|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$38.00
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCN Commercial |
$19.64
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Mclaren Medicaid |
$9.59
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.78
|
| Rate for Payer: UHC Medicaid |
$9.59
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,611.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$535.70 |
| Max. Negotiated Rate |
$1,775.11 |
| Rate for Payer: Aetna Commercial |
$1,096.73
|
| Rate for Payer: Aetna Medicare |
$805.50
|
| Rate for Payer: BCBS Complete |
$562.49
|
| Rate for Payer: BCN Commercial |
$1,334.10
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Mclaren Medicaid |
$535.70
|
| Rate for Payer: Meridian Medicaid |
$562.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,775.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,775.11
|
| Rate for Payer: UHC Medicaid |
$535.70
|
| Rate for Payer: UHCCP Medicaid |
$535.70
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,166.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$429.62 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna Commercial |
$870.38
|
| Rate for Payer: Aetna Medicare |
$1,083.00
|
| Rate for Payer: BCBS Complete |
$451.10
|
| Rate for Payer: BCN Commercial |
$1,062.20
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Mclaren Medicaid |
$429.62
|
| Rate for Payer: Meridian Medicaid |
$451.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,624.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,413.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,413.33
|
| Rate for Payer: UHC Medicaid |
$429.62
|
| Rate for Payer: UHCCP Medicaid |
$429.62
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$314.90
|
|
|
Service Code
|
NDC 70954001910
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.17 |
| Max. Negotiated Rate |
$283.41 |
| Rate for Payer: Aetna Commercial |
$267.67
|
| Rate for Payer: BCBS Trust/PPO |
$260.08
|
| Rate for Payer: BCN Commercial |
$260.08
|
| Rate for Payer: Cash Price |
$251.92
|
| Rate for Payer: Cofinity Commercial |
$270.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.92
|
| Rate for Payer: Healthscope Commercial |
$283.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.67
|
| Rate for Payer: Nomi Health Commercial |
$258.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.18
|
| Rate for Payer: PHP Commercial |
$267.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$273.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.11
|
| Rate for Payer: UHC Core |
$262.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.18
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
NDC 00378110101
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.60 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: BCBS Trust/PPO |
$392.30
|
| Rate for Payer: BCN Commercial |
$392.30
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.75
|
| Rate for Payer: Nomi Health Commercial |
$389.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.25
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$413.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.00
|
| Rate for Payer: UHC Core |
$396.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$483.84
|
|
|
Service Code
|
NDC 00904702061
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.30 |
| Max. Negotiated Rate |
$435.46 |
| Rate for Payer: Aetna Commercial |
$411.26
|
| Rate for Payer: Aetna Medicare |
$125.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$151.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$151.20
|
| Rate for Payer: BCBS Complete |
$89.56
|
| Rate for Payer: BCBS MAPPO |
$120.96
|
| Rate for Payer: BCBS Trust/PPO |
$397.76
|
| Rate for Payer: BCN Commercial |
$397.76
|
| Rate for Payer: BCN Medicare Advantage |
$120.96
|
| Rate for Payer: Cash Price |
$387.07
|
| Rate for Payer: Cofinity Commercial |
$416.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.96
|
| Rate for Payer: Healthscope Commercial |
$435.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.88
|
| Rate for Payer: Mclaren Medicaid |
$85.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.01
|
| Rate for Payer: Meridian Medicaid |
$89.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$133.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.26
|
| Rate for Payer: Nomi Health Commercial |
$396.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.88
|
| Rate for Payer: PACE Senior Care Partners |
$114.91
|
| Rate for Payer: PACE SWMI |
$120.96
|
| Rate for Payer: PHP Commercial |
$411.26
|
| Rate for Payer: PHP Medicare Advantage |
$120.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$420.94
|
| Rate for Payer: Priority Health Medicare |
$122.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.75
|
| Rate for Payer: Railroad Medicare Medicare |
