|
PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 33226
|
| Min. Negotiated Rate |
$306.72 |
| Max. Negotiated Rate |
$1,099.92 |
| Rate for Payer: Aetna Commercial |
$624.57
|
| Rate for Payer: Aetna Medicare |
$484.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$671.18
|
| Rate for Payer: BCBS Complete |
$322.06
|
| Rate for Payer: BCBS MAPPO |
$466.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.92
|
| Rate for Payer: BCN Commercial |
$702.72
|
| 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 |
$624.57
|
| Rate for Payer: Cofinity Commercial |
$671.18
|
| 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: Meridian Medicaid |
$322.06
|
| 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 Choice Medicaid |
$306.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$763.18
|
| Rate for Payer: Priority Health Medicare |
$466.10
|
| Rate for Payer: Priority Health Narrow Network |
$763.18
|
| Rate for Payer: Priority Health SBD |
$763.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.10
|
| Rate for Payer: UHC Medicare Advantage |
$466.10
|
| Rate for Payer: UHCCP Medicaid |
$306.72
|
| 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 |
$196.17 |
| Max. Negotiated Rate |
$1,453.88 |
| Rate for Payer: Aetna Commercial |
$395.37
|
| Rate for Payer: Aetna Medicare |
$306.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.87
|
| Rate for Payer: BCBS Complete |
$205.98
|
| Rate for Payer: BCBS MAPPO |
$295.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,453.88
|
| Rate for Payer: BCN Commercial |
$448.61
|
| 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 |
$395.37
|
| Rate for Payer: Cofinity Commercial |
$424.87
|
| 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: Meridian Medicaid |
$205.98
|
| 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 Choice Medicaid |
$196.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$668.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$487.69
|
| Rate for Payer: Priority Health Medicare |
$295.05
|
| Rate for Payer: Priority Health Narrow Network |
$487.69
|
| Rate for Payer: Priority Health SBD |
$487.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.05
|
| Rate for Payer: UHC Medicare Advantage |
$295.05
|
| Rate for Payer: UHCCP Medicaid |
$196.17
|
| 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 |
$37.91 |
| Max. Negotiated Rate |
$578.49 |
| Rate for Payer: Aetna Commercial |
$76.77
|
| Rate for Payer: Aetna Medicare |
$59.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.50
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCBS MAPPO |
$57.29
|
| Rate for Payer: BCBS Trust/PPO |
$578.49
|
| Rate for Payer: BCN Commercial |
$163.71
|
| 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: Meridian Medicaid |
$39.81
|
| 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 Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.61
|
| Rate for Payer: Priority Health Medicare |
$57.29
|
| Rate for Payer: Priority Health Narrow Network |
$93.61
|
| Rate for Payer: Priority Health SBD |
$93.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.29
|
| Rate for Payer: UHC Medicare Advantage |
$57.29
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
| 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 |
$504.90 |
| Max. Negotiated Rate |
$846.95 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Medicare |
$651.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.90
|
| Rate for Payer: BCBS Complete |
$521.20
|
| Rate for Payer: BCBS Trust/PPO |
$504.90
|
| Rate for Payer: Cash Price |
$1,042.40
|
| 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 |
$504.90 |
| Max. Negotiated Rate |
$846.95 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Medicare |
$651.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.90
|
| Rate for Payer: BCBS Complete |
$521.20
|
| Rate for Payer: BCBS Trust/PPO |
$504.90
|
| Rate for Payer: Cash Price |
$1,042.40
|
| 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 |
$300.90 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna Commercial |
$300.90
|
| Rate for Payer: Aetna Medicare |
$420.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.90
|
| Rate for Payer: BCBS Complete |
$336.00
|
| Rate for Payer: BCBS Trust/PPO |
$347.00
|
| Rate for Payer: Cash Price |
$672.00
|
| 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 |
$285.60 |
| Max. Negotiated Rate |
$518.05 |
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: Aetna Medicare |
$398.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.60
