PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$286.25
|
|
Service Code
|
HCPCS J2730
|
Hospital Charge Code |
6462
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$174.58 |
Max. Negotiated Rate |
$257.62 |
Rate for Payer: Aetna Commercial |
$243.31
|
Rate for Payer: BCBS Trust/PPO |
$221.21
|
Rate for Payer: BCN Commercial |
$221.21
|
Rate for Payer: Cash Price |
$229.00
|
Rate for Payer: Cofinity Commercial |
$246.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
Rate for Payer: Healthscope Commercial |
$257.62
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.31
|
Rate for Payer: PHP Commercial |
$243.31
|
Rate for Payer: Priority Health Cigna Priority Health |
$200.38
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.04
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$174.58
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$251.90
|
Rate for Payer: UHC Core |
$239.02
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED
|
Professional
|
Both
|
$479.00
|
|
Service Code
|
HCPCS 20930
|
Min. Negotiated Rate |
$135.79 |
Max. Negotiated Rate |
$11,952.59 |
Rate for Payer: Aetna Commercial |
$155.86
|
Rate for Payer: BCBS Complete |
$191.60
|
Rate for Payer: BCBS Trust/PPO |
$11,952.59
|
Rate for Payer: BCN Commercial |
$135.79
|
Rate for Payer: Cash Price |
$383.20
|
Rate for Payer: Cash Price |
$383.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$335.30
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.73
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$178.73
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL
|
Professional
|
Both
|
$437.00
|
|
Service Code
|
HCPCS 20931
|
Min. Negotiated Rate |
$70.29 |
Max. Negotiated Rate |
$29,358.48 |
Rate for Payer: Aetna Commercial |
$147.76
|
Rate for Payer: Aetna Medicare |
$114.68
|
Rate for Payer: BCBS Complete |
$73.80
|
Rate for Payer: BCBS MAPPO |
$110.27
|
Rate for Payer: BCBS Trust/PPO |
$29,358.48
|
Rate for Payer: BCN Commercial |
$177.03
|
Rate for Payer: BCN Medicare Advantage |
$110.27
|
Rate for Payer: Cash Price |
$349.60
|
Rate for Payer: Cash Price |
$349.60
|
Rate for Payer: Cofinity Commercial |
$158.79
|
Rate for Payer: Cofinity Commercial |
$147.76
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.27
|
Rate for Payer: Mclaren Medicaid |
$70.29
|
Rate for Payer: Meridian Medicaid |
$73.80
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$115.78
|
Rate for Payer: PACE SWMI |
$110.27
|
Rate for Payer: PHP Medicare Advantage |
$110.27
|
Rate for Payer: Priority Health Choice Medicaid |
$70.29
|
Rate for Payer: Priority Health Cigna Priority Health |
$305.90
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.01
|
Rate for Payer: Priority Health Medicare |
$110.27
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$168.01
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$110.27
|
Rate for Payer: UHC Dual Complete DSNP |
$110.27
|
Rate for Payer: UHC Medicare Advantage |
$113.58
|
|
PR ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$89.00
|
|
Service Code
|
HCPCS J2997
|
Min. Negotiated Rate |
$35.60 |
Max. Negotiated Rate |
$128.37 |
Rate for Payer: Aetna Commercial |
$119.46
|
Rate for Payer: Aetna Medicare |
$92.71
|
Rate for Payer: BCBS Complete |
$35.60
|
Rate for Payer: BCBS MAPPO |
$89.15
|
Rate for Payer: BCBS Trust/PPO |
$88.53
|
Rate for Payer: BCN Commercial |
$87.12
|
Rate for Payer: BCN Medicare Advantage |
$89.15
|
Rate for Payer: Cash Price |
$71.20
|
Rate for Payer: Cash Price |
$71.20
|
Rate for Payer: Cofinity Commercial |
$119.46
|
Rate for Payer: Cofinity Commercial |
$128.37
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.15
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.60
|
Rate for Payer: PACE SWMI |
$89.15
|
Rate for Payer: PHP Medicare Advantage |
$89.15
|
Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
Rate for Payer: Priority Health Medicare |
$89.15
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$89.15
|
