|
PR AMBULATORY EEG MONITORING
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 95950
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$451.50 |
| Rate for Payer: Aetna Medicare |
$301.00
|
| Rate for Payer: BCBS Complete |
$240.80
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$451.50
|
| Rate for Payer: UMR Bronson Commercial |
$276.92
|
|
|
PR AMINOLEVULINIC ACID HCL TOP
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS J7308
|
| Min. Negotiated Rate |
$83.72 |
| Max. Negotiated Rate |
$561.63 |
| Rate for Payer: Aetna Commercial |
$522.63
|
| Rate for Payer: Aetna Medicare |
$405.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$561.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.63
|
| Rate for Payer: BCBS MAPPO |
$390.02
|
| Rate for Payer: BCBS Trust/PPO |
$397.18
|
| Rate for Payer: BCN Commercial |
$401.85
|
| Rate for Payer: BCN Medicare Advantage |
$390.02
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$522.63
|
| Rate for Payer: Cofinity Commercial |
$561.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$429.02
|
| Rate for Payer: Nomi Health Commercial |
$468.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.50
|
| Rate for Payer: PACE SWMI |
$390.02
|
| Rate for Payer: PHP Commercial |
$546.03
|
| Rate for Payer: PHP Medicare Advantage |
$390.02
|
| Rate for Payer: Priority Health Medicare |
$390.02
|
| Rate for Payer: Railroad Medicare Medicare |
$390.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.83
|
| Rate for Payer: UHC Core |
$389.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$390.02
|
| Rate for Payer: UHC Exchange |
$389.83
|
| Rate for Payer: UMR Bronson Commercial |
$83.72
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UMR Bronson Commercial |
$95.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$190.95
|
|
|
Service Code
|
NDC 60687057001
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$171.85 |
| Rate for Payer: Aetna American Axle |
$124.12
|
| Rate for Payer: Aetna Commercial |
$162.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.12
|
| Rate for Payer: Cash Price |
$152.76
|
| Rate for Payer: Cofinity Advantage |
$133.66
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.76
|
| Rate for Payer: Healthscope Commercial |
$171.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.21
|
| Rate for Payer: PHP Commercial |
$162.31
|
| Rate for Payer: Priority Health SBD |
$120.30
|
| Rate for Payer: UMR Bronson Commercial |
$84.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.21
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$1.91
|
|
|
Service Code
|
NDC 60687057011
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna American Axle |
$1.24
|
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.24
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Advantage |
$1.34
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$1.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.43
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC Core |
$1.00
|
| Rate for Payer: UHC Exchange |
$0.75
|
| Rate for Payer: UMR Bronson Commercial |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.43
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033190
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.60
|
| Rate for Payer: UHC Core |
$113.50
|
| Rate for Payer: UHC Exchange |
$85.62
|
| Rate for Payer: UMR Bronson Commercial |
$80.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$190.95
|
|
|
Service Code
|
NDC 60687057001
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.65 |
| Max. Negotiated Rate |
$171.85 |
| Rate for Payer: Aetna American Axle |
$124.12
|
| Rate for Payer: Aetna Commercial |
$162.31
|
| Rate for Payer: Aetna Medicare |
$95.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.12
|
| Rate for Payer: BCBS Complete |
$76.38
|
| Rate for Payer: Cash Price |
$152.76
|
| Rate for Payer: Cofinity Advantage |
$133.66
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.76
|
| Rate for Payer: Healthscope Commercial |
$171.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.21
|
| Rate for Payer: PHP Commercial |
$162.31
|
| Rate for Payer: Priority Health SBD |
$120.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.12
|
| Rate for Payer: UHC Core |
$99.48
|
| Rate for Payer: UHC Exchange |
$75.04
|
| Rate for Payer: UMR Bronson Commercial |
$70.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.21
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$1.91
|
|
|
Service Code
|
NDC 60687057011
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna American Axle |
$1.24
|
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.24
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Advantage |
$1.34
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$1.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.43
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.43
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033290
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.60
|
| Rate for Payer: UHC Core |
$113.50
|
| Rate for Payer: UHC Exchange |
$85.62
|
| Rate for Payer: UMR Bronson Commercial |
