|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$91.50 |
| Rate for Payer: Aetna Commercial |
$54.14
|
| Rate for Payer: Aetna Medicare |
$42.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.18
|
| Rate for Payer: BCBS Complete |
$27.06
|
| Rate for Payer: BCBS MAPPO |
$40.40
|
| Rate for Payer: BCN Commercial |
$62.25
|
| Rate for Payer: BCN Medicare Advantage |
$40.40
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$54.14
|
| Rate for Payer: Cofinity Commercial |
$58.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.42
|
| Rate for Payer: Meridian Medicaid |
$27.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.44
|
| Rate for Payer: Nomi Health Commercial |
$48.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.50
|
| Rate for Payer: PACE SWMI |
$40.40
|
| Rate for Payer: PHP Commercial |
$56.56
|
| Rate for Payer: PHP Medicare Advantage |
$40.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$71.81
|
| Rate for Payer: Priority Health Medicare |
$40.40
|
| Rate for Payer: Priority Health SBD |
$71.81
|
| Rate for Payer: Priority Health Tiered Network |
$71.81
|
| Rate for Payer: Railroad Medicare Medicare |
$40.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.11
|
| Rate for Payer: UHC Core |
$62.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.40
|
| Rate for Payer: UHC Exchange |
$62.11
|
| Rate for Payer: UHC Medicaid |
$25.77
|
| Rate for Payer: UHCCP Medicaid |
$25.77
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$63.38 |
| Max. Negotiated Rate |
$303.75 |
| Rate for Payer: Aetna Commercial |
$84.93
|
| Rate for Payer: Aetna Medicare |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.27
|
| Rate for Payer: BCBS MAPPO |
$63.38
|
| Rate for Payer: BCN Commercial |
$95.61
|
| Rate for Payer: BCN Medicare Advantage |
$63.38
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cash Price |
$324.00
|
| Rate for Payer: Cofinity Commercial |
$91.27
|
| Rate for Payer: Cofinity Commercial |
$84.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.72
|
| Rate for Payer: Nomi Health Commercial |
$76.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$303.75
|
| Rate for Payer: PACE SWMI |
$63.38
|
| Rate for Payer: PHP Commercial |
$88.73
|
| Rate for Payer: PHP Medicare Advantage |
$63.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$104.16
|
| Rate for Payer: Priority Health Medicare |
$63.38
|
| Rate for Payer: Priority Health SBD |
$104.16
|
| Rate for Payer: Priority Health Tiered Network |
$104.16
|
| Rate for Payer: Railroad Medicare Medicare |
$63.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.81
|
| Rate for Payer: UHC Core |
$114.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$63.38
|
| Rate for Payer: UHC Exchange |
$114.81
|
| Rate for Payer: UMR Bronson Commercial |
$186.30
|
|
|
PRENATAL VIT 14-FERROUS FUM 29 MG IRON-FOLIC ACID 1 MG CHEWABLE TABLET
|
Facility
|
IP
|
$225.51
|
|
|
Service Code
|
NDC 13811001490
|
| Hospital Charge Code |
115087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.22 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna American Axle |
$146.58
|
| Rate for Payer: Aetna Commercial |
$191.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.58
|
| Rate for Payer: Cash Price |
$180.41
|
| Rate for Payer: Cofinity Advantage |
$157.86
|
| Rate for Payer: Cofinity Commercial |
$193.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.41
|
| Rate for Payer: Healthscope Commercial |
$202.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.13
|
| Rate for Payer: PHP Commercial |
$191.68
|
| Rate for Payer: Priority Health SBD |
$142.07
|
| Rate for Payer: UMR Bronson Commercial |
$99.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.13
|
|
|
PRENATAL VIT 14-FERROUS FUM 29 MG IRON-FOLIC ACID 1 MG CHEWABLE TABLET
|
Facility
|
OP
|
$225.51
|
|
|
Service Code
|
NDC 13811001490
|
| Hospital Charge Code |
115087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$202.96 |
| Rate for Payer: Aetna American Axle |
$146.58
|
| Rate for Payer: Aetna Commercial |
$191.68
|
| Rate for Payer: Aetna Medicare |
$112.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.58
|
| Rate for Payer: BCBS Complete |
$90.20
|
| Rate for Payer: Cash Price |
$180.41
|
| Rate for Payer: Cofinity Advantage |
$157.86
|
| Rate for Payer: Cofinity Commercial |
$193.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.41
|
| Rate for Payer: Healthscope Commercial |
$202.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.13
|
| Rate for Payer: PHP Commercial |
$191.68
|
| Rate for Payer: Priority Health SBD |
$142.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.58
|
| Rate for Payer: UHC Core |
$117.49
|
| Rate for Payer: UHC Exchange |
$88.63
|
| Rate for Payer: UMR Bronson Commercial |
$83.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.13
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
NDC 77333071510
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.12 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: BCBS Complete |
$150.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Advantage |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.40
