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Service Code NDC 72888001001
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $60.70
Max. Negotiated Rate $86.72
Rate for Payer: Aetna Commercial $81.90
Rate for Payer: Aetna New Business (MI Preferred) $62.63
Rate for Payer: Cash Price $77.08
Rate for Payer: Cofinity Commercial $67.44
Rate for Payer: Cofinity Commercial $82.86
Rate for Payer: Cofinity Medicare Advantage $67.44
Rate for Payer: Encore Health Key Benefits Commercial $77.08
Rate for Payer: Healthscope Commercial $86.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial $81.90
Rate for Payer: PHP Commercial $81.90
Rate for Payer: Priority Health Cigna Priority Health $62.63
Rate for Payer: Priority Health SBD $60.70
Service Code NDC 60687050301
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $160.57
Max. Negotiated Rate $229.39
Rate for Payer: Aetna Commercial $216.65
Rate for Payer: Aetna New Business (MI Preferred) $165.67
Rate for Payer: Cash Price $203.90
Rate for Payer: Cofinity Commercial $178.42
Rate for Payer: Cofinity Commercial $219.20
Rate for Payer: Cofinity Medicare Advantage $178.42
Rate for Payer: Encore Health Key Benefits Commercial $203.90
Rate for Payer: Healthscope Commercial $229.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial $216.65
Rate for Payer: PHP Commercial $216.65
Rate for Payer: Priority Health Cigna Priority Health $165.67
Rate for Payer: Priority Health SBD $160.57
Service Code NDC 50268010611
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $2.00
Max. Negotiated Rate $2.85
Rate for Payer: Aetna Commercial $2.69
Rate for Payer: Aetna New Business (MI Preferred) $2.06
Rate for Payer: Cash Price $2.54
Rate for Payer: Cofinity Commercial $2.22
Rate for Payer: Cofinity Commercial $2.73
Rate for Payer: Cofinity Medicare Advantage $2.22
Rate for Payer: Encore Health Key Benefits Commercial $2.54
Rate for Payer: Healthscope Commercial $2.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial $2.69
Rate for Payer: PHP Commercial $2.69
Rate for Payer: Priority Health Cigna Priority Health $2.06
Rate for Payer: Priority Health SBD $2.00
Service Code NDC 52817032010
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $82.91
Max. Negotiated Rate $118.44
Rate for Payer: Aetna Commercial $111.86
Rate for Payer: Aetna New Business (MI Preferred) $85.54
Rate for Payer: Cash Price $105.28
Rate for Payer: Cofinity Commercial $113.18
Rate for Payer: Cofinity Commercial $92.12
Rate for Payer: Cofinity Medicare Advantage $92.12
Rate for Payer: Encore Health Key Benefits Commercial $105.28
Rate for Payer: Healthscope Commercial $118.44
Rate for Payer: Multiplan/Beech St/PHCS Commercial $111.86
Rate for Payer: PHP Commercial $111.86
Rate for Payer: Priority Health Cigna Priority Health $85.54
Rate for Payer: Priority Health SBD $82.91
Service Code NDC 60687081501
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $256.16
Max. Negotiated Rate $365.94
Rate for Payer: Aetna Commercial $345.61
Rate for Payer: Aetna New Business (MI Preferred) $264.29
Rate for Payer: Cash Price $325.28
Rate for Payer: Cofinity Commercial $284.62
Rate for Payer: Cofinity Commercial $349.68
Rate for Payer: Cofinity Medicare Advantage $284.62
Rate for Payer: Encore Health Key Benefits Commercial $325.28
Rate for Payer: Healthscope Commercial $365.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial $345.61
Rate for Payer: PHP Commercial $345.61
Rate for Payer: Priority Health Cigna Priority Health $264.29
Rate for Payer: Priority Health SBD $256.16
Service Code NDC 60687081501
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $162.64
Max. Negotiated Rate $365.94
Rate for Payer: Aetna Commercial $345.61
Rate for Payer: Aetna Medicare $203.30
