|
PR OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH
|
Professional
|
Both
|
$4,812.00
|
|
|
Service Code
|
HCPCS 34830
|
| Min. Negotiated Rate |
$1,698.38 |
| Max. Negotiated Rate |
$3,127.80 |
| Rate for Payer: Aetna Commercial |
$2,275.83
|
| Rate for Payer: Aetna Medicare |
$1,766.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,445.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,275.83
|
| Rate for Payer: BCBS Complete |
$1,924.80
|
| Rate for Payer: BCBS MAPPO |
$1,698.38
|
| Rate for Payer: BCN Medicare Advantage |
$1,698.38
|
| Rate for Payer: Cash Price |
$3,849.60
|
| Rate for Payer: Cash Price |
$3,849.60
|
| Rate for Payer: Cofinity Commercial |
$2,445.67
|
| Rate for Payer: Cofinity Commercial |
$2,275.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,698.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,783.30
|
| Rate for Payer: Nomi Health Commercial |
$2,038.06
|
| Rate for Payer: PACE SWMI |
$1,698.38
|
| Rate for Payer: PHP Commercial |
$2,377.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,698.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,127.80
|
| Rate for Payer: Priority Health Medicare |
$1,698.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,698.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,698.38
|
| Rate for Payer: UMR Bronson Commercial |
$2,213.52
|
|
|
PR OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH
|
Professional
|
Both
|
$4,077.00
|
|
|
Service Code
|
HCPCS 34831
|
| Min. Negotiated Rate |
$1,630.80 |
| Max. Negotiated Rate |
$2,679.05 |
| Rate for Payer: Aetna Commercial |
$2,493.00
|
| Rate for Payer: Aetna Medicare |
$1,934.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,679.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,493.00
|
| Rate for Payer: BCBS Complete |
$1,630.80
|
| Rate for Payer: BCBS MAPPO |
$1,860.45
|
| Rate for Payer: BCN Medicare Advantage |
$1,860.45
|
| Rate for Payer: Cash Price |
$3,261.60
|
| Rate for Payer: Cash Price |
$3,261.60
|
| Rate for Payer: Cofinity Commercial |
$2,679.05
|
| Rate for Payer: Cofinity Commercial |
$2,493.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,860.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,953.47
|
| Rate for Payer: Nomi Health Commercial |
$2,232.54
|
| Rate for Payer: PACE SWMI |
$1,860.45
|
| Rate for Payer: PHP Commercial |
$2,604.63
|
| Rate for Payer: PHP Medicare Advantage |
$1,860.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,650.05
|
| Rate for Payer: Priority Health Medicare |
$1,860.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,860.45
|
| Rate for Payer: UHC Medicare Advantage |
$1,860.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,875.42
|
|
|
PR OPN SUBCLA CRTD ART TRPOS NCK INC ULAT
|
Professional
|
Both
|
$3,200.00
|
|
|
Service Code
|
HCPCS 33889
|
| Min. Negotiated Rate |
$766.74 |
| Max. Negotiated Rate |
$2,080.00 |
| Rate for Payer: Aetna Commercial |
$1,027.43
|
| Rate for Payer: Aetna Medicare |
$797.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,104.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.43
|
| Rate for Payer: BCBS Complete |
$1,280.00
|
| Rate for Payer: BCBS MAPPO |
$766.74
|
| Rate for Payer: BCN Medicare Advantage |
$766.74
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cash Price |
$2,560.00
|
| Rate for Payer: Cofinity Commercial |
$1,104.11
|
| Rate for Payer: Cofinity Commercial |
$1,027.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$805.08
|
| Rate for Payer: Nomi Health Commercial |
$920.09
|
| Rate for Payer: PACE SWMI |
$766.74
|
| Rate for Payer: PHP Commercial |
$1,073.44
|
| Rate for Payer: PHP Medicare Advantage |
$766.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,080.00
|
| Rate for Payer: Priority Health Medicare |
$766.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.74
|
| Rate for Payer: UHC Medicare Advantage |
$766.74
|
| Rate for Payer: UMR Bronson Commercial |
$1,472.00
|
|
|
PROPOFOL 10 MG/ML 100 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$65.18
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.68 |
| Max. Negotiated Rate |
$58.66 |
| Rate for Payer: Aetna American Axle |
$42.37
|
| Rate for Payer: Aetna Commercial |
$55.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.37
|
| Rate for Payer: Cash Price |
$52.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$56.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.14
|
| Rate for Payer: Healthscope Commercial |
$58.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.40
