|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$1,855.41 |
| Rate for Payer: Aetna Commercial |
$1,344.90
|
| Rate for Payer: Aetna Medicare |
$1,043.81
|
| Rate for Payer: BCBS Complete |
$699.13
|
| Rate for Payer: BCBS MAPPO |
$1,003.66
|
| Rate for Payer: BCBS Trust/PPO |
$81.93
|
| Rate for Payer: BCN Commercial |
$1,512.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,003.66
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cofinity Commercial |
$1,445.27
|
| Rate for Payer: Cofinity Commercial |
$1,344.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,003.66
|
| Rate for Payer: Mclaren Medicaid |
$665.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,053.84
|
| Rate for Payer: Meridian Medicaid |
$699.13
|
| Rate for Payer: Nomi Health Commercial |
$1,204.39
|
| Rate for Payer: PACE SWMI |
$1,003.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,003.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$665.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,855.41
|
| Rate for Payer: Priority Health Medicare |
$1,013.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,855.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,003.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,003.66
|
| Rate for Payer: UHC Exchange |
$1,003.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,003.66
|
| Rate for Payer: UHCCP Medicaid |
$665.84
|
|
|
PR ILIAC ART ANGIO,CARDIAC CATH
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G0278
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Medicare |
$13.15
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$12.64
|
| Rate for Payer: BCBS Trust/PPO |
$152.15
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: BCN Medicare Advantage |
$12.64
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$16.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.27
|
| Rate for Payer: Nomi Health Commercial |
$15.17
|
| Rate for Payer: PACE SWMI |
$12.64
|
| Rate for Payer: PHP Medicare Advantage |
$12.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO |
$20.54
|
| Rate for Payer: Priority Health Medicare |
$12.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.64
|
| Rate for Payer: UHC Exchange |
$12.64
|
| Rate for Payer: UHC Medicare Advantage |
$12.64
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$611.77 |
| Rate for Payer: Aetna Commercial |
$20.52
|
| Rate for Payer: Aetna Medicare |
$15.92
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$15.31
|
| Rate for Payer: BCBS Trust/PPO |
$611.77
|
| Rate for Payer: BCN Commercial |
$19.24
|
| Rate for Payer: BCN Medicare Advantage |
$15.31
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$22.05
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.08
|
| Rate for Payer: Nomi Health Commercial |
$18.37
|
| Rate for Payer: PACE SWMI |
$15.31
|
| Rate for Payer: PHP Medicare Advantage |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$15.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.31
|
| Rate for Payer: UHC Exchange |
$15.31
|
| Rate for Payer: UHC Medicare Advantage |
$15.31
|
|
|
PR IM ADM INTRANSL/ORAL EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90474
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$652.45 |
| Rate for Payer: Aetna Commercial |
$14.90
|
| Rate for Payer: Aetna Medicare |
$11.56
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$11.12
|
| Rate for Payer: BCBS Trust/PPO |
$652.45
|
| Rate for Payer: BCN Commercial |
$13.75
|
| Rate for Payer: BCN Medicare Advantage |
$11.12
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$14.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.68
|
| Rate for Payer: Nomi Health Commercial |
$13.34
|
| Rate for Payer: PACE SWMI |
$11.12
|
| Rate for Payer: PHP Medicare Advantage |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO |
$16.28
|
| Rate for Payer: Priority Health Medicare |
$11.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.12
|
| Rate for Payer: UHC Exchange |
$11.12
|
| Rate for Payer: UHC Medicare Advantage |
$11.12
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90471
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$25.25
|
| Rate for Payer: Aetna Medicare |
$19.59
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$18.84
|
| Rate for Payer: BCBS Trust/PPO |
$593.28
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: BCN Medicare Advantage |
$18.84
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$27.13
|
| Rate for Payer: Cofinity Commercial |
$25.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.78
|
| Rate for Payer: Nomi Health Commercial |
$22.61
|
| Rate for Payer: PACE SWMI |
$18.84
|
| Rate for Payer: PHP Medicare Advantage |
$18.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$19.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.84
|
| Rate for Payer: UHC Exchange |
