|
PRASUGREL 10 MG TABLET
|
Facility
|
OP
|
$109.73
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.06 |
| Max. Negotiated Rate |
$98.76 |
| Rate for Payer: Aetna Commercial |
$93.27
|
| Rate for Payer: Aetna Medicare |
$28.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.29
|
| Rate for Payer: BCBS Complete |
$43.89
|
| Rate for Payer: BCBS MAPPO |
$27.43
|
| Rate for Payer: BCBS Trust/PPO |
$90.21
|
| Rate for Payer: BCN Commercial |
$85.32
|
| Rate for Payer: BCN Medicare Advantage |
$27.43
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$94.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.43
|
| Rate for Payer: Healthscope Commercial |
$98.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.27
|
| Rate for Payer: Nomi Health Commercial |
$89.98
|
| Rate for Payer: PACE Senior Care Partners |
$26.06
|
| Rate for Payer: PACE SWMI |
$27.43
|
| Rate for Payer: PHP Commercial |
$93.27
|
| Rate for Payer: PHP Medicare Advantage |
$27.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: Priority Health HMO/PPO |
$95.47
|
| Rate for Payer: Priority Health Medicare |
$27.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.52
|
| Rate for Payer: Railroad Medicare Medicare |
$27.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.56
|
| Rate for Payer: UHC Core |
$91.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.43
|
| Rate for Payer: UHC Exchange |
$27.43
|
| Rate for Payer: UHC Medicare Advantage |
$27.43
|
| Rate for Payer: VA VA |
$27.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.30
|
|
|
PR ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 33257
|
| Min. Negotiated Rate |
$558.60 |
| Max. Negotiated Rate |
$991.25 |
| Rate for Payer: Aetna Commercial |
$748.52
|
| Rate for Payer: Aetna Medicare |
$580.94
|
| Rate for Payer: BCBS Complete |
$610.00
|
| Rate for Payer: BCBS MAPPO |
$558.60
|
| Rate for Payer: BCN Medicare Advantage |
$558.60
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Cofinity Commercial |
$804.38
|
| Rate for Payer: Cofinity Commercial |
$748.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$586.53
|
| Rate for Payer: Nomi Health Commercial |
$670.32
|
| Rate for Payer: PACE SWMI |
$558.60
|
| Rate for Payer: PHP Medicare Advantage |
$558.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.25
|
| Rate for Payer: Priority Health Medicare |
$564.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.60
|
| Rate for Payer: UHC Exchange |
$558.60
|
| Rate for Payer: UHC Medicare Advantage |
$558.60
|
|
|
PR ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
HCPCS 33259
|
| Min. Negotiated Rate |
$811.34 |
| Max. Negotiated Rate |
$1,496.95 |
| Rate for Payer: Aetna Commercial |
$1,087.20
|
| Rate for Payer: Aetna Medicare |
$843.79
|
| Rate for Payer: BCBS Complete |
$921.20
|
| Rate for Payer: BCBS MAPPO |
$811.34
|
| Rate for Payer: BCN Medicare Advantage |
$811.34
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cofinity Commercial |
$1,168.33
|
| Rate for Payer: Cofinity Commercial |
$1,087.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$811.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$851.91
|
| Rate for Payer: Nomi Health Commercial |
$973.61
|
| Rate for Payer: PACE SWMI |
$811.34
|
| Rate for Payer: PHP Medicare Advantage |
$811.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,496.95
|
| Rate for Payer: Priority Health Medicare |
$819.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$811.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$811.34
|
| Rate for Payer: UHC Exchange |
$811.34
|
| Rate for Payer: UHC Medicare Advantage |
$811.34
|
|
|
PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 99464
|
| Min. Negotiated Rate |
$68.23 |
| Max. Negotiated Rate |
$266.50 |
| Rate for Payer: Aetna Commercial |
$91.43
|
| Rate for Payer: Aetna Medicare |
$70.96
|
| Rate for Payer: BCBS Complete |
$164.00
|
| Rate for Payer: BCBS MAPPO |
$68.23
|
| Rate for Payer: BCN Medicare Advantage |
$68.23
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cofinity Commercial |
$91.43
|
| Rate for Payer: Cofinity Commercial |
$98.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.64
|
| Rate for Payer: Nomi Health Commercial |
$81.88
|
| Rate for Payer: PACE SWMI |
$68.23
|
| Rate for Payer: PHP Medicare Advantage |
$68.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health Medicare |
$68.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.23
|
| Rate for Payer: UHC Exchange |
$68.23
|
| Rate for Payer: UHC Medicare Advantage |
$68.23
|
|
|
PR AUDIOMETRY FOR HEARING AID
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS S0618
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
|
|
PR AUDITORY EVOKED POTENTIAL
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 92585
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$221.65 |
| Rate for Payer: Aetna Medicare |
$170.50
|
| Rate for Payer: BCBS Complete |
$136.40
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.65
|
|
|
PR AUDITORY EVOKED POTENTIAL, LIMITED
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 92586
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$178.44 |
| Max. Negotiated Rate |
$786.50 |
| Rate for Payer: Aetna Commercial |
