|
PR ILEOSCOPY STOMA W/BALLOON DILATION
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 44381
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$14,832.00 |
| Rate for Payer: Aetna Commercial |
$106.37
|
| Rate for Payer: Aetna Medicare |
$82.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.31
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS MAPPO |
$79.38
|
| Rate for Payer: BCBS Trust/PPO |
$282.11
|
| Rate for Payer: BCN Commercial |
$1,457.24
|
| Rate for Payer: BCN Medicare Advantage |
$79.38
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$114.31
|
| Rate for Payer: Cofinity Commercial |
$106.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.38
|
| Rate for Payer: Healthscope Commercial |
$127.01
|
| Rate for Payer: Healthscope Commercial |
$146.85
|
| Rate for Payer: Mclaren Medicaid |
$53.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.35
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,832.00
|
| Rate for Payer: Nomi Health Commercial |
$95.26
|
| Rate for Payer: PACE SWMI |
$79.38
|
| Rate for Payer: PHP Medicare Advantage |
$79.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.33
|
| Rate for Payer: Priority Health Medicare |
$79.38
|
| Rate for Payer: Priority Health Narrow Network |
$150.33
|
| Rate for Payer: Priority Health SBD |
$150.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.38
|
| Rate for Payer: UHC Medicare Advantage |
$79.38
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
|
|
PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
HCPCS 44382
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$12,976.00 |
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: Aetna Medicare |
$72.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.48
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS MAPPO |
$69.76
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$440.79
|
| Rate for Payer: BCN Medicare Advantage |
$69.76
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cofinity Commercial |
$93.48
|
| Rate for Payer: Cofinity Commercial |
$100.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.76
|
| Rate for Payer: Healthscope Commercial |
$129.06
|
| Rate for Payer: Healthscope Commercial |
$111.62
|
| Rate for Payer: Mclaren Medicaid |
$47.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.25
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,976.00
|
| Rate for Payer: Nomi Health Commercial |
$83.71
|
| Rate for Payer: PACE SWMI |
$69.76
|
| Rate for Payer: PHP Medicare Advantage |
$69.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.25
|
| Rate for Payer: Priority Health Medicare |
$69.76
|
| Rate for Payer: Priority Health Narrow Network |
$131.25
|
| Rate for Payer: Priority Health SBD |
$131.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.76
|
| Rate for Payer: UHC Exchange |
$122.70
|
| Rate for Payer: UHC Medicare Advantage |
$69.76
|
| Rate for Payer: UHCCP Medicaid |
$47.07
|
|
|
PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 44384
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$27,193.00 |
| Rate for Payer: Aetna Commercial |
$194.23
|
| Rate for Payer: Aetna Medicare |
$150.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.73
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS MAPPO |
$144.95
|
| Rate for Payer: BCBS Trust/PPO |
$402.56
|
| Rate for Payer: BCN Commercial |
$222.35
|
| Rate for Payer: BCN Medicare Advantage |
$144.95
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$208.73
|
| Rate for Payer: Cofinity Commercial |
$194.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.95
|
| Rate for Payer: Healthscope Commercial |
$231.92
|
| Rate for Payer: Healthscope Commercial |
$268.16
|
| Rate for Payer: Mclaren Medicaid |
$96.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.20
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,193.00
|
| Rate for Payer: Nomi Health Commercial |
$173.94
|
| Rate for Payer: PACE SWMI |
$144.95
|
| Rate for Payer: PHP Medicare Advantage |
$144.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.46
|
| Rate for Payer: Priority Health Medicare |
$144.95
|
| Rate for Payer: Priority Health Narrow Network |
$268.46
|
| Rate for Payer: Priority Health SBD |
$268.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.95
|
| Rate for Payer: UHC Medicare Advantage |
$144.95
|
| Rate for Payer: UHCCP Medicaid |
$96.70
|
|
|
PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 44380
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$9,918.00 |
| Rate for Payer: Aetna Commercial |
$73.03
|
| Rate for Payer: Aetna Medicare |
$56.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.48
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$54.50
|
| Rate for Payer: BCBS Trust/PPO |
$247.77
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: BCN Medicare Advantage |
