|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,611.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$535.70 |
| Max. Negotiated Rate |
$1,775.11 |
| Rate for Payer: Aetna Commercial |
$1,113.33
|
| Rate for Payer: Aetna Medicare |
$864.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,113.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,196.41
|
| Rate for Payer: BCBS Complete |
$562.49
|
| Rate for Payer: BCBS MAPPO |
$830.84
|
| Rate for Payer: BCN Commercial |
$1,334.10
|
| Rate for Payer: BCN Medicare Advantage |
$830.84
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cash Price |
$1,288.80
|
| Rate for Payer: Cofinity Commercial |
$1,113.33
|
| Rate for Payer: Cofinity Commercial |
$1,196.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$830.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$872.38
|
| Rate for Payer: Meridian Medicaid |
$562.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$913.92
|
| Rate for Payer: Nomi Health Commercial |
$997.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,208.25
|
| Rate for Payer: PACE SWMI |
$830.84
|
| Rate for Payer: PHP Commercial |
$1,163.18
|
| Rate for Payer: PHP Medicare Advantage |
$830.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$535.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,775.11
|
| Rate for Payer: Priority Health Medicare |
$830.84
|
| Rate for Payer: Priority Health SBD |
$1,775.11
|
| Rate for Payer: Priority Health Tiered Network |
$1,775.11
|
| Rate for Payer: Railroad Medicare Medicare |
$830.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,559.39
|
| Rate for Payer: UHC Core |
$1,559.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$830.84
|
| Rate for Payer: UHC Exchange |
$1,559.39
|
| Rate for Payer: UHC Medicaid |
$535.70
|
| Rate for Payer: UHCCP Medicaid |
$535.70
|
| Rate for Payer: UMR Bronson Commercial |
$741.06
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,166.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$429.62 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna Commercial |
$890.74
|
| Rate for Payer: Aetna Medicare |
$691.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$890.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$957.21
|
| Rate for Payer: BCBS Complete |
$451.10
|
| Rate for Payer: BCBS MAPPO |
$664.73
|
| Rate for Payer: BCN Commercial |
$1,062.20
|
| Rate for Payer: BCN Medicare Advantage |
$664.73
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cash Price |
$1,732.80
|
| Rate for Payer: Cofinity Commercial |
$890.74
|
| Rate for Payer: Cofinity Commercial |
$957.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.97
|
| Rate for Payer: Meridian Medicaid |
$451.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$731.20
|
| Rate for Payer: Nomi Health Commercial |
$797.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,624.50
|
| Rate for Payer: PACE SWMI |
$664.73
|
| Rate for Payer: PHP Commercial |
$930.62
|
| Rate for Payer: PHP Medicare Advantage |
$664.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,413.33
|
| Rate for Payer: Priority Health Medicare |
$664.73
|
| Rate for Payer: Priority Health SBD |
$1,413.33
|
| Rate for Payer: Priority Health Tiered Network |
$1,413.33
|
| Rate for Payer: Railroad Medicare Medicare |
$664.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,236.44
|
| Rate for Payer: UHC Core |
$1,236.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$664.73
|
| Rate for Payer: UHC Exchange |
$1,236.44
|
| Rate for Payer: UHC Medicaid |
$429.62
|
| Rate for Payer: UHCCP Medicaid |
$429.62
|
| Rate for Payer: UMR Bronson Commercial |
$996.36
|
|
|
PRAZIQUANTEL 600 MG TABLET
|
Facility
|
IP
|
$1,350.87
|
|
|
Service Code
|
NDC 49884023183
|
| Hospital Charge Code |
11113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$594.38 |
| Max. Negotiated Rate |
$1,215.78 |
| Rate for Payer: Aetna American Axle |
$878.07
|
| Rate for Payer: Aetna Commercial |
$1,148.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$878.07
|
| Rate for Payer: Cash Price |
$1,080.70
|
| Rate for Payer: Cofinity Advantage |
$945.61
|
| Rate for Payer: Cofinity Commercial |
$1,161.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.70
|
| Rate for Payer: Healthscope Commercial |
$1,215.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$945.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,013.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,148.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,013.15