Rate for Payer: UHC Dual Complete DSNP |
$89.15
|
Rate for Payer: UHC Medicare Advantage |
$91.82
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$252.00
|
|
Service Code
|
HCPCS 93784
|
Min. Negotiated Rate |
$37.78 |
Max. Negotiated Rate |
$176.40 |
Rate for Payer: Aetna Commercial |
$58.02
|
Rate for Payer: Aetna Medicare |
$45.03
|
Rate for Payer: BCBS Complete |
$100.80
|
Rate for Payer: BCBS MAPPO |
$43.30
|
Rate for Payer: BCBS Trust/PPO |
$37.78
|
Rate for Payer: BCN Commercial |
$66.46
|
Rate for Payer: BCN Medicare Advantage |
$43.30
|
Rate for Payer: Cash Price |
$201.60
|
Rate for Payer: Cash Price |
$201.60
|
Rate for Payer: Cofinity Commercial |
$58.02
|
Rate for Payer: Cofinity Commercial |
$62.35
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.30
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.46
|
Rate for Payer: PACE SWMI |
$43.30
|
Rate for Payer: PHP Medicare Advantage |
$43.30
|
Rate for Payer: Priority Health Cigna Priority Health |
$176.40
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.31
|
Rate for Payer: Priority Health Medicare |
$43.30
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$64.31
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$43.30
|
Rate for Payer: UHC Dual Complete DSNP |
$43.30
|
Rate for Payer: UHC Medicare Advantage |
$44.60
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$35.00
|
|
Service Code
|
HCPCS 93790
|
Min. Negotiated Rate |
$14.00 |
Max. Negotiated Rate |
$31.84 |
Rate for Payer: Aetna Commercial |
$23.53
|
Rate for Payer: Aetna Medicare |
$18.26
|
Rate for Payer: BCBS Complete |
$14.00
|
Rate for Payer: BCBS MAPPO |
$17.56
|
Rate for Payer: BCBS Trust/PPO |
$31.84
|
Rate for Payer: BCN Commercial |
$25.90
|
Rate for Payer: BCN Medicare Advantage |
$17.56
|
Rate for Payer: Cash Price |
$28.00
|
Rate for Payer: Cash Price |
$28.00
|
Rate for Payer: Cofinity Commercial |
$25.29
|
Rate for Payer: Cofinity Commercial |
$23.53
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.56
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.44
|
Rate for Payer: PACE SWMI |
$17.56
|
Rate for Payer: PHP Medicare Advantage |
$17.56
|
Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.06
|
Rate for Payer: Priority Health Medicare |
$17.56
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$25.06
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$17.56
|
Rate for Payer: UHC Dual Complete DSNP |
$17.56
|
Rate for Payer: UHC Medicare Advantage |
$18.09
|
|
PR AMBULATORY EEG MONITORING
|
Professional
|
Both
|
$573.00
|
|
Service Code
|
HCPCS 95950
|
Min. Negotiated Rate |
$229.20 |
Max. Negotiated Rate |
$401.10 |
Rate for Payer: BCBS Complete |
$229.20
|
Rate for Payer: Cash Price |
$458.40
|
Rate for Payer: Priority Health Cigna Priority Health |
$401.10
|
|
PR AMINOLEVULINIC ACID HCL TOP
|
Professional
|
Both
|
$174.00
|
|
Service Code
|
HCPCS J7308
|
Min. Negotiated Rate |
$69.60 |
Max. Negotiated Rate |
$563.37 |
Rate for Payer: Aetna Commercial |
$524.25
|
Rate for Payer: Aetna Medicare |
$406.88
|
Rate for Payer: BCBS Complete |
$69.60
|
Rate for Payer: BCBS MAPPO |
$391.23
|
Rate for Payer: BCBS Trust/PPO |
$399.72
|
Rate for Payer: BCN Commercial |
$388.57
|
Rate for Payer: BCN Medicare Advantage |
$391.23
|
Rate for Payer: Cash Price |
$139.20
|
Rate for Payer: Cash Price |
$139.20
|
Rate for Payer: Cofinity Commercial |
$563.37
|
Rate for Payer: Cofinity Commercial |
$524.25
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.23
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$410.79
|
Rate for Payer: PACE SWMI |
$391.23
|
Rate for Payer: PHP Medicare Advantage |
$391.23
|
Rate for Payer: Priority Health Cigna Priority Health |
$121.80
|
Rate for Payer: Priority Health Medicare |
$391.23
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$391.23
|
Rate for Payer: UHC Dual Complete DSNP |
$391.23
|
Rate for Payer: UHC Medicare Advantage |
$402.97
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
Service Code
|
NDC 68462-330-90
