|
PR AUDIOMETRY FOR HEARING AID
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS S0618
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$53.90 |
| Rate for Payer: Aetna Commercial |
$43.02
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
|
|
PR AUDITORY EVOKED POTENTIAL
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 92585
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$233.80 |
| Rate for Payer: BCBS Complete |
$133.60
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.80
|
|
|
PR AUDITORY EVOKED POTENTIAL, LIMITED
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 92586
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$101.50 |
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.50
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,186.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$244.13
|
| Rate for Payer: Aetna Medicare |
$182.19
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS MAPPO |
$182.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$292.71
|
| Rate for Payer: BCN Medicare Advantage |
$182.19
|
| Rate for Payer: Cash Price |
$948.80
|
| Rate for Payer: Cash Price |
$948.80
|
| Rate for Payer: Cofinity Commercial |
$262.35
|
| Rate for Payer: Cofinity Commercial |
$244.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.19
|
| Rate for Payer: Healthscope Commercial |
$218.63
|
| Rate for Payer: Healthscope Whirlpool |
$218.63
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$191.30
|
| Rate for Payer: PACE SWMI |
$182.19
|
| Rate for Payer: PHP Medicare Advantage |
$182.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$830.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.80
|
| Rate for Payer: Priority Health Medicare |
$182.19
|
| Rate for Payer: Priority Health Narrow Network |
$277.80
|
| Rate for Payer: UHC Medicare Advantage |
$187.66
|
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$165.78 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$165.78
|
| Rate for Payer: BCBS Complete |
$291.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$182.92
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.47
|
| Rate for Payer: Priority Health Narrow Network |
$190.47
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$106.07 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$222.72
|
| Rate for Payer: Aetna Medicare |
$166.21
|
| Rate for Payer: BCBS Complete |
$111.37
|
| Rate for Payer: BCBS MAPPO |
$166.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$267.42
|
| Rate for Payer: BCN Medicare Advantage |
$166.21
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cofinity Commercial |
$222.72
|
| Rate for Payer: Cofinity Commercial |
$239.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.21
|
| Rate for Payer: Healthscope Commercial |
$199.45
|
| Rate for Payer: Healthscope Whirlpool |
$199.45
|
| Rate for Payer: Meridian Medicaid |
$111.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$174.52
|
| Rate for Payer: PACE SWMI |
$166.21
|
| Rate for Payer: PHP Medicare Advantage |
$166.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.79
|
| Rate for Payer: Priority Health Medicare |
$166.21
|
| Rate for Payer: Priority Health Narrow Network |
$253.79
|
| Rate for Payer: UHC Medicare Advantage |
$171.20
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,315.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$2,514.45 |
| Rate for Payer: Aetna Commercial |
$2,174.23
|
| Rate for Payer: Aetna Medicare |
$1,622.56
|
| Rate for Payer: BCBS Complete |
$1,108.63
|
| Rate for Payer: BCBS MAPPO |
$1,622.56
|
| Rate for Payer: BCBS Trust/PPO |
$149.51
|
| Rate for Payer: BCN Commercial |
$2,406.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,622.56
|
| Rate for Payer: Cash Price |
$2,652.00
|
| Rate for Payer: Cash Price |
$2,652.00
|
| Rate for Payer: Cofinity Commercial |
$2,174.23
|
| Rate for Payer: Cofinity Commercial |
$2,336.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,622.56
|
| Rate for Payer: Healthscope Commercial |
$1,947.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,947.07
|
| Rate for Payer: Meridian Medicaid |
$1,108.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,703.69
|
| Rate for Payer: PACE SWMI |
$1,622.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,622.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,055.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,320.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,514.45
|
| Rate for Payer: Priority Health Medicare |
$1,622.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,514.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,671.24
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$314.45
|
|
|
Service Code
|
NDC 0904-5891-61
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.12 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna Commercial |
$283.00
|
| Rate for Payer: ASR ASR |
$305.02
|
| Rate for Payer: BCBS Trust/PPO |
$243.79
|
| Rate for Payer: BCN Commercial |
$243.79
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Commercial |
$295.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$314.45
|
| Rate for Payer: Healthscope Whirlpool |
$305.02
|
| Rate for Payer: Mclaren Commercial |
$283.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.72
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$276.96
|
|
|
Service Code
|
NDC 0904-5893-61
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.87 |
| Max. Negotiated Rate |
$276.96 |
| Rate for Payer: Aetna Commercial |
$249.26
|
| Rate for Payer: ASR ASR |
$268.65
|