|
| Rate for Payer: PHP Commercial |
$1,148.24
|
| Rate for Payer: Priority Health SBD |
$851.05
|
| Rate for Payer: UMR Bronson Commercial |
$594.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,013.15
|
|
|
PRAZIQUANTEL 600 MG TABLET
|
Facility
|
OP
|
$1,350.87
|
|
|
Service Code
|
NDC 49884023183
|
| Hospital Charge Code |
11113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$499.82 |
| Max. Negotiated Rate |
$1,215.78 |
| Rate for Payer: Aetna American Axle |
$878.07
|
| Rate for Payer: Aetna Commercial |
$1,148.24
|
| Rate for Payer: Aetna Medicare |
$675.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$878.07
|
| Rate for Payer: BCBS Complete |
$540.35
|
| Rate for Payer: Cash Price |
$1,080.70
|
| Rate for Payer: Cofinity Advantage |
$945.61
|
| Rate for Payer: Cofinity Commercial |
$1,161.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,080.70
|
| Rate for Payer: Healthscope Commercial |
$1,215.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$945.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,013.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,080.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,148.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,013.15
|
| Rate for Payer: PHP Commercial |
$1,148.24
|
| Rate for Payer: Priority Health SBD |
$851.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$878.07
|
| Rate for Payer: UHC Core |
$703.80
|
| Rate for Payer: UHC Exchange |
$530.89
|
| Rate for Payer: UMR Bronson Commercial |
$499.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,013.15
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$483.84
|
|
|
Service Code
|
NDC 00904702061
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.89 |
| Max. Negotiated Rate |
$435.46 |
| Rate for Payer: Aetna American Axle |
$314.50
|
| Rate for Payer: Aetna Commercial |
$411.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.50
|
| Rate for Payer: Cash Price |
$387.07
|
| Rate for Payer: Cofinity Advantage |
$338.69
|
| Rate for Payer: Cofinity Commercial |
$416.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.07
|
| Rate for Payer: Healthscope Commercial |
$435.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.88
|
| Rate for Payer: PHP Commercial |
$411.26
|
| Rate for Payer: Priority Health SBD |
$304.82
|
| Rate for Payer: UMR Bronson Commercial |
$212.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.88
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$643.20
|
|
|
Service Code
|
NDC 51079063020
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.98 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna American Axle |
$418.08
|
| Rate for Payer: Aetna Commercial |
$546.72
|
| Rate for Payer: Aetna Medicare |
$321.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.08
|
| Rate for Payer: BCBS Complete |
$257.28
|
| Rate for Payer: Cash Price |
$514.56
|
| Rate for Payer: Cofinity Advantage |
$450.24
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.56
|
| Rate for Payer: Healthscope Commercial |
$578.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$450.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.40
|
| Rate for Payer: PHP Commercial |
$546.72
|
| Rate for Payer: Priority Health SBD |
$405.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.08
|
| Rate for Payer: UHC Core |
$335.11
|
| Rate for Payer: UHC Exchange |
$252.78
|
| Rate for Payer: UMR Bronson Commercial |
$237.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.40
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$643.20
|
|
|
Service Code
|
NDC 51079063020
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.01 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna American Axle |
$418.08
|
| Rate for Payer: Aetna Commercial |
$546.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.08
|
| Rate for Payer: Cash Price |
$514.56
|
| Rate for Payer: Cofinity Advantage |
$450.24
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.56
|
| Rate for Payer: Healthscope Commercial |
$578.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$450.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.40
|
| Rate for Payer: PHP Commercial |
$546.72
|
| Rate for Payer: Priority Health SBD |
$405.22
|
| Rate for Payer: UMR Bronson Commercial |
$283.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.40
