|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 99448
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$79.18 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna Medicare |
$49.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.13
|
| Rate for Payer: BCBS Complete |
$31.98
|
| Rate for Payer: BCBS MAPPO |
$47.31
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: BCN Medicare Advantage |
$47.31
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$63.40
|
| Rate for Payer: Cofinity Commercial |
$68.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.68
|
| Rate for Payer: Meridian Medicaid |
$31.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.04
|
| Rate for Payer: Nomi Health Commercial |
$56.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
| Rate for Payer: PACE SWMI |
$47.31
|
| Rate for Payer: PHP Commercial |
$66.23
|
| Rate for Payer: PHP Medicare Advantage |
$47.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$60.27
|
| Rate for Payer: Priority Health Medicare |
$47.31
|
| Rate for Payer: Priority Health SBD |
$60.27
|
| Rate for Payer: Priority Health Tiered Network |
$60.27
|
| Rate for Payer: Railroad Medicare Medicare |
$47.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.18
|
| Rate for Payer: UHC Core |
$77.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.31
|
| Rate for Payer: UHC Exchange |
$77.18
|
| Rate for Payer: UHC Medicaid |
$30.46
|
| Rate for Payer: UHCCP Medicaid |
$30.46
|
| Rate for Payer: UMR Bronson Commercial |
$43.70
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 99449
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$84.25
|
| Rate for Payer: Aetna Medicare |
$65.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.53
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS MAPPO |
$62.87
|
| Rate for Payer: BCN Commercial |
$107.07
|
| Rate for Payer: BCN Medicare Advantage |
$62.87
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cofinity Commercial |
$84.25
|
| Rate for Payer: Cofinity Commercial |
$90.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.01
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.16
|
| Rate for Payer: Nomi Health Commercial |
$75.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.00
|
| Rate for Payer: PACE SWMI |
$62.87
|
| Rate for Payer: PHP Commercial |
$88.02
|
| Rate for Payer: PHP Medicare Advantage |
$62.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81.50
|
| Rate for Payer: Priority Health Medicare |
$62.87
|
| Rate for Payer: Priority Health SBD |
$81.50
|
| Rate for Payer: Priority Health Tiered Network |
$81.50
|
| Rate for Payer: Railroad Medicare Medicare |
$62.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.69
|
| Rate for Payer: UHC Core |
$102.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.87
|
| Rate for Payer: UHC Exchange |
$102.69
|
| Rate for Payer: UHC Medicaid |
$40.47
|
| Rate for Payer: UHCCP Medicaid |
$40.47
|
| Rate for Payer: UMR Bronson Commercial |
$69.92
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 99446
|
| Min. Negotiated Rate |
$10.22 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Aetna Commercial |
$21.36
|
| Rate for Payer: Aetna Medicare |
$16.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.95
|
| Rate for Payer: BCBS Complete |
$10.73
|
| Rate for Payer: BCBS MAPPO |
$15.94
|
| Rate for Payer: BCN Commercial |
$26.40
|
| Rate for Payer: BCN Medicare Advantage |
$15.94
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$21.36
|
| Rate for Payer: Cofinity Commercial |
$22.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.74
|
| Rate for Payer: Meridian Medicaid |
$10.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.53
|
| Rate for Payer: Nomi Health Commercial |
$19.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.50
|
| Rate for Payer: PACE SWMI |
$15.94
|
| Rate for Payer: PHP Commercial |
$22.32
|
| Rate for Payer: PHP Medicare Advantage |
$15.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$20.09
|
| Rate for Payer: Priority Health Medicare |
$15.94
|
| Rate for Payer: Priority Health SBD |
$20.09
|
| Rate for Payer: Priority Health Tiered Network |
$20.09
|
| Rate for Payer: Railroad Medicare Medicare |
$15.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.57
|
| Rate for Payer: UHC Core |
$25.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.94
|
| Rate for Payer: UHC Exchange |
$25.57
|
| Rate for Payer: UHC Medicaid |
$10.22
|
| Rate for Payer: UHCCP Medicaid |
$10.22
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
|
|
PR NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS
