|
PROPOFOL 10 MG/ML 20 ML VIAL (BULK CHARGE)
|
Facility
|
OP
|
$63.61
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.11 |
| Max. Negotiated Rate |
$57.25 |
| Rate for Payer: Aetna Commercial |
$54.07
|
| Rate for Payer: Aetna Medicare |
$16.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.88
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: BCBS MAPPO |
$15.90
|
| Rate for Payer: BCBS Trust/PPO |
$52.29
|
| Rate for Payer: BCN Commercial |
$49.46
|
| Rate for Payer: BCN Medicare Advantage |
$15.90
|
| Rate for Payer: Cash Price |
$50.89
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.07
|
| Rate for Payer: Nomi Health Commercial |
$52.16
|
| Rate for Payer: PACE Senior Care Partners |
$15.11
|
| Rate for Payer: PACE SWMI |
$15.90
|
| Rate for Payer: PHP Commercial |
$54.07
|
| Rate for Payer: PHP Medicare Advantage |
$15.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.35
|
| Rate for Payer: Priority Health HMO/PPO |
$55.34
|
| Rate for Payer: Priority Health Medicare |
$16.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.62
|
| Rate for Payer: Railroad Medicare Medicare |
$15.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.98
|
| Rate for Payer: UHC Core |
$53.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.90
|
| Rate for Payer: UHC Exchange |
$15.90
|
| Rate for Payer: UHC Medicare Advantage |
$15.90
|
| Rate for Payer: VA VA |
$15.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.71
|
|
|
PROPOFOL 10 MG/ML 20 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$63.61
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.35 |
| Max. Negotiated Rate |
$57.25 |
| Rate for Payer: Aetna Commercial |
$54.07
|
| Rate for Payer: BCBS Trust/PPO |
$51.92
|
| Rate for Payer: BCN Commercial |
$49.16
|
| Rate for Payer: Cash Price |
$50.89
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.89
|
| Rate for Payer: Healthscope Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.07
|
| Rate for Payer: Nomi Health Commercial |
$52.16
|
| Rate for Payer: PHP Commercial |
$54.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.35
|
| Rate for Payer: Priority Health HMO/PPO |
$55.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.98
|
| Rate for Payer: UHC Core |
$53.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.71
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
OP
|
$77.12
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$69.41 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Medicare |
$20.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.10
|
| Rate for Payer: BCBS Complete |
$30.85
|
| Rate for Payer: BCBS MAPPO |
$19.28
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCN Commercial |
$59.96
|
| Rate for Payer: BCN Medicare Advantage |
$19.28
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.28
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.55
|
| Rate for Payer: Nomi Health Commercial |
$63.24
|
| Rate for Payer: PACE Senior Care Partners |
$18.32
|
| Rate for Payer: PACE SWMI |
$19.28
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: PHP Medicare Advantage |
$19.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.13
|
| Rate for Payer: Priority Health HMO/PPO |
$67.09
|
| Rate for Payer: Priority Health Medicare |
$19.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.67
|
| Rate for Payer: Railroad Medicare Medicare |
$19.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.87
|
| Rate for Payer: UHC Core |
$64.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.28
|
| Rate for Payer: UHC Exchange |
$19.28
|
| Rate for Payer: UHC Medicare Advantage |
$19.28
|
| Rate for Payer: VA VA |
$19.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.84
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
IP
|
$77.12
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.13 |
| Max. Negotiated Rate |
$69.41 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: BCBS Trust/PPO |
$62.95
|
| Rate for Payer: BCN Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.70
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.55
|
| Rate for Payer: Nomi Health Commercial |
$63.24
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.13
|
| Rate for Payer: Priority Health HMO/PPO |
$67.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.87
|
| Rate for Payer: UHC Core |
$64.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.84
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
IP
|
$62.23
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.45 |
| Max. Negotiated Rate |
$56.01 |
| Rate for Payer: Aetna Commercial |
$52.90
|
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Commercial |
$61.65
|
| Rate for Payer: Aetna Commercial |
$67.11
|
| Rate for Payer: Aetna Commercial |
$57.66
|
| Rate for Payer: Aetna Commercial |
$76.47
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Commercial |
$73.36
|
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: BCBS Trust/PPO |
