|
PR PNEUMOCOCCAL CONJ VACCINE 7 VALENT IM
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 90669
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Aetna Medicare |
$59.50
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.25
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
|
|
PR PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX
|
Professional
|
Both
|
$2,651.00
|
|
|
Service Code
|
HCPCS 32940
|
| Min. Negotiated Rate |
$749.33 |
| Max. Negotiated Rate |
$2,185.58 |
| Rate for Payer: Aetna Commercial |
$1,569.17
|
| Rate for Payer: Aetna Medicare |
$1,217.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,569.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,686.27
|
| Rate for Payer: BCBS Complete |
$786.80
|
| Rate for Payer: BCBS MAPPO |
$1,171.02
|
| Rate for Payer: BCN Commercial |
$1,825.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,171.02
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cofinity Commercial |
$1,686.27
|
| Rate for Payer: Cofinity Commercial |
$1,569.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,171.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,229.57
|
| Rate for Payer: Meridian Medicaid |
$786.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,288.12
|
| Rate for Payer: Nomi Health Commercial |
$1,405.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,988.25
|
| Rate for Payer: PACE SWMI |
$1,171.02
|
| Rate for Payer: PHP Commercial |
$1,639.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,171.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$749.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,719.17
|
| Rate for Payer: Priority Health Medicare |
$1,171.02
|
| Rate for Payer: Priority Health SBD |
$1,719.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,719.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,171.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,185.58
|
| Rate for Payer: UHC Core |
$2,185.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,171.02
|
| Rate for Payer: UHC Exchange |
$2,185.58
|
| Rate for Payer: UHC Medicaid |
$749.33
|
| Rate for Payer: UHCCP Medicaid |
$749.33
|
| Rate for Payer: UMR Bronson Commercial |
$1,219.46
|
|
|
PR PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST
|
Professional
|
Both
|
$2,811.00
|
|
|
Service Code
|
HCPCS 32200
|
| Min. Negotiated Rate |
$707.16 |
| Max. Negotiated Rate |
$2,108.25 |
| Rate for Payer: Aetna Commercial |
$1,471.84
|
| Rate for Payer: Aetna Medicare |
$1,142.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,471.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,581.68
|
| Rate for Payer: BCBS Complete |
$742.52
|
| Rate for Payer: BCBS MAPPO |
$1,098.39
|
| Rate for Payer: BCN Commercial |
$1,696.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,098.39
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cofinity Commercial |
$1,471.84
|
| Rate for Payer: Cofinity Commercial |
$1,581.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,098.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,153.31
|
| Rate for Payer: Meridian Medicaid |
$742.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,208.23
|
| Rate for Payer: Nomi Health Commercial |
$1,318.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,108.25
|
| Rate for Payer: PACE SWMI |
$1,098.39
|
| Rate for Payer: PHP Commercial |
$1,537.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,098.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$707.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,597.24
|
| Rate for Payer: Priority Health Medicare |
$1,098.39
|
| Rate for Payer: Priority Health SBD |
$1,597.24
|
| Rate for Payer: Priority Health Tiered Network |
$1,597.24
|
| Rate for Payer: Railroad Medicare Medicare |
$1,098.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,006.19
|
| Rate for Payer: UHC Core |
$2,006.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,098.39
|
| Rate for Payer: UHC Exchange |
$2,006.19
|
| Rate for Payer: UHC Medicaid |
$707.16
|
| Rate for Payer: UHCCP Medicaid |
$707.16
|
| Rate for Payer: UMR Bronson Commercial |
$1,293.06
|
|
|
PR PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 32960
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Aetna Commercial |
$108.94
|
| Rate for Payer: Aetna Medicare |
$84.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.07
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS MAPPO |
$81.30
|
| Rate for Payer: BCN Commercial |
$133.96
|
| Rate for Payer: BCN Medicare Advantage |
$81.30
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cofinity Commercial |
$108.94
|
| Rate for Payer: Cofinity Commercial |
$117.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.36
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.43
|
| Rate for Payer: Nomi Health Commercial |
$97.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.50
|
| Rate for Payer: PACE SWMI |
$81.30
|
| Rate for Payer: PHP Commercial |
$113.82
|
| Rate for Payer: PHP Medicare Advantage |
$81.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$126.14
|
| Rate for Payer: Priority Health Medicare |
$81.30
|
| Rate for Payer: Priority Health SBD |
$126.14
|
| Rate for Payer: Priority Health Tiered Network |
$126.14
|
| Rate for Payer: Railroad Medicare Medicare |
$81.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.05
|
| Rate for Payer: UHC Core |
$161.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$81.30
|
| Rate for Payer: UHC Exchange |
$161.05
|
| Rate for Payer: UHC Medicaid |
$52.40
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
| Rate for Payer: UMR Bronson Commercial |
$146.28
|
|
|
PR PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 55000