|
Professional
|
Both
|
$7,322.00
|
|
|
Service Code
|
HCPCS 62161
|
| Min. Negotiated Rate |
$958.29 |
| Max. Negotiated Rate |
$5,491.50 |
| Rate for Payer: Aetna Commercial |
$2,002.58
|
| Rate for Payer: Aetna Medicare |
$1,554.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,002.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,152.02
|
| Rate for Payer: BCBS Complete |
$1,006.20
|
| Rate for Payer: BCBS MAPPO |
$1,494.46
|
| Rate for Payer: BCN Commercial |
$3,215.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,494.46
|
| Rate for Payer: Cash Price |
$5,857.60
|
| Rate for Payer: Cash Price |
$5,857.60
|
| Rate for Payer: Cofinity Commercial |
$2,002.58
|
| Rate for Payer: Cofinity Commercial |
$2,152.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,494.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,569.18
|
| Rate for Payer: Meridian Medicaid |
$1,006.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,643.91
|
| Rate for Payer: Nomi Health Commercial |
$1,793.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,491.50
|
| Rate for Payer: PACE SWMI |
$1,494.46
|
| Rate for Payer: PHP Commercial |
$2,092.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,494.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$958.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,703.43
|
| Rate for Payer: Priority Health Medicare |
$1,494.46
|
| Rate for Payer: Priority Health SBD |
$2,703.43
|
| Rate for Payer: Priority Health Tiered Network |
$2,703.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,494.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,661.94
|
| Rate for Payer: UHC Core |
$2,661.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,494.46
|
| Rate for Payer: UHC Exchange |
$2,661.94
|
| Rate for Payer: UHC Medicaid |
$958.29
|
| Rate for Payer: UHCCP Medicaid |
$958.29
|
| Rate for Payer: UMR Bronson Commercial |
$3,368.12
|
|
|
PR NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 62165
|
| Min. Negotiated Rate |
$893.11 |
| Max. Negotiated Rate |
$2,679.27 |
| Rate for Payer: Aetna Commercial |
$1,865.60
|
| Rate for Payer: Aetna Medicare |
$1,447.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,865.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,004.83
|
| Rate for Payer: BCBS Complete |
$937.77
|
| Rate for Payer: BCBS MAPPO |
$1,392.24
|
| Rate for Payer: BCN Commercial |
$2,294.70
|
| Rate for Payer: BCN Medicare Advantage |
$1,392.24
|
| Rate for Payer: Cash Price |
$2,327.20
|
| Rate for Payer: Cash Price |
$2,327.20
|
| Rate for Payer: Cofinity Commercial |
$1,865.60
|
| Rate for Payer: Cofinity Commercial |
$2,004.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,392.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,461.85
|
| Rate for Payer: Meridian Medicaid |
$937.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,531.46
|
| Rate for Payer: Nomi Health Commercial |
$1,670.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,181.75
|
| Rate for Payer: PACE SWMI |
$1,392.24
|
| Rate for Payer: PHP Commercial |
$1,949.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,392.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$893.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,665.25
|
| Rate for Payer: Priority Health Medicare |
$1,392.24
|
| Rate for Payer: Priority Health SBD |
$2,665.25
|
| Rate for Payer: Priority Health Tiered Network |
$2,665.25
|
| Rate for Payer: Railroad Medicare Medicare |
$1,392.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,679.27
|
| Rate for Payer: UHC Core |
$2,679.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,392.24
|
| Rate for Payer: UHC Exchange |
$2,679.27
|
| Rate for Payer: UHC Medicaid |
$893.11
|
| Rate for Payer: UHCCP Medicaid |
$893.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,338.14
|
|
|
PR NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG
|
Professional
|
Both
|
$8,069.00
|
|
|
Service Code
|
HCPCS 62162
|
| Min. Negotiated Rate |
$1,181.94 |
| Max. Negotiated Rate |
$6,051.75 |
| Rate for Payer: Aetna Commercial |
$2,476.08
|
| Rate for Payer: Aetna Medicare |
$1,921.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,476.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,660.86
|
| Rate for Payer: BCBS Complete |
$1,241.04
|
| Rate for Payer: BCBS MAPPO |
$1,847.82
|
| Rate for Payer: BCN Commercial |
$2,881.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,847.82
|
| Rate for Payer: Cash Price |
$6,455.20
|
| Rate for Payer: Cash Price |
$6,455.20
|
| Rate for Payer: Cofinity Commercial |
$2,476.08
|