|
| Rate for Payer: PHP Commercial |
$55.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.37
|
| Rate for Payer: Priority Health SBD |
$41.06
|
| Rate for Payer: UMR Bronson Commercial |
$28.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.88
|
|
|
PROPOFOL 10 MG/ML 100 ML VIAL (BULK CHARGE)
|
Facility
|
OP
|
$65.18
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180097
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.12 |
| Max. Negotiated Rate |
$58.66 |
| Rate for Payer: Aetna American Axle |
$42.37
|
| Rate for Payer: Aetna Commercial |
$55.40
|
| Rate for Payer: Aetna Medicare |
$32.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.37
|
| Rate for Payer: BCBS Complete |
$26.07
|
| Rate for Payer: Cash Price |
$52.14
|
| Rate for Payer: Cofinity Commercial |
$45.63
|
| Rate for Payer: Cofinity Commercial |
$56.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.14
|
| Rate for Payer: Healthscope Commercial |
$58.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.40
|
| Rate for Payer: PHP Commercial |
$55.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.37
|
| Rate for Payer: Priority Health SBD |
$41.06
|
| Rate for Payer: UMR Bronson Commercial |
$24.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.88
|
|
|
PROPOFOL 10 MG/ML 20 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$63.61
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$57.25 |
| Rate for Payer: Aetna American Axle |
$41.35
|
| Rate for Payer: Aetna Commercial |
$54.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.35
|
| Rate for Payer: Cash Price |
$50.89
|
| Rate for Payer: Cofinity Commercial |
$44.53
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.89
|
| Rate for Payer: Healthscope Commercial |
$57.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.07
|
| Rate for Payer: PHP Commercial |
$54.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.35
|
| Rate for Payer: Priority Health SBD |
$40.07
|
| Rate for Payer: UMR Bronson Commercial |
$27.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.71
|
|
|
PROPOFOL 10 MG/ML 20 ML VIAL (BULK CHARGE)
|
Facility
|
OP
|
$63.61
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.54 |
| Max. Negotiated Rate |
$57.25 |
| Rate for Payer: Aetna American Axle |
$41.35
|
| Rate for Payer: Aetna Commercial |
$54.07
|
| Rate for Payer: Aetna Medicare |
$31.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.35
|
| Rate for Payer: BCBS Complete |
$25.44
|
| Rate for Payer: Cash Price |
$50.89
|
| Rate for Payer: Cofinity Commercial |
$44.53
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.89
|
| Rate for Payer: Healthscope Commercial |
$57.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.07
|
| Rate for Payer: PHP Commercial |
$54.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.35
|
| Rate for Payer: Priority Health SBD |
$40.07
|
| Rate for Payer: UMR Bronson Commercial |
$23.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.71
|
|
|
PROPOFOL 10 MG/ML 50 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$56.63
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$50.97 |
| Rate for Payer: Aetna American Axle |
$36.81
|
| Rate for Payer: Aetna Commercial |
$48.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.81
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Cofinity Commercial |
$48.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$50.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.14
|
| Rate for Payer: PHP Commercial |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.81
|
| Rate for Payer: Priority Health SBD |
$35.68
|
| Rate for Payer: UMR Bronson Commercial |
$24.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.47
|
|
|
PROPOFOL 10 MG/ML 50 ML VIAL (BULK CHARGE)
|
Facility
|
OP
|
$56.63
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180096
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$50.97 |
| Rate for Payer: Aetna American Axle |
$36.81
|
| Rate for Payer: Aetna Commercial |
$48.14
|
| Rate for Payer: Aetna Medicare |
$28.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.81
|
| Rate for Payer: BCBS Complete |
$22.65
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Cofinity Commercial |
$48.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$50.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.14
|
| Rate for Payer: PHP Commercial |
$48.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.81
|
| Rate for Payer: Priority Health SBD |
$35.68
|
| Rate for Payer: UMR Bronson Commercial |
