|
PROPYLENE GLYCOL 1 %-GLYCERIN 0.3 % EYE DROPS
|
Facility
|
OP
|
$26.80
|
|
|
Service Code
|
NDC 10119002003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna American Axle |
$17.42
|
| Rate for Payer: Aetna Commercial |
$22.78
|
| Rate for Payer: Aetna Medicare |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.42
|
| Rate for Payer: BCBS Complete |
$10.72
|
| Rate for Payer: Cash Price |
$21.44
|
| Rate for Payer: Cofinity Commercial |
$18.76
|
| Rate for Payer: Cofinity Commercial |
$23.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$18.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.44
|
| Rate for Payer: Healthscope Commercial |
$24.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.78
|
| Rate for Payer: PHP Commercial |
$22.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.42
|
| Rate for Payer: Priority Health SBD |
$16.88
|
| Rate for Payer: UMR Bronson Commercial |
$9.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.10
|
|
|
PROPYLPARABEN (BULK) CRYSTALS
|
Facility
|
IP
|
$205.20
|
|
|
Service Code
|
NDC 38779155105
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.29 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna American Axle |
$133.38
|
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
PROPYLPARABEN (BULK) CRYSTALS
|
Facility
|
OP
|
$205.20
|
|
|
Service Code
|
NDC 38779155105
|
| Hospital Charge Code |
13102
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.92 |
| Max. Negotiated Rate |
$184.68 |
| Rate for Payer: Aetna American Axle |
$133.38
|
| Rate for Payer: Aetna Commercial |
$174.42
|
| Rate for Payer: Aetna Medicare |
$102.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.38
|
| Rate for Payer: BCBS Complete |
$82.08
|
| Rate for Payer: Cash Price |
$164.16
|
| Rate for Payer: Cofinity Commercial |
$143.64
|
| Rate for Payer: Cofinity Commercial |
$176.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$164.16
|
| Rate for Payer: Healthscope Commercial |
$184.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.42
|
| Rate for Payer: PHP Commercial |
$174.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.38
|
| Rate for Payer: Priority Health SBD |
$129.28
|
| Rate for Payer: UMR Bronson Commercial |
$75.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.90
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$252.48
|
|
|
Service Code
|
NDC 00228234810
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$227.23 |
| Rate for Payer: Aetna American Axle |
$164.11
|
| Rate for Payer: Aetna Commercial |
$214.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.11
|
| Rate for Payer: Cash Price |
$201.98
|
| Rate for Payer: Cofinity Commercial |
$176.74
|
| Rate for Payer: Cofinity Commercial |
$217.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.98
|
| Rate for Payer: Healthscope Commercial |
$227.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.61
|
| Rate for Payer: PHP Commercial |
$214.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.11
|
| Rate for Payer: Priority Health SBD |
$159.06
|
| Rate for Payer: UMR Bronson Commercial |
$111.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.36
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
OP
|
$252.48
|
|
|
Service Code
|
NDC 00228234810
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.42 |
| Max. Negotiated Rate |
$227.23 |
| Rate for Payer: Aetna American Axle |
$164.11
|
| Rate for Payer: Aetna Commercial |
$214.61
|
| Rate for Payer: Aetna Medicare |
$126.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.11
|
| Rate for Payer: BCBS Complete |
$100.99
|
| Rate for Payer: Cash Price |
$201.98
|
| Rate for Payer: Cofinity Commercial |
$176.74
|
| Rate for Payer: Cofinity Commercial |
$217.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$176.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.98
|
| Rate for Payer: Healthscope Commercial |
$227.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$176.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.61
|
| Rate for Payer: PHP Commercial |
$214.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.11
|
| Rate for Payer: Priority Health SBD |
$159.06
|
| Rate for Payer: UMR Bronson Commercial |
$93.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.36
|
|
|
PR ORAL DEXAMETHASONE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J8540
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$0.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.02
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.02
|
| Rate for Payer: Nomi Health Commercial |
$0.02
|
| Rate for Payer: PACE SWMI |
$0.02
|
| Rate for Payer: PHP Commercial |
$0.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.02
|
| Rate for Payer: UHC Medicare Advantage |
$0.02
|
| Rate for Payer: UMR Bronson Commercial |
$0.46
|
|
|
PR ORAL POLIOVIRUS IMMUNIZATN,LIVE,OPC
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 90712
