|
PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS
|
Professional
|
Both
|
$654.00
|
|
|
Service Code
|
HCPCS 93271
|
| Min. Negotiated Rate |
$120.90 |
| Max. Negotiated Rate |
$425.10 |
| Rate for Payer: Aetna Commercial |
$162.01
|
| Rate for Payer: Aetna Medicare |
$125.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.01
|
| Rate for Payer: BCBS Complete |
$261.60
|
| Rate for Payer: BCBS MAPPO |
$120.90
|
| Rate for Payer: BCN Medicare Advantage |
$120.90
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cash Price |
$523.20
|
| Rate for Payer: Cofinity Commercial |
$174.10
|
| Rate for Payer: Cofinity Commercial |
$162.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.90
|
| Rate for Payer: Healthscope Commercial |
$193.44
|
| Rate for Payer: Healthscope Commercial |
$223.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$425.10
|
| Rate for Payer: Nomi Health Commercial |
$145.08
|
| Rate for Payer: PACE SWMI |
$120.90
|
| Rate for Payer: PHP Medicare Advantage |
$120.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.10
|
| Rate for Payer: Priority Health Medicare |
$120.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.90
|
| Rate for Payer: UHC Medicare Advantage |
$120.90
|
|
|
PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 93270
|
| Min. Negotiated Rate |
$7.16 |
| Max. Negotiated Rate |
$79.95 |
| Rate for Payer: Aetna Commercial |
$9.59
|
| Rate for Payer: Aetna Medicare |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.31
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$7.16
|
| Rate for Payer: BCN Medicare Advantage |
$7.16
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$9.59
|
| Rate for Payer: Cofinity Commercial |
$10.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.16
|
| Rate for Payer: Healthscope Commercial |
$13.25
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.95
|
| Rate for Payer: Nomi Health Commercial |
$8.59
|
| Rate for Payer: PACE SWMI |
$7.16
|
| Rate for Payer: PHP Medicare Advantage |
$7.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.95
|
| Rate for Payer: Priority Health Medicare |
$7.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.16
|
| Rate for Payer: UHC Medicare Advantage |
$7.16
|
|
|
PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
|
Professional
|
Both
|
$871.00
|
|
|
Service Code
|
HCPCS 93268
|
| Min. Negotiated Rate |
$150.65 |
| Max. Negotiated Rate |
$566.15 |
| Rate for Payer: Aetna Commercial |
$201.87
|
| Rate for Payer: Aetna Medicare |
$156.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.87
|
| Rate for Payer: BCBS Complete |
$348.40
|
| Rate for Payer: BCBS MAPPO |
$150.65
|
| Rate for Payer: BCN Medicare Advantage |
$150.65
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cash Price |
$696.80
|
| Rate for Payer: Cofinity Commercial |
$216.94
|
| Rate for Payer: Cofinity Commercial |
$201.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.65
|
| Rate for Payer: Healthscope Commercial |
$241.04
|
| Rate for Payer: Healthscope Commercial |
$278.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.15
|
| Rate for Payer: Nomi Health Commercial |
$180.78
|
| Rate for Payer: PACE SWMI |
$150.65
|
| Rate for Payer: PHP Medicare Advantage |
$150.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.15
|
| Rate for Payer: Priority Health Medicare |
$150.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.65
|
| Rate for Payer: UHC Medicare Advantage |
$150.65
|
|
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 93272
|
| Min. Negotiated Rate |
$22.59 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Aetna Commercial |
$30.27
|
| Rate for Payer: Aetna Medicare |
$23.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.27
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: BCBS MAPPO |
$22.59
|
| Rate for Payer: BCN Medicare Advantage |
$22.59
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cofinity Commercial |
$32.53
|
| Rate for Payer: Cofinity Commercial |
$30.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.59
|
| Rate for Payer: Healthscope Commercial |
$41.79
|
| Rate for Payer: Healthscope Commercial |
$36.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.10
|
| Rate for Payer: Nomi Health Commercial |
$27.11
|
| Rate for Payer: PACE SWMI |
$22.59
|
| Rate for Payer: PHP Medicare Advantage |
$22.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
| Rate for Payer: Priority Health Medicare |
$22.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.59
|
| Rate for Payer: UHC Medicare Advantage |
$22.59
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL
|
Professional
|
Both
|
$608.00
|
|
|
Service Code
|
HCPCS 41015
|
| Min. Negotiated Rate |
$243.20 |
| Max. Negotiated Rate |
$526.66 |
| Rate for Payer: Aetna Commercial |
$381.47
|
| Rate for Payer: Aetna Medicare |
$296.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$409.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.47
|
| Rate for Payer: BCBS Complete |
$243.20
|
| Rate for Payer: BCBS MAPPO |
$284.68
|
| Rate for Payer: BCN Medicare Advantage |
$284.68
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cash Price |
$486.40
|
| Rate for Payer: Cofinity Commercial |
$409.94
|
| Rate for Payer: Cofinity Commercial |
$381.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.68
|
| Rate for Payer: Healthscope Commercial |
$455.49
|
| Rate for Payer: Healthscope Commercial |
$526.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.20
|
| Rate for Payer: Nomi Health Commercial |
$341.62
|
| Rate for Payer: PACE SWMI |
$284.68
|
| Rate for Payer: PHP Medicare Advantage |
