|
PR AUDITORY EVOKED POTENTIAL
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 92585
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$233.80 |
| Rate for Payer: BCBS Complete |
$133.60
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.80
|
|
|
PR AUDITORY EVOKED POTENTIAL, LIMITED
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 92586
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$101.50 |
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.50
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,186.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$244.13
|
| Rate for Payer: Aetna Medicare |
$189.48
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS MAPPO |
$182.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$292.71
|
| Rate for Payer: BCN Medicare Advantage |
$182.19
|
| Rate for Payer: Cash Price |
$948.80
|
| Rate for Payer: Cash Price |
$948.80
|
| Rate for Payer: Cofinity Commercial |
$262.35
|
| Rate for Payer: Cofinity Commercial |
$244.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.19
|
| Rate for Payer: Mclaren Medicaid |
$116.94
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$191.30
|
| Rate for Payer: PACE SWMI |
$182.19
|
| Rate for Payer: PHP Medicare Advantage |
$182.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.80
|
| Rate for Payer: Priority Health Medicare |
$182.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.19
|
| Rate for Payer: UHC Medicare Advantage |
$187.66
|
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$165.78 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$165.78
|
| Rate for Payer: BCBS Complete |
$291.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$182.92
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.47
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$222.72
|
| Rate for Payer: Aetna Medicare |
$172.86
|
| Rate for Payer: BCBS Complete |
$111.37
|
| Rate for Payer: BCBS MAPPO |
$166.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$267.42
|
| Rate for Payer: BCN Medicare Advantage |
$166.21
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cofinity Commercial |
$239.34
|
| Rate for Payer: Cofinity Commercial |
$222.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.21
|
| Rate for Payer: Mclaren Medicaid |
$106.07
|
| Rate for Payer: Meridian Medicaid |
$111.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.52
|
| Rate for Payer: PACE SWMI |
$166.21
|
| Rate for Payer: PHP Medicare Advantage |
$166.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.79
|
| Rate for Payer: Priority Health Medicare |
$166.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.21
|
| Rate for Payer: UHC Medicare Advantage |
$171.20
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,315.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$2,514.45 |
| Rate for Payer: Aetna Commercial |
$2,174.23
|
| Rate for Payer: Aetna Medicare |
$1,687.46
|
| Rate for Payer: BCBS Complete |
$1,108.63
|
| Rate for Payer: BCBS MAPPO |
$1,622.56
|
| Rate for Payer: BCBS Trust/PPO |
$149.51
|
| Rate for Payer: BCN Commercial |
$2,406.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.56
|
| Rate for Payer: Cash Price |
$2,652.00
|
| Rate for Payer: Cash Price |
$2,652.00
|
| Rate for Payer: Cofinity Commercial |
$2,336.49
|
| Rate for Payer: Cofinity Commercial |
$2,174.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.56
|
| Rate for Payer: Mclaren Medicaid |
$1,055.84
|
| Rate for Payer: Meridian Medicaid |
$1,108.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.69
|
| Rate for Payer: PACE SWMI |
$1,622.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,055.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,514.45
|
| Rate for Payer: Priority Health Medicare |
$1,622.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,514.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,622.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,622.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.24
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$314.45
|
|
|
Service Code
|
NDC 0904-5891-61
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.78 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna Commercial |
$267.28
|
| Rate for Payer: BCBS Trust/PPO |
$243.01
|
| Rate for Payer: BCN Commercial |
$243.01
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Commercial |
$270.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.28
|
| Rate for Payer: PHP Commercial |
$267.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$273.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$276.72
|
| Rate for Payer: UHC Core |
$262.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.84
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 68382-071-16
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$239.36 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: BCBS Trust/PPO |
$303.29
|
| Rate for Payer: BCN Commercial |
$303.29
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$341.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.36
|
| Rate for Payer: UHC Core |
$327.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$431.30
|
|
|
Service Code
|
NDC 0904-5892-61
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.05 |
| Max. Negotiated Rate |
$388.17 |
| Rate for Payer: Aetna Commercial |
$366.60
|
| Rate for Payer: BCBS Trust/PPO |
$333.31
|
| Rate for Payer: BCN Commercial |
$333.31
|
| Rate for Payer: Cash Price |
$345.04
|
| Rate for Payer: Cofinity Commercial |
$370.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.04
|
| Rate for Payer: Healthscope Commercial |
$388.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.60
|
| Rate for Payer: PHP Commercial |
$366.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$375.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$379.54
|
| Rate for Payer: UHC Core |
$360.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.48
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 51079-782-01
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$2.84
|
| Rate for Payer: BCN Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.12
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.23
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$300.11
|
|
|
Service Code
|
NDC 68462-197-90
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.04 |
| Max. Negotiated Rate |
$270.10 |
| Rate for Payer: Aetna Commercial |
$255.09
|
| Rate for Payer: BCBS Trust/PPO |
$231.93
|
| Rate for Payer: BCN Commercial |
