|
PR WORK HARDENING/CONDITIONING EACH HOUR
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 97546
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$94.44 |
| Rate for Payer: Aetna Commercial |
$47.77
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.77
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCN Commercial |
$94.44
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89.48
|
| Rate for Payer: Priority Health SBD |
$89.48
|
| Rate for Payer: Priority Health Tiered Network |
$89.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.83
|
| Rate for Payer: UHC Core |
$56.83
|
| Rate for Payer: UHC Exchange |
$56.83
|
| Rate for Payer: UMR Bronson Commercial |
$46.92
|
|
|
PR WORK RELATED/MED DBLT XM TREATING PHYS
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 99455
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Aetna Commercial |
$84.95
|
| Rate for Payer: Aetna Medicare |
$57.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.95
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.25
|
| Rate for Payer: UMR Bronson Commercial |
$52.90
|
|
|
PR WOUND CLOSURE BY ADHESIVE
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS G0168
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$19.00
|
| Rate for Payer: Aetna Medicare |
$14.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.42
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$14.18
|
| Rate for Payer: BCN Commercial |
$21.41
|
| Rate for Payer: BCN Medicare Advantage |
$14.18
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$19.00
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.89
|
| Rate for Payer: Meridian Medicaid |
$9.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$15.60
|
| Rate for Payer: Nomi Health Commercial |
$17.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PACE SWMI |
$14.18
|
| Rate for Payer: PHP Commercial |
$19.85
|
| Rate for Payer: PHP Medicare Advantage |
$14.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19.60
|
| Rate for Payer: Priority Health Medicare |
$14.18
|
| Rate for Payer: Priority Health SBD |
$19.60
|
| Rate for Payer: Priority Health Tiered Network |
$19.60
|
| Rate for Payer: Railroad Medicare Medicare |
$14.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.99
|
| Rate for Payer: UHC Core |
$32.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14.18
|
| Rate for Payer: UHC Exchange |
$32.99
|
| Rate for Payer: UHC Medicaid |
$8.95
|
| Rate for Payer: UHCCP Medicaid |
$8.95
|
| Rate for Payer: UMR Bronson Commercial |
$95.68
|
|
|
PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
HCPCS 66984
|
| Min. Negotiated Rate |
$295.01 |
| Max. Negotiated Rate |
$948.75 |
| Rate for Payer: Aetna Commercial |
$599.10
|
| Rate for Payer: Aetna Medicare |
$464.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.81
|
| Rate for Payer: BCBS Complete |
$309.76
|
| Rate for Payer: BCBS MAPPO |
$447.09
|
| Rate for Payer: BCN Commercial |
$803.24
|
| Rate for Payer: BCN Medicare Advantage |
$447.09
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cash Price |
$1,012.00
|
| Rate for Payer: Cofinity Commercial |
$599.10
|
| Rate for Payer: Cofinity Commercial |
$643.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.44
|
| Rate for Payer: Meridian Medicaid |
$309.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$491.80
|
| Rate for Payer: Nomi Health Commercial |
$536.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$948.75
|
| Rate for Payer: PACE SWMI |
$447.09
|
| Rate for Payer: PHP Commercial |
$625.93
|
| Rate for Payer: PHP Medicare Advantage |
$447.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$295.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$940.87
|
| Rate for Payer: Priority Health Medicare |
$447.09
|
| Rate for Payer: Priority Health SBD |
$940.87
|
| Rate for Payer: Priority Health Tiered Network |
$940.87
|
| Rate for Payer: Railroad Medicare Medicare |
$447.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$929.75
|
| Rate for Payer: UHC Core |
$929.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.09
|
| Rate for Payer: UHC Exchange |
$929.75
|
| Rate for Payer: UHC Medicaid |
$295.01
|
| Rate for Payer: UHCCP Medicaid |
$295.01
|
| Rate for Payer: UMR Bronson Commercial |
$581.90
|
|
|
PR XEOMIN
|
Professional
|
Both
|
$10.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 94617
|
| Min. Negotiated Rate |
