|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN
|
Professional
|
Both
|
$1,418.00
|
|
|
Service Code
|
HCPCS 25270
|
| Min. Negotiated Rate |
$479.04 |
| Max. Negotiated Rate |
$921.70 |
| Rate for Payer: Aetna Commercial |
$641.91
|
| Rate for Payer: Aetna Medicare |
$498.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.91
|
| Rate for Payer: BCBS Complete |
$567.20
|
| Rate for Payer: BCBS MAPPO |
$479.04
|
| Rate for Payer: BCN Medicare Advantage |
$479.04
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cash Price |
$1,134.40
|
| Rate for Payer: Cofinity Commercial |
$689.82
|
| Rate for Payer: Cofinity Commercial |
$641.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$479.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$502.99
|
| Rate for Payer: Nomi Health Commercial |
$574.85
|
| Rate for Payer: PACE SWMI |
$479.04
|
| Rate for Payer: PHP Commercial |
$670.66
|
| Rate for Payer: PHP Medicare Advantage |
$479.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.70
|
| Rate for Payer: Priority Health Medicare |
$479.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$479.04
|
| Rate for Payer: UHC Medicare Advantage |
$479.04
|
| Rate for Payer: UMR Bronson Commercial |
$652.28
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU
|
Professional
|
Both
|
$1,621.00
|
|
|
Service Code
|
HCPCS 25272
|
| Min. Negotiated Rate |
$542.71 |
| Max. Negotiated Rate |
$1,053.65 |
| Rate for Payer: Aetna Commercial |
$727.23
|
| Rate for Payer: Aetna Medicare |
$564.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$781.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$727.23
|
| Rate for Payer: BCBS Complete |
$648.40
|
| Rate for Payer: BCBS MAPPO |
$542.71
|
| Rate for Payer: BCN Medicare Advantage |
$542.71
|
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Cofinity Commercial |
$781.50
|
| Rate for Payer: Cofinity Commercial |
$727.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$542.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$569.85
|
| Rate for Payer: Nomi Health Commercial |
$651.25
|
| Rate for Payer: PACE SWMI |
$542.71
|
| Rate for Payer: PHP Commercial |
$759.79
|
| Rate for Payer: PHP Medicare Advantage |
$542.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,053.65
|
| Rate for Payer: Priority Health Medicare |
$542.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$542.71
|
| Rate for Payer: UHC Medicare Advantage |
$542.71
|
| Rate for Payer: UMR Bronson Commercial |
$745.66
|
|
|
PR RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN
|
Professional
|
Both
|
$2,302.00
|
|
|
Service Code
|
HCPCS 25274
|
| Min. Negotiated Rate |
$644.31 |
| Max. Negotiated Rate |
$1,496.30 |
| Rate for Payer: Aetna Commercial |
$863.38
|
| Rate for Payer: Aetna Medicare |
$670.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$927.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.38
|
| Rate for Payer: BCBS Complete |
$920.80
|
| Rate for Payer: BCBS MAPPO |
$644.31
|
| Rate for Payer: BCN Medicare Advantage |
$644.31
|
| Rate for Payer: Cash Price |
$1,841.60
|
| Rate for Payer: Cash Price |
$1,841.60
|
| Rate for Payer: Cofinity Commercial |
$927.81
|
| Rate for Payer: Cofinity Commercial |
$863.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$676.53
|
| Rate for Payer: Nomi Health Commercial |
$773.17
|
| Rate for Payer: PACE SWMI |
$644.31
|
| Rate for Payer: PHP Commercial |
$902.03
|
| Rate for Payer: PHP Medicare Advantage |
$644.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,496.30
|
| Rate for Payer: Priority Health Medicare |
$644.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$644.31
|
| Rate for Payer: UHC Medicare Advantage |
$644.31
|
| Rate for Payer: UMR Bronson Commercial |
$1,058.92
|
|
|
PR RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT
|
Professional
|
Both
|
$2,025.00
|
|
|
Service Code
|
HCPCS 25275
|
| Min. Negotiated Rate |
$650.90 |
| Max. Negotiated Rate |
$1,316.25 |
| Rate for Payer: Aetna Commercial |
$872.21
|
| Rate for Payer: Aetna Medicare |
