|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 70710166801
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.52 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UMR Bronson Commercial |
$137.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$270.48
|
|
|
Service Code
|
NDC 50268068515
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.01 |
| Max. Negotiated Rate |
$243.43 |
| Rate for Payer: Aetna American Axle |
$175.81
|
| Rate for Payer: Aetna Commercial |
$229.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.81
|
| Rate for Payer: Cash Price |
$216.38
|
| Rate for Payer: Cofinity Commercial |
$189.34
|
| Rate for Payer: Cofinity Commercial |
$232.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.38
|
| Rate for Payer: Healthscope Commercial |
$243.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.91
|
| Rate for Payer: PHP Commercial |
$229.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.81
|
| Rate for Payer: Priority Health SBD |
$170.40
|
| Rate for Payer: UMR Bronson Commercial |
$119.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.86
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$5.41
|
|
|
Service Code
|
NDC 50268068511
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna American Axle |
$3.52
|
| Rate for Payer: Aetna Commercial |
$4.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.52
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Cofinity Commercial |
$4.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.33
|
| Rate for Payer: Healthscope Commercial |
$4.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.60
|
| Rate for Payer: PHP Commercial |
$4.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health SBD |
$3.41
|
| Rate for Payer: UMR Bronson Commercial |
$2.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.06
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 27241028701
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna Medicare |
$156.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UMR Bronson Commercial |
$115.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$307.80
|
|
|
Service Code
|
NDC 70710166701
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.43 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$215.46
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.07
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UMR Bronson Commercial |
$135.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
OP
|
$307.80
|
|
|
Service Code
|
NDC 70710166701
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$153.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: BCBS Complete |
$123.12
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$215.46
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.07
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UMR Bronson Commercial |
$113.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$307.80
|
|
|
Service Code
|
NDC 59746011306
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.43 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$215.46
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.07
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UMR Bronson Commercial |
$135.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
OP
|
$307.80
|
|
|
Service Code
|
NDC 59746011306
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$153.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: BCBS Complete |
$123.12
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$215.46
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.07
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UMR Bronson Commercial |
$113.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 45505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Exchange |
$5,111.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,433.59
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$2,502.92
|
|
|
Service Code
|
CPT 45300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$476.60 |
| Max. Negotiated Rate |
$2,502.92 |
| Rate for Payer: Aetna Medicare |
$924.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,111.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,111.46
|
| Rate for Payer: BCBS Complete |
$500.42
|
| Rate for Payer: BCBS MAPPO |
$889.17
|
| Rate for Payer: BCN Medicare Advantage |
$889.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$889.17
|
| Rate for Payer: Mclaren Medicaid |
$476.60
|
| Rate for Payer: Mclaren Medicare |
$889.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$933.63
|
| Rate for Payer: Meridian Medicaid |
$500.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,022.55
|
| Rate for Payer: PACE Medicare |
$844.71
|
| Rate for Payer: PACE SWMI |
$889.17
|
| Rate for Payer: PHP Medicare Advantage |
$889.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.60
|
| Rate for Payer: Priority Health Medicare |
$889.17
|
| Rate for Payer: Railroad Medicare Medicare |
$889.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,502.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$889.17
|
| Rate for Payer: UHC Exchange |
$1,699.29
|
| Rate for Payer: UHC Medicare Advantage |
$889.17
|
| Rate for Payer: UHCCP Medicaid |
$476.60
|
| Rate for Payer: VA VA |
$889.17
|
|
|
PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$3,236.94
|
|
|
Service Code
|
CPT 45305
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$616.36 |
| Max. Negotiated Rate |
$3,236.94 |
| Rate for Payer: Aetna Medicare |
$1,195.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,437.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,437.41
|
| Rate for Payer: BCBS Complete |
$647.18
|
| Rate for Payer: BCBS MAPPO |
$1,149.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,149.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,149.93
|
| Rate for Payer: Mclaren Medicaid |
$616.36
|
| Rate for Payer: Mclaren Medicare |
$1,149.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,207.43
|
| Rate for Payer: Meridian Medicaid |
$647.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,322.42
|
| Rate for Payer: PACE Medicare |
$1,092.43
|
| Rate for Payer: PACE SWMI |
$1,149.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,149.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$616.36
|
| Rate for Payer: Priority Health Medicare |
$1,149.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1,149.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,236.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,149.93
|
| Rate for Payer: UHC Exchange |
$2,197.63
|
| Rate for Payer: UHC Medicare Advantage |
$1,149.93
|
| Rate for Payer: UHCCP Medicaid |
$616.36
|
| Rate for Payer: VA VA |
$1,149.93
|
|
|
PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 99241
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Medicare |
$56.50
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: UMR Bronson Commercial |
$51.98
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 99245
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$241.15 |
| Rate for Payer: Aetna Medicare |
$185.50
|
| Rate for Payer: BCBS Complete |
$148.40
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.15
|
| Rate for Payer: UMR Bronson Commercial |
