|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$162.74 |
| Max. Negotiated Rate |
$631.15 |
| Rate for Payer: Aetna Commercial |
$218.07
|
| Rate for Payer: Aetna Medicare |
$162.74
|
| Rate for Payer: BCBS Complete |
$388.40
|
| Rate for Payer: BCBS MAPPO |
$162.74
|
| Rate for Payer: BCN Medicare Advantage |
$162.74
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cofinity Commercial |
$234.35
|
| Rate for Payer: Cofinity Commercial |
$218.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.74
|
| Rate for Payer: Healthscope Commercial |
$195.29
|
| Rate for Payer: Healthscope Whirlpool |
$195.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.88
|
| Rate for Payer: Nomi Health Commercial |
$195.29
|
| Rate for Payer: PACE SWMI |
$162.74
|
| Rate for Payer: PHP Medicare Advantage |
$162.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.15
|
| Rate for Payer: Priority Health Medicare |
$162.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.74
|
| Rate for Payer: UHC Medicare Advantage |
$162.74
|
| Rate for Payer: UHCCP DNSP |
$162.74
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,381.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$1,352.40 |
| Max. Negotiated Rate |
$2,285.25 |
| Rate for Payer: Aetna Commercial |
$2,126.55
|
| Rate for Payer: Aetna Medicare |
$1,586.98
|
| Rate for Payer: BCBS Complete |
$1,352.40
|
| Rate for Payer: BCBS MAPPO |
$1,586.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,586.98
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cofinity Commercial |
$2,285.25
|
| Rate for Payer: Cofinity Commercial |
$2,126.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,586.98
|
| Rate for Payer: Healthscope Commercial |
$1,904.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,904.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,666.33
|
| Rate for Payer: Nomi Health Commercial |
$1,904.38
|
| Rate for Payer: PACE SWMI |
$1,586.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,586.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,197.65
|
| Rate for Payer: Priority Health Medicare |
$1,586.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,586.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,586.98
|
| Rate for Payer: UHCCP DNSP |
$1,586.98
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: ASR ASR |
$313.31
|
| Rate for Payer: ASR Commercial |
$313.31
|
| Rate for Payer: BCBS Trust/PPO |
$263.21
|
| Rate for Payer: BCN Commercial |
$250.42
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$303.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$323.00
|
| Rate for Payer: Healthscope Whirlpool |
$313.31
|
| Rate for Payer: Mclaren Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: Nomi Health Commercial |
$264.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.24
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Medicare |
$161.50
|
| Rate for Payer: ASR ASR |
$313.31
|
| Rate for Payer: ASR Commercial |
$313.31
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: BCBS Trust/PPO |
$264.50
|
| Rate for Payer: BCN Commercial |
$250.42
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$303.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$323.00
|
| Rate for Payer: Healthscope Whirlpool |
$313.31
|
| Rate for Payer: Mclaren Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: Nomi Health Commercial |
$264.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.01
|
| Rate for Payer: Priority Health Narrow Network |
$226.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.24
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$137.52
|
|
|
Service Code
|
NDC 50268066715
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.39 |
| Max. Negotiated Rate |
$137.52 |
| Rate for Payer: Aetna Commercial |
$123.77
|
| Rate for Payer: ASR ASR |
$133.39
|
| Rate for Payer: ASR Commercial |
$133.39
|
| Rate for Payer: BCBS Trust/PPO |
$112.07
|
| Rate for Payer: BCN Commercial |
$106.62
|
| Rate for Payer: Cash Price |
$110.02
|
| Rate for Payer: Cofinity Commercial |
$129.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.02
|
| Rate for Payer: Healthscope Commercial |
$137.52
|
| Rate for Payer: Healthscope Whirlpool |
$133.39
|
| Rate for Payer: Mclaren Commercial |
$123.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.89
|
| Rate for Payer: Nomi Health Commercial |
$112.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.02
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$284.16
|
|
|
Service Code
|
NDC 00904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.70 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$255.74
|
| Rate for Payer: ASR ASR |
$275.64
|
| Rate for Payer: ASR Commercial |
$275.64
|
| Rate for Payer: BCBS Trust/PPO |
$231.56
|
| Rate for Payer: BCN Commercial |
$220.31
|
| Rate for Payer: Cash Price |
$227.33
|
| Rate for Payer: Cofinity Commercial |
$267.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.33
|
| Rate for Payer: Healthscope Commercial |
$284.16
|
| Rate for Payer: Healthscope Whirlpool |
$275.64
|
| Rate for Payer: Mclaren Commercial |
$255.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.54
|
| Rate for Payer: Nomi Health Commercial |
