|
PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 99242
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$158.49 |
| Rate for Payer: Aetna Commercial |
$70.73
|
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.73
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS Trust/PPO |
$158.49
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.49
|
| Rate for Payer: Priority Health Narrow Network |
$74.49
|
| Rate for Payer: Priority Health SBD |
$74.49
|
| Rate for Payer: UHCCP Medicaid |
$35.15
|
| Rate for Payer: UMR Bronson Commercial |
$69.46
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 99215
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$1,816.82 |
| Rate for Payer: Aetna Commercial |
$182.59
|
| Rate for Payer: Aetna Medicare |
$141.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.21
|
| Rate for Payer: BCBS Complete |
$95.95
|
| Rate for Payer: BCBS MAPPO |
$136.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.82
|
| Rate for Payer: BCN Commercial |
$154.50
|
| Rate for Payer: BCN Medicare Advantage |
$136.26
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$196.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.07
|
| Rate for Payer: Meridian Medicaid |
$95.95
|
| Rate for Payer: Nomi Health Commercial |
$163.51
|
| Rate for Payer: PACE SWMI |
$136.26
|
| Rate for Payer: PHP Commercial |
$190.76
|
| Rate for Payer: PHP Medicare Advantage |
$136.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.44
|
| Rate for Payer: Priority Health Medicare |
$136.26
|
| Rate for Payer: Priority Health Narrow Network |
$160.44
|
| Rate for Payer: Priority Health SBD |
$160.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.26
|
| Rate for Payer: UHC Medicare Advantage |
$136.26
|
| Rate for Payer: UHCCP Medicaid |
$91.38
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99213
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$1,305.96 |
| Rate for Payer: Aetna Commercial |
$83.94
|
| Rate for Payer: Aetna Medicare |
$65.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.20
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS MAPPO |
$62.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.96
|
| Rate for Payer: BCN Commercial |
$79.38
|
| Rate for Payer: BCN Medicare Advantage |
$62.64
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$83.94
|
| Rate for Payer: Cofinity Commercial |
$90.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.77
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$75.17
|
| Rate for Payer: PACE SWMI |
$62.64
|
| Rate for Payer: PHP Commercial |
$87.70
|
| Rate for Payer: PHP Medicare Advantage |
$62.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.30
|
| Rate for Payer: Priority Health Medicare |
$62.64
|
| Rate for Payer: Priority Health Narrow Network |
$73.30
|
| Rate for Payer: Priority Health SBD |
$73.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.64
|
| Rate for Payer: UHC Medicare Advantage |
$62.64
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99214
|
| Min. Negotiated Rate |
$61.77 |
| Max. Negotiated Rate |
$1,340.83 |
| Rate for Payer: Aetna Commercial |
$123.62
|
| Rate for Payer: Aetna Medicare |
$95.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.84
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: BCBS MAPPO |
$92.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,340.83
|
| Rate for Payer: BCN Commercial |
$115.12
|
| Rate for Payer: BCN Medicare Advantage |
$92.25
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$123.62
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.86
|
| Rate for Payer: Meridian Medicaid |
$64.86
|
| Rate for Payer: Nomi Health Commercial |
$110.70
|
| Rate for Payer: PACE SWMI |
$92.25
|
| Rate for Payer: PHP Commercial |
$129.15
|
| Rate for Payer: PHP Medicare Advantage |
$92.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.08
|
| Rate for Payer: Priority Health Medicare |
$92.25
|
| Rate for Payer: Priority Health Narrow Network |
$108.08
|
| Rate for Payer: Priority Health SBD |
$108.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.25
|
| Rate for Payer: UHC Medicare Advantage |
$92.25
|
| Rate for Payer: UHCCP Medicaid |
$61.77
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 99212
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$2,731.31 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: Aetna Medicare |
$34.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.07
|
| Rate for Payer: BCBS Complete |
$23.49
|
| Rate for Payer: BCBS MAPPO |
$33.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,731.31
|
| Rate for Payer: BCN Commercial |
$50.51
|
