|
PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 11-20 MIN
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 98971
|
| Min. Negotiated Rate |
$20.97 |
| Max. Negotiated Rate |
$529.88 |
| Rate for Payer: Aetna Commercial |
$28.10
|
| Rate for Payer: Aetna Medicare |
$21.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.20
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS MAPPO |
$20.97
|
| Rate for Payer: BCBS Trust/PPO |
$529.88
|
| Rate for Payer: BCN Commercial |
$29.32
|
| Rate for Payer: BCN Medicare Advantage |
$20.97
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$28.10
|
| Rate for Payer: Cofinity Commercial |
$30.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.02
|
| Rate for Payer: Nomi Health Commercial |
$25.16
|
| Rate for Payer: PACE SWMI |
$20.97
|
| Rate for Payer: PHP Commercial |
$29.36
|
| Rate for Payer: PHP Medicare Advantage |
$20.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.05
|
| Rate for Payer: Priority Health Medicare |
$20.97
|
| Rate for Payer: Priority Health Narrow Network |
$28.05
|
| Rate for Payer: Priority Health SBD |
$28.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.97
|
| Rate for Payer: UHC Medicare Advantage |
$20.97
|
| Rate for Payer: UMR Bronson Commercial |
$30.82
|
|
|
PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 21+ MIN
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS 98972
|
| Min. Negotiated Rate |
$31.41 |
| Max. Negotiated Rate |
$800.90 |
| Rate for Payer: Aetna Commercial |
$42.09
|
| Rate for Payer: Aetna Medicare |
$32.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.23
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS MAPPO |
$31.41
|
| Rate for Payer: BCBS Trust/PPO |
$800.90
|
| Rate for Payer: BCN Commercial |
$44.96
|
| Rate for Payer: BCN Medicare Advantage |
$31.41
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$45.23
|
| Rate for Payer: Cofinity Commercial |
$42.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.98
|
| Rate for Payer: Nomi Health Commercial |
$37.69
|
| Rate for Payer: PACE SWMI |
$31.41
|
| Rate for Payer: PHP Commercial |
$43.97
|
| Rate for Payer: PHP Medicare Advantage |
$31.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.16
|
| Rate for Payer: Priority Health Medicare |
$31.41
|
| Rate for Payer: Priority Health Narrow Network |
$41.16
|
| Rate for Payer: Priority Health SBD |
$41.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.41
|
| Rate for Payer: UHC Medicare Advantage |
$31.41
|
| Rate for Payer: UMR Bronson Commercial |
$42.78
|
|
|
PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 5-10 MIN
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 98970
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$131.55 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.01
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$131.55
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Medicare Advantage |
$11.12
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.68
|
| Rate for Payer: Nomi Health Commercial |
$13.34
|
| Rate for Payer: PACE SWMI |
$11.12
|
| Rate for Payer: PHP Commercial |
$15.57
|
| Rate for Payer: PHP Medicare Advantage |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.83
|
| Rate for Payer: Priority Health Medicare |
$11.12
|
| Rate for Payer: Priority Health Narrow Network |
$15.83
|
| Rate for Payer: Priority Health SBD |
$15.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.12
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS
|
Professional
|
Both
|
$809.00
|
|
|
Service Code
|
HCPCS 31267
|
| Min. Negotiated Rate |
$168.91 |
| Max. Negotiated Rate |
$1,047.62 |
| Rate for Payer: Aetna Commercial |
$338.79
|
| Rate for Payer: Aetna Medicare |
$262.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.79
|
| Rate for Payer: BCBS Complete |
$177.36
|
| Rate for Payer: BCBS MAPPO |
$252.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,047.62
|
| Rate for Payer: BCN Commercial |
$385.57
|
| Rate for Payer: BCN Medicare Advantage |
$252.83
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cash Price |
$647.20
|
| Rate for Payer: Cofinity Commercial |
$364.08
|
| Rate for Payer: Cofinity Commercial |
$338.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.47
|
| Rate for Payer: Meridian Medicaid |
$177.36
|
| Rate for Payer: Nomi Health Commercial |
$303.40
|
| Rate for Payer: PACE SWMI |
$252.83
|
| Rate for Payer: PHP Commercial |
$353.96
|
| Rate for Payer: PHP Medicare Advantage |
$252.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$168.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$525.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.07
|
| Rate for Payer: Priority Health Medicare |
$252.83
|
| Rate for Payer: Priority Health Narrow Network |
$367.07
|
| Rate for Payer: Priority Health SBD |
$367.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.83
