|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$135.47 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Aetna Medicare |
$53.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.64
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$51.14
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$135.47
|
| Rate for Payer: BCN Medicare Advantage |
$51.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$68.53
|
| Rate for Payer: Cofinity Commercial |
$73.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.70
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Nomi Health Commercial |
$61.37
|
| Rate for Payer: PACE SWMI |
$51.14
|
| Rate for Payer: PHP Commercial |
$71.60
|
| Rate for Payer: PHP Medicare Advantage |
$51.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.24
|
| Rate for Payer: Priority Health Medicare |
$51.14
|
| Rate for Payer: Priority Health Narrow Network |
$72.24
|
| Rate for Payer: Priority Health SBD |
$72.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.14
|
| Rate for Payer: UHC Medicare Advantage |
$51.14
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
| Rate for Payer: UMR Bronson Commercial |
$73.60
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$106.97 |
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Medicare |
$16.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.16
|
| Rate for Payer: BCBS Complete |
$11.18
|
| Rate for Payer: BCBS MAPPO |
$16.08
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$39.27
|
| Rate for Payer: BCN Medicare Advantage |
$16.08
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$21.55
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.88
|
| Rate for Payer: Meridian Medicaid |
$11.18
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: PACE SWMI |
$16.08
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: PHP Medicare Advantage |
$16.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.57
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: Priority Health Narrow Network |
$22.57
|
| Rate for Payer: Priority Health SBD |
$22.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.08
|
| Rate for Payer: UHC Medicare Advantage |
$16.08
|
| Rate for Payer: UHCCP Medicaid |
$10.65
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$570.63 |
| Max. Negotiated Rate |
$1,772.22 |
| Rate for Payer: Aetna Commercial |
$1,150.42
|
| Rate for Payer: Aetna Medicare |
$892.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.27
|
| Rate for Payer: BCBS Complete |
$599.16
|
| Rate for Payer: BCBS MAPPO |
$858.52
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$1,289.62
|
| Rate for Payer: BCN Medicare Advantage |
$858.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,150.42
|
| Rate for Payer: Cofinity Commercial |
$1,236.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.45
|
| Rate for Payer: Meridian Medicaid |
$599.16
|
| Rate for Payer: Nomi Health Commercial |
$1,030.22
|
| Rate for Payer: PACE SWMI |
$858.52
|
| Rate for Payer: PHP Commercial |
$1,201.93
|
| Rate for Payer: PHP Medicare Advantage |
$858.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,772.22
|
| Rate for Payer: Priority Health Medicare |
$858.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,772.22
|
| Rate for Payer: Priority Health SBD |
$1,772.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.52
|
| Rate for Payer: UHC Medicare Advantage |
$858.52
|
| Rate for Payer: UHCCP Medicaid |
$570.63
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$578.68 |
| Max. Negotiated Rate |
$17,966.53 |
| Rate for Payer: Aetna American Axle |
$1,016.60
|
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: Aetna Medicare |
$5,945.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$3,704.89
|
| Rate for Payer: BCN Commercial |
$3,704.89
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,345.04
|
| Rate for Payer: Cofinity Commercial |
$1,094.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,094.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,094.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,173.00
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: Nomi Health Commercial |
$12,004.42
|
| Rate for Payer: PACE Medicare |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,966.53
|
| Rate for Payer: Priority Health Medicare |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$14,373.22
|
| Rate for Payer: Priority Health SBD |
$985.32
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$950.78
|
| Rate for Payer: UHC Core |
$8,596.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$864.35
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: UMR Bronson Commercial |
$578.68
|
| Rate for Payer: VA VA |
$5,716.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,173.00
