|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 27455
|
| Min. Negotiated Rate |
$813.20 |
| Max. Negotiated Rate |
$1,331.28 |
| Rate for Payer: Aetna Commercial |
$1,238.83
|
| Rate for Payer: Aetna Medicare |
$961.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.83
|
| Rate for Payer: BCBS Complete |
$813.20
|
| Rate for Payer: BCBS MAPPO |
$924.50
|
| Rate for Payer: BCN Medicare Advantage |
$924.50
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Cofinity Commercial |
$1,238.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.73
|
| Rate for Payer: Nomi Health Commercial |
$1,109.40
|
| Rate for Payer: PACE SWMI |
$924.50
|
| Rate for Payer: PHP Commercial |
$1,294.30
|
| Rate for Payer: PHP Medicare Advantage |
$924.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.45
|
| Rate for Payer: Priority Health Medicare |
$924.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.50
|
| Rate for Payer: UHC Medicare Advantage |
$924.50
|
| Rate for Payer: UMR Bronson Commercial |
$935.18
|
|
|
PR OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 28312
|
| Min. Negotiated Rate |
$324.40 |
| Max. Negotiated Rate |
$527.15 |
| Rate for Payer: Aetna Commercial |
$455.32
|
| Rate for Payer: Aetna Medicare |
$353.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.32
|
| Rate for Payer: BCBS Complete |
$324.40
|
| Rate for Payer: BCBS MAPPO |
$339.79
|
| Rate for Payer: BCN Medicare Advantage |
$339.79
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$489.30
|
| Rate for Payer: Cofinity Commercial |
$455.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.78
|
| Rate for Payer: Nomi Health Commercial |
$407.75
|
| Rate for Payer: PACE SWMI |
$339.79
|
| Rate for Payer: PHP Commercial |
$475.71
|
| Rate for Payer: PHP Medicare Advantage |
$339.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.15
|
| Rate for Payer: Priority Health Medicare |
$339.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.79
|
| Rate for Payer: UHC Medicare Advantage |
$339.79
|
| Rate for Payer: UMR Bronson Commercial |
$373.06
|
|
|
PR OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 28310
|
| Min. Negotiated Rate |
$351.79 |
| Max. Negotiated Rate |
$621.40 |
| Rate for Payer: Aetna Commercial |
$471.40
|
| Rate for Payer: Aetna Medicare |
$365.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.40
|
| Rate for Payer: BCBS Complete |
$382.40
|
| Rate for Payer: BCBS MAPPO |
$351.79
|
| Rate for Payer: BCN Medicare Advantage |
$351.79
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$506.58
|
| Rate for Payer: Cofinity Commercial |
$471.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.38
|
| Rate for Payer: Nomi Health Commercial |
$422.15
|
| Rate for Payer: PACE SWMI |
$351.79
|
| Rate for Payer: PHP Commercial |
$492.51
|
| Rate for Payer: PHP Medicare Advantage |
$351.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.40
|
| Rate for Payer: Priority Health Medicare |
$351.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.79
|
| Rate for Payer: UHC Medicare Advantage |
$351.79
|
| Rate for Payer: UMR Bronson Commercial |
$439.76
|
|
|
PR OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 22216
|
| Min. Negotiated Rate |
$353.64 |
| Max. Negotiated Rate |
$1,714.05 |
| Rate for Payer: Aetna Commercial |
$473.88
|
| Rate for Payer: Aetna Medicare |
$367.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.88
|
| Rate for Payer: BCBS Complete |
$1,054.80
|
| Rate for Payer: BCBS MAPPO |
$353.64
|
| Rate for Payer: BCN Medicare Advantage |
$353.64
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cofinity Commercial |
$509.24
|
| Rate for Payer: Cofinity Commercial |
$473.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.32
|
| Rate for Payer: Nomi Health Commercial |
$424.37
|
| Rate for Payer: PACE SWMI |
$353.64
|
| Rate for Payer: PHP Commercial |
$495.10
|
| Rate for Payer: PHP Medicare Advantage |
$353.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,714.05
|
| Rate for Payer: Priority Health Medicare |
$353.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.64
|
| Rate for Payer: UHC Medicare Advantage |
$353.64
|
| Rate for Payer: UMR Bronson Commercial |
$1,213.02
|
|
|
PR OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 28305
|
| Min. Negotiated Rate |
$646.96 |
| Max. Negotiated Rate |
$1,119.30 |
| Rate for Payer: Aetna Commercial |
$866.93
|
| Rate for Payer: Aetna Medicare |
$672.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$931.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.93
|
| Rate for Payer: BCBS Complete |
$688.80
|
| Rate for Payer: BCBS MAPPO |