$231.93
|
| Rate for Payer: Cash Price |
$240.09
|
| Rate for Payer: Cofinity Commercial |
$258.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.09
|
| Rate for Payer: Healthscope Commercial |
$270.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.09
|
| Rate for Payer: PHP Commercial |
$255.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$183.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.10
|
| Rate for Payer: UHC Core |
$250.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.08
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$366.24
|
|
|
Service Code
|
NDC 51079-782-20
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.37 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: BCBS Trust/PPO |
$283.03
|
| Rate for Payer: BCN Commercial |
$283.03
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$311.30
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$256.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$286.42
|
|
|
Service Code
|
NDC 68382-072-16
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.69 |
| Max. Negotiated Rate |
$257.78 |
| Rate for Payer: Aetna Commercial |
$243.46
|
| Rate for Payer: BCBS Trust/PPO |
$221.35
|
| Rate for Payer: BCN Commercial |
$221.35
|
| Rate for Payer: Cash Price |
$229.14
|
| Rate for Payer: Cofinity Commercial |
$246.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.14
|
| Rate for Payer: Healthscope Commercial |
$257.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.46
|
| Rate for Payer: PHP Commercial |
$243.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.05
|
| Rate for Payer: UHC Core |
$239.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.82
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$276.96
|
|
|
Service Code
|
NDC 0904-5893-61
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.92 |
| Max. Negotiated Rate |
$249.26 |
| Rate for Payer: Aetna Commercial |
$235.42
|
| Rate for Payer: BCBS Trust/PPO |
$214.03
|
| Rate for Payer: BCN Commercial |
$214.03
|
| Rate for Payer: Cash Price |
$221.57
|
| Rate for Payer: Cofinity Commercial |
$238.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.57
|
| Rate for Payer: Healthscope Commercial |
$249.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.42
|
| Rate for Payer: PHP Commercial |
$235.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$243.72
|
| Rate for Payer: UHC Core |
$231.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.72
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$135.47 |
| Rate for Payer: Aetna Commercial |
$70.77
|
| Rate for Payer: Aetna Medicare |
$54.92
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$52.81
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$135.47
|
| Rate for Payer: BCN Medicare Advantage |
$52.81
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Cofinity Commercial |
$70.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.81
|
| Rate for Payer: Mclaren Medicaid |
$34.08
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.45
|
| Rate for Payer: PACE SWMI |
$52.81
|
| Rate for Payer: PHP Medicare Advantage |
$52.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.35
|
| Rate for Payer: Priority Health Medicare |
$52.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.81
|
| Rate for Payer: UHC Medicare Advantage |
$54.39
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$106.97 |
| Rate for Payer: Aetna Commercial |
$22.93
|
| Rate for Payer: Aetna Medicare |
$17.79
|
| Rate for Payer: BCBS Complete |
$11.18
|
| Rate for Payer: BCBS MAPPO |
$17.11
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$39.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.11
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$22.93
|
| Rate for Payer: Cofinity Commercial |
$24.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.11
|
| Rate for Payer: Mclaren Medicaid |
$10.65
|
| Rate for Payer: Meridian Medicaid |
$11.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.97
|
| Rate for Payer: PACE SWMI |
$17.11
|
| Rate for Payer: PHP Medicare Advantage |
$17.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.96
|
| Rate for Payer: Priority Health Medicare |
$17.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.11
|
| Rate for Payer: UHC Medicare Advantage |
$17.62
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$567.01 |
| Max. Negotiated Rate |
$1,911.53 |
| Rate for Payer: Aetna Commercial |
$1,173.00
|
| Rate for Payer: Aetna Medicare |
$910.38
|
| Rate for Payer: BCBS Complete |
$595.36
|
| Rate for Payer: BCBS MAPPO |
$875.37
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$1,289.62
|
| Rate for Payer: BCN Medicare Advantage |
$875.37
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,260.53
|
| Rate for Payer: Cofinity Commercial |
$1,173.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$875.37
|
| Rate for Payer: Mclaren Medicaid |
$567.01
|
| Rate for Payer: Meridian Medicaid |
$595.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$919.14
|
| Rate for Payer: PACE SWMI |
$875.37
|
| Rate for Payer: PHP Medicare Advantage |
$875.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,911.53
|
| Rate for Payer: Priority Health Medicare |
$875.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,911.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$875.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$875.37
|
| Rate for Payer: UHC Medicare Advantage |
$901.63
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$567.01 |
| Max. Negotiated Rate |
$1,911.53 |
| Rate for Payer: Aetna Commercial |
$1,173.00
|
| Rate for Payer: Aetna Medicare |
$910.38
|
| Rate for Payer: BCBS Complete |
$595.36
|
| Rate for Payer: BCBS MAPPO |
$875.37
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$1,289.62
|
| Rate for Payer: BCN Medicare Advantage |
$875.37
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,260.53
|
| Rate for Payer: Cofinity Commercial |
$1,173.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$875.37
|
| Rate for Payer: Mclaren Medicaid |
$567.01
|
| Rate for Payer: Meridian Medicaid |
$595.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$919.14
|
| Rate for Payer: PACE SWMI |
$875.37
|
| Rate for Payer: PHP Medicare Advantage |
$875.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,911.53
|
| Rate for Payer: Priority Health Medicare |
$875.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,911.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$875.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$875.37
