|
PR ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 96105
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$164.86 |
| Rate for Payer: Aetna Commercial |
$126.21
|
| Rate for Payer: Aetna Medicare |
$94.19
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: BCBS MAPPO |
$94.19
|
| Rate for Payer: BCN Commercial |
$144.41
|
| Rate for Payer: BCN Medicare Advantage |
$94.19
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$135.63
|
| Rate for Payer: Cofinity Commercial |
$126.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.19
|
| Rate for Payer: Healthscope Commercial |
$113.03
|
| Rate for Payer: Healthscope Whirlpool |
$113.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.61
|
| Rate for Payer: Nomi Health Commercial |
$113.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: PACE SWMI |
$94.19
|
| Rate for Payer: PHP Medicare Advantage |
$94.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.17
|
| Rate for Payer: Priority Health Medicare |
$94.19
|
| Rate for Payer: Priority Health Narrow Network |
$133.17
|
| Rate for Payer: Railroad Medicare Medicare |
$94.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$94.19
|
| Rate for Payer: UHC Exchange |
$164.86
|
| Rate for Payer: UHCCP DNSP |
$94.19
|
|
|
PR ASSESSMENT FOR HEARING AID
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS V5010
|
| Min. Negotiated Rate |
$47.05 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Aetna Commercial |
$47.05
|
| Rate for Payer: BCBS Complete |
$58.80
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.68
|
| Rate for Payer: UHC Exchange |
$78.68
|
|
|
PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS 99483
|
| Min. Negotiated Rate |
$108.20 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$225.15
|
| Rate for Payer: Aetna Medicare |
$168.02
|
| Rate for Payer: BCBS Complete |
$113.61
|
| Rate for Payer: BCBS MAPPO |
$168.02
|
| Rate for Payer: BCN Commercial |
$208.87
|
| Rate for Payer: BCN Medicare Advantage |
$168.02
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$241.95
|
| Rate for Payer: Cofinity Commercial |
$225.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.02
|
| Rate for Payer: Healthscope Commercial |
$184.82
|
| Rate for Payer: Healthscope Whirlpool |
$184.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.42
|
| Rate for Payer: Meridian Medicaid |
$113.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.82
|
| Rate for Payer: Nomi Health Commercial |
$201.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.00
|
| Rate for Payer: PACE SWMI |
$168.02
|
| Rate for Payer: PHP Medicare Advantage |
$168.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$257.55
|
| Rate for Payer: Priority Health Medicare |
$168.02
|
| Rate for Payer: Priority Health Narrow Network |
$257.55
|
| Rate for Payer: Railroad Medicare Medicare |
$168.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.02
|
| Rate for Payer: UHC Exchange |
$256.10
|
| Rate for Payer: UHC Medicaid |
$108.20
|
| Rate for Payer: UHCCP DNSP |
$168.02
|
| Rate for Payer: UHCCP Medicaid |
$108.20
|
|
|
PRASUGREL HCL 10 MG TABLET
|
Facility
|
OP
|
$110.30
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.81 |
| Max. Negotiated Rate |
$110.30 |
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: Aetna Medicare |
$40.81
|
| Rate for Payer: ASR ASR |
$106.99
|
| Rate for Payer: BCBS Complete |
$44.12
|
| Rate for Payer: BCBS Trust/PPO |
$90.94
|
| Rate for Payer: BCN Commercial |
$90.94
|
| Rate for Payer: Cash Price |
$88.24
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.24
|
| Rate for Payer: Healthscope Commercial |
$106.99
|
| Rate for Payer: Healthscope Whirlpool |
$110.30
|
| Rate for Payer: Mclaren Commercial |
$99.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.75
|
| Rate for Payer: Nomi Health Commercial |
$90.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$96.64
|
| Rate for Payer: Priority Health Narrow Network |
$77.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.06
|
|
|
PRASUGREL HCL 10 MG TABLET
|
Facility
|
IP
|
$110.30
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$110.30 |
| Rate for Payer: Aetna Commercial |
$99.27
|
| Rate for Payer: ASR ASR |
$106.99
|
| Rate for Payer: BCBS Trust/PPO |
$90.57
|
| Rate for Payer: BCN Commercial |
$90.57
|
| Rate for Payer: Cash Price |
$88.24
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.24
|
| Rate for Payer: Healthscope Commercial |
$106.99
|
| Rate for Payer: Healthscope Whirlpool |
$110.30
|
| Rate for Payer: Mclaren Commercial |
$99.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.75
|
| Rate for Payer: Nomi Health Commercial |
$90.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.06
|
|
|
PR ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
