|
PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 44384
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$402.56 |
| Rate for Payer: Aetna Commercial |
$202.43
|
| Rate for Payer: Aetna Medicare |
$157.11
|
| Rate for Payer: BCBS Complete |
$100.64
|
| Rate for Payer: BCBS MAPPO |
$151.07
|
| Rate for Payer: BCBS Trust/PPO |
$402.56
|
| Rate for Payer: BCN Commercial |
$222.35
|
| Rate for Payer: BCN Medicare Advantage |
$151.07
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$217.54
|
| Rate for Payer: Cofinity Commercial |
$202.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.07
|
| Rate for Payer: Mclaren Medicaid |
$95.85
|
| Rate for Payer: Meridian Medicaid |
$100.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.62
|
| Rate for Payer: PACE SWMI |
$151.07
|
| Rate for Payer: PHP Medicare Advantage |
$151.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.53
|
| Rate for Payer: Priority Health Medicare |
$151.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.07
|
| Rate for Payer: UHC Medicare Advantage |
$155.60
|
|
|
PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 44380
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$575.40 |
| Rate for Payer: Aetna Commercial |
$73.83
|
| Rate for Payer: Aetna Medicare |
$57.30
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCBS MAPPO |
$55.10
|
| Rate for Payer: BCBS Trust/PPO |
$247.77
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: BCN Medicare Advantage |
$55.10
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$79.34
|
| Rate for Payer: Cofinity Commercial |
$73.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.10
|
| Rate for Payer: Mclaren Medicaid |
$36.42
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.86
|
| Rate for Payer: PACE SWMI |
$55.10
|
| Rate for Payer: PHP Medicare Advantage |
$55.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.78
|
| Rate for Payer: Priority Health Medicare |
$55.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.10
|
| Rate for Payer: UHC Medicare Advantage |
$56.75
|
|
|
PR ILEOSCOPY,THRU STOMA,TRANSENDO STENT
|
Professional
|
Both
|
$1,066.00
|
|
|
Service Code
|
HCPCS 44383
|
| Min. Negotiated Rate |
$426.40 |
| Max. Negotiated Rate |
$746.20 |
| Rate for Payer: BCBS Complete |
$426.40
|
| Rate for Payer: Cash Price |
$852.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$746.20
|
|
|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$2,504.00
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$1,819.78 |
| Rate for Payer: Aetna Commercial |
$1,379.29
|
| Rate for Payer: Aetna Medicare |
$1,070.49
|
| Rate for Payer: BCBS Complete |
$695.55
|
| Rate for Payer: BCBS MAPPO |
$1,029.32
|
| Rate for Payer: BCBS Trust/PPO |
$81.93
|
| Rate for Payer: BCN Commercial |
$1,512.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,029.32
|
| Rate for Payer: Cash Price |
$2,003.20
|
| Rate for Payer: Cash Price |
$2,003.20
|
| Rate for Payer: Cofinity Commercial |
$1,482.22
|
| Rate for Payer: Cofinity Commercial |
$1,379.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,029.32
|
| Rate for Payer: Mclaren Medicaid |
$662.43
|
| Rate for Payer: Meridian Medicaid |
$695.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,080.79
|
| Rate for Payer: PACE SWMI |
$1,029.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,029.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$662.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,752.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,819.78
|
| Rate for Payer: Priority Health Medicare |
$1,029.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,819.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,029.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,060.20
|
|
|
PR ILIAC ART ANGIO,CARDIAC CATH
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS G0278
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$18.01
|
| Rate for Payer: Aetna Medicare |
$13.98
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$13.44
|
| Rate for Payer: BCBS Trust/PPO |
$152.15
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: BCN Medicare Advantage |
$13.44
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$18.01
|
| Rate for Payer: Cofinity Commercial |
$19.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.11
|
| Rate for Payer: PACE SWMI |
$13.44
|
| Rate for Payer: PHP Medicare Advantage |
$13.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.48
|
| Rate for Payer: Priority Health Medicare |
$13.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.44
|
| Rate for Payer: UHC Medicare Advantage |
$13.84
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$611.77 |
| Rate for Payer: Aetna Commercial |
$21.04
|
| Rate for Payer: Aetna Medicare |
$16.33
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$15.70
|
| Rate for Payer: BCBS Trust/PPO |
$611.77
|
| Rate for Payer: BCN Commercial |
$19.24
|
| Rate for Payer: BCN Medicare Advantage |
$15.70
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$22.61
|
| Rate for Payer: Cofinity Commercial |
$21.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16.48
|
| Rate for Payer: PACE SWMI |
$15.70
|
| Rate for Payer: PHP Medicare Advantage |
$15.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$15.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.70
|
| Rate for Payer: UHC Medicare Advantage |
$16.17
|
|
|
PR IM ADM INTRANSL/ORAL EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90474
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$652.45 |
