|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 51079078201
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO |
$3.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.23
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$300.11
|
|
|
Service Code
|
NDC 68462019790
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.07 |
| Max. Negotiated Rate |
$270.10 |
| Rate for Payer: Aetna Commercial |
$255.09
|
| Rate for Payer: BCBS Trust/PPO |
$244.98
|
| Rate for Payer: BCN Commercial |
$231.93
|
| Rate for Payer: Cash Price |
$240.09
|
| Rate for Payer: Cofinity Commercial |
$258.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.09
|
| Rate for Payer: Healthscope Commercial |
$270.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.09
|
| Rate for Payer: Nomi Health Commercial |
$246.09
|
| Rate for Payer: PHP Commercial |
$255.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.07
|
| Rate for Payer: Priority Health HMO/PPO |
$261.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.10
|
| Rate for Payer: UHC Core |
$250.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.08
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$51.14 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Aetna Medicare |
$53.19
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS MAPPO |
$51.14
|
| Rate for Payer: BCN Medicare Advantage |
$51.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$73.64
|
| Rate for Payer: Cofinity Commercial |
$68.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.70
|
| Rate for Payer: Nomi Health Commercial |
$61.37
|
| Rate for Payer: PACE SWMI |
$51.14
|
| Rate for Payer: PHP Medicare Advantage |
$51.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health Medicare |
$51.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.14
|
| Rate for Payer: UHC Exchange |
$51.14
|
| Rate for Payer: UHC Medicare Advantage |
$51.14
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$16.08 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Medicare |
$16.72
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS MAPPO |
$16.08
|
| Rate for Payer: BCN Medicare Advantage |
$16.08
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$21.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.88
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: PACE SWMI |
$16.08
|
| Rate for Payer: PHP Medicare Advantage |
$16.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health Medicare |
$16.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.08
|
| Rate for Payer: UHC Exchange |
$16.08
|
| Rate for Payer: UHC Medicare Advantage |
$16.08
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$625.60 |
| Max. Negotiated Rate |
$1,236.27 |
| Rate for Payer: Aetna Commercial |
$1,150.42
|
| Rate for Payer: Aetna Medicare |
$892.86
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$858.52
|
| Rate for Payer: BCN Medicare Advantage |
$858.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,236.27
|
| Rate for Payer: Cofinity Commercial |
$1,150.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.45
|
| Rate for Payer: Nomi Health Commercial |
$1,030.22
|
| Rate for Payer: PACE SWMI |
$858.52
|
| Rate for Payer: PHP Medicare Advantage |
$858.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$867.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.52
|
| Rate for Payer: UHC Exchange |
$858.52
|
| Rate for Payer: UHC Medicare Advantage |
$858.52
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$625.60 |
| Max. Negotiated Rate |
$1,236.27 |
| Rate for Payer: Aetna Commercial |
$1,150.42
|
| Rate for Payer: Aetna Medicare |
$892.86
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$858.52
|
| Rate for Payer: BCN Medicare Advantage |
$858.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,236.27
|
| Rate for Payer: Cofinity Commercial |
$1,150.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.45
|
| Rate for Payer: Nomi Health Commercial |
$1,030.22
|
| Rate for Payer: PACE SWMI |
$858.52
|
| Rate for Payer: PHP Medicare Advantage |
$858.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$867.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.52
|
| Rate for Payer: UHC Exchange |
$858.52
|
| Rate for Payer: UHC Medicare Advantage |
$858.52
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$371.45 |
| Max. Negotiated Rate |
$4,429.45 |
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: Aetna Medicare |
$406.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.75
|
| Rate for Payer: BCBS Complete |
$4,429.45
|
| Rate for Payer: BCBS MAPPO |