|
| Rate for Payer: BCBS Complete |
$318.80
|
| Rate for Payer: BCBS Trust/PPO |
$285.60
|
| Rate for Payer: Cash Price |
$637.60
|
| 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 |
$215.98 |
| Max. Negotiated Rate |
$2,206.87 |
| Rate for Payer: BCBS Complete |
$226.78
|
| 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 MAPPO |
$327.97
|
| Rate for Payer: BCBS Trust/PPO |
$524.07
|
| Rate for Payer: BCN Commercial |
$2,206.87
|
| 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 |
$472.28
|
| Rate for Payer: Cofinity Commercial |
$439.48
|
| 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: Meridian Medicaid |
$226.78
|
| 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 Choice Medicaid |
$215.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,914.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.61
|
| Rate for Payer: Priority Health Medicare |
$327.97
|
| Rate for Payer: Priority Health Narrow Network |
$536.61
|
| Rate for Payer: Priority Health SBD |
$536.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.97
|
| Rate for Payer: UHC Medicare Advantage |
$327.97
|
| Rate for Payer: UHCCP Medicaid |
$215.98
|
| 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 |
$137.29 |
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Medicare |
$79.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.29
|
| Rate for Payer: BCBS Complete |
$63.60
|
| Rate for Payer: BCBS Trust/PPO |
$129.14
|
| Rate for Payer: BCN Commercial |
$129.14
|
| Rate for Payer: Cash Price |
$127.20
|
| 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
|
|
|
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 |
$97.75 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna Medicare |
$48.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.75
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: BCBS Trust/PPO |
$91.96
|
| Rate for Payer: BCN Commercial |
$91.96
|
| Rate for Payer: Cash Price |
$76.80
|
| 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 |
$684.68 |
| Max. Negotiated Rate |
$2,397.99 |
| Rate for Payer: Aetna Commercial |
$1,963.48
|
| Rate for Payer: Aetna Medicare |
$1,523.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,963.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,110.00
|
| Rate for Payer: BCBS Complete |
$1,012.24
|
| Rate for Payer: BCBS MAPPO |
$1,465.28
|
| Rate for Payer: BCBS Trust/PPO |
$684.68
|
| Rate for Payer: BCN Commercial |
$2,191.23
|
| 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 |
$1,963.48
|
| Rate for Payer: Cofinity Commercial |
$2,110.00
|
| 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: Meridian Medicaid |
$1,012.24
|
| 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 Choice Medicaid |
$964.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,042.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,397.99
|
| Rate for Payer: Priority Health Medicare |
$1,465.28
|
| Rate for Payer: Priority Health Narrow Network |
$2,397.99
|
| Rate for Payer: Priority Health SBD |
$2,397.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,465.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,465.28
|
| Rate for Payer: UHCCP Medicaid |
$964.04
|
| 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 |
$36.00 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.40
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$145.62
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.18
|
| Rate for Payer: Priority Health Narrow Network |
$70.18
|
| Rate for Payer: Priority Health SBD |
$70.18
|
| Rate for Payer: UHCCP Medicaid |
$36.00
|
| 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 |
$37.80 |
| Max. Negotiated Rate |
$686.79 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Medicare |
$68.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.80
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS Trust/PPO |
$686.79
|
| Rate for Payer: BCN Commercial |
$126.57
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.53
|
| Rate for Payer: Priority Health Narrow Network |
$41.53
|
| Rate for Payer: Priority Health SBD |
$41.53
|
| 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 |
$22.50 |
| Max. Negotiated Rate |
$902.34 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.67
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS Trust/PPO |
$902.34
|
| Rate for Payer: BCN Commercial |
$22.50
|
| Rate for Payer: Cash Price |
$130.40
|
| 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 |
$138.94 |
| Max. Negotiated Rate |
$1,199.44 |