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$101.55
|
| Rate for Payer: Aetna Medicare |
$78.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.12
|
| Rate for Payer: BCBS Complete |
$51.66
|
| Rate for Payer: BCBS MAPPO |
$75.78
|
| Rate for Payer: BCN Commercial |
$126.49
|
| Rate for Payer: BCN Medicare Advantage |
$75.78
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$101.55
|
| Rate for Payer: Cofinity Commercial |
$109.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.57
|
| Rate for Payer: Meridian Medicaid |
$51.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.36
|
| Rate for Payer: Nomi Health Commercial |
$90.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.00
|
| Rate for Payer: PACE SWMI |
$75.78
|
| Rate for Payer: PHP Commercial |
$106.09
|
| Rate for Payer: PHP Medicare Advantage |
$75.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$137.79
|
| Rate for Payer: Priority Health Medicare |
$75.78
|
| Rate for Payer: Priority Health SBD |
$137.79
|
| Rate for Payer: Priority Health Tiered Network |
$137.79
|
| Rate for Payer: Railroad Medicare Medicare |
$75.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.79
|
| Rate for Payer: UHC Core |
$148.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$75.78
|
| Rate for Payer: UHC Exchange |
$148.79
|
| Rate for Payer: UHC Medicaid |
$49.20
|
| Rate for Payer: UHCCP Medicaid |
$49.20
|
| Rate for Payer: UMR Bronson Commercial |
$104.88
|
|
|
PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 90713
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.27
|
| Rate for Payer: BCBS Trust/PPO |
$47.81
|
| Rate for Payer: BCN Commercial |
$43.89
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.27
|
| Rate for Payer: UHC Core |
$46.27
|
| Rate for Payer: UHC Exchange |
$46.27
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR POLLICIZATION DIGIT
|
Professional
|
Both
|
$2,851.00
|
|
|
Service Code
|
HCPCS 26550
|
| Min. Negotiated Rate |
$981.08 |
| Max. Negotiated Rate |
$2,863.59 |
| Rate for Payer: Aetna Commercial |
$2,007.99
|
| Rate for Payer: Aetna Medicare |
$1,558.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,007.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,157.84
|
| Rate for Payer: BCBS Complete |
$1,030.13
|
| Rate for Payer: BCBS MAPPO |
$1,498.50
|
| Rate for Payer: BCN Commercial |
$2,479.95
|
| Rate for Payer: BCN Medicare Advantage |
$1,498.50
|
| Rate for Payer: Cash Price |
$2,280.80
|
| Rate for Payer: Cash Price |
$2,280.80
|
| Rate for Payer: Cofinity Commercial |
$2,007.99
|
| Rate for Payer: Cofinity Commercial |
$2,157.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,498.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,573.42
|
| Rate for Payer: Meridian Medicaid |
$1,030.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,648.35
|
| Rate for Payer: Nomi Health Commercial |
$1,798.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,138.25
|
| Rate for Payer: PACE SWMI |
$1,498.50
|
| Rate for Payer: PHP Commercial |
$2,097.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,498.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$981.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,651.00
|
| Rate for Payer: Priority Health Medicare |
$1,498.50
|
| Rate for Payer: Priority Health SBD |
$2,651.00
|
| Rate for Payer: Priority Health Tiered Network |
$2,651.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1,498.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,863.59
|
| Rate for Payer: UHC Core |
$2,863.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,498.50
|
| Rate for Payer: UHC Exchange |
$2,863.59
|
| Rate for Payer: UHC Medicaid |
$981.08
|
| Rate for Payer: UHCCP Medicaid |
$981.08
|
| Rate for Payer: UMR Bronson Commercial |
$1,311.46
|
|
|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$488.00
|
|
|
Service Code
|
HCPCS 95810
|
| Min. Negotiated Rate |
$224.48 |
| Max. Negotiated Rate |
$928.29 |
| Rate for Payer: Aetna Commercial |
$836.23
|
| Rate for Payer: Aetna Commercial |
$836.23
|
| Rate for Payer: Aetna Medicare |
$649.01
|
| Rate for Payer: Aetna Medicare |
$649.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$898.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$898.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.23
|
| Rate for Payer: BCBS MAPPO |
$624.05
|
| Rate for Payer: BCBS MAPPO |
$624.05
|
| Rate for Payer: BCN Commercial |
$738.67
|
| Rate for Payer: BCN Commercial |
$738.67
|
| Rate for Payer: BCN Medicare Advantage |
$624.05
|
| Rate for Payer: BCN Medicare Advantage |
$624.05
|
| Rate for Payer: Cash Price |
$821.60
|
| Rate for Payer: Cash Price |
$821.60
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cofinity Commercial |
$898.63
|
| Rate for Payer: Cofinity Commercial |
$898.63
|
| Rate for Payer: Cofinity Commercial |
$836.23
|
| Rate for Payer: Cofinity Commercial |
$836.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$686.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$686.46
|
| Rate for Payer: Nomi Health Commercial |
$748.86
|
| Rate for Payer: Nomi Health Commercial |
$748.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$770.25
|
| Rate for Payer: PACE SWMI |
$624.05
|
| Rate for Payer: PACE SWMI |
$624.05
|
| Rate for Payer: PHP Commercial |
$873.67
|
| Rate for Payer: PHP Commercial |
$873.67
|
| Rate for Payer: PHP Medicare Advantage |
$624.05
|
| Rate for Payer: PHP Medicare Advantage |
$624.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$863.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$863.84
|
| Rate for Payer: Priority Health Medicare |
$624.05
|
