|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP
|
Professional
|
Both
|
$3,468.00
|
|
|
Service Code
|
HCPCS 27822
|
| Min. Negotiated Rate |
$564.02 |
| Max. Negotiated Rate |
$3,847.61 |
| Rate for Payer: Aetna Commercial |
$1,164.75
|
| Rate for Payer: BCBS Complete |
$592.22
|
| Rate for Payer: BCBS Trust/PPO |
$3,847.61
|
| Rate for Payer: Cash Price |
$2,774.40
|
| Rate for Payer: Cash Price |
$2,774.40
|
| Rate for Payer: Meridian Medicaid |
$592.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$564.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,427.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,345.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,345.05
|
| Rate for Payer: Priority Health SBD |
$1,345.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,595.28
|
|
|
PR OPHTH MEDICAL XM&EVAL COMPRE NEW PT 1/> VST
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 92004
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$1,175.47 |
| Rate for Payer: Aetna Commercial |
$103.20
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,175.47
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.21
|
| Rate for Payer: Priority Health Narrow Network |
$111.21
|
| Rate for Payer: Priority Health SBD |
$111.21
|
| Rate for Payer: UMR Bronson Commercial |
$94.30
|
|
|
PR OPHTH MEDICAL XM&EVAL COMPRHNSV ESTAB PT 1/>
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 92014
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$1,611.32 |
| Rate for Payer: Aetna Commercial |
$82.96
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,611.32
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.93
|
| Rate for Payer: Priority Health Narrow Network |
$89.93
|
| Rate for Payer: Priority Health SBD |
$89.93
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
PR OPHTH MEDICAL XM&EVAL INTERMEDIATE ESTAB PT
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 92012
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$1,213.51 |
| Rate for Payer: Aetna Commercial |
$55.00
|
| Rate for Payer: BCBS Complete |
$33.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,213.51
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Meridian Medicaid |
$33.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.82
|
| Rate for Payer: Priority Health Narrow Network |
$59.82
|
| Rate for Payer: Priority Health SBD |
$59.82
|
| Rate for Payer: UMR Bronson Commercial |
$67.62
|
|
|
PR OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 92002
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$902.86 |
| Rate for Payer: Aetna Commercial |
$50.66
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS Trust/PPO |
$902.86
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.20
|
| Rate for Payer: Priority Health Narrow Network |
$54.20
|
| Rate for Payer: Priority Health SBD |
$54.20
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
|
|
PR OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 92018
|
| Min. Negotiated Rate |
$87.54 |
| Max. Negotiated Rate |
$7,723.22 |
| Rate for Payer: Aetna Commercial |
$150.76
|
| Rate for Payer: BCBS Complete |
$91.92
|
| Rate for Payer: BCBS Trust/PPO |
$7,723.22
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Meridian Medicaid |
$91.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.80
|
| Rate for Payer: Priority Health Narrow Network |
$163.80
|
| Rate for Payer: Priority Health SBD |
$163.80
|
| Rate for Payer: UMR Bronson Commercial |
$96.60
|
|
|
PR OPHTH XM&EVAL ANES W/WO MANJ GLOBE LMTD
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 92019
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$1,793.58 |
| Rate for Payer: Aetna Commercial |
$77.34
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,793.58
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.71
|
| Rate for Payer: Priority Health Narrow Network |
$84.71
|
| Rate for Payer: Priority Health SBD |
$84.71
|
| Rate for Payer: UMR Bronson Commercial |
$66.24
|
|
|
PR OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 34716
|
| Min. Negotiated Rate |
$231.53 |
| Max. Negotiated Rate |
$1,773.50 |
| Rate for Payer: Aetna Commercial |
$499.69
|
| Rate for Payer: BCBS Complete |
$243.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,773.50
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Meridian Medicaid |
$243.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$540.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$577.18
|
| Rate for Payer: Priority Health Narrow Network |
$577.18
|
| Rate for Payer: Priority Health SBD |
$577.18
|
| Rate for Payer: UMR Bronson Commercial |
$355.12
|
|
|
PR OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 34834
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$1,323.92 |
| Rate for Payer: Aetna Commercial |
$174.94
|
| Rate for Payer: BCBS Complete |
$84.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,323.92
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Meridian Medicaid |
$84.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.54
|
| Rate for Payer: Priority Health Narrow Network |
$200.54
|
