|
PR ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS J2997
|
| Min. Negotiated Rate |
$70.50 |
| Max. Negotiated Rate |
$175.92 |
| Rate for Payer: Aetna Commercial |
$127.42
|
| Rate for Payer: Aetna Medicare |
$98.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.93
|
| Rate for Payer: BCBS MAPPO |
$95.09
|
| Rate for Payer: BCBS Trust/PPO |
$93.17
|
| Rate for Payer: BCN Commercial |
$90.82
|
| Rate for Payer: BCN Medicare Advantage |
$95.09
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$127.42
|
| Rate for Payer: Cofinity Commercial |
$136.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.09
|
| Rate for Payer: Healthscope Commercial |
$175.92
|
| Rate for Payer: Healthscope Commercial |
$152.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$104.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.16
|
| Rate for Payer: Nomi Health Commercial |
$114.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
| Rate for Payer: PACE SWMI |
$95.09
|
| Rate for Payer: PHP Medicare Advantage |
$95.09
|
| Rate for Payer: Priority Health Medicare |
$95.09
|
| Rate for Payer: Railroad Medicare Medicare |
$95.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.83
|
| Rate for Payer: UHC Core |
$93.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.09
|
| Rate for Payer: UHC Exchange |
$93.83
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 93784
|
| Min. Negotiated Rate |
$44.90 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Aetna Commercial |
$60.17
|
| Rate for Payer: Aetna Medicare |
$46.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.66
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$44.90
|
| Rate for Payer: BCN Commercial |
$68.72
|
| Rate for Payer: BCN Medicare Advantage |
$44.90
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$64.66
|
| Rate for Payer: Cofinity Commercial |
$60.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.90
|
| Rate for Payer: Healthscope Commercial |
$83.06
|
| Rate for Payer: Healthscope Commercial |
$71.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.95
|
| Rate for Payer: Nomi Health Commercial |
$53.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.75
|
| Rate for Payer: PACE SWMI |
$44.90
|
| Rate for Payer: PHP Medicare Advantage |
$44.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$65.32
|
| Rate for Payer: Priority Health Medicare |
$44.90
|
| Rate for Payer: Priority Health SBD |
$65.32
|
| Rate for Payer: Priority Health Tiered Network |
$65.32
|
| Rate for Payer: Railroad Medicare Medicare |
$44.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.68
|
| Rate for Payer: UHC Core |
$71.68
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.90
|
| Rate for Payer: UHC Exchange |
$71.68
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 93790
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$32.58 |
| Rate for Payer: Aetna Commercial |
$23.60
|
| Rate for Payer: Aetna Medicare |
$18.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.36
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$17.61
|
| Rate for Payer: BCN Commercial |
$26.40
|
| Rate for Payer: BCN Medicare Advantage |
$17.61
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$23.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.61
|
| Rate for Payer: Healthscope Commercial |
$32.58
|
| Rate for Payer: Healthscope Commercial |
$28.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.34
|
| Rate for Payer: Nomi Health Commercial |
$21.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$17.61
|
| Rate for Payer: PHP Medicare Advantage |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$25.08
|
| Rate for Payer: Priority Health Medicare |
$17.61
|
| Rate for Payer: Priority Health SBD |
$25.08
|
| Rate for Payer: Priority Health Tiered Network |
$25.08
|
| Rate for Payer: Railroad Medicare Medicare |
$17.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.11
|
| Rate for Payer: UHC Core |
$30.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.61
|
| Rate for Payer: UHC Exchange |
$30.11
|
|
|
PR AMBULATORY EEG MONITORING
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 95950
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$451.50 |
| Rate for Payer: Aetna Medicare |
$301.00
|
| Rate for Payer: BCBS Complete |
$240.80
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.50
|
|
|
PR AMINOLEVULINIC ACID HCL TOP
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS J7308
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$721.54 |
| Rate for Payer: Aetna Commercial |
$522.63
|
| Rate for Payer: Aetna Medicare |
$405.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.63
|
| Rate for Payer: BCBS MAPPO |
$390.02
|
| Rate for Payer: BCBS Trust/PPO |
$397.18
|
| Rate for Payer: BCN Commercial |
$401.85
|
| Rate for Payer: BCN Medicare Advantage |
$390.02
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$561.63
|
| Rate for Payer: Cofinity Commercial |
$522.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.02
|
| Rate for Payer: Healthscope Commercial |
$721.54
|
| Rate for Payer: Healthscope Commercial |
$624.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$429.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$390.56
|
| Rate for Payer: Nomi Health Commercial |
$468.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.50
|
| Rate for Payer: PACE SWMI |
$390.02
|
| Rate for Payer: PHP Medicare Advantage |
$390.02
|
| Rate for Payer: Priority Health Medicare |
$390.02
|
| Rate for Payer: Railroad Medicare Medicare |
$390.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.83
|
| Rate for Payer: UHC Core |
$389.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$390.02
|
| Rate for Payer: UHC Exchange |
$389.83
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 57237018090
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.62 |
| 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 Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.60
|
| Rate for Payer: UHC Core |
$113.50
|
| Rate for Payer: UHC Exchange |
$85.62
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
OP
|
$93.06
|
|
|
Service Code
|
NDC 13668009190
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.57 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna Medicare |
$46.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: BCBS Complete |
$37.22