$391.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,285.76
|
| Rate for Payer: BCN Commercial |
$1,216.01
|
| Rate for Payer: BCN Medicare Advantage |
$391.00
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,345.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.00
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,173.00
|
| Rate for Payer: Mclaren Medicaid |
$4,218.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.55
|
| Rate for Payer: Meridian Medicaid |
$4,429.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: Nomi Health Commercial |
$1,282.48
|
| Rate for Payer: PACE Senior Care Partners |
$371.45
|
| Rate for Payer: PACE SWMI |
$391.00
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: PHP Medicare Advantage |
$391.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,218.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,360.68
|
| Rate for Payer: Priority Health Medicare |
$394.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,047.88
|
| Rate for Payer: Railroad Medicare Medicare |
$391.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,376.32
|
| Rate for Payer: UHC Core |
$1,305.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.00
|
| Rate for Payer: UHC Exchange |
$391.00
|
| Rate for Payer: UHC Medicare Advantage |
$391.00
|
| Rate for Payer: UHCCP Medicaid |
$4,218.24
|
| Rate for Payer: VA VA |
$391.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,173.00
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$1,016.60 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,276.69
|
| Rate for Payer: BCN Commercial |
$1,208.66
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,345.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,173.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: Nomi Health Commercial |
$1,282.48
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO |
$1,360.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,047.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,376.32
|
| Rate for Payer: UHC Core |
$1,305.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,173.00
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$681.81 |
| Max. Negotiated Rate |
$1,366.95 |
| Rate for Payer: Aetna Commercial |
$913.63
|
| Rate for Payer: Aetna Medicare |
$709.08
|
| Rate for Payer: BCBS Complete |
$841.20
|
| Rate for Payer: BCBS MAPPO |
$681.81
|
| Rate for Payer: BCN Medicare Advantage |
$681.81
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$981.81
|
| Rate for Payer: Cofinity Commercial |
$913.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.90
|
| Rate for Payer: Nomi Health Commercial |
$818.17
|
| Rate for Payer: PACE SWMI |
$681.81
|
| Rate for Payer: PHP Medicare Advantage |
$681.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: Priority Health Medicare |
$688.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$681.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.81
|
| Rate for Payer: UHC Exchange |
$681.81
|
| Rate for Payer: UHC Medicare Advantage |
$681.81
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
NDC 00378110101
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.75 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: BCBS Trust/PPO |
$387.74
|
| Rate for Payer: BCN Commercial |
$367.08
|
| 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: PHP Commercial |
$403.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health HMO/PPO |
$413.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.25
|
| 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
|
$475.00
|
|
|
Service Code
|
NDC 00378110101
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.81 |
| 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 |
$190.00
|
| Rate for Payer: BCBS MAPPO |
$118.75
|
| Rate for Payer: BCBS Trust/PPO |
$390.50
|
| Rate for Payer: BCN Commercial |
$369.31
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.75
|
| Rate for Payer: Nomi Health Commercial |
$389.50
|
| 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 Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health HMO/PPO |
$413.25
|
| Rate for Payer: Priority Health Medicare |
$119.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.25
|
| 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 Dual Complete DSNP |
$118.75
|
| Rate for Payer: UHC Exchange |
$118.75
|
| Rate for Payer: UHC Medicare Advantage |
$118.75
|
| Rate for Payer: VA VA |
$118.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.25
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$462.72
|
|
|
Service Code
|
NDC 00904702061
