|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 68382007116
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.21 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$196.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: BCBS Complete |
$156.98
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
OP
|
$441.75
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.45 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna American Axle |
$287.14
|
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna Medicare |
$220.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: BCBS Complete |
$176.70
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$309.23
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| Rate for Payer: UMR Bronson Commercial |
$163.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.31
|
|
|
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 Commercial |
$172.03
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.03
|
| 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: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.74
|
| Rate for Payer: Priority Health SBD |
$154.83
|
| Rate for Payer: UMR Bronson Commercial |
$90.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.32
|
|
|
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 Commercial |
$207.31
|
| Rate for Payer: Cofinity Commercial |
$254.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.31
|
| 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: PHP Commercial |
$251.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health SBD |
$186.58
|
| 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
|
$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 Commercial |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.72
|
| 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: PHP Commercial |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| 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
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$93.06
|
|
|
Service Code
|
NDC 00093720198
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna American Axle |
$60.49
|
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Commercial |
$65.14
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.49
|
| Rate for Payer: Priority Health SBD |
$58.63
|
| Rate for Payer: UMR Bronson Commercial |
$40.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
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 Commercial |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.08
|
| 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: PHP Commercial |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.93
|
| 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
|
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 Commercial |
$2.08
|
| Rate for Payer: Cofinity Commercial |
$2.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.08
|
| 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: PHP Commercial |
$2.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.93
|
| Rate for Payer: Priority Health SBD |
$1.87
|
| 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
|
$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 Commercial |
$37.02
|
| Rate for Payer: Cofinity Commercial |
$45.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.02
|
| 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: PHP Commercial |
$44.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.37
|
| 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
|
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 Commercial |
$172.03
|
| Rate for Payer: Cofinity Commercial |
$211.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$172.03
|
| 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: PHP Commercial |
$208.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.74
|
| 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
|
$93.06
|
|
|
Service Code
|
NDC 00093720198
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.43 |
| Max. Negotiated Rate |
$83.75 |
| Rate for Payer: Aetna American Axle |
$60.49
|
| Rate for Payer: Aetna Commercial |
$79.10
|
| Rate for Payer: Aetna Medicare |
$46.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.49
|
| Rate for Payer: BCBS Complete |
$37.22
|
| Rate for Payer: Cash Price |
$74.45
|
| Rate for Payer: Cofinity Commercial |
$65.14
|
| Rate for Payer: Cofinity Commercial |
$80.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$65.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.45
|
| Rate for Payer: Healthscope Commercial |
$83.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$69.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.10
|
| Rate for Payer: PHP Commercial |
$79.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.49
|
| Rate for Payer: Priority Health SBD |
$58.63
|
| Rate for Payer: UMR Bronson Commercial |
$34.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$69.80
|
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$397.57 |
| Rate for Payer: Aetna American Axle |
$287.14
|
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$309.23
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health SBD |
$278.30
|
| Rate for Payer: UMR Bronson Commercial |
$194.37
|
| 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 |
$172.68 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna American Axle |
$255.09
|
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.09
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$274.71
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.09
|
| Rate for Payer: Priority Health SBD |
$247.24
|
| Rate for Payer: UMR Bronson Commercial |
$172.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
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 Commercial |
$1.72
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.72
|