$170.66
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 99243
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 99244
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$194.35 |
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: UMR Bronson Commercial |
$137.54
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 99242
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$98.15 |
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: UMR Bronson Commercial |
$69.46
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 99215
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$196.21 |
| Rate for Payer: Aetna Commercial |
$182.59
|
| Rate for Payer: Aetna Medicare |
$141.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.59
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$136.26
|
| Rate for Payer: BCN Medicare Advantage |
$136.26
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$196.21
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.07
|
| Rate for Payer: Nomi Health Commercial |
$163.51
|
| Rate for Payer: PACE SWMI |
$136.26
|
| Rate for Payer: PHP Commercial |
$190.76
|
| Rate for Payer: PHP Medicare Advantage |
$136.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$136.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.26
|
| Rate for Payer: UHC Medicare Advantage |
$136.26
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99213
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$90.20 |
| Rate for Payer: Aetna Commercial |
$83.94
|
| Rate for Payer: Aetna Medicare |
$65.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.94
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$62.64
|
| Rate for Payer: BCN Medicare Advantage |
$62.64
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$90.20
|
| Rate for Payer: Cofinity Commercial |
$83.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.77
|
| Rate for Payer: Nomi Health Commercial |
$75.17
|
| Rate for Payer: PACE SWMI |
$62.64
|
| Rate for Payer: PHP Commercial |
$87.70
|
| Rate for Payer: PHP Medicare Advantage |
$62.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$62.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.64
|
| Rate for Payer: UHC Medicare Advantage |
$62.64
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99214
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$132.84 |
| Rate for Payer: Aetna Commercial |
$123.61
|
| Rate for Payer: Aetna Medicare |
$95.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.61
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$92.25
|
| Rate for Payer: BCN Medicare Advantage |
$92.25
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Cofinity Commercial |
$123.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.86
|
| Rate for Payer: Nomi Health Commercial |
$110.70
|
| Rate for Payer: PACE SWMI |
$92.25
|
| Rate for Payer: PHP Commercial |
$129.15
|
| Rate for Payer: PHP Medicare Advantage |
$92.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health Medicare |
$92.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.25
|
| Rate for Payer: UHC Medicare Advantage |
$92.25
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 99212
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$48.07 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: Aetna Medicare |
$34.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.73
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS MAPPO |
$33.38
|
| Rate for Payer: BCN Medicare Advantage |
$33.38
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$44.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.05
|
| Rate for Payer: Nomi Health Commercial |
$40.06
|
| Rate for Payer: PACE SWMI |
$33.38
|
| Rate for Payer: PHP Commercial |
$46.73
|
| Rate for Payer: PHP Medicare Advantage |
$33.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.95
|
| Rate for Payer: Priority Health Medicare |
$33.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.38
|
| Rate for Payer: UHC Medicare Advantage |
$33.38
|
| Rate for Payer: UMR Bronson Commercial |
$28.98
|
|
|
PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 99211
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Commercial |
$11.56
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 99205
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$249.08 |
| Rate for Payer: Aetna Commercial |
$231.78
|
| Rate for Payer: Aetna Medicare |
$179.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.78
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$172.97
|
| Rate for Payer: BCN Medicare Advantage |
$172.97
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$249.08
|
| Rate for Payer: Cofinity Commercial |
$231.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.62
|
| Rate for Payer: Nomi Health Commercial |
$207.56
|
| Rate for Payer: PACE SWMI |
$172.97
|
| Rate for Payer: PHP Commercial |
$242.16
|
| Rate for Payer: PHP Medicare Advantage |
$172.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$172.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.97
|
| Rate for Payer: UHC Medicare Advantage |
$172.97
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR OFFICE OUTPATIENT NEW LEVL I
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 99201
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
| Rate for Payer: UMR Bronson Commercial |
$32.66
|
|
|
PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99203
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$112.55 |
| Rate for Payer: Aetna Commercial |
$104.73
|
| Rate for Payer: Aetna Medicare |
$81.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.55
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$78.16
|
| Rate for Payer: BCN Medicare Advantage |
$78.16
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Cofinity Commercial |
$112.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.07
|
| Rate for Payer: Nomi Health Commercial |
$93.79
|
| Rate for Payer: PACE SWMI |
$78.16
|
| Rate for Payer: PHP Commercial |
$109.42
|
| Rate for Payer: PHP Medicare Advantage |
$78.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health Medicare |
$78.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.16
|
| Rate for Payer: UHC Medicare Advantage |
$78.16
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 99204
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$183.01 |
| Rate for Payer: Aetna Commercial |
$170.30
|
| Rate for Payer: Aetna Medicare |
$132.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.30
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS MAPPO |
$127.09
|
| Rate for Payer: BCN Medicare Advantage |
$127.09
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Cofinity Commercial |
$170.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.44
|
| Rate for Payer: Nomi Health Commercial |
$152.51
|
| Rate for Payer: PACE SWMI |
$127.09
|
| Rate for Payer: PHP Commercial |
$177.93
|
| Rate for Payer: PHP Medicare Advantage |
$127.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health Medicare |
$127.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.09
|
| Rate for Payer: UHC Medicare Advantage |
$127.09
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
