|
PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99460
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$136.44 |
| Rate for Payer: Aetna Commercial |
$107.52
|
| Rate for Payer: Aetna Medicare |
$83.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.55
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS MAPPO |
$80.24
|
| Rate for Payer: BCN Commercial |
$136.44
|
| Rate for Payer: BCN Medicare Advantage |
$80.24
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$107.52
|
| Rate for Payer: Cofinity Commercial |
$115.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.25
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.26
|
| Rate for Payer: Nomi Health Commercial |
$96.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.25
|
| Rate for Payer: PACE SWMI |
$80.24
|
| Rate for Payer: PHP Commercial |
$112.34
|
| Rate for Payer: PHP Medicare Advantage |
$80.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$122.73
|
| Rate for Payer: Priority Health Medicare |
$80.24
|
| Rate for Payer: Priority Health SBD |
$122.73
|
| Rate for Payer: Priority Health Tiered Network |
$122.73
|
| Rate for Payer: Railroad Medicare Medicare |
$80.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$135.48
|
| Rate for Payer: UHC Core |
$135.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.24
|
| Rate for Payer: UHC Exchange |
$135.48
|
| Rate for Payer: UHC Medicaid |
$51.55
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 99463
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$159.85 |
| Rate for Payer: Aetna Commercial |
$125.60
|
| Rate for Payer: Aetna Medicare |
$97.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.97
|
| Rate for Payer: BCBS Complete |
$63.51
|
| Rate for Payer: BCBS MAPPO |
$93.73
|
| Rate for Payer: BCN Commercial |
$159.85
|
| Rate for Payer: BCN Medicare Advantage |
$93.73
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$134.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.42
|
| Rate for Payer: Meridian Medicaid |
$63.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.10
|
| Rate for Payer: Nomi Health Commercial |
$112.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.75
|
| Rate for Payer: PACE SWMI |
$93.73
|
| Rate for Payer: PHP Commercial |
$131.22
|
| Rate for Payer: PHP Medicare Advantage |
$93.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$143.79
|
| Rate for Payer: Priority Health Medicare |
$93.73
|
| Rate for Payer: Priority Health SBD |
$143.79
|
| Rate for Payer: Priority Health Tiered Network |
$143.79
|
| Rate for Payer: Railroad Medicare Medicare |
$93.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.14
|
| Rate for Payer: UHC Core |
$156.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$93.73
|
| Rate for Payer: UHC Exchange |
$156.14
|
| Rate for Payer: UHC Medicaid |
$60.49
|
| Rate for Payer: UHCCP Medicaid |
$60.49
|
| Rate for Payer: UMR Bronson Commercial |
$81.42
|
|
|
PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 99223
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$285.78 |
| Rate for Payer: Aetna Commercial |
$207.58
|
| Rate for Payer: Aetna Medicare |
$161.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.07
|
| Rate for Payer: BCBS Complete |
$104.66
|
| Rate for Payer: BCBS MAPPO |
$154.91
|
| Rate for Payer: BCN Commercial |
$187.79
|
| Rate for Payer: BCN Medicare Advantage |
$154.91
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$207.58
|
| Rate for Payer: Cofinity Commercial |
$223.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.66
|
| Rate for Payer: Meridian Medicaid |
$104.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$170.40
|
| Rate for Payer: Nomi Health Commercial |
$185.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE SWMI |
$154.91
|
| Rate for Payer: PHP Commercial |
$216.87
|
| Rate for Payer: PHP Medicare Advantage |
$154.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$231.58
|
| Rate for Payer: Priority Health Medicare |
$154.91
|
| Rate for Payer: Priority Health SBD |
$231.58
|