| Rate for Payer: Cofinity Commercial |
$2,660.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,847.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,940.21
|
| Rate for Payer: Meridian Medicaid |
$1,241.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,032.60
|
| Rate for Payer: Nomi Health Commercial |
$2,217.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,051.75
|
| Rate for Payer: PACE SWMI |
$1,847.82
|
| Rate for Payer: PHP Commercial |
$2,586.95
|
| Rate for Payer: PHP Medicare Advantage |
$1,847.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,181.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,347.17
|
| Rate for Payer: Priority Health Medicare |
$1,847.82
|
| Rate for Payer: Priority Health SBD |
$3,347.17
|
| Rate for Payer: Priority Health Tiered Network |
$3,347.17
|
| Rate for Payer: Railroad Medicare Medicare |
$1,847.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,328.46
|
| Rate for Payer: UHC Core |
$3,328.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,847.82
|
| Rate for Payer: UHC Exchange |
$3,328.46
|
| Rate for Payer: UHC Medicaid |
$1,181.94
|
| Rate for Payer: UHCCP Medicaid |
$1,181.94
|
| Rate for Payer: UMR Bronson Commercial |
$3,711.74
|
|
|
PR NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 62160
|
| Min. Negotiated Rate |
$109.91 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$233.96
|
| Rate for Payer: Aetna Medicare |
$181.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.42
|
| Rate for Payer: BCBS Complete |
$115.41
|
| Rate for Payer: BCBS MAPPO |
$174.60
|
| Rate for Payer: BCN Commercial |
$390.76
|
| Rate for Payer: BCN Medicare Advantage |
$174.60
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cofinity Commercial |
$233.96
|
| Rate for Payer: Cofinity Commercial |
$251.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.33
|
| Rate for Payer: Meridian Medicaid |
$115.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$192.06
|
| Rate for Payer: Nomi Health Commercial |
$209.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$630.00
|
| Rate for Payer: PACE SWMI |
$174.60
|
| Rate for Payer: PHP Commercial |
$244.44
|
| Rate for Payer: PHP Medicare Advantage |
$174.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$328.53
|
| Rate for Payer: Priority Health Medicare |
$174.60
|
| Rate for Payer: Priority Health SBD |
$328.53
|
| Rate for Payer: Priority Health Tiered Network |
$328.53
|
| Rate for Payer: Railroad Medicare Medicare |
$174.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.06
|
| Rate for Payer: UHC Core |
$336.06
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$174.60
|
| Rate for Payer: UHC Exchange |
$336.06
|
| Rate for Payer: UHC Medicaid |
$109.91
|
| Rate for Payer: UHCCP Medicaid |
$109.91
|
| Rate for Payer: UMR Bronson Commercial |
$386.40
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99316
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$193.71 |
| Rate for Payer: Aetna Commercial |
$155.21
|
| Rate for Payer: Aetna Medicare |
$120.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.80
|
| Rate for Payer: BCBS Complete |
$108.63
|
| Rate for Payer: BCBS MAPPO |
$115.83
|
| Rate for Payer: BCN Commercial |
$193.71
|
| Rate for Payer: BCN Medicare Advantage |
$115.83
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$155.21
|
| Rate for Payer: Cofinity Commercial |
$166.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.62
|
| Rate for Payer: Meridian Medicaid |
$108.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.41
|
| Rate for Payer: Nomi Health Commercial |
$139.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.25
|
| Rate for Payer: PACE SWMI |
$115.83
|
| Rate for Payer: PHP Commercial |
$162.16
|
| Rate for Payer: PHP Medicare Advantage |
$115.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$174.25
|
| Rate for Payer: Priority Health Medicare |
$115.83
|
| Rate for Payer: Priority Health SBD |
$174.25
|
| Rate for Payer: Priority Health Tiered Network |
$174.25
|
| Rate for Payer: Railroad Medicare Medicare |
$115.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.02
|
| Rate for Payer: UHC Core |
$148.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.83
|
| Rate for Payer: UHC Exchange |
$148.02
|
| Rate for Payer: UHC Medicaid |
$103.46
|
| Rate for Payer: UHCCP Medicaid |
$103.46
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 99315
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$121.01 |
| Rate for Payer: Aetna Commercial |
$96.20
|
| Rate for Payer: Aetna Medicare |
$74.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: BCBS Complete |
