Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PROMOTE CONTINUOUS FEED

Facility

$9.60

Service Code	NDC 98716016356
Hospital Charge Code	180296
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CYCLIC FEED

Facility

$9.60

Service Code	NDC 98716026356
Hospital Charge Code	200094
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CYCLIC FEED

Facility

$9.60

Service Code	NDC 98716016356
Hospital Charge Code	200094
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CYCLIC FEED

Facility

$9.60

Service Code	NDC 98716026356
Hospital Charge Code	200094
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE CYCLIC FEED

Facility

$9.60

Service Code	NDC 98716016356
Hospital Charge Code	200094
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 98716026356
Hospital Charge Code	200093
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 98716016356
Hospital Charge Code	200093
Hospital Revenue Code	637
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 98716026356
Hospital Charge Code	200093
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PROMOTE INTERMITTENT FEED

Facility

$9.60

Service Code	NDC 98716016356
Hospital Charge Code	200093
Hospital Revenue Code	637
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.64
Rate for Payer: Aetna Commercial	$8.16
Rate for Payer: Aetna Medicare	$4.80
Rate for Payer: Aetna New Business (MI Preferred)	$6.24
Rate for Payer: BCBS Complete	$3.84
Rate for Payer: Cash Price	$7.68
Rate for Payer: Cofinity Commercial	$6.72
Rate for Payer: Cofinity Commercial	$8.26
Rate for Payer: Cofinity Medicare Advantage	$6.72
Rate for Payer: Encore Health Key Benefits Commercial	$7.68
Rate for Payer: Healthscope Commercial	$8.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.16
Rate for Payer: PHP Commercial	$8.16
Rate for Payer: Priority Health Cigna Priority Health	$6.24
Rate for Payer: Priority Health SBD	$6.05

PR ONDANSETRON HCL INJECTION

Professional

Both

$31.00

Service Code	HCPCS J2405
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Commercial	$0.12
Rate for Payer: Aetna Medicare	$0.09
Rate for Payer: Aetna New Business (MI Preferred)	$0.13
Rate for Payer: Aetna New Business (MI Preferred)	$0.12
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS MAPPO	$0.09
Rate for Payer: BCN Medicare Advantage	$0.09
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cofinity Commercial	$0.13
Rate for Payer: Cofinity Commercial	$0.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.09
Rate for Payer: Healthscope Commercial	$0.14
Rate for Payer: Healthscope Commercial	$0.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.15
Rate for Payer: Nomi Health Commercial	$0.11
Rate for Payer: PACE SWMI	$0.09
Rate for Payer: PHP Medicare Advantage	$0.09
Rate for Payer: Priority Health Cigna Priority Health	$20.15
Rate for Payer: Priority Health Medicare	$0.09
Rate for Payer: UHC Dual Complete DSNP	$0.09
Rate for Payer: UHC Medicare Advantage	$0.09

PR ONE AREA LIPOSUCTION - 1 AREA 1.0 HR

Professional

Both

$2,040.00

Service Code	HCPCS 00527
Hospital Revenue Code	990
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$1,326.00
Rate for Payer: Aetna Medicare	$1,020.00
Rate for Payer: BCBS Complete	$816.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,326.00
Rate for Payer: Priority Health Cigna Priority Health	$1,326.00

PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES

Professional

Both

$36.00

Service Code	HCPCS 99422
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$44.71
Rate for Payer: Aetna Commercial	$32.39
Rate for Payer: Aetna Medicare	$25.14
Rate for Payer: Aetna New Business (MI Preferred)	$32.39
Rate for Payer: Aetna New Business (MI Preferred)	$34.80
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCBS MAPPO	$24.17
Rate for Payer: BCN Medicare Advantage	$24.17
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cofinity Commercial	$34.80
Rate for Payer: Cofinity Commercial	$32.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$24.17
Rate for Payer: Healthscope Commercial	$44.71
Rate for Payer: Healthscope Commercial	$38.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$25.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.40
Rate for Payer: Nomi Health Commercial	$29.00
Rate for Payer: PACE SWMI	$24.17
Rate for Payer: PHP Medicare Advantage	$24.17
Rate for Payer: Priority Health Cigna Priority Health	$23.40
Rate for Payer: Priority Health Medicare	$24.17
Rate for Payer: UHC Dual Complete DSNP	$24.17
Rate for Payer: UHC Medicare Advantage	$24.17

PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES

Professional

Both

$36.00

Service Code	HCPCS 99423
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$69.21
Rate for Payer: Aetna Commercial	$50.13
Rate for Payer: Aetna Medicare	$38.91
Rate for Payer: Aetna New Business (MI Preferred)	$50.13
Rate for Payer: Aetna New Business (MI Preferred)	$53.87
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCBS MAPPO	$37.41
Rate for Payer: BCN Medicare Advantage	$37.41
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cofinity Commercial	$50.13
Rate for Payer: Cofinity Commercial	$53.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$37.41
Rate for Payer: Healthscope Commercial	$59.86
Rate for Payer: Healthscope Commercial	$69.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$39.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.40
Rate for Payer: Nomi Health Commercial	$44.89
Rate for Payer: PACE SWMI	$37.41
Rate for Payer: PHP Medicare Advantage	$37.41
Rate for Payer: Priority Health Cigna Priority Health	$23.40
Rate for Payer: Priority Health Medicare	$37.41
Rate for Payer: UHC Dual Complete DSNP	$37.41
Rate for Payer: UHC Medicare Advantage	$37.41

PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES

Professional

Both

$36.00

Service Code	HCPCS 99421
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Commercial	$16.20
Rate for Payer: Aetna Medicare	$12.57
Rate for Payer: Aetna New Business (MI Preferred)	$17.41
Rate for Payer: Aetna New Business (MI Preferred)	$16.20
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCBS MAPPO	$12.09
Rate for Payer: BCN Medicare Advantage	$12.09
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cofinity Commercial	$17.41
Rate for Payer: Cofinity Commercial	$16.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$12.09
Rate for Payer: Healthscope Commercial	$22.37
Rate for Payer: Healthscope Commercial	$19.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$12.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.40
Rate for Payer: Nomi Health Commercial	$14.51
Rate for Payer: PACE SWMI	$12.09
Rate for Payer: PHP Medicare Advantage	$12.09
Rate for Payer: Priority Health Cigna Priority Health	$23.40
Rate for Payer: Priority Health Medicare	$12.09
Rate for Payer: UHC Dual Complete DSNP	$12.09
Rate for Payer: UHC Medicare Advantage	$12.09

PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI

Professional

Both

$2,819.00

Service Code	HCPCS 58940
Min. Negotiated Rate	$531.77
Max. Negotiated Rate	$1,832.35
Rate for Payer: Aetna Commercial	$712.57
Rate for Payer: Aetna Medicare	$553.04
Rate for Payer: Aetna New Business (MI Preferred)	$765.75
Rate for Payer: Aetna New Business (MI Preferred)	$712.57
Rate for Payer: BCBS Complete	$1,127.60
Rate for Payer: BCBS MAPPO	$531.77
Rate for Payer: BCN Medicare Advantage	$531.77
Rate for Payer: Cash Price	$2,255.20
Rate for Payer: Cash Price	$2,255.20
Rate for Payer: Cofinity Commercial	$765.75
Rate for Payer: Cofinity Commercial	$712.57
Rate for Payer: Health Alliance Plan Medicare Advantage	$531.77
Rate for Payer: Healthscope Commercial	$850.83
Rate for Payer: Healthscope Commercial	$983.77
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$558.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,832.35
Rate for Payer: Nomi Health Commercial	$638.12
Rate for Payer: PACE SWMI	$531.77
Rate for Payer: PHP Medicare Advantage	$531.77
Rate for Payer: Priority Health Cigna Priority Health	$1,832.35
Rate for Payer: Priority Health Medicare	$531.77
Rate for Payer: UHC Dual Complete DSNP	$531.77
Rate for Payer: UHC Medicare Advantage	$531.77

PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY

Professional

Both

$2,306.00

Service Code	HCPCS 58943
Min. Negotiated Rate	$922.40
Max. Negotiated Rate	$2,131.94
Rate for Payer: Aetna Commercial	$1,544.22
Rate for Payer: Aetna Medicare	$1,198.50
Rate for Payer: Aetna New Business (MI Preferred)	$1,659.46
Rate for Payer: Aetna New Business (MI Preferred)	$1,544.22
Rate for Payer: BCBS Complete	$922.40
Rate for Payer: BCBS MAPPO	$1,152.40
Rate for Payer: BCN Medicare Advantage	$1,152.40
Rate for Payer: Cash Price	$1,844.80
Rate for Payer: Cash Price	$1,844.80
Rate for Payer: Cofinity Commercial	$1,659.46
Rate for Payer: Cofinity Commercial	$1,544.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,152.40
Rate for Payer: Healthscope Commercial	$2,131.94
Rate for Payer: Healthscope Commercial	$1,843.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,210.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,498.90
Rate for Payer: Nomi Health Commercial	$1,382.88
Rate for Payer: PACE SWMI	$1,152.40
Rate for Payer: PHP Medicare Advantage	$1,152.40
Rate for Payer: Priority Health Cigna Priority Health	$1,498.90
Rate for Payer: Priority Health Medicare	$1,152.40
Rate for Payer: UHC Dual Complete DSNP	$1,152.40
Rate for Payer: UHC Medicare Advantage	$1,152.40

PROPAFENONE 150 MG TABLET

Facility

$241.30

Service Code	NDC 53489055101
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$96.52
Max. Negotiated Rate	$217.17
Rate for Payer: Aetna Commercial	$205.10
Rate for Payer: Aetna Medicare	$120.65
Rate for Payer: Aetna New Business (MI Preferred)	$156.84
Rate for Payer: BCBS Complete	$96.52
Rate for Payer: Cash Price	$193.04
Rate for Payer: Cofinity Commercial	$168.91
Rate for Payer: Cofinity Commercial	$207.52
Rate for Payer: Cofinity Medicare Advantage	$168.91
Rate for Payer: Encore Health Key Benefits Commercial	$193.04
Rate for Payer: Healthscope Commercial	$217.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.10
Rate for Payer: PHP Commercial	$205.10
Rate for Payer: Priority Health Cigna Priority Health	$156.84
Rate for Payer: Priority Health SBD	$152.02

PROPAFENONE 150 MG TABLET

Facility

$3.75

Service Code	NDC 60687070911
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna Medicare	$1.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.23
Rate for Payer: Cofinity Medicare Advantage	$2.62
Rate for Payer: Encore Health Key Benefits Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.19
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.36

PROPAFENONE 150 MG TABLET

Facility

$374.88

Service Code	NDC 60687070901
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$149.95
Max. Negotiated Rate	$337.39
Rate for Payer: Aetna Commercial	$318.65
Rate for Payer: Aetna Medicare	$187.44
Rate for Payer: Aetna New Business (MI Preferred)	$243.67
Rate for Payer: BCBS Complete	$149.95
Rate for Payer: Cash Price	$299.90
Rate for Payer: Cofinity Commercial	$262.42
Rate for Payer: Cofinity Commercial	$322.40
Rate for Payer: Cofinity Medicare Advantage	$262.42
Rate for Payer: Encore Health Key Benefits Commercial	$299.90
Rate for Payer: Healthscope Commercial	$337.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.65
Rate for Payer: PHP Commercial	$318.65
Rate for Payer: Priority Health Cigna Priority Health	$243.67
Rate for Payer: Priority Health SBD	$236.17

PROPAFENONE 150 MG TABLET

Facility

$241.30

Service Code	NDC 53489055101
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$152.02
Max. Negotiated Rate	$217.17
Rate for Payer: Aetna Commercial	$205.10
Rate for Payer: Aetna New Business (MI Preferred)	$156.84
Rate for Payer: Cash Price	$193.04
Rate for Payer: Cofinity Commercial	$168.91
Rate for Payer: Cofinity Commercial	$207.52
Rate for Payer: Cofinity Medicare Advantage	$168.91
Rate for Payer: Encore Health Key Benefits Commercial	$193.04
Rate for Payer: Healthscope Commercial	$217.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$205.10
Rate for Payer: PHP Commercial	$205.10
Rate for Payer: Priority Health Cigna Priority Health	$156.84
Rate for Payer: Priority Health SBD	$152.02