$44.52
|
| Rate for Payer: BCBS Trust/PPO |
$70.45
|
| Rate for Payer: BCBS Trust/PPO |
$83.93
|
| Rate for Payer: BCBS Trust/PPO |
$64.45
|
| Rate for Payer: BCBS Trust/PPO |
$55.37
|
| Rate for Payer: BCBS Trust/PPO |
$50.80
|
| Rate for Payer: BCBS Trust/PPO |
$59.21
|
| Rate for Payer: BCBS Trust/PPO |
$62.95
|
| Rate for Payer: BCBS Trust/PPO |
$53.08
|
| Rate for Payer: BCBS Trust/PPO |
$73.44
|
| Rate for Payer: BCN Commercial |
$50.26
|
| Rate for Payer: BCN Commercial |
$79.46
|
| Rate for Payer: BCN Commercial |
$48.09
|
| Rate for Payer: BCN Commercial |
$61.01
|
| Rate for Payer: BCN Commercial |
$59.60
|
| Rate for Payer: BCN Commercial |
$66.69
|
| Rate for Payer: BCN Commercial |
$52.42
|
| Rate for Payer: BCN Commercial |
$69.53
|
| Rate for Payer: BCN Commercial |
$56.05
|
| Rate for Payer: BCN Commercial |
$42.15
|
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$63.16
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Cofinity Commercial |
$77.37
|
| Rate for Payer: Cofinity Commercial |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Commercial |
$53.52
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$67.90
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.98
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Healthscope Commercial |
$61.05
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$77.67
|
| Rate for Payer: Healthscope Commercial |
$80.97
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$49.09
|
| Rate for Payer: Healthscope Commercial |
$56.01
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.47
|
| Rate for Payer: Nomi Health Commercial |
$84.31
|
| Rate for Payer: Nomi Health Commercial |
$53.32
|
| Rate for Payer: Nomi Health Commercial |
$64.74
|
| Rate for Payer: Nomi Health Commercial |
$63.24
|
| Rate for Payer: Nomi Health Commercial |
$70.77
|
| Rate for Payer: Nomi Health Commercial |
$44.72
|
| Rate for Payer: Nomi Health Commercial |
$51.03
|
| Rate for Payer: Nomi Health Commercial |
$59.47
|
| Rate for Payer: Nomi Health Commercial |
$55.62
|
| Rate for Payer: Nomi Health Commercial |
$73.78
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: PHP Commercial |
$57.66
|
| Rate for Payer: PHP Commercial |
$61.65
|
| Rate for Payer: PHP Commercial |
$52.90
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$46.36
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: PHP Commercial |
$67.11
|
| Rate for Payer: PHP Commercial |
$73.36
|
| Rate for Payer: PHP Commercial |
$76.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.32
|
| Rate for Payer: Priority Health HMO/PPO |
$63.10
|
| Rate for Payer: Priority Health HMO/PPO |
$78.27
|
| Rate for Payer: Priority Health HMO/PPO |
$54.14
|
| Rate for Payer: Priority Health HMO/PPO |
$67.09
|
| Rate for Payer: Priority Health HMO/PPO |
$59.01
|
| Rate for Payer: Priority Health HMO/PPO |
$75.08
|
| Rate for Payer: Priority Health HMO/PPO |
$68.69
|
| Rate for Payer: Priority Health HMO/PPO |
$56.58
|
| Rate for Payer: Priority Health HMO/PPO |
$89.45
|
| Rate for Payer: Priority Health HMO/PPO |
$47.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.23
|
| Rate for Payer: UHC Core |
$54.30
|
| Rate for Payer: UHC Core |
$60.56
|
| Rate for Payer: UHC Core |
$85.85
|
| Rate for Payer: UHC Core |
$45.54
|
| Rate for Payer: UHC Core |
$65.92
|
| Rate for Payer: UHC Core |
$72.06
|
| Rate for Payer: UHC Core |
$51.96
|
| Rate for Payer: UHC Core |
$64.40
|
| Rate for Payer: UHC Core |
$75.12
|
| Rate for Payer: UHC Core |
$56.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.84
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
OP
|
$77.12
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.32 |
| Max. Negotiated Rate |
$69.41 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Commercial |
$61.65
|
| Rate for Payer: Aetna Commercial |
$73.36
|
| Rate for Payer: Aetna Commercial |
$76.47
|
| Rate for Payer: Aetna Commercial |
$57.66
|
| Rate for Payer: Aetna Commercial |
$52.90
|
| Rate for Payer: Aetna Commercial |
$67.11
|
| Rate for Payer: Aetna Medicare |
$16.91
|
| Rate for Payer: Aetna Medicare |
$26.73
|
| Rate for Payer: Aetna Medicare |
$16.18
|
| Rate for Payer: Aetna Medicare |
$20.05
|
| Rate for Payer: Aetna Medicare |
$20.53
|
| Rate for Payer: Aetna Medicare |
$22.44
|
| Rate for Payer: Aetna Medicare |
$23.39
|
| Rate for Payer: Aetna Medicare |
$17.64
|
| Rate for Payer: Aetna Medicare |
$18.86
|
| Rate for Payer: Aetna Medicare |
$14.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.97
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.20
|
| Rate for Payer: BCBS Complete |
$34.52
|
| Rate for Payer: BCBS Complete |
$24.89
|
| Rate for Payer: BCBS Complete |
$21.82
|
| Rate for Payer: BCBS Complete |
$26.01
|
| Rate for Payer: BCBS Complete |
$31.58
|
| Rate for Payer: BCBS Complete |
$27.13
|
| Rate for Payer: BCBS Complete |
$29.01
|
| Rate for Payer: BCBS Complete |
$35.99
|