| Rate for Payer: Priority Health Medicare |
$624.05
|
| Rate for Payer: Priority Health SBD |
$863.84
|
| Rate for Payer: Priority Health SBD |
$863.84
|
| Rate for Payer: Priority Health Tiered Network |
$863.84
|
| Rate for Payer: Priority Health Tiered Network |
$863.84
|
| Rate for Payer: Railroad Medicare Medicare |
$624.05
|
| Rate for Payer: Railroad Medicare Medicare |
$624.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$928.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$928.29
|
| Rate for Payer: UHC Core |
$928.29
|
| Rate for Payer: UHC Core |
$928.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$624.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$624.05
|
| Rate for Payer: UHC Exchange |
$928.29
|
| Rate for Payer: UHC Exchange |
$928.29
|
| Rate for Payer: UMR Bronson Commercial |
$472.42
|
| Rate for Payer: UMR Bronson Commercial |
$224.48
|
|
|
PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 95782
|
| Min. Negotiated Rate |
$122.36 |
| Max. Negotiated Rate |
$1,451.62 |
| Rate for Payer: Aetna Commercial |
$1,248.38
|
| Rate for Payer: Aetna Commercial |
$1,248.38
|
| Rate for Payer: Aetna Medicare |
$968.90
|
| Rate for Payer: Aetna Medicare |
$968.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,341.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,341.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.38
|
| Rate for Payer: BCBS MAPPO |
$931.63
|
| Rate for Payer: BCBS MAPPO |
$931.63
|
| Rate for Payer: BCN Commercial |
$1,451.62
|
| Rate for Payer: BCN Commercial |
$1,451.62
|
| Rate for Payer: BCN Medicare Advantage |
$931.63
|
| Rate for Payer: BCN Medicare Advantage |
$931.63
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$1,341.55
|
| Rate for Payer: Cofinity Commercial |
$1,341.55
|
| Rate for Payer: Cofinity Commercial |
$1,248.38
|
| Rate for Payer: Cofinity Commercial |
$1,248.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$931.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$978.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,024.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,024.79
|
| Rate for Payer: Nomi Health Commercial |
$1,117.96
|
| Rate for Payer: Nomi Health Commercial |
$1,117.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,341.00
|
| Rate for Payer: PACE SWMI |
$931.63
|
| Rate for Payer: PACE SWMI |
$931.63
|
| Rate for Payer: PHP Commercial |
$1,304.28
|
| Rate for Payer: PHP Commercial |
$1,304.28
|
| Rate for Payer: PHP Medicare Advantage |
$931.63
|
| Rate for Payer: PHP Medicare Advantage |
$931.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,338.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,338.70
|
| Rate for Payer: Priority Health Medicare |
$931.63
|
| Rate for Payer: Priority Health Medicare |
$931.63
|
| Rate for Payer: Priority Health SBD |
$1,338.70
|
| Rate for Payer: Priority Health SBD |
$1,338.70
|
| Rate for Payer: Priority Health Tiered Network |
$1,338.70
|
| Rate for Payer: Priority Health Tiered Network |
$1,338.70
|
| Rate for Payer: Railroad Medicare Medicare |
$931.63
|
| Rate for Payer: Railroad Medicare Medicare |
$931.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,369.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,369.40
|
| Rate for Payer: UHC Core |
$1,369.40
|
| Rate for Payer: UHC Core |
$1,369.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$931.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$931.63
|
| Rate for Payer: UHC Exchange |
$1,369.40
|
| Rate for Payer: UHC Exchange |
$1,369.40
|
| Rate for Payer: UMR Bronson Commercial |
$822.48
|
| Rate for Payer: UMR Bronson Commercial |
$122.36
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 95811
|
| Min. Negotiated Rate |
$237.82 |
| Max. Negotiated Rate |
$969.74 |
| Rate for Payer: Aetna Commercial |
$878.49
|
| Rate for Payer: Aetna Commercial |
$878.49
|
| Rate for Payer: Aetna Medicare |
$681.81
|
| Rate for Payer: Aetna Medicare |
$681.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$878.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$944.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$878.49
|
| Rate for Payer: BCBS MAPPO |
$655.59
|
| Rate for Payer: BCBS MAPPO |
$655.59
|
| Rate for Payer: BCN Commercial |
$773.62
|
| Rate for Payer: BCN Commercial |
$773.62
|
| Rate for Payer: BCN Medicare Advantage |
$655.59
|
| Rate for Payer: BCN Medicare Advantage |
$655.59
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$944.05
|
| Rate for Payer: Cofinity Commercial |
$944.05
|
| Rate for Payer: Cofinity Commercial |
$878.49
|
| Rate for Payer: Cofinity Commercial |
$878.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$655.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$688.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$688.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$721.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$721.15
|
| Rate for Payer: Nomi Health Commercial |
$786.71
|
| Rate for Payer: Nomi Health Commercial |
$786.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$962.25
|
| Rate for Payer: PACE SWMI |
$655.59
|
| Rate for Payer: PACE SWMI |
$655.59
|
| Rate for Payer: PHP Commercial |
$917.83
|
| Rate for Payer: PHP Commercial |
$917.83
|
| Rate for Payer: PHP Medicare Advantage |
$655.59
|
| Rate for Payer: PHP Medicare Advantage |
$655.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$904.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$904.72
|
| Rate for Payer: Priority Health Medicare |
$655.59
|
| Rate for Payer: Priority Health Medicare |
$655.59
|
| Rate for Payer: Priority Health SBD |
$904.72
|
| Rate for Payer: Priority Health SBD |
$904.72
|
