|
PR AFO ANKLE GAUNTLET PRE OTS
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS L1902
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$129.50 |
| Rate for Payer: Aetna Commercial |
$120.51
|
| Rate for Payer: Aetna Medicare |
$89.93
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$89.93
|
| Rate for Payer: BCN Medicare Advantage |
$89.93
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$129.50
|
| Rate for Payer: Cofinity Commercial |
$120.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.93
|
| Rate for Payer: Healthscope Commercial |
$107.92
|
| Rate for Payer: Healthscope Whirlpool |
$107.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.43
|
| Rate for Payer: Nomi Health Commercial |
$107.92
|
| Rate for Payer: PACE SWMI |
$89.93
|
| Rate for Payer: PHP Medicare Advantage |
$89.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health Medicare |
$89.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.93
|
| Rate for Payer: UHC Medicare Advantage |
$89.93
|
| Rate for Payer: UHCCP DNSP |
$89.93
|
|
|
PR AFO MULTILIG ANK SUP PRE OTS
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS L1906
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$195.11 |
| Rate for Payer: Aetna Commercial |
$181.56
|
| Rate for Payer: Aetna Medicare |
$135.49
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$135.49
|
| Rate for Payer: BCN Medicare Advantage |
$135.49
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$195.11
|
| Rate for Payer: Cofinity Commercial |
$181.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$135.49
|
| Rate for Payer: Healthscope Commercial |
$162.59
|
| Rate for Payer: Healthscope Whirlpool |
$162.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$142.26
|
| Rate for Payer: Nomi Health Commercial |
$162.59
|
| Rate for Payer: PACE SWMI |
$135.49
|
| Rate for Payer: PHP Medicare Advantage |
$135.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$135.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$135.49
|
| Rate for Payer: UHC Medicare Advantage |
$135.49
|
| Rate for Payer: UHCCP DNSP |
$135.49
|
|
|
PR AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 90694
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
|
|
PR AK SLEEVE SUSP NEOPRENE/EQUA
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS L5695
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$281.85 |
| Rate for Payer: Aetna Commercial |
$262.28
|
| Rate for Payer: Aetna Medicare |
$195.73
|
| Rate for Payer: BCBS Complete |
$63.60
|
| Rate for Payer: BCBS MAPPO |
$195.73
|
| Rate for Payer: BCN Medicare Advantage |
$195.73
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$281.85
|
| Rate for Payer: Cofinity Commercial |
$262.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.73
|
| Rate for Payer: Healthscope Commercial |
$234.88
|
| Rate for Payer: Healthscope Whirlpool |
$234.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$205.52
|
| Rate for Payer: Nomi Health Commercial |
$234.88
|
| Rate for Payer: PACE SWMI |
$195.73
|
| Rate for Payer: PHP Medicare Advantage |
$195.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.35
|
| Rate for Payer: Priority Health Medicare |
$195.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$195.73
|
| Rate for Payer: UHC Medicare Advantage |
$195.73
|
| Rate for Payer: UHCCP DNSP |
$195.73
|
|
|
PR ALBUTEROL IPRATROP NON-COMP
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7620
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.27
|
| Rate for Payer: Aetna Medicare |
$0.20
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.20
|
| Rate for Payer: BCN Medicare Advantage |
$0.20
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.29
|
| Rate for Payer: Cofinity Commercial |
$0.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.20
|
| Rate for Payer: Healthscope Commercial |
$0.24
|
| Rate for Payer: Healthscope Whirlpool |
$0.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.21
|
| Rate for Payer: Nomi Health Commercial |
$0.24
|
| Rate for Payer: PACE SWMI |
$0.20
|
| Rate for Payer: PHP Medicare Advantage |
$0.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.20
|
| Rate for Payer: UHC Medicare Advantage |
$0.20
|
| Rate for Payer: UHCCP DNSP |
$0.20
|
|
|
PR ALBUTEROL NON-COMP CON
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7611
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.23
|
| Rate for Payer: Aetna Medicare |
$0.17
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.17
|
| Rate for Payer: BCN Medicare Advantage |
$0.17
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.24
|
| Rate for Payer: Cofinity Commercial |
$0.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.17
|
| Rate for Payer: Healthscope Commercial |
$0.20
|
| Rate for Payer: Healthscope Whirlpool |
$0.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.18
|
| Rate for Payer: Nomi Health Commercial |
$0.20
|
| Rate for Payer: PACE SWMI |
$0.17
|
| Rate for Payer: PHP Medicare Advantage |