$120.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.78
|
| Rate for Payer: UHC Core |
$404.01
|
| Rate for Payer: UHC Exchange |
$120.96
|
| Rate for Payer: UHC Medicaid |
$85.30
|
| Rate for Payer: UHC Medicare Advantage |
$120.96
|
| Rate for Payer: UHCCP Medicaid |
$85.30
|
| Rate for Payer: VA VA |
$120.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.88
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$314.90
|
|
|
Service Code
|
NDC 70954001910
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.52 |
| Max. Negotiated Rate |
$283.41 |
| Rate for Payer: Aetna Commercial |
$267.67
|
| Rate for Payer: Aetna Medicare |
$81.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.41
|
| Rate for Payer: BCBS Complete |
$58.29
|
| Rate for Payer: BCBS MAPPO |
$78.72
|
| Rate for Payer: BCBS Trust/PPO |
$258.88
|
| Rate for Payer: BCN Commercial |
$258.88
|
| Rate for Payer: BCN Medicare Advantage |
$78.72
|
| Rate for Payer: Cash Price |
$251.92
|
| Rate for Payer: Cofinity Commercial |
$270.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.72
|
| Rate for Payer: Healthscope Commercial |
$283.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.18
|
| Rate for Payer: Mclaren Medicaid |
$55.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.66
|
| Rate for Payer: Meridian Medicaid |
$58.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.67
|
| Rate for Payer: Nomi Health Commercial |
$258.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.18
|
| Rate for Payer: PACE Senior Care Partners |
$74.79
|
| Rate for Payer: PACE SWMI |
$78.72
|
| Rate for Payer: PHP Commercial |
$267.67
|
| Rate for Payer: PHP Medicare Advantage |
$78.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$273.96
|
| Rate for Payer: Priority Health Medicare |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.17
|
| Rate for Payer: Railroad Medicare Medicare |
$78.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.11
|
| Rate for Payer: UHC Core |
$262.94
|
| Rate for Payer: UHC Exchange |
$78.72
|
| Rate for Payer: UHC Medicaid |
$55.52
|
| Rate for Payer: UHC Medicare Advantage |
$78.72
|
| Rate for Payer: UHCCP Medicaid |
$55.52
|
| Rate for Payer: VA VA |
$78.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.18
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$483.84
|
|
|
Service Code
|
NDC 00904702061
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$336.75 |
| Max. Negotiated Rate |
$435.46 |
| Rate for Payer: Aetna Commercial |
$411.26
|
| Rate for Payer: BCBS Trust/PPO |
$399.60
|
| Rate for Payer: BCN Commercial |
$399.60
|
| Rate for Payer: Cash Price |
$387.07
|
| Rate for Payer: Cofinity Commercial |
$416.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.07
|
| Rate for Payer: Healthscope Commercial |
$435.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.26
|
| Rate for Payer: Nomi Health Commercial |
$396.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.88
|
| Rate for Payer: PHP Commercial |
$411.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$420.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.78
|
| Rate for Payer: UHC Core |
$404.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.88
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
NDC 00378110101
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.74 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.44
|
| Rate for Payer: BCBS Complete |
$87.92
|
| Rate for Payer: BCBS MAPPO |
$118.75
|
| Rate for Payer: BCBS Trust/PPO |
$390.50
|
| Rate for Payer: BCN Commercial |
$390.50
|
| Rate for Payer: BCN Medicare Advantage |
$118.75
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$408.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$380.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.75
|
| Rate for Payer: Healthscope Commercial |
$427.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.25
|
| Rate for Payer: Mclaren Medicaid |
$83.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.69
|
| Rate for Payer: Meridian Medicaid |
$87.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.75
|
| Rate for Payer: Nomi Health Commercial |
$389.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.25
|
| Rate for Payer: PACE Senior Care Partners |
$112.81
|
| Rate for Payer: PACE SWMI |
$118.75
|
| Rate for Payer: PHP Commercial |
$403.75
|
| Rate for Payer: PHP Medicare Advantage |
$118.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$413.25
|
| Rate for Payer: Priority Health Medicare |
$119.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.60
|
| Rate for Payer: Railroad Medicare Medicare |
$118.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.00
|
| Rate for Payer: UHC Core |
$396.62
|
| Rate for Payer: UHC Exchange |
$118.75
|
| Rate for Payer: UHC Medicaid |
$83.74
|