$239.11
|
| Rate for Payer: Aetna Medicare |
$185.58
|
| Rate for Payer: BCBS Complete |
$484.00
|
| Rate for Payer: BCBS MAPPO |
$178.44
|
| Rate for Payer: BCN Medicare Advantage |
$178.44
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cofinity Commercial |
$256.95
|
| Rate for Payer: Cofinity Commercial |
$239.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.36
|
| Rate for Payer: Nomi Health Commercial |
$214.13
|
| Rate for Payer: PACE SWMI |
$178.44
|
| Rate for Payer: PHP Medicare Advantage |
$178.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: Priority Health Medicare |
$180.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.44
|
| Rate for Payer: UHC Exchange |
$178.44
|
| Rate for Payer: UHC Medicare Advantage |
$178.44
|
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$483.60 |
| Rate for Payer: Aetna Medicare |
$372.00
|
| Rate for Payer: BCBS Complete |
$297.60
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.60
|
|
|
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 |
$169.25
|
| 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: 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 |
$164.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.74
|
| Rate for Payer: UHC Exchange |
$162.74
|
| Rate for Payer: UHC Medicare Advantage |
$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 |
$1,650.46
|
| 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: 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 |
$1,602.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,586.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,586.98
|
| Rate for Payer: UHC Exchange |
$1,586.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,586.98
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.71 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna Medicare |
$83.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$100.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$100.94
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: BCBS MAPPO |
$80.75
|
| Rate for Payer: BCBS Trust/PPO |
$265.54
|
| Rate for Payer: BCN Commercial |
$251.13
|
| Rate for Payer: BCN Medicare Advantage |
$80.75
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.75
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: Nomi Health Commercial |
$264.86
|
| Rate for Payer: PACE Senior Care Partners |
$76.71
|
| Rate for Payer: PACE SWMI |
$80.75
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: PHP Medicare Advantage |
$80.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO |
$281.01
|
| Rate for Payer: Priority Health Medicare |
$81.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.41
|
| Rate for Payer: Railroad Medicare Medicare |
$80.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.24
|
| Rate for Payer: UHC Core |
$269.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.75
|
| Rate for Payer: UHC Exchange |
$80.75
|
| Rate for Payer: UHC Medicare Advantage |
$80.75
|
| Rate for Payer: VA VA |
$80.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
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 |
$290.70 |
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: BCBS Trust/PPO |
$263.66
|
| Rate for Payer: BCN Commercial |
$249.61
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: Nomi Health Commercial |
$264.86
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO |
$281.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$216.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.24
|
| Rate for Payer: UHC Core |
$269.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$441.75
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.92 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna Medicare |
$114.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$138.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$138.05
|
| Rate for Payer: BCBS Complete |
$176.70
|
| Rate for Payer: BCBS MAPPO |
$110.44
|
| Rate for Payer: BCBS Trust/PPO |
$363.16
|
| Rate for Payer: BCN Commercial |
$343.46
|
| Rate for Payer: BCN Medicare Advantage |
$110.44
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.44
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$127.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Nomi Health Commercial |
$362.24
|
| Rate for Payer: PACE Senior Care Partners |
$104.92
|
| Rate for Payer: PACE SWMI |
$110.44
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: PHP Medicare Advantage |
$110.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health HMO/PPO |
$384.32
|
| Rate for Payer: Priority Health Medicare |
$111.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.97
|
| Rate for Payer: Railroad Medicare Medicare |
$110.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.74
|
| Rate for Payer: UHC Core |
$368.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.44
|
| Rate for Payer: UHC Exchange |
$110.44
|
| Rate for Payer: UHC Medicare Advantage |
$110.44
|
| Rate for Payer: VA VA |
$110.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.14 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: BCBS Trust/PPO |
$360.60
|
| Rate for Payer: BCN Commercial |
$341.38
