|
PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 92653
|
| Min. Negotiated Rate |
$76.51 |
| Max. Negotiated Rate |
$142.16 |
| Rate for Payer: Aetna Commercial |
$102.52
|
| Rate for Payer: Aetna Medicare |
$79.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.17
|
| Rate for Payer: BCBS MAPPO |
$76.51
|
| Rate for Payer: BCN Commercial |
$121.01
|
| Rate for Payer: BCN Medicare Advantage |
$76.51
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cofinity Commercial |
$110.17
|
| Rate for Payer: Cofinity Commercial |
$102.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.16
|
| Rate for Payer: Nomi Health Commercial |
$91.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.50
|
| Rate for Payer: PACE SWMI |
$76.51
|
| Rate for Payer: PHP Commercial |
$107.11
|
| Rate for Payer: PHP Medicare Advantage |
$76.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$111.59
|
| Rate for Payer: Priority Health Medicare |
$76.51
|
| Rate for Payer: Priority Health SBD |
$111.59
|
| Rate for Payer: Priority Health Tiered Network |
$111.59
|
| Rate for Payer: Railroad Medicare Medicare |
$76.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.16
|
| Rate for Payer: UHC Core |
$142.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.51
|
| Rate for Payer: UHC Exchange |
$142.16
|
| Rate for Payer: UMR Bronson Commercial |
$80.04
|
|
|
PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 92650
|
| Min. Negotiated Rate |
$13.63 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: Aetna Medicare |
$28.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.47
|
| Rate for Payer: BCBS Complete |
$14.31
|
| Rate for Payer: BCN Commercial |
$39.34
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Meridian Medicaid |
$14.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$36.27
|
| Rate for Payer: Priority Health SBD |
$36.27
|
| Rate for Payer: Priority Health Tiered Network |
$36.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.53
|
| Rate for Payer: UHC Core |
$46.53
|
| Rate for Payer: UHC Exchange |
$46.53
|
| Rate for Payer: UHC Medicaid |
$13.63
|
| Rate for Payer: UHCCP Medicaid |
$13.63
|
| Rate for Payer: UMR Bronson Commercial |
$26.22
|
|
|
PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 92652
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$193.39 |
| Rate for Payer: Aetna Commercial |
$138.35
|
| Rate for Payer: Aetna Medicare |
$107.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.68
|
| Rate for Payer: BCBS MAPPO |
$103.25
|
| Rate for Payer: BCN Commercial |
$161.85
|
| Rate for Payer: BCN Medicare Advantage |
$103.25
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$148.68
|
| Rate for Payer: Cofinity Commercial |
$138.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$113.58
|
| Rate for Payer: Nomi Health Commercial |
$123.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.00
|
| Rate for Payer: PACE SWMI |
$103.25
|
| Rate for Payer: PHP Commercial |
$144.55
|
| Rate for Payer: PHP Medicare Advantage |
$103.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$149.26
|
| Rate for Payer: Priority Health Medicare |
$103.25
|
| Rate for Payer: Priority Health SBD |
$149.26
|
| Rate for Payer: Priority Health Tiered Network |
$149.26
|
| Rate for Payer: Railroad Medicare Medicare |
$103.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.39
|
| Rate for Payer: UHC Core |
$193.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$103.25
|
| Rate for Payer: UHC Exchange |
$193.39
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
|
|
PR AFO ANKLE GAUNTLET PRE OTS
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS L1902
|
| Min. Negotiated Rate |
$29.91 |
| Max. Negotiated Rate |
$132.09 |
| Rate for Payer: Aetna Commercial |
$122.92
|
| Rate for Payer: Aetna Medicare |
$95.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.09
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$91.73
|
| Rate for Payer: BCN Commercial |
$87.83
|
| Rate for Payer: BCN Medicare Advantage |
$91.73
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$132.09
|
| Rate for Payer: Cofinity Commercial |
$122.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.90
|
| Rate for Payer: Nomi Health Commercial |
$110.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: PACE SWMI |
$91.73
|
| Rate for Payer: PHP Commercial |
$128.42
|
| Rate for Payer: PHP Medicare Advantage |
$91.73
|
| Rate for Payer: Priority Health Medicare |
$91.73
|
| Rate for Payer: Railroad Medicare Medicare |
$91.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.91
|
| Rate for Payer: UHC Core |
$29.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$91.73
|
| Rate for Payer: UHC Exchange |
$29.91
|
| Rate for Payer: UMR Bronson Commercial |
$34.50
|
|
|
PR AFO MULTILIG ANK SUP PRE OTS
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS L1906
|
| Min. Negotiated Rate |
$45.06 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$185.19
