|
PR AK SLEEVE SUSP NEOPRENE/EQUA
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS L5695
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$191.15 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Medicare |
$82.00
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCN Commercial |
$191.15
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.00
|
|
|
PR ALBUTEROL IPRATROP NON-COMP
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7620
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.18
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
|
|
PR ALBUTEROL NON-COMP CON
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7611
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.15
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.09
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
|
|
PR ALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7613
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.50 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$1.00
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.50
|
|
|
PR ALCOHOL AND/OR DRUG SERVICES
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS H0015
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$190.50 |
| Rate for Payer: Aetna Commercial |
$134.33
|
| Rate for Payer: Aetna Medicare |
$127.00
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.50
|
|
|
PR ALCOHOL/SUBS INTERV 15-30MN
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS G0396
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$32.66
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: BCBS Complete |
$19.46
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Mclaren Medicaid |
$18.53
|
| Rate for Payer: Meridian Medicaid |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.56
|
| Rate for Payer: UHC Medicaid |
$18.53
|
| Rate for Payer: UHCCP Medicaid |
$18.53
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 99408
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$47.31 |
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: Aetna Medicare |
$28.00
|
| Rate for Payer: BCBS Complete |
$18.56
|
| Rate for Payer: BCN Commercial |
$47.31
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Mclaren Medicaid |
$17.68
|
| Rate for Payer: Meridian Medicaid |
$18.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.56
|
| Rate for Payer: UHC Medicaid |
$17.68
|
| Rate for Payer: UHCCP Medicaid |
$17.68
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 99409
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$93.62 |
| Rate for Payer: Aetna Commercial |
$67.61
|
| Rate for Payer: Aetna Medicare |
$53.50
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCN Commercial |
$93.62
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Mclaren Medicaid |
$35.36
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$84.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.21
|
| Rate for Payer: UHC Medicaid |
$35.36
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
|
|
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 |
$50.47 |
| 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 |
$52.98
|
| Rate for Payer: BCBS MAPPO |
$71.56
|
| Rate for Payer: BCBS Trust/PPO |
$235.33
|
| Rate for Payer: BCN Commercial |
$235.33
|
| 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: Mclaren Medicaid |
$50.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.14
|
| Rate for Payer: Meridian Medicaid |
$52.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: Nomi Health Commercial |
$234.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$214.69
|
| 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 Choice Medicaid |
$50.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$249.04
|
| Rate for Payer: Priority Health Medicare |
$72.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.23
|
| 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 Exchange |
$71.56
|
| Rate for Payer: UHC Medicaid |
$50.47
|
| Rate for Payer: UHC Medicare Advantage |
$71.56
|
| Rate for Payer: UHCCP Medicaid |
$50.47
|
| Rate for Payer: VA VA |
$71.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
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 |
$199.23 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: BCBS Trust/PPO |
$236.41
|
| Rate for Payer: BCN Commercial |
$236.41
|
| 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: Opus (Opus Packaging Group) HMA |
$214.69
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$249.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.90
|
| Rate for Payer: UHC Core |
$239.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
HCPCS 20930
|
| Min. Negotiated Rate |
$137.26 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna Commercial |
$155.86
|
| Rate for Payer: Aetna Medicare |
$252.00
|
| Rate for Payer: BCBS Complete |
$201.60
|
| Rate for Payer: BCN Commercial |
$137.26
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$188.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.45
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL
|
Professional
|
Both
|
$459.00
|
|
|
Service Code
|
HCPCS 20931
|
| Min. Negotiated Rate |
$62.62 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Aetna Commercial |
$148.79
|
| Rate for Payer: Aetna Medicare |
$229.50
|
| Rate for Payer: BCBS Complete |
$65.75
|
| Rate for Payer: BCN Commercial |
