|
PRASUGREL HCL 10 MG TABLET
|
Facility
|
IP
|
$110.30
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.77 |
| Max. Negotiated Rate |
$99.27 |
| Rate for Payer: Aetna Commercial |
$93.75
|
| Rate for Payer: BCBS Trust/PPO |
$91.10
|
| Rate for Payer: BCN Commercial |
$91.10
|
| Rate for Payer: Cash Price |
$88.24
|
| Rate for Payer: Cofinity Commercial |
$94.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.24
|
| Rate for Payer: Healthscope Commercial |
$99.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.75
|
| Rate for Payer: Nomi Health Commercial |
$90.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.72
|
| Rate for Payer: PHP Commercial |
$93.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.06
|
| Rate for Payer: UHC Core |
$92.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.72
|
|
|
PRASUGREL HCL 10 MG TABLET
|
Facility
|
OP
|
$110.30
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$99.27 |
| Rate for Payer: Aetna Commercial |
$93.75
|
| Rate for Payer: Aetna Medicare |
$28.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.47
|
| Rate for Payer: BCBS Complete |
$20.42
|
| Rate for Payer: BCBS MAPPO |
$27.57
|
| Rate for Payer: BCBS Trust/PPO |
$90.68
|
| Rate for Payer: BCN Commercial |
$90.68
|
| Rate for Payer: BCN Medicare Advantage |
$27.57
|
| Rate for Payer: Cash Price |
$88.24
|
| Rate for Payer: Cofinity Commercial |
$94.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.57
|
| Rate for Payer: Healthscope Commercial |
$99.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.72
|
| Rate for Payer: Mclaren Medicaid |
$19.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.95
|
| Rate for Payer: Meridian Medicaid |
$20.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$30.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.75
|
| Rate for Payer: Nomi Health Commercial |
$90.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.72
|
| Rate for Payer: PACE Senior Care Partners |
$26.20
|
| Rate for Payer: PACE SWMI |
$27.57
|
| Rate for Payer: PHP Commercial |
$93.75
|
| Rate for Payer: PHP Medicare Advantage |
$27.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.96
|
| Rate for Payer: Priority Health Medicare |
$27.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.77
|
| Rate for Payer: Railroad Medicare Medicare |
$27.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.06
|
| Rate for Payer: UHC Core |
$92.10
|
| Rate for Payer: UHC Exchange |
$27.57
|
| Rate for Payer: UHC Medicaid |
$19.45
|
| Rate for Payer: UHC Medicare Advantage |
$27.57
|
| Rate for Payer: UHCCP Medicaid |
$19.45
|
| Rate for Payer: VA VA |
$27.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.72
|
|
|
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 |
$778.27
|
| Rate for Payer: Aetna Medicare |
$785.50
|
| Rate for Payer: BCBS Complete |
$381.10
|
| Rate for Payer: BCN Commercial |
$864.49
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Cash Price |
$1,256.80
|
| Rate for Payer: Mclaren Medicaid |
$362.95
|
| Rate for Payer: Meridian Medicaid |
$381.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,178.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$929.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$929.66
|
| Rate for Payer: UHC Medicaid |
$362.95
|
| 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 |
$1,129.42
|
| Rate for Payer: Aetna Medicare |
$1,186.00
|
| Rate for Payer: BCBS Complete |
$549.73
|
| Rate for Payer: BCN Commercial |
$1,254.91
|
| Rate for Payer: Cash Price |
$1,897.60
|
| Rate for Payer: Cash Price |
$1,897.60
|
| Rate for Payer: Mclaren Medicaid |
$523.55
|
| Rate for Payer: Meridian Medicaid |
$549.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,779.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$523.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,349.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,349.50
|
| Rate for Payer: UHC Medicaid |
$523.55
|
| 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 |
$73.65
|
| Rate for Payer: Aetna Medicare |
$211.00
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCN Commercial |
$106.57
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Mclaren Medicaid |
$40.26
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$316.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$95.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$95.85
|
| Rate for Payer: UHC Medicaid |
$40.26
|
| 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: Aetna Medicare |
$40.50
|
| 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: Aetna Medicare |
$175.50
|
| 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: Aetna Medicare |
$76.00
|
| 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 |
$248.13
|
| Rate for Payer: Aetna Medicare |
$623.00
|
| Rate for Payer: BCBS Complete |
$109.37
|
| Rate for Payer: BCN Commercial |
$300.34
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Mclaren Medicaid |
$104.16
|
| Rate for Payer: Meridian Medicaid |
$109.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$934.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$292.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.24
|
| Rate for Payer: UHC Medicaid |