| Rate for Payer: Priority Health Tiered Network |
$904.72
|
| Rate for Payer: Priority Health Tiered Network |
$904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$655.59
|
| Rate for Payer: Railroad Medicare Medicare |
$655.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$969.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$969.74
|
| Rate for Payer: UHC Core |
$969.74
|
| Rate for Payer: UHC Core |
$969.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$655.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$655.59
|
| Rate for Payer: UHC Exchange |
$969.74
|
| Rate for Payer: UHC Exchange |
$969.74
|
| Rate for Payer: UMR Bronson Commercial |
$590.18
|
| Rate for Payer: UMR Bronson Commercial |
$237.82
|
|
|
PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 95783
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$1,538.26 |
| Rate for Payer: Aetna Commercial |
$1,322.16
|
| Rate for Payer: Aetna Commercial |
$1,322.16
|
| Rate for Payer: Aetna Medicare |
$1,026.16
|
| Rate for Payer: Aetna Medicare |
$1,026.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,420.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,420.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,322.16
|
| Rate for Payer: BCBS MAPPO |
$986.69
|
| Rate for Payer: BCBS MAPPO |
$986.69
|
| Rate for Payer: BCN Commercial |
$1,538.26
|
| Rate for Payer: BCN Commercial |
$1,538.26
|
| Rate for Payer: BCN Medicare Advantage |
$986.69
|
| Rate for Payer: BCN Medicare Advantage |
$986.69
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$1,420.83
|
| Rate for Payer: Cofinity Commercial |
$1,420.83
|
| Rate for Payer: Cofinity Commercial |
$1,322.16
|
| Rate for Payer: Cofinity Commercial |
$1,322.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$986.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$986.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,036.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,036.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,085.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,085.36
|
| Rate for Payer: Nomi Health Commercial |
$1,184.03
|
| Rate for Payer: Nomi Health Commercial |
$1,184.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,431.75
|
| Rate for Payer: PACE SWMI |
$986.69
|
| Rate for Payer: PACE SWMI |
$986.69
|
| Rate for Payer: PHP Commercial |
$1,381.37
|
| Rate for Payer: PHP Commercial |
$1,381.37
|
| Rate for Payer: PHP Medicare Advantage |
$986.69
|
| Rate for Payer: PHP Medicare Advantage |
$986.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,418.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,418.60
|
| Rate for Payer: Priority Health Medicare |
$986.69
|
| Rate for Payer: Priority Health Medicare |
$986.69
|
| Rate for Payer: Priority Health SBD |
$1,418.60
|
| Rate for Payer: Priority Health SBD |
$1,418.60
|
| Rate for Payer: Priority Health Tiered Network |
$1,418.60
|
| Rate for Payer: Priority Health Tiered Network |
$1,418.60
|
| Rate for Payer: Railroad Medicare Medicare |
$986.69
|
| Rate for Payer: Railroad Medicare Medicare |
$986.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,456.28
|
| Rate for Payer: UHC Core |
$1,456.28
|
| Rate for Payer: UHC Core |
$1,456.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$986.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$986.69
|
| Rate for Payer: UHC Exchange |
$1,456.28
|
| Rate for Payer: UHC Exchange |
$1,456.28
|
| Rate for Payer: UMR Bronson Commercial |
$878.14
|
| Rate for Payer: UMR Bronson Commercial |
$133.40
|
|
|
PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 95808
|
| Min. Negotiated Rate |
$203.78 |
| Max. Negotiated Rate |
$988.64 |
| Rate for Payer: Aetna Commercial |
$635.40
|
| Rate for Payer: Aetna Commercial |
$635.40
|
| Rate for Payer: Aetna Medicare |
$493.15
|
| Rate for Payer: Aetna Medicare |
$493.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$682.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$682.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$635.40
|
| Rate for Payer: BCBS MAPPO |
$474.18
|
| Rate for Payer: BCBS MAPPO |
$474.18
|
| Rate for Payer: BCN Commercial |
$578.05
|
| Rate for Payer: BCN Commercial |
$578.05
|
| Rate for Payer: BCN Medicare Advantage |
$474.18
|
| Rate for Payer: BCN Medicare Advantage |
$474.18
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$682.82
|
| Rate for Payer: Cofinity Commercial |
$682.82
|
| Rate for Payer: Cofinity Commercial |
$635.40
|
| Rate for Payer: Cofinity Commercial |
$635.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$474.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$474.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$497.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$497.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$521.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$521.60
|
| Rate for Payer: Nomi Health Commercial |
$569.02
|
| Rate for Payer: Nomi Health Commercial |
$569.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.00
|
| Rate for Payer: PACE SWMI |
$474.18
|
| Rate for Payer: PACE SWMI |
$474.18
|
| Rate for Payer: PHP Commercial |
$663.85
|
| Rate for Payer: PHP Commercial |
$663.85
|
| Rate for Payer: PHP Medicare Advantage |
$474.18
|
| Rate for Payer: PHP Medicare Advantage |
$474.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$676.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$676.01
|
| Rate for Payer: Priority Health Medicare |
$474.18
|
| Rate for Payer: Priority Health Medicare |
$474.18
|
| Rate for Payer: Priority Health SBD |
$676.01
|
| Rate for Payer: Priority Health SBD |
$676.01
|
| Rate for Payer: Priority Health Tiered Network |