$54.50
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$78.48
|
| Rate for Payer: Cofinity Commercial |
$73.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.50
|
| Rate for Payer: Healthscope Commercial |
$87.20
|
| Rate for Payer: Healthscope Commercial |
$100.82
|
| Rate for Payer: Mclaren Medicaid |
$36.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.22
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,918.00
|
| Rate for Payer: Nomi Health Commercial |
$65.40
|
| Rate for Payer: PACE SWMI |
$54.50
|
| Rate for Payer: PHP Medicare Advantage |
$54.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.01
|
| Rate for Payer: Priority Health Medicare |
$54.50
|
| Rate for Payer: Priority Health Narrow Network |
$102.01
|
| Rate for Payer: Priority Health SBD |
$102.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.50
|
| Rate for Payer: UHC Exchange |
$105.08
|
| Rate for Payer: UHC Medicare Advantage |
$54.50
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
|
|
PR ILEOSCOPY,THRU STOMA,TRANSENDO STENT
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 44383
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$706.55 |
| Rate for Payer: Aetna Medicare |
$543.50
|
| Rate for Payer: BCBS Complete |
$434.80
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$706.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.55
|
|
|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$185,278.00 |
| Rate for Payer: Aetna Commercial |
$1,344.90
|
| Rate for Payer: Aetna Medicare |
$1,043.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,344.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,445.27
|
| Rate for Payer: BCBS Complete |
$699.13
|
| Rate for Payer: BCBS MAPPO |
$1,003.66
|
| Rate for Payer: BCBS Trust/PPO |
$81.93
|
| Rate for Payer: BCN Commercial |
$1,512.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.66
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cofinity Commercial |
$1,445.27
|
| Rate for Payer: Cofinity Commercial |
$1,344.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.66
|
| Rate for Payer: Healthscope Commercial |
$1,856.77
|
| Rate for Payer: Healthscope Commercial |
$1,605.86
|
| Rate for Payer: Mclaren Medicaid |
$665.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,053.84
|
| Rate for Payer: Meridian Medicaid |
$699.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185,278.00
|
| Rate for Payer: Nomi Health Commercial |
$1,204.39
|
| Rate for Payer: PACE SWMI |
$1,003.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$665.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,855.41
|
| Rate for Payer: Priority Health Medicare |
$1,003.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,855.41
|
| Rate for Payer: Priority Health SBD |
$1,855.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$963.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.66
|
| Rate for Payer: UHC Exchange |
$963.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.66
|
| Rate for Payer: UHCCP Medicaid |
$665.84
|
|
|
PR ILIAC ART ANGIO,CARDIAC CATH
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G0278
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$2,016.00 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Medicare |
$13.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.20
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$12.64
|
| Rate for Payer: BCBS Trust/PPO |
$152.15
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: BCN Medicare Advantage |
$12.64
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$16.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.64
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$23.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,016.00
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PACE SWMI |
$12.64
|
| Rate for Payer: PHP Medicare Advantage |
$12.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.54
|
| Rate for Payer: Priority Health Medicare |
$12.64
|
| Rate for Payer: Priority Health Narrow Network |
$20.54
|
| Rate for Payer: Priority Health SBD |
$20.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.64
|
| Rate for Payer: UHC Exchange |
$14.21
|
| Rate for Payer: UHC Medicare Advantage |
$12.64
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$2,355.00 |
| Rate for Payer: Aetna Commercial |
$20.52
|
| Rate for Payer: Aetna Medicare |
$15.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.05
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$15.31
|
| Rate for Payer: BCBS Trust/PPO |
$611.77
|
| Rate for Payer: BCN Commercial |
$19.24
|
| Rate for Payer: BCN Medicare Advantage |
$15.31
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.31
|
| Rate for Payer: Healthscope Commercial |
$24.50
|
| Rate for Payer: Healthscope Commercial |