| Rate for Payer: UHC Medicare Advantage |
$118.75
|
| Rate for Payer: UHCCP Medicaid |
$83.74
|
| Rate for Payer: VA VA |
$118.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$584.64
|
|
|
Service Code
|
NDC 00378320501
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$406.91 |
| Max. Negotiated Rate |
$526.18 |
| Rate for Payer: Aetna Commercial |
$496.94
|
| Rate for Payer: BCBS Trust/PPO |
$482.85
|
| Rate for Payer: BCN Commercial |
$482.85
|
| Rate for Payer: Cash Price |
$467.71
|
| Rate for Payer: Cofinity Commercial |
$502.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.71
|
| Rate for Payer: Healthscope Commercial |
$526.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.94
|
| Rate for Payer: Nomi Health Commercial |
$479.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.48
|
| Rate for Payer: PHP Commercial |
$496.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$508.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$406.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.48
|
| Rate for Payer: UHC Core |
$488.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.48
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$217.79
|
|
|
Service Code
|
NDC 60687057232
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.58 |
| Max. Negotiated Rate |
$196.01 |
| Rate for Payer: Aetna Commercial |
$185.12
|
| Rate for Payer: BCBS Trust/PPO |
$179.87
|
| Rate for Payer: BCN Commercial |
$179.87
|
| Rate for Payer: Cash Price |
$174.23
|
| Rate for Payer: Cofinity Commercial |
$187.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.23
|
| Rate for Payer: Healthscope Commercial |
$196.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.12
|
| Rate for Payer: Nomi Health Commercial |
$178.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.34
|
| Rate for Payer: PHP Commercial |
$185.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.66
|
| Rate for Payer: UHC Core |
$181.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.34
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
OP
|
$217.79
|
|
|
Service Code
|
NDC 60687057232
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$196.01 |
| Rate for Payer: Aetna Commercial |
$185.12
|
| Rate for Payer: Aetna Medicare |
$56.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.06
|
| Rate for Payer: BCBS Complete |
$40.31
|
| Rate for Payer: BCBS MAPPO |
$54.45
|
| Rate for Payer: BCBS Trust/PPO |
$179.05
|
| Rate for Payer: BCN Commercial |
$179.05
|
| Rate for Payer: BCN Medicare Advantage |
$54.45
|
| Rate for Payer: Cash Price |
$174.23
|
| Rate for Payer: Cofinity Commercial |
$187.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.45
|
| Rate for Payer: Healthscope Commercial |
$196.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.34
|
| Rate for Payer: Mclaren Medicaid |
$38.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.17
|
| Rate for Payer: Meridian Medicaid |
$40.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$59.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.12
|
| Rate for Payer: Nomi Health Commercial |
$178.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.34
|
| Rate for Payer: PACE Senior Care Partners |
$51.73
|
| Rate for Payer: PACE SWMI |
$54.45
|
| Rate for Payer: PHP Commercial |
$185.12
|
| Rate for Payer: PHP Medicare Advantage |
$54.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$189.48
|
| Rate for Payer: Priority Health Medicare |
$54.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.58
|
| Rate for Payer: Railroad Medicare Medicare |
$54.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.66
|
| Rate for Payer: UHC Core |
$181.85
|
| Rate for Payer: UHC Exchange |
$54.45
|
| Rate for Payer: UHC Medicaid |
$38.40
|
| Rate for Payer: UHC Medicare Advantage |
$54.45
|
| Rate for Payer: UHCCP Medicaid |
$38.40
|
| Rate for Payer: VA VA |
$54.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.34
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
OP
|
$207.10
|
|
|
Service Code
|
NDC 70756044011
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.51 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna Commercial |
$176.03
|
| Rate for Payer: Aetna Medicare |
$53.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.72
|
| Rate for Payer: BCBS Complete |
$38.33
|
| Rate for Payer: BCBS MAPPO |
$51.77
|
| Rate for Payer: BCBS Trust/PPO |
$170.26
|
| Rate for Payer: BCN Commercial |
$170.26
|
| Rate for Payer: BCN Medicare Advantage |
$51.77
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.77
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.32
|
| Rate for Payer: Mclaren Medicaid |
$36.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.36
|
| Rate for Payer: Meridian Medicaid |
$38.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.03
|
| Rate for Payer: Nomi Health Commercial |