| Rate for Payer: BCBS Trust/PPO |
$214.73
|
| Rate for Payer: BCN Commercial |
$214.73
|
| Rate for Payer: Cash Price |
$221.57
|
| Rate for Payer: Cofinity Commercial |
$260.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.57
|
| Rate for Payer: Healthscope Commercial |
$276.96
|
| Rate for Payer: Healthscope Whirlpool |
$268.65
|
| Rate for Payer: Mclaren Commercial |
$249.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.72
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$135.47 |
| Rate for Payer: Aetna Commercial |
$70.77
|
| Rate for Payer: Aetna Medicare |
$52.81
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$52.81
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$135.47
|
| Rate for Payer: BCN Medicare Advantage |
$52.81
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cofinity Commercial |
$70.77
|
| Rate for Payer: Cofinity Commercial |
$76.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.81
|
| Rate for Payer: Healthscope Commercial |
$63.37
|
| Rate for Payer: Healthscope Whirlpool |
$63.37
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.45
|
| Rate for Payer: PACE SWMI |
$52.81
|
| Rate for Payer: PHP Medicare Advantage |
$52.81
|
| 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 Medicare |
$52.81
|
| Rate for Payer: Priority Health Narrow Network |
$65.35
|
| Rate for Payer: UHC Medicare Advantage |
$54.39
|
|
|
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 |
$22.93
|
| Rate for Payer: Aetna Medicare |
$17.11
|
| Rate for Payer: BCBS Complete |
$11.18
|
| Rate for Payer: BCBS MAPPO |
$17.11
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$39.27
|
| Rate for Payer: BCN Medicare Advantage |
$17.11
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$24.64
|
| Rate for Payer: Cofinity Commercial |
$22.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.11
|
| Rate for Payer: Healthscope Commercial |
$20.53
|
| Rate for Payer: Healthscope Whirlpool |
$20.53
|
| Rate for Payer: Meridian Medicaid |
$11.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.97
|
| Rate for Payer: PACE SWMI |
$17.11
|
| Rate for Payer: PHP Medicare Advantage |
$17.11
|
| 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 Medicare |
$17.11
|
| Rate for Payer: Priority Health Narrow Network |
$20.96
|
| Rate for Payer: UHC Medicare Advantage |
$17.62
|
|
|
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 |
$1,173.00
|
| Rate for Payer: Aetna Medicare |
$875.37
|
| Rate for Payer: BCBS Complete |
$595.36
|
| Rate for Payer: BCBS MAPPO |
$875.37
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$1,289.62
|
| Rate for Payer: BCN Medicare Advantage |
$875.37
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,260.53
|
| Rate for Payer: Cofinity Commercial |
$1,173.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$875.37
|
| Rate for Payer: Healthscope Commercial |
$1,050.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,050.44
|
| Rate for Payer: Meridian Medicaid |
$595.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$919.14
|
| Rate for Payer: PACE SWMI |
$875.37
|
| Rate for Payer: PHP Medicare Advantage |
$875.37
|
| 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 Medicare |
$875.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,911.53
|
| Rate for Payer: UHC Medicare Advantage |
$901.63
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
OP
|
$1,533.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$1,073.10 |
| Max. Negotiated Rate |
$6,411.01 |
| Rate for Payer: Aetna Commercial |
$1,379.70
|
| Rate for Payer: Aetna Medicare |
$5,128.81
|
| 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: ASR ASR |
$1,487.01
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.53
|
| Rate for Payer: BCN Commercial |
$1,188.53
|
| 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 |
$1,441.02
|
| 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 |
$1,533.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,487.01
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,128.81
|
| Rate for Payer: Mclaren Commercial |
$1,379.70
|
| 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 |
$5,641.69
|
| Rate for Payer: PHP Medicaid |
$2,805.46
|
| 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 |
$1,395.03
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,088.43
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,349.04
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
IP
|
$1,533.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$1,073.10 |
| Max. Negotiated Rate |
$1,533.00 |
| Rate for Payer: Aetna Commercial |
$1,379.70
|
| Rate for Payer: ASR ASR |
$1,487.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,188.53
|
| Rate for Payer: BCN Commercial |
$1,188.53
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,441.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,226.40
|
| Rate for Payer: Healthscope Commercial |
$1,533.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,487.01
|
| Rate for Payer: Mclaren Commercial |
$1,379.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,303.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,349.04
|
|
|
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 |
$1,173.00
|
| Rate for Payer: Aetna Medicare |
$875.37
|
| Rate for Payer: BCBS Complete |
$595.36
|
| Rate for Payer: BCBS MAPPO |
$875.37
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$1,289.62
|
| Rate for Payer: BCN Medicare Advantage |
$875.37
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$1,260.53
|
| Rate for Payer: Cofinity Commercial |
