|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$2.97
|
|
|
Service Code
|
NDC 51079-458-01
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna American Axle |
$1.93
|
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.93
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Commercial |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.52
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.08
|
| Rate for Payer: Priority Health SBD |
$1.87
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$431.30
|
|
|
Service Code
|
NDC 0904-5892-61
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.77 |
| Max. Negotiated Rate |
$388.17 |
| Rate for Payer: Aetna American Axle |
$280.34
|
| Rate for Payer: Aetna Commercial |
$366.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.34
|
| Rate for Payer: Cash Price |
$345.04
|
| Rate for Payer: Cofinity Commercial |
$301.91
|
| Rate for Payer: Cofinity Commercial |
$370.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.04
|
| Rate for Payer: Healthscope Commercial |
$388.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$366.60
|
| Rate for Payer: PHP Commercial |
$366.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.91
|
| Rate for Payer: Priority Health SBD |
$271.72
|
| Rate for Payer: UMR Bronson Commercial |
$189.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.48
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 68382-071-16
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.68 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.72
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$109.90 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.35
|
| Rate for Payer: Priority Health Narrow Network |
$65.35
|
| Rate for Payer: Priority Health SBD |
$65.35
|
| Rate for Payer: UMR Bronson Commercial |
$72.22
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$106.97 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: BCBS Complete |
$11.18
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Meridian Medicaid |
$11.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.96
|
| Rate for Payer: Priority Health Narrow Network |
$20.96
|
| Rate for Payer: Priority Health SBD |
$20.96
|
| Rate for Payer: UMR Bronson Commercial |
$33.58
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$567.01 |
| Max. Negotiated Rate |
$1,911.53 |
| Rate for Payer: Aetna Commercial |
$1,096.73
|
| Rate for Payer: BCBS Complete |
$595.36
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Meridian Medicaid |
$595.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,911.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,911.53
|
| Rate for Payer: Priority Health SBD |
$1,911.53
|
| Rate for Payer: UMR Bronson Commercial |
$705.18
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$674.52 |
| Max. Negotiated Rate |
$1,379.70 |
| Rate for Payer: Aetna American Axle |
$996.45
|
| Rate for Payer: Aetna Commercial |
$1,303.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$996.45
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,073.10
|
| Rate for Payer: Cofinity Commercial |
$1,318.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,226.40
|
| Rate for Payer: Healthscope Commercial |
$1,379.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,073.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,149.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,303.05
|
| Rate for Payer: PHP Commercial |
$1,303.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health SBD |
$965.79
|
| Rate for Payer: UMR Bronson Commercial |
$674.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,149.75
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$567.21 |
| Max. Negotiated Rate |
$16,145.72 |
| Rate for Payer: Aetna American Axle |
$996.45
|
| Rate for Payer: Aetna Commercial |
$1,303.05
|
| Rate for Payer: Aetna Medicare |
$5,333.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$996.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,532.46
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,073.10
|
| Rate for Payer: Cofinity Commercial |
$1,318.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,226.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$1,379.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,073.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,149.75
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,303.05
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$1,303.05
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16,145.72
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$12,916.58
|
| Rate for Payer: Priority Health SBD |
$965.79
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$958.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,128.81
|
| Rate for Payer: UHC Exchange |
$871.65
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: UMR Bronson Commercial |
$567.21
|
| Rate for Payer: VA VA |
