|
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 Commercial |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.98
|
| 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: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.13
|
| 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
|
|
|
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 Commercial |
$417.98
|
| Rate for Payer: Cofinity Commercial |
$513.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$417.98
|
| 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: PHP Commercial |
$507.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$388.13
|
| Rate for Payer: Priority Health SBD |
$376.19
|
| Rate for Payer: UMR Bronson Commercial |
$220.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$447.84
|
|
|
PR IMBRICATION DIAPHRAGM EVENTRATION
|
Professional
|
Both
|
$5,419.00
|
|
|
Service Code
|
HCPCS 39545
|
| Min. Negotiated Rate |
$571.91 |
| Max. Negotiated Rate |
$3,522.35 |
| Rate for Payer: Aetna Commercial |
$1,157.01
|
| Rate for Payer: Aetna Medicare |
$897.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,157.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,243.35
|
| Rate for Payer: BCBS Complete |
$600.51
|
| Rate for Payer: BCBS MAPPO |
$863.44
|
| Rate for Payer: BCBS Trust/PPO |
$671.47
|
| Rate for Payer: BCN Commercial |
$1,295.97
|
| Rate for Payer: BCN Medicare Advantage |
$863.44
|
| Rate for Payer: Cash Price |
$4,335.20
|
| Rate for Payer: Cash Price |
$4,335.20
|
| Rate for Payer: Cofinity Commercial |
$1,157.01
|
| Rate for Payer: Cofinity Commercial |
$1,243.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$863.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$906.61
|
| Rate for Payer: Meridian Medicaid |
$600.51
|
| Rate for Payer: Nomi Health Commercial |
$1,036.13
|
| Rate for Payer: PACE SWMI |
$863.44
|
| Rate for Payer: PHP Commercial |
$1,208.82
|
| Rate for Payer: PHP Medicare Advantage |
$863.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,522.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,418.38
|
| Rate for Payer: Priority Health Medicare |
$863.44
|
| Rate for Payer: Priority Health Narrow Network |
$1,418.38
|
| Rate for Payer: Priority Health SBD |
$1,418.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$863.44
|
| Rate for Payer: UHC Medicare Advantage |
$863.44
|
| Rate for Payer: UHCCP Medicaid |
$571.91
|
| Rate for Payer: UMR Bronson Commercial |
$2,492.74
|
|
|
PR IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
HCPCS 10030
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$171.45
|
| Rate for Payer: Aetna Medicare |
$133.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.25
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$127.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,625.00
|
| Rate for Payer: BCN Commercial |
$952.93
|
| Rate for Payer: BCN Medicare Advantage |
$127.95
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cofinity Commercial |
$171.45
|
| Rate for Payer: Cofinity Commercial |
$184.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.35
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Nomi Health Commercial |
$153.54
|
| Rate for Payer: PACE SWMI |
$127.95
|
| Rate for Payer: PHP Commercial |
$179.13
|
| Rate for Payer: PHP Medicare Advantage |
$127.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.25
|
| Rate for Payer: Priority Health Medicare |
$127.95
|
| Rate for Payer: Priority Health Narrow Network |
$179.25
|
| Rate for Payer: Priority Health SBD |
$179.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.95
|
| Rate for Payer: UHC Medicare Advantage |
$127.95
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
| Rate for Payer: UMR Bronson Commercial |
$346.84
|
|
|
PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 49406
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$2,515.24 |
| Rate for Payer: Aetna Commercial |
$245.45
|
| Rate for Payer: Aetna Medicare |
$190.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.76
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCBS MAPPO |
$183.17
|
| Rate for Payer: BCBS Trust/PPO |
$2,515.24
|
| Rate for Payer: BCN Commercial |
$1,311.61
|
| Rate for Payer: BCN Medicare Advantage |
$183.17
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$263.76
|
| Rate for Payer: Cofinity Commercial |
$245.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.33
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Nomi Health Commercial |
$219.80
|
| Rate for Payer: PACE SWMI |
$183.17
|
| Rate for Payer: PHP Commercial |
$256.44
|
| Rate for Payer: PHP Medicare Advantage |
$183.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.27
|
| Rate for Payer: Priority Health Medicare |
$183.17
|
| Rate for Payer: Priority Health Narrow Network |
$338.27
|
| Rate for Payer: Priority Health SBD |
$338.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.17
|
| Rate for Payer: UHC Medicare Advantage |
$183.17
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$319.20
|
|
|
Service Code
|
NDC 53746054501
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.10 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna American Axle |
$207.48
|
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna Medicare |
$159.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: BCBS Complete |
$127.68
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health SBD |
$201.10
|
| Rate for Payer: UMR Bronson Commercial |
$118.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$318.24
|
|
|
Service Code
|
NDC 68084020301
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.75 |
| Max. Negotiated Rate |
$286.42 |
| Rate for Payer: Aetna American Axle |
$206.86
|
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Medicare |
$159.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: BCBS Complete |
$127.30
|
| Rate for Payer: Cash Price |
$254.59
|
| Rate for Payer: Cofinity Commercial |
$222.77
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.59
|
| Rate for Payer: Healthscope Commercial |
