|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
HCPCS 33215
|
| Min. Negotiated Rate |
$175.51 |
| Max. Negotiated Rate |
$795.00 |
| Rate for Payer: Aetna Commercial |
$366.42
|
| Rate for Payer: Aetna Medicare |
$284.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$366.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.77
|
| Rate for Payer: BCBS Complete |
$184.29
|
| Rate for Payer: BCBS MAPPO |
$273.45
|
| Rate for Payer: BCN Commercial |
$458.64
|
| Rate for Payer: BCN Medicare Advantage |
$273.45
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Cofinity Commercial |
$366.42
|
| Rate for Payer: Cofinity Commercial |
$393.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$287.12
|
| Rate for Payer: Meridian Medicaid |
$184.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$300.80
|
| Rate for Payer: Nomi Health Commercial |
$328.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$795.00
|
| Rate for Payer: PACE SWMI |
$273.45
|
| Rate for Payer: PHP Commercial |
$382.83
|
| Rate for Payer: PHP Medicare Advantage |
$273.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$493.21
|
| Rate for Payer: Priority Health Medicare |
$273.45
|
| Rate for Payer: Priority Health SBD |
$493.21
|
| Rate for Payer: Priority Health Tiered Network |
$493.21
|
| Rate for Payer: Railroad Medicare Medicare |
$273.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$549.72
|
| Rate for Payer: UHC Core |
$549.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$273.45
|
| Rate for Payer: UHC Exchange |
$549.72
|
| Rate for Payer: UHC Medicaid |
$175.51
|
| Rate for Payer: UHCCP Medicaid |
$175.51
|
| Rate for Payer: UMR Bronson Commercial |
$487.60
|
|
|
PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 36597
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Aetna Commercial |
$69.79
|
| Rate for Payer: Aetna Medicare |
$54.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.00
|
| Rate for Payer: BCBS Complete |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$52.08
|
| Rate for Payer: BCN Commercial |
$88.64
|
| Rate for Payer: BCN Medicare Advantage |
$52.08
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$69.79
|
| Rate for Payer: Cofinity Commercial |
$75.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.68
|
| Rate for Payer: Meridian Medicaid |
$34.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.29
|
| Rate for Payer: Nomi Health Commercial |
$62.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
| Rate for Payer: PACE SWMI |
$52.08
|
| Rate for Payer: PHP Commercial |
$72.91
|
| Rate for Payer: PHP Medicare Advantage |
$52.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.33
|
| Rate for Payer: Priority Health Medicare |
$52.08
|
| Rate for Payer: Priority Health SBD |
$95.33
|
| Rate for Payer: Priority Health Tiered Network |
$95.33
|
| Rate for Payer: Railroad Medicare Medicare |
$52.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.64
|
| Rate for Payer: UHC Core |
$107.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$52.08
|
| Rate for Payer: UHC Exchange |
$107.64
|
| Rate for Payer: UHC Medicaid |
$33.23
|
| Rate for Payer: UHCCP Medicaid |
$33.23
|
| Rate for Payer: UMR Bronson Commercial |
$149.50
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE
|
Professional
|
Both
|
$1,342.00
|
|
|
Service Code
|
HCPCS 90380
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$1,006.50 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Medicare |
$671.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.90
|
| Rate for Payer: BCBS Trust/PPO |
$595.06
|
| Rate for Payer: BCN Commercial |
$547.23
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,006.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.06
|
| Rate for Payer: UHC Core |
$595.06
|
| Rate for Payer: UHC Exchange |
$595.06
|
| Rate for Payer: UMR Bronson Commercial |
$617.32
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE
|
Professional
|
Both
|
$1,342.00
|
|
|
Service Code
|
HCPCS 90381
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$1,006.50 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Medicare |
$671.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.90
|
| Rate for Payer: BCBS Trust/PPO |
$595.06
|
| Rate for Payer: BCN Commercial |
$547.23
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Cash Price |
$1,073.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,006.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.06
|
| Rate for Payer: UHC Core |
$595.06
|
