|
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING), WITH OR WITHOUT METHYLMETHACRYLATE, HUMERAL SHAFT
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 24498
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$10,929.23
|
| Rate for Payer: BCN Commercial |
$10,929.23
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING) WITH OR WITHOUT METHYLMETHACRYLATE; PROXIMAL HUMERUS
|
Facility
|
OP
|
$41,369.85
|
|
|
Service Code
|
CPT 23491
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,690.48 |
| Max. Negotiated Rate |
$41,369.85 |
| Rate for Payer: Aetna Medicare |
$13,304.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,990.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,990.64
|
| Rate for Payer: BCBS Complete |
$7,025.65
|
| Rate for Payer: BCBS MAPPO |
$12,792.51
|
| Rate for Payer: BCBS Trust/PPO |
$9,367.90
|
| Rate for Payer: BCN Commercial |
$9,367.90
|
| Rate for Payer: BCN Medicare Advantage |
$12,792.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,792.51
|
| Rate for Payer: Mclaren Medicaid |
$12,792.51
|
| Rate for Payer: Mclaren Medicare |
$12,792.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,432.14
|
| Rate for Payer: Meridian Medicaid |
$13,432.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,711.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$14,071.76
|
| Rate for Payer: Nomi Health Commercial |
$38,377.53
|
| Rate for Payer: PACE Medicare |
$12,152.88
|
| Rate for Payer: PACE SWMI |
$12,792.51
|
| Rate for Payer: PHP Medicare Advantage |
$12,792.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,690.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41,369.85
|
| Rate for Payer: Priority Health Medicare |
$12,792.51
|
| Rate for Payer: Priority Health Tiered Network |
$33,095.88
|
| Rate for Payer: Railroad Medicare Medicare |
$12,792.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,792.51
|
| Rate for Payer: UHC Medicaid |
$6,690.48
|
| Rate for Payer: UHCCP Medicaid |
$6,690.48
|
| Rate for Payer: VA VA |
$12,792.51
|
|
|
PR OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 34716
|
| Min. Negotiated Rate |
$215.77 |
| Max. Negotiated Rate |
$667.52 |
| Rate for Payer: Aetna Commercial |
$457.97
|
| Rate for Payer: Aetna Medicare |
$355.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$492.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.97
|
| Rate for Payer: BCBS Complete |
$226.56
|
| Rate for Payer: BCBS MAPPO |
$341.77
|
| Rate for Payer: BCN Commercial |
$543.80
|
| Rate for Payer: BCN Medicare Advantage |
$341.77
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$492.15
|
| Rate for Payer: Cofinity Commercial |
$457.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$341.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$358.86
|
| Rate for Payer: Meridian Medicaid |
$226.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$375.95
|
| Rate for Payer: Nomi Health Commercial |
$410.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$608.25
|
| Rate for Payer: PACE SWMI |
$341.77
|
| Rate for Payer: PHP Commercial |
$478.48
|
| Rate for Payer: PHP Medicare Advantage |
$341.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$584.78
|
| Rate for Payer: Priority Health Medicare |
$341.77
|
| Rate for Payer: Priority Health SBD |
$584.78
|
| Rate for Payer: Priority Health Tiered Network |
$584.78
|
| Rate for Payer: Railroad Medicare Medicare |
$341.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$667.52
|
| Rate for Payer: UHC Core |
$667.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$341.77
|
| Rate for Payer: UHC Exchange |
$667.52
|
| Rate for Payer: UHC Medicaid |
$215.77
|
| Rate for Payer: UHCCP Medicaid |
$215.77
|
| Rate for Payer: UMR Bronson Commercial |
$373.06
|
|
|
PR OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 34834
|
| Min. Negotiated Rate |
$74.34 |
| Max. Negotiated Rate |
$234.03 |
| Rate for Payer: Aetna Commercial |
$158.94
|
| Rate for Payer: Aetna Medicare |
$123.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.80
|
| Rate for Payer: BCBS Complete |
$78.06
|
| Rate for Payer: BCBS MAPPO |
$118.61
|
| Rate for Payer: BCN Commercial |
$187.74
|
| Rate for Payer: BCN Medicare Advantage |
$118.61
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$158.94
|
| Rate for Payer: Cofinity Commercial |
$170.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.54
|
| Rate for Payer: Meridian Medicaid |
$78.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.47
|
| Rate for Payer: Nomi Health Commercial |
$142.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$224.25
|
| Rate for Payer: PACE SWMI |
$118.61
|
| Rate for Payer: PHP Commercial |
$166.05
|
| Rate for Payer: PHP Medicare Advantage |
$118.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$201.90
|
| Rate for Payer: Priority Health Medicare |
$118.61
|
| Rate for Payer: Priority Health SBD |
$201.90
|
| Rate for Payer: Priority Health Tiered Network |
$201.90
|
| Rate for Payer: Railroad Medicare Medicare |
$118.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.03
|
| Rate for Payer: UHC Core |
