|
PR NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID
|
Professional
|
Both
|
$2,824.00
|
|
|
Service Code
|
HCPCS 62165
|
| Min. Negotiated Rate |
$1,129.60 |
| Max. Negotiated Rate |
$2,132.91 |
| Rate for Payer: Aetna Commercial |
$1,984.79
|
| Rate for Payer: Aetna Medicare |
$1,540.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,132.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.79
|
| Rate for Payer: BCBS Complete |
$1,129.60
|
| Rate for Payer: BCBS MAPPO |
$1,481.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,481.19
|
| Rate for Payer: Cash Price |
$2,259.20
|
| Rate for Payer: Cash Price |
$2,259.20
|
| Rate for Payer: Cofinity Commercial |
$2,132.91
|
| Rate for Payer: Cofinity Commercial |
$1,984.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,481.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,555.25
|
| Rate for Payer: Nomi Health Commercial |
$1,777.43
|
| Rate for Payer: PACE SWMI |
$1,481.19
|
| Rate for Payer: PHP Commercial |
$2,073.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,481.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.60
|
| Rate for Payer: Priority Health Medicare |
$1,481.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,481.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,481.19
|
| Rate for Payer: UMR Bronson Commercial |
$1,299.04
|
|
|
PR NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG
|
Professional
|
Both
|
$7,834.00
|
|
|
Service Code
|
HCPCS 62162
|
| Min. Negotiated Rate |
$1,875.84 |
| Max. Negotiated Rate |
$5,092.10 |
| Rate for Payer: Aetna Commercial |
$2,513.63
|
| Rate for Payer: Aetna Medicare |
$1,950.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,701.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,513.63
|
| Rate for Payer: BCBS Complete |
$3,133.60
|
| Rate for Payer: BCBS MAPPO |
$1,875.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,875.84
|
| Rate for Payer: Cash Price |
$6,267.20
|
| Rate for Payer: Cash Price |
$6,267.20
|
| Rate for Payer: Cofinity Commercial |
$2,701.21
|
| Rate for Payer: Cofinity Commercial |
$2,513.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,875.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,969.63
|
| Rate for Payer: Nomi Health Commercial |
$2,251.01
|
| Rate for Payer: PACE SWMI |
$1,875.84
|
| Rate for Payer: PHP Commercial |
$2,626.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,875.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,092.10
|
| Rate for Payer: Priority Health Medicare |
$1,875.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,875.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,875.84
|
| Rate for Payer: UMR Bronson Commercial |
$3,603.64
|
|
|
PR NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 62160
|
| Min. Negotiated Rate |
$186.44 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Commercial |
$249.83
|
| Rate for Payer: Aetna Medicare |
$193.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.83
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$186.44
|
| Rate for Payer: BCN Medicare Advantage |
$186.44
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$268.47
|
| Rate for Payer: Cofinity Commercial |
$249.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.76
|
| Rate for Payer: Nomi Health Commercial |
$223.73
|
| Rate for Payer: PACE SWMI |
$186.44
|
| Rate for Payer: PHP Commercial |
$261.02
|
| Rate for Payer: PHP Medicare Advantage |
$186.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$186.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.44
|
| Rate for Payer: UHC Medicare Advantage |
$186.44
|
| Rate for Payer: UMR Bronson Commercial |
$375.36
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99316
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Aetna Commercial |
$165.06
|
| Rate for Payer: Aetna Medicare |
$128.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.06
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$123.18
|
| Rate for Payer: BCN Medicare Advantage |
$123.18
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$177.38
|
| Rate for Payer: Cofinity Commercial |
$165.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.34
|
| Rate for Payer: Nomi Health Commercial |
$147.82
|
| Rate for Payer: PACE SWMI |
$123.18
|
| Rate for Payer: PHP Commercial |
$172.45
|
| Rate for Payer: PHP Medicare Advantage |
$123.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$123.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.18
|
| Rate for Payer: UHC Medicare Advantage |
$123.18
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99315
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$110.55 |
| Rate for Payer: Aetna Commercial |
$102.87
|
| Rate for Payer: Aetna Medicare |
$79.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.87
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$76.77
|
| Rate for Payer: BCN Medicare Advantage |
$76.77
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$110.55
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.61
|
| Rate for Payer: Nomi Health Commercial |
$92.12
|
| Rate for Payer: PACE SWMI |
$76.77
|
| Rate for Payer: PHP Commercial |
$107.48
|