| Rate for Payer: UHC Exchange |
$595.06
|
| Rate for Payer: UMR Bronson Commercial |
$617.32
|
|
|
PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 90678
|
| Min. Negotiated Rate |
$300.90 |
| Max. Negotiated Rate |
$648.75 |
| Rate for Payer: Aetna Commercial |
$300.90
|
| Rate for Payer: Aetna Medicare |
$432.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.90
|
| Rate for Payer: BCBS Trust/PPO |
$319.07
|
| Rate for Payer: BCN Commercial |
$325.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$648.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.07
|
| Rate for Payer: UHC Core |
$319.07
|
| Rate for Payer: UHC Exchange |
$319.07
|
| Rate for Payer: UMR Bronson Commercial |
$397.90
|
|
|
PR RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
HCPCS 90679
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$615.75 |
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: Aetna Medicare |
$410.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.60
|
| Rate for Payer: BCBS Trust/PPO |
$306.35
|
| Rate for Payer: BCN Commercial |
$289.29
|
| Rate for Payer: Cash Price |
$656.80
|
| Rate for Payer: Cash Price |
$656.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.35
|
| Rate for Payer: UHC Core |
$306.35
|
| Rate for Payer: UHC Exchange |
$306.35
|
| Rate for Payer: UMR Bronson Commercial |
$377.66
|
|
|
PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$3,034.00
|
|
|
Service Code
|
HCPCS 37193
|
| Min. Negotiated Rate |
$192.55 |
| Max. Negotiated Rate |
$2,275.50 |
| Rate for Payer: Aetna Commercial |
$406.69
|
| Rate for Payer: Aetna Medicare |
$315.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$406.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$437.04
|
| Rate for Payer: BCBS Complete |
$202.18
|
| Rate for Payer: BCBS MAPPO |
$303.50
|
| Rate for Payer: BCN Commercial |
$504.96
|
| Rate for Payer: BCN Medicare Advantage |
$303.50
|
| Rate for Payer: Cash Price |
$2,427.20
|
| Rate for Payer: Cash Price |
$2,427.20
|
| Rate for Payer: Cofinity Commercial |
$406.69
|
| Rate for Payer: Cofinity Commercial |
$437.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$318.68
|
| Rate for Payer: Meridian Medicaid |
$202.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$333.85
|
| Rate for Payer: Nomi Health Commercial |
$364.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,275.50
|
| Rate for Payer: PACE SWMI |
$303.50
|
| Rate for Payer: PHP Commercial |
$424.90
|
| Rate for Payer: PHP Medicare Advantage |
$303.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$192.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$543.01
|
| Rate for Payer: Priority Health Medicare |
$303.50
|
| Rate for Payer: Priority Health SBD |
$543.01
|
| Rate for Payer: Priority Health Tiered Network |
$543.01
|
| Rate for Payer: Railroad Medicare Medicare |
$303.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$624.96
|
| Rate for Payer: UHC Core |
$624.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$303.50
|
| Rate for Payer: UHC Exchange |
$624.96
|
| Rate for Payer: UHC Medicaid |
$192.55
|
| Rate for Payer: UHCCP Medicaid |
$192.55
|
| Rate for Payer: UMR Bronson Commercial |
$1,395.64
|
|
|
PR RUBELLA IMMUNIZATION, SUBCUT
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90706
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 90681
|
| Min. Negotiated Rate |
$75.44 |
| Max. Negotiated Rate |
$147.02 |
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Medicare |
$82.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.29
|
| Rate for Payer: BCBS Trust/PPO |
$147.02
|
| Rate for Payer: BCN Commercial |
$144.54
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.02
|
| Rate for Payer: UHC Core |
$147.02
|
| Rate for Payer: UHC Exchange |
$147.02
|
| Rate for Payer: UMR Bronson Commercial |
$75.44
|
|
|
PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 90680
|
| Min. Negotiated Rate |
$45.54 |
| Max. Negotiated Rate |
$102.74 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.75
|
| Rate for Payer: BCBS Trust/PPO |
$102.74
|
| Rate for Payer: BCN Commercial |
$97.11
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.74
|
| Rate for Payer: UHC Core |
$102.74
|
| Rate for Payer: UHC Exchange |
$102.74
|
| Rate for Payer: UMR Bronson Commercial |
$45.54
|
|
|
PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY
|
Professional
|
Both
|
$3,236.00
|
|
|
Service Code
|
HCPCS 33476
|
| Min. Negotiated Rate |
$923.78 |
| Max. Negotiated Rate |
$2,703.06 |
| Rate for Payer: Aetna Commercial |
