PR ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Professional
|
Both
|
$132.00
|
|
Service Code
|
HCPCS 20612
|
Min. Negotiated Rate |
$26.20 |
Max. Negotiated Rate |
$2,114.22 |
Rate for Payer: Aetna Commercial |
$55.18
|
Rate for Payer: BCBS Complete |
$27.51
|
Rate for Payer: BCBS Trust/PPO |
$2,114.22
|
Rate for Payer: Cash Price |
$105.60
|
Rate for Payer: Cash Price |
$105.60
|
Rate for Payer: Meridian Medicaid |
$27.51
|
Rate for Payer: Priority Health Choice Medicaid |
$26.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.30
|
Rate for Payer: Priority Health Narrow Network |
$62.30
|
Rate for Payer: Priority Health SBD |
$62.30
|
Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
PR ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR
|
Professional
|
Both
|
$199.00
|
|
Service Code
|
HCPCS 96105
|
Min. Negotiated Rate |
$79.60 |
Max. Negotiated Rate |
$332.30 |
Rate for Payer: Aetna Commercial |
$109.95
|
Rate for Payer: BCBS Complete |
$79.60
|
Rate for Payer: BCBS Trust/PPO |
$332.30
|
Rate for Payer: Cash Price |
$159.20
|
Rate for Payer: Cash Price |
$159.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$139.30
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.25
|
Rate for Payer: Priority Health Narrow Network |
$130.25
|
Rate for Payer: Priority Health SBD |
$130.25
|
Rate for Payer: UMR Bronson Commercial |
$91.54
|
|
PR ASSESSMENT FOR HEARING AID
|
Professional
|
Both
|
$140.00
|
|
Service Code
|
HCPCS V5010
|
Min. Negotiated Rate |
$47.05 |
Max. Negotiated Rate |
$98.00 |
Rate for Payer: Aetna Commercial |
$47.05
|
Rate for Payer: BCBS Complete |
$56.00
|
Rate for Payer: Cash Price |
$112.00
|
Rate for Payer: Cash Price |
$112.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
Rate for Payer: UMR Bronson Commercial |
$64.40
|
|
PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT
|
Professional
|
Both
|
$350.00
|
|
Service Code
|
HCPCS 99483
|
Min. Negotiated Rate |
$122.26 |
Max. Negotiated Rate |
$405.21 |
Rate for Payer: Aetna Commercial |
$195.52
|
Rate for Payer: BCBS Complete |
$128.37
|
Rate for Payer: BCBS Trust/PPO |
$405.21
|
Rate for Payer: Cash Price |
$280.00
|
Rate for Payer: Cash Price |
$280.00
|
Rate for Payer: Meridian Medicaid |
$128.37
|
Rate for Payer: Priority Health Choice Medicaid |
$122.26
|
Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$245.42
|
Rate for Payer: Priority Health Narrow Network |
$245.42
|
Rate for Payer: Priority Health SBD |
$245.42
|
Rate for Payer: UMR Bronson Commercial |
$161.00
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$4,753.91
|
|
Service Code
|
NDC 0002-5123-77
|
Hospital Charge Code |
98373
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$2,091.72 |
Max. Negotiated Rate |
$4,278.52 |
Rate for Payer: Aetna American Axle |
$3,090.04
|
Rate for Payer: Aetna Commercial |
$4,040.82
|
Rate for Payer: Aetna New Business (MI Preferred) |
$3,090.04
|
Rate for Payer: Cash Price |
$3,803.13
|
Rate for Payer: Cofinity Commercial |
$3,327.74
|
Rate for Payer: Cofinity Commercial |
$4,088.36
|
Rate for Payer: Encore Health Key Benefits Commercial |
$3,803.13
|
Rate for Payer: Healthscope Commercial |
$4,278.52
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,327.74
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,565.43
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,040.82
|
Rate for Payer: PHP Commercial |
$4,040.82
|
Rate for Payer: Priority Health Cigna Priority Health |
$3,327.74
|
Rate for Payer: Priority Health SBD |
$2,994.96
|
Rate for Payer: UMR Bronson Commercial |
$2,091.72
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,565.43
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$86.26
|
|
Service Code
|
NDC 67877-605-30
|
Hospital Charge Code |
98373
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$37.95 |
