|
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
|
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 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 Commercial |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.85
|
| 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: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.86
|
| 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
|
|
|
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 Commercial |
$125.85
|
| Rate for Payer: Cofinity Commercial |
$154.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$125.85
|
| 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: PHP Commercial |
$152.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.86
|
| Rate for Payer: Priority Health SBD |
$113.26
|
| 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
|
$33.14
|
|
|
Service Code
|
NDC 00904531346
|
| Hospital Charge Code |
177116
|
|
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 NO.130-FERROUS FUM 27 MG IRON-FOLIC ACID 800 MCG TABLET
|
Facility
|
OP
|
$33.14
|
|
|
Service Code
|
NDC 00904531346
|
| Hospital Charge Code |
177116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna American Axle |
$21.54
|
| Rate for Payer: Aetna Commercial |
$28.17
|
| Rate for Payer: Aetna Medicare |
$16.57
|
| 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
|
|
|
PR ENDOBRONCHIAL U/S ADD-ON
|
Professional
|
Both
|
$464.00
|
|
|
Service Code
|
HCPCS 31620
|
| Min. Negotiated Rate |
$185.60 |
| Max. Negotiated Rate |
$301.60 |
| Rate for Payer: Aetna Medicare |
$232.00
|
| Rate for Payer: BCBS Complete |
$185.60
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.60
|
| Rate for Payer: UMR Bronson Commercial |
$213.44
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna American Axle |
$202.80
|
| Rate for Payer: Aetna Commercial |
$265.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.80
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$268.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.60
|
| Rate for Payer: Healthscope Commercial |
$280.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: PHP Commercial |
$265.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health SBD |
$196.56
|
| Rate for Payer: UMR Bronson Commercial |
$137.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.00
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 57505
|
| Hospital Charge Code |
57505
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$104.22 |
| Max. Negotiated Rate |
$2,681.40 |
| Rate for Payer: Aetna American Axle |
$202.80
|
| Rate for Payer: Aetna Commercial |
$265.20
|
| Rate for Payer: Aetna Medicare |
$887.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,066.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,066.41
|
| Rate for Payer: BCBS Complete |
$480.14
|
| Rate for Payer: BCBS MAPPO |
$853.13
|
| Rate for Payer: BCBS Trust/PPO |
$789.01
|
| Rate for Payer: BCCCP Commercial |
$145.60
|
| Rate for Payer: BCN Commercial |
$789.01
|
| Rate for Payer: BCN Medicare Advantage |
$853.13
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$268.32
|
| Rate for Payer: Cofinity Commercial |
$218.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$853.13
|
| Rate for Payer: Healthscope Commercial |
$280.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.00
|
| Rate for Payer: Mclaren Medicaid |
$457.28
|
| Rate for Payer: Mclaren Medicare |
$853.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$895.79
|
| Rate for Payer: Meridian Medicaid |
$480.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$981.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Nomi Health Commercial |
$1,791.57
|
| Rate for Payer: PACE Medicare |
$810.47
|
| Rate for Payer: PACE SWMI |
$853.13
|
| Rate for Payer: PHP Commercial |
$265.20
|
| Rate for Payer: PHP Medicare Advantage |
$853.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$457.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,681.40
|
| Rate for Payer: Priority Health Medicare |
$853.13
|
| Rate for Payer: Priority Health Narrow Network |
$2,145.12
|
| Rate for Payer: Priority Health SBD |
$196.56
|
| Rate for Payer: Railroad Medicare Medicare |
$853.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$114.64
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$853.13
|
| Rate for Payer: UHC Exchange |
$104.22
|
| Rate for Payer: UHC Medicare Advantage |
$853.13
|
| Rate for Payer: UHCCP Medicaid |
$457.28
|
| Rate for Payer: UMR Bronson Commercial |
$115.44
|
| Rate for Payer: VA VA |
$853.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.00
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 57505
|