| Rate for Payer: Priority Health SBD |
$200.54
|
| Rate for Payer: UMR Bronson Commercial |
$130.64
|
|
|
PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$1,242.00
|
|
|
Service Code
|
HCPCS 34812
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Aetna Commercial |
$278.36
|
| Rate for Payer: BCBS Complete |
$134.41
|
| Rate for Payer: BCBS Trust/PPO |
$498.72
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Meridian Medicaid |
$134.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.64
|
| Rate for Payer: Priority Health Narrow Network |
$318.64
|
| Rate for Payer: Priority Health SBD |
$318.64
|
| Rate for Payer: UMR Bronson Commercial |
$571.32
|
|
|
PR OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
HCPCS 34714
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$1,553.20 |
| Rate for Payer: Aetna Commercial |
$363.18
|
| Rate for Payer: BCBS Complete |
$176.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.20
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Meridian Medicaid |
$176.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$167.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$417.58
|
| Rate for Payer: Priority Health Narrow Network |
$417.58
|
| Rate for Payer: Priority Health SBD |
$417.58
|
| Rate for Payer: UMR Bronson Commercial |
$256.22
|
|
|
PR OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 34833
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$1,531.60 |
| Rate for Payer: Aetna Commercial |
$530.13
|
| Rate for Payer: BCBS Complete |
$256.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,407.92
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Meridian Medicaid |
$256.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,531.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.96
|
| Rate for Payer: Priority Health Narrow Network |
$606.96
|
| Rate for Payer: Priority Health SBD |
$606.96
|
| Rate for Payer: UMR Bronson Commercial |
$1,006.48
|
|
|
PR OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH
|
Professional
|
Both
|
$4,718.00
|
|
|
Service Code
|
HCPCS 34830
|
| Min. Negotiated Rate |
$841.05 |
| Max. Negotiated Rate |
$3,302.60 |
| Rate for Payer: Aetna Commercial |
$2,372.61
|
| Rate for Payer: BCBS Complete |
$1,154.03
|
| Rate for Payer: BCBS Trust/PPO |
$841.05
|
| Rate for Payer: Cash Price |
$3,774.40
|
| Rate for Payer: Cash Price |
$3,774.40
|
| Rate for Payer: Meridian Medicaid |
$1,154.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,099.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,302.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,733.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,733.19
|
| Rate for Payer: Priority Health SBD |
$2,733.19
|
| Rate for Payer: UMR Bronson Commercial |
$2,170.28
|
|
|
PR OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH
|
Professional
|
Both
|
$3,997.00
|
|
|
Service Code
|
HCPCS 34831
|
| Min. Negotiated Rate |
$953.05 |
| Max. Negotiated Rate |
$2,988.53 |
| Rate for Payer: Aetna Commercial |
$2,587.95
|
| Rate for Payer: BCBS Complete |
$1,262.06
|
| Rate for Payer: BCBS Trust/PPO |
$953.05
|
| Rate for Payer: Cash Price |
$3,197.60
|
| Rate for Payer: Cash Price |
$3,197.60
|
| Rate for Payer: Meridian Medicaid |
$1,262.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,201.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,988.53
|
| Rate for Payer: Priority Health Narrow Network |
$2,988.53
|
| Rate for Payer: Priority Health SBD |
$2,988.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,838.62
|
|
|
PR OPN SUBCLA CRTD ART TRPOS NCK INC ULAT
|
Professional
|
Both
|
$3,137.00
|
|
|
Service Code
|
HCPCS 33889
|
| Min. Negotiated Rate |
$494.59 |
| Max. Negotiated Rate |
$2,852.29 |
| Rate for Payer: Aetna Commercial |
$1,063.36
|
| Rate for Payer: BCBS Complete |
$519.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,852.29
|
| Rate for Payer: Cash Price |
$2,509.60
|
| Rate for Payer: Cash Price |
$2,509.60
|
| Rate for Payer: Meridian Medicaid |
$519.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$494.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,195.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,230.95
|
| Rate for Payer: Priority Health SBD |
$1,230.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,443.02
|
|
|
PROPOFOL 10 MG/ML 100 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$65.18
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$58.66 |
| Rate for Payer: Aetna American Axle |
$42.37
|
| Rate for Payer: Aetna Commercial |
$55.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.37
|
| Rate for Payer: Cash Price |
$52.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$56.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.14
|
| Rate for Payer: Healthscope Commercial |
$58.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.40
|
| Rate for Payer: PHP Commercial |
$55.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.63
|
| Rate for Payer: Priority Health SBD |
$41.06
|
| Rate for Payer: UMR Bronson Commercial |
$28.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.88
|
|
