|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$389.05
|
|
|
Service Code
|
NDC 60432-608-16
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.18 |
| Max. Negotiated Rate |
$350.14 |
| Rate for Payer: Aetna American Axle |
$252.88
|
| Rate for Payer: Aetna Commercial |
$330.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.88
|
| Rate for Payer: Cash Price |
$311.24
|
| Rate for Payer: Cofinity Commercial |
$272.34
|
| Rate for Payer: Cofinity Commercial |
$334.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.24
|
| Rate for Payer: Healthscope Commercial |
$350.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.69
|
| Rate for Payer: PHP Commercial |
$330.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.34
|
| Rate for Payer: Priority Health SBD |
$245.10
|
| Rate for Payer: UMR Bronson Commercial |
$171.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.79
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$653.93
|
|
|
Service Code
|
NDC 70408-146-34
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$588.54 |
| Rate for Payer: Aetna American Axle |
$425.05
|
| Rate for Payer: Aetna Commercial |
$555.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.05
|
| Rate for Payer: Cash Price |
$523.14
|
| Rate for Payer: Cofinity Commercial |
$457.75
|
| Rate for Payer: Cofinity Commercial |
$562.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.14
|
| Rate for Payer: Healthscope Commercial |
$588.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$457.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$555.84
|
| Rate for Payer: PHP Commercial |
$555.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.75
|
| Rate for Payer: Priority Health SBD |
$411.98
|
| Rate for Payer: UMR Bronson Commercial |
$287.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.45
|
|
|
PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$2,085.00
|
|
|
Service Code
|
HCPCS 49255
|
| Min. Negotiated Rate |
$508.64 |
| Max. Negotiated Rate |
$1,459.50 |
| Rate for Payer: Aetna Commercial |
$1,060.40
|
| Rate for Payer: BCBS Complete |
$534.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.96
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Meridian Medicaid |
$534.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,459.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,392.91
|
| Rate for Payer: Priority Health Narrow Network |
$1,392.91
|
| Rate for Payer: Priority Health SBD |
$1,392.91
|
| Rate for Payer: UMR Bronson Commercial |
$959.10
|
|
|
PR ONDANSETRON HCL INJECTION
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J2405
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$0.10
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
PR ONE AREA LIPOSUCTION - 1 AREA 1.0 HR
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 00527
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: BCBS Complete |
$800.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.00
|
| Rate for Payer: UMR Bronson Commercial |
$920.00
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99422
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$25.74
|
| Rate for Payer: BCBS Complete |
$22.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Meridian Medicaid |
$22.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.11
|
| Rate for Payer: Priority Health Narrow Network |
$26.11
|
| Rate for Payer: Priority Health SBD |
$26.11
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$16.10 |
| Max. Negotiated Rate |
$873.28 |
| Rate for Payer: Aetna Commercial |
$40.51
|
| Rate for Payer: BCBS Complete |
$36.31
|
| Rate for Payer: BCBS Trust/PPO |
$873.28
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Meridian Medicaid |
$36.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.42
|
| Rate for Payer: Priority Health Narrow Network |
$41.42
|
| Rate for Payer: Priority Health SBD |
$41.42
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$1,630.70 |
| Rate for Payer: Aetna Commercial |
$12.71
|
| Rate for Payer: BCBS Complete |
$11.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,630.70
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Meridian Medicaid |
$11.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.23
|
| Rate for Payer: Priority Health Narrow Network |
$13.23
|
| Rate for Payer: Priority Health SBD |
$13.23
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,764.00
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$1,934.80 |
| Rate for Payer: Aetna Commercial |
$655.82
|
| Rate for Payer: BCBS Complete |
$375.73
|
| Rate for Payer: BCBS Trust/PPO |
$144.75
|
| Rate for Payer: Cash Price |
$2,211.20
|
| Rate for Payer: Cash Price |
$2,211.20
|
| Rate for Payer: Meridian Medicaid |
$375.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,934.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$792.51
|
| Rate for Payer: Priority Health Narrow Network |
$792.51
|
| Rate for Payer: Priority Health SBD |
$792.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,271.44
|
|
|
PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
HCPCS 58943
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$1,660.29 |
| Rate for Payer: Aetna Commercial |
$1,398.24
|
| Rate for Payer: BCBS Complete |
