|
PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 99464
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$83.84
|
| Rate for Payer: Aetna Medicare |
$65.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.10
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$62.57
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: BCN Medicare Advantage |
$62.57
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$90.10
|
| Rate for Payer: Cofinity Commercial |
$83.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.57
|
| Rate for Payer: Healthscope Commercial |
$115.75
|
| Rate for Payer: Healthscope Commercial |
$100.11
|
| Rate for Payer: Mclaren Medicaid |
$40.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.70
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.19
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PACE SWMI |
$62.57
|
| Rate for Payer: PHP Medicare Advantage |
$62.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$95.85
|
| Rate for Payer: Priority Health Medicare |
$62.57
|
| Rate for Payer: Priority Health SBD |
$95.85
|
| Rate for Payer: Priority Health Tiered Network |
$95.85
|
| Rate for Payer: Railroad Medicare Medicare |
$62.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.86
|
| Rate for Payer: UHC Core |
$105.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.57
|
| Rate for Payer: UHC Exchange |
$105.86
|
| Rate for Payer: UHC Medicaid |
$40.26
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
|
PR AUDIOMETRY FOR HEARING AID
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS S0618
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$43.02
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.02
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
|
|
PR AUDITORY EVOKED POTENTIAL
|
Professional
|
Both
|
$351.00
|
|
|
Service Code
|
HCPCS 92585
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Aetna Medicare |
$175.50
|
| Rate for Payer: BCBS Complete |
$140.40
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$228.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.25
|
|
|
PR AUDITORY EVOKED POTENTIAL, LIMITED
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 92586
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Medicare |
$76.00
|
| Rate for Payer: BCBS Complete |
$60.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.00
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,246.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$934.50 |
| Rate for Payer: Aetna Commercial |
$220.55
|
| Rate for Payer: Aetna Medicare |
$171.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.01
|
| Rate for Payer: BCBS Complete |
$109.37
|
| Rate for Payer: BCBS MAPPO |
$164.59
|
| Rate for Payer: BCN Commercial |
$300.34
|
| Rate for Payer: BCN Medicare Advantage |
$164.59
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cofinity Commercial |
$220.55
|
| Rate for Payer: Cofinity Commercial |
$237.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.59
|
| Rate for Payer: Healthscope Commercial |
$304.49
|
| Rate for Payer: Healthscope Commercial |
$263.34
|
| Rate for Payer: Mclaren Medicaid |
$104.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.82
|
| Rate for Payer: Meridian Medicaid |
$109.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$181.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$327.94
|
| Rate for Payer: Nomi Health Commercial |
$197.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$934.50
|
| Rate for Payer: PACE SWMI |
$164.59
|
| Rate for Payer: PHP Medicare Advantage |
$164.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$292.24
|
| Rate for Payer: Priority Health Medicare |
$164.59
|
| Rate for Payer: Priority Health SBD |
$292.24
|
| Rate for Payer: Priority Health Tiered Network |
$292.24
|
| Rate for Payer: Railroad Medicare Medicare |
$164.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.59
|
| Rate for Payer: UHC Core |
$327.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$164.59
|
| Rate for Payer: UHC Exchange |
$327.59
|
| Rate for Payer: UHC Medicaid |
$104.16
|
| Rate for Payer: UHCCP Medicaid |
$104.16
|
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$165.78 |
| Max. Negotiated Rate |
$574.50 |
| Rate for Payer: Aetna Commercial |
$165.78
|
| Rate for Payer: Aetna Medicare |
$383.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.78
|
| Rate for Payer: BCBS Complete |
$306.40
|
| Rate for Payer: BCN Commercial |
$184.90
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$200.69
|
| Rate for Payer: Priority Health SBD |
$200.69
|
| Rate for Payer: Priority Health Tiered Network |
$200.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.34
|
| Rate for Payer: UHC Core |
$220.34
|
| Rate for Payer: UHC Exchange |
$220.34
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$198.44
|
| Rate for Payer: Aetna Medicare |
$154.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.25
|
| Rate for Payer: BCBS Complete |
$98.63
|
| Rate for Payer: BCBS MAPPO |
$148.09
|
| Rate for Payer: BCN Commercial |
$274.63
|
| Rate for Payer: BCN Medicare Advantage |
$148.09
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$213.25
|
| Rate for Payer: Cofinity Commercial |
$198.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.09
|
| Rate for Payer: Healthscope Commercial |
$273.97
|
| Rate for Payer: Healthscope Commercial |
$236.94
|
| Rate for Payer: Mclaren Medicaid |
$93.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.49
|
| Rate for Payer: Meridian Medicaid |
$98.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.18
|
| Rate for Payer: Nomi Health Commercial |
$177.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.00
