|
PR ZOSTER VACCINE HZV LIVE FOR SUBCUTANEOUS USE
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 90736
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$221.01 |
| Rate for Payer: Aetna Commercial |
$216.92
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.92
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS Trust/PPO |
$221.01
|
| Rate for Payer: BCN Commercial |
$216.92
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
IP
|
$44.65
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.65 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna American Axle |
$29.02
|
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health SBD |
$28.13
|
| Rate for Payer: UMR Bronson Commercial |
$19.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
PSEUDOEPHEDRINE 30 MG TABLET
|
Facility
|
OP
|
$44.65
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$40.18 |
| Rate for Payer: Aetna American Axle |
$29.02
|
| Rate for Payer: Aetna Commercial |
$37.95
|
| Rate for Payer: Aetna Medicare |
$22.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.02
|
| Rate for Payer: BCBS Complete |
$17.86
|
| Rate for Payer: Cash Price |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$31.26
|
| Rate for Payer: Cofinity Commercial |
$38.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.72
|
| Rate for Payer: Healthscope Commercial |
$40.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.95
|
| Rate for Payer: PHP Commercial |
$37.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.02
|
| Rate for Payer: Priority Health SBD |
$28.13
|
| Rate for Payer: UMR Bronson Commercial |
$16.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.49
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$27.74
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna American Axle |
$18.03
|
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.03
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: Cofinity Commercial |
$19.42
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.19
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.58
|
| Rate for Payer: PHP Commercial |
$23.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health SBD |
$17.48
|
| Rate for Payer: UMR Bronson Commercial |
$12.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$28.79
|
|
|
Service Code
|
NDC 00810067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Medicare |
$14.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: BCBS Complete |
$11.52
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UMR Bronson Commercial |
$10.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.89
|
|
|
Service Code
|
NDC 09900000882
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: BCBS Complete |
$1.16
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$27.74
|
|
|
Service Code
|
NDC 45802010752
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.26 |
| Max. Negotiated Rate |
$24.97 |
| Rate for Payer: Aetna American Axle |
$18.03
|
| Rate for Payer: Aetna Commercial |
$23.58
|
| Rate for Payer: Aetna Medicare |
$13.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.03
|
| Rate for Payer: BCBS Complete |
$11.10
|
| Rate for Payer: Cash Price |
$22.19
|
| Rate for Payer: Cofinity Commercial |
$19.42
|
| Rate for Payer: Cofinity Commercial |
$23.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.19
|
| Rate for Payer: Healthscope Commercial |
$24.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.58
|
| Rate for Payer: PHP Commercial |
$23.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.03
|
| Rate for Payer: Priority Health SBD |
$17.48
|
| Rate for Payer: UMR Bronson Commercial |
$10.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.80
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$28.79
|
|
|
Service Code
|
NDC 00810067013
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$25.91 |
| Rate for Payer: Aetna American Axle |
$18.71
|
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.71
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Cofinity Commercial |
$20.15
|
| Rate for Payer: Cofinity Commercial |
$24.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.03
|
| Rate for Payer: Healthscope Commercial |
$25.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.47
|
| Rate for Payer: PHP Commercial |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.71
|
| Rate for Payer: Priority Health SBD |
$18.14
|
| Rate for Payer: UMR Bronson Commercial |
$12.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.59
|
|
|
PSEUDOEPHEDRINE ER 120 MG TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$2.89
|
|
|
Service Code
|
NDC 09900000882
|
| Hospital Charge Code |
6716
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna American Axle |
$1.88
|
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.88
|
| Rate for Payer: Cash Price |
$2.31
|
| Rate for Payer: Cofinity Commercial |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.31
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.46
|
| Rate for Payer: PHP Commercial |
$2.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.88
|
| Rate for Payer: Priority Health SBD |
$1.82
|
| Rate for Payer: UMR Bronson Commercial |