$646.96
|
| Rate for Payer: BCN Medicare Advantage |
$646.96
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cofinity Commercial |
$931.62
|
| Rate for Payer: Cofinity Commercial |
$866.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$646.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.31
|
| Rate for Payer: Nomi Health Commercial |
$776.35
|
| Rate for Payer: PACE SWMI |
$646.96
|
| Rate for Payer: PHP Commercial |
$905.74
|
| Rate for Payer: PHP Medicare Advantage |
$646.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,119.30
|
| Rate for Payer: Priority Health Medicare |
$646.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$646.96
|
| Rate for Payer: UHC Medicare Advantage |
$646.96
|
| Rate for Payer: UMR Bronson Commercial |
$792.12
|
|
|
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
|
Professional
|
Both
|
$3,962.00
|
|
|
Service Code
|
HCPCS 28309
|
| Min. Negotiated Rate |
$870.69 |
| Max. Negotiated Rate |
$2,575.30 |
| Rate for Payer: Aetna Commercial |
$1,166.72
|
| Rate for Payer: Aetna Medicare |
$905.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,253.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,166.72
|
| Rate for Payer: BCBS Complete |
$1,584.80
|
| Rate for Payer: BCBS MAPPO |
$870.69
|
| Rate for Payer: BCN Medicare Advantage |
$870.69
|
| Rate for Payer: Cash Price |
$3,169.60
|
| Rate for Payer: Cash Price |
$3,169.60
|
| Rate for Payer: Cofinity Commercial |
$1,253.79
|
| Rate for Payer: Cofinity Commercial |
$1,166.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.22
|
| Rate for Payer: Nomi Health Commercial |
$1,044.83
|
| Rate for Payer: PACE SWMI |
$870.69
|
| Rate for Payer: PHP Commercial |
$1,218.97
|
| Rate for Payer: PHP Medicare Advantage |
$870.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,575.30
|
| Rate for Payer: Priority Health Medicare |
$870.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.69
|
| Rate for Payer: UHC Medicare Advantage |
$870.69
|
| Rate for Payer: UMR Bronson Commercial |
$1,822.52
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR
|
Professional
|
Both
|
$1,417.00
|
|
|
Service Code
|
HCPCS 28306
|
| Min. Negotiated Rate |
$390.34 |
| Max. Negotiated Rate |
$921.05 |
| Rate for Payer: Aetna Commercial |
$523.06
|
| Rate for Payer: Aetna Medicare |
$405.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.06
|
| Rate for Payer: BCBS Complete |
$566.80
|
| Rate for Payer: BCBS MAPPO |
$390.34
|
| Rate for Payer: BCN Medicare Advantage |
$390.34
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cofinity Commercial |
$562.09
|
| Rate for Payer: Cofinity Commercial |
$523.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.86
|
| Rate for Payer: Nomi Health Commercial |
$468.41
|
| Rate for Payer: PACE SWMI |
$390.34
|
| Rate for Payer: PHP Commercial |
$546.48
|
| Rate for Payer: PHP Medicare Advantage |
$390.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.05
|
| Rate for Payer: Priority Health Medicare |
$390.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.34
|
| Rate for Payer: UHC Medicare Advantage |
$390.34
|
| Rate for Payer: UMR Bronson Commercial |
$651.82
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 28308
|
| Min. Negotiated Rate |
$371.07 |
| Max. Negotiated Rate |
$706.55 |
| Rate for Payer: Aetna Commercial |
$497.23
|
| Rate for Payer: Aetna Medicare |
$385.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.23
|
| Rate for Payer: BCBS Complete |
$434.80
|
| Rate for Payer: BCBS MAPPO |
$371.07
|
| Rate for Payer: BCN Medicare Advantage |
$371.07
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cofinity Commercial |
$534.34
|
| Rate for Payer: Cofinity Commercial |
$497.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.62
|
| Rate for Payer: Nomi Health Commercial |
$445.28
|
| Rate for Payer: PACE SWMI |
$371.07
|
| Rate for Payer: PHP Commercial |
$519.50
|
| Rate for Payer: PHP Medicare Advantage |
$371.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.55
|
| Rate for Payer: Priority Health Medicare |
$371.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.07
|
| Rate for Payer: UHC Medicare Advantage |
$371.07
|
| Rate for Payer: UMR Bronson Commercial |
$500.02
|
|
|
PR OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 63295
|
| Min. Negotiated Rate |
$327.42 |
| Max. Negotiated Rate |
$825.50 |
| Rate for Payer: Aetna Commercial |
$438.74
|
| Rate for Payer: Aetna Medicare |
$340.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.74
|
| Rate for Payer: BCBS Complete |
$508.00
|
| Rate for Payer: BCBS MAPPO |
$327.42
|
