|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 00115166101
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 23155011201
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| 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 |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.77
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 69238207901
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.73
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 00603548421
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UMR Bronson Commercial |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$729.12
|
|
|
Service Code
|
NDC 00228277811
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.77 |
| Max. Negotiated Rate |
$656.21 |
| Rate for Payer: Aetna American Axle |
$473.93
|
| Rate for Payer: Aetna Commercial |
$619.75
|
| Rate for Payer: Aetna Medicare |
$364.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.93
|
| Rate for Payer: BCBS Complete |
$291.65
|
| Rate for Payer: Cash Price |
$583.30
|
| Rate for Payer: Cofinity Commercial |
$510.38
|
| Rate for Payer: Cofinity Commercial |
$627.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.30
|
| Rate for Payer: Healthscope Commercial |
$656.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.75
|
| Rate for Payer: PHP Commercial |
$619.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.93
|
| Rate for Payer: Priority Health SBD |
$459.35
|
| Rate for Payer: UMR Bronson Commercial |
$269.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.84
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$729.12
|
|
|
Service Code
|
NDC 00228277811
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$320.81 |
| Max. Negotiated Rate |
$656.21 |
| Rate for Payer: Aetna American Axle |
$473.93
|
| Rate for Payer: Aetna Commercial |
$619.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.93
|
| Rate for Payer: Cash Price |
$583.30
|
| Rate for Payer: Cofinity Commercial |
$510.38
|
| Rate for Payer: Cofinity Commercial |
$627.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.30
|
| Rate for Payer: Healthscope Commercial |
$656.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.75
|
| Rate for Payer: PHP Commercial |
$619.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.93
|
| Rate for Payer: Priority Health SBD |
$459.35
|
| Rate for Payer: UMR Bronson Commercial |
$320.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.84
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 62559053001
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$243.84
|
|
|
Service Code
|
NDC 51991081701
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.22 |
| Max. Negotiated Rate |
$219.46 |
| Rate for Payer: Aetna American Axle |
$158.50
|
| Rate for Payer: Aetna Commercial |
$207.26
|
| Rate for Payer: Aetna Medicare |
$121.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.50
|
| Rate for Payer: BCBS Complete |
$97.54
|
| Rate for Payer: Cash Price |
$195.07
|
| Rate for Payer: Cofinity Commercial |
$170.69
|
| Rate for Payer: Cofinity Commercial |
$209.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$219.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.26
|
| Rate for Payer: PHP Commercial |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.50
|
| Rate for Payer: Priority Health SBD |
$153.62
|
| Rate for Payer: UMR Bronson Commercial |
$90.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.88
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$243.84
|
|
|
Service Code
|
NDC 51991081701
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$219.46 |
| Rate for Payer: Aetna American Axle |
$158.50
|
| Rate for Payer: Aetna Commercial |
$207.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.50
|
| Rate for Payer: Cash Price |
$195.07
|
| Rate for Payer: Cofinity Commercial |
$170.69
|
| Rate for Payer: Cofinity Commercial |
$209.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$219.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.26
|
| Rate for Payer: PHP Commercial |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.50
|
| Rate for Payer: Priority Health SBD |
$153.62
|
| Rate for Payer: UMR Bronson Commercial |
$107.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.88
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 00527411637
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 62559053001
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 00527411637
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00527411737
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.11 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UMR Bronson Commercial |
$86.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$285.12
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.49 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna American Axle |
$185.33
|
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna Medicare |
$142.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.33
|
| Rate for Payer: BCBS Complete |
$114.05
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$199.58
