|
PR ALBUTEROL NON-COMP CON
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7611
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.23
|
| Rate for Payer: Aetna Medicare |
$0.18
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.17
|
| Rate for Payer: BCN Medicare Advantage |
$0.17
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.24
|
| Rate for Payer: Cofinity Commercial |
$0.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.18
|
| Rate for Payer: Nomi Health Commercial |
$0.20
|
| Rate for Payer: PACE SWMI |
$0.17
|
| Rate for Payer: PHP Medicare Advantage |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.17
|
| Rate for Payer: UHC Exchange |
$0.17
|
| Rate for Payer: UHC Medicare Advantage |
$0.17
|
|
|
PR ALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7613
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.11
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.08
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.11
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.08
|
| Rate for Payer: Nomi Health Commercial |
$0.10
|
| Rate for Payer: PACE SWMI |
$0.08
|
| Rate for Payer: PHP Medicare Advantage |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.08
|
| Rate for Payer: UHC Exchange |
$0.08
|
| Rate for Payer: UHC Medicare Advantage |
$0.08
|
|
|
PR ALCOHOL AND/OR DRUG SERVICES
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS H0015
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 99408
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 99409
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$67.60 |
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
|
|
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 |
$186.06 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: BCBS Trust/PPO |
$233.67
|
| 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 Commercial |
$243.31
|
| Rate for Payer: Nomi Health Commercial |
$234.72
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health HMO/PPO |
$249.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.79
|
| 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
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
6462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.98 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna Medicare |
$74.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.45
|
| Rate for Payer: BCBS Complete |
$114.50
|
| Rate for Payer: BCBS MAPPO |
$71.56
|
| Rate for Payer: BCBS Trust/PPO |
$235.33
|
| Rate for Payer: BCN Commercial |
$222.56
|
| Rate for Payer: BCN Medicare Advantage |
$71.56
|
| 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: Health Alliance Plan Medicare Advantage |
$71.56
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: Nomi Health Commercial |
$234.72
|
| Rate for Payer: PACE Senior Care Partners |
$67.98
|
| Rate for Payer: PACE SWMI |
$71.56
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: PHP Medicare Advantage |
$71.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health HMO/PPO |
$249.04
|
| Rate for Payer: Priority Health Medicare |
$72.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.79
|
| Rate for Payer: Railroad Medicare Medicare |
$71.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.90
|
| Rate for Payer: UHC Core |
$239.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.56
|
| Rate for Payer: UHC Exchange |
$71.56
|
| Rate for Payer: UHC Medicare Advantage |
$71.56
|
| Rate for Payer: VA VA |
$71.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 20930
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$317.85 |
| Rate for Payer: Aetna Medicare |
$244.50
|
| Rate for Payer: BCBS Complete |
$195.60
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.85
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 20931
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$289.90 |
| Rate for Payer: Aetna Commercial |
$145.28
|
| Rate for Payer: Aetna Medicare |
$112.76
|
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: BCBS MAPPO |
$108.42
|
| Rate for Payer: BCN Medicare Advantage |
$108.42
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$156.12
|
| Rate for Payer: Cofinity Commercial |
$145.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.84
|
| Rate for Payer: Nomi Health Commercial |
$130.10
|
| Rate for Payer: PACE SWMI |
$108.42
|
| Rate for Payer: PHP Medicare Advantage |
$108.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health Medicare |
$109.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.42
|
| Rate for Payer: UHC Exchange |
$108.42
|
| Rate for Payer: UHC Medicare Advantage |
$108.42
|
|
|
PR ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS J2997
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$136.01 |
| Rate for Payer: Aetna Commercial |
$126.56
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$126.56
|
| Rate for Payer: Cofinity Commercial |
$136.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Nomi Health Commercial |
$113.34
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$95.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Exchange |
$94.45
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 93784
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Medicare |
$43.69
|
| Rate for Payer: BCBS Complete |
$102.80
|
| Rate for Payer: BCBS MAPPO |
$42.01
|
| Rate for Payer: BCN Medicare Advantage |
$42.01
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cofinity Commercial |
$60.49
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.11
|
| Rate for Payer: Nomi Health Commercial |
$50.41
|
| Rate for Payer: PACE SWMI |
$42.01
|
| Rate for Payer: PHP Medicare Advantage |
$42.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.05
|
| Rate for Payer: Priority Health Medicare |
$42.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.01
|
| Rate for Payer: UHC Exchange |
$42.01
|
| Rate for Payer: UHC Medicare Advantage |
$42.01
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 93790
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$24.19 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$24.19
|
| Rate for Payer: Cofinity Commercial |
$22.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Nomi Health Commercial |
$20.16
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Exchange |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
|
|
PR AMBULATORY EEG MONITORING
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 95950
