|
PR ELVTN DEPRS SKL FX W/RPR DURA&/DBRDMT BRN
|
Professional
|
Both
|
$6,878.00
|
|
|
Service Code
|
HCPCS 62010
|
| Min. Negotiated Rate |
$1,004.93 |
| Max. Negotiated Rate |
$4,470.70 |
| Rate for Payer: Aetna Commercial |
$2,045.70
|
| Rate for Payer: Aetna Medicare |
$1,587.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,045.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,198.36
|
| Rate for Payer: BCBS Complete |
$1,055.18
|
| Rate for Payer: BCBS MAPPO |
$1,526.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,117.43
|
| Rate for Payer: BCN Commercial |
$3,154.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,526.64
|
| Rate for Payer: Cash Price |
$5,502.40
|
| Rate for Payer: Cash Price |
$5,502.40
|
| Rate for Payer: Cofinity Commercial |
$2,045.70
|
| Rate for Payer: Cofinity Commercial |
$2,198.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,526.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,602.97
|
| Rate for Payer: Meridian Medicaid |
$1,055.18
|
| Rate for Payer: Nomi Health Commercial |
$1,831.97
|
| Rate for Payer: PACE SWMI |
$1,526.64
|
| Rate for Payer: PHP Commercial |
$2,137.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,526.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,004.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,470.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,671.25
|
| Rate for Payer: Priority Health Medicare |
$1,526.64
|
| Rate for Payer: Priority Health Narrow Network |
$2,671.25
|
| Rate for Payer: Priority Health SBD |
$2,671.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,526.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,526.64
|
| Rate for Payer: UHCCP Medicaid |
$1,004.93
|
| Rate for Payer: UMR Bronson Commercial |
$3,163.88
|
|
|
PR E/M ANNUAL NURSING FACILITY ASSESS STABLE 30 MIN
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 99318
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: UMR Bronson Commercial |
$66.70
|
|
|
PR EMBLC/THRMBC AX BRACH INNOMINATE SUBCLA ART
|
Professional
|
Both
|
$2,337.00
|
|
|
Service Code
|
HCPCS 34101
|
| Min. Negotiated Rate |
$374.24 |
| Max. Negotiated Rate |
$1,746.03 |
| Rate for Payer: Aetna Commercial |
$766.27
|
| Rate for Payer: Aetna Medicare |
$594.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$766.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.45
|
| Rate for Payer: BCBS Complete |
$392.95
|
| Rate for Payer: BCBS MAPPO |
$571.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,746.03
|
| Rate for Payer: BCN Commercial |
$854.70
|
| Rate for Payer: BCN Medicare Advantage |
$571.84
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Cash Price |
$1,869.60
|
| Rate for Payer: Cofinity Commercial |
$766.27
|
| Rate for Payer: Cofinity Commercial |
$823.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$571.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$600.43
|
| Rate for Payer: Meridian Medicaid |
$392.95
|
| Rate for Payer: Nomi Health Commercial |
$686.21
|
| Rate for Payer: PACE SWMI |
$571.84
|
| Rate for Payer: PHP Commercial |
$800.58
|
| Rate for Payer: PHP Medicare Advantage |
$571.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,519.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$930.69
|
| Rate for Payer: Priority Health Medicare |
$571.84
|
| Rate for Payer: Priority Health Narrow Network |
$930.69
|
| Rate for Payer: Priority Health SBD |
$930.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$571.84
|
| Rate for Payer: UHC Medicare Advantage |
$571.84
|
| Rate for Payer: UHCCP Medicaid |
$374.24
|
| Rate for Payer: UMR Bronson Commercial |
$1,075.02
|
|
|
PR EMBLC/THRMBC CATH CRTD SUBCLA/INNOMINATE ART
|
Professional
|
Both
|
$2,034.00
|
|
|
Service Code
|
HCPCS 34001
|
| Min. Negotiated Rate |
$573.18 |
| Max. Negotiated Rate |
$1,434.86 |
| Rate for Payer: Aetna Commercial |
$1,181.53
|
| Rate for Payer: Aetna Medicare |
$917.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,181.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,269.71
|
| Rate for Payer: BCBS Complete |
$601.84
|
| Rate for Payer: BCBS MAPPO |