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.77 |
| Max. Negotiated Rate |
$416.45 |
| Rate for Payer: Aetna Commercial |
$393.31
|
| Rate for Payer: BCBS Trust/PPO |
$377.72
|
| Rate for Payer: BCN Commercial |
$357.59
|
| Rate for Payer: Cash Price |
$370.18
|
| Rate for Payer: Cofinity Commercial |
$397.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.18
|
| Rate for Payer: Healthscope Commercial |
$416.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.31
|
| Rate for Payer: Nomi Health Commercial |
$379.43
|
| Rate for Payer: PHP Commercial |
$393.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.77
|
| Rate for Payer: Priority Health HMO/PPO |
$402.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.19
|
| Rate for Payer: UHC Core |
$386.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.04
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 70954001910
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.91 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: BCBS Trust/PPO |
$272.40
|
| Rate for Payer: BCN Commercial |
$257.88
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.91
|
| Rate for Payer: Priority Health HMO/PPO |
$290.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.66
|
| Rate for Payer: UHC Core |
$278.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 70954001910
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.25 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna Medicare |
$86.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$104.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$104.28
|
| Rate for Payer: BCBS Complete |
$133.48
|
| Rate for Payer: BCBS MAPPO |
$83.42
|
| Rate for Payer: BCBS Trust/PPO |
$274.33
|
| Rate for Payer: BCN Commercial |
$259.45
|
| Rate for Payer: BCN Medicare Advantage |
$83.42
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.42
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Nomi Health Commercial |
$273.63
|
| Rate for Payer: PACE Senior Care Partners |
$79.25
|
| Rate for Payer: PACE SWMI |
$83.42
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: PHP Medicare Advantage |
$83.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.91
|
| Rate for Payer: Priority Health HMO/PPO |
$290.32
|
| Rate for Payer: Priority Health Medicare |
$84.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$223.58
|
| Rate for Payer: Railroad Medicare Medicare |
$83.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.66
|
| Rate for Payer: UHC Core |
$278.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.42
|
| Rate for Payer: UHC Exchange |
$83.42
|
| Rate for Payer: UHC Medicare Advantage |
$83.42
|
| Rate for Payer: VA VA |
$83.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.28
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$462.72
|
|
|
Service Code
|
NDC 00904702061
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$416.45 |
| Rate for Payer: Aetna Commercial |
$393.31
|
| Rate for Payer: Aetna Medicare |
$120.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$144.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$144.60
|
| Rate for Payer: BCBS Complete |
$185.09
|
| Rate for Payer: BCBS MAPPO |
$115.68
|
| Rate for Payer: BCBS Trust/PPO |
$380.40
|
| Rate for Payer: BCN Commercial |
$359.76
|
| Rate for Payer: BCN Medicare Advantage |
$115.68
|
| Rate for Payer: Cash Price |
$370.18
|
| Rate for Payer: Cofinity Commercial |
$397.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.68
|
| Rate for Payer: Healthscope Commercial |
$416.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$133.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.31
|
| Rate for Payer: Nomi Health Commercial |
$379.43
|
| Rate for Payer: PACE Senior Care Partners |
$109.90
|
| Rate for Payer: PACE SWMI |
$115.68
|
| Rate for Payer: PHP Commercial |
$393.31
|
| Rate for Payer: PHP Medicare Advantage |
$115.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.77
|
| Rate for Payer: Priority Health HMO/PPO |
$402.57
|
| Rate for Payer: Priority Health Medicare |
$116.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$310.02
|
| Rate for Payer: Railroad Medicare Medicare |
$115.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.19
|
| Rate for Payer: UHC Core |
$386.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.68
|
| Rate for Payer: UHC Exchange |
$115.68
|
| Rate for Payer: UHC Medicare Advantage |
$115.68
|
| Rate for Payer: VA VA |
$115.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.04
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$584.64
|
|
|
Service Code
|
NDC 00378320501