| Rate for Payer: Priority Health Tiered Network |
$231.58
|
| Rate for Payer: Railroad Medicare Medicare |
$154.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.78
|
| Rate for Payer: UHC Core |
$285.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$154.91
|
| Rate for Payer: UHC Exchange |
$285.78
|
| Rate for Payer: UHC Medicaid |
$99.68
|
| Rate for Payer: UHCCP Medicaid |
$99.68
|
| Rate for Payer: UMR Bronson Commercial |
$167.44
|
|
|
PR 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 99222
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$194.72 |
| Rate for Payer: Aetna Commercial |
$155.37
|
| Rate for Payer: Aetna Medicare |
$120.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.97
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS MAPPO |
$115.95
|
| Rate for Payer: BCN Commercial |
$140.94
|
| Rate for Payer: BCN Medicare Advantage |
$115.95
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cofinity Commercial |
$155.37
|
| Rate for Payer: Cofinity Commercial |
$166.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.75
|
| Rate for Payer: Meridian Medicaid |
$78.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.55
|
| Rate for Payer: Nomi Health Commercial |
$139.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.00
|
| Rate for Payer: PACE SWMI |
$115.95
|
| Rate for Payer: PHP Commercial |
$162.33
|
| Rate for Payer: PHP Medicare Advantage |
$115.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$173.80
|
| Rate for Payer: Priority Health Medicare |
$115.95
|
| Rate for Payer: Priority Health SBD |
$173.80
|
| Rate for Payer: Priority Health Tiered Network |
$173.80
|
| Rate for Payer: Railroad Medicare Medicare |
$115.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.72
|
| Rate for Payer: UHC Core |
$194.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.95
|
| Rate for Payer: UHC Exchange |
$194.72
|
| Rate for Payer: UHC Medicaid |
$74.55
|
| Rate for Payer: UHCCP Medicaid |
$74.55
|
| Rate for Payer: UMR Bronson Commercial |
$114.08
|
|
|
PR 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 99221
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$144.23 |
| Rate for Payer: Aetna Commercial |
$99.31
|
| Rate for Payer: Aetna Medicare |
$77.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.31
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS MAPPO |
$74.11
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: BCN Medicare Advantage |
$74.11
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$106.72
|
| Rate for Payer: Cofinity Commercial |
$99.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.82
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.52
|
| Rate for Payer: Nomi Health Commercial |
$88.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.50
|
| Rate for Payer: PACE SWMI |
$74.11
|
| Rate for Payer: PHP Commercial |
$103.75
|
| Rate for Payer: PHP Medicare Advantage |
$74.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$110.19
|
| Rate for Payer: Priority Health Medicare |
$74.11
|
| Rate for Payer: Priority Health SBD |
$110.19
|
| Rate for Payer: Priority Health Tiered Network |
$110.19
|
| Rate for Payer: Railroad Medicare Medicare |
$74.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.23
|
| Rate for Payer: UHC Core |
$144.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.11
|
| Rate for Payer: UHC Exchange |
$144.23
|
| Rate for Payer: UHC Medicaid |
$47.50
|
| Rate for Payer: UHCCP Medicaid |
$47.50
|
| Rate for Payer: UMR Bronson Commercial |
$83.72
|
|
|
PR 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 99468
|
| Min. Negotiated Rate |
$772.71 |
| Max. Negotiated Rate |
$1,313.18 |
| Rate for Payer: Aetna Commercial |
$1,035.43
|
| Rate for Payer: Aetna Medicare |
$803.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,035.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,112.70
|
| Rate for Payer: BCBS Complete |
$811.35
|
| Rate for Payer: BCBS MAPPO |
$772.71
|
| Rate for Payer: BCN Commercial |
$1,313.18
|
| Rate for Payer: BCN Medicare Advantage |
