|
PR ILEOSCOPY STOMA W/BALLOON DILATION
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 44381
|
| Min. Negotiated Rate |
$79.38 |
| Max. Negotiated Rate |
$152.75 |
| Rate for Payer: Aetna Commercial |
$106.37
|
| Rate for Payer: Aetna Medicare |
$82.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.37
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$79.38
|
| Rate for Payer: BCN Medicare Advantage |
$79.38
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$114.31
|
| Rate for Payer: Cofinity Commercial |
$106.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.35
|
| Rate for Payer: Nomi Health Commercial |
$95.26
|
| Rate for Payer: PACE SWMI |
$79.38
|
| Rate for Payer: PHP Commercial |
$111.13
|
| Rate for Payer: PHP Medicare Advantage |
$79.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health Medicare |
$79.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.38
|
| Rate for Payer: UHC Medicare Advantage |
$79.38
|
| Rate for Payer: UMR Bronson Commercial |
$108.10
|
|
|
PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
HCPCS 44382
|
| Min. Negotiated Rate |
$69.76 |
| Max. Negotiated Rate |
$609.05 |
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: Aetna Medicare |
$72.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.45
|
| Rate for Payer: BCBS Complete |
$374.80
|
| Rate for Payer: BCBS MAPPO |
$69.76
|
| Rate for Payer: BCN Medicare Advantage |
$69.76
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cofinity Commercial |
$93.48
|
| Rate for Payer: Cofinity Commercial |
$100.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.25
|
| Rate for Payer: Nomi Health Commercial |
$83.71
|
| Rate for Payer: PACE SWMI |
$69.76
|
| Rate for Payer: PHP Commercial |
$97.66
|
| Rate for Payer: PHP Medicare Advantage |
$69.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.05
|
| Rate for Payer: Priority Health Medicare |
$69.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.76
|
| Rate for Payer: UHC Medicare Advantage |
$69.76
|
| Rate for Payer: UMR Bronson Commercial |
$431.02
|
|
|
PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 44384
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$208.73 |
| Rate for Payer: Aetna Commercial |
$194.23
|
| Rate for Payer: Aetna Medicare |
$150.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.23
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$144.95
|
| Rate for Payer: BCN Medicare Advantage |
$144.95
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$208.73
|
| Rate for Payer: Cofinity Commercial |
$194.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.20
|
| Rate for Payer: Nomi Health Commercial |
$173.94
|
| Rate for Payer: PACE SWMI |
$144.95
|
| Rate for Payer: PHP Commercial |
$202.93
|
| Rate for Payer: PHP Medicare Advantage |
$144.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health Medicare |
$144.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.95
|
| Rate for Payer: UHC Medicare Advantage |
$144.95
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
|
|
PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 44380
|
| Min. Negotiated Rate |
$54.50 |
| Max. Negotiated Rate |
$544.70 |
| Rate for Payer: Aetna Commercial |
$73.03
|
| Rate for Payer: Aetna Medicare |
$56.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.03
|
| Rate for Payer: BCBS Complete |
$335.20
|
| Rate for Payer: BCBS MAPPO |
$54.50
|
| Rate for Payer: BCN Medicare Advantage |
$54.50
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Cofinity Commercial |
$73.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.23
|
| Rate for Payer: Nomi Health Commercial |
$65.40
|
| Rate for Payer: PACE SWMI |
$54.50
|
| Rate for Payer: PHP Commercial |
$76.30
|
| Rate for Payer: PHP Medicare Advantage |
$54.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health Medicare |
$54.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.50
|
| Rate for Payer: UHC Medicare Advantage |
$54.50
|
| Rate for Payer: UMR Bronson Commercial |
$385.48
|
|
|
PR ILEOSCOPY,THRU STOMA,TRANSENDO STENT
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 44383
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$706.55 |
| Rate for Payer: Aetna Medicare |
$543.50
|
| Rate for Payer: BCBS Complete |
$434.80
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.55
|
| Rate for Payer: UMR Bronson Commercial |
$500.02
|
|
|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$1,003.66 |
| Max. Negotiated Rate |
$1,660.10 |
| Rate for Payer: Aetna Commercial |
$1,344.90
|
| Rate for Payer: Aetna Medicare |
$1,043.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,445.27
|
| Rate for Payer: BCBS Complete |
$1,021.60
|
| Rate for Payer: BCBS MAPPO |
$1,003.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.66
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cofinity Commercial |
$1,344.90
|
| Rate for Payer: Cofinity Commercial |