$1,936.26
|
| Rate for Payer: Aetna Medicare |
$1,502.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,936.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,080.76
|
| Rate for Payer: BCBS Complete |
$969.97
|
| Rate for Payer: BCBS MAPPO |
$1,444.97
|
| Rate for Payer: BCN Commercial |
$2,253.86
|
| Rate for Payer: BCN Medicare Advantage |
$1,444.97
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cash Price |
$2,588.80
|
| Rate for Payer: Cofinity Commercial |
$2,080.76
|
| Rate for Payer: Cofinity Commercial |
$1,936.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,444.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,517.22
|
| Rate for Payer: Meridian Medicaid |
$969.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,589.47
|
| Rate for Payer: Nomi Health Commercial |
$1,733.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,427.00
|
| Rate for Payer: PACE SWMI |
$1,444.97
|
| Rate for Payer: PHP Commercial |
$2,022.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,444.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$923.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,423.74
|
| Rate for Payer: Priority Health Medicare |
$1,444.97
|
| Rate for Payer: Priority Health SBD |
$2,423.74
|
| Rate for Payer: Priority Health Tiered Network |
$2,423.74
|
| Rate for Payer: Railroad Medicare Medicare |
$1,444.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,703.06
|
| Rate for Payer: UHC Core |
$2,703.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,444.97
|
| Rate for Payer: UHC Exchange |
$2,703.06
|
| Rate for Payer: UHC Medicaid |
$923.78
|
| Rate for Payer: UHCCP Medicaid |
$923.78
|
| Rate for Payer: UMR Bronson Commercial |
$1,488.56
|
|
|
PR RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 92310
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$85.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.40
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCN Commercial |
$84.16
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$127.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$72.02
|
| Rate for Payer: Priority Health SBD |
$72.02
|
| Rate for Payer: Priority Health Tiered Network |
$72.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.35
|
| Rate for Payer: UHC Core |
$76.35
|
| Rate for Payer: UHC Exchange |
$76.35
|
| Rate for Payer: UHC Medicaid |
$31.10
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
| Rate for Payer: UMR Bronson Commercial |
$78.20
|
|
|
PR RX&FITG C-LENS TECH CRNL LENS OU XCPT APHAKIA
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
HCPCS 92314
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$105.75 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Medicare |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.80
|
| Rate for Payer: BCBS Complete |
$56.40
|
| Rate for Payer: BCN Commercial |
$49.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42.61
|
| Rate for Payer: Priority Health SBD |
$42.61
|
| Rate for Payer: Priority Health Tiered Network |
$42.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.54
|
| Rate for Payer: UHC Core |
$45.54
|
| Rate for Payer: UHC Exchange |
$45.54
|
| Rate for Payer: UMR Bronson Commercial |
$64.86
|
|
|
PR RX RIB FRACTURE W EXTERN FIXATN
|
Professional
|
Both
|
$1,357.00
|
|
|
Service Code
|
HCPCS 21810
|
| Min. Negotiated Rate |
$542.80 |
| Max. Negotiated Rate |
$1,017.75 |
| Rate for Payer: Aetna Medicare |
$678.50
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,017.75
|
| Rate for Payer: UMR Bronson Commercial |
$624.22
|
|
|
PR SACRAL NERVE STIM TEST LEAD
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS A4290
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.67
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCN Commercial |
$22.50
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.92
|
| Rate for Payer: UHC Core |
$55.92
|
| Rate for Payer: UHC Exchange |
$55.92
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$1,801.00
|
|
|
Service Code
|
HCPCS 58700
|
| Min. Negotiated Rate |
$465.83 |
| Max. Negotiated Rate |
$1,396.79 |
| Rate for Payer: Aetna Commercial |
$966.93
|
| Rate for Payer: Aetna Medicare |
$750.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,039.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$966.93
|
| Rate for Payer: BCBS Complete |
$489.12
|
| Rate for Payer: BCBS MAPPO |
$721.59
|
| Rate for Payer: BCN Commercial |
$1,205.61
|
| Rate for Payer: BCN Medicare Advantage |
$721.59