Rate for Payer: Aetna New Business (MI Preferred) $264.29
Rate for Payer: BCBS Complete $162.64
Rate for Payer: Cash Price $325.28
Rate for Payer: Cofinity Commercial $284.62
Rate for Payer: Cofinity Commercial $349.68
Rate for Payer: Cofinity Medicare Advantage $284.62
Rate for Payer: Encore Health Key Benefits Commercial $325.28
Rate for Payer: Healthscope Commercial $365.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial $345.61
Rate for Payer: PHP Commercial $345.61
Rate for Payer: Priority Health Cigna Priority Health $264.29
Rate for Payer: Priority Health SBD $256.16
Service Code NDC 60687081511
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $1.63
Max. Negotiated Rate $3.66
Rate for Payer: Aetna Commercial $3.46
Rate for Payer: Aetna Medicare $2.04
Rate for Payer: Aetna New Business (MI Preferred) $2.65
Rate for Payer: BCBS Complete $1.63
Rate for Payer: Cash Price $3.26
Rate for Payer: Cofinity Commercial $2.85
Rate for Payer: Cofinity Commercial $3.50
Rate for Payer: Cofinity Medicare Advantage $2.85
Rate for Payer: Encore Health Key Benefits Commercial $3.26
Rate for Payer: Healthscope Commercial $3.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial $3.46
Rate for Payer: PHP Commercial $3.46
Rate for Payer: Priority Health Cigna Priority Health $2.65
Rate for Payer: Priority Health SBD $2.56
Service Code NDC 72888001001
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $38.54
Max. Negotiated Rate $86.72
Rate for Payer: Aetna Commercial $81.90
Rate for Payer: Aetna Medicare $48.18
Rate for Payer: Aetna New Business (MI Preferred) $62.63
Rate for Payer: BCBS Complete $38.54
Rate for Payer: Cash Price $77.08
Rate for Payer: Cofinity Commercial $67.44
Rate for Payer: Cofinity Commercial $82.86
Rate for Payer: Cofinity Medicare Advantage $67.44
Rate for Payer: Encore Health Key Benefits Commercial $77.08
Rate for Payer: Healthscope Commercial $86.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial $81.90
Rate for Payer: PHP Commercial $81.90
Rate for Payer: Priority Health Cigna Priority Health $62.63
Rate for Payer: Priority Health SBD $60.70
Service Code NDC 60687050311
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $1.02
Max. Negotiated Rate $2.30
Rate for Payer: Aetna Commercial $2.17
Rate for Payer: Aetna Medicare $1.28
Rate for Payer: Aetna New Business (MI Preferred) $1.66
Rate for Payer: BCBS Complete $1.02
Rate for Payer: Cash Price $2.04
Rate for Payer: Cofinity Commercial $1.78
Rate for Payer: Cofinity Commercial $2.19
Rate for Payer: Cofinity Medicare Advantage $1.78
Rate for Payer: Encore Health Key Benefits Commercial $2.04
Rate for Payer: Healthscope Commercial $2.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial $2.17
Rate for Payer: PHP Commercial $2.17
Rate for Payer: Priority Health Cigna Priority Health $1.66
Rate for Payer: Priority Health SBD $1.61
Service Code NDC 00904647561
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $214.86
Max. Negotiated Rate $306.94
Rate for Payer: Aetna Commercial $289.89
Rate for Payer: Aetna New Business (MI Preferred) $221.68
Rate for Payer: Cash Price $272.84
Rate for Payer: Cofinity Commercial $238.74
Rate for Payer: Cofinity Commercial $293.30
Rate for Payer: Cofinity Medicare Advantage $238.74
Rate for Payer: Encore Health Key Benefits Commercial $272.84
Rate for Payer: Healthscope Commercial $306.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial $289.89
Rate for Payer: PHP Commercial $289.89
Rate for Payer: Priority Health Cigna Priority Health $221.68
Rate for Payer: Priority Health SBD $214.86
Service Code NDC 50268010615
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $99.65
Max. Negotiated Rate $142.36
Rate for Payer: Aetna Commercial $134.45