| Rate for Payer: BCBS Complete |
$30.85
|
| Rate for Payer: BCBS Complete |
$41.13
|
| Rate for Payer: BCBS MAPPO |
$21.58
|
| Rate for Payer: BCBS MAPPO |
$16.96
|
| Rate for Payer: BCBS MAPPO |
$18.13
|
| Rate for Payer: BCBS MAPPO |
$19.74
|
| Rate for Payer: BCBS MAPPO |
$13.64
|
| Rate for Payer: BCBS MAPPO |
$25.70
|
| Rate for Payer: BCBS MAPPO |
$16.26
|
| Rate for Payer: BCBS MAPPO |
$15.56
|
| Rate for Payer: BCBS MAPPO |
$22.49
|
| Rate for Payer: BCBS MAPPO |
$19.28
|
| Rate for Payer: BCBS Trust/PPO |
$73.96
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCBS Trust/PPO |
$55.76
|
| Rate for Payer: BCBS Trust/PPO |
$59.63
|
| Rate for Payer: BCBS Trust/PPO |
$70.95
|
| Rate for Payer: BCBS Trust/PPO |
$64.90
|
| Rate for Payer: BCBS Trust/PPO |
$84.53
|
| Rate for Payer: BCBS Trust/PPO |
$44.84
|
| Rate for Payer: BCBS Trust/PPO |
$51.16
|
| Rate for Payer: BCBS Trust/PPO |
$53.46
|
| Rate for Payer: BCN Commercial |
$50.56
|
| Rate for Payer: BCN Commercial |
$61.38
|
| Rate for Payer: BCN Commercial |
$42.40
|
| Rate for Payer: BCN Commercial |
$79.94
|
| Rate for Payer: BCN Commercial |
$56.39
|
| Rate for Payer: BCN Commercial |
$52.74
|
| Rate for Payer: BCN Commercial |
$69.95
|
| Rate for Payer: BCN Commercial |
$59.96
|
| Rate for Payer: BCN Commercial |
$67.10
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: BCN Medicare Advantage |
$15.56
|
| Rate for Payer: BCN Medicare Advantage |
$19.74
|
| Rate for Payer: BCN Medicare Advantage |
$16.26
|
| Rate for Payer: BCN Medicare Advantage |
$21.58
|
| Rate for Payer: BCN Medicare Advantage |
$19.28
|
| Rate for Payer: BCN Medicare Advantage |
$22.49
|
| Rate for Payer: BCN Medicare Advantage |
$18.13
|
| Rate for Payer: BCN Medicare Advantage |
$16.96
|
| Rate for Payer: BCN Medicare Advantage |
$25.70
|
| Rate for Payer: BCN Medicare Advantage |
$13.64
|
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$63.16
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cofinity Commercial |
$67.90
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Cofinity Commercial |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Cofinity Commercial |
$53.52
|
| Rate for Payer: Cofinity Commercial |
$77.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.96
|
| Rate for Payer: Healthscope Commercial |
$56.01
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$77.67
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$49.09
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$61.05
|
| Rate for Payer: Healthscope Commercial |
$80.97
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.90
|
| Rate for Payer: Nomi Health Commercial |
$84.31
|
| Rate for Payer: Nomi Health Commercial |
$53.32
|
| Rate for Payer: Nomi Health Commercial |
$64.74
|
| Rate for Payer: Nomi Health Commercial |
$70.77
|
| Rate for Payer: Nomi Health Commercial |
$63.24
|
| Rate for Payer: Nomi Health Commercial |
$55.62
|
| Rate for Payer: Nomi Health Commercial |
$51.03
|
| Rate for Payer: Nomi Health Commercial |
$59.47
|
| Rate for Payer: Nomi Health Commercial |
$73.78
|
| Rate for Payer: Nomi Health Commercial |
$44.72
|
| Rate for Payer: PACE Senior Care Partners |
$21.37
|
| Rate for Payer: PACE Senior Care Partners |
$16.11
|
| Rate for Payer: PACE Senior Care Partners |
$12.95
|
| Rate for Payer: PACE Senior Care Partners |
$17.23
|
| Rate for Payer: PACE Senior Care Partners |
$24.42
|
| Rate for Payer: PACE Senior Care Partners |
$14.78
|
| Rate for Payer: PACE Senior Care Partners |
$15.44
|
| Rate for Payer: PACE Senior Care Partners |
$18.75
|
| Rate for Payer: PACE Senior Care Partners |
$20.50
|
| Rate for Payer: PACE Senior Care Partners |
$18.32
|
| Rate for Payer: PACE SWMI |
$16.96
|
| Rate for Payer: PACE SWMI |
$13.64
|
| Rate for Payer: PACE SWMI |
$25.70
|
| Rate for Payer: PACE SWMI |
$15.56
|
| Rate for Payer: PACE SWMI |
$21.58
|
| Rate for Payer: PACE SWMI |
$16.26
|
| Rate for Payer: PACE SWMI |
$19.74
|
| Rate for Payer: PACE SWMI |
$19.28
|
| Rate for Payer: PACE SWMI |
$18.13
|
| Rate for Payer: PACE SWMI |
$22.49
|
| Rate for Payer: PHP Commercial |
$76.47
|
| Rate for Payer: PHP Commercial |
$73.36
|
| Rate for Payer: PHP Commercial |
$61.65
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: PHP Commercial |
$46.36
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$52.90
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: PHP Commercial |
$67.11
|
| Rate for Payer: PHP Commercial |
$57.66
|
| Rate for Payer: PHP Medicare Advantage |
$21.58
|
| Rate for Payer: PHP Medicare Advantage |
$22.49
|
| Rate for Payer: PHP Medicare Advantage |
$15.56
|
| Rate for Payer: PHP Medicare Advantage |
$16.26
|
| Rate for Payer: PHP Medicare Advantage |
$19.28
|
| Rate for Payer: PHP Medicare Advantage |
$16.96
|
| Rate for Payer: PHP Medicare Advantage |
$25.70
|
| Rate for Payer: PHP Medicare Advantage |
$13.64
|
| Rate for Payer: PHP Medicare Advantage |
$18.13
|
| Rate for Payer: PHP Medicare Advantage |