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Medicare |
$11.76
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$11.31
|
| Rate for Payer: BCBS Trust/PPO |
$652.45
|
| Rate for Payer: BCN Commercial |
$13.75
|
| Rate for Payer: BCN Medicare Advantage |
$11.31
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$16.29
|
| Rate for Payer: Cofinity Commercial |
$15.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.88
|
| Rate for Payer: PACE SWMI |
$11.31
|
| Rate for Payer: PHP Medicare Advantage |
$11.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.72
|
| Rate for Payer: Priority Health Medicare |
$11.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.31
|
| Rate for Payer: UHC Medicare Advantage |
$11.65
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90471
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$25.58
|
| Rate for Payer: Aetna Medicare |
$19.85
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$19.09
|
| Rate for Payer: BCBS Trust/PPO |
$593.28
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: BCN Medicare Advantage |
$19.09
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$25.58
|
| Rate for Payer: Cofinity Commercial |
$27.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.04
|
| Rate for Payer: PACE SWMI |
$19.09
|
| Rate for Payer: PHP Medicare Advantage |
$19.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$19.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.09
|
| Rate for Payer: UHC Medicare Advantage |
$19.66
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90472
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$1,006.41 |
| Rate for Payer: Aetna Commercial |
$18.47
|
| Rate for Payer: Aetna Medicare |
$14.33
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$13.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.41
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$13.78
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.47
|
| Rate for Payer: PACE SWMI |
$13.78
|
| Rate for Payer: PHP Medicare Advantage |
$13.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health Medicare |
$13.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.78
|
| Rate for Payer: UHC Medicare Advantage |
$14.19
|
|
|
PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 90460
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$519.85 |
| Rate for Payer: Aetna Commercial |
$28.84
|
| Rate for Payer: Aetna Medicare |
$22.38
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$21.52
|
| Rate for Payer: BCBS Trust/PPO |
$519.85
|
| Rate for Payer: BCN Commercial |
$25.68
|
| Rate for Payer: BCN Medicare Advantage |
$21.52
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$30.99
|
| Rate for Payer: Cofinity Commercial |
$28.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.60
|
| Rate for Payer: PACE SWMI |
$21.52
|
| Rate for Payer: PHP Medicare Advantage |
$21.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$21.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.52
|
| Rate for Payer: UHC Medicare Advantage |
$22.17
|
|
|
PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90461
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$544.68 |
| Rate for Payer: Aetna Commercial |
$13.21
|
| Rate for Payer: Aetna Medicare |
$10.25
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$9.86
|
| Rate for Payer: BCBS Trust/PPO |
$544.68
|
| Rate for Payer: BCN Commercial |
$13.65
|
| Rate for Payer: BCN Medicare Advantage |
$9.86
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$13.21
|
| Rate for Payer: Cofinity Commercial |
$14.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.35
|
| Rate for Payer: PACE SWMI |
$9.86
|
| Rate for Payer: PHP Medicare Advantage |
$9.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.48
|
| Rate for Payer: Priority Health Medicare |
$9.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.86
|
| Rate for Payer: UHC Medicare Advantage |
$10.16
|
|
|
PR IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
HCPCS 10030
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$177.93
|
| Rate for Payer: Aetna Medicare |
$138.09
|
| Rate for Payer: BCBS Complete |
$88.79
|
| Rate for Payer: BCBS MAPPO |
$132.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,625.00
|
| Rate for Payer: BCN Commercial |
$952.93
|
| Rate for Payer: BCN Medicare Advantage |
$132.78
|
| Rate for Payer: Cash Price |
$591.20
|
| Rate for Payer: Cash Price |
$591.20
|
| Rate for Payer: Cofinity Commercial |
$191.20
|
| Rate for Payer: Cofinity Commercial |
$177.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$132.78
|
| Rate for Payer: Mclaren Medicaid |
$84.56
|
| Rate for Payer: Meridian Medicaid |
$88.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$139.42
|
| Rate for Payer: PACE SWMI |
$132.78
|
| Rate for Payer: PHP Medicare Advantage |
$132.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$517.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.59
|
| Rate for Payer: Priority Health Medicare |
$132.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$132.78
|
| Rate for Payer: UHC Medicare Advantage |
$136.76
|
|
|
PR IMBRICATION DIAPHRAGM EVENTRATION
|
Professional
|
Both
|
$5,313.00
|
|
|
Service Code
|
HCPCS 39545
|
| Min. Negotiated Rate |
$568.07 |
| Max. Negotiated Rate |
$3,719.10 |
| Rate for Payer: Aetna Commercial |
$1,182.50
|
| Rate for Payer: Aetna Medicare |
$917.76
|
| Rate for Payer: BCBS Complete |
$596.47
|
| Rate for Payer: BCBS MAPPO |
$882.46
|
| Rate for Payer: BCBS Trust/PPO |
$671.47
|
