|
PRALATREXATE 40 MG/2 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65,881.15
|
|
|
Service Code
|
HCPCS J9307
|
| Hospital Charge Code |
119254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$210.45 |
| Max. Negotiated Rate |
$59,293.04 |
| Rate for Payer: Aetna American Axle |
$42,822.75
|
| Rate for Payer: Aetna American Axle |
$27,044.14
|
| Rate for Payer: Aetna Commercial |
$35,365.41
|
| Rate for Payer: Aetna Commercial |
$55,998.98
|
| Rate for Payer: Aetna Medicare |
$408.34
|
| Rate for Payer: Aetna Medicare |
$408.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42,822.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27,044.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$490.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$490.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$490.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$490.79
|
| Rate for Payer: BCBS Complete |
$220.97
|
| Rate for Payer: BCBS Complete |
$220.97
|
| Rate for Payer: BCBS MAPPO |
$392.63
|
| Rate for Payer: BCBS MAPPO |
$392.63
|
| Rate for Payer: BCN Medicare Advantage |
$392.63
|
| Rate for Payer: BCN Medicare Advantage |
$392.63
|
| Rate for Payer: Cash Price |
$33,285.10
|
| Rate for Payer: Cash Price |
$52,704.92
|
| Rate for Payer: Cash Price |
$52,704.92
|
| Rate for Payer: Cash Price |
$33,285.10
|
| Rate for Payer: Cofinity Commercial |
$29,124.46
|
| Rate for Payer: Cofinity Commercial |
$35,781.48
|
| Rate for Payer: Cofinity Commercial |
$46,116.81
|
| Rate for Payer: Cofinity Commercial |
$56,657.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$29,124.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$46,116.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52,704.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33,285.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.63
|
| Rate for Payer: Healthscope Commercial |
$59,293.04
|
| Rate for Payer: Healthscope Commercial |
$37,445.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46,116.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29,124.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31,204.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49,410.86
|
| Rate for Payer: Mclaren Medicaid |
$210.45
|
| Rate for Payer: Mclaren Medicaid |
$210.45
|
| Rate for Payer: Mclaren Medicare |
$392.63
|
| Rate for Payer: Mclaren Medicare |
$392.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$412.26
|
| Rate for Payer: Meridian Medicaid |
$220.97
|
| Rate for Payer: Meridian Medicaid |
$220.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$451.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55,998.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35,365.41
|
| Rate for Payer: PACE Medicare |
$373.00
|
| Rate for Payer: PACE Medicare |
$373.00
|
| Rate for Payer: PACE SWMI |
$392.63
|
| Rate for Payer: PACE SWMI |
$392.63
|
| Rate for Payer: PHP Commercial |
$35,365.41
|
| Rate for Payer: PHP Commercial |
$55,998.98
|
| Rate for Payer: PHP Medicare Advantage |
$392.63
|
| Rate for Payer: PHP Medicare Advantage |
$392.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27,044.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42,822.75
|
| Rate for Payer: Priority Health Medicare |
$392.63
|
| Rate for Payer: Priority Health Medicare |
$392.63
|
| Rate for Payer: Priority Health SBD |
$26,212.01
|
| Rate for Payer: Priority Health SBD |
$41,505.12
|
| Rate for Payer: Railroad Medicare Medicare |
$392.63
|
| Rate for Payer: Railroad Medicare Medicare |
$392.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,105.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,105.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.63
|
| Rate for Payer: UHC Exchange |
$750.36
|
| Rate for Payer: UHC Exchange |
$750.36
|
| Rate for Payer: UHC Medicare Advantage |
$392.63
|
| Rate for Payer: UHC Medicare Advantage |
$392.63
|
| Rate for Payer: UHCCP Medicaid |
$210.45
|
| Rate for Payer: UHCCP Medicaid |
$210.45
|
| Rate for Payer: UMR Bronson Commercial |
$15,394.36
|
| Rate for Payer: UMR Bronson Commercial |
$24,376.03
|
| Rate for Payer: VA VA |
$392.63
|
| Rate for Payer: VA VA |
$392.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49,410.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31,204.78
|
|
|
PR ALBUTEROL IPRATROP NON-COMP
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7620
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.27
|
| Rate for Payer: Aetna Medicare |
$0.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.27
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.20
|
| Rate for Payer: BCN Medicare Advantage |
$0.20
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.29
|
| Rate for Payer: Cofinity Commercial |
$0.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.21
|
| Rate for Payer: Nomi Health Commercial |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.20
|
| Rate for Payer: PHP Commercial |
$0.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.20
|
| Rate for Payer: UHC Medicare Advantage |
$0.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR ALBUTEROL NON-COMP CON
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7611
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.23
|
| Rate for Payer: Aetna Medicare |
$0.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.23
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.17
|
| Rate for Payer: BCN Medicare Advantage |
$0.17
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.24
|
| Rate for Payer: Cofinity Commercial |
$0.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.18
|
| Rate for Payer: Nomi Health Commercial |
$0.20
|
| Rate for Payer: PACE SWMI |
$0.17
|
| Rate for Payer: PHP Commercial |
$0.24
|
| Rate for Payer: PHP Medicare Advantage |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.17
|