|
| Rate for Payer: PACE SWMI |
$148.09
|
| Rate for Payer: PHP Medicare Advantage |
$148.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$267.23
|
| Rate for Payer: Priority Health Medicare |
$148.09
|
| Rate for Payer: Priority Health SBD |
$267.23
|
| Rate for Payer: Priority Health Tiered Network |
$267.23
|
| Rate for Payer: Railroad Medicare Medicare |
$148.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.26
|
| Rate for Payer: UHC Core |
$297.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$148.09
|
| Rate for Payer: UHC Exchange |
$297.26
|
| Rate for Payer: UHC Medicaid |
$93.93
|
| Rate for Payer: UHCCP Medicaid |
$93.93
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,482.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$953.18 |
| Max. Negotiated Rate |
$2,920.61 |
| Rate for Payer: Aetna Commercial |
$1,972.14
|
| Rate for Payer: Aetna Medicare |
$1,530.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,972.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,119.32
|
| Rate for Payer: BCBS Complete |
$1,000.84
|
| Rate for Payer: BCBS MAPPO |
$1,471.75
|
| Rate for Payer: BCN Commercial |
$2,488.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,471.75
|
| Rate for Payer: Cash Price |
$2,785.60
|
| Rate for Payer: Cash Price |
$2,785.60
|
| Rate for Payer: Cofinity Commercial |
$2,119.32
|
| Rate for Payer: Cofinity Commercial |
$1,972.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,471.75
|
| Rate for Payer: Healthscope Commercial |
$2,722.74
|
| Rate for Payer: Healthscope Commercial |
$2,354.80
|
| Rate for Payer: Mclaren Medicaid |
$953.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,545.34
|
| Rate for Payer: Meridian Medicaid |
$1,000.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,618.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,920.61
|
| Rate for Payer: Nomi Health Commercial |
$1,766.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,611.50
|
| Rate for Payer: PACE SWMI |
$1,471.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,471.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$953.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,660.58
|
| Rate for Payer: Priority Health Medicare |
$1,471.75
|
| Rate for Payer: Priority Health SBD |
$2,660.58
|
| Rate for Payer: Priority Health Tiered Network |
$2,660.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,471.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,898.56
|
| Rate for Payer: UHC Core |
$2,898.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,471.75
|
| Rate for Payer: UHC Exchange |
$2,898.56
|
| Rate for Payer: UHC Medicaid |
$953.18
|
| Rate for Payer: UHCCP Medicaid |
$953.18
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$389.50
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.07 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna Commercial |
$331.07
|
| Rate for Payer: Aetna Medicare |
$194.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.18
|
| Rate for Payer: BCBS Complete |
$155.80
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Advantage |
$272.65
|
| Rate for Payer: Cofinity Commercial |
$334.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$350.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.12
|
| Rate for Payer: PHP Commercial |
$331.07
|
| Rate for Payer: Priority Health SBD |
$245.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.18
|
| Rate for Payer: UHC Core |
$202.93
|
| Rate for Payer: UHC Exchange |
$153.07
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$389.50
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.38 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna Commercial |
$331.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.18
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Advantage |
$272.65
|
| Rate for Payer: Cofinity Commercial |
$334.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.12
|
| Rate for Payer: PHP Commercial |
$331.07
|
| Rate for Payer: Priority Health SBD |
$245.38
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 00904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Advantage |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health SBD |
$176.60
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$280.32
|
|
|
Service Code
|
NDC 00904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.17 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna Medicare |
$140.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: BCBS Complete |
$112.13
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Advantage |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health SBD |
$176.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.21
|
| Rate for Payer: UHC Core |
$146.05
|
| Rate for Payer: UHC Exchange |
$110.17
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 50268066711
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Advantage |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health SBD |
$1.78
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 50268066711
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$1.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.83
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Cofinity Advantage |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.26
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.12
|
| Rate for Payer: PHP Commercial |
$2.40
|
| Rate for Payer: Priority Health SBD |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.83
|
| Rate for Payer: UHC Core |
$1.47
|
| Rate for Payer: UHC Exchange |
$1.11
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$140.88
|
|
|
Service Code
|
NDC 50268066715
