|
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
|
| Rate for Payer: UMR Bronson Commercial |
$69.92
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,246.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$934.50 |
| Rate for Payer: Aetna Commercial |
$220.55
|
| Rate for Payer: Aetna Medicare |
$171.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.01
|
| Rate for Payer: BCBS Complete |
$109.37
|
| Rate for Payer: BCBS MAPPO |
$164.59
|
| Rate for Payer: BCN Commercial |
$300.34
|
| Rate for Payer: BCN Medicare Advantage |
$164.59
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cofinity Commercial |
$237.01
|
| Rate for Payer: Cofinity Commercial |
$220.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.82
|
| Rate for Payer: Meridian Medicaid |
$109.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$181.05
|
| Rate for Payer: Nomi Health Commercial |
$197.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$934.50
|
| Rate for Payer: PACE SWMI |
$164.59
|
| Rate for Payer: PHP Commercial |
$230.43
|
| Rate for Payer: PHP Medicare Advantage |
$164.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$104.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$292.24
|
| Rate for Payer: Priority Health Medicare |
$164.59
|
| Rate for Payer: Priority Health SBD |
$292.24
|
| Rate for Payer: Priority Health Tiered Network |
$292.24
|
| Rate for Payer: Railroad Medicare Medicare |
$164.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.59
|
| Rate for Payer: UHC Core |
$327.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$164.59
|
| Rate for Payer: UHC Exchange |
$327.59
|
| Rate for Payer: UHC Medicaid |
$104.16
|
| Rate for Payer: UHCCP Medicaid |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$573.16
|
|
|
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: Aetna New Business (MI Preferred) |
$165.78
|
| Rate for Payer: BCBS Complete |
$306.40
|
| Rate for Payer: BCN Commercial |
$184.90
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Cash Price |
$612.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$574.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$200.69
|
| Rate for Payer: Priority Health SBD |
$200.69
|
| Rate for Payer: Priority Health Tiered Network |
$200.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.34
|
| Rate for Payer: UHC Core |
$220.34
|
| Rate for Payer: UHC Exchange |
$220.34
|
| Rate for Payer: UMR Bronson Commercial |
$352.36
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$93.93 |
| Max. Negotiated Rate |
$750.00 |
| Rate for Payer: Aetna Commercial |
$198.44
|
| Rate for Payer: Aetna Medicare |
$154.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.25
|
| Rate for Payer: BCBS Complete |
$98.63
|
| Rate for Payer: BCBS MAPPO |
$148.09
|
| Rate for Payer: BCN Commercial |
$274.63
|
| Rate for Payer: BCN Medicare Advantage |
$148.09
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$198.44
|
| Rate for Payer: Cofinity Commercial |
$213.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.49
|
| Rate for Payer: Meridian Medicaid |
$98.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$162.90
|
| Rate for Payer: Nomi Health Commercial |
$177.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.00
|
| Rate for Payer: PACE SWMI |
$148.09
|
| Rate for Payer: PHP Commercial |
$207.33
|
| Rate for Payer: PHP Medicare Advantage |
$148.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$267.23
|
| Rate for Payer: Priority Health Medicare |
$148.09
|
| Rate for Payer: Priority Health SBD |
$267.23
|
| Rate for Payer: Priority Health Tiered Network |
$267.23
|
| Rate for Payer: Railroad Medicare Medicare |
$148.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.26
|
| Rate for Payer: UHC Core |
$297.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$148.09
|
| Rate for Payer: UHC Exchange |
$297.26
|
| Rate for Payer: UHC Medicaid |
$93.93
|
| Rate for Payer: UHCCP Medicaid |
$93.93
|
| Rate for Payer: UMR Bronson Commercial |
$460.00
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,482.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$953.18 |
| Max. Negotiated Rate |
$2,898.56 |
| Rate for Payer: Aetna Commercial |
$1,972.14
|
| Rate for Payer: Aetna Medicare |
$1,530.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,972.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,119.32
|
| Rate for Payer: BCBS Complete |
$1,000.84
|
| Rate for Payer: BCBS MAPPO |
$1,471.75
|
| Rate for Payer: BCN Commercial |
$2,488.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,471.75
|
| Rate for Payer: Cash Price |
$2,785.60
|
| Rate for Payer: Cash Price |
$2,785.60
|
| Rate for Payer: Cofinity Commercial |
$1,972.14
|
| Rate for Payer: Cofinity Commercial |
$2,119.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,471.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,545.34
|
| Rate for Payer: Meridian Medicaid |
$1,000.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,618.92
|
| Rate for Payer: Nomi Health Commercial |
$1,766.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,611.50
|
| Rate for Payer: PACE SWMI |
$1,471.75
|
| Rate for Payer: PHP Commercial |
$2,060.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,471.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$953.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,660.58
|
| Rate for Payer: Priority Health Medicare |
$1,471.75
|
| Rate for Payer: Priority Health SBD |
$2,660.58
|
| Rate for Payer: Priority Health Tiered Network |
$2,660.58
|
| Rate for Payer: Railroad Medicare Medicare |
$1,471.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,898.56
|
| Rate for Payer: UHC Core |
$2,898.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,471.75
|
| Rate for Payer: UHC Exchange |
$2,898.56
|
| Rate for Payer: UHC Medicaid |
$953.18
|
