|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033290
|
| Hospital Charge Code |
22719
|
|
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 0.5 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033290
|
| Hospital Charge Code |
22719
|
|
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 0.5 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
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033390
|
| Hospital Charge Code |
21288
|
|
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 1 MG TABLET
|
Facility
|
IP
|
$120.56
|
|
|
Service Code
|
NDC 13668009490
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$53.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033390
|
| Hospital Charge Code |
21288
|
|
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 1 MG TABLET
|
Facility
|
OP
|
$120.56
|
|
|
Service Code
|
NDC 13668009490
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.61 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna Medicare |
$60.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: BCBS Complete |
$48.22
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Cofinity Commercial |
$84.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.36
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$44.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$78.36 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare |
$81.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.00
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$78.36
|
| Rate for Payer: BCN Medicare Advantage |
$78.36
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$112.84
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.28
|
| Rate for Payer: Nomi Health Commercial |
$94.03
|
| Rate for Payer: PACE SWMI |
$78.36
|
| Rate for Payer: PHP Commercial |
$109.70
|
| Rate for Payer: PHP Medicare Advantage |
$78.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health Medicare |
$78.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.36
|
| Rate for Payer: UHC Medicare Advantage |
$78.36
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
|
|
PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 59001
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.65
|
| Rate for Payer: BCBS Complete |
$167.20
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$250.01
|
| Rate for Payer: Cofinity Commercial |
$232.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Nomi Health Commercial |
$208.34
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Commercial |
$243.07
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UMR Bronson Commercial |
$192.28
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
OP
|
$134.14
|
|
|
Service Code
|
NDC 51862018015
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Aetna American Axle |
$87.19
|
| Rate for Payer: Aetna Commercial |
$114.02
|
| Rate for Payer: Aetna Medicare |
$67.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.19
|
| Rate for Payer: BCBS Complete |
$53.66
|
| Rate for Payer: Cash Price |
$107.31
|
| Rate for Payer: Cofinity Commercial |
$115.36
|
| Rate for Payer: Cofinity Commercial |
$93.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.31
|
| Rate for Payer: Healthscope Commercial |
$120.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.02
|
| Rate for Payer: PHP Commercial |
$114.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.19
|
| Rate for Payer: Priority Health SBD |
$84.51
|
| Rate for Payer: UMR Bronson Commercial |
$49.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.61
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
OP
|
$280.93
|
|
|
Service Code
|
NDC 00037682315
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.94 |
| Max. Negotiated Rate |
$252.84 |
| Rate for Payer: Aetna American Axle |
$182.60
|
| Rate for Payer: Aetna Commercial |
$238.79
|
| Rate for Payer: Aetna Medicare |
$140.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.60
|
| Rate for Payer: BCBS Complete |
$112.37
|
| Rate for Payer: Cash Price |
$224.74
|
| Rate for Payer: Cofinity Commercial |
$196.65
|
| Rate for Payer: Cofinity Commercial |
$241.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.74
|
| Rate for Payer: Healthscope Commercial |
$252.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.79
|
| Rate for Payer: PHP Commercial |
$238.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: Priority Health SBD |
$176.99
|
| Rate for Payer: UMR Bronson Commercial |
$103.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.70