|
PROPOFOL 10 MG/ML 20 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$63.61
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$57.25 |
| Rate for Payer: Aetna American Axle |
$41.35
|
| Rate for Payer: Aetna Commercial |
$54.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.35
|
| Rate for Payer: Cash Price |
$50.89
|
| Rate for Payer: Cofinity Commercial |
$44.53
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.89
|
| Rate for Payer: Healthscope Commercial |
$57.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.07
|
| Rate for Payer: PHP Commercial |
$54.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.53
|
| Rate for Payer: Priority Health SBD |
$40.07
|
| Rate for Payer: UMR Bronson Commercial |
$27.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.71
|
|
|
PROPOFOL 10 MG/ML 50 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$56.63
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$50.97 |
| Rate for Payer: Aetna American Axle |
$36.81
|
| Rate for Payer: Aetna Commercial |
$48.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.81
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Cofinity Commercial |
$48.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$50.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.14
|
| Rate for Payer: PHP Commercial |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.64
|
| Rate for Payer: Priority Health SBD |
$35.68
|
| Rate for Payer: UMR Bronson Commercial |
$24.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.47
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
IP
|
$102.82
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.24 |
| Max. Negotiated Rate |
$92.54 |
| Rate for Payer: Aetna American Axle |
$66.83
|
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna American Axle |
$36.81
|
| Rate for Payer: Aetna American Axle |
$88.58
|
| Rate for Payer: Aetna American Axle |
$62.06
|
| Rate for Payer: Aetna Commercial |
$115.84
|
| Rate for Payer: Aetna Commercial |
$81.16
|
| Rate for Payer: Aetna Commercial |
$48.14
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$109.02
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$48.70
|
| Rate for Payer: Cofinity Commercial |
$71.97
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$95.40
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.02
|
| Rate for Payer: Healthscope Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$50.97
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Healthscope Commercial |
$85.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.40
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$81.16
|
| Rate for Payer: PHP Commercial |
$115.84
|
| Rate for Payer: PHP Commercial |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.64
|
| Rate for Payer: Priority Health SBD |
$85.86
|
| Rate for Payer: Priority Health SBD |
$35.68
|
| Rate for Payer: Priority Health SBD |
$60.15
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: Priority Health SBD |
$64.78
|
| Rate for Payer: UMR Bronson Commercial |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$45.24
|
| Rate for Payer: UMR Bronson Commercial |
$39.30
|
| Rate for Payer: UMR Bronson Commercial |
$24.92
|
| Rate for Payer: UMR Bronson Commercial |
$59.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.61
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
IP
|
$58.74
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$52.87 |
| Rate for Payer: Aetna American Axle |
$38.18
|
| Rate for Payer: Aetna American Axle |
$47.27
|
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna American Axle |
$44.54
|
| Rate for Payer: Aetna American Axle |
$40.44
|
| Rate for Payer: Aetna American Axle |
$62.06
|
| Rate for Payer: Aetna American Axle |
$46.55
|
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna American Axle |
$39.99
|
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Commercial |
$67.11
|
| Rate for Payer: Aetna Commercial |
$61.81
|
| Rate for Payer: Aetna Commercial |
$52.88
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Commercial |
$58.25
|
| Rate for Payer: Aetna Commercial |
$52.30
|
| Rate for Payer: Aetna Commercial |
$49.93
|
| Rate for Payer: Aetna Commercial |
$81.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.44
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cash Price |
$63.16
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$49.77
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cofinity Commercial |
$47.97
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$43.55
|
| Rate for Payer: Cofinity Commercial |
$53.50
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Cofinity Commercial |
$50.13
|
| Rate for Payer: Cofinity Commercial |
$61.58
|
| Rate for Payer: Cofinity Commercial |
$50.90
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Cofinity Commercial |
$55.26
|
| Rate for Payer: Cofinity Commercial |
$67.90
|
| Rate for Payer: Cofinity Commercial |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.22
|
| Rate for Payer: Healthscope Commercial |
$64.45
|
| Rate for Payer: Healthscope Commercial |