$20.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.47
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
OP
|
$136.28
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.42 |
| Max. Negotiated Rate |
$122.65 |
| Rate for Payer: Aetna American Axle |
$88.58
|
| Rate for Payer: Aetna American Axle |
$56.09
|
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna American Axle |
$66.83
|
| Rate for Payer: Aetna American Axle |
$36.81
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Commercial |
$48.14
|
| Rate for Payer: Aetna Commercial |
$73.36
|
| Rate for Payer: Aetna Commercial |
$115.84
|
| Rate for Payer: Aetna Medicare |
$43.15
|
| Rate for Payer: Aetna Medicare |
$68.14
|
| Rate for Payer: Aetna Medicare |
$44.66
|
| Rate for Payer: Aetna Medicare |
$28.32
|
| Rate for Payer: Aetna Medicare |
$51.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: BCBS Complete |
$35.73
|
| Rate for Payer: BCBS Complete |
$41.13
|
| Rate for Payer: BCBS Complete |
$34.52
|
| Rate for Payer: BCBS Complete |
$22.65
|
| Rate for Payer: BCBS Complete |
$54.51
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$109.02
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cofinity Commercial |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$95.40
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Cofinity Commercial |
$71.97
|
| Rate for Payer: Cofinity Commercial |
$48.70
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Cofinity Commercial |
$60.41
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$50.97
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Healthscope Commercial |
$77.67
|
| Rate for Payer: Healthscope Commercial |
$122.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: PHP Commercial |
$73.36
|
| Rate for Payer: PHP Commercial |
$48.14
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$115.84
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.58
|
| Rate for Payer: Priority Health SBD |
$85.86
|
| Rate for Payer: Priority Health SBD |
$64.78
|
| Rate for Payer: Priority Health SBD |
$35.68
|
| Rate for Payer: Priority Health SBD |
$54.37
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: UMR Bronson Commercial |
$33.05
|
| Rate for Payer: UMR Bronson Commercial |
$31.93
|
| Rate for Payer: UMR Bronson Commercial |
$50.42
|
| Rate for Payer: UMR Bronson Commercial |
$38.04
|
| Rate for Payer: UMR Bronson Commercial |
$20.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.47
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
IP
|
$86.30
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.97 |
| Max. Negotiated Rate |
$77.67 |
| Rate for Payer: Aetna American Axle |
$56.09
|
| Rate for Payer: Aetna American Axle |
$66.83
|
| Rate for Payer: Aetna American Axle |
$88.58
|
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna American Axle |
$36.81
|
| Rate for Payer: Aetna Commercial |
$73.36
|
| Rate for Payer: Aetna Commercial |
$115.84
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Commercial |
$48.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.58
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$109.02
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cofinity Commercial |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$71.97
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Cofinity Commercial |
$60.41
|
| Rate for Payer: Cofinity Commercial |
$39.64
|
| Rate for Payer: Cofinity Commercial |
$117.20
|
| Rate for Payer: Cofinity Commercial |
$95.40
|
| Rate for Payer: Cofinity Commercial |
$48.70
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$71.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.30
|
| Rate for Payer: Healthscope Commercial |
$122.65
|
| Rate for Payer: Healthscope Commercial |
$77.67
|
| Rate for Payer: Healthscope Commercial |
$50.97
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$39.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: PHP Commercial |
$48.14
|
| Rate for Payer: PHP Commercial |
$73.36
|
| Rate for Payer: PHP Commercial |
$115.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.83
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: Priority Health SBD |
$35.68
|
| Rate for Payer: Priority Health SBD |
$85.86
|
| Rate for Payer: Priority Health SBD |
$64.78
|
| Rate for Payer: Priority Health SBD |
$54.37
|
| Rate for Payer: UMR Bronson Commercial |
$45.24
|
| Rate for Payer: UMR Bronson Commercial |
$59.96
|
| Rate for Payer: UMR Bronson Commercial |
$37.97
|
| Rate for Payer: UMR Bronson Commercial |
