|
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 |
$39,056.00 |
| Rate for Payer: Aetna Commercial |
$527.79
|
| Rate for Payer: Aetna Medicare |
$409.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.18
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$393.87
|
| Rate for Payer: BCBS Trust/PPO |
$399.72
|
| Rate for Payer: BCN Commercial |
$388.57
|
| Rate for Payer: BCN Medicare Advantage |
$393.87
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$567.18
|
| Rate for Payer: Cofinity Commercial |
$527.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.87
|
| Rate for Payer: Healthscope Commercial |
$630.20
|
| Rate for Payer: Healthscope Commercial |
$728.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39,056.00
|
| Rate for Payer: Nomi Health Commercial |
$472.65
|
| Rate for Payer: PACE SWMI |
$393.87
|
| Rate for Payer: PHP Medicare Advantage |
$393.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Medicare |
$393.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.87
|
| Rate for Payer: UHC Exchange |
$418.98
|
| Rate for Payer: UHC Medicare Advantage |
$393.87
|
|
|
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 0.125 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
|
$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
|
$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
|
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
|
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 0.25 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 |
$222.08
|
| 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
|
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
|
$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
|
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
|
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
|
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
|
$105.75
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$95.18 |
| 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 |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| 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
|
$105.75
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.62 |
| Max. Negotiated Rate |
$95.18 |
| 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 |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| 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
|
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 |
$47.60
|
| 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
|
|
|
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
|
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$14,425.00 |
| 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 |
$54.13
|
| Rate for Payer: BCBS MAPPO |
$78.36
|
| Rate for Payer: BCBS Trust/PPO |
$570.04
|
| Rate for Payer: BCN Commercial |
$172.01
|
| 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: Mclaren Medicaid |
$51.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.28
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,425.00
|
| 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 Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.18
|
| Rate for Payer: Priority Health Medicare |
$78.36
|
| Rate for Payer: Priority Health Narrow Network |
$113.18
|
| Rate for Payer: Priority Health SBD |
$113.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.36
|
| Rate for Payer: UHC Exchange |
$151.85
|
| Rate for Payer: UHC Medicare Advantage |
$78.36
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
|
|
PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 59001
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$32,098.00 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.01
|
| Rate for Payer: BCBS Complete |
$119.43
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$523.55
|
| Rate for Payer: BCN Commercial |
$259.98
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$250.01
|
| Rate for Payer: Cofinity Commercial |
$232.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$321.20
|
| Rate for Payer: Healthscope Commercial |
$277.79
|
| Rate for Payer: Mclaren Medicaid |
$113.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$119.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32,098.00
|
| Rate for Payer: Nomi Health Commercial |
$208.34
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.18
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$249.18
|
| Rate for Payer: Priority Health SBD |
$249.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$193.05
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
OP
|
$134.14
|
|
|
Service Code
|
NDC 51862018015
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.66 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Aetna Commercial |
$114.02
|
| Rate for Payer: Aetna Medicare |
$67.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.19
|
| Rate for Payer: BCBS Complete |
$53.66
|
| Rate for Payer: Cash Price |
$107.31
|
| Rate for Payer: Cofinity Commercial |
$115.36
|
| Rate for Payer: Cofinity Commercial |
$93.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.31
|
| Rate for Payer: Healthscope Commercial |
$120.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.02
|
| Rate for Payer: PHP Commercial |
$114.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.19
|
| Rate for Payer: Priority Health SBD |
$84.51
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
IP
|
$134.14
|
|
|
Service Code
|
NDC 51862018015
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.51 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Aetna Commercial |
$114.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.19
|
| Rate for Payer: Cash Price |
$107.31
|
| Rate for Payer: Cofinity Commercial |
$115.36
|
| Rate for Payer: Cofinity Commercial |
$93.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.31
|
| Rate for Payer: Healthscope Commercial |
$120.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.02
|
| Rate for Payer: PHP Commercial |
$114.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.19
|
| Rate for Payer: Priority Health SBD |
$84.51
|
|
|
PR AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 24925
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$101,308.00 |
| Rate for Payer: Aetna Commercial |
$739.76
|
| Rate for Payer: Aetna Medicare |
$574.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.97
|
| Rate for Payer: BCBS Complete |
$393.40
|
| Rate for Payer: BCBS MAPPO |
$552.06
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$842.97
|
| Rate for Payer: BCN Medicare Advantage |
$552.06
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cofinity Commercial |
$794.97
|
| Rate for Payer: Cofinity Commercial |
$739.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.06
|
| Rate for Payer: Healthscope Commercial |
$883.30
|
| Rate for Payer: Healthscope Commercial |
$1,021.31
|
| Rate for Payer: Mclaren Medicaid |
$374.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$579.66
|
| Rate for Payer: Meridian Medicaid |
$393.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101,308.00
|
| Rate for Payer: Nomi Health Commercial |
$662.47
|
| Rate for Payer: PACE SWMI |
$552.06
|
| Rate for Payer: PHP Medicare Advantage |
$552.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$886.44
|
| Rate for Payer: Priority Health Medicare |
$552.06
|
| Rate for Payer: Priority Health Narrow Network |
$886.44
|
| Rate for Payer: Priority Health SBD |
$886.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$687.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.06
|
| Rate for Payer: UHC Exchange |
$687.09
|
| Rate for Payer: UHC Medicare Advantage |
$552.06
|
| Rate for Payer: UHCCP Medicaid |
$374.67
|
|