| Rate for Payer: UHC Medicare Advantage |
$0.17
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR ALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7613
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.11
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.11
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.08
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Cofinity Commercial |
$0.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.08
|
| Rate for Payer: Nomi Health Commercial |
$0.10
|
| Rate for Payer: PACE SWMI |
$0.08
|
| Rate for Payer: PHP Commercial |
$0.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.08
|
| Rate for Payer: UHC Medicare Advantage |
$0.08
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
|
|
PR ALCOHOL AND/OR DRUG SERVICES
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS H0015
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 99408
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 99409
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$67.60 |
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
| Rate for Payer: UMR Bronson Commercial |
$47.84
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR IM INJECTION
|
Facility
|
OP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
151068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.91 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna Medicare |
$143.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: BCBS Complete |
$114.50
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UMR Bronson Commercial |
$105.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR IM INJECTION
|
Facility
|
IP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
151068
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UMR Bronson Commercial |
$125.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
IP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
6462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.95 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UMR Bronson Commercial |
$125.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION
|
Facility
|
OP
|
$286.25
|
|
|
Service Code
|
HCPCS J2730
|
| Hospital Charge Code |
6462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.91 |
| Max. Negotiated Rate |
$257.62 |
| Rate for Payer: Aetna American Axle |
$186.06
|
| Rate for Payer: Aetna Commercial |
$243.31
|
| Rate for Payer: Aetna Medicare |
$143.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.06
|
| Rate for Payer: BCBS Complete |
$114.50
|
| Rate for Payer: Cash Price |
$229.00
|
| Rate for Payer: Cofinity Commercial |
$200.38
|
| Rate for Payer: Cofinity Commercial |
$246.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$200.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.00
|
| Rate for Payer: Healthscope Commercial |
$257.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.31
|
| Rate for Payer: PHP Commercial |
$243.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.06
|
| Rate for Payer: Priority Health SBD |
$180.34
|
| Rate for Payer: UMR Bronson Commercial |
$105.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.69
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 20930
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$317.85 |
| Rate for Payer: Aetna Medicare |
$244.50
|
| Rate for Payer: BCBS Complete |
$195.60
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.85
|
| Rate for Payer: UMR Bronson Commercial |
$224.94
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 20931
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$289.90 |
| Rate for Payer: Aetna Commercial |
$145.28
|
| Rate for Payer: Aetna Medicare |
$112.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.12
|
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: BCBS MAPPO |
$108.42
|
| Rate for Payer: BCN Medicare Advantage |
$108.42
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$156.12
|
| Rate for Payer: Cofinity Commercial |
$145.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.84
|
| Rate for Payer: Nomi Health Commercial |
$130.10
|
| Rate for Payer: PACE SWMI |
$108.42
|
| Rate for Payer: PHP Commercial |
$151.79
|
| Rate for Payer: PHP Medicare Advantage |
$108.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health Medicare |
$108.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.42
|
| Rate for Payer: UHC Medicare Advantage |
$108.42
|
| Rate for Payer: UMR Bronson Commercial |
$205.16
|
|
|
PR ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS J2997
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$136.01 |
| Rate for Payer: Aetna Commercial |
$126.56
|
| Rate for Payer: Aetna Medicare |
$98.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.56
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$136.01
|
| Rate for Payer: Cofinity Commercial |
$126.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Nomi Health Commercial |
$113.34
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Commercial |
$132.23
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UMR Bronson Commercial |
$41.86
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 93784
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Medicare |
$43.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.29
|
| Rate for Payer: BCBS Complete |
$102.80
|
| Rate for Payer: BCBS MAPPO |
$42.01
|
| Rate for Payer: BCN Medicare Advantage |
$42.01
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cofinity Commercial |
$60.49
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.11
|
| Rate for Payer: Nomi Health Commercial |
$50.41
|
| Rate for Payer: PACE SWMI |
$42.01
|
| Rate for Payer: PHP Commercial |
$58.81
|
| Rate for Payer: PHP Medicare Advantage |
$42.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.05
|
| Rate for Payer: Priority Health Medicare |
$42.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.01