$5,128.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,149.75
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$567.01 |
| Max. Negotiated Rate |
$1,911.53 |
| Rate for Payer: Aetna Commercial |
$1,096.73
|
| Rate for Payer: BCBS Complete |
$595.36
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Meridian Medicaid |
$595.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$567.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,911.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,911.53
|
| Rate for Payer: Priority Health SBD |
$1,911.53
|
| Rate for Payer: UMR Bronson Commercial |
$705.18
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$451.56 |
| Max. Negotiated Rate |
$1,522.57 |
| Rate for Payer: Aetna Commercial |
$870.38
|
| Rate for Payer: BCBS Complete |
$474.14
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Meridian Medicaid |
$474.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$451.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,443.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,522.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,522.57
|
| Rate for Payer: Priority Health SBD |
$1,522.57
|
| Rate for Payer: UMR Bronson Commercial |
$948.52
|
|
|
PRAZIQUANTEL 600 MG TABLET
|
Facility
|
IP
|
$1,224.71
|
|
|
Service Code
|
NDC 49884-231-83
|
| Hospital Charge Code |
11113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$538.87 |
| Max. Negotiated Rate |
$1,102.24 |
| Rate for Payer: Aetna American Axle |
$796.06
|
| Rate for Payer: Aetna Commercial |
$1,041.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$796.06
|
| Rate for Payer: Cash Price |
$979.77
|
| Rate for Payer: Cofinity Commercial |
$1,053.25
|
| Rate for Payer: Cofinity Commercial |
$857.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$979.77
|
| Rate for Payer: Healthscope Commercial |
$1,102.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$857.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$918.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,041.00
|
| Rate for Payer: PHP Commercial |
$1,041.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$857.30
|
| Rate for Payer: Priority Health SBD |
$771.57
|
| Rate for Payer: UMR Bronson Commercial |
$538.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$918.53
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$454.56
|
|
|
Service Code
|
NDC 0904-7020-61
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.01 |
| Max. Negotiated Rate |
$409.10 |
| Rate for Payer: Aetna American Axle |
$295.46
|
| Rate for Payer: Aetna Commercial |
$386.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.46
|
| Rate for Payer: Cash Price |
$363.65
|
| Rate for Payer: Cofinity Commercial |
$318.19
|
| Rate for Payer: Cofinity Commercial |
$390.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.65
|
| Rate for Payer: Healthscope Commercial |
$409.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$318.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.38
|
| Rate for Payer: PHP Commercial |
$386.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.19
|
| Rate for Payer: Priority Health SBD |
$286.37
|
| Rate for Payer: UMR Bronson Commercial |
$200.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.92
|
|
|
PRAZOSIN 5 MG CAPSULE
|
Facility
|
IP
|
$584.64
|
|
|
Service Code
|
NDC 0378-3205-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$496.94
|
| Rate for Payer: PHP Commercial |
$496.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.25
|
| 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
|
$1,171.05
|
|
|
Service Code
|
NDC 0904-7022-61
|
| Hospital Charge Code |
6470
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$515.26 |
| Max. Negotiated Rate |
$1,053.94 |
| Rate for Payer: Aetna American Axle |
$761.18
|
| Rate for Payer: Aetna Commercial |
$995.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$761.18
|
| Rate for Payer: Cash Price |
$936.84
|
| Rate for Payer: Cofinity Commercial |
$1,007.10
|
| Rate for Payer: Cofinity Commercial |
$819.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$936.84
|
| Rate for Payer: Healthscope Commercial |
$1,053.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$819.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$878.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$995.39
|
| Rate for Payer: PHP Commercial |
$995.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.74
|
| Rate for Payer: Priority Health SBD |
$737.76
|
| Rate for Payer: UMR Bronson Commercial |
$515.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$878.29
|
|
|
PR B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA
|
Professional
|
Both
|
$2,131.00
|
|
|
Service Code
|
HCPCS 27170
|
| Min. Negotiated Rate |
$750.40 |
| Max. Negotiated Rate |
$1,814.18 |
| Rate for Payer: Aetna Commercial |
$1,567.73
|
| Rate for Payer: BCBS Complete |
$787.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.18
