|
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
|
$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
|
$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 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
|
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
|
$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 1 MG TABLET
|
Facility
|
OP
|
$142.13
|
|
|
Service Code
|
NDC 60687059221
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$127.92 |
| Rate for Payer: Aetna Commercial |
$120.81
|
| Rate for Payer: Aetna Medicare |
$36.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.42
|
| Rate for Payer: BCBS Complete |
$56.85
|
| Rate for Payer: BCBS MAPPO |
$35.53
|
| Rate for Payer: BCBS Trust/PPO |
$116.85
|
| Rate for Payer: BCN Commercial |
$110.51
|
| Rate for Payer: BCN Medicare Advantage |
$35.53
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cofinity Commercial |
$122.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.53
|
| Rate for Payer: Healthscope Commercial |
$127.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.81
|
| Rate for Payer: Nomi Health Commercial |
$116.55
|
| Rate for Payer: PACE Senior Care Partners |
$33.76
|
| Rate for Payer: PACE SWMI |
$35.53
|
| Rate for Payer: PHP Commercial |
$120.81
|
| Rate for Payer: PHP Medicare Advantage |
$35.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.38
|
| Rate for Payer: Priority Health HMO/PPO |
$123.65
|
| Rate for Payer: Priority Health Medicare |
$35.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.23
|
| Rate for Payer: Railroad Medicare Medicare |
$35.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.07
|
| Rate for Payer: UHC Core |
$118.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.53
|
| Rate for Payer: UHC Exchange |
$35.53
|
| Rate for Payer: UHC Medicare Advantage |
$35.53
|
| Rate for Payer: VA VA |
$35.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.60
|
|
|
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
|
IP
|
$4.74
|
|
|
Service Code
|
NDC 60687059211
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$4.03
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.66
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.79
|
| Rate for Payer: Healthscope Commercial |
$4.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.03
|
| Rate for Payer: Nomi Health Commercial |
$3.89
|
| Rate for Payer: PHP Commercial |
$4.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.08
|
| Rate for Payer: Priority Health HMO/PPO |
$4.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.17
|
| Rate for Payer: UHC Core |
$3.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
OP
|
$4.74
|
|
|
Service Code
|
NDC 60687059211
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.27 |
| Rate for Payer: Aetna Commercial |
$4.03
|
| Rate for Payer: Aetna Medicare |
$1.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.48
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS MAPPO |
$1.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.90
|
| Rate for Payer: BCN Commercial |
$3.69
|
| Rate for Payer: BCN Medicare Advantage |
$1.18
|
| Rate for Payer: Cash Price |
$3.79
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.18
|
| Rate for Payer: Healthscope Commercial |
$4.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.03
|
| Rate for Payer: Nomi Health Commercial |
$3.89
|
| Rate for Payer: PACE Senior Care Partners |
$1.13
|
| Rate for Payer: PACE SWMI |
$1.18
|
| Rate for Payer: PHP Commercial |
$4.03
|
| Rate for Payer: PHP Medicare Advantage |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.08
|
| Rate for Payer: Priority Health HMO/PPO |
$4.12
|
| Rate for Payer: Priority Health Medicare |
$1.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.17
|
| Rate for Payer: UHC Core |
$3.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.18
|
| Rate for Payer: UHC Exchange |
$1.18
|
| Rate for Payer: UHC Medicare Advantage |
$1.18
|
| Rate for Payer: VA VA |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.56
|
|
|
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 |
$37.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$37.68
|
| 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
|
$142.13
|
|
|
Service Code
|
NDC 60687059221
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.38 |
| Max. Negotiated Rate |
$127.92 |
| Rate for Payer: Aetna Commercial |
$120.81
|
| Rate for Payer: BCBS Trust/PPO |
$116.02
|
| Rate for Payer: BCN Commercial |
$109.84
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cofinity Commercial |