$104.16
|
| 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: Aetna Medicare |
$383.00
|
| 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 |
$200.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.69
|
|
|
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 |
$224.25
|
| Rate for Payer: Aetna Medicare |
$500.00
|
| Rate for Payer: BCBS Complete |
$98.63
|
| Rate for Payer: BCN Commercial |
$274.63
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Mclaren Medicaid |
$93.93
|
| Rate for Payer: Meridian Medicaid |
$98.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$267.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$267.23
|
| Rate for Payer: UHC Medicaid |
$93.93
|
| 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 |
$2,660.58 |
| Rate for Payer: Aetna Commercial |
$2,202.92
|
| Rate for Payer: Aetna Medicare |
$1,741.00
|
| Rate for Payer: BCBS Complete |
$1,000.84
|
| Rate for Payer: BCN Commercial |
$2,488.90
|
| Rate for Payer: Cash Price |
$2,785.60
|
| Rate for Payer: Cash Price |
$2,785.60
|
| Rate for Payer: Mclaren Medicaid |
$953.18
|
| Rate for Payer: Meridian Medicaid |
$1,000.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,611.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$953.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,660.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,660.58
|
| Rate for Payer: UHC Medicaid |
$953.18
|
| Rate for Payer: UHCCP Medicaid |
$953.18
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$389.50
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.09 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna Commercial |
$331.07
|
| Rate for Payer: BCBS Trust/PPO |
$321.69
|
| Rate for Payer: BCN Commercial |
$321.69
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Commercial |
$334.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$350.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.12
|
| 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: PHP Commercial |
$331.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$338.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.76
|
| Rate for Payer: UHC Core |
$325.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.12
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$389.50
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.67 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna Commercial |
$331.07
|
| Rate for Payer: Aetna Medicare |
$101.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$121.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$121.72
|
| Rate for Payer: BCBS Complete |
$72.10
|
| Rate for Payer: BCBS MAPPO |
$97.38
|
| Rate for Payer: BCBS Trust/PPO |
$320.21
|
| Rate for Payer: BCN Commercial |
$320.21
|
| Rate for Payer: BCN Medicare Advantage |
$97.38
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Commercial |
$334.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$350.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.12
|
| Rate for Payer: Mclaren Medicaid |
$68.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.24
|
| Rate for Payer: Meridian Medicaid |
$72.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.11
|
| 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: PACE Senior Care Partners |
$92.51
|
| Rate for Payer: PACE SWMI |
$97.38
|
| Rate for Payer: PHP Commercial |
$331.07
|
| Rate for Payer: PHP Medicare Advantage |
$97.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$338.87
|
| Rate for Payer: Priority Health Medicare |
$98.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.09
|
| Rate for Payer: Railroad Medicare Medicare |
$97.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$342.76
|
| Rate for Payer: UHC Core |
$325.23
|
| Rate for Payer: UHC Exchange |
$97.38
|
| Rate for Payer: UHC Medicaid |
$68.67
|
| Rate for Payer: UHC Medicare Advantage |
$97.38
|
| Rate for Payer: UHCCP Medicaid |
$68.67
|
| Rate for Payer: VA VA |
$97.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.12
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$469.30
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.74 |
| Max. Negotiated Rate |
$422.37 |
| Rate for Payer: Aetna Commercial |
$398.90
|
| Rate for Payer: Aetna Medicare |
$122.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.66
|
| Rate for Payer: BCBS Complete |
$86.87
|
| Rate for Payer: BCBS MAPPO |
$117.33
|
| Rate for Payer: BCBS Trust/PPO |
$385.81
|
| Rate for Payer: BCN Commercial |
$385.81
|
| Rate for Payer: BCN Medicare Advantage |
$117.33
|
| Rate for Payer: Cash Price |
$375.44
|
| Rate for Payer: Cofinity Commercial |
$403.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.33
|
| Rate for Payer: Healthscope Commercial |
$422.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.98
|
| Rate for Payer: Mclaren Medicaid |
$82.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.19
|
| Rate for Payer: Meridian Medicaid |
$86.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.90
|
| Rate for Payer: Nomi Health Commercial |
$384.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.98
|
| Rate for Payer: PACE Senior Care Partners |
$111.46
|
| Rate for Payer: PACE SWMI |
$117.33
|