|
| Rate for Payer: UHC Medicare Advantage |
$252.83
|
| Rate for Payer: UHCCP Medicaid |
$168.91
|
| Rate for Payer: UMR Bronson Commercial |
$372.14
|
|
|
PR NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 31288
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$1,515.16 |
| Rate for Payer: Aetna Commercial |
$299.44
|
| Rate for Payer: Aetna Medicare |
$232.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$321.78
|
| Rate for Payer: BCBS Complete |
$156.78
|
| Rate for Payer: BCBS MAPPO |
$223.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,515.16
|
| Rate for Payer: BCN Commercial |
$340.61
|
| Rate for Payer: BCN Medicare Advantage |
$223.46
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cofinity Commercial |
$299.44
|
| Rate for Payer: Cofinity Commercial |
$321.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.63
|
| Rate for Payer: Meridian Medicaid |
$156.78
|
| Rate for Payer: Nomi Health Commercial |
$268.15
|
| Rate for Payer: PACE SWMI |
$223.46
|
| Rate for Payer: PHP Commercial |
$312.84
|
| Rate for Payer: PHP Medicare Advantage |
$223.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$149.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$499.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.50
|
| Rate for Payer: Priority Health Medicare |
$223.46
|
| Rate for Payer: Priority Health Narrow Network |
$323.50
|
| Rate for Payer: Priority Health SBD |
$323.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.46
|
| Rate for Payer: UHC Medicare Advantage |
$223.46
|
| Rate for Payer: UHCCP Medicaid |
$149.31
|
| Rate for Payer: UMR Bronson Commercial |
$353.74
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 11-20 MIN
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 99447
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$873.81 |
| Rate for Payer: Aetna Commercial |
$45.63
|
| Rate for Payer: Aetna Medicare |
$35.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.03
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS MAPPO |
$34.05
|
| Rate for Payer: BCBS Trust/PPO |
$873.81
|
| Rate for Payer: BCN Commercial |
$51.31
|
| Rate for Payer: BCN Medicare Advantage |
$34.05
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$49.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.75
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Nomi Health Commercial |
$40.86
|
| Rate for Payer: PACE SWMI |
$34.05
|
| Rate for Payer: PHP Commercial |
$47.67
|
| Rate for Payer: PHP Medicare Advantage |
$34.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.39
|
| Rate for Payer: Priority Health Medicare |
$34.05
|
| Rate for Payer: Priority Health Narrow Network |
$40.39
|
| Rate for Payer: Priority Health SBD |
$40.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.05
|
| Rate for Payer: UHC Medicare Advantage |
$34.05
|
| Rate for Payer: UHCCP Medicaid |
$22.79
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 99448
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$899.17 |
| Rate for Payer: Aetna Commercial |
$67.74
|
| Rate for Payer: Aetna Medicare |
$52.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.79
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCBS MAPPO |
$50.55
|
| Rate for Payer: BCBS Trust/PPO |
$899.17
|
| Rate for Payer: BCN Commercial |
$78.19
|
| Rate for Payer: BCN Medicare Advantage |
$50.55
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$67.74
|
| Rate for Payer: Cofinity Commercial |
$72.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.08
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Nomi Health Commercial |
$60.66
|
| Rate for Payer: PACE SWMI |
$50.55
|
| Rate for Payer: PHP Commercial |
$70.77
|
| Rate for Payer: PHP Medicare Advantage |
$50.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.84
|
| Rate for Payer: Priority Health Medicare |
$50.55
|
| Rate for Payer: Priority Health Narrow Network |
$59.84
|
| Rate for Payer: Priority Health SBD |
$59.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.55
|
| Rate for Payer: UHC Medicare Advantage |
$50.55
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
| Rate for Payer: UMR Bronson Commercial |
$42.32
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 99449
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$1,202.41 |
| Rate for Payer: Aetna Commercial |
$91.66
|
| Rate for Payer: Aetna Medicare |
$71.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.50
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCBS MAPPO |
$68.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.41
|
| Rate for Payer: BCN Commercial |
$103.60
|
| Rate for Payer: BCN Medicare Advantage |
$68.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$91.66
|
| Rate for Payer: Cofinity Commercial |
$98.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.82
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| Rate for Payer: Nomi Health Commercial |