$122.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.70
|
| Rate for Payer: Healthscope Commercial |
$127.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$120.81
|
| Rate for Payer: Nomi Health Commercial |
$116.55
|
| Rate for Payer: PHP Commercial |
$120.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.38
|
| Rate for Payer: Priority Health HMO/PPO |
$123.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.07
|
| Rate for Payer: UHC Core |
$118.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.60
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033390
|
| Hospital Charge Code |
21288
|
|
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 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
|
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$570.04 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare |
$81.49
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS MAPPO |
$78.36
|
| Rate for Payer: BCBS Trust/PPO |
$570.04
|
| Rate for Payer: BCN Commercial |
$172.01
|
| Rate for Payer: BCN Medicare Advantage |
$78.36
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$112.84
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.36
|
| Rate for Payer: Mclaren Medicaid |
$51.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.28
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Nomi Health Commercial |
$94.03
|
| Rate for Payer: PACE SWMI |
$78.36
|
| Rate for Payer: PHP Medicare Advantage |
$78.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health HMO/PPO |
$113.18
|
| Rate for Payer: Priority Health Medicare |
$79.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.36
|
| Rate for Payer: UHC Exchange |
$78.36
|
| Rate for Payer: UHC Medicare Advantage |
$78.36
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
|
|
PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 59001
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$523.55 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: BCBS Complete |
$119.43
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$523.55
|
| Rate for Payer: BCN Commercial |
$259.98
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$250.01
|
| Rate for Payer: Cofinity Commercial |
$232.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Mclaren Medicaid |
$113.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Meridian Medicaid |
$119.43
|
| Rate for Payer: Nomi Health Commercial |
$208.34
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO |
$249.18
|
| Rate for Payer: Priority Health Medicare |
$175.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Exchange |
$173.62
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
|
|
PRAMOXINE-ZINC OXIDE 1 %-5 % TOPICAL CREAM
|
Facility
|
OP
|
$23.94
|
|
|
Service Code
|
NDC 11868081401
|
| Hospital Charge Code |
40249
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: Aetna Medicare |
$6.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.48
|
| Rate for Payer: BCBS Complete |
$9.58
|
| Rate for Payer: BCBS MAPPO |
$5.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCN Commercial |
$18.61
|
| Rate for Payer: BCN Medicare Advantage |
$5.98
|
| 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: Health Alliance Plan Medicare Advantage |
$5.98
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: PACE Senior Care Partners |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.98
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.56
|
| Rate for Payer: Priority Health HMO/PPO |
$20.83
|
| Rate for Payer: Priority Health Medicare |
$6.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.04
|
| Rate for Payer: Railroad Medicare Medicare |
$5.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.07
|
| Rate for Payer: UHC Core |
$19.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.98
|
| Rate for Payer: UHC Exchange |
$5.98
|
| Rate for Payer: UHC Medicare Advantage |
$5.98
|
| Rate for Payer: VA VA |
$5.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.96
|
|
|
PRAMOXINE-ZINC OXIDE 1 %-5 % TOPICAL CREAM
|
Facility
|
IP
|
$23.94
|
|
|
Service Code
|
NDC 11868081401
|
| Hospital Charge Code |
40249
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: BCBS Trust/PPO |
$19.54
|
| 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 Commercial |
$20.35
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.56
|
| Rate for Payer: Priority Health HMO/PPO |
$20.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.04
|
| 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
|
$1,591.00
|
|
|
Service Code
|
HCPCS 24925
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$1,034.15 |