$1.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.17
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
OP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna American Axle |
$5.75
|
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna Medicare |
$4.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.75
|
| Rate for Payer: BCBS Complete |
$3.54
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UMR Bronson Commercial |
$3.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PSYLLIUM ORAL PACKET
|
Facility
|
IP
|
$8.85
|
|
|
Service Code
|
NDC 37000002410
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$7.96 |
| Rate for Payer: Aetna American Axle |
$5.75
|
| Rate for Payer: Aetna Commercial |
$7.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.75
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cofinity Commercial |
$6.20
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.08
|
| Rate for Payer: Healthscope Commercial |
$7.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.52
|
| Rate for Payer: PHP Commercial |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.75
|
| Rate for Payer: Priority Health SBD |
$5.58
|
| Rate for Payer: UMR Bronson Commercial |
$3.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.64
|
|
|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); EACH SEPARATE/ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 11105
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: BCBS Trust/PPO |
$211.02
|
| Rate for Payer: BCN Commercial |
$211.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.95
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$24.50
|
|
|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$1,230.33
|
|
|
Service Code
|
CPT 11104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$44.74 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$187.96
|
| Rate for Payer: BCN Commercial |
$187.96
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.21
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$44.74
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
|
Facility
|
OP
|
$1,230.33
|
|
|
Service Code
|
CPT 10160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$291.18
|
| Rate for Payer: BCN Commercial |
$291.18
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.00
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$91.82
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST
|
Facility
|
OP
|
$1,230.33
|
|
|
Service Code
|
CPT 10160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$91.82 |
| Max. Negotiated Rate |
$1,230.33 |
| Rate for Payer: Aetna Medicare |
$407.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$489.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$489.31
|
| Rate for Payer: BCBS Complete |
$220.31
|
| Rate for Payer: BCBS MAPPO |
$391.45
|
| Rate for Payer: BCBS Trust/PPO |
$291.18
|
| Rate for Payer: BCN Commercial |
$291.18
|
| Rate for Payer: BCN Medicare Advantage |
$391.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$391.45
|
| Rate for Payer: Mclaren Medicaid |
$209.82
|
| Rate for Payer: Mclaren Medicare |
$391.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.02
|
| Rate for Payer: Meridian Medicaid |
$220.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$450.17
|
| Rate for Payer: Nomi Health Commercial |
$822.04
|
| Rate for Payer: PACE Medicare |
$371.88
|
| Rate for Payer: PACE SWMI |
$391.45
|
| Rate for Payer: PHP Medicare Advantage |
$391.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.33
|
| Rate for Payer: Priority Health Medicare |
$391.45
|
| Rate for Payer: Priority Health Narrow Network |
$984.26
|
| Rate for Payer: Railroad Medicare Medicare |
$391.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.00
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$391.45
|
| Rate for Payer: UHC Exchange |
$91.82
|
| Rate for Payer: UHC Medicare Advantage |
$391.45
|
| Rate for Payer: UHCCP Medicaid |
$209.82
|
| Rate for Payer: VA VA |
$391.45
|
|
|
PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS, WITH OR WITHOUT INJECTION OF MEDICATION
|
Facility
|
OP
|
$2,166.65
|
|
|
Service Code
|
CPT 55000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.18 |
| Max. Negotiated Rate |
$2,166.65 |
| Rate for Payer: Aetna Medicare |
$716.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$861.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$861.70
|
| Rate for Payer: BCBS Complete |
$387.97
|
| Rate for Payer: BCBS MAPPO |
$689.36
|
| Rate for Payer: BCBS Trust/PPO |
$83.12
|
| Rate for Payer: BCN Commercial |
$83.12
|
| Rate for Payer: BCN Medicare Advantage |
$689.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$689.36
|
| Rate for Payer: Mclaren Medicaid |
$369.50
|
| Rate for Payer: Mclaren Medicare |
$689.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$723.83
|
| Rate for Payer: Meridian Medicaid |
$387.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$792.76
|
| Rate for Payer: Nomi Health Commercial |
$1,447.66
|
| Rate for Payer: PACE Medicare |
$654.89
|
| Rate for Payer: PACE SWMI |
$689.36
|
| Rate for Payer: PHP Medicare Advantage |
