|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$165.78 |
| Max. Negotiated Rate |
$22,039.00 |
| Rate for Payer: Aetna Commercial |
$165.78
|
| Rate for Payer: Aetna Medicare |
$372.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.78
|
| Rate for Payer: BCBS Complete |
$297.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$182.92
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,039.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.32
|
| Rate for Payer: Priority Health Narrow Network |
$190.32
|
| Rate for Payer: Priority Health SBD |
$190.32
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$106.93 |
| Max. Negotiated Rate |
$29,918.00 |
| Rate for Payer: Aetna Commercial |
$218.07
|
| Rate for Payer: Aetna Medicare |
$169.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.35
|
| Rate for Payer: BCBS Complete |
$112.28
|
| Rate for Payer: BCBS MAPPO |
$162.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$267.42
|
| Rate for Payer: BCN Medicare Advantage |
$162.74
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cofinity Commercial |
$218.07
|
| Rate for Payer: Cofinity Commercial |
$234.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.74
|
| Rate for Payer: Healthscope Commercial |
$301.07
|
| Rate for Payer: Healthscope Commercial |
$260.38
|
| Rate for Payer: Mclaren Medicaid |
$106.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.88
|
| Rate for Payer: Meridian Medicaid |
$112.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,918.00
|
| Rate for Payer: Nomi Health Commercial |
$195.29
|
| Rate for Payer: PACE SWMI |
$162.74
|
| Rate for Payer: PHP Medicare Advantage |
$162.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.41
|
| Rate for Payer: Priority Health Medicare |
$162.74
|
| Rate for Payer: Priority Health Narrow Network |
$253.41
|
| Rate for Payer: Priority Health SBD |
$253.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.74
|
| Rate for Payer: UHC Exchange |
$267.89
|
| Rate for Payer: UHC Medicare Advantage |
$162.74
|
| Rate for Payer: UHCCP Medicaid |
$106.93
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,381.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$292,061.00 |
| Rate for Payer: Aetna Commercial |
$2,126.55
|
| Rate for Payer: Aetna Medicare |
$1,650.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,126.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,285.25
|
| Rate for Payer: BCBS Complete |
$1,117.80
|
| Rate for Payer: BCBS MAPPO |
$1,586.98
|
| Rate for Payer: BCBS Trust/PPO |
$149.51
|
| Rate for Payer: BCN Commercial |
$2,406.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,586.98
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cofinity Commercial |
$2,285.25
|
| Rate for Payer: Cofinity Commercial |
$2,126.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,586.98
|
| Rate for Payer: Healthscope Commercial |
$2,935.91
|
| Rate for Payer: Healthscope Commercial |
$2,539.17
|
| Rate for Payer: Mclaren Medicaid |
$1,064.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.33
|
| Rate for Payer: Meridian Medicaid |
$1,117.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292,061.00
|
| Rate for Payer: Nomi Health Commercial |
$1,904.38
|
| Rate for Payer: PACE SWMI |
$1,586.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,586.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,064.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,197.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,522.42
|
| Rate for Payer: Priority Health Medicare |
$1,586.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,522.42
|
| Rate for Payer: Priority Health SBD |
$2,522.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,063.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,586.98
|
| Rate for Payer: UHC Exchange |
$2,063.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,586.98
|
| Rate for Payer: UHCCP Medicaid |
$1,064.57
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.49 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health SBD |
$203.49
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna Medicare |
$161.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health SBD |
$203.49
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$2.97
|
|
|
Service Code
|
NDC 51079045801
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$1.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.93
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.93
|
| Rate for Payer: Priority Health SBD |
$1.87
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$296.16
|
|
|
Service Code
|
NDC 51079045820
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.46 |
| Max. Negotiated Rate |
$266.54 |
| Rate for Payer: Aetna Commercial |
$251.74
|
| Rate for Payer: Aetna Medicare |
$148.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.50
|
| Rate for Payer: BCBS Complete |
$118.46
|
| Rate for Payer: Cash Price |
$236.93
|
| Rate for Payer: Cofinity Commercial |
$207.31
|
| Rate for Payer: Cofinity Commercial |