$39.30
|
| Rate for Payer: UMR Bronson Commercial |
$24.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.72
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
IP
|
$61.53
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$55.38 |
| Rate for Payer: Aetna American Axle |
$39.99
|
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna American Axle |
$38.18
|
| Rate for Payer: Aetna American Axle |
$44.09
|
| Rate for Payer: Aetna American Axle |
$44.54
|
| Rate for Payer: Aetna American Axle |
$42.27
|
| Rate for Payer: Aetna American Axle |
$47.14
|
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna American Axle |
$62.06
|
| Rate for Payer: Aetna American Axle |
$40.45
|
| Rate for Payer: Aetna Commercial |
$58.25
|
| Rate for Payer: Aetna Commercial |
$61.65
|
| Rate for Payer: Aetna Commercial |
$52.90
|
| Rate for Payer: Aetna Commercial |
$81.16
|
| Rate for Payer: Aetna Commercial |
$57.66
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$52.30
|
| Rate for Payer: Aetna Commercial |
$49.93
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Commercial |
$67.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.45
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$63.16
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$53.52
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Commercial |
$43.56
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Commercial |
$45.52
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Cofinity Commercial |
$47.97
|
| Rate for Payer: Cofinity Commercial |
$47.48
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$67.90
|
| Rate for Payer: Cofinity Commercial |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Healthscope Commercial |
$61.05
|
| Rate for Payer: Healthscope Commercial |
$52.87
|
| Rate for Payer: Healthscope Commercial |
$55.38
|
| Rate for Payer: Healthscope Commercial |
$56.01
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$61.68
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Healthscope Commercial |
$85.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.16
|
| Rate for Payer: PHP Commercial |
$49.93
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: PHP Commercial |
$67.11
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$57.66
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: PHP Commercial |
$58.25
|
| Rate for Payer: PHP Commercial |
$81.16
|
| Rate for Payer: PHP Commercial |
$52.30
|
| Rate for Payer: PHP Commercial |
$52.90
|
| Rate for Payer: PHP Commercial |
$61.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.09
|
| Rate for Payer: Priority Health SBD |
$38.76
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: Priority Health SBD |
$60.15
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: Priority Health SBD |
$42.73
|
| Rate for Payer: Priority Health SBD |
$43.17
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: Priority Health SBD |
$45.69
|
| Rate for Payer: UMR Bronson Commercial |
$34.74
|
| Rate for Payer: UMR Bronson Commercial |
$27.07
|
| Rate for Payer: UMR Bronson Commercial |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$31.91
|
| Rate for Payer: UMR Bronson Commercial |
$27.38
|
| Rate for Payer: UMR Bronson Commercial |
$29.85
|
| Rate for Payer: UMR Bronson Commercial |
$39.30
|
| Rate for Payer: UMR Bronson Commercial |
$25.85
|
| Rate for Payer: UMR Bronson Commercial |
$28.07
|
| Rate for Payer: UMR Bronson Commercial |
$30.15
|
| Rate for Payer: UMR Bronson Commercial |
$28.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.87
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
OP
|
$65.03
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.06 |
| Max. Negotiated Rate |
$58.53 |
| Rate for Payer: Aetna American Axle |
$42.27
|
| Rate for Payer: Aetna American Axle |
$44.54
|
| Rate for Payer: Aetna American Axle |
$39.99
|
| Rate for Payer: Aetna American Axle |
$44.09
|
| Rate for Payer: Aetna American Axle |
$41.47
|
| Rate for Payer: Aetna American Axle |
$38.18
|
| Rate for Payer: Aetna American Axle |
$62.06
|
| Rate for Payer: Aetna American Axle |
$40.45
|
| Rate for Payer: Aetna American Axle |
$58.06
|
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna American Axle |
$47.14
|
| Rate for Payer: Aetna Commercial |
$58.25
|
| Rate for Payer: Aetna Commercial |
$52.30
|
| Rate for Payer: Aetna Commercial |
$49.93
|
| Rate for Payer: Aetna Commercial |
$57.66
|
| Rate for Payer: Aetna Commercial |
$81.16
|
| Rate for Payer: Aetna Commercial |
$54.23