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cofinity Commercial |
$966.93
|
| Rate for Payer: Cofinity Commercial |
$1,039.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$721.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$757.67
|
| Rate for Payer: Meridian Medicaid |
$489.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$793.75
|
| Rate for Payer: Nomi Health Commercial |
$865.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,350.75
|
| Rate for Payer: PACE SWMI |
$721.59
|
| Rate for Payer: PHP Commercial |
$1,010.23
|
| Rate for Payer: PHP Medicare Advantage |
$721.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,221.03
|
| Rate for Payer: Priority Health Medicare |
$721.59
|
| Rate for Payer: Priority Health SBD |
$1,221.03
|
| Rate for Payer: Priority Health Tiered Network |
$1,221.03
|
| Rate for Payer: Railroad Medicare Medicare |
$721.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,396.79
|
| Rate for Payer: UHC Core |
$1,396.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$721.59
|
| Rate for Payer: UHC Exchange |
$1,396.79
|
| Rate for Payer: UHC Medicaid |
$465.83
|
| Rate for Payer: UHCCP Medicaid |
$465.83
|
| Rate for Payer: UMR Bronson Commercial |
$828.46
|
|
|
PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX
|
Professional
|
Both
|
$2,102.00
|
|
|
Service Code
|
HCPCS 58720
|
| Min. Negotiated Rate |
$445.38 |
| Max. Negotiated Rate |
$1,576.50 |
| Rate for Payer: Aetna Commercial |
$924.13
|
| Rate for Payer: Aetna Medicare |
$717.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$924.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$993.10
|
| Rate for Payer: BCBS Complete |
$467.65
|
| Rate for Payer: BCBS MAPPO |
$689.65
|
| Rate for Payer: BCN Commercial |
$1,143.36
|
| Rate for Payer: BCN Medicare Advantage |
$689.65
|
| Rate for Payer: Cash Price |
$1,681.60
|
| Rate for Payer: Cash Price |
$1,681.60
|
| Rate for Payer: Cofinity Commercial |
$924.13
|
| Rate for Payer: Cofinity Commercial |
$993.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$724.13
|
| Rate for Payer: Meridian Medicaid |
$467.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$758.62
|
| Rate for Payer: Nomi Health Commercial |
$827.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,576.50
|
| Rate for Payer: PACE SWMI |
$689.65
|
| Rate for Payer: PHP Commercial |
$965.51
|
| Rate for Payer: PHP Medicare Advantage |
$689.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$445.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,157.99
|
| Rate for Payer: Priority Health Medicare |
$689.65
|
| Rate for Payer: Priority Health SBD |
$1,157.99
|
| Rate for Payer: Priority Health Tiered Network |
$1,157.99
|
| Rate for Payer: Railroad Medicare Medicare |
$689.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,314.83
|
| Rate for Payer: UHC Core |
$1,314.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$689.65
|
| Rate for Payer: UHC Exchange |
$1,314.83
|
| Rate for Payer: UHC Medicaid |
$445.38
|
| Rate for Payer: UHCCP Medicaid |
$445.38
|
| Rate for Payer: UMR Bronson Commercial |
$966.92
|
|
|
PR SALPINGOSTOMY
|
Professional
|
Both
|
$2,809.00
|
|
|
Service Code
|
HCPCS 58770
|
| Min. Negotiated Rate |
$484.79 |
| Max. Negotiated Rate |
$2,106.75 |
| Rate for Payer: Aetna Commercial |
$1,010.57
|
| Rate for Payer: Aetna Medicare |
$784.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,010.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,085.99
|
| Rate for Payer: BCBS Complete |
$509.03
|
| Rate for Payer: BCBS MAPPO |
$754.16
|
| Rate for Payer: BCN Commercial |
$1,290.27
|
| Rate for Payer: BCN Medicare Advantage |
$754.16
|
| Rate for Payer: Cash Price |
$2,247.20
|
| Rate for Payer: Cash Price |
$2,247.20
|
| Rate for Payer: Cofinity Commercial |
$1,010.57
|
| Rate for Payer: Cofinity Commercial |
$1,085.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$754.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$791.87
|
| Rate for Payer: Meridian Medicaid |
$509.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$829.58
|
| Rate for Payer: Nomi Health Commercial |
$904.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,106.75
|
| Rate for Payer: PACE SWMI |
$754.16
|
| Rate for Payer: PHP Commercial |
$1,055.82
|
| Rate for Payer: PHP Medicare Advantage |
$754.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$484.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,306.77
|
| Rate for Payer: Priority Health Medicare |
$754.16
|
| Rate for Payer: Priority Health SBD |
$1,306.77
|