|
Hospital Charge Code |
21287
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$132.87 |
Max. Negotiated Rate |
$196.06 |
Rate for Payer: Aetna Commercial |
$185.17
|
Rate for Payer: BCBS Trust/PPO |
$168.35
|
Rate for Payer: BCN Commercial |
$168.35
|
Rate for Payer: Cash Price |
$174.28
|
Rate for Payer: Cofinity Commercial |
$187.35
|
Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
Rate for Payer: Healthscope Commercial |
$196.06
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.17
|
Rate for Payer: PHP Commercial |
$185.17
|
Rate for Payer: Priority Health Cigna Priority Health |
$152.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.53
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$132.87
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
Rate for Payer: UHC Core |
$181.90
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$107.87
|
|
Service Code
|
NDC 13668-092-90
|
Hospital Charge Code |
21290
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$65.79 |
Max. Negotiated Rate |
$97.08 |
Rate for Payer: Aetna Commercial |
$91.69
|
Rate for Payer: BCBS Trust/PPO |
$83.36
|
Rate for Payer: BCN Commercial |
$83.36
|
Rate for Payer: Cash Price |
$86.30
|
Rate for Payer: Cofinity Commercial |
$92.77
|
Rate for Payer: Encore Health Key Benefits Commercial |
$86.30
|
Rate for Payer: Healthscope Commercial |
$97.08
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.90
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.69
|
Rate for Payer: PHP Commercial |
$91.69
|
Rate for Payer: Priority Health Cigna Priority Health |
$75.51
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.85
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$65.79
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$94.93
|
Rate for Payer: UHC Core |
$90.07
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.90
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
Service Code
|
NDC 68462-331-90
|
Hospital Charge Code |
21290
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$132.87 |
Max. Negotiated Rate |
$196.06 |
Rate for Payer: Aetna Commercial |
$185.17
|
Rate for Payer: BCBS Trust/PPO |
$168.35
|
Rate for Payer: BCN Commercial |
$168.35
|
Rate for Payer: Cash Price |
$174.28
|
Rate for Payer: Cofinity Commercial |
$187.35
|
Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
Rate for Payer: Healthscope Commercial |
$196.06
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.17
|
Rate for Payer: PHP Commercial |
$185.17
|
Rate for Payer: Priority Health Cigna Priority Health |
$152.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.53
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$132.87
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
Rate for Payer: UHC Core |
$181.90
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$432.40
|
|
Service Code
|
NDC 0904-6704-61
|
Hospital Charge Code |
21290
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$263.72 |
Max. Negotiated Rate |
$389.16 |
Rate for Payer: Aetna Commercial |
$367.54
|
Rate for Payer: BCBS Trust/PPO |
$334.16
|
Rate for Payer: BCN Commercial |
$334.16
|
Rate for Payer: Cash Price |
$345.92
|
Rate for Payer: Cofinity Commercial |
$371.86
|
Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
Rate for Payer: Healthscope Commercial |
$389.16
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$367.54
|
Rate for Payer: PHP Commercial |
$367.54
|
Rate for Payer: Priority Health Cigna Priority Health |
$302.68
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.19
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$263.72
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$380.51
|
Rate for Payer: UHC Core |
$361.05
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$116.33
|
|
Service Code
|
NDC 13668-094-90
|
Hospital Charge Code |
21288
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$70.95 |
Max. Negotiated Rate |
$104.70 |
Rate for Payer: Aetna Commercial |
$98.88
|
Rate for Payer: BCBS Trust/PPO |
