|
PR ASPIRATION AND/OR INJECTION THYROID CYST
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 60300
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$3,338.86 |
| Rate for Payer: Aetna Commercial |
$61.73
|
| Rate for Payer: Aetna Medicare |
$47.91
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS MAPPO |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$3,338.86
|
| Rate for Payer: BCN Commercial |
$157.35
|
| Rate for Payer: BCN Medicare Advantage |
$46.07
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$66.34
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.07
|
| Rate for Payer: Mclaren Medicaid |
$30.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.37
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Nomi Health Commercial |
$55.28
|
| Rate for Payer: PACE SWMI |
$46.07
|
| Rate for Payer: PHP Medicare Advantage |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health HMO/PPO |
$77.00
|
| Rate for Payer: Priority Health Medicare |
$46.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.07
|
| Rate for Payer: UHC Exchange |
$46.07
|
| Rate for Payer: UHC Medicare Advantage |
$46.07
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
|
|
PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 51102
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$1,872.30 |
| Rate for Payer: Aetna Commercial |
$179.95
|
| Rate for Payer: Aetna Medicare |
$139.66
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS MAPPO |
$134.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.30
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: BCN Medicare Advantage |
$134.29
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$193.38
|
| Rate for Payer: Cofinity Commercial |
$179.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.29
|
| Rate for Payer: Mclaren Medicaid |
$89.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.00
|
| Rate for Payer: Meridian Medicaid |
$94.15
|
| Rate for Payer: Nomi Health Commercial |
$161.15
|
| Rate for Payer: PACE SWMI |
$134.29
|
| Rate for Payer: PHP Medicare Advantage |
$134.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO |
$224.75
|
| Rate for Payer: Priority Health Medicare |
$135.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.29
|
| Rate for Payer: UHC Exchange |
$134.29
|
| Rate for Payer: UHC Medicare Advantage |
$134.29
|
| Rate for Payer: UHCCP Medicaid |
$89.67
|
|
|
PR ASPIRATION BLADDER NEEDLE
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 51100
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$2,925.20 |
| Rate for Payer: Aetna Commercial |
$49.96
|
| Rate for Payer: Aetna Medicare |
$38.77
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS MAPPO |
$37.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.20
|
| Rate for Payer: BCN Commercial |
$107.02
|
| Rate for Payer: BCN Medicare Advantage |
$37.28
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$53.68
|
| Rate for Payer: Cofinity Commercial |
$49.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.28
|
| Rate for Payer: Mclaren Medicaid |
$24.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.14
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Nomi Health Commercial |
$44.74
|
| Rate for Payer: PACE SWMI |
$37.28
|
| Rate for Payer: PHP Medicare Advantage |
$37.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health HMO/PPO |
$61.78
|
| Rate for Payer: Priority Health Medicare |
$37.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.28
|
| Rate for Payer: UHC Exchange |
$37.28
|
| Rate for Payer: UHC Medicare Advantage |
$37.28
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
|
|
PR ASPIRATION BLADDER TROCAR/INTRACATHETER
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 51101
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$2,914.10 |
| Rate for Payer: Aetna Commercial |
$65.43
|
| Rate for Payer: Aetna Medicare |
$50.78
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$48.83
|
| Rate for Payer: BCBS Trust/PPO |
$2,914.10
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: BCN Medicare Advantage |
$48.83
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cofinity Commercial |
$70.32
|
| Rate for Payer: Cofinity Commercial |
$65.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.83
|
| Rate for Payer: Mclaren Medicaid |
$32.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.27
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$58.60
|
| Rate for Payer: PACE SWMI |
$48.83
|
| Rate for Payer: PHP Medicare Advantage |
$48.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.55
|
| Rate for Payer: Priority Health HMO/PPO |
$80.42
|
| Rate for Payer: Priority Health Medicare |