HCPCS 33257
|
| Min. Negotiated Rate |
$362.95 |
| Max. Negotiated Rate |
$1,178.25 |
| Rate for Payer: Aetna Commercial |
$755.40
|
| Rate for Payer: Aetna Medicare |
$563.73
|
| Rate for Payer: BCBS Complete |
$381.10
|
| Rate for Payer: BCBS MAPPO |
$563.73
|
| Rate for Payer: BCN Commercial |
$864.49
|
| Rate for Payer: BCN Medicare Advantage |
$563.73
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cofinity Commercial |
$811.77
|
| Rate for Payer: Cofinity Commercial |
$755.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$563.73
|
| Rate for Payer: Healthscope Commercial |
$676.48
|
| Rate for Payer: Healthscope Whirlpool |
$676.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$591.92
|
| Rate for Payer: Meridian Medicaid |
$381.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$620.10
|
| Rate for Payer: Nomi Health Commercial |
$676.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,178.25
|
| Rate for Payer: PACE SWMI |
$563.73
|
| Rate for Payer: PHP Medicare Advantage |
$563.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$929.66
|
| Rate for Payer: Priority Health Medicare |
$563.73
|
| Rate for Payer: Priority Health Narrow Network |
$929.66
|
| Rate for Payer: Railroad Medicare Medicare |
$563.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,028.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$563.73
|
| Rate for Payer: UHC Exchange |
$1,028.15
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| Rate for Payer: UHCCP DNSP |
$563.73
|
| Rate for Payer: UHCCP Medicaid |
$362.95
|
|
|
PR ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS
|
Professional
|
Both
|
$2,372.00
|
|
|
Service Code
|
HCPCS 33259
|
| Min. Negotiated Rate |
$523.55 |
| Max. Negotiated Rate |
$1,779.00 |
| Rate for Payer: Aetna Commercial |
$1,090.60
|
| Rate for Payer: Aetna Medicare |
$813.88
|
| Rate for Payer: BCBS Complete |
$549.73
|
| Rate for Payer: BCBS MAPPO |
$813.88
|
| Rate for Payer: BCN Commercial |
$1,254.91
|
| Rate for Payer: BCN Medicare Advantage |
$813.88
|
| Rate for Payer: Cash Price |
$1,897.60
|
| Rate for Payer: Cash Price |
$1,897.60
|
| Rate for Payer: Cofinity Commercial |
$1,171.99
|
| Rate for Payer: Cofinity Commercial |
$1,090.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$813.88
|
| Rate for Payer: Healthscope Commercial |
$976.66
|
| Rate for Payer: Healthscope Whirlpool |
$976.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$854.57
|
| Rate for Payer: Meridian Medicaid |
$549.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$895.27
|
| Rate for Payer: Nomi Health Commercial |
$976.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,779.00
|
| Rate for Payer: PACE SWMI |
$813.88
|
| Rate for Payer: PHP Medicare Advantage |
$813.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$523.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,349.50
|
| Rate for Payer: Priority Health Medicare |
$813.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,349.50
|
| Rate for Payer: Railroad Medicare Medicare |
$813.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,492.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$813.88
|
| Rate for Payer: UHC Exchange |
$1,492.97
|
| Rate for Payer: UHC Medicaid |
$523.55
|
| Rate for Payer: UHCCP DNSP |
$813.88
|
| Rate for Payer: UHCCP Medicaid |
$523.55
|
|
|
PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 99464
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$316.50 |
| Rate for Payer: Aetna Commercial |
$83.84
|
| Rate for Payer: Aetna Medicare |
$62.57
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$62.57
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: BCN Medicare Advantage |
$62.57
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$90.10
|
| Rate for Payer: Cofinity Commercial |
$83.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.57
|
| Rate for Payer: Healthscope Commercial |
$68.83
|
| Rate for Payer: Healthscope Whirlpool |
$68.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.70
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.83
|
| Rate for Payer: Nomi Health Commercial |
$75.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: PACE SWMI |
$62.57
|
| Rate for Payer: PHP Medicare Advantage |
$62.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.85
|
| Rate for Payer: Priority Health Medicare |
$62.57
|
| Rate for Payer: Priority Health Narrow Network |
$95.85
|
| Rate for Payer: Railroad Medicare Medicare |
$62.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.57
|
| Rate for Payer: UHC Exchange |
$105.86
|
| Rate for Payer: UHC Medicaid |
$40.26
|
| Rate for Payer: UHCCP DNSP |
$62.57
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
|
PR AUDIOMETRY FOR HEARING AID