$89.90
|
Rate for Payer: BCN Commercial |
$89.90
|
Rate for Payer: Cash Price |
$93.06
|
Rate for Payer: Cofinity Commercial |
$100.04
|
Rate for Payer: Encore Health Key Benefits Commercial |
$93.06
|
Rate for Payer: Healthscope Commercial |
$104.70
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.25
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.88
|
Rate for Payer: PHP Commercial |
$98.88
|
Rate for Payer: Priority Health Cigna Priority Health |
$81.43
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.21
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$70.95
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$102.37
|
Rate for Payer: UHC Core |
$97.14
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.25
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
Service Code
|
NDC 68462-333-90
|
Hospital Charge Code |
21288
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$132.87 |
Max. Negotiated Rate |
$196.06 |
Rate for Payer: Aetna Commercial |
$185.17
|
Rate for Payer: BCBS Trust/PPO |
$168.35
|
Rate for Payer: BCN Commercial |
$168.35
|
Rate for Payer: Cash Price |
$174.28
|
Rate for Payer: Cofinity Commercial |
$187.35
|
Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
Rate for Payer: Healthscope Commercial |
$196.06
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$185.17
|
Rate for Payer: PHP Commercial |
$185.17
|
Rate for Payer: Priority Health Cigna Priority Health |
$152.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.53
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$132.87
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
Rate for Payer: UHC Core |
$181.90
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$130.90
|
|
Service Code
|
NDC 60687-592-21
|
Hospital Charge Code |
21288
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$79.84 |
Max. Negotiated Rate |
$117.81 |
Rate for Payer: Aetna Commercial |
$111.26
|
Rate for Payer: BCBS Trust/PPO |
$101.16
|
Rate for Payer: BCN Commercial |
$101.16
|
Rate for Payer: Cash Price |
$104.72
|
Rate for Payer: Cofinity Commercial |
$112.57
|
Rate for Payer: Encore Health Key Benefits Commercial |
$104.72
|
Rate for Payer: Healthscope Commercial |
$117.81
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.18
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.26
|
Rate for Payer: PHP Commercial |
$111.26
|
Rate for Payer: Priority Health Cigna Priority Health |
$91.63
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.88
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$79.84
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$115.19
|
Rate for Payer: UHC Core |
$109.30
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.18
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$4.37
|
|
Service Code
|
NDC 60687-592-11
|
Hospital Charge Code |
21288
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$2.67 |
Max. Negotiated Rate |
$3.93 |
Rate for Payer: Aetna Commercial |
$3.71
|
Rate for Payer: BCBS Trust/PPO |
$3.38
|
Rate for Payer: BCN Commercial |
$3.38
|
Rate for Payer: Cash Price |
$3.50
|
Rate for Payer: Cofinity Commercial |
$3.76
|
Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
Rate for Payer: Healthscope Commercial |
$3.93
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.71
|
Rate for Payer: PHP Commercial |
$3.71
|
Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.80
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$2.67
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
Rate for Payer: UHC Core |
$3.65
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$235.00
|
|
Service Code
|
HCPCS 59000
|
Min. Negotiated Rate |
$51.76 |
Max. Negotiated Rate |
$570.04 |
Rate for Payer: Aetna Commercial |
$107.39
|
Rate for Payer: Aetna Medicare |
$83.35
|
Rate for Payer: BCBS Complete |
$54.35
|
Rate for Payer: BCBS MAPPO |
$80.14
|
Rate for Payer: BCBS Trust/PPO |
$570.04
|
Rate for Payer: BCN Commercial |
$172.01
|
Rate for Payer: BCN Medicare Advantage |