| 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: PHP Commercial |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.60
|
| Rate for Payer: Priority Health SBD |
$1.55
|
| Rate for Payer: UMR Bronson Commercial |
$0.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.84
|
|
|
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 Commercial |
$207.31
|
| Rate for Payer: Cofinity Commercial |
$254.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.31
|
| 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: PHP Commercial |
$251.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| 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
|
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 Commercial |
$37.02
|
| Rate for Payer: Cofinity Commercial |
$45.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.02
|
| 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: PHP Commercial |
$44.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.37
|
| Rate for Payer: Priority Health SBD |
$33.31
|
| Rate for Payer: UMR Bronson Commercial |
$19.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.66
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 11730
|
| Min. Negotiated Rate |
$51.14 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$68.53
|
| Rate for Payer: Aetna Medicare |
$53.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.53
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS MAPPO |
$51.14
|
| Rate for Payer: BCN Medicare Advantage |
$51.14
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$73.64
|
| Rate for Payer: Cofinity Commercial |
$68.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.70
|
| Rate for Payer: Nomi Health Commercial |
$61.37
|
| Rate for Payer: PACE SWMI |
$51.14
|
| Rate for Payer: PHP Commercial |
$71.60
|
| Rate for Payer: PHP Medicare Advantage |
$51.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.00
|
| Rate for Payer: Priority Health Medicare |
$51.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.14
|
| Rate for Payer: UHC Medicare Advantage |
$51.14
|
| Rate for Payer: UMR Bronson Commercial |
$73.60
|
|
|
PR AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 11732
|
| Min. Negotiated Rate |
$16.08 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Aetna Commercial |
$21.55
|
| Rate for Payer: Aetna Medicare |
$16.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.55
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS MAPPO |
$16.08
|
| Rate for Payer: BCN Medicare Advantage |
$16.08
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$23.16
|
| Rate for Payer: Cofinity Commercial |
$21.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.88
|
| Rate for Payer: Nomi Health Commercial |
$19.30
|
| Rate for Payer: PACE SWMI |
$16.08
|
| Rate for Payer: PHP Commercial |
$22.51
|
| Rate for Payer: PHP Medicare Advantage |
$16.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.10
|
| Rate for Payer: Priority Health Medicare |
$16.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.08
|
| Rate for Payer: UHC Medicare Advantage |
$16.08
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
IP
|
$1,564.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$688.16 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Aetna American Axle |
$1,016.60
|
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.60
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,094.80
|
| Rate for Payer: Cofinity Commercial |
$1,345.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,094.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,094.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,173.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health SBD |
$985.32
|
| Rate for Payer: UMR Bronson Commercial |
$688.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,173.00
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Facility
|
OP
|
$1,564.00
|
|
|
Service Code
|
CPT 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$578.68 |
| Max. Negotiated Rate |
$16,017.15 |
| Rate for Payer: Aetna American Axle |
$1,016.60
|
| Rate for Payer: Aetna Commercial |
$1,329.40
|
| Rate for Payer: Aetna Medicare |
$5,917.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,112.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,112.66
|
| Rate for Payer: BCBS Complete |
$3,202.41
|
| Rate for Payer: BCBS MAPPO |
$5,690.13
|
| Rate for Payer: BCN Medicare Advantage |
$5,690.13
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,345.04
|
| Rate for Payer: Cofinity Commercial |
$1,094.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,094.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,251.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,690.13
|
| Rate for Payer: Healthscope Commercial |
$1,407.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,094.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,173.00
|
| Rate for Payer: Mclaren Medicaid |
$3,049.91
|
| Rate for Payer: Mclaren Medicare |
$5,690.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,974.64
|
| Rate for Payer: Meridian Medicaid |
$3,202.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,543.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,329.40
|
| Rate for Payer: PACE Medicare |
$5,405.62
|
| Rate for Payer: PACE SWMI |
$5,690.13
|
| Rate for Payer: PHP Commercial |
$1,329.40
|
| Rate for Payer: PHP Medicare Advantage |
$5,690.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,049.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$5,690.13
|
| Rate for Payer: Priority Health SBD |
$985.32
|
| Rate for Payer: Railroad Medicare Medicare |
$5,690.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,017.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$5,690.13
|
| Rate for Payer: UHC Exchange |
$10,874.41
|
| Rate for Payer: UHC Medicare Advantage |
$5,690.13
|