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Commercial |
$61.65
|
| Rate for Payer: Aetna Commercial |
$52.90
|
| Rate for Payer: Aetna Commercial |
$67.11
|
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Medicare |
$31.90
|
| Rate for Payer: Aetna Medicare |
$31.11
|
| Rate for Payer: Aetna Medicare |
$36.27
|
| Rate for Payer: Aetna Medicare |
$47.74
|
| Rate for Payer: Aetna Medicare |
$33.91
|
| Rate for Payer: Aetna Medicare |
$29.37
|
| Rate for Payer: Aetna Medicare |
$34.27
|
| Rate for Payer: Aetna Medicare |
$44.66
|
| Rate for Payer: Aetna Medicare |
$32.52
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: Aetna Medicare |
$30.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.54
|
| Rate for Payer: BCBS Complete |
$29.01
|
| Rate for Payer: BCBS Complete |
$31.58
|
| Rate for Payer: BCBS Complete |
$38.19
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Complete |
$27.13
|
| Rate for Payer: BCBS Complete |
$27.41
|
| Rate for Payer: BCBS Complete |
$23.50
|
| Rate for Payer: BCBS Complete |
$35.73
|
| Rate for Payer: BCBS Complete |
$24.89
|
| Rate for Payer: BCBS Complete |
$26.01
|
| Rate for Payer: BCBS Complete |
$24.61
|
| Rate for Payer: Cash Price |
$49.78
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cash Price |
$63.16
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cofinity Commercial |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$45.52
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Cofinity Commercial |
$47.97
|
| Rate for Payer: Cofinity Commercial |
$67.90
|
| Rate for Payer: Cofinity Commercial |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Commercial |
$43.56
|
| Rate for Payer: Cofinity Commercial |
$53.52
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$62.38
|
| Rate for Payer: Cofinity Commercial |
$50.77
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Cofinity Commercial |
$44.66
|
| Rate for Payer: Cofinity Commercial |
$47.48
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$55.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.38
|
| Rate for Payer: Healthscope Commercial |
$56.01
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$65.28
|
| Rate for Payer: Healthscope Commercial |
$61.68
|
| Rate for Payer: Healthscope Commercial |
$61.05
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Healthscope Commercial |
$52.87
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$55.38
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Healthscope Commercial |
$85.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$46.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.25
|
| Rate for Payer: PHP Commercial |
$67.11
|
| Rate for Payer: PHP Commercial |
$52.90
|
| Rate for Payer: PHP Commercial |
$61.65
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: PHP Commercial |
$57.66
|
| Rate for Payer: PHP Commercial |
$49.93
|
| Rate for Payer: PHP Commercial |
$81.16
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: PHP Commercial |
$52.30
|
| Rate for Payer: PHP Commercial |
$54.23
|
| Rate for Payer: PHP Commercial |
$58.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.06
|
| Rate for Payer: Priority Health SBD |
$38.76
|
| Rate for Payer: Priority Health SBD |
$43.17
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: Priority Health SBD |
$42.73
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: Priority Health SBD |
$60.15
|
| Rate for Payer: Priority Health SBD |
$39.20
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: Priority Health SBD |
$45.69
|
| Rate for Payer: Priority Health SBD |
$40.19
|
| Rate for Payer: UMR Bronson Commercial |
$26.84
|
| Rate for Payer: UMR Bronson Commercial |
$23.03
|
| Rate for Payer: UMR Bronson Commercial |
$21.73
|
| Rate for Payer: UMR Bronson Commercial |
$25.36
|
| Rate for Payer: UMR Bronson Commercial |
$33.05
|
| Rate for Payer: UMR Bronson Commercial |
$35.33
|
| Rate for Payer: UMR Bronson Commercial |
$24.06
|
| Rate for Payer: UMR Bronson Commercial |
$22.77
|
| Rate for Payer: UMR Bronson Commercial |
$23.61
|
| Rate for Payer: UMR Bronson Commercial |
$25.10
|
| Rate for Payer: UMR Bronson Commercial |
$29.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$46.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.87
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$65.03
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.06 |
| Max. Negotiated Rate |
$58.53 |
| Rate for Payer: Aetna American Axle |
$42.27
|
| Rate for Payer: Aetna American Axle |