$19.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.45
|
| Rate for Payer: Priority Health HMO/PPO |
$68.69
|
| Rate for Payer: Priority Health HMO/PPO |
$67.09
|
| Rate for Payer: Priority Health HMO/PPO |
$75.08
|
| Rate for Payer: Priority Health HMO/PPO |
$47.45
|
| Rate for Payer: Priority Health HMO/PPO |
$56.58
|
| Rate for Payer: Priority Health HMO/PPO |
$89.45
|
| Rate for Payer: Priority Health HMO/PPO |
$78.27
|
| Rate for Payer: Priority Health HMO/PPO |
$63.10
|
| Rate for Payer: Priority Health HMO/PPO |
$59.01
|
| Rate for Payer: Priority Health HMO/PPO |
$54.14
|
| Rate for Payer: Priority Health Medicare |
$21.79
|
| Rate for Payer: Priority Health Medicare |
$18.31
|
| Rate for Payer: Priority Health Medicare |
$16.42
|
| Rate for Payer: Priority Health Medicare |
$19.47
|
| Rate for Payer: Priority Health Medicare |
$15.71
|
| Rate for Payer: Priority Health Medicare |
$19.93
|
| Rate for Payer: Priority Health Medicare |
$25.96
|
| Rate for Payer: Priority Health Medicare |
$13.77
|
| Rate for Payer: Priority Health Medicare |
$22.72
|
| Rate for Payer: Priority Health Medicare |
$17.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.45
|
| Rate for Payer: Railroad Medicare Medicare |
$19.28
|
| Rate for Payer: Railroad Medicare Medicare |
$22.49
|
| Rate for Payer: Railroad Medicare Medicare |
$13.64
|
| Rate for Payer: Railroad Medicare Medicare |
$19.74
|
| Rate for Payer: Railroad Medicare Medicare |
$15.56
|
| Rate for Payer: Railroad Medicare Medicare |
$25.70
|
| Rate for Payer: Railroad Medicare Medicare |
$16.26
|
| Rate for Payer: Railroad Medicare Medicare |
$16.96
|
| Rate for Payer: Railroad Medicare Medicare |
$21.58
|
| Rate for Payer: Railroad Medicare Medicare |
$18.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.94
|
| Rate for Payer: UHC Core |
$60.56
|
| Rate for Payer: UHC Core |
$54.30
|
| Rate for Payer: UHC Core |
$65.92
|
| Rate for Payer: UHC Core |
$56.64
|
| Rate for Payer: UHC Core |
$64.40
|
| Rate for Payer: UHC Core |
$75.12
|
| Rate for Payer: UHC Core |
$51.96
|
| Rate for Payer: UHC Core |
$72.06
|
| Rate for Payer: UHC Core |
$85.85
|
| Rate for Payer: UHC Core |
$45.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.96
|
| Rate for Payer: UHC Exchange |
$13.64
|
| Rate for Payer: UHC Exchange |
$19.28
|
| Rate for Payer: UHC Exchange |
$19.74
|
| Rate for Payer: UHC Exchange |
$25.70
|
| Rate for Payer: UHC Exchange |
$22.49
|
| Rate for Payer: UHC Exchange |
$15.56
|
| Rate for Payer: UHC Exchange |
$21.58
|
| Rate for Payer: UHC Exchange |
$18.13
|
| Rate for Payer: UHC Exchange |
$16.26
|
| Rate for Payer: UHC Exchange |
$16.96
|
| Rate for Payer: UHC Medicare Advantage |
$25.70
|
| Rate for Payer: UHC Medicare Advantage |
$21.58
|
| Rate for Payer: UHC Medicare Advantage |
$22.49
|
| Rate for Payer: UHC Medicare Advantage |
$16.26
|
| Rate for Payer: UHC Medicare Advantage |
$19.28
|
| Rate for Payer: UHC Medicare Advantage |
$19.74
|
| Rate for Payer: UHC Medicare Advantage |
$15.56
|
| Rate for Payer: UHC Medicare Advantage |
$18.13
|
| Rate for Payer: UHC Medicare Advantage |
$16.96
|
| Rate for Payer: UHC Medicare Advantage |
$13.64
|
| Rate for Payer: VA VA |
$21.58
|
| Rate for Payer: VA VA |
$19.74
|
| Rate for Payer: VA VA |
$19.28
|
| Rate for Payer: VA VA |
$25.70
|
| Rate for Payer: VA VA |
$18.13
|
| Rate for Payer: VA VA |
$22.49
|
| Rate for Payer: VA VA |
$13.64
|
| Rate for Payer: VA VA |
$16.26
|
| Rate for Payer: VA VA |
$15.56
|
| Rate for Payer: VA VA |
$16.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.40
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$65.03
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$58.53 |
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Medicare |
$16.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.32
|
| Rate for Payer: BCBS Complete |
$26.01
|
| Rate for Payer: BCBS MAPPO |
$16.26
|
| Rate for Payer: BCBS Trust/PPO |
$53.46
|
| Rate for Payer: BCN Commercial |
$50.56
|
| Rate for Payer: BCN Medicare Advantage |
$16.26
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.26
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Nomi Health Commercial |
$53.32
|
| Rate for Payer: PACE Senior Care Partners |
$15.44
|
| Rate for Payer: PACE SWMI |
$16.26
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: PHP Medicare Advantage |
$16.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health HMO/PPO |
$56.58
|
| Rate for Payer: Priority Health Medicare |
$16.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.57
|
| Rate for Payer: Railroad Medicare Medicare |
$16.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.23
|
| Rate for Payer: UHC Core |
$54.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.26
|
| Rate for Payer: UHC Exchange |
$16.26
|
| Rate for Payer: UHC Medicare Advantage |
$16.26
|
| Rate for Payer: VA VA |
$16.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$65.03
