|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
OP
|
$145.94
|
|
|
Service Code
|
NDC 13668009490
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$131.35 |
| Rate for Payer: Aetna Commercial |
$124.05
|
| Rate for Payer: Aetna Medicare |
$37.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.61
|
| Rate for Payer: BCBS Complete |
$27.01
|
| Rate for Payer: BCBS MAPPO |
$36.48
|
| Rate for Payer: BCBS Trust/PPO |
$119.98
|
| Rate for Payer: BCN Commercial |
$119.98
|
| Rate for Payer: BCN Medicare Advantage |
$36.48
|
| Rate for Payer: Cash Price |
$116.75
|
| Rate for Payer: Cofinity Commercial |
$125.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.48
|
| Rate for Payer: Healthscope Commercial |
$131.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.45
|
| Rate for Payer: Mclaren Medicaid |
$25.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.31
|
| Rate for Payer: Meridian Medicaid |
$27.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$40.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.05
|
| Rate for Payer: Nomi Health Commercial |
$119.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.45
|
| Rate for Payer: PACE Senior Care Partners |
$34.66
|
| Rate for Payer: PACE SWMI |
$36.48
|
| Rate for Payer: PHP Commercial |
$124.05
|
| Rate for Payer: PHP Medicare Advantage |
$36.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.97
|
| Rate for Payer: Priority Health Medicare |
$36.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.57
|
| Rate for Payer: Railroad Medicare Medicare |
$36.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.43
|
| Rate for Payer: UHC Core |
$121.86
|
| Rate for Payer: UHC Exchange |
$36.48
|
| Rate for Payer: UHC Medicaid |
$25.73
|
| Rate for Payer: UHC Medicare Advantage |
$36.48
|
| Rate for Payer: UHCCP Medicaid |
$25.73
|
| Rate for Payer: VA VA |
$36.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.45
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
OP
|
$5.16
|
|
|
Service Code
|
NDC 60687059211
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: Aetna Commercial |
$4.39
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.96
|
| Rate for Payer: BCBS MAPPO |
$1.29
|
| Rate for Payer: BCBS Trust/PPO |
$4.24
|
| Rate for Payer: BCN Commercial |
$4.24
|
| Rate for Payer: BCN Medicare Advantage |
$1.29
|
| 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: Health Alliance Plan Medicare Advantage |
$1.29
|
| Rate for Payer: Healthscope Commercial |
$4.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.87
|
| Rate for Payer: Mclaren Medicaid |
$0.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.35
|
| Rate for Payer: Meridian Medicaid |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.42
|
| 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: PACE Senior Care Partners |
$1.23
|
| Rate for Payer: PACE SWMI |
$1.29
|
| Rate for Payer: PHP Commercial |
$4.39
|
| Rate for Payer: PHP Medicare Advantage |
$1.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.49
|
| Rate for Payer: Priority Health Medicare |
$1.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.59
|
| Rate for Payer: Railroad Medicare Medicare |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.54
|
| Rate for Payer: UHC Core |
$4.31
|
| Rate for Payer: UHC Exchange |
$1.29
|
| Rate for Payer: UHC Medicaid |
$0.91
|
| Rate for Payer: UHC Medicare Advantage |
$1.29
|
| Rate for Payer: UHCCP Medicaid |
$0.91
|
| Rate for Payer: VA VA |
$1.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.87
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033390
|
| Hospital Charge Code |
21288
|
|
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 1 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033390
|
| Hospital Charge Code |
21288
|
|
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 1 MG TABLET
|
Facility
|
IP
|
$145.94
|
|
|
Service Code
|
NDC 13668009490
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.57 |
| Max. Negotiated Rate |
$131.35 |
| Rate for Payer: Aetna Commercial |
$124.05
|
| Rate for Payer: BCBS Trust/PPO |
$120.53
|
| Rate for Payer: BCN Commercial |
$120.53
|
| Rate for Payer: Cash Price |
$116.75
|
| Rate for Payer: Cofinity Commercial |
$125.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.75
|
| Rate for Payer: Healthscope Commercial |
$131.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.05
|
| Rate for Payer: Nomi Health Commercial |
$119.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.45
|
| Rate for Payer: PHP Commercial |
$124.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.43
|
| Rate for Payer: UHC Core |
$121.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.45
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$154.66
|
|
|
Service Code
|
NDC 60687059221