$82.08
|
| Rate for Payer: PACE SWMI |
$68.40
|
| Rate for Payer: PHP Commercial |
$95.76
|
| Rate for Payer: PHP Medicare Advantage |
$68.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.65
|
| Rate for Payer: Priority Health Medicare |
$68.40
|
| Rate for Payer: Priority Health Narrow Network |
$79.65
|
| Rate for Payer: Priority Health SBD |
$79.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.40
|
| Rate for Payer: UHC Medicare Advantage |
$68.40
|
| Rate for Payer: UHCCP Medicaid |
$45.80
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
|
|
PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99446
|
| Min. Negotiated Rate |
$11.29 |
| Max. Negotiated Rate |
$776.07 |
| Rate for Payer: Aetna Commercial |
$22.62
|
| Rate for Payer: Aetna Medicare |
$17.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.31
|
| Rate for Payer: BCBS Complete |
$11.85
|
| Rate for Payer: BCBS MAPPO |
$16.88
|
| Rate for Payer: BCBS Trust/PPO |
$776.07
|
| Rate for Payer: BCN Commercial |
$25.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.88
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$22.62
|
| Rate for Payer: Cofinity Commercial |
$24.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.72
|
| Rate for Payer: Meridian Medicaid |
$11.85
|
| Rate for Payer: Nomi Health Commercial |
$20.26
|
| Rate for Payer: PACE SWMI |
$16.88
|
| Rate for Payer: PHP Commercial |
$23.63
|
| Rate for Payer: PHP Medicare Advantage |
$16.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.81
|
| Rate for Payer: Priority Health Medicare |
$16.88
|
| Rate for Payer: Priority Health Narrow Network |
$19.81
|
| Rate for Payer: Priority Health SBD |
$19.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.88
|
| Rate for Payer: UHC Medicare Advantage |
$16.88
|
| Rate for Payer: UHCCP Medicaid |
$11.29
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS
|
Professional
|
Both
|
$7,109.00
|
|
|
Service Code
|
HCPCS 62161
|
| Min. Negotiated Rate |
$214.49 |
| Max. Negotiated Rate |
$4,620.85 |
| Rate for Payer: Aetna Commercial |
$2,026.08
|
| Rate for Payer: Aetna Medicare |
$1,572.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,026.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,177.28
|
| Rate for Payer: BCBS Complete |
$1,045.34
|
| Rate for Payer: BCBS MAPPO |
$1,512.00
|
| Rate for Payer: BCBS Trust/PPO |
$214.49
|
| Rate for Payer: BCN Commercial |
$3,118.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,512.00
|
| Rate for Payer: Cash Price |
$5,687.20
|
| Rate for Payer: Cash Price |
$5,687.20
|
| Rate for Payer: Cofinity Commercial |
$2,026.08
|
| Rate for Payer: Cofinity Commercial |
$2,177.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,512.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,587.60
|
| Rate for Payer: Meridian Medicaid |
$1,045.34
|
| Rate for Payer: Nomi Health Commercial |
$1,814.40
|
| Rate for Payer: PACE SWMI |
$1,512.00
|
| Rate for Payer: PHP Commercial |
$2,116.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,512.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$995.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,620.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,649.64
|
| Rate for Payer: Priority Health Medicare |
$1,512.00
|
| Rate for Payer: Priority Health Narrow Network |
$2,649.64
|
| Rate for Payer: Priority Health SBD |
$2,649.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,512.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,512.00
|
| Rate for Payer: UHCCP Medicaid |
$995.56
|
| Rate for Payer: UMR Bronson Commercial |
$3,270.14
|
|
|
PR NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID
|
Professional
|
Both
|
$2,824.00
|
|
|
Service Code
|
HCPCS 62165
|
| Min. Negotiated Rate |
$981.50 |
| Max. Negotiated Rate |
$2,613.25 |
| Rate for Payer: Aetna Commercial |
$1,984.79
|
| Rate for Payer: Aetna Medicare |
$1,540.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,984.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,132.91
|
| Rate for Payer: BCBS Complete |
$1,030.58
|
| Rate for Payer: BCBS MAPPO |
$1,481.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.62
|
| Rate for Payer: BCN Commercial |
$2,234.73
|
| 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 |
$1,984.79
|
| Rate for Payer: Cofinity Commercial |
$2,132.91
|
| 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: Meridian Medicaid |
$1,030.58
|
| 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 Choice Medicaid |
$981.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,835.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,613.25
|
| Rate for Payer: Priority Health Medicare |
$1,481.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,613.25
|
| Rate for Payer: Priority Health SBD |
$2,613.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,481.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,481.19