$67.59
|
| Rate for Payer: BCBS MAPPO |
$71.79
|
| Rate for Payer: BCN Commercial |
$121.01
|
| Rate for Payer: BCN Medicare Advantage |
$71.79
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$103.38
|
| Rate for Payer: Cofinity Commercial |
$96.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.38
|
| Rate for Payer: Meridian Medicaid |
$67.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.97
|
| Rate for Payer: Nomi Health Commercial |
$86.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.75
|
| Rate for Payer: PACE SWMI |
$71.79
|
| Rate for Payer: PHP Commercial |
$100.51
|
| Rate for Payer: PHP Medicare Advantage |
$71.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$108.84
|
| Rate for Payer: Priority Health Medicare |
$71.79
|
| Rate for Payer: Priority Health SBD |
$108.84
|
| Rate for Payer: Priority Health Tiered Network |
$108.84
|
| Rate for Payer: Railroad Medicare Medicare |
$71.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.02
|
| Rate for Payer: UHC Core |
$103.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.79
|
| Rate for Payer: UHC Exchange |
$103.02
|
| Rate for Payer: UHC Medicaid |
$64.37
|
| Rate for Payer: UHCCP Medicaid |
$64.37
|
| Rate for Payer: UMR Bronson Commercial |
$51.98
|
|
|
PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 94690
|
| Min. Negotiated Rate |
$48.22 |
| Max. Negotiated Rate |
$100.50 |
| Rate for Payer: Aetna Commercial |
$64.61
|
| Rate for Payer: Aetna Medicare |
$50.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.44
|
| Rate for Payer: BCBS MAPPO |
$48.22
|
| Rate for Payer: BCN Commercial |
$72.21
|
| Rate for Payer: BCN Medicare Advantage |
$48.22
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$64.61
|
| Rate for Payer: Cofinity Commercial |
$69.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.04
|
| Rate for Payer: Nomi Health Commercial |
$57.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.50
|
| Rate for Payer: PACE SWMI |
$48.22
|
| Rate for Payer: PHP Commercial |
$67.51
|
| Rate for Payer: PHP Medicare Advantage |
$48.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$66.59
|
| Rate for Payer: Priority Health Medicare |
$48.22
|
| Rate for Payer: Priority Health SBD |
$66.59
|
| Rate for Payer: Priority Health Tiered Network |
$66.59
|
| Rate for Payer: Railroad Medicare Medicare |
$48.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.48
|
| Rate for Payer: UHC Core |
$76.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.22
|
| Rate for Payer: UHC Exchange |
$76.48
|
| Rate for Payer: UMR Bronson Commercial |
$61.64
|
|
|
PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMPLE
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 94680
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$87.75 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$55.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.33
|
| Rate for Payer: BCBS MAPPO |
$53.70
|
| Rate for Payer: BCN Commercial |
$78.68
|
| Rate for Payer: BCN Medicare Advantage |
$53.70
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$77.33
|
| Rate for Payer: Cofinity Commercial |
$71.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$56.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.07
|
| Rate for Payer: Nomi Health Commercial |
$64.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.75
|
| Rate for Payer: PACE SWMI |
$53.70
|
| Rate for Payer: PHP Commercial |
$75.18
|
| Rate for Payer: PHP Medicare Advantage |
$53.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$72.56
|
| Rate for Payer: Priority Health Medicare |
$53.70
|
| Rate for Payer: Priority Health SBD |
$72.56
|
| Rate for Payer: Priority Health Tiered Network |
$72.56
|
| Rate for Payer: Railroad Medicare Medicare |
$53.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.66
|
| Rate for Payer: UHC Core |
$81.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$53.70
|
| Rate for Payer: UHC Exchange |
$81.66
|
| Rate for Payer: UMR Bronson Commercial |
$53.82
|
|
|
PROAIR HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$116.90
|
|
|
Service Code
|
NDC 00093317431
|
| Hospital Charge Code |
76821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.44 |
| Max. Negotiated Rate |
$105.21 |
| Rate for Payer: Aetna American Axle |
$75.98
|
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.98
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Advantage |
$81.83
|
| Rate for Payer: Cofinity Commercial |
$100.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$105.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.67