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.27 |
| Max. Negotiated Rate |
$58.53 |
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: BCBS Trust/PPO |
$53.08
|
| Rate for Payer: BCN Commercial |
$50.26
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Nomi Health Commercial |
$53.32
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health HMO/PPO |
$56.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.23
|
| Rate for Payer: UHC Core |
$54.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
|
|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,594.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$584.90 |
| Max. Negotiated Rate |
$2,336.10 |
| Rate for Payer: Aetna Commercial |
$1,144.63
|
| Rate for Payer: Aetna Medicare |
$888.37
|
| Rate for Payer: BCBS Complete |
$614.14
|
| Rate for Payer: BCBS MAPPO |
$854.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.26
|
| Rate for Payer: BCN Commercial |
$1,346.31
|
| Rate for Payer: BCN Medicare Advantage |
$854.20
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Cofinity Commercial |
$1,230.05
|
| Rate for Payer: Cofinity Commercial |
$1,144.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$854.20
|
| Rate for Payer: Mclaren Medicaid |
$584.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$896.91
|
| Rate for Payer: Meridian Medicaid |
$614.14
|
| Rate for Payer: Nomi Health Commercial |
$1,025.04
|
| Rate for Payer: PACE SWMI |
$854.20
|
| Rate for Payer: PHP Medicare Advantage |
$854.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,336.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,401.41
|
| Rate for Payer: Priority Health Medicare |
$862.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,401.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$854.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$854.20
|
| Rate for Payer: UHC Exchange |
$854.20
|
| Rate for Payer: UHC Medicare Advantage |
$854.20
|
| Rate for Payer: UHCCP Medicaid |
$584.90
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$542.09 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna Commercial |
$1,058.21
|
| Rate for Payer: Aetna Medicare |
$821.30
|
| Rate for Payer: BCBS Complete |
$569.19
|
| Rate for Payer: BCBS MAPPO |
$789.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.11
|
| Rate for Payer: BCN Commercial |
$1,246.61
|
| Rate for Payer: BCN Medicare Advantage |
$789.71
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cofinity Commercial |
$1,137.18
|
| Rate for Payer: Cofinity Commercial |
$1,058.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$789.71
|
| Rate for Payer: Mclaren Medicaid |
$542.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$829.20
|
| Rate for Payer: Meridian Medicaid |
$569.19
|
| Rate for Payer: Nomi Health Commercial |
$947.65
|
| Rate for Payer: PACE SWMI |
$789.71
|
| Rate for Payer: PHP Medicare Advantage |
$789.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health HMO/PPO |
$1,297.09
|
| Rate for Payer: Priority Health Medicare |
$797.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,297.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$789.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$789.71
|
| Rate for Payer: UHC Exchange |
$789.71
|
| Rate for Payer: UHC Medicare Advantage |
$789.71
|
| Rate for Payer: UHCCP Medicaid |
$542.09
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$599.17 |
| Max. Negotiated Rate |
$1,433.97 |
| Rate for Payer: Aetna Commercial |
$1,171.66
|
| Rate for Payer: Aetna Medicare |
$909.34
|
| Rate for Payer: BCBS Complete |
$629.13
|
| Rate for Payer: BCBS MAPPO |
$874.37
|
| Rate for Payer: BCBS Trust/PPO |
$977.36
|
| Rate for Payer: BCN Commercial |
$1,377.09
|
| Rate for Payer: BCN Medicare Advantage |
$874.37
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cofinity Commercial |
$1,259.09
|
| Rate for Payer: Cofinity Commercial |
$1,171.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.37
|
| Rate for Payer: Mclaren Medicaid |
$599.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$918.09
|
| Rate for Payer: Meridian Medicaid |
$629.13
|
| Rate for Payer: Nomi Health Commercial |
$1,049.24
|
| Rate for Payer: PACE SWMI |
$874.37
|
| Rate for Payer: PHP Medicare Advantage |
$874.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,433.97
|
| Rate for Payer: Priority Health Medicare |
$883.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,433.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$874.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.37
|
| Rate for Payer: UHC Exchange |
$874.37
|
| Rate for Payer: UHC Medicare Advantage |
$874.37
|
| Rate for Payer: UHCCP Medicaid |
$599.17
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$220.40
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.26 |
| Max. Negotiated Rate |
$198.36 |
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: BCBS Trust/PPO |
$179.91
|