|
| Rate for Payer: UHC Medicare Advantage |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$118.22
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 93790
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$24.19 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$17.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.51
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$24.19
|
| Rate for Payer: Cofinity Commercial |
$22.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Nomi Health Commercial |
$20.16
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Commercial |
$23.52
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$16.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR AMBULATORY EEG MONITORING
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 95950
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$379.60 |
| Rate for Payer: Aetna Medicare |
$292.00
|
| Rate for Payer: BCBS Complete |
$233.60
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.60
|
| Rate for Payer: UMR Bronson Commercial |
$268.64
|
|
|
PR AMINOLEVULINIC ACID HCL TOP
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS J7308
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$564.61 |
| Rate for Payer: Aetna Commercial |
$525.40
|
| Rate for Payer: Aetna Medicare |
$407.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$525.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$564.61
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$392.09
|
| Rate for Payer: BCN Medicare Advantage |
$392.09
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$525.40
|
| Rate for Payer: Cofinity Commercial |
$564.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.69
|
| Rate for Payer: Nomi Health Commercial |
$470.51
|
| Rate for Payer: PACE SWMI |
$392.09
|
| Rate for Payer: PHP Commercial |
$548.93
|
| Rate for Payer: PHP Medicare Advantage |
$392.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Medicare |
$392.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.09
|
| Rate for Payer: UHC Medicare Advantage |
$392.09
|
| Rate for Payer: UMR Bronson Commercial |
$81.42
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$197.60
|
|
|
Service Code
|
NDC 60687057001
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna American Axle |
$128.44
|
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.44
|
| Rate for Payer: Cash Price |
$158.08
|
| Rate for Payer: Cofinity Commercial |
$138.32
|
| Rate for Payer: Cofinity Commercial |
$169.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.08
|
| Rate for Payer: Healthscope Commercial |
$177.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.96
|
| Rate for Payer: PHP Commercial |
$167.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.44
|
| Rate for Payer: Priority Health SBD |
$124.49
|
| Rate for Payer: UMR Bronson Commercial |
$86.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.20
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$197.60
|
|
|
Service Code
|
NDC 60687057001
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$177.84 |
| Rate for Payer: Aetna American Axle |
$128.44
|
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna Medicare |
$98.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.44
|
| Rate for Payer: BCBS Complete |
$79.04
|
| Rate for Payer: Cash Price |
$158.08
|
| Rate for Payer: Cofinity Commercial |
$138.32
|
| Rate for Payer: Cofinity Commercial |
$169.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$138.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.08
|
| Rate for Payer: Healthscope Commercial |
$177.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.96
|
| Rate for Payer: PHP Commercial |
$167.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.44
|
| Rate for Payer: Priority Health SBD |
$124.49
|
| Rate for Payer: UMR Bronson Commercial |
$73.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.20
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 60687057011
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UMR Bronson Commercial |
$80.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Commercial |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.60
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UMR Bronson Commercial |
$95.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$1.98
|
|
|
Service Code
|
NDC 60687057011
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna American Axle |
$1.29
|
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.29
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.39
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.68
|
| Rate for Payer: PHP Commercial |
$1.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.29
|
| Rate for Payer: Priority Health SBD |
$1.25
|
| Rate for Payer: UMR Bronson Commercial |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.49
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$329.94
|
|
|
Service Code
|
NDC 42543070690
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.08 |
| Max. Negotiated Rate |
$296.95 |
| Rate for Payer: Aetna American Axle |
$214.46
|
| Rate for Payer: Aetna Commercial |
$280.45
|
| Rate for Payer: Aetna Medicare |
$164.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.46
|
| Rate for Payer: BCBS Complete |
$131.98
|
| Rate for Payer: Cash Price |
$263.95
|
| Rate for Payer: Cofinity Commercial |
$230.96
|
| Rate for Payer: Cofinity Commercial |
$283.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.95
|
| Rate for Payer: Healthscope Commercial |
$296.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.45
|
| Rate for Payer: PHP Commercial |
$280.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.46
|
| Rate for Payer: Priority Health SBD |
$207.86
|
| Rate for Payer: UMR Bronson Commercial |
$122.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.46
|
|