Rate for Payer: Aetna New Business (MI Preferred) $102.82
Rate for Payer: Cash Price $126.54
Rate for Payer: Cofinity Commercial $110.73
Rate for Payer: Cofinity Commercial $136.03
Rate for Payer: Cofinity Medicare Advantage $110.73
Rate for Payer: Encore Health Key Benefits Commercial $126.54
Rate for Payer: Healthscope Commercial $142.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial $134.45
Rate for Payer: PHP Commercial $134.45
Rate for Payer: Priority Health Cigna Priority Health $102.82
Rate for Payer: Priority Health SBD $99.65
Service Code NDC 00172409660
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $112.52
Max. Negotiated Rate $160.74
Rate for Payer: Aetna Commercial $151.81
Rate for Payer: Aetna New Business (MI Preferred) $116.09
Rate for Payer: Cash Price $142.88
Rate for Payer: Cofinity Commercial $125.02
Rate for Payer: Cofinity Commercial $153.60
Rate for Payer: Cofinity Medicare Advantage $125.02
Rate for Payer: Encore Health Key Benefits Commercial $142.88
Rate for Payer: Healthscope Commercial $160.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial $151.81
Rate for Payer: PHP Commercial $151.81
Rate for Payer: Priority Health Cigna Priority Health $116.09
Rate for Payer: Priority Health SBD $112.52
Service Code NDC 50268010611
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $1.27
Max. Negotiated Rate $2.85
Rate for Payer: Aetna Commercial $2.69
Rate for Payer: Aetna Medicare $1.58
Rate for Payer: Aetna New Business (MI Preferred) $2.06
Rate for Payer: BCBS Complete $1.27
Rate for Payer: Cash Price $2.54
Rate for Payer: Cofinity Commercial $2.22
Rate for Payer: Cofinity Commercial $2.73
Rate for Payer: Cofinity Medicare Advantage $2.22
Rate for Payer: Encore Health Key Benefits Commercial $2.54
Rate for Payer: Healthscope Commercial $2.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial $2.69
Rate for Payer: PHP Commercial $2.69
Rate for Payer: Priority Health Cigna Priority Health $2.06
Rate for Payer: Priority Health SBD $2.00
Service Code NDC 00904647561
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $136.42
Max. Negotiated Rate $306.94
Rate for Payer: Aetna Commercial $289.89
Rate for Payer: Aetna Medicare $170.52
Rate for Payer: Aetna New Business (MI Preferred) $221.68
Rate for Payer: BCBS Complete $136.42
Rate for Payer: Cash Price $272.84
Rate for Payer: Cofinity Commercial $238.74
Rate for Payer: Cofinity Commercial $293.30
Rate for Payer: Cofinity Medicare Advantage $238.74
Rate for Payer: Encore Health Key Benefits Commercial $272.84
Rate for Payer: Healthscope Commercial $306.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial $289.89
Rate for Payer: PHP Commercial $289.89
Rate for Payer: Priority Health Cigna Priority Health $221.68
Rate for Payer: Priority Health SBD $214.86
Service Code NDC 00172409680
Hospital Charge Code 860
Hospital Revenue Code 637
Min. Negotiated Rate $1,065.96
Max. Negotiated Rate $1,522.80
Rate for Payer: Aetna Commercial $1,438.20
Rate for Payer: Aetna New Business (MI Preferred) $1,099.80
Rate for Payer: Cash Price $1,353.60
Rate for Payer: Cofinity Commercial $1,184.40
Rate for Payer: Cofinity Commercial $1,455.12
Rate for Payer: Cofinity Medicare Advantage $1,184.40
Rate for Payer: Encore Health Key Benefits Commercial $1,353.60
Rate for Payer: Healthscope Commercial $1,522.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial $1,438.20
Rate for Payer: PHP Commercial $1,438.20
Rate for Payer: Priority Health Cigna Priority Health $1,099.80
Rate for Payer: Priority Health SBD $1,065.96
Service Code NDC 00904647661
Hospital Charge Code 861
Hospital Revenue Code 637
Min. Negotiated Rate $155.43
Max. Negotiated Rate $222.05
Rate for Payer: Aetna Commercial $209.71