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
|
|
PR ORAL PRESCRIP DRUG NON CHEMO
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J8499
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
|
|
PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 95933
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$97.50
|
| Rate for Payer: Aetna Medicare |
$75.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.77
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$72.76
|
| Rate for Payer: BCN Medicare Advantage |
$72.76
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$97.50
|
| Rate for Payer: Cofinity Commercial |
$104.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.40
|
| Rate for Payer: Nomi Health Commercial |
$87.31
|
| Rate for Payer: PACE SWMI |
$72.76
|
| Rate for Payer: PHP Commercial |
$101.86
|
| Rate for Payer: PHP Medicare Advantage |
$72.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Medicare |
$72.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.76
|
| Rate for Payer: UHC Medicare Advantage |
$72.76
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ
|
Professional
|
Both
|
$7,956.00
|
|
|
Service Code
|
HCPCS 61584
|
| Min. Negotiated Rate |
$2,802.64 |
| Max. Negotiated Rate |
$5,171.40 |
| Rate for Payer: Aetna Commercial |
$3,755.54
|
| Rate for Payer: Aetna Medicare |
$2,914.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,035.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,755.54
|
| Rate for Payer: BCBS Complete |
$3,182.40
|
| Rate for Payer: BCBS MAPPO |
$2,802.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,802.64
|
| Rate for Payer: Cash Price |
$6,364.80
|
| Rate for Payer: Cash Price |
$6,364.80
|
| Rate for Payer: Cofinity Commercial |
$4,035.80
|
| Rate for Payer: Cofinity Commercial |
$3,755.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,802.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,942.77
|
| Rate for Payer: Nomi Health Commercial |
$3,363.17
|
| Rate for Payer: PACE SWMI |
$2,802.64
|
| Rate for Payer: PHP Commercial |
$3,923.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,802.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,171.40
|
| Rate for Payer: Priority Health Medicare |
$2,802.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,802.64
|
| Rate for Payer: UHC Medicare Advantage |
$2,802.64
|
| Rate for Payer: UMR Bronson Commercial |
$3,659.76
|
|
|
PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE
|
Professional
|
Both
|
$5,759.00
|
|
|
Service Code
|
HCPCS 61592
|
| Min. Negotiated Rate |
$2,303.60 |
| Max. Negotiated Rate |
$4,440.38 |
| Rate for Payer: Aetna Commercial |
$4,132.02
|
| Rate for Payer: Aetna Medicare |
$3,206.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,440.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,132.02
|
| Rate for Payer: BCBS Complete |
$2,303.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.60
|
| Rate for Payer: Cash Price |
$4,607.20
|
| Rate for Payer: Cash Price |
$4,607.20
|
| Rate for Payer: Cofinity Commercial |
$4,440.38
|
| Rate for Payer: Cofinity Commercial |
$4,132.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,237.78
|
| Rate for Payer: Nomi Health Commercial |
$3,700.32
|
| Rate for Payer: PACE SWMI |
$3,083.60
|
| Rate for Payer: PHP Commercial |
$4,317.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,743.35
|
| Rate for Payer: Priority Health Medicare |
$3,083.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.60
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.60
|
| Rate for Payer: UMR Bronson Commercial |
$2,649.14
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN
|
Professional
|
Both
|
$3,588.00
|
|
|
Service Code
|
HCPCS 67445
|
| Min. Negotiated Rate |
$1,394.99 |
| Max. Negotiated Rate |
$2,332.20 |
| Rate for Payer: Aetna Commercial |
$1,869.29
|
| Rate for Payer: Aetna Medicare |
$1,450.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,008.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,869.29
|
| Rate for Payer: BCBS Complete |
$1,435.20
|
| Rate for Payer: BCBS MAPPO |
$1,394.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,394.99
|
| Rate for Payer: Cash Price |
$2,870.40
|
| Rate for Payer: Cash Price |
$2,870.40
|
| Rate for Payer: Cofinity Commercial |
$2,008.79
|
| Rate for Payer: Cofinity Commercial |
$1,869.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,394.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,464.74
|
| Rate for Payer: Nomi Health Commercial |
$1,673.99
|
| Rate for Payer: PACE SWMI |
$1,394.99
|
| Rate for Payer: PHP Commercial |
$1,952.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,394.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.20
|
| Rate for Payer: Priority Health Medicare |
$1,394.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,394.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,394.99
|
