|
PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$275.62
|
|
|
Service Code
|
NDC 69680013160
|
| Hospital Charge Code |
37644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.98 |
| Max. Negotiated Rate |
$248.06 |
| Rate for Payer: Aetna American Axle |
$179.15
|
| Rate for Payer: Aetna Commercial |
$234.28
|
| Rate for Payer: Aetna Medicare |
$137.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.15
|
| Rate for Payer: BCBS Complete |
$110.25
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$192.93
|
| Rate for Payer: Cofinity Commercial |
$237.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.50
|
| Rate for Payer: Healthscope Commercial |
$248.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.28
|
| Rate for Payer: PHP Commercial |
$234.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.15
|
| Rate for Payer: Priority Health SBD |
$173.64
|
| Rate for Payer: UMR Bronson Commercial |
$101.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.72
|
|
|
PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$275.62
|
|
|
Service Code
|
NDC 69680013160
|
| Hospital Charge Code |
37644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$248.06 |
| Rate for Payer: Aetna American Axle |
$179.15
|
| Rate for Payer: Aetna Commercial |
$234.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.15
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$192.93
|
| Rate for Payer: Cofinity Commercial |
$237.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$192.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.50
|
| Rate for Payer: Healthscope Commercial |
$248.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.28
|
| Rate for Payer: PHP Commercial |
$234.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.15
|
| Rate for Payer: Priority Health SBD |
$173.64
|
| Rate for Payer: UMR Bronson Commercial |
$121.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.72
|
|
|
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 Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.49
|
| 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: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| 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
|
OP
|
$3,151.07
|
|
|
Service Code
|
NDC 00173082618
|
| Hospital Charge Code |
37645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,165.90 |
| 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 Medicare |
$1,575.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,048.20
|
| Rate for Payer: BCBS Complete |
$1,260.43
|
| Rate for Payer: Cash Price |
$2,520.86
|
| Rate for Payer: Cofinity Commercial |
$2,205.75
|
| Rate for Payer: Cofinity Commercial |
$2,709.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,205.75
|
| 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: PHP Commercial |
$2,678.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,048.20
|
| Rate for Payer: Priority Health SBD |
$1,985.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,165.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,363.30
|
|
|
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 Commercial |
$2,205.75
|
| Rate for Payer: Cofinity Commercial |
$2,709.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,205.75
|
| 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: PHP Commercial |
$2,678.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,048.20
|
| 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
|
|
|
PROPAFENONE ER 425 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 64380018601
|
| Hospital Charge Code |
37645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.49
|
| 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: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$99.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$131.10
|
|
|
Service Code
|
NDC 00998001615
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna American Axle |
$85.22
|
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna Medicare |
$65.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.22
|
| Rate for Payer: BCBS Complete |
$52.44
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Cofinity Commercial |
$91.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.22
|
| Rate for Payer: Priority Health SBD |
$82.59
|
| Rate for Payer: UMR Bronson Commercial |
$48.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.33
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$131.10
|
|
|
Service Code
|
NDC 00998001615
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna American Axle |
$85.22
|
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.22
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Cofinity Commercial |
$91.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$91.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.22
|
| Rate for Payer: Priority Health SBD |
$82.59
|
| Rate for Payer: UMR Bronson Commercial |
$57.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.33
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$116.71
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$105.04 |
| Rate for Payer: Aetna American Axle |
$75.86
|
| Rate for Payer: Aetna Commercial |