| Rate for Payer: BCN Medicare Advantage |
$33.38
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$44.73
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.05
|
| Rate for Payer: Meridian Medicaid |
$23.49
|
| Rate for Payer: Nomi Health Commercial |
$40.06
|
| Rate for Payer: PACE SWMI |
$33.38
|
| Rate for Payer: PHP Commercial |
$46.73
|
| Rate for Payer: PHP Medicare Advantage |
$33.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.27
|
| Rate for Payer: Priority Health Medicare |
$33.38
|
| Rate for Payer: Priority Health Narrow Network |
$39.27
|
| Rate for Payer: Priority Health SBD |
$39.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.38
|
| Rate for Payer: UHC Medicare Advantage |
$33.38
|
| Rate for Payer: UHCCP Medicaid |
$22.37
|
| Rate for Payer: UMR Bronson Commercial |
$28.98
|
|
|
PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 99211
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$2,495.16 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,495.16
|
| Rate for Payer: BCN Commercial |
$23.28
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Commercial |
$11.56
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.72
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: Priority Health Narrow Network |
$9.72
|
| Rate for Payer: Priority Health SBD |
$9.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 99205
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$2,028.67 |
| Rate for Payer: Aetna Commercial |
$231.78
|
| Rate for Payer: Aetna Medicare |
$179.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.08
|
| Rate for Payer: BCBS Complete |
$121.44
|
| Rate for Payer: BCBS MAPPO |
$172.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,028.67
|
| Rate for Payer: BCN Commercial |
$209.60
|
| Rate for Payer: BCN Medicare Advantage |
$172.97
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$231.78
|
| Rate for Payer: Cofinity Commercial |
$249.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.62
|
| Rate for Payer: Meridian Medicaid |
$121.44
|
| Rate for Payer: Nomi Health Commercial |
$207.56
|
| Rate for Payer: PACE SWMI |
$172.97
|
| Rate for Payer: PHP Commercial |
$242.16
|
| Rate for Payer: PHP Medicare Advantage |
$172.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.95
|
| Rate for Payer: Priority Health Medicare |
$172.97
|
| Rate for Payer: Priority Health Narrow Network |
$201.95
|
| Rate for Payer: Priority Health SBD |
$201.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.97
|
| Rate for Payer: UHC Medicare Advantage |
$172.97
|
| Rate for Payer: UHCCP Medicaid |
$115.66
|
| Rate for Payer: UMR Bronson Commercial |
$145.36
|
|
|
PR OFFICE OUTPATIENT NEW LEVL I
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 99201
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
| Rate for Payer: UMR Bronson Commercial |
$32.66
|
|
|
PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99203
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$931.39 |
| Rate for Payer: Aetna Commercial |
$104.73
|
| Rate for Payer: Aetna Medicare |
$81.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.55
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$78.16
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$108.55
|
| Rate for Payer: BCN Medicare Advantage |
$78.16
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$112.55
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.07
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Nomi Health Commercial |
$93.79
|
| Rate for Payer: PACE SWMI |
$78.16
|
| Rate for Payer: PHP Commercial |
$109.42
|
| Rate for Payer: PHP Medicare Advantage |
$78.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.26
|
| Rate for Payer: Priority Health Medicare |
$78.16
|
| Rate for Payer: Priority Health Narrow Network |
$91.26
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.16
|
| Rate for Payer: UHC Medicare Advantage |
$78.16
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 99204
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$1,704.30 |
| Rate for Payer: Aetna Commercial |
$170.30
|
| Rate for Payer: Aetna Medicare |
$132.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.01
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$127.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.30
|
| Rate for Payer: BCN Commercial |
$165.88
|
| Rate for Payer: BCN Medicare Advantage |
$127.09
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$170.30
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.44
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Nomi Health Commercial |
$152.51
|
| Rate for Payer: PACE SWMI |
$127.09
|