$182.18
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Mclaren Medicaid |
$62.62
|
| Rate for Payer: Meridian Medicaid |
$65.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$344.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$177.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.26
|
| Rate for Payer: UHC Medicaid |
$62.62
|
| Rate for Payer: UHCCP Medicaid |
$62.62
|
|
|
PR ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS J2997
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$93.17 |
| Rate for Payer: Aetna Commercial |
$91.64
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: BCBS Trust/PPO |
$93.17
|
| Rate for Payer: BCN Commercial |
$90.82
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 93784
|
| Min. Negotiated Rate |
$49.46 |
| Max. Negotiated Rate |
$198.75 |
| Rate for Payer: Aetna Commercial |
$49.46
|
| Rate for Payer: Aetna Medicare |
$132.50
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCN Commercial |
$68.72
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.32
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 93790
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$20.22
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCN Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$25.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.08
|
|
|
PR AMBULATORY EEG MONITORING
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 95950
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$451.50 |
| Rate for Payer: Aetna Medicare |
$301.00
|
| Rate for Payer: BCBS Complete |
$240.80
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.50
|
|
|
PR AMINOLEVULINIC ACID HCL TOP
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS J7308
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$404.09 |
| Rate for Payer: Aetna Commercial |
$404.09
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: BCBS Trust/PPO |
$397.18
|
| Rate for Payer: BCN Commercial |
$401.85
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.50
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.41 |
| 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 |
$40.32
|
| Rate for Payer: BCBS MAPPO |
$54.46
|
| Rate for Payer: BCBS Trust/PPO |
$179.09
|
| Rate for Payer: BCN Commercial |
$179.09
|
| 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: Mclaren Medicaid |
$38.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.19
|
| Rate for Payer: Meridian Medicaid |
$40.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Nomi Health Commercial |
$178.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| 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 Choice Medicaid |
$38.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.53
|
| Rate for Payer: Priority Health Medicare |
$55.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.62
|
| 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 Exchange |
$54.46
|
| Rate for Payer: UHC Medicaid |
$38.41
|
| Rate for Payer: UHC Medicare Advantage |
$54.46
|
| Rate for Payer: UHCCP Medicaid |
$38.41
|
| 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
|
$430.05
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$299.31 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: BCBS Trust/PPO |
$355.18
|
| Rate for Payer: BCN Commercial |
$355.18
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Healthscope Commercial |
$387.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Nomi Health Commercial |
$352.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.44
|
| Rate for Payer: UHC Core |
$359.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$112.10
|
|
|
Service Code
|
NDC 13668009290
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: Aetna Medicare |
$29.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.03
|
| Rate for Payer: BCBS Complete |
$20.75
|
| Rate for Payer: BCBS MAPPO |
$28.02
|
| Rate for Payer: BCBS Trust/PPO |
$92.16
|
| Rate for Payer: BCN Commercial |
$92.16
|
| Rate for Payer: BCN Medicare Advantage |
$28.02
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.02
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Mclaren Medicaid |
$19.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.43
|
| Rate for Payer: Meridian Medicaid |
$20.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: Nomi Health Commercial |
$91.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.08
|
| Rate for Payer: PACE Senior Care Partners |
$26.62
|
| Rate for Payer: PACE SWMI |
$28.02
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: PHP Medicare Advantage |
$28.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$97.53
|
| Rate for Payer: Priority Health Medicare |
$28.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.02
|
| Rate for Payer: Railroad Medicare Medicare |
$28.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.65
|
| Rate for Payer: UHC Core |
$93.60
|
| Rate for Payer: UHC Exchange |
$28.02
|
| Rate for Payer: UHC Medicaid |
$19.76
|
| Rate for Payer: UHC Medicare Advantage |
$28.02
|
| Rate for Payer: UHCCP Medicaid |
$19.76
|
| Rate for Payer: VA VA |
$28.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: BCBS Trust/PPO |
$179.92
|
| Rate for Payer: BCN Commercial |
$179.92
|
| 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: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.62
|