$234.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$118.61
|
| Rate for Payer: UHC Exchange |
$234.03
|
| Rate for Payer: UHC Medicaid |
$74.34
|
| Rate for Payer: UHCCP Medicaid |
$74.34
|
| Rate for Payer: UMR Bronson Commercial |
$137.54
|
|
|
PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$1,305.00
|
|
|
Service Code
|
HCPCS 34812
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$978.75 |
| Rate for Payer: Aetna Commercial |
$252.13
|
| Rate for Payer: Aetna Medicare |
$195.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.95
|
| Rate for Payer: BCBS Complete |
$123.90
|
| Rate for Payer: BCBS MAPPO |
$188.16
|
| Rate for Payer: BCN Commercial |
$299.28
|
| Rate for Payer: BCN Medicare Advantage |
$188.16
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cash Price |
$1,044.00
|
| Rate for Payer: Cofinity Commercial |
$252.13
|
| Rate for Payer: Cofinity Commercial |
$270.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$197.57
|
| Rate for Payer: Meridian Medicaid |
$123.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$206.98
|
| Rate for Payer: Nomi Health Commercial |
$225.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$978.75
|
| Rate for Payer: PACE SWMI |
$188.16
|
| Rate for Payer: PHP Commercial |
$263.42
|
| Rate for Payer: PHP Medicare Advantage |
$188.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$118.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$321.84
|
| Rate for Payer: Priority Health Medicare |
$188.16
|
| Rate for Payer: Priority Health SBD |
$321.84
|
| Rate for Payer: Priority Health Tiered Network |
$321.84
|
| Rate for Payer: Railroad Medicare Medicare |
$188.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$372.43
|
| Rate for Payer: UHC Core |
$372.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.16
|
| Rate for Payer: UHC Exchange |
$372.43
|
| Rate for Payer: UHC Medicaid |
$118.00
|
| Rate for Payer: UHCCP Medicaid |
$118.00
|
| Rate for Payer: UMR Bronson Commercial |
$600.30
|
|
|
PR OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH
|
Professional
|
Both
|
$585.00
|
|
|
Service Code
|
HCPCS 34714
|
| Min. Negotiated Rate |
$156.34 |
| Max. Negotiated Rate |
$486.61 |
| Rate for Payer: Aetna Commercial |
$332.25
|
| Rate for Payer: Aetna Medicare |
$257.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.05
|
| Rate for Payer: BCBS Complete |
$164.16
|
| Rate for Payer: BCBS MAPPO |
$247.95
|
| Rate for Payer: BCN Commercial |
$392.91
|
| Rate for Payer: BCN Medicare Advantage |
$247.95
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cofinity Commercial |
$332.25
|
| Rate for Payer: Cofinity Commercial |
$357.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$247.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.35
|
| Rate for Payer: Meridian Medicaid |
$164.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$272.75
|
| Rate for Payer: Nomi Health Commercial |
$297.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.75
|
| Rate for Payer: PACE SWMI |
$247.95
|
| Rate for Payer: PHP Commercial |
$347.13
|
| Rate for Payer: PHP Medicare Advantage |
$247.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$156.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$422.52
|
| Rate for Payer: Priority Health Medicare |
$247.95
|
| Rate for Payer: Priority Health SBD |
$422.52
|
| Rate for Payer: Priority Health Tiered Network |
$422.52
|
| Rate for Payer: Railroad Medicare Medicare |
$247.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$486.61
|
| Rate for Payer: UHC Core |
$486.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$247.95
|
| Rate for Payer: UHC Exchange |
$486.61
|
| Rate for Payer: UHC Medicaid |
$156.34
|
| Rate for Payer: UHCCP Medicaid |
$156.34
|
| Rate for Payer: UMR Bronson Commercial |
$269.10
|
|
|
PR OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP
|
Professional
|
Both
|
$2,299.00
|
|
|
Service Code
|
HCPCS 34833
|
| Min. Negotiated Rate |
$226.42 |
| Max. Negotiated Rate |
$1,724.25 |
| Rate for Payer: Aetna Commercial |
$485.09
|
| Rate for Payer: Aetna Medicare |
$376.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$521.29
|
| Rate for Payer: BCBS Complete |
$237.74
|
| Rate for Payer: BCBS MAPPO |
$362.01
|
| Rate for Payer: BCN Commercial |
$571.68
|
| Rate for Payer: BCN Medicare Advantage |
$362.01
|
| Rate for Payer: Cash Price |
$1,839.20
|
| Rate for Payer: Cash Price |
$1,839.20
|
| Rate for Payer: Cofinity Commercial |
$485.09
|
| Rate for Payer: Cofinity Commercial |
$521.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.11
|
| Rate for Payer: Meridian Medicaid |
$237.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$398.21
|
| Rate for Payer: Nomi Health Commercial |
$434.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,724.25
|
| Rate for Payer: PACE SWMI |
$362.01
|
| Rate for Payer: PHP Commercial |
$506.81
|
| Rate for Payer: PHP Medicare Advantage |
$362.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$614.78
|
| Rate for Payer: Priority Health Medicare |
$362.01
|
| Rate for Payer: Priority Health SBD |
$614.78
|