| Rate for Payer: UHCCP Medicaid |
$3,049.91
|
| Rate for Payer: UMR Bronson Commercial |
$578.68
|
| Rate for Payer: VA VA |
$5,690.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,173.00
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Hospital Charge Code |
38745
|
| Min. Negotiated Rate |
$625.60 |
| Max. Negotiated Rate |
$1,236.27 |
| Rate for Payer: Aetna Commercial |
$1,150.42
|
| Rate for Payer: Aetna Medicare |
$892.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.42
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$858.52
|
| Rate for Payer: BCN Medicare Advantage |
$858.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,150.42
|
| Rate for Payer: Cofinity Commercial |
$1,236.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.45
|
| Rate for Payer: Nomi Health Commercial |
$1,030.22
|
| Rate for Payer: PACE SWMI |
$858.52
|
| Rate for Payer: PHP Commercial |
$1,201.93
|
| Rate for Payer: PHP Medicare Advantage |
$858.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$858.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.52
|
| Rate for Payer: UHC Medicare Advantage |
$858.52
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
PR AXILLARY LYMPHADENECTOMY COMPLETE
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 38745
|
| Min. Negotiated Rate |
$625.60 |
| Max. Negotiated Rate |
$1,236.27 |
| Rate for Payer: Aetna Commercial |
$1,150.42
|
| Rate for Payer: Aetna Medicare |
$892.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,236.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,150.42
|
| Rate for Payer: BCBS Complete |
$625.60
|
| Rate for Payer: BCBS MAPPO |
$858.52
|
| Rate for Payer: BCN Medicare Advantage |
$858.52
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cash Price |
$1,251.20
|
| Rate for Payer: Cofinity Commercial |
$1,236.27
|
| Rate for Payer: Cofinity Commercial |
$1,150.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$901.45
|
| Rate for Payer: Nomi Health Commercial |
$1,030.22
|
| Rate for Payer: PACE SWMI |
$858.52
|
| Rate for Payer: PHP Commercial |
$1,201.93
|
| Rate for Payer: PHP Medicare Advantage |
$858.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,016.60
|
| Rate for Payer: Priority Health Medicare |
$858.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.52
|
| Rate for Payer: UHC Medicare Advantage |
$858.52
|
| Rate for Payer: UMR Bronson Commercial |
$719.44
|
|
|
PR AXILLARY LYMPHADENECTOMY SUPERFICIAL
|
Professional
|
Both
|
$2,103.00
|
|
|
Service Code
|
HCPCS 38740
|
| Min. Negotiated Rate |
$681.81 |
| Max. Negotiated Rate |
$1,366.95 |
| Rate for Payer: Aetna Commercial |
$913.63
|
| Rate for Payer: Aetna Medicare |
$709.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$981.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$913.63
|
| Rate for Payer: BCBS Complete |
$841.20
|
| Rate for Payer: BCBS MAPPO |
$681.81
|
| Rate for Payer: BCN Medicare Advantage |
$681.81
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cofinity Commercial |
$981.81
|
| Rate for Payer: Cofinity Commercial |
$913.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$681.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$715.90
|
| Rate for Payer: Nomi Health Commercial |
$818.17
|
| Rate for Payer: PACE SWMI |
$681.81
|
| Rate for Payer: PHP Commercial |
$954.53
|
| Rate for Payer: PHP Medicare Advantage |
$681.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.95
|
| Rate for Payer: Priority Health Medicare |
$681.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$681.81
|
| Rate for Payer: UHC Medicare Advantage |
$681.81
|
| Rate for Payer: UMR Bronson Commercial |
$967.38
|
|
|
PRAZIQUANTEL 600 MG TABLET
|
Facility
|
OP
|
$1,259.34
|
|
|
Service Code
|
NDC 49884023183
|
| Hospital Charge Code |
11113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$465.96 |
| Max. Negotiated Rate |
$1,133.41 |
| Rate for Payer: Aetna American Axle |
$818.57
|
| Rate for Payer: Aetna Commercial |
$1,070.44
|
| Rate for Payer: Aetna Medicare |
$629.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.57
|
| Rate for Payer: BCBS Complete |
$503.74
|
| Rate for Payer: Cash Price |
$1,007.47
|
| Rate for Payer: Cofinity Commercial |
$1,083.03
|
| Rate for Payer: Cofinity Commercial |
$881.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$881.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.47
|
| Rate for Payer: Healthscope Commercial |
$1,133.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$881.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.44
|
| Rate for Payer: PHP Commercial |
$1,070.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.57
|
| Rate for Payer: Priority Health SBD |
$793.38
|
| Rate for Payer: UMR Bronson Commercial |
$465.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.50
|
|
|
PRAZIQUANTEL 600 MG TABLET
|
Facility
|
IP
|
$1,259.34
|
|
|
Service Code
|
NDC 49884023183
|
| Hospital Charge Code |
11113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$554.11 |
| Max. Negotiated Rate |
$1,133.41 |
| Rate for Payer: Aetna American Axle |
$818.57
|
| Rate for Payer: Aetna Commercial |
$1,070.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.57
|
| Rate for Payer: Cash Price |
$1,007.47
|
| Rate for Payer: Cofinity Commercial |
$1,083.03
|
| Rate for Payer: Cofinity Commercial |
$881.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$881.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.47
|
| Rate for Payer: Healthscope Commercial |
$1,133.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$881.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.44
|
| Rate for Payer: PHP Commercial |
$1,070.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$818.57
|
| Rate for Payer: Priority Health SBD |
$793.38
|
| Rate for Payer: UMR Bronson Commercial |
$554.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.50
|
|
