|
PR IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 10030
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$582.75 |
| Rate for Payer: Aetna Commercial |
$148.19
|
| Rate for Payer: Aetna Medicare |
$388.50
|
| Rate for Payer: BCBS Complete |
$79.17
|
| Rate for Payer: BCN Commercial |
$198.70
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Mclaren Medicaid |
$75.40
|
| Rate for Payer: Meridian Medicaid |
$79.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$582.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$181.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.85
|
| Rate for Payer: UHC Medicaid |
$75.40
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
|
|
PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 49406
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$346.46 |
| Rate for Payer: Aetna Commercial |
$260.75
|
| Rate for Payer: Aetna Medicare |
$210.00
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: BCN Commercial |
$284.34
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Mclaren Medicaid |
$106.29
|
| Rate for Payer: Meridian Medicaid |
$111.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$346.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$346.46
|
| Rate for Payer: UHC Medicaid |
$106.29
|
| Rate for Payer: UHCCP Medicaid |
$106.29
|
|
|
PR IMG RETINA DETCJ/MNTR DS POC AUTON A/R UNI/BI
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 92229
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$57.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.53
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$362.88
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.98 |
| Max. Negotiated Rate |
$326.59 |
| Rate for Payer: Aetna Commercial |
$308.45
|
| Rate for Payer: Aetna Medicare |
$94.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.40
|
| Rate for Payer: BCBS Complete |
$67.17
|
| Rate for Payer: BCBS MAPPO |
$90.72
|
| Rate for Payer: BCBS Trust/PPO |
$298.32
|
| Rate for Payer: BCN Commercial |
$298.32
|
| Rate for Payer: BCN Medicare Advantage |
$90.72
|
| Rate for Payer: Cash Price |
$290.30
|
| Rate for Payer: Cofinity Commercial |
$312.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$326.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.16
|
| Rate for Payer: Mclaren Medicaid |
$63.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.26
|
| Rate for Payer: Meridian Medicaid |
$67.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$99.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.45
|
| Rate for Payer: Nomi Health Commercial |
$297.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.16
|
| Rate for Payer: PACE Senior Care Partners |
$86.18
|
| Rate for Payer: PACE SWMI |
$90.72
|
| Rate for Payer: PHP Commercial |
$308.45
|
| Rate for Payer: PHP Medicare Advantage |
$90.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$315.71
|
| Rate for Payer: Priority Health Medicare |
$91.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.56
|
| Rate for Payer: Railroad Medicare Medicare |
$90.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.33
|
| Rate for Payer: UHC Core |
$303.00
|
| Rate for Payer: UHC Exchange |
$90.72
|
| Rate for Payer: UHC Medicaid |
$63.98
|
| Rate for Payer: UHC Medicare Advantage |
$90.72
|
| Rate for Payer: UHCCP Medicaid |
$63.98
|
| Rate for Payer: VA VA |
$90.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.16
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$3.77
|
|
|
Service Code
|
NDC 50268068611
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.18
|
| Rate for Payer: BCBS Complete |
$0.70
|
| Rate for Payer: BCBS MAPPO |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.10
|
| Rate for Payer: BCN Commercial |
$3.10
|
| Rate for Payer: BCN Medicare Advantage |
$0.94
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.94
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.83
|
| Rate for Payer: Mclaren Medicaid |
$0.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.99
|
| Rate for Payer: Meridian Medicaid |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.83
|
| Rate for Payer: PACE Senior Care Partners |
$0.90
|
| Rate for Payer: PACE SWMI |
$0.94
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.28
|
| Rate for Payer: Priority Health Medicare |
$0.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.62
|
| Rate for Payer: Railroad Medicare Medicare |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.32
|
| Rate for Payer: UHC Core |
$3.15
|
| Rate for Payer: UHC Exchange |
$0.94
|
| Rate for Payer: UHC Medicaid |
$0.66
|
| Rate for Payer: UHC Medicare Advantage |
$0.94
|
| Rate for Payer: UHCCP Medicaid |
$0.66
|
| Rate for Payer: VA VA |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.83
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$188.10
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.92 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: BCBS Trust/PPO |
$155.35
|
| Rate for Payer: BCN Commercial |
$155.35
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: Nomi Health Commercial |
$154.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.07
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.53
|
| Rate for Payer: UHC Core |
$157.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.07
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$3.63
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.72
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.19
|
| Rate for Payer: UHC Core |
$3.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$362.88
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.56 |
| Max. Negotiated Rate |
$326.59 |
| Rate for Payer: Aetna Commercial |
$308.45
|
| Rate for Payer: BCBS Trust/PPO |
$299.70
|
| Rate for Payer: BCN Commercial |
$299.70
|
| Rate for Payer: Cash Price |