| Rate for Payer: Priority Health Tiered Network |
$614.78
|
| Rate for Payer: Railroad Medicare Medicare |
$362.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.24
|
| Rate for Payer: UHC Core |
$728.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$362.01
|
| Rate for Payer: UHC Exchange |
$728.24
|
| Rate for Payer: UHC Medicaid |
$226.42
|
| Rate for Payer: UHCCP Medicaid |
$226.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,057.54
|
|
|
PR OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH
|
Professional
|
Both
|
$4,956.00
|
|
|
Service Code
|
HCPCS 34830
|
| Min. Negotiated Rate |
$1,021.12 |
| Max. Negotiated Rate |
$3,717.00 |
| Rate for Payer: Aetna Commercial |
$2,177.71
|
| Rate for Payer: Aetna Medicare |
$1,690.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,177.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,340.23
|
| Rate for Payer: BCBS Complete |
$1,072.18
|
| Rate for Payer: BCBS MAPPO |
$1,625.16
|
| Rate for Payer: BCN Commercial |
$2,574.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,625.16
|
| Rate for Payer: Cash Price |
$3,964.80
|
| Rate for Payer: Cash Price |
$3,964.80
|
| Rate for Payer: Cofinity Commercial |
$2,177.71
|
| Rate for Payer: Cofinity Commercial |
$2,340.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,625.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,706.42
|
| Rate for Payer: Meridian Medicaid |
$1,072.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,787.68
|
| Rate for Payer: Nomi Health Commercial |
$1,950.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,717.00
|
| Rate for Payer: PACE SWMI |
$1,625.16
|
| Rate for Payer: PHP Commercial |
$2,275.22
|
| Rate for Payer: PHP Medicare Advantage |
$1,625.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,021.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,768.61
|
| Rate for Payer: Priority Health Medicare |
$1,625.16
|
| Rate for Payer: Priority Health SBD |
$2,768.61
|
| Rate for Payer: Priority Health Tiered Network |
$2,768.61
|
| Rate for Payer: Railroad Medicare Medicare |
$1,625.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,175.10
|
| Rate for Payer: UHC Core |
$3,175.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,625.16
|
| Rate for Payer: UHC Exchange |
$3,175.10
|
| Rate for Payer: UHC Medicaid |
$1,021.12
|
| Rate for Payer: UHCCP Medicaid |
$1,021.12
|
| Rate for Payer: UMR Bronson Commercial |
$2,279.76
|
|
|
PR OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH
|
Professional
|
Both
|
$4,199.00
|
|
|
Service Code
|
HCPCS 34831
|
| Min. Negotiated Rate |
$1,118.68 |
| Max. Negotiated Rate |
$3,470.53 |
| Rate for Payer: Aetna Commercial |
$2,381.39
|
| Rate for Payer: Aetna Medicare |
$1,848.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,381.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,559.11
|
| Rate for Payer: BCBS Complete |
$1,174.61
|
| Rate for Payer: BCBS MAPPO |
$1,777.16
|
| Rate for Payer: BCN Commercial |
$2,825.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,777.16
|
| Rate for Payer: Cash Price |
$3,359.20
|
| Rate for Payer: Cash Price |
$3,359.20
|
| Rate for Payer: Cofinity Commercial |
$2,381.39
|
| Rate for Payer: Cofinity Commercial |
$2,559.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,777.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,866.02
|
| Rate for Payer: Meridian Medicaid |
$1,174.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,954.88
|
| Rate for Payer: Nomi Health Commercial |
$2,132.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,149.25
|
| Rate for Payer: PACE SWMI |
$1,777.16
|
| Rate for Payer: PHP Commercial |
$2,488.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,777.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,118.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,037.98
|
| Rate for Payer: Priority Health Medicare |
$1,777.16
|
| Rate for Payer: Priority Health SBD |
$3,037.98
|
| Rate for Payer: Priority Health Tiered Network |
$3,037.98
|
| Rate for Payer: Railroad Medicare Medicare |
$1,777.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,470.53
|
| Rate for Payer: UHC Core |
$3,470.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,777.16
|
| Rate for Payer: UHC Exchange |
$3,470.53
|
| Rate for Payer: UHC Medicaid |
$1,118.68
|
| Rate for Payer: UHCCP Medicaid |
$1,118.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,931.54
|
|
|
PR OPN SUBCLA CRTD ART TRPOS NCK INC ULAT
|
Professional
|
Both
|
$3,296.00
|
|
|
Service Code
|
HCPCS 33889
|
| Min. Negotiated Rate |
$1,063.36 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$1,063.36
|
| Rate for Payer: Aetna Medicare |
$1,648.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,063.36
|
| Rate for Payer: BCBS Complete |
$1,318.40
|
| Rate for Payer: BCN Commercial |
$1,162.29
|
| Rate for Payer: Cash Price |
$2,636.80
|
| Rate for Payer: Cash Price |
$2,636.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,472.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,516.16
|
|
|
PROPOFOL 10 MG/ML 100 ML VIAL (BULK CHARGE)
|
Facility
|
OP
|
$65.18