$1,445.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,053.84
|
| Rate for Payer: Nomi Health Commercial |
$1,204.39
|
| Rate for Payer: PACE SWMI |
$1,003.66
|
| Rate for Payer: PHP Commercial |
$1,405.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.10
|
| Rate for Payer: Priority Health Medicare |
$1,003.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,174.84
|
|
|
PR ILIAC ART ANGIO,CARDIAC CATH
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G0278
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Medicare |
$13.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.94
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$12.64
|
| Rate for Payer: BCN Medicare Advantage |
$12.64
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$16.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PACE SWMI |
$12.64
|
| Rate for Payer: PHP Commercial |
$17.70
|
| Rate for Payer: PHP Medicare Advantage |
$12.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$12.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.64
|
| Rate for Payer: UHC Medicare Advantage |
$12.64
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna Commercial |
$20.52
|
| Rate for Payer: Aetna Medicare |
$15.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.52
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$15.31
|
| Rate for Payer: BCN Medicare Advantage |
$15.31
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.08
|
| Rate for Payer: Nomi Health Commercial |
$18.37
|
| Rate for Payer: PACE SWMI |
$15.31
|
| Rate for Payer: PHP Commercial |
$21.43
|
| Rate for Payer: PHP Medicare Advantage |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$15.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.31
|
| Rate for Payer: UHC Medicare Advantage |
$15.31
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR IM ADM INTRANSL/ORAL EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90474
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$16.01 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$11.12
|
| Rate for Payer: BCN Medicare Advantage |
$11.12
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.68
|
| Rate for Payer: Nomi Health Commercial |
$13.34
|
| Rate for Payer: PACE SWMI |
$11.12
|
| Rate for Payer: PHP Commercial |
$15.57
|
| Rate for Payer: PHP Medicare Advantage |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$11.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.12
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90471
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$27.13 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Medicare |
$19.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$18.84
|
| Rate for Payer: BCN Medicare Advantage |
$18.84
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$25.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.78
|
| Rate for Payer: Nomi Health Commercial |
$22.61
|
| Rate for Payer: PACE SWMI |
$18.84
|
| Rate for Payer: PHP Commercial |
$26.38
|
| Rate for Payer: PHP Medicare Advantage |
$18.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$18.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.84
|
| Rate for Payer: UHC Medicare Advantage |
$18.84
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90472
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$19.41 |
| Rate for Payer: Aetna Commercial |
$18.06
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.06
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$13.48
|
| Rate for Payer: BCN Medicare Advantage |
$13.48
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$16.18
|
| Rate for Payer: PACE SWMI |
$13.48
|
| Rate for Payer: PHP Commercial |
$18.87
|
| Rate for Payer: PHP Medicare Advantage |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$13.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.48
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 90460
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$30.51 |
| Rate for Payer: Aetna Commercial |
$28.39
|
| Rate for Payer: Aetna Medicare |
$22.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.39
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$21.19
|
| Rate for Payer: BCN Medicare Advantage |
$21.19
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$30.51
|
| Rate for Payer: Cofinity Commercial |
$28.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.25
|
| Rate for Payer: Nomi Health Commercial |
$25.43
|
| Rate for Payer: PACE SWMI |
$21.19
|
| Rate for Payer: PHP Commercial |
$29.67
|
| Rate for Payer: PHP Medicare Advantage |
$21.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$21.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.19
|
| Rate for Payer: UHC Medicare Advantage |
$21.19
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90461
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Commercial |
$11.56
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