|
| Rate for Payer: UHC Core |
$195.90
|
| Rate for Payer: UHC Exchange |
$147.77
|
| Rate for Payer: UMR Bronson Commercial |
$139.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
IP
|
$36.66
|
|
|
Service Code
|
NDC 00904531346
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$32.99 |
| Rate for Payer: Aetna American Axle |
$23.83
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: UMR Bronson Commercial |
$16.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.50
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 57896057501
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna American Axle |
$62.63
|
| 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 Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UMR Bronson Commercial |
$42.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
OP
|
$36.66
|
|
|
Service Code
|
NDC 00904531346
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$32.99 |
| Rate for Payer: Aetna American Axle |
$23.83
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.83
|
| Rate for Payer: UHC Core |
$19.10
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UMR Bronson Commercial |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.50
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
OP
|
$3.76
|
|
|
Service Code
|
NDC 77333071525
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Advantage |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.82
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health SBD |
$2.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.44
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.82
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
OP
|
$70.50
|
|
|
Service Code
|
NDC 00904531360
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: BCBS Complete |
$28.20
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.83
|
| Rate for Payer: UHC Core |
$36.73
|
| Rate for Payer: UHC Exchange |
$27.71
|
| Rate for Payer: UMR Bronson Commercial |
$26.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
IP
|
$3.76
|
|
|
Service Code
|
NDC 77333071525
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Aetna American Axle |
$2.44
|
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.44
|
| Rate for Payer: Cash Price |
$3.01
|
| Rate for Payer: Cofinity Advantage |
$2.63
|
| Rate for Payer: Cofinity Commercial |
$3.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.01
|
| Rate for Payer: Healthscope Commercial |
$3.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.82
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health SBD |
$2.37
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.82
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
NDC 77333071510
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$165.44 |
| Max. Negotiated Rate |
$338.40 |
| Rate for Payer: Aetna American Axle |
$244.40
|
| Rate for Payer: Aetna Commercial |
$319.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.40
|
| Rate for Payer: Cash Price |
$300.80
|
| Rate for Payer: Cofinity Advantage |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$323.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.80
|
| Rate for Payer: Healthscope Commercial |
$338.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.00
|
| Rate for Payer: PHP Commercial |
$319.60
|
| Rate for Payer: Priority Health SBD |
$236.88
|
| Rate for Payer: UMR Bronson Commercial |
$165.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$282.00
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 57896057501
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.65 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna American Axle |
$62.63
|
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| 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 Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.63
|
| Rate for Payer: UHC Core |
$50.20
|
| Rate for Payer: UHC Exchange |
$37.87
|
| Rate for Payer: UMR Bronson Commercial |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
IP
|
$70.50
|
|
|
Service Code
|
NDC 00904531360
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna American Axle |
$45.83
|
| Rate for Payer: Aetna Commercial |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.83
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cofinity Advantage |
$49.35
|
| Rate for Payer: Cofinity Commercial |
$60.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.40
|
| Rate for Payer: Healthscope Commercial |
$63.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.88
|
| Rate for Payer: PHP Commercial |
$59.92
|
| Rate for Payer: Priority Health SBD |
$44.41
|
| Rate for Payer: UMR Bronson Commercial |
$31.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.88
|
|
|
PRENATAL VITS NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET
|
Facility
|
OP
|
$36.66
|
|
|
Service Code
|
NDC 00904531346
|
| Hospital Charge Code |
177116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.56 |
| Max. Negotiated Rate |
$32.99 |
| Rate for Payer: Aetna American Axle |
$23.83
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna Medicare |