| Rate for Payer: Priority Health Tiered Network |
$1,306.77
|
| Rate for Payer: Railroad Medicare Medicare |
$754.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,525.91
|
| Rate for Payer: UHC Core |
$1,525.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$754.16
|
| Rate for Payer: UHC Exchange |
$1,525.91
|
| Rate for Payer: UHC Medicaid |
$484.79
|
| Rate for Payer: UHCCP Medicaid |
$484.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,292.14
|
|
|
PR SARSCOV2 VACC 10MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 91319
|
| Min. Negotiated Rate |
$75.76 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Aetna Commercial |
$127.03
|
| Rate for Payer: Aetna Medicare |
$98.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.51
|
| Rate for Payer: BCBS MAPPO |
$94.80
|
| Rate for Payer: BCBS Trust/PPO |
$83.16
|
| Rate for Payer: BCN Commercial |
$75.76
|
| Rate for Payer: BCN Medicare Advantage |
$94.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$127.03
|
| Rate for Payer: Cofinity Commercial |
$136.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.28
|
| Rate for Payer: Nomi Health Commercial |
$113.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.50
|
| Rate for Payer: PACE SWMI |
$94.80
|
| Rate for Payer: PHP Commercial |
$132.72
|
| Rate for Payer: PHP Medicare Advantage |
$94.80
|
| Rate for Payer: Priority Health Medicare |
$94.80
|
| Rate for Payer: Railroad Medicare Medicare |
$94.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.16
|
| Rate for Payer: UHC Core |
$83.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.80
|
| Rate for Payer: UHC Exchange |
$83.16
|
| Rate for Payer: UMR Bronson Commercial |
$103.96
|
|
|
PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 91320
|
| Min. Negotiated Rate |
$134.56 |
| Max. Negotiated Rate |
$252.75 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$175.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.45
|
| Rate for Payer: BCBS MAPPO |
$168.37
|
| Rate for Payer: BCBS Trust/PPO |
$168.94
|
| Rate for Payer: BCN Commercial |
$134.56
|
| Rate for Payer: BCN Medicare Advantage |
$168.37
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$242.45
|
| Rate for Payer: Cofinity Commercial |
$225.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$185.21
|
| Rate for Payer: Nomi Health Commercial |
$202.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.75
|
| Rate for Payer: PACE SWMI |
$168.37
|
| Rate for Payer: PHP Commercial |
$235.72
|
| Rate for Payer: PHP Medicare Advantage |
$168.37
|
| Rate for Payer: Priority Health Medicare |
$168.37
|
| Rate for Payer: Railroad Medicare Medicare |
$168.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.84
|
| Rate for Payer: UHC Core |
$169.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.37
|
| Rate for Payer: UHC Exchange |
$169.84
|
| Rate for Payer: UMR Bronson Commercial |
$155.02
|
|
|
PR SARSCOV2 VACC 3MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$169.00
|
|
|
Service Code
|
HCPCS 91318
|
| Min. Negotiated Rate |
$56.58 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$65.36
|
| Rate for Payer: Aetna Medicare |
$84.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.36
|
| Rate for Payer: BCBS Trust/PPO |
$57.50
|
| Rate for Payer: BCN Commercial |
$56.58
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.55
|
| Rate for Payer: UHC Core |
$65.55
|
| Rate for Payer: UHC Exchange |
$65.55
|
| Rate for Payer: UMR Bronson Commercial |
$77.74
|
|
|
PR SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 91321
|
| Min. Negotiated Rate |
$126.93 |
| Max. Negotiated Rate |
$267.00 |
| Rate for Payer: Aetna Commercial |
$197.06
|
| Rate for Payer: Aetna Medicare |
$152.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.77
|
| Rate for Payer: BCBS MAPPO |
$147.06
|
| Rate for Payer: BCBS Trust/PPO |
$129.00
|
| Rate for Payer: BCN Commercial |
$126.93
|
| Rate for Payer: BCN Medicare Advantage |
$147.06
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$197.06
|
| Rate for Payer: Cofinity Commercial |
$211.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$161.77
|
| Rate for Payer: Nomi Health Commercial |
$176.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.00
|
| Rate for Payer: PACE SWMI |
$147.06
|
| Rate for Payer: PHP Commercial |
$205.88
|
| Rate for Payer: PHP Medicare Advantage |
$147.06
|
| Rate for Payer: Priority Health Medicare |
$147.06
|
| Rate for Payer: Railroad Medicare Medicare |
$147.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.00