|
| Rate for Payer: Aetna Medicare |
$143.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.01
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS MAPPO |
$138.20
|
| Rate for Payer: BCN Commercial |
$132.31
|
| Rate for Payer: BCN Medicare Advantage |
$138.20
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$185.19
|
| Rate for Payer: Cofinity Commercial |
$199.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$152.02
|
| Rate for Payer: Nomi Health Commercial |
$165.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.75
|
| Rate for Payer: PACE SWMI |
$138.20
|
| Rate for Payer: PHP Commercial |
$193.48
|
| Rate for Payer: PHP Medicare Advantage |
$138.20
|
| Rate for Payer: Priority Health Medicare |
$138.20
|
| Rate for Payer: Railroad Medicare Medicare |
$138.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.06
|
| Rate for Payer: UHC Core |
$45.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$138.20
|
| Rate for Payer: UHC Exchange |
$45.06
|
| Rate for Payer: UMR Bronson Commercial |
$51.98
|
|
|
PR AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 90694
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Aetna Commercial |
$77.36
|
| Rate for Payer: Aetna Medicare |
$93.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.36
|
| Rate for Payer: BCBS Trust/PPO |
$67.98
|
| Rate for Payer: BCN Commercial |
$77.36
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.36
|
| Rate for Payer: UHC Core |
$77.36
|
| Rate for Payer: UHC Exchange |
$77.36
|
| Rate for Payer: UMR Bronson Commercial |
$86.02
|
|
|
PR AK SLEEVE SUSP NEOPRENE/EQUA
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS L5695
|
| Min. Negotiated Rate |
$65.10 |
| Max. Negotiated Rate |
$287.50 |
| Rate for Payer: Aetna Commercial |
$267.53
|
| Rate for Payer: Aetna Medicare |
$207.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.53
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS MAPPO |
$199.65
|
| Rate for Payer: BCN Commercial |
$191.15
|
| Rate for Payer: BCN Medicare Advantage |
$199.65
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$267.53
|
| Rate for Payer: Cofinity Commercial |
$287.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$219.62
|
| Rate for Payer: Nomi Health Commercial |
$239.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.00
|
| Rate for Payer: PACE SWMI |
$199.65
|
| Rate for Payer: PHP Commercial |
$279.51
|
| Rate for Payer: PHP Medicare Advantage |
$199.65
|
| Rate for Payer: Priority Health Medicare |
$199.65
|
| Rate for Payer: Railroad Medicare Medicare |
$199.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.10
|
| Rate for Payer: UHC Core |
$65.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$199.65
|
| Rate for Payer: UHC Exchange |
$65.10
|
| Rate for Payer: UMR Bronson Commercial |
$75.44
|
|
|
PRALATREXATE 20 MG/ML (1 ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20,803.16
|
|
|
Service Code
|
HCPCS J9307
|
| Hospital Charge Code |
99982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.39 |
| Max. Negotiated Rate |
$18,722.84 |
| Rate for Payer: Aetna American Axle |
$13,522.05
|
| Rate for Payer: Aetna Commercial |
$17,682.69
|
| Rate for Payer: Aetna Medicare |
$408.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,522.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$490.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$490.90
|
| Rate for Payer: BCBS Complete |
$215.68
|
| Rate for Payer: BCBS MAPPO |
$392.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,273.42
|
| Rate for Payer: BCN Commercial |
$1,273.42
|
| Rate for Payer: BCN Medicare Advantage |
$392.72
|
| Rate for Payer: Cash Price |
$16,642.53
|
| Rate for Payer: Cash Price |
$16,642.53
|
| Rate for Payer: Cofinity Advantage |
$14,562.21
|
| Rate for Payer: Cofinity Commercial |
$17,890.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,642.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.72
|
| Rate for Payer: Healthscope Commercial |
$18,722.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,562.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,602.37
|
| Rate for Payer: Mclaren Medicaid |
$392.72
|
| Rate for Payer: Mclaren Medicare |
$392.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.36
|
| Rate for Payer: Meridian Medicaid |
$412.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$431.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,682.69
|
| Rate for Payer: Nomi Health Commercial |
$1,178.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15,602.37
|
| Rate for Payer: PACE Medicare |
$373.08
|
| Rate for Payer: PACE SWMI |
$392.72
|
| Rate for Payer: PHP Commercial |
$17,682.69
|
| Rate for Payer: PHP Medicare Advantage |
$392.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,238.33
|
| Rate for Payer: Priority Health Medicare |
$392.72
|
| Rate for Payer: Priority Health SBD |
$13,105.99
|
| Rate for Payer: Priority Health Tiered Network |
