|
PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 90680
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$62.40 |
| Rate for Payer: Aetna Medicare |
$48.00
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
| Rate for Payer: UMR Bronson Commercial |
$44.16
|
|
|
PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY
|
Professional
|
Both
|
$3,142.00
|
|
|
Service Code
|
HCPCS 33476
|
| Min. Negotiated Rate |
$1,256.80 |
| Max. Negotiated Rate |
$2,110.00 |
| Rate for Payer: Aetna Commercial |
$1,963.48
|
| Rate for Payer: Aetna Medicare |
$1,523.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,110.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,963.48
|
| Rate for Payer: BCBS Complete |
$1,256.80
|
| Rate for Payer: BCBS MAPPO |
$1,465.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,465.28
|
| Rate for Payer: Cash Price |
$2,513.60
|
| Rate for Payer: Cash Price |
$2,513.60
|
| Rate for Payer: Cofinity Commercial |
$2,110.00
|
| Rate for Payer: Cofinity Commercial |
$1,963.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,465.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,538.54
|
| Rate for Payer: Nomi Health Commercial |
$1,758.34
|
| Rate for Payer: PACE SWMI |
$1,465.28
|
| Rate for Payer: PHP Commercial |
$2,051.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,465.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,042.30
|
| Rate for Payer: Priority Health Medicare |
$1,465.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,465.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,465.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,445.32
|
|
|
PR RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 92310
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$107.25 |
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: UMR Bronson Commercial |
$75.90
|
|
|
PR RX&FITG C-LENS TECH CRNL LENS OU XCPT APHAKIA
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 92314
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Aetna Medicare |
$68.50
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: UMR Bronson Commercial |
$63.02
|
|
|
PR RX RIB FRACTURE W EXTERN FIXATN
|
Professional
|
Both
|
$1,317.00
|
|
|
Service Code
|
HCPCS 21810
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$856.05 |
| Rate for Payer: Aetna Medicare |
$658.50
|
| Rate for Payer: BCBS Complete |
$526.80
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.05
|
| Rate for Payer: UMR Bronson Commercial |
$605.82
|
|
|
PR SACRAL NERVE STIM TEST LEAD
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS A4290
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$105.95 |
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$1,749.00
|
|
|
Service Code
|
HCPCS 58700
|
| Min. Negotiated Rate |
$699.60 |
| Max. Negotiated Rate |
$1,136.85 |
| Rate for Payer: Aetna Commercial |
$1,033.18
|
| Rate for Payer: Aetna Medicare |
$801.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,110.28
|
| Rate for Payer: BCBS Complete |
$699.60
|
| Rate for Payer: BCBS MAPPO |
$771.03
|
| Rate for Payer: BCN Medicare Advantage |
$771.03
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cofinity Commercial |
$1,110.28
|
| Rate for Payer: Cofinity Commercial |
$1,033.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$771.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.58
|
| Rate for Payer: Nomi Health Commercial |
$925.24
|
| Rate for Payer: PACE SWMI |
$771.03
|
| Rate for Payer: PHP Commercial |
$1,079.44
|
| Rate for Payer: PHP Medicare Advantage |
$771.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.85
|
| Rate for Payer: Priority Health Medicare |
$771.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$771.03
|
| Rate for Payer: UHC Medicare Advantage |
$771.03
|
| Rate for Payer: UMR Bronson Commercial |
$804.54
|
|
|
PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX
|
Professional
|
Both
|
$2,041.00
|
|
|
Service Code
|
HCPCS 58720
|
| Min. Negotiated Rate |
$729.64 |
| Max. Negotiated Rate |
$1,326.65 |
| Rate for Payer: Aetna Commercial |
$977.72
|
| Rate for Payer: Aetna Medicare |
$758.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$977.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,050.68
|
| Rate for Payer: BCBS Complete |
$816.40
|
| Rate for Payer: BCBS MAPPO |
$729.64
|
| Rate for Payer: BCN Medicare Advantage |
$729.64
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cofinity Commercial |
$977.72
|
| Rate for Payer: Cofinity Commercial |
$1,050.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$729.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$766.12
|
| Rate for Payer: Nomi Health Commercial |
$875.57
|
| Rate for Payer: PACE SWMI |
$729.64
|
| Rate for Payer: PHP Commercial |
$1,021.50
|
| Rate for Payer: PHP Medicare Advantage |
$729.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.65
|
| Rate for Payer: Priority Health Medicare |
$729.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$729.64
|
| Rate for Payer: UHC Medicare Advantage |
$729.64
|
| Rate for Payer: UMR Bronson Commercial |
$938.86
|
|
|
PR SALPINGOSTOMY
|
Professional
|
Both
|
$2,727.00
|
|
|
Service Code
|
HCPCS 58770
|
| Min. Negotiated Rate |
$826.88 |
| Max. Negotiated Rate |
$1,772.55 |
| Rate for Payer: Aetna Commercial |
$1,108.02
|
| Rate for Payer: Aetna Medicare |
$859.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,108.02
|
| Rate for Payer: BCBS Complete |
$1,090.80
|
| Rate for Payer: BCBS MAPPO |
$826.88
|
| Rate for Payer: BCN Medicare Advantage |
$826.88
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cofinity Commercial |
$1,190.71
|
| Rate for Payer: Cofinity Commercial |
$1,108.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$826.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$868.22
|
| Rate for Payer: Nomi Health Commercial |
$992.26
|
| Rate for Payer: PACE SWMI |
$826.88
|