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$379.60 |
| Rate for Payer: Aetna Medicare |
$292.00
|
| Rate for Payer: BCBS Complete |
$233.60
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.60
|
|
|
PR AMINOLEVULINIC ACID HCL TOP
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS J7308
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$564.61 |
| Rate for Payer: Aetna Commercial |
$525.40
|
| Rate for Payer: Aetna Medicare |
$407.77
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$392.09
|
| Rate for Payer: BCN Medicare Advantage |
$392.09
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$564.61
|
| Rate for Payer: Cofinity Commercial |
$525.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.69
|
| Rate for Payer: Nomi Health Commercial |
$470.51
|
| Rate for Payer: PACE SWMI |
$392.09
|
| Rate for Payer: PHP Medicare Advantage |
$392.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Medicare |
$396.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$392.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.09
|
| Rate for Payer: UHC Exchange |
$392.09
|
| Rate for Payer: UHC Medicare Advantage |
$392.09
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033090
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.08
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: BCBS MAPPO |
$54.46
|
| Rate for Payer: BCBS Trust/PPO |
$179.09
|
| Rate for Payer: BCN Commercial |
$169.38
|
| Rate for Payer: BCN Medicare Advantage |
$54.46
|
| 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: Health Alliance Plan Medicare Advantage |
$54.46
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Nomi Health Commercial |
$178.64
|
| Rate for Payer: PACE Senior Care Partners |
$51.74
|
| Rate for Payer: PACE SWMI |
$54.46
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: PHP Medicare Advantage |
$54.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health HMO/PPO |
$189.53
|
| Rate for Payer: Priority Health Medicare |
$55.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.96
|
| Rate for Payer: Railroad Medicare Medicare |
$54.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
| Rate for Payer: UHC Core |
$181.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.46
|
| Rate for Payer: UHC Exchange |
$54.46
|
| Rate for Payer: UHC Medicare Advantage |
$54.46
|
| Rate for Payer: VA VA |
$54.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033090
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: BCBS Trust/PPO |
$177.83
|
| 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 Commercial |
$185.17
|
| Rate for Payer: Nomi Health Commercial |
$178.64
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health HMO/PPO |
$189.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.96
|
| 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
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.60 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: BCBS Trust/PPO |
$177.83
|
| 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 Commercial |
$185.17
|
| Rate for Payer: Nomi Health Commercial |
$178.64
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health HMO/PPO |
$189.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.96
|
| 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
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.08
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: BCBS MAPPO |
$54.46
|
| Rate for Payer: BCBS Trust/PPO |
$179.09
|
| Rate for Payer: BCN Commercial |
$169.38
|
| Rate for Payer: BCN Medicare Advantage |
$54.46
|
| 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: Health Alliance Plan Medicare Advantage |
$54.46
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Nomi Health Commercial |
$178.64
|
| Rate for Payer: PACE Senior Care Partners |
$51.74
|
| Rate for Payer: PACE SWMI |
$54.46
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: PHP Medicare Advantage |
$54.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health HMO/PPO |
$189.53
|
| Rate for Payer: Priority Health Medicare |
$55.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.96
|
| Rate for Payer: Railroad Medicare Medicare |
$54.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
| Rate for Payer: UHC Core |
$181.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.46
|
| Rate for Payer: UHC Exchange |
$54.46
|
| Rate for Payer: UHC Medicare Advantage |
$54.46
|
| Rate for Payer: VA VA |
$54.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$109.98
|
|
|
Service Code
|
NDC 13668009290
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.49 |
| Max. Negotiated Rate |
$98.98 |
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: BCBS Trust/PPO |
$89.78
|
| Rate for Payer: BCN Commercial |
$84.99
|
| Rate for Payer: Cash Price |
$87.98
|
| Rate for Payer: Cofinity Commercial |
$94.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.98
|
| Rate for Payer: Healthscope Commercial |
$98.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.48
|
| Rate for Payer: Nomi Health Commercial |
$90.18
|
| Rate for Payer: PHP Commercial |
$93.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.49
|
| Rate for Payer: Priority Health HMO/PPO |
$95.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.78
|
| Rate for Payer: UHC Core |
$91.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.48
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$109.98
|
|
|
Service Code
|
NDC 13668009290
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$98.98 |
| Rate for Payer: Aetna Commercial |
$93.48
|
| Rate for Payer: Aetna Medicare |
$28.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.37
|
| Rate for Payer: BCBS Complete |
$43.99
|
| Rate for Payer: BCBS MAPPO |
$27.50
|
| Rate for Payer: BCBS Trust/PPO |
$90.41
|
| Rate for Payer: BCN Commercial |
$85.51
|
| Rate for Payer: BCN Medicare Advantage |
$27.50
|
| Rate for Payer: Cash Price |
$87.98
|
| Rate for Payer: Cofinity Commercial |
$94.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.50
|
| Rate for Payer: Healthscope Commercial |
$98.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.48
|
| Rate for Payer: Nomi Health Commercial |
$90.18
|
| Rate for Payer: PACE Senior Care Partners |
$26.12
|
| Rate for Payer: PACE SWMI |
$27.50
|
| Rate for Payer: PHP Commercial |
$93.48
|
| Rate for Payer: PHP Medicare Advantage |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.49