$28.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,355.00
|
| Rate for Payer: Nomi Health Commercial |
$18.37
|
| Rate for Payer: PACE SWMI |
$15.31
|
| Rate for Payer: PHP Medicare Advantage |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$15.31
|
| Rate for Payer: Priority Health Narrow Network |
$26.75
|
| Rate for Payer: Priority Health SBD |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.31
|
| Rate for Payer: UHC Exchange |
$8.00
|
| Rate for Payer: UHC Medicare Advantage |
$15.31
|
|
|
PR IM ADM INTRANSL/ORAL EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90474
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,697.00 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$11.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.01
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$652.45
|
| Rate for Payer: BCN Commercial |
$13.75
|
| Rate for Payer: BCN Medicare Advantage |
$11.12
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.12
|
| Rate for Payer: Healthscope Commercial |
$17.79
|
| Rate for Payer: Healthscope Commercial |
$20.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,697.00
|
| Rate for Payer: Nomi Health Commercial |
$13.34
|
| Rate for Payer: PACE SWMI |
$11.12
|
| Rate for Payer: PHP Medicare Advantage |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.28
|
| Rate for Payer: Priority Health Medicare |
$11.12
|
| Rate for Payer: Priority Health Narrow Network |
$16.28
|
| Rate for Payer: Priority Health SBD |
$16.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.12
|
| Rate for Payer: UHC Exchange |
$8.00
|
| Rate for Payer: UHC Medicare Advantage |
$11.12
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90471
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$2,864.00 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Medicare |
$19.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.13
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$18.84
|
| Rate for Payer: BCBS Trust/PPO |
$593.28
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: BCN Medicare Advantage |
$18.84
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$25.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$30.14
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,864.00
|
| Rate for Payer: Nomi Health Commercial |
$22.61
|
| Rate for Payer: PACE SWMI |
$18.84
|
| Rate for Payer: PHP Medicare Advantage |
$18.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$18.84
|
| Rate for Payer: Priority Health Narrow Network |
$26.75
|
| Rate for Payer: Priority Health SBD |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.84
|
| Rate for Payer: UHC Exchange |
$8.00
|
| Rate for Payer: UHC Medicare Advantage |
$18.84
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90472
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$2,067.00 |
| Rate for Payer: Aetna Commercial |
$18.06
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.41
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$13.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.41
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$13.48
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$24.94
|
| Rate for Payer: Healthscope Commercial |
$21.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,067.00
|
| Rate for Payer: Nomi Health Commercial |
$16.18
|
| Rate for Payer: PACE SWMI |
$13.48
|
| Rate for Payer: PHP Medicare Advantage |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.91
|
| Rate for Payer: Priority Health Medicare |
$13.48
|
| Rate for Payer: Priority Health Narrow Network |
$19.91
|
| Rate for Payer: Priority Health SBD |
$19.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.48
|
| Rate for Payer: UHC Exchange |
$8.00
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
|
|
PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 90460
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$3,228.00 |
| Rate for Payer: Aetna Commercial |
$28.39
|
| Rate for Payer: Aetna Medicare |
$22.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.51
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$21.19
|
| Rate for Payer: BCBS Trust/PPO |
$519.85
|
| Rate for Payer: BCN Commercial |
$25.68
|
| Rate for Payer: BCN Medicare Advantage |
$21.19
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$30.51
|
| Rate for Payer: Cofinity Commercial |
$28.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.19
|
| Rate for Payer: Healthscope Commercial |
$33.90
|
| Rate for Payer: Healthscope Commercial |
$39.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,228.00
|
| Rate for Payer: Nomi Health Commercial |
$25.43
|
| Rate for Payer: PACE SWMI |
$21.19
|
| Rate for Payer: PHP Medicare Advantage |
$21.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$21.19