| Rate for Payer: BCN Medicare Advantage |
$327.42
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$471.48
|
| Rate for Payer: Cofinity Commercial |
$438.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.79
|
| Rate for Payer: Nomi Health Commercial |
$392.90
|
| Rate for Payer: PACE SWMI |
$327.42
|
| Rate for Payer: PHP Commercial |
$458.39
|
| Rate for Payer: PHP Medicare Advantage |
$327.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health Medicare |
$327.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.42
|
| Rate for Payer: UHC Medicare Advantage |
$327.42
|
| Rate for Payer: UMR Bronson Commercial |
$584.20
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$135.40
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.10 |
| Max. Negotiated Rate |
$121.86 |
| Rate for Payer: Aetna American Axle |
$88.01
|
| Rate for Payer: Aetna American Axle |
$29.30
|
| Rate for Payer: Aetna Commercial |
$115.09
|
| Rate for Payer: Aetna Commercial |
$38.32
|
| Rate for Payer: Aetna Medicare |
$67.70
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.30
|
| Rate for Payer: BCBS Complete |
$18.03
|
| Rate for Payer: BCBS Complete |
$54.16
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cofinity Commercial |
$94.78
|
| Rate for Payer: Cofinity Commercial |
$116.44
|
| Rate for Payer: Cofinity Commercial |
$31.56
|
| Rate for Payer: Cofinity Commercial |
$38.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.06
|
| Rate for Payer: Healthscope Commercial |
$40.57
|
| Rate for Payer: Healthscope Commercial |
$121.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.32
|
| Rate for Payer: PHP Commercial |
$38.32
|
| Rate for Payer: PHP Commercial |
$115.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.30
|
| Rate for Payer: Priority Health SBD |
$28.40
|
| Rate for Payer: Priority Health SBD |
$85.30
|
| Rate for Payer: UMR Bronson Commercial |
$50.10
|
| Rate for Payer: UMR Bronson Commercial |
$16.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.55
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$135.40
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.58 |
| Max. Negotiated Rate |
$121.86 |
| Rate for Payer: Aetna American Axle |
$88.01
|
| Rate for Payer: Aetna American Axle |
$29.30
|
| Rate for Payer: Aetna Commercial |
$115.09
|
| Rate for Payer: Aetna Commercial |
$38.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.30
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cofinity Commercial |
$38.77
|
| Rate for Payer: Cofinity Commercial |
$31.56
|
| Rate for Payer: Cofinity Commercial |
$116.44
|
| Rate for Payer: Cofinity Commercial |
$94.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.06
|
| Rate for Payer: Healthscope Commercial |
$121.86
|
| Rate for Payer: Healthscope Commercial |
$40.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.09
|
| Rate for Payer: PHP Commercial |
$38.32
|
| Rate for Payer: PHP Commercial |
$115.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.30
|
| Rate for Payer: Priority Health SBD |
$85.30
|
| Rate for Payer: Priority Health SBD |
$28.40
|
| Rate for Payer: UMR Bronson Commercial |
$59.58
|
| Rate for Payer: UMR Bronson Commercial |
$19.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.81
|
|
|
PROTEIN SUPPLEMENT ORAL
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
NDC 43900028430
|
| Hospital Charge Code |
150950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
PROTEIN SUPPLEMENT ORAL
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
NDC 43900028430
|
| Hospital Charge Code |
150950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna American Axle |
$2.23
|
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
| Rate for Payer: UMR Bronson Commercial |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.57
|
|
|
PR OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA
|
Professional
|
Both
|
$4,482.00
|
|
|
Service Code
|
HCPCS 61345
|
| Min. Negotiated Rate |
$1,792.80 |
| Max. Negotiated Rate |
$2,920.08 |
| Rate for Payer: Aetna Commercial |
$2,717.29
|
| Rate for Payer: Aetna Medicare |
$2,108.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,920.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,717.29
|
| Rate for Payer: BCBS Complete |
$1,792.80
|
| Rate for Payer: BCBS MAPPO |
$2,027.83
|
| Rate for Payer: BCN Medicare Advantage |
$2,027.83
|
| Rate for Payer: Cash Price |
$3,585.60
|
| Rate for Payer: Cash Price |
$3,585.60
|
| Rate for Payer: Cofinity Commercial |
$2,920.08
|
| Rate for Payer: Cofinity Commercial |
$2,717.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,027.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,129.22