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: Nomi Health Commercial |
$362.24
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health HMO/PPO |
$384.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$295.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.74
|
| Rate for Payer: UHC Core |
$368.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 68382007116
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$255.09 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: BCBS Trust/PPO |
$320.36
|
| Rate for Payer: BCN Commercial |
$303.29
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Nomi Health Commercial |
$321.81
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health HMO/PPO |
$341.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.36
|
| Rate for Payer: UHC Core |
$327.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 68382007116
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.21 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$102.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.64
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: BCBS MAPPO |
$98.11
|
| Rate for Payer: BCBS Trust/PPO |
$322.63
|
| Rate for Payer: BCN Commercial |
$305.13
|
| Rate for Payer: BCN Medicare Advantage |
$98.11
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.11
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Nomi Health Commercial |
$321.81
|
| Rate for Payer: PACE Senior Care Partners |
$93.21
|
| Rate for Payer: PACE SWMI |
$98.11
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: PHP Medicare Advantage |
$98.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health HMO/PPO |
$341.43
|
| Rate for Payer: Priority Health Medicare |
$99.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.94
|
| Rate for Payer: Railroad Medicare Medicare |
$98.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.36
|
| Rate for Payer: UHC Core |
$327.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.11
|
| Rate for Payer: UHC Exchange |
$98.11
|
| Rate for Payer: UHC Medicare Advantage |
$98.11
|
| Rate for Payer: VA VA |
$98.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 51079078201
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| 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 |
$1.47
|
| Rate for Payer: BCBS MAPPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.85
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| 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 Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO |
$3.19
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.46
|
| 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 Dual Complete DSNP |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Medicare Advantage |
$0.92
|
| Rate for Payer: VA VA |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$300.11
|
|
|
Service Code
|
NDC 68462019790
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.28 |
| 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 |
$120.04
|
| Rate for Payer: BCBS MAPPO |
$75.03
|
| Rate for Payer: BCBS Trust/PPO |
$246.72
|
| Rate for Payer: BCN Commercial |
$233.34
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.09
|
| Rate for Payer: Nomi Health Commercial |
$246.09
|
| 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 Cigna Priority Health |
$195.07
|
| Rate for Payer: Priority Health HMO/PPO |
$261.10
|
| Rate for Payer: Priority Health Medicare |
$75.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.07
|
| 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 Dual Complete DSNP |
$75.03
|
| Rate for Payer: UHC Exchange |
$75.03
|
| Rate for Payer: UHC Medicare Advantage |
$75.03
|
| Rate for Payer: VA VA |
$75.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.08
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$286.42
|
|
|
Service Code
|
NDC 68382007216
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.02 |
| Max. Negotiated Rate |
$257.78 |
| Rate for Payer: Aetna Commercial |
$243.46
|
| Rate for Payer: Aetna Medicare |
$74.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.51
|
| Rate for Payer: BCBS Complete |
$114.57
|
| Rate for Payer: BCBS MAPPO |
$71.61
|
| Rate for Payer: BCBS Trust/PPO |
$235.47
|
| Rate for Payer: BCN Commercial |
$222.69
|
| Rate for Payer: BCN Medicare Advantage |
$71.61
|
| Rate for Payer: Cash Price |
$229.14
|
| Rate for Payer: Cofinity Commercial |
$246.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.61
|
| Rate for Payer: Healthscope Commercial |
$257.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.46
|
| Rate for Payer: Nomi Health Commercial |
$234.86
|
| Rate for Payer: PACE Senior Care Partners |
$68.02
|
| Rate for Payer: PACE SWMI |
$71.61
|
| Rate for Payer: PHP Commercial |
$243.46
|
| Rate for Payer: PHP Medicare Advantage |
$71.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.17
|
| Rate for Payer: Priority Health HMO/PPO |
$249.19
|
| Rate for Payer: Priority Health Medicare |
$72.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.90
|
| Rate for Payer: Railroad Medicare Medicare |
$71.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.05
|
| Rate for Payer: UHC Core |
$239.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.61