$881.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,434.86
|
| Rate for Payer: BCN Commercial |
$1,305.26
|
| Rate for Payer: BCN Medicare Advantage |
$881.74
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cash Price |
$1,627.20
|
| Rate for Payer: Cofinity Commercial |
$1,181.53
|
| Rate for Payer: Cofinity Commercial |
$1,269.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$881.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$925.83
|
| Rate for Payer: Meridian Medicaid |
$601.84
|
| Rate for Payer: Nomi Health Commercial |
$1,058.09
|
| Rate for Payer: PACE SWMI |
$881.74
|
| Rate for Payer: PHP Commercial |
$1,234.44
|
| Rate for Payer: PHP Medicare Advantage |
$881.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$573.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,322.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,426.88
|
| Rate for Payer: Priority Health Medicare |
$881.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,426.88
|
| Rate for Payer: Priority Health SBD |
$1,426.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$881.74
|
| Rate for Payer: UHC Medicare Advantage |
$881.74
|
| Rate for Payer: UHCCP Medicaid |
$573.18
|
| Rate for Payer: UMR Bronson Commercial |
$935.64
|
|
|
PR EMBLC/THRMBC FEMORAL POPLITEAL AORTO-ILIAC ART
|
Professional
|
Both
|
$1,995.00
|
|
|
Service Code
|
HCPCS 34201
|
| Min. Negotiated Rate |
$637.94 |
| Max. Negotiated Rate |
$2,634.63 |
| Rate for Payer: Aetna Commercial |
$1,311.94
|
| Rate for Payer: Aetna Medicare |
$1,018.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,311.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,409.85
|
| Rate for Payer: BCBS Complete |
$669.84
|
| Rate for Payer: BCBS MAPPO |
$979.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,634.63
|
| Rate for Payer: BCN Commercial |
$1,457.73
|
| Rate for Payer: BCN Medicare Advantage |
$979.06
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cash Price |
$1,596.00
|
| Rate for Payer: Cofinity Commercial |
$1,311.94
|
| Rate for Payer: Cofinity Commercial |
$1,409.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,028.01
|
| Rate for Payer: Meridian Medicaid |
$669.84
|
| Rate for Payer: Nomi Health Commercial |
$1,174.87
|
| Rate for Payer: PACE SWMI |
$979.06
|
| Rate for Payer: PHP Commercial |
$1,370.68
|
| Rate for Payer: PHP Medicare Advantage |
$979.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$637.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,296.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,591.74
|
| Rate for Payer: Priority Health Medicare |
$979.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,591.74
|
| Rate for Payer: Priority Health SBD |
$1,591.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.06
|
| Rate for Payer: UHC Medicare Advantage |
$979.06
|
| Rate for Payer: UHCCP Medicaid |
$637.94
|
| Rate for Payer: UMR Bronson Commercial |
$917.70
|
|
|
PR EMBLC/THRMBC INNOMINATE SUBCLAVIAN ARTERY
|
Professional
|
Both
|
$2,010.00
|
|
|
Service Code
|
HCPCS 34051
|
| Min. Negotiated Rate |
$627.50 |
| Max. Negotiated Rate |
$2,053.50 |
| Rate for Payer: Aetna Commercial |
$1,272.77
|
| Rate for Payer: Aetna Medicare |
$987.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,272.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,367.76
|
| Rate for Payer: BCBS Complete |
$658.88
|
| Rate for Payer: BCBS MAPPO |
$949.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,053.50
|
| Rate for Payer: BCN Commercial |
$1,427.42
|
| Rate for Payer: BCN Medicare Advantage |
$949.83
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cash Price |
$1,608.00
|
| Rate for Payer: Cofinity Commercial |
$1,272.77
|
| Rate for Payer: Cofinity Commercial |
$1,367.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$949.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$997.32
|
| Rate for Payer: Meridian Medicaid |
$658.88
|
| Rate for Payer: Nomi Health Commercial |
$1,139.80
|
| Rate for Payer: PACE SWMI |
$949.83
|
| Rate for Payer: PHP Commercial |
$1,329.76
|
| Rate for Payer: PHP Medicare Advantage |