| Rate for Payer: UMR Bronson Commercial |
$1,650.48
|
|
|
PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY
|
Professional
|
Both
|
$1,662.00
|
|
|
Service Code
|
HCPCS 67400
|
| Min. Negotiated Rate |
$664.80 |
| Max. Negotiated Rate |
$1,352.66 |
| Rate for Payer: Aetna Commercial |
$1,258.73
|
| Rate for Payer: Aetna Medicare |
$976.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,352.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,258.73
|
| Rate for Payer: BCBS Complete |
$664.80
|
| Rate for Payer: BCBS MAPPO |
$939.35
|
| Rate for Payer: BCN Medicare Advantage |
$939.35
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cofinity Commercial |
$1,352.66
|
| Rate for Payer: Cofinity Commercial |
$1,258.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$986.32
|
| Rate for Payer: Nomi Health Commercial |
$1,127.22
|
| Rate for Payer: PACE SWMI |
$939.35
|
| Rate for Payer: PHP Commercial |
$1,315.09
|
| Rate for Payer: PHP Medicare Advantage |
$939.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.30
|
| Rate for Payer: Priority Health Medicare |
$939.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.35
|
| Rate for Payer: UHC Medicare Advantage |
$939.35
|
| Rate for Payer: UMR Bronson Commercial |
$764.52
|
|
|
PR ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 67413
|
| Min. Negotiated Rate |
$871.96 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Commercial |
$1,168.43
|
| Rate for Payer: Aetna Medicare |
$906.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,255.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,168.43
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: BCBS MAPPO |
$871.96
|
| Rate for Payer: BCN Medicare Advantage |
$871.96
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,255.62
|
| Rate for Payer: Cofinity Commercial |
$1,168.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$871.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.56
|
| Rate for Payer: Nomi Health Commercial |
$1,046.35
|
| Rate for Payer: PACE SWMI |
$871.96
|
| Rate for Payer: PHP Commercial |
$1,220.74
|
| Rate for Payer: PHP Medicare Advantage |
$871.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$871.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$871.96
|
| Rate for Payer: UHC Medicare Advantage |
$871.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,219.92
|
|
|
PR ORCHIECTOMY PARTIAL
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS 54522
|
| Min. Negotiated Rate |
$441.20 |
| Max. Negotiated Rate |
$809.67 |
| Rate for Payer: Aetna Commercial |
$753.44
|
| Rate for Payer: Aetna Medicare |
$584.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$809.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$753.44
|
| Rate for Payer: BCBS Complete |
$441.20
|
| Rate for Payer: BCBS MAPPO |
$562.27
|
| Rate for Payer: BCN Medicare Advantage |
$562.27
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cofinity Commercial |
$809.67
|
| Rate for Payer: Cofinity Commercial |
$753.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$562.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$590.38
|
| Rate for Payer: Nomi Health Commercial |
$674.72
|
| Rate for Payer: PACE SWMI |
$562.27
|
| Rate for Payer: PHP Commercial |
$787.18
|
| Rate for Payer: PHP Medicare Advantage |
$562.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.95
|
| Rate for Payer: Priority Health Medicare |
$562.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$562.27
|
| Rate for Payer: UHC Medicare Advantage |
$562.27
|
| Rate for Payer: UMR Bronson Commercial |
$507.38
|
|
|
PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 54530
|
| Min. Negotiated Rate |
$387.60 |
| Max. Negotiated Rate |
$702.03 |
| Rate for Payer: Aetna Commercial |
$653.28
|
| Rate for Payer: Aetna Medicare |
$507.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$653.28
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$487.52
|
| Rate for Payer: BCN Medicare Advantage |
$487.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$702.03
|
| Rate for Payer: Cofinity Commercial |
$653.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$511.90
|
| Rate for Payer: Nomi Health Commercial |
$585.02
|
| Rate for Payer: PACE SWMI |
$487.52
|
| Rate for Payer: PHP Commercial |
$682.53
|
| Rate for Payer: PHP Medicare Advantage |
$487.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$487.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.52
|
| Rate for Payer: UHC Medicare Advantage |
$487.52
|
| Rate for Payer: UMR Bronson Commercial |
$445.74
|
|
|
PR ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL
|
Professional
|
Both
|
$1,401.00
|
|
|
Service Code
|
HCPCS 54535
|
| Min. Negotiated Rate |
$560.40 |
| Max. Negotiated Rate |
$1,024.17 |
| Rate for Payer: Aetna Commercial |
$953.05
|
| Rate for Payer: Aetna Medicare |