$676.01
|
| Rate for Payer: Priority Health Tiered Network |
$676.01
|
| Rate for Payer: Railroad Medicare Medicare |
$474.18
|
| Rate for Payer: Railroad Medicare Medicare |
$474.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$988.64
|
| Rate for Payer: UHC Core |
$988.64
|
| Rate for Payer: UHC Core |
$988.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$474.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$474.18
|
| Rate for Payer: UHC Exchange |
$988.64
|
| Rate for Payer: UHC Exchange |
$988.64
|
| Rate for Payer: UMR Bronson Commercial |
$824.32
|
| Rate for Payer: UMR Bronson Commercial |
$203.78
|
|
|
PR PORTOENETEROSTOMY
|
Professional
|
Both
|
$4,959.00
|
|
|
Service Code
|
HCPCS 47701
|
| Min. Negotiated Rate |
$1,033.26 |
| Max. Negotiated Rate |
$3,719.25 |
| Rate for Payer: Aetna Commercial |
$2,163.66
|
| Rate for Payer: Aetna Medicare |
$1,679.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,163.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,325.12
|
| Rate for Payer: BCBS Complete |
$1,084.92
|
| Rate for Payer: BCBS MAPPO |
$1,614.67
|
| Rate for Payer: BCN Commercial |
$2,600.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,614.67
|
| Rate for Payer: Cash Price |
$3,967.20
|
| Rate for Payer: Cash Price |
$3,967.20
|
| Rate for Payer: Cofinity Commercial |
$2,163.66
|
| Rate for Payer: Cofinity Commercial |
$2,325.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,614.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,695.40
|
| Rate for Payer: Meridian Medicaid |
$1,084.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,776.14
|
| Rate for Payer: Nomi Health Commercial |
$1,937.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,719.25
|
| Rate for Payer: PACE SWMI |
$1,614.67
|
| Rate for Payer: PHP Commercial |
$2,260.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,614.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,168.48
|
| Rate for Payer: Priority Health Medicare |
$1,614.67
|
| Rate for Payer: Priority Health SBD |
$3,168.48
|
| Rate for Payer: Priority Health Tiered Network |
$3,168.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,614.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,104.40
|
| Rate for Payer: UHC Core |
$3,104.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,614.67
|
| Rate for Payer: UHC Exchange |
$3,104.40
|
| Rate for Payer: UHC Medicaid |
$1,033.26
|
| Rate for Payer: UHCCP Medicaid |
$1,033.26
|
| Rate for Payer: UMR Bronson Commercial |
$2,281.14
|
|
|
PR POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 92542
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$47.12 |
| Rate for Payer: Aetna Commercial |
$36.76
|
| Rate for Payer: Aetna Medicare |
$28.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.50
|
| Rate for Payer: BCBS MAPPO |
$27.43
|
| Rate for Payer: BCN Commercial |
$42.82
|
| Rate for Payer: BCN Medicare Advantage |
$27.43
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$36.76
|
| Rate for Payer: Cofinity Commercial |
$39.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.17
|
| Rate for Payer: Nomi Health Commercial |
$32.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.25
|
| Rate for Payer: PACE SWMI |
$27.43
|
| Rate for Payer: PHP Commercial |
$38.40
|
| Rate for Payer: PHP Medicare Advantage |
$27.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.50
|
| Rate for Payer: Priority Health Medicare |
$27.43
|
| Rate for Payer: Priority Health SBD |
$39.50
|
| Rate for Payer: Priority Health Tiered Network |
$39.50
|
| Rate for Payer: Railroad Medicare Medicare |
$27.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.12
|
| Rate for Payer: UHC Core |
$47.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$27.43
|
| Rate for Payer: UHC Exchange |
$47.12
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
|
|
PR POST-CATARACT LASER SURGERY
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 66821
|
| Min. Negotiated Rate |
$175.51 |
| Max. Negotiated Rate |
$538.97 |
| Rate for Payer: Aetna Commercial |
$352.10
|
| Rate for Payer: Aetna Medicare |
$273.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.37
|
| Rate for Payer: BCBS Complete |
$184.29
|
| Rate for Payer: BCBS MAPPO |
$262.76
|
| Rate for Payer: BCN Commercial |
$460.13
|
| Rate for Payer: BCN Medicare Advantage |
$262.76
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cofinity Commercial |
$378.37
|
| Rate for Payer: Cofinity Commercial |
$352.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.90
|
| Rate for Payer: Meridian Medicaid |
$184.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$289.04
|
| Rate for Payer: Nomi Health Commercial |
$315.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.25
|
| Rate for Payer: PACE SWMI |
$262.76
|
| Rate for Payer: PHP Commercial |
$367.86
|
| Rate for Payer: PHP Medicare Advantage |
$262.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$538.97
|
| Rate for Payer: Priority Health Medicare |
$262.76
|
| Rate for Payer: Priority Health SBD |
$538.97
|
| Rate for Payer: Priority Health Tiered Network |
$538.97
|
| Rate for Payer: Railroad Medicare Medicare |
$262.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$525.83
|
| Rate for Payer: UHC Core |
$525.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$262.76
|
| Rate for Payer: UHC Exchange |
$525.83
|
| Rate for Payer: UHC Medicaid |
$175.51
|
| Rate for Payer: UHCCP Medicaid |
$175.51
|
| Rate for Payer: UMR Bronson Commercial |
$271.86
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 57250
|
| Min. Negotiated Rate |
$347.83 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Aetna Commercial |
$721.52
|