$676.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$937.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.21
|
| Rate for Payer: BCBS Complete |
$810.00
|
| Rate for Payer: BCBS MAPPO |
$650.90
|
| Rate for Payer: BCN Medicare Advantage |
$650.90
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cash Price |
$1,620.00
|
| Rate for Payer: Cofinity Commercial |
$937.30
|
| Rate for Payer: Cofinity Commercial |
$872.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$650.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$683.45
|
| Rate for Payer: Nomi Health Commercial |
$781.08
|
| Rate for Payer: PACE SWMI |
$650.90
|
| Rate for Payer: PHP Commercial |
$911.26
|
| Rate for Payer: PHP Medicare Advantage |
$650.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,316.25
|
| Rate for Payer: Priority Health Medicare |
$650.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$650.90
|
| Rate for Payer: UHC Medicare Advantage |
$650.90
|
| Rate for Payer: UMR Bronson Commercial |
$931.50
|
|
|
PR RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON
|
Professional
|
Both
|
$947.00
|
|
|
Service Code
|
HCPCS 28210
|
| Min. Negotiated Rate |
$378.80 |
| Max. Negotiated Rate |
$615.55 |
| Rate for Payer: Aetna Commercial |
$539.78
|
| Rate for Payer: Aetna Medicare |
$418.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.78
|
| Rate for Payer: BCBS Complete |
$378.80
|
| Rate for Payer: BCBS MAPPO |
$402.82
|
| Rate for Payer: BCN Medicare Advantage |
$402.82
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$580.06
|
| Rate for Payer: Cofinity Commercial |
$539.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$422.96
|
| Rate for Payer: Nomi Health Commercial |
$483.38
|
| Rate for Payer: PACE SWMI |
$402.82
|
| Rate for Payer: PHP Commercial |
$563.95
|
| Rate for Payer: PHP Medicare Advantage |
$402.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: Priority Health Medicare |
$402.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.82
|
| Rate for Payer: UHC Medicare Advantage |
$402.82
|
| Rate for Payer: UMR Bronson Commercial |
$435.62
|
|
|
PR RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS
|
Professional
|
Both
|
$8,690.00
|
|
|
Service Code
|
HCPCS 33877
|
| Min. Negotiated Rate |
$3,459.74 |
| Max. Negotiated Rate |
$5,648.50 |
| Rate for Payer: Aetna Commercial |
$4,636.05
|
| Rate for Payer: Aetna Medicare |
$3,598.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,982.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,636.05
|
| Rate for Payer: BCBS Complete |
$3,476.00
|
| Rate for Payer: BCBS MAPPO |
$3,459.74
|
| Rate for Payer: BCN Medicare Advantage |
$3,459.74
|
| Rate for Payer: Cash Price |
$6,952.00
|
| Rate for Payer: Cash Price |
$6,952.00
|
| Rate for Payer: Cofinity Commercial |
$4,982.03
|
| Rate for Payer: Cofinity Commercial |
$4,636.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,459.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,632.73
|
| Rate for Payer: Nomi Health Commercial |
$4,151.69
|
| Rate for Payer: PACE SWMI |
$3,459.74
|
| Rate for Payer: PHP Commercial |
$4,843.64
|
| Rate for Payer: PHP Medicare Advantage |
$3,459.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,648.50
|
| Rate for Payer: Priority Health Medicare |
$3,459.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,459.74
|
| Rate for Payer: UHC Medicare Advantage |
$3,459.74
|
| Rate for Payer: UMR Bronson Commercial |
$3,997.40
|
|
|
PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 55060
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$523.60 |
| Rate for Payer: Aetna Commercial |
$487.24
|
| Rate for Payer: Aetna Medicare |
$378.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$487.24
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: BCBS MAPPO |
$363.61
|
| Rate for Payer: BCN Medicare Advantage |
$363.61
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$523.60
|
| Rate for Payer: Cofinity Commercial |
$487.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.79
|
| Rate for Payer: Nomi Health Commercial |
$436.33
|
| Rate for Payer: PACE SWMI |
$363.61
|
| Rate for Payer: PHP Commercial |