$284.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$395.20
|
| Rate for Payer: Priority Health Medicare |
$284.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.68
|
| Rate for Payer: UHC Medicare Advantage |
$284.68
|
|
|
PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB
|
Professional
|
Both
|
$902.00
|
|
|
Service Code
|
HCPCS 41017
|
| Min. Negotiated Rate |
$322.30 |
| Max. Negotiated Rate |
$596.25 |
| Rate for Payer: Aetna Commercial |
$431.88
|
| Rate for Payer: Aetna Medicare |
$335.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.88
|
| Rate for Payer: BCBS Complete |
$360.80
|
| Rate for Payer: BCBS MAPPO |
$322.30
|
| Rate for Payer: BCN Medicare Advantage |
$322.30
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cash Price |
$721.60
|
| Rate for Payer: Cofinity Commercial |
$464.11
|
| Rate for Payer: Cofinity Commercial |
$431.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.30
|
| Rate for Payer: Healthscope Commercial |
$596.25
|
| Rate for Payer: Healthscope Commercial |
$515.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$586.30
|
| Rate for Payer: Nomi Health Commercial |
$386.76
|
| Rate for Payer: PACE SWMI |
$322.30
|
| Rate for Payer: PHP Medicare Advantage |
$322.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$586.30
|
| Rate for Payer: Priority Health Medicare |
$322.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.30
|
| Rate for Payer: UHC Medicare Advantage |
$322.30
|
|
|
PR ZINC PASTE BAND W >=3""<5""/YD
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS A6456
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna Medicare |
$1.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.35
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS MAPPO |
$1.75
|
| Rate for Payer: BCN Medicare Advantage |
$1.75
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$2.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.75
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.70
|
| Rate for Payer: Nomi Health Commercial |
$2.10
|
| Rate for Payer: PACE SWMI |
$1.75
|
| Rate for Payer: PHP Medicare Advantage |
$1.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: Priority Health Medicare |
$1.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.75
|
| Rate for Payer: UHC Medicare Advantage |
$1.75
|
|
|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$72.85
|
|
|
Service Code
|
NDC 00904699061
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.14 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna Medicare |
$36.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.35
|
| Rate for Payer: Priority Health SBD |
$45.90
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$61.10
|
|
|
Service Code
|
NDC 00904672760
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.44 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna Medicare |
$30.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: BCBS Complete |
$24.44
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health SBD |
$38.49
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$72.85
|
|
|
Service Code
|
NDC 00904699061
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$65.56 |
| Rate for Payer: Aetna Commercial |
$61.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.35
|
| Rate for Payer: Cash Price |
$58.28
|
| Rate for Payer: Cofinity Commercial |
$50.99
|
| Rate for Payer: Cofinity Commercial |
$62.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.28
|
| Rate for Payer: Healthscope Commercial |
$65.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.92
|
| Rate for Payer: PHP Commercial |
$61.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.35
|
| Rate for Payer: Priority Health SBD |
$45.90
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 00904672760
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.49 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.72
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$42.77
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$42.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health SBD |
$38.49
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$44.65
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health SBD |
$28.13
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$44.65
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.13 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$31.25
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health SBD |
$28.13
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$31.83
|
|
|
Service Code
|
NDC 00904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.69
|
| Rate for Payer: Priority Health SBD |
$20.05
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$31.83
|
|
|
Service Code
|
NDC 00904675415
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.73 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Medicare |
$15.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.69
|
| Rate for Payer: BCBS Complete |
$12.73
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$22.28
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.69
|
| Rate for Payer: Priority Health SBD |
$20.05
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$42.68
|
|
|
Service Code
|
NDC 38485080857
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.89 |
| Max. Negotiated Rate |
$38.41 |
| Rate for Payer: Aetna Commercial |
$36.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.74
|
| Rate for Payer: Cash Price |
$34.14
|
| Rate for Payer: Cofinity Commercial |
$29.88
|
| Rate for Payer: Cofinity Commercial |