|
| Rate for Payer: UHC Medicare Advantage |
$901.63
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$364.09 |
| Max. Negotiated Rate |
$3,974.31 |
| Rate for Payer: Aetna Commercial |
$1,303.05
|
| Rate for Payer: Aetna Medicare |
$398.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$479.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$479.06
|
| Rate for Payer: BCBS Complete |
$3,974.31
|
| Rate for Payer: BCBS MAPPO |
$383.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,191.91
|
| Rate for Payer: BCN Commercial |
$1,191.91
|
| Rate for Payer: BCN Medicare Advantage |
$383.25
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,318.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,226.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$383.25
|
| Rate for Payer: Healthscope Commercial |
$1,379.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,149.75
|
| Rate for Payer: Mclaren Medicaid |
$3,785.06
|
| Rate for Payer: Meridian Medicaid |
$3,974.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$402.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$440.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,303.05
|
| Rate for Payer: PACE Senior Care Partners |
$364.09
|
| Rate for Payer: PACE SWMI |
$383.25
|
| Rate for Payer: PHP Commercial |
$1,303.05
|
| Rate for Payer: PHP Medicare Advantage |
$383.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,785.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,333.71
|
| Rate for Payer: Priority Health Medicare |
$383.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$934.98
|
| Rate for Payer: Railroad Medicare Medicare |
$383.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,349.04
|
| Rate for Payer: UHC Core |
$1,280.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$383.25
|
| Rate for Payer: UHC Medicare Advantage |
$394.75
|
| Rate for Payer: VA VA |
$383.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,149.75
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$934.98 |
| Max. Negotiated Rate |
$1,379.70 |
| Rate for Payer: Aetna Commercial |
$1,303.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,184.70
|
| Rate for Payer: BCN Commercial |
$1,184.70
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,318.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,226.40
|
| Rate for Payer: Healthscope Commercial |
$1,379.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,149.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,303.05
|
| Rate for Payer: PHP Commercial |
$1,303.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,333.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$934.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,349.04
|
| Rate for Payer: UHC Core |
$1,280.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,149.75
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$451.56 |
| Max. Negotiated Rate |
$1,522.57 |
| Rate for Payer: Aetna Commercial |
$932.35
|
| Rate for Payer: Aetna Medicare |
$723.61
|
| Rate for Payer: BCBS Complete |
$474.14
|
| Rate for Payer: BCBS MAPPO |
$695.78
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$1,027.20
|
| Rate for Payer: BCN Medicare Advantage |
$695.78
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cofinity Commercial |
$932.35
|
| Rate for Payer: Cofinity Commercial |
$1,001.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.78
|
| Rate for Payer: Mclaren Medicaid |
$451.56
|
| Rate for Payer: Meridian Medicaid |
$474.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$730.57
|
| Rate for Payer: PACE SWMI |
$695.78
|
| Rate for Payer: PHP Medicare Advantage |
$695.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$451.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,443.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,522.57
|
| Rate for Payer: Priority Health Medicare |
$695.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,522.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.78
|
| Rate for Payer: UHC Medicare Advantage |
$716.65
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$415.95
|
|
|
Service Code
|
NDC 70954-019-10
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.69 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: BCBS Trust/PPO |
$321.45
|
| Rate for Payer: BCN Commercial |
$321.45
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$353.56
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.04
|
| Rate for Payer: UHC Core |
$347.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.96
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
NDC 0378-1101-01
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.70 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: BCBS Trust/PPO |
$367.08
|
| Rate for Payer: BCN Commercial |
$367.08
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.00
|
| Rate for Payer: UHC Core |
$396.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$584.64
|
|
|
Service Code
|
NDC 0378-3205-01
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.57 |
| Max. Negotiated Rate |
$526.18 |
| Rate for Payer: Aetna Commercial |
$496.94
|
| Rate for Payer: BCBS Trust/PPO |
$451.81
|
| Rate for Payer: BCN Commercial |
$451.81
|
| Rate for Payer: Cash Price |
$467.71
|
| Rate for Payer: Cofinity Commercial |
$502.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.71
|
| Rate for Payer: Healthscope Commercial |
$526.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$496.94
|
| Rate for Payer: PHP Commercial |
$496.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$508.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$356.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.48
|
| Rate for Payer: UHC Core |
$488.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.48
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$10.10
|
|
|
Service Code
|
NDC 60687-572-33
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$9.09 |
| Rate for Payer: Aetna Commercial |
$8.58
|
| Rate for Payer: BCBS Trust/PPO |
$7.81
|
| Rate for Payer: BCN Commercial |
$7.81
|
| Rate for Payer: Cash Price |
$8.08
|
| Rate for Payer: Cofinity Commercial |
$8.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.08
|
| Rate for Payer: Healthscope Commercial |
$9.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.58
|
| Rate for Payer: PHP Commercial |
$8.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.89
|
| Rate for Payer: UHC Core |
$8.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.58
|
|