| Hospital Charge Code |
57505
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$232.98 |
| Rate for Payer: Aetna Commercial |
$137.16
|
| Rate for Payer: Aetna Medicare |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.40
|
| Rate for Payer: BCBS Complete |
$73.80
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCBS Trust/PPO |
$232.98
|
| Rate for Payer: BCN Commercial |
$184.16
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$147.40
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: Meridian Medicaid |
$73.80
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Commercial |
$143.30
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.68
|
| Rate for Payer: Priority Health Medicare |
$102.36
|
| Rate for Payer: Priority Health Narrow Network |
$164.68
|
| Rate for Payer: Priority Health SBD |
$164.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.36
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
| Rate for Payer: UHCCP Medicaid |
$70.29
|
| Rate for Payer: UMR Bronson Commercial |
$143.52
|
|
|
PR ENDOCERVICAL CURETTAGE NOT DONE AS PART OF D&C
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 57505
|
| Min. Negotiated Rate |
$70.29 |
| Max. Negotiated Rate |
$232.98 |
| Rate for Payer: Aetna Commercial |
$137.16
|
| Rate for Payer: Aetna Medicare |
$106.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.40
|
| Rate for Payer: BCBS Complete |
$73.80
|
| Rate for Payer: BCBS MAPPO |
$102.36
|
| Rate for Payer: BCBS Trust/PPO |
$232.98
|
| Rate for Payer: BCN Commercial |
$184.16
|
| Rate for Payer: BCN Medicare Advantage |
$102.36
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$147.40
|
| Rate for Payer: Cofinity Commercial |
$137.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.48
|
| Rate for Payer: Meridian Medicaid |
$73.80
|
| Rate for Payer: Nomi Health Commercial |
$122.83
|
| Rate for Payer: PACE SWMI |
$102.36
|
| Rate for Payer: PHP Commercial |
$143.30
|
| Rate for Payer: PHP Medicare Advantage |
$102.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.68
|
| Rate for Payer: Priority Health Medicare |
$102.36
|
| Rate for Payer: Priority Health Narrow Network |
$164.68
|
| Rate for Payer: Priority Health SBD |
$164.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.36
|
| Rate for Payer: UHC Medicare Advantage |
$102.36
|
| Rate for Payer: UHCCP Medicaid |
$70.29
|
| Rate for Payer: UMR Bronson Commercial |
$143.52
|
|
|
PR END OF LIFE COUNSELING
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS S0257
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$206.57 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.85
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Trust/PPO |
$206.57
|
| Rate for Payer: BCN Commercial |
$28.73
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.64
|
| Rate for Payer: Priority Health Narrow Network |
$47.64
|
| Rate for Payer: Priority Health SBD |
$47.64
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R ADDL VESSEL
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 92979
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.41
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS Trust/PPO |
$230.34
|
| Rate for Payer: BCN Commercial |
$233.10
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.12
|
| Rate for Payer: Priority Health Narrow Network |
$224.12
|
| Rate for Payer: Priority Health SBD |
$103.11
|
| Rate for Payer: UHCCP Medicaid |
$47.07
|
| Rate for Payer: UMR Bronson Commercial |
$141.22
|
|
|
PR ENDOLUMINAL CORONARY IVUS OCT I&R INITIAL VESSEL
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS 92978
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$386.06 |
| Rate for Payer: Aetna Commercial |
$348.91
|
| Rate for Payer: Aetna Medicare |
$250.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$348.91
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCBS Trust/PPO |
$154.26
|
| Rate for Payer: BCN Commercial |
$386.06
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$371.49
|
| Rate for Payer: Priority Health Narrow Network |
$371.49
|
| Rate for Payer: Priority Health SBD |
$129.95
|
| Rate for Payer: UHCCP Medicaid |
$59.00
|
| Rate for Payer: UMR Bronson Commercial |
$230.46
|
|
|
PR ENDOMETRIAL ABLTJ THERMAL W/O HYSTEROSCOPIC GUID
|
Professional
|
Both
|
$2,043.00
|
|
|
Service Code
|
HCPCS 58353
|
| Min. Negotiated Rate |
$148.04 |
| Max. Negotiated Rate |
$1,387.35 |
| Rate for Payer: Aetna Commercial |
$295.14
|
| Rate for Payer: Aetna Medicare |
$229.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.16
|
| Rate for Payer: BCBS Complete |
$155.44
|
| Rate for Payer: BCBS MAPPO |
$220.25
|
| Rate for Payer: BCBS Trust/PPO |
