|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$183.02
|
|
|
Service Code
|
NDC 00713053612
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.96 |
| Max. Negotiated Rate |
$164.72 |
| Rate for Payer: Aetna Commercial |
$155.57
|
| Rate for Payer: BCBS Trust/PPO |
$149.40
|
| Rate for Payer: BCN Commercial |
$141.44
|
| Rate for Payer: Cash Price |
$146.42
|
| Rate for Payer: Cofinity Commercial |
$157.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.42
|
| Rate for Payer: Healthscope Commercial |
$164.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.57
|
| Rate for Payer: Nomi Health Commercial |
$150.08
|
| Rate for Payer: PHP Commercial |
$155.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.96
|
| Rate for Payer: Priority Health HMO/PPO |
$159.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.06
|
| Rate for Payer: UHC Core |
$152.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.26
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
OP
|
$397.10
|
|
|
Service Code
|
NDC 60687066001
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.31 |
| Max. Negotiated Rate |
$357.39 |
| Rate for Payer: Aetna Commercial |
$337.54
|
| Rate for Payer: Aetna Medicare |
$103.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.09
|
| Rate for Payer: BCBS Complete |
$158.84
|
| Rate for Payer: BCBS MAPPO |
$99.28
|
| Rate for Payer: BCBS Trust/PPO |
$326.46
|
| Rate for Payer: BCN Commercial |
$308.75
|
| Rate for Payer: BCN Medicare Advantage |
$99.28
|
| Rate for Payer: Cash Price |
$317.68
|
| Rate for Payer: Cofinity Commercial |
$341.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.28
|
| Rate for Payer: Healthscope Commercial |
$357.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.54
|
| Rate for Payer: Nomi Health Commercial |
$325.62
|
| Rate for Payer: PACE Senior Care Partners |
$94.31
|
| Rate for Payer: PACE SWMI |
$99.28
|
| Rate for Payer: PHP Commercial |
$337.54
|
| Rate for Payer: PHP Medicare Advantage |
$99.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.12
|
| Rate for Payer: Priority Health HMO/PPO |
$345.48
|
| Rate for Payer: Priority Health Medicare |
$100.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.06
|
| Rate for Payer: Railroad Medicare Medicare |
$99.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.45
|
| Rate for Payer: UHC Core |
$331.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.28
|
| Rate for Payer: UHC Exchange |
$99.28
|
| Rate for Payer: UHC Medicare Advantage |
$99.28
|
| Rate for Payer: VA VA |
$99.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.82
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$3.98
|
|
|
Service Code
|
NDC 60687066011
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: BCBS Trust/PPO |
$3.25
|
| Rate for Payer: BCN Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.38
|
| Rate for Payer: Nomi Health Commercial |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.59
|
| Rate for Payer: Priority Health HMO/PPO |
$3.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.50
|
| Rate for Payer: UHC Core |
$3.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.98
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$397.10
|
|
|
Service Code
|
NDC 60687066001
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.12 |
| Max. Negotiated Rate |
$357.39 |
| Rate for Payer: Aetna Commercial |
$337.54
|
| Rate for Payer: BCBS Trust/PPO |
$324.15
|
| Rate for Payer: BCN Commercial |
$306.88
|
| Rate for Payer: Cash Price |
$317.68
|
| Rate for Payer: Cofinity Commercial |
$341.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.68
|
| Rate for Payer: Healthscope Commercial |
$357.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.54
|
| Rate for Payer: Nomi Health Commercial |
$325.62
|
| Rate for Payer: PHP Commercial |
$337.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.12
|
| Rate for Payer: Priority Health HMO/PPO |
$345.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.45
|
| Rate for Payer: UHC Core |
$331.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.82
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
OP
|
$3.98
|
|
|
Service Code
|
NDC 60687066011
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.24
|
| Rate for Payer: BCBS Complete |
$1.59
|
| Rate for Payer: BCBS MAPPO |
$1.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$3.09
|
| Rate for Payer: BCN Medicare Advantage |
$1.00
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$3.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.38
|
| Rate for Payer: Nomi Health Commercial |
$3.26
|
| Rate for Payer: PACE Senior Care Partners |
$0.95
|
| Rate for Payer: PACE SWMI |
$1.00
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Medicare Advantage |
$1.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.59
|
| Rate for Payer: Priority Health HMO/PPO |
$3.46
|
| Rate for Payer: Priority Health Medicare |
$1.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.50
|
| Rate for Payer: UHC Core |
$3.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.00
|
| Rate for Payer: UHC Exchange |
$1.00
|
| Rate for Payer: UHC Medicare Advantage |
$1.00
|
| Rate for Payer: VA VA |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.98
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Aetna Medicare |
$4.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.10
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$4.08
|
| Rate for Payer: BCBS MAPPO |
$5.56
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$17.30
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: BCN Medicare Advantage |
$5.56
|
| Rate for Payer: BCN Medicare Advantage |
$4.08
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: PACE Senior Care Partners |
$5.28
|