| Rate for Payer: BCN Commercial |
$1,295.97
|
| Rate for Payer: BCN Medicare Advantage |
$882.46
|
| Rate for Payer: Cash Price |
$4,250.40
|
| Rate for Payer: Cash Price |
$4,250.40
|
| Rate for Payer: Cofinity Commercial |
$1,182.50
|
| Rate for Payer: Cofinity Commercial |
$1,270.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$882.46
|
| Rate for Payer: Mclaren Medicaid |
$568.07
|
| Rate for Payer: Meridian Medicaid |
$596.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$926.58
|
| Rate for Payer: PACE SWMI |
$882.46
|
| Rate for Payer: PHP Medicare Advantage |
$882.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$568.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,719.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,410.75
|
| Rate for Payer: Priority Health Medicare |
$882.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,410.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$882.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$882.46
|
| Rate for Payer: UHC Medicare Advantage |
$908.93
|
|
|
PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 49406
|
| Min. Negotiated Rate |
$120.77 |
| Max. Negotiated Rate |
$2,515.24 |
| Rate for Payer: Aetna Commercial |
$253.98
|
| Rate for Payer: Aetna Medicare |
$197.12
|
| Rate for Payer: BCBS Complete |
$126.81
|
| Rate for Payer: BCBS MAPPO |
$189.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,515.24
|
| Rate for Payer: BCN Commercial |
$1,311.61
|
| Rate for Payer: BCN Medicare Advantage |
$189.54
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$272.94
|
| Rate for Payer: Cofinity Commercial |
$253.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.54
|
| Rate for Payer: Mclaren Medicaid |
$120.77
|
| Rate for Payer: Meridian Medicaid |
$126.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.02
|
| Rate for Payer: PACE SWMI |
$189.54
|
| Rate for Payer: PHP Medicare Advantage |
$189.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$333.97
|
| Rate for Payer: Priority Health Medicare |
$189.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$333.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.54
|
| Rate for Payer: UHC Medicare Advantage |
$195.23
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
NDC 50268-686-11
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna Commercial |
$2.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.53
|
| Rate for Payer: BCN Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$2.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$2.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.79
|
| Rate for Payer: PHP Commercial |
$2.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.89
|
| Rate for Payer: UHC Core |
$2.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.46
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$163.88
|
|
|
Service Code
|
NDC 50268-686-15
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.95 |
| Max. Negotiated Rate |
$147.49 |
| Rate for Payer: Aetna Commercial |
$139.30
|
| Rate for Payer: BCBS Trust/PPO |
$126.65
|
| Rate for Payer: BCN Commercial |
$126.65
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cofinity Commercial |
$140.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.10
|
| Rate for Payer: Healthscope Commercial |
$147.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.30
|
| Rate for Payer: PHP Commercial |
$139.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.21
|
| Rate for Payer: UHC Core |
$136.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.91
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$3.11
|
|
|
Service Code
|
NDC 68084-202-11
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.64
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.74
|
| Rate for Payer: UHC Core |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$310.56
|
|
|
Service Code
|
NDC 68084-202-01
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.41 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$263.98
|
| Rate for Payer: BCBS Trust/PPO |
$240.00
|
| Rate for Payer: BCN Commercial |
$240.00
|
| Rate for Payer: Cash Price |
$248.45
|
| Rate for Payer: Cofinity Commercial |
$267.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.45
|
| Rate for Payer: Healthscope Commercial |
$279.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.98
|
| Rate for Payer: PHP Commercial |
$263.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.29
|
| Rate for Payer: UHC Core |
$259.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.92
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 0011A
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$18.75
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 0012A
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 3RD DOSE
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 0013A
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 1ST
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 0071A
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$320.45
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 2ND
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 0072A
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 3RD
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 0073A
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE BST
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 0074A
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$85.82 |
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$85.82
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