|
| Rate for Payer: UHC Exchange |
$71.61
|
| Rate for Payer: UHC Medicare Advantage |
$71.61
|
| Rate for Payer: VA VA |
$71.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.81
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$286.42
|
|
|
Service Code
|
NDC 68382007216
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.17 |
| Max. Negotiated Rate |
$257.78 |
| Rate for Payer: Aetna Commercial |
$243.46
|
| Rate for Payer: BCBS Trust/PPO |
$233.80
|
| Rate for Payer: BCN Commercial |
$221.35
|
| Rate for Payer: Cash Price |
$229.14
|
| Rate for Payer: Cofinity Commercial |
$246.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.14
|
| Rate for Payer: Healthscope Commercial |
$257.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$214.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$243.46
|
| Rate for Payer: Nomi Health Commercial |
$234.86
|
| Rate for Payer: PHP Commercial |
$243.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.17
|
| Rate for Payer: Priority Health HMO/PPO |
$249.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.05
|
| Rate for Payer: UHC Core |
$239.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$214.81
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$366.24
|
|
|
Service Code
|
NDC 51079078220
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.98 |
| 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 |
$146.50
|
| Rate for Payer: BCBS MAPPO |
$91.56
|
| Rate for Payer: BCBS Trust/PPO |
$301.09
|
| Rate for Payer: BCN Commercial |
$284.75
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.30
|
| Rate for Payer: Nomi Health Commercial |
$300.32
|
| 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 Cigna Priority Health |
$238.06
|
| Rate for Payer: Priority Health HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Medicare |
$92.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.38
|
| 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 Dual Complete DSNP |
$91.56
|
| Rate for Payer: UHC Exchange |
$91.56
|
| Rate for Payer: UHC Medicare Advantage |
$91.56
|
| Rate for Payer: VA VA |
$91.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.68
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$366.24
|
|
|
Service Code
|
NDC 51079078220
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.06 |
| Max. Negotiated Rate |
$329.62 |
| Rate for Payer: Aetna Commercial |
$311.30
|
| Rate for Payer: BCBS Trust/PPO |
$298.96
|
| Rate for Payer: BCN Commercial |
$283.03
|
| 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: PHP Commercial |
$311.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.06
|
| Rate for Payer: Priority Health HMO/PPO |
$318.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.38
|
| 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
|
OP
|
$284.16
|
|
|
Service Code
|
NDC 00904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$255.74 |
| Rate for Payer: Aetna Commercial |
$241.54
|
| Rate for Payer: Aetna Medicare |
$73.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.80
|
| Rate for Payer: BCBS Complete |
$113.66
|
| Rate for Payer: BCBS MAPPO |
$71.04
|
| Rate for Payer: BCBS Trust/PPO |
$233.61
|
| Rate for Payer: BCN Commercial |
$220.93
|
| Rate for Payer: BCN Medicare Advantage |
$71.04
|
| Rate for Payer: Cash Price |
$227.33
|
| Rate for Payer: Cofinity Commercial |
$244.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.04
|
| Rate for Payer: Healthscope Commercial |
$255.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.54
|
| Rate for Payer: Nomi Health Commercial |
$233.01
|
| Rate for Payer: PACE Senior Care Partners |
$67.49
|
| Rate for Payer: PACE SWMI |
$71.04
|
| Rate for Payer: PHP Commercial |
$241.54
|
| Rate for Payer: PHP Medicare Advantage |
$71.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.70
|
| Rate for Payer: Priority Health HMO/PPO |
$247.22
|
| Rate for Payer: Priority Health Medicare |
$71.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.39
|
| Rate for Payer: Railroad Medicare Medicare |
$71.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.06
|
| Rate for Payer: UHC Core |
$237.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.04
|
| Rate for Payer: UHC Exchange |
$71.04
|
| Rate for Payer: UHC Medicare Advantage |
$71.04
|
| Rate for Payer: VA VA |
$71.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.12
|
|
|
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 |
$255.74 |
| Rate for Payer: Aetna Commercial |
$241.54
|
| Rate for Payer: BCBS Trust/PPO |
$231.96
|
| Rate for Payer: BCN Commercial |
$219.60
|
| Rate for Payer: Cash Price |
$227.33
|
| Rate for Payer: Cofinity Commercial |
$244.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.33
|
| Rate for Payer: Healthscope Commercial |
$255.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.54
|
| Rate for Payer: Nomi Health Commercial |
$233.01
|
| Rate for Payer: PHP Commercial |
$241.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.70
|
| Rate for Payer: Priority Health HMO/PPO |
$247.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.06
|
| Rate for Payer: UHC Core |
$237.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.12
|
|