PROPAFENONE 150 MG TABLET

Facility

$3.75

Service Code	NDC 60687070911
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$2.36
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.19
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: Cash Price	$3.00
Rate for Payer: Cofinity Commercial	$2.62
Rate for Payer: Cofinity Commercial	$3.23
Rate for Payer: Cofinity Medicare Advantage	$2.62
Rate for Payer: Encore Health Key Benefits Commercial	$3.00
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.19
Rate for Payer: PHP Commercial	$3.19
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.36

PROPAFENONE 150 MG TABLET

Facility

$340.10

Service Code	NDC 00591058201
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$214.26
Max. Negotiated Rate	$306.09
Rate for Payer: Aetna Commercial	$289.08
Rate for Payer: Aetna New Business (MI Preferred)	$221.06
Rate for Payer: Cash Price	$272.08
Rate for Payer: Cofinity Commercial	$238.07
Rate for Payer: Cofinity Commercial	$292.49
Rate for Payer: Cofinity Medicare Advantage	$238.07
Rate for Payer: Encore Health Key Benefits Commercial	$272.08
Rate for Payer: Healthscope Commercial	$306.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$289.08
Rate for Payer: PHP Commercial	$289.08
Rate for Payer: Priority Health Cigna Priority Health	$221.06
Rate for Payer: Priority Health SBD	$214.26

PROPAFENONE 150 MG TABLET

Facility

$374.88

Service Code	NDC 60687070901
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$236.17
Max. Negotiated Rate	$337.39
Rate for Payer: Aetna Commercial	$318.65
Rate for Payer: Aetna New Business (MI Preferred)	$243.67
Rate for Payer: Cash Price	$299.90
Rate for Payer: Cofinity Commercial	$262.42
Rate for Payer: Cofinity Commercial	$322.40
Rate for Payer: Cofinity Medicare Advantage	$262.42
Rate for Payer: Encore Health Key Benefits Commercial	$299.90
Rate for Payer: Healthscope Commercial	$337.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$318.65
Rate for Payer: PHP Commercial	$318.65
Rate for Payer: Priority Health Cigna Priority Health	$243.67
Rate for Payer: Priority Health SBD	$236.17

PROPAFENONE 150 MG TABLET

Facility

$291.36

Service Code	NDC 60687053701
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$116.54
Max. Negotiated Rate	$262.22
Rate for Payer: Aetna Commercial	$247.66
Rate for Payer: Aetna Medicare	$145.68
Rate for Payer: Aetna New Business (MI Preferred)	$189.38
Rate for Payer: BCBS Complete	$116.54
Rate for Payer: Cash Price	$233.09
Rate for Payer: Cofinity Commercial	$203.95
Rate for Payer: Cofinity Commercial	$250.57
Rate for Payer: Cofinity Medicare Advantage	$203.95
Rate for Payer: Encore Health Key Benefits Commercial	$233.09
Rate for Payer: Healthscope Commercial	$262.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.66
Rate for Payer: PHP Commercial	$247.66
Rate for Payer: Priority Health Cigna Priority Health	$189.38
Rate for Payer: Priority Health SBD	$183.56

PROPAFENONE 150 MG TABLET

Facility

$350.15

Service Code	NDC 59651025601
Hospital Charge Code	11146
Hospital Revenue Code	637
Min. Negotiated Rate	$140.06
Max. Negotiated Rate	$315.13
Rate for Payer: Aetna Commercial	$297.63
Rate for Payer: Aetna Medicare	$175.07
Rate for Payer: Aetna New Business (MI Preferred)	$227.60
Rate for Payer: BCBS Complete	$140.06
Rate for Payer: Cash Price	$280.12
Rate for Payer: Cofinity Commercial	$245.10
Rate for Payer: Cofinity Commercial	$301.13
Rate for Payer: Cofinity Medicare Advantage	$245.10
Rate for Payer: Encore Health Key Benefits Commercial	$280.12
Rate for Payer: Healthscope Commercial	$315.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$297.63
Rate for Payer: PHP Commercial	$297.63
Rate for Payer: Priority Health Cigna Priority Health	$227.60
Rate for Payer: Priority Health SBD	$220.59

Know your out-of-pocket cost for care.

All Charges