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$688.16 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Aetna American Axle |
$1,016.60
|
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.60
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,094.80
|
| Rate for Payer: Cofinity Commercial |
$1,345.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,094.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,094.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,173.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health SBD |
$985.32
|
| Rate for Payer: UMR Bronson Commercial |
$688.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,173.00
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$570.63 |
| Max. Negotiated Rate |
$1,772.22 |
| Rate for Payer: Aetna Commercial |
$1,150.42
|
| Rate for Payer: Aetna Medicare |
$892.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.27
|
| Rate for Payer: BCBS Complete |
$599.16
|
| Rate for Payer: BCBS MAPPO |
$858.52
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$1,289.62
|
| Rate for Payer: BCN Medicare Advantage |
$858.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,236.27
|
| Rate for Payer: Cofinity Commercial |
$1,150.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.45
|
| Rate for Payer: Meridian Medicaid |
$599.16
|
| Rate for Payer: Nomi Health Commercial |
$1,030.22
|
| Rate for Payer: PACE SWMI |
$858.52
|
| Rate for Payer: PHP Commercial |
$1,201.93
|
| Rate for Payer: PHP Medicare Advantage |
$858.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,772.22
|
| Rate for Payer: Priority Health Medicare |
$858.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,772.22
|
| Rate for Payer: Priority Health SBD |
$1,772.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.52
|
| Rate for Payer: UHC Medicare Advantage |
$858.52
|
| Rate for Payer: UHCCP Medicaid |
$570.63
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$454.33 |
| Max. Negotiated Rate |
$1,411.40 |
| Rate for Payer: Aetna Commercial |
$913.63
|
| Rate for Payer: Aetna Medicare |
$709.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$981.81
|
| Rate for Payer: BCBS Complete |
$477.05
|
| Rate for Payer: BCBS MAPPO |
$681.81
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$1,027.20
|
| Rate for Payer: BCN Medicare Advantage |
$681.81
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$913.63
|
| Rate for Payer: Cofinity Commercial |
$981.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.90
|
| Rate for Payer: Meridian Medicaid |
$477.05
|
| Rate for Payer: Nomi Health Commercial |
$818.17
|
| Rate for Payer: PACE SWMI |
$681.81
|
| Rate for Payer: PHP Commercial |
$954.53
|
| Rate for Payer: PHP Medicare Advantage |
$681.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,411.40
|
| Rate for Payer: Priority Health Medicare |
$681.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,411.40
|
| Rate for Payer: Priority Health SBD |
$1,411.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.81
|
| Rate for Payer: UHC Medicare Advantage |
$681.81
|
| Rate for Payer: UHCCP Medicaid |
$454.33
|
| Rate for Payer: UMR Bronson Commercial |
$967.38
|
|
|
PRAZIQUANTEL 600 MG TABLET
|
Facility
|
IP
|
$1,259.34
|
|
|
Service Code
|
NDC 49884023183
|
| Hospital Charge Code |
11113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$554.11 |
| Max. Negotiated Rate |
$1,133.41 |
| Rate for Payer: Aetna American Axle |
$818.57
|
| Rate for Payer: Aetna Commercial |
$1,070.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.57
|
| Rate for Payer: Cash Price |
$1,007.47
|
| Rate for Payer: Cofinity Commercial |
$1,083.03
|
| Rate for Payer: Cofinity Commercial |
$881.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$881.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.47
|
| Rate for Payer: Healthscope Commercial |
$1,133.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$881.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.44
|
| Rate for Payer: PHP Commercial |
$1,070.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.57
|
| Rate for Payer: Priority Health SBD |
$793.38
|
| Rate for Payer: UMR Bronson Commercial |
$554.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.50
|
|
|
PRAZIQUANTEL 600 MG TABLET
|
Facility
|
OP
|
$1,259.34
|
|
|
Service Code
|
NDC 49884023183
|
| Hospital Charge Code |
11113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$465.96 |
| Max. Negotiated Rate |
$1,133.41 |
| Rate for Payer: Aetna American Axle |
$818.57
|
| Rate for Payer: Aetna Commercial |
$1,070.44
|
| Rate for Payer: Aetna Medicare |
$629.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.57
|
| Rate for Payer: BCBS Complete |
$503.74
|
| Rate for Payer: Cash Price |
$1,007.47
|
| Rate for Payer: Cofinity Commercial |
$1,083.03
|