$572.15
|
| Rate for Payer: BCN Commercial |
$1,387.35
|
| Rate for Payer: BCN Medicare Advantage |
$220.25
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cash Price |
$1,634.40
|
| Rate for Payer: Cofinity Commercial |
$295.14
|
| Rate for Payer: Cofinity Commercial |
$317.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$220.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$231.26
|
| Rate for Payer: Meridian Medicaid |
$155.44
|
| Rate for Payer: Nomi Health Commercial |
$264.30
|
| Rate for Payer: PACE SWMI |
$220.25
|
| Rate for Payer: PHP Commercial |
$308.35
|
| Rate for Payer: PHP Medicare Advantage |
$220.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,327.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.74
|
| Rate for Payer: Priority Health Medicare |
$220.25
|
| Rate for Payer: Priority Health Narrow Network |
$345.74
|
| Rate for Payer: Priority Health SBD |
$345.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$220.25
|
| Rate for Payer: UHC Medicare Advantage |
$220.25
|
| Rate for Payer: UHCCP Medicaid |
$148.04
|
| Rate for Payer: UMR Bronson Commercial |
$939.78
|
|
|
PR ENDOMETRIAL BX CONJUNCT W/COLPOSCOPY
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 58110
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$1,845.88 |
| Rate for Payer: Aetna Commercial |
$52.22
|
| Rate for Payer: Aetna Medicare |
$40.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.12
|
| Rate for Payer: BCBS Complete |
$27.06
|
| Rate for Payer: BCBS MAPPO |
$38.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,845.88
|
| Rate for Payer: BCN Commercial |
$72.82
|
| Rate for Payer: BCN Medicare Advantage |
$38.97
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$52.22
|
| Rate for Payer: Cofinity Commercial |
$56.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.92
|
| Rate for Payer: Meridian Medicaid |
$27.06
|
| Rate for Payer: Nomi Health Commercial |
$46.76
|
| Rate for Payer: PACE SWMI |
$38.97
|
| Rate for Payer: PHP Commercial |
$54.56
|
| Rate for Payer: PHP Medicare Advantage |
$38.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.53
|
| Rate for Payer: Priority Health Medicare |
$38.97
|
| Rate for Payer: Priority Health Narrow Network |
$59.53
|
| Rate for Payer: Priority Health SBD |
$59.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.97
|
| Rate for Payer: UHC Medicare Advantage |
$38.97
|
| Rate for Payer: UHCCP Medicaid |
$25.77
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
58100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$94.60 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna American Axle |
$139.75
|
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health SBD |
$135.45
|
| Rate for Payer: UMR Bronson Commercial |
$94.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.25
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 58100
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$1,579.09 |
| Rate for Payer: Aetna Commercial |
$81.57
|
| Rate for Payer: Aetna Medicare |
$63.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.65
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$60.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.09
|
| Rate for Payer: BCN Commercial |
$120.16
|
| Rate for Payer: BCN Medicare Advantage |
$60.87
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$81.57
|
| Rate for Payer: Cofinity Commercial |
$87.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.91
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Nomi Health Commercial |
$73.04
|
| Rate for Payer: PACE SWMI |
$60.87
|
| Rate for Payer: PHP Commercial |
$85.22
|
| Rate for Payer: PHP Medicare Advantage |
$60.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.75
|
| Rate for Payer: Priority Health Medicare |
$60.87
|
| Rate for Payer: Priority Health Narrow Network |
$93.75
|
| Rate for Payer: Priority Health SBD |
$93.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.87
|
| Rate for Payer: UHC Medicare Advantage |
$60.87
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
| Rate for Payer: UMR Bronson Commercial |
$98.90
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 58100
|
| Hospital Charge Code |
58100
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$1,579.09 |
| Rate for Payer: Aetna Commercial |
$81.57
|
| Rate for Payer: Aetna Medicare |
$63.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.65
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$60.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,579.09
|
| Rate for Payer: BCN Commercial |
$120.16
|
| Rate for Payer: BCN Medicare Advantage |
$60.87
