|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99422
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$29.71
|
| Rate for Payer: Aetna Medicare |
$23.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.92
|
| Rate for Payer: BCBS Complete |
$20.67
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCN Commercial |
$49.00
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.28
|
| Rate for Payer: Meridian Medicaid |
$20.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.39
|
| Rate for Payer: Nomi Health Commercial |
$26.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Commercial |
$31.04
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28.81
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health SBD |
$28.81
|
| Rate for Payer: Priority Health Tiered Network |
$28.81
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.03
|
| Rate for Payer: UHC Core |
$38.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.17
|
| Rate for Payer: UHC Exchange |
$38.03
|
| Rate for Payer: UHC Medicaid |
$19.69
|
| Rate for Payer: UHCCP Medicaid |
$19.69
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$60.56 |
| Rate for Payer: Aetna Commercial |
$46.51
|
| Rate for Payer: Aetna Medicare |
$36.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.98
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS MAPPO |
$34.71
|
| Rate for Payer: BCN Commercial |
$50.49
|
| Rate for Payer: BCN Medicare Advantage |
$34.71
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.45
|
| Rate for Payer: Meridian Medicaid |
$32.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.18
|
| Rate for Payer: Nomi Health Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$34.71
|
| Rate for Payer: PHP Commercial |
$48.59
|
| Rate for Payer: PHP Medicare Advantage |
$34.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44.73
|
| Rate for Payer: Priority Health Medicare |
$34.71
|
| Rate for Payer: Priority Health SBD |
$44.73
|
| Rate for Payer: Priority Health Tiered Network |
$44.73
|
| Rate for Payer: Railroad Medicare Medicare |
$34.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.56
|
| Rate for Payer: UHC Core |
$60.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.71
|
| Rate for Payer: UHC Exchange |
$60.56
|
| Rate for Payer: UHC Medicaid |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$30.86
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: Aetna Medicare |
$11.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.74
|
| Rate for Payer: BCBS Complete |
$10.19
|
| Rate for Payer: BCBS MAPPO |
$10.93
|
| Rate for Payer: BCN Commercial |
$22.41
|
| Rate for Payer: BCN Medicare Advantage |
$10.93
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Cofinity Commercial |
$15.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.48
|
| Rate for Payer: Meridian Medicaid |
$10.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.02
|
| Rate for Payer: Nomi Health Commercial |
$13.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$10.93
|
| Rate for Payer: PHP Commercial |
$15.30
|
| Rate for Payer: PHP Medicare Advantage |
$10.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.41
|
| Rate for Payer: Priority Health Medicare |
$10.93
|
| Rate for Payer: Priority Health SBD |
$14.41
|
| Rate for Payer: Priority Health Tiered Network |
$14.41
|
| Rate for Payer: Railroad Medicare Medicare |
$10.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.53
|
| Rate for Payer: UHC Core |
$18.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.93
|
| Rate for Payer: UHC Exchange |
$18.53
|
| Rate for Payer: UHC Medicaid |
$9.70
|
| Rate for Payer: UHCCP Medicaid |
$9.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,904.00
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$328.66 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna Commercial |
$677.85
|
| Rate for Payer: Aetna Medicare |
$526.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.44
|
| Rate for Payer: BCBS Complete |
$345.09
|
| Rate for Payer: BCBS MAPPO |
$505.86
|
| Rate for Payer: BCN Commercial |
$836.61
|
| Rate for Payer: BCN Medicare Advantage |
$505.86
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cofinity Commercial |
$677.85
|
| Rate for Payer: Cofinity Commercial |
$728.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.15
|
| Rate for Payer: Meridian Medicaid |
$345.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$556.45
|
| Rate for Payer: Nomi Health Commercial |
$607.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,178.00
|
| Rate for Payer: PACE SWMI |
$505.86
|
| Rate for Payer: PHP Commercial |
$708.20
|
| Rate for Payer: PHP Medicare Advantage |
$505.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$847.30
|
| Rate for Payer: Priority Health Medicare |
$505.86
|
| Rate for Payer: Priority Health SBD |
$847.30
|
| Rate for Payer: Priority Health Tiered Network |
$847.30
|
| Rate for Payer: Railroad Medicare Medicare |
$505.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$950.86
|
| Rate for Payer: UHC Core |
$950.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$505.86
|
| Rate for Payer: UHC Exchange |
$950.86
|
| Rate for Payer: UHC Medicaid |
$328.66
|
| Rate for Payer: UHCCP Medicaid |
$328.66
|
| Rate for Payer: UMR Bronson Commercial |
$1,335.84
|
|
|
PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 58943
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$2,055.74 |
| Rate for Payer: Aetna Commercial |
$1,498.63
|
| Rate for Payer: Aetna Medicare |
$1,163.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,498.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,610.47
|
| Rate for Payer: BCBS Complete |
$756.39
|
| Rate for Payer: BCBS MAPPO |
$1,118.38
|
| Rate for Payer: BCN Commercial |
$1,805.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cofinity Commercial |
$1,498.63
|
| Rate for Payer: Cofinity Commercial |