$87.35 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Aetna Commercial |
$117.05
|
| Rate for Payer: Aetna Commercial |
$117.05
|
| Rate for Payer: Aetna Medicare |
$90.84
|
| Rate for Payer: Aetna Medicare |
$90.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.78
|
| Rate for Payer: BCBS MAPPO |
$87.35
|
| Rate for Payer: BCBS MAPPO |
$87.35
|
| Rate for Payer: BCN Commercial |
$133.46
|
| Rate for Payer: BCN Commercial |
$133.46
|
| Rate for Payer: BCN Medicare Advantage |
$87.35
|
| Rate for Payer: BCN Medicare Advantage |
$87.35
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$125.78
|
| Rate for Payer: Cofinity Commercial |
$125.78
|
| Rate for Payer: Cofinity Commercial |
$117.05
|
| Rate for Payer: Cofinity Commercial |
$117.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.08
|
| Rate for Payer: Nomi Health Commercial |
$104.82
|
| Rate for Payer: Nomi Health Commercial |
$104.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$61.50
|
| Rate for Payer: PACE SWMI |
$87.35
|
| Rate for Payer: PACE SWMI |
$87.35
|
| Rate for Payer: PHP Commercial |
$122.29
|
| Rate for Payer: PHP Commercial |
$122.29
|
| Rate for Payer: PHP Medicare Advantage |
$87.35
|
| Rate for Payer: PHP Medicare Advantage |
$87.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$123.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$123.08
|
| Rate for Payer: Priority Health Medicare |
$87.35
|
| Rate for Payer: Priority Health Medicare |
$87.35
|
| Rate for Payer: Priority Health SBD |
$123.08
|
| Rate for Payer: Priority Health SBD |
$123.08
|
| Rate for Payer: Priority Health Tiered Network |
$123.08
|
| Rate for Payer: Priority Health Tiered Network |
$123.08
|
| Rate for Payer: Railroad Medicare Medicare |
$87.35
|
| Rate for Payer: Railroad Medicare Medicare |
$87.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.88
|
| Rate for Payer: UHC Core |
$140.88
|
| Rate for Payer: UHC Core |
$140.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$87.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$87.35
|
| Rate for Payer: UHC Exchange |
$140.88
|
| Rate for Payer: UHC Exchange |
$140.88
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
| Rate for Payer: UMR Bronson Commercial |
$96.14
|
|
|
PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 94619
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$83.88
|
| Rate for Payer: Aetna Medicare |
$65.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.14
|
| Rate for Payer: BCBS MAPPO |
$62.60
|
| Rate for Payer: BCN Commercial |
$97.60
|
| Rate for Payer: BCN Medicare Advantage |
$62.60
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$83.88
|
| Rate for Payer: Cofinity Commercial |
$90.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.86
|
| Rate for Payer: Nomi Health Commercial |
$75.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
| Rate for Payer: PACE SWMI |
$62.60
|
| Rate for Payer: PHP Commercial |
$87.64
|
| Rate for Payer: PHP Medicare Advantage |
$62.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$90.01
|
| Rate for Payer: Priority Health Medicare |
$62.60
|
| Rate for Payer: Priority Health SBD |
$90.01
|
| Rate for Payer: Priority Health Tiered Network |
$90.01
|
| Rate for Payer: Railroad Medicare Medicare |
$62.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.45
|
| Rate for Payer: UHC Core |
$117.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.60
|
| Rate for Payer: UHC Exchange |
$117.45
|
| Rate for Payer: UMR Bronson Commercial |
$75.90
|
|
|
PR XTRNL ECG REC>48HR<7D RECORDING SCAN A/R R&I
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS 93241
|
| Min. Negotiated Rate |
$121.30 |
| Max. Negotiated Rate |
$380.06 |
| Rate for Payer: Aetna Commercial |
$343.91
|
| Rate for Payer: Aetna Medicare |
$266.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$369.58
|
| Rate for Payer: BCBS MAPPO |
$256.65
|
| Rate for Payer: BCN Commercial |
$315.34
|
| Rate for Payer: BCN Medicare Advantage |
$256.65
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cofinity Commercial |
$369.58
|
| Rate for Payer: Cofinity Commercial |
$343.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$282.31
|
| Rate for Payer: Nomi Health Commercial |
$307.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.75
|
| Rate for Payer: PACE SWMI |
$256.65
|
| Rate for Payer: PHP Commercial |
$359.31
|