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.64 |
| Max. Negotiated Rate |
$139.19 |
| Rate for Payer: Aetna Commercial |
$131.46
|
| Rate for Payer: BCBS Trust/PPO |
$127.73
|
| Rate for Payer: BCN Commercial |
$127.73
|
| 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: Healthscope Commercial |
$139.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.00
|
| 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: PHP Commercial |
$131.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.10
|
| Rate for Payer: UHC Core |
$129.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.00
|
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna Commercial |
$86.80
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$48.75
|
| Rate for Payer: BCN Commercial |
$120.51
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Mclaren Medicaid |
$46.43
|
| Rate for Payer: Meridian Medicaid |
$48.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$113.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.77
|
| Rate for Payer: UHC Medicaid |
$46.43
|
| Rate for Payer: UHCCP Medicaid |
$46.43
|
|
|
PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 59001
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$323.25 |
| Rate for Payer: Aetna Commercial |
$194.91
|
| Rate for Payer: Aetna Medicare |
$215.50
|
| Rate for Payer: BCBS Complete |
$106.90
|
| Rate for Payer: BCN Commercial |
$265.92
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Mclaren Medicaid |
$101.81
|
| Rate for Payer: Meridian Medicaid |
$106.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$251.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.03
|
| Rate for Payer: UHC Medicaid |
$101.81
|
| Rate for Payer: UHCCP Medicaid |
$101.81
|
|
|
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 |
$16.66 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$20.35
|
| Rate for Payer: BCBS Trust/PPO |
$19.77
|
| Rate for Payer: BCN Commercial |
$19.77
|
| 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 |
$17.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.95
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.66
|
| 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 |
$17.95
|
|
|
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 |
$4.22 |
| 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 |
$4.43
|
| Rate for Payer: BCBS MAPPO |
$5.99
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Medicare Advantage |
$5.99
|
| 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 |
$5.99
|
| Rate for Payer: Healthscope Commercial |
$21.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.95
|
| Rate for Payer: Mclaren Medicaid |
$4.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.28
|
| Rate for Payer: Meridian Medicaid |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.35
|
| Rate for Payer: Nomi Health Commercial |
$19.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.95
|
| Rate for Payer: PACE Senior Care Partners |
$5.69
|
| Rate for Payer: PACE SWMI |
$5.99
|
| Rate for Payer: PHP Commercial |
$20.35
|
| Rate for Payer: PHP Medicare Advantage |
$5.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.83
|
| Rate for Payer: Priority Health Medicare |
$6.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.66
|
| Rate for Payer: Railroad Medicare Medicare |
$5.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.07
|
| Rate for Payer: UHC Core |
$19.99
|
| Rate for Payer: UHC Exchange |
$5.99
|
| Rate for Payer: UHC Medicaid |
$4.22
|
| Rate for Payer: UHC Medicare Advantage |
$5.99
|
| Rate for Payer: UHCCP Medicaid |
$4.22
|
| Rate for Payer: VA VA |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.95
|
|
|
PR AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ
|
Professional
|
Both
|
$1,639.00
|
|
|
Service Code
|
HCPCS 24925
|
| Min. Negotiated Rate |
$347.83 |
| Max. Negotiated Rate |
$1,229.25 |
| Rate for Payer: Aetna Commercial |
$758.37
|
| Rate for Payer: Aetna Medicare |
$819.50
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCN Commercial |
$875.95
|
| Rate for Payer: Cash Price |
$1,311.20
|
| Rate for Payer: Cash Price |
$1,311.20
|
| Rate for Payer: Mclaren Medicaid |
$347.83
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,229.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$936.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$936.36
|
| Rate for Payer: UHC Medicaid |
$347.83
|
| Rate for Payer: UHCCP Medicaid |
$347.83
|
|
|
PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE
|
Professional
|
Both
|
$1,664.00
|
|
|
Service Code
|
HCPCS 25907
|
| Min. Negotiated Rate |
$373.39 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$820.99
|
| Rate for Payer: Aetna Medicare |
$832.00
|
| Rate for Payer: BCBS Complete |
$392.06
|
| Rate for Payer: BCN Commercial |
$943.68