$233.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.06
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$2.75
|
|
|
Service Code
|
NDC 50268066711
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: ASR ASR |
$2.67
|
| Rate for Payer: ASR Commercial |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Healthscope Whirlpool |
$2.67
|
| Rate for Payer: Mclaren Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.34
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.42
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$137.52
|
|
|
Service Code
|
NDC 50268066715
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.01 |
| Max. Negotiated Rate |
$137.52 |
| Rate for Payer: Aetna Commercial |
$123.77
|
| Rate for Payer: Aetna Medicare |
$68.76
|
| Rate for Payer: ASR ASR |
$133.39
|
| Rate for Payer: ASR Commercial |
$133.39
|
| Rate for Payer: BCBS Complete |
$55.01
|
| Rate for Payer: BCBS Trust/PPO |
$112.62
|
| Rate for Payer: BCN Commercial |
$106.62
|
| Rate for Payer: Cash Price |
$110.02
|
| Rate for Payer: Cofinity Commercial |
$129.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.02
|
| Rate for Payer: Healthscope Commercial |
$137.52
|
| Rate for Payer: Healthscope Whirlpool |
$133.39
|
| Rate for Payer: Mclaren Commercial |
$123.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.89
|
| Rate for Payer: Nomi Health Commercial |
$112.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.50
|
| Rate for Payer: Priority Health Narrow Network |
$96.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.02
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$2.75
|
|
|
Service Code
|
NDC 50268066711
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: ASR ASR |
$2.67
|
| Rate for Payer: ASR Commercial |
$2.67
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.25
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Healthscope Whirlpool |
$2.67
|
| Rate for Payer: Mclaren Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.34
|
| Rate for Payer: Nomi Health Commercial |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.41
|
| Rate for Payer: Priority Health Narrow Network |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.42
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$284.16
|
|
|
Service Code
|
NDC 00904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.66 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$255.74
|
| Rate for Payer: Aetna Medicare |
$142.08
|
| Rate for Payer: ASR ASR |
$275.64
|
| Rate for Payer: ASR Commercial |
$275.64
|
| Rate for Payer: BCBS Complete |
$113.66
|
| Rate for Payer: BCBS Trust/PPO |
$232.70
|
| Rate for Payer: BCN Commercial |
$220.31
|
| Rate for Payer: Cash Price |
$227.33
|
| Rate for Payer: Cofinity Commercial |
$267.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.33
|
| Rate for Payer: Healthscope Commercial |
$284.16
|
| Rate for Payer: Healthscope Whirlpool |
$275.64
|
| Rate for Payer: Mclaren Commercial |
$255.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.54
|
| Rate for Payer: Nomi Health Commercial |
$233.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.98
|
| Rate for Payer: Priority Health Narrow Network |
$199.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.06
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$51.14 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Aetna Medicare |
$51.14
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS MAPPO |
$51.14
|
| Rate for Payer: BCN Medicare Advantage |
$51.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$73.64
|
| Rate for Payer: Cofinity Commercial |
$68.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.14
|
| Rate for Payer: Healthscope Commercial |
$61.37
|
| Rate for Payer: Healthscope Whirlpool |
$61.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.70
|
| Rate for Payer: Nomi Health Commercial |
$61.37
|
| Rate for Payer: PACE SWMI |
$51.14
|
| Rate for Payer: PHP Medicare Advantage |
$51.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health Medicare |
$51.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.14
|
| Rate for Payer: UHC Medicare Advantage |
$51.14
|
| Rate for Payer: UHCCP DNSP |
$51.14
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$16.08 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Medicare |
$16.08
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS MAPPO |
$16.08
|
| Rate for Payer: BCN Medicare Advantage |
$16.08
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$21.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.08
|
| Rate for Payer: Healthscope Commercial |
$19.30
|
| Rate for Payer: Healthscope Whirlpool |
$19.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.88
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: PACE SWMI |
$16.08
|
| Rate for Payer: PHP Medicare Advantage |
$16.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.08
|
| Rate for Payer: UHC Medicare Advantage |
$16.08
|
| Rate for Payer: UHCCP DNSP |
$16.08
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$1,016.60 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: ASR ASR |
$1,517.08
|
| Rate for Payer: ASR Commercial |