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Advantage |
$65.14
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.80
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: Priority Health SBD |
$58.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.49
|
| Rate for Payer: UHC Core |
$48.48
|
| Rate for Payer: UHC Exchange |
$36.57
|
|
|
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 Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| 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: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| 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 |
$85.62 |
| 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 Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.60
|
| Rate for Payer: UHC Core |
$113.50
|
| Rate for Payer: UHC Exchange |
$85.62
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
NDC 13668009190
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.63 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Advantage |
$65.14
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.80
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: Priority Health SBD |
$58.63
|
|
|
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 Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| 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: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
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 Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| 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: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 13668009290
|
| Hospital Charge Code |
21290
|
|
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 Advantage |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| 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: Opus (Opus Packaging Group) HMA |
$84.08
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health SBD |
$70.62
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$112.10
|
|
|
Service Code
|
NDC 13668009290
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.06 |
| 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 Advantage |
$78.47
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.08
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health SBD |
$70.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.86
|
| Rate for Payer: UHC Core |
$58.40
|
| Rate for Payer: UHC Exchange |
$44.06
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.62 |
| 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 Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.60
|
| Rate for Payer: UHC Core |
$113.50
|
| Rate for Payer: UHC Exchange |
$85.62
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$430.05
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.93 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.53
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Advantage |
$301.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health SBD |
$270.93
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$430.05
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.01 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna Medicare |
$215.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$279.53
|
| Rate for Payer: BCBS Complete |
$172.02
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Advantage |
$301.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health SBD |
$270.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.53
|
| Rate for Payer: UHC Core |
$224.06
|
| Rate for Payer: UHC Exchange |
$169.01
|
|
|
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 Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| 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: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$110.45
|
|
|
Service Code
|
NDC 60687058121
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.41 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna Medicare |
$55.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: BCBS Complete |
$44.18
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.79
|
| Rate for Payer: UHC Core |
$57.54
|
| Rate for Payer: UHC Exchange |
$43.41
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 60687058111
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna Medicare |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: BCBS Complete |
$1.48
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.40
|
| Rate for Payer: UHC Core |
$1.92
|
| Rate for Payer: UHC Exchange |
$1.45
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.95 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$126.90
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.87 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna Medicare |
$63.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.48
|
| Rate for Payer: UHC Core |
$66.11
|
| Rate for Payer: UHC Exchange |
$49.87
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 60687058111
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Aetna Commercial |
$3.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.40
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Cofinity Advantage |
$2.58
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.95
|
| Rate for Payer: Healthscope Commercial |
$3.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.77
|
| Rate for Payer: PHP Commercial |
$3.14
|
| Rate for Payer: Priority Health SBD |
$2.32
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033290
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.62 |
| 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 Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.60
|
| Rate for Payer: UHC Core |
$113.50
|
| Rate for Payer: UHC Exchange |
$85.62
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$110.45
|
|
|
Service Code
|
NDC 60687058121
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$99.41 |
| Rate for Payer: Aetna Commercial |
$93.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.79
|
| Rate for Payer: Cash Price |
$88.36
|
| Rate for Payer: Cofinity Advantage |
$77.31
|
| Rate for Payer: Cofinity Commercial |
$94.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.36
|
| Rate for Payer: Healthscope Commercial |
$99.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.84
|
| Rate for Payer: PHP Commercial |
$93.88
|
| Rate for Payer: Priority Health SBD |
$69.58
|
|