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Meridian Medicaid |
$787.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$750.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,491.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,790.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,790.84
|
| Rate for Payer: Priority Health SBD |
$1,790.84
|
| Rate for Payer: UMR Bronson Commercial |
$980.26
|
|
|
PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 90586
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$187.60 |
| Rate for Payer: Aetna Commercial |
$144.50
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS Trust/PPO |
$147.22
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.60
|
| Rate for Payer: UMR Bronson Commercial |
$123.28
|
|
|
PR BALLN ANGIOPLASTY OPEN,BRACHCEPH
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
HCPCS 35458
|
| Min. Negotiated Rate |
$375.60 |
| Max. Negotiated Rate |
$657.30 |
| Rate for Payer: BCBS Complete |
$375.60
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$657.30
|
| Rate for Payer: UMR Bronson Commercial |
$431.94
|
|
|
PR BALLN ANGIOPLASTY PERC,AORTIC
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 35472
|
| Min. Negotiated Rate |
$270.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: BCBS Complete |
$270.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: UMR Bronson Commercial |
$310.50
|
|
|
PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH
|
Professional
|
Both
|
$1,999.00
|
|
|
Service Code
|
HCPCS 35475
|
| Min. Negotiated Rate |
$799.60 |
| Max. Negotiated Rate |
$1,399.30 |
| Rate for Payer: BCBS Complete |
$799.60
|
| Rate for Payer: Cash Price |
$1,599.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,399.30
|
| Rate for Payer: UMR Bronson Commercial |
$919.54
|
|
|
PR BALLN ANGIOPLASTY,PERC VENOUS
|
Professional
|
Both
|
$3,374.00
|
|
|
Service Code
|
HCPCS 35476
|
| Min. Negotiated Rate |
$1,349.60 |
| Max. Negotiated Rate |
$2,361.80 |
| Rate for Payer: BCBS Complete |
$1,349.60
|
| Rate for Payer: Cash Price |
$2,699.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,361.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,552.04
|
|
|
PR BALLN ANGIOPLASTY PERC,VISCERAL
|
Professional
|
Both
|
$2,801.00
|
|
|
Service Code
|
HCPCS 35471
|
| Min. Negotiated Rate |
$1,120.40 |
| Max. Negotiated Rate |
$1,960.70 |
| Rate for Payer: BCBS Complete |
$1,120.40
|
| Rate for Payer: Cash Price |
$2,240.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,960.70
|
| Rate for Payer: UMR Bronson Commercial |
$1,288.46
|
|
|
PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS
|
Professional
|
Both
|
$4,825.00
|
|
|
Service Code
|
HCPCS 61630
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$3,377.50 |
| Rate for Payer: Aetna Commercial |
$1,768.28
|
| Rate for Payer: BCBS Complete |
$1,930.00
|
| Rate for Payer: BCBS Trust/PPO |
$18.49
|
| Rate for Payer: Cash Price |
$3,860.00
|
| Rate for Payer: Cash Price |
$3,860.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,377.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,312.45
|
| Rate for Payer: Priority Health Narrow Network |
$2,312.45
|
| Rate for Payer: Priority Health SBD |
$2,312.45
|
| Rate for Payer: UMR Bronson Commercial |
$2,219.50
|
|
|
PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
HCPCS 61640
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$793.28 |
| Rate for Payer: Aetna Commercial |
$633.90
|
| Rate for Payer: BCBS Complete |
$386.80
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Cash Price |
$773.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$676.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$793.28
|
| Rate for Payer: Priority Health Narrow Network |
$793.28
|
| Rate for Payer: Priority Health SBD |
$793.28
|
| Rate for Payer: UMR Bronson Commercial |
$444.82
|
|
|
PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I
|
Professional
|
Both
|
$1,883.00
|
|
|
Service Code
|
HCPCS 50706
|
| Min. Negotiated Rate |
$111.83 |
| Max. Negotiated Rate |
$4,073.19 |
| Rate for Payer: Aetna Commercial |
$233.34
|
| Rate for Payer: BCBS Complete |
$117.42
|
| Rate for Payer: BCBS Trust/PPO |
$4,073.19
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Cash Price |
$1,506.40
|
| Rate for Payer: Meridian Medicaid |
$117.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$111.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,318.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.23
|
| Rate for Payer: Priority Health Narrow Network |
$284.23
|
| Rate for Payer: Priority Health SBD |
$284.23
|
| Rate for Payer: UMR Bronson Commercial |
$866.18
|
|
|
PR BCG LIVE INTRAVESICAL VAC
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS J9031
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$123.20 |
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.20
|
| Rate for Payer: UMR Bronson Commercial |
$80.96
|
|
