|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$340.10
|
|
|
Service Code
|
NDC 00591058201
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.66 |
| 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 Advantage |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$272.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.07
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health SBD |
$214.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.06
|
| Rate for Payer: UHC Core |
$177.19
|
| Rate for Payer: UHC Exchange |
$133.66
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 60687053711
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| 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 Advantage |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.19
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: Priority Health SBD |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.52
|
| Rate for Payer: UHC Exchange |
$1.15
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$291.36
|
|
|
Service Code
|
NDC 60687053701
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.50 |
| 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 Advantage |
$203.95
|
| Rate for Payer: Cofinity Commercial |
$250.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.09
|
| Rate for Payer: Healthscope Commercial |
$262.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.52
|
| Rate for Payer: PHP Commercial |
$247.66
|
| Rate for Payer: Priority Health SBD |
$183.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.38
|
| Rate for Payer: UHC Core |
$151.80
|
| Rate for Payer: UHC Exchange |
$114.50
|
|
|
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 Advantage |
$203.95
|
| Rate for Payer: Cofinity Commercial |
$250.57
|
| 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: Opus (Opus Packaging Group) HMA |
$218.52
|
| Rate for Payer: PHP Commercial |
$247.66
|
| 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 |
$94.83 |
| 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 Advantage |
$168.91
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health SBD |
$152.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.84
|
| Rate for Payer: UHC Core |
$125.72
|
| Rate for Payer: UHC Exchange |
$94.83
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$348.48
|
|
|
Service Code
|
NDC 60687070901
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.95 |
| Max. Negotiated Rate |
$313.63 |
| Rate for Payer: Aetna Commercial |
$296.21
|
| Rate for Payer: Aetna Medicare |
$174.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.51
|
| Rate for Payer: BCBS Complete |
$139.39
|
| Rate for Payer: Cash Price |
$278.78
|
| Rate for Payer: Cofinity Advantage |
$243.94
|
| Rate for Payer: Cofinity Commercial |
$299.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.78
|
| Rate for Payer: Healthscope Commercial |
$313.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$278.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.36
|
| Rate for Payer: PHP Commercial |
$296.21
|
| Rate for Payer: Priority Health SBD |
$219.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$226.51
|
| Rate for Payer: UHC Core |
$181.56
|
| Rate for Payer: UHC Exchange |
$136.95
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$359.55
|
|
|
Service Code
|
NDC 59651025601
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.30 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna Medicare |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.71
|
| Rate for Payer: BCBS Complete |
$143.82
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Advantage |
$251.69
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.66
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health SBD |
$226.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.71
|
| Rate for Payer: UHC Core |
$187.33
|
| Rate for Payer: UHC Exchange |
$141.30
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$3.49
|
|
|
Service Code
|
NDC 60687070911
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cofinity Advantage |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.79
|
| Rate for Payer: Healthscope Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.97
|
| Rate for Payer: Priority Health SBD |
$2.20
|
|
|
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 Advantage |
$168.91
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| 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: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health SBD |
$152.02
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$3.49
|
|
|
Service Code
|
NDC 60687070911
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.14 |
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: Aetna Medicare |
$1.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.27
|
| Rate for Payer: BCBS Complete |
$1.40
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cofinity Advantage |
$2.44
|
| Rate for Payer: Cofinity Commercial |
$3.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.79
|
| Rate for Payer: Healthscope Commercial |
$3.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.62
|
| Rate for Payer: PHP Commercial |
$2.97
|
| Rate for Payer: Priority Health SBD |
$2.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.27
|
| Rate for Payer: UHC Core |
$1.82
|
| Rate for Payer: UHC Exchange |
$1.37
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$359.55
|
|
|
Service Code
|
NDC 59651025601
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.52 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.71
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Advantage |
$251.69
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.66
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health SBD |
$226.52
|
|
|
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 Advantage |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| 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: Opus (Opus Packaging Group) HMA |
$255.07
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health SBD |
$214.26
|
|
|