| Rate for Payer: BCN Commercial |
$170.33
|
| Rate for Payer: Cash Price |
$176.32
|
| Rate for Payer: Cofinity Commercial |
$189.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.32
|
| Rate for Payer: Healthscope Commercial |
$198.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.34
|
| Rate for Payer: Nomi Health Commercial |
$180.73
|
| Rate for Payer: PHP Commercial |
$187.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.26
|
| Rate for Payer: Priority Health HMO/PPO |
$191.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.95
|
| Rate for Payer: UHC Core |
$184.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.30
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$357.20
|
|
|
Service Code
|
NDC 00904655061
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.84 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna Medicare |
$92.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$111.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$111.62
|
| Rate for Payer: BCBS Complete |
$142.88
|
| Rate for Payer: BCBS MAPPO |
$89.30
|
| Rate for Payer: BCBS Trust/PPO |
$293.65
|
| Rate for Payer: BCN Commercial |
$277.72
|
| Rate for Payer: BCN Medicare Advantage |
$89.30
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.30
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: Nomi Health Commercial |
$292.90
|
| Rate for Payer: PACE Senior Care Partners |
$84.84
|
| Rate for Payer: PACE SWMI |
$89.30
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: PHP Medicare Advantage |
$89.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health HMO/PPO |
$310.76
|
| Rate for Payer: Priority Health Medicare |
$90.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.32
|
| Rate for Payer: Railroad Medicare Medicare |
$89.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.34
|
| Rate for Payer: UHC Core |
$298.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.30
|
| Rate for Payer: UHC Exchange |
$89.30
|
| Rate for Payer: UHC Medicare Advantage |
$89.30
|
| Rate for Payer: VA VA |
$89.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 00904655061
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.18 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: BCBS Trust/PPO |
$291.58
|
| Rate for Payer: BCN Commercial |
$276.04
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: Nomi Health Commercial |
$292.90
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health HMO/PPO |
$310.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$239.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.34
|
| Rate for Payer: UHC Core |
$298.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$220.40
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$198.36 |
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Aetna Medicare |
$57.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.88
|
| Rate for Payer: BCBS Complete |
$88.16
|
| Rate for Payer: BCBS MAPPO |
$55.10
|
| Rate for Payer: BCBS Trust/PPO |
$181.19
|
| Rate for Payer: BCN Commercial |
$171.36
|
| Rate for Payer: BCN Medicare Advantage |
$55.10
|
| Rate for Payer: Cash Price |
$176.32
|
| Rate for Payer: Cofinity Commercial |
$189.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.10
|
| Rate for Payer: Healthscope Commercial |
$198.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.34
|
| Rate for Payer: Nomi Health Commercial |
$180.73
|
| Rate for Payer: PACE Senior Care Partners |
$52.34
|
| Rate for Payer: PACE SWMI |
$55.10
|
| Rate for Payer: PHP Commercial |
$187.34
|
| Rate for Payer: PHP Medicare Advantage |
$55.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.26
|
| Rate for Payer: Priority Health HMO/PPO |
$191.75
|
| Rate for Payer: Priority Health Medicare |
$55.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.67
|
| Rate for Payer: Railroad Medicare Medicare |
$55.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.95
|
| Rate for Payer: UHC Core |
$184.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.10
|
| Rate for Payer: UHC Exchange |
$55.10
|
| Rate for Payer: UHC Medicare Advantage |
$55.10
|
| Rate for Payer: VA VA |
$55.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.30
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
NDC 60687058711
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.69
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: BCBS MAPPO |
$0.55
|
| Rate for Payer: BCBS Trust/PPO |
$1.82
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: BCN Medicare Advantage |
$0.55
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.55
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: Nomi Health Commercial |
$1.81
|
| Rate for Payer: PACE Senior Care Partners |
$0.52
|
| Rate for Payer: PACE SWMI |
$0.55
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: PHP Medicare Advantage |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1.92
|
| Rate for Payer: Priority Health Medicare |