$990.66
|
| Rate for Payer: Railroad Medicare Medicare |
$392.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.99
|
| Rate for Payer: UHC Core |
$647.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$392.72
|
| Rate for Payer: UHC Exchange |
$647.99
|
| Rate for Payer: UHC Medicaid |
$205.39
|
| Rate for Payer: UHCCP Medicaid |
$205.39
|
| Rate for Payer: UMR Bronson Commercial |
$7,697.17
|
| Rate for Payer: VA VA |
$392.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,602.37
|
|
|
PRALATREXATE 40 MG/2 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69,901.85
|
|
|
Service Code
|
HCPCS J9307
|
| Hospital Charge Code |
119254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$205.39 |
| Max. Negotiated Rate |
$62,911.67 |
| Rate for Payer: Aetna American Axle |
$45,436.20
|
| Rate for Payer: Aetna American Axle |
$27,044.14
|
| Rate for Payer: Aetna Commercial |
$35,365.41
|
| Rate for Payer: Aetna Commercial |
$59,416.57
|
| Rate for Payer: Aetna Medicare |
$408.43
|
| Rate for Payer: Aetna Medicare |
$408.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,044.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45,436.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$490.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$490.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$490.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$490.90
|
| Rate for Payer: BCBS Complete |
$215.68
|
| Rate for Payer: BCBS Complete |
$215.68
|
| Rate for Payer: BCBS MAPPO |
$392.72
|
| Rate for Payer: BCBS MAPPO |
$392.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,273.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,273.42
|
| Rate for Payer: BCN Commercial |
$1,273.42
|
| Rate for Payer: BCN Commercial |
$1,273.42
|
| Rate for Payer: BCN Medicare Advantage |
$392.72
|
| Rate for Payer: BCN Medicare Advantage |
$392.72
|
| Rate for Payer: Cash Price |
$33,285.10
|
| Rate for Payer: Cash Price |
$55,921.48
|
| Rate for Payer: Cash Price |
$55,921.48
|
| Rate for Payer: Cash Price |
$33,285.10
|
| Rate for Payer: Cofinity Advantage |
$48,931.29
|
| Rate for Payer: Cofinity Advantage |
$29,124.46
|
| Rate for Payer: Cofinity Commercial |
$35,781.48
|
| Rate for Payer: Cofinity Commercial |
$60,115.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,285.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55,921.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.72
|
| Rate for Payer: Healthscope Commercial |
$37,445.73
|
| Rate for Payer: Healthscope Commercial |
$62,911.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48,931.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,124.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,204.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52,426.39
|
| Rate for Payer: Mclaren Medicaid |
$392.72
|
| Rate for Payer: Mclaren Medicaid |
$392.72
|
| Rate for Payer: Mclaren Medicare |
$392.72
|
| Rate for Payer: Mclaren Medicare |
$392.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.36
|
| Rate for Payer: Meridian Medicaid |
$412.36
|
| Rate for Payer: Meridian Medicaid |
$412.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$431.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$431.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,365.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59,416.57
|
| Rate for Payer: Nomi Health Commercial |
$1,178.16
|
| Rate for Payer: Nomi Health Commercial |
$1,178.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52,426.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31,204.78
|
| Rate for Payer: PACE Medicare |
$373.08
|
| Rate for Payer: PACE Medicare |
$373.08
|
| Rate for Payer: PACE SWMI |
$392.72
|
| Rate for Payer: PACE SWMI |
$392.72
|
| Rate for Payer: PHP Commercial |
$35,365.41
|
| Rate for Payer: PHP Commercial |
$59,416.57
|
| Rate for Payer: PHP Medicare Advantage |
$392.72
|
| Rate for Payer: PHP Medicare Advantage |
$392.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,238.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,238.33
|
| Rate for Payer: Priority Health Medicare |
$392.72
|
| Rate for Payer: Priority Health Medicare |
$392.72
|
| Rate for Payer: Priority Health SBD |
$26,212.01
|
| Rate for Payer: Priority Health SBD |
$44,038.17
|
| Rate for Payer: Priority Health Tiered Network |
$990.66
|
| Rate for Payer: Priority Health Tiered Network |
$990.66
|
| Rate for Payer: Railroad Medicare Medicare |
$392.72
|
| Rate for Payer: Railroad Medicare Medicare |
$392.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.99
|
| Rate for Payer: UHC Core |
$647.99
|
| Rate for Payer: UHC Core |
$647.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$392.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$392.72
|
| Rate for Payer: UHC Exchange |
$647.99
|
| Rate for Payer: UHC Exchange |
$647.99
|
| Rate for Payer: UHC Medicaid |
$205.39
|
| Rate for Payer: UHC Medicaid |