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Mclaren Medicaid |
$373.39
|
| Rate for Payer: Meridian Medicaid |
$392.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,248.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$373.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,008.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,008.77
|
| Rate for Payer: UHC Medicaid |
$373.39
|
| Rate for Payer: UHCCP Medicaid |
$373.39
|
|
|
PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR
|
Professional
|
Both
|
$1,978.00
|
|
|
Service Code
|
HCPCS 25905
|
| Min. Negotiated Rate |
$420.89 |
| Max. Negotiated Rate |
$1,483.50 |
| Rate for Payer: Aetna Commercial |
$938.09
|
| Rate for Payer: Aetna Medicare |
$989.00
|
| Rate for Payer: BCBS Complete |
$441.93
|
| Rate for Payer: BCN Commercial |
$1,073.15
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Mclaren Medicaid |
$420.89
|
| Rate for Payer: Meridian Medicaid |
$441.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,483.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,147.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,147.17
|
| Rate for Payer: UHC Medicaid |
$420.89
|
| Rate for Payer: UHCCP Medicaid |
$420.89
|
|
|
PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 25909
|
| Min. Negotiated Rate |
$411.94 |
| Max. Negotiated Rate |
$1,122.14 |
| Rate for Payer: Aetna Commercial |
$915.24
|
| Rate for Payer: Aetna Medicare |
$637.00
|
| Rate for Payer: BCBS Complete |
$432.54
|
| Rate for Payer: BCN Commercial |
$1,049.74
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Mclaren Medicaid |
$411.94
|
| Rate for Payer: Meridian Medicaid |
$432.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$955.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,122.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,122.14
|
| Rate for Payer: UHC Medicaid |
$411.94
|
| Rate for Payer: UHCCP Medicaid |
$411.94
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$2,266.00
|
|
|
Service Code
|
HCPCS 26952
|
| Min. Negotiated Rate |
$425.79 |
| Max. Negotiated Rate |
$1,699.50 |
| Rate for Payer: Aetna Commercial |
$900.77
|
| Rate for Payer: Aetna Medicare |
$1,133.00
|
| Rate for Payer: BCBS Complete |
$447.08
|
| Rate for Payer: BCN Commercial |
$1,034.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Mclaren Medicaid |
$425.79
|
| Rate for Payer: Meridian Medicaid |
$447.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,699.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$425.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,106.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,106.18
|
| Rate for Payer: UHC Medicaid |
$425.79
|
| Rate for Payer: UHCCP Medicaid |
$425.79
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26951
|
| Min. Negotiated Rate |
$446.02 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna Commercial |
$916.42
|
| Rate for Payer: Aetna Medicare |
$850.00
|
| Rate for Payer: BCBS Complete |
$468.32
|
| Rate for Payer: BCN Commercial |
$1,065.18
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Mclaren Medicaid |
$446.02
|
| Rate for Payer: Meridian Medicaid |
$468.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,275.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,138.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,138.65
|
| Rate for Payer: UHC Medicaid |
$446.02
|
| Rate for Payer: UHCCP Medicaid |
$446.02
|
|
|
PR AMPICILLIN 500 MG INJ
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J0290
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$1.04
|
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
|
|
PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 27886
|
| Min. Negotiated Rate |
$383.83 |
| Max. Negotiated Rate |
$1,539.75 |
| Rate for Payer: Aetna Commercial |
$873.61
|
| Rate for Payer: Aetna Medicare |
$1,026.50
|
| Rate for Payer: BCBS Complete |
$403.02
|
| Rate for Payer: BCN Commercial |
$974.05
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Mclaren Medicaid |
$383.83
|
| Rate for Payer: Meridian Medicaid |
$403.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,539.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,041.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,041.24
|
| Rate for Payer: UHC Medicaid |
$383.83
|
| Rate for Payer: UHCCP Medicaid |
$383.83
|
|
|
PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV
|
Professional
|
Both
|
$1,773.00
|
|
|
Service Code
|
HCPCS 27884
|
| Min. Negotiated Rate |
$349.32 |
| Max. Negotiated Rate |
$1,329.75 |
| Rate for Payer: Aetna Commercial |
$767.81
|
| Rate for Payer: Aetna Medicare |
$886.50
|
| Rate for Payer: BCBS Complete |
$366.79
|
| Rate for Payer: BCN Commercial |
$870.97
|
| Rate for Payer: Cash Price |
$1,418.40
|
| Rate for Payer: Cash Price |
$1,418.40
