|
PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 20931
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$289.90 |
| Rate for Payer: Aetna Commercial |
$145.28
|
| Rate for Payer: Aetna Medicare |
$112.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.12
|
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: BCBS MAPPO |
$108.42
|
| Rate for Payer: BCN Medicare Advantage |
$108.42
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$156.12
|
| Rate for Payer: Cofinity Commercial |
$145.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.42
|
| Rate for Payer: Healthscope Commercial |
$173.47
|
| Rate for Payer: Healthscope Commercial |
$200.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.90
|
| Rate for Payer: Nomi Health Commercial |
$130.10
|
| Rate for Payer: PACE SWMI |
$108.42
|
| Rate for Payer: PHP Medicare Advantage |
$108.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health Medicare |
$108.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.42
|
| Rate for Payer: UHC Medicare Advantage |
$108.42
|
|
|
PR ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS J2997
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$174.73 |
| Rate for Payer: Aetna Commercial |
$126.56
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.56
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$136.01
|
| Rate for Payer: Cofinity Commercial |
$126.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$174.73
|
| Rate for Payer: Healthscope Commercial |
$151.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.15
|
| Rate for Payer: Nomi Health Commercial |
$113.34
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 93784
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Medicare |
$43.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.29
|
| Rate for Payer: BCBS Complete |
$102.80
|
| Rate for Payer: BCBS MAPPO |
$42.01
|
| Rate for Payer: BCN Medicare Advantage |
$42.01
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cofinity Commercial |
$60.49
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.01
|
| Rate for Payer: Healthscope Commercial |
$67.22
|
| Rate for Payer: Healthscope Commercial |
$77.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.05
|
| Rate for Payer: Nomi Health Commercial |
$50.41
|
| Rate for Payer: PACE SWMI |
$42.01
|
| Rate for Payer: PHP Medicare Advantage |
$42.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.05
|
| Rate for Payer: Priority Health Medicare |
$42.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.01
|
| Rate for Payer: UHC Medicare Advantage |
$42.01
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 93790
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$31.08 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.51
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$24.19
|
| Rate for Payer: Cofinity Commercial |
$22.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$26.88
|
| Rate for Payer: Healthscope Commercial |
$31.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Nomi Health Commercial |
$20.16
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$16.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
|
|
PR AMBULATORY EEG MONITORING
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 95950
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$379.60 |
| Rate for Payer: Aetna Medicare |
$292.00
|
| Rate for Payer: BCBS Complete |
$233.60
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$379.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.60
|
|
|
PR AMINOLEVULINIC ACID HCL TOP
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS J7308
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$725.37 |
| Rate for Payer: Aetna Commercial |
$525.40
|
| Rate for Payer: Aetna Medicare |
$407.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.61
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$392.09
|
| Rate for Payer: BCN Medicare Advantage |
$392.09
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$525.40
|
| Rate for Payer: Cofinity Commercial |
$564.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.09
|
| Rate for Payer: Healthscope Commercial |
$627.34
|
| Rate for Payer: Healthscope Commercial |
$725.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.05
|
| Rate for Payer: Nomi Health Commercial |
$470.51
|
| Rate for Payer: PACE SWMI |
$392.09
|
| Rate for Payer: PHP Medicare Advantage |
$392.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Medicare |
$392.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.09
|
| Rate for Payer: UHC Medicare Advantage |
$392.09
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 13668009190
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.62 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health SBD |
$70.62
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 57237018090
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033090
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
OP
|
$112.10
|
|
|
Service Code
|
NDC 13668009190
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna Medicare |
$56.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.86
|
| Rate for Payer: BCBS Complete |
$44.84
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health SBD |
$70.62
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 57237018090
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.25 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033090
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.25 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$444.15
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.81 |
| Max. Negotiated Rate |
$399.74 |
| Rate for Payer: Aetna Commercial |
$377.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.70
|
| Rate for Payer: Cash Price |
$355.32
|
| Rate for Payer: Cofinity Commercial |
$310.90
|
| Rate for Payer: Cofinity Commercial |
$381.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.32
|
| Rate for Payer: Healthscope Commercial |
$399.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.53
|
| Rate for Payer: PHP Commercial |
$377.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.70
|
| Rate for Payer: Priority Health SBD |
$279.81
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.25 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$444.15
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.66 |
| Max. Negotiated Rate |
$399.74 |
| Rate for Payer: Aetna Commercial |
$377.53
|
| Rate for Payer: Aetna Medicare |
$222.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.70
|
| Rate for Payer: BCBS Complete |
$177.66
|
| Rate for Payer: Cash Price |
$355.32
|
| Rate for Payer: Cofinity Commercial |
$310.90
|
| Rate for Payer: Cofinity Commercial |
$381.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$310.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.32
|
| Rate for Payer: Healthscope Commercial |
$399.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.53
|
| Rate for Payer: PHP Commercial |
$377.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.70
|
| Rate for Payer: Priority Health SBD |
$279.81
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033290
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033290
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.25 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$3.18
|
|
|
Service Code
|
NDC 60687058111
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.54
|
| Rate for Payer: Healthscope Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.70
|
| Rate for Payer: PHP Commercial |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health SBD |
$2.00
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$95.19
|
|
|
Service Code
|
NDC 60687058121
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.97
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$3.18
|
|
|
Service Code
|
NDC 60687058111
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: BCBS Complete |
$1.27
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.54
|
| Rate for Payer: Healthscope Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.70
|
| Rate for Payer: PHP Commercial |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health SBD |
$2.00
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$95.19
|
|
|
Service Code
|
NDC 60687058121
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.08 |
| Max. Negotiated Rate |
$85.67 |
| Rate for Payer: Aetna Commercial |
$80.91
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: BCBS Complete |
$38.08
|
| Rate for Payer: Cash Price |
$76.15
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.15
|
| Rate for Payer: Healthscope Commercial |
$85.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.91
|
| Rate for Payer: PHP Commercial |
$80.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.97
|
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$78.36 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare |
$81.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.00
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$78.36
|
| Rate for Payer: BCN Medicare Advantage |
$78.36
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$112.84
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.36
|
| Rate for Payer: Healthscope Commercial |
$144.97
|
| Rate for Payer: Healthscope Commercial |
$125.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.00
|
| Rate for Payer: Nomi Health Commercial |
$94.03
|
| Rate for Payer: PACE SWMI |
$78.36
|
| Rate for Payer: PHP Medicare Advantage |
$78.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health Medicare |
$78.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.36
|
| Rate for Payer: UHC Medicare Advantage |
$78.36
|
|