$0.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.17
|
| Rate for Payer: UHC Medicare Advantage |
$0.17
|
| Rate for Payer: UHCCP DNSP |
$0.17
|
|
|
PR ALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7613
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna Commercial |
$0.11
|
| Rate for Payer: Aetna Medicare |
$0.08
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.08
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Cofinity Commercial |
$0.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.08
|
| Rate for Payer: Healthscope Commercial |
$0.10
|
| Rate for Payer: Healthscope Whirlpool |
$0.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.08
|
| Rate for Payer: Nomi Health Commercial |
$0.10
|
| Rate for Payer: PACE SWMI |
$0.08
|
| Rate for Payer: PHP Medicare Advantage |
$0.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health Medicare |
$0.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.08
|
| Rate for Payer: UHC Medicare Advantage |
$0.08
|
| Rate for Payer: UHCCP DNSP |
$0.08
|
|
|
PR ALCOHOL AND/OR DRUG SERVICES
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS H0015
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$160.55 |
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 99408
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 99409
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$67.60 |
| Rate for Payer: Aetna Medicare |
$52.00
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
HCPCS 20930
|
| Min. Negotiated Rate |
$195.60 |
| Max. Negotiated Rate |
$317.85 |
| Rate for Payer: Aetna Medicare |
$244.50
|
| Rate for Payer: BCBS Complete |
$195.60
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.85
|
|
|
PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
HCPCS 20931
|
| Min. Negotiated Rate |
$108.42 |
| Max. Negotiated Rate |
$289.90 |
| Rate for Payer: Aetna Commercial |
$145.28
|
| Rate for Payer: Aetna Medicare |
$108.42
|
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: BCBS MAPPO |
$108.42
|
| Rate for Payer: BCN Medicare Advantage |
$108.42
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Cofinity Commercial |
$156.12
|
| Rate for Payer: Cofinity Commercial |
$145.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.42
|
| Rate for Payer: Healthscope Commercial |
$130.10
|
| Rate for Payer: Healthscope Whirlpool |
$130.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.84
|
| Rate for Payer: Nomi Health Commercial |
$130.10
|
| Rate for Payer: PACE SWMI |
$108.42
|
| Rate for Payer: PHP Medicare Advantage |
$108.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.90
|
| Rate for Payer: Priority Health Medicare |
$108.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.42
|
| Rate for Payer: UHC Medicare Advantage |
$108.42
|
| Rate for Payer: UHCCP DNSP |
$108.42
|
|
|
PR ALTEPLASE RECOMBINANT
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS J2997
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$136.01 |
| Rate for Payer: Aetna Commercial |
$126.56
|
| Rate for Payer: Aetna Medicare |
$94.45
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$94.45
|
| Rate for Payer: BCN Medicare Advantage |
$94.45
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$136.01
|
| Rate for Payer: Cofinity Commercial |
$126.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.45
|
| Rate for Payer: Healthscope Commercial |
$113.34
|
| Rate for Payer: Healthscope Whirlpool |
$113.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.17
|
| Rate for Payer: Nomi Health Commercial |
$113.34
|
| Rate for Payer: PACE SWMI |
$94.45
|
| Rate for Payer: PHP Medicare Advantage |
$94.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$94.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.45
|
| Rate for Payer: UHC Medicare Advantage |
$94.45
|
| Rate for Payer: UHCCP DNSP |
$94.45
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
HCPCS 93784
|
| Min. Negotiated Rate |
$42.01 |
| Max. Negotiated Rate |
$167.05 |
| Rate for Payer: Aetna Commercial |
$56.29
|
| Rate for Payer: Aetna Medicare |
$42.01
|
| Rate for Payer: BCBS Complete |
$102.80
|
| Rate for Payer: BCBS MAPPO |
$42.01
|
| Rate for Payer: BCN Medicare Advantage |
$42.01
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cofinity Commercial |
$60.49
|
| Rate for Payer: Cofinity Commercial |
$56.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.01
|
| Rate for Payer: Healthscope Commercial |
$50.41
|
| Rate for Payer: Healthscope Whirlpool |
$50.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.11
|
| Rate for Payer: Nomi Health Commercial |
$50.41
|
| Rate for Payer: PACE SWMI |
$42.01
|
| Rate for Payer: PHP Medicare Advantage |
$42.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.05
|
| Rate for Payer: Priority Health Medicare |
$42.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.01
|
| Rate for Payer: UHC Medicare Advantage |
$42.01
|
| Rate for Payer: UHCCP DNSP |
$42.01
|
|
|
PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 93790
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$24.19 |
| Rate for Payer: Aetna Commercial |
$22.51
|
| Rate for Payer: Aetna Medicare |
$16.80
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$16.80
|
| Rate for Payer: BCN Medicare Advantage |
$16.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$24.19
|
| Rate for Payer: Cofinity Commercial |
$22.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.80
|
| Rate for Payer: Healthscope Commercial |
$20.16
|
| Rate for Payer: Healthscope Whirlpool |
$20.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.64
|
| Rate for Payer: Nomi Health Commercial |
$20.16
|
| Rate for Payer: PACE SWMI |
$16.80
|
| Rate for Payer: PHP Medicare Advantage |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$16.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.80
|
| Rate for Payer: UHC Medicare Advantage |
$16.80
|
| Rate for Payer: UHCCP DNSP |
$16.80
|
|
|
PR AMBULATORY EEG MONITORING
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 95950
|
| Min. Negotiated Rate |
$233.60 |
| Max. Negotiated Rate |
$379.60 |
| Rate for Payer: Aetna Medicare |
$292.00
|
| Rate for Payer: BCBS Complete |
$233.60
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.60
|
|
|
PR AMINOLEVULINIC ACID HCL TOP
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS J7308
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$564.61 |
| Rate for Payer: Aetna Commercial |
$525.40
|
| Rate for Payer: Aetna Medicare |
$392.09
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$392.09
|
| Rate for Payer: BCN Medicare Advantage |
$392.09
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$564.61
|
| Rate for Payer: Cofinity Commercial |
$525.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$392.09
|
| Rate for Payer: Healthscope Commercial |
$470.51
|
| Rate for Payer: Healthscope Whirlpool |
$470.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$411.69
|
| Rate for Payer: Nomi Health Commercial |
$470.51
|
| Rate for Payer: PACE SWMI |
$392.09
|
| Rate for Payer: PHP Medicare Advantage |
$392.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Medicare |
$392.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$392.09
|
| Rate for Payer: UHC Medicare Advantage |
$392.09
|
| Rate for Payer: UHCCP DNSP |
$392.09
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
OP
|
$112.10
|
|
|
Service Code
|
NDC 13668009190
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$100.89
|
| Rate for Payer: Aetna Medicare |
$56.05
|
| Rate for Payer: ASR ASR |
$108.74
|
| Rate for Payer: ASR Commercial |
$108.74
|
| Rate for Payer: BCBS Complete |
$44.84
|
| Rate for Payer: BCBS Trust/PPO |
$91.80
|
| Rate for Payer: BCN Commercial |
$86.91
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$105.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$112.10
|
| Rate for Payer: Healthscope Whirlpool |
$108.74
|
| Rate for Payer: Mclaren Commercial |
$100.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: Nomi Health Commercial |
$91.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.22
|
| Rate for Payer: Priority Health Narrow Network |
$78.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.65
|
|
|
PRAMIPEXOLE 0.125 MG TABLET
|
Facility
|
IP
|
$112.10
|
|
|
Service Code
|
NDC 13668009190
|
| Hospital Charge Code |
21287
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.86 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$100.89
|
| Rate for Payer: ASR ASR |
$108.74
|
| Rate for Payer: ASR Commercial |
$108.74
|
| Rate for Payer: BCBS Trust/PPO |
$91.35
|
| Rate for Payer: BCN Commercial |
$86.91
|
| Rate for Payer: Cash Price |
$89.68
|
| Rate for Payer: Cofinity Commercial |
$105.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.68
|
| Rate for Payer: Healthscope Commercial |
$112.10
|
| Rate for Payer: Healthscope Whirlpool |
$108.74
|
| Rate for Payer: Mclaren Commercial |
$100.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.28
|
| Rate for Payer: Nomi Health Commercial |
$91.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.65
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$109.98
|
|
|
Service Code
|
NDC 13668009290
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.99 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$98.98
|
| Rate for Payer: Aetna Medicare |
$54.99
|
| Rate for Payer: ASR ASR |
$106.68
|
| Rate for Payer: ASR Commercial |
$106.68
|
| Rate for Payer: BCBS Complete |
$43.99
|
| Rate for Payer: BCBS Trust/PPO |
$90.06
|
| Rate for Payer: BCN Commercial |
$85.27
|
| Rate for Payer: Cash Price |
$87.98
|
| Rate for Payer: Cofinity Commercial |
$103.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.98
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Healthscope Whirlpool |
$106.68
|
| Rate for Payer: Mclaren Commercial |
$98.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.48
|
| Rate for Payer: Nomi Health Commercial |