| Rate for Payer: UHCCP Medicaid |
$953.18
|
| Rate for Payer: UMR Bronson Commercial |
$1,601.72
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$389.50
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.12 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna American Axle |
$253.18
|
| Rate for Payer: Aetna Commercial |
$331.07
|
| Rate for Payer: Aetna Medicare |
$194.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.18
|
| Rate for Payer: BCBS Complete |
$155.80
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Advantage |
$272.65
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$272.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.12
|
| Rate for Payer: PHP Commercial |
$331.07
|
| Rate for Payer: Priority Health SBD |
$245.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.18
|
| Rate for Payer: UHC Core |
$202.93
|
| Rate for Payer: UHC Exchange |
$153.07
|
| Rate for Payer: UMR Bronson Commercial |
$144.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.12
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$211.19
|
|
|
Service Code
|
NDC 00093077198
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.92 |
| Max. Negotiated Rate |
$190.07 |
| Rate for Payer: Aetna American Axle |
$137.27
|
| Rate for Payer: Aetna Commercial |
$179.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.27
|
| Rate for Payer: Cash Price |
$168.95
|
| Rate for Payer: Cofinity Advantage |
$147.83
|
| Rate for Payer: Cofinity Commercial |
$181.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.95
|
| Rate for Payer: Healthscope Commercial |
$190.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.39
|
| Rate for Payer: PHP Commercial |
$179.51
|
| Rate for Payer: Priority Health SBD |
$133.05
|
| Rate for Payer: UMR Bronson Commercial |
$92.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.39
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$211.19
|
|
|
Service Code
|
NDC 00093077198
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.14 |
| Max. Negotiated Rate |
$190.07 |
| Rate for Payer: Aetna American Axle |
$137.27
|
| Rate for Payer: Aetna Commercial |
$179.51
|
| Rate for Payer: Aetna Medicare |
$105.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.27
|
| Rate for Payer: BCBS Complete |
$84.48
|
| Rate for Payer: Cash Price |
$168.95
|
| Rate for Payer: Cofinity Advantage |
$147.83
|
| Rate for Payer: Cofinity Commercial |
$181.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.95
|
| Rate for Payer: Healthscope Commercial |
$190.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.39
|
| Rate for Payer: PHP Commercial |
$179.51
|
| Rate for Payer: Priority Health SBD |
$133.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.27
|
| Rate for Payer: UHC Core |
$110.03
|
| Rate for Payer: UHC Exchange |
$83.00
|
| Rate for Payer: UMR Bronson Commercial |
$78.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.39
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$389.50
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.38 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna American Axle |
$253.18
|
| Rate for Payer: Aetna Commercial |
$331.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.18
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Advantage |
$272.65
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$272.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$331.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.12
|
| Rate for Payer: PHP Commercial |
$331.07
|
| Rate for Payer: Priority Health SBD |
$245.38
|
| Rate for Payer: UMR Bronson Commercial |
$171.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.12
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$95.18
|
|
|
Service Code
|
NDC 00093720198
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$85.66 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.90
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: BCBS Complete |
$38.07
|
| Rate for Payer: Cash Price |
$76.14
|
| Rate for Payer: Cofinity Advantage |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.14
|
| Rate for Payer: Healthscope Commercial |
$85.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: PHP Commercial |
$80.90
|
| Rate for Payer: Priority Health SBD |
$59.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.87
|
| Rate for Payer: UHC Core |
$49.59
|
| Rate for Payer: UHC Exchange |
$37.41
|
| Rate for Payer: UMR Bronson Commercial |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$95.18
|
|
|
Service Code
|
NDC 00093720198
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$85.66 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$76.14
|
| Rate for Payer: Cofinity Advantage |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.14
|
| Rate for Payer: Healthscope Commercial |
$85.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.39
|
| Rate for Payer: PHP Commercial |
$80.90
|
| Rate for Payer: Priority Health SBD |
$59.96
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$469.30
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.64 |
| Max. Negotiated Rate |
$422.37 |
| Rate for Payer: Aetna American Axle |
$305.05
|
| Rate for Payer: Aetna Commercial |
$398.90
|
| Rate for Payer: Aetna Medicare |
$234.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.05
|
| Rate for Payer: BCBS Complete |
$187.72
|
| Rate for Payer: Cash Price |
$375.44
|
| Rate for Payer: Cofinity Advantage |
$328.51
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$328.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$375.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.98
|
| Rate for Payer: PHP Commercial |
$398.90
|
| Rate for Payer: Priority Health SBD |
$295.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.05
|
| Rate for Payer: UHC Core |
$244.51
|
| Rate for Payer: UHC Exchange |
$184.43