|
| Rate for Payer: Priority Health Narrow Network |
$26.75
|
| Rate for Payer: Priority Health SBD |
$26.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.19
|
| Rate for Payer: UHC Medicare Advantage |
$21.19
|
|
|
PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90461
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$1,479.00 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$544.68
|
| Rate for Payer: BCN Commercial |
$13.65
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$13.22
|
| Rate for Payer: Healthscope Commercial |
$15.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,479.00
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: Priority Health Narrow Network |
$11.75
|
| Rate for Payer: Priority Health SBD |
$11.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
IP
|
$597.12
|
|
|
Service Code
|
NDC 76385010201
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.19 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Commercial |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.13
|
| Rate for Payer: Priority Health SBD |
$376.19
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
OP
|
$597.12
|
|
|
Service Code
|
NDC 76385010201
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.85 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna Medicare |
$298.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Commercial |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.13
|
| Rate for Payer: Priority Health SBD |
$376.19
|
|
|
PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, NONCORONARY, NON-INTRACRANIAL, ARTERIAL OR ARTERIAL BYPASS GRAFT, INCLUDING FLUOROSCOPIC GUIDANCE AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); INITIAL VESSEL
|
Facility
|
OP
|
$55,296.52
|
|
|
Service Code
|
CPT 37184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$453.57 |
| Max. Negotiated Rate |
$55,296.52 |
| Rate for Payer: Aetna Medicare |
$18,297.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,992.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,992.05
|
| Rate for Payer: BCBS Complete |
$9,901.70
|
| Rate for Payer: BCBS MAPPO |
$17,593.64
|
| Rate for Payer: BCBS Trust/PPO |
$2,636.15
|
| Rate for Payer: BCN Commercial |
$2,636.15
|
| Rate for Payer: BCN Medicare Advantage |
$17,593.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,593.64
|
| Rate for Payer: Mclaren Medicaid |
$9,430.19
|
| Rate for Payer: Mclaren Medicare |
$17,593.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18,473.32
|
| Rate for Payer: Meridian Medicaid |
$9,901.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,232.69
|
| Rate for Payer: Nomi Health Commercial |
$36,946.64
|
| Rate for Payer: PACE Medicare |
$16,713.96
|
| Rate for Payer: PACE SWMI |
$17,593.64
|
| Rate for Payer: PHP Medicare Advantage |
$17,593.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,430.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,296.52
|
| Rate for Payer: Priority Health Medicare |
$17,593.64
|
| Rate for Payer: Priority Health Narrow Network |
$44,237.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17,593.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.57
|
| Rate for Payer: UHC Core |
$7,632.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$17,593.64
|
| Rate for Payer: UHC Exchange |
$8,174.00
|
| Rate for Payer: UHC Medicare Advantage |
$17,593.64
|
| Rate for Payer: UHCCP Medicaid |
$9,905.22
|
| Rate for Payer: VA VA |
$17,593.64
|
|
|
PR IMBRICATION DIAPHRAGM EVENTRATION
|
Professional
|
Both
|
$5,419.00
|
|
|
Service Code
|
HCPCS 39545
|
| Min. Negotiated Rate |
$571.91 |
| Max. Negotiated Rate |
$158,843.00 |
| Rate for Payer: Aetna Commercial |
$1,157.01
|
| Rate for Payer: Aetna Medicare |
$897.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,243.35
|
| Rate for Payer: BCBS Complete |
$600.51
|
| Rate for Payer: BCBS MAPPO |
$863.44
|
| Rate for Payer: BCBS Trust/PPO |
$671.47
|
| Rate for Payer: BCN Commercial |
$1,295.97
|
| Rate for Payer: BCN Medicare Advantage |
$863.44
|
| Rate for Payer: Cash Price |
$4,335.20
|
| Rate for Payer: Cash Price |
$4,335.20
|
| Rate for Payer: Cofinity Commercial |
$1,243.35
|
| Rate for Payer: Cofinity Commercial |
$1,157.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$863.44
|
| Rate for Payer: Healthscope Commercial |
$1,597.36
|
| Rate for Payer: Healthscope Commercial |
$1,381.50
|
| Rate for Payer: Mclaren Medicaid |
$571.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$906.61
|
| Rate for Payer: Meridian Medicaid |
$600.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$158,843.00
|
| Rate for Payer: Nomi Health Commercial |
$1,036.13
|
| Rate for Payer: PACE SWMI |
$863.44
|
| Rate for Payer: PHP Medicare Advantage |
$863.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,522.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,418.38