$80.14
|
Rate for Payer: Cash Price |
$188.00
|
Rate for Payer: Cash Price |
$188.00
|
Rate for Payer: Cofinity Commercial |
$115.40
|
Rate for Payer: Cofinity Commercial |
$107.39
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.14
|
Rate for Payer: Mclaren Medicaid |
$51.76
|
Rate for Payer: Meridian Medicaid |
$54.35
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.15
|
Rate for Payer: PACE SWMI |
$80.14
|
Rate for Payer: PHP Medicare Advantage |
$80.14
|
Rate for Payer: Priority Health Choice Medicaid |
$51.76
|
Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.32
|
Rate for Payer: Priority Health Medicare |
$80.14
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$113.32
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$80.14
|
Rate for Payer: UHC Dual Complete DSNP |
$80.14
|
Rate for Payer: UHC Medicare Advantage |
$82.54
|
|
PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID
|
Professional
|
Both
|
$410.00
|
|
Service Code
|
HCPCS 59001
|
Min. Negotiated Rate |
$113.96 |
Max. Negotiated Rate |
$523.55 |
Rate for Payer: Aetna Commercial |
$238.95
|
Rate for Payer: Aetna Medicare |
$185.45
|
Rate for Payer: BCBS Complete |
$119.66
|
Rate for Payer: BCBS MAPPO |
$178.32
|
Rate for Payer: BCBS Trust/PPO |
$523.55
|
Rate for Payer: BCN Commercial |
$259.98
|
Rate for Payer: BCN Medicare Advantage |
$178.32
|
Rate for Payer: Cash Price |
$328.00
|
Rate for Payer: Cash Price |
$328.00
|
Rate for Payer: Cofinity Commercial |
$256.78
|
Rate for Payer: Cofinity Commercial |
$238.95
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.32
|
Rate for Payer: Mclaren Medicaid |
$113.96
|
Rate for Payer: Meridian Medicaid |
$119.66
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$187.24
|
Rate for Payer: PACE SWMI |
$178.32
|
Rate for Payer: PHP Medicare Advantage |
$178.32
|
Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
Rate for Payer: Priority Health Cigna Priority Health |
$287.00
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.20
|
Rate for Payer: Priority Health Medicare |
$178.32
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$251.20
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$178.32
|
Rate for Payer: UHC Dual Complete DSNP |
$178.32
|
Rate for Payer: UHC Medicare Advantage |
$183.67
|
|
PRAMOXINE-ZINC OXIDE 1 %-5 % TOPICAL CREAM
|
Facility
|
IP
|
$23.94
|
|
Service Code
|
NDC 11868-814-01
|
Hospital Charge Code |
40249
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$14.60 |
Max. Negotiated Rate |
$21.55 |
Rate for Payer: Aetna Commercial |
$20.35
|
Rate for Payer: BCBS Trust/PPO |
$18.50
|
Rate for Payer: BCN Commercial |
$18.50
|
Rate for Payer: Cash Price |
$19.15
|
Rate for Payer: Cofinity Commercial |
$20.59
|
Rate for Payer: Encore Health Key Benefits Commercial |
$19.15
|
Rate for Payer: Healthscope Commercial |
$21.55
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.96
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.35
|
Rate for Payer: PHP Commercial |
$20.35
|
Rate for Payer: Priority Health Cigna Priority Health |
$16.76
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.83
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$14.60
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$21.07
|
Rate for Payer: UHC Core |
$19.99
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.96
|
|
PR AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ
|
Professional
|
Both
|
$1,560.00
|
|
Service Code
|
HCPCS 24925
|
Min. Negotiated Rate |
$140.00 |
Max. Negotiated Rate |
$1,092.00 |
Rate for Payer: Aetna Commercial |
$754.18
|
Rate for Payer: Aetna Medicare |
$585.33
|
Rate for Payer: BCBS Complete |
$389.60
|
Rate for Payer: BCBS MAPPO |
$562.82
|
Rate for Payer: BCBS Trust/PPO |
$140.00
|
Rate for Payer: BCN Commercial |
$842.97
|
Rate for Payer: BCN Medicare Advantage |
$562.82
|
Rate for Payer: Cash Price |
$1,248.00
|
Rate for Payer: Cash Price |
$1,248.00
|
Rate for Payer: Cofinity Commercial |
$810.46
|