| 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 |
$541.45
|
| Rate for Payer: BCBS MAPPO |
$771.03
|
| Rate for Payer: BCBS Trust/PPO |
$138.94
|
| Rate for Payer: BCN Commercial |
$1,174.29
|
| 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 |
$1,033.18
|
| Rate for Payer: Cofinity Commercial |
$1,110.28
|
| 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: Meridian Medicaid |
$541.45
|
| 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 Choice Medicaid |
$515.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,199.44
|
| Rate for Payer: Priority Health Medicare |
$771.03
|
| Rate for Payer: Priority Health Narrow Network |
$1,199.44
|
| Rate for Payer: Priority Health SBD |
$1,199.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$771.03
|
| Rate for Payer: UHC Medicare Advantage |
$771.03
|
| Rate for Payer: UHCCP Medicaid |
$515.67
|
| 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 |
$429.51 |
| 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) |
$1,050.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$977.72
|
| Rate for Payer: BCBS Complete |
$513.50
|
| Rate for Payer: BCBS MAPPO |
$729.64
|
| Rate for Payer: BCBS Trust/PPO |
$429.51
|
| Rate for Payer: BCN Commercial |
$1,111.74
|
| 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 |
$1,050.68
|
| Rate for Payer: Cofinity Commercial |
$977.72
|
| 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: Meridian Medicaid |
$513.50
|
| 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 Choice Medicaid |
$489.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,138.92
|
| Rate for Payer: Priority Health Medicare |
$729.64
|
| Rate for Payer: Priority Health Narrow Network |
$1,138.92
|
| Rate for Payer: Priority Health SBD |
$1,138.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$729.64
|
| Rate for Payer: UHC Medicare Advantage |
$729.64
|
| Rate for Payer: UHCCP Medicaid |
$489.05
|
| Rate for Payer: UMR Bronson Commercial |
$938.86
|
|
|
PR SALPINGOSTOMY
|
Professional
|
Both
|
$2,727.00
|
|
|
Service Code
|
HCPCS 58770
|
| Min. Negotiated Rate |
$209.21 |
| 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) |
$1,108.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,190.71
|
| Rate for Payer: BCBS Complete |
$579.47
|
| Rate for Payer: BCBS MAPPO |
$826.88
|
| Rate for Payer: BCBS Trust/PPO |
$209.21
|
| Rate for Payer: BCN Commercial |
$1,266.17
|
| 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 |
$1,108.02
|
| Rate for Payer: Cofinity Commercial |
$1,190.71
|
| 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: Meridian Medicaid |
$579.47
|
| 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 Choice Medicaid |
$551.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,772.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,288.73
|
| Rate for Payer: Priority Health Medicare |
$826.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,288.73
|
| Rate for Payer: Priority Health SBD |
$1,288.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$826.88
|
| Rate for Payer: UHC Medicare Advantage |
$826.88
|
| Rate for Payer: UHCCP Medicaid |
$551.88
|
| 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 |
$78.54 |
| Max. Negotiated Rate |
$142.35 |
| Rate for Payer: Aetna Commercial |
$117.63
|
| Rate for Payer: Aetna Medicare |
$91.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.63
|
| Rate for Payer: BCBS Complete |
$87.60
|
| Rate for Payer: BCBS MAPPO |
$87.78
|
| Rate for Payer: BCBS Trust/PPO |
$78.54
|
| Rate for Payer: BCN Medicare Advantage |
$87.78
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$117.63
|
| Rate for Payer: Cofinity Commercial |
$126.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.17
|
| Rate for Payer: Nomi Health Commercial |
$105.34
|
| Rate for Payer: PACE SWMI |
$87.78
|
| Rate for Payer: PHP Commercial |
$122.89
|
| Rate for Payer: PHP Medicare Advantage |
$87.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.35
|
| Rate for Payer: Priority Health Medicare |
$87.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.78
|
| Rate for Payer: UHC Medicare Advantage |
$87.78
|
| 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 |
$125.00 |
| Max. Negotiated Rate |
$224.49 |
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna Medicare |
$162.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.49
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS MAPPO |
$155.90
|
| Rate for Payer: BCBS Trust/PPO |
$125.00
|
| Rate for Payer: BCN Medicare Advantage |
$155.90
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$224.49