| Rate for Payer: Aetna Commercial |
$739.76
|
| Rate for Payer: Aetna Medicare |
$574.14
|
| Rate for Payer: BCBS Complete |
$393.40
|
| Rate for Payer: BCBS MAPPO |
$552.06
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$842.97
|
| Rate for Payer: BCN Medicare Advantage |
$552.06
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cofinity Commercial |
$794.97
|
| Rate for Payer: Cofinity Commercial |
$739.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.06
|
| Rate for Payer: Mclaren Medicaid |
$374.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$579.66
|
| Rate for Payer: Meridian Medicaid |
$393.40
|
| Rate for Payer: Nomi Health Commercial |
$662.47
|
| Rate for Payer: PACE SWMI |
$552.06
|
| Rate for Payer: PHP Medicare Advantage |
$552.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.15
|
| Rate for Payer: Priority Health HMO/PPO |
$886.44
|
| Rate for Payer: Priority Health Medicare |
$557.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$886.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.06
|
| Rate for Payer: UHC Exchange |
$552.06
|
| Rate for Payer: UHC Medicare Advantage |
$552.06
|
| Rate for Payer: UHCCP Medicaid |
$374.67
|
|
|
PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 25907
|
| Min. Negotiated Rate |
$206.57 |
| Max. Negotiated Rate |
$1,050.40 |
| Rate for Payer: Aetna Commercial |
$798.22
|
| Rate for Payer: Aetna Medicare |
$619.52
|
| Rate for Payer: BCBS Complete |
$423.82
|
| Rate for Payer: BCBS MAPPO |
$595.69
|
| Rate for Payer: BCBS Trust/PPO |
$206.57
|
| Rate for Payer: BCN Commercial |
$908.45
|
| Rate for Payer: BCN Medicare Advantage |
$595.69
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$857.79
|
| Rate for Payer: Cofinity Commercial |
$798.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.69
|
| Rate for Payer: Mclaren Medicaid |
$403.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$625.47
|
| Rate for Payer: Meridian Medicaid |
$423.82
|
| Rate for Payer: Nomi Health Commercial |
$714.83
|
| Rate for Payer: PACE SWMI |
$595.69
|
| Rate for Payer: PHP Medicare Advantage |
$595.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health HMO/PPO |
$956.15
|
| Rate for Payer: Priority Health Medicare |
$601.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$956.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$595.69
|
| Rate for Payer: UHC Exchange |
$595.69
|
| Rate for Payer: UHC Medicare Advantage |
$595.69
|
| Rate for Payer: UHCCP Medicaid |
$403.64
|
|
|
PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR
|
Professional
|
Both
|
$1,920.00
|
|
|
Service Code
|
HCPCS 25905
|
| Min. Negotiated Rate |
$173.28 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$910.20
|
| Rate for Payer: Aetna Medicare |
$706.42
|
| Rate for Payer: BCBS Complete |
$481.97
|
| Rate for Payer: BCBS MAPPO |
$679.25
|
| Rate for Payer: BCBS Trust/PPO |
$173.28
|
| Rate for Payer: BCN Commercial |
$1,035.02
|
| Rate for Payer: BCN Medicare Advantage |
$679.25
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cofinity Commercial |
$978.12
|
| Rate for Payer: Cofinity Commercial |
$910.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.25
|
| Rate for Payer: Mclaren Medicaid |
$459.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$713.21
|
| Rate for Payer: Meridian Medicaid |
$481.97
|
| Rate for Payer: Nomi Health Commercial |
$815.10
|
| Rate for Payer: PACE SWMI |
$679.25
|
| Rate for Payer: PHP Medicare Advantage |
$679.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,248.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,087.95
|
| Rate for Payer: Priority Health Medicare |
$686.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,087.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$679.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.25
|
| Rate for Payer: UHC Exchange |
$679.25
|
| Rate for Payer: UHC Medicare Advantage |
$679.25
|
| Rate for Payer: UHCCP Medicaid |
$459.02
|
|
|
PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION
|
Professional
|
Both
|
$1,237.00
|
|
|
Service Code
|
HCPCS 25909
|
| Min. Negotiated Rate |
$304.30 |
| Max. Negotiated Rate |
$1,061.99 |
| Rate for Payer: Aetna Commercial |
$889.99
|
| Rate for Payer: Aetna Medicare |
$690.74
|
| Rate for Payer: BCBS Complete |
$471.45
|
| Rate for Payer: BCBS MAPPO |
$664.17
|
| Rate for Payer: BCBS Trust/PPO |
$304.30
|
| Rate for Payer: BCN Commercial |
$1,012.05
|
| Rate for Payer: BCN Medicare Advantage |
$664.17
|
| Rate for Payer: Cash Price |
$989.60
|
| Rate for Payer: Cash Price |