$254.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.93
|
| Rate for Payer: Healthscope Commercial |
$266.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.74
|
| Rate for Payer: PHP Commercial |
$251.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$186.58
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$2.97
|
|
|
Service Code
|
NDC 51079045801
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.93
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.93
|
| Rate for Payer: Priority Health SBD |
$1.87
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$296.16
|
|
|
Service Code
|
NDC 51079045820
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.58 |
| Max. Negotiated Rate |
$266.54 |
| Rate for Payer: Aetna Commercial |
$251.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.50
|
| Rate for Payer: Cash Price |
$236.93
|
| Rate for Payer: Cofinity Commercial |
$207.31
|
| Rate for Payer: Cofinity Commercial |
$254.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.93
|
| Rate for Payer: Healthscope Commercial |
$266.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.74
|
| Rate for Payer: PHP Commercial |
$251.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$186.58
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$2.76
|
|
|
Service Code
|
NDC 50268066711
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.79
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health SBD |
$1.74
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$2.76
|
|
|
Service Code
|
NDC 50268066711
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.48 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.79
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cofinity Commercial |
$1.93
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.21
|
| Rate for Payer: Healthscope Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.35
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health SBD |
$1.74
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$284.16
|
|
|
Service Code
|
NDC 00904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.02 |
| Max. Negotiated Rate |
$255.74 |
| Rate for Payer: Aetna Commercial |
$241.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.70
|
| Rate for Payer: Cash Price |
$227.33
|
| Rate for Payer: Cofinity Commercial |
$198.91
|
| Rate for Payer: Cofinity Commercial |
$244.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.33
|
| Rate for Payer: Healthscope Commercial |
$255.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.54
|
| Rate for Payer: PHP Commercial |
$241.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.70
|
| Rate for Payer: Priority Health SBD |
$179.02
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$284.16
|
|
|
Service Code
|
NDC 00904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.66 |
| Max. Negotiated Rate |
$255.74 |
| Rate for Payer: Aetna Commercial |
$241.54
|
| Rate for Payer: Aetna Medicare |
$142.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.70
|
| Rate for Payer: BCBS Complete |
$113.66
|
| Rate for Payer: Cash Price |
$227.33
|
| Rate for Payer: Cofinity Commercial |
$198.91
|
| Rate for Payer: Cofinity Commercial |
$244.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$198.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.33
|
| Rate for Payer: Healthscope Commercial |
$255.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.54
|
| Rate for Payer: PHP Commercial |
$241.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.70
|
| Rate for Payer: Priority Health SBD |
$179.02
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$137.52
|
|
|
Service Code
|
NDC 50268066715
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.01 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Aetna Commercial |
$116.89
|
| Rate for Payer: Aetna Medicare |
$68.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.39
|
| Rate for Payer: BCBS Complete |
$55.01
|
| Rate for Payer: Cash Price |
$110.02
|
| Rate for Payer: Cofinity Commercial |
$118.27
|
| Rate for Payer: Cofinity Commercial |
$96.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.02
|
| Rate for Payer: Healthscope Commercial |
$123.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.89
|
| Rate for Payer: PHP Commercial |
$116.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.39
|
| Rate for Payer: Priority Health SBD |
$86.64
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$137.52
|
|
|
Service Code
|
NDC 50268066715
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.64 |
| Max. Negotiated Rate |
$123.77 |
| Rate for Payer: Aetna Commercial |
$116.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.39
|
| Rate for Payer: Cash Price |
$110.02
|
| Rate for Payer: Cofinity Commercial |
$118.27
|
| Rate for Payer: Cofinity Commercial |
$96.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.02
|
| Rate for Payer: Healthscope Commercial |
$123.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.89
|