|
| Rate for Payer: Nomi Health Commercial |
$2,433.40
|
| Rate for Payer: PACE SWMI |
$2,027.83
|
| Rate for Payer: PHP Commercial |
$2,838.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,027.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,913.30
|
| Rate for Payer: Priority Health Medicare |
$2,027.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,027.83
|
| Rate for Payer: UHC Medicare Advantage |
$2,027.83
|
| Rate for Payer: UMR Bronson Commercial |
$2,061.72
|
|
|
PR OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 92502
|
| Min. Negotiated Rate |
$89.47 |
| Max. Negotiated Rate |
$216.45 |
| Rate for Payer: Aetna Commercial |
$119.89
|
| Rate for Payer: Aetna Medicare |
$93.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.89
|
| Rate for Payer: BCBS Complete |
$133.20
|
| Rate for Payer: BCBS MAPPO |
$89.47
|
| Rate for Payer: BCN Medicare Advantage |
$89.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$128.84
|
| Rate for Payer: Cofinity Commercial |
$119.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.94
|
| Rate for Payer: Nomi Health Commercial |
$107.36
|
| Rate for Payer: PACE SWMI |
$89.47
|
| Rate for Payer: PHP Commercial |
$125.26
|
| Rate for Payer: PHP Medicare Advantage |
$89.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
| Rate for Payer: Priority Health Medicare |
$89.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.47
|
| Rate for Payer: UHC Medicare Advantage |
$89.47
|
| Rate for Payer: UMR Bronson Commercial |
$153.18
|
|
|
PR OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
HCPCS 69300
|
| Min. Negotiated Rate |
$447.13 |
| Max. Negotiated Rate |
$1,027.65 |
| Rate for Payer: Aetna Commercial |
$599.15
|
| Rate for Payer: Aetna Medicare |
$465.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.15
|
| Rate for Payer: BCBS Complete |
$632.40
|
| Rate for Payer: BCBS MAPPO |
$447.13
|
| Rate for Payer: BCN Medicare Advantage |
$447.13
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cofinity Commercial |
$643.87
|
| Rate for Payer: Cofinity Commercial |
$599.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.49
|
| Rate for Payer: Nomi Health Commercial |
$536.56
|
| Rate for Payer: PACE SWMI |
$447.13
|
| Rate for Payer: PHP Commercial |
$625.98
|
| Rate for Payer: PHP Medicare Advantage |
$447.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.65
|
| Rate for Payer: Priority Health Medicare |
$447.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.13
|
| Rate for Payer: UHC Medicare Advantage |
$447.13
|
| Rate for Payer: UMR Bronson Commercial |
$727.26
|
|
|
PR OVARIAN CYSTECTOMY UNI/BI
|
Professional
|
Both
|
$2,385.00
|
|
|
Service Code
|
HCPCS 58925
|
| Min. Negotiated Rate |
$739.77 |
| Max. Negotiated Rate |
$1,550.25 |
| Rate for Payer: Aetna Commercial |
$991.29
|
| Rate for Payer: Aetna Medicare |
$769.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$991.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.27
|
| Rate for Payer: BCBS Complete |
$954.00
|
| Rate for Payer: BCBS MAPPO |
$739.77
|
| Rate for Payer: BCN Medicare Advantage |
$739.77
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cofinity Commercial |
$991.29
|
| Rate for Payer: Cofinity Commercial |
$1,065.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$739.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$776.76
|
| Rate for Payer: Nomi Health Commercial |
$887.72
|
| Rate for Payer: PACE SWMI |
$739.77
|
| Rate for Payer: PHP Commercial |
$1,035.68
|
| Rate for Payer: PHP Medicare Advantage |
$739.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,550.25
|
| Rate for Payer: Priority Health Medicare |
$739.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$739.77
|
| Rate for Payer: UHC Medicare Advantage |
$739.77
|
| Rate for Payer: UMR Bronson Commercial |
$1,097.10
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$149.10
|
|
|
Service Code
|
NDC 00085113204
|
| Hospital Charge Code |
17934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna American Axle |
$96.92
|
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.92
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Cofinity Commercial |
$128.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$134.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.73
|
| Rate for Payer: PHP Commercial |
$126.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.92
|
| Rate for Payer: Priority Health SBD |
$93.93
|
| Rate for Payer: UMR Bronson Commercial |
$65.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.83