$18.84
|
| Rate for Payer: UHC Medicare Advantage |
$18.84
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90472
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$1,006.41 |
| Rate for Payer: Aetna Commercial |
$18.06
|
| Rate for Payer: Aetna Medicare |
$14.02
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$13.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.41
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: BCN Medicare Advantage |
$13.48
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.41
|
| Rate for Payer: Cofinity Commercial |
$18.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.15
|
| Rate for Payer: Nomi Health Commercial |
$16.18
|
| Rate for Payer: PACE SWMI |
$13.48
|
| Rate for Payer: PHP Medicare Advantage |
$13.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO |
$19.91
|
| Rate for Payer: Priority Health Medicare |
$13.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.48
|
| Rate for Payer: UHC Exchange |
$13.48
|
| Rate for Payer: UHC Medicare Advantage |
$13.48
|
|
|
PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 90460
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$519.85 |
| Rate for Payer: Aetna Commercial |
$28.39
|
| Rate for Payer: Aetna Medicare |
$22.04
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$21.19
|
| Rate for Payer: BCBS Trust/PPO |
$519.85
|
| Rate for Payer: BCN Commercial |
$25.68
|
| Rate for Payer: BCN Medicare Advantage |
$21.19
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$30.51
|
| Rate for Payer: Cofinity Commercial |
$28.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.25
|
| Rate for Payer: Nomi Health Commercial |
$25.43
|
| Rate for Payer: PACE SWMI |
$21.19
|
| Rate for Payer: PHP Medicare Advantage |
$21.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$21.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.19
|
| Rate for Payer: UHC Exchange |
$21.19
|
| Rate for Payer: UHC Medicare Advantage |
$21.19
|
|
|
PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90461
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$544.68 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$544.68
|
| Rate for Payer: BCN Commercial |
$13.65
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO |
$11.75
|
| Rate for Payer: Priority Health Medicare |
$8.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Exchange |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
|
|
PR IMBRICATION DIAPHRAGM EVENTRATION
|
Professional
|
Both
|
$5,419.00
|
|
|
Service Code
|
HCPCS 39545
|
| Min. Negotiated Rate |
$571.91 |
| Max. Negotiated Rate |
$3,522.35 |
| Rate for Payer: Aetna Commercial |
$1,157.01
|
| Rate for Payer: Aetna Medicare |
$897.98
|
| Rate for Payer: BCBS Complete |
$600.51
|
| Rate for Payer: BCBS MAPPO |
$863.44
|
| Rate for Payer: BCBS Trust/PPO |
$671.47
|
| Rate for Payer: BCN Commercial |
$1,295.97
|
| Rate for Payer: BCN Medicare Advantage |
$863.44
|
| Rate for Payer: Cash Price |
$4,335.20
|
| Rate for Payer: Cash Price |
$4,335.20
|
| Rate for Payer: Cofinity Commercial |
$1,157.01
|
| Rate for Payer: Cofinity Commercial |
$1,243.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$863.44
|
| Rate for Payer: Mclaren Medicaid |
$571.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$906.61
|
| Rate for Payer: Meridian Medicaid |
$600.51
|
| Rate for Payer: Nomi Health Commercial |
$1,036.13
|
| Rate for Payer: PACE SWMI |
$863.44
|
| Rate for Payer: PHP Medicare Advantage |
$863.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,522.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,418.38
|
| Rate for Payer: Priority Health Medicare |
$872.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,418.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$863.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$863.44
|
| Rate for Payer: UHC Exchange |
$863.44
|
| Rate for Payer: UHC Medicare Advantage |
$863.44
|
| Rate for Payer: UHCCP Medicaid |
$571.91
|
|
|
PR IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
HCPCS 10030
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$171.45
|
| Rate for Payer: Aetna Medicare |
$133.07
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$127.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,625.00
|
| Rate for Payer: BCN Commercial |
$952.93
|
| Rate for Payer: BCN Medicare Advantage |
$127.95
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cofinity Commercial |
$184.25
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.95
|
| Rate for Payer: Mclaren Medicaid |
$84.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.35
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Nomi Health Commercial |
$153.54
|
| Rate for Payer: PACE SWMI |
$127.95
|
| Rate for Payer: PHP Medicare Advantage |
$127.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.10