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$483.84
|
|
|
Service Code
|
NDC 00904702061
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.02 |
| Max. Negotiated Rate |
$435.46 |
| Rate for Payer: Aetna American Axle |
$314.50
|
| Rate for Payer: Aetna Commercial |
$411.26
|
| Rate for Payer: Aetna Medicare |
$241.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$314.50
|
| Rate for Payer: BCBS Complete |
$193.54
|
| Rate for Payer: Cash Price |
$387.07
|
| Rate for Payer: Cofinity Advantage |
$338.69
|
| Rate for Payer: Cofinity Commercial |
$416.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$387.07
|
| Rate for Payer: Healthscope Commercial |
$435.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$338.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$362.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$387.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$411.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$362.88
|
| Rate for Payer: PHP Commercial |
$411.26
|
| Rate for Payer: Priority Health SBD |
$304.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.50
|
| Rate for Payer: UHC Core |
$252.08
|
| Rate for Payer: UHC Exchange |
$190.15
|
| Rate for Payer: UMR Bronson Commercial |
$179.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$362.88
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
OP
|
$1,418.21
|
|
|
Service Code
|
NDC 00904702261
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$524.74 |
| Max. Negotiated Rate |
$1,276.39 |
| Rate for Payer: Aetna American Axle |
$921.84
|
| Rate for Payer: Aetna Commercial |
$1,205.48
|
| Rate for Payer: Aetna Medicare |
$709.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.84
|
| Rate for Payer: BCBS Complete |
$567.28
|
| Rate for Payer: Cash Price |
$1,134.57
|
| Rate for Payer: Cofinity Advantage |
$992.75
|
| Rate for Payer: Cofinity Commercial |
$1,219.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,134.57
|
| Rate for Payer: Healthscope Commercial |
$1,276.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$992.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,063.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,134.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,205.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,063.66
|
| Rate for Payer: PHP Commercial |
$1,205.48
|
| Rate for Payer: Priority Health SBD |
$893.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$921.84
|
| Rate for Payer: UHC Core |
$738.89
|
| Rate for Payer: UHC Exchange |
$557.36
|
| Rate for Payer: UMR Bronson Commercial |
$524.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,063.66
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
OP
|
$295.92
|
|
|
Service Code
|
NDC 66993043385
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.49 |
| Max. Negotiated Rate |
$266.33 |
| Rate for Payer: Aetna American Axle |
$192.35
|
| Rate for Payer: Aetna Commercial |
$251.53
|
| Rate for Payer: Aetna Medicare |
$147.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: BCBS Complete |
$118.37
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cofinity Advantage |
$207.14
|
| Rate for Payer: Cofinity Commercial |
$254.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.74
|
| Rate for Payer: Healthscope Commercial |
$266.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.94
|
| Rate for Payer: PHP Commercial |
$251.53
|
| Rate for Payer: Priority Health SBD |
$186.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.35
|
| Rate for Payer: UHC Core |
$154.17
|
| Rate for Payer: UHC Exchange |
$116.30
|
| Rate for Payer: UMR Bronson Commercial |
$109.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.94
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$584.64
|
|
|
Service Code
|
NDC 00378320501
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.24 |
| Max. Negotiated Rate |
$526.18 |
| Rate for Payer: Aetna American Axle |
$380.02
|
| Rate for Payer: Aetna Commercial |
$496.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.02
|
| Rate for Payer: Cash Price |
$467.71
|
| Rate for Payer: Cofinity Advantage |
$409.25
|
| Rate for Payer: Cofinity Commercial |
$502.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.71
|
| Rate for Payer: Healthscope Commercial |
$526.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$409.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.48
|
| Rate for Payer: PHP Commercial |
$496.94
|
| Rate for Payer: Priority Health SBD |