$80.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$126.90
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna Medicare |
$63.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: BCBS Complete |
$50.76
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.48
|
| Rate for Payer: UHC Core |
$66.11
|
| Rate for Payer: UHC Exchange |
$49.87
|
| Rate for Payer: UMR Bronson Commercial |
$46.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.17
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
OP
|
$329.94
|
|
|
Service Code
|
NDC 42543070690
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.08 |
| Max. Negotiated Rate |
$296.95 |
| Rate for Payer: Aetna American Axle |
$214.46
|
| Rate for Payer: Aetna Commercial |
$280.45
|
| Rate for Payer: Aetna Medicare |
$164.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.46
|
| Rate for Payer: BCBS Complete |
$131.98
|
| Rate for Payer: Cash Price |
$263.95
|
| Rate for Payer: Cofinity Advantage |
$230.96
|
| Rate for Payer: Cofinity Commercial |
$283.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.95
|
| Rate for Payer: Healthscope Commercial |
$296.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$263.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.46
|
| Rate for Payer: PHP Commercial |
$280.45
|
| Rate for Payer: Priority Health SBD |
$207.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.46
|
| Rate for Payer: UHC Core |
$171.90
|
| Rate for Payer: UHC Exchange |
$129.67
|
| Rate for Payer: UMR Bronson Commercial |
$122.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.46
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$126.90
|
|
|
Service Code
|
NDC 13668009390
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.84 |
| Max. Negotiated Rate |
$114.21 |
| Rate for Payer: Aetna American Axle |
$82.48
|
| Rate for Payer: Aetna Commercial |
$107.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.48
|
| Rate for Payer: Cash Price |
$101.52
|
| Rate for Payer: Cofinity Advantage |
$88.83
|
| Rate for Payer: Cofinity Commercial |
$109.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.52
|
| Rate for Payer: Healthscope Commercial |
$114.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.17
|
| Rate for Payer: PHP Commercial |
$107.86
|
| Rate for Payer: Priority Health SBD |
$79.95
|
| Rate for Payer: UMR Bronson Commercial |
$55.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.17
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033290
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UMR Bronson Commercial |
$95.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PRAMIPEXOLE 0.5 MG TABLET
|
Facility
|
IP
|
$329.94
|
|
|
Service Code
|
NDC 42543070690
|
| Hospital Charge Code |
22719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.17 |
| Max. Negotiated Rate |
$296.95 |
| Rate for Payer: Aetna American Axle |
$214.46
|
| Rate for Payer: Aetna Commercial |
$280.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.46
|
| Rate for Payer: Cash Price |
$263.95
|
| Rate for Payer: Cofinity Advantage |
$230.96
|
| Rate for Payer: Cofinity Commercial |
$283.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.95
|
| Rate for Payer: Healthscope Commercial |
$296.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.46
|
| Rate for Payer: PHP Commercial |
$280.45
|
| Rate for Payer: Priority Health SBD |
$207.86
|
| Rate for Payer: UMR Bronson Commercial |
$145.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.46
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$217.85
|
|
|
Service Code
|
NDC 68462033390
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UMR Bronson Commercial |
$95.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
IP
|
$145.94
|
|
|
Service Code
|
NDC 13668009490
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.21 |
| Max. Negotiated Rate |
$131.35 |
| Rate for Payer: Aetna American Axle |
$94.86
|
| Rate for Payer: Aetna Commercial |
$124.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.86
|
| Rate for Payer: Cash Price |
$116.75
|
| Rate for Payer: Cofinity Advantage |
$102.16
|
| Rate for Payer: Cofinity Commercial |
$125.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.75
|
| Rate for Payer: Healthscope Commercial |
$131.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.45
|
| Rate for Payer: PHP Commercial |
$124.05
|
| Rate for Payer: Priority Health SBD |
$91.94
|
| Rate for Payer: UMR Bronson Commercial |
$64.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.45
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
OP
|
$145.94
|
|
|
Service Code
|
NDC 13668009490
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$131.35 |
| Rate for Payer: Aetna American Axle |
$94.86
|
| Rate for Payer: Aetna Commercial |
$124.05
|
| Rate for Payer: Aetna Medicare |
$72.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.86
|
| Rate for Payer: BCBS Complete |
$58.38
|
| Rate for Payer: Cash Price |
$116.75
|
| Rate for Payer: Cofinity Advantage |
$102.16
|
| Rate for Payer: Cofinity Commercial |
$125.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.75