|
| Rate for Payer: UHC Core |
$129.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$147.06
|
| Rate for Payer: UHC Exchange |
$129.00
|
| Rate for Payer: UMR Bronson Commercial |
$163.76
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 99233
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$157.68 |
| Rate for Payer: Aetna Commercial |
$141.85
|
| Rate for Payer: Aetna Medicare |
$110.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.44
|
| Rate for Payer: BCBS Complete |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$105.86
|
| Rate for Payer: BCN Commercial |
$127.86
|
| Rate for Payer: BCN Medicare Advantage |
$105.86
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$141.85
|
| Rate for Payer: Cofinity Commercial |
$152.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.15
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.45
|
| Rate for Payer: Nomi Health Commercial |
$127.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: PACE SWMI |
$105.86
|
| Rate for Payer: PHP Commercial |
$148.20
|
| Rate for Payer: PHP Medicare Advantage |
$105.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$157.68
|
| Rate for Payer: Priority Health Medicare |
$105.86
|
| Rate for Payer: Priority Health SBD |
$157.68
|
| Rate for Payer: Priority Health Tiered Network |
$157.68
|
| Rate for Payer: Railroad Medicare Medicare |
$105.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.13
|
| Rate for Payer: UHC Core |
$147.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$105.86
|
| Rate for Payer: UHC Exchange |
$147.13
|
| Rate for Payer: UHC Medicaid |
$68.16
|
| Rate for Payer: UHCCP Medicaid |
$68.16
|
| Rate for Payer: UMR Bronson Commercial |
$87.40
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$105.71 |
| Rate for Payer: Aetna Commercial |
$93.57
|
| Rate for Payer: Aetna Medicare |
$72.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.57
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS MAPPO |
$69.83
|
| Rate for Payer: BCN Commercial |
$85.73
|
| Rate for Payer: BCN Medicare Advantage |
$69.83
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$100.56
|
| Rate for Payer: Cofinity Commercial |
$93.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.32
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$76.81
|
| Rate for Payer: Nomi Health Commercial |
$83.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: PACE SWMI |
$69.83
|
| Rate for Payer: PHP Commercial |
$97.76
|
| Rate for Payer: PHP Medicare Advantage |
$69.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$105.71
|
| Rate for Payer: Priority Health Medicare |
$69.83
|
| Rate for Payer: Priority Health SBD |
$105.71
|
| Rate for Payer: Priority Health Tiered Network |
$105.71
|
| Rate for Payer: Railroad Medicare Medicare |
$69.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.10
|
| Rate for Payer: UHC Core |
$102.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$69.83
|
| Rate for Payer: UHC Exchange |
$102.10
|
| Rate for Payer: UHC Medicaid |
$44.94
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$65.40 |
| Rate for Payer: Aetna Commercial |
$58.61
|
| Rate for Payer: Aetna Medicare |
$45.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.99
|
| Rate for Payer: BCBS Complete |
$29.53
|
| Rate for Payer: BCBS MAPPO |
$43.74
|
| Rate for Payer: BCN Commercial |
$53.03
|
| Rate for Payer: BCN Medicare Advantage |
$43.74
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Cofinity Commercial |
$62.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.93
|
| Rate for Payer: Meridian Medicaid |
$29.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$48.11
|
| Rate for Payer: Nomi Health Commercial |
$52.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.00
|
| Rate for Payer: PACE SWMI |
$43.74
|
| Rate for Payer: PHP Commercial |
$61.24
|
| Rate for Payer: PHP Medicare Advantage |
$43.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$65.40
|
| Rate for Payer: Priority Health Medicare |
$43.74
|
| Rate for Payer: Priority Health SBD |
$65.40
|
| Rate for Payer: Priority Health Tiered Network |
$65.40
|
| Rate for Payer: Railroad Medicare Medicare |
$43.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.62
|
| Rate for Payer: UHC Core |
$55.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$43.74
|
| Rate for Payer: UHC Exchange |
$55.62
|
| Rate for Payer: UHC Medicaid |
$28.12
|
| Rate for Payer: UHCCP Medicaid |
$28.12
|
| Rate for Payer: UMR Bronson Commercial |
$36.80
|
|