$290.30
|
| Rate for Payer: Cofinity Commercial |
$312.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.30
|
| Rate for Payer: Healthscope Commercial |
$326.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.45
|
| Rate for Payer: Nomi Health Commercial |
$297.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.16
|
| Rate for Payer: PHP Commercial |
$308.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$315.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$252.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.33
|
| Rate for Payer: UHC Core |
$303.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.16
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$3.77
|
|
|
Service Code
|
NDC 50268068611
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$3.11
|
| Rate for Payer: BCN Commercial |
$3.11
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.02
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.83
|
| Rate for Payer: PHP Commercial |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.32
|
| Rate for Payer: UHC Core |
$3.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.83
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$188.10
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.16 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna Medicare |
$48.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.78
|
| Rate for Payer: BCBS Complete |
$34.82
|
| Rate for Payer: BCBS MAPPO |
$47.02
|
| Rate for Payer: BCBS Trust/PPO |
$154.64
|
| Rate for Payer: BCN Commercial |
$154.64
|
| Rate for Payer: BCN Medicare Advantage |
$47.02
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.02
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.07
|
| Rate for Payer: Mclaren Medicaid |
$33.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.38
|
| Rate for Payer: Meridian Medicaid |
$34.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: Nomi Health Commercial |
$154.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.07
|
| Rate for Payer: PACE Senior Care Partners |
$44.67
|
| Rate for Payer: PACE SWMI |
$47.02
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: PHP Medicare Advantage |
$47.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.65
|
| Rate for Payer: Priority Health Medicare |
$47.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.92
|
| Rate for Payer: Railroad Medicare Medicare |
$47.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.53
|
| Rate for Payer: UHC Core |
$157.06
|
| Rate for Payer: UHC Exchange |
$47.02
|
| Rate for Payer: UHC Medicaid |
$33.16
|
| Rate for Payer: UHC Medicare Advantage |
$47.02
|
| Rate for Payer: UHCCP Medicaid |
$33.16
|
| Rate for Payer: VA VA |
$47.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.07
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$3.63
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna Medicare |
$0.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.13
|
| Rate for Payer: BCBS Complete |
$0.67
|
| Rate for Payer: BCBS MAPPO |
$0.91
|
| Rate for Payer: BCBS Trust/PPO |
$2.98
|
| Rate for Payer: BCN Commercial |
$2.98
|
| Rate for Payer: BCN Medicare Advantage |
$0.91
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.91
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Mclaren Medicaid |
$0.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.95
|
| Rate for Payer: Meridian Medicaid |
$0.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Nomi Health Commercial |
$2.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.72
|
| Rate for Payer: PACE Senior Care Partners |
$0.86
|
| Rate for Payer: PACE SWMI |
$0.91
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.16
|
| Rate for Payer: Priority Health Medicare |
$0.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.53
|
| Rate for Payer: Railroad Medicare Medicare |
$0.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.19
|
| Rate for Payer: UHC Core |
$3.03
|
| Rate for Payer: UHC Exchange |
$0.91
|
| Rate for Payer: UHC Medicaid |
$0.64
|
| Rate for Payer: UHC Medicare Advantage |
$0.91
|
| Rate for Payer: UHCCP Medicaid |
$0.64
|
| Rate for Payer: VA VA |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0011A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0012A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 3RD DOSE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0013A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 1ST
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0071A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 2ND
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0072A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 3RD
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0073A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE BST
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0074A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 25 MCG/0.25 ML 1ST DOSE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0111A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 25 MCG/0.25 ML 2ND DOSE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0112A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 1ST DOSE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0001A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 2ND DOSE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0002A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 3RD DOSE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0003A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON BST DOSE
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0004A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
|
PR IMM ADMN SARSCOV2 30MCG/0.3ML TRIS-SUCROSE 1ST
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 0051A
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
|