$169.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.32
|
| Rate for Payer: PACE Senior Care Partners |
$49.19
|
| Rate for Payer: PACE SWMI |
$51.77
|
| Rate for Payer: PHP Commercial |
$176.03
|
| Rate for Payer: PHP Medicare Advantage |
$51.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.18
|
| Rate for Payer: Priority Health Medicare |
$52.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.14
|
| Rate for Payer: Railroad Medicare Medicare |
$51.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.25
|
| Rate for Payer: UHC Core |
$172.93
|
| Rate for Payer: UHC Exchange |
$51.77
|
| Rate for Payer: UHC Medicaid |
$36.51
|
| Rate for Payer: UHC Medicare Advantage |
$51.77
|
| Rate for Payer: UHCCP Medicaid |
$36.51
|
| Rate for Payer: VA VA |
$51.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.32
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
OP
|
$10.89
|
|
|
Service Code
|
NDC 60687057233
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$9.80 |
| Rate for Payer: Aetna Commercial |
$9.26
|
| Rate for Payer: Aetna Medicare |
$2.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.40
|
| Rate for Payer: BCBS Complete |
$2.02
|
| Rate for Payer: BCBS MAPPO |
$2.72
|
| Rate for Payer: BCBS Trust/PPO |
$8.95
|
| Rate for Payer: BCN Commercial |
$8.95
|
| Rate for Payer: BCN Medicare Advantage |
$2.72
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.72
|
| Rate for Payer: Healthscope Commercial |
$9.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.17
|
| Rate for Payer: Mclaren Medicaid |
$1.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.86
|
| Rate for Payer: Meridian Medicaid |
$2.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.26
|
| Rate for Payer: Nomi Health Commercial |
$8.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.17
|
| Rate for Payer: PACE Senior Care Partners |
$2.59
|
| Rate for Payer: PACE SWMI |
$2.72
|
| Rate for Payer: PHP Commercial |
$9.26
|
| Rate for Payer: PHP Medicare Advantage |
$2.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.47
|
| Rate for Payer: Priority Health Medicare |
$2.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.58
|
| Rate for Payer: Railroad Medicare Medicare |
$2.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.58
|
| Rate for Payer: UHC Core |
$9.09
|
| Rate for Payer: UHC Exchange |
$2.72
|
| Rate for Payer: UHC Medicaid |
$1.92
|
| Rate for Payer: UHC Medicare Advantage |
$2.72
|
| Rate for Payer: UHCCP Medicaid |
$1.92
|
| Rate for Payer: VA VA |
$2.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.17
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
OP
|
$584.64
|
|
|
Service Code
|
NDC 00378320501
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.07 |
| Max. Negotiated Rate |
$526.18 |
| Rate for Payer: Aetna Commercial |
$496.94
|
| Rate for Payer: Aetna Medicare |
$152.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.70
|
| Rate for Payer: BCBS Complete |
$108.22
|
| Rate for Payer: BCBS MAPPO |
$146.16
|
| Rate for Payer: BCBS Trust/PPO |
$480.63
|
| Rate for Payer: BCN Commercial |
$480.63
|
| Rate for Payer: BCN Medicare Advantage |
$146.16
|
| Rate for Payer: Cash Price |
$467.71
|
| Rate for Payer: Cofinity Commercial |
$502.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.16
|
| Rate for Payer: Healthscope Commercial |
$526.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.48
|
| Rate for Payer: Mclaren Medicaid |
$103.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.47
|
| Rate for Payer: Meridian Medicaid |
$108.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.94
|
| Rate for Payer: Nomi Health Commercial |
$479.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.48
|
| Rate for Payer: PACE Senior Care Partners |
$138.85
|
| Rate for Payer: PACE SWMI |
$146.16
|
| Rate for Payer: PHP Commercial |
$496.94
|
| Rate for Payer: PHP Medicare Advantage |
$146.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$508.64
|
| Rate for Payer: Priority Health Medicare |
$147.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$406.91
|
| Rate for Payer: Railroad Medicare Medicare |
$146.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.48
|
| Rate for Payer: UHC Core |
$488.17
|
| Rate for Payer: UHC Exchange |
$146.16
|
| Rate for Payer: UHC Medicaid |
$103.07
|
| Rate for Payer: UHC Medicare Advantage |
$146.16
|
| Rate for Payer: UHCCP Medicaid |
$103.07
|
| Rate for Payer: VA VA |
$146.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.48
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$207.10
|
|
|
Service Code
|
NDC 70756044011
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.14 |
| Max. Negotiated Rate |
$186.39 |
| Rate for Payer: Aetna Commercial |
$176.03
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: Cash Price |
$165.68
|
| Rate for Payer: Cofinity Commercial |