| Rate for Payer: PHP Medicare Advantage |
$256.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$380.06
|
| Rate for Payer: Priority Health Medicare |
$256.65
|
| Rate for Payer: Priority Health SBD |
$380.06
|
| Rate for Payer: Priority Health Tiered Network |
$380.06
|
| Rate for Payer: Railroad Medicare Medicare |
$256.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.30
|
| Rate for Payer: UHC Core |
$121.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$256.65
|
| Rate for Payer: UHC Exchange |
$121.30
|
| Rate for Payer: UMR Bronson Commercial |
$147.66
|
|
|
PR XTRNL ECG REC<48 HRS RECORDING
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 93225
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: Aetna Medicare |
$17.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.82
|
| Rate for Payer: BCBS MAPPO |
$16.54
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: BCN Medicare Advantage |
$16.54
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$22.16
|
| Rate for Payer: Cofinity Commercial |
$23.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.19
|
| Rate for Payer: Nomi Health Commercial |
$19.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.00
|
| Rate for Payer: PACE SWMI |
$16.54
|
| Rate for Payer: PHP Commercial |
$23.16
|
| Rate for Payer: PHP Medicare Advantage |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.56
|
| Rate for Payer: Priority Health Medicare |
$16.54
|
| Rate for Payer: Priority Health SBD |
$25.56
|
| Rate for Payer: Priority Health Tiered Network |
$25.56
|
| Rate for Payer: Railroad Medicare Medicare |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.33
|
| Rate for Payer: UHC Core |
$38.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$16.54
|
| Rate for Payer: UHC Exchange |
$38.33
|
| Rate for Payer: UMR Bronson Commercial |
$57.04
|
|
|
PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 93224
|
| Min. Negotiated Rate |
$65.67 |
| Max. Negotiated Rate |
$181.50 |
| Rate for Payer: Aetna Commercial |
$88.00
|
| Rate for Payer: Aetna Medicare |
$68.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.56
|
| Rate for Payer: BCBS MAPPO |
$65.67
|
| Rate for Payer: BCN Commercial |
$105.08
|
| Rate for Payer: BCN Medicare Advantage |
$65.67
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$94.56
|
| Rate for Payer: Cofinity Commercial |
$88.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.24
|
| Rate for Payer: Nomi Health Commercial |
$78.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.50
|
| Rate for Payer: PACE SWMI |
$65.67
|
| Rate for Payer: PHP Commercial |
$91.94
|
| Rate for Payer: PHP Medicare Advantage |
$65.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$99.87
|
| Rate for Payer: Priority Health Medicare |
$65.67
|
| Rate for Payer: Priority Health SBD |
$99.87
|
| Rate for Payer: Priority Health Tiered Network |
$99.87
|
| Rate for Payer: Railroad Medicare Medicare |
$65.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.14
|
| Rate for Payer: UHC Core |
$135.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65.67
|
| Rate for Payer: UHC Exchange |
$135.14
|
| Rate for Payer: UMR Bronson Commercial |
$111.32
|
|
|
PR XTRNL ECG REC<48 HRS RVW&INTERPJ PHYS/QHP
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 93227
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$154.50 |
| Rate for Payer: Aetna Commercial |
$23.24
|
| Rate for Payer: Aetna Medicare |
$18.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.97
|
| Rate for Payer: BCBS Complete |
$11.85
|
| Rate for Payer: BCBS MAPPO |
$17.34
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: BCN Medicare Advantage |
$17.34
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$24.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.21
|
| Rate for Payer: Meridian Medicaid |
$11.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.07
|
| Rate for Payer: Nomi Health Commercial |
$20.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$154.50
|
| Rate for Payer: PACE SWMI |
$17.34
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Medicare Advantage |
$17.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.56
|
| Rate for Payer: Priority Health Medicare |
$17.34
|
| Rate for Payer: Priority Health SBD |
$25.56
|
| Rate for Payer: Priority Health Tiered Network |
$25.56
|
| Rate for Payer: Railroad Medicare Medicare |
