|
PR IMBRICATION DIAPHRAGM EVENTRATION
|
Professional
|
Both
|
$5,582.00
|
|
|
Service Code
|
HCPCS 39545
|
| Min. Negotiated Rate |
$556.57 |
| Max. Negotiated Rate |
$4,186.50 |
| Rate for Payer: Healthscope Commercial |
$1,382.86
|
| Rate for Payer: Aetna Commercial |
$1,158.15
|
| Rate for Payer: Aetna Medicare |
$898.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,158.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,244.58
|
| Rate for Payer: BCBS Complete |
$584.40
|
| Rate for Payer: BCBS MAPPO |
$864.29
|
| Rate for Payer: BCN Commercial |
$1,337.08
|
| Rate for Payer: BCN Medicare Advantage |
$864.29
|
| Rate for Payer: Cash Price |
$4,465.60
|
| Rate for Payer: Cash Price |
$4,465.60
|
| Rate for Payer: Cofinity Commercial |
$1,244.58
|
| Rate for Payer: Cofinity Commercial |
$1,158.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.29
|
| Rate for Payer: Healthscope Commercial |
$1,598.94
|
| Rate for Payer: Mclaren Medicaid |
$556.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.50
|
| Rate for Payer: Meridian Medicaid |
$584.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$950.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,588.43
|
| Rate for Payer: Nomi Health Commercial |
$1,037.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,186.50
|
| Rate for Payer: PACE SWMI |
$864.29
|
| Rate for Payer: PHP Medicare Advantage |
$864.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$556.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,437.85
|
| Rate for Payer: Priority Health Medicare |
$864.29
|
| Rate for Payer: Priority Health SBD |
$1,437.85
|
| Rate for Payer: Priority Health Tiered Network |
$1,437.85
|
| Rate for Payer: Railroad Medicare Medicare |
$864.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,581.10
|
| Rate for Payer: UHC Core |
$1,581.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$864.29
|
| Rate for Payer: UHC Exchange |
$1,581.10
|
| Rate for Payer: UHC Medicaid |
$556.57
|
| Rate for Payer: UHCCP Medicaid |
$556.57
|
|
|
PR IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 10030
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$582.75 |
| Rate for Payer: Aetna Commercial |
$158.48
|
| Rate for Payer: Aetna Medicare |
$123.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.31
|
| Rate for Payer: BCBS Complete |
$79.17
|
| Rate for Payer: BCBS MAPPO |
$118.27
|
| Rate for Payer: BCN Commercial |
$198.70
|
| Rate for Payer: BCN Medicare Advantage |
$118.27
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cofinity Commercial |
$170.31
|
| Rate for Payer: Cofinity Commercial |
$158.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.27
|
| Rate for Payer: Healthscope Commercial |
$218.80
|
| Rate for Payer: Healthscope Commercial |
$189.23
|
| Rate for Payer: Mclaren Medicaid |
$75.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.18
|
| Rate for Payer: Meridian Medicaid |
$79.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$239.00
|
| Rate for Payer: Nomi Health Commercial |
$141.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$582.75
|
| Rate for Payer: PACE SWMI |
$118.27
|
| Rate for Payer: PHP Medicare Advantage |
$118.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$181.85
|
| Rate for Payer: Priority Health Medicare |
$118.27
|
| Rate for Payer: Priority Health SBD |
$181.85
|
| Rate for Payer: Priority Health Tiered Network |
$181.85
|
| Rate for Payer: Railroad Medicare Medicare |
$118.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.73
|
| Rate for Payer: UHC Core |
$244.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$118.27
|
| Rate for Payer: UHC Exchange |
$244.73
|
| Rate for Payer: UHC Medicaid |
$75.40
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
|
|
PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 49406
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$350.66 |
| Rate for Payer: Aetna Commercial |
$223.15
|
| Rate for Payer: Aetna Medicare |
$173.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.80
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: BCBS MAPPO |
$166.53
|
| Rate for Payer: BCN Commercial |
$284.34
|
| Rate for Payer: BCN Medicare Advantage |
$166.53
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$239.80
|
| Rate for Payer: Cofinity Commercial |
$223.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.53
|
| Rate for Payer: Healthscope Commercial |
$308.08
|
| Rate for Payer: Healthscope Commercial |
$266.45
|
| Rate for Payer: Mclaren Medicaid |
$106.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.86
|
| Rate for Payer: Meridian Medicaid |
$111.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$183.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.17
|
| Rate for Payer: Nomi Health Commercial |
$199.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
| Rate for Payer: PACE SWMI |
$166.53
|
| Rate for Payer: PHP Medicare Advantage |
$166.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$346.46
|
| Rate for Payer: Priority Health Medicare |
$166.53
|
| Rate for Payer: Priority Health SBD |
$346.46
|
| Rate for Payer: Priority Health Tiered Network |
$346.46
|
| Rate for Payer: Railroad Medicare Medicare |
$166.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.66
|
| Rate for Payer: UHC Core |
$350.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$166.53
|
| Rate for Payer: UHC Exchange |
$350.66
|
| Rate for Payer: UHC Medicaid |
$106.29
|
| Rate for Payer: UHCCP Medicaid |
$106.29
|
|
|
PR IMG RETINA DETCJ/MNTR DS POC AUTON A/R UNI/BI
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 92229
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$57.31
|
| Rate for Payer: Aetna Medicare |
$44.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.59
|
| Rate for Payer: BCBS MAPPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: BCN Medicare Advantage |
$42.77
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$57.31
|
| Rate for Payer: Cofinity Commercial |
$61.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.77
