|
PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 90460
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$31.91 |
| Rate for Payer: Aetna Commercial |
$29.69
|
| Rate for Payer: Aetna Medicare |
$23.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.91
|
| Rate for Payer: BCBS MAPPO |
$22.16
|
| Rate for Payer: BCN Commercial |
$25.96
|
| Rate for Payer: BCN Medicare Advantage |
$22.16
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$31.91
|
| Rate for Payer: Cofinity Commercial |
$29.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.38
|
| Rate for Payer: Nomi Health Commercial |
$26.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$22.16
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: PHP Medicare Advantage |
$22.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$26.75
|
| Rate for Payer: Priority Health Medicare |
$22.16
|
| Rate for Payer: Priority Health SBD |
$26.75
|
| Rate for Payer: Priority Health Tiered Network |
$26.75
|
| Rate for Payer: Railroad Medicare Medicare |
$22.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.76
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.16
|
| Rate for Payer: UHC Exchange |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 90461
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Aetna Commercial |
$11.42
|
| Rate for Payer: Aetna Medicare |
$8.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.27
|
| Rate for Payer: BCBS MAPPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$13.80
|
| Rate for Payer: BCN Medicare Advantage |
$8.52
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$12.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.37
|
| Rate for Payer: Nomi Health Commercial |
$10.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.00
|
| Rate for Payer: PACE SWMI |
$8.52
|
| Rate for Payer: PHP Commercial |
$11.93
|
| Rate for Payer: PHP Medicare Advantage |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11.94
|
| Rate for Payer: Priority Health Medicare |
$8.52
|
| Rate for Payer: Priority Health SBD |
$11.94
|
| Rate for Payer: Priority Health Tiered Network |
$11.94
|
| Rate for Payer: Railroad Medicare Medicare |
$8.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$12.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.52
|
| Rate for Payer: UHC Exchange |
$12.38
|
| Rate for Payer: UMR Bronson Commercial |
$11.04
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
OP
|
$913.44
|
|
|
Service Code
|
NDC 00024159601
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$337.97 |
| Max. Negotiated Rate |
$822.10 |
| Rate for Payer: Aetna American Axle |
$593.74
|
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna Medicare |
$456.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.74
|
| Rate for Payer: BCBS Complete |
$365.38
|
| Rate for Payer: Cash Price |
$730.75
|
| Rate for Payer: Cofinity Advantage |
$639.41
|
| Rate for Payer: Cofinity Commercial |
$785.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.75
|
| Rate for Payer: Healthscope Commercial |
$822.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$730.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$685.08
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: Priority Health SBD |
$575.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$593.74
|
| Rate for Payer: UHC Core |
$475.90
|
| Rate for Payer: UHC Exchange |
$358.98
|
| Rate for Payer: UMR Bronson Commercial |
$337.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.08
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
OP
|
$597.12
|
|
|
Service Code
|
NDC 76385010201
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.93 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna American Axle |
$388.13
|
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna Medicare |
$298.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: BCBS Complete |
$238.85
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Advantage |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$477.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.84
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health SBD |
$376.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.13
|
| Rate for Payer: UHC Core |
$311.10
|
| Rate for Payer: UHC Exchange |
$234.67
|
| Rate for Payer: UMR Bronson Commercial |
$220.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.84
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
IP
|
$913.44
|
|
|
Service Code
|
NDC 00024159601
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$401.91 |
| Max. Negotiated Rate |
$822.10 |
| Rate for Payer: Aetna American Axle |
$593.74
|
| Rate for Payer: Aetna Commercial |
$776.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$593.74
|
| Rate for Payer: Cash Price |
$730.75
|
| Rate for Payer: Cofinity Advantage |
$639.41
|
| Rate for Payer: Cofinity Commercial |
$785.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$730.75