|
| Rate for Payer: Healthscope Commercial |
$131.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$109.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.45
|
| Rate for Payer: PHP Commercial |
$124.05
|
| Rate for Payer: Priority Health SBD |
$91.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.86
|
| Rate for Payer: UHC Core |
$76.03
|
| Rate for Payer: UHC Exchange |
$57.35
|
| Rate for Payer: UMR Bronson Commercial |
$54.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$109.45
|
|
|
PRAMIPEXOLE 1 MG TABLET
|
Facility
|
OP
|
$217.85
|
|
|
Service Code
|
NDC 68462033390
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.60 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Aetna American Axle |
$141.60
|
| Rate for Payer: Aetna Commercial |
$185.17
|
| Rate for Payer: Aetna Medicare |
$108.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.60
|
| Rate for Payer: BCBS Complete |
$87.14
|
| Rate for Payer: Cash Price |
$174.28
|
| Rate for Payer: Cofinity Advantage |
$152.50
|
| Rate for Payer: Cofinity Commercial |
$187.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.28
|
| Rate for Payer: Healthscope Commercial |
$196.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$174.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.39
|
| Rate for Payer: PHP Commercial |
$185.17
|
| Rate for Payer: Priority Health SBD |
$137.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.60
|
| Rate for Payer: UHC Core |
$113.50
|
| Rate for Payer: UHC Exchange |
$85.62
|
| Rate for Payer: UMR Bronson Commercial |
$80.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.39
|
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna Commercial |
$97.99
|
| Rate for Payer: Aetna Medicare |
$76.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.31
|
| Rate for Payer: BCBS Complete |
$48.75
|
| Rate for Payer: BCBS MAPPO |
$73.13
|
| Rate for Payer: BCN Commercial |
$120.51
|
| Rate for Payer: BCN Medicare Advantage |
$73.13
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$97.99
|
| Rate for Payer: Cofinity Commercial |
$105.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.79
|
| Rate for Payer: Meridian Medicaid |
$48.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.44
|
| Rate for Payer: Nomi Health Commercial |
$87.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$185.25
|
| Rate for Payer: PACE SWMI |
$73.13
|
| Rate for Payer: PHP Commercial |
$102.38
|
| Rate for Payer: PHP Medicare Advantage |
$73.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$113.77
|
| Rate for Payer: Priority Health Medicare |
$73.13
|
| Rate for Payer: Priority Health SBD |
$113.77
|
| Rate for Payer: Priority Health Tiered Network |
$113.77
|
| Rate for Payer: Railroad Medicare Medicare |
$73.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.66
|
| Rate for Payer: UHC Core |
$142.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.13
|
| Rate for Payer: UHC Exchange |
$142.66
|
| Rate for Payer: UHC Medicaid |
$46.43
|
| Rate for Payer: UHCCP Medicaid |
$46.43
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
|
|
PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 59001
|
| Min. Negotiated Rate |
$101.81 |
| Max. Negotiated Rate |
$323.25 |
| Rate for Payer: Aetna Commercial |
$215.73
|
| Rate for Payer: Aetna Medicare |
$167.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.83
|
| Rate for Payer: BCBS Complete |
$106.90
|
| Rate for Payer: BCBS MAPPO |
$160.99
|
| Rate for Payer: BCN Commercial |
$265.92
|
| Rate for Payer: BCN Medicare Advantage |
$160.99
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$215.73
|
| Rate for Payer: Cofinity Commercial |
$231.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.04
|
| Rate for Payer: Meridian Medicaid |
$106.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$177.09
|
| Rate for Payer: Nomi Health Commercial |
$193.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.25
|
| Rate for Payer: PACE SWMI |
$160.99
|
| Rate for Payer: PHP Commercial |
$225.39
|
| Rate for Payer: PHP Medicare Advantage |
$160.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$251.03
|
| Rate for Payer: Priority Health Medicare |
$160.99
|
| Rate for Payer: Priority Health SBD |
$251.03
|
| Rate for Payer: Priority Health Tiered Network |
$251.03
|
| Rate for Payer: Railroad Medicare Medicare |
$160.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.97
|
| Rate for Payer: UHC Core |
$317.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$160.99
|
| Rate for Payer: UHC Exchange |
$317.97
|
| Rate for Payer: UHC Medicaid |
$101.81
|
| Rate for Payer: UHCCP Medicaid |
$101.81
|
| Rate for Payer: UMR Bronson Commercial |
$198.26
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
IP
|
$134.14
|
|
|
Service Code
|
NDC 51862018015
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Aetna American Axle |
$87.19
|
| Rate for Payer: Aetna Commercial |
$114.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.19
|
| Rate for Payer: Cash Price |
$107.31
|
| Rate for Payer: Cofinity Advantage |
$93.90
|
| Rate for Payer: Cofinity Commercial |