$1,517.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,274.50
|
| Rate for Payer: BCN Commercial |
$1,212.57
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,470.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Healthscope Commercial |
$1,564.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.08
|
| Rate for Payer: Mclaren Commercial |
$1,407.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: Nomi Health Commercial |
$1,282.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,376.32
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$1,016.60 |
| Max. Negotiated Rate |
$8,819.70 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: Aetna Medicare |
$5,690.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: ASR ASR |
$1,517.08
|
| Rate for Payer: ASR Commercial |
$1,517.08
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,280.76
|
| Rate for Payer: BCN Commercial |
$1,212.57
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,470.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$1,564.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,690.13
|
| Rate for Payer: Mclaren Commercial |
$1,407.60
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: Nomi Health Commercial |
$1,282.48
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Commercial |
$6,259.14
|
| Rate for Payer: PHP Medicaid |
$3,049.91
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,370.38
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,096.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,376.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$8,819.70
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP DNSP |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: VA VA |
$5,690.13
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$625.60 |
| Max. Negotiated Rate |
$1,236.27 |
| Rate for Payer: Aetna Commercial |
$1,150.42
|
| Rate for Payer: Aetna Medicare |
$858.52
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$858.52
|
| Rate for Payer: BCN Medicare Advantage |
$858.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,236.27
|
| Rate for Payer: Cofinity Commercial |
$1,150.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.52
|
| Rate for Payer: Healthscope Commercial |
$1,030.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,030.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.45
|
| Rate for Payer: Nomi Health Commercial |
$1,030.22
|
| Rate for Payer: PACE SWMI |
$858.52
|
| Rate for Payer: PHP Medicare Advantage |
$858.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$858.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.52
|
| Rate for Payer: UHC Medicare Advantage |
$858.52
|
| Rate for Payer: UHCCP DNSP |
$858.52
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$625.60 |
| Max. Negotiated Rate |
$1,236.27 |
| Rate for Payer: Aetna Commercial |
$1,150.42
|
| Rate for Payer: Aetna Medicare |
$858.52
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$858.52
|
| Rate for Payer: BCN Medicare Advantage |
$858.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,236.27
|
| Rate for Payer: Cofinity Commercial |
$1,150.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.52
|
| Rate for Payer: Healthscope Commercial |
$1,030.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,030.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.45
|
| Rate for Payer: Nomi Health Commercial |
$1,030.22
|
| Rate for Payer: PACE SWMI |
$858.52
|
| Rate for Payer: PHP Medicare Advantage |
$858.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$858.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.52
|
| Rate for Payer: UHC Medicare Advantage |
$858.52
|
| Rate for Payer: UHCCP DNSP |
$858.52
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$681.81 |
| Max. Negotiated Rate |
$1,366.95 |
| Rate for Payer: Aetna Commercial |
$913.63
|
| Rate for Payer: Aetna Medicare |
$681.81
|
| Rate for Payer: BCBS Complete |
$841.20
|
| Rate for Payer: BCBS MAPPO |
$681.81
|
| Rate for Payer: BCN Medicare Advantage |
$681.81
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$981.81
|
| Rate for Payer: Cofinity Commercial |
$913.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.81
|
| Rate for Payer: Healthscope Commercial |
$818.17
|
| Rate for Payer: Healthscope Whirlpool |
$818.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.90
|
| Rate for Payer: Nomi Health Commercial |
$818.17
|
| Rate for Payer: PACE SWMI |
$681.81
|
| Rate for Payer: PHP Medicare Advantage |
$681.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: Priority Health Medicare |
$681.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.81
|
| Rate for Payer: UHC Medicare Advantage |
$681.81
|
| Rate for Payer: UHCCP DNSP |
$681.81
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$508.80
|
|
|
Service Code
|
NDC 68084099601
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.52 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$457.92
|
| Rate for Payer: Aetna Medicare |
$254.40
|
| Rate for Payer: ASR ASR |
$493.54
|
| Rate for Payer: ASR Commercial |
$493.54
|
| Rate for Payer: BCBS Complete |
$203.52
|
| Rate for Payer: BCBS Trust/PPO |
$416.66
|
| Rate for Payer: BCN Commercial |