$61.68
|
| Rate for Payer: Healthscope Commercial |
$52.87
|
| Rate for Payer: Healthscope Commercial |
$55.99
|
| Rate for Payer: Healthscope Commercial |
$55.38
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Healthscope Commercial |
$65.45
|
| Rate for Payer: Healthscope Commercial |
$85.93
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.88
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: PHP Commercial |
$58.25
|
| Rate for Payer: PHP Commercial |
$60.87
|
| Rate for Payer: PHP Commercial |
$52.30
|
| Rate for Payer: PHP Commercial |
$61.81
|
| Rate for Payer: PHP Commercial |
$67.11
|
| Rate for Payer: PHP Commercial |
$49.93
|
| Rate for Payer: PHP Commercial |
$81.16
|
| Rate for Payer: PHP Commercial |
$52.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health SBD |
$39.19
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: Priority Health SBD |
$43.17
|
| Rate for Payer: Priority Health SBD |
$45.81
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: Priority Health SBD |
$45.11
|
| Rate for Payer: Priority Health SBD |
$38.76
|
| Rate for Payer: Priority Health SBD |
$60.15
|
| Rate for Payer: UMR Bronson Commercial |
$39.30
|
| Rate for Payer: UMR Bronson Commercial |
$31.51
|
| Rate for Payer: UMR Bronson Commercial |
$27.37
|
| Rate for Payer: UMR Bronson Commercial |
$25.85
|
| Rate for Payer: UMR Bronson Commercial |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$27.07
|
| Rate for Payer: UMR Bronson Commercial |
$34.74
|
| Rate for Payer: UMR Bronson Commercial |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$32.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.71
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$68.53
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$61.68 |
| Rate for Payer: Aetna American Axle |
$44.54
|
| Rate for Payer: Aetna American Axle |
$47.27
|
| Rate for Payer: Aetna Commercial |
$61.81
|
| Rate for Payer: Aetna Commercial |
$58.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.54
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cofinity Commercial |
$50.90
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Cofinity Commercial |
$47.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.18
|
| Rate for Payer: Healthscope Commercial |
$61.68
|
| Rate for Payer: Healthscope Commercial |
$65.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$58.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.81
|
| Rate for Payer: PHP Commercial |
$61.81
|
| Rate for Payer: PHP Commercial |
$58.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.90
|
| Rate for Payer: Priority Health SBD |
$43.17
|
| Rate for Payer: Priority Health SBD |
$45.81
|
| Rate for Payer: UMR Bronson Commercial |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$32.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.40
|
|
|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,524.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$2,466.80 |
| Rate for Payer: Aetna Commercial |
$1,203.70
|
| Rate for Payer: BCBS Complete |
$615.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.26
|
| Rate for Payer: Cash Price |
$2,819.20
|
| Rate for Payer: Cash Price |
$2,819.20
|
| Rate for Payer: Meridian Medicaid |
$615.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,466.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,406.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,406.84
|
| Rate for Payer: Priority Health SBD |
$1,406.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,621.04
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,333.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$542.94 |
| Max. Negotiated Rate |
$1,633.10 |
| Rate for Payer: Aetna Commercial |
$1,112.25
|
| Rate for Payer: BCBS Complete |
$570.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.11
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Meridian Medicaid |
$570.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,633.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,302.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,302.66
|
| Rate for Payer: Priority Health SBD |
$1,302.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,073.18
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,511.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$600.23 |
| Max. Negotiated Rate |
$1,439.01 |
| Rate for Payer: Aetna Commercial |
$1,229.30
|
| Rate for Payer: BCBS Complete |
$630.24
|
| Rate for Payer: BCBS Trust/PPO |
$977.36
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Meridian Medicaid |
$630.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$600.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,057.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,439.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,439.01
|
| Rate for Payer: Priority Health SBD |
$1,439.01
|
| Rate for Payer: UMR Bronson Commercial |
$695.06
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 23155-110-01
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.19
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.78
|
|