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.33
|
| Rate for Payer: Priority Health SBD |
$179.63
|
| Rate for Payer: UMR Bronson Commercial |
$105.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.84
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$285.12
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.45 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna American Axle |
$185.33
|
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.33
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$199.58
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.33
|
| Rate for Payer: Priority Health SBD |
$179.63
|
| Rate for Payer: UMR Bronson Commercial |
$125.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.84
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00527411737
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.41 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UMR Bronson Commercial |
$72.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$24.28 |
| Rate for Payer: Aetna Commercial |
$22.59
|
| Rate for Payer: Aetna Medicare |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.59
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$16.86
|
| Rate for Payer: BCN Medicare Advantage |
$16.86
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.70
|
| Rate for Payer: Nomi Health Commercial |
$20.23
|
| Rate for Payer: PACE SWMI |
$16.86
|
| Rate for Payer: PHP Commercial |
$23.60
|
| Rate for Payer: PHP Medicare Advantage |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$16.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.86
|
| Rate for Payer: UHC Medicare Advantage |
$16.86
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$623.93 |
| Max. Negotiated Rate |
$2,256.15 |
| Rate for Payer: Aetna Commercial |
$836.07
|
| Rate for Payer: Aetna Medicare |
$648.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$898.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.07
|
| Rate for Payer: BCBS Complete |
$1,388.40
|
| Rate for Payer: BCBS MAPPO |
$623.93
|
| Rate for Payer: BCN Medicare Advantage |
$623.93
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$898.46
|
| Rate for Payer: Cofinity Commercial |
$836.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.13
|
| Rate for Payer: Nomi Health Commercial |
$748.72
|
| Rate for Payer: PACE SWMI |
$623.93
|
| Rate for Payer: PHP Commercial |
$873.50
|
| Rate for Payer: PHP Medicare Advantage |
$623.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health Medicare |
$623.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.93
|
| Rate for Payer: UHC Medicare Advantage |
$623.93
|
| Rate for Payer: UMR Bronson Commercial |
$1,596.66
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$3,890.00
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$1,556.00 |
| Max. Negotiated Rate |
$2,601.94 |
| Rate for Payer: Aetna Commercial |
$2,421.25
|
| Rate for Payer: Aetna Medicare |
$1,879.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,601.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,421.25
|
| Rate for Payer: BCBS Complete |
$1,556.00
|
| Rate for Payer: BCBS MAPPO |
$1,806.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,806.90
|
| Rate for Payer: Cash Price |
$3,112.00
|
| Rate for Payer: Cash Price |
$3,112.00
|
| Rate for Payer: Cofinity Commercial |
$2,601.94
|
| Rate for Payer: Cofinity Commercial |
$2,421.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,806.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,897.24
|
| Rate for Payer: Nomi Health Commercial |
$2,168.28
|
| Rate for Payer: PACE SWMI |
$1,806.90
|
| Rate for Payer: PHP Commercial |
$2,529.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,806.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,528.50
|
| Rate for Payer: Priority Health Medicare |
$1,806.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,806.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,806.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,789.40
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$4,665.00
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$1,590.05 |
| Max. Negotiated Rate |
$3,032.25 |
| Rate for Payer: Aetna Commercial |
$2,130.67
|
| Rate for Payer: Aetna Medicare |
$1,653.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,289.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,130.67
|
| Rate for Payer: BCBS Complete |
$1,866.00
|
| Rate for Payer: BCBS MAPPO |
$1,590.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,590.05
|
| Rate for Payer: Cash Price |
$3,732.00
|
| Rate for Payer: Cash Price |
$3,732.00
|
| Rate for Payer: Cofinity Commercial |
$2,289.67
|
| Rate for Payer: Cofinity Commercial |
$2,130.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,590.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,669.55
|
| Rate for Payer: Nomi Health Commercial |
$1,908.06
|
| Rate for Payer: PACE SWMI |
$1,590.05
|
| Rate for Payer: PHP Commercial |
$2,226.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,590.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,032.25