|
| Rate for Payer: Priority Health HMO/PPO |
$179.25
|
| Rate for Payer: Priority Health Medicare |
$129.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.95
|
| Rate for Payer: UHC Exchange |
$127.95
|
| Rate for Payer: UHC Medicare Advantage |
$127.95
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 49406
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$2,515.24 |
| Rate for Payer: Aetna Commercial |
$245.45
|
| Rate for Payer: Aetna Medicare |
$190.50
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCBS MAPPO |
$183.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,515.24
|
| Rate for Payer: BCN Commercial |
$1,311.61
|
| Rate for Payer: BCN Medicare Advantage |
$183.17
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$263.76
|
| Rate for Payer: Cofinity Commercial |
$245.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.17
|
| Rate for Payer: Mclaren Medicaid |
$121.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.33
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Nomi Health Commercial |
$219.80
|
| Rate for Payer: PACE SWMI |
$183.17
|
| Rate for Payer: PHP Medicare Advantage |
$183.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO |
$338.27
|
| Rate for Payer: Priority Health Medicare |
$185.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$338.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.17
|
| Rate for Payer: UHC Exchange |
$183.17
|
| Rate for Payer: UHC Medicare Advantage |
$183.17
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 50268068611
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.06
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.78
|
| Rate for Payer: BCN Commercial |
$2.63
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Nomi Health Commercial |
$2.77
|
| Rate for Payer: PACE Senior Care Partners |
$0.80
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2.94
|
| Rate for Payer: Priority Health Medicare |
$0.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.26
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC Core |
$2.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.85
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$356.16
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Aetna Commercial |
$302.74
|
| Rate for Payer: Aetna Medicare |
$92.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.30
|
| Rate for Payer: BCBS Complete |
$142.46
|
| Rate for Payer: BCBS MAPPO |
$89.04
|
| Rate for Payer: BCBS Trust/PPO |
$292.80
|
| Rate for Payer: BCN Commercial |
$276.91
|
| Rate for Payer: BCN Medicare Advantage |
$89.04
|
| Rate for Payer: Cash Price |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.04
|
| Rate for Payer: Healthscope Commercial |
$320.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.74
|
| Rate for Payer: Nomi Health Commercial |
$292.05
|
| Rate for Payer: PACE Senior Care Partners |
$84.59
|
| Rate for Payer: PACE SWMI |
$89.04
|
| Rate for Payer: PHP Commercial |
$302.74
|
| Rate for Payer: PHP Medicare Advantage |
$89.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.50
|
| Rate for Payer: Priority Health HMO/PPO |
$309.86
|
| Rate for Payer: Priority Health Medicare |
$89.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.63
|
| Rate for Payer: Railroad Medicare Medicare |
$89.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.42
|
| Rate for Payer: UHC Core |
$297.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.04
|
| Rate for Payer: UHC Exchange |
$89.04
|
| Rate for Payer: UHC Medicare Advantage |
$89.04
|
| Rate for Payer: VA VA |
$89.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.12
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$3.57
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.12
|
| Rate for Payer: BCBS Complete |
$1.43
|
| Rate for Payer: BCBS MAPPO |
$0.89
|
| Rate for Payer: BCBS Trust/PPO |
$2.93
|
| Rate for Payer: BCN Commercial |
$2.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.89
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.89
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.93
|
| Rate for Payer: PACE Senior Care Partners |
$0.85
|
| Rate for Payer: PACE SWMI |
$0.89
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health HMO/PPO |
$3.11
|
| Rate for Payer: Priority Health Medicare |
$0.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.39
|
| Rate for Payer: Railroad Medicare Medicare |
$0.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.89
|
| Rate for Payer: UHC Exchange |
$0.89
|
| Rate for Payer: UHC Medicare Advantage |
$0.89
|
| Rate for Payer: VA VA |
$0.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$3.57
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.32 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$2.91
|
| Rate for Payer: BCN Commercial |
$2.76