|
| Rate for Payer: Healthscope Commercial |
$822.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$639.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$685.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$776.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$685.08
|
| Rate for Payer: PHP Commercial |
$776.42
|
| Rate for Payer: Priority Health SBD |
$575.47
|
| Rate for Payer: UMR Bronson Commercial |
$401.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$685.08
|
|
|
PRIMAQUINE 26.3 MG (15 MG BASE) TABLET
|
Facility
|
IP
|
$597.12
|
|
|
Service Code
|
NDC 76385010201
|
| Hospital Charge Code |
6541
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.73 |
| Max. Negotiated Rate |
$537.41 |
| Rate for Payer: Aetna American Axle |
$388.13
|
| Rate for Payer: Aetna Commercial |
$507.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$388.13
|
| Rate for Payer: Cash Price |
$477.70
|
| Rate for Payer: Cofinity Advantage |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$477.70
|
| Rate for Payer: Healthscope Commercial |
$537.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$417.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$447.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$507.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$447.84
|
| Rate for Payer: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health SBD |
$376.19
|
| Rate for Payer: UMR Bronson Commercial |
$262.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.84
|
|
|
PR IMBRICATION DIAPHRAGM EVENTRATION
|
Professional
|
Both
|
$5,582.00
|
|
|
Service Code
|
HCPCS 39545
|
| Min. Negotiated Rate |
$556.57 |
| Max. Negotiated Rate |
$4,186.50 |
| Rate for Payer: Aetna Commercial |
$1,158.15
|
| Rate for Payer: Aetna Medicare |
$898.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,158.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,244.58
|
| Rate for Payer: BCBS Complete |
$584.40
|
| Rate for Payer: BCBS MAPPO |
$864.29
|
| Rate for Payer: BCN Commercial |
$1,337.08
|
| Rate for Payer: BCN Medicare Advantage |
$864.29
|
| Rate for Payer: Cash Price |
$4,465.60
|
| Rate for Payer: Cash Price |
$4,465.60
|
| Rate for Payer: Cofinity Commercial |
$1,244.58
|
| Rate for Payer: Cofinity Commercial |
$1,158.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.50
|
| Rate for Payer: Meridian Medicaid |
$584.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$950.72
|
| Rate for Payer: Nomi Health Commercial |
$1,037.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,186.50
|
| Rate for Payer: PACE SWMI |
$864.29
|
| Rate for Payer: PHP Commercial |
$1,210.01
|
| Rate for Payer: PHP Medicare Advantage |
$864.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$556.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,437.85
|
| Rate for Payer: Priority Health Medicare |
$864.29
|
| Rate for Payer: Priority Health SBD |
$1,437.85
|
| Rate for Payer: Priority Health Tiered Network |
$1,437.85
|
| Rate for Payer: Railroad Medicare Medicare |
$864.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,581.10
|
| Rate for Payer: UHC Core |
$1,581.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$864.29
|
| Rate for Payer: UHC Exchange |
$1,581.10
|
| Rate for Payer: UHC Medicaid |
$556.57
|
| Rate for Payer: UHCCP Medicaid |
$556.57
|
| Rate for Payer: UMR Bronson Commercial |
$2,567.72
|
|
|
PR IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 10030
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$582.75 |
| Rate for Payer: Aetna Commercial |
$158.48
|
| Rate for Payer: Aetna Medicare |
$123.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.31
|
| Rate for Payer: BCBS Complete |
$79.17
|
| Rate for Payer: BCBS MAPPO |
$118.27
|
| Rate for Payer: BCN Commercial |
$198.70
|
| Rate for Payer: BCN Medicare Advantage |
$118.27
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cofinity Commercial |
$158.48
|
| Rate for Payer: Cofinity Commercial |
$170.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.18
|
| Rate for Payer: Meridian Medicaid |
$79.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.10
|
| Rate for Payer: Nomi Health Commercial |
$141.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$582.75
|
| Rate for Payer: PACE SWMI |
$118.27
|
| Rate for Payer: PHP Commercial |
$165.58
|
| Rate for Payer: PHP Medicare Advantage |
$118.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$181.85
|
| Rate for Payer: Priority Health Medicare |
$118.27
|
| Rate for Payer: Priority Health SBD |
$181.85
|
| Rate for Payer: Priority Health Tiered Network |
$181.85
|
| Rate for Payer: Railroad Medicare Medicare |
$118.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.73
|
| Rate for Payer: UHC Core |
$244.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$118.27
|
| Rate for Payer: UHC Exchange |
$244.73
|
| Rate for Payer: UHC Medicaid |
$75.40