| Rate for Payer: PHP Medicare Advantage |
$76.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$76.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.77
|
| Rate for Payer: UHC Medicare Advantage |
$76.77
|
| Rate for Payer: UMR Bronson Commercial |
$50.60
|
|
|
PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 94690
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare |
$44.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.75
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$43.10
|
| Rate for Payer: BCN Medicare Advantage |
$43.10
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$62.06
|
| Rate for Payer: Cofinity Commercial |
$57.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.26
|
| Rate for Payer: Nomi Health Commercial |
$51.72
|
| Rate for Payer: PACE SWMI |
$43.10
|
| Rate for Payer: PHP Commercial |
$60.34
|
| Rate for Payer: PHP Medicare Advantage |
$43.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$43.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.10
|
| Rate for Payer: UHC Medicare Advantage |
$43.10
|
| Rate for Payer: UMR Bronson Commercial |
$59.80
|
|
|
PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 94680
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$63.85
|
| Rate for Payer: Aetna Medicare |
$49.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.85
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$47.65
|
| Rate for Payer: BCN Medicare Advantage |
$47.65
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$68.62
|
| Rate for Payer: Cofinity Commercial |
$63.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.03
|
| Rate for Payer: Nomi Health Commercial |
$57.18
|
| Rate for Payer: PACE SWMI |
$47.65
|
| Rate for Payer: PHP Commercial |
$66.71
|
| Rate for Payer: PHP Medicare Advantage |
$47.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$47.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.65
|
| Rate for Payer: UHC Medicare Advantage |
$47.65
|
| Rate for Payer: UMR Bronson Commercial |
$52.44
|
|
|
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 Commercial |
$100.53
|
| Rate for Payer: Cofinity Commercial |
$81.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.83
|
| 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: PHP Commercial |
$99.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.98
|
| Rate for Payer: Priority Health SBD |
$73.65
|
| Rate for Payer: UMR Bronson Commercial |
$43.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.67
|
|
|
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 Commercial |
$100.53
|
| Rate for Payer: Cofinity Commercial |
$81.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.83
|
| 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: PHP Commercial |
$99.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.98
|
| 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
|
|
|
PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM
|
Professional
|
Both
|
$4,249.00
|
|
|
Service Code
|
HCPCS 59510
|
| Min. Negotiated Rate |
$1,699.60 |
| Max. Negotiated Rate |
$3,752.73 |
| Rate for Payer: Aetna Commercial |
$3,492.12
|
| Rate for Payer: Aetna Medicare |
$2,710.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,752.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,492.12
|
| Rate for Payer: BCBS Complete |
$1,699.60
|
| Rate for Payer: BCBS MAPPO |
$2,606.06
|
| Rate for Payer: BCN Medicare Advantage |
$2,606.06
|
| Rate for Payer: Cash Price |
$3,399.20
|
| Rate for Payer: Cash Price |
$3,399.20
|
| Rate for Payer: Cofinity Commercial |
$3,752.73
|
| Rate for Payer: Cofinity Commercial |
$3,492.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,606.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,736.36
|
| Rate for Payer: Nomi Health Commercial |
$3,127.27
|
| Rate for Payer: PACE SWMI |
$2,606.06
|
| Rate for Payer: PHP Commercial |
$3,648.48
|
| Rate for Payer: PHP Medicare Advantage |
$2,606.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,761.85
|
| Rate for Payer: Priority Health Medicare |
$2,606.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,606.06
|
| Rate for Payer: UHC Medicare Advantage |
$2,606.06
|
| Rate for Payer: UMR Bronson Commercial |
$1,954.54
|
|
|
PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM
|
Professional
|
Both
|
$3,830.00
|
|
|
Service Code
|
HCPCS 59400
|
| Min. Negotiated Rate |
$1,532.00 |
| Max. Negotiated Rate |
$3,366.16 |
| Rate for Payer: UHC Dual Complete DSNP |
$2,337.61
|
| Rate for Payer: UHC Medicare Advantage |
$2,337.61
|
| Rate for Payer: UMR Bronson Commercial |
$1,761.80
|
| Rate for Payer: Aetna Commercial |
$3,132.40
|
| Rate for Payer: Aetna Medicare |
$2,431.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,366.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,132.40
|
| Rate for Payer: BCBS Complete |
$1,532.00
|
| Rate for Payer: BCBS MAPPO |
$2,337.61
|
| Rate for Payer: BCN Medicare Advantage |
$2,337.61
|
| Rate for Payer: Cash Price |
$3,064.00
|
| Rate for Payer: Cash Price |
$3,064.00
|
| Rate for Payer: Cofinity Commercial |
$3,366.16
|
| Rate for Payer: Cofinity Commercial |
$3,132.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,337.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,454.49