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS S0618
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$60.75 |
| Rate for Payer: Aetna Commercial |
$43.02
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.75
|
|
|
PR AUDITORY EVOKED POTENTIAL
|
Professional
|
Both
|
$351.00
|
|
|
Service Code
|
HCPCS 92585
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: BCBS Complete |
$140.40
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.25
|
|
|
PR AUDITORY EVOKED POTENTIAL, LIMITED
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 92586
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: BCBS Complete |
$60.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.00
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,246.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$934.50 |
| Rate for Payer: Aetna Commercial |
$220.55
|
| Rate for Payer: Aetna Medicare |
$164.59
|
| Rate for Payer: BCBS Complete |
$109.37
|
| Rate for Payer: BCBS MAPPO |
$164.59
|
| Rate for Payer: BCN Commercial |
$300.34
|
| Rate for Payer: BCN Medicare Advantage |
$164.59
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cofinity Commercial |
$237.01
|
| Rate for Payer: Cofinity Commercial |
$220.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.59
|
| Rate for Payer: Healthscope Commercial |
$197.51
|
| Rate for Payer: Healthscope Whirlpool |
$197.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.82
|
| Rate for Payer: Meridian Medicaid |
$109.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$181.05
|
| Rate for Payer: Nomi Health Commercial |
$197.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$934.50
|
| Rate for Payer: PACE SWMI |
$164.59
|
| Rate for Payer: PHP Medicare Advantage |
$164.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$292.24
|
| Rate for Payer: Priority Health Medicare |
$164.59
|
| Rate for Payer: Priority Health Narrow Network |
$292.24
|
| Rate for Payer: Railroad Medicare Medicare |
$164.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$164.59
|
| Rate for Payer: UHC Exchange |
$327.59
|
| Rate for Payer: UHC Medicaid |
$104.16
|
| Rate for Payer: UHCCP DNSP |
$164.59
|
| Rate for Payer: UHCCP Medicaid |
$104.16
|
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$165.78 |
| Max. Negotiated Rate |
$574.50 |
| Rate for Payer: Aetna Commercial |
$165.78
|
| Rate for Payer: BCBS Complete |
$306.40
|
| Rate for Payer: BCN Commercial |
$184.90
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$200.69
|
| Rate for Payer: Priority Health Narrow Network |
$200.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.34
|
| Rate for Payer: UHC Exchange |
$220.34
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$198.44
|
| Rate for Payer: Aetna Medicare |
$148.09
|
| Rate for Payer: BCBS Complete |
$98.63
|
| Rate for Payer: BCBS MAPPO |
$148.09
|
| Rate for Payer: BCN Commercial |
$274.63
|
| Rate for Payer: BCN Medicare Advantage |
$148.09
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$213.25
|
| Rate for Payer: Cofinity Commercial |
$198.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.09
|
| Rate for Payer: Healthscope Commercial |
$177.71
|
| Rate for Payer: Healthscope Whirlpool |
$177.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.49
|
| Rate for Payer: Meridian Medicaid |
$98.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.90
|
| Rate for Payer: Nomi Health Commercial |
$177.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.00
|
| Rate for Payer: PACE SWMI |
$148.09
|
| Rate for Payer: PHP Medicare Advantage |
$148.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$267.23
|
| Rate for Payer: Priority Health Medicare |
$148.09
|
| Rate for Payer: Priority Health Narrow Network |
$267.23
|
| Rate for Payer: Railroad Medicare Medicare |
$148.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$148.09
|
| Rate for Payer: UHC Exchange |
$297.26
|
| Rate for Payer: UHC Medicaid |
$93.93
|
| Rate for Payer: UHCCP DNSP |
$148.09
|
| Rate for Payer: UHCCP Medicaid |
$93.93
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,482.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$953.18 |
| Max. Negotiated Rate |
$2,898.56 |
| Rate for Payer: Aetna Commercial |
$1,972.14
|
| Rate for Payer: Aetna Medicare |
$1,471.75
|
| Rate for Payer: BCBS Complete |
$1,000.84
|
| Rate for Payer: BCBS MAPPO |
$1,471.75
|
| Rate for Payer: BCN Commercial |
$2,488.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,471.75
|
| Rate for Payer: Cash Price |
$2,785.60
|
| Rate for Payer: Cash Price |
$2,785.60
|
| Rate for Payer: Cofinity Commercial |
$2,119.32
|
| Rate for Payer: Cofinity Commercial |
$1,972.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,471.75
|
| Rate for Payer: Healthscope Commercial |