$509.05
|
| Rate for Payer: PHP Medicare Advantage |
$363.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health Medicare |
$363.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.61
|
| Rate for Payer: UHC Medicare Advantage |
$363.61
|
| Rate for Payer: UMR Bronson Commercial |
$289.80
|
|
|
PR RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 36575
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$291.20 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna Medicare |
$32.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.48
|
| Rate for Payer: BCBS Complete |
$179.20
|
| Rate for Payer: BCBS MAPPO |
$31.70
|
| Rate for Payer: BCN Medicare Advantage |
$31.70
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cofinity Commercial |
$45.65
|
| Rate for Payer: Cofinity Commercial |
$42.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.28
|
| Rate for Payer: Nomi Health Commercial |
$38.04
|
| Rate for Payer: PACE SWMI |
$31.70
|
| Rate for Payer: PHP Commercial |
$44.38
|
| Rate for Payer: PHP Medicare Advantage |
$31.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.20
|
| Rate for Payer: Priority Health Medicare |
$31.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.70
|
| Rate for Payer: UHC Medicare Advantage |
$31.70
|
| Rate for Payer: UMR Bronson Commercial |
$206.08
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS INCARCERATED
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 49582
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Aetna Medicare |
$731.50
|
| Rate for Payer: BCBS Complete |
$585.20
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
| Rate for Payer: UMR Bronson Commercial |
$672.98
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,268.00
|
|
|
Service Code
|
HCPCS 49580
|
| Min. Negotiated Rate |
$507.20 |
| Max. Negotiated Rate |
$824.20 |
| Rate for Payer: Aetna Medicare |
$634.00
|
| Rate for Payer: BCBS Complete |
$507.20
|
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.20
|
| Rate for Payer: UMR Bronson Commercial |
$583.28
|
|
|
PR RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,685.00
|
|
|
Service Code
|
HCPCS 49587
|
| Min. Negotiated Rate |
$674.00 |
| Max. Negotiated Rate |
$1,095.25 |
| Rate for Payer: Aetna Medicare |
$842.50
|
| Rate for Payer: BCBS Complete |
$674.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,095.25
|
| Rate for Payer: UMR Bronson Commercial |
$775.10
|
|
|
PR RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 49585
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Aetna Medicare |
$731.50
|
| Rate for Payer: BCBS Complete |
$585.20
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
| Rate for Payer: UMR Bronson Commercial |
$672.98
|
|
|
PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC
|
Professional
|
Both
|
$8,041.00
|
|
|
Service Code
|
HCPCS 33414
|
| Min. Negotiated Rate |
$2,061.73 |
| Max. Negotiated Rate |
$5,226.65 |
| Rate for Payer: Aetna Commercial |
$2,762.72
|
| Rate for Payer: Aetna Medicare |
$2,144.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,762.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,968.89
|
| Rate for Payer: BCBS Complete |
$3,216.40
|
| Rate for Payer: BCBS MAPPO |
$2,061.73
|
| Rate for Payer: BCN Medicare Advantage |
$2,061.73
|
| Rate for Payer: Cash Price |
$6,432.80
|
| Rate for Payer: Cash Price |
$6,432.80
|
| Rate for Payer: Cofinity Commercial |
$2,968.89
|
| Rate for Payer: Cofinity Commercial |
$2,762.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,061.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,164.82
|
| Rate for Payer: Nomi Health Commercial |
$2,474.08
|
| Rate for Payer: PACE SWMI |
$2,061.73
|
| Rate for Payer: PHP Commercial |
$2,886.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,061.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,226.65
|
| Rate for Payer: Priority Health Medicare |
$2,061.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,061.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,061.73
|
| Rate for Payer: UMR Bronson Commercial |
$3,698.86
|
|
|