$949.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$627.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,306.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,558.24
|
| Rate for Payer: Priority Health Medicare |
$949.83
|
| Rate for Payer: Priority Health Narrow Network |
$1,558.24
|
| Rate for Payer: Priority Health SBD |
$1,558.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$949.83
|
| Rate for Payer: UHC Medicare Advantage |
$949.83
|
| Rate for Payer: UHCCP Medicaid |
$627.50
|
| Rate for Payer: UMR Bronson Commercial |
$924.60
|
|
|
PR EMBLC/THRMBC POPLITEAL-TIBIO-PRONEAL ART LEG INC
|
Professional
|
Both
|
$1,977.00
|
|
|
Service Code
|
HCPCS 34203
|
| Min. Negotiated Rate |
$593.63 |
| Max. Negotiated Rate |
$3,301.73 |
| Rate for Payer: Aetna Commercial |
$1,219.24
|
| Rate for Payer: Aetna Medicare |
$946.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,219.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,310.23
|
| Rate for Payer: BCBS Complete |
$623.31
|
| Rate for Payer: BCBS MAPPO |
$909.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,301.73
|
| Rate for Payer: BCN Commercial |
$1,353.15
|
| Rate for Payer: BCN Medicare Advantage |
$909.88
|
| Rate for Payer: Cash Price |
$1,581.60
|
| Rate for Payer: Cash Price |
$1,581.60
|
| Rate for Payer: Cofinity Commercial |
$1,219.24
|
| Rate for Payer: Cofinity Commercial |
$1,310.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$909.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$955.37
|
| Rate for Payer: Meridian Medicaid |
$623.31
|
| Rate for Payer: Nomi Health Commercial |
$1,091.86
|
| Rate for Payer: PACE SWMI |
$909.88
|
| Rate for Payer: PHP Commercial |
$1,273.83
|
| Rate for Payer: PHP Medicare Advantage |
$909.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$593.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,285.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,479.01
|
| Rate for Payer: Priority Health Medicare |
$909.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,479.01
|
| Rate for Payer: Priority Health SBD |
$1,479.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$909.88
|
| Rate for Payer: UHC Medicare Advantage |
$909.88
|
| Rate for Payer: UHCCP Medicaid |
$593.63
|
| Rate for Payer: UMR Bronson Commercial |
$909.42
|
|
|
PR EMBLC/THRMBC RNL CELIAC MESENTRY AORTO-ILIAC ART
|
Professional
|
Both
|
$2,730.00
|
|
|
Service Code
|
HCPCS 34151
|
| Min. Negotiated Rate |
$870.11 |
| Max. Negotiated Rate |
$2,233.15 |
| Rate for Payer: Aetna Commercial |
$1,789.49
|
| Rate for Payer: Aetna Medicare |
$1,388.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,789.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,923.03
|
| Rate for Payer: BCBS Complete |
$913.62
|
| Rate for Payer: BCBS MAPPO |
$1,335.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,233.15
|
| Rate for Payer: BCN Commercial |
$1,987.94
|
| Rate for Payer: BCN Medicare Advantage |
$1,335.44
|
| Rate for Payer: Cash Price |
$2,184.00
|
| Rate for Payer: Cash Price |
$2,184.00
|
| Rate for Payer: Cofinity Commercial |
$1,789.49
|
| Rate for Payer: Cofinity Commercial |
$1,923.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,335.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,402.21
|
| Rate for Payer: Meridian Medicaid |
$913.62
|
| Rate for Payer: Nomi Health Commercial |
$1,602.53
|
| Rate for Payer: PACE SWMI |
$1,335.44
|
| Rate for Payer: PHP Commercial |
$1,869.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,335.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$870.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,774.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,168.25
|
| Rate for Payer: Priority Health Medicare |
$1,335.44
|
| Rate for Payer: Priority Health Narrow Network |
$2,168.25
|
| Rate for Payer: Priority Health SBD |
$2,168.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,335.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,335.44
|
| Rate for Payer: UHCCP Medicaid |
$870.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,255.80
|
|
|
PR EMBLC/THRMBC W/WO CATH RADIAL/ULNAR ART ARM INC
|