| Rate for Payer: PHP Commercial |
$116.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.39
|
| Rate for Payer: Priority Health SBD |
$86.64
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$9,506.00 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Aetna Medicare |
$53.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.64
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$51.14
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$135.47
|
| Rate for Payer: BCN Medicare Advantage |
$51.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$73.64
|
| Rate for Payer: Cofinity Commercial |
$68.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$94.61
|
| Rate for Payer: Healthscope Commercial |
$81.82
|
| Rate for Payer: Mclaren Medicaid |
$34.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.70
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,506.00
|
| Rate for Payer: Nomi Health Commercial |
$61.37
|
| Rate for Payer: PACE SWMI |
$51.14
|
| Rate for Payer: PHP Medicare Advantage |
$51.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.24
|
| Rate for Payer: Priority Health Medicare |
$51.14
|
| Rate for Payer: Priority Health Narrow Network |
$72.24
|
| Rate for Payer: Priority Health SBD |
$72.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.14
|
| Rate for Payer: UHC Exchange |
$92.37
|
| Rate for Payer: UHC Medicare Advantage |
$51.14
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$3,080.00 |
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Medicare |
$16.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.16
|
| Rate for Payer: BCBS Complete |
$11.18
|
| Rate for Payer: BCBS MAPPO |
$16.08
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$39.27
|
| Rate for Payer: BCN Medicare Advantage |
$16.08
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$21.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.08
|
| Rate for Payer: Healthscope Commercial |
$29.75
|
| Rate for Payer: Healthscope Commercial |
$25.73
|
| Rate for Payer: Mclaren Medicaid |
$10.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.88
|
| Rate for Payer: Meridian Medicaid |
$11.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,080.00
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: PACE SWMI |
$16.08
|
| Rate for Payer: PHP Medicare Advantage |
$16.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.57
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: Priority Health Narrow Network |
$22.57
|
| Rate for Payer: Priority Health SBD |
$22.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.08
|
| Rate for Payer: UHC Exchange |
$41.95
|
| Rate for Payer: UHC Medicare Advantage |
$16.08
|
| Rate for Payer: UHCCP Medicaid |
$10.65
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$570.63 |
| Max. Negotiated Rate |
$157,567.00 |
| Rate for Payer: Aetna Commercial |
$1,150.42
|
| Rate for Payer: Aetna Medicare |
$892.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.27
|
| Rate for Payer: BCBS Complete |
$599.16
|
| Rate for Payer: BCBS MAPPO |
$858.52
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$1,289.62
|
| Rate for Payer: BCN Medicare Advantage |
$858.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,236.27
|
| Rate for Payer: Cofinity Commercial |
$1,150.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.52
|
| Rate for Payer: Healthscope Commercial |
$1,588.26
|
| Rate for Payer: Healthscope Commercial |
$1,373.63
|
| Rate for Payer: Mclaren Medicaid |
$570.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.45
|
| Rate for Payer: Meridian Medicaid |
$599.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157,567.00
|
| Rate for Payer: Nomi Health Commercial |
$1,030.22
|
| Rate for Payer: PACE SWMI |
$858.52
|
| Rate for Payer: PHP Medicare Advantage |
$858.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,772.22
|
| Rate for Payer: Priority Health Medicare |
$858.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,772.22
|
| Rate for Payer: Priority Health SBD |
$1,772.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$893.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.52
|
| Rate for Payer: UHC Exchange |
$893.01
|
| Rate for Payer: UHC Medicare Advantage |
$858.52
|
| Rate for Payer: UHCCP Medicaid |
$570.63
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$950.78 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$2,126.28
|
| Rate for Payer: BCN Commercial |
$2,126.28
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,094.80
|
| Rate for Payer: Cofinity Commercial |
$1,345.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,094.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Priority Health SBD |
$985.32
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$950.78
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,218.33
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$570.63 |
| Max. Negotiated Rate |
$157,567.00 |
| Rate for Payer: Aetna Commercial |
$1,150.42
|
| Rate for Payer: Aetna Medicare |