$36.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.14
|
| Rate for Payer: Healthscope Commercial |
$38.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.28
|
| Rate for Payer: PHP Commercial |
$36.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.74
|
| Rate for Payer: Priority Health SBD |
$26.89
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
OP
|
$42.68
|
|
|
Service Code
|
NDC 38485080857
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.07 |
| Max. Negotiated Rate |
$38.41 |
| Rate for Payer: Aetna Commercial |
$36.28
|
| Rate for Payer: Aetna Medicare |
$21.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.74
|
| Rate for Payer: BCBS Complete |
$17.07
|
| Rate for Payer: Cash Price |
$34.14
|
| Rate for Payer: Cofinity Commercial |
$29.88
|
| Rate for Payer: Cofinity Commercial |
$36.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.14
|
| Rate for Payer: Healthscope Commercial |
$38.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.28
|
| Rate for Payer: PHP Commercial |
$36.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.74
|
| Rate for Payer: Priority Health SBD |
$26.89
|
|
|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 11104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
|
Facility
|
OP
|
$1,096.83
|
|
|
Service Code
|
CPT 10160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$1,096.83 |
| Rate for Payer: Aetna Medicare |
$405.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,096.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$219.37
|
| Rate for Payer: VA VA |
$389.65
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$894.72
|
|
|
Service Code
|
NDC 61748001211
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$563.67 |
| Max. Negotiated Rate |
$805.25 |
| Rate for Payer: Aetna Commercial |
$760.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$581.57
|
| Rate for Payer: Cash Price |
$715.78
|
| Rate for Payer: Cofinity Commercial |
$626.30
|
| Rate for Payer: Cofinity Commercial |
$769.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$626.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$715.78
|
| Rate for Payer: Healthscope Commercial |
$805.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$760.51
|
| Rate for Payer: PHP Commercial |
$760.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$581.57
|
| Rate for Payer: Priority Health SBD |
$563.67
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$1,368.63
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,231.77 |
| Rate for Payer: Aetna Commercial |
$1,163.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.61
|
| Rate for Payer: Cash Price |
$1,094.90
|
| Rate for Payer: Cofinity Commercial |
$1,177.02
|
| Rate for Payer: Cofinity Commercial |
$958.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$958.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,094.90
|
| Rate for Payer: Healthscope Commercial |
$1,231.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.34
|
| Rate for Payer: PHP Commercial |
$1,163.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.61
|
| Rate for Payer: Priority Health SBD |
$862.24
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$948.17
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$597.35 |
| Max. Negotiated Rate |
$853.35 |
| Rate for Payer: Aetna Commercial |
$805.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.31
|
| Rate for Payer: Cash Price |
$758.54
|
| Rate for Payer: Cofinity Commercial |
$663.72
|
| Rate for Payer: Cofinity Commercial |
$815.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$663.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.54
|
| Rate for Payer: Healthscope Commercial |
$853.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$805.94
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.31
|
| Rate for Payer: Priority Health SBD |
$597.35
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$948.17
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$379.27 |
| Max. Negotiated Rate |
$853.35 |
| Rate for Payer: Aetna Commercial |
$805.94
|
| Rate for Payer: Aetna Medicare |
$474.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.31
|
| Rate for Payer: BCBS Complete |
$379.27
|
| Rate for Payer: Cash Price |
$758.54
|
| Rate for Payer: Cofinity Commercial |
$663.72
|
| Rate for Payer: Cofinity Commercial |
$815.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$663.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.54
|
| Rate for Payer: Healthscope Commercial |
$853.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$805.94
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.31
|
| Rate for Payer: Priority Health SBD |
$597.35
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$1,540.31
|
|
|
Service Code
|
NDC 61748001201
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$616.12 |
| Max. Negotiated Rate |
$1,386.28 |
| Rate for Payer: Aetna Commercial |
$1,309.26
|
| Rate for Payer: Aetna Medicare |
$770.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.20
|
| Rate for Payer: BCBS Complete |
$616.12
|
| Rate for Payer: Cash Price |
$1,232.25
|
| Rate for Payer: Cofinity Commercial |
$1,078.22
|
| Rate for Payer: Cofinity Commercial |
$1,324.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,078.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,232.25
|
| Rate for Payer: Healthscope Commercial |
$1,386.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,309.26
|
| Rate for Payer: PHP Commercial |
$1,309.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.20
|
| Rate for Payer: Priority Health SBD |
$970.40
|
|