$17.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.54
|
| Rate for Payer: UHC Core |
$42.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.34
|
| Rate for Payer: UHC Exchange |
$42.54
|
| Rate for Payer: UHC Medicaid |
$11.29
|
| Rate for Payer: UHCCP Medicaid |
$11.29
|
| Rate for Payer: UMR Bronson Commercial |
$94.76
|
|
|
PR XTRNL ECG REC<48 HRS SCANNING A/R
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 93226
|
| Min. Negotiated Rate |
$31.79 |
| Max. Negotiated Rate |
$55.50 |
| Rate for Payer: Aetna Commercial |
$42.60
|
| Rate for Payer: Aetna Medicare |
$33.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.78
|
| Rate for Payer: BCBS MAPPO |
$31.79
|
| Rate for Payer: BCN Commercial |
$51.29
|
| Rate for Payer: BCN Medicare Advantage |
$31.79
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$42.60
|
| Rate for Payer: Cofinity Commercial |
$45.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$34.97
|
| Rate for Payer: Nomi Health Commercial |
$38.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.50
|
| Rate for Payer: PACE SWMI |
$31.79
|
| Rate for Payer: PHP Commercial |
$44.51
|
| Rate for Payer: PHP Medicare Advantage |
$31.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$48.76
|
| Rate for Payer: Priority Health Medicare |
$31.79
|
| Rate for Payer: Priority Health SBD |
$48.76
|
| Rate for Payer: Priority Health Tiered Network |
$48.76
|
| Rate for Payer: Railroad Medicare Medicare |
$31.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.27
|
| Rate for Payer: UHC Core |
$54.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31.79
|
| Rate for Payer: UHC Exchange |
$54.27
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 93228
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Medicare |
$25.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.21
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$24.45
|
| Rate for Payer: BCN Commercial |
$37.35
|
| Rate for Payer: BCN Medicare Advantage |
$24.45
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$35.21
|
| Rate for Payer: Cofinity Commercial |
$32.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.67
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.89
|
| Rate for Payer: Nomi Health Commercial |
$29.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: PACE SWMI |
$24.45
|
| Rate for Payer: PHP Commercial |
$34.23
|
| Rate for Payer: PHP Medicare Advantage |
$24.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$35.50
|
| Rate for Payer: Priority Health Medicare |
$24.45
|
| Rate for Payer: Priority Health SBD |
$35.50
|
| Rate for Payer: Priority Health Tiered Network |
$35.50
|
| Rate for Payer: Railroad Medicare Medicare |
$24.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.21
|
| Rate for Payer: UHC Core |
$43.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.45
|
| Rate for Payer: UHC Exchange |
$43.21
|
| Rate for Payer: UHC Medicaid |
$15.98
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
| Rate for Payer: UMR Bronson Commercial |
$27.60
|
|
|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 93271
|
| Min. Negotiated Rate |
$125.71 |
| Max. Negotiated Rate |
$505.50 |
| Rate for Payer: Aetna Commercial |
$168.45
|
| Rate for Payer: Aetna Medicare |
$130.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.02
|
| Rate for Payer: BCBS MAPPO |
$125.71
|
| Rate for Payer: BCN Commercial |
$204.18
|
| Rate for Payer: BCN Medicare Advantage |
$125.71
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Cofinity Commercial |
$168.45
|
| Rate for Payer: Cofinity Commercial |
$181.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$138.28
|
| Rate for Payer: Nomi Health Commercial |
$150.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$505.50
|
| Rate for Payer: PACE SWMI |
$125.71
|
| Rate for Payer: PHP Commercial |
$175.99
|
| Rate for Payer: PHP Medicare Advantage |
$125.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$194.05
|
| Rate for Payer: Priority Health Medicare |
$125.71
|
| Rate for Payer: Priority Health SBD |
$194.05
|
| Rate for Payer: Priority Health Tiered Network |
$194.05
|
| Rate for Payer: Railroad Medicare Medicare |
$125.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.33
|
| Rate for Payer: UHC Core |
$248.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$125.71
|
| Rate for Payer: UHC Exchange |
$248.33
|
| Rate for Payer: UMR Bronson Commercial |