| Rate for Payer: Aetna Medicare |
$559.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$775.37
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCBS MAPPO |
$538.45
|
| Rate for Payer: BCN Commercial |
$924.26
|
| Rate for Payer: BCN Medicare Advantage |
$538.45
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cofinity Commercial |
$721.52
|
| Rate for Payer: Cofinity Commercial |
$775.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$565.37
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$592.29
|
| Rate for Payer: Nomi Health Commercial |
$646.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: PACE SWMI |
$538.45
|
| Rate for Payer: PHP Commercial |
$753.83
|
| Rate for Payer: PHP Medicare Advantage |
$538.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$936.07
|
| Rate for Payer: Priority Health Medicare |
$538.45
|
| Rate for Payer: Priority Health SBD |
$936.07
|
| Rate for Payer: Priority Health Tiered Network |
$936.07
|
| Rate for Payer: Railroad Medicare Medicare |
$538.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,073.09
|
| Rate for Payer: UHC Core |
$1,073.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$538.45
|
| Rate for Payer: UHC Exchange |
$1,073.09
|
| Rate for Payer: UHC Medicaid |
$347.83
|
| Rate for Payer: UHCCP Medicaid |
$347.83
|
| Rate for Payer: UMR Bronson Commercial |
$666.54
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 57250
|
| Hospital Charge Code |
57250
|
| Min. Negotiated Rate |
$347.83 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Aetna Commercial |
$721.52
|
| Rate for Payer: Aetna Medicare |
$559.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$721.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$775.37
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCBS MAPPO |
$538.45
|
| Rate for Payer: BCN Commercial |
$924.26
|
| Rate for Payer: BCN Medicare Advantage |
$538.45
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cofinity Commercial |
$721.52
|
| Rate for Payer: Cofinity Commercial |
$775.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$538.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$565.37
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$592.29
|
| Rate for Payer: Nomi Health Commercial |
$646.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: PACE SWMI |
$538.45
|
| Rate for Payer: PHP Commercial |
$753.83
|
| Rate for Payer: PHP Medicare Advantage |
$538.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$936.07
|
| Rate for Payer: Priority Health Medicare |
$538.45
|
| Rate for Payer: Priority Health SBD |
$936.07
|
| Rate for Payer: Priority Health Tiered Network |
$936.07
|
| Rate for Payer: Railroad Medicare Medicare |
$538.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,073.09
|
| Rate for Payer: UHC Core |
$1,073.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$538.45
|
| Rate for Payer: UHC Exchange |
$1,073.09
|
| Rate for Payer: UHC Medicaid |
$347.83
|
| Rate for Payer: UHCCP Medicaid |
$347.83
|
| Rate for Payer: UMR Bronson Commercial |
$666.54
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Facility
|
IP
|
$1,407.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
57250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$619.08 |
| Max. Negotiated Rate |
$1,266.30 |
| Rate for Payer: Aetna American Axle |
$914.55
|
| Rate for Payer: Aetna Commercial |
$1,195.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$914.55
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Advantage |
$984.90
|
| Rate for Payer: Cofinity Commercial |
$1,210.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.60
|
| Rate for Payer: Healthscope Commercial |
$1,266.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$984.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,055.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,055.25
|
| Rate for Payer: PHP Commercial |
$1,195.95
|
| Rate for Payer: Priority Health SBD |
$886.41
|
| Rate for Payer: UMR Bronson Commercial |
$619.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,055.25
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
57250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$520.59 |
| Max. Negotiated Rate |
$16,119.31 |
| Rate for Payer: Aetna American Axle |
$914.55
|
| Rate for Payer: Aetna Commercial |
$1,195.95
|
| Rate for Payer: Aetna Medicare |
$5,183.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$914.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,230.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,230.57
|
| Rate for Payer: BCBS Complete |
$2,737.47
|
| Rate for Payer: BCBS MAPPO |
$4,984.46
|
| Rate for Payer: BCBS Trust/PPO |
$5,659.96
|
| Rate for Payer: BCN Commercial |
$5,659.96
|
| Rate for Payer: BCN Medicare Advantage |
$4,984.46
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Advantage |
$984.90
|
| Rate for Payer: Cofinity Commercial |
$1,210.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,984.46
|
| Rate for Payer: Healthscope Commercial |
$1,266.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$984.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,055.25
|
| Rate for Payer: Mclaren Medicaid |
$4,984.46
|
| Rate for Payer: Mclaren Medicare |
$4,984.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,233.68
|
| Rate for Payer: Meridian Medicaid |
$5,233.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,732.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,482.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.95
|
| Rate for Payer: Nomi Health Commercial |
$14,953.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,055.25
|
| Rate for Payer: PACE Medicare |
$4,735.24
|