$368.32
|
| Rate for Payer: UMR Bronson Commercial |
$257.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.48
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$295.92
|
|
|
Service Code
|
NDC 66993043385
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.20 |
| Max. Negotiated Rate |
$266.33 |
| Rate for Payer: Aetna American Axle |
$192.35
|
| Rate for Payer: Aetna Commercial |
$251.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.35
|
| Rate for Payer: Cash Price |
$236.74
|
| Rate for Payer: Cofinity Advantage |
$207.14
|
| Rate for Payer: Cofinity Commercial |
$254.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.74
|
| Rate for Payer: Healthscope Commercial |
$266.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.94
|
| Rate for Payer: PHP Commercial |
$251.53
|
| Rate for Payer: Priority Health SBD |
$186.43
|
| Rate for Payer: UMR Bronson Commercial |
$130.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.94
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
OP
|
$584.64
|
|
|
Service Code
|
NDC 00378320501
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.32 |
| Max. Negotiated Rate |
$526.18 |
| Rate for Payer: Aetna American Axle |
$380.02
|
| Rate for Payer: Aetna Commercial |
$496.94
|
| Rate for Payer: Aetna Medicare |
$292.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.02
|
| Rate for Payer: BCBS Complete |
$233.86
|
| Rate for Payer: Cash Price |
$467.71
|
| Rate for Payer: Cofinity Advantage |
$409.25
|
| Rate for Payer: Cofinity Commercial |
$502.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.71
|
| Rate for Payer: Healthscope Commercial |
$526.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$409.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$467.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.48
|
| Rate for Payer: PHP Commercial |
$496.94
|
| Rate for Payer: Priority Health SBD |
$368.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$380.02
|
| Rate for Payer: UHC Core |
$304.60
|
| Rate for Payer: UHC Exchange |
$229.76
|
| Rate for Payer: UMR Bronson Commercial |
$216.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.48
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$1,418.21
|
|
|
Service Code
|
NDC 00904702261
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$624.01 |
| Max. Negotiated Rate |
$1,276.39 |
| Rate for Payer: Aetna American Axle |
$921.84
|
| Rate for Payer: Aetna Commercial |
$1,205.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.84
|
| Rate for Payer: Cash Price |
$1,134.57
|
| Rate for Payer: Cofinity Advantage |
$992.75
|
| Rate for Payer: Cofinity Commercial |
$1,219.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,134.57
|
| Rate for Payer: Healthscope Commercial |
$1,276.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$992.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,063.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,205.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,063.66
|
| Rate for Payer: PHP Commercial |
$1,205.48
|
| Rate for Payer: Priority Health SBD |
$893.47
|
| Rate for Payer: UMR Bronson Commercial |
$624.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,063.66
|
|
|
PR B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA
|
Professional
|
Both
|
$2,239.00
|
|
|
Service Code
|
HCPCS 27170
|
| Min. Negotiated Rate |
$679.26 |
| Max. Negotiated Rate |
$2,064.27 |
| Rate for Payer: Aetna Commercial |
$1,405.27
|
| Rate for Payer: Aetna Medicare |
$1,090.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,405.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,510.14
|
| Rate for Payer: BCBS Complete |
$713.22
|
| Rate for Payer: BCBS MAPPO |
$1,048.71
|
| Rate for Payer: BCN Commercial |
$1,770.32
|
| Rate for Payer: BCN Medicare Advantage |
$1,048.71
|
| Rate for Payer: Cash Price |
$1,791.20
|
| Rate for Payer: Cash Price |
$1,791.20
|
| Rate for Payer: Cofinity Commercial |
$1,405.27
|
| Rate for Payer: Cofinity Commercial |
$1,510.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,048.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,101.15
|
| Rate for Payer: Meridian Medicaid |
$713.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,153.58
|
| Rate for Payer: Nomi Health Commercial |
$1,258.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,679.25
|
| Rate for Payer: PACE SWMI |
$1,048.71
|
| Rate for Payer: PHP Commercial |