$739.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$953.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,024.17
|
| Rate for Payer: BCBS Complete |
$560.40
|
| Rate for Payer: BCBS MAPPO |
$711.23
|
| Rate for Payer: BCN Medicare Advantage |
$711.23
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cash Price |
$1,120.80
|
| Rate for Payer: Cofinity Commercial |
$953.05
|
| Rate for Payer: Cofinity Commercial |
$1,024.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$711.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$746.79
|
| Rate for Payer: Nomi Health Commercial |
$853.48
|
| Rate for Payer: PACE SWMI |
$711.23
|
| Rate for Payer: PHP Commercial |
$995.72
|
| Rate for Payer: PHP Medicare Advantage |
$711.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$910.65
|
| Rate for Payer: Priority Health Medicare |
$711.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$711.23
|
| Rate for Payer: UHC Medicare Advantage |
$711.23
|
| Rate for Payer: UMR Bronson Commercial |
$644.46
|
|
|
PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
HCPCS 54520
|
| Min. Negotiated Rate |
$246.00 |
| Max. Negotiated Rate |
$452.85 |
| Rate for Payer: Aetna Commercial |
$421.40
|
| Rate for Payer: Aetna Medicare |
$327.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.40
|
| Rate for Payer: BCBS Complete |
$246.00
|
| Rate for Payer: BCBS MAPPO |
$314.48
|
| Rate for Payer: BCN Medicare Advantage |
$314.48
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cofinity Commercial |
$452.85
|
| Rate for Payer: Cofinity Commercial |
$421.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.20
|
| Rate for Payer: Nomi Health Commercial |
$377.38
|
| Rate for Payer: PACE SWMI |
$314.48
|
| Rate for Payer: PHP Commercial |
$440.27
|
| Rate for Payer: PHP Medicare Advantage |
$314.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$399.75
|
| Rate for Payer: Priority Health Medicare |
$314.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$314.48
|
| Rate for Payer: UHC Medicare Advantage |
$314.48
|
| Rate for Payer: UMR Bronson Commercial |
$282.90
|
|
|
PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
HCPCS 54650
|
| Min. Negotiated Rate |
$599.60 |
| Max. Negotiated Rate |
$980.71 |
| Rate for Payer: Aetna Commercial |
$912.61
|
| Rate for Payer: Aetna Medicare |
$708.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$980.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$912.61
|
| Rate for Payer: BCBS Complete |
$599.60
|
| Rate for Payer: BCBS MAPPO |
$681.05
|
| Rate for Payer: BCN Medicare Advantage |
$681.05
|
| Rate for Payer: Cash Price |
$1,199.20
|
| Rate for Payer: Cash Price |
$1,199.20
|
| Rate for Payer: Cofinity Commercial |
$980.71
|
| Rate for Payer: Cofinity Commercial |
$912.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.10
|
| Rate for Payer: Nomi Health Commercial |
$817.26
|
| Rate for Payer: PACE SWMI |
$681.05
|
| Rate for Payer: PHP Commercial |
$953.47
|
| Rate for Payer: PHP Medicare Advantage |
$681.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$974.35
|
| Rate for Payer: Priority Health Medicare |
$681.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.05
|
| Rate for Payer: UHC Medicare Advantage |
$681.05
|
| Rate for Payer: UMR Bronson Commercial |
$689.54
|
|
|
PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
HCPCS 54640
|
| Min. Negotiated Rate |
$415.58 |
| Max. Negotiated Rate |
$1,141.40 |
| Rate for Payer: Aetna Commercial |
$556.88
|
| Rate for Payer: Aetna Medicare |
$432.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$598.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.88
|
| Rate for Payer: BCBS Complete |
$702.40
|
| Rate for Payer: BCBS MAPPO |
$415.58
|
| Rate for Payer: BCN Medicare Advantage |
$415.58
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Cash Price |
$1,404.80
|
| Rate for Payer: Cofinity Commercial |
$598.44
|
| Rate for Payer: Cofinity Commercial |
$556.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$415.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$436.36
|
| Rate for Payer: Nomi Health Commercial |
$498.70
|
| Rate for Payer: PACE SWMI |
$415.58
|
| Rate for Payer: PHP Commercial |
$581.81
|
| Rate for Payer: PHP Medicare Advantage |
$415.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.40
|
| Rate for Payer: Priority Health Medicare |
$415.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$415.58
|
| Rate for Payer: UHC Medicare Advantage |
$415.58
|
| Rate for Payer: UMR Bronson Commercial |
$807.76
|
|
|
PR ORPHENADRINE INJECTION
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J2360
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna Commercial |
$14.99
|
| Rate for Payer: Aetna Medicare |
$11.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.99
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$11.19
|
| Rate for Payer: BCN Medicare Advantage |
$11.19
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$16.11