| Rate for Payer: PHP Commercial |
$177.93
|
| Rate for Payer: PHP Medicare Advantage |
$127.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.47
|
| Rate for Payer: Priority Health Medicare |
$127.09
|
| Rate for Payer: Priority Health Narrow Network |
$148.47
|
| Rate for Payer: Priority Health SBD |
$148.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.09
|
| Rate for Payer: UHC Medicare Advantage |
$127.09
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99202
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$706.34 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$46.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.12
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCBS MAPPO |
$44.53
|
| Rate for Payer: BCBS Trust/PPO |
$706.34
|
| Rate for Payer: BCN Commercial |
$76.66
|
| Rate for Payer: BCN Medicare Advantage |
$44.53
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$64.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.76
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| Rate for Payer: Nomi Health Commercial |
$53.44
|
| Rate for Payer: PACE SWMI |
$44.53
|
| Rate for Payer: PHP Commercial |
$62.34
|
| Rate for Payer: PHP Medicare Advantage |
$44.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.74
|
| Rate for Payer: Priority Health Medicare |
$44.53
|
| Rate for Payer: Priority Health Narrow Network |
$52.74
|
| Rate for Payer: Priority Health SBD |
$52.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.53
|
| Rate for Payer: UHC Medicare Advantage |
$44.53
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 59651015201
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$1,804.64
|
|
|
Service Code
|
NDC 72989037230
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$794.04 |
| Max. Negotiated Rate |
$1,624.18 |
| Rate for Payer: Aetna American Axle |
$1,173.02
|
| Rate for Payer: Aetna Commercial |
$1,533.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,173.02
|
| Rate for Payer: Cash Price |
$1,443.71
|
| Rate for Payer: Cofinity Commercial |
$1,263.25
|
| Rate for Payer: Cofinity Commercial |
$1,551.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,263.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,443.71
|
| Rate for Payer: Healthscope Commercial |
$1,624.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,263.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,353.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,533.94
|
| Rate for Payer: PHP Commercial |
$1,533.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.02
|
| Rate for Payer: Priority Health SBD |
$1,136.92
|
| Rate for Payer: UMR Bronson Commercial |
$794.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,353.48
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
OP
|
$256.80
|
|
|
Service Code
|
NDC 17478076610
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.02 |
| Max. Negotiated Rate |
$231.12 |
| Rate for Payer: Aetna American Axle |
$166.92
|
| Rate for Payer: Aetna Commercial |
$218.28
|
| Rate for Payer: Aetna Medicare |
$128.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.92
|
| Rate for Payer: BCBS Complete |
$102.72
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cofinity Commercial |
$179.76
|
| Rate for Payer: Cofinity Commercial |
$220.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.44
|
| Rate for Payer: Healthscope Commercial |
$231.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.28
|
| Rate for Payer: PHP Commercial |
$218.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health SBD |
$161.78
|
| Rate for Payer: UMR Bronson Commercial |
$95.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.60
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$256.80
|
|
|
Service Code
|
NDC 17478076610
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$231.12 |
| Rate for Payer: Aetna American Axle |
$166.92
|
| Rate for Payer: Aetna Commercial |
$218.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.92
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cofinity Commercial |
$179.76
|
| Rate for Payer: Cofinity Commercial |
$220.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.44
|
| Rate for Payer: Healthscope Commercial |
$231.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.28
|
| Rate for Payer: PHP Commercial |
$218.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health SBD |
$161.78
|
| Rate for Payer: UMR Bronson Commercial |
$112.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.60
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
OP
|
$1,804.64
|
|
|
Service Code
|
NDC 72989037230
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$1,624.18 |