| Rate for Payer: PHP Commercial |
$398.90
|
| Rate for Payer: PHP Medicare Advantage |
$117.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$408.29
|
| Rate for Payer: Priority Health Medicare |
$118.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.63
|
| Rate for Payer: Railroad Medicare Medicare |
$117.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.98
|
| Rate for Payer: UHC Core |
$391.87
|
| Rate for Payer: UHC Exchange |
$117.33
|
| Rate for Payer: UHC Medicaid |
$82.74
|
| Rate for Payer: UHC Medicare Advantage |
$117.33
|
| Rate for Payer: UHCCP Medicaid |
$82.74
|
| Rate for Payer: VA VA |
$117.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.98
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$469.30
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.63 |
| Max. Negotiated Rate |
$422.37 |
| Rate for Payer: Aetna Commercial |
$398.90
|
| Rate for Payer: BCBS Trust/PPO |
$387.59
|
| Rate for Payer: BCN Commercial |
$387.59
|
| Rate for Payer: Cash Price |
$375.44
|
| Rate for Payer: Cofinity Commercial |
$403.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.44
|
| Rate for Payer: Healthscope Commercial |
$422.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.90
|
| Rate for Payer: Nomi Health Commercial |
$384.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.98
|
| Rate for Payer: PHP Commercial |
$398.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$408.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$326.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$412.98
|
| Rate for Payer: UHC Core |
$391.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.98
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 51079078201
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.15
|
| Rate for Payer: BCBS Complete |
$0.68
|
| Rate for Payer: BCBS MAPPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.92
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.92
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Mclaren Medicaid |
$0.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.96
|
| Rate for Payer: Meridian Medicaid |
$0.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.75
|
| Rate for Payer: PACE Senior Care Partners |
$0.87
|
| Rate for Payer: PACE SWMI |
$0.92
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: PHP Medicare Advantage |
$0.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.19
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.55
|
| Rate for Payer: Railroad Medicare Medicare |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.23
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Medicaid |
$0.65
|
| Rate for Payer: UHC Medicare Advantage |
$0.92
|
| Rate for Payer: UHCCP Medicaid |
$0.65
|
| Rate for Payer: VA VA |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 51079078201
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| Rate for Payer: BCN Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.75
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.23
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$366.24
|
|
|
Service Code
|
NDC 51079078220
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.57 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: Aetna Medicare |
$95.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.45
|
| Rate for Payer: BCBS Complete |
$67.79
|
| Rate for Payer: BCBS MAPPO |
$91.56
|
| Rate for Payer: BCBS Trust/PPO |
$301.09
|
| Rate for Payer: BCN Commercial |
$301.09
|
| Rate for Payer: BCN Medicare Advantage |
$91.56
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.56
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Mclaren Medicaid |
$64.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.14
|
| Rate for Payer: Meridian Medicaid |
$67.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.68
|
| Rate for Payer: PACE Senior Care Partners |
$86.98
|
| Rate for Payer: PACE SWMI |
$91.56
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: PHP Medicare Advantage |
$91.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Medicare |
$92.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.90
|
| Rate for Payer: Railroad Medicare Medicare |
$91.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: UHC Exchange |
$91.56
|
| Rate for Payer: UHC Medicaid |
$64.57
|
| Rate for Payer: UHC Medicare Advantage |
$91.56
|
| Rate for Payer: UHCCP Medicaid |
$64.57
|
| Rate for Payer: VA VA |
$91.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$300.11
|
|
|
Service Code
|
NDC 68462019790
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$270.10 |
| Rate for Payer: Aetna Commercial |
$255.09
|
| Rate for Payer: Aetna Medicare |
$78.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$93.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$93.78
|
| Rate for Payer: BCBS Complete |
$55.55
|
| Rate for Payer: BCBS MAPPO |
$75.03
|
| Rate for Payer: BCBS Trust/PPO |
$246.72
|
| Rate for Payer: BCN Commercial |
$246.72
|
| Rate for Payer: BCN Medicare Advantage |
$75.03
|
| Rate for Payer: Cash Price |
$240.09
|
| Rate for Payer: Cofinity Commercial |
$258.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.03
|
| Rate for Payer: Healthscope Commercial |
