|
PROMOTE CYCLIC FEED
|
Facility
|
OP
|
$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 INTERMITTENT FEED
|
Facility
|
OP
|
$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
|
|
|
PROMOTE INTERMITTENT FEED
|
Facility
|
OP
|
$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
|
IP
|
$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
|
IP
|
$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
|
|
|
PR ONDANSETRON HCL INJECTION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J2405
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Aetna Medicare |
$0.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.13
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.04
|
| 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 |
$0.15
|
| Rate for Payer: Healthscope Commercial |
$0.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.00
|
| 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 All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.10
|
| 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 |
$16.19 |
| Max. Negotiated Rate |
$3,734.00 |
| 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 |
$17.00
|
| Rate for Payer: BCBS MAPPO |
$24.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$42.64
|
| 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 |
$38.67
|
| Rate for Payer: Healthscope Commercial |
$44.71
|
| Rate for Payer: Mclaren Medicaid |
$16.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.38
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,734.00
|
| 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 Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.06
|
| Rate for Payer: Priority Health Medicare |
$24.17
|
| Rate for Payer: Priority Health Narrow Network |
$28.06
|
| Rate for Payer: Priority Health SBD |
$28.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.17
|
| Rate for Payer: UHC Medicare Advantage |
$24.17
|
| Rate for Payer: UHCCP Medicaid |
$16.19
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$5,924.00 |
| 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 |
$26.39
|
| Rate for Payer: BCBS MAPPO |
$37.41
|
| Rate for Payer: BCBS Trust/PPO |
$873.28
|
| Rate for Payer: BCN Commercial |
$49.79
|
| 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 |
$53.87
|
| Rate for Payer: Cofinity Commercial |
$50.13
|
| 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: Mclaren Medicaid |
$25.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.28
|
| Rate for Payer: Meridian Medicaid |
$26.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,924.00
|
| 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 Choice Medicaid |
$25.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.89
|
| Rate for Payer: Priority Health Medicare |
$37.41
|
| Rate for Payer: Priority Health Narrow Network |
$44.89
|
| Rate for Payer: Priority Health SBD |
$44.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.41
|
| Rate for Payer: UHC Medicare Advantage |
$37.41
|
| Rate for Payer: UHCCP Medicaid |
$25.13
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$1,890.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Medicare |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.41
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$12.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,630.70
|
| Rate for Payer: BCN Commercial |
$21.51
|
| 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 |
$19.34
|
| Rate for Payer: Healthscope Commercial |
$22.37
|
| Rate for Payer: Mclaren Medicaid |
$8.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.69
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,890.00
|
| 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 Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.22
|
| Rate for Payer: Priority Health Medicare |
$12.09
|
| Rate for Payer: Priority Health Narrow Network |
$14.22
|
| Rate for Payer: Priority Health SBD |
$14.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.09
|
| Rate for Payer: UHC Medicare Advantage |
$12.09
|
| Rate for Payer: UHCCP Medicaid |
$8.09
|
|
|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,819.00
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$99,043.00 |
| Rate for Payer: Aetna Commercial |
$712.57
|
| Rate for Payer: Aetna Medicare |
$553.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$712.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.75
|
| Rate for Payer: BCBS Complete |
$375.73
|
| Rate for Payer: BCBS MAPPO |
$531.77
|
| Rate for Payer: BCBS Trust/PPO |
$144.75
|
| Rate for Payer: BCN Commercial |
$818.04
|
| 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 |
$983.77
|
| Rate for Payer: Healthscope Commercial |
$850.83
|
| Rate for Payer: Mclaren Medicaid |
$357.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.36
|
| Rate for Payer: Meridian Medicaid |
$375.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99,043.00
|
| 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 Choice Medicaid |
$357.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,832.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$833.36
|
| Rate for Payer: Priority Health Medicare |
$531.77
|
| Rate for Payer: Priority Health Narrow Network |
$833.36
|
| Rate for Payer: Priority Health SBD |
$833.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$801.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.77
|
| Rate for Payer: UHC Exchange |
$801.90
|
| Rate for Payer: UHC Medicare Advantage |
$531.77
|
| Rate for Payer: UHCCP Medicaid |
$357.84
|
|
|
PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY
|
Professional
|
Both
|
$2,306.00
|
|
|
Service Code
|
HCPCS 58943
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$208,805.00 |
| Rate for Payer: Aetna Commercial |
$1,544.22
|
| Rate for Payer: Aetna Medicare |
$1,198.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,544.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,659.46
|
| Rate for Payer: BCBS Complete |
$810.96
|
| Rate for Payer: BCBS MAPPO |
$1,152.40
|
| Rate for Payer: BCBS Trust/PPO |
$132.60
|
| Rate for Payer: BCN Commercial |
$1,713.79
|
| 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: Mclaren Medicaid |
$772.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,210.02
|
| Rate for Payer: Meridian Medicaid |
$810.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208,805.00
|
| 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 Choice Medicaid |
$772.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,498.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,797.18
|
| Rate for Payer: Priority Health Medicare |
$1,152.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,797.18
|
| Rate for Payer: Priority Health SBD |
$1,797.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,570.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,152.40
|
| Rate for Payer: UHC Exchange |
$1,570.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,152.40
|
| Rate for Payer: UHCCP Medicaid |
$772.34
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$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
|
OP
|
$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
|
IP
|
$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
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 60687053711
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.90
|
| Rate for Payer: BCBS Complete |
$1.17
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health SBD |
$1.84
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$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 |
$3.22
|
| 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
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 60687053711
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.90
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.90
|
| Rate for Payer: Priority Health SBD |
$1.84
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$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 |
$3.22
|
| 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
|
IP
|
$291.36
|
|
|
Service Code
|
NDC 60687053701
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.38
|
| 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
|
OP
|
$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
|
IP
|
$350.15
|
|
|
Service Code
|
NDC 59651025601
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.59 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| 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 |
$315.14
|
| 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
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$340.10
|
|
|
Service Code
|
NDC 00591058201
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.04 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: Aetna Medicare |
$170.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.06
|
| Rate for Payer: BCBS Complete |
$136.04
|
| 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
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 59651025601
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.06 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$175.08
|
| 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 |
$315.14
|
| 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
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$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
|
|
