Service Code
|
HCPCS 00560
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$856.80 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Aetna Medicare |
$1,071.00
|
| Rate for Payer: BCBS Complete |
$856.80
|
| Rate for Payer: Cash Price |
$1,713.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,392.30
|
| Rate for Payer: UMR Bronson Commercial |
$985.32
|
|
|
PR MONOVISC INJ PER DOSE
|
Professional
|
Both
|
$941.00
|
|
|
Service Code
|
HCPCS J7327
|
| Min. Negotiated Rate |
$376.40 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$708.29
|
| Rate for Payer: Aetna Medicare |
$549.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$708.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.15
|
| Rate for Payer: BCBS Complete |
$376.40
|
| Rate for Payer: BCBS MAPPO |
$528.58
|
| Rate for Payer: BCBS Trust/PPO |
$727.84
|
| Rate for Payer: BCN Commercial |
$800.00
|
| Rate for Payer: BCN Medicare Advantage |
$528.58
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cash Price |
$752.80
|
| Rate for Payer: Cofinity Commercial |
$708.29
|
| Rate for Payer: Cofinity Commercial |
$761.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$528.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.00
|
| Rate for Payer: Nomi Health Commercial |
$634.29
|
| Rate for Payer: PACE SWMI |
$528.58
|
| Rate for Payer: PHP Commercial |
$740.01
|
| Rate for Payer: PHP Medicare Advantage |
$528.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$611.65
|
| Rate for Payer: Priority Health Medicare |
$528.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$528.58
|
| Rate for Payer: UHC Medicare Advantage |
$528.58
|
| Rate for Payer: UMR Bronson Commercial |
$432.86
|
|
|
PR MORPHINE SULFATE INJECTION
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J2270
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$6.54 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.54
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$4.54
|
| Rate for Payer: BCBS Trust/PPO |
$0.09
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Medicare Advantage |
$4.54
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$6.09
|
| Rate for Payer: Cofinity Commercial |
$6.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.77
|
| Rate for Payer: Nomi Health Commercial |
$5.45
|
| Rate for Payer: PACE SWMI |
$4.54
|
| Rate for Payer: PHP Commercial |
$6.36
|
| Rate for Payer: PHP Medicare Advantage |
$4.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$4.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.54
|
| Rate for Payer: UHC Medicare Advantage |
$4.54
|
| Rate for Payer: UMR Bronson Commercial |
$3.68
|
|
|
PR MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 95905
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1,790.41 |
| Rate for Payer: Aetna Commercial |
$39.11
|
| Rate for Payer: Aetna Medicare |
$30.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.03
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS MAPPO |
$29.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,790.41
|
| Rate for Payer: BCN Commercial |
$50.33
|
| Rate for Payer: BCN Medicare Advantage |
$29.19
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cofinity Commercial |
$42.03
|
| Rate for Payer: Cofinity Commercial |
$39.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.65
|
| Rate for Payer: Meridian Medicaid |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$35.03
|
| Rate for Payer: PACE SWMI |
$29.19
|
| Rate for Payer: PHP Commercial |
$40.87
|
| Rate for Payer: PHP Medicare Advantage |
$29.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.68
|
| Rate for Payer: Priority Health Medicare |
$29.19
|
| Rate for Payer: Priority Health Narrow Network |
$45.68
|
| Rate for Payer: Priority Health SBD |
$3.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.19
|
| Rate for Payer: UHC Medicare Advantage |
$29.19
|
| Rate for Payer: UHCCP Medicaid |
$1.70
|
| Rate for Payer: UMR Bronson Commercial |
$63.48
|
|
|
PR MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 90733
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$125.50 |
| Rate for Payer: Aetna Commercial |
$125.50
|
| Rate for Payer: Aetna Medicare |
$64.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.50
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS Trust/PPO |
$125.49
|
| Rate for Payer: BCN Commercial |
$123.17
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: UMR Bronson Commercial |
$59.34
|
|
|
PR MULTIPLE FAM GROUP BHV TX GDN PHYS/QHP EA 15 MIN
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 97157
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$997.43 |
| Rate for Payer: Aetna Commercial |
$20.79
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.79
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$997.43
|
| Rate for Payer: BCN Commercial |
$23.79
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.60
|
| Rate for Payer: Priority Health Narrow Network |
$27.60
|
| Rate for Payer: Priority Health SBD |
$27.60
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