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.75 |
| Max. Negotiated Rate |
$126.79 |
| Rate for Payer: Aetna Commercial |
$119.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.57
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cofinity Advantage |
$98.62
|
| Rate for Payer: Cofinity Commercial |
$121.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.70
|
| Rate for Payer: Healthscope Commercial |
$126.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.66
|
| Rate for Payer: PHP Commercial |
$119.75
|
| Rate for Payer: Priority Health SBD |
$88.75
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$140.88
|
|
|
Service Code
|
NDC 50268066715
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$126.79 |
| Rate for Payer: Aetna Commercial |
$119.75
|
| Rate for Payer: Aetna Medicare |
$70.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.57
|
| Rate for Payer: BCBS Complete |
$56.35
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cofinity Advantage |
$98.62
|
| Rate for Payer: Cofinity Commercial |
$121.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.70
|
| Rate for Payer: Healthscope Commercial |
$126.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.66
|
| Rate for Payer: PHP Commercial |
$119.75
|
| Rate for Payer: Priority Health SBD |
$88.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.57
|
| Rate for Payer: UHC Core |
$73.40
|
| Rate for Payer: UHC Exchange |
$55.37
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$49.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.21
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$48.06
|
| Rate for Payer: BCN Commercial |
$63.22
|
| Rate for Payer: BCN Medicare Advantage |
$48.06
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$69.21
|
| Rate for Payer: Cofinity Commercial |
$64.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$88.91
|
| Rate for Payer: Healthscope Commercial |
$76.90
|
| Rate for Payer: Mclaren Medicaid |
$31.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.46
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.06
|
| Rate for Payer: Nomi Health Commercial |
$57.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
| Rate for Payer: PACE SWMI |
$48.06
|
| Rate for Payer: PHP Medicare Advantage |
$48.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73.38
|
| Rate for Payer: Priority Health Medicare |
$48.06
|
| Rate for Payer: Priority Health SBD |
$73.38
|
| Rate for Payer: Priority Health Tiered Network |
$73.38
|
| Rate for Payer: Railroad Medicare Medicare |
$48.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.29
|
| Rate for Payer: UHC Core |
$96.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.06
|
| Rate for Payer: UHC Exchange |
$96.29
|
| Rate for Payer: UHC Medicaid |
$31.10
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Aetna Medicare |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.61
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$15.01
|
| Rate for Payer: BCN Commercial |
$19.64
|
| Rate for Payer: BCN Medicare Advantage |
$15.01
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Cofinity Commercial |
$20.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.01
|
| Rate for Payer: Healthscope Commercial |
$27.77
|
| Rate for Payer: Healthscope Commercial |
$24.02
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.76
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.80
|
| Rate for Payer: Nomi Health Commercial |
$18.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: PACE SWMI |
$15.01
|
| Rate for Payer: PHP Medicare Advantage |
$15.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.78
|
| Rate for Payer: Priority Health Medicare |
$15.01
|
| Rate for Payer: Priority Health SBD |
$22.78
|
| Rate for Payer: Priority Health Tiered Network |
$22.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.92
|
| Rate for Payer: UHC Core |
$30.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.01
|
| Rate for Payer: UHC Exchange |
$30.92
|
| Rate for Payer: UHC Medicaid |
$9.59
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,611.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$535.70 |
| Max. Negotiated Rate |
$1,775.11 |
| Rate for Payer: Aetna Commercial |
$1,113.33
|
| Rate for Payer: Aetna Medicare |
$864.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,196.41
|
| Rate for Payer: BCBS Complete |
$562.49
|
| Rate for Payer: BCBS MAPPO |
$830.84
|
| Rate for Payer: BCN Commercial |
$1,334.10
|
| Rate for Payer: BCN Medicare Advantage |
$830.84
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cofinity Commercial |
$1,196.41
|
| Rate for Payer: Cofinity Commercial |
$1,113.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.84
|
| Rate for Payer: Healthscope Commercial |
$1,537.05
|
| Rate for Payer: Healthscope Commercial |
$1,329.34
|
| Rate for Payer: Mclaren Medicaid |
$535.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.38
|
| Rate for Payer: Meridian Medicaid |
$562.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$913.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,575.67
|
| Rate for Payer: Nomi Health Commercial |
$997.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.25
|
| Rate for Payer: PACE SWMI |
$830.84
|
| Rate for Payer: PHP Medicare Advantage |
$830.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,775.11
|
| Rate for Payer: Priority Health Medicare |
$830.84
|
| Rate for Payer: Priority Health SBD |
$1,775.11
|
| Rate for Payer: Priority Health Tiered Network |
$1,775.11
|
| Rate for Payer: Railroad Medicare Medicare |
$830.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,559.39
|
| Rate for Payer: UHC Core |