$310.04
|
|
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 93270
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$95.25 |
| Rate for Payer: Aetna Commercial |
$10.32
|
| Rate for Payer: Aetna Medicare |
$8.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.09
|
| Rate for Payer: BCBS MAPPO |
$7.70
|
| Rate for Payer: BCN Commercial |
$11.95
|
| Rate for Payer: BCN Medicare Advantage |
$7.70
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cofinity Commercial |
$11.09
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.47
|
| Rate for Payer: Nomi Health Commercial |
$9.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.25
|
| Rate for Payer: PACE SWMI |
$7.70
|
| Rate for Payer: PHP Commercial |
$10.78
|
| Rate for Payer: PHP Medicare Advantage |
$7.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.35
|
| Rate for Payer: Priority Health Medicare |
$7.70
|
| Rate for Payer: Priority Health SBD |
$11.35
|
| Rate for Payer: Priority Health Tiered Network |
$11.35
|
| Rate for Payer: Railroad Medicare Medicare |
$7.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.35
|
| Rate for Payer: UHC Core |
$13.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.70
|
| Rate for Payer: UHC Exchange |
$13.35
|
| Rate for Payer: UMR Bronson Commercial |
$58.42
|
|
|
PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
|
Professional
|
Both
|
$897.00
|
|
|
Service Code
|
HCPCS 93268
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$672.75 |
| Rate for Payer: Aetna Commercial |
$209.96
|
| Rate for Payer: Aetna Medicare |
$162.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.63
|
| Rate for Payer: BCBS MAPPO |
$156.69
|
| Rate for Payer: BCN Commercial |
$251.48
|
| Rate for Payer: BCN Medicare Advantage |
$156.69
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cash Price |
$717.60
|
| Rate for Payer: Cofinity Commercial |
$209.96
|
| Rate for Payer: Cofinity Commercial |
$225.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$172.36
|
| Rate for Payer: Nomi Health Commercial |
$188.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$672.75
|
| Rate for Payer: PACE SWMI |
$156.69
|
| Rate for Payer: PHP Commercial |
$219.37
|
| Rate for Payer: PHP Medicare Advantage |
$156.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$239.02
|
| Rate for Payer: Priority Health Medicare |
$156.69
|
| Rate for Payer: Priority Health SBD |
$239.02
|
| Rate for Payer: Priority Health Tiered Network |
$239.02
|
| Rate for Payer: Railroad Medicare Medicare |
$156.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.62
|
| Rate for Payer: UHC Core |
$302.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$156.69
|
| Rate for Payer: UHC Exchange |
$302.62
|
| Rate for Payer: UMR Bronson Commercial |
$412.62
|
|
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 93272
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: Aetna Commercial |
$31.20
|
| Rate for Payer: Aetna Medicare |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.52
|
| Rate for Payer: BCBS Complete |
$15.88
|
| Rate for Payer: BCBS MAPPO |
$23.28
|
| Rate for Payer: BCN Commercial |
$35.35
|
| Rate for Payer: BCN Medicare Advantage |
$23.28
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cofinity Commercial |
$33.52
|
| Rate for Payer: Cofinity Commercial |
$31.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.44
|
| Rate for Payer: Meridian Medicaid |
$15.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.61
|
| Rate for Payer: Nomi Health Commercial |
$27.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.25
|
| Rate for Payer: PACE SWMI |
$23.28
|
| Rate for Payer: PHP Commercial |
$32.59
|
| Rate for Payer: PHP Medicare Advantage |
$23.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$33.61
|
| Rate for Payer: Priority Health Medicare |
$23.28
|
| Rate for Payer: Priority Health SBD |
$33.61
|
| Rate for Payer: Priority Health Tiered Network |
$33.61
|
| Rate for Payer: Railroad Medicare Medicare |
$23.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.94
|
| Rate for Payer: UHC Core |
$40.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$23.28
|
| Rate for Payer: UHC Exchange |
$40.94
|
| Rate for Payer: UHC Medicaid |
$15.12
|
| Rate for Payer: UHCCP Medicaid |
$15.12
|
| Rate for Payer: UMR Bronson Commercial |
$82.34
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
