|
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 |
$567.18 |
| Rate for Payer: Aetna Commercial |
$527.79
|
| Rate for Payer: Aetna Medicare |
$409.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$527.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$567.18
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$393.87
|
| Rate for Payer: BCBS Trust/PPO |
$399.72
|
| Rate for Payer: BCN Commercial |
$388.57
|
| Rate for Payer: BCN Medicare Advantage |
$393.87
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$527.79
|
| Rate for Payer: Cofinity Commercial |
$567.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$393.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$413.57
|
| Rate for Payer: Nomi Health Commercial |
$472.65
|
| Rate for Payer: PACE SWMI |
$393.87
|
| Rate for Payer: PHP Commercial |
$551.42
|
| Rate for Payer: PHP Medicare Advantage |
$393.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Medicare |
$393.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$393.87
|
| Rate for Payer: UHC Medicare Advantage |
$393.87
|
| Rate for Payer: UMR Bronson Commercial |
$81.42
|
|
|
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
|
$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
|
$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
|
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 |
$1.48
|
| 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 |
$1.48
|
|
|
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
|
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: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.39
|
| 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: 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 |
$1.48
|
| 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 |
$1.48
|
|
|
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 |
$95.18 |
| 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 |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| 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
|
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
|
$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: Cofinity Medicare Advantage |
$152.50
|
| 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: 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
|
IP
|
$329.94
|
|
|
Service Code
|
NDC 42543070690
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.17 |
| Max. Negotiated Rate |
$296.95 |
| Rate for Payer: Aetna American Axle |
$214.46
|
| Rate for Payer: Aetna Commercial |
$280.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.46
|
| 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 |
$145.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.46
|
|
|
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 |
$95.18 |
| 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 |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| 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
|
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: PHP Commercial |
$185.17
|
| 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: 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
|
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
|
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
|
|
|
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
|
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$570.04 |
| 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 |
$54.13
|
| Rate for Payer: BCBS MAPPO |
$78.36
|
| Rate for Payer: BCBS Trust/PPO |
$570.04
|
| Rate for Payer: BCN Commercial |
$172.01
|
| 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 |
$105.00
|
| Rate for Payer: Cofinity Commercial |
$112.84
|
| 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: Meridian Medicaid |
$54.13
|
| 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 Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.18
|
| Rate for Payer: Priority Health Medicare |
$78.36
|
| Rate for Payer: Priority Health Narrow Network |
$113.18
|
| Rate for Payer: Priority Health SBD |
$113.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.36
|
| Rate for Payer: UHC Medicare Advantage |
$78.36
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
| 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 |
$113.74 |
| Max. Negotiated Rate |
$523.55 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$180.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$250.01
|
| Rate for Payer: BCBS Complete |
$119.43
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCBS Trust/PPO |
$523.55
|
| Rate for Payer: BCN Commercial |
$259.98
|
| 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 |
$232.65
|
| Rate for Payer: Cofinity Commercial |
$250.01
|
| 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: Meridian Medicaid |
$119.43
|
| 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 Choice Medicaid |
$113.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.18
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: Priority Health Narrow Network |
$249.18
|
| Rate for Payer: Priority Health SBD |
$249.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP Medicaid |
$113.74
|
| 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 |
$100.60
|
| 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 |
$100.60
|
|
|
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 |
$140.46
|
| 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: PHP Commercial |
$114.02
|
| 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 |
$100.60
|
| Rate for Payer: Multiplan/Beech St/PHCS 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 |
$100.60
|
|
|
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 |
$140.00 |
| 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) |
$739.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$794.97
|
| Rate for Payer: BCBS Complete |
$393.40
|
| Rate for Payer: BCBS MAPPO |
$552.06
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$842.97
|
| 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 |
$739.76
|
| Rate for Payer: Cofinity Commercial |
$794.97
|
| 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: Meridian Medicaid |
$393.40
|
| 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 Choice Medicaid |
$374.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,034.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$886.44
|
| Rate for Payer: Priority Health Medicare |
$552.06
|
| Rate for Payer: Priority Health Narrow Network |
$886.44
|
| Rate for Payer: Priority Health SBD |
$886.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.06
|
| Rate for Payer: UHC Medicare Advantage |
$552.06
|
| Rate for Payer: UHCCP Medicaid |
$374.67
|
| Rate for Payer: UMR Bronson Commercial |
$731.86
|
|