$1,610.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,118.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,174.30
|
| Rate for Payer: Meridian Medicaid |
$756.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,230.22
|
| Rate for Payer: Nomi Health Commercial |
$1,342.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,781.25
|
| Rate for Payer: PACE SWMI |
$1,118.38
|
| Rate for Payer: PHP Commercial |
$1,565.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,118.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,828.76
|
| Rate for Payer: Priority Health Medicare |
$1,118.38
|
| Rate for Payer: Priority Health SBD |
$1,828.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,828.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,118.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,055.74
|
| Rate for Payer: UHC Core |
$2,055.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,118.38
|
| Rate for Payer: UHC Exchange |
$2,055.74
|
| Rate for Payer: UHC Medicaid |
$720.37
|
| Rate for Payer: UHCCP Medicaid |
$720.37
|
| Rate for Payer: UMR Bronson Commercial |
$1,092.50
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$359.55
|
|
|
Service Code
|
NDC 59651025601
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna American Axle |
$233.71
|
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.71
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Advantage |
$251.69
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.66
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health SBD |
$226.52
|
| Rate for Payer: UMR Bronson Commercial |
$158.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$239.40
|
|
|
Service Code
|
NDC 62559023001
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.58 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna American Axle |
$155.61
|
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: Aetna Medicare |
$119.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.61
|
| Rate for Payer: BCBS Complete |
$95.76
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Advantage |
$167.58
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$191.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.55
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: Priority Health SBD |
$150.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.61
|
| Rate for Payer: UHC Core |
$124.73
|
| Rate for Payer: UHC Exchange |
$94.08
|
| Rate for Payer: UMR Bronson Commercial |
$88.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$241.30
|
|
|
Service Code
|
NDC 53489055101
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.28 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna American Axle |
$156.84
|
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna Medicare |
$120.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.84
|
| Rate for Payer: BCBS Complete |
$96.52
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Advantage |
$168.91
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health SBD |
$152.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.84
|
| Rate for Payer: UHC Core |
$125.72
|
| Rate for Payer: UHC Exchange |
$94.83
|
| Rate for Payer: UMR Bronson Commercial |
$89.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$3.84
|
|
|
Service Code
|
NDC 60687093011
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna American Axle |
$2.50
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cofinity Advantage |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.88
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health SBD |
$2.42
|
| Rate for Payer: UMR Bronson Commercial |
$1.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.88
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$359.55
|
|
|
Service Code
|
NDC 59651025601
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.03 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna American Axle |
$233.71
|
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna Medicare |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.71
|
| Rate for Payer: BCBS Complete |
$143.82
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Advantage |
$251.69
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.66
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health SBD |
$226.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.71
|
| Rate for Payer: UHC Core |
$187.33
|
| Rate for Payer: UHC Exchange |
$141.30
|
| Rate for Payer: UMR Bronson Commercial |
$133.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$204.25
|
|
|
Service Code
|
NDC 00603544821
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.87 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna American Axle |
$132.76
|
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.76
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Advantage |
$142.97
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$183.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health SBD |
$128.68
|
| Rate for Payer: UMR Bronson Commercial |
$89.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.19
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$239.40
|
|
|
Service Code
|
NDC 62559023001
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna American Axle |
$155.61
|
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.61
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Advantage |
$167.58
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$179.55
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: Priority Health SBD |
$150.82
|
| Rate for Payer: UMR Bronson Commercial |
$105.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$241.30
|
|
|
Service Code
|
NDC 53489055101
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.17 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna American Axle |
$156.84
|
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.84