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$87.65
|
| Rate for Payer: Cofinity Commercial |
$81.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.91
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Nomi Health Commercial |
$73.04
|
| Rate for Payer: PACE SWMI |
$60.87
|
| Rate for Payer: PHP Commercial |
$85.22
|
| Rate for Payer: PHP Medicare Advantage |
$60.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.75
|
| Rate for Payer: Priority Health Medicare |
$60.87
|
| Rate for Payer: Priority Health Narrow Network |
$93.75
|
| Rate for Payer: Priority Health SBD |
$93.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.87
|
| Rate for Payer: UHC Medicare Advantage |
$60.87
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
| Rate for Payer: UMR Bronson Commercial |
$98.90
|
|
|
PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
58100
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$139.75
|
| Rate for Payer: Aetna Commercial |
$182.75
|
| Rate for Payer: Aetna Medicare |
$204.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$246.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$246.38
|
| Rate for Payer: BCBS Complete |
$110.93
|
| Rate for Payer: BCBS MAPPO |
$197.10
|
| Rate for Payer: BCBS Trust/PPO |
$132.24
|
| Rate for Payer: BCCCP Commercial |
$97.15
|
| Rate for Payer: BCN Commercial |
$132.24
|
| Rate for Payer: BCN Medicare Advantage |
$197.10
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$150.50
|
| Rate for Payer: Cofinity Commercial |
$184.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.10
|
| Rate for Payer: Healthscope Commercial |
$193.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.25
|
| Rate for Payer: Mclaren Medicaid |
$105.65
|
| Rate for Payer: Mclaren Medicare |
$197.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.96
|
| Rate for Payer: Meridian Medicaid |
$110.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$226.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.75
|
| Rate for Payer: Nomi Health Commercial |
$413.91
|
| Rate for Payer: PACE Medicare |
$187.24
|
| Rate for Payer: PACE SWMI |
$197.10
|
| Rate for Payer: PHP Commercial |
$182.75
|
| Rate for Payer: PHP Medicare Advantage |
$197.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.50
|
| Rate for Payer: Priority Health Medicare |
$197.10
|
| Rate for Payer: Priority Health Narrow Network |
$495.60
|
| Rate for Payer: Priority Health SBD |
$135.45
|
| Rate for Payer: Railroad Medicare Medicare |
$197.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.78
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.10
|
| Rate for Payer: UHC Exchange |
$61.62
|
| Rate for Payer: UHC Medicare Advantage |
$197.10
|
| Rate for Payer: UHCCP Medicaid |
$105.65
|
| Rate for Payer: UMR Bronson Commercial |
$79.55
|
| Rate for Payer: VA VA |
$197.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.25
|
|
|
PR ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR
|
Professional
|
Both
|
$2,813.00
|
|
|
Service Code
|
HCPCS 58356
|
| Min. Negotiated Rate |
$225.14 |
| Max. Negotiated Rate |
$2,491.27 |
| Rate for Payer: Aetna Commercial |
$454.25
|
| Rate for Payer: Aetna Medicare |
$352.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$488.15
|
| Rate for Payer: BCBS Complete |
$236.40
|
| Rate for Payer: BCBS MAPPO |
$338.99
|
| Rate for Payer: BCBS Trust/PPO |
$503.47
|
| Rate for Payer: BCN Commercial |
$2,491.27
|
| Rate for Payer: BCN Medicare Advantage |
$338.99
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cash Price |
$2,250.40
|
| Rate for Payer: Cofinity Commercial |
$454.25
|
| Rate for Payer: Cofinity Commercial |
$488.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$355.94
|
| Rate for Payer: Meridian Medicaid |
$236.40
|
| Rate for Payer: Nomi Health Commercial |
$406.79
|
| Rate for Payer: PACE SWMI |
$338.99
|
| Rate for Payer: PHP Commercial |
$474.59
|
| Rate for Payer: PHP Medicare Advantage |
$338.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$225.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,828.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$527.30
|
| Rate for Payer: Priority Health Medicare |
$338.99
|
| Rate for Payer: Priority Health Narrow Network |
$527.30
|
| Rate for Payer: Priority Health SBD |
$527.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.99
|
| Rate for Payer: UHC Medicare Advantage |
$338.99
|
| Rate for Payer: UHCCP Medicaid |
$225.14
|
| Rate for Payer: UMR Bronson Commercial |
$1,293.98
|
|
|
PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC
|
Professional
|
Both
|
$468.00
|
|
|
Service Code
|
HCPCS 43273
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$786.11 |