| Rate for Payer: Aetna American Axle |
$1,173.02
|
| Rate for Payer: Aetna Commercial |
$1,533.94
|
| Rate for Payer: Aetna Medicare |
$902.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,173.02
|
| Rate for Payer: BCBS Complete |
$721.86
|
| Rate for Payer: Cash Price |
$1,443.71
|
| Rate for Payer: Cofinity Commercial |
$1,263.25
|
| Rate for Payer: Cofinity Commercial |
$1,551.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,263.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,443.71
|
| Rate for Payer: Healthscope Commercial |
$1,624.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,263.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,353.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,533.94
|
| Rate for Payer: PHP Commercial |
$1,533.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,173.02
|
| Rate for Payer: Priority Health SBD |
$1,136.92
|
| Rate for Payer: UMR Bronson Commercial |
$667.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,353.48
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 59651015201
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROGESTERONE MICRONIZED 8 % VAGINAL GEL
|
Facility
|
OP
|
$107.07
|
|
|
Service Code
|
NDC 00023615108
|
| Hospital Charge Code |
21321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$96.36 |
| Rate for Payer: Aetna American Axle |
$69.60
|
| Rate for Payer: Aetna Commercial |
$91.01
|
| Rate for Payer: Aetna Medicare |
$53.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.60
|
| Rate for Payer: BCBS Complete |
$42.83
|
| Rate for Payer: Cash Price |
$85.66
|
| Rate for Payer: Cofinity Commercial |
$74.95
|
| Rate for Payer: Cofinity Commercial |
$92.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.66
|
| Rate for Payer: Healthscope Commercial |
$96.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.01
|
| Rate for Payer: PHP Commercial |
$91.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.60
|
| Rate for Payer: Priority Health SBD |
$67.45
|
| Rate for Payer: UMR Bronson Commercial |
$39.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.30
|
|
|
PROGESTERONE MICRONIZED 8 % VAGINAL GEL
|
Facility
|
IP
|
$107.07
|
|
|
Service Code
|
NDC 00023615108
|
| Hospital Charge Code |
21321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$96.36 |
| Rate for Payer: Aetna American Axle |
$69.60
|
| Rate for Payer: Aetna Commercial |
$91.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.60
|
| Rate for Payer: Cash Price |
$85.66
|
| Rate for Payer: Cofinity Commercial |
$74.95
|
| Rate for Payer: Cofinity Commercial |
$92.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.66
|
| Rate for Payer: Healthscope Commercial |
$96.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.01
|
| Rate for Payer: PHP Commercial |
$91.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.60
|
| Rate for Payer: Priority Health SBD |
$67.45
|
| Rate for Payer: UMR Bronson Commercial |
$47.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.30
|
|
|
PROGESTERONE MICRONIZED 8 % VAGINAL GEL
|
Facility
|
IP
|
$107.07
|
|
|
Service Code
|
NDC 00023615109
|
| Hospital Charge Code |
21321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.11 |
| Max. Negotiated Rate |
$96.36 |
| Rate for Payer: Aetna American Axle |
$69.60
|
| Rate for Payer: Aetna Commercial |
$91.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.60
|
| Rate for Payer: Cash Price |
$85.66
|
| Rate for Payer: Cofinity Commercial |
$74.95
|
| Rate for Payer: Cofinity Commercial |
$92.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.66
|
| Rate for Payer: Healthscope Commercial |
$96.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.01
|
| Rate for Payer: PHP Commercial |
$91.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.60
|
| Rate for Payer: Priority Health SBD |
$67.45
|
| Rate for Payer: UMR Bronson Commercial |
$47.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.30
|
|
|
PROGESTERONE MICRONIZED 8 % VAGINAL GEL
|
Facility
|
OP
|
$107.07
|
|
|
Service Code
|
NDC 00023615109
|
| Hospital Charge Code |
21321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.62 |
| Max. Negotiated Rate |
$96.36 |
| Rate for Payer: Aetna American Axle |
$69.60
|
| Rate for Payer: Aetna Commercial |
$91.01
|
| Rate for Payer: Aetna Medicare |
$53.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.60
|
| Rate for Payer: BCBS Complete |
$42.83
|
| Rate for Payer: Cash Price |
$85.66
|
| Rate for Payer: Cofinity Commercial |
$74.95
|
| Rate for Payer: Cofinity Commercial |
$92.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.66
|
| Rate for Payer: Healthscope Commercial |