$90.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.36
|
| Rate for Payer: Priority Health Narrow Network |
$77.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.78
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
OP
|
$444.15
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.66 |
| Max. Negotiated Rate |
$444.15 |
| Rate for Payer: Aetna Commercial |
$399.74
|
| Rate for Payer: Aetna Medicare |
$222.07
|
| Rate for Payer: ASR ASR |
$430.83
|
| Rate for Payer: ASR Commercial |
$430.83
|
| Rate for Payer: BCBS Complete |
$177.66
|
| Rate for Payer: BCBS Trust/PPO |
$363.71
|
| Rate for Payer: BCN Commercial |
$344.35
|
| Rate for Payer: Cash Price |
$355.32
|
| Rate for Payer: Cofinity Commercial |
$417.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.32
|
| Rate for Payer: Healthscope Commercial |
$444.15
|
| Rate for Payer: Healthscope Whirlpool |
$430.83
|
| Rate for Payer: Mclaren Commercial |
$399.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.53
|
| Rate for Payer: Nomi Health Commercial |
$364.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$389.16
|
| Rate for Payer: Priority Health Narrow Network |
$311.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$390.85
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$109.98
|
|
|
Service Code
|
NDC 13668009290
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.49 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$98.98
|
| Rate for Payer: ASR ASR |
$106.68
|
| Rate for Payer: ASR Commercial |
$106.68
|
| Rate for Payer: BCBS Trust/PPO |
$89.62
|
| Rate for Payer: BCN Commercial |
$85.27
|
| Rate for Payer: Cash Price |
$87.98
|
| Rate for Payer: Cofinity Commercial |
$103.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.98
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Healthscope Whirlpool |
$106.68
|
| Rate for Payer: Mclaren Commercial |
$98.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.48
|
| Rate for Payer: Nomi Health Commercial |
$90.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.78
|
|
|
PRAMIPEXOLE 0.25 MG TABLET
|
Facility
|
IP
|
$444.15
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$288.70 |
| Max. Negotiated Rate |
$444.15 |
| Rate for Payer: Aetna Commercial |
$399.74
|
| Rate for Payer: ASR ASR |
$430.83
|
| Rate for Payer: ASR Commercial |
$430.83
|
| Rate for Payer: BCBS Trust/PPO |
$361.94
|
| Rate for Payer: BCN Commercial |
$344.35
|
| Rate for Payer: Cash Price |
$355.32
|
| Rate for Payer: Cofinity Commercial |
$417.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.32
|
| Rate for Payer: Healthscope Commercial |
$444.15
|
| Rate for Payer: Healthscope Whirlpool |
$430.83
|
| Rate for Payer: Mclaren Commercial |
$399.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.53
|
| Rate for Payer: Nomi Health Commercial |
$364.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$390.85
|
|
|
PR AMNIOCENTESIS DIAGNOSIC
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 59000
|
| Min. Negotiated Rate |
$78.36 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$105.00
|
| Rate for Payer: Aetna Medicare |
$78.36
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$78.36
|
| Rate for Payer: BCN Medicare Advantage |
$78.36
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$112.84
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.36
|
| Rate for Payer: Healthscope Commercial |
$94.03
|
| Rate for Payer: Healthscope Whirlpool |
$94.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.28
|
| Rate for Payer: Nomi Health Commercial |
$94.03
|
| Rate for Payer: PACE SWMI |
$78.36
|
| Rate for Payer: PHP Medicare Advantage |
$78.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health Medicare |
$78.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.36
|
| Rate for Payer: UHC Medicare Advantage |
$78.36
|
| Rate for Payer: UHCCP DNSP |
$78.36
|
|
|
PR AMNIOCENTESIS THER AMNIOTIC FLUID RDCTJ US GUID
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
HCPCS 59001
|
| Min. Negotiated Rate |
$167.20 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$173.62
|
| Rate for Payer: BCBS Complete |
$167.20
|
| Rate for Payer: BCBS MAPPO |
$173.62
|
| Rate for Payer: BCN Medicare Advantage |
$173.62
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cofinity Commercial |
$250.01
|
| Rate for Payer: Cofinity Commercial |
$232.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$173.62
|
| Rate for Payer: Healthscope Commercial |
$208.34
|
| Rate for Payer: Healthscope Whirlpool |
$208.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$182.30
|
| Rate for Payer: Nomi Health Commercial |
$208.34
|
| Rate for Payer: PACE SWMI |
$173.62
|
| Rate for Payer: PHP Medicare Advantage |
$173.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.70
|
| Rate for Payer: Priority Health Medicare |
$173.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$173.62
|
| Rate for Payer: UHC Medicare Advantage |
$173.62
|
| Rate for Payer: UHCCP DNSP |
$173.62
|
|