$689.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,166.65
|
| Rate for Payer: Priority Health Medicare |
$689.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,733.32
|
| Rate for Payer: Railroad Medicare Medicare |
$689.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.30
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$689.36
|
| Rate for Payer: UHC Exchange |
$81.18
|
| Rate for Payer: UHC Medicare Advantage |
$689.36
|
| Rate for Payer: UHCCP Medicaid |
$369.50
|
| Rate for Payer: VA VA |
$689.36
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$1,368.63
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.39 |
| Max. Negotiated Rate |
$1,231.77 |
| Rate for Payer: Aetna American Axle |
$889.61
|
| Rate for Payer: Aetna Commercial |
$1,163.34
|
| Rate for Payer: Aetna Medicare |
$684.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.61
|
| Rate for Payer: BCBS Complete |
$547.45
|
| Rate for Payer: Cash Price |
$1,094.90
|
| Rate for Payer: Cofinity Commercial |
$1,177.02
|
| Rate for Payer: Cofinity Commercial |
$958.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$958.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,094.90
|
| Rate for Payer: Healthscope Commercial |
$1,231.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$958.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,026.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.34
|
| Rate for Payer: PHP Commercial |
$1,163.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.61
|
| Rate for Payer: Priority Health SBD |
$862.24
|
| Rate for Payer: UMR Bronson Commercial |
$506.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,026.47
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$948.17
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$350.82 |
| Max. Negotiated Rate |
$853.35 |
| Rate for Payer: Aetna American Axle |
$616.31
|
| Rate for Payer: Aetna Commercial |
$805.94
|
| Rate for Payer: Aetna Medicare |
$474.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.31
|
| Rate for Payer: BCBS Complete |
$379.27
|
| Rate for Payer: Cash Price |
$758.54
|
| Rate for Payer: Cofinity Commercial |
$663.72
|
| Rate for Payer: Cofinity Commercial |
$815.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$663.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.54
|
| Rate for Payer: Healthscope Commercial |
$853.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$805.94
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.31
|
| Rate for Payer: Priority Health SBD |
$597.35
|
| Rate for Payer: UMR Bronson Commercial |
$350.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.13
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$862.47
|
|
|
Service Code
|
NDC 70954048410
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$379.49 |
| Max. Negotiated Rate |
$776.22 |
| Rate for Payer: Cash Price |
$689.98
|
| Rate for Payer: Aetna American Axle |
$560.61
|
| Rate for Payer: Aetna Commercial |
$733.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.61
|
| Rate for Payer: Cofinity Commercial |
$603.73
|
| Rate for Payer: Cofinity Commercial |
$741.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.98
|
| Rate for Payer: Healthscope Commercial |
$776.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.10
|
| Rate for Payer: PHP Commercial |
$733.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.61
|
| Rate for Payer: Priority Health SBD |
$543.36
|
| Rate for Payer: UMR Bronson Commercial |
$379.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.85
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$862.47
|
|
|
Service Code
|
NDC 70954048410
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.11 |
| Max. Negotiated Rate |
$776.22 |
| Rate for Payer: Aetna American Axle |
$560.61
|
| Rate for Payer: Aetna Commercial |
$733.10
|
| Rate for Payer: Aetna Medicare |
$431.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$560.61
|
| Rate for Payer: BCBS Complete |
$344.99
|
| Rate for Payer: Cash Price |
$689.98
|
| Rate for Payer: Cofinity Commercial |
$603.73
|
| Rate for Payer: Cofinity Commercial |
$741.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$603.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$689.98
|
| Rate for Payer: Healthscope Commercial |
$776.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$603.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$646.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$733.10
|
| Rate for Payer: PHP Commercial |
$733.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.61
|
| Rate for Payer: Priority Health SBD |
$543.36
|
| Rate for Payer: UMR Bronson Commercial |
$319.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$646.85
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$1,420.25
|
|
|
Service Code
|
NDC 61748001209
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$624.91 |
| Max. Negotiated Rate |
$1,278.22 |
| Rate for Payer: Aetna American Axle |
$923.16
|
| Rate for Payer: Aetna Commercial |
$1,207.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.16
|
| Rate for Payer: Cash Price |
$1,136.20
|
| Rate for Payer: Cofinity Commercial |
$1,221.42
|