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$58.66 |
| Rate for Payer: Aetna American Axle |
$42.37
|
| Rate for Payer: Aetna Commercial |
$55.40
|
| Rate for Payer: Aetna Medicare |
$32.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.37
|
| Rate for Payer: BCBS Complete |
$26.07
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$52.14
|
| Rate for Payer: Cash Price |
$52.14
|
| Rate for Payer: Cofinity Advantage |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$56.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.14
|
| Rate for Payer: Healthscope Commercial |
$58.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.88
|
| Rate for Payer: PHP Commercial |
$55.40
|
| Rate for Payer: Priority Health SBD |
$41.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$24.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.88
|
|
|
PROPOFOL 10 MG/ML 100 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$65.18
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$58.66 |
| Rate for Payer: Aetna American Axle |
$42.37
|
| Rate for Payer: Aetna Commercial |
$55.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.37
|
| Rate for Payer: Cash Price |
$52.14
|
| Rate for Payer: Cofinity Advantage |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$56.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.14
|
| Rate for Payer: Healthscope Commercial |
$58.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.88
|
| Rate for Payer: PHP Commercial |
$55.40
|
| Rate for Payer: Priority Health SBD |
$41.06
|
| Rate for Payer: UMR Bronson Commercial |
$28.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.88
|
|
|
PROPOFOL 10 MG/ML 20 ML VIAL (BULK CHARGE)
|
Facility
|
OP
|
$63.61
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$57.25 |
| Rate for Payer: Aetna American Axle |
$41.35
|
| Rate for Payer: Aetna Commercial |
$54.07
|
| Rate for Payer: Aetna Medicare |
$31.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.35
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$50.89
|
| Rate for Payer: Cash Price |
$50.89
|
| Rate for Payer: Cofinity Advantage |
$44.53
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.89
|
| Rate for Payer: Healthscope Commercial |
$57.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.71
|
| Rate for Payer: PHP Commercial |
$54.07
|
| Rate for Payer: Priority Health SBD |
$40.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$23.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.71
|
|
|
PROPOFOL 10 MG/ML 20 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$63.61
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$57.25 |
| Rate for Payer: Aetna American Axle |
$41.35
|
| Rate for Payer: Aetna Commercial |
$54.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.35
|
| Rate for Payer: Cash Price |
$50.89
|
| Rate for Payer: Cofinity Advantage |
$44.53
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.89
|
| Rate for Payer: Healthscope Commercial |
$57.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.71
|
| Rate for Payer: PHP Commercial |
$54.07
|
| Rate for Payer: Priority Health SBD |
$40.07
|
| Rate for Payer: UMR Bronson Commercial |
$27.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.71
|
|
|
PROPOFOL 10 MG/ML 50 ML VIAL (BULK CHARGE)
|
Facility
|
OP
|
$56.63
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$50.97 |
| Rate for Payer: Aetna American Axle |
$36.81
|
| Rate for Payer: Aetna Commercial |
$48.14
|
| Rate for Payer: Aetna Medicare |
$28.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.81
|
| Rate for Payer: BCBS Complete |
$22.65
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cofinity Advantage |
$39.64
|
| Rate for Payer: Cofinity Commercial |
$48.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$50.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.47
|
| Rate for Payer: PHP Commercial |
$48.14
|
| Rate for Payer: Priority Health SBD |
$35.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$20.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.47
|
|
|
PROPOFOL 10 MG/ML 50 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$56.63
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$50.97 |
| Rate for Payer: Aetna American Axle |
$36.81
|
| Rate for Payer: Aetna Commercial |
$48.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.81
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cofinity Advantage |
$39.64
|
| Rate for Payer: Cofinity Commercial |
$48.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$50.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.47
|
| Rate for Payer: PHP Commercial |
$48.14
|
| Rate for Payer: Priority Health SBD |
$35.68
|
| Rate for Payer: UMR Bronson Commercial |
$24.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.47
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
OP
|
$89.32
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$80.39 |
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna American Axle |
$66.83
|
| Rate for Payer: Aetna American Axle |
$88.58
|
| Rate for Payer: Aetna American Axle |
$56.09
