|
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
|
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 |
$33.96 |
| Max. Negotiated Rate |
$135.47 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$135.47
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.24
|
| Rate for Payer: Priority Health Narrow Network |
$72.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.35
|
| Rate for Payer: UHC Exchange |
$59.35
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$10.65 |
| Max. Negotiated Rate |
$106.97 |
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna Medicare |
$37.00
|
| Rate for Payer: BCBS Complete |
$11.18
|
| Rate for Payer: BCBS Trust/PPO |
$106.97
|
| Rate for Payer: BCN Commercial |
$39.27
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Meridian Medicaid |
$11.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.57
|
| Rate for Payer: Priority Health Narrow Network |
$22.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$31.08
|
| Rate for Payer: UHC Exchange |
$31.08
|
| Rate for Payer: UHCCP Medicaid |
$10.65
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$570.63 |
| Max. Negotiated Rate |
$1,772.22 |
| Rate for Payer: Aetna Commercial |
$1,096.73
|
| Rate for Payer: Aetna Medicare |
$782.00
|
| Rate for Payer: BCBS Complete |
$599.16
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$1,289.62
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Meridian Medicaid |
$599.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,772.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,772.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$962.33
|
| Rate for Payer: UHC Exchange |
$962.33
|
| Rate for Payer: UHCCP Medicaid |
$570.63
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$570.63 |
| Max. Negotiated Rate |
$1,772.22 |
| Rate for Payer: Aetna Commercial |
$1,096.73
|
| Rate for Payer: Aetna Medicare |
$782.00
|
| Rate for Payer: BCBS Complete |
$599.16
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$1,289.62
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Meridian Medicaid |
$599.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$570.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,772.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,772.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$962.33
|
| Rate for Payer: UHC Exchange |
$962.33
|
| Rate for Payer: UHCCP Medicaid |
$570.63
|
|
|
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 |
$8,860.40 |
| Rate for Payer: Aetna Commercial |
$1,407.60
|
| Rate for Payer: Aetna Medicare |
$5,716.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,145.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,145.49
|
| Rate for Payer: ASR ASR |
$1,517.08
|
| Rate for Payer: ASR Commercial |
$1,517.08
|
| Rate for Payer: BCBS Complete |
$3,217.18
|
| Rate for Payer: BCBS MAPPO |
$5,716.39
|
| Rate for Payer: BCBS Trust/PPO |
$1,280.76
|
| Rate for Payer: BCN Commercial |
$1,212.57
|
| Rate for Payer: BCN Medicare Advantage |
$5,716.39
|
| 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 |
$5,716.39
|
| Rate for Payer: Healthscope Commercial |
$1,564.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,517.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,716.39
|
| Rate for Payer: Mclaren Commercial |
$1,407.60
|
| Rate for Payer: Mclaren Medicaid |
$3,063.99
|
| Rate for Payer: Mclaren Medicare |
$5,716.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,002.21
|
| Rate for Payer: Meridian Medicaid |
$3,217.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,573.85
|
| 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 |
$5,430.57
|
| Rate for Payer: PACE SWMI |
$5,716.39
|
| Rate for Payer: PHP Commercial |
$6,288.03
|
| Rate for Payer: PHP Medicaid |
$3,063.99
|
| Rate for Payer: PHP Medicare Advantage |
$5,716.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,063.99
|
| 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 |
$5,716.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,096.36
|
| Rate for Payer: Railroad Medicare Medicare |
$5,716.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,376.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,716.39
|
| Rate for Payer: UHC Exchange |
$8,860.40
|
| Rate for Payer: UHC Medicare Advantage |
$5,716.39
|
| Rate for Payer: UHCCP DNSP |
$5,716.39
|
| Rate for Payer: UHCCP Medicaid |
$3,063.99
|
| Rate for Payer: VA VA |
$5,716.39
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$454.33 |
| Max. Negotiated Rate |
$1,411.40 |
| Rate for Payer: Aetna Commercial |
$870.38
|
| Rate for Payer: Aetna Medicare |
$1,051.50
|
| Rate for Payer: BCBS Complete |
$477.05
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$1,027.20
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Meridian Medicaid |