$99.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.86
|
| Rate for Payer: Cash Price |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.37
|
| Rate for Payer: Healthscope Commercial |
$105.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.20
|
| Rate for Payer: PHP Commercial |
$99.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.86
|
| Rate for Payer: Priority Health SBD |
$73.53
|
| Rate for Payer: UMR Bronson Commercial |
$51.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.53
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$8.69
|
|
|
Service Code
|
NDC 09900000394
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna American Axle |
$5.65
|
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.65
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cofinity Commercial |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.95
|
| Rate for Payer: Healthscope Commercial |
$7.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.65
|
| Rate for Payer: Priority Health SBD |
$5.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.52
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.08 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna American Axle |
$73.92
|
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna Medicare |
$56.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.92
|
| Rate for Payer: Priority Health SBD |
$71.64
|
| Rate for Payer: UMR Bronson Commercial |
$42.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.97 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health SBD |
$61.52
|
| Rate for Payer: UMR Bronson Commercial |
$42.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$8.69
|
|
|
Service Code
|
NDC 09900000394
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna American Axle |
$5.65
|
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna Medicare |
$4.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.65
|
| Rate for Payer: BCBS Complete |
$3.48
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cofinity Commercial |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.95
|
| Rate for Payer: Healthscope Commercial |
$7.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.39
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.65
|
| Rate for Payer: Priority Health SBD |
$5.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.52
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$116.71
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.18 |
| Max. Negotiated Rate |
$105.04 |
| Rate for Payer: Aetna American Axle |
$75.86
|
| Rate for Payer: Aetna Commercial |
$99.20
|
| Rate for Payer: Aetna Medicare |
$58.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.86
|
| Rate for Payer: BCBS Complete |
$46.68
|
| Rate for Payer: Cash Price |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.37
|
| Rate for Payer: Healthscope Commercial |
$105.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.20
|
| Rate for Payer: PHP Commercial |
$99.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.86
|
| Rate for Payer: Priority Health SBD |
$73.53
|
| Rate for Payer: UMR Bronson Commercial |
$43.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.53
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$87.89 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna Medicare |
$48.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$68.36
|
| Rate for Payer: Cofinity Commercial |
$83.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$87.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: PHP Commercial |
$83.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health SBD |
$61.52
|
| Rate for Payer: UMR Bronson Commercial |
$36.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.24
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna American Axle |
$73.92
|
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.92
|
| Rate for Payer: Priority Health SBD |
$71.64
|
| Rate for Payer: UMR Bronson Commercial |
$50.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
PR OPEN ABLATION 1/>RENAL MASS LESION CRYOSURGICAL
|
Professional
|
Both
|
$2,527.00
|
|
|
Service Code
|
HCPCS 50250
|
| Min. Negotiated Rate |
$1,010.80 |
| Max. Negotiated Rate |
$1,668.84 |
| Rate for Payer: Aetna Commercial |
$1,552.95
|
| Rate for Payer: Aetna Medicare |
$1,205.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,668.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,552.95
|
| Rate for Payer: BCBS Complete |
$1,010.80
|
| Rate for Payer: BCBS MAPPO |
$1,158.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,158.92
|
| Rate for Payer: Cash Price |
$2,021.60
|
| Rate for Payer: Cash Price |
$2,021.60
|
| Rate for Payer: Cofinity Commercial |
$1,668.84
|
| Rate for Payer: Cofinity Commercial |
$1,552.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,158.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,216.87
|
| Rate for Payer: Nomi Health Commercial |
$1,390.70
|
| Rate for Payer: PACE SWMI |
$1,158.92
|
| Rate for Payer: PHP Commercial |
$1,622.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,158.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,642.55
|
| Rate for Payer: Priority Health Medicare |