$49.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.83
|
| Rate for Payer: UHC Exchange |
$48.83
|
| Rate for Payer: UHC Medicare Advantage |
$48.83
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
|
|
PR ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 20612
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$2,114.22 |
| Rate for Payer: Aetna Commercial |
$52.80
|
| Rate for Payer: Aetna Medicare |
$40.98
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$39.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,114.22
|
| Rate for Payer: BCN Commercial |
$93.82
|
| Rate for Payer: BCN Medicare Advantage |
$39.40
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$56.74
|
| Rate for Payer: Cofinity Commercial |
$52.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.40
|
| Rate for Payer: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.37
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Nomi Health Commercial |
$47.28
|
| Rate for Payer: PACE SWMI |
$39.40
|
| Rate for Payer: PHP Medicare Advantage |
$39.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health HMO/PPO |
$62.58
|
| Rate for Payer: Priority Health Medicare |
$39.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.40
|
| Rate for Payer: UHC Exchange |
$39.40
|
| Rate for Payer: UHC Medicare Advantage |
$39.40
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
PR ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 96105
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$332.30 |
| Rate for Payer: Aetna Commercial |
$121.94
|
| Rate for Payer: Aetna Medicare |
$94.64
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$91.00
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: BCN Medicare Advantage |
$91.00
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$131.04
|
| Rate for Payer: Cofinity Commercial |
$121.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.55
|
| Rate for Payer: Nomi Health Commercial |
$109.20
|
| Rate for Payer: PACE SWMI |
$91.00
|
| Rate for Payer: PHP Medicare Advantage |
$91.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health HMO/PPO |
$130.27
|
| Rate for Payer: Priority Health Medicare |
$91.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.00
|
| Rate for Payer: UHC Exchange |
$91.00
|
| Rate for Payer: UHC Medicare Advantage |
$91.00
|
|
|
PR ASSESSMENT FOR HEARING AID
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS V5010
|
| Min. Negotiated Rate |
$47.05 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Aetna Commercial |
$47.05
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
|
|
PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 99483
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$405.21 |
| Rate for Payer: Aetna Commercial |
$244.93
|
| Rate for Payer: Aetna Medicare |
$190.09
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS MAPPO |
$182.78
|
| Rate for Payer: BCBS Trust/PPO |
$405.21
|
| Rate for Payer: BCN Commercial |
$288.40
|
| Rate for Payer: BCN Medicare Advantage |
$182.78
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$244.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.78
|
| Rate for Payer: Mclaren Medicaid |
$122.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.92
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Nomi Health Commercial |
$219.34
|
| Rate for Payer: PACE SWMI |
$182.78
|
| Rate for Payer: PHP Medicare Advantage |
$182.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO |
$257.57
|
| Rate for Payer: Priority Health Medicare |
$184.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.78
|
| Rate for Payer: UHC Exchange |
$182.78
|
| Rate for Payer: UHC Medicare Advantage |
$182.78
|
| Rate for Payer: UHCCP Medicaid |
$122.48
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$109.73
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.32 |
| Max. Negotiated Rate |
$98.76 |
| Rate for Payer: Aetna Commercial |
$93.27
|
| Rate for Payer: BCBS Trust/PPO |
$89.57
|
| Rate for Payer: BCN Commercial |
$84.80
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$98.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.27
|
| Rate for Payer: Nomi Health Commercial |
$89.98
|
| Rate for Payer: PHP Commercial |
$93.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: Priority Health HMO/PPO |
$95.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.56
|
| Rate for Payer: UHC Core |
$91.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.30
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
OP
|
$109.73
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$98.76 |
| Rate for Payer: Aetna Commercial |
$93.27
|
| Rate for Payer: Aetna Medicare |