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 Advantage |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| 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: Opus (Opus Packaging Group) HMA |
$2.19
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: Priority Health SBD |
$1.84
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$348.48
|
|
|
Service Code
|
NDC 60687070901
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.54 |
| Max. Negotiated Rate |
$313.63 |
| Rate for Payer: Aetna Commercial |
$296.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.51
|
| Rate for Payer: Cash Price |
$278.78
|
| Rate for Payer: Cofinity Advantage |
$243.94
|
| Rate for Payer: Cofinity Commercial |
$299.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$278.78
|
| Rate for Payer: Healthscope Commercial |
$313.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$296.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.36
|
| Rate for Payer: PHP Commercial |
$296.21
|
| Rate for Payer: Priority Health SBD |
$219.54
|
|
|
PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$263.52
|
|
|
Service Code
|
NDC 69680013160
|
| Hospital Charge Code |
37644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.56 |
| Max. Negotiated Rate |
$237.17 |
| Rate for Payer: Aetna Commercial |
$223.99
|
| Rate for Payer: Aetna Medicare |
$131.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: BCBS Complete |
$105.41
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cofinity Advantage |
$184.46
|
| Rate for Payer: Cofinity Commercial |
$226.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.82
|
| Rate for Payer: Healthscope Commercial |
$237.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.64
|
| Rate for Payer: PHP Commercial |
$223.99
|
| Rate for Payer: Priority Health SBD |
$166.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.29
|
| Rate for Payer: UHC Core |
$137.29
|
| Rate for Payer: UHC Exchange |
$103.56
|
|
|
PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$263.52
|
|
|
Service Code
|
NDC 69680013160
|
| Hospital Charge Code |
37644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.02 |
| Max. Negotiated Rate |
$237.17 |
| Rate for Payer: Aetna Commercial |
$223.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cofinity Advantage |
$184.46
|
| Rate for Payer: Cofinity Commercial |
$226.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.82
|
| Rate for Payer: Healthscope Commercial |
$237.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.64
|
| Rate for Payer: PHP Commercial |
$223.99
|
| Rate for Payer: Priority Health SBD |
$166.02
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$114.19
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$102.77 |
| Rate for Payer: Aetna Commercial |
$97.06
|
| Rate for Payer: Aetna Medicare |
$57.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.22
|
| Rate for Payer: BCBS Complete |
$45.68
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cofinity Advantage |
$79.93
|
| Rate for Payer: Cofinity Commercial |
$98.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.35
|
| Rate for Payer: Healthscope Commercial |
$102.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.64
|
| Rate for Payer: PHP Commercial |
$97.06
|
| Rate for Payer: Priority Health SBD |
$71.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.22
|
| Rate for Payer: UHC Core |
$59.49
|
| Rate for Payer: UHC Exchange |
$44.88
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$99.54
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.12 |
| Max. Negotiated Rate |
$89.59 |
| Rate for Payer: Aetna Commercial |
$84.61
|
| Rate for Payer: Aetna Medicare |
$49.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.70
|
| Rate for Payer: BCBS Complete |
$39.82
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Cofinity Advantage |
$69.68
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.63
|
| Rate for Payer: Healthscope Commercial |
$89.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.66
|
| Rate for Payer: PHP Commercial |
$84.61
|
| Rate for Payer: Priority Health SBD |
$62.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.70
|
| Rate for Payer: UHC Core |
$51.86
|
| Rate for Payer: UHC Exchange |
$39.12
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$114.19
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.94 |
| Max. Negotiated Rate |
$102.77 |
| Rate for Payer: Aetna Commercial |
$97.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.22
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cofinity Advantage |
$79.93
|
| Rate for Payer: Cofinity Commercial |
$98.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.35
|
| Rate for Payer: Healthscope Commercial |
$102.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.64
|
| Rate for Payer: PHP Commercial |
$97.06
|
| Rate for Payer: Priority Health SBD |
$71.94
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.64 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Advantage |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.29
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health SBD |
$71.64
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.69 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna Medicare |
$56.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Advantage |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.29
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health SBD |
$71.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.92
|
| Rate for Payer: UHC Core |
$59.25
|
| Rate for Payer: UHC Exchange |
$44.69
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$99.54
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.71 |
| Max. Negotiated Rate |
$89.59 |
| Rate for Payer: Aetna Commercial |
$84.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.70
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Cofinity Advantage |
$69.68
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.63
|
| Rate for Payer: Healthscope Commercial |
$89.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.66