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
| Rate for Payer: UMR Bronson Commercial |
$357.42
|
|
|
PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 49406
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$350.66 |
| Rate for Payer: Aetna Commercial |
$223.15
|
| Rate for Payer: Aetna Medicare |
$173.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.80
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: BCBS MAPPO |
$166.53
|
| Rate for Payer: BCN Commercial |
$284.34
|
| Rate for Payer: BCN Medicare Advantage |
$166.53
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$223.15
|
| Rate for Payer: Cofinity Commercial |
$239.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.86
|
| Rate for Payer: Meridian Medicaid |
$111.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$183.18
|
| Rate for Payer: Nomi Health Commercial |
$199.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
| Rate for Payer: PACE SWMI |
$166.53
|
| Rate for Payer: PHP Commercial |
$233.14
|
| Rate for Payer: PHP Medicare Advantage |
$166.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$346.46
|
| Rate for Payer: Priority Health Medicare |
$166.53
|
| Rate for Payer: Priority Health SBD |
$346.46
|
| Rate for Payer: Priority Health Tiered Network |
$346.46
|
| Rate for Payer: Railroad Medicare Medicare |
$166.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.66
|
| Rate for Payer: UHC Core |
$350.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$166.53
|
| Rate for Payer: UHC Exchange |
$350.66
|
| Rate for Payer: UHC Medicaid |
$106.29
|
| Rate for Payer: UHCCP Medicaid |
$106.29
|
| Rate for Payer: UMR Bronson Commercial |
$193.20
|
|
|
PR IMG RETINA DETCJ/MNTR DS POC AUTON A/R UNI/BI
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 92229
|
| Min. Negotiated Rate |
$42.77 |
| Max. Negotiated Rate |
$72.75 |
| Rate for Payer: Aetna Commercial |
$57.31
|
| Rate for Payer: Aetna Medicare |
$44.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.59
|
| Rate for Payer: BCBS MAPPO |
$42.77
|
| Rate for Payer: BCN Commercial |
$67.23
|
| Rate for Payer: BCN Medicare Advantage |
$42.77
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$61.59
|
| Rate for Payer: Cofinity Commercial |
$57.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.05
|
| Rate for Payer: Nomi Health Commercial |
$51.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: PACE SWMI |
$42.77
|
| Rate for Payer: PHP Commercial |
$59.88
|
| Rate for Payer: PHP Medicare Advantage |
$42.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.53
|
| Rate for Payer: Priority Health Medicare |
$42.77
|
| Rate for Payer: Priority Health SBD |
$57.53
|
| Rate for Payer: Priority Health Tiered Network |
$57.53
|
| Rate for Payer: Railroad Medicare Medicare |
$42.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.61
|
| Rate for Payer: UHC Core |
$69.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.77
|
| Rate for Payer: UHC Exchange |
$69.61
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$417.12
|
|
|
Service Code
|
NDC 68084020301
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.53 |
| Max. Negotiated Rate |
$375.41 |
| Rate for Payer: Aetna American Axle |
$271.13
|
| Rate for Payer: Aetna Commercial |
$354.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.13
|
| Rate for Payer: Cash Price |
$333.70
|
| Rate for Payer: Cofinity Advantage |
$291.98
|
| Rate for Payer: Cofinity Commercial |
$358.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.70
|
| Rate for Payer: Healthscope Commercial |
$375.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.84
|
| Rate for Payer: PHP Commercial |
$354.55
|
| Rate for Payer: Priority Health SBD |
$262.79
|
| Rate for Payer: UMR Bronson Commercial |
$183.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.84
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$320.15
|
|
|
Service Code
|
NDC 00591532101
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$288.13 |
| Rate for Payer: Aetna American Axle |
$208.10
|
| Rate for Payer: Aetna Commercial |
$272.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: Cash Price |
$256.12
|
| Rate for Payer: Cofinity Advantage |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$288.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.11
|
| Rate for Payer: PHP Commercial |
$272.13
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: UMR Bronson Commercial |
$140.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.11
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$257.45
|
|
|
Service Code
|
NDC 00527123101
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.28 |
| Max. Negotiated Rate |
$231.71 |
| Rate for Payer: Aetna American Axle |
$167.34
|
| Rate for Payer: Aetna Commercial |
$218.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.34
|
| Rate for Payer: Cash Price |
$205.96
|
| Rate for Payer: Cofinity Advantage |