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Commercial |
$73.36
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Commercial |
$115.84
|
| Rate for Payer: Aetna Medicare |
$43.15
|
| Rate for Payer: Aetna Medicare |
$68.14
|
| Rate for Payer: Aetna Medicare |
$44.66
|
| Rate for Payer: Aetna Medicare |
$51.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: BCBS Complete |
$41.13
|
| Rate for Payer: BCBS Complete |
$54.51
|
| Rate for Payer: BCBS Complete |
$34.52
|
| Rate for Payer: BCBS Complete |
$35.73
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$109.02
|
| Rate for Payer: Cash Price |
$109.02
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cofinity Advantage |
$62.52
|
| Rate for Payer: Cofinity Advantage |
$60.41
|
| Rate for Payer: Cofinity Advantage |
$95.40
|
| Rate for Payer: Cofinity Advantage |
$71.97
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Healthscope Commercial |
$77.67
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.99
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$73.36
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: PHP Commercial |
$115.84
|
| Rate for Payer: Priority Health SBD |
$54.37
|
| Rate for Payer: Priority Health SBD |
$64.78
|
| Rate for Payer: Priority Health SBD |
$85.86
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$33.05
|
| Rate for Payer: UMR Bronson Commercial |
$38.04
|
| Rate for Payer: UMR Bronson Commercial |
$50.42
|
| Rate for Payer: UMR Bronson Commercial |
$31.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
IP
|
$86.30
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.97 |
| Max. Negotiated Rate |
$77.67 |
| Rate for Payer: Aetna American Axle |
$56.09
|
| Rate for Payer: Aetna American Axle |
$88.58
|
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna American Axle |
$66.83
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Commercial |
$73.36
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Commercial |
$115.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$109.02
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cofinity Advantage |
$95.40
|
| Rate for Payer: Cofinity Advantage |
$71.97
|
| Rate for Payer: Cofinity Advantage |
$60.41
|
| Rate for Payer: Cofinity Advantage |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.02
|
| Rate for Payer: Healthscope Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Healthscope Commercial |
$77.67
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.11
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$73.36
|
| Rate for Payer: PHP Commercial |
$115.84
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: Priority Health SBD |
$64.78
|
| Rate for Payer: Priority Health SBD |
$54.37
|
| Rate for Payer: Priority Health SBD |
$85.86
|
| Rate for Payer: UMR Bronson Commercial |
$59.96
|
| Rate for Payer: UMR Bronson Commercial |
$37.97
|
| Rate for Payer: UMR Bronson Commercial |
$45.24
|
| Rate for Payer: UMR Bronson Commercial |
$39.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
OP
|
$82.94
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$74.65 |
| Rate for Payer: Aetna American Axle |
$53.91
|
| Rate for Payer: Aetna American Axle |
$41.36
|
| Rate for Payer: Aetna American Axle |
$41.99
|
| Rate for Payer: Aetna American Axle |
$42.27
|
| Rate for Payer: Aetna American Axle |
$38.18
|
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna American Axle |
$48.33
|
| Rate for Payer: Aetna American Axle |
$43.63
|
| Rate for Payer: Aetna American Axle |
$40.90
|
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna American Axle |
$62.06
|
| Rate for Payer: Aetna American Axle |
$88.58
|
| Rate for Payer: Aetna Commercial |
$53.49
|
| Rate for Payer: Aetna Commercial |
$54.09
|
| Rate for Payer: Aetna Commercial |
$49.93
|
| Rate for Payer: Aetna Commercial |
$70.50
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: Aetna Commercial |
$54.91
|
| Rate for Payer: Aetna Commercial |
$115.84
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Commercial |
$57.06
|
| Rate for Payer: Aetna Commercial |
$81.16
|
| Rate for Payer: Aetna Medicare |
$41.47
|
| Rate for Payer: Aetna Medicare |
$29.37
|
| Rate for Payer: Aetna Medicare |
$44.66
|
| Rate for Payer: Aetna Medicare |
$68.14
|
| Rate for Payer: Aetna Medicare |
$31.46
|
| Rate for Payer: Aetna Medicare |
$32.52
|
| Rate for Payer: Aetna Medicare |
$33.56
|
| Rate for Payer: Aetna Medicare |
$31.82
|
| Rate for Payer: Aetna Medicare |
$47.74
|
| Rate for Payer: Aetna Medicare |
$37.18
|
| Rate for Payer: Aetna Medicare |
$32.30
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.63
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Complete |
$25.84
|
| Rate for Payer: BCBS Complete |
$54.51
|
| Rate for Payer: BCBS Complete |
$23.50
|
| Rate for Payer: BCBS Complete |
$25.17
|
| Rate for Payer: BCBS Complete |
$38.19
|
| Rate for Payer: BCBS Complete |
$35.73
|
| Rate for Payer: BCBS Complete |
$33.18
|
| Rate for Payer: BCBS Complete |
$29.74
|
| Rate for Payer: BCBS Complete |
$26.85
|
| Rate for Payer: BCBS Complete |
$25.45
|