| Rate for Payer: Cofinity Commercial |
$881.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$881.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.47
|
| Rate for Payer: Healthscope Commercial |
$1,133.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$881.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.44
|
| Rate for Payer: PHP Commercial |
$1,070.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.57
|
| Rate for Payer: Priority Health SBD |
$793.38
|
| Rate for Payer: UMR Bronson Commercial |
$465.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.50
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$462.72
|
|
|
Service Code
|
NDC 00904702061
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.60 |
| Max. Negotiated Rate |
$416.45 |
| Rate for Payer: Aetna American Axle |
$300.77
|
| Rate for Payer: Aetna Commercial |
$393.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.77
|
| Rate for Payer: Cash Price |
$370.18
|
| Rate for Payer: Cofinity Commercial |
$323.90
|
| Rate for Payer: Cofinity Commercial |
$397.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$323.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.18
|
| Rate for Payer: Healthscope Commercial |
$416.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.31
|
| Rate for Payer: PHP Commercial |
$393.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.77
|
| Rate for Payer: Priority Health SBD |
$291.51
|
| Rate for Payer: UMR Bronson Commercial |
$203.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.04
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$462.72
|
|
|
Service Code
|
NDC 00904702061
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.21 |
| Max. Negotiated Rate |
$416.45 |
| Rate for Payer: Aetna American Axle |
$300.77
|
| Rate for Payer: Aetna Commercial |
$393.31
|
| Rate for Payer: Aetna Medicare |
$231.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.77
|
| Rate for Payer: BCBS Complete |
$185.09
|
| Rate for Payer: Cash Price |
$370.18
|
| Rate for Payer: Cofinity Commercial |
$323.90
|
| Rate for Payer: Cofinity Commercial |
$397.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$323.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.18
|
| Rate for Payer: Healthscope Commercial |
$416.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.31
|
| Rate for Payer: PHP Commercial |
$393.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.77
|
| Rate for Payer: Priority Health SBD |
$291.51
|
| Rate for Payer: UMR Bronson Commercial |
$171.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.04
|
|
|
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 Commercial |
$409.25
|
| Rate for Payer: Cofinity Commercial |
$502.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$409.25
|
| 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: PHP Commercial |
$496.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.02
|
| Rate for Payer: Priority Health SBD |
$368.32
|
| Rate for Payer: UMR Bronson Commercial |
$216.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.48
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
OP
|
$1,199.54
|
|
|
Service Code
|
NDC 00904702261
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$443.83 |
| Max. Negotiated Rate |
$1,079.59 |
| Rate for Payer: Aetna American Axle |
$779.70
|
| Rate for Payer: Aetna Commercial |
$1,019.61
|
| Rate for Payer: Aetna Medicare |
$599.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$779.70
|
| Rate for Payer: BCBS Complete |
$479.82
|
| Rate for Payer: Cash Price |
$959.63
|
| Rate for Payer: Cofinity Commercial |
$1,031.60
|
| Rate for Payer: Cofinity Commercial |
$839.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$839.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$959.63
|
| Rate for Payer: Healthscope Commercial |
$1,079.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$839.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$899.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,019.61
|
| Rate for Payer: PHP Commercial |
$1,019.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$779.70
|
| Rate for Payer: Priority Health SBD |
$755.71
|
| Rate for Payer: UMR Bronson Commercial |
$443.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$899.66
|
|
|
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 Commercial |
$409.25
|
| Rate for Payer: Cofinity Commercial |
$502.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$409.25
|
| 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: PHP Commercial |
$496.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$380.02
|
| 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
|
$1,199.54
|
|
|
Service Code
|
NDC 00904702261
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$527.80 |
| Max. Negotiated Rate |
$1,079.59 |