$18.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: BCBS Complete |
$14.66
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.83
|
| Rate for Payer: UHC Core |
$19.10
|
| Rate for Payer: UHC Exchange |
$14.41
|
| Rate for Payer: UMR Bronson Commercial |
$13.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.50
|
|
|
PRENATAL VITS NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET
|
Facility
|
IP
|
$36.66
|
|
|
Service Code
|
NDC 00904531346
|
| Hospital Charge Code |
177116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$32.99 |
| Rate for Payer: Aetna American Axle |
$23.83
|
| Rate for Payer: Aetna Commercial |
$31.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Cash Price |
$29.33
|
| Rate for Payer: Cofinity Advantage |
$25.66
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.33
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.50
|
| Rate for Payer: PHP Commercial |
$31.16
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: UMR Bronson Commercial |
$16.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.50
|
|
|
PRENATAL VITS NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET
|
Facility
|
OP
|
$179.78
|
|
|
Service Code
|
NDC 07610010418
|
| Hospital Charge Code |
177116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.52 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna Medicare |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: BCBS Complete |
$71.91
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Advantage |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.82
|
| Rate for Payer: Healthscope Commercial |
$161.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.84
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.86
|
| Rate for Payer: UHC Core |
$93.67
|
| Rate for Payer: UHC Exchange |
$70.65
|
| Rate for Payer: UMR Bronson Commercial |
$66.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
PRENATAL VITS NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET
|
Facility
|
IP
|
$179.78
|
|
|
Service Code
|
NDC 07610010418
|
| Hospital Charge Code |
177116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$161.80 |
| Rate for Payer: Aetna American Axle |
$116.86
|
| Rate for Payer: Aetna Commercial |
$152.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.86
|
| Rate for Payer: Cash Price |
$143.82
|
| Rate for Payer: Cofinity Advantage |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$143.82
|
| Rate for Payer: Healthscope Commercial |
$161.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$125.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$134.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$152.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.84
|
| Rate for Payer: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| Rate for Payer: UMR Bronson Commercial |
$79.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$134.84
|
|
|
PR ENDOBRONCHIAL U/S ADD-ON
|
Professional
|
Both
|
$478.00
|
|
|
Service Code
|
HCPCS 31620
|
| Min. Negotiated Rate |
$191.20 |
| Max. Negotiated Rate |
$358.50 |
| Rate for Payer: Aetna Medicare |
$239.00
|
| Rate for Payer: BCBS Complete |
$191.20
|
| Rate for Payer: Cash Price |
$382.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$358.50
|
| Rate for Payer: UMR Bronson Commercial |
$219.88
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
57505
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$240.75 |
| Rate for Payer: Aetna Commercial |
$128.32
|
| Rate for Payer: Aetna Medicare |
$99.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.89
|
| Rate for Payer: BCBS Complete |
$66.64
|
| Rate for Payer: BCBS MAPPO |
$95.76
|
| Rate for Payer: BCN Commercial |
$129.59
|
| Rate for Payer: BCN Medicare Advantage |
$95.76
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cofinity Commercial |
$128.32
|
| Rate for Payer: Cofinity Commercial |
$137.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.55
|
| Rate for Payer: Meridian Medicaid |
$66.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.34
|
| Rate for Payer: Nomi Health Commercial |
$114.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.75
|
| Rate for Payer: PACE SWMI |
$95.76
|
| Rate for Payer: PHP Commercial |
$134.06
|
| Rate for Payer: PHP Medicare Advantage |
$95.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$166.43
|
| Rate for Payer: Priority Health Medicare |
$95.76
|
| Rate for Payer: Priority Health SBD |
$166.43
|
| Rate for Payer: Priority Health Tiered Network |
$166.43
|
| Rate for Payer: Railroad Medicare Medicare |
$95.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.93
|
| Rate for Payer: UHC Core |
$173.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.76
|
| Rate for Payer: UHC Exchange |
$173.93
|
| Rate for Payer: UHC Medicaid |
$63.47
|
| Rate for Payer: UHCCP Medicaid |
$63.47
|
| Rate for Payer: UMR Bronson Commercial |
$147.66
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$288.90 |
| Rate for Payer: Aetna American Axle |
$208.65
|
| Rate for Payer: Aetna Commercial |
$272.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.65
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cofinity Advantage |
$224.70
|