$286.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.50
|
| Rate for Payer: PHP Commercial |
$270.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.86
|
| Rate for Payer: Priority Health SBD |
$200.49
|
| Rate for Payer: UMR Bronson Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.68
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$3.19
|
|
|
Service Code
|
NDC 68084020311
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna American Axle |
$2.07
|
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna Medicare |
$1.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: BCBS Complete |
$1.28
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health SBD |
$2.01
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
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 |
$288.14 |
| Rate for Payer: Aetna American Axle |
$208.10
|
| Rate for Payer: Aetna Commercial |
$272.13
|
| Rate for Payer: Aetna Medicare |
$160.08
|
| 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 Commercial |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$288.14
|
| 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: PHP Commercial |
$272.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.10
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: UMR Bronson Commercial |
$118.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$240.11
|
|
|
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 |
$288.14 |
| 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 Commercial |
$224.10
|
| Rate for Payer: Cofinity Commercial |
$275.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$224.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$256.12
|
| Rate for Payer: Healthscope Commercial |
$288.14
|
| 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: PHP Commercial |
$272.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.10
|
| 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
|
$318.24
|
|
|
Service Code
|
NDC 68084020301
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.03 |
| Max. Negotiated Rate |
$286.42 |
| Rate for Payer: Aetna American Axle |
$206.86
|
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: Cash Price |
$254.59
|
| Rate for Payer: Cofinity Commercial |
$222.77
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.59
|
| Rate for Payer: Healthscope Commercial |
$286.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.50
|
| Rate for Payer: PHP Commercial |
$270.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.86
|
| Rate for Payer: Priority Health SBD |
$200.49
|
| Rate for Payer: UMR Bronson Commercial |
$140.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.68
|
|
|
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 |
$231.70 |
| 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 Commercial |
$180.22
|
| Rate for Payer: Cofinity Commercial |
$221.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.96
|
| Rate for Payer: Healthscope Commercial |
$231.70
|
| 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: PHP Commercial |
$218.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.34
|
| Rate for Payer: Priority Health SBD |
$162.19
|
| Rate for Payer: UMR Bronson Commercial |
$95.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.09
|
|
|
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 |
$231.70 |
| 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 Commercial |
$180.22
|
| Rate for Payer: Cofinity Commercial |
$221.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$180.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.96
|
| Rate for Payer: Healthscope Commercial |
$231.70
|
| 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: PHP Commercial |
$218.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.34
|
| 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
|
$319.20
|
|
|
Service Code
|
NDC 53746054501
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.45 |
| Max. Negotiated Rate |
$287.28 |
| Rate for Payer: Aetna American Axle |
$207.48
|
| Rate for Payer: Aetna Commercial |
$271.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.48
|
| Rate for Payer: Cash Price |
$255.36
|
| Rate for Payer: Cofinity Commercial |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$274.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$223.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.36
|
| Rate for Payer: Healthscope Commercial |
$287.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.32
|
| Rate for Payer: PHP Commercial |
$271.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health SBD |
$201.10
|
| Rate for Payer: UMR Bronson Commercial |
$140.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.40
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$3.19
|
|
|
Service Code
|
NDC 68084020311
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna American Axle |
$2.07
|
| Rate for Payer: Aetna Commercial |
$2.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cofinity Commercial |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.55
|
| Rate for Payer: Healthscope Commercial |
$2.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.71
|
| Rate for Payer: PHP Commercial |
$2.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.07
|
| Rate for Payer: Priority Health SBD |
$2.01
|
| Rate for Payer: UMR Bronson Commercial |
$1.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.39
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$347.80
|
|
|
Service Code
|
NDC 00527130101
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.69 |
| Max. Negotiated Rate |
$313.02 |
| Rate for Payer: Aetna American Axle |
$226.07
|
| Rate for Payer: Aetna Commercial |
$295.63
|
| Rate for Payer: Aetna Medicare |
$173.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.07
|
| Rate for Payer: BCBS Complete |
$139.12
|
| Rate for Payer: Cash Price |
$278.24
|
| Rate for Payer: Cofinity Commercial |
$243.46
|
| Rate for Payer: Cofinity Commercial |
$299.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.46
|
| 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: PHP Commercial |