$772.71
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cofinity Commercial |
$1,035.43
|
| Rate for Payer: Cofinity Commercial |
$1,112.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.35
|
| Rate for Payer: Meridian Medicaid |
$811.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$849.98
|
| Rate for Payer: Nomi Health Commercial |
$927.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,293.75
|
| Rate for Payer: PACE SWMI |
$772.71
|
| Rate for Payer: PHP Commercial |
$1,081.79
|
| Rate for Payer: PHP Medicare Advantage |
$772.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,181.21
|
| Rate for Payer: Priority Health Medicare |
$772.71
|
| Rate for Payer: Priority Health SBD |
$1,181.21
|
| Rate for Payer: Priority Health Tiered Network |
$1,181.21
|
| Rate for Payer: Railroad Medicare Medicare |
$772.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,303.73
|
| Rate for Payer: UHC Core |
$1,303.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$772.71
|
| Rate for Payer: UHC Exchange |
$1,303.73
|
| Rate for Payer: UHC Medicaid |
$772.71
|
| Rate for Payer: UHCCP Medicaid |
$772.71
|
| Rate for Payer: UMR Bronson Commercial |
$793.50
|
|
|
PR 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 99492
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna Commercial |
$109.20
|
| Rate for Payer: Aetna Medicare |
$84.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.35
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS MAPPO |
$81.49
|
| Rate for Payer: BCN Commercial |
$109.08
|
| Rate for Payer: BCN Medicare Advantage |
$81.49
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$109.20
|
| Rate for Payer: Cofinity Commercial |
$117.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.56
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.64
|
| Rate for Payer: Nomi Health Commercial |
$97.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.00
|
| Rate for Payer: PACE SWMI |
$81.49
|
| Rate for Payer: PHP Commercial |
$114.09
|
| Rate for Payer: PHP Medicare Advantage |
$81.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$172.40
|
| Rate for Payer: Priority Health Medicare |
$81.49
|
| Rate for Payer: Priority Health SBD |
$172.40
|
| Rate for Payer: Priority Health Tiered Network |
$172.40
|
| Rate for Payer: Railroad Medicare Medicare |
$81.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.10
|
| Rate for Payer: UHC Core |
$125.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$81.49
|
| Rate for Payer: UHC Exchange |
$125.10
|
| Rate for Payer: UHC Medicaid |
$52.40
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
| Rate for Payer: UMR Bronson Commercial |
$149.04
|
|
|
PR 1ST/SBSQ PSYCH COLLAB CARE MGMT EA ADDL 30 MINS
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 99494
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$47.91
|
| Rate for Payer: Aetna Medicare |
$37.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.48
|
| Rate for Payer: BCBS Complete |
$24.15
|
| Rate for Payer: BCBS MAPPO |
$35.75
|
| Rate for Payer: BCN Commercial |
$53.02
|
| Rate for Payer: BCN Medicare Advantage |
$35.75
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Cofinity Commercial |
$51.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.54
|
| Rate for Payer: Meridian Medicaid |
$24.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.33
|
| Rate for Payer: Nomi Health Commercial |
$42.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: PACE SWMI |
$35.75
|
| Rate for Payer: PHP Commercial |
$50.05
|
| Rate for Payer: PHP Medicare Advantage |
$35.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$82.71
|
| Rate for Payer: Priority Health Medicare |
$35.75
|
| Rate for Payer: Priority Health SBD |
$82.71
|
| Rate for Payer: Priority Health Tiered Network |
$82.71
|
| Rate for Payer: Railroad Medicare Medicare |
$35.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.05
|
| Rate for Payer: UHC Core |
$60.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.75
|
| Rate for Payer: UHC Exchange |
$60.05