$1,173.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$875.37
|
| Rate for Payer: Healthscope Commercial |
$1,050.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,050.44
|
| Rate for Payer: Meridian Medicaid |
$595.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$919.14
|
| Rate for Payer: PACE SWMI |
$875.37
|
| Rate for Payer: PHP Medicare Advantage |
$875.37
|
| 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 Medicare |
$875.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,911.53
|
| Rate for Payer: UHC Medicare Advantage |
$901.63
|
|
|
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 |
$932.35
|
| Rate for Payer: Aetna Medicare |
$695.78
|
| Rate for Payer: BCBS Complete |
$474.14
|
| Rate for Payer: BCBS MAPPO |
$695.78
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$1,027.20
|
| Rate for Payer: BCN Medicare Advantage |
$695.78
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cash Price |
$1,649.60
|
| Rate for Payer: Cofinity Commercial |
$1,001.92
|
| Rate for Payer: Cofinity Commercial |
$932.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.78
|
| Rate for Payer: Healthscope Commercial |
$834.94
|
| Rate for Payer: Healthscope Whirlpool |
$834.94
|
| Rate for Payer: Meridian Medicaid |
$474.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$730.57
|
| Rate for Payer: PACE SWMI |
$695.78
|
| Rate for Payer: PHP Medicare Advantage |
$695.78
|
| 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 Medicare |
$695.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,522.57
|
| Rate for Payer: UHC Medicare Advantage |
$716.65
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$394.80
|
|
|
Service Code
|
NDC 70377-066-11
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.36 |
| Max. Negotiated Rate |
$394.80 |
| Rate for Payer: Aetna Commercial |
$355.32
|
| Rate for Payer: ASR ASR |
$382.96
|
| Rate for Payer: BCBS Trust/PPO |
$306.09
|
| Rate for Payer: BCN Commercial |
$306.09
|
| Rate for Payer: Cash Price |
$315.84
|
| Rate for Payer: Cofinity Commercial |
$371.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.84
|
| Rate for Payer: Healthscope Commercial |
$394.80
|
| Rate for Payer: Healthscope Whirlpool |
$382.96
|
| Rate for Payer: Mclaren Commercial |
$355.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$335.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$347.42
|
|
|
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 |
$1,548.75
|
| Rate for Payer: Aetna Medicare |
$1,155.78
|
| Rate for Payer: BCBS Complete |
$787.92
|
| Rate for Payer: BCBS MAPPO |
$1,155.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.18
|
| Rate for Payer: BCN Commercial |
$1,713.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.78
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Cofinity Commercial |
$1,664.32
|
| Rate for Payer: Cofinity Commercial |
$1,548.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.78
|
| Rate for Payer: Healthscope Commercial |
$1,386.94
|
| Rate for Payer: Healthscope Whirlpool |
$1,386.94
|
| Rate for Payer: Meridian Medicaid |
$787.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,213.57
|
| Rate for Payer: PACE SWMI |
$1,155.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.78
|
| 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 Medicare |
$1,155.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,790.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,190.45
|
|
|
PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 90586
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$208.39 |
| Rate for Payer: Aetna Commercial |
$193.92
|
| Rate for Payer: Aetna Medicare |
$144.71
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS MAPPO |
$144.71
|
| Rate for Payer: BCBS Trust/PPO |
$147.22
|
| Rate for Payer: BCN Commercial |
$146.43
|
| Rate for Payer: BCN Medicare Advantage |
$144.71
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$208.39
|
| Rate for Payer: Cofinity Commercial |
$193.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.71
|
| Rate for Payer: Healthscope Commercial |
$173.66
|
| Rate for Payer: Healthscope Whirlpool |
$173.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.95
|
| Rate for Payer: PACE SWMI |
$144.71
|
| Rate for Payer: PHP Medicare Advantage |
$144.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.60
|
| Rate for Payer: Priority Health Medicare |
$144.71
|
| Rate for Payer: UHC Medicare Advantage |
$149.06
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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 |
$1,827.41
|
| Rate for Payer: Aetna Medicare |
$1,363.74
|
| Rate for Payer: BCBS Complete |
$1,930.00
|
| Rate for Payer: BCBS MAPPO |
$1,363.74
|
| Rate for Payer: BCBS Trust/PPO |
$18.49
|
| Rate for Payer: BCN Commercial |
$1,995.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,363.74
|
| Rate for Payer: Cash Price |
$3,860.00
|
| Rate for Payer: Cash Price |
$3,860.00
|
| Rate for Payer: Cofinity Commercial |
$1,963.79
|
| Rate for Payer: Cofinity Commercial |
$1,827.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,363.74
|
| Rate for Payer: Healthscope Commercial |
$1,636.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,636.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,431.93
|
| Rate for Payer: PACE SWMI |
$1,363.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,363.74
|
| 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 Medicare |
$1,363.74
|
| Rate for Payer: Priority Health Narrow Network |
$2,312.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,404.65
|
|