Rate for Payer: Aetna New Business (MI Preferred) $160.37
Rate for Payer: Cash Price $197.38
Rate for Payer: Cofinity Commercial $172.70
Rate for Payer: Cofinity Commercial $212.18
Rate for Payer: Cofinity Medicare Advantage $172.70
Rate for Payer: Encore Health Key Benefits Commercial $197.38
Rate for Payer: Healthscope Commercial $222.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial $209.71
Rate for Payer: PHP Commercial $209.71
Rate for Payer: Priority Health Cigna Priority Health $160.37
Rate for Payer: Priority Health SBD $155.43
Service Code NDC 00904647661
Hospital Charge Code 861
Hospital Revenue Code 637
Min. Negotiated Rate $98.69
Max. Negotiated Rate $222.05
Rate for Payer: Aetna Commercial $209.71
Rate for Payer: Aetna Medicare $123.36
Rate for Payer: Aetna New Business (MI Preferred) $160.37
Rate for Payer: BCBS Complete $98.69
Rate for Payer: Cash Price $197.38
Rate for Payer: Cofinity Commercial $172.70
Rate for Payer: Cofinity Commercial $212.18
Rate for Payer: Cofinity Medicare Advantage $172.70
Rate for Payer: Encore Health Key Benefits Commercial $197.38
Rate for Payer: Healthscope Commercial $222.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial $209.71
Rate for Payer: PHP Commercial $209.71
Rate for Payer: Priority Health Cigna Priority Health $160.37
Rate for Payer: Priority Health SBD $155.43
Service Code NDC 50268010515
Hospital Charge Code 186653
Hospital Revenue Code 637
Min. Negotiated Rate $164.96
Max. Negotiated Rate $235.66
Rate for Payer: Aetna Commercial $222.56
Rate for Payer: Aetna New Business (MI Preferred) $170.20
Rate for Payer: Cash Price $209.47
Rate for Payer: Cofinity Commercial $183.29
Rate for Payer: Cofinity Commercial $225.18
Rate for Payer: Cofinity Medicare Advantage $183.29
Rate for Payer: Encore Health Key Benefits Commercial $209.47
Rate for Payer: Healthscope Commercial $235.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial $222.56
Rate for Payer: PHP Commercial $222.56
Rate for Payer: Priority Health Cigna Priority Health $170.20
Rate for Payer: Priority Health SBD $164.96
Service Code NDC 50268010515
Hospital Charge Code 186653
Hospital Revenue Code 637
Min. Negotiated Rate $104.74
Max. Negotiated Rate $235.66
Rate for Payer: Aetna Commercial $222.56
Rate for Payer: Aetna Medicare $130.92
Rate for Payer: Aetna New Business (MI Preferred) $170.20
Rate for Payer: BCBS Complete $104.74
Rate for Payer: Cash Price $209.47
Rate for Payer: Cofinity Commercial $183.29
Rate for Payer: Cofinity Commercial $225.18
Rate for Payer: Cofinity Medicare Advantage $183.29
Rate for Payer: Encore Health Key Benefits Commercial $209.47
Rate for Payer: Healthscope Commercial $235.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial $222.56
Rate for Payer: PHP Commercial $222.56
Rate for Payer: Priority Health Cigna Priority Health $170.20
Rate for Payer: Priority Health SBD $164.96
Service Code NDC 50268010511
Hospital Charge Code 186653
Hospital Revenue Code 637
Min. Negotiated Rate $2.10
Max. Negotiated Rate $4.72
Rate for Payer: Aetna Commercial $4.45
Rate for Payer: Aetna Medicare $2.62
Rate for Payer: Aetna New Business (MI Preferred) $3.41
Rate for Payer: BCBS Complete $2.10
Rate for Payer: Cash Price $4.19
Rate for Payer: Cofinity Commercial $3.67
Rate for Payer: Cofinity Commercial $4.51
Rate for Payer: Cofinity Medicare Advantage $3.67
Rate for Payer: Encore Health Key Benefits Commercial $4.19
Rate for Payer: Healthscope Commercial $4.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial $4.45
Rate for Payer: PHP Commercial $4.45
Rate for Payer: Priority Health Cigna Priority Health $3.41
Rate for Payer: Priority Health SBD $3.30
Service Code NDC 50268010511
Hospital Charge Code 186653
Hospital Revenue Code 637