|
| Rate for Payer: UHC Medicaid |
$23.00
|
| Rate for Payer: UHCCP Medicaid |
$23.00
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
PR 2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 90650
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$141.25
|
| Rate for Payer: Aetna Medicare |
$143.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.25
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: BCBS Trust/PPO |
$133.16
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.96
|
| Rate for Payer: UHC Core |
$158.96
|
| Rate for Payer: UHC Exchange |
$158.96
|
| Rate for Payer: UMR Bronson Commercial |
$132.02
|
|
|
PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 90649
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Aetna Medicare |
$135.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.24
|
| Rate for Payer: BCBS Complete |
$108.40
|
| Rate for Payer: BCBS Trust/PPO |
$160.17
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.98
|
| Rate for Payer: UHC Core |
$164.98
|
| Rate for Payer: UHC Exchange |
$164.98
|
| Rate for Payer: UMR Bronson Commercial |
$124.66
|
|
|
PR 5% DEXTROSE IN LAC RINGERS
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J7121
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$7.42
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.42
|
| Rate for Payer: BCBS Trust/PPO |
$1.84
|
| Rate for Payer: BCN Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.98
|
| Rate for Payer: UHC Core |
$7.98
|
| Rate for Payer: UHC Exchange |
$7.98
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR 9VHPV VACC 2/3 DOSE SCHED IM USE
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 90651
|
| Min. Negotiated Rate |
$140.30 |
| Max. Negotiated Rate |
$329.09 |
| Rate for Payer: Aetna Commercial |
$293.16
|
| Rate for Payer: Aetna Medicare |
$152.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.16
|
| Rate for Payer: BCBS Trust/PPO |
$329.09
|
| Rate for Payer: BCN Commercial |
$310.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$329.09
|
| Rate for Payer: UHC Core |
$329.09
|
| Rate for Payer: UHC Exchange |
$329.09
|
| Rate for Payer: UMR Bronson Commercial |
$140.30
|
|
|
PR AAA REPAIR,AORTO-AORTIC TUBE PROSTH
|
Professional
|
Both
|
$4,055.00
|
|
|
Service Code
|
HCPCS 34800
|
| Min. Negotiated Rate |
$1,622.00 |
| Max. Negotiated Rate |
$3,041.25 |
| Rate for Payer: Aetna Medicare |
$2,027.50
|
| Rate for Payer: BCBS Complete |
$1,622.00
|
| Rate for Payer: Cash Price |
$3,244.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,041.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,865.30
|
|
|
PR AAA REPAIR,MODULR BIFURCATED PROSTH
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 34802
|
| Min. Negotiated Rate |
$1,052.80 |
| Max. Negotiated Rate |
$1,974.00 |
| Rate for Payer: Aetna Medicare |
$1,316.00
|
| Rate for Payer: BCBS Complete |
$1,052.80
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,974.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,210.72
|
|
|
PR AAA REPAIR,MODULR BIFUR PROSTH,2-DOCK
|
Professional
|
Both
|
$2,701.00
|
|
|
Service Code
|
HCPCS 34803
|
| Min. Negotiated Rate |
$1,080.40 |
| Max. Negotiated Rate |
$2,025.75 |
| Rate for Payer: Aetna Medicare |
$1,350.50
|
| Rate for Payer: BCBS Complete |
$1,080.40
|
| Rate for Payer: Cash Price |
$2,160.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,025.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,242.46
|
|
|
PR AAA REPAIR,UNIBODY BIFURCATED PROSTH
|
Professional
|
Both
|
$5,677.00
|
|
|
Service Code
|
HCPCS 34804
|
| Min. Negotiated Rate |
$2,270.80 |
| Max. Negotiated Rate |
$4,257.75 |
| Rate for Payer: Aetna Medicare |
$2,838.50
|
| Rate for Payer: BCBS Complete |
$2,270.80
|
| Rate for Payer: Cash Price |
$4,541.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,257.75
|
| Rate for Payer: UMR Bronson Commercial |
$2,611.42
|
|
|
PR AAA REPR,1ST VESSEL,EXTENSION PROSTH
|
Professional
|
Both
|
$2,779.00
|
|
|
Service Code
|
HCPCS 34825
|
| Min. Negotiated Rate |
$1,111.60 |
| Max. Negotiated Rate |