|
| Rate for Payer: Mclaren Medicaid |
$349.32
|
| Rate for Payer: Meridian Medicaid |
$366.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,329.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$931.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$931.04
|
| Rate for Payer: UHC Medicaid |
$349.32
|
| Rate for Payer: UHCCP Medicaid |
$349.32
|
|
|
PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$2,549.00
|
|
|
Service Code
|
HCPCS 26910
|
| Min. Negotiated Rate |
$472.22 |
| Max. Negotiated Rate |
$1,911.75 |
| Rate for Payer: Aetna Commercial |
$1,007.60
|
| Rate for Payer: Aetna Medicare |
$1,274.50
|
| Rate for Payer: BCBS Complete |
$495.83
|
| Rate for Payer: BCN Commercial |
$1,152.83
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Mclaren Medicaid |
$472.22
|
| Rate for Payer: Meridian Medicaid |
$495.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,911.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,232.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,232.34
|
| Rate for Payer: UHC Medicaid |
$472.22
|
| Rate for Payer: UHCCP Medicaid |
$472.22
|
|
|
PR AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 27594
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$858.75 |
| Rate for Payer: Aetna Commercial |
$678.16
|
| Rate for Payer: Aetna Medicare |
$572.50
|
| Rate for Payer: BCBS Complete |
$320.04
|
| Rate for Payer: BCN Commercial |
$763.41
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Mclaren Medicaid |
$304.80
|
| Rate for Payer: Meridian Medicaid |
$320.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$816.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$816.06
|
| Rate for Payer: UHC Medicaid |
$304.80
|
| Rate for Payer: UHCCP Medicaid |
$304.80
|
|
|
PR AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 24920
|
| Min. Negotiated Rate |
$438.14 |
| Max. Negotiated Rate |
$1,197.74 |
| Rate for Payer: Aetna Commercial |
$978.81
|
| Rate for Payer: Aetna Medicare |
$650.50
|
| Rate for Payer: BCBS Complete |
$460.05
|
| Rate for Payer: BCN Commercial |
$1,120.46
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Mclaren Medicaid |
$438.14
|
| Rate for Payer: Meridian Medicaid |
$460.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$438.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,197.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,197.74
|
| Rate for Payer: UHC Medicaid |
$438.14
|
| Rate for Payer: UHCCP Medicaid |
$438.14
|
|
|
PR AMPUTATION ARM THRU HUMERUS RE-AMPUTATION
|
Professional
|
Both
|
$2,445.00
|
|
|
Service Code
|
HCPCS 24930
|
| Min. Negotiated Rate |
$460.51 |
| Max. Negotiated Rate |
$1,833.75 |
| Rate for Payer: Aetna Commercial |
$1,034.61
|
| Rate for Payer: Aetna Medicare |
$1,222.50
|
| Rate for Payer: BCBS Complete |
$483.54
|
| Rate for Payer: BCN Commercial |
$1,180.21
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Mclaren Medicaid |
$460.51
|
| Rate for Payer: Meridian Medicaid |
$483.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,833.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,261.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,261.61
|
| Rate for Payer: UHC Medicaid |
$460.51
|
| Rate for Payer: UHCCP Medicaid |
$460.51
|
|
|
PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE
|
Professional
|
Both
|
$2,382.00
|
|
|
Service Code
|
HCPCS 24900
|
| Min. Negotiated Rate |
$459.23 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Aetna Commercial |
$983.83
|
| Rate for Payer: Aetna Medicare |
$1,191.00
|
| Rate for Payer: BCBS Complete |
$482.19
|
| Rate for Payer: BCN Commercial |
$1,167.26
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Mclaren Medicaid |
$459.23
|
| Rate for Payer: Meridian Medicaid |
$482.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,786.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,247.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,247.77
|
| Rate for Payer: UHC Medicaid |
$459.23
|
| Rate for Payer: UHCCP Medicaid |
$459.23
|
|
|
PR AMPUTATION FOOT MIDTARSAL
|
Professional
|
Both
|
$1,682.00
|
|
|
Service Code
|
HCPCS 28800
|
| Min. Negotiated Rate |
$313.32 |
| Max. Negotiated Rate |
$1,261.50 |
| Rate for Payer: Aetna Commercial |
$707.25
|
| Rate for Payer: Aetna Medicare |
$841.00
|
| Rate for Payer: BCBS Complete |
$328.99
|
| Rate for Payer: BCN Commercial |
$796.27
|
| Rate for Payer: Cash Price |
$1,345.60
|
| Rate for Payer: Cash Price |
$1,345.60
|
| Rate for Payer: Mclaren Medicaid |
$313.32
|
| Rate for Payer: Meridian Medicaid |
$328.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,261.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$851.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$851.19
|
| Rate for Payer: UHC Medicaid |
$313.32
|
| Rate for Payer: UHCCP Medicaid |
$313.32
|
|