$96.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.01
|
| Rate for Payer: PHP Commercial |
$91.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.60
|
| Rate for Payer: Priority Health SBD |
$67.45
|
| Rate for Payer: UMR Bronson Commercial |
$39.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.30
|
|
|
PR OMALIZUMAB INJECTION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J2357
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$58.41 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$42.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.41
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$40.56
|
| Rate for Payer: BCBS Trust/PPO |
$40.20
|
| Rate for Payer: BCN Commercial |
$38.63
|
| Rate for Payer: BCN Medicare Advantage |
$40.56
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$54.35
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.59
|
| Rate for Payer: Nomi Health Commercial |
$48.68
|
| Rate for Payer: PACE SWMI |
$40.56
|
| Rate for Payer: PHP Commercial |
$56.79
|
| Rate for Payer: PHP Medicare Advantage |
$40.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$40.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.56
|
| Rate for Payer: UHC Medicare Advantage |
$40.56
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR OMENTAL FLAP INTRA-ABDOMINAL
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 49905
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$4,973.94 |
| Rate for Payer: Aetna Commercial |
$456.14
|
| Rate for Payer: Aetna Medicare |
$354.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$490.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.14
|
| Rate for Payer: BCBS Complete |
$234.61
|
| Rate for Payer: BCBS MAPPO |
$340.40
|
| Rate for Payer: BCBS Trust/PPO |
$4,973.94
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: BCN Medicare Advantage |
$340.40
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cofinity Commercial |
$456.14
|
| Rate for Payer: Cofinity Commercial |
$490.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$357.42
|
| Rate for Payer: Meridian Medicaid |
$234.61
|
| Rate for Payer: Nomi Health Commercial |
$408.48
|
| Rate for Payer: PACE SWMI |
$340.40
|
| Rate for Payer: PHP Commercial |
$476.56
|
| Rate for Payer: PHP Medicare Advantage |
$340.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$624.63
|
| Rate for Payer: Priority Health Medicare |
$340.40
|
| Rate for Payer: Priority Health Narrow Network |
$624.63
|
| Rate for Payer: Priority Health SBD |
$624.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$340.40
|
| Rate for Payer: UHC Medicare Advantage |
$340.40
|
| Rate for Payer: UHCCP Medicaid |
$223.44
|
| Rate for Payer: UMR Bronson Commercial |
$295.32
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$183.02
|
|
|
Service Code
|
NDC 00713053612
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.72 |
| Max. Negotiated Rate |
$164.72 |
| Rate for Payer: Aetna American Axle |
$118.96
|
| Rate for Payer: Aetna Commercial |
$155.57
|
| Rate for Payer: Aetna Medicare |
$91.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.96
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: Cash Price |
$146.42
|
| Rate for Payer: Cofinity Commercial |
$128.11
|
| Rate for Payer: Cofinity Commercial |
$157.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.42
|
| Rate for Payer: Healthscope Commercial |
$164.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.57
|
| Rate for Payer: PHP Commercial |
$155.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.96
|
| Rate for Payer: Priority Health SBD |
$115.30
|
| Rate for Payer: UMR Bronson Commercial |
$67.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.26
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$15.26
|
|
|
Service Code
|
NDC 00713053606
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$13.73 |
| Rate for Payer: Aetna American Axle |
$9.92
|
| Rate for Payer: Aetna Commercial |
$12.97
|
| Rate for Payer: Aetna Medicare |
$7.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.92
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: Cash Price |
$12.21
|
| Rate for Payer: Cofinity Commercial |
$10.68
|
| Rate for Payer: Cofinity Commercial |
$13.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.21
|
| Rate for Payer: Healthscope Commercial |
$13.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.97
|
| Rate for Payer: PHP Commercial |
$12.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.92
|
| Rate for Payer: Priority Health SBD |
$9.61
|
| Rate for Payer: UMR Bronson Commercial |
$5.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.44
|
|