|
| Rate for Payer: Healthscope Commercial |
$68.43
|
| Rate for Payer: Healthscope Commercial |
$79.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.60
|
| Rate for Payer: Nomi Health Commercial |
$51.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: PACE SWMI |
$42.77
|
| Rate for Payer: PHP Medicare Advantage |
$42.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.53
|
| Rate for Payer: Priority Health Medicare |
$42.77
|
| Rate for Payer: Priority Health SBD |
$57.53
|
| Rate for Payer: Priority Health Tiered Network |
$57.53
|
| Rate for Payer: Railroad Medicare Medicare |
$42.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.61
|
| Rate for Payer: UHC Core |
$69.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.77
|
| Rate for Payer: UHC Exchange |
$69.61
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$120.48
|
|
|
Service Code
|
NDC 50268068715
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.90 |
| Max. Negotiated Rate |
$108.43 |
| Rate for Payer: Aetna Commercial |
$102.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.31
|
| Rate for Payer: Cash Price |
$96.38
|
| Rate for Payer: Cofinity Advantage |
$84.34
|
| Rate for Payer: Cofinity Commercial |
$103.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.38
|
| Rate for Payer: Healthscope Commercial |
$108.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.36
|
| Rate for Payer: PHP Commercial |
$102.41
|
| Rate for Payer: Priority Health SBD |
$75.90
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$4.18
|
|
|
Service Code
|
NDC 68084020311
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Advantage |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.72
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: UHC Exchange |
$1.64
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$257.45
|
|
|
Service Code
|
NDC 00527123101
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.19 |
| Max. Negotiated Rate |
$231.71 |
| Rate for Payer: Aetna Commercial |
$218.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.34
|
| Rate for Payer: Cash Price |
$205.96
|
| Rate for Payer: Cofinity Advantage |
$180.22
|
| Rate for Payer: Cofinity Commercial |
$221.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.96
|
| Rate for Payer: Healthscope Commercial |
$231.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.09
|
| Rate for Payer: PHP Commercial |
$218.83
|
| Rate for Payer: Priority Health SBD |
$162.19
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$417.12
|
|
|
Service Code
|
NDC 68084020301
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.93 |
| Max. Negotiated Rate |
$375.41 |
| Rate for Payer: Aetna Commercial |
$354.55
|
| Rate for Payer: Aetna Medicare |
$208.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.13
|
| Rate for Payer: BCBS Complete |
$166.85
|
| Rate for Payer: Cash Price |
$333.70
|
| Rate for Payer: Cofinity Advantage |
$291.98
|
| Rate for Payer: Cofinity Commercial |
$358.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.70
|
| Rate for Payer: Healthscope Commercial |
$375.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.84
|
| Rate for Payer: PHP Commercial |
$354.55
|
| Rate for Payer: Priority Health SBD |
$262.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.13
|
| Rate for Payer: UHC Core |
$217.32
|
| Rate for Payer: UHC Exchange |
$163.93
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$4.18
|
|
|
Service Code
|
NDC 68084020311
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Advantage |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health SBD |
$2.63
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 53746054501
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.59 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna Medicare |
$153.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Advantage |
$214.79
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.45
|
| Rate for Payer: UHC Core |
$159.87
|
| Rate for Payer: UHC Exchange |
$120.59
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$2.41
|
|
|
Service Code
|
NDC 50268068711
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Advantage |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.81
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health SBD |
$1.52
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$120.48
|
|
|
Service Code
|
NDC 50268068715
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.35 |
| Max. Negotiated Rate |
$108.43 |
| Rate for Payer: Aetna Commercial |
$102.41
|
| Rate for Payer: Aetna Medicare |
$60.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.31
|
| Rate for Payer: BCBS Complete |
$48.19
|
| Rate for Payer: Cash Price |
$96.38
|
| Rate for Payer: Cofinity Advantage |
$84.34
|
| Rate for Payer: Cofinity Commercial |
$103.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.38
|
| Rate for Payer: Healthscope Commercial |
$108.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.36
|
| Rate for Payer: PHP Commercial |
$102.41
|
| Rate for Payer: Priority Health SBD |
$75.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.31
|
| Rate for Payer: UHC Core |
$62.77
|
| Rate for Payer: UHC Exchange |
$47.35
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$2.41
|
|
|
Service Code
|
NDC 50268068711
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: Aetna Commercial |
$2.05
|
| Rate for Payer: Aetna Medicare |
$1.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.57
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: Cash Price |
$1.93
|
| Rate for Payer: Cofinity Advantage |
$1.69
|
| Rate for Payer: Cofinity Commercial |
$2.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.93
|
| Rate for Payer: Healthscope Commercial |
$2.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.81
|
| Rate for Payer: PHP Commercial |
$2.05
|
| Rate for Payer: Priority Health SBD |
$1.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.57
|
| Rate for Payer: UHC Core |
$1.26
|
| Rate for Payer: UHC Exchange |
$0.95