Max. Negotiated Rate |
$77.63 |
Rate for Payer: Aetna American Axle |
$56.07
|
Rate for Payer: Aetna Commercial |
$73.32
|
Rate for Payer: Aetna New Business (MI Preferred) |
$56.07
|
Rate for Payer: Cash Price |
$69.01
|
Rate for Payer: Cofinity Commercial |
$60.38
|
Rate for Payer: Cofinity Commercial |
$74.18
|
Rate for Payer: Encore Health Key Benefits Commercial |
$69.01
|
Rate for Payer: Healthscope Commercial |
$77.63
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.38
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.70
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.32
|
Rate for Payer: PHP Commercial |
$73.32
|
Rate for Payer: Priority Health Cigna Priority Health |
$60.38
|
Rate for Payer: Priority Health SBD |
$54.34
|
Rate for Payer: UMR Bronson Commercial |
$37.95
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.70
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$133.92
|
|
Service Code
|
NDC 0378-5186-93
|
Hospital Charge Code |
98373
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$58.92 |
Max. Negotiated Rate |
$120.53 |
Rate for Payer: Aetna American Axle |
$87.05
|
Rate for Payer: Aetna Commercial |
$113.83
|
Rate for Payer: Aetna New Business (MI Preferred) |
$87.05
|
Rate for Payer: Cash Price |
$107.14
|
Rate for Payer: Cofinity Commercial |
$115.17
|
Rate for Payer: Cofinity Commercial |
$93.74
|
Rate for Payer: Encore Health Key Benefits Commercial |
$107.14
|
Rate for Payer: Healthscope Commercial |
$120.53
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.74
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.44
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$113.83
|
Rate for Payer: PHP Commercial |
$113.83
|
Rate for Payer: Priority Health Cigna Priority Health |
$93.74
|
Rate for Payer: Priority Health SBD |
$84.37
|
Rate for Payer: UMR Bronson Commercial |
$58.92
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.44
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$52.83
|
|
Service Code
|
NDC 0002-5123-01
|
Hospital Charge Code |
98373
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$23.25 |
Max. Negotiated Rate |
$47.55 |
Rate for Payer: Aetna American Axle |
$34.34
|
Rate for Payer: Aetna Commercial |
$44.91
|
Rate for Payer: Aetna New Business (MI Preferred) |
$34.34
|
Rate for Payer: Cash Price |
$42.26
|
Rate for Payer: Cofinity Commercial |
$36.98
|
Rate for Payer: Cofinity Commercial |
$45.43
|
Rate for Payer: Encore Health Key Benefits Commercial |
$42.26
|
Rate for Payer: Healthscope Commercial |
$47.55
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.98
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.62
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.91
|
Rate for Payer: PHP Commercial |
$44.91
|
Rate for Payer: Priority Health Cigna Priority Health |
$36.98
|
Rate for Payer: Priority Health SBD |
$33.28
|
Rate for Payer: UMR Bronson Commercial |
$23.25
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.62
|
|
PR ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE
|
Professional
|
Both
|
$1,495.00
|
|
Service Code
|
HCPCS 33257
|
Min. Negotiated Rate |
$367.43 |
Max. Negotiated Rate |
$2,631.46 |
Rate for Payer: Aetna Commercial |
$778.27
|
Rate for Payer: BCBS Complete |
$385.80
|
Rate for Payer: BCBS Trust/PPO |
$2,631.46
|
Rate for Payer: Cash Price |
$1,196.00
|
Rate for Payer: Cash Price |
$1,196.00
|
Rate for Payer: Meridian Medicaid |
$385.80
|
Rate for Payer: Priority Health Choice Medicaid |
$367.43
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,046.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$912.83
|
Rate for Payer: Priority Health Narrow Network |
$912.83
|
Rate for Payer: Priority Health SBD |
$912.83
|
Rate for Payer: UMR Bronson Commercial |
$687.70
|
|
PR ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS
|
Professional
|
Both
|
$2,258.00
|
|
Service Code
|
HCPCS 33259
|
Min. Negotiated Rate |
$533.78 |
Max. Negotiated Rate |
$5,209.57 |
Rate for Payer: Aetna Commercial |
$1,129.42
|
Rate for Payer: BCBS Complete |
$560.47
|
Rate for Payer: BCBS Trust/PPO |
$5,209.57
|
Rate for Payer: Cash Price |
$1,806.40
|
Rate for Payer: Cash Price |
$1,806.40
|
Rate for Payer: Meridian Medicaid |
$560.47
|
Rate for Payer: Priority Health Choice Medicaid |
$533.78
|
Rate for Payer: Priority Health Cigna Priority Health |
$1,580.60
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,324.04
|
Rate for Payer: Priority Health Narrow Network |
$1,324.04
|
Rate for Payer: Priority Health SBD |
$1,324.04
|
Rate for Payer: UMR Bronson Commercial |
$1,038.68
|
|
PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$402.00
|
|
Service Code
|
HCPCS 99464
|
Min. Negotiated Rate |
$45.80 |
Max. Negotiated Rate |
$1,378.86 |
Rate for Payer: Aetna Commercial |
$73.65
|
Rate for Payer: BCBS Complete |
$48.09
|
Rate for Payer: BCBS Trust/PPO |
$1,378.86
|
Rate for Payer: Cash Price |
$321.60
|
Rate for Payer: Cash Price |
$321.60
|
Rate for Payer: Meridian Medicaid |
$48.09
|
Rate for Payer: Priority Health Choice Medicaid |
$45.80
|
Rate for Payer: Priority Health Cigna Priority Health |
$281.40
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.09
|
Rate for Payer: Priority Health Narrow Network |
$92.09
|
Rate for Payer: Priority Health SBD |
$92.09
|
Rate for Payer: UMR Bronson Commercial |
$184.92
|
|
PR AUDIOMETRY FOR HEARING AID
|
Professional
|
Both
|
$77.00
|
|
Service Code
|
HCPCS S0618
|
Min. Negotiated Rate |
$30.80 |
Max. Negotiated Rate |
$53.90 |
Rate for Payer: Aetna Commercial |
$43.02
|
Rate for Payer: BCBS Complete |
$30.80
|
Rate for Payer: Cash Price |
$61.60
|
Rate for Payer: Cash Price |
$61.60
|
Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
PR AUDITORY EVOKED POTENTIAL
|
Professional
|
Both
|
$334.00
|
|
Service Code
|
HCPCS 92585
|
Min. Negotiated Rate |
$133.60 |
Max. Negotiated Rate |
$233.80 |
Rate for Payer: BCBS Complete |
$133.60
|
Rate for Payer: Cash Price |
$267.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$233.80
|
Rate for Payer: UMR Bronson Commercial |
$153.64
|
|
PR AUDITORY EVOKED POTENTIAL, LIMITED
|
Professional
|
Both
|
$145.00
|
|
Service Code
|
HCPCS 92586
|
Min. Negotiated Rate |
$58.00 |
Max. Negotiated Rate |
$101.50 |
Rate for Payer: BCBS Complete |
$58.00
|
Rate for Payer: Cash Price |
$116.00
|
Rate for Payer: Priority Health Cigna Priority Health |
$101.50
|
Rate for Payer: UMR Bronson Commercial |
$66.70
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,186.00
|
|
Service Code
|
HCPCS 20938
|
Min. Negotiated Rate |
$116.94 |
Max. Negotiated Rate |
$3,247.68 |
Rate for Payer: Aetna Commercial |
$248.13
|
Rate for Payer: BCBS Complete |
$122.79
|
Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
Rate for Payer: Cash Price |
$948.80
|
Rate for Payer: Cash Price |
$948.80
|
Rate for Payer: Meridian Medicaid |
$122.79
|
Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
Rate for Payer: Priority Health Cigna Priority Health |
$830.20
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.80
|
Rate for Payer: Priority Health Narrow Network |
$277.80
|
Rate for Payer: Priority Health SBD |
$277.80
|
Rate for Payer: UMR Bronson Commercial |
$545.56
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$729.00
|
|
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: BCBS Complete |
$291.60
|
Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
Rate for Payer: Cash Price |
$583.20
|
Rate for Payer: Cash Price |
$583.20
|
Rate for Payer: Priority Health Cigna Priority Health |
$510.30
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.47
|
Rate for Payer: Priority Health Narrow Network |
$190.47