$28.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.29
|
| Rate for Payer: BCBS Complete |
$43.89
|
| Rate for Payer: BCBS MAPPO |
$27.43
|
| Rate for Payer: BCBS Trust/PPO |
$90.21
|
| Rate for Payer: BCN Commercial |
$85.32
|
| Rate for Payer: BCN Medicare Advantage |
$27.43
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.43
|
| Rate for Payer: Healthscope Commercial |
$98.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.27
|
| Rate for Payer: Nomi Health Commercial |
$89.98
|
| Rate for Payer: PACE Senior Care Partners |
$26.06
|
| Rate for Payer: PACE SWMI |
$27.43
|
| Rate for Payer: PHP Commercial |
$93.27
|
| Rate for Payer: PHP Medicare Advantage |
$27.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: Priority Health HMO/PPO |
$95.47
|
| Rate for Payer: Priority Health Medicare |
$27.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.52
|
| Rate for Payer: Railroad Medicare Medicare |
$27.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.56
|
| Rate for Payer: UHC Core |
$91.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.43
|
| Rate for Payer: UHC Exchange |
$27.43
|
| Rate for Payer: UHC Medicare Advantage |
$27.43
|
| Rate for Payer: VA VA |
$27.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.30
|
|
|
PR ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 33257
|
| Min. Negotiated Rate |
$369.77 |
| Max. Negotiated Rate |
$2,631.46 |
| Rate for Payer: Aetna Commercial |
$748.52
|
| Rate for Payer: Aetna Medicare |
$580.94
|
| Rate for Payer: BCBS Complete |
$388.26
|
| Rate for Payer: BCBS MAPPO |
$558.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,631.46
|
| Rate for Payer: BCN Commercial |
$838.57
|
| Rate for Payer: BCN Medicare Advantage |
$558.60
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Cofinity Commercial |
$804.38
|
| Rate for Payer: Cofinity Commercial |
$748.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.60
|
| Rate for Payer: Mclaren Medicaid |
$369.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$586.53
|
| Rate for Payer: Meridian Medicaid |
$388.26
|
| Rate for Payer: Nomi Health Commercial |
$670.32
|
| Rate for Payer: PACE SWMI |
$558.60
|
| Rate for Payer: PHP Medicare Advantage |
$558.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.25
|
| Rate for Payer: Priority Health HMO/PPO |
$917.40
|
| Rate for Payer: Priority Health Medicare |
$564.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$917.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.60
|
| Rate for Payer: UHC Exchange |
$558.60
|
| Rate for Payer: UHC Medicare Advantage |
$558.60
|
| Rate for Payer: UHCCP Medicaid |
$369.77
|
|
|
PR ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
HCPCS 33259
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$5,209.57 |
| Rate for Payer: Aetna Commercial |
$1,087.20
|
| Rate for Payer: Aetna Medicare |
$843.79
|
| Rate for Payer: BCBS Complete |
$563.60
|
| Rate for Payer: BCBS MAPPO |
$811.34
|
| Rate for Payer: BCBS Trust/PPO |
$5,209.57
|
| Rate for Payer: BCN Commercial |
$1,216.32
|
| Rate for Payer: BCN Medicare Advantage |
$811.34
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cofinity Commercial |
$1,168.33
|
| Rate for Payer: Cofinity Commercial |
$1,087.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.34
|
| Rate for Payer: Mclaren Medicaid |
$536.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$851.91
|
| Rate for Payer: Meridian Medicaid |
$563.60
|
| Rate for Payer: Nomi Health Commercial |
$973.61
|
| Rate for Payer: PACE SWMI |
$811.34
|
| Rate for Payer: PHP Medicare Advantage |
$811.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$536.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,496.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,332.74
|
| Rate for Payer: Priority Health Medicare |
$819.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,332.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$811.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.34
|
| Rate for Payer: UHC Exchange |
$811.34
|
| Rate for Payer: UHC Medicare Advantage |
$811.34
|
| Rate for Payer: UHCCP Medicaid |
$536.76
|
|
|
PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 99464
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$1,378.86 |
| Rate for Payer: Aetna Commercial |
$91.43
|
| Rate for Payer: Aetna Medicare |
$70.96
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS MAPPO |
$68.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,378.86
|
| Rate for Payer: BCN Commercial |
$105.06
|
| Rate for Payer: BCN Medicare Advantage |
$68.23
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$98.25
|
| Rate for Payer: Cofinity Commercial |