Professional
|
Both
|
$1,258.00
|
|
|
Service Code
|
HCPCS 34111
|
| Min. Negotiated Rate |
$373.39 |
| Max. Negotiated Rate |
$1,789.88 |
| Rate for Payer: Aetna Commercial |
$764.68
|
| Rate for Payer: Aetna Medicare |
$593.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$764.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$821.75
|
| Rate for Payer: BCBS Complete |
$392.06
|
| Rate for Payer: BCBS MAPPO |
$570.66
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCN Commercial |
$857.63
|
| Rate for Payer: BCN Medicare Advantage |
$570.66
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cash Price |
$1,006.40
|
| Rate for Payer: Cofinity Commercial |
$764.68
|
| Rate for Payer: Cofinity Commercial |
$821.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$570.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$599.19
|
| Rate for Payer: Meridian Medicaid |
$392.06
|
| Rate for Payer: Nomi Health Commercial |
$684.79
|
| Rate for Payer: PACE SWMI |
$570.66
|
| Rate for Payer: PHP Commercial |
$798.92
|
| Rate for Payer: PHP Medicare Advantage |
$570.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$373.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$817.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$929.64
|
| Rate for Payer: Priority Health Medicare |
$570.66
|
| Rate for Payer: Priority Health Narrow Network |
$929.64
|
| Rate for Payer: Priority Health SBD |
$929.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$570.66
|
| Rate for Payer: UHC Medicare Advantage |
$570.66
|
| Rate for Payer: UHCCP Medicaid |
$373.39
|
| Rate for Payer: UMR Bronson Commercial |
$578.68
|
|
|
PR EMERGENCY DEPARTMENT VISIT HIGH MDM
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 99285
|
| Min. Negotiated Rate |
$77.24 |
| Max. Negotiated Rate |
$932.45 |
| Rate for Payer: Aetna Commercial |
$226.43
|
| Rate for Payer: Aetna Medicare |
$175.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.33
|
| Rate for Payer: BCBS Complete |
$81.10
|
| Rate for Payer: BCBS MAPPO |
$168.98
|
| Rate for Payer: BCBS Trust/PPO |
$932.45
|
| Rate for Payer: BCN Commercial |
$254.60
|
| Rate for Payer: BCN Medicare Advantage |
$168.98
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cofinity Commercial |
$226.43
|
| Rate for Payer: Cofinity Commercial |
$243.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.43
|
| Rate for Payer: Meridian Medicaid |
$81.10
|
| Rate for Payer: Nomi Health Commercial |
$202.78
|
| Rate for Payer: PACE SWMI |
$168.98
|
| Rate for Payer: PHP Commercial |
$236.57
|
| Rate for Payer: PHP Medicare Advantage |
$168.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$299.15
|
| Rate for Payer: Priority Health Medicare |
$168.98
|
| Rate for Payer: Priority Health Narrow Network |
$299.15
|
| Rate for Payer: Priority Health SBD |
$299.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$168.98
|
| Rate for Payer: UHC Medicare Advantage |
$168.98
|
| Rate for Payer: UHCCP Medicaid |
$77.24
|
| Rate for Payer: UMR Bronson Commercial |
$170.66
|
|
|
PR EMERGENCY DEPARTMENT VISIT LOW MDM
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99283
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$91.31
|
| Rate for Payer: Aetna Medicare |
$70.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.12
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS MAPPO |
$68.14
|
| Rate for Payer: BCBS Trust/PPO |
$75.14
|
| Rate for Payer: BCN Commercial |
$104.09
|
| Rate for Payer: BCN Medicare Advantage |
$68.14
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$91.31
|
| Rate for Payer: Cofinity Commercial |
$98.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.55
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Nomi Health Commercial |
$81.77
|
| Rate for Payer: PACE SWMI |
$68.14
|
| Rate for Payer: PHP Commercial |
$95.40
|
| Rate for Payer: PHP Medicare Advantage |
$68.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.00
|
| Rate for Payer: Priority Health Medicare |
$68.14
|
| Rate for Payer: Priority Health Narrow Network |
$114.00
|
| Rate for Payer: Priority Health SBD |