$180.22
|
| Rate for Payer: Cofinity Commercial |
$221.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.96
|
| Rate for Payer: Healthscope Commercial |
$231.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.09
|
| Rate for Payer: PHP Commercial |
$218.83
|
| Rate for Payer: Priority Health SBD |
$162.19
|
| Rate for Payer: UMR Bronson Commercial |
$113.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.09
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$4.18
|
|
|
Service Code
|
NDC 68084020311
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Advantage |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.13
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 53746054501
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.53 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna Medicare |
$153.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Advantage |
$214.79
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.45
|
| Rate for Payer: UHC Core |
$159.87
|
| Rate for Payer: UHC Exchange |
$120.59
|
| Rate for Payer: UMR Bronson Commercial |
$113.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$320.15
|
|
|
Service Code
|
NDC 00591532101
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.46 |
| Max. Negotiated Rate |
$288.13 |
| Rate for Payer: Aetna American Axle |
$208.10
|
| Rate for Payer: Aetna Commercial |
$272.13
|
| Rate for Payer: Aetna Medicare |
$160.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.10
|
| Rate for Payer: BCBS Complete |
$128.06
|
| Rate for Payer: Cash Price |
$256.12
|
| Rate for Payer: Cofinity Advantage |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$288.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$224.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$240.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$256.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.11
|
| Rate for Payer: PHP Commercial |
$272.13
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.10
|
| Rate for Payer: UHC Core |
$166.80
|
| Rate for Payer: UHC Exchange |
$125.82
|
| Rate for Payer: UMR Bronson Commercial |
$118.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.11
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$257.45
|
|
|
Service Code
|
NDC 00527123101
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.26 |
| Max. Negotiated Rate |
$231.71 |
| Rate for Payer: Aetna American Axle |
$167.34
|
| Rate for Payer: Aetna Commercial |
$218.83
|
| Rate for Payer: Aetna Medicare |
$128.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.34
|
| Rate for Payer: BCBS Complete |
$102.98
|
| Rate for Payer: Cash Price |
$205.96
|
| Rate for Payer: Cofinity Advantage |
$180.22
|
| Rate for Payer: Cofinity Commercial |
$221.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.96
|
| Rate for Payer: Healthscope Commercial |
$231.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$180.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.09
|
| Rate for Payer: PHP Commercial |
$218.83
|
| Rate for Payer: Priority Health SBD |
$162.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$167.34
|
| Rate for Payer: UHC Core |
$134.13
|
| Rate for Payer: UHC Exchange |
$101.18
|
| Rate for Payer: UMR Bronson Commercial |
$95.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.09
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$417.12
|
|
|
Service Code
|
NDC 68084020301
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.33 |
| Max. Negotiated Rate |
$375.41 |
| Rate for Payer: Aetna American Axle |
$271.13
|
| Rate for Payer: Aetna Commercial |
$354.55
|
| Rate for Payer: Aetna Medicare |
$208.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.13
|
| Rate for Payer: BCBS Complete |
$166.85
|
| Rate for Payer: Cash Price |
$333.70
|
| Rate for Payer: Cofinity Advantage |
$291.98
|
| Rate for Payer: Cofinity Commercial |
$358.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.70
|
| Rate for Payer: Healthscope Commercial |
$375.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$333.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.84
|
| Rate for Payer: PHP Commercial |
$354.55
|
| Rate for Payer: Priority Health SBD |
$262.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.13
|
| Rate for Payer: UHC Core |
$217.32
|
| Rate for Payer: UHC Exchange |
$163.93
|
| Rate for Payer: UMR Bronson Commercial |
$154.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.84
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 53746054501
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.01 |
| Max. Negotiated Rate |
$276.17 |
| Rate for Payer: Aetna American Axle |
$199.45
|
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.45
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Advantage |
$214.79
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.14
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health SBD |
$193.32