$91.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.23
|
| Rate for Payer: Mclaren Medicaid |
$45.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.64
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Nomi Health Commercial |
$81.88
|
| Rate for Payer: PACE SWMI |
$68.23
|
| Rate for Payer: PHP Medicare Advantage |
$68.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO |
$96.47
|
| Rate for Payer: Priority Health Medicare |
$68.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.23
|
| Rate for Payer: UHC Exchange |
$68.23
|
| Rate for Payer: UHC Medicare Advantage |
$68.23
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR AUDIOMETRY FOR HEARING AID
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS S0618
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Commercial |
$43.02
|
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
|
|
PR AUDITORY EVOKED POTENTIAL
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 92585
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$221.65 |
| Rate for Payer: Aetna Medicare |
$170.50
|
| Rate for Payer: BCBS Complete |
$136.40
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.65
|
|
|
PR AUDITORY EVOKED POTENTIAL, LIMITED
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 92586
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$239.11
|
| Rate for Payer: Aetna Medicare |
$185.58
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS MAPPO |
$178.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$292.71
|
| Rate for Payer: BCN Medicare Advantage |
$178.44
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$239.11
|
| Rate for Payer: Cofinity Commercial |
$256.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.44
|
| Rate for Payer: Mclaren Medicaid |
$116.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.36
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Nomi Health Commercial |
$214.13
|
| Rate for Payer: PACE SWMI |
$178.44
|
| Rate for Payer: PHP Medicare Advantage |
$178.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: Priority Health HMO/PPO |
$279.37
|
| Rate for Payer: Priority Health Medicare |
$180.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.44
|
| Rate for Payer: UHC Exchange |
$178.44
|
| Rate for Payer: UHC Medicare Advantage |
$178.44
|
| Rate for Payer: UHCCP Medicaid |
$116.94
|
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$165.78 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$165.78
|
| Rate for Payer: Aetna Medicare |
$372.00
|
| Rate for Payer: BCBS Complete |
$297.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$182.92
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.60
|
| Rate for Payer: Priority Health HMO/PPO |
$190.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.32
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$106.93 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$218.07
|
| Rate for Payer: Aetna Medicare |
$169.25
|
| Rate for Payer: BCBS Complete |
$112.28
|
| Rate for Payer: BCBS MAPPO |
$162.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$267.42
|
| Rate for Payer: BCN Medicare Advantage |
$162.74
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cofinity Commercial |
$234.35
|
| Rate for Payer: Cofinity Commercial |
$218.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.74
|
| Rate for Payer: Mclaren Medicaid |
$106.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.88
|
| Rate for Payer: Meridian Medicaid |
$112.28
|
| Rate for Payer: Nomi Health Commercial |
$195.29
|
| Rate for Payer: PACE SWMI |
$162.74
|
| Rate for Payer: PHP Medicare Advantage |
$162.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.15
|
| Rate for Payer: Priority Health HMO/PPO |
$253.41
|
| Rate for Payer: Priority Health Medicare |
$164.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.74
|
| Rate for Payer: UHC Exchange |
$162.74
|
| Rate for Payer: UHC Medicare Advantage |
$162.74
|
| Rate for Payer: UHCCP Medicaid |
$106.93
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,381.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$2,522.42 |
| Rate for Payer: Aetna Commercial |
$2,126.55
|
| Rate for Payer: Aetna Medicare |
$1,650.46
|
| Rate for Payer: BCBS Complete |
$1,117.80
|
| Rate for Payer: BCBS MAPPO |
$1,586.98
|
| Rate for Payer: BCBS Trust/PPO |
$149.51
|
| Rate for Payer: BCN Commercial |
$2,406.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,586.98
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cofinity Commercial |
$2,285.25
|
| Rate for Payer: Cofinity Commercial |
$2,126.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,586.98
|
| Rate for Payer: Mclaren Medicaid |
$1,064.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.33