$1,158.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,158.92
|
| Rate for Payer: UHC Medicare Advantage |
$1,158.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,162.42
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 38531
|
| Min. Negotiated Rate |
$360.40 |
| Max. Negotiated Rate |
$624.14 |
| Rate for Payer: Aetna Commercial |
$580.80
|
| Rate for Payer: Aetna Medicare |
$450.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.80
|
| Rate for Payer: BCBS Complete |
$360.40
|
| Rate for Payer: BCBS MAPPO |
$433.43
|
| Rate for Payer: BCN Medicare Advantage |
$433.43
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$624.14
|
| Rate for Payer: Cofinity Commercial |
$580.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.10
|
| Rate for Payer: Nomi Health Commercial |
$520.12
|
| Rate for Payer: PACE SWMI |
$433.43
|
| Rate for Payer: PHP Commercial |
$606.80
|
| Rate for Payer: PHP Medicare Advantage |
$433.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health Medicare |
$433.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.43
|
| Rate for Payer: UHC Medicare Advantage |
$433.43
|
| Rate for Payer: UMR Bronson Commercial |
$414.46
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$333.37 |
| Max. Negotiated Rate |
$10,512.58 |
| Rate for Payer: Aetna American Axle |
$585.65
|
| Rate for Payer: Aetna Commercial |
$765.85
|
| Rate for Payer: Aetna Medicare |
$3,884.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,668.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,668.27
|
| Rate for Payer: BCBS Complete |
$2,101.84
|
| Rate for Payer: BCBS MAPPO |
$3,734.62
|
| Rate for Payer: BCN Medicare Advantage |
$3,734.62
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$774.86
|
| Rate for Payer: Cofinity Commercial |
$630.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$630.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,734.62
|
| Rate for Payer: Healthscope Commercial |
$810.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.75
|
| Rate for Payer: Mclaren Medicaid |
$2,001.76
|
| Rate for Payer: Mclaren Medicare |
$3,734.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,921.35
|
| Rate for Payer: Meridian Medicaid |
$2,101.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,294.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.85
|
| Rate for Payer: PACE Medicare |
$3,547.89
|
| Rate for Payer: PACE SWMI |
$3,734.62
|
| Rate for Payer: PHP Commercial |
$765.85
|
| Rate for Payer: PHP Medicare Advantage |
$3,734.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,001.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health Medicare |
$3,734.62
|
| Rate for Payer: Priority Health SBD |
$567.63
|
| Rate for Payer: Railroad Medicare Medicare |
$3,734.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,512.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,734.62
|
| Rate for Payer: UHC Exchange |
$7,137.23
|
| Rate for Payer: UHC Medicare Advantage |
$3,734.62
|
| Rate for Payer: UHCCP Medicaid |
$2,001.76
|
| Rate for Payer: UMR Bronson Commercial |
$333.37
|
| Rate for Payer: VA VA |
$3,734.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.75
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
HCPCS 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$360.40 |
| Max. Negotiated Rate |
$624.14 |
| Rate for Payer: Aetna Commercial |
$580.80
|
| Rate for Payer: Aetna Medicare |
$450.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$624.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$580.80
|
| Rate for Payer: BCBS Complete |
$360.40
|
| Rate for Payer: BCBS MAPPO |
$433.43
|
| Rate for Payer: BCN Medicare Advantage |
$433.43
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$624.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$433.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$455.10
|
| Rate for Payer: Nomi Health Commercial |
$520.12
|
| Rate for Payer: PACE SWMI |
$433.43
|
| Rate for Payer: PHP Commercial |
$606.80
|
| Rate for Payer: PHP Medicare Advantage |
$433.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health Medicare |
$433.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$433.43
|
| Rate for Payer: UHC Medicare Advantage |
$433.43
|
| Rate for Payer: UMR Bronson Commercial |
$414.46
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 38531
|
| Hospital Charge Code |
38531
|
| Min. Negotiated Rate |
$396.44 |
| Max. Negotiated Rate |
$810.90 |
| Rate for Payer: Aetna American Axle |
$585.65
|
| Rate for Payer: Aetna Commercial |
$765.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$585.65
|
| Rate for Payer: Cash Price |
$720.80
|
| Rate for Payer: Cofinity Commercial |
$630.70
|
| Rate for Payer: Cofinity Commercial |
$774.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$630.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$720.80
|
| Rate for Payer: Healthscope Commercial |
$810.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$765.85
|
| Rate for Payer: PHP Commercial |
$765.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$585.65
|
| Rate for Payer: Priority Health SBD |
$567.63
|
| Rate for Payer: UMR Bronson Commercial |
$396.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.75