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$380.02 |
| Max. Negotiated Rate |
$526.18 |
| Rate for Payer: Aetna Commercial |
$496.94
|
| Rate for Payer: BCBS Trust/PPO |
$477.24
|
| Rate for Payer: BCN Commercial |
$451.81
|
| 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: PHP Commercial |
$496.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.02
|
| Rate for Payer: Priority Health HMO/PPO |
$508.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$391.71
|
| 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
|
OP
|
$584.64
|
|
|
Service Code
|
NDC 00378320501
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.85 |
| 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 |
$233.86
|
| Rate for Payer: BCBS MAPPO |
$146.16
|
| Rate for Payer: BCBS Trust/PPO |
$480.63
|
| Rate for Payer: BCN Commercial |
$454.56
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.94
|
| Rate for Payer: Nomi Health Commercial |
$479.40
|
| 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 Cigna Priority Health |
$380.02
|
| Rate for Payer: Priority Health HMO/PPO |
$508.64
|
| Rate for Payer: Priority Health Medicare |
$147.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$391.71
|
| 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 Dual Complete DSNP |
$146.16
|
| Rate for Payer: UHC Exchange |
$146.16
|
| Rate for Payer: UHC Medicare Advantage |
$146.16
|
| Rate for Payer: VA VA |
$146.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.48
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
OP
|
$10.34
|
|
|
Service Code
|
NDC 60687057233
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.79
|
| Rate for Payer: Aetna Medicare |
$2.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.23
|
| Rate for Payer: BCBS Complete |
$4.14
|
| Rate for Payer: BCBS MAPPO |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$8.50
|
| Rate for Payer: BCN Commercial |
$8.04
|
| Rate for Payer: BCN Medicare Advantage |
$2.58
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cofinity Commercial |
$8.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.58
|
| Rate for Payer: Healthscope Commercial |
$9.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.79
|
| Rate for Payer: Nomi Health Commercial |
$8.48
|
| Rate for Payer: PACE Senior Care Partners |
$2.46
|
| Rate for Payer: PACE SWMI |
$2.58
|
| Rate for Payer: PHP Commercial |
$8.79
|
| Rate for Payer: PHP Medicare Advantage |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health HMO/PPO |
$9.00
|
| Rate for Payer: Priority Health Medicare |
$2.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.93
|
| Rate for Payer: Railroad Medicare Medicare |
$2.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.10
|
| Rate for Payer: UHC Core |
$8.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.58
|
| Rate for Payer: UHC Exchange |
$2.58
|
| Rate for Payer: UHC Medicare Advantage |
$2.58
|
| Rate for Payer: VA VA |
$2.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$206.61
|
|
|
Service Code
|
NDC 60687057232
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.30 |
| Max. Negotiated Rate |
$185.95 |
| Rate for Payer: Aetna Commercial |
$175.62
|
| Rate for Payer: BCBS Trust/PPO |
$168.66
|
| Rate for Payer: BCN Commercial |
$159.67
|
| Rate for Payer: Cash Price |
$165.29
|
| Rate for Payer: Cofinity Commercial |
$177.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.29
|
| Rate for Payer: Healthscope Commercial |
$185.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.62
|
| Rate for Payer: Nomi Health Commercial |
$169.42
|
| Rate for Payer: PHP Commercial |
$175.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.30
|
| Rate for Payer: Priority Health HMO/PPO |
$179.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.82
|
| Rate for Payer: UHC Core |
$172.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.96
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$10.34
|
|
|
Service Code
|
NDC 60687057233
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.79
|
| Rate for Payer: BCBS Trust/PPO |
$8.44
|
| Rate for Payer: BCN Commercial |
$7.99
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: Cofinity Commercial |
$8.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.27
|
| Rate for Payer: Healthscope Commercial |
$9.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.79
|
| Rate for Payer: Nomi Health Commercial |
$8.48
|
| Rate for Payer: PHP Commercial |
$8.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.72
|
| Rate for Payer: Priority Health HMO/PPO |
$9.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.10