|
| Rate for Payer: UMR Bronson Commercial |
$173.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.98
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 60687017811
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna American Axle |
$1.60
|
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Aetna Medicare |
$1.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.60
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Advantage |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.84
|
| Rate for Payer: PHP Commercial |
$2.09
|
| Rate for Payer: Priority Health SBD |
$1.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.60
|
| Rate for Payer: UHC Core |
$1.28
|
| Rate for Payer: UHC Exchange |
$0.97
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$296.16
|
|
|
Service Code
|
NDC 51079045820
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.58 |
| Max. Negotiated Rate |
$266.54 |
| Rate for Payer: Aetna American Axle |
$192.50
|
| Rate for Payer: Aetna Commercial |
$251.74
|
| Rate for Payer: Aetna Medicare |
$148.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.50
|
| Rate for Payer: BCBS Complete |
$118.46
|
| Rate for Payer: Cash Price |
$236.93
|
| Rate for Payer: Cofinity Advantage |
$207.31
|
| Rate for Payer: Cofinity Commercial |
$254.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.93
|
| Rate for Payer: Healthscope Commercial |
$266.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$236.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.12
|
| Rate for Payer: PHP Commercial |
$251.74
|
| Rate for Payer: Priority Health SBD |
$186.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.50
|
| Rate for Payer: UHC Core |
$154.30
|
| Rate for Payer: UHC Exchange |
$116.39
|
| Rate for Payer: UMR Bronson Commercial |
$109.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.12
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$296.16
|
|
|
Service Code
|
NDC 51079045820
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.31 |
| Max. Negotiated Rate |
$266.54 |
| Rate for Payer: Aetna American Axle |
$192.50
|
| Rate for Payer: Aetna Commercial |
$251.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.50
|
| Rate for Payer: Cash Price |
$236.93
|
| Rate for Payer: Cofinity Advantage |
$207.31
|
| Rate for Payer: Cofinity Commercial |
$254.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$236.93
|
| Rate for Payer: Healthscope Commercial |
$266.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$222.12
|
| Rate for Payer: PHP Commercial |
$251.74
|
| Rate for Payer: Priority Health SBD |
$186.58
|
| Rate for Payer: UMR Bronson Commercial |
$130.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.12
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$469.30
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.49 |
| Max. Negotiated Rate |
$422.37 |
| Rate for Payer: Aetna American Axle |
$305.05
|
| Rate for Payer: Aetna Commercial |
$398.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.05
|
| Rate for Payer: Cash Price |
$375.44
|
| Rate for Payer: Cofinity Advantage |
$328.51
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$328.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$351.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$351.98
|
| Rate for Payer: PHP Commercial |
$398.90
|
| Rate for Payer: Priority Health SBD |
$295.66
|
| Rate for Payer: UMR Bronson Commercial |
$206.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$351.98
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$52.88
|
|
|
Service Code
|
NDC 42291066790
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$47.59 |
| Rate for Payer: Aetna American Axle |
$34.37
|
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Aetna Medicare |
$26.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.37
|
| Rate for Payer: BCBS Complete |
$21.15
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cofinity Advantage |
$37.02
|
| Rate for Payer: Cofinity Commercial |
$45.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.30
|
| Rate for Payer: Healthscope Commercial |
$47.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.66
|
| Rate for Payer: PHP Commercial |
$44.95
|
| Rate for Payer: Priority Health SBD |
$33.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.37
|
| Rate for Payer: UHC Core |
$27.55
|
| Rate for Payer: UHC Exchange |
$20.78
|
| Rate for Payer: UMR Bronson Commercial |
$19.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.66
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$52.88
|
|
|
Service Code
|
NDC 42291066790
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.27 |
| Max. Negotiated Rate |
$47.59 |
| Rate for Payer: Aetna American Axle |
$34.37
|
| Rate for Payer: Aetna Commercial |
$44.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.37
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cofinity Advantage |
$37.02
|
| Rate for Payer: Cofinity Commercial |
$45.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.30
|
| Rate for Payer: Healthscope Commercial |
$47.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.66
|
| Rate for Payer: PHP Commercial |
$44.95
|
| Rate for Payer: Priority Health SBD |
$33.31
|
| Rate for Payer: UMR Bronson Commercial |
$23.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.66
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$2.97
|
|
|
Service Code
|
NDC 51079045801
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna American Axle |
$1.93
|
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.93
|
| Rate for Payer: BCBS Complete |
$1.19
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Advantage |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.23
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: Priority Health SBD |
$1.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.93