| Rate for Payer: Aetna Commercial |
$150.31
|
| Rate for Payer: Aetna Medicare |
$116.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.52
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$112.17
|
| Rate for Payer: BCBS Trust/PPO |
$786.11
|
| Rate for Payer: BCN Commercial |
$169.57
|
| Rate for Payer: BCN Medicare Advantage |
$112.17
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cofinity Commercial |
$150.31
|
| Rate for Payer: Cofinity Commercial |
$161.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.78
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Nomi Health Commercial |
$134.60
|
| Rate for Payer: PACE SWMI |
$112.17
|
| Rate for Payer: PHP Commercial |
$157.04
|
| Rate for Payer: PHP Medicare Advantage |
$112.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.81
|
| Rate for Payer: Priority Health Medicare |
$112.17
|
| Rate for Payer: Priority Health Narrow Network |
$208.81
|
| Rate for Payer: Priority Health SBD |
$208.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.17
|
| Rate for Payer: UHC Medicare Advantage |
$112.17
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
| Rate for Payer: UMR Bronson Commercial |
$215.28
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE
|
Professional
|
Both
|
$935.00
|
|
|
Service Code
|
HCPCS 44360
|
| Min. Negotiated Rate |
$90.53 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Aetna Commercial |
$180.71
|
| Rate for Payer: Aetna Medicare |
$140.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.20
|
| Rate for Payer: BCBS Complete |
$95.06
|
| Rate for Payer: BCBS MAPPO |
$134.86
|
| Rate for Payer: BCBS Trust/PPO |
$381.96
|
| Rate for Payer: BCN Commercial |
$205.73
|
| Rate for Payer: BCN Medicare Advantage |
$134.86
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cash Price |
$748.00
|
| Rate for Payer: Cofinity Commercial |
$180.71
|
| Rate for Payer: Cofinity Commercial |
$194.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.60
|
| Rate for Payer: Meridian Medicaid |
$95.06
|
| Rate for Payer: Nomi Health Commercial |
$161.83
|
| Rate for Payer: PACE SWMI |
$134.86
|
| Rate for Payer: PHP Commercial |
$188.80
|
| Rate for Payer: PHP Medicare Advantage |
$134.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$607.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.55
|
| Rate for Payer: Priority Health Medicare |
$134.86
|
| Rate for Payer: Priority Health Narrow Network |
$253.55
|
| Rate for Payer: Priority Health SBD |
$253.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.86
|
| Rate for Payer: UHC Medicare Advantage |
$134.86
|
| Rate for Payer: UHCCP Medicaid |
$90.53
|
| Rate for Payer: UMR Bronson Commercial |
$430.10
|
|
|
PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY
|
Professional
|
Both
|
$988.00
|
|
|
Service Code
|
HCPCS 44361
|
| Min. Negotiated Rate |
$100.11 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna Commercial |
$200.02
|
| Rate for Payer: Aetna Medicare |
$155.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.95
|
| Rate for Payer: BCBS Complete |
$105.12
|
| Rate for Payer: BCBS MAPPO |
$149.27
|
| Rate for Payer: BCBS Trust/PPO |
$508.22
|
| Rate for Payer: BCN Commercial |
$226.75
|
| Rate for Payer: BCN Medicare Advantage |
$149.27
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cash Price |
$790.40
|
| Rate for Payer: Cofinity Commercial |
$200.02
|
| Rate for Payer: Cofinity Commercial |
$214.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.73
|
| Rate for Payer: Meridian Medicaid |
$105.12
|
| Rate for Payer: Nomi Health Commercial |
$179.12
|
| Rate for Payer: PACE SWMI |
$149.27
|
| Rate for Payer: PHP Commercial |
$208.98
|
| Rate for Payer: PHP Medicare Advantage |
$149.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$100.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$279.21
|
| Rate for Payer: Priority Health Medicare |
$149.27
|
| Rate for Payer: Priority Health Narrow Network |
$279.21
|
| Rate for Payer: Priority Health SBD |
$279.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.27
|
| Rate for Payer: UHC Medicare Advantage |
$149.27
|
| Rate for Payer: UHCCP Medicaid |
$100.11
|
| Rate for Payer: UMR Bronson Commercial |
$454.48
|
|
|
PR ENDOVASC ABDO REPAIR W/PROS
|
Professional
|
Both
|
$5,333.00
|
|
|
Service Code
|
HCPCS 34805
|
| Min. Negotiated Rate |
$2,133.20 |
| Max. Negotiated Rate |
$3,466.45 |
| Rate for Payer: Aetna Medicare |
$2,666.50
|
| Rate for Payer: BCBS Complete |
$2,133.20
|
| Rate for Payer: Cash Price |
$4,266.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,466.45
|
| Rate for Payer: UMR Bronson Commercial |
$2,453.18
|
|