$205.39
|
| Rate for Payer: UHCCP Medicaid |
$205.39
|
| Rate for Payer: UHCCP Medicaid |
$205.39
|
| Rate for Payer: UMR Bronson Commercial |
$15,394.36
|
| Rate for Payer: UMR Bronson Commercial |
$25,863.68
|
| Rate for Payer: VA VA |
$392.72
|
| Rate for Payer: VA VA |
$392.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52,426.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,204.78
|
|
|
PR ALBUTEROL IPRATROP NON-COMP
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7620
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.28
|
| Rate for Payer: Aetna Medicare |
$0.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.30
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.21
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Medicare Advantage |
$0.21
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.30
|
| Rate for Payer: Cofinity Commercial |
$0.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.23
|
| Rate for Payer: Nomi Health Commercial |
$0.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
| Rate for Payer: PACE SWMI |
$0.21
|
| Rate for Payer: PHP Commercial |
$0.29
|
| Rate for Payer: PHP Medicare Advantage |
$0.21
|
| Rate for Payer: Priority Health Medicare |
$0.21
|
| Rate for Payer: Railroad Medicare Medicare |
$0.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.20
|
| Rate for Payer: UHC Core |
$0.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.21
|
| Rate for Payer: UHC Exchange |
$0.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR ALBUTEROL NON-COMP CON
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7611
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.32
|
| Rate for Payer: Aetna Medicare |
$0.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.35
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.24
|
| Rate for Payer: BCN Commercial |
$0.09
|
| Rate for Payer: BCN Medicare Advantage |
$0.24
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.32
|
| Rate for Payer: Cofinity Commercial |
$0.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.26
|
| Rate for Payer: Nomi Health Commercial |
$0.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
| Rate for Payer: PACE SWMI |
$0.24
|
| Rate for Payer: PHP Commercial |
$0.34
|
| Rate for Payer: PHP Medicare Advantage |
$0.24
|
| Rate for Payer: Priority Health Medicare |
$0.24
|
| Rate for Payer: Railroad Medicare Medicare |
$0.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.26
|
| Rate for Payer: UHC Core |
$0.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.24
|
| Rate for Payer: UHC Exchange |
$0.26
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR ALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7613
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.11
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.12
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.08
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.08
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Cofinity Commercial |
$0.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.09
|
| Rate for Payer: Nomi Health Commercial |
$0.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
| Rate for Payer: PACE SWMI |
$0.08
|
| Rate for Payer: PHP Commercial |
$0.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.08
|
| Rate for Payer: Priority Health Medicare |
$0.08
|
| Rate for Payer: Railroad Medicare Medicare |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.07
|
| Rate for Payer: UHC Core |
$0.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.07
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR ALCOHOL AND/OR DRUG SERVICES
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS H0015
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$190.50 |
| Rate for Payer: Aetna Commercial |
$134.33
|
| Rate for Payer: Aetna Medicare |
$127.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.33
|
| Rate for Payer: BCBS Complete |
$101.60
|
| 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: UMR Bronson Commercial |
$116.84
|
|
|
PR ALCOHOL/SUBS INTERV 15-30MN
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS G0396
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$38.66
|
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.54
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: BCBS MAPPO |
$28.85
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: BCN Medicare Advantage |
$28.85
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$38.66
|
| Rate for Payer: Cofinity Commercial |
$41.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.29
|
| Rate for Payer: Meridian Medicaid |
$19.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.73
|
| Rate for Payer: Nomi Health Commercial |
$34.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: PACE SWMI |
$28.85
|
| Rate for Payer: PHP Commercial |
$40.39
|
| Rate for Payer: PHP Medicare Advantage |
$28.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42.56