$1,766.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,766.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,545.34
|
| Rate for Payer: Meridian Medicaid |
$1,000.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,618.92
|
| Rate for Payer: Nomi Health Commercial |
$1,766.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,611.50
|
| Rate for Payer: PACE SWMI |
$1,471.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,471.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$953.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,660.58
|
| Rate for Payer: Priority Health Medicare |
$1,471.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,660.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,471.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,898.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,471.75
|
| Rate for Payer: UHC Exchange |
$2,898.56
|
| Rate for Payer: UHC Medicaid |
$953.18
|
| Rate for Payer: UHCCP DNSP |
$1,471.75
|
| Rate for Payer: UHCCP Medicaid |
$953.18
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$389.50
|
|
|
Service Code
|
NDC 904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.12 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Aetna Commercial |
$350.55
|
| Rate for Payer: Aetna Medicare |
$144.12
|
| Rate for Payer: ASR ASR |
$377.81
|
| Rate for Payer: BCBS Complete |
$155.80
|
| Rate for Payer: BCBS Trust/PPO |
$321.14
|
| Rate for Payer: BCN Commercial |
$321.14
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Commercial |
$366.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$377.81
|
| Rate for Payer: Healthscope Whirlpool |
$389.50
|
| Rate for Payer: Mclaren Commercial |
$350.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.07
|
| Rate for Payer: Nomi Health Commercial |
$319.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$341.28
|
| Rate for Payer: Priority Health Narrow Network |
$273.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.76
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$389.50
|
|
|
Service Code
|
NDC 904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.12 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Aetna Commercial |
$350.55
|
| Rate for Payer: ASR ASR |
$377.81
|
| Rate for Payer: BCBS Trust/PPO |
$319.86
|
| Rate for Payer: BCN Commercial |
$319.86
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Commercial |
$366.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$377.81
|
| Rate for Payer: Healthscope Whirlpool |
$389.50
|
| Rate for Payer: Mclaren Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.07
|
| Rate for Payer: Nomi Health Commercial |
$319.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.76
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$2.82
|
|
|
Service Code
|
NDC 50268066711
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: ASR ASR |
$2.73
|
| Rate for Payer: BCBS Trust/PPO |
$2.31
|
| Rate for Payer: BCN Commercial |
$2.31
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Healthscope Whirlpool |
$2.82
|
| Rate for Payer: Mclaren Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.48
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$2.82
|
|
|
Service Code
|
NDC 50268066711
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Aetna Commercial |
$2.54
|
| Rate for Payer: Aetna Medicare |
$1.04
|
| Rate for Payer: ASR ASR |
$2.73
|
| Rate for Payer: BCBS Complete |
$1.13
|
| Rate for Payer: BCBS Trust/PPO |
$2.32
|
| Rate for Payer: BCN Commercial |
$2.32
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Healthscope Whirlpool |
$2.82
|
| Rate for Payer: Mclaren Commercial |
$2.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.40
|
| Rate for Payer: Nomi Health Commercial |
$2.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.47
|
| Rate for Payer: Priority Health Narrow Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.48
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$280.32
|
|
|
Service Code
|
NDC 904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.72 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$252.29
|
| Rate for Payer: Aetna Medicare |
$103.72
|
| Rate for Payer: ASR ASR |
$271.91
|
| Rate for Payer: BCBS Complete |
$112.13
|
| Rate for Payer: BCBS Trust/PPO |
$231.12
|
| Rate for Payer: BCN Commercial |
$231.12
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$263.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$271.91
|
| Rate for Payer: Healthscope Whirlpool |
$280.32
|
| Rate for Payer: Mclaren Commercial |
$252.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Nomi Health Commercial |
$229.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$245.62
|
| Rate for Payer: Priority Health Narrow Network |