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: Nomi Health Commercial |
$2.93
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health HMO/PPO |
$3.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.14
|
| Rate for Payer: UHC Core |
$2.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
NDC 50268068611
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.76
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: Nomi Health Commercial |
$2.77
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.97
|
| Rate for Payer: UHC Core |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$168.63
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.05 |
| Max. Negotiated Rate |
$151.77 |
| Rate for Payer: Aetna Commercial |
$143.34
|
| Rate for Payer: Aetna Medicare |
$43.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.70
|
| Rate for Payer: BCBS Complete |
$67.45
|
| Rate for Payer: BCBS MAPPO |
$42.16
|
| Rate for Payer: BCBS Trust/PPO |
$138.63
|
| Rate for Payer: BCN Commercial |
$131.11
|
| Rate for Payer: BCN Medicare Advantage |
$42.16
|
| Rate for Payer: Cash Price |
$134.90
|
| Rate for Payer: Cofinity Commercial |
$145.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.16
|
| Rate for Payer: Healthscope Commercial |
$151.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.34
|
| Rate for Payer: Nomi Health Commercial |
$138.28
|
| Rate for Payer: PACE Senior Care Partners |
$40.05
|
| Rate for Payer: PACE SWMI |
$42.16
|
| Rate for Payer: PHP Commercial |
$143.34
|
| Rate for Payer: PHP Medicare Advantage |
$42.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.61
|
| Rate for Payer: Priority Health HMO/PPO |
$146.71
|
| Rate for Payer: Priority Health Medicare |
$42.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.98
|
| Rate for Payer: Railroad Medicare Medicare |
$42.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.39
|
| Rate for Payer: UHC Core |
$140.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.16
|
| Rate for Payer: UHC Exchange |
$42.16
|
| Rate for Payer: UHC Medicare Advantage |
$42.16
|
| Rate for Payer: VA VA |
$42.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.47
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$168.63
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$151.77 |
| Rate for Payer: Aetna Commercial |
$143.34
|
| Rate for Payer: BCBS Trust/PPO |
$137.65
|
| Rate for Payer: BCN Commercial |
$130.32
|
| Rate for Payer: Cash Price |
$134.90
|
| Rate for Payer: Cofinity Commercial |
$145.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.90
|
| Rate for Payer: Healthscope Commercial |
$151.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.34
|
| Rate for Payer: Nomi Health Commercial |
$138.28
|
| Rate for Payer: PHP Commercial |
$143.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.61
|
| Rate for Payer: Priority Health HMO/PPO |
$146.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.39
|
| Rate for Payer: UHC Core |
$140.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.47
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$356.16
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.50 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Aetna Commercial |
$302.74
|
| Rate for Payer: BCBS Trust/PPO |
$290.73
|
| Rate for Payer: BCN Commercial |
$275.24
|
| Rate for Payer: Cash Price |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.93
|
| Rate for Payer: Healthscope Commercial |
$320.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.74
|
| Rate for Payer: Nomi Health Commercial |
$292.05
|
| Rate for Payer: PHP Commercial |
$302.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.50
|
| Rate for Payer: Priority Health HMO/PPO |
$309.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.42
|
| Rate for Payer: UHC Core |
$297.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.12
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0011A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$18.75
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0012A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 3RD DOSE
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0013A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$377.55 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$377.55
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 1ST
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0071A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$320.45
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 2ND
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0072A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
|
PR IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 3RD
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0073A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$570.00
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