| Rate for Payer: PACE SWMI |
$4,984.46
|
| Rate for Payer: PHP Commercial |
$1,195.95
|
| Rate for Payer: PHP Medicare Advantage |
$4,984.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,606.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,119.31
|
| Rate for Payer: Priority Health Medicare |
$4,984.46
|
| Rate for Payer: Priority Health SBD |
$886.41
|
| Rate for Payer: Priority Health Tiered Network |
$12,895.45
|
| Rate for Payer: Railroad Medicare Medicare |
$4,984.46
|
| Rate for Payer: UHC Medicaid |
$2,606.87
|
| Rate for Payer: UHCCP Medicaid |
$2,606.87
|
| Rate for Payer: UMR Bronson Commercial |
$520.59
|
| Rate for Payer: VA VA |
$4,984.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,055.25
|
|
|
PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,433.00
|
|
|
Service Code
|
HCPCS 22840
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$2,574.75 |
| Rate for Payer: Aetna Commercial |
$901.57
|
| Rate for Payer: Aetna Medicare |
$699.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$901.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$968.85
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCBS MAPPO |
$672.81
|
| Rate for Payer: BCN Commercial |
$1,238.57
|
| Rate for Payer: BCN Medicare Advantage |
$672.81
|
| Rate for Payer: Cash Price |
$2,746.40
|
| Rate for Payer: Cash Price |
$2,746.40
|
| Rate for Payer: Cofinity Commercial |
$901.57
|
| Rate for Payer: Cofinity Commercial |
$968.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$672.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$706.45
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$740.09
|
| Rate for Payer: Nomi Health Commercial |
$807.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,574.75
|
| Rate for Payer: PACE SWMI |
$672.81
|
| Rate for Payer: PHP Commercial |
$941.93
|
| Rate for Payer: PHP Medicare Advantage |
$672.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,205.18
|
| Rate for Payer: Priority Health Medicare |
$672.81
|
| Rate for Payer: Priority Health SBD |
$1,205.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,205.18
|
| Rate for Payer: Railroad Medicare Medicare |
$672.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,354.22
|
| Rate for Payer: UHC Core |
$1,354.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$672.81
|
| Rate for Payer: UHC Exchange |
$1,354.22
|
| Rate for Payer: UHC Medicaid |
$426.21
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
| Rate for Payer: UMR Bronson Commercial |
$1,579.18
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE
|
Professional
|
Both
|
$4,047.00
|
|
|
Service Code
|
HCPCS 22844
|
| Min. Negotiated Rate |
$558.06 |
| Max. Negotiated Rate |
$3,035.25 |
| Rate for Payer: Aetna Commercial |
$1,180.04
|
| Rate for Payer: Aetna Medicare |
$915.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,180.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,268.11
|
| Rate for Payer: BCBS Complete |
$585.96
|
| Rate for Payer: BCBS MAPPO |
$880.63
|
| Rate for Payer: BCN Commercial |
$1,619.33
|
| Rate for Payer: BCN Medicare Advantage |
$880.63
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Cofinity Commercial |
$1,180.04
|
| Rate for Payer: Cofinity Commercial |
$1,268.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$880.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$924.66
|
| Rate for Payer: Meridian Medicaid |
$585.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$968.69
|
| Rate for Payer: Nomi Health Commercial |
$1,056.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,035.25
|
| Rate for Payer: PACE SWMI |
$880.63
|
| Rate for Payer: PHP Commercial |
$1,232.88
|
| Rate for Payer: PHP Medicare Advantage |
$880.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,575.70
|
| Rate for Payer: Priority Health Medicare |
$880.63
|
| Rate for Payer: Priority Health SBD |
$1,575.70
|
| Rate for Payer: Priority Health Tiered Network |
$1,575.70
|
| Rate for Payer: Railroad Medicare Medicare |
$880.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,755.56
|
| Rate for Payer: UHC Core |
$1,755.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$880.63
|
| Rate for Payer: UHC Exchange |
$1,755.56
|
| Rate for Payer: UHC Medicaid |
$558.06
|
| Rate for Payer: UHCCP Medicaid |
$558.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,861.62
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,832.00
|
|
|
Service Code
|
HCPCS 22842
|
| Min. Negotiated Rate |
$433.67 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$918.45
|
| Rate for Payer: Aetna Medicare |
$712.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$918.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$986.99
|
| Rate for Payer: BCBS Complete |
$455.35
|
| Rate for Payer: BCBS MAPPO |
$685.41
|
| Rate for Payer: BCN Commercial |
$1,253.88
|
| Rate for Payer: BCN Medicare Advantage |
$685.41
|
| Rate for Payer: Cash Price |
$3,065.60
|
| Rate for Payer: Cash Price |
$3,065.60
|
| Rate for Payer: Cofinity Commercial |
$918.45
|
| Rate for Payer: Cofinity Commercial |
$986.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$685.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$719.68
|
| Rate for Payer: Meridian Medicaid |
$455.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$753.95
|
| Rate for Payer: Nomi Health Commercial |
$822.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,874.00
|
| Rate for Payer: PACE SWMI |
$685.41
|
| Rate for Payer: PHP Commercial |
$959.57
|
| Rate for Payer: PHP Medicare Advantage |
$685.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$433.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,220.09
|
| Rate for Payer: Priority Health Medicare |