|
| Rate for Payer: UHC Core |
$8.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
OP
|
$206.61
|
|
|
Service Code
|
NDC 60687057232
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.07 |
| Max. Negotiated Rate |
$185.95 |
| Rate for Payer: Aetna Commercial |
$175.62
|
| Rate for Payer: Aetna Medicare |
$53.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$64.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$64.57
|
| Rate for Payer: BCBS Complete |
$82.64
|
| Rate for Payer: BCBS MAPPO |
$51.65
|
| Rate for Payer: BCBS Trust/PPO |
$169.85
|
| Rate for Payer: BCN Commercial |
$160.64
|
| Rate for Payer: BCN Medicare Advantage |
$51.65
|
| Rate for Payer: Cash Price |
$165.29
|
| Rate for Payer: Cofinity Commercial |
$177.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.65
|
| Rate for Payer: Healthscope Commercial |
$185.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$154.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.62
|
| Rate for Payer: Nomi Health Commercial |
$169.42
|
| Rate for Payer: PACE Senior Care Partners |
$49.07
|
| Rate for Payer: PACE SWMI |
$51.65
|
| Rate for Payer: PHP Commercial |
$175.62
|
| Rate for Payer: PHP Medicare Advantage |
$51.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.30
|
| Rate for Payer: Priority Health HMO/PPO |
$179.75
|
| Rate for Payer: Priority Health Medicare |
$52.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.43
|
| Rate for Payer: Railroad Medicare Medicare |
$51.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.82
|
| Rate for Payer: UHC Core |
$172.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.65
|
| Rate for Payer: UHC Exchange |
$51.65
|
| Rate for Payer: UHC Medicare Advantage |
$51.65
|
| Rate for Payer: VA VA |
$51.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$154.96
|
|
|
PR B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA
|
Professional
|
Both
|
$2,174.00
|
|
|
Service Code
|
HCPCS 27170
|
| Min. Negotiated Rate |
$869.60 |
| Max. Negotiated Rate |
$1,625.44 |
| Rate for Payer: Aetna Commercial |
$1,512.57
|
| Rate for Payer: Aetna Medicare |
$1,173.93
|
| Rate for Payer: BCBS Complete |
$869.60
|
| Rate for Payer: BCBS MAPPO |
$1,128.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,128.78
|
| Rate for Payer: Cash Price |
$1,739.20
|
| Rate for Payer: Cash Price |
$1,739.20
|
| Rate for Payer: Cofinity Commercial |
$1,625.44
|
| Rate for Payer: Cofinity Commercial |
$1,512.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,128.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,185.22
|
| Rate for Payer: Nomi Health Commercial |
$1,354.54
|
| Rate for Payer: PACE SWMI |
$1,128.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,128.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,413.10
|
| Rate for Payer: Priority Health Medicare |
$1,140.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,128.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,128.78
|
| Rate for Payer: UHC Exchange |
$1,128.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,128.78
|
|
|
PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 90586
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$234.69 |
| Rate for Payer: Aetna Commercial |
$218.39
|
| Rate for Payer: Aetna Medicare |
$169.50
|
| Rate for Payer: BCBS Complete |
$109.20
|
| Rate for Payer: BCBS MAPPO |
$162.98
|
| Rate for Payer: BCN Medicare Advantage |
$162.98
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$218.39
|
| Rate for Payer: Cofinity Commercial |
$234.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$171.13
|
| Rate for Payer: Nomi Health Commercial |
$195.58
|
| Rate for Payer: PACE SWMI |
$162.98
|
| Rate for Payer: PHP Medicare Advantage |
$162.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health Medicare |
$164.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.98
|
| Rate for Payer: UHC Exchange |
$162.98
|
| Rate for Payer: UHC Medicare Advantage |
$162.98
|
|
|
PR BALLN ANGIOPLASTY OPEN,BRACHCEPH
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 35458
|
| Min. Negotiated Rate |
$383.20 |
| Max. Negotiated Rate |
$622.70 |
| Rate for Payer: Aetna Medicare |
$479.00
|
| Rate for Payer: BCBS Complete |
$383.20
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.70
|
|
|
PR BALLN ANGIOPLASTY PERC,AORTIC
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 35472
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$447.85 |
| Rate for Payer: Aetna Medicare |
$344.50
|
| Rate for Payer: BCBS Complete |
$275.60
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
|