| Rate for Payer: PHP Commercial |
$1,157.63
|
| Rate for Payer: PHP Medicare Advantage |
$826.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,772.55
|
| Rate for Payer: Priority Health Medicare |
$826.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$826.88
|
| Rate for Payer: UHC Medicare Advantage |
$826.88
|
| Rate for Payer: UMR Bronson Commercial |
$1,254.42
|
|
|
PR SARSCOV2 VACC 10MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 91319
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$142.35 |
| Rate for Payer: Aetna Commercial |
$127.03
|
| Rate for Payer: Aetna Medicare |
$98.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.03
|
| Rate for Payer: BCBS Complete |
$87.60
|
| Rate for Payer: BCBS MAPPO |
$94.80
|
| Rate for Payer: BCN Medicare Advantage |
$94.80
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$136.51
|
| Rate for Payer: Cofinity Commercial |
$127.03
|
| 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: Nomi Health Commercial |
$113.76
|
| 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 Cigna Priority Health |
$142.35
|
| Rate for Payer: Priority Health Medicare |
$94.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.80
|
| Rate for Payer: UHC Medicare Advantage |
$94.80
|
| Rate for Payer: UMR Bronson Commercial |
$100.74
|
|
|
PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 91320
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$242.45 |
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$175.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.62
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS MAPPO |
$168.37
|
| Rate for Payer: BCN Medicare Advantage |
$168.37
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| 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: Nomi Health Commercial |
$202.04
|
| 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 Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health Medicare |
$168.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.37
|
| Rate for Payer: UHC Medicare Advantage |
$168.37
|
| Rate for Payer: UMR Bronson Commercial |
$150.42
|
|
|
PR SARSCOV2 VACC 3MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 91318
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Medicare |
$82.00
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: UMR Bronson Commercial |
$75.44
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 99233
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$161.40 |
| Rate for Payer: Aetna Commercial |
$150.19
|
| Rate for Payer: Aetna Medicare |
$116.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.40
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$112.08
|
| Rate for Payer: BCN Medicare Advantage |
$112.08
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$150.19
|
| Rate for Payer: Cofinity Commercial |
$161.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.68
|
| Rate for Payer: Nomi Health Commercial |
$134.50
|
| Rate for Payer: PACE SWMI |
$112.08
|
| Rate for Payer: PHP Commercial |
$156.91
|
| Rate for Payer: PHP Medicare Advantage |
$112.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$112.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.08
|
| Rate for Payer: UHC Medicare Advantage |
$112.08
|
| Rate for Payer: UMR Bronson Commercial |
$84.64
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$108.32 |
| Rate for Payer: Aetna Commercial |
$100.79
|
| Rate for Payer: Aetna Medicare |
$78.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.79
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$75.22
|
| Rate for Payer: BCN Medicare Advantage |
$75.22
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$108.32
|
| Rate for Payer: Cofinity Commercial |
$100.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.98
|
| Rate for Payer: Nomi Health Commercial |
$90.26
|
| Rate for Payer: PACE SWMI |
$75.22
|
| Rate for Payer: PHP Commercial |
$105.31
|
| Rate for Payer: PHP Medicare Advantage |
$75.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health Medicare |
$75.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.22
|
| Rate for Payer: UHC Medicare Advantage |
$75.22
|
| Rate for Payer: UMR Bronson Commercial |
$59.34
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$67.08 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$48.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.42
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS MAPPO |
$46.58
|
| Rate for Payer: BCN Medicare Advantage |
$46.58
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.91
|
| Rate for Payer: Nomi Health Commercial |
$55.90
|
| Rate for Payer: PACE SWMI |
$46.58
|
| Rate for Payer: PHP Commercial |
$65.21
|
| Rate for Payer: PHP Medicare Advantage |
$46.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health Medicare |
$46.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.58
|
| Rate for Payer: UHC Medicare Advantage |
$46.58
|
| Rate for Payer: UMR Bronson Commercial |
$35.88
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$208.81 |
| Rate for Payer: Aetna Commercial |
$194.31
|
| Rate for Payer: Aetna Medicare |
$150.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.31
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: BCBS MAPPO |
$145.01
|
| Rate for Payer: BCN Medicare Advantage |
$145.01
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$208.81
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.26
|
| Rate for Payer: Nomi Health Commercial |
$174.01
|
| Rate for Payer: PACE SWMI |
$145.01
|
| Rate for Payer: PHP Commercial |
$203.01
|
| Rate for Payer: PHP Medicare Advantage |
$145.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health Medicare |
$145.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.01
|
| Rate for Payer: UHC Medicare Advantage |
$145.01
|
| Rate for Payer: UMR Bronson Commercial |
$93.84
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$100.57 |