$44.54
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Commercial |
$58.25
|
| Rate for Payer: Aetna Medicare |
$32.52
|
| Rate for Payer: Aetna Medicare |
$34.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.54
|
| Rate for Payer: BCBS Complete |
$27.41
|
| Rate for Payer: BCBS Complete |
$26.01
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$45.52
|
| Rate for Payer: Cofinity Commercial |
$47.97
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Healthscope Commercial |
$61.68
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.25
|
| Rate for Payer: PHP Commercial |
$58.25
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.54
|
| Rate for Payer: Priority Health SBD |
$43.17
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: UMR Bronson Commercial |
$24.06
|
| Rate for Payer: UMR Bronson Commercial |
$25.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$65.03
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.61 |
| Max. Negotiated Rate |
$58.53 |
| Rate for Payer: Aetna American Axle |
$42.27
|
| Rate for Payer: Aetna American Axle |
$44.54
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Commercial |
$58.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.54
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Cofinity Commercial |
$47.97
|
| Rate for Payer: Cofinity Commercial |
$45.52
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$61.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: PHP Commercial |
$58.25
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.54
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: Priority Health SBD |
$43.17
|
| Rate for Payer: UMR Bronson Commercial |
$28.61
|
| Rate for Payer: UMR Bronson Commercial |
$30.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.40
|
|
|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,594.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$854.20 |
| Max. Negotiated Rate |
$2,336.10 |
| Rate for Payer: Aetna Commercial |
$1,144.63
|
| Rate for Payer: Aetna Medicare |
$888.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.63
|
| Rate for Payer: BCBS Complete |
$1,437.60
|
| Rate for Payer: BCBS MAPPO |
$854.20
|
| Rate for Payer: BCN Medicare Advantage |
$854.20
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Cofinity Commercial |
$1,230.05
|
| Rate for Payer: Cofinity Commercial |
$1,144.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$854.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$896.91
|
| Rate for Payer: Nomi Health Commercial |
$1,025.04
|
| Rate for Payer: PACE SWMI |
$854.20
|
| Rate for Payer: PHP Commercial |
$1,195.88
|
| Rate for Payer: PHP Medicare Advantage |
$854.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,336.10
|
| Rate for Payer: Priority Health Medicare |
$854.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$854.20
|
| Rate for Payer: UHC Medicare Advantage |
$854.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,653.24
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$789.71 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna Commercial |
$1,058.21
|
| Rate for Payer: Aetna Medicare |
$821.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,137.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,058.21
|
| Rate for Payer: BCBS Complete |
$952.00
|
| Rate for Payer: BCBS MAPPO |
$789.71
|
| Rate for Payer: BCN Medicare Advantage |
$789.71
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cofinity Commercial |
$1,137.18
|
| Rate for Payer: Cofinity Commercial |
$1,058.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$789.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$829.20
|
| Rate for Payer: Nomi Health Commercial |
$947.65
|
| Rate for Payer: PACE SWMI |
$789.71
|
| Rate for Payer: PHP Commercial |
$1,105.59
|
| Rate for Payer: PHP Medicare Advantage |
$789.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health Medicare |
$789.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$789.71
|
| Rate for Payer: UHC Medicare Advantage |
$789.71
|
| Rate for Payer: UMR Bronson Commercial |
$1,094.80
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$616.40 |
| Max. Negotiated Rate |
$1,259.09 |
| Rate for Payer: Aetna Commercial |
$1,171.66
|
| Rate for Payer: Aetna Medicare |
$909.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.66
|
| Rate for Payer: BCBS Complete |
$616.40
|
| Rate for Payer: BCBS MAPPO |
$874.37
|
| Rate for Payer: BCN Medicare Advantage |
$874.37
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cofinity Commercial |