$114.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.14
|
| Rate for Payer: UHC Medicare Advantage |
$68.14
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
| Rate for Payer: UMR Bronson Commercial |
$79.58
|
|
|
PR EMERGENCY DEPARTMENT VISIT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 99281
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$171.07 |
| Rate for Payer: Aetna Commercial |
$14.73
|
| Rate for Payer: Aetna Medicare |
$11.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.83
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS MAPPO |
$10.99
|
| Rate for Payer: BCBS Trust/PPO |
$171.07
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: BCN Medicare Advantage |
$10.99
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$14.73
|
| Rate for Payer: Cofinity Commercial |
$15.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.54
|
| Rate for Payer: Meridian Medicaid |
$7.60
|
| Rate for Payer: Nomi Health Commercial |
$13.19
|
| Rate for Payer: PACE SWMI |
$10.99
|
| Rate for Payer: PHP Commercial |
$15.39
|
| Rate for Payer: PHP Medicare Advantage |
$10.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.89
|
| Rate for Payer: Priority Health Medicare |
$10.99
|
| Rate for Payer: Priority Health Narrow Network |
$36.89
|
| Rate for Payer: Priority Health SBD |
$36.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.99
|
| Rate for Payer: UHC Medicare Advantage |
$10.99
|
| Rate for Payer: UHCCP Medicaid |
$7.24
|
| Rate for Payer: UMR Bronson Commercial |
$42.78
|
|
|
PR EMERGENCY DEPARTMENT VISIT MODERATE MDM
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 99284
|
| Min. Negotiated Rate |
$46.49 |
| Max. Negotiated Rate |
$203.10 |
| Rate for Payer: Aetna Commercial |
$156.02
|
| Rate for Payer: Aetna Medicare |
$121.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.66
|
| Rate for Payer: BCBS Complete |
$80.51
|
| Rate for Payer: BCBS MAPPO |
$116.43
|
| Rate for Payer: BCBS Trust/PPO |
$46.49
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: BCN Medicare Advantage |
$116.43
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$156.02
|
| Rate for Payer: Cofinity Commercial |
$167.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.25
|
| Rate for Payer: Meridian Medicaid |
$80.51
|
| Rate for Payer: Nomi Health Commercial |
$139.72
|
| Rate for Payer: PACE SWMI |
$116.43
|
| Rate for Payer: PHP Commercial |
$163.00
|
| Rate for Payer: PHP Medicare Advantage |
$116.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.10
|
| Rate for Payer: Priority Health Medicare |
$116.43
|
| Rate for Payer: Priority Health Narrow Network |
$203.10
|
| Rate for Payer: Priority Health SBD |
$203.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.43
|
| Rate for Payer: UHC Medicare Advantage |
$116.43
|
| Rate for Payer: UHCCP Medicaid |
$76.68
|
| Rate for Payer: UMR Bronson Commercial |
$114.54
|
|
|
PR EMERGENCY DEPARTMENT VISIT STRAIGHTFORWARD MDM
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 99282
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$338.11 |
| Rate for Payer: Aetna Commercial |
$54.08
|
| Rate for Payer: Aetna Medicare |
$41.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.12
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$40.36
|
| Rate for Payer: BCBS Trust/PPO |
$338.11
|
| Rate for Payer: BCN Commercial |
$60.60
|
| Rate for Payer: BCN Medicare Advantage |
$40.36
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$54.08
|
| Rate for Payer: Cofinity Commercial |
$58.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.38
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Nomi Health Commercial |
$48.43
|
| Rate for Payer: PACE SWMI |
$40.36
|
| Rate for Payer: PHP Commercial |
$56.50
|
| Rate for Payer: PHP Medicare Advantage |
$40.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.81
|
| Rate for Payer: Priority Health Medicare |
$40.36
|
| Rate for Payer: Priority Health Narrow Network |
$71.81
|
| Rate for Payer: Priority Health SBD |
$71.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.36
|
| Rate for Payer: UHC Medicare Advantage |
$40.36
|