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$417.12
|
|
|
Service Code
|
NDC 68084020301
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.79 |
| Max. Negotiated Rate |
$375.41 |
| Rate for Payer: Aetna Commercial |
$354.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.13
|
| Rate for Payer: Cash Price |
$333.70
|
| Rate for Payer: Cofinity Advantage |
$291.98
|
| Rate for Payer: Cofinity Commercial |
$358.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.70
|
| Rate for Payer: Healthscope Commercial |
$375.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.84
|
| Rate for Payer: PHP Commercial |
$354.55
|
| Rate for Payer: Priority Health SBD |
$262.79
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 53746054501
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.32 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Advantage |
$214.79
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health SBD |
$193.32
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$257.45
|
|
|
Service Code
|
NDC 00527123101
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.18 |
| Max. Negotiated Rate |
$231.71 |
| Rate for Payer: Aetna Commercial |
$218.83
|
| Rate for Payer: Aetna Medicare |
$128.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.34
|
| Rate for Payer: BCBS Complete |
$102.98
|
| Rate for Payer: Cash Price |
$205.96
|
| Rate for Payer: Cofinity Advantage |
$180.22
|
| Rate for Payer: Cofinity Commercial |
$221.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.96
|
| Rate for Payer: Healthscope Commercial |
$231.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.09
|
| Rate for Payer: PHP Commercial |
$218.83
|
| Rate for Payer: Priority Health SBD |
$162.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.34
|
| Rate for Payer: UHC Core |
$134.13
|
| Rate for Payer: UHC Exchange |
$101.18
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$3.63
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.36
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Advantage |
$2.54
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.72
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.29
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$362.88
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.61 |
| Max. Negotiated Rate |
$326.59 |
| Rate for Payer: Aetna Commercial |
$308.45
|
| Rate for Payer: Aetna Medicare |
$181.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.87
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: Cash Price |
$290.30
|
| Rate for Payer: Cofinity Advantage |
$254.02
|
| Rate for Payer: Cofinity Commercial |
$312.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.30
|
| Rate for Payer: Healthscope Commercial |
$326.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.16
|
| Rate for Payer: PHP Commercial |
$308.45
|
| Rate for Payer: Priority Health SBD |
$228.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.87
|
| Rate for Payer: UHC Core |
$189.06
|
| Rate for Payer: UHC Exchange |
$142.61
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$188.10
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna Medicare |
$94.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.27
|
| Rate for Payer: BCBS Complete |
$75.24
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Advantage |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.07
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: Priority Health SBD |
$118.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.27
|
| Rate for Payer: UHC Core |
$98.00
|
| Rate for Payer: UHC Exchange |
$73.92
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 50268068611
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$1.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.45
|
| Rate for Payer: BCBS Complete |
$1.51
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Advantage |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.83
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health SBD |
$2.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.45
|
| Rate for Payer: UHC Core |
$1.96
|
| Rate for Payer: UHC Exchange |
$1.48
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$362.88
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.61 |
| Max. Negotiated Rate |
$326.59 |
| Rate for Payer: Aetna Commercial |
$308.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.87
|
| Rate for Payer: Cash Price |
$290.30
|
| Rate for Payer: Cofinity Advantage |
$254.02
|
| Rate for Payer: Cofinity Commercial |
$312.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.30
|
| Rate for Payer: Healthscope Commercial |
$326.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.16
|
| Rate for Payer: PHP Commercial |
$308.45
|
| Rate for Payer: Priority Health SBD |
$228.61
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$188.10
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.27
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Advantage |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.07
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: Priority Health SBD |
$118.50
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 50268068611
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.45
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Advantage |
$2.64
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.83
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health SBD |
$2.38
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$3.63
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna Medicare |
$1.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.36
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Advantage |
$2.54
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.72
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$1.89
|
| Rate for Payer: UHC Exchange |
$1.43
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0011A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$54.65 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