|
| Rate for Payer: Priority Health Medicare |
$863.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,418.38
|
| Rate for Payer: Priority Health SBD |
$1,418.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,170.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$863.44
|
| Rate for Payer: UHC Exchange |
$1,170.61
|
| Rate for Payer: UHC Medicare Advantage |
$863.44
|
| Rate for Payer: UHCCP Medicaid |
$571.91
|
|
|
PR IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
HCPCS 10030
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$23,900.00 |
| Rate for Payer: Aetna Commercial |
$171.45
|
| Rate for Payer: Aetna Medicare |
$133.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.25
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$127.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,625.00
|
| Rate for Payer: BCN Commercial |
$952.93
|
| Rate for Payer: BCN Medicare Advantage |
$127.95
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cofinity Commercial |
$184.25
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.95
|
| Rate for Payer: Healthscope Commercial |
$204.72
|
| Rate for Payer: Healthscope Commercial |
$236.71
|
| Rate for Payer: Mclaren Medicaid |
$84.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.35
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,900.00
|
| Rate for Payer: Nomi Health Commercial |
$153.54
|
| Rate for Payer: PACE SWMI |
$127.95
|
| Rate for Payer: PHP Medicare Advantage |
$127.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.25
|
| Rate for Payer: Priority Health Medicare |
$127.95
|
| Rate for Payer: Priority Health Narrow Network |
$179.25
|
| Rate for Payer: Priority Health SBD |
$179.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.95
|
| Rate for Payer: UHC Medicare Advantage |
$127.95
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 49406
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$34,117.00 |
| Rate for Payer: Aetna Commercial |
$245.45
|
| Rate for Payer: Aetna Medicare |
$190.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.76
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCBS MAPPO |
$183.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,515.24
|
| Rate for Payer: BCN Commercial |
$1,311.61
|
| Rate for Payer: BCN Medicare Advantage |
$183.17
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$263.76
|
| Rate for Payer: Cofinity Commercial |
$245.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.17
|
| Rate for Payer: Healthscope Commercial |
$293.07
|
| Rate for Payer: Healthscope Commercial |
$338.86
|
| Rate for Payer: Mclaren Medicaid |
$121.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.33
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,117.00
|
| Rate for Payer: Nomi Health Commercial |
$219.80
|
| Rate for Payer: PACE SWMI |
$183.17
|
| Rate for Payer: PHP Medicare Advantage |
$183.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.27
|
| Rate for Payer: Priority Health Medicare |
$183.17
|
| Rate for Payer: Priority Health Narrow Network |
$338.27
|
| Rate for Payer: Priority Health SBD |
$338.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.17
|
| Rate for Payer: UHC Medicare Advantage |
$183.17
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 50268068715
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health SBD |
$140.05
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$319.20
|
|
|
Service Code
|
NDC 53746054501
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.68 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna Medicare |
$159.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: BCBS Complete |
$127.68
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health SBD |
$201.10
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 68084020311
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health SBD |
$2.01
|
|
|
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 |
$231.70 |
| 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 Commercial |
$180.22
|
| Rate for Payer: Cofinity Commercial |
$221.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.96
|
| Rate for Payer: Healthscope Commercial |
$231.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.83
|
| Rate for Payer: PHP Commercial |
$218.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.34
|
| Rate for Payer: Priority Health SBD |
$162.19
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$319.20
|
|
|
Service Code
|
NDC 53746054501
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.10 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health SBD |
$201.10
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 68084020311
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health SBD |
$2.01
|
|