|
Rate for Payer: Priority Health SBD |
$190.47
|
Rate for Payer: UMR Bronson Commercial |
$335.34
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$952.00
|
|
Service Code
|
HCPCS 20937
|
Min. Negotiated Rate |
$106.07 |
Max. Negotiated Rate |
$3,247.68 |
Rate for Payer: Aetna Commercial |
$224.25
|
Rate for Payer: BCBS Complete |
$111.37
|
Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
Rate for Payer: Cash Price |
$761.60
|
Rate for Payer: Cash Price |
$761.60
|
Rate for Payer: Meridian Medicaid |
$111.37
|
Rate for Payer: Priority Health Choice Medicaid |
$106.07
|
Rate for Payer: Priority Health Cigna Priority Health |
$666.40
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.79
|
Rate for Payer: Priority Health Narrow Network |
$253.79
|
Rate for Payer: Priority Health SBD |
$253.79
|
Rate for Payer: UMR Bronson Commercial |
$437.92
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,315.00
|
|
Service Code
|
HCPCS 27412
|
Min. Negotiated Rate |
$149.51 |
Max. Negotiated Rate |
$2,514.45 |
Rate for Payer: Aetna Commercial |
$2,202.92
|
Rate for Payer: BCBS Complete |
$1,108.63
|
Rate for Payer: BCBS Trust/PPO |
$149.51
|
Rate for Payer: Cash Price |
$2,652.00
|
Rate for Payer: Cash Price |
$2,652.00
|
Rate for Payer: Meridian Medicaid |
$1,108.63
|
Rate for Payer: Priority Health Choice Medicaid |
$1,055.84
|
Rate for Payer: Priority Health Cigna Priority Health |
$2,320.50
|
Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,514.45
|
Rate for Payer: Priority Health Narrow Network |
$2,514.45
|
Rate for Payer: Priority Health SBD |
$2,514.45
|
Rate for Payer: UMR Bronson Commercial |
$1,524.90
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$314.45
|
|
Service Code
|
NDC 0904-5891-61
|
Hospital Charge Code |
11110
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$138.36 |
Max. Negotiated Rate |
$283.00 |
Rate for Payer: Aetna American Axle |
$204.39
|
Rate for Payer: Aetna Commercial |
$267.28
|
Rate for Payer: Aetna New Business (MI Preferred) |
$204.39
|
Rate for Payer: Cash Price |
$251.56
|
Rate for Payer: Cofinity Commercial |
$220.12
|
Rate for Payer: Cofinity Commercial |
$270.43
|
Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
Rate for Payer: Healthscope Commercial |
$283.00
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.12
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.84
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.28
|
Rate for Payer: PHP Commercial |
$267.28
|
Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
Rate for Payer: Priority Health SBD |
$198.10
|
Rate for Payer: UMR Bronson Commercial |
$138.36
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.84
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$80.37
|
|
Service Code
|
NDC 0093-0771-98
|
Hospital Charge Code |
11110
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$35.36 |
Max. Negotiated Rate |
$72.33 |
Rate for Payer: Aetna American Axle |
$52.24
|
Rate for Payer: Aetna Commercial |
$68.31
|
Rate for Payer: Aetna New Business (MI Preferred) |
$52.24
|
Rate for Payer: Cash Price |
$64.30
|
Rate for Payer: Cofinity Commercial |
$56.26
|
Rate for Payer: Cofinity Commercial |
$69.12
|
Rate for Payer: Encore Health Key Benefits Commercial |
$64.30
|
Rate for Payer: Healthscope Commercial |
$72.33
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.26
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.28
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.31
|
Rate for Payer: PHP Commercial |
$68.31
|
Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
Rate for Payer: Priority Health SBD |
$50.63
|
Rate for Payer: UMR Bronson Commercial |
$35.36
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.28
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$292.80
|
|
Service Code
|
NDC 60687-178-01