| Rate for Payer: UHCCP Medicaid |
$26.63
|
| Rate for Payer: UMR Bronson Commercial |
$54.28
|
|
|
PR EMG STDS ANAL/URTL SPHNCTR OTH/THN NDL
|
Professional
|
Both
|
$393.00
|
|
|
Service Code
|
HCPCS 51784
|
| Min. Negotiated Rate |
$23.22 |
| Max. Negotiated Rate |
$3,642.10 |
| Rate for Payer: Aetna Commercial |
$79.50
|
| Rate for Payer: Aetna Medicare |
$61.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.44
|
| Rate for Payer: BCBS Complete |
$24.38
|
| Rate for Payer: BCBS MAPPO |
$59.33
|
| Rate for Payer: BCBS Trust/PPO |
$3,642.10
|
| Rate for Payer: BCN Commercial |
$93.34
|
| Rate for Payer: BCN Medicare Advantage |
$59.33
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cofinity Commercial |
$79.50
|
| Rate for Payer: Cofinity Commercial |
$85.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.30
|
| Rate for Payer: Meridian Medicaid |
$24.38
|
| Rate for Payer: Nomi Health Commercial |
$71.20
|
| Rate for Payer: PACE SWMI |
$59.33
|
| Rate for Payer: PHP Commercial |
$83.06
|
| Rate for Payer: PHP Medicare Advantage |
$59.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.78
|
| Rate for Payer: Priority Health Medicare |
$59.33
|
| Rate for Payer: Priority Health Narrow Network |
$102.78
|
| Rate for Payer: Priority Health SBD |
$58.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.33
|
| Rate for Payer: UHC Medicare Advantage |
$59.33
|
| Rate for Payer: UHCCP Medicaid |
$23.22
|
| Rate for Payer: UMR Bronson Commercial |
$180.78
|
|
|
PRENATAL VIT 14-FERROUS FUM 29 MG IRON-FOLIC ACID 1 MG CHEWABLE TABLET
|
Facility
|
IP
|
$222.05
|
|
|
Service Code
|
NDC 13811001490
|
| Hospital Charge Code |
115087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.70 |
| Max. Negotiated Rate |
$199.84 |
| Rate for Payer: Aetna American Axle |
$144.33
|
| Rate for Payer: Aetna Commercial |
$188.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.33
|
| Rate for Payer: Cash Price |
$177.64
|
| Rate for Payer: Cofinity Commercial |
$155.44
|
| Rate for Payer: Cofinity Commercial |
$190.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.64
|
| Rate for Payer: Healthscope Commercial |
$199.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.74
|
| Rate for Payer: PHP Commercial |
$188.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.33
|
| Rate for Payer: Priority Health SBD |
$139.89
|
| Rate for Payer: UMR Bronson Commercial |
$97.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.54
|
|
|
PRENATAL VIT 14-FERROUS FUM 29 MG IRON-FOLIC ACID 1 MG CHEWABLE TABLET
|
Facility
|
OP
|
$222.05
|
|
|
Service Code
|
NDC 13811001490
|
| Hospital Charge Code |
115087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.16 |
| Max. Negotiated Rate |
$199.84 |
| Rate for Payer: Aetna American Axle |
$144.33
|
| Rate for Payer: Aetna Commercial |
$188.74
|
| Rate for Payer: Aetna Medicare |
$111.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.33
|
| Rate for Payer: BCBS Complete |
$88.82
|
| Rate for Payer: Cash Price |
$177.64
|
| Rate for Payer: Cofinity Commercial |
$155.44
|
| Rate for Payer: Cofinity Commercial |
$190.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.64
|
| Rate for Payer: Healthscope Commercial |
$199.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.74
|
| Rate for Payer: PHP Commercial |
$188.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.33
|
| Rate for Payer: Priority Health SBD |
$139.89
|
| Rate for Payer: UMR Bronson Commercial |
$82.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.54
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
OP
|
$33.14
|
|
|
Service Code
|
NDC 00904531346
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna Commercial |
$28.17
|
| Rate for Payer: Aetna Medicare |
$16.57
|
| Rate for Payer: Aetna American Axle |
$21.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.54
|
| Rate for Payer: BCBS Complete |
$13.26
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$28.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.51
|
| Rate for Payer: Healthscope Commercial |
$29.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.17
|