|
| Rate for Payer: Priority Health HMO/PPO |
$95.68
|
| Rate for Payer: Priority Health Medicare |
$27.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.69
|
| Rate for Payer: Railroad Medicare Medicare |
$27.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.78
|
| Rate for Payer: UHC Core |
$91.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.50
|
| Rate for Payer: UHC Exchange |
$27.50
|
| Rate for Payer: UHC Medicare Advantage |
$27.50
|
| Rate for Payer: VA VA |
$27.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.48
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$444.15
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.70 |
| Max. Negotiated Rate |
$399.74 |
| Rate for Payer: Aetna Commercial |
$377.53
|
| Rate for Payer: BCBS Trust/PPO |
$362.56
|
| Rate for Payer: BCN Commercial |
$343.24
|
| Rate for Payer: Cash Price |
$355.32
|
| Rate for Payer: Cofinity Commercial |
$381.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.32
|
| Rate for Payer: Healthscope Commercial |
$399.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.53
|
| Rate for Payer: Nomi Health Commercial |
$364.20
|
| Rate for Payer: PHP Commercial |
$377.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.70
|
| Rate for Payer: Priority Health HMO/PPO |
$386.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.85
|
| Rate for Payer: UHC Core |
$370.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.11
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$444.15
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.49 |
| Max. Negotiated Rate |
$399.74 |
| Rate for Payer: Aetna Commercial |
$377.53
|
| Rate for Payer: Aetna Medicare |
$115.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.80
|
| Rate for Payer: BCBS Complete |
$177.66
|
| Rate for Payer: BCBS MAPPO |
$111.04
|
| Rate for Payer: BCBS Trust/PPO |
$365.14
|
| Rate for Payer: BCN Commercial |
$345.33
|
| Rate for Payer: BCN Medicare Advantage |
$111.04
|
| Rate for Payer: Cash Price |
$355.32
|
| Rate for Payer: Cofinity Commercial |
$381.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.04
|
| Rate for Payer: Healthscope Commercial |
$399.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.53
|
| Rate for Payer: Nomi Health Commercial |
$364.20
|
| Rate for Payer: PACE Senior Care Partners |
$105.49
|
| Rate for Payer: PACE SWMI |
$111.04
|
| Rate for Payer: PHP Commercial |
$377.53
|
| Rate for Payer: PHP Medicare Advantage |
$111.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.70
|
| Rate for Payer: Priority Health HMO/PPO |
$386.41
|
| Rate for Payer: Priority Health Medicare |
$112.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.58
|
| Rate for Payer: Railroad Medicare Medicare |
$111.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.85
|
| Rate for Payer: UHC Core |
$370.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.04
|
| Rate for Payer: UHC Exchange |
$111.04
|
| Rate for Payer: UHC Medicare Advantage |
$111.04
|
| Rate for Payer: VA VA |
$111.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.11
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
OP
|
$120.56
|
|
|
Service Code
|
NDC 13668009490
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.63 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$31.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$37.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.67
|
| Rate for Payer: BCBS Complete |
$48.22
|
| Rate for Payer: BCBS MAPPO |
$30.14
|
| Rate for Payer: BCBS Trust/PPO |
$99.11
|
| Rate for Payer: BCN Commercial |
$93.74
|
| Rate for Payer: BCN Medicare Advantage |
$30.14
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.14
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$34.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: Nomi Health Commercial |
$98.86
|
| Rate for Payer: PACE Senior Care Partners |
$28.63
|
| Rate for Payer: PACE SWMI |
$30.14
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: PHP Medicare Advantage |
$30.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health HMO/PPO |
$104.89
|
| Rate for Payer: Priority Health Medicare |
$30.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.78
|
| Rate for Payer: Railroad Medicare Medicare |
$30.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.09
|
| Rate for Payer: UHC Core |
$100.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.14
|
| Rate for Payer: UHC Exchange |
$30.14
|
| Rate for Payer: UHC Medicare Advantage |
$30.14
|
| Rate for Payer: VA VA |
$30.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$120.56
|
|
|
Service Code
|
NDC 13668009490
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.36 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: BCBS Trust/PPO |
$98.41
|
| Rate for Payer: BCN Commercial |
$93.17
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: Nomi Health Commercial |
$98.86
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health HMO/PPO |
$104.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.09
|
| Rate for Payer: UHC Core |
$100.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033390
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$56.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.08
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: BCBS MAPPO |
$54.46
|
| Rate for Payer: BCBS Trust/PPO |
$179.09
|
| Rate for Payer: BCN Commercial |
$169.38
|
| Rate for Payer: BCN Medicare Advantage |
$54.46
|
| 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: Health Alliance Plan Medicare Advantage |
$54.46
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Nomi Health Commercial |
$178.64
|
| Rate for Payer: PACE Senior Care Partners |
$51.74
|
| Rate for Payer: PACE SWMI |
$54.46
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: PHP Medicare Advantage |
$54.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health HMO/PPO |
$189.53
|
| Rate for Payer: Priority Health Medicare |
$55.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.96
|
| Rate for Payer: Railroad Medicare Medicare |
$54.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.71
|
| Rate for Payer: UHC Core |
$181.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.46
|
| Rate for Payer: UHC Exchange |
$54.46
|
| Rate for Payer: UHC Medicare Advantage |
$54.46
|
| Rate for Payer: VA VA |
$54.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