| Rate for Payer: Aetna Commercial |
$93.59
|
| Rate for Payer: Aetna Medicare |
$72.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.57
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$69.84
|
| Rate for Payer: BCN Medicare Advantage |
$69.84
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$93.59
|
| Rate for Payer: Cofinity Commercial |
$100.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.33
|
| Rate for Payer: Nomi Health Commercial |
$83.81
|
| Rate for Payer: PACE SWMI |
$69.84
|
| Rate for Payer: PHP Commercial |
$97.78
|
| Rate for Payer: PHP Medicare Advantage |
$69.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$69.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.84
|
| Rate for Payer: UHC Medicare Advantage |
$69.84
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$146.17 |
| Rate for Payer: Aetna Commercial |
$136.02
|
| Rate for Payer: Aetna Medicare |
$105.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.02
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$101.51
|
| Rate for Payer: BCN Medicare Advantage |
$101.51
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$146.17
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.59
|
| Rate for Payer: Nomi Health Commercial |
$121.81
|
| Rate for Payer: PACE SWMI |
$101.51
|
| Rate for Payer: PHP Commercial |
$142.11
|
| Rate for Payer: PHP Medicare Advantage |
$101.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health Medicare |
$101.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.51
|
| Rate for Payer: UHC Medicare Advantage |
$101.51
|
| Rate for Payer: UMR Bronson Commercial |
$63.02
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 99307
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$50.14
|
| Rate for Payer: Aetna Medicare |
$38.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.14
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS MAPPO |
$37.42
|
| Rate for Payer: BCN Medicare Advantage |
$37.42
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$53.88
|
| Rate for Payer: Cofinity Commercial |
$50.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.29
|
| Rate for Payer: Nomi Health Commercial |
$44.90
|
| Rate for Payer: PACE SWMI |
$37.42
|
| Rate for Payer: PHP Commercial |
$52.39
|
| Rate for Payer: PHP Medicare Advantage |
$37.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health Medicare |
$37.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.42
|
| Rate for Payer: UHC Medicare Advantage |
$37.42
|
| Rate for Payer: UMR Bronson Commercial |
$30.82
|
|
|
PR SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 99224
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
|
|
PR SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99225
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
| Rate for Payer: UMR Bronson Commercial |
$69.00
|
|
|
PR SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 99226
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: UMR Bronson Commercial |
$103.04
|
|
|
PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 99493
|
| Min. Negotiated Rate |
$97.34 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$130.44
|
| Rate for Payer: Aetna Medicare |
$101.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$100.80
|
| Rate for Payer: BCBS MAPPO |
$97.34
|
| Rate for Payer: BCN Medicare Advantage |
$97.34
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$130.44
|
| Rate for Payer: Cofinity Commercial |
$140.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.21
|
| Rate for Payer: Nomi Health Commercial |
$116.81
|
| Rate for Payer: PACE SWMI |
$97.34
|
| Rate for Payer: PHP Commercial |
$136.28
|
| Rate for Payer: PHP Medicare Advantage |
$97.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health Medicare |
$97.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.34
|
| Rate for Payer: UHC Medicare Advantage |
$97.34
|
| Rate for Payer: UMR Bronson Commercial |
$115.92
|
|
|
PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 49185
|
| Min. Negotiated Rate |
$113.45 |
| Max. Negotiated Rate |
$1,473.55 |
| Rate for Payer: Aetna Commercial |
$152.02
|
| Rate for Payer: Aetna Medicare |
$117.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.02
|
| Rate for Payer: BCBS Complete |
$906.80
|
| Rate for Payer: BCBS MAPPO |
$113.45
|
| Rate for Payer: BCN Medicare Advantage |
$113.45
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cofinity Commercial |
$163.37
|
| Rate for Payer: Cofinity Commercial |
$152.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.12
|
| Rate for Payer: Nomi Health Commercial |
$136.14
|
| Rate for Payer: PACE SWMI |
$113.45
|
| Rate for Payer: PHP Commercial |
$158.83
|
| Rate for Payer: PHP Medicare Advantage |
$113.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.55
|
| Rate for Payer: Priority Health Medicare |
$113.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.45
|
| Rate for Payer: UHC Medicare Advantage |
$113.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,042.82
|
|
|
PR SCREENING PAP SMEAR BY PHYS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS P3001
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$23.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.73
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS MAPPO |
$22.93
|
| Rate for Payer: BCN Medicare Advantage |
$22.93
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Cofinity Commercial |
$30.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.08
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: PACE SWMI |
$22.93
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: PHP Medicare Advantage |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Medicare |
$22.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.93
|
| Rate for Payer: UHC Medicare Advantage |
$22.93
|
| Rate for Payer: UMR Bronson Commercial |
$29.44
|
|