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$116.90
|
|
|
Service Code
|
NDC 00254100752
|
| Hospital Charge Code |
17934
|
|
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
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$116.90
|
|
|
Service Code
|
NDC 00254100752
|
| Hospital Charge Code |
17934
|
|
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
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$149.10
|
|
|
Service Code
|
NDC 00085113204
|
| Hospital Charge Code |
17934
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.17 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna American Axle |
$96.92
|
| Rate for Payer: Aetna Commercial |
$126.73
|
| Rate for Payer: Aetna Medicare |
$74.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.92
|
| Rate for Payer: BCBS Complete |
$59.64
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Cofinity Commercial |
$128.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$134.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$104.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.73
|
| Rate for Payer: PHP Commercial |
$126.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.92
|
| Rate for Payer: Priority Health SBD |
$93.93
|
| Rate for Payer: UMR Bronson Commercial |
$55.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.83
|
|
|
PR OVINE, UP TO 999 USP UNITS
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J3471
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.67
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.67
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.50
|
| Rate for Payer: BCN Medicare Advantage |
$0.50
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.72
|
| Rate for Payer: Cofinity Commercial |
$0.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.53
|
| Rate for Payer: Nomi Health Commercial |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.50
|
| Rate for Payer: PHP Commercial |
$0.70
|
| Rate for Payer: PHP Medicare Advantage |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.50
|
| Rate for Payer: UHC Medicare Advantage |
$0.50
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR PACKING STRIPS, NON-IMPREG
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS A6407
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna Commercial |
$3.50
|
| Rate for Payer: Aetna Medicare |
$2.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$2.61
|
| Rate for Payer: BCN Medicare Advantage |
$2.61
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$3.76
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.74
|
| Rate for Payer: Nomi Health Commercial |
$3.13
|
| Rate for Payer: PACE SWMI |
$2.61
|
| Rate for Payer: PHP Commercial |
$3.65
|
| Rate for Payer: PHP Medicare Advantage |
$2.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$2.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.61
|
| Rate for Payer: UHC Medicare Advantage |
$2.61
|
| Rate for Payer: UMR Bronson Commercial |
$2.76
|
|
|
PR PALATOPHARYNGOPLASTY
|
Professional
|
Both
|
$2,472.00
|
|
|
Service Code
|
HCPCS 42145
|
| Min. Negotiated Rate |
$652.82 |
| Max. Negotiated Rate |
$1,606.80 |
| Rate for Payer: Aetna Commercial |
$874.78
|
| Rate for Payer: Aetna Medicare |
$678.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$874.78
|
| Rate for Payer: BCBS Complete |
$988.80
|
| Rate for Payer: BCBS MAPPO |
$652.82
|
| Rate for Payer: BCN Medicare Advantage |
$652.82
|
| Rate for Payer: Cash Price |
$1,977.60
|
| Rate for Payer: Cash Price |
$1,977.60
|
| Rate for Payer: Cofinity Commercial |
$940.06
|
| Rate for Payer: Cofinity Commercial |
$874.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$685.46
|
| Rate for Payer: Nomi Health Commercial |
$783.38
|
| Rate for Payer: PACE SWMI |
$652.82
|
| Rate for Payer: PHP Commercial |
$913.95
|
| Rate for Payer: PHP Medicare Advantage |
$652.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,606.80
|
| Rate for Payer: Priority Health Medicare |
$652.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$652.82
|
| Rate for Payer: UHC Medicare Advantage |
$652.82
|
| Rate for Payer: UMR Bronson Commercial |
$1,137.12
|
|
|
PR PANCREATECTOMY W/TRNSPLJ PANCREAS/ISLET CELLS
|
Professional
|
Both
|
$7,598.00
|
|
|
Service Code
|
HCPCS 48160
|
| Min. Negotiated Rate |
$3,039.20 |
| Max. Negotiated Rate |
$4,938.70 |
| Rate for Payer: Aetna Medicare |
$3,799.00
|
| Rate for Payer: BCBS Complete |
$3,039.20
|
| Rate for Payer: Cash Price |
$6,078.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,938.70
|
| Rate for Payer: UMR Bronson Commercial |
$3,495.08
|
|