| Rate for Payer: PACE Senior Care Partners |
$3.88
|
| Rate for Payer: PACE SWMI |
$5.56
|
| Rate for Payer: PACE SWMI |
$4.08
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: PHP Medicare Advantage |
$4.08
|
| Rate for Payer: PHP Medicare Advantage |
$5.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health HMO/PPO |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO |
$19.36
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Medicare |
$4.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.93
|
| Rate for Payer: Railroad Medicare Medicare |
$4.08
|
| Rate for Payer: Railroad Medicare Medicare |
$5.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.08
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UHC Exchange |
$5.56
|
| Rate for Payer: UHC Medicare Advantage |
$4.08
|
| Rate for Payer: UHC Medicare Advantage |
$5.56
|
| Rate for Payer: VA VA |
$4.08
|
| Rate for Payer: VA VA |
$5.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: BCBS Trust/PPO |
$13.32
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCN Commercial |
$12.61
|
| Rate for Payer: BCN Commercial |
$17.19
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health HMO/PPO |
$19.36
|
| Rate for Payer: Priority Health HMO/PPO |
$14.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 68084015501
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$50.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.27
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: BCBS MAPPO |
$48.21
|
| Rate for Payer: BCBS Trust/PPO |
$158.54
|
| Rate for Payer: BCN Commercial |
$149.94
|
| Rate for Payer: BCN Medicare Advantage |
$48.21
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.21
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: PACE Senior Care Partners |
$45.80
|
| Rate for Payer: PACE SWMI |
$48.21
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: PHP Medicare Advantage |
$48.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Medicare |
$48.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: Railroad Medicare Medicare |
$48.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.21
|
| Rate for Payer: UHC Exchange |
$48.21
|
| Rate for Payer: UHC Medicare Advantage |
$48.21
|
| Rate for Payer: VA VA |
$48.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$1.93
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: BCBS Trust/PPO |
$1.58
|
| Rate for Payer: BCN Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.64
|
| Rate for Payer: Nomi Health Commercial |
$1.58
|
| Rate for Payer: PHP Commercial |
$1.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.70
|
| Rate for Payer: UHC Core |
$1.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.45
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 68084015501
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.35 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: BCBS Trust/PPO |
$157.42
|
| Rate for Payer: BCN Commercial |
$149.03
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 00904730461
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: BCBS Trust/PPO |
$274.32
|
| Rate for Payer: BCN Commercial |
$259.70
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health HMO/PPO |
$292.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Core |
$280.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.60
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Medicare Advantage |
$0.48
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.48
|
| Rate for Payer: Healthscope Commercial |
$1.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.64
|
| Rate for Payer: Nomi Health Commercial |
$1.58
|
| Rate for Payer: PACE Senior Care Partners |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.48
|
| Rate for Payer: PHP Commercial |
$1.64
|
| Rate for Payer: PHP Medicare Advantage |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1.68
|
| Rate for Payer: Priority Health Medicare |
$0.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.29
|
| Rate for Payer: Railroad Medicare Medicare |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.70
|
| Rate for Payer: UHC Core |
$1.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.48
|
| Rate for Payer: VA VA |
$0.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.45
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: BCBS Trust/PPO |
$205.26
|
| Rate for Payer: BCN Commercial |
$194.32
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.72 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$65.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.58
|
| Rate for Payer: BCBS Complete |
$100.58
|
| Rate for Payer: BCBS MAPPO |
$62.86
|
| Rate for Payer: BCBS Trust/PPO |
$206.72
|
| Rate for Payer: BCN Commercial |
$195.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.86
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.86
|
| Rate for Payer: Healthscope Commercial |
$226.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: PACE Senior Care Partners |
$59.72
|
| Rate for Payer: PACE SWMI |
$62.86
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: PHP Medicare Advantage |
$62.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Medicare |
$63.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| Rate for Payer: Railroad Medicare Medicare |
$62.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.86
|
| Rate for Payer: UHC Exchange |
$62.86
|
| Rate for Payer: UHC Medicare Advantage |
$62.86
|
| Rate for Payer: VA VA |
$62.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 00904730461
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.81 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$87.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.02
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: BCBS MAPPO |