|
| Rate for Payer: PHP Commercial |
$84.61
|
| Rate for Payer: Priority Health SBD |
$62.71
|
|
|
PR OPEN ABLATION 1/>RENAL MASS LESION CRYOSURGICAL
|
Professional
|
Both
|
$2,603.00
|
|
|
Service Code
|
HCPCS 50250
|
| Min. Negotiated Rate |
$693.95 |
| Max. Negotiated Rate |
$2,151.20 |
| Rate for Payer: Aetna Commercial |
$1,442.55
|
| Rate for Payer: Aetna Medicare |
$1,119.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,442.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,550.20
|
| Rate for Payer: BCBS Complete |
$728.65
|
| Rate for Payer: BCBS MAPPO |
$1,076.53
|
| Rate for Payer: BCN Commercial |
$1,812.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,076.53
|
| Rate for Payer: Cash Price |
$2,082.40
|
| Rate for Payer: Cash Price |
$2,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,550.20
|
| Rate for Payer: Cofinity Commercial |
$1,442.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,076.53
|
| Rate for Payer: Healthscope Commercial |
$1,991.58
|
| Rate for Payer: Healthscope Commercial |
$1,722.45
|
| Rate for Payer: Mclaren Medicaid |
$693.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,130.36
|
| Rate for Payer: Meridian Medicaid |
$728.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,184.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,135.52
|
| Rate for Payer: Nomi Health Commercial |
$1,291.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,952.25
|
| Rate for Payer: PACE SWMI |
$1,076.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,076.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$693.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,974.03
|
| Rate for Payer: Priority Health Medicare |
$1,076.53
|
| Rate for Payer: Priority Health SBD |
$1,974.03
|
| Rate for Payer: Priority Health Tiered Network |
$1,974.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,076.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,151.20
|
| Rate for Payer: UHC Core |
$2,151.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,076.53
|
| Rate for Payer: UHC Exchange |
$2,151.20
|
| Rate for Payer: UHC Medicaid |
$693.95
|
| Rate for Payer: UHCCP Medicaid |
$693.95
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 38531
|
| Min. Negotiated Rate |
$275.84 |
| Max. Negotiated Rate |
$900.48 |
| Rate for Payer: Aetna Commercial |
$570.52
|
| Rate for Payer: Aetna Medicare |
$442.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$570.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$613.09
|
| Rate for Payer: BCBS Complete |
$289.63
|
| Rate for Payer: BCBS MAPPO |
$425.76
|
| Rate for Payer: BCN Commercial |
$676.75
|
| Rate for Payer: BCN Medicare Advantage |
$425.76
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cofinity Commercial |
$613.09
|
| Rate for Payer: Cofinity Commercial |
$570.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.76
|
| Rate for Payer: Healthscope Commercial |
$787.66
|
| Rate for Payer: Healthscope Commercial |
$681.22
|
| Rate for Payer: Mclaren Medicaid |
$275.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$447.05
|
| Rate for Payer: Meridian Medicaid |
$289.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$468.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.90
|
| Rate for Payer: Nomi Health Commercial |
$510.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.00
|
| Rate for Payer: PACE SWMI |
$425.76
|
| Rate for Payer: PHP Medicare Advantage |
$425.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$900.48
|
| Rate for Payer: Priority Health Medicare |
$425.76
|
| Rate for Payer: Priority Health SBD |
$900.48
|
| Rate for Payer: Priority Health Tiered Network |
$900.48
|
| Rate for Payer: Railroad Medicare Medicare |
$425.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$761.22
|
| Rate for Payer: UHC Core |
$761.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$425.76
|
| Rate for Payer: UHC Exchange |
$761.22
|
| Rate for Payer: UHC Medicaid |
$275.84
|
| Rate for Payer: UHCCP Medicaid |
$275.84
|
|
|
PR OPEN CLOSURE MAJOR BRONCHIAL FISTULA
|
Professional
|
Both
|
$4,925.00
|
|
|
Service Code
|
HCPCS 32815
|
| Min. Negotiated Rate |
$1,676.52 |
| Max. Negotiated Rate |
$4,976.17 |
| Rate for Payer: Aetna Commercial |
$3,525.41
|
| Rate for Payer: Aetna Medicare |
$2,736.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,525.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,788.50
|
| Rate for Payer: BCBS Complete |
$1,760.35
|
| Rate for Payer: BCBS MAPPO |
$2,630.90
|
| Rate for Payer: BCN Commercial |
$4,126.27
|
| Rate for Payer: BCN Medicare Advantage |
$2,630.90
|
| Rate for Payer: Cash Price |
$3,940.00
|
| Rate for Payer: Cash Price |
$3,940.00
|
| Rate for Payer: Cofinity Commercial |
$3,788.50
|
| Rate for Payer: Cofinity Commercial |
$3,525.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,630.90
|
| Rate for Payer: Healthscope Commercial |
$4,867.16
|
| Rate for Payer: Healthscope Commercial |
$4,209.44
|
| Rate for Payer: Mclaren Medicaid |
$1,676.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,762.45
|
| Rate for Payer: Meridian Medicaid |
$1,760.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,893.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,975.60
|
| Rate for Payer: Nomi Health Commercial |
$3,157.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,693.75
|
| Rate for Payer: PACE SWMI |
$2,630.90
|
| Rate for Payer: PHP Medicare Advantage |
$2,630.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,676.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,885.72
|
| Rate for Payer: Priority Health Medicare |
$2,630.90
|
| Rate for Payer: Priority Health SBD |
$3,885.72
|
| Rate for Payer: Priority Health Tiered Network |
$3,885.72
|
| Rate for Payer: Railroad Medicare Medicare |
$2,630.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,976.17
|
| Rate for Payer: UHC Core |
$4,976.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,630.90
|
| Rate for Payer: UHC Exchange |
$4,976.17
|
| Rate for Payer: UHC Medicaid |
$1,676.52
|
| Rate for Payer: UHCCP Medicaid |
$1,676.52
|
|