|
| Rate for Payer: Nomi Health Commercial |
$2,805.13
|
| Rate for Payer: PACE SWMI |
$2,337.61
|
| Rate for Payer: PHP Commercial |
$3,272.65
|
| Rate for Payer: PHP Medicare Advantage |
$2,337.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,489.50
|
| Rate for Payer: Priority Health Medicare |
$2,337.61
|
|
|
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 Commercial |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.00
|
| 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: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.00
|
| 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 Commercial |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.00
|
| 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: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.00
|
| Rate for Payer: Priority Health SBD |
$226.80
|
| Rate for Payer: UMR Bronson Commercial |
$133.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.00
|
|
|
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 Commercial |
$629.66
|
| Rate for Payer: Cofinity Commercial |
$773.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$629.66
|
| 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: PHP Commercial |
$764.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.69
|
| 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
|
$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 Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| 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: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| 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
|
$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 Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.81
|
| 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: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.54
|
| 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
|
$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 Commercial |
$629.66
|
| Rate for Payer: Cofinity Commercial |
$773.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$629.66
|
| 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: PHP Commercial |
$764.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.69
|
| Rate for Payer: Priority Health SBD |
$566.70
|
| Rate for Payer: UMR Bronson Commercial |
$332.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$674.64
|
|
|
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 Commercial |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.22
|
| 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: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.21
|
| Rate for Payer: Priority Health SBD |
$176.60
|
| Rate for Payer: UMR Bronson Commercial |
$103.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
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 Commercial |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.22
|
| 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: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.21
|
| 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
|
|
|
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH INSERTION OF TUBE OR STENT
|
Facility
|
OP
|
$6,404.71
|
|
|
Service Code
|
CPT 68815
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,219.56 |
| Max. Negotiated Rate |
$6,404.71 |
| Rate for Payer: Aetna Medicare |
$2,366.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,844.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,844.11
|
| Rate for Payer: BCBS Complete |
$1,280.53
|
| Rate for Payer: BCBS MAPPO |
$2,275.29
|
| Rate for Payer: BCN Medicare Advantage |
$2,275.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,275.29
|
| Rate for Payer: Mclaren Medicaid |
$1,219.56
|
| Rate for Payer: Mclaren Medicare |
$2,275.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,389.05
|
| Rate for Payer: Meridian Medicaid |
$1,280.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,616.58
|
| Rate for Payer: PACE Medicare |
$2,161.53
|
| Rate for Payer: PACE SWMI |
$2,275.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,275.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,219.56
|
| Rate for Payer: Priority Health Medicare |
$2,275.29
|
| Rate for Payer: Railroad Medicare Medicare |
$2,275.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,404.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,275.29
|
| Rate for Payer: UHC Exchange |
$4,348.31
|
| Rate for Payer: UHC Medicare Advantage |
$2,275.29
|
| Rate for Payer: UHCCP Medicaid |
$1,219.56
|
| Rate for Payer: VA VA |
$2,275.29
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 33813
|
| Min. Negotiated Rate |
$962.40 |
| Max. Negotiated Rate |
$1,563.90 |
| Rate for Payer: Aetna Medicare |
$1,203.00
|
| Rate for Payer: BCBS Complete |
$962.40
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,563.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,106.76
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DFCT W/CARD BYPASS
|
Professional
|
Both
|
$3,091.00
|
|
|
Service Code
|
HCPCS 33814
|
| Min. Negotiated Rate |
$1,236.40 |
| Max. Negotiated Rate |
$2,111.28 |