|
| Rate for Payer: UHCCP Medicaid |
$981.50
|
| 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 |
$757.05 |
| 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) |
$2,513.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,701.21
|
| Rate for Payer: BCBS Complete |
$1,294.26
|
| Rate for Payer: BCBS MAPPO |
$1,875.84
|
| Rate for Payer: BCBS Trust/PPO |
$757.05
|
| Rate for Payer: BCN Commercial |
$2,789.86
|
| 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 |
$2,513.63
|
| Rate for Payer: Cofinity Commercial |
$2,701.21
|
| 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: Meridian Medicaid |
$1,294.26
|
| 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 Choice Medicaid |
$1,232.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,092.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,276.95
|
| Rate for Payer: Priority Health Medicare |
$1,875.84
|
| Rate for Payer: Priority Health Narrow Network |
$3,276.95
|
| Rate for Payer: Priority Health SBD |
$3,276.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,875.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,875.84
|
| Rate for Payer: UHCCP Medicaid |
$1,232.63
|
| 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 |
$120.98 |
| 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) |
$249.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.47
|
| Rate for Payer: BCBS Complete |
$127.03
|
| Rate for Payer: BCBS MAPPO |
$186.44
|
| Rate for Payer: BCBS Trust/PPO |
$437.96
|
| Rate for Payer: BCN Commercial |
$381.67
|
| 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 |
$249.83
|
| Rate for Payer: Cofinity Commercial |
$268.47
|
| 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: Meridian Medicaid |
$127.03
|
| 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 Choice Medicaid |
$120.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$321.32
|
| Rate for Payer: Priority Health Medicare |
$186.44
|
| Rate for Payer: Priority Health Narrow Network |
$321.32
|
| Rate for Payer: Priority Health SBD |
$321.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.44
|
| Rate for Payer: UHC Medicare Advantage |
$186.44
|
| Rate for Payer: UHCCP Medicaid |
$120.98
|
| 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 |
$72.68 |
| Max. Negotiated Rate |
$1,849.05 |
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Aetna Commercial |
$165.06
|
| Rate for Payer: Aetna Medicare |
$128.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.38
|
| Rate for Payer: BCBS Complete |
$87.00
|
| Rate for Payer: BCBS MAPPO |
$123.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,849.05
|
| Rate for Payer: BCN Commercial |
$189.61
|
| Rate for Payer: BCN Medicare Advantage |
$123.18
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$165.06
|
| Rate for Payer: Cofinity Commercial |
$177.38
|
| 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: Meridian Medicaid |
$87.00
|
| 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 Choice Medicaid |
$82.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.99
|
| Rate for Payer: Priority Health Medicare |
$123.18
|
| Rate for Payer: Priority Health Narrow Network |
$174.99
|
| Rate for Payer: Priority Health SBD |
$174.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.18
|
| Rate for Payer: UHC Medicare Advantage |
$123.18
|
| Rate for Payer: UHCCP Medicaid |
$82.86
|
| 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 |
$50.60 |
| Max. Negotiated Rate |
$402.56 |
| Rate for Payer: Aetna Commercial |
$102.87
|
| Rate for Payer: Aetna Medicare |
$79.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.55
|
| Rate for Payer: BCBS Complete |
$54.35
|
| Rate for Payer: BCBS MAPPO |
$76.77
|
| Rate for Payer: BCBS Trust/PPO |
$402.56
|
| Rate for Payer: BCN Commercial |
$117.77
|
| 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 |
$102.87
|
| Rate for Payer: Cofinity Commercial |
$110.55
|
| 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: Meridian Medicaid |
$54.35
|
| 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 Choice Medicaid |
$51.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$109.04
|
| Rate for Payer: Priority Health Medicare |
$76.77
|
| Rate for Payer: Priority Health Narrow Network |
$109.04
|
| Rate for Payer: Priority Health SBD |
$109.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.77
|
| Rate for Payer: UHC Medicare Advantage |
$76.77
|
| Rate for Payer: UHCCP Medicaid |
$51.76
|
| 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 |
$2.34 |
| Max. Negotiated Rate |
$603.85 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare |
$44.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: BCBS Complete |
$2.46
|
| Rate for Payer: BCBS MAPPO |
$43.10
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: BCN Commercial |
$69.39
|