$196.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.68
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$140.88
|
|
|
Service Code
|
NDC 50268066715
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.66 |
| Max. Negotiated Rate |
$140.88 |
| Rate for Payer: Aetna Commercial |
$126.79
|
| Rate for Payer: ASR ASR |
$136.65
|
| Rate for Payer: BCBS Trust/PPO |
$115.69
|
| Rate for Payer: BCN Commercial |
$115.69
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.70
|
| Rate for Payer: Healthscope Commercial |
$136.65
|
| Rate for Payer: Healthscope Whirlpool |
$140.88
|
| Rate for Payer: Mclaren Commercial |
$126.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.75
|
| Rate for Payer: Nomi Health Commercial |
$115.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.97
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$140.88
|
|
|
Service Code
|
NDC 50268066715
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.13 |
| Max. Negotiated Rate |
$140.88 |
| Rate for Payer: Aetna Commercial |
$126.79
|
| Rate for Payer: Aetna Medicare |
$52.13
|
| Rate for Payer: ASR ASR |
$136.65
|
| Rate for Payer: BCBS Complete |
$56.35
|
| Rate for Payer: BCBS Trust/PPO |
$116.16
|
| Rate for Payer: BCN Commercial |
$116.16
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cofinity Commercial |
$132.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.70
|
| Rate for Payer: Healthscope Commercial |
$136.65
|
| Rate for Payer: Healthscope Whirlpool |
$140.88
|
| Rate for Payer: Mclaren Commercial |
$126.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.75
|
| Rate for Payer: Nomi Health Commercial |
$115.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$123.44
|
| Rate for Payer: Priority Health Narrow Network |
$98.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.97
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.24 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$252.29
|
| Rate for Payer: ASR ASR |
$271.91
|
| Rate for Payer: BCBS Trust/PPO |
$230.20
|
| Rate for Payer: BCN Commercial |
$230.20
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$263.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$271.91
|
| Rate for Payer: Healthscope Whirlpool |
$280.32
|
| Rate for Payer: Mclaren Commercial |
$252.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.27
|
| Rate for Payer: Nomi Health Commercial |
$229.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.68
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$48.06
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$48.06
|
| Rate for Payer: BCN Commercial |
$63.22
|
| Rate for Payer: BCN Medicare Advantage |
$48.06
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$69.21
|
| Rate for Payer: Cofinity Commercial |
$64.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.06
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Healthscope Whirlpool |
$57.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.46
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.87
|
| Rate for Payer: Nomi Health Commercial |
$57.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
| Rate for Payer: PACE SWMI |
$48.06
|
| Rate for Payer: PHP Medicare Advantage |
$48.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.38
|
| Rate for Payer: Priority Health Medicare |
$48.06
|
| Rate for Payer: Priority Health Narrow Network |
$73.38
|
| Rate for Payer: Railroad Medicare Medicare |
$48.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.06
|
| Rate for Payer: UHC Exchange |
$96.29
|
| Rate for Payer: UHC Medicaid |
$31.10
|
| Rate for Payer: UHCCP DNSP |
$48.06
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Aetna Medicare |
$15.01
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$15.01
|
| Rate for Payer: BCN Commercial |
$19.64
|
| Rate for Payer: BCN Medicare Advantage |
$15.01
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Cofinity Commercial |
$20.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.01
|
| Rate for Payer: Healthscope Commercial |
$18.01
|
| Rate for Payer: Healthscope Whirlpool |
$18.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.76
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.51
|
| Rate for Payer: Nomi Health Commercial |
$18.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: PACE SWMI |
$15.01
|
| Rate for Payer: PHP Medicare Advantage |
$15.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.78
|
| Rate for Payer: Priority Health Medicare |
$15.01
|
| Rate for Payer: Priority Health Narrow Network |
$22.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.01
|
| Rate for Payer: UHC Exchange |
$30.92
|
| Rate for Payer: UHC Medicaid |
$9.59
|
| Rate for Payer: UHCCP DNSP |
$15.01
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
|