Rate for Payer: Cofinity Commercial |
$754.18
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$562.82
|
Rate for Payer: Mclaren Medicaid |
$371.05
|
Rate for Payer: Meridian Medicaid |
$389.60
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$590.96
|
Rate for Payer: PACE SWMI |
$562.82
|
Rate for Payer: PHP Medicare Advantage |
$562.82
|
Rate for Payer: Priority Health Choice Medicaid |
$371.05
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,092.00
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$880.86
|
Rate for Payer: Priority Health Medicare |
$562.82
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$880.86
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$562.82
|
Rate for Payer: UHC Dual Complete DSNP |
$562.82
|
Rate for Payer: UHC Medicare Advantage |
$579.70
|
|
PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE
|
Professional
|
Both
|
$1,584.00
|
|
Service Code
|
HCPCS 25907
|
Min. Negotiated Rate |
$206.57 |
Max. Negotiated Rate |
$1,108.80 |
Rate for Payer: Aetna Commercial |
$813.85
|
Rate for Payer: Aetna Medicare |
$631.64
|
Rate for Payer: BCBS Complete |
$420.24
|
Rate for Payer: BCBS MAPPO |
$607.35
|
Rate for Payer: BCBS Trust/PPO |
$206.57
|
Rate for Payer: BCN Commercial |
$908.45
|
Rate for Payer: BCN Medicare Advantage |
$607.35
|
Rate for Payer: Cash Price |
$1,267.20
|
Rate for Payer: Cash Price |
$1,267.20
|
Rate for Payer: Cofinity Commercial |
$874.58
|
Rate for Payer: Cofinity Commercial |
$813.85
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.35
|
Rate for Payer: Mclaren Medicaid |
$400.23
|
Rate for Payer: Meridian Medicaid |
$420.24
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$637.72
|
Rate for Payer: PACE SWMI |
$607.35
|
Rate for Payer: PHP Medicare Advantage |
$607.35
|
Rate for Payer: Priority Health Choice Medicaid |
$400.23
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,108.80
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$949.29
|
Rate for Payer: Priority Health Medicare |
$607.35
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$949.29
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$607.35
|
Rate for Payer: UHC Dual Complete DSNP |
$607.35
|
Rate for Payer: UHC Medicare Advantage |
$625.57
|
|
PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR
|
Professional
|
Both
|
$1,882.00
|
|
Service Code
|
HCPCS 25905
|
Min. Negotiated Rate |
$173.28 |
Max. Negotiated Rate |
$1,317.40 |
Rate for Payer: Aetna Commercial |
$929.38
|
Rate for Payer: Aetna Medicare |
$721.31
|
Rate for Payer: BCBS Complete |
$478.16
|
Rate for Payer: BCBS MAPPO |
$693.57
|
Rate for Payer: BCBS Trust/PPO |
$173.28
|
Rate for Payer: BCN Commercial |
$1,035.02
|
Rate for Payer: BCN Medicare Advantage |
$693.57
|
Rate for Payer: Cash Price |
$1,505.60
|
Rate for Payer: Cash Price |
$1,505.60
|
Rate for Payer: Cofinity Commercial |
$998.74
|
Rate for Payer: Cofinity Commercial |
$929.38
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$693.57
|
Rate for Payer: Mclaren Medicaid |
$455.39
|
Rate for Payer: Meridian Medicaid |
$478.16
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$728.25
|
Rate for Payer: PACE SWMI |
$693.57
|
Rate for Payer: PHP Medicare Advantage |
$693.57
|
Rate for Payer: Priority Health Choice Medicaid |
$455.39
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,317.40
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,081.56
|
Rate for Payer: Priority Health Medicare |
$693.57
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$1,081.56
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$693.57
|
Rate for Payer: UHC Dual Complete DSNP |
$693.57
|
Rate for Payer: UHC Medicare Advantage |
$714.38
|
|
PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION
|
Professional
|
Both
|
$1,213.00
|
|
Service Code
|
HCPCS 25909
|
Min. Negotiated Rate |
$304.30 |
Max. Negotiated Rate |
$1,057.55 |
Rate for Payer: Aetna Commercial |
$908.43
|
Rate for Payer: Aetna Medicare |
$705.05
|
Rate for Payer: BCBS Complete |