$0.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.48
|
| Rate for Payer: Railroad Medicare Medicare |
$0.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.55
|
| Rate for Payer: UHC Exchange |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.55
|
| Rate for Payer: VA VA |
$0.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
NDC 00115165901
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.12 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: BCBS Trust/PPO |
$287.75
|
| Rate for Payer: BCN Commercial |
$272.41
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: Nomi Health Commercial |
$289.05
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.12
|
| Rate for Payer: Priority Health HMO/PPO |
$306.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.20
|
| Rate for Payer: UHC Core |
$294.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
NDC 60687058711
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.80
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: Nomi Health Commercial |
$1.81
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health HMO/PPO |
$1.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$352.50
|
|
|
Service Code
|
NDC 00115165901
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.72 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna Medicare |
$91.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.16
|
| Rate for Payer: BCBS Complete |
$141.00
|
| Rate for Payer: BCBS MAPPO |
$88.12
|
| Rate for Payer: BCBS Trust/PPO |
$289.79
|
| Rate for Payer: BCN Commercial |
$274.07
|
| Rate for Payer: BCN Medicare Advantage |
$88.12
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.12
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: Nomi Health Commercial |
$289.05
|
| Rate for Payer: PACE Senior Care Partners |
$83.72
|
| Rate for Payer: PACE SWMI |
$88.12
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: PHP Medicare Advantage |
$88.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.12
|
| Rate for Payer: Priority Health HMO/PPO |
$306.68
|
| Rate for Payer: Priority Health Medicare |
$89.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.18
|
| Rate for Payer: Railroad Medicare Medicare |
$88.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.20
|
| Rate for Payer: UHC Core |
$294.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.12
|
| Rate for Payer: UHC Exchange |
$88.12
|
| Rate for Payer: UHC Medicare Advantage |
$88.12
|
| Rate for Payer: VA VA |
$88.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$27.86
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
29335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$25.07 |
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Medicare |
$7.24
|
| Rate for Payer: Aetna Medicare |
$5.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.21
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS Complete |
$11.14
|
| Rate for Payer: BCBS MAPPO |
$4.97
|
| Rate for Payer: BCBS MAPPO |
$6.96
|
| Rate for Payer: BCBS Trust/PPO |
$22.90
|
| Rate for Payer: BCBS Trust/PPO |
$16.34
|
| Rate for Payer: BCN Commercial |
$21.66
|
| Rate for Payer: BCN Commercial |
$15.45
|
| Rate for Payer: BCN Medicare Advantage |
$6.96
|
| Rate for Payer: BCN Medicare Advantage |
$4.97
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.96
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: Nomi Health Commercial |
$22.85
|
| Rate for Payer: Nomi Health Commercial |
$16.29
|
| Rate for Payer: PACE Senior Care Partners |
$6.62
|
| Rate for Payer: PACE Senior Care Partners |
$4.72
|
| Rate for Payer: PACE SWMI |
$6.96
|
| Rate for Payer: PACE SWMI |
$4.97
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: PHP Medicare Advantage |
$4.97
|
| Rate for Payer: PHP Medicare Advantage |
$6.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.92
|
| Rate for Payer: Priority Health HMO/PPO |
$17.29
|
| Rate for Payer: Priority Health HMO/PPO |
$24.24
|
| Rate for Payer: Priority Health Medicare |
$7.03
|
| Rate for Payer: Priority Health Medicare |
$5.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.31
|
| Rate for Payer: Railroad Medicare Medicare |
$4.97
|
| Rate for Payer: Railroad Medicare Medicare |
$6.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.52
|
| Rate for Payer: UHC Core |
$23.26
|
| Rate for Payer: UHC Core |
$16.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.97
|
| Rate for Payer: UHC Exchange |
$4.97
|
| Rate for Payer: UHC Exchange |
$6.96
|
| Rate for Payer: UHC Medicare Advantage |
$4.97
|
| Rate for Payer: UHC Medicare Advantage |
$6.96
|
| Rate for Payer: VA VA |
$4.97
|
| Rate for Payer: VA VA |
$6.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.90
|
|
|
PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.87
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
29335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Commercial |
$23.68
|
| Rate for Payer: BCBS Trust/PPO |
$16.22
|