Min. Negotiated Rate $3.30
Max. Negotiated Rate $4.72
Rate for Payer: Aetna Commercial $4.45
Rate for Payer: Aetna New Business (MI Preferred) $3.41
Rate for Payer: Cash Price $4.19
Rate for Payer: Cofinity Commercial $3.67
Rate for Payer: Cofinity Commercial $4.51
Rate for Payer: Cofinity Medicare Advantage $3.67
Rate for Payer: Encore Health Key Benefits Commercial $4.19
Rate for Payer: Healthscope Commercial $4.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial $4.45
Rate for Payer: PHP Commercial $4.45
Rate for Payer: Priority Health Cigna Priority Health $3.41
Rate for Payer: Priority Health SBD $3.30
Service Code NDC 00065053001
Hospital Charge Code 10780
Hospital Revenue Code 250
Min. Negotiated Rate $35.45
Max. Negotiated Rate $79.76
Rate for Payer: Aetna Commercial $75.33
Rate for Payer: Aetna Medicare $44.31
Rate for Payer: Aetna New Business (MI Preferred) $57.60
Rate for Payer: BCBS Complete $35.45
Rate for Payer: Cash Price $70.90
Rate for Payer: Cofinity Commercial $62.03
Rate for Payer: Cofinity Commercial $76.21
Rate for Payer: Cofinity Medicare Advantage $62.03
Rate for Payer: Encore Health Key Benefits Commercial $70.90
Rate for Payer: Healthscope Commercial $79.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial $75.33
Rate for Payer: PHP Commercial $75.33
Rate for Payer: Priority Health Cigna Priority Health $57.60
Rate for Payer: Priority Health SBD $55.83
Service Code NDC 00065053001
Hospital Charge Code 10780
Hospital Revenue Code 250
Min. Negotiated Rate $55.83
Max. Negotiated Rate $79.76
Rate for Payer: Aetna Commercial $75.33
Rate for Payer: Aetna New Business (MI Preferred) $57.60
Rate for Payer: Cash Price $70.90
Rate for Payer: Cofinity Commercial $62.03
Rate for Payer: Cofinity Commercial $76.21
Rate for Payer: Cofinity Medicare Advantage $62.03
Rate for Payer: Encore Health Key Benefits Commercial $70.90
Rate for Payer: Healthscope Commercial $79.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial $75.33
Rate for Payer: PHP Commercial $75.33
Rate for Payer: Priority Health Cigna Priority Health $57.60
Rate for Payer: Priority Health SBD $55.83
Service Code NDC 00002418230
Hospital Charge Code 186973
Hospital Revenue Code 637
Min. Negotiated Rate $6,133.84
Max. Negotiated Rate $8,762.63
Rate for Payer: Aetna Commercial $8,275.82
Rate for Payer: Aetna New Business (MI Preferred) $6,328.57
Rate for Payer: Cash Price $7,789.01
Rate for Payer: Cofinity Commercial $6,815.38
Rate for Payer: Cofinity Commercial $8,373.18
Rate for Payer: Cofinity Medicare Advantage $6,815.38
Rate for Payer: Encore Health Key Benefits Commercial $7,789.01
Rate for Payer: Healthscope Commercial $8,762.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial $8,275.82
Rate for Payer: PHP Commercial $8,275.82
Rate for Payer: Priority Health Cigna Priority Health $6,328.57
Rate for Payer: Priority Health SBD $6,133.84
Service Code NDC 00002418230
Hospital Charge Code 186973
Hospital Revenue Code 637
Min. Negotiated Rate $3,894.50
Max. Negotiated Rate $8,762.63
Rate for Payer: Aetna Commercial $8,275.82
Rate for Payer: Aetna Medicare $4,868.13
Rate for Payer: Aetna New Business (MI Preferred) $6,328.57
Rate for Payer: BCBS Complete $3,894.50
Rate for Payer: Cash Price $7,789.01
Rate for Payer: Cofinity Commercial $6,815.38
Rate for Payer: Cofinity Commercial $8,373.18
Rate for Payer: Cofinity Medicare Advantage $6,815.38
Rate for Payer: Encore Health Key Benefits Commercial $7,789.01
Rate for Payer: Healthscope Commercial $8,762.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial $8,275.82
Rate for Payer: PHP Commercial $8,275.82
Rate for Payer: Priority Health Cigna Priority Health $6,328.57
Rate for Payer: Priority Health SBD $6,133.84