| Rate for Payer: Cofinity Commercial |
$276.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.80
|
| Rate for Payer: Healthscope Commercial |
$288.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.75
|
| Rate for Payer: PHP Commercial |
$272.85
|
| Rate for Payer: Priority Health SBD |
$202.23
|
| Rate for Payer: UMR Bronson Commercial |
$141.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.75
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS 57505
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$240.75 |
| Rate for Payer: Aetna Commercial |
$128.32
|
| Rate for Payer: Aetna Medicare |
$99.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.89
|
| Rate for Payer: BCBS Complete |
$66.64
|
| Rate for Payer: BCBS MAPPO |
$95.76
|
| Rate for Payer: BCN Commercial |
$129.59
|
| Rate for Payer: BCN Medicare Advantage |
$95.76
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cofinity Commercial |
$128.32
|
| Rate for Payer: Cofinity Commercial |
$137.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.55
|
| Rate for Payer: Meridian Medicaid |
$66.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.34
|
| Rate for Payer: Nomi Health Commercial |
$114.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.75
|
| Rate for Payer: PACE SWMI |
$95.76
|
| Rate for Payer: PHP Commercial |
$134.06
|
| Rate for Payer: PHP Medicare Advantage |
$95.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$166.43
|
| Rate for Payer: Priority Health Medicare |
$95.76
|
| Rate for Payer: Priority Health SBD |
$166.43
|
| Rate for Payer: Priority Health Tiered Network |
$166.43
|
| Rate for Payer: Railroad Medicare Medicare |
$95.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.93
|
| Rate for Payer: UHC Core |
$173.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.76
|
| Rate for Payer: UHC Exchange |
$173.93
|
| Rate for Payer: UHC Medicaid |
$63.47
|
| Rate for Payer: UHCCP Medicaid |
$63.47
|
| Rate for Payer: UMR Bronson Commercial |
$147.66
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$118.77 |
| Max. Negotiated Rate |
$2,967.88 |
| Rate for Payer: Aetna American Axle |
$208.65
|
| Rate for Payer: Aetna Commercial |
$272.85
|
| Rate for Payer: Aetna Medicare |
$954.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,147.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,147.17
|
| Rate for Payer: BCBS Complete |
$504.02
|
| Rate for Payer: BCBS MAPPO |
$917.74
|
| Rate for Payer: BCBS Trust/PPO |
$953.20
|
| Rate for Payer: BCCCP Commercial |
$145.60
|
| Rate for Payer: BCN Commercial |
$953.20
|
| Rate for Payer: BCN Medicare Advantage |
$917.74
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cofinity Advantage |
$224.70
|
| Rate for Payer: Cofinity Commercial |
$276.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$917.74
|
| Rate for Payer: Healthscope Commercial |
$288.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.75
|
| Rate for Payer: Mclaren Medicaid |
$917.74
|
| Rate for Payer: Mclaren Medicare |
$917.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$963.63
|
| Rate for Payer: Meridian Medicaid |
$963.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,055.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,009.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.85
|
| Rate for Payer: Nomi Health Commercial |
$2,753.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.75
|
| Rate for Payer: PACE Medicare |
$871.85
|
| Rate for Payer: PACE SWMI |
$917.74
|
| Rate for Payer: PHP Commercial |
$272.85
|
| Rate for Payer: PHP Medicare Advantage |
$917.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,967.88
|
| Rate for Payer: Priority Health Medicare |
$917.74
|
| Rate for Payer: Priority Health SBD |
$202.23
|
| Rate for Payer: Priority Health Tiered Network |
$2,374.30
|
| Rate for Payer: Railroad Medicare Medicare |
$917.74
|
| Rate for Payer: UHC Medicaid |
$479.98
|
| Rate for Payer: UHCCP Medicaid |
$479.98
|
| Rate for Payer: UMR Bronson Commercial |
$118.77
|
| Rate for Payer: VA VA |
$917.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.75
|
|
|
PR END OF LIFE COUNSELING
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS S0257
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$47.64 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.85
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCN Commercial |
$29.04
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$47.64
|
| Rate for Payer: Priority Health SBD |
$47.64
|
| Rate for Payer: Priority Health Tiered Network |
$47.64
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 92979
|
| Min. Negotiated Rate |
$110.06 |
| Max. Negotiated Rate |
$284.12 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.41
|
| Rate for Payer: BCN Commercial |
$110.06
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$227.18
|
| Rate for Payer: Priority Health SBD |
$227.18
|
| Rate for Payer: Priority Health Tiered Network |
$227.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.12
|
| Rate for Payer: UHC Core |
$284.12
|
| Rate for Payer: UHC Exchange |
$284.12
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