$892.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.27
|
| Rate for Payer: BCBS Complete |
$599.16
|
| Rate for Payer: BCBS MAPPO |
$858.52
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$1,289.62
|
| Rate for Payer: BCN Medicare Advantage |
$858.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,236.27
|
| Rate for Payer: Cofinity Commercial |
$1,150.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.52
|
| Rate for Payer: Healthscope Commercial |
$1,588.26
|
| Rate for Payer: Healthscope Commercial |
$1,373.63
|
| Rate for Payer: Mclaren Medicaid |
$570.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.45
|
| Rate for Payer: Meridian Medicaid |
$599.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157,567.00
|
| Rate for Payer: Nomi Health Commercial |
$1,030.22
|
| Rate for Payer: PACE SWMI |
$858.52
|
| Rate for Payer: PHP Medicare Advantage |
$858.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,772.22
|
| Rate for Payer: Priority Health Medicare |
$858.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,772.22
|
| Rate for Payer: Priority Health SBD |
$1,772.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$893.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.52
|
| Rate for Payer: UHC Exchange |
$893.01
|
| Rate for Payer: UHC Medicare Advantage |
$858.52
|
| Rate for Payer: UHCCP Medicaid |
$570.63
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$985.32 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.60
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,094.80
|
| Rate for Payer: Cofinity Commercial |
$1,345.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,094.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health SBD |
$985.32
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$454.33 |
| Max. Negotiated Rate |
$125,240.00 |
| Rate for Payer: Aetna Commercial |
$913.63
|
| Rate for Payer: Aetna Medicare |
$709.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$981.81
|
| Rate for Payer: BCBS Complete |
$477.05
|
| Rate for Payer: BCBS MAPPO |
$681.81
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$1,027.20
|
| Rate for Payer: BCN Medicare Advantage |
$681.81
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$981.81
|
| Rate for Payer: Cofinity Commercial |
$913.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.81
|
| Rate for Payer: Healthscope Commercial |
$1,261.35
|
| Rate for Payer: Healthscope Commercial |
$1,090.90
|
| Rate for Payer: Mclaren Medicaid |
$454.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.90
|
| Rate for Payer: Meridian Medicaid |
$477.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$125,240.00
|
| Rate for Payer: Nomi Health Commercial |
$818.17
|
| Rate for Payer: PACE SWMI |
$681.81
|
| Rate for Payer: PHP Medicare Advantage |
$681.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,411.40
|
| Rate for Payer: Priority Health Medicare |
$681.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,411.40
|
| Rate for Payer: Priority Health SBD |
$1,411.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$680.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.81
|
| Rate for Payer: UHC Exchange |
$680.41
|
| Rate for Payer: UHC Medicare Advantage |
$681.81
|
| Rate for Payer: UHCCP Medicaid |
$454.33
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$5.09
|
|
|
Service Code
|
NDC 68084099611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.07
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: Priority Health SBD |
$3.21
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$685.92
|
|
|
Service Code
|
NDC 51079063020
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.37 |
| Max. Negotiated Rate |
$617.33 |
| Rate for Payer: Aetna Commercial |
$583.03
|
| Rate for Payer: Aetna Medicare |
$342.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.85
|
| Rate for Payer: BCBS Complete |
$274.37
|
| Rate for Payer: Cash Price |
$548.74
|
| Rate for Payer: Cofinity Commercial |
$480.14
|
| Rate for Payer: Cofinity Commercial |
$589.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$480.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$548.74
|
| Rate for Payer: Healthscope Commercial |
$617.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$583.03
|
| Rate for Payer: PHP Commercial |
$583.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.85
|
| Rate for Payer: Priority Health SBD |
$432.13
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$5.09
|
|
|
Service Code
|
NDC 68084099611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.58 |
| Rate for Payer: Aetna Commercial |
$4.33
|
| Rate for Payer: Aetna Medicare |
$2.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.31
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$4.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.07
|
| Rate for Payer: Healthscope Commercial |
$4.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: PHP Commercial |
$4.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: Priority Health SBD |
$3.21
|
|