HCPCS 41015
|
| Min. Negotiated Rate |
$178.49 |
| Max. Negotiated Rate |
$555.18 |
| Rate for Payer: Aetna Commercial |
$362.28
|
| Rate for Payer: Aetna Medicare |
$281.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.32
|
| Rate for Payer: BCBS Complete |
$187.41
|
| Rate for Payer: BCBS MAPPO |
$270.36
|
| Rate for Payer: BCN Commercial |
$455.65
|
| Rate for Payer: BCN Medicare Advantage |
$270.36
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cash Price |
$500.80
|
| Rate for Payer: Cofinity Commercial |
$362.28
|
| Rate for Payer: Cofinity Commercial |
$389.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$270.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$283.88
|
| Rate for Payer: Meridian Medicaid |
$187.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$297.40
|
| Rate for Payer: Nomi Health Commercial |
$324.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$469.50
|
| Rate for Payer: PACE SWMI |
$270.36
|
| Rate for Payer: PHP Commercial |
$378.50
|
| Rate for Payer: PHP Medicare Advantage |
$270.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$178.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$555.18
|
| Rate for Payer: Priority Health Medicare |
$270.36
|
| Rate for Payer: Priority Health SBD |
$555.18
|
| Rate for Payer: Priority Health Tiered Network |
$555.18
|
| Rate for Payer: Railroad Medicare Medicare |
$270.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$536.15
|
| Rate for Payer: UHC Core |
$536.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$270.36
|
| Rate for Payer: UHC Exchange |
$536.15
|
| Rate for Payer: UHC Medicaid |
$178.49
|
| Rate for Payer: UHCCP Medicaid |
$178.49
|
| Rate for Payer: UMR Bronson Commercial |
$287.96
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
HCPCS 41016
|
| Min. Negotiated Rate |
$207.46 |
| Max. Negotiated Rate |
$635.28 |
| Rate for Payer: Aetna Commercial |
$419.35
|
| Rate for Payer: Aetna Medicare |
$325.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.65
|
| Rate for Payer: BCBS Complete |
$217.83
|
| Rate for Payer: BCBS MAPPO |
$312.95
|
| Rate for Payer: BCN Commercial |
$521.38
|
| Rate for Payer: BCN Medicare Advantage |
$312.95
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cofinity Commercial |
$419.35
|
| Rate for Payer: Cofinity Commercial |
$450.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.60
|
| Rate for Payer: Meridian Medicaid |
$217.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$344.25
|
| Rate for Payer: Nomi Health Commercial |
$375.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$560.25
|
| Rate for Payer: PACE SWMI |
$312.95
|
| Rate for Payer: PHP Commercial |
$438.13
|
| Rate for Payer: PHP Medicare Advantage |
$312.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$207.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$635.28
|
| Rate for Payer: Priority Health Medicare |
$312.95
|
| Rate for Payer: Priority Health SBD |
$635.28
|
| Rate for Payer: Priority Health Tiered Network |
$635.28
|
| Rate for Payer: Railroad Medicare Medicare |
$312.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$594.78
|
| Rate for Payer: UHC Core |
$594.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$312.95
|
| Rate for Payer: UHC Exchange |
$594.78
|
| Rate for Payer: UHC Medicaid |
$207.46
|
| Rate for Payer: UHCCP Medicaid |
$207.46
|
| Rate for Payer: UMR Bronson Commercial |
$343.62
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB
|
Professional
|
Both
|
$929.00
|
|
|
Service Code
|
HCPCS 41017
|
| Min. Negotiated Rate |
$204.91 |
| Max. Negotiated Rate |
$696.75 |
| Rate for Payer: Aetna Commercial |
$414.35
|
| Rate for Payer: Aetna Medicare |
$321.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.28
|
| Rate for Payer: BCBS Complete |
$215.16
|
| Rate for Payer: BCBS MAPPO |
$309.22
|
| Rate for Payer: BCN Commercial |
$517.40
|
| Rate for Payer: BCN Medicare Advantage |
$309.22
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cash Price |
$743.20
|
| Rate for Payer: Cofinity Commercial |
$414.35
|
| Rate for Payer: Cofinity Commercial |
$445.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.68
|
| Rate for Payer: Meridian Medicaid |
$215.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$340.14
|
| Rate for Payer: Nomi Health Commercial |
$371.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.75
|