| Rate for Payer: Aetna American Axle |
$779.70
|
| Rate for Payer: Aetna Commercial |
$1,019.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$779.70
|
| Rate for Payer: Cash Price |
$959.63
|
| Rate for Payer: Cofinity Commercial |
$1,031.60
|
| Rate for Payer: Cofinity Commercial |
$839.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$839.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$959.63
|
| Rate for Payer: Healthscope Commercial |
$1,079.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$839.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$899.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,019.61
|
| Rate for Payer: PHP Commercial |
$1,019.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$779.70
|
| Rate for Payer: Priority Health SBD |
$755.71
|
| Rate for Payer: UMR Bronson Commercial |
$527.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$899.66
|
|
|
PR B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA
|
Professional
|
Both
|
$2,174.00
|
|
|
Service Code
|
HCPCS 27170
|
| Min. Negotiated Rate |
$757.22 |
| Max. Negotiated Rate |
$1,814.18 |
| Rate for Payer: Aetna Commercial |
$1,512.57
|
| Rate for Payer: Aetna Medicare |
$1,173.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,512.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,625.44
|
| Rate for Payer: BCBS Complete |
$795.08
|
| Rate for Payer: BCBS MAPPO |
$1,128.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.18
|
| Rate for Payer: BCN Commercial |
$1,713.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,128.78
|
| Rate for Payer: Cash Price |
$1,739.20
|
| Rate for Payer: Cash Price |
$1,739.20
|
| Rate for Payer: Cofinity Commercial |
$1,512.57
|
| Rate for Payer: Cofinity Commercial |
$1,625.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,128.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,185.22
|
| Rate for Payer: Meridian Medicaid |
$795.08
|
| Rate for Payer: Nomi Health Commercial |
$1,354.54
|
| Rate for Payer: PACE SWMI |
$1,128.78
|
| Rate for Payer: PHP Commercial |
$1,580.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,128.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$757.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,413.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,792.72
|
| Rate for Payer: Priority Health Medicare |
$1,128.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.72
|
| Rate for Payer: Priority Health SBD |
$1,792.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,128.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,128.78
|
| Rate for Payer: UHCCP Medicaid |
$757.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,000.04
|
|
|
PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 90586
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$224.87 |
| Rate for Payer: Aetna Commercial |
$209.26
|
| Rate for Payer: Aetna Medicare |
$162.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.87
|
| Rate for Payer: BCBS Complete |
$109.20
|
| Rate for Payer: BCBS MAPPO |
$156.16
|
| Rate for Payer: BCBS Trust/PPO |
$147.22
|
| Rate for Payer: BCN Commercial |
$146.43
|
| Rate for Payer: BCN Medicare Advantage |
$156.16
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$224.87
|
| Rate for Payer: Cofinity Commercial |
$209.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.97
|
| Rate for Payer: Nomi Health Commercial |
$187.39
|
| Rate for Payer: PACE SWMI |
$156.16
|
| Rate for Payer: PHP Commercial |
$218.63
|
| Rate for Payer: PHP Medicare Advantage |
$156.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health Medicare |
$156.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.16
|
| Rate for Payer: UHC Medicare Advantage |
$156.16
|
| Rate for Payer: UMR Bronson Commercial |
$125.58
|
|
|
PR BALLN ANGIOPLASTY OPEN,BRACHCEPH
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 35458
|
| Min. Negotiated Rate |
$383.20 |
| Max. Negotiated Rate |
$622.70 |
| Rate for Payer: Aetna Medicare |
$479.00
|
| Rate for Payer: BCBS Complete |
$383.20
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.70
|
| Rate for Payer: UMR Bronson Commercial |
$440.68
|
|
|
PR BALLN ANGIOPLASTY PERC,AORTIC
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 35472
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$447.85 |
| Rate for Payer: Aetna Medicare |
$344.50
|
| Rate for Payer: BCBS Complete |
$275.60
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
| Rate for Payer: UMR Bronson Commercial |
$316.94
|
|
|
PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH
|
Professional
|
Both
|
$2,039.00
|
|
|
Service Code
|
HCPCS 35475
|
| Min. Negotiated Rate |
$815.60 |
| Max. Negotiated Rate |
$1,325.35 |
| Rate for Payer: Aetna Medicare |
$1,019.50
|
| Rate for Payer: BCBS Complete |
$815.60
|