$1,468.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,048.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$679.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,892.43
|
| Rate for Payer: Priority Health Medicare |
$1,048.71
|
| Rate for Payer: Priority Health SBD |
$1,892.43
|
| Rate for Payer: Priority Health Tiered Network |
$1,892.43
|
| Rate for Payer: Railroad Medicare Medicare |
$1,048.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,064.27
|
| Rate for Payer: UHC Core |
$2,064.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,048.71
|
| Rate for Payer: UHC Exchange |
$2,064.27
|
| Rate for Payer: UHC Medicaid |
$679.26
|
| Rate for Payer: UHCCP Medicaid |
$679.26
|
| Rate for Payer: UMR Bronson Commercial |
$1,029.94
|
|
|
PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 90586
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$210.75 |
| Rate for Payer: Aetna Commercial |
$144.50
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS Trust/PPO |
$181.97
|
| Rate for Payer: BCN Commercial |
$173.84
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.97
|
| Rate for Payer: UHC Core |
$163.97
|
| Rate for Payer: UHC Exchange |
$163.97
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
|
|
PR BALLN ANGIOPLASTY OPEN,BRACHCEPH
|
Professional
|
Both
|
$987.00
|
|
|
Service Code
|
HCPCS 35458
|
| Min. Negotiated Rate |
$394.80 |
| Max. Negotiated Rate |
$740.25 |
| Rate for Payer: Aetna Medicare |
$493.50
|
| Rate for Payer: BCBS Complete |
$394.80
|
| Rate for Payer: Cash Price |
$789.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$740.25
|
| Rate for Payer: UMR Bronson Commercial |
$454.02
|
|
|
PR BALLN ANGIOPLASTY PERC,AORTIC
|
Professional
|
Both
|
$710.00
|
|
|
Service Code
|
HCPCS 35472
|
| Min. Negotiated Rate |
$284.00 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Aetna Medicare |
$355.00
|
| Rate for Payer: BCBS Complete |
$284.00
|
| Rate for Payer: Cash Price |
$568.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.50
|
| Rate for Payer: UMR Bronson Commercial |
$326.60
|
|
|
PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH
|
Professional
|
Both
|
$2,100.00
|
|
|
Service Code
|
HCPCS 35475
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$1,575.00 |
| Rate for Payer: Aetna Medicare |
$1,050.00
|
| Rate for Payer: BCBS Complete |
$840.00
|
| Rate for Payer: Cash Price |
$1,680.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,575.00
|
| Rate for Payer: UMR Bronson Commercial |
$966.00
|
|
|
PR BALLN ANGIOPLASTY,PERC VENOUS
|
Professional
|
Both
|
$3,544.00
|
|
|
Service Code
|
HCPCS 35476
|
| Min. Negotiated Rate |
$1,417.60 |
| Max. Negotiated Rate |
$2,658.00 |
| Rate for Payer: Aetna Medicare |
$1,772.00
|
| Rate for Payer: BCBS Complete |
$1,417.60
|
| Rate for Payer: Cash Price |
$2,835.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,658.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,630.24
|
|
|
PR BALLN ANGIOPLASTY PERC,VISCERAL
|
Professional
|
Both
|
$2,943.00
|
|
|
Service Code
|
HCPCS 35471
|
| Min. Negotiated Rate |
$1,177.20 |
| Max. Negotiated Rate |
$2,207.25 |
| Rate for Payer: Aetna Medicare |
$1,471.50
|
| Rate for Payer: BCBS Complete |
$1,177.20
|
| Rate for Payer: Cash Price |
$2,354.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,207.25
|
| Rate for Payer: UMR Bronson Commercial |
$1,353.78
|
|
|
PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS
|
Professional
|
Both
|
$5,070.00
|
|
|
Service Code
|
HCPCS 61630
|
| Min. Negotiated Rate |
$1,257.13 |
| Max. Negotiated Rate |
$3,802.50 |
| Rate for Payer: Aetna Commercial |
$1,684.55
|
| Rate for Payer: Aetna Medicare |
$1,307.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,684.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,810.27
|
| Rate for Payer: BCBS Complete |
$2,028.00
|
| Rate for Payer: BCBS MAPPO |
$1,257.13
|
| Rate for Payer: BCN Commercial |
$2,048.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,257.13
|
| Rate for Payer: Cash Price |
$4,056.00
|
| Rate for Payer: Cash Price |
$4,056.00
|
| Rate for Payer: Cofinity Commercial |
$1,810.27
|
| Rate for Payer: Cofinity Commercial |
$1,684.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,257.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,319.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,382.84
|
| Rate for Payer: Nomi Health Commercial |
$1,508.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,802.50
|