|
| Rate for Payer: PHP Commercial |
$99.36
|
| Rate for Payer: Priority Health SBD |
$73.65
|
| Rate for Payer: UMR Bronson Commercial |
$51.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.67
|
|
|
PROAIR HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$116.90
|
|
|
Service Code
|
NDC 00093317431
|
| Hospital Charge Code |
76821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$105.21 |
| Rate for Payer: Aetna American Axle |
$75.98
|
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: Aetna Medicare |
$58.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.98
|
| Rate for Payer: BCBS Complete |
$46.76
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Advantage |
$81.83
|
| Rate for Payer: Cofinity Commercial |
$100.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$105.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.67
|
| Rate for Payer: PHP Commercial |
$99.36
|
| Rate for Payer: Priority Health SBD |
$73.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.98
|
| Rate for Payer: UHC Core |
$60.90
|
| Rate for Payer: UHC Exchange |
$45.94
|
| Rate for Payer: UMR Bronson Commercial |
$43.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.67
|
|
|
PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM
|
Professional
|
Both
|
$4,376.00
|
|
|
Service Code
|
HCPCS 59510
|
| Min. Negotiated Rate |
$2,012.96 |
| Max. Negotiated Rate |
$3,802.61 |
| Rate for Payer: Aetna Commercial |
$3,311.45
|
| Rate for Payer: Aetna Medicare |
$2,570.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,311.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,558.57
|
| Rate for Payer: BCBS Complete |
$2,465.36
|
| Rate for Payer: BCBS MAPPO |
$2,471.23
|
| Rate for Payer: BCN Commercial |
$3,276.87
|
| Rate for Payer: BCN Medicare Advantage |
$2,471.23
|
| Rate for Payer: Cash Price |
$3,500.80
|
| Rate for Payer: Cash Price |
$3,500.80
|
| Rate for Payer: Cofinity Commercial |
$3,311.45
|
| Rate for Payer: Cofinity Commercial |
$3,558.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,471.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,594.79
|
| Rate for Payer: Meridian Medicaid |
$2,465.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,718.35
|
| Rate for Payer: Nomi Health Commercial |
$2,965.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,282.00
|
| Rate for Payer: PACE SWMI |
$2,471.23
|
| Rate for Payer: PHP Commercial |
$3,459.72
|
| Rate for Payer: PHP Medicare Advantage |
$2,471.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,347.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,802.61
|
| Rate for Payer: Priority Health Medicare |
$2,471.23
|
| Rate for Payer: Priority Health SBD |
$3,802.61
|
| Rate for Payer: Priority Health Tiered Network |
$3,802.61
|
| Rate for Payer: Railroad Medicare Medicare |
$2,471.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,966.43
|
| Rate for Payer: UHC Core |
$2,966.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,471.23
|
| Rate for Payer: UHC Exchange |
$2,966.43
|
| Rate for Payer: UHC Medicaid |
$2,347.96
|
| Rate for Payer: UHCCP Medicaid |
$2,347.96
|
| Rate for Payer: UMR Bronson Commercial |
$2,012.96
|
|
|
PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM
|
Professional
|
Both
|
$3,945.00
|
|
|
Service Code
|
HCPCS 59400
|
| Min. Negotiated Rate |
$1,814.70 |
| Max. Negotiated Rate |
$3,423.23 |
| Rate for Payer: Aetna Commercial |
$2,955.21
|
| Rate for Payer: Aetna Medicare |
$2,293.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,955.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,175.75
|
| Rate for Payer: BCBS Complete |
$2,199.49
|
| Rate for Payer: BCBS MAPPO |
$2,205.38
|
| Rate for Payer: BCN Commercial |
$3,276.87
|
| Rate for Payer: BCN Medicare Advantage |
$2,205.38
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Cofinity Commercial |
$2,955.21
|
| Rate for Payer: Cofinity Commercial |
$3,175.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,205.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,315.65
|
| Rate for Payer: Meridian Medicaid |
$2,199.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,425.92
|
| Rate for Payer: Nomi Health Commercial |
$2,646.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,958.75
|
| Rate for Payer: PACE SWMI |
$2,205.38
|
| Rate for Payer: PHP Commercial |
$3,087.53
|
| Rate for Payer: PHP Medicare Advantage |
$2,205.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,094.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,423.23
|
| Rate for Payer: Priority Health Medicare |
$2,205.38
|