| Rate for Payer: Cofinity Commercial |
$994.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$994.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.20
|
| Rate for Payer: Healthscope Commercial |
$1,278.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.21
|
| Rate for Payer: PHP Commercial |
$1,207.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.16
|
| Rate for Payer: Priority Health SBD |
$894.76
|
| Rate for Payer: UMR Bronson Commercial |
$624.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.19
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$948.17
|
|
|
Service Code
|
NDC 61748001206
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$417.19 |
| Max. Negotiated Rate |
$853.35 |
| Rate for Payer: Aetna American Axle |
$616.31
|
| Rate for Payer: Aetna Commercial |
$805.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$616.31
|
| Rate for Payer: Cash Price |
$758.54
|
| Rate for Payer: Cofinity Commercial |
$663.72
|
| Rate for Payer: Cofinity Commercial |
$815.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$663.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$758.54
|
| Rate for Payer: Healthscope Commercial |
$853.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$663.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$711.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$805.94
|
| Rate for Payer: PHP Commercial |
$805.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.31
|
| Rate for Payer: Priority Health SBD |
$597.35
|
| Rate for Payer: UMR Bronson Commercial |
$417.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$711.13
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
OP
|
$1,420.25
|
|
|
Service Code
|
NDC 61748001209
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$525.49 |
| Max. Negotiated Rate |
$1,278.22 |
| Rate for Payer: Aetna American Axle |
$923.16
|
| Rate for Payer: Aetna Commercial |
$1,207.21
|
| Rate for Payer: Aetna Medicare |
$710.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$923.16
|
| Rate for Payer: BCBS Complete |
$568.10
|
| Rate for Payer: Cash Price |
$1,136.20
|
| Rate for Payer: Cofinity Commercial |
$1,221.42
|
| Rate for Payer: Cofinity Commercial |
$994.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$994.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,136.20
|
| Rate for Payer: Healthscope Commercial |
$1,278.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$994.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,065.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,207.21
|
| Rate for Payer: PHP Commercial |
$1,207.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.16
|
| Rate for Payer: Priority Health SBD |
$894.76
|
| Rate for Payer: UMR Bronson Commercial |
$525.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,065.19
|
|
|
PYRAZINAMIDE 500 MG TABLET
|
Facility
|
IP
|
$1,368.63
|
|
|
Service Code
|
NDC 70954048430
|
| Hospital Charge Code |
6738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$602.20 |
| Max. Negotiated Rate |
$1,231.77 |
| Rate for Payer: Aetna American Axle |
$889.61
|
| Rate for Payer: Aetna Commercial |
$1,163.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.61
|
| Rate for Payer: Cash Price |
$1,094.90
|
| Rate for Payer: Cofinity Commercial |
$1,177.02
|
| Rate for Payer: Cofinity Commercial |
$958.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$958.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,094.90
|
| Rate for Payer: Healthscope Commercial |
$1,231.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$958.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,026.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,163.34
|
| Rate for Payer: PHP Commercial |
$1,163.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$889.61
|
| Rate for Payer: Priority Health SBD |
$862.24
|
| Rate for Payer: UMR Bronson Commercial |
$602.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,026.47
|
|
|
PYRIDOSTIGMINE BROMIDE 30 MG TABLET
|
Facility
|
OP
|
$503.11
|
|
|
Service Code
|
NDC 58657081021
|
| Hospital Charge Code |
190688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.15 |
| Max. Negotiated Rate |
$452.80 |
| Rate for Payer: Aetna American Axle |
$327.02
|
| Rate for Payer: Aetna Commercial |
$427.64
|
| Rate for Payer: Aetna Medicare |
$251.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$327.02
|
| Rate for Payer: BCBS Complete |
$201.24
|
| Rate for Payer: Cash Price |
$402.49
|
| Rate for Payer: Cofinity Commercial |
$352.18
|
| Rate for Payer: Cofinity Commercial |
$432.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$352.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$402.49
|
| Rate for Payer: Healthscope Commercial |
$452.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$352.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$377.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$427.64
|
| Rate for Payer: PHP Commercial |
$427.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$327.02
|
| Rate for Payer: Priority Health SBD |
$316.96
|
| Rate for Payer: UMR Bronson Commercial |
$186.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$377.33
|
|