$270.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.08
|
| Rate for Payer: Mclaren Medicaid |
$52.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.78
|
| Rate for Payer: Meridian Medicaid |
$55.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.09
|
| Rate for Payer: Nomi Health Commercial |
$246.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.08
|
| Rate for Payer: PACE Senior Care Partners |
$71.28
|
| Rate for Payer: PACE SWMI |
$75.03
|
| Rate for Payer: PHP Commercial |
$255.09
|
| Rate for Payer: PHP Medicare Advantage |
$75.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.10
|
| Rate for Payer: Priority Health Medicare |
$75.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.88
|
| Rate for Payer: Railroad Medicare Medicare |
$75.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.10
|
| Rate for Payer: UHC Core |
$250.59
|
| Rate for Payer: UHC Exchange |
$75.03
|
| Rate for Payer: UHC Medicaid |
$52.91
|
| Rate for Payer: UHC Medicare Advantage |
$75.03
|
| Rate for Payer: UHCCP Medicaid |
$52.91
|
| Rate for Payer: VA VA |
$75.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.08
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$300.11
|
|
|
Service Code
|
NDC 68462019790
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.88 |
| Max. Negotiated Rate |
$270.10 |
| Rate for Payer: Aetna Commercial |
$255.09
|
| Rate for Payer: BCBS Trust/PPO |
$247.86
|
| Rate for Payer: BCN Commercial |
$247.86
|
| Rate for Payer: Cash Price |
$240.09
|
| Rate for Payer: Cofinity Commercial |
$258.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.09
|
| Rate for Payer: Healthscope Commercial |
$270.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.09
|
| Rate for Payer: Nomi Health Commercial |
$246.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.08
|
| Rate for Payer: PHP Commercial |
$255.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$261.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.10
|
| Rate for Payer: UHC Core |
$250.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.08
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$280.32
|
|
|
Service Code
|
NDC 00904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna Medicare |
$72.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.60
|
| Rate for Payer: BCBS Complete |
$51.89
|
| Rate for Payer: BCBS MAPPO |
$70.08
|
| Rate for Payer: BCBS Trust/PPO |
$230.45
|
| Rate for Payer: BCN Commercial |
$230.45
|
| Rate for Payer: BCN Medicare Advantage |
$70.08
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.08
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Mclaren Medicaid |
$49.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.58
|
| Rate for Payer: Meridian Medicaid |
$51.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$77.09
|
| 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: PACE Senior Care Partners |
$66.58
|
| Rate for Payer: PACE SWMI |
$70.08
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: PHP Medicare Advantage |
$70.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$243.88
|
| Rate for Payer: Priority Health Medicare |
$70.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.10
|
| Rate for Payer: Railroad Medicare Medicare |
$70.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.68
|
| Rate for Payer: UHC Core |
$234.07
|
| Rate for Payer: UHC Exchange |
$70.08
|
| Rate for Payer: UHC Medicaid |
$49.42
|
| Rate for Payer: UHC Medicare Advantage |
$70.08
|
| Rate for Payer: UHCCP Medicaid |
$49.42
|
| Rate for Payer: VA VA |
$70.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$366.24
|
|
|
Service Code
|
NDC 51079078220
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$254.90 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: BCBS Trust/PPO |
$302.48
|
| Rate for Payer: BCN Commercial |
$302.48
|
| Rate for Payer: Cash Price |
$292.99
|
| Rate for Payer: Cofinity Commercial |
$314.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$292.99
|
| Rate for Payer: Healthscope Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$274.68
|
| Rate for Payer: PHP Commercial |
$311.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.29
|
| Rate for Payer: UHC Core |
$305.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 00904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.10 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: BCBS Trust/PPO |
$231.52
|
| Rate for Payer: BCN Commercial |
$231.52
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| 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: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$243.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$246.68
|
| Rate for Payer: UHC Core |
$234.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
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 |
$56.05
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCN Commercial |
$63.22
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Mclaren Medicaid |
$31.10
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$73.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.38
|
| Rate for Payer: UHC Medicaid |
$31.10
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
|