$84.01
|
| Rate for Payer: BCBS Trust/PPO |
$276.27
|
| Rate for Payer: BCN Commercial |
$261.28
|
| Rate for Payer: BCN Medicare Advantage |
$84.01
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.01
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: PACE Senior Care Partners |
$79.81
|
| Rate for Payer: PACE SWMI |
$84.01
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: PHP Medicare Advantage |
$84.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health HMO/PPO |
$292.36
|
| Rate for Payer: Priority Health Medicare |
$84.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.15
|
| Rate for Payer: Railroad Medicare Medicare |
$84.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Core |
$280.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.01
|
| Rate for Payer: UHC Exchange |
$84.01
|
| Rate for Payer: UHC Medicare Advantage |
$84.01
|
| Rate for Payer: VA VA |
$84.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$2,127.00
|
|
|
Service Code
|
HCPCS 49255
|
| Min. Negotiated Rate |
$767.78 |
| Max. Negotiated Rate |
$1,382.55 |
| Rate for Payer: Aetna Commercial |
$1,028.83
|
| Rate for Payer: Aetna Medicare |
$798.49
|
| Rate for Payer: BCBS Complete |
$850.80
|
| Rate for Payer: BCBS MAPPO |
$767.78
|
| Rate for Payer: BCN Medicare Advantage |
$767.78
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cofinity Commercial |
$1,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,028.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$767.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$806.17
|
| Rate for Payer: Nomi Health Commercial |
$921.34
|
| Rate for Payer: PACE SWMI |
$767.78
|
| Rate for Payer: PHP Medicare Advantage |
$767.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,382.55
|
| Rate for Payer: Priority Health Medicare |
$775.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$767.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$767.78
|
| Rate for Payer: UHC Exchange |
$767.78
|
| Rate for Payer: UHC Medicare Advantage |
$767.78
|
|
|
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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| 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) |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Exchange |
$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: 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 |
$34.80 |
| Rate for Payer: Aetna Commercial |
$32.39
|
| Rate for Payer: Aetna Medicare |
$25.14
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.38
|
| 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 |
$24.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.17
|
| Rate for Payer: UHC Exchange |
$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 |
$53.87 |
| Rate for Payer: Aetna Commercial |
$50.13
|
| Rate for Payer: Aetna Medicare |
$38.91
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.28
|
| 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 |
$37.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.41
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.69
|
| 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 |
$12.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.09
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.36
|
| 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 |
$537.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$531.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.77
|
| Rate for Payer: UHC Exchange |
$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 |
$1,659.46 |
| Rate for Payer: Aetna Commercial |
$1,544.22
|
| Rate for Payer: Aetna Medicare |
$1,198.50
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,210.02
|
| 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 |
$1,163.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,152.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,152.40
|
| Rate for Payer: UHC Exchange |
$1,152.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,152.40
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$241.30
|
|
|
Service Code
|
NDC 53489055101
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.84 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: BCBS Trust/PPO |
$196.97
|
| Rate for Payer: BCN Commercial |
$186.48
|
| Rate for Payer: Cash Price |
$193.04
|
| 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: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.84
|
| Rate for Payer: Priority Health HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$241.30
|
|
|
Service Code
|
NDC 53489055101
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.31 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna Medicare |
$62.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.41
|
| Rate for Payer: BCBS Complete |
$96.52
|
| Rate for Payer: BCBS MAPPO |
$60.33
|
| Rate for Payer: BCBS Trust/PPO |
$198.37
|
| Rate for Payer: BCN Commercial |
$187.61
|
| Rate for Payer: BCN Medicare Advantage |
$60.33
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.33
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: PACE Senior Care Partners |
$57.31
|
| Rate for Payer: PACE SWMI |
$60.33
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: PHP Medicare Advantage |
$60.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.84
|
| Rate for Payer: Priority Health HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Medicare |
$60.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.67
|
| Rate for Payer: Railroad Medicare Medicare |
$60.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.33
|
| Rate for Payer: UHC Exchange |
$60.33
|
| Rate for Payer: UHC Medicare Advantage |
$60.33
|
| Rate for Payer: VA VA |
$60.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