|
| Rate for Payer: UMR Bronson Commercial |
$135.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$4.18
|
|
|
Service Code
|
NDC 68084020311
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna Medicare |
$2.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Advantage |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.13
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health SBD |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.72
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: UHC Exchange |
$1.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.13
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$362.88
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.67 |
| Max. Negotiated Rate |
$326.59 |
| Rate for Payer: Aetna American Axle |
$235.87
|
| Rate for Payer: Aetna Commercial |
$308.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.87
|
| Rate for Payer: Cash Price |
$290.30
|
| Rate for Payer: Cofinity Advantage |
$254.02
|
| Rate for Payer: Cofinity Commercial |
$312.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.30
|
| Rate for Payer: Healthscope Commercial |
$326.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.16
|
| Rate for Payer: PHP Commercial |
$308.45
|
| Rate for Payer: Priority Health SBD |
$228.61
|
| Rate for Payer: UMR Bronson Commercial |
$159.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.16
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$362.88
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.27 |
| Max. Negotiated Rate |
$326.59 |
| Rate for Payer: Aetna American Axle |
$235.87
|
| Rate for Payer: Aetna Commercial |
$308.45
|
| Rate for Payer: Aetna Medicare |
$181.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.87
|
| Rate for Payer: BCBS Complete |
$145.15
|
| Rate for Payer: Cash Price |
$290.30
|
| Rate for Payer: Cofinity Advantage |
$254.02
|
| Rate for Payer: Cofinity Commercial |
$312.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$290.30
|
| Rate for Payer: Healthscope Commercial |
$326.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$254.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$272.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$290.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$272.16
|
| Rate for Payer: PHP Commercial |
$308.45
|
| Rate for Payer: Priority Health SBD |
$228.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.87
|
| Rate for Payer: UHC Core |
$189.06
|
| Rate for Payer: UHC Exchange |
$142.61
|
| Rate for Payer: UMR Bronson Commercial |
$134.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$272.16
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$3.63
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna American Axle |
$2.36
|
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna Medicare |
$1.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.36
|
| Rate for Payer: BCBS Complete |
$1.45
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Advantage |
$2.54
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.72
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$1.89
|
| Rate for Payer: UHC Exchange |
$1.43
|
| Rate for Payer: UMR Bronson Commercial |
$1.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$3.63
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.27 |
| Rate for Payer: Aetna American Axle |
$2.36
|
| Rate for Payer: Aetna Commercial |
$3.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.36
|
| Rate for Payer: Cash Price |
$2.90
|
| Rate for Payer: Cofinity Advantage |
$2.54
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.90
|
| Rate for Payer: Healthscope Commercial |
$3.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.72
|
| Rate for Payer: PHP Commercial |
$3.09
|
| Rate for Payer: Priority Health SBD |
$2.29
|
| Rate for Payer: UMR Bronson Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.72
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$347.80
|
|
|
Service Code
|
NDC 00527130101
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.03 |
| Max. Negotiated Rate |
$313.02 |
| Rate for Payer: Aetna American Axle |
$226.07
|
| Rate for Payer: Aetna Commercial |
$295.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.07
|
| Rate for Payer: Cash Price |
$278.24
|
| Rate for Payer: Cofinity Advantage |
$243.46
|
| Rate for Payer: Cofinity Commercial |
$299.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.24
|
| Rate for Payer: Healthscope Commercial |
$313.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$243.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$260.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$295.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$260.85
|
| Rate for Payer: PHP Commercial |
$295.63
|
| Rate for Payer: Priority Health SBD |
$219.11
|
| Rate for Payer: UMR Bronson Commercial |
$153.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.85
|
|