|
| Rate for Payer: UHC Core |
$1.55
|
| Rate for Payer: UHC Exchange |
$1.17
|
| Rate for Payer: UMR Bronson Commercial |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$2.97
|
|
|
Service Code
|
NDC 51079045801
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$2.67 |
| Rate for Payer: Aetna American Axle |
$1.93
|
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.93
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Cofinity Advantage |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.38
|
| Rate for Payer: Healthscope Commercial |
$2.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.23
|
| Rate for Payer: PHP Commercial |
$2.52
|
| Rate for Payer: Priority Health SBD |
$1.87
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.23
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$245.76
|
|
|
Service Code
|
NDC 60687017801
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.13 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna American Axle |
$159.74
|
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.74
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Advantage |
$172.03
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.32
|
| Rate for Payer: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health SBD |
$154.83
|
| Rate for Payer: UMR Bronson Commercial |
$108.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.32
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$245.76
|
|
|
Service Code
|
NDC 60687017801
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.93 |
| Max. Negotiated Rate |
$221.18 |
| Rate for Payer: Aetna American Axle |
$159.74
|
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna Medicare |
$122.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.74
|
| Rate for Payer: BCBS Complete |
$98.30
|
| Rate for Payer: Cash Price |
$196.61
|
| Rate for Payer: Cofinity Advantage |
$172.03
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.61
|
| Rate for Payer: Healthscope Commercial |
$221.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$172.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$196.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.32
|
| Rate for Payer: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health SBD |
$154.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.74
|
| Rate for Payer: UHC Core |
$128.04
|
| Rate for Payer: UHC Exchange |
$96.58
|
| Rate for Payer: UMR Bronson Commercial |
$90.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.32
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 60687017811
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.21 |
| Rate for Payer: Aetna American Axle |
$1.60
|
| Rate for Payer: Aetna Commercial |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.60
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Advantage |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.84
|
| Rate for Payer: PHP Commercial |
$2.09
|
| Rate for Payer: Priority Health SBD |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$123.75 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$49.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.21
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$48.06
|
| Rate for Payer: BCN Commercial |
$63.22
|
| Rate for Payer: BCN Medicare Advantage |
$48.06
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$64.40
|
| Rate for Payer: Cofinity Commercial |
$69.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.46
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.87
|
| Rate for Payer: Nomi Health Commercial |
$57.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.75
|
| Rate for Payer: PACE SWMI |
$48.06
|
| Rate for Payer: PHP Commercial |
$67.28
|
| Rate for Payer: PHP Medicare Advantage |
$48.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73.38
|
| Rate for Payer: Priority Health Medicare |
$48.06
|
| Rate for Payer: Priority Health SBD |
$73.38
|
| Rate for Payer: Priority Health Tiered Network |
$73.38
|
| Rate for Payer: Railroad Medicare Medicare |
$48.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.29
|
| Rate for Payer: UHC Core |
$96.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.06
|
| Rate for Payer: UHC Exchange |
$96.29
|
| Rate for Payer: UHC Medicaid |
$31.10
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
| Rate for Payer: UMR Bronson Commercial |
$75.90
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$20.11
|
| Rate for Payer: Aetna Medicare |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.61
|
| Rate for Payer: BCBS Complete |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$15.01
|
| Rate for Payer: BCN Commercial |
$19.64
|
| Rate for Payer: BCN Medicare Advantage |
$15.01
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$20.11
|
| Rate for Payer: Cofinity Commercial |
$21.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.76
|
| Rate for Payer: Meridian Medicaid |
$10.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.51
|
| Rate for Payer: Nomi Health Commercial |
$18.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.00
|
| Rate for Payer: PACE SWMI |
$15.01
|
| Rate for Payer: PHP Commercial |
$21.01
|
| Rate for Payer: PHP Medicare Advantage |
$15.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$22.78
|
| Rate for Payer: Priority Health Medicare |
$15.01
|
| Rate for Payer: Priority Health SBD |
$22.78
|
| Rate for Payer: Priority Health Tiered Network |
$22.78
|
| Rate for Payer: Railroad Medicare Medicare |
$15.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.92
|
| Rate for Payer: UHC Core |
$30.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15.01
|
| Rate for Payer: UHC Exchange |
$30.92
|
| Rate for Payer: UHC Medicaid |
$9.59
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| Rate for Payer: UMR Bronson Commercial |
$34.96
|
|