IP
|
$913.44
|
|
|
Service Code
|
NDC 00024159601
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.91 |
| Max. Negotiated Rate |
$822.10 |
| Rate for Payer: Aetna American Axle |
$593.74
|
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.74
|
| Rate for Payer: Cash Price |
$730.75
|
| Rate for Payer: Cofinity Commercial |
$639.41
|
| Rate for Payer: Cofinity Commercial |
$785.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.75
|
| Rate for Payer: Healthscope Commercial |
$822.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.74
|
| Rate for Payer: Priority Health SBD |
$575.47
|
| Rate for Payer: UMR Bronson Commercial |
$401.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.08
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
OP
|
$597.12
|
|
|
Service Code
|
NDC 76385010201
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.93 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna American Axle |
$388.13
|
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna Medicare |
$298.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Commercial |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.13
|
| Rate for Payer: Priority Health SBD |
$376.19
|
| Rate for Payer: UMR Bronson Commercial |
$220.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.84
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
OP
|
$913.44
|
|
|
Service Code
|
NDC 00024159601
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.97 |
| Max. Negotiated Rate |
$822.10 |
| Rate for Payer: Aetna American Axle |
$593.74
|
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna Medicare |
$456.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.74
|
| Rate for Payer: BCBS Complete |
$365.38
|
| Rate for Payer: Cash Price |
$730.75
|
| Rate for Payer: Cofinity Commercial |
$639.41
|
| Rate for Payer: Cofinity Commercial |
$785.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$639.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.75
|
| Rate for Payer: Healthscope Commercial |
$822.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.74
|
| Rate for Payer: Priority Health SBD |
$575.47
|
| Rate for Payer: UMR Bronson Commercial |
$337.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.08
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
IP
|
$597.12
|
|
|
Service Code
|
NDC 76385010201
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.73 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna American Axle |
$388.13
|
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Commercial |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.13
|
| Rate for Payer: Priority Health SBD |
$376.19
|
| Rate for Payer: UMR Bronson Commercial |
$262.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.84
|
|
|
PR IMBRICATION DIAPHRAGM EVENTRATION
|
Professional
|
Both
|
$5,419.00
|
|
|
Service Code
|
HCPCS 39545
|
| Min. Negotiated Rate |
$863.44 |
| Max. Negotiated Rate |
$3,522.35 |
| Rate for Payer: Aetna Commercial |
$1,157.01
|
| Rate for Payer: Aetna Medicare |
$897.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,243.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.01
|
| Rate for Payer: BCBS Complete |
$2,167.60
|
| Rate for Payer: BCBS MAPPO |
$863.44
|
| Rate for Payer: BCN Medicare Advantage |
$863.44
|
| Rate for Payer: Cash Price |
$4,335.20
|
| Rate for Payer: Cash Price |
$4,335.20
|
| Rate for Payer: Cofinity Commercial |
$1,243.35
|
| Rate for Payer: Cofinity Commercial |
$1,157.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$863.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$906.61
|
| Rate for Payer: Nomi Health Commercial |
$1,036.13
|
| Rate for Payer: PACE SWMI |
$863.44
|
| Rate for Payer: PHP Commercial |
$1,208.82
|
| Rate for Payer: PHP Medicare Advantage |
$863.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,522.35
|
| Rate for Payer: Priority Health Medicare |
$863.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$863.44
|
| Rate for Payer: UHC Medicare Advantage |
$863.44
|
| Rate for Payer: UMR Bronson Commercial |
$2,492.74
|
|
|
PR IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
HCPCS 10030
|
| Min. Negotiated Rate |
$127.95 |
| Max. Negotiated Rate |
$490.10 |
| Rate for Payer: Aetna Commercial |
$171.45
|
| Rate for Payer: Aetna Medicare |
$133.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.45
|
| Rate for Payer: BCBS Complete |
$301.60
|
| Rate for Payer: BCBS MAPPO |
$127.95
|
| Rate for Payer: BCN Medicare Advantage |
$127.95
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cofinity Commercial |
$184.25
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.35
|
| Rate for Payer: Nomi Health Commercial |
$153.54
|
| Rate for Payer: PACE SWMI |
$127.95
|
| Rate for Payer: PHP Commercial |
$179.13
|
| Rate for Payer: PHP Medicare Advantage |
$127.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.10