| Rate for Payer: PHP Commercial |
$28.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.54
|
| Rate for Payer: Priority Health SBD |
$20.88
|
| Rate for Payer: UMR Bronson Commercial |
$12.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.86
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
NDC 77333071525
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UMR Bronson Commercial |
$1.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
OP
|
$68.15
|
|
|
Service Code
|
NDC 00904531360
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna American Axle |
$44.30
|
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna Medicare |
$34.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: BCBS Complete |
$27.26
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.30
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: UMR Bronson Commercial |
$25.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.11
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
IP
|
$68.15
|
|
|
Service Code
|
NDC 00904531360
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.99 |
| Max. Negotiated Rate |
$61.34 |
| Rate for Payer: Aetna American Axle |
$44.30
|
| Rate for Payer: Aetna Commercial |
$57.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.30
|
| Rate for Payer: Cash Price |
$54.52
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$58.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.52
|
| Rate for Payer: Healthscope Commercial |
$61.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.93
|
| Rate for Payer: PHP Commercial |
$57.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.30
|
| Rate for Payer: Priority Health SBD |
$42.93
|
| Rate for Payer: UMR Bronson Commercial |
$29.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.11
|
|
|
PRENATAL VITS-FERROUS FUMARATE-IRON-FOLIC ACID 800 MCG TABLET WRAPPER
|
Facility
|
IP
|
$33.14
|
|
|
Service Code
|
NDC 00904531346
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.58 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna American Axle |
$21.54
|
| Rate for Payer: Aetna Commercial |
$28.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.54
|
| Rate for Payer: Cash Price |
$26.51
|
| Rate for Payer: Cofinity Commercial |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$28.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.51
|
| Rate for Payer: Healthscope Commercial |
$29.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.17
|
| Rate for Payer: PHP Commercial |
$28.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.54
|
| Rate for Payer: Priority Health SBD |
$20.88
|
| Rate for Payer: UMR Bronson Commercial |
$14.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.86
|
|
|
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 |
$48.18
|
| 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: 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: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.63
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| 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
|
OP
|
$3.25
|
|
|
Service Code
|
NDC 77333071525
|
| Hospital Charge Code |
300610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.92 |
| Rate for Payer: Aetna American Axle |
$2.11
|
| Rate for Payer: Aetna Commercial |
$2.76
|
| Rate for Payer: Aetna Medicare |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.11
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Cofinity Commercial |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.60
|
| Rate for Payer: Healthscope Commercial |
$2.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.76
|
| Rate for Payer: PHP Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.11
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UMR Bronson Commercial |
$1.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.44
|
|
|
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 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: 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: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.63
|
| 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
|
|