$1,259.09
|
| Rate for Payer: Cofinity Commercial |
$1,171.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$918.09
|
| Rate for Payer: Nomi Health Commercial |
$1,049.24
|
| Rate for Payer: PACE SWMI |
$874.37
|
| Rate for Payer: PHP Commercial |
$1,224.12
|
| Rate for Payer: PHP Medicare Advantage |
$874.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.65
|
| Rate for Payer: Priority Health Medicare |
$874.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.37
|
| Rate for Payer: UHC Medicare Advantage |
$874.37
|
| Rate for Payer: UMR Bronson Commercial |
$708.86
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$361.90
|
|
|
Service Code
|
NDC 69292053001
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna Medicare |
$180.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: BCBS Complete |
$144.76
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$133.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$220.40
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$198.36 |
| Rate for Payer: Aetna American Axle |
$143.26
|
| Rate for Payer: Aetna Commercial |
$187.34
|
| Rate for Payer: Aetna Medicare |
$110.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.26
|
| Rate for Payer: BCBS Complete |
$88.16
|
| Rate for Payer: Cash Price |
$176.32
|
| Rate for Payer: Cofinity Commercial |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$189.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.32
|
| Rate for Payer: Healthscope Commercial |
$198.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.34
|
| Rate for Payer: PHP Commercial |
$187.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.26
|
| Rate for Payer: Priority Health SBD |
$138.85
|
| Rate for Payer: UMR Bronson Commercial |
$81.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.30
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$2.21
|
|
|
Service Code
|
NDC 60687058711
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna American Axle |
$1.44
|
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.44
|
| Rate for Payer: BCBS Complete |
$0.88
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$0.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$361.90
|
|
|
Service Code
|
NDC 69292053001
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.24 |
| Max. Negotiated Rate |
$325.71 |
| Rate for Payer: Aetna American Axle |
$235.24
|
| Rate for Payer: Aetna Commercial |
$307.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.24
|
| Rate for Payer: Cash Price |
$289.52
|
| Rate for Payer: Cofinity Commercial |
$253.33
|
| Rate for Payer: Cofinity Commercial |
$311.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$253.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.52
|
| Rate for Payer: Healthscope Commercial |
$325.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.62
|
| Rate for Payer: PHP Commercial |
$307.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$235.24
|
| Rate for Payer: Priority Health SBD |
$228.00
|
| Rate for Payer: UMR Bronson Commercial |
$159.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.43
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
NDC 23155011001
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: Aetna Medicare |
$25.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: BCBS Complete |
$20.68
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.95
|
| Rate for Payer: PHP Commercial |
$43.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.77
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 00603548221
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.17 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna American Axle |
$232.18
|
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$250.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$250.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.18
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UMR Bronson Commercial |
$157.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$2.21
|
|
|
Service Code
|
NDC 60687058711
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna American Axle |
$1.44
|
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.44
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$1.55
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.88
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.44
|
| Rate for Payer: Priority Health SBD |
$1.39
|
| Rate for Payer: UMR Bronson Commercial |
$0.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