|
| Rate for Payer: Cofinity Commercial |
$208.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.69
|
| Rate for Payer: Nomi Health Commercial |
$187.07
|
| Rate for Payer: PACE SWMI |
$155.90
|
| Rate for Payer: PHP Commercial |
$218.25
|
| Rate for Payer: PHP Medicare Advantage |
$155.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health Medicare |
$155.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.90
|
| Rate for Payer: UHC Medicare Advantage |
$155.90
|
| 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 |
$58.65 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Commercial |
$87.84
|
| Rate for Payer: Aetna Medicare |
$68.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.39
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS MAPPO |
$65.55
|
| Rate for Payer: BCBS Trust/PPO |
$58.65
|
| Rate for Payer: BCN Medicare Advantage |
$65.55
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Cofinity Commercial |
$87.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.83
|
| Rate for Payer: Nomi Health Commercial |
$78.66
|
| Rate for Payer: PACE SWMI |
$65.55
|
| Rate for Payer: PHP Commercial |
$91.77
|
| Rate for Payer: PHP Medicare Advantage |
$65.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health Medicare |
$65.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.55
|
| Rate for Payer: UHC Medicare Advantage |
$65.55
|
| 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 |
$74.98 |
| Max. Negotiated Rate |
$1,858.56 |
| Rate for Payer: Aetna Commercial |
$150.19
|
| Rate for Payer: Aetna Medicare |
$116.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.19
|
| Rate for Payer: BCBS Complete |
$78.73
|
| Rate for Payer: BCBS MAPPO |
$112.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,858.56
|
| Rate for Payer: BCN Commercial |
$126.11
|
| 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: Meridian Medicaid |
$78.73
|
| 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 Choice Medicaid |
$74.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.94
|
| Rate for Payer: Priority Health Medicare |
$112.08
|
| Rate for Payer: Priority Health Narrow Network |
$157.94
|
| Rate for Payer: Priority Health SBD |
$157.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.08
|
| Rate for Payer: UHC Medicare Advantage |
$112.08
|
| Rate for Payer: UHCCP Medicaid |
$74.98
|
| 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 |
$50.27 |
| Max. Negotiated Rate |
$2,072.52 |
| Rate for Payer: Aetna Commercial |
$100.79
|
| Rate for Payer: Aetna Medicare |
$78.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.32
|
| Rate for Payer: BCBS Complete |
$52.78
|
| Rate for Payer: BCBS MAPPO |
$75.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,072.52
|
| Rate for Payer: BCN Commercial |
$83.83
|
| 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 |
$100.79
|
| Rate for Payer: Cofinity Commercial |
$108.32
|
| 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: Meridian Medicaid |
$52.78
|
| 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 Choice Medicaid |
$50.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.00
|
| Rate for Payer: Priority Health Medicare |
$75.22
|
| Rate for Payer: Priority Health Narrow Network |
$105.00
|
| Rate for Payer: Priority Health SBD |
$105.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.22
|
| Rate for Payer: UHC Medicare Advantage |
$75.22
|
| Rate for Payer: UHCCP Medicaid |
$50.27
|
| 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 |
$31.10 |
| Max. Negotiated Rate |
$1,703.77 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$48.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.08
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$46.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.77
|
| Rate for Payer: BCN Commercial |
$52.66
|
| 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 |
$62.42
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| 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: Meridian Medicaid |
$32.66
|
| 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 Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.96
|
| Rate for Payer: Priority Health Medicare |
$46.58
|
| Rate for Payer: Priority Health Narrow Network |
$65.96
|
| Rate for Payer: Priority Health SBD |
$65.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.58
|
| Rate for Payer: UHC Medicare Advantage |
$46.58
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
| Rate for Payer: UMR Bronson Commercial |
$35.88
|
|