|
| Rate for Payer: Priority Health Medicare |
$127.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.95
|
| Rate for Payer: UHC Medicare Advantage |
$127.95
|
| Rate for Payer: UMR Bronson Commercial |
$346.84
|
|
|
PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 49406
|
| Min. Negotiated Rate |
$163.20 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Commercial |
$245.45
|
| Rate for Payer: Aetna Medicare |
$190.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.45
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$183.17
|
| Rate for Payer: BCN Medicare Advantage |
$183.17
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$263.76
|
| Rate for Payer: Cofinity Commercial |
$245.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.33
|
| Rate for Payer: Nomi Health Commercial |
$219.80
|
| Rate for Payer: PACE SWMI |
$183.17
|
| Rate for Payer: PHP Commercial |
$256.44
|
| Rate for Payer: PHP Medicare Advantage |
$183.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health Medicare |
$183.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.17
|
| Rate for Payer: UHC Medicare Advantage |
$183.17
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$320.15
|
|
|
Service Code
|
NDC 00591532101
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$288.13 |
| Rate for Payer: Aetna American Axle |
$208.10
|
| Rate for Payer: Aetna Commercial |
$272.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: Cash Price |
$256.12
|
| Rate for Payer: Cofinity Commercial |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$288.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.13
|
| Rate for Payer: PHP Commercial |
$272.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.10
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: UMR Bronson Commercial |
$140.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.11
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$257.45
|
|
|
Service Code
|
NDC 00527123101
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.28 |
| Max. Negotiated Rate |
$231.71 |
| Rate for Payer: Aetna American Axle |
$167.34
|
| Rate for Payer: Aetna Commercial |
$218.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.34
|
| Rate for Payer: Cash Price |
$205.96
|
| Rate for Payer: Cofinity Commercial |
$180.22
|
| Rate for Payer: Cofinity Commercial |
$221.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.96
|
| Rate for Payer: Healthscope Commercial |
$231.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.83
|
| Rate for Payer: PHP Commercial |
$218.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.34
|
| Rate for Payer: Priority Health SBD |
$162.19
|
| Rate for Payer: UMR Bronson Commercial |
$113.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.09
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$257.45
|
|
|
Service Code
|
NDC 00527123101
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.26 |
| Max. Negotiated Rate |
$231.71 |
| Rate for Payer: Aetna American Axle |
$167.34
|
| Rate for Payer: Aetna Commercial |
$218.83
|
| Rate for Payer: Aetna Medicare |
$128.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.34
|
| Rate for Payer: BCBS Complete |
$102.98
|
| Rate for Payer: Cash Price |
$205.96
|
| Rate for Payer: Cofinity Commercial |
$180.22
|
| Rate for Payer: Cofinity Commercial |
$221.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.96
|
| Rate for Payer: Healthscope Commercial |
$231.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.83
|
| Rate for Payer: PHP Commercial |
$218.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.34
|
| Rate for Payer: Priority Health SBD |
$162.19
|
| Rate for Payer: UMR Bronson Commercial |
$95.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.09
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$318.24
|
|
|
Service Code
|
NDC 68084020301
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.03 |
| Max. Negotiated Rate |
$286.42 |
| Rate for Payer: Aetna American Axle |
$206.86
|
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: Cash Price |
$254.59
|
| Rate for Payer: Cofinity Commercial |
$222.77
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.59
|
| Rate for Payer: Healthscope Commercial |
$286.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.50
|
| Rate for Payer: PHP Commercial |
$270.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.86
|
| Rate for Payer: Priority Health SBD |
$200.49
|
| Rate for Payer: UMR Bronson Commercial |
$140.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.68
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$319.20
|
|
|
Service Code
|
NDC 53746054501
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna American Axle |
$207.48
|
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health SBD |
$201.10
|
| Rate for Payer: UMR Bronson Commercial |
$140.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