| Rate for Payer: BCBS Complete |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cash Price |
$59.49
|
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cash Price |
$109.02
|
| Rate for Payer: Cash Price |
$109.02
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$59.49
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Advantage |
$44.05
|
| Rate for Payer: Cofinity Advantage |
$41.12
|
| Rate for Payer: Cofinity Advantage |
$95.40
|
| Rate for Payer: Cofinity Advantage |
$44.54
|
| Rate for Payer: Cofinity Advantage |
$45.22
|
| Rate for Payer: Cofinity Advantage |
$45.52
|
| Rate for Payer: Cofinity Advantage |
$46.99
|
| Rate for Payer: Cofinity Advantage |
$52.05
|
| Rate for Payer: Cofinity Advantage |
$58.06
|
| Rate for Payer: Cofinity Advantage |
$62.52
|
| Rate for Payer: Cofinity Advantage |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$63.95
|
| Rate for Payer: Cofinity Commercial |
$71.33
|
| Rate for Payer: Cofinity Commercial |
$54.72
|
| Rate for Payer: Cofinity Commercial |
$57.73
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Cofinity Commercial |
$55.56
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.38
|
| Rate for Payer: Healthscope Commercial |
$56.64
|
| Rate for Payer: Healthscope Commercial |
$57.27
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$74.65
|
| Rate for Payer: Healthscope Commercial |
$85.93
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Healthscope Commercial |
$52.87
|
| Rate for Payer: Healthscope Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$58.14
|
| Rate for Payer: Healthscope Commercial |
$60.42
|
| Rate for Payer: Healthscope Commercial |
$66.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$109.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.21
|
| Rate for Payer: PHP Commercial |
$81.16
|
| Rate for Payer: PHP Commercial |
$53.49
|
| Rate for Payer: PHP Commercial |
$54.09
|
| Rate for Payer: PHP Commercial |
$70.50
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$115.84
|
| Rate for Payer: PHP Commercial |
$57.06
|
| Rate for Payer: PHP Commercial |
$49.93
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: PHP Commercial |
$54.91
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: Priority Health SBD |
$46.85
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: Priority Health SBD |
$39.65
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: Priority Health SBD |
$42.29
|
| Rate for Payer: Priority Health SBD |
$52.25
|
| Rate for Payer: Priority Health SBD |
$60.15
|
| Rate for Payer: Priority Health SBD |
$85.86
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: Priority Health SBD |
$40.09
|
| Rate for Payer: Priority Health SBD |
$40.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$23.90
|
| Rate for Payer: UMR Bronson Commercial |
$23.28
|
| Rate for Payer: UMR Bronson Commercial |
$35.33
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
| Rate for Payer: UMR Bronson Commercial |
$21.73
|
| Rate for Payer: UMR Bronson Commercial |
$50.42
|
| Rate for Payer: UMR Bronson Commercial |
$27.51
|
| Rate for Payer: UMR Bronson Commercial |
$30.69
|
| Rate for Payer: UMR Bronson Commercial |
$23.54
|
| Rate for Payer: UMR Bronson Commercial |
$33.97
|
| Rate for Payer: UMR Bronson Commercial |
$33.05
|
| Rate for Payer: UMR Bronson Commercial |
$24.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
IP
|
$95.48
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$85.93 |
| Rate for Payer: Aetna American Axle |
$62.06
|
| Rate for Payer: Aetna American Axle |
$41.99
|
| Rate for Payer: Aetna American Axle |
$41.36
|
| Rate for Payer: Aetna American Axle |
$40.90
|
| Rate for Payer: Aetna American Axle |
$38.18
|
| Rate for Payer: Aetna American Axle |
$48.33
|
| Rate for Payer: Aetna American Axle |
$43.63
|
| Rate for Payer: Aetna American Axle |
$42.27
|
| Rate for Payer: Aetna American Axle |
$88.58
|
| Rate for Payer: Aetna American Axle |
$53.91
|
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna Commercial |
$54.91
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Commercial |
$81.16
|
| Rate for Payer: Aetna Commercial |
$70.50
|
| Rate for Payer: Aetna Commercial |
$53.49
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Commercial |
$54.09
|
| Rate for Payer: Aetna Commercial |
$49.93
|
| Rate for Payer: Aetna Commercial |
$57.06
|
| Rate for Payer: Aetna Commercial |
$115.84
|
| Rate for Payer: Aetna Commercial |
$63.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.33
|
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$50.34
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$109.02
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$59.49
|
| Rate for Payer: Cash Price |
$51.68
|
| Rate for Payer: Cofinity Advantage |
$95.40
|
| Rate for Payer: Cofinity Advantage |
$46.99
|
| Rate for Payer: Cofinity Advantage |
$45.52
|
| Rate for Payer: Cofinity Advantage |
$58.06
|
| Rate for Payer: Cofinity Advantage |
$44.54
|
| Rate for Payer: Cofinity Advantage |
$41.12
|
| Rate for Payer: Cofinity Advantage |
$45.22
|
| Rate for Payer: Cofinity Advantage |
$66.84
|
| Rate for Payer: Cofinity Advantage |