$989.60
|
| Rate for Payer: Cofinity Commercial |
$956.40
|
| Rate for Payer: Cofinity Commercial |
$889.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.17
|
| Rate for Payer: Mclaren Medicaid |
$449.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.38
|
| Rate for Payer: Meridian Medicaid |
$471.45
|
| Rate for Payer: Nomi Health Commercial |
$797.00
|
| Rate for Payer: PACE SWMI |
$664.17
|
| Rate for Payer: PHP Medicare Advantage |
$664.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.05
|
| Rate for Payer: Priority Health HMO/PPO |
$1,061.99
|
| Rate for Payer: Priority Health Medicare |
$670.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,061.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$664.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$664.17
|
| Rate for Payer: UHC Exchange |
$664.17
|
| Rate for Payer: UHC Medicare Advantage |
$664.17
|
| Rate for Payer: UHCCP Medicaid |
$449.00
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 26952
|
| Min. Negotiated Rate |
$285.28 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$859.50
|
| Rate for Payer: Aetna Medicare |
$667.08
|
| Rate for Payer: BCBS Complete |
$464.74
|
| Rate for Payer: BCBS MAPPO |
$641.42
|
| Rate for Payer: BCBS Trust/PPO |
$285.28
|
| Rate for Payer: BCN Commercial |
$1,018.41
|
| Rate for Payer: BCN Medicare Advantage |
$641.42
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cofinity Commercial |
$923.64
|
| Rate for Payer: Cofinity Commercial |
$859.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.42
|
| Rate for Payer: Mclaren Medicaid |
$442.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.49
|
| Rate for Payer: Meridian Medicaid |
$464.74
|
| Rate for Payer: Nomi Health Commercial |
$769.70
|
| Rate for Payer: PACE SWMI |
$641.42
|
| Rate for Payer: PHP Medicare Advantage |
$641.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,058.43
|
| Rate for Payer: Priority Health Medicare |
$647.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,058.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$641.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.42
|
| Rate for Payer: UHC Exchange |
$641.42
|
| Rate for Payer: UHC Medicare Advantage |
$641.42
|
| Rate for Payer: UHCCP Medicaid |
$442.61
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 26951
|
| Min. Negotiated Rate |
$455.61 |
| Max. Negotiated Rate |
$4,383.83 |
| Rate for Payer: Aetna Commercial |
$881.09
|
| Rate for Payer: Aetna Medicare |
$683.83
|
| Rate for Payer: BCBS Complete |
$478.39
|
| Rate for Payer: BCBS MAPPO |
$657.53
|
| Rate for Payer: BCBS Trust/PPO |
$4,383.83
|
| Rate for Payer: BCN Commercial |
$1,042.35
|
| Rate for Payer: BCN Medicare Advantage |
$657.53
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cofinity Commercial |
$946.84
|
| Rate for Payer: Cofinity Commercial |
$881.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.53
|
| Rate for Payer: Mclaren Medicaid |
$455.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.41
|
| Rate for Payer: Meridian Medicaid |
$478.39
|
| Rate for Payer: Nomi Health Commercial |
$789.04
|
| Rate for Payer: PACE SWMI |
$657.53
|
| Rate for Payer: PHP Medicare Advantage |
$657.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,072.50
|
| Rate for Payer: Priority Health HMO/PPO |
$1,088.96
|
| Rate for Payer: Priority Health Medicare |
$664.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,088.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$657.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.53
|
| Rate for Payer: UHC Exchange |
$657.53
|
| Rate for Payer: UHC Medicare Advantage |
$657.53
|
| Rate for Payer: UHCCP Medicaid |
$455.61
|
|
|
PR AMPICILLIN 500 MG INJ
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0290
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$0.66
|
| Rate for Payer: Aetna Medicare |
$0.51
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.49
|
| Rate for Payer: BCBS Trust/PPO |
$0.17
|
| Rate for Payer: BCN Commercial |
$0.15
|
| Rate for Payer: BCN Medicare Advantage |
$0.49
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$0.70
|
| Rate for Payer: Cofinity Commercial |
$0.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.51
|
| Rate for Payer: Nomi Health Commercial |
$0.59
|
| Rate for Payer: PACE SWMI |
$0.49
|
| Rate for Payer: PHP Medicare Advantage |
$0.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$0.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.49
|
| Rate for Payer: UHC Exchange |
$0.49
|
| Rate for Payer: UHC Medicare Advantage |
$0.49
|
|