|
|
|
PR OPEN CLOSURE MAJOR BRONCHIAL FISTULA
|
Professional
|
Both
|
$4,782.00
|
|
|
Service Code
|
HCPCS 32815
|
| Min. Negotiated Rate |
$1,912.80 |
| Max. Negotiated Rate |
$3,872.69 |
| Rate for Payer: Aetna Commercial |
$3,603.76
|
| Rate for Payer: Aetna Medicare |
$2,796.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,872.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,603.76
|
| Rate for Payer: BCBS Complete |
$1,912.80
|
| Rate for Payer: BCBS MAPPO |
$2,689.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,689.37
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cash Price |
$3,825.60
|
| Rate for Payer: Cofinity Commercial |
$3,872.69
|
| Rate for Payer: Cofinity Commercial |
$3,603.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,689.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,823.84
|
| Rate for Payer: Nomi Health Commercial |
$3,227.24
|
| Rate for Payer: PACE SWMI |
$2,689.37
|
| Rate for Payer: PHP Commercial |
$3,765.12
|
| Rate for Payer: PHP Medicare Advantage |
$2,689.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,108.30
|
| Rate for Payer: Priority Health Medicare |
$2,689.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,689.37
|
| Rate for Payer: UHC Medicare Advantage |
$2,689.37
|
| Rate for Payer: UMR Bronson Commercial |
$2,199.72
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 10.1-20 CM
|
Professional
|
Both
|
$4,070.00
|
|
|
Service Code
|
HCPCS 49188
|
| Min. Negotiated Rate |
$1,628.00 |
| Max. Negotiated Rate |
$2,791.57 |
| Rate for Payer: Aetna Commercial |
$2,597.71
|
| Rate for Payer: Aetna Medicare |
$2,016.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,791.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,597.71
|
| Rate for Payer: BCBS Complete |
$1,628.00
|
| Rate for Payer: BCBS MAPPO |
$1,938.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,938.59
|
| Rate for Payer: Cash Price |
$3,256.00
|
| Rate for Payer: Cash Price |
$3,256.00
|
| Rate for Payer: Cofinity Commercial |
$2,791.57
|
| Rate for Payer: Cofinity Commercial |
$2,597.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,938.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,035.52
|
| Rate for Payer: Nomi Health Commercial |
$2,326.31
|
| Rate for Payer: PACE SWMI |
$1,938.59
|
| Rate for Payer: PHP Commercial |
$2,714.03
|
| Rate for Payer: PHP Medicare Advantage |
$1,938.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,645.50
|
| Rate for Payer: Priority Health Medicare |
$1,938.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,938.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,938.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,872.20
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5 CM OR LESS
|
Professional
|
Both
|
$2,694.00
|
|
|
Service Code
|
HCPCS 49186
|
| Min. Negotiated Rate |
$1,077.60 |
| Max. Negotiated Rate |
$1,821.02 |
| Rate for Payer: Aetna Commercial |
$1,694.56
|
| Rate for Payer: Aetna Medicare |
$1,315.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,821.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,694.56
|
| Rate for Payer: BCBS Complete |
$1,077.60
|
| Rate for Payer: BCBS MAPPO |
$1,264.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,264.60
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cofinity Commercial |
$1,821.02
|
| Rate for Payer: Cofinity Commercial |
$1,694.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,264.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,327.83
|
| Rate for Payer: Nomi Health Commercial |
$1,517.52
|
| Rate for Payer: PACE SWMI |
$1,264.60
|
| Rate for Payer: PHP Commercial |
$1,770.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,264.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,751.10
|
| Rate for Payer: Priority Health Medicare |
$1,264.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,264.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,264.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,239.24
|
|
|
PR OPEN HARVEST UPPER EXTREMITY ART 1 SEGMENT CAB
|
Professional
|
Both
|
$1,287.00
|
|
|
Service Code
|
HCPCS 35600
|
| Min. Negotiated Rate |
$178.14 |
| Max. Negotiated Rate |
$836.55 |
| Rate for Payer: Aetna Commercial |
$238.71
|
| Rate for Payer: Aetna Medicare |
$185.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.71
|
| Rate for Payer: BCBS Complete |
$514.80
|
| Rate for Payer: BCBS MAPPO |
$178.14
|
| Rate for Payer: BCN Medicare Advantage |
$178.14
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cash Price |
$1,029.60
|
| Rate for Payer: Cofinity Commercial |
$256.52
|
| Rate for Payer: Cofinity Commercial |
$238.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.05
|
| Rate for Payer: Nomi Health Commercial |
$213.77
|
| Rate for Payer: PACE SWMI |
$178.14
|
| Rate for Payer: PHP Commercial |
$249.40
|
| Rate for Payer: PHP Medicare Advantage |
$178.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$836.55
|
| Rate for Payer: Priority Health Medicare |
$178.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$178.14
|
| Rate for Payer: UHC Medicare Advantage |
$178.14
|
| Rate for Payer: UMR Bronson Commercial |
$592.02
|
|