| Rate for Payer: Aetna Commercial |
$1,964.67
|
| Rate for Payer: Aetna Medicare |
$1,524.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,964.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,111.28
|
| Rate for Payer: BCBS Complete |
$1,236.40
|
| Rate for Payer: BCBS MAPPO |
$1,466.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,466.17
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cofinity Commercial |
$1,964.67
|
| Rate for Payer: Cofinity Commercial |
$2,111.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,539.48
|
| Rate for Payer: Nomi Health Commercial |
$1,759.40
|
| Rate for Payer: PACE SWMI |
$1,466.17
|
| Rate for Payer: PHP Commercial |
$2,052.64
|
| Rate for Payer: PHP Medicare Advantage |
$1,466.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,009.15
|
| Rate for Payer: Priority Health Medicare |
$1,466.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,466.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,421.86
|
|
|
PR OBSERVATION CARE DISCHARGE MANAGEMENT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99217
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Commercial |
$22.98
|
| Rate for Payer: Aetna Medicare |
$17.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.98
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$17.15
|
| Rate for Payer: BCN Medicare Advantage |
$17.15
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.01
|
| Rate for Payer: Nomi Health Commercial |
$20.58
|
| Rate for Payer: PACE SWMI |
$17.15
|
| Rate for Payer: PHP Commercial |
$24.01
|
| Rate for Payer: PHP Medicare Advantage |
$17.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health Medicare |
$17.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.15
|
| Rate for Payer: UHC Medicare Advantage |
$17.15
|
| Rate for Payer: UMR Bronson Commercial |
$33.58
|
|
|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$210.73
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
6562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$829.52 |
| Rate for Payer: Aetna American Axle |
$136.97
|
| Rate for Payer: Aetna American Axle |
$1,102.61
|
| Rate for Payer: Aetna Commercial |
$1,441.87
|
| Rate for Payer: Aetna Commercial |
$179.12
|
| Rate for Payer: Aetna Medicare |
$306.48
|
| Rate for Payer: Aetna Medicare |
$306.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.36
|
| Rate for Payer: BCBS Complete |
$165.85
|
| Rate for Payer: BCBS Complete |
$165.85
|
| Rate for Payer: BCBS MAPPO |
$294.69
|
| Rate for Payer: BCBS MAPPO |
$294.69
|
| Rate for Payer: BCN Medicare Advantage |
$294.69
|
| Rate for Payer: BCN Medicare Advantage |
$294.69
|
| Rate for Payer: Cash Price |
$1,357.06
|
| Rate for Payer: Cash Price |
$168.58
|
| Rate for Payer: Cash Price |
$168.58
|
| Rate for Payer: Cash Price |
$1,357.06
|
| Rate for Payer: Cofinity Commercial |
$1,187.42
|
| Rate for Payer: Cofinity Commercial |
$1,458.84
|
| Rate for Payer: Cofinity Commercial |
$147.51
|
| Rate for Payer: Cofinity Commercial |
$181.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,187.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.69
|
| Rate for Payer: Healthscope Commercial |
$189.66
|
| Rate for Payer: Healthscope Commercial |
$1,526.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,187.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,272.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.05
|
| Rate for Payer: Mclaren Medicaid |
$157.95
|
| Rate for Payer: Mclaren Medicaid |
$157.95
|
| Rate for Payer: Mclaren Medicare |
$294.69
|
| Rate for Payer: Mclaren Medicare |
$294.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.42
|
| Rate for Payer: Meridian Medicaid |
$165.85
|
| Rate for Payer: Meridian Medicaid |
$165.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,441.87
|
| Rate for Payer: PACE Medicare |
$279.96
|
| Rate for Payer: PACE Medicare |
$279.96
|
| Rate for Payer: PACE SWMI |
$294.69
|
| Rate for Payer: PACE SWMI |
$294.69
|
| Rate for Payer: PHP Commercial |
$1,441.87
|
| Rate for Payer: PHP Commercial |
$179.12
|
| Rate for Payer: PHP Medicare Advantage |
$294.69
|
| Rate for Payer: PHP Medicare Advantage |
$294.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,102.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.97
|
| Rate for Payer: Priority Health Medicare |
$294.69
|
| Rate for Payer: Priority Health Medicare |
$294.69
|
| Rate for Payer: Priority Health SBD |
$1,068.68
|
| Rate for Payer: Priority Health SBD |
$132.76
|
| Rate for Payer: Railroad Medicare Medicare |
$294.69
|
| Rate for Payer: Railroad Medicare Medicare |
$294.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.69
|
| Rate for Payer: UHC Exchange |
$563.18
|
| Rate for Payer: UHC Exchange |
$563.18
|
| Rate for Payer: UHC Medicare Advantage |
$294.69
|
| Rate for Payer: UHC Medicare Advantage |
$294.69
|
| Rate for Payer: UHCCP Medicaid |
$157.95
|
| Rate for Payer: UHCCP Medicaid |
$157.95
|
| Rate for Payer: UMR Bronson Commercial |
$627.64
|
| Rate for Payer: UMR Bronson Commercial |
$77.97
|
| Rate for Payer: VA VA |
$294.69
|
| Rate for Payer: VA VA |
$294.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,272.24
|
|