$64.26
|
| Rate for Payer: Cofinity Advantage |
$52.05
|
| Rate for Payer: Cofinity Advantage |
$62.52
|
| Rate for Payer: Cofinity Advantage |
$44.05
|
| Rate for Payer: Cofinity Commercial |
$54.72
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$63.95
|
| Rate for Payer: Cofinity Commercial |
$54.12
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$71.33
|
| Rate for Payer: Cofinity Commercial |
$55.56
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$57.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.38
|
| Rate for Payer: Healthscope Commercial |
$58.14
|
| Rate for Payer: Healthscope Commercial |
$74.65
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Healthscope Commercial |
$66.92
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$85.93
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$57.27
|
| Rate for Payer: Healthscope Commercial |
$52.87
|
| Rate for Payer: Healthscope Commercial |
$56.64
|
| Rate for Payer: Healthscope Commercial |
$60.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.72
|
| Rate for Payer: PHP Commercial |
$70.50
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: PHP Commercial |
$63.21
|
| Rate for Payer: PHP Commercial |
$54.91
|
| Rate for Payer: PHP Commercial |
$81.16
|
| Rate for Payer: PHP Commercial |
$57.06
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: PHP Commercial |
$54.09
|
| Rate for Payer: PHP Commercial |
$115.84
|
| Rate for Payer: PHP Commercial |
$49.93
|
| Rate for Payer: PHP Commercial |
$53.49
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: Priority Health SBD |
$52.25
|
| Rate for Payer: Priority Health SBD |
$40.09
|
| Rate for Payer: Priority Health SBD |
$42.29
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: Priority Health SBD |
$39.65
|
| Rate for Payer: Priority Health SBD |
$40.70
|
| Rate for Payer: Priority Health SBD |
$46.85
|
| Rate for Payer: Priority Health SBD |
$85.86
|
| Rate for Payer: Priority Health SBD |
$60.15
|
| Rate for Payer: UMR Bronson Commercial |
$25.85
|
| Rate for Payer: UMR Bronson Commercial |
$39.30
|
| Rate for Payer: UMR Bronson Commercial |
$28.61
|
| Rate for Payer: UMR Bronson Commercial |
$29.54
|
| Rate for Payer: UMR Bronson Commercial |
$28.00
|
| Rate for Payer: UMR Bronson Commercial |
$59.96
|
| Rate for Payer: UMR Bronson Commercial |
$27.69
|
| Rate for Payer: UMR Bronson Commercial |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$36.49
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: UMR Bronson Commercial |
$32.72
|
| Rate for Payer: UMR Bronson Commercial |
$28.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.77
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$63.63
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$57.27 |
| Rate for Payer: Aetna American Axle |
$41.36
|
| Rate for Payer: Aetna American Axle |
$42.27
|
| Rate for Payer: Aetna Commercial |
$54.09
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cofinity Advantage |
$45.52
|
| Rate for Payer: Cofinity Advantage |
$44.54
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$54.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Healthscope Commercial |
$57.27
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.77
|
| Rate for Payer: PHP Commercial |
$54.09
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: Priority Health SBD |
$40.09
|
| Rate for Payer: UMR Bronson Commercial |
$28.00
|
| Rate for Payer: UMR Bronson Commercial |
$28.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$63.63
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$57.27 |
| Rate for Payer: Aetna American Axle |
$41.36
|
| Rate for Payer: Aetna American Axle |
$42.27
|
| Rate for Payer: Aetna Commercial |
$54.09
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Medicare |
$31.82
|
| Rate for Payer: Aetna Medicare |
$32.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: BCBS Complete |
$26.01
|
| Rate for Payer: BCBS Complete |
$25.45
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$50.90
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cofinity Advantage |
$44.54
|
| Rate for Payer: Cofinity Advantage |
$45.52
|
| Rate for Payer: Cofinity Commercial |
$54.72
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Healthscope Commercial |
$57.27
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.72
|
| Rate for Payer: PHP Commercial |
$54.09
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: Priority Health SBD |
$40.09
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Core |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UHC Exchange |
$0.15
|
| Rate for Payer: UMR Bronson Commercial |
$23.54
|
| Rate for Payer: UMR Bronson Commercial |
$24.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
|
|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,702.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$561.68 |
| Max. Negotiated Rate |
$2,776.50 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Medicare |
$880.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,134.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,219.09