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Advantage |
$168.91
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health SBD |
$152.02
|
| Rate for Payer: UMR Bronson Commercial |
$106.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$3.84
|
|
|
Service Code
|
NDC 60687093011
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Aetna American Axle |
$2.50
|
| Rate for Payer: Aetna Commercial |
$3.26
|
| Rate for Payer: Aetna Medicare |
$1.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.50
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cofinity Advantage |
$2.69
|
| Rate for Payer: Cofinity Commercial |
$3.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.07
|
| Rate for Payer: Healthscope Commercial |
$3.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.88
|
| Rate for Payer: PHP Commercial |
$3.26
|
| Rate for Payer: Priority Health SBD |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.50
|
| Rate for Payer: UHC Core |
$2.00
|
| Rate for Payer: UHC Exchange |
$1.51
|
| Rate for Payer: UMR Bronson Commercial |
$1.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.88
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$383.52
|
|
|
Service Code
|
NDC 60687093001
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$345.17 |
| Rate for Payer: Aetna American Axle |
$249.29
|
| Rate for Payer: Aetna Commercial |
$325.99
|
| Rate for Payer: Aetna Medicare |
$191.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.29
|
| Rate for Payer: BCBS Complete |
$153.41
|
| Rate for Payer: Cash Price |
$306.82
|
| Rate for Payer: Cofinity Advantage |
$268.46
|
| Rate for Payer: Cofinity Commercial |
$329.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.82
|
| Rate for Payer: Healthscope Commercial |
$345.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$306.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.64
|
| Rate for Payer: PHP Commercial |
$325.99
|
| Rate for Payer: Priority Health SBD |
$241.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$249.29
|
| Rate for Payer: UHC Core |
$199.81
|
| Rate for Payer: UHC Exchange |
$150.72
|
| Rate for Payer: UMR Bronson Commercial |
$141.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.64
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$383.52
|
|
|
Service Code
|
NDC 60687093001
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.75 |
| Max. Negotiated Rate |
$345.17 |
| Rate for Payer: Aetna American Axle |
$249.29
|
| Rate for Payer: Aetna Commercial |
$325.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.29
|
| Rate for Payer: Cash Price |
$306.82
|
| Rate for Payer: Cofinity Advantage |
$268.46
|
| Rate for Payer: Cofinity Commercial |
$329.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$306.82
|
| Rate for Payer: Healthscope Commercial |
$345.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$268.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$287.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$325.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$287.64
|
| Rate for Payer: PHP Commercial |
$325.99
|
| Rate for Payer: Priority Health SBD |
$241.62
|
| Rate for Payer: UMR Bronson Commercial |
$168.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$287.64
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$204.25
|
|
|
Service Code
|
NDC 00603544821
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.57 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna American Axle |
$132.76
|
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: Aetna Medicare |
$102.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.76
|
| Rate for Payer: BCBS Complete |
$81.70
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Advantage |
$142.97
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$183.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.19
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health SBD |
$128.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.76
|
| Rate for Payer: UHC Core |
$106.41
|
| Rate for Payer: UHC Exchange |
$80.27
|
| Rate for Payer: UMR Bronson Commercial |
$75.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.19
|
|
|
PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$1,214.12
|
|
|
Service Code
|
NDC 49884011302
|
| Hospital Charge Code |
37643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$449.22 |
| Max. Negotiated Rate |
$1,092.71 |
| Rate for Payer: Aetna American Axle |
$789.18
|
| Rate for Payer: Aetna Commercial |
$1,032.00
|
| Rate for Payer: Aetna Medicare |
$607.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.18
|
| Rate for Payer: BCBS Complete |
$485.65
|
| Rate for Payer: Cash Price |
$971.30
|
| Rate for Payer: Cofinity Advantage |
$849.88
|
| Rate for Payer: Cofinity Commercial |
$1,044.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.30
|
| Rate for Payer: Healthscope Commercial |
$1,092.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$971.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,032.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$910.59
|
| Rate for Payer: PHP Commercial |
$1,032.00
|
| Rate for Payer: Priority Health SBD |
$764.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$789.18
|
| Rate for Payer: UHC Core |
$632.56
|
| Rate for Payer: UHC Exchange |
$477.15
|
| Rate for Payer: UMR Bronson Commercial |
$449.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.59
|
|
|
PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$452.66
|
|
|
Service Code
|
NDC 00832074060
|
| Hospital Charge Code |
37643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.17 |
| Max. Negotiated Rate |
$407.39 |
| Rate for Payer: Aetna American Axle |
$294.23
|
| Rate for Payer: Aetna Commercial |
$384.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.23
|
| Rate for Payer: Cash Price |
$362.13
|
| Rate for Payer: Cofinity Advantage |
$316.86
|
| Rate for Payer: Cofinity Commercial |