$477.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,411.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,411.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$755.94
|
| Rate for Payer: UHC Exchange |
$755.94
|
| Rate for Payer: UHCCP Medicaid |
$454.33
|
|
|
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
|
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 |
$255.92
|
| 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 |
$255.92
|
| 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
|
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
|
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
|
$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
|
$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
|
$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 |
$255.92
|
| 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 |
$255.92
|
| 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
|
|
|
PR B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA
|
Professional
|
Both
|
$2,174.00
|
|
|
Service Code
|
HCPCS 27170
|
| Min. Negotiated Rate |
$757.22 |
| Max. Negotiated Rate |
$1,814.18 |
| Rate for Payer: Aetna Commercial |
$1,567.73
|
| Rate for Payer: Aetna Medicare |
$1,087.00
|
| Rate for Payer: BCBS Complete |
$795.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,814.18
|
| Rate for Payer: BCN Commercial |
$1,713.79
|
| Rate for Payer: Cash Price |
$1,739.20
|
| Rate for Payer: Cash Price |
$1,739.20
|
| Rate for Payer: Meridian Medicaid |
$795.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$757.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,413.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,792.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,792.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,369.20
|
| Rate for Payer: UHC Exchange |
$1,369.20
|
| Rate for Payer: UHCCP Medicaid |
$757.22
|
|
|
PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 90586
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$180.31 |
| Rate for Payer: Aetna Commercial |
$144.50
|
| Rate for Payer: Aetna Medicare |
$136.50
|
| Rate for Payer: BCBS Complete |
$109.20
|
| Rate for Payer: BCBS Trust/PPO |
$147.22
|
| Rate for Payer: BCN Commercial |
$146.43
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.31
|
| Rate for Payer: UHC Exchange |
$180.31
|
|
|
PR BALLN ANGIOPLASTY OPEN,BRACHCEPH
|
Professional
|
Both
|
$958.00
|
|
|
Service Code
|
HCPCS 35458
|
| Min. Negotiated Rate |
$383.20 |
| Max. Negotiated Rate |
$622.70 |
| Rate for Payer: Aetna Medicare |
$479.00
|
| Rate for Payer: BCBS Complete |
$383.20
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$622.70
|
|
|
PR BALLN ANGIOPLASTY PERC,AORTIC
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 35472
|
| Min. Negotiated Rate |
$275.60 |
| Max. Negotiated Rate |
$447.85 |
| Rate for Payer: Aetna Medicare |
$344.50
|
| Rate for Payer: BCBS Complete |
$275.60
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
|
|
PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH
|
Professional
|
Both
|
$2,039.00
|
|
|
Service Code
|
HCPCS 35475
|
| Min. Negotiated Rate |
$815.60 |
| Max. Negotiated Rate |
$1,325.35 |
| Rate for Payer: Aetna Medicare |
$1,019.50
|
| Rate for Payer: BCBS Complete |
$815.60
|
| Rate for Payer: Cash Price |
$1,631.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,325.35
|
|
|
PR BALLN ANGIOPLASTY,PERC VENOUS
|
Professional
|
Both
|
$3,441.00
|
|
|
Service Code
|
HCPCS 35476
|
| Min. Negotiated Rate |
$1,376.40 |
| Max. Negotiated Rate |
$2,236.65 |
| Rate for Payer: Aetna Medicare |
$1,720.50
|
| Rate for Payer: BCBS Complete |
$1,376.40
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,236.65
|
|
|
PR BALLN ANGIOPLASTY PERC,VISCERAL
|
Professional
|
Both
|
$2,857.00
|
|
|
Service Code
|
HCPCS 35471
|
| Min. Negotiated Rate |
$1,142.80 |
| Max. Negotiated Rate |
$1,857.05 |
| Rate for Payer: Aetna Medicare |
$1,428.50
|
| Rate for Payer: BCBS Complete |
$1,142.80
|
| Rate for Payer: Cash Price |
$2,285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,857.05
|
|
|
PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS
|
Professional
|
Both
|
$4,922.00
|
|
|
Service Code
|
HCPCS 61630
|
| Min. Negotiated Rate |
$18.49 |
| Max. Negotiated Rate |
$3,199.30 |
| Rate for Payer: Aetna Commercial |
$1,768.28
|
| Rate for Payer: Aetna Medicare |
$2,461.00
|
| Rate for Payer: BCBS Complete |
$1,968.80
|
| Rate for Payer: BCBS Trust/PPO |
$18.49
|
| Rate for Payer: BCN Commercial |
$1,995.76
|
| Rate for Payer: Cash Price |
$3,937.60
|
| Rate for Payer: Cash Price |
$3,937.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,199.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,327.76
|
| Rate for Payer: Priority Health Narrow Network |
$2,327.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,539.53
|
| Rate for Payer: UHC Exchange |
$1,539.53
|
|