PR RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER
|
Professional
|
Both
|
$2,823.00
|
|
|
Service Code
|
HCPCS 26428
|
| Min. Negotiated Rate |
$744.65 |
| Max. Negotiated Rate |
$1,834.95 |
| Rate for Payer: Aetna Commercial |
$997.83
|
| Rate for Payer: Aetna Medicare |
$774.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$997.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,072.30
|
| Rate for Payer: BCBS Complete |
$1,129.20
|
| Rate for Payer: BCBS MAPPO |
$744.65
|
| Rate for Payer: BCN Medicare Advantage |
$744.65
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Cofinity Commercial |
$997.83
|
| Rate for Payer: Cofinity Commercial |
$1,072.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$781.88
|
| Rate for Payer: Nomi Health Commercial |
$893.58
|
| Rate for Payer: PACE SWMI |
$744.65
|
| Rate for Payer: PHP Commercial |
$1,042.51
|
| Rate for Payer: PHP Medicare Advantage |
$744.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,834.95
|
| Rate for Payer: Priority Health Medicare |
$744.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.65
|
| Rate for Payer: UHC Medicare Advantage |
$744.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,298.58
|
|
|
PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 26426
|
| Min. Negotiated Rate |
$488.18 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$654.16
|
| Rate for Payer: Aetna Medicare |
$507.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$702.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$654.16
|
| Rate for Payer: BCBS Complete |
$793.20
|
| Rate for Payer: BCBS MAPPO |
$488.18
|
| Rate for Payer: BCN Medicare Advantage |
$488.18
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$702.98
|
| Rate for Payer: Cofinity Commercial |
$654.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.59
|
| Rate for Payer: Nomi Health Commercial |
$585.82
|
| Rate for Payer: PACE SWMI |
$488.18
|
| Rate for Payer: PHP Commercial |
$683.45
|
| Rate for Payer: PHP Medicare Advantage |
$488.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health Medicare |
$488.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$488.18
|
| Rate for Payer: UHC Medicare Advantage |
$488.18
|
| Rate for Payer: UMR Bronson Commercial |
$912.18
|
|
|
PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 33226
|
| Min. Negotiated Rate |
$466.10 |
| Max. Negotiated Rate |
$843.05 |
| Rate for Payer: Aetna Commercial |
$624.57
|
| Rate for Payer: Aetna Medicare |
$484.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.57
|
| Rate for Payer: BCBS Complete |
$518.80
|
| Rate for Payer: BCBS MAPPO |
$466.10
|
| Rate for Payer: BCN Medicare Advantage |
$466.10
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$671.18
|
| Rate for Payer: Cofinity Commercial |
$624.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.40
|
| Rate for Payer: Nomi Health Commercial |
$559.32
|
| Rate for Payer: PACE SWMI |
$466.10
|
| Rate for Payer: PHP Commercial |
$652.54
|
| Rate for Payer: PHP Medicare Advantage |
$466.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health Medicare |
$466.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.10
|
| Rate for Payer: UHC Medicare Advantage |
$466.10
|
| Rate for Payer: UMR Bronson Commercial |
$596.62
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 33215
|
| Min. Negotiated Rate |
$295.05 |
| Max. Negotiated Rate |
$668.85 |
| Rate for Payer: Aetna Commercial |
$395.37
|
| Rate for Payer: Aetna Medicare |
$306.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.37
|
| Rate for Payer: BCBS Complete |
$411.60
|
| Rate for Payer: BCBS MAPPO |
$295.05
|
| Rate for Payer: BCN Medicare Advantage |
$295.05
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cofinity Commercial |
$424.87
|
| Rate for Payer: Cofinity Commercial |
$395.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.80
|
| Rate for Payer: Nomi Health Commercial |
$354.06
|
| Rate for Payer: PACE SWMI |
$295.05
|
| Rate for Payer: PHP Commercial |
$413.07
|
| Rate for Payer: PHP Medicare Advantage |
$295.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$668.85