|
| Rate for Payer: Priority Health Medicare |
$28.85
|
| Rate for Payer: Priority Health SBD |
$42.56
|
| Rate for Payer: Priority Health Tiered Network |
$42.56
|
| Rate for Payer: Railroad Medicare Medicare |
$28.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.13
|
| Rate for Payer: UHC Core |
$47.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$28.85
|
| Rate for Payer: UHC Exchange |
$47.13
|
| Rate for Payer: UHC Medicaid |
$18.53
|
| Rate for Payer: UHCCP Medicaid |
$18.53
|
| Rate for Payer: UMR Bronson Commercial |
$32.20
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 99408
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$47.60 |
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.63
|
| Rate for Payer: BCBS Complete |
$18.56
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Meridian Medicaid |
$18.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$42.56
|
| Rate for Payer: Priority Health SBD |
$42.56
|
| Rate for Payer: Priority Health Tiered Network |
$42.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.60
|
| Rate for Payer: UHC Core |
$47.60
|
| Rate for Payer: UHC Exchange |
$47.60
|
| Rate for Payer: UHC Medicaid |
$17.68
|
| Rate for Payer: UHCCP Medicaid |
$17.68
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 99409
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$95.69 |
| Rate for Payer: Aetna Commercial |
$67.61
|
| Rate for Payer: Aetna Medicare |
$53.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.61
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCN Commercial |
$93.62
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$84.21
|
| Rate for Payer: Priority Health SBD |
$84.21
|
| Rate for Payer: Priority Health Tiered Network |
$84.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.69
|
| Rate for Payer: UHC Core |
$95.69
|
| Rate for Payer: UHC Exchange |
$95.69
|
| Rate for Payer: UHC Medicaid |
$35.36
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
| Rate for Payer: UMR Bronson Commercial |
$49.22
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR IM INJECTION
|
Facility
|
IP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
151068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Advantage |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.69
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UMR Bronson Commercial |
$125.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR IM INJECTION
|
Facility
|
OP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
151068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.91 |
| Max. Negotiated Rate |
$272.40 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna Medicare |
$143.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: BCBS Complete |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$272.40
|
| Rate for Payer: BCN Commercial |
$272.40
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Advantage |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.69
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.67
|
| Rate for Payer: UHC Core |
$171.67
|
| Rate for Payer: UHC Exchange |
$171.67
|
| Rate for Payer: UMR Bronson Commercial |
$105.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
6462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Advantage |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.69
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UMR Bronson Commercial |
$125.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
6462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.91 |
| Max. Negotiated Rate |
$272.40 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna Medicare |
$143.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: BCBS Complete |
$114.50
|
| Rate for Payer: BCBS Trust/PPO |
$272.40
|
| Rate for Payer: BCN Commercial |
$272.40
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Advantage |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$229.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.69
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.67
|
| Rate for Payer: UHC Core |
$171.67
|
| Rate for Payer: UHC Exchange |
$171.67
|
| Rate for Payer: UMR Bronson Commercial |
$105.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 20930
|
| Min. Negotiated Rate |
$137.26 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna Commercial |
$155.86
|
| Rate for Payer: Aetna Medicare |
$252.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.86
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: BCN Commercial |
$137.26
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$188.45
|
| Rate for Payer: Priority Health SBD |
$188.45
|
| Rate for Payer: Priority Health Tiered Network |
$188.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.06
|
| Rate for Payer: UHC Core |
$207.06
|
| Rate for Payer: UHC Exchange |
$207.06
|
| Rate for Payer: UMR Bronson Commercial |
$231.84