|
| Rate for Payer: Priority Health Medicare |
$1,590.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,590.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,590.05
|
| Rate for Payer: UMR Bronson Commercial |
$2,145.90
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$697.73 |
| Max. Negotiated Rate |
$1,953.25 |
| Rate for Payer: Aetna Commercial |
$934.96
|
| Rate for Payer: Aetna Medicare |
$725.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.73
|
| Rate for Payer: BCBS Complete |
$1,202.00
|
| Rate for Payer: BCBS MAPPO |
$697.73
|
| Rate for Payer: BCN Medicare Advantage |
$697.73
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$934.96
|
| Rate for Payer: Cofinity Commercial |
$1,004.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.62
|
| Rate for Payer: Nomi Health Commercial |
$837.28
|
| Rate for Payer: PACE SWMI |
$697.73
|
| Rate for Payer: PHP Commercial |
$976.82
|
| Rate for Payer: PHP Medicare Advantage |
$697.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health Medicare |
$697.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.73
|
| Rate for Payer: UHC Medicare Advantage |
$697.73
|
| Rate for Payer: UMR Bronson Commercial |
$1,382.30
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$3,247.00
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$766.60 |
| Max. Negotiated Rate |
$2,110.55 |
| Rate for Payer: Aetna Commercial |
$1,027.24
|
| Rate for Payer: Aetna Medicare |
$797.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.24
|
| Rate for Payer: BCBS Complete |
$1,298.80
|
| Rate for Payer: BCBS MAPPO |
$766.60
|
| Rate for Payer: BCN Medicare Advantage |
$766.60
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cofinity Commercial |
$1,103.90
|
| Rate for Payer: Cofinity Commercial |
$1,027.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.93
|
| Rate for Payer: Nomi Health Commercial |
$919.92
|
| Rate for Payer: PACE SWMI |
$766.60
|
| Rate for Payer: PHP Commercial |
$1,073.24
|
| Rate for Payer: PHP Medicare Advantage |
$766.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,110.55
|
| Rate for Payer: Priority Health Medicare |
$766.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.60
|
| Rate for Payer: UHC Medicare Advantage |
$766.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,493.62
|
|
|
PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS 27217
|
| Min. Negotiated Rate |
$1,253.60 |
| Max. Negotiated Rate |
$2,037.10 |
| Rate for Payer: Aetna Medicare |
$1,567.00
|
| Rate for Payer: BCBS Complete |
$1,253.60
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
| Rate for Payer: UMR Bronson Commercial |
$1,441.64
|
|
|
PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ
|
Professional
|
Both
|
$3,239.00
|
|
|
Service Code
|
HCPCS 26686
|
| Min. Negotiated Rate |
$602.95 |
| Max. Negotiated Rate |
$2,105.35 |
| Rate for Payer: Aetna Commercial |
$807.95
|
| Rate for Payer: Aetna Medicare |
$627.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.25
|
| Rate for Payer: BCBS Complete |
$1,295.60
|
| Rate for Payer: BCBS MAPPO |
$602.95
|
| Rate for Payer: BCN Medicare Advantage |
$602.95
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cofinity Commercial |
$807.95
|
| Rate for Payer: Cofinity Commercial |
$868.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.10
|
| Rate for Payer: Nomi Health Commercial |
$723.54
|
| Rate for Payer: PACE SWMI |
$602.95
|
| Rate for Payer: PHP Commercial |
$844.13
|
| Rate for Payer: PHP Medicare Advantage |
$602.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,105.35
|
| Rate for Payer: Priority Health Medicare |
$602.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.95
|
| Rate for Payer: UHC Medicare Advantage |
$602.95
|
| Rate for Payer: UMR Bronson Commercial |
$1,489.94
|
|
|
PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
|
Professional
|
Both
|
$2,461.00
|
|
|
Service Code
|
HCPCS 21470
|
| Min. Negotiated Rate |
$984.40 |
| Max. Negotiated Rate |
$1,599.65 |
| Rate for Payer: Aetna Commercial |
$1,484.79
|
| Rate for Payer: Aetna Medicare |
$1,152.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,595.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,484.79
|
| Rate for Payer: BCBS Complete |
$984.40
|
| Rate for Payer: BCBS MAPPO |
$1,108.05
|
| Rate for Payer: BCN Medicare Advantage |
$1,108.05
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cofinity Commercial |
$1,595.59
|
| Rate for Payer: Cofinity Commercial |
$1,484.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,108.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,163.45
|
| Rate for Payer: Nomi Health Commercial |
$1,329.66
|
| Rate for Payer: PACE SWMI |
$1,108.05
|
| Rate for Payer: PHP Commercial |
$1,551.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,108.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,599.65
|
| Rate for Payer: Priority Health Medicare |
$1,108.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,108.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,108.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,132.06
|
|