$685.41
|
| Rate for Payer: Priority Health SBD |
$1,220.09
|
| Rate for Payer: Priority Health Tiered Network |
$1,220.09
|
| Rate for Payer: Railroad Medicare Medicare |
$685.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,360.45
|
| Rate for Payer: UHC Core |
$1,360.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$685.41
|
| Rate for Payer: UHC Exchange |
$1,360.45
|
| Rate for Payer: UHC Medicaid |
$433.67
|
| Rate for Payer: UHCCP Medicaid |
$433.67
|
| Rate for Payer: UMR Bronson Commercial |
$1,762.72
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG
|
Professional
|
Both
|
$4,214.00
|
|
|
Service Code
|
HCPCS 22843
|
| Min. Negotiated Rate |
$464.55 |
| Max. Negotiated Rate |
$3,160.50 |
| Rate for Payer: Aetna Commercial |
$983.91
|
| Rate for Payer: Aetna Medicare |
$763.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,057.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$983.91
|
| Rate for Payer: BCBS Complete |
$487.78
|
| Rate for Payer: BCBS MAPPO |
$734.26
|
| Rate for Payer: BCN Commercial |
$1,343.60
|
| Rate for Payer: BCN Medicare Advantage |
$734.26
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: Cofinity Commercial |
$1,057.33
|
| Rate for Payer: Cofinity Commercial |
$983.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$734.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.97
|
| Rate for Payer: Meridian Medicaid |
$487.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$807.69
|
| Rate for Payer: Nomi Health Commercial |
$881.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,160.50
|
| Rate for Payer: PACE SWMI |
$734.26
|
| Rate for Payer: PHP Commercial |
$1,027.96
|
| Rate for Payer: PHP Medicare Advantage |
$734.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$464.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,307.40
|
| Rate for Payer: Priority Health Medicare |
$734.26
|
| Rate for Payer: Priority Health SBD |
$1,307.40
|
| Rate for Payer: Priority Health Tiered Network |
$1,307.40
|
| Rate for Payer: Railroad Medicare Medicare |
$734.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,453.54
|
| Rate for Payer: UHC Core |
$1,453.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$734.26
|
| Rate for Payer: UHC Exchange |
$1,453.54
|
| Rate for Payer: UHC Medicaid |
$464.55
|
| Rate for Payer: UHCCP Medicaid |
$464.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,938.44
|
|
|
PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
HCPCS 59430
|
| Min. Negotiated Rate |
$155.05 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Aetna Commercial |
$219.21
|
| Rate for Payer: Aetna Medicare |
$170.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.57
|
| Rate for Payer: BCBS Complete |
$162.80
|
| Rate for Payer: BCBS MAPPO |
$163.59
|
| Rate for Payer: BCN Commercial |
$253.10
|
| Rate for Payer: BCN Medicare Advantage |
$163.59
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cash Price |
$369.60
|
| Rate for Payer: Cofinity Commercial |
$219.21
|
| Rate for Payer: Cofinity Commercial |
$235.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$163.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.77
|
| Rate for Payer: Meridian Medicaid |
$162.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$179.95
|
| Rate for Payer: Nomi Health Commercial |
$196.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.50
|
| Rate for Payer: PACE SWMI |
$163.59
|
| Rate for Payer: PHP Commercial |
$229.03
|
| Rate for Payer: PHP Medicare Advantage |
$163.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$251.98
|
| Rate for Payer: Priority Health Medicare |
$163.59
|
| Rate for Payer: Priority Health SBD |
$251.98
|
| Rate for Payer: Priority Health Tiered Network |
$251.98
|
| Rate for Payer: Railroad Medicare Medicare |
$163.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.17
|
| Rate for Payer: UHC Core |
$249.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$163.59
|
| Rate for Payer: UHC Exchange |
$249.17
|
| Rate for Payer: UHC Medicaid |
$155.05
|
| Rate for Payer: UHCCP Medicaid |
$155.05
|
| Rate for Payer: UMR Bronson Commercial |
$212.52
|
|
|
PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 64566
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna Commercial |
$34.85
|
| Rate for Payer: Aetna Medicare |
$27.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.45
|
| Rate for Payer: BCBS Complete |
$17.44
|
| Rate for Payer: BCBS MAPPO |
$26.01
|
| Rate for Payer: BCN Commercial |
$44.32
|
| Rate for Payer: BCN Medicare Advantage |
$26.01
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$34.85
|
| Rate for Payer: Cofinity Commercial |
$37.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.31
|
| Rate for Payer: Meridian Medicaid |
$17.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.61
|
| Rate for Payer: Nomi Health Commercial |
$31.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.50
|
| Rate for Payer: PACE SWMI |
$26.01
|
| Rate for Payer: PHP Commercial |
$36.41
|
| Rate for Payer: PHP Medicare Advantage |
$26.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$51.48
|
| Rate for Payer: Priority Health Medicare |
$26.01
|
| Rate for Payer: Priority Health SBD |
$51.48
|
| Rate for Payer: Priority Health Tiered Network |
$51.48
|
| Rate for Payer: Railroad Medicare Medicare |
$26.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.38
|
| Rate for Payer: UHC Core |
$55.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$26.01
|
| Rate for Payer: UHC Exchange |
$55.38
|
| Rate for Payer: UHC Medicaid |
$16.61
|
| Rate for Payer: UHCCP Medicaid |
$16.61
|
| Rate for Payer: UMR Bronson Commercial |
$109.48
|
|