$2,084.25 |
| Rate for Payer: Aetna Medicare |
$1,389.50
|
| Rate for Payer: BCBS Complete |
$1,111.60
|
| Rate for Payer: Cash Price |
$2,223.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,084.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,278.34
|
|
|
PR AAA REPR,ADD VESSEL,EXTENSION PROSTH
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 34826
|
| Min. Negotiated Rate |
$179.60 |
| Max. Negotiated Rate |
$336.75 |
| Rate for Payer: Aetna Medicare |
$224.50
|
| Rate for Payer: BCBS Complete |
$179.60
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$336.75
|
| Rate for Payer: UMR Bronson Commercial |
$206.54
|
|
|
PR ABATACEPT INJECTION
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS J0129
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$44.72
|
| Rate for Payer: BCBS Trust/PPO |
$58.53
|
| Rate for Payer: BCN Commercial |
$57.21
|
| Rate for Payer: BCN Medicare Advantage |
$44.72
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$64.40
|
| Rate for Payer: Cofinity Commercial |
$59.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.19
|
| Rate for Payer: Nomi Health Commercial |
$53.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: PACE SWMI |
$44.72
|
| Rate for Payer: PHP Commercial |
$62.61
|
| Rate for Payer: PHP Medicare Advantage |
$44.72
|
| Rate for Payer: Priority Health Medicare |
$44.72
|
| Rate for Payer: Railroad Medicare Medicare |
$44.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.77
|
| Rate for Payer: UHC Core |
$44.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.72
|
| Rate for Payer: UHC Exchange |
$44.77
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
|
|
PR ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
HCPCS 38747
|
| Min. Negotiated Rate |
$152.72 |
| Max. Negotiated Rate |
$525.45 |
| Rate for Payer: Aetna Commercial |
$323.03
|
| Rate for Payer: Aetna Medicare |
$250.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.14
|
| Rate for Payer: BCBS Complete |
$160.36
|
| Rate for Payer: BCBS MAPPO |
$241.07
|
| Rate for Payer: BCN Commercial |
$394.90
|
| Rate for Payer: BCN Medicare Advantage |
$241.07
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cofinity Commercial |
$323.03
|
| Rate for Payer: Cofinity Commercial |
$347.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.12
|
| Rate for Payer: Meridian Medicaid |
$160.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$265.18
|
| Rate for Payer: Nomi Health Commercial |
$289.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$372.75
|
| Rate for Payer: PACE SWMI |
$241.07
|
| Rate for Payer: PHP Commercial |
$337.50
|
| Rate for Payer: PHP Medicare Advantage |
$241.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$525.45
|
| Rate for Payer: Priority Health Medicare |
$241.07
|
| Rate for Payer: Priority Health SBD |
$525.45
|
| Rate for Payer: Priority Health Tiered Network |
$525.45
|
| Rate for Payer: Railroad Medicare Medicare |
$241.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$478.99
|
| Rate for Payer: UHC Core |
$478.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$241.07
|
| Rate for Payer: UHC Exchange |
$478.99
|
| Rate for Payer: UHC Medicaid |
$152.72
|
| Rate for Payer: UHCCP Medicaid |
$152.72
|
| Rate for Payer: UMR Bronson Commercial |
$228.62
|
|
|
PR ABDOMINOPLASTY (2HRS)
|
Professional
|
Both
|
$3,605.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,442.00 |
| Max. Negotiated Rate |
$2,703.75 |
| Rate for Payer: Aetna Medicare |
$1,802.50
|
| Rate for Payer: BCBS Complete |
$1,442.00
|
| Rate for Payer: Cash Price |
$2,884.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,703.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,658.30
|
|
|
PR ABDOMINOPLASTY (3HRS)
|
Professional
|
Both
|
$5,408.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2,163.20 |
| Max. Negotiated Rate |
$4,056.00 |
| Rate for Payer: Aetna Medicare |
$2,704.00
|
| Rate for Payer: BCBS Complete |
$2,163.20
|
| Rate for Payer: Cash Price |
$4,326.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,056.00