| Rate for Payer: Cash Price |
$1,631.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,325.35
|
| Rate for Payer: UMR Bronson Commercial |
$937.94
|
|
|
PR BALLN ANGIOPLASTY,PERC VENOUS
|
Professional
|
Both
|
$3,441.00
|
|
|
Service Code
|
HCPCS 35476
|
| Min. Negotiated Rate |
$1,376.40 |
| Max. Negotiated Rate |
$2,236.65 |
| Rate for Payer: Aetna Medicare |
$1,720.50
|
| Rate for Payer: BCBS Complete |
$1,376.40
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,236.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,582.86
|
|
|
PR BALLN ANGIOPLASTY PERC,VISCERAL
|
Professional
|
Both
|
$2,857.00
|
|
|
Service Code
|
HCPCS 35471
|
| Min. Negotiated Rate |
$1,142.80 |
| Max. Negotiated Rate |
$1,857.05 |
| Rate for Payer: Aetna Medicare |
$1,428.50
|
| Rate for Payer: BCBS Complete |
$1,142.80
|
| Rate for Payer: Cash Price |
$2,285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,857.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,314.22
|
|
|
PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS
|
Professional
|
Both
|
$4,922.00
|
|
|
Service Code
|
HCPCS 61630
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$3,199.30 |
| Rate for Payer: Aetna Commercial |
$1,784.40
|
| Rate for Payer: Aetna Medicare |
$1,384.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,784.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,917.56
|
| Rate for Payer: BCBS Complete |
$1,968.80
|
| Rate for Payer: BCBS MAPPO |
$1,331.64
|
| Rate for Payer: BCBS Trust/PPO |
$18.49
|
| Rate for Payer: BCN Commercial |
$1,995.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,331.64
|
| Rate for Payer: Cash Price |
$3,937.60
|
| Rate for Payer: Cash Price |
$3,937.60
|
| Rate for Payer: Cofinity Commercial |
$1,784.40
|
| Rate for Payer: Cofinity Commercial |
$1,917.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,331.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,398.22
|
| Rate for Payer: Nomi Health Commercial |
$1,597.97
|
| Rate for Payer: PACE SWMI |
$1,331.64
|
| Rate for Payer: PHP Commercial |
$1,864.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,331.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,199.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,327.76
|
| Rate for Payer: Priority Health Medicare |
$1,331.64
|
| Rate for Payer: Priority Health Narrow Network |
$2,327.76
|
| Rate for Payer: Priority Health SBD |
$2,327.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,331.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,331.64
|
| Rate for Payer: UMR Bronson Commercial |
$2,264.12
|
|
|
PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT
|
Professional
|
Both
|
$1,175.00
|
|
|
Service Code
|
HCPCS 47542
|
| Min. Negotiated Rate |
$84.35 |
| Max. Negotiated Rate |
$763.75 |
| Rate for Payer: Aetna Commercial |
$170.65
|
| Rate for Payer: Aetna Medicare |
$132.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.38
|
| Rate for Payer: BCBS Complete |
$88.57
|
| Rate for Payer: BCBS MAPPO |
$127.35
|
| Rate for Payer: BCN Commercial |
$736.44
|
| Rate for Payer: BCN Medicare Advantage |
$127.35
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cash Price |
$940.00
|
| Rate for Payer: Cofinity Commercial |
$170.65
|
| Rate for Payer: Cofinity Commercial |
$183.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.72
|
| Rate for Payer: Meridian Medicaid |
$88.57
|
| Rate for Payer: Nomi Health Commercial |
$152.82
|
| Rate for Payer: PACE SWMI |
$127.35
|
| Rate for Payer: PHP Commercial |
$178.29
|
| Rate for Payer: PHP Medicare Advantage |
$127.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.46
|
| Rate for Payer: Priority Health Medicare |
$127.35
|
| Rate for Payer: Priority Health Narrow Network |
$234.46
|
| Rate for Payer: Priority Health SBD |
$234.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.35
|
| Rate for Payer: UHC Medicare Advantage |
$127.35
|
| Rate for Payer: UHCCP Medicaid |
$84.35
|
| Rate for Payer: UMR Bronson Commercial |
$540.50
|
|
|
PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL
|
Professional
|
Both
|
$986.00
|
|
|
Service Code
|
HCPCS 61640
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$796.77 |
| Rate for Payer: Aetna Commercial |
$633.90
|
| Rate for Payer: Aetna Medicare |
$493.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$633.90
|
| Rate for Payer: BCBS Complete |
$394.40
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCN Commercial |
$684.64
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Cash Price |
$788.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$640.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$796.77
|
| Rate for Payer: Priority Health Narrow Network |
$796.77
|
| Rate for Payer: Priority Health SBD |
$796.77
|
| Rate for Payer: UMR Bronson Commercial |
$453.56
|
|