|
| Rate for Payer: Cofinity Commercial |
$14.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.75
|
| Rate for Payer: Nomi Health Commercial |
$13.43
|
| Rate for Payer: PACE SWMI |
$11.19
|
| Rate for Payer: PHP Commercial |
$15.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$11.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.19
|
| Rate for Payer: UHC Medicare Advantage |
$11.19
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
PR ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 97760
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$62.45 |
| Rate for Payer: Aetna Commercial |
$58.12
|
| Rate for Payer: Aetna Medicare |
$45.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.12
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: BCBS MAPPO |
$43.37
|
| Rate for Payer: BCN Medicare Advantage |
$43.37
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$62.45
|
| Rate for Payer: Cofinity Commercial |
$58.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.54
|
| Rate for Payer: Nomi Health Commercial |
$52.04
|
| Rate for Payer: PACE SWMI |
$43.37
|
| Rate for Payer: PHP Commercial |
$60.72
|
| Rate for Payer: PHP Medicare Advantage |
$43.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.80
|
| Rate for Payer: Priority Health Medicare |
$43.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.37
|
| Rate for Payer: UHC Medicare Advantage |
$43.37
|
| Rate for Payer: UMR Bronson Commercial |
$33.12
|
|
|
PR ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 97763
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$68.90 |
| Rate for Payer: Aetna Commercial |
$63.17
|
| Rate for Payer: Aetna Medicare |
$49.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.17
|
| Rate for Payer: BCBS Complete |
$42.40
|
| Rate for Payer: BCBS MAPPO |
$47.14
|
| Rate for Payer: BCN Medicare Advantage |
$47.14
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$67.88
|
| Rate for Payer: Cofinity Commercial |
$63.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.50
|
| Rate for Payer: Nomi Health Commercial |
$56.57
|
| Rate for Payer: PACE SWMI |
$47.14
|
| Rate for Payer: PHP Commercial |
$66.00
|
| Rate for Payer: PHP Medicare Advantage |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.90
|
| Rate for Payer: Priority Health Medicare |
$47.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.14
|
| Rate for Payer: UHC Medicare Advantage |
$47.14
|
| Rate for Payer: UMR Bronson Commercial |
$48.76
|
|
|
PR ORTHOVISC INJ PER DOSE
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
HCPCS J7324
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$164.94 |
| Rate for Payer: Aetna Commercial |
$153.48
|
| Rate for Payer: Aetna Medicare |
$119.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.48
|
| Rate for Payer: BCBS Complete |
$75.60
|
| Rate for Payer: BCBS MAPPO |
$114.54
|
| Rate for Payer: BCN Medicare Advantage |
$114.54
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cofinity Commercial |
$164.94
|
| Rate for Payer: Cofinity Commercial |
$153.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.27
|
| Rate for Payer: Nomi Health Commercial |
$137.45
|
| Rate for Payer: PACE SWMI |
$114.54
|
| Rate for Payer: PHP Commercial |
$160.36
|
| Rate for Payer: PHP Medicare Advantage |
$114.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.85
|
| Rate for Payer: Priority Health Medicare |
$114.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.54
|
| Rate for Payer: UHC Medicare Advantage |
$114.54
|
| Rate for Payer: UMR Bronson Commercial |
$86.94
|
|
|
PR OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC
|
Professional
|
Both
|
$1,938.00
|
|
|
Service Code
|
HCPCS 28114
|
| Min. Negotiated Rate |
$775.20 |
| Max. Negotiated Rate |
$1,259.70 |
| Rate for Payer: Aetna Commercial |
$1,075.66
|
| Rate for Payer: Aetna Medicare |
$834.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,155.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,075.66
|
| Rate for Payer: BCBS Complete |
$775.20
|
| Rate for Payer: BCBS MAPPO |
$802.73
|
| Rate for Payer: BCN Medicare Advantage |
$802.73
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cash Price |
$1,550.40
|
| Rate for Payer: Cofinity Commercial |
$1,155.93
|
| Rate for Payer: Cofinity Commercial |
$1,075.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$802.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$842.87
|
| Rate for Payer: Nomi Health Commercial |
$963.28
|
| Rate for Payer: PACE SWMI |
$802.73
|
| Rate for Payer: PHP Commercial |
$1,123.82
|
| Rate for Payer: PHP Medicare Advantage |
$802.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,259.70
|
| Rate for Payer: Priority Health Medicare |
$802.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$802.73
|
| Rate for Payer: UHC Medicare Advantage |
$802.73
|
| Rate for Payer: UMR Bronson Commercial |
$891.48
|
|
