|
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 Commercial |
$142.98
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.98
|
| 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 |
$142.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.76
|
| 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
|
$236.55
|
|
|
Service Code
|
NDC 62559023001
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna American Axle |
$153.76
|
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.76
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.07
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.76
|
| Rate for Payer: Priority Health SBD |
$149.03
|
| Rate for Payer: UMR Bronson Commercial |
$104.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$350.15
|
|
|
Service Code
|
NDC 59651025601
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.56 |
| Max. Negotiated Rate |
$315.14 |
| Rate for Payer: Aetna American Axle |
$227.60
|
| Rate for Payer: Aetna Commercial |
$297.63
|
| Rate for Payer: Aetna Medicare |
$175.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.60
|
| Rate for Payer: BCBS Complete |
$140.06
|
| Rate for Payer: Cash Price |
$280.12
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$301.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$245.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.12
|
| Rate for Payer: Healthscope Commercial |
$315.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$262.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$297.63
|
| Rate for Payer: PHP Commercial |
$297.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.60
|
| Rate for Payer: Priority Health SBD |
$220.59
|
| Rate for Payer: UMR Bronson Commercial |
$129.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$262.61
|
|
|
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 Commercial |
$142.98
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.98
|
| 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 |
$142.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.61
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.76
|
| Rate for Payer: Priority Health SBD |
$128.68
|
| Rate for Payer: UMR Bronson Commercial |
$75.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.19
|
|
|
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 Commercial |
$168.91
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.91
|
| 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 |
$180.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.84
|
| Rate for Payer: Priority Health SBD |
$152.02
|
| Rate for Payer: UMR Bronson Commercial |
$89.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.98
|
|
|
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 Commercial |
$168.91
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$168.91
|
| 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 |
$180.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.84
|
| 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 |
$180.98
|
|
|
PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$270.75
|
|
|
Service Code
|
NDC 00832074060
|
| Hospital Charge Code |
37643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Aetna American Axle |
$175.99
|
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.99
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Commercial |
$189.52
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.14
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.99
|
| Rate for Payer: Priority Health SBD |
$170.57
|
| Rate for Payer: UMR Bronson Commercial |
$119.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
|
|
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 Commercial |
$1,044.14
|
| Rate for Payer: Cofinity Commercial |
$849.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.88
|
| 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: PHP Commercial |
$1,032.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.18
|
| 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 225 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
OP
|
$270.75
|
|
|
Service Code
|
NDC 00832074060
|
| Hospital Charge Code |
37643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.18 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Aetna American Axle |
$175.99
|
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: Aetna Medicare |
$135.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.99
|
| Rate for Payer: BCBS Complete |
$108.30
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Commercial |
$189.52
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.14
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.99
|
| Rate for Payer: Priority Health SBD |
$170.57
|
| Rate for Payer: UMR Bronson Commercial |
$100.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
|
|
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 Commercial |
$1,044.14
|
| Rate for Payer: Cofinity Commercial |
$849.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$849.88
|
| 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: PHP Commercial |
$1,032.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$789.18
|
| Rate for Payer: Priority Health SBD |
$764.90
|
| Rate for Payer: UMR Bronson Commercial |
$449.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.59
|
|
|
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 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 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
|
|
|
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
|
|
|
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 |
$87.88 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$83.00
|
| Rate for Payer: Aetna Medicare |
$48.82
|
| 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 |
$87.88
|
| 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
|
$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
|
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
|
$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 |
$98.32
|
| 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 |
$98.32
|
|
|
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 |
$58.36
|
| 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
|
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
|
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
|
|
|
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 |
$98.32
|
| 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 |
$98.32
|
|
|
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 |
$87.88 |
| 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 |
$87.88
|
| 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
|
|