|
| Rate for Payer: Priority Health Medicare |
$295.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.05
|
| Rate for Payer: UHC Medicare Advantage |
$295.05
|
| Rate for Payer: UMR Bronson Commercial |
$473.34
|
|
|
PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 36597
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$205.40 |
| Rate for Payer: Aetna Commercial |
$76.77
|
| Rate for Payer: Aetna Medicare |
$59.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.77
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$57.29
|
| Rate for Payer: BCN Medicare Advantage |
$57.29
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$82.50
|
| Rate for Payer: Cofinity Commercial |
$76.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.15
|
| Rate for Payer: Nomi Health Commercial |
$68.75
|
| Rate for Payer: PACE SWMI |
$57.29
|
| Rate for Payer: PHP Commercial |
$80.21
|
| Rate for Payer: PHP Medicare Advantage |
$57.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$57.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.29
|
| Rate for Payer: UHC Medicare Advantage |
$57.29
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
HCPCS 90380
|
| Min. Negotiated Rate |
$521.20 |
| Max. Negotiated Rate |
$846.95 |
| Rate for Payer: Aetna Medicare |
$651.50
|
| Rate for Payer: BCBS Complete |
$521.20
|
| Rate for Payer: Cash Price |
$1,042.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.95
|
| Rate for Payer: UMR Bronson Commercial |
$599.38
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
HCPCS 90381
|
| Min. Negotiated Rate |
$521.20 |
| Max. Negotiated Rate |
$846.95 |
| Rate for Payer: Aetna Medicare |
$651.50
|
| Rate for Payer: BCBS Complete |
$521.20
|
| Rate for Payer: Cash Price |
$1,042.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.95
|
| Rate for Payer: UMR Bronson Commercial |
$599.38
|
|
|
PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 90678
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna Medicare |
$420.00
|
| Rate for Payer: BCBS Complete |
$336.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
| Rate for Payer: UMR Bronson Commercial |
$386.40
|
|
|
PR RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 90679
|
| Min. Negotiated Rate |
$318.80 |
| Max. Negotiated Rate |
$518.05 |
| Rate for Payer: Aetna Medicare |
$398.50
|
| Rate for Payer: BCBS Complete |
$318.80
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.05
|
| Rate for Payer: UMR Bronson Commercial |
$366.62
|
|
|
PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$2,946.00
|
|
|
Service Code
|
HCPCS 37193
|
| Min. Negotiated Rate |
$327.97 |
| Max. Negotiated Rate |
$1,914.90 |
| Rate for Payer: Aetna Commercial |
$439.48
|
| Rate for Payer: Aetna Medicare |
$341.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$472.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.48
|
| Rate for Payer: BCBS Complete |
$1,178.40
|
| Rate for Payer: BCBS MAPPO |
$327.97
|
| Rate for Payer: BCN Medicare Advantage |
$327.97
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cofinity Commercial |
$439.48
|
| Rate for Payer: Cofinity Commercial |
$472.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.37
|
| Rate for Payer: Nomi Health Commercial |
$393.56
|
| Rate for Payer: PACE SWMI |
$327.97
|
| Rate for Payer: PHP Commercial |
$459.16
|
| Rate for Payer: PHP Medicare Advantage |
$327.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,914.90
|
| Rate for Payer: Priority Health Medicare |
$327.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.97
|
| Rate for Payer: UHC Medicare Advantage |
$327.97
|
| Rate for Payer: UMR Bronson Commercial |
$1,355.16
|
|
|
PR RUBELLA IMMUNIZATION, SUBCUT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 90706
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 90681
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$103.35 |
| Rate for Payer: Aetna Medicare |
$79.50
|
| Rate for Payer: BCBS Complete |
$63.60
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.35
|
| Rate for Payer: UMR Bronson Commercial |
$73.14
|
|