| 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 |
$57.75
|
| Rate for Payer: Cofinity Commercial |
$62.06
|
| 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: Meridian Medicaid |
$2.46
|
| 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 Choice Medicaid |
$2.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.04
|
| Rate for Payer: Priority Health Medicare |
$43.10
|
| Rate for Payer: Priority Health Narrow Network |
$66.04
|
| Rate for Payer: Priority Health SBD |
$4.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.10
|
| Rate for Payer: UHC Medicare Advantage |
$43.10
|
| Rate for Payer: UHCCP Medicaid |
$2.34
|
| 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 |
$7.88 |
| Max. Negotiated Rate |
$444.83 |
| Rate for Payer: Aetna Commercial |
$63.85
|
| Rate for Payer: Aetna Medicare |
$49.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.62
|
| Rate for Payer: BCBS Complete |
$8.27
|
| Rate for Payer: BCBS MAPPO |
$47.65
|
| Rate for Payer: BCBS Trust/PPO |
$444.83
|
| Rate for Payer: BCN Commercial |
$76.72
|
| 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 |
$63.85
|
| Rate for Payer: Cofinity Commercial |
$68.62
|
| 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: Meridian Medicaid |
$8.27
|
| 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 Choice Medicaid |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.28
|
| Rate for Payer: Priority Health Medicare |
$47.65
|
| Rate for Payer: Priority Health Narrow Network |
$73.28
|
| Rate for Payer: Priority Health SBD |
$16.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.65
|
| Rate for Payer: UHC Medicare Advantage |
$47.65
|
| Rate for Payer: UHCCP Medicaid |
$7.88
|
| Rate for Payer: UMR Bronson Commercial |
$52.44
|
|
|
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 |
$87.68
|
| 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 |
$87.68
|
|
|
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 |
$87.68
|
| 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 |
$87.68
|
|
|
PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM
|
Professional
|
Both
|
$4,249.00
|
|
|
Service Code
|
HCPCS 59510
|
| Min. Negotiated Rate |
$69.21 |
| Max. Negotiated Rate |
$3,780.59 |
| Rate for Payer: Aetna Commercial |
$3,492.12
|
| Rate for Payer: Aetna Medicare |
$2,710.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,492.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,752.73
|
| Rate for Payer: BCBS Complete |
$2,599.55
|
| Rate for Payer: BCBS MAPPO |
$2,606.06
|
| Rate for Payer: BCBS Trust/PPO |
$69.21
|
| Rate for Payer: BCN Commercial |
$3,201.80
|
| 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 |
$3,492.12
|
| Rate for Payer: Cofinity Commercial |
$3,752.73
|
| 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: Meridian Medicaid |
$2,599.55
|
| 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 Choice Medicaid |
$2,475.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,761.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,780.59
|
| Rate for Payer: Priority Health Medicare |
$2,606.06
|
| Rate for Payer: Priority Health Narrow Network |
$3,780.59
|
| Rate for Payer: Priority Health SBD |
$3,780.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,606.06
|
| Rate for Payer: UHC Medicare Advantage |
$2,606.06
|
| Rate for Payer: UHCCP Medicaid |
$2,475.76
|
| 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 |
$42.26 |
| Max. Negotiated Rate |
$3,400.06 |
| Rate for Payer: Aetna Commercial |
$3,132.40
|
| Rate for Payer: Aetna Medicare |
$2,431.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,132.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,366.16
|
| Rate for Payer: BCBS Complete |
$2,331.77
|
| Rate for Payer: BCBS MAPPO |
$2,337.61
|
| Rate for Payer: BCBS Trust/PPO |
$42.26
|
| Rate for Payer: BCN Commercial |
$3,201.80
|
| 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 |
$3,132.40
|
| Rate for Payer: Cofinity Commercial |
$3,366.16
|
| 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: Meridian Medicaid |
$2,331.77
|
| 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 Choice Medicaid |
$2,220.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,489.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,400.06
|
| Rate for Payer: Priority Health Medicare |
$2,337.61
|
| Rate for Payer: Priority Health Narrow Network |
$3,400.06
|
| Rate for Payer: Priority Health SBD |
$3,400.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,337.61
|
| Rate for Payer: UHC Medicare Advantage |
$2,337.61
|
| Rate for Payer: UHCCP Medicaid |
$2,220.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,761.80
|
|
|
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-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 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
|
|
|
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
|
|