$466.76
|
Rate for Payer: BCBS MAPPO |
$677.93
|
Rate for Payer: BCBS Trust/PPO |
$304.30
|
Rate for Payer: BCN Commercial |
$1,012.05
|
Rate for Payer: BCN Medicare Advantage |
$677.93
|
Rate for Payer: Cash Price |
$970.40
|
Rate for Payer: Cash Price |
$970.40
|
Rate for Payer: Cofinity Commercial |
$908.43
|
Rate for Payer: Cofinity Commercial |
$976.22
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$677.93
|
Rate for Payer: Mclaren Medicaid |
$444.53
|
Rate for Payer: Meridian Medicaid |
$466.76
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$711.83
|
Rate for Payer: PACE SWMI |
$677.93
|
Rate for Payer: PHP Medicare Advantage |
$677.93
|
Rate for Payer: Priority Health Choice Medicaid |
$444.53
|
Rate for Payer: Priority Health Cigna Priority Health |
$849.10
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,057.55
|
Rate for Payer: Priority Health Medicare |
$677.93
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$1,057.55
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$677.93
|
Rate for Payer: UHC Dual Complete DSNP |
$677.93
|
Rate for Payer: UHC Medicare Advantage |
$698.27
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$2,157.00
|
|
Service Code
|
HCPCS 26952
|
Min. Negotiated Rate |
$285.28 |
Max. Negotiated Rate |
$1,509.90 |
Rate for Payer: Aetna Commercial |
$897.28
|
Rate for Payer: Aetna Medicare |
$696.39
|
Rate for Payer: BCBS Complete |
$465.19
|
Rate for Payer: BCBS MAPPO |
$669.61
|
Rate for Payer: BCBS Trust/PPO |
$285.28
|
Rate for Payer: BCN Commercial |
$1,018.41
|
Rate for Payer: BCN Medicare Advantage |
$669.61
|
Rate for Payer: Cash Price |
$1,725.60
|
Rate for Payer: Cash Price |
$1,725.60
|
Rate for Payer: Cofinity Commercial |
$897.28
|
Rate for Payer: Cofinity Commercial |
$964.24
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$669.61
|
Rate for Payer: Mclaren Medicaid |
$443.04
|
Rate for Payer: Meridian Medicaid |
$465.19
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$703.09
|
Rate for Payer: PACE SWMI |
$669.61
|
Rate for Payer: PHP Medicare Advantage |
$669.61
|
Rate for Payer: Priority Health Choice Medicaid |
$443.04
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,509.90
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,064.20
|
Rate for Payer: Priority Health Medicare |
$669.61
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$1,064.20
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$669.61
|
Rate for Payer: UHC Dual Complete DSNP |
$669.61
|
Rate for Payer: UHC Medicare Advantage |
$689.70
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$1,618.00
|
|
Service Code
|
HCPCS 26951
|
Min. Negotiated Rate |
$455.82 |
Max. Negotiated Rate |
$4,383.83 |
Rate for Payer: Aetna Commercial |
$915.31
|
Rate for Payer: Aetna Medicare |
$710.39
|
Rate for Payer: BCBS Complete |
$478.61
|
Rate for Payer: BCBS MAPPO |
$683.07
|
Rate for Payer: BCBS Trust/PPO |
$4,383.83
|
Rate for Payer: BCN Commercial |
$1,042.35
|
Rate for Payer: BCN Medicare Advantage |
$683.07
|
Rate for Payer: Cash Price |
$1,294.40
|
Rate for Payer: Cash Price |
$1,294.40
|
Rate for Payer: Cofinity Commercial |
$915.31
|
Rate for Payer: Cofinity Commercial |
$983.62
|
Rate for Payer: Health Alliance Plan Medicare Advantage |
$683.07
|
Rate for Payer: Mclaren Medicaid |
$455.82
|
Rate for Payer: Meridian Medicaid |
$478.61
|
Rate for Payer: Meridian Wellcare - Medicare Advantage |
$717.22
|
Rate for Payer: PACE SWMI |
$683.07
|
Rate for Payer: PHP Medicare Advantage |
$683.07
|
Rate for Payer: Priority Health Choice Medicaid |
$455.82
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,132.60
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,089.21
|
Rate for Payer: Priority Health Medicare |
$683.07
|
Rate for Payer: Priority Health Narrow/Tiered Network |
$1,089.21
|
Rate for Payer: UHC All Payor (Choice/PPO) |
$683.07
|
Rate for Payer: UHC Dual Complete DSNP |
$683.07
|
Rate for Payer: UHC Medicare Advantage |
$703.56
|
|