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
IP
|
$134.14
|
|
|
Service Code
|
NDC 51862018015
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Aetna American Axle |
$87.19
|
| Rate for Payer: Aetna Commercial |
$114.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.19
|
| Rate for Payer: Cash Price |
$107.31
|
| Rate for Payer: Cofinity Commercial |
$115.36
|
| Rate for Payer: Cofinity Commercial |
$93.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.31
|
| Rate for Payer: Healthscope Commercial |
$120.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.02
|
| Rate for Payer: PHP Commercial |
$114.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.19
|
| Rate for Payer: Priority Health SBD |
$84.51
|
| Rate for Payer: UMR Bronson Commercial |
$59.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.61
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
IP
|
$280.93
|
|
|
Service Code
|
NDC 00037682315
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.61 |
| Max. Negotiated Rate |
$252.84 |
| Rate for Payer: Aetna American Axle |
$182.60
|
| Rate for Payer: Aetna Commercial |
$238.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.60
|
| Rate for Payer: Cash Price |
$224.74
|
| Rate for Payer: Cofinity Commercial |
$196.65
|
| Rate for Payer: Cofinity Commercial |
$241.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.74
|
| Rate for Payer: Healthscope Commercial |
$252.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.79
|
| Rate for Payer: PHP Commercial |
$238.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.60
|
| Rate for Payer: Priority Health SBD |
$176.99
|
| Rate for Payer: UMR Bronson Commercial |
$123.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.70
|
|
|
PR AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ
|
Professional
|
Both
|
$1,591.00
|
|
|
Service Code
|
HCPCS 24925
|
| Min. Negotiated Rate |
$552.06 |
| Max. Negotiated Rate |
$1,034.15 |
| Rate for Payer: Aetna Commercial |
$739.76
|
| Rate for Payer: Aetna Medicare |
$574.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.76
|
| Rate for Payer: BCBS Complete |
$636.40
|
| Rate for Payer: BCBS MAPPO |
$552.06
|
| Rate for Payer: BCN Medicare Advantage |
$552.06
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cash Price |
$1,272.80
|
| Rate for Payer: Cofinity Commercial |
$794.97
|
| Rate for Payer: Cofinity Commercial |
$739.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$579.66
|
| Rate for Payer: Nomi Health Commercial |
$662.47
|
| Rate for Payer: PACE SWMI |
$552.06
|
| Rate for Payer: PHP Commercial |
$772.88
|
| Rate for Payer: PHP Medicare Advantage |
$552.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.15
|
| Rate for Payer: Priority Health Medicare |
$552.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.06
|
| Rate for Payer: UHC Medicare Advantage |
$552.06
|
| Rate for Payer: UMR Bronson Commercial |
$731.86
|
|
|
PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE
|
Professional
|
Both
|
$1,616.00
|
|
|
Service Code
|
HCPCS 25907
|
| Min. Negotiated Rate |
$595.69 |
| Max. Negotiated Rate |
$1,050.40 |
| Rate for Payer: Aetna Commercial |
$798.22
|
| Rate for Payer: Aetna Medicare |
$619.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$798.22
|
| Rate for Payer: BCBS Complete |
$646.40
|
| Rate for Payer: BCBS MAPPO |
$595.69
|
| Rate for Payer: BCN Medicare Advantage |
$595.69
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cash Price |
$1,292.80
|
| Rate for Payer: Cofinity Commercial |
$857.79
|
| Rate for Payer: Cofinity Commercial |
$798.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$625.47
|
| Rate for Payer: Nomi Health Commercial |
$714.83
|
| Rate for Payer: PACE SWMI |
$595.69
|
| Rate for Payer: PHP Commercial |
$833.97
|
| Rate for Payer: PHP Medicare Advantage |
$595.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,050.40
|
| Rate for Payer: Priority Health Medicare |
$595.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$595.69
|
| Rate for Payer: UHC Medicare Advantage |
$595.69
|
| Rate for Payer: UMR Bronson Commercial |
$743.36
|
|
|
PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR
|
Professional
|
Both
|
$1,920.00
|
|
|
Service Code
|
HCPCS 25905
|
| Min. Negotiated Rate |
$679.25 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$910.20
|
| Rate for Payer: Aetna Medicare |
$706.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$978.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$910.20