$1,559.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$830.84
|
| Rate for Payer: UHC Exchange |
$1,559.39
|
| Rate for Payer: UHC Medicaid |
$535.70
|
| Rate for Payer: UHCCP Medicaid |
$535.70
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,166.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$429.62 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna Commercial |
$890.74
|
| Rate for Payer: Aetna Medicare |
$691.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$890.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.21
|
| Rate for Payer: BCBS Complete |
$451.10
|
| Rate for Payer: BCBS MAPPO |
$664.73
|
| Rate for Payer: BCN Commercial |
$1,062.20
|
| Rate for Payer: BCN Medicare Advantage |
$664.73
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cofinity Commercial |
$957.21
|
| Rate for Payer: Cofinity Commercial |
$890.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.73
|
| Rate for Payer: Healthscope Commercial |
$1,229.75
|
| Rate for Payer: Healthscope Commercial |
$1,063.57
|
| Rate for Payer: Mclaren Medicaid |
$429.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.97
|
| Rate for Payer: Meridian Medicaid |
$451.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$731.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,252.40
|
| Rate for Payer: Nomi Health Commercial |
$797.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,624.50
|
| Rate for Payer: PACE SWMI |
$664.73
|
| Rate for Payer: PHP Medicare Advantage |
$664.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,413.33
|
| Rate for Payer: Priority Health Medicare |
$664.73
|
| Rate for Payer: Priority Health SBD |
$1,413.33
|
| Rate for Payer: Priority Health Tiered Network |
$1,413.33
|
| Rate for Payer: Railroad Medicare Medicare |
$664.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,236.44
|
| Rate for Payer: UHC Core |
$1,236.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$664.73
|
| Rate for Payer: UHC Exchange |
$1,236.44
|
| Rate for Payer: UHC Medicaid |
$429.62
|
| Rate for Payer: UHCCP Medicaid |
$429.62
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$6.44
|
|
|
Service Code
|
NDC 51079063001
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna Commercial |
$5.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.19
|
| Rate for Payer: Cash Price |
$5.15
|
| Rate for Payer: Cofinity Advantage |
$4.51
|
| Rate for Payer: Cofinity Commercial |
$5.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.15
|
| Rate for Payer: Healthscope Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.83
|
| Rate for Payer: PHP Commercial |
$5.47
|
| Rate for Payer: Priority Health SBD |
$4.06
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$483.84
|
|
|
Service Code
|
NDC 00904702061
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.15 |
| Max. Negotiated Rate |
$435.46 |
| Rate for Payer: Aetna Commercial |
$411.26
|
| Rate for Payer: Aetna Medicare |
$241.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.50
|
| Rate for Payer: BCBS Complete |
$193.54
|
| Rate for Payer: Cash Price |
$387.07
|
| Rate for Payer: Cofinity Advantage |
$338.69
|
| Rate for Payer: Cofinity Commercial |
$416.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.07
|
| Rate for Payer: Healthscope Commercial |
$435.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.88
|
| Rate for Payer: PHP Commercial |
$411.26
|
| Rate for Payer: Priority Health SBD |
$304.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.50
|
| Rate for Payer: UHC Core |
$252.08
|
| Rate for Payer: UHC Exchange |
$190.15
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$6.44
|
|
|
Service Code
|
NDC 51079063001
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Aetna Commercial |
$5.47
|
| Rate for Payer: Aetna Medicare |
$3.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.19
|
| Rate for Payer: BCBS Complete |
$2.58
|
| Rate for Payer: Cash Price |
$5.15
|
| Rate for Payer: Cofinity Advantage |
$4.51
|
| Rate for Payer: Cofinity Commercial |
$5.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.15
|
| Rate for Payer: Healthscope Commercial |
$5.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.83
|
| Rate for Payer: PHP Commercial |
$5.47
|
| Rate for Payer: Priority Health SBD |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.19
|
| Rate for Payer: UHC Core |
$3.36
|
| Rate for Payer: UHC Exchange |
$2.53
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
NDC 00093406701
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cofinity Advantage |
$266.00
|
| Rate for Payer: Cofinity Commercial |
$326.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.00
|
| Rate for Payer: Healthscope Commercial |
$342.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.00
|
| Rate for Payer: PHP Commercial |
$323.00
|
| Rate for Payer: Priority Health SBD |
$239.40
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$5.33
|
|
|
Service Code
|
NDC 68084099611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Aetna Commercial |
$4.53
|
| Rate for Payer: Aetna Medicare |
$2.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.46
|
| Rate for Payer: BCBS Complete |
$2.13
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cofinity Advantage |
$3.73
|
| Rate for Payer: Cofinity Commercial |
$4.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.26
|
| Rate for Payer: Healthscope Commercial |
$4.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.00
|
| Rate for Payer: PHP Commercial |
$4.53
|
| Rate for Payer: Priority Health SBD |
$3.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.46
|
| Rate for Payer: UHC Core |
$2.78
|
| Rate for Payer: UHC Exchange |
$2.09
|
|