$295.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.07
|
| Rate for Payer: Priority Health SBD |
$219.11
|
| Rate for Payer: UMR Bronson Commercial |
$128.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$260.85
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$3.57
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna American Axle |
$2.32
|
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$1.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.32
|
| Rate for Payer: BCBS Complete |
$1.43
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health SBD |
$2.25
|
| Rate for Payer: UMR Bronson Commercial |
$1.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$356.16
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.78 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Aetna American Axle |
$231.50
|
| Rate for Payer: Aetna Commercial |
$302.74
|
| Rate for Payer: Aetna Medicare |
$178.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.50
|
| Rate for Payer: BCBS Complete |
$142.46
|
| Rate for Payer: Cash Price |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$249.31
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.93
|
| Rate for Payer: Healthscope Commercial |
$320.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.74
|
| Rate for Payer: PHP Commercial |
$302.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.50
|
| Rate for Payer: Priority Health SBD |
$224.38
|
| Rate for Payer: UMR Bronson Commercial |
$131.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.12
|
|
|
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 Commercial |
$243.46
|
| Rate for Payer: Cofinity Commercial |
$299.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$243.46
|
| 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: PHP Commercial |
$295.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.07
|
| 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
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$356.16
|
|
|
Service Code
|
NDC 68084020201
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.71 |
| Max. Negotiated Rate |
$320.54 |
| Rate for Payer: Aetna American Axle |
$231.50
|
| Rate for Payer: Aetna Commercial |
$302.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.50
|
| Rate for Payer: Cash Price |
$284.93
|
| Rate for Payer: Cofinity Commercial |
$249.31
|
| Rate for Payer: Cofinity Commercial |
$306.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$249.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.93
|
| Rate for Payer: Healthscope Commercial |
$320.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$249.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.74
|
| Rate for Payer: PHP Commercial |
$302.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.50
|
| Rate for Payer: Priority Health SBD |
$224.38
|
| Rate for Payer: UMR Bronson Commercial |
$156.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.12
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
OP
|
$168.63
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.39 |
| Max. Negotiated Rate |
$151.77 |
| Rate for Payer: Aetna American Axle |
$109.61
|
| Rate for Payer: Aetna Commercial |
$143.34
|
| Rate for Payer: Aetna Medicare |
$84.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.61
|
| Rate for Payer: BCBS Complete |
$67.45
|
| Rate for Payer: Cash Price |
$134.90
|
| Rate for Payer: Cofinity Commercial |
$118.04
|
| Rate for Payer: Cofinity Commercial |
$145.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.90
|
| Rate for Payer: Healthscope Commercial |
$151.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.34
|
| Rate for Payer: PHP Commercial |
$143.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.61
|
| Rate for Payer: Priority Health SBD |
$106.24
|
| Rate for Payer: UMR Bronson Commercial |
$62.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.47
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$3.57
|
|
|
Service Code
|
NDC 68084020211
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$3.21 |
| Rate for Payer: Aetna American Axle |
$2.32
|
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.32
|
| Rate for Payer: Cash Price |
$2.86
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$3.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.86
|
| Rate for Payer: Healthscope Commercial |
$3.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.03
|
| Rate for Payer: PHP Commercial |
$3.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.32
|
| Rate for Payer: Priority Health SBD |
$2.25
|
| Rate for Payer: UMR Bronson Commercial |
$1.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.68
|
|
|
PRIMIDONE 50 MG TABLET
|
Facility
|
IP
|
$168.63
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$151.77 |
| Rate for Payer: Aetna American Axle |
$109.61
|
| Rate for Payer: Aetna Commercial |
$143.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.61
|
| Rate for Payer: Cash Price |
$134.90
|
| Rate for Payer: Cofinity Commercial |
$118.04
|
| Rate for Payer: Cofinity Commercial |
$145.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$118.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.90
|
| Rate for Payer: Healthscope Commercial |
$151.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$118.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.34
|
| Rate for Payer: PHP Commercial |
$143.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.61
|
| Rate for Payer: Priority Health SBD |
$106.24
|
| Rate for Payer: UMR Bronson Commercial |
$74.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.47
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 1ST DOSE
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0011A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.78 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$18.75
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
PR IMM ADMN SARSCOV2 100 MCG/0.5 ML 2ND DOSE
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 0012A
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