| Rate for Payer: PACE SWMI |
$309.22
|
| Rate for Payer: PHP Commercial |
$432.91
|
| Rate for Payer: PHP Medicare Advantage |
$309.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$630.42
|
| Rate for Payer: Priority Health Medicare |
$309.22
|
| Rate for Payer: Priority Health SBD |
$630.42
|
| Rate for Payer: Priority Health Tiered Network |
$630.42
|
| Rate for Payer: Railroad Medicare Medicare |
$309.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.11
|
| Rate for Payer: UHC Core |
$591.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$309.22
|
| Rate for Payer: UHC Exchange |
$591.11
|
| Rate for Payer: UHC Medicaid |
$204.91
|
| Rate for Payer: UHCCP Medicaid |
$204.91
|
| Rate for Payer: UMR Bronson Commercial |
$427.34
|
|
|
PR ZINC PASTE BAND W >=3""<5""/YD
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS A6456
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.58
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS MAPPO |
$1.79
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: BCN Medicare Advantage |
$1.79
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.97
|
| Rate for Payer: Nomi Health Commercial |
$2.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.25
|
| Rate for Payer: PACE SWMI |
$1.79
|
| Rate for Payer: PHP Commercial |
$2.51
|
| Rate for Payer: PHP Medicare Advantage |
$1.79
|
| Rate for Payer: Priority Health Medicare |
$1.79
|
| Rate for Payer: Railroad Medicare Medicare |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.79
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$8.74
|
|
|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$221.01 |
| Rate for Payer: Aetna Commercial |
$216.92
|
| Rate for Payer: Aetna Medicare |
$127.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.92
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS Trust/PPO |
$221.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.05
|
| Rate for Payer: UHC Core |
$219.05
|
| Rate for Payer: UHC Exchange |
$219.05
|
| Rate for Payer: UMR Bronson Commercial |
$116.84
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.82 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna American Axle |
$36.66
|
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.66
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Advantage |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health SBD |
$35.53
|
| Rate for Payer: UMR Bronson Commercial |
$24.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$56.40
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$50.76 |
| Rate for Payer: Aetna American Axle |
$36.66
|
| Rate for Payer: Aetna Commercial |
$47.94
|
| Rate for Payer: Aetna Medicare |
$28.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.66
|
| Rate for Payer: BCBS Complete |
$22.56
|
| Rate for Payer: Cash Price |
$45.12
|
| Rate for Payer: Cofinity Advantage |
$39.48
|
| Rate for Payer: Cofinity Commercial |
$48.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.12
|
| Rate for Payer: Healthscope Commercial |
$50.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.30
|
| Rate for Payer: PHP Commercial |
$47.94
|
| Rate for Payer: Priority Health SBD |
$35.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.66
|
| Rate for Payer: UHC Core |
$29.38
|
| Rate for Payer: UHC Exchange |
$22.17
|
| Rate for Payer: UMR Bronson Commercial |
$20.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.30
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$37.05
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$33.34 |
| Rate for Payer: Aetna American Axle |
$24.08
|
| Rate for Payer: Aetna Commercial |
$31.49
|
| Rate for Payer: Aetna Medicare |
$18.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.08
|
| Rate for Payer: BCBS Complete |
$14.82
|
| Rate for Payer: Cash Price |
$29.64
|
| Rate for Payer: Cofinity Advantage |
$25.93
|
| Rate for Payer: Cofinity Commercial |
$31.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.64
|
| Rate for Payer: Healthscope Commercial |
$33.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.79
|
| Rate for Payer: PHP Commercial |
$31.49
|
| Rate for Payer: Priority Health SBD |
$23.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.08
|
| Rate for Payer: UHC Core |
$19.30
|
| Rate for Payer: UHC Exchange |
$14.56
|
| Rate for Payer: UMR Bronson Commercial |
$13.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.79
|
|