| Rate for Payer: BCBS Trust/PPO |
$22.74
|
| Rate for Payer: BCN Commercial |
$15.36
|
| Rate for Payer: BCN Commercial |
$21.53
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$23.96
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Commercial |
$25.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.68
|
| Rate for Payer: Nomi Health Commercial |
$16.29
|
| Rate for Payer: Nomi Health Commercial |
$22.85
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: PHP Commercial |
$23.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.92
|
| Rate for Payer: Priority Health HMO/PPO |
$24.24
|
| Rate for Payer: Priority Health HMO/PPO |
$17.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.52
|
| Rate for Payer: UHC Core |
$16.59
|
| Rate for Payer: UHC Core |
$23.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.90
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$4.18
|
|
|
Service Code
|
NDC 60687059811
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: Aetna Medicare |
$1.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.31
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS MAPPO |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.44
|
| Rate for Payer: BCN Commercial |
$3.25
|
| Rate for Payer: BCN Medicare Advantage |
$1.04
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.04
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: Nomi Health Commercial |
$3.43
|
| Rate for Payer: PACE Senior Care Partners |
$0.99
|
| Rate for Payer: PACE SWMI |
$1.04
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: PHP Medicare Advantage |
$1.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3.64
|
| Rate for Payer: Priority Health Medicare |
$1.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.68
|
| Rate for Payer: UHC Core |
$3.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.04
|
| Rate for Payer: UHC Exchange |
$1.04
|
| Rate for Payer: UHC Medicare Advantage |
$1.04
|
| Rate for Payer: VA VA |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904670561
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.54 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: BCBS Trust/PPO |
$227.99
|
| Rate for Payer: BCN Commercial |
$215.84
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.40
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health HMO/PPO |
$242.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.48
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$165.78
|
|
|
Service Code
|
NDC 00904670506
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$149.20 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: BCBS Trust/PPO |
$135.33
|
| Rate for Payer: BCN Commercial |
$128.11
|
| Rate for Payer: Cash Price |
$132.62
|
| Rate for Payer: Cofinity Commercial |
$142.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.62
|
| Rate for Payer: Healthscope Commercial |
$149.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.91
|
| Rate for Payer: Nomi Health Commercial |
$135.94
|
| Rate for Payer: PHP Commercial |
$140.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.76
|
| Rate for Payer: Priority Health HMO/PPO |
$144.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.89
|
| Rate for Payer: UHC Core |
$138.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.34
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$165.78
|
|
|
Service Code
|
NDC 00904670506
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.37 |
| Max. Negotiated Rate |
$149.20 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Aetna Medicare |
$43.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.81
|
| Rate for Payer: BCBS Complete |
$66.31
|
| Rate for Payer: BCBS MAPPO |
$41.44
|
| Rate for Payer: BCBS Trust/PPO |
$136.29
|
| Rate for Payer: BCN Commercial |
$128.89
|
| Rate for Payer: BCN Medicare Advantage |
$41.44
|
| Rate for Payer: Cash Price |
$132.62
|
| Rate for Payer: Cofinity Commercial |
$142.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.44
|
| Rate for Payer: Healthscope Commercial |
$149.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.91
|
| Rate for Payer: Nomi Health Commercial |
$135.94
|
| Rate for Payer: PACE Senior Care Partners |
$39.37
|
| Rate for Payer: PACE SWMI |
$41.44
|
| Rate for Payer: PHP Commercial |
$140.91
|
| Rate for Payer: PHP Medicare Advantage |
$41.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.76
|
| Rate for Payer: Priority Health HMO/PPO |
$144.23
|
| Rate for Payer: Priority Health Medicare |
$41.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.07
|
| Rate for Payer: Railroad Medicare Medicare |
$41.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.89
|
| Rate for Payer: UHC Core |
$138.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.44
|
| Rate for Payer: UHC Exchange |
$41.44
|
| Rate for Payer: UHC Medicare Advantage |
$41.44
|
| Rate for Payer: VA VA |
$41.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.34
|
|