|
| Rate for Payer: BCBS Complete |
$768.00
|
| Rate for Payer: BCBS MAPPO |
$679.25
|
| Rate for Payer: BCN Medicare Advantage |
$679.25
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cash Price |
$1,536.00
|
| Rate for Payer: Cofinity Commercial |
$978.12
|
| Rate for Payer: Cofinity Commercial |
$910.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$679.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$713.21
|
| Rate for Payer: Nomi Health Commercial |
$815.10
|
| Rate for Payer: PACE SWMI |
$679.25
|
| Rate for Payer: PHP Commercial |
$950.95
|
| Rate for Payer: PHP Medicare Advantage |
$679.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,248.00
|
| Rate for Payer: Priority Health Medicare |
$679.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$679.25
|
| Rate for Payer: UHC Medicare Advantage |
$679.25
|
| Rate for Payer: UMR Bronson Commercial |
$883.20
|
|
|
PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION
|
Professional
|
Both
|
$1,237.00
|
|
|
Service Code
|
HCPCS 25909
|
| Min. Negotiated Rate |
$494.80 |
| Max. Negotiated Rate |
$956.40 |
| Rate for Payer: Aetna Commercial |
$889.99
|
| Rate for Payer: Aetna Medicare |
$690.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$956.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.99
|
| Rate for Payer: BCBS Complete |
$494.80
|
| Rate for Payer: BCBS MAPPO |
$664.17
|
| Rate for Payer: BCN Medicare Advantage |
$664.17
|
| Rate for Payer: Cash Price |
$989.60
|
| Rate for Payer: Cash Price |
$989.60
|
| Rate for Payer: Cofinity Commercial |
$956.40
|
| Rate for Payer: Cofinity Commercial |
$889.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.38
|
| Rate for Payer: Nomi Health Commercial |
$797.00
|
| Rate for Payer: PACE SWMI |
$664.17
|
| Rate for Payer: PHP Commercial |
$929.84
|
| Rate for Payer: PHP Medicare Advantage |
$664.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$804.05
|
| Rate for Payer: Priority Health Medicare |
$664.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$664.17
|
| Rate for Payer: UHC Medicare Advantage |
$664.17
|
| Rate for Payer: UMR Bronson Commercial |
$569.02
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 26952
|
| Min. Negotiated Rate |
$641.42 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$859.50
|
| Rate for Payer: Aetna Medicare |
$667.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$859.50
|
| Rate for Payer: BCBS Complete |
$880.00
|
| Rate for Payer: BCBS MAPPO |
$641.42
|
| Rate for Payer: BCN Medicare Advantage |
$641.42
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cofinity Commercial |
$923.64
|
| Rate for Payer: Cofinity Commercial |
$859.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$641.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$673.49
|
| Rate for Payer: Nomi Health Commercial |
$769.70
|
| Rate for Payer: PACE SWMI |
$641.42
|
| Rate for Payer: PHP Commercial |
$897.99
|
| Rate for Payer: PHP Medicare Advantage |
$641.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.00
|
| Rate for Payer: Priority Health Medicare |
$641.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$641.42
|
| Rate for Payer: UHC Medicare Advantage |
$641.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,012.00
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$1,650.00
|
|
|
Service Code
|
HCPCS 26951
|
| Min. Negotiated Rate |
$657.53 |
| Max. Negotiated Rate |
$1,072.50 |
| Rate for Payer: Aetna Commercial |
$881.09
|
| Rate for Payer: Aetna Medicare |
$683.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$881.09
|
| Rate for Payer: BCBS Complete |
$660.00
|
| Rate for Payer: BCBS MAPPO |
$657.53
|
| Rate for Payer: BCN Medicare Advantage |
$657.53
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cash Price |
$1,320.00
|
| Rate for Payer: Cofinity Commercial |
$946.84
|
| Rate for Payer: Cofinity Commercial |
$881.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$657.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$690.41
|
| Rate for Payer: Nomi Health Commercial |
$789.04
|
| Rate for Payer: PACE SWMI |
$657.53
|
| Rate for Payer: PHP Commercial |
$920.54
|
| Rate for Payer: PHP Medicare Advantage |
$657.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,072.50
|
| Rate for Payer: Priority Health Medicare |
$657.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$657.53
|
| Rate for Payer: UHC Medicare Advantage |
$657.53
|
| Rate for Payer: UMR Bronson Commercial |