|
| Rate for Payer: BCBS Complete |
$589.76
|
| Rate for Payer: BCBS MAPPO |
$846.59
|
| Rate for Payer: BCN Commercial |
$1,367.46
|
| Rate for Payer: BCN Medicare Advantage |
$846.59
|
| Rate for Payer: Cash Price |
$2,961.60
|
| Rate for Payer: Cash Price |
$2,961.60
|
| Rate for Payer: Cofinity Commercial |
$1,219.09
|
| Rate for Payer: Cofinity Commercial |
$1,134.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$846.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$888.92
|
| Rate for Payer: Meridian Medicaid |
$589.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$931.25
|
| Rate for Payer: Nomi Health Commercial |
$1,015.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,776.50
|
| Rate for Payer: PACE SWMI |
$846.59
|
| Rate for Payer: PHP Commercial |
$1,185.23
|
| Rate for Payer: PHP Medicare Advantage |
$846.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,461.76
|
| Rate for Payer: Priority Health Medicare |
$846.59
|
| Rate for Payer: Priority Health SBD |
$1,461.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,461.76
|
| Rate for Payer: Railroad Medicare Medicare |
$846.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,494.17
|
| Rate for Payer: UHC Core |
$1,494.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$846.59
|
| Rate for Payer: UHC Exchange |
$1,494.17
|
| Rate for Payer: UHC Medicaid |
$561.68
|
| Rate for Payer: UHCCP Medicaid |
$561.68
|
| Rate for Payer: UMR Bronson Commercial |
$1,702.92
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,451.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$523.77 |
| Max. Negotiated Rate |
$1,838.25 |
| Rate for Payer: Aetna Commercial |
$1,054.61
|
| Rate for Payer: Aetna Medicare |
$818.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,054.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.31
|
| Rate for Payer: BCBS Complete |
$549.96
|
| Rate for Payer: BCBS MAPPO |
$787.02
|
| Rate for Payer: BCN Commercial |
$1,267.36
|
| Rate for Payer: BCN Medicare Advantage |
$787.02
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cofinity Commercial |
$1,054.61
|
| Rate for Payer: Cofinity Commercial |
$1,133.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.37
|
| Rate for Payer: Meridian Medicaid |
$549.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$865.72
|
| Rate for Payer: Nomi Health Commercial |
$944.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,838.25
|
| Rate for Payer: PACE SWMI |
$787.02
|
| Rate for Payer: PHP Commercial |
$1,101.83
|
| Rate for Payer: PHP Medicare Advantage |
$787.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$523.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,354.78
|
| Rate for Payer: Priority Health Medicare |
$787.02
|
| Rate for Payer: Priority Health SBD |
$1,354.78
|
| Rate for Payer: Priority Health Tiered Network |
$1,354.78
|
| Rate for Payer: Railroad Medicare Medicare |
$787.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,393.03
|
| Rate for Payer: UHC Core |
$1,393.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$787.02
|
| Rate for Payer: UHC Exchange |
$1,393.03
|
| Rate for Payer: UHC Medicaid |
$523.77
|
| Rate for Payer: UHCCP Medicaid |
$523.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.46
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,587.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$575.53 |
| Max. Negotiated Rate |
$1,547.52 |
| Rate for Payer: Aetna Commercial |
$1,161.28
|
| Rate for Payer: Aetna Medicare |
$901.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,161.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.95
|
| Rate for Payer: BCBS Complete |
$604.31
|
| Rate for Payer: BCBS MAPPO |
$866.63
|
| Rate for Payer: BCN Commercial |
$1,400.82
|
| Rate for Payer: BCN Medicare Advantage |
$866.63
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cofinity Commercial |
$1,161.28
|
| Rate for Payer: Cofinity Commercial |
$1,247.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$866.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$909.96
|
| Rate for Payer: Meridian Medicaid |
$604.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$953.29
|
| Rate for Payer: Nomi Health Commercial |
$1,039.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,190.25
|
| Rate for Payer: PACE SWMI |
$866.63
|
| Rate for Payer: PHP Commercial |
$1,213.28
|
| Rate for Payer: PHP Medicare Advantage |
$866.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$575.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,497.44
|
| Rate for Payer: Priority Health Medicare |
$866.63
|
| Rate for Payer: Priority Health SBD |
$1,497.44
|
| Rate for Payer: Priority Health Tiered Network |
$1,497.44
|
| Rate for Payer: Railroad Medicare Medicare |
$866.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,547.52
|
| Rate for Payer: UHC Core |
$1,547.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$866.63
|
| Rate for Payer: UHC Exchange |
$1,547.52
|
| Rate for Payer: UHC Medicaid |
$575.53
|
| Rate for Payer: UHCCP Medicaid |
$575.53
|
| Rate for Payer: UMR Bronson Commercial |
$730.02
|
|