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 20931
|
| Min. Negotiated Rate |
$62.62 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Aetna Commercial |
$132.70
|
| Rate for Payer: Aetna Medicare |
$102.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.60
|
| Rate for Payer: BCBS Complete |
$65.75
|
| Rate for Payer: BCBS MAPPO |
$99.03
|
| Rate for Payer: BCN Commercial |
$182.18
|
| Rate for Payer: BCN Medicare Advantage |
$99.03
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cofinity Commercial |
$132.70
|
| Rate for Payer: Cofinity Commercial |
$142.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.98
|
| Rate for Payer: Meridian Medicaid |
$65.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$108.93
|
| Rate for Payer: Nomi Health Commercial |
$118.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.25
|
| Rate for Payer: PACE SWMI |
$99.03
|
| Rate for Payer: PHP Commercial |
$138.64
|
| Rate for Payer: PHP Medicare Advantage |
$99.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$177.26
|
| Rate for Payer: Priority Health Medicare |
$99.03
|
| Rate for Payer: Priority Health SBD |
$177.26
|
| Rate for Payer: Priority Health Tiered Network |
$177.26
|
| Rate for Payer: Railroad Medicare Medicare |
$99.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.52
|
| Rate for Payer: UHC Core |
$197.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$99.03
|
| Rate for Payer: UHC Exchange |
$197.52
|
| Rate for Payer: UHC Medicaid |
$62.62
|
| Rate for Payer: UHCCP Medicaid |
$62.62
|
| Rate for Payer: UMR Bronson Commercial |
$211.14
|
|
|
PR ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS J2997
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$136.93 |
| Rate for Payer: Aetna Commercial |
$127.42
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.93
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$93.17
|
| Rate for Payer: BCN Commercial |
$90.82
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$127.42
|
| Rate for Payer: Cofinity Commercial |
$136.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Nomi Health Commercial |
$114.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Commercial |
$133.13
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.83
|
| Rate for Payer: UHC Core |
$93.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$93.83
|
| Rate for Payer: UMR Bronson Commercial |
$43.24
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 93784
|
| Min. Negotiated Rate |
$44.90 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Aetna Commercial |
$60.17
|
| Rate for Payer: Aetna Medicare |
$46.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.66
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$44.90
|
| Rate for Payer: BCN Commercial |
$68.72
|
| Rate for Payer: BCN Medicare Advantage |
$44.90
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$64.66
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.39
|
| Rate for Payer: Nomi Health Commercial |
$53.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.75
|
| Rate for Payer: PACE SWMI |
$44.90
|
| Rate for Payer: PHP Commercial |
$62.86
|
| Rate for Payer: PHP Medicare Advantage |
$44.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$65.32
|
| Rate for Payer: Priority Health Medicare |
$44.90
|
| Rate for Payer: Priority Health SBD |
$65.32
|
| Rate for Payer: Priority Health Tiered Network |
$65.32
|
| Rate for Payer: Railroad Medicare Medicare |
$44.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.68
|
| Rate for Payer: UHC Core |
$71.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.90
|
| Rate for Payer: UHC Exchange |
$71.68
|
| Rate for Payer: UMR Bronson Commercial |
$121.90
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 93790
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$30.11 |
| Rate for Payer: Aetna Commercial |
$23.60
|
| Rate for Payer: Aetna Medicare |
$18.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.36
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$17.61
|
| Rate for Payer: BCN Commercial |
$26.40
|
| Rate for Payer: BCN Medicare Advantage |
$17.61
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$23.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.37
|
| Rate for Payer: Nomi Health Commercial |
$21.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$17.61
|
| Rate for Payer: PHP Commercial |
$24.65
|
| Rate for Payer: PHP Medicare Advantage |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.08
|
| Rate for Payer: Priority Health Medicare |
$17.61
|
| Rate for Payer: Priority Health SBD |
$25.08
|
| Rate for Payer: Priority Health Tiered Network |
$25.08
|
| Rate for Payer: Railroad Medicare Medicare |
$17.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.11
|
| Rate for Payer: UHC Core |
$30.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.61
|
| Rate for Payer: UHC Exchange |
$30.11
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