|
Hospital Charge Code |
11111
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$128.83 |
Max. Negotiated Rate |
$263.52 |
Rate for Payer: Aetna American Axle |
$190.32
|
Rate for Payer: Aetna Commercial |
$248.88
|
Rate for Payer: Aetna New Business (MI Preferred) |
$190.32
|
Rate for Payer: Cash Price |
$234.24
|
Rate for Payer: Cofinity Commercial |
$204.96
|
Rate for Payer: Cofinity Commercial |
$251.81
|
Rate for Payer: Encore Health Key Benefits Commercial |
$234.24
|
Rate for Payer: Healthscope Commercial |
$263.52
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$204.96
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$219.60
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$248.88
|
Rate for Payer: PHP Commercial |
$248.88
|
Rate for Payer: Priority Health Cigna Priority Health |
$204.96
|
Rate for Payer: Priority Health SBD |
$184.46
|
Rate for Payer: UMR Bronson Commercial |
$128.83
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$219.60
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$2.93
|
|
Service Code
|
NDC 60687-178-11
|
Hospital Charge Code |
11111
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$1.29 |
Max. Negotiated Rate |
$2.64 |
Rate for Payer: Aetna American Axle |
$1.90
|
Rate for Payer: Aetna Commercial |
$2.49
|
Rate for Payer: Aetna New Business (MI Preferred) |
$1.90
|
Rate for Payer: Cash Price |
$2.34
|
Rate for Payer: Cofinity Commercial |
$2.05
|
Rate for Payer: Cofinity Commercial |
$2.52
|
Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
Rate for Payer: Healthscope Commercial |
$2.64
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.05
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.20
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.49
|
Rate for Payer: PHP Commercial |
$2.49
|
Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
Rate for Payer: Priority Health SBD |
$1.85
|
Rate for Payer: UMR Bronson Commercial |
$1.29
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.20
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$80.37
|
|
Service Code
|
NDC 0093-7201-98
|
Hospital Charge Code |
11111
|
Hospital Revenue Code
|
637
|
Min. Negotiated Rate |
$35.36 |
Max. Negotiated Rate |
$72.33 |
Rate for Payer: Aetna American Axle |
$52.24
|
Rate for Payer: Aetna Commercial |
$68.31
|
Rate for Payer: Aetna New Business (MI Preferred) |
$52.24
|
Rate for Payer: Cash Price |
$64.30
|
Rate for Payer: Cofinity Commercial |
$56.26
|
Rate for Payer: Cofinity Commercial |
$69.12
|
Rate for Payer: Encore Health Key Benefits Commercial |
$64.30
|
Rate for Payer: Healthscope Commercial |
$72.33
|
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.26
|
Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.28
|
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.31
|
Rate for Payer: PHP Commercial |
$68.31
|
Rate for Payer: Priority Health Cigna Priority Health |
$56.26
|
Rate for Payer: Priority Health SBD |
$50.63
|
Rate for Payer: UMR Bronson Commercial |
$35.36
|
Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.28
|
|
PRAVASTATIN 20 MG TABLET
|
Facility
|
IP
|
$296.16
|
|
Service Code
|
NDC 51079-458-20
|
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: 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 Multiplan/Beech St/PHCS |
$251.74
|
Rate for Payer: PHP Commercial |
$251.74
|
Rate for Payer: Priority Health Cigna Priority Health |
$207.31
|
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
|
$52.88
|
|
Service Code
|
NDC 42291-667-90
|
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: 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 Multiplan/Beech St/PHCS |
$44.95
|
Rate for Payer: PHP Commercial |
$44.95
|
Rate for Payer: Priority Health Cigna Priority Health |
$37.02
|
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
|
|