| Rate for Payer: PACE SWMI |
$1,257.13
|
| Rate for Payer: PHP Commercial |
$1,759.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,257.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,378.94
|
| Rate for Payer: Priority Health Medicare |
$1,257.13
|
| Rate for Payer: Priority Health SBD |
$2,378.94
|
| Rate for Payer: Priority Health Tiered Network |
$2,378.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1,257.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,419.84
|
| Rate for Payer: UHC Core |
$2,419.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,257.13
|
| Rate for Payer: UHC Exchange |
$2,419.84
|
| Rate for Payer: UMR Bronson Commercial |
$2,332.20
|
|
|
PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 47542
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$907.50 |
| Rate for Payer: Aetna Commercial |
$157.45
|
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.20
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCN Commercial |
$197.20
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$157.45
|
| Rate for Payer: Cofinity Commercial |
$169.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.25
|
| Rate for Payer: Nomi Health Commercial |
$141.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$907.50
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Commercial |
$164.50
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$240.27
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health SBD |
$240.27
|
| Rate for Payer: Priority Health Tiered Network |
$240.27
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.12
|
| Rate for Payer: UHC Core |
$244.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$117.50
|
| Rate for Payer: UHC Exchange |
$244.12
|
| Rate for Payer: UHC Medicaid |
$74.76
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
| Rate for Payer: UMR Bronson Commercial |
$556.60
|
|
|
PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL
|
Professional
|
Both
|
$1,016.00
|
|
|
Service Code
|
HCPCS 61640
|
| Min. Negotiated Rate |
$406.40 |
| Max. Negotiated Rate |
$879.66 |
| Rate for Payer: Aetna Commercial |
$633.90
|
| Rate for Payer: Aetna Medicare |
$508.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.90
|
| Rate for Payer: BCBS Complete |
$406.40
|
| Rate for Payer: BCN Commercial |
$697.67
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Cash Price |
$812.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$762.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$810.32
|
| Rate for Payer: Priority Health SBD |
$810.32
|
| Rate for Payer: Priority Health Tiered Network |
$810.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$879.66
|
| Rate for Payer: UHC Core |
$879.66
|
| Rate for Payer: UHC Exchange |
$879.66
|
| Rate for Payer: UMR Bronson Commercial |
$467.36
|
|
|
PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
HCPCS 50706
|
| Min. Negotiated Rate |
$99.05 |
| Max. Negotiated Rate |
$1,484.25 |
| Rate for Payer: Aetna Commercial |
$208.42
|
| Rate for Payer: Aetna Medicare |
$161.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.98
|
| Rate for Payer: BCBS Complete |
$104.00
|
| Rate for Payer: BCBS MAPPO |
$155.54
|
| Rate for Payer: BCN Commercial |
$263.44
|
| Rate for Payer: BCN Medicare Advantage |
$155.54
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cofinity Commercial |
$208.42
|
| Rate for Payer: Cofinity Commercial |
$223.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.32
|
| Rate for Payer: Meridian Medicaid |
$104.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$171.09
|
| Rate for Payer: Nomi Health Commercial |
$186.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,484.25
|
| Rate for Payer: PACE SWMI |
$155.54
|
| Rate for Payer: PHP Commercial |
$217.76
|
| Rate for Payer: PHP Medicare Advantage |
$155.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$286.96
|
| Rate for Payer: Priority Health Medicare |
$155.54
|
| Rate for Payer: Priority Health SBD |
$286.96
|
| Rate for Payer: Priority Health Tiered Network |
$286.96
|
| Rate for Payer: Railroad Medicare Medicare |
$155.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$326.60
|
| Rate for Payer: UHC Core |
$326.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.54
|
| Rate for Payer: UHC Exchange |
$326.60
|
| Rate for Payer: UHC Medicaid |
$99.05
|
| Rate for Payer: UHCCP Medicaid |
$99.05
|
| Rate for Payer: UMR Bronson Commercial |
$910.34
|
|