$759.00
|
|
|
PR AMPICILLIN 500 MG INJ
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0290
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$13.00 |
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.74
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.55
|
| Rate for Payer: BCN Medicare Advantage |
$0.55
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Cofinity Commercial |
$0.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.58
|
| Rate for Payer: Nomi Health Commercial |
$0.66
|
| Rate for Payer: PACE SWMI |
$0.55
|
| Rate for Payer: PHP Commercial |
$0.77
|
| Rate for Payer: PHP Medicare Advantage |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.55
|
| Rate for Payer: UMR Bronson Commercial |
$9.20
|
|
|
PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$1,993.00
|
|
|
Service Code
|
HCPCS 27886
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$1,295.45 |
| Rate for Payer: Aetna Commercial |
$837.47
|
| Rate for Payer: Aetna Medicare |
$649.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$837.47
|
| Rate for Payer: BCBS Complete |
$797.20
|
| Rate for Payer: BCBS MAPPO |
$624.98
|
| Rate for Payer: BCN Medicare Advantage |
$624.98
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cash Price |
$1,594.40
|
| Rate for Payer: Cofinity Commercial |
$899.97
|
| Rate for Payer: Cofinity Commercial |
$837.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$624.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$656.23
|
| Rate for Payer: Nomi Health Commercial |
$749.98
|
| Rate for Payer: PACE SWMI |
$624.98
|
| Rate for Payer: PHP Commercial |
$874.97
|
| Rate for Payer: PHP Medicare Advantage |
$624.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,295.45
|
| Rate for Payer: Priority Health Medicare |
$624.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$624.98
|
| Rate for Payer: UHC Medicare Advantage |
$624.98
|
| Rate for Payer: UMR Bronson Commercial |
$916.78
|
|
|
PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV
|
Professional
|
Both
|
$1,721.00
|
|
|
Service Code
|
HCPCS 27884
|
| Min. Negotiated Rate |
$557.73 |
| Max. Negotiated Rate |
$1,118.65 |
| Rate for Payer: Aetna Commercial |
$747.36
|
| Rate for Payer: Aetna Medicare |
$580.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$803.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$747.36
|
| Rate for Payer: BCBS Complete |
$688.40
|
| Rate for Payer: BCBS MAPPO |
$557.73
|
| Rate for Payer: BCN Medicare Advantage |
$557.73
|
| Rate for Payer: Cash Price |
$1,376.80
|
| Rate for Payer: Cash Price |
$1,376.80
|
| Rate for Payer: Cofinity Commercial |
$803.13
|
| Rate for Payer: Cofinity Commercial |
$747.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$557.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$585.62
|
| Rate for Payer: Nomi Health Commercial |
$669.28
|
| Rate for Payer: PACE SWMI |
$557.73
|
| Rate for Payer: PHP Commercial |
$780.82
|
| Rate for Payer: PHP Medicare Advantage |
$557.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.65
|
| Rate for Payer: Priority Health Medicare |
$557.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$557.73
|
| Rate for Payer: UHC Medicare Advantage |
$557.73
|
| Rate for Payer: UMR Bronson Commercial |
$791.66
|
|
|
PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
HCPCS 26910
|
| Min. Negotiated Rate |
$717.40 |
| Max. Negotiated Rate |
$1,608.75 |
| Rate for Payer: Aetna Commercial |
$961.32
|
| Rate for Payer: Aetna Medicare |
$746.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$961.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,033.06
|
| Rate for Payer: BCBS Complete |
$990.00
|
| Rate for Payer: BCBS MAPPO |
$717.40
|
| Rate for Payer: BCN Medicare Advantage |
$717.40
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cofinity Commercial |
$961.32
|
| Rate for Payer: Cofinity Commercial |
$1,033.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$717.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$753.27
|
| Rate for Payer: Nomi Health Commercial |
$860.88
|
| Rate for Payer: PACE SWMI |
$717.40
|
| Rate for Payer: PHP Commercial |
$1,004.36
|
| Rate for Payer: PHP Medicare Advantage |
$717.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,608.75
|
| Rate for Payer: Priority Health Medicare |
$717.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$717.40
|
| Rate for Payer: UHC Medicare Advantage |
$717.40
|
| Rate for Payer: UMR Bronson Commercial |
$1,138.50
|
|