| 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
|
$430.05
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.82 |
| Max. Negotiated Rate |
$387.05 |
| Rate for Payer: Aetna Commercial |
$365.54
|
| Rate for Payer: Aetna Medicare |
$111.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$134.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$134.39
|
| Rate for Payer: BCBS Complete |
$79.60
|
| Rate for Payer: BCBS MAPPO |
$107.51
|
| Rate for Payer: BCBS Trust/PPO |
$353.54
|
| Rate for Payer: BCN Commercial |
$353.54
|
| Rate for Payer: BCN Medicare Advantage |
$107.51
|
| Rate for Payer: Cash Price |
$344.04
|
| Rate for Payer: Cofinity Commercial |
$369.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.51
|
| Rate for Payer: Healthscope Commercial |
$387.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.54
|
| Rate for Payer: Mclaren Medicaid |
$75.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$112.89
|
| Rate for Payer: Meridian Medicaid |
$79.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$123.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$365.54
|
| Rate for Payer: Nomi Health Commercial |
$352.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$322.54
|
| Rate for Payer: PACE Senior Care Partners |
$102.14
|
| Rate for Payer: PACE SWMI |
$107.51
|
| Rate for Payer: PHP Commercial |
$365.54
|
| Rate for Payer: PHP Medicare Advantage |
$107.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$374.14
|
| Rate for Payer: Priority Health Medicare |
$108.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$299.31
|
| Rate for Payer: Railroad Medicare Medicare |
$107.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$378.44
|
| Rate for Payer: UHC Core |
$359.09
|
| Rate for Payer: UHC Exchange |
$107.51
|
| Rate for Payer: UHC Medicaid |
$75.82
|
| Rate for Payer: UHC Medicare Advantage |
$107.51
|
| Rate for Payer: UHCCP Medicaid |
$75.82
|
| Rate for Payer: VA VA |
$107.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.54
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 13668009290
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.02 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Aetna Commercial |
$95.28
|
| Rate for Payer: BCBS Trust/PPO |
$92.58
|
| Rate for Payer: BCN Commercial |
$92.58
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$96.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$100.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: Nomi Health Commercial |
$91.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.08
|
| Rate for Payer: PHP Commercial |
$95.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$97.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.65
|
| Rate for Payer: UHC Core |
$93.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.08
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$5.16
|
|
|
Service Code
|
NDC 60687059211
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: BCBS Trust/PPO |
$4.26
|
| Rate for Payer: BCN Commercial |
$4.26
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Cofinity Commercial |
$4.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.13
|
| Rate for Payer: Healthscope Commercial |
$4.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.39
|
| Rate for Payer: Nomi Health Commercial |
$4.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.87
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.54
|
| Rate for Payer: UHC Core |
$4.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.87
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
OP
|
$154.66
|
|
|
Service Code
|
NDC 60687059221
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.27 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna Commercial |
$131.46
|
| Rate for Payer: Aetna Medicare |
$40.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.33
|
| Rate for Payer: BCBS Complete |
$28.63
|
| Rate for Payer: BCBS MAPPO |
$38.66
|
| Rate for Payer: BCBS Trust/PPO |
$127.15
|
| Rate for Payer: BCN Commercial |
$127.15
|
| Rate for Payer: BCN Medicare Advantage |
$38.66
|
| Rate for Payer: Cash Price |
$123.73
|
| Rate for Payer: Cofinity Commercial |
$133.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.66
|
| Rate for Payer: Healthscope Commercial |
$139.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.00
|
| Rate for Payer: Mclaren Medicaid |
$27.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.60
|
| Rate for Payer: Meridian Medicaid |
$28.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.46
|
| Rate for Payer: Nomi Health Commercial |
$126.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.00
|
| Rate for Payer: PACE Senior Care Partners |
$36.73
|
| Rate for Payer: PACE SWMI |
$38.66
|
| Rate for Payer: PHP Commercial |
$131.46
|
| Rate for Payer: PHP Medicare Advantage |
$38.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$39.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.64
|
| Rate for Payer: Railroad Medicare Medicare |
$38.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.10
|
| Rate for Payer: UHC Core |
$129.14
|
| Rate for Payer: UHC Exchange |
$38.66
|
| Rate for Payer: UHC Medicaid |
$27.27
|
| Rate for Payer: UHC Medicare Advantage |
$38.66
|
| Rate for Payer: UHCCP Medicaid |
$27.27
|
| Rate for Payer: VA VA |
$38.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.00
|
|