$394.47
|
| Rate for Payer: Cash Price |
$407.04
|
| Rate for Payer: Cofinity Commercial |
$478.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.04
|
| Rate for Payer: Healthscope Commercial |
$508.80
|
| Rate for Payer: Healthscope Whirlpool |
$493.54
|
| Rate for Payer: Mclaren Commercial |
$457.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.48
|
| Rate for Payer: Nomi Health Commercial |
$417.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$445.81
|
| Rate for Payer: Priority Health Narrow Network |
$356.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$447.74
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$508.80
|
|
|
Service Code
|
NDC 68084099601
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.72 |
| Max. Negotiated Rate |
$508.80 |
| Rate for Payer: Aetna Commercial |
$457.92
|
| Rate for Payer: ASR ASR |
$493.54
|
| Rate for Payer: ASR Commercial |
$493.54
|
| Rate for Payer: BCBS Trust/PPO |
$414.62
|
| Rate for Payer: BCN Commercial |
$394.47
|
| Rate for Payer: Cash Price |
$407.04
|
| Rate for Payer: Cofinity Commercial |
$478.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.04
|
| Rate for Payer: Healthscope Commercial |
$508.80
|
| Rate for Payer: Healthscope Whirlpool |
$493.54
|
| Rate for Payer: Mclaren Commercial |
$457.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$432.48
|
| Rate for Payer: Nomi Health Commercial |
$417.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$447.74
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 70756042911
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: Aetna Medicare |
$142.18
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: ASR Commercial |
$275.82
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: BCBS Trust/PPO |
$232.85
|
| Rate for Payer: BCN Commercial |
$220.46
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$284.35
|
| Rate for Payer: Healthscope Whirlpool |
$275.82
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.15
|
| Rate for Payer: Priority Health Narrow Network |
$199.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$5.09
|
|
|
Service Code
|
NDC 68084099611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Aetna Commercial |
$4.58
|
| Rate for Payer: ASR ASR |
$4.94
|
| Rate for Payer: ASR Commercial |
$4.94
|
| Rate for Payer: BCBS Trust/PPO |
$4.15
|
| Rate for Payer: BCN Commercial |
$3.95
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.07
|
| Rate for Payer: Healthscope Commercial |
$5.09
|
| Rate for Payer: Healthscope Whirlpool |
$4.94
|
| Rate for Payer: Mclaren Commercial |
$4.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Nomi Health Commercial |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.48
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 70377006611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.84 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: ASR Commercial |
$423.99
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS Trust/PPO |
$357.94
|
| Rate for Payer: BCN Commercial |
$338.88
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$437.10
|
| Rate for Payer: Healthscope Whirlpool |
$423.99
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health Narrow Network |
$306.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
OP
|
$5.09
|
|
|
Service Code
|
NDC 68084099611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Aetna Commercial |
$4.58
|
| Rate for Payer: Aetna Medicare |
$2.54
|
| Rate for Payer: ASR ASR |
$4.94
|
| Rate for Payer: ASR Commercial |
$4.94
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: BCBS Trust/PPO |
$4.17
|
| Rate for Payer: BCN Commercial |
$3.95
|
| Rate for Payer: Cash Price |
$4.07
|
| Rate for Payer: Cofinity Commercial |
$4.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.07
|
| Rate for Payer: Healthscope Commercial |
$5.09
|
| Rate for Payer: Healthscope Whirlpool |
$4.94
|
| Rate for Payer: Mclaren Commercial |
$4.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.33
|
| Rate for Payer: Nomi Health Commercial |
$4.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.46
|
| Rate for Payer: Priority Health Narrow Network |
$3.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.48
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 70377006611
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.12 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: ASR Commercial |
$423.99
|
| Rate for Payer: BCBS Trust/PPO |
$356.19
|
| Rate for Payer: BCN Commercial |
$338.88
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$437.10
|
| Rate for Payer: Healthscope Whirlpool |
$423.99
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
PRAZOSIN 1 MG CAPSULE
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 70756042911
|
| Hospital Charge Code |
6468
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.83 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: ASR Commercial |
$275.82
|
| Rate for Payer: BCBS Trust/PPO |
$231.72
|
| Rate for Payer: BCN Commercial |
$220.46
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$284.35
|
| Rate for Payer: Healthscope Whirlpool |
$275.82
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
