|
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
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$239.11
|
| Rate for Payer: Aetna Medicare |
$185.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.95
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS MAPPO |
$178.44
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$292.71
|
| 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: Meridian Medicaid |
$122.79
|
| Rate for Payer: Nomi Health Commercial |
$214.13
|
| Rate for Payer: PACE SWMI |
$178.44
|
| Rate for Payer: PHP Commercial |
$249.82
|
| Rate for Payer: PHP Medicare Advantage |
$178.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$279.37
|
| Rate for Payer: Priority Health Medicare |
$178.44
|
| Rate for Payer: Priority Health Narrow Network |
$279.37
|
| Rate for Payer: Priority Health SBD |
$279.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.44
|
| Rate for Payer: UHC Medicare Advantage |
$178.44
|
| Rate for Payer: UHCCP Medicaid |
$116.94
|
| Rate for Payer: UMR Bronson Commercial |
$556.60
|
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$165.78 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$165.78
|
| Rate for Payer: Aetna Medicare |
$372.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.78
|
| Rate for Payer: BCBS Complete |
$297.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$182.92
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.32
|
| Rate for Payer: Priority Health Narrow Network |
$190.32
|
| Rate for Payer: Priority Health SBD |
$190.32
|
| Rate for Payer: UMR Bronson Commercial |
$342.24
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$106.93 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$218.07
|
| Rate for Payer: Aetna Medicare |
$169.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$218.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.35
|
| Rate for Payer: BCBS Complete |
$112.28
|
| Rate for Payer: BCBS MAPPO |
$162.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$267.42
|
| 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: Meridian Medicaid |
$112.28
|
| Rate for Payer: Nomi Health Commercial |
$195.29
|
| Rate for Payer: PACE SWMI |
$162.74
|
| Rate for Payer: PHP Commercial |
$227.84
|
| Rate for Payer: PHP Medicare Advantage |
$162.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.41
|
| Rate for Payer: Priority Health Medicare |
$162.74
|
| Rate for Payer: Priority Health Narrow Network |
$253.41
|
| Rate for Payer: Priority Health SBD |
$253.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.74
|
| Rate for Payer: UHC Medicare Advantage |
$162.74
|
| Rate for Payer: UHCCP Medicaid |
$106.93
|
| Rate for Payer: UMR Bronson Commercial |
$446.66
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,381.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$2,522.42 |
| Rate for Payer: Aetna Commercial |
$2,126.55
|
| Rate for Payer: Aetna Medicare |
$1,650.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,126.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,285.25
|
| Rate for Payer: BCBS Complete |
$1,117.80
|
| Rate for Payer: BCBS MAPPO |
$1,586.98
|
| Rate for Payer: BCBS Trust/PPO |
$149.51
|
| Rate for Payer: BCN Commercial |
$2,406.25
|
| 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 |
$2,126.55
|
| Rate for Payer: Cofinity Commercial |
$2,285.25
|
| 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: Meridian Medicaid |
$1,117.80
|
| Rate for Payer: Nomi Health Commercial |
$1,904.38
|
| Rate for Payer: PACE SWMI |
$1,586.98
|
| Rate for Payer: PHP Commercial |
$2,221.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,586.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,064.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,197.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,522.42
|
| Rate for Payer: Priority Health Medicare |
$1,586.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,522.42
|
| Rate for Payer: Priority Health SBD |
$2,522.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,586.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,586.98
|
| Rate for Payer: UHCCP Medicaid |
$1,064.57
|
| Rate for Payer: UMR Bronson Commercial |
$1,555.26
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 00093077198
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.51 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna Medicare |
$161.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$119.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 00093077198
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.12 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna American Axle |
$209.95
|
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.95
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$226.10
|
| Rate for Payer: Cofinity Commercial |
$277.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$226.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$290.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: PHP Commercial |
$274.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health SBD |
$203.49
|
| Rate for Payer: UMR Bronson Commercial |
$142.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.25
|
|
|
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
|
$441.75
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.37 |
| Max. Negotiated Rate |
$397.58 |
| 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 |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.22
|
| 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
|
OP
|
$441.75
|
|
|
Service Code
|
NDC 00904589261
|
| Hospital Charge Code |
11111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.45 |
| Max. Negotiated Rate |
$397.58 |
| 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 |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.22
|
| 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
|
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 |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.72
|
| 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 |
$274.72
|
| 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
|
$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
|
$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
|
$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
|
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
|
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
|
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
|
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
|
|
|
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 |
$1.48
|
| 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
|
$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
|
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
|
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 |
$274.72
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.72
|
| 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 |
$274.72
|
| 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
|
$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
|
|