|
| Rate for Payer: UMR Bronson Commercial |
$2,487.68
|
|
|
PR ABDOMINOPLASTY W/ BREAST AUGMENT
|
Professional
|
Both
|
$7,669.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$3,067.60 |
| Max. Negotiated Rate |
$5,751.75 |
| Rate for Payer: Aetna Medicare |
$3,834.50
|
| Rate for Payer: BCBS Complete |
$3,067.60
|
| Rate for Payer: Cash Price |
$6,135.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,751.75
|
| Rate for Payer: UMR Bronson Commercial |
$3,527.74
|
|
|
PR ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL
|
Professional
|
Both
|
$2,707.00
|
|
|
Service Code
|
HCPCS 51845
|
| Min. Negotiated Rate |
$338.24 |
| Max. Negotiated Rate |
$2,030.25 |
| Rate for Payer: Aetna Commercial |
$699.83
|
| Rate for Payer: Aetna Medicare |
$543.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$699.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$752.05
|
| Rate for Payer: BCBS Complete |
$355.15
|
| Rate for Payer: BCBS MAPPO |
$522.26
|
| Rate for Payer: BCN Commercial |
$875.45
|
| Rate for Payer: BCN Medicare Advantage |
$522.26
|
| Rate for Payer: Cash Price |
$2,165.60
|
| Rate for Payer: Cash Price |
$2,165.60
|
| Rate for Payer: Cofinity Commercial |
$699.83
|
| Rate for Payer: Cofinity Commercial |
$752.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$522.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$548.37
|
| Rate for Payer: Meridian Medicaid |
$355.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$574.49
|
| Rate for Payer: Nomi Health Commercial |
$626.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,030.25
|
| Rate for Payer: PACE SWMI |
$522.26
|
| Rate for Payer: PHP Commercial |
$731.16
|
| Rate for Payer: PHP Medicare Advantage |
$522.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$338.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$953.65
|
| Rate for Payer: Priority Health Medicare |
$522.26
|
| Rate for Payer: Priority Health SBD |
$953.65
|
| Rate for Payer: Priority Health Tiered Network |
$953.65
|
| Rate for Payer: Railroad Medicare Medicare |
$522.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,025.59
|
| Rate for Payer: UHC Core |
$1,025.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$522.26
|
| Rate for Payer: UHC Exchange |
$1,025.59
|
| Rate for Payer: UHC Medicaid |
$338.24
|
| Rate for Payer: UHCCP Medicaid |
$338.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,245.22
|
|
|
PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 49083
|
| Min. Negotiated Rate |
$59.21 |
| Max. Negotiated Rate |
$366.75 |
| Rate for Payer: Aetna Commercial |
$123.23
|
| Rate for Payer: Aetna Medicare |
$95.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.42
|
| Rate for Payer: BCBS Complete |
$62.17
|
| Rate for Payer: BCBS MAPPO |
$91.96
|
| Rate for Payer: BCN Commercial |
$156.86
|
| Rate for Payer: BCN Medicare Advantage |
$91.96
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cofinity Commercial |
$123.23
|
| Rate for Payer: Cofinity Commercial |
$132.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.56
|
| Rate for Payer: Meridian Medicaid |
$62.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.16
|
| Rate for Payer: Nomi Health Commercial |
$110.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.75
|
| Rate for Payer: PACE SWMI |
$91.96
|
| Rate for Payer: PHP Commercial |
$128.74
|
| Rate for Payer: PHP Medicare Advantage |
$91.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$191.13
|
| Rate for Payer: Priority Health Medicare |
$91.96
|
| Rate for Payer: Priority Health SBD |
$191.13
|
| Rate for Payer: Priority Health Tiered Network |
$191.13
|
| Rate for Payer: Railroad Medicare Medicare |
$91.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$190.32
|
| Rate for Payer: UHC Core |
$190.32
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$91.96
|
| Rate for Payer: UHC Exchange |
$190.32
|
| Rate for Payer: UHC Medicaid |
$59.21
|
| Rate for Payer: UHCCP Medicaid |
$59.21
|
| Rate for Payer: UMR Bronson Commercial |
$224.94
|
|