$178.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.68
|
| Rate for Payer: Healthscope Commercial |
$186.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.03
|
| Rate for Payer: Nomi Health Commercial |
$169.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.32
|
| Rate for Payer: PHP Commercial |
$176.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$180.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.25
|
| Rate for Payer: UHC Core |
$172.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.32
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$10.89
|
|
|
Service Code
|
NDC 60687057233
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$9.80 |
| Rate for Payer: Aetna Commercial |
$9.26
|
| Rate for Payer: BCBS Trust/PPO |
$8.99
|
| Rate for Payer: BCN Commercial |
$8.99
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Cofinity Commercial |
$9.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.71
|
| Rate for Payer: Healthscope Commercial |
$9.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.26
|
| Rate for Payer: Nomi Health Commercial |
$8.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.17
|
| Rate for Payer: PHP Commercial |
$9.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.58
|
| Rate for Payer: UHC Core |
$9.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.17
|
|
|
PR B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA
|
Professional
|
Both
|
$2,239.00
|
|
|
Service Code
|
HCPCS 27170
|
| Min. Negotiated Rate |
$679.26 |
| Max. Negotiated Rate |
$1,892.43 |
| Rate for Payer: Aetna Commercial |
$1,567.73
|
| Rate for Payer: Aetna Medicare |
$1,119.50
|
| Rate for Payer: BCBS Complete |
$713.22
|
| Rate for Payer: BCN Commercial |
$1,770.32
|
| Rate for Payer: Cash Price |
$1,791.20
|
| Rate for Payer: Cash Price |
$1,791.20
|
| Rate for Payer: Mclaren Medicaid |
$679.26
|
| Rate for Payer: Meridian Medicaid |
$713.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,679.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$679.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,892.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,892.43
|
| Rate for Payer: UHC Medicaid |
$679.26
|
| Rate for Payer: UHCCP Medicaid |
$679.26
|
|
|
PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 90586
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$210.75 |
| Rate for Payer: Aetna Commercial |
$144.50
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS Trust/PPO |
$181.97
|
| Rate for Payer: BCN Commercial |
$173.84
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.75
|
|
|
PR BALLN ANGIOPLASTY OPEN,BRACHCEPH
|
Professional
|
Both
|
$987.00
|
|
|
Service Code
|
HCPCS 35458
|
| Min. Negotiated Rate |
$394.80 |
| Max. Negotiated Rate |
$740.25 |
| Rate for Payer: Aetna Medicare |
$493.50
|
| Rate for Payer: BCBS Complete |
$394.80
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$740.25
|
|
|
PR BALLN ANGIOPLASTY PERC,AORTIC
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 35472
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Aetna Medicare |
$355.00
|
| Rate for Payer: BCBS Complete |
$284.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.50
|
|
|
PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35475
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Aetna Medicare |
$1,050.00
|
| Rate for Payer: BCBS Complete |
$840.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.00
|
|
|
PR BALLN ANGIOPLASTY,PERC VENOUS
|
Professional
|
Both
|
$3,544.00
|
|
|
Service Code
|
HCPCS 35476
|
| Min. Negotiated Rate |
$1,417.60 |
| Max. Negotiated Rate |
$2,658.00 |
| Rate for Payer: Aetna Medicare |
$1,772.00
|
| Rate for Payer: BCBS Complete |
$1,417.60
|
| Rate for Payer: Cash Price |
$2,835.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,658.00
|
|
|
PR BALLN ANGIOPLASTY PERC,VISCERAL
|
Professional
|
Both
|
$2,943.00
|
|
|
Service Code
|
HCPCS 35471
|
| Min. Negotiated Rate |
$1,177.20 |
| Max. Negotiated Rate |
$2,207.25 |
| Rate for Payer: Aetna Medicare |
$1,471.50
|
| Rate for Payer: BCBS Complete |
$1,177.20
|
| Rate for Payer: Cash Price |
$2,354.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,207.25
|
|
|
PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS
|
Professional
|
Both
|
$5,070.00
|
|
|
Service Code
|
HCPCS 61630
|
| Min. Negotiated Rate |
$1,768.28 |
| Max. Negotiated Rate |
$3,802.50 |
| Rate for Payer: Aetna Commercial |
$1,768.28
|
| Rate for Payer: Aetna Medicare |
$2,535.00
|
| Rate for Payer: BCBS Complete |
$2,028.00
|
| Rate for Payer: BCN Commercial |
$2,048.19
|
| Rate for Payer: Cash Price |
$4,056.00
|
| Rate for Payer: Cash Price |
$4,056.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,802.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,378.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,378.94
|
|