|
| Rate for Payer: Meridian Medicaid |
$1,117.80
|
| Rate for Payer: Nomi Health Commercial |
$1,904.38
|
| Rate for Payer: PACE SWMI |
$1,586.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,586.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,064.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,197.65
|
| Rate for Payer: Priority Health HMO/PPO |
$2,522.42
|
| Rate for Payer: Priority Health Medicare |
$1,602.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,522.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,586.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,586.98
|
| Rate for Payer: UHC Exchange |
$1,586.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,586.98
|
| Rate for Payer: UHCCP Medicaid |
$1,064.57
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna Medicare |
$83.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.94
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: BCBS MAPPO |
$80.75
|
| Rate for Payer: BCBS Trust/PPO |
$265.54
|
| Rate for Payer: BCN Commercial |
$251.13
|
| Rate for Payer: BCN Medicare Advantage |
$80.75
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.75
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: Nomi Health Commercial |
$264.86
|
| Rate for Payer: PACE Senior Care Partners |
$76.71
|
| Rate for Payer: PACE SWMI |
$80.75
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: PHP Medicare Advantage |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO |
$281.01
|
| Rate for Payer: Priority Health Medicare |
$81.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.41
|
| Rate for Payer: Railroad Medicare Medicare |
$80.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.24
|
| Rate for Payer: UHC Core |
$269.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.75
|
| Rate for Payer: UHC Exchange |
$80.75
|
| Rate for Payer: UHC Medicare Advantage |
$80.75
|
| Rate for Payer: VA VA |
$80.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: BCBS Trust/PPO |
$263.66
|
| Rate for Payer: BCN Commercial |
$249.61
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: Nomi Health Commercial |
$264.86
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO |
$281.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.24
|
| Rate for Payer: UHC Core |
$269.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$441.75
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.92 |
| Max. Negotiated Rate |
$397.58 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna Medicare |
$114.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.05
|
| Rate for Payer: BCBS Complete |
$176.70
|
| Rate for Payer: BCBS MAPPO |
$110.44
|
| Rate for Payer: BCBS Trust/PPO |
$363.16
|
| Rate for Payer: BCN Commercial |
$343.46
|
| Rate for Payer: BCN Medicare Advantage |
$110.44
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.44
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Nomi Health Commercial |
$362.24
|
| Rate for Payer: PACE Senior Care Partners |
$104.92
|
| Rate for Payer: PACE SWMI |
$110.44
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: PHP Medicare Advantage |
$110.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health HMO/PPO |
$384.32
|
| Rate for Payer: Priority Health Medicare |
$111.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.97
|
| Rate for Payer: Railroad Medicare Medicare |
$110.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.74
|
| Rate for Payer: UHC Core |
$368.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.44
|
| Rate for Payer: UHC Exchange |
$110.44
|
| Rate for Payer: UHC Medicare Advantage |
$110.44
|
| Rate for Payer: VA VA |
$110.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 68382007116
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.09 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: BCBS Trust/PPO |
$320.36
|
| Rate for Payer: BCN Commercial |
$303.29
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Nomi Health Commercial |
$321.81
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health HMO/PPO |
$341.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.36
|
| Rate for Payer: UHC Core |
$327.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.14 |
| Max. Negotiated Rate |
$397.58 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: BCBS Trust/PPO |
$360.60
|
| Rate for Payer: BCN Commercial |
$341.38
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Nomi Health Commercial |
$362.24
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health HMO/PPO |
$384.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.74
|
| Rate for Payer: UHC Core |
$368.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