| Rate for Payer: Priority Health SBD |
$3,423.23
|
| Rate for Payer: Priority Health Tiered Network |
$3,423.23
|
| Rate for Payer: Railroad Medicare Medicare |
$2,205.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,672.37
|
| Rate for Payer: UHC Core |
$2,672.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,205.38
|
| Rate for Payer: UHC Exchange |
$2,672.37
|
| Rate for Payer: UHC Medicaid |
$2,094.75
|
| Rate for Payer: UHCCP Medicaid |
$2,094.75
|
| Rate for Payer: UMR Bronson Commercial |
$1,814.70
|
|
|
PROBENECID 500 MG-COLCHICINE 0.5 MG TABLET
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 00591532501
|
| Hospital Charge Code |
9675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna American Axle |
$234.00
|
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Advantage |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.00
|
| Rate for Payer: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health SBD |
$226.80
|
| Rate for Payer: UMR Bronson Commercial |
$158.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.00
|
|
|
PROBENECID 500 MG-COLCHICINE 0.5 MG TABLET
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
NDC 00591532501
|
| Hospital Charge Code |
9675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna American Axle |
$234.00
|
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna Medicare |
$180.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.00
|
| Rate for Payer: BCBS Complete |
$144.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Advantage |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$288.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$270.00
|
| Rate for Payer: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health SBD |
$226.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.00
|
| Rate for Payer: UHC Core |
$187.56
|
| Rate for Payer: UHC Exchange |
$141.48
|
| Rate for Payer: UMR Bronson Commercial |
$133.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.00
|
|
|
PROBENECID 500 MG TABLET
|
Facility
|
OP
|
$265.44
|
|
|
Service Code
|
NDC 00591534701
|
| Hospital Charge Code |
6561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.21 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna Medicare |
$132.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: BCBS Complete |
$106.18
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Advantage |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.08
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.54
|
| Rate for Payer: UHC Core |
$138.29
|
| Rate for Payer: UHC Exchange |
$104.32
|
| Rate for Payer: UMR Bronson Commercial |
$98.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
PROBENECID 500 MG TABLET
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 00378015601
|
| Hospital Charge Code |
6561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.34 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna American Axle |
$182.21
|
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Advantage |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health SBD |
$176.60
|
| Rate for Payer: UMR Bronson Commercial |
$123.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
PROBENECID 500 MG TABLET
|
Facility
|
IP
|
$899.52
|
|
|
Service Code
|
NDC 00527136701
|
| Hospital Charge Code |
6561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$395.79 |
| Max. Negotiated Rate |
$809.57 |
| Rate for Payer: Aetna American Axle |
$584.69
|
| Rate for Payer: Aetna Commercial |
$764.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.69
|
| Rate for Payer: Cash Price |
$719.62
|
| Rate for Payer: Cofinity Advantage |
$629.66
|
| Rate for Payer: Cofinity Commercial |
$773.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.62
|
| Rate for Payer: Healthscope Commercial |
$809.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.64
|
| Rate for Payer: PHP Commercial |
$764.59
|
| Rate for Payer: Priority Health SBD |
$566.70
|
| Rate for Payer: UMR Bronson Commercial |
$395.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.64
|
|
|
PROBENECID 500 MG TABLET
|
Facility
|
OP
|
$899.52
|
|
|
Service Code
|
NDC 00527136701
|
| Hospital Charge Code |
6561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$332.82 |
| Max. Negotiated Rate |
$809.57 |
| Rate for Payer: Aetna American Axle |
$584.69
|
| Rate for Payer: Aetna Commercial |
$764.59
|
| Rate for Payer: Aetna Medicare |
$449.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$584.69
|
| Rate for Payer: BCBS Complete |
$359.81
|
| Rate for Payer: Cash Price |
$719.62
|
| Rate for Payer: Cofinity Advantage |