$115.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.31
|
| Rate for Payer: Healthscope Commercial |
$120.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.61
|
| Rate for Payer: PHP Commercial |
$114.02
|
| Rate for Payer: Priority Health SBD |
$84.51
|
| Rate for Payer: UMR Bronson Commercial |
$59.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.61
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
NDC 00037682315
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.15 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Aetna American Axle |
$191.75
|
| Rate for Payer: Aetna Commercial |
$250.75
|
| Rate for Payer: Aetna Medicare |
$147.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.75
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cofinity Advantage |
$206.50
|
| Rate for Payer: Cofinity Commercial |
$253.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$265.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.25
|
| Rate for Payer: PHP Commercial |
$250.75
|
| Rate for Payer: Priority Health SBD |
$185.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.75
|
| Rate for Payer: UHC Core |
$153.69
|
| Rate for Payer: UHC Exchange |
$115.94
|
| Rate for Payer: UMR Bronson Commercial |
$109.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.25
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
NDC 00037682315
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.80 |
| Max. Negotiated Rate |
$265.50 |
| Rate for Payer: Aetna American Axle |
$191.75
|
| Rate for Payer: Aetna Commercial |
$250.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.75
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cofinity Advantage |
$206.50
|
| Rate for Payer: Cofinity Commercial |
$253.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.00
|
| Rate for Payer: Healthscope Commercial |
$265.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$206.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$221.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$250.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$221.25
|
| Rate for Payer: PHP Commercial |
$250.75
|
| Rate for Payer: Priority Health SBD |
$185.85
|
| Rate for Payer: UMR Bronson Commercial |
$129.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$221.25
|
|
|
PRAMOXINE 1 % TOPICAL FOAM
|
Facility
|
OP
|
$134.14
|
|
|
Service Code
|
NDC 51862018015
|
| Hospital Charge Code |
19749
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$120.73 |
| Rate for Payer: Aetna American Axle |
$87.19
|
| Rate for Payer: Aetna Commercial |
$114.02
|
| Rate for Payer: Aetna Medicare |
$67.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.19
|
| Rate for Payer: BCBS Complete |
$53.66
|
| Rate for Payer: Cash Price |
$107.31
|
| Rate for Payer: Cofinity Advantage |
$93.90
|
| Rate for Payer: Cofinity Commercial |
$115.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.31
|
| Rate for Payer: Healthscope Commercial |
$120.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.61
|
| Rate for Payer: PHP Commercial |
$114.02
|
| Rate for Payer: Priority Health SBD |
$84.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.19
|
| Rate for Payer: UHC Core |
$69.89
|
| Rate for Payer: UHC Exchange |
$52.72
|
| Rate for Payer: UMR Bronson Commercial |
$49.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.61
|
|
|
PR AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ
|
Professional
|
Both
|
$1,639.00
|
|
|
Service Code
|
HCPCS 24925
|
| Min. Negotiated Rate |
$347.83 |
| Max. Negotiated Rate |
$1,229.25 |
| Rate for Payer: Aetna Commercial |
$709.53
|
| Rate for Payer: Aetna Medicare |
$550.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$709.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$762.48
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCBS MAPPO |
$529.50
|
| Rate for Payer: BCN Commercial |
$875.95
|
| Rate for Payer: BCN Medicare Advantage |
$529.50
|
| Rate for Payer: Cash Price |
$1,311.20
|
| Rate for Payer: Cash Price |
$1,311.20
|
| Rate for Payer: Cofinity Commercial |
$709.53
|
| Rate for Payer: Cofinity Commercial |
$762.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$555.98
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$582.45
|
| Rate for Payer: Nomi Health Commercial |
$635.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,229.25
|
| Rate for Payer: PACE SWMI |
$529.50
|
| Rate for Payer: PHP Commercial |
$741.30
|
| Rate for Payer: PHP Medicare Advantage |
$529.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$936.36
|
| Rate for Payer: Priority Health Medicare |
$529.50
|
| Rate for Payer: Priority Health SBD |
$936.36
|
| Rate for Payer: Priority Health Tiered Network |
$936.36
|
| Rate for Payer: Railroad Medicare Medicare |
$529.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$986.01
|
| Rate for Payer: UHC Core |
$986.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$529.50
|
| Rate for Payer: UHC Exchange |
$986.01
|
| Rate for Payer: UHC Medicaid |
$347.83
|
| Rate for Payer: UHCCP Medicaid |
$347.83
|
| Rate for Payer: UMR Bronson Commercial |
$753.94
|
|