$389.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.13
|
| Rate for Payer: Healthscope Commercial |
$407.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.50
|
| Rate for Payer: PHP Commercial |
$384.76
|
| Rate for Payer: Priority Health SBD |
$285.18
|
| Rate for Payer: UMR Bronson Commercial |
$199.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.50
|
|
|
PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$452.66
|
|
|
Service Code
|
NDC 00832074060
|
| Hospital Charge Code |
37643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.48 |
| Max. Negotiated Rate |
$407.39 |
| Rate for Payer: Aetna American Axle |
$294.23
|
| Rate for Payer: Aetna Commercial |
$384.76
|
| Rate for Payer: Aetna Medicare |
$226.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.23
|
| Rate for Payer: BCBS Complete |
$181.06
|
| Rate for Payer: Cash Price |
$362.13
|
| Rate for Payer: Cofinity Advantage |
$316.86
|
| Rate for Payer: Cofinity Commercial |
$389.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.13
|
| Rate for Payer: Healthscope Commercial |
$407.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.50
|
| Rate for Payer: PHP Commercial |
$384.76
|
| Rate for Payer: Priority Health SBD |
$285.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.23
|
| Rate for Payer: UHC Core |
$235.84
|
| Rate for Payer: UHC Exchange |
$177.90
|
| Rate for Payer: UMR Bronson Commercial |
$167.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.50
|
|
|
PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$1,214.12
|
|
|
Service Code
|
NDC 49884011302
|
| Hospital Charge Code |
37643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$534.21 |
| Max. Negotiated Rate |
$1,092.71 |
| Rate for Payer: Aetna American Axle |
$789.18
|
| Rate for Payer: Aetna Commercial |
$1,032.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.18
|
| Rate for Payer: Cash Price |
$971.30
|
| Rate for Payer: Cofinity Advantage |
$849.88
|
| Rate for Payer: Cofinity Commercial |
$1,044.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.30
|
| Rate for Payer: Healthscope Commercial |
$1,092.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,032.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$910.59
|
| Rate for Payer: PHP Commercial |
$1,032.00
|
| Rate for Payer: Priority Health SBD |
$764.90
|
| Rate for Payer: UMR Bronson Commercial |
$534.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.59
|
|
|
PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$263.52
|
|
|
Service Code
|
NDC 69680013160
|
| Hospital Charge Code |
37644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.95 |
| Max. Negotiated Rate |
$237.17 |
| Rate for Payer: Aetna American Axle |
$171.29
|
| Rate for Payer: Aetna Commercial |
$223.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cofinity Advantage |
$184.46
|
| Rate for Payer: Cofinity Commercial |
$226.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.82
|
| Rate for Payer: Healthscope Commercial |
$237.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.64
|
| Rate for Payer: PHP Commercial |
$223.99
|
| Rate for Payer: Priority Health SBD |
$166.02
|
| Rate for Payer: UMR Bronson Commercial |
$115.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.64
|
|
|
PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$263.52
|
|
|
Service Code
|
NDC 69680013160
|
| Hospital Charge Code |
37644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.50 |
| Max. Negotiated Rate |
$237.17 |
| Rate for Payer: Aetna American Axle |
$171.29
|
| Rate for Payer: Aetna Commercial |
$223.99
|
| Rate for Payer: Aetna Medicare |
$131.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.29
|
| Rate for Payer: BCBS Complete |
$105.41
|
| Rate for Payer: Cash Price |
$210.82
|
| Rate for Payer: Cofinity Advantage |
$184.46
|
| Rate for Payer: Cofinity Commercial |
$226.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.82
|
| Rate for Payer: Healthscope Commercial |
$237.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$210.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$223.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.64
|
| Rate for Payer: PHP Commercial |
$223.99
|
| Rate for Payer: Priority Health SBD |
$166.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.29
|
| Rate for Payer: UHC Core |
$137.29
|
| Rate for Payer: UHC Exchange |
$103.56
|
| Rate for Payer: UMR Bronson Commercial |
$97.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.64
|
|
|
PROPAFENONE ER 425 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 64380018601
|
| Hospital Charge Code |
37645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Advantage |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.88
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
PROPAFENONE ER 425 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$3,151.07
|
|
|
Service Code
|
NDC 00173082618
|
| Hospital Charge Code |
37645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,386.47 |
| Max. Negotiated Rate |
$2,835.96 |
| Rate for Payer: Aetna American Axle |
$2,048.20
|
| Rate for Payer: Aetna Commercial |
$2,678.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,048.20
|
| Rate for Payer: Cash Price |
$2,520.86
|
| Rate for Payer: Cofinity Advantage |
$2,205.75
|
| Rate for Payer: Cofinity Commercial |
$2,709.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,520.86
|
| Rate for Payer: Healthscope Commercial |
$2,835.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,205.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,363.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,678.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,363.30
|
| Rate for Payer: PHP Commercial |
$2,678.41
|
| Rate for Payer: Priority Health SBD |
$1,985.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,386.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,363.30
|
|