$629.66
|
| Rate for Payer: Cofinity Commercial |
$773.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$719.62
|
| Rate for Payer: Healthscope Commercial |
$809.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$629.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$674.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$719.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$764.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$674.64
|
| Rate for Payer: PHP Commercial |
$764.59
|
| Rate for Payer: Priority Health SBD |
$566.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.69
|
| Rate for Payer: UHC Core |
$468.65
|
| Rate for Payer: UHC Exchange |
$353.51
|
| Rate for Payer: UMR Bronson Commercial |
$332.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.64
|
|
|
PROBENECID 500 MG TABLET
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 00591534701
|
| Hospital Charge Code |
6561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.79 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Advantage |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.08
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UMR Bronson Commercial |
$116.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
PROBENECID 500 MG TABLET
|
Facility
|
OP
|
$280.32
|
|
|
Service Code
|
NDC 00378015601
|
| Hospital Charge Code |
6561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.72 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna American Axle |
$182.21
|
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna Medicare |
$140.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: BCBS Complete |
$112.13
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Advantage |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health SBD |
$176.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.21
|
| Rate for Payer: UHC Core |
$146.05
|
| Rate for Payer: UHC Exchange |
$110.17
|
| Rate for Payer: UMR Bronson Commercial |
$103.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS
|
Professional
|
Both
|
$2,478.00
|
|
|
Service Code
|
HCPCS 33813
|
| Min. Negotiated Rate |
$991.20 |
| Max. Negotiated Rate |
$1,858.50 |
| Rate for Payer: Aetna Commercial |
$1,663.43
|
| Rate for Payer: Aetna Medicare |
$1,239.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,663.43
|
| Rate for Payer: BCBS Complete |
$991.20
|
| Rate for Payer: BCN Commercial |
$1,811.49
|
| Rate for Payer: Cash Price |
$1,982.40
|
| Rate for Payer: Cash Price |
$1,982.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,858.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,139.88
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DFCT W/CARD BYPASS
|
Professional
|
Both
|
$3,184.00
|
|
|
Service Code
|
HCPCS 33814
|
| Min. Negotiated Rate |
$924.42 |
| Max. Negotiated Rate |
$2,705.35 |
| Rate for Payer: Aetna Commercial |
$1,937.49
|
| Rate for Payer: Aetna Medicare |
$1,503.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,937.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,082.08
|
| Rate for Payer: BCBS Complete |
$970.64
|
| Rate for Payer: BCBS MAPPO |
$1,445.89
|
| Rate for Payer: BCN Commercial |
$2,255.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,445.89
|
| Rate for Payer: Cash Price |
$2,547.20
|
| Rate for Payer: Cash Price |
$2,547.20
|
| Rate for Payer: Cofinity Commercial |
$2,082.08
|
| Rate for Payer: Cofinity Commercial |
$1,937.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,445.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,518.18
|
| Rate for Payer: Meridian Medicaid |
$970.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,590.48
|
| Rate for Payer: Nomi Health Commercial |
$1,735.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,388.00
|
| Rate for Payer: PACE SWMI |
$1,445.89
|
| Rate for Payer: PHP Commercial |
$2,024.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,445.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$924.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,425.34
|
| Rate for Payer: Priority Health Medicare |
$1,445.89
|
| Rate for Payer: Priority Health SBD |
$2,425.34
|
| Rate for Payer: Priority Health Tiered Network |
$2,425.34
|
| Rate for Payer: Railroad Medicare Medicare |
$1,445.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,705.35
|
| Rate for Payer: UHC Core |
$2,705.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,445.89
|
| Rate for Payer: UHC Exchange |
$2,705.35
|
| Rate for Payer: UHC Medicaid |
$924.42
|
| Rate for Payer: UHCCP Medicaid |
$924.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,464.64
|
|