$810.28
|
| Rate for Payer: BCBS Trust/PPO |
$132.60
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Cash Price |
$1,808.80
|
| Rate for Payer: Meridian Medicaid |
$810.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$771.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,582.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,660.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,660.29
|
| Rate for Payer: Priority Health SBD |
$1,660.29
|
| Rate for Payer: UMR Bronson Commercial |
$1,040.06
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$343.10
|
|
|
Service Code
|
NDC 59651-256-01
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna American Axle |
$223.02
|
| Rate for Payer: Aetna Commercial |
$291.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.02
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$240.17
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$240.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$291.64
|
| Rate for Payer: PHP Commercial |
$291.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$240.17
|
| Rate for Payer: Priority Health SBD |
$216.15
|
| Rate for Payer: UMR Bronson Commercial |
$150.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$236.55
|
|
|
Service Code
|
NDC 62559-230-01
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna American Axle |
$153.76
|
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.76
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.07
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.58
|
| Rate for Payer: Priority Health SBD |
$149.03
|
| Rate for Payer: UMR Bronson Commercial |
$104.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$204.25
|
|
|
Service Code
|
NDC 0603-5448-21
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.87 |
| Max. Negotiated Rate |
$183.82 |
| Rate for Payer: Aetna American Axle |
$132.76
|
| Rate for Payer: Aetna Commercial |
$173.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.76
|
| Rate for Payer: Cash Price |
$163.40
|
| Rate for Payer: Cofinity Commercial |
$142.98
|
| Rate for Payer: Cofinity Commercial |
$175.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.40
|
| Rate for Payer: Healthscope Commercial |
$183.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$173.61
|
| Rate for Payer: PHP Commercial |
$173.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.98
|
| Rate for Payer: Priority Health SBD |
$128.68
|
| Rate for Payer: UMR Bronson Commercial |
$89.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.19
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$241.30
|
|
|
Service Code
|
NDC 53489-551-01
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.17 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna American Axle |
$156.84
|
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.84
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$168.91
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$168.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$205.10
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.91
|
| Rate for Payer: Priority Health SBD |
$152.02
|
| Rate for Payer: UMR Bronson Commercial |
$106.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.98
|
|
|
PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$270.75
|
|
|
Service Code
|
NDC 0832-0740-60
|
| Hospital Charge Code |
37643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.13 |
| Max. Negotiated Rate |
$243.68 |
| Rate for Payer: Aetna American Axle |
$175.99
|
| Rate for Payer: Aetna Commercial |
$230.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.99
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cofinity Commercial |
$189.52
|
| Rate for Payer: Cofinity Commercial |
$232.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.60
|
| Rate for Payer: Healthscope Commercial |
$243.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$203.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$230.14
|
| Rate for Payer: PHP Commercial |
$230.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.52
|
| Rate for Payer: Priority Health SBD |
$170.57
|
| Rate for Payer: UMR Bronson Commercial |
$119.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$203.06
|
|
|
PROPAFENONE ER 225 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$1,214.12
|
|
|
Service Code
|
NDC 49884-113-02
|
| Hospital Charge Code |
37643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$534.21 |
| Max. Negotiated Rate |
$1,092.71 |
| Rate for Payer: Aetna American Axle |
$789.18
|
| Rate for Payer: Aetna Commercial |
$1,032.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$789.18
|
| Rate for Payer: Cash Price |
$971.30
|
| Rate for Payer: Cofinity Commercial |
$1,044.14
|
| Rate for Payer: Cofinity Commercial |
$849.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$971.30
|
| Rate for Payer: Healthscope Commercial |
$1,092.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$849.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$910.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,032.00
|
| Rate for Payer: PHP Commercial |
$1,032.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$849.88
|
| Rate for Payer: Priority Health SBD |
$764.90
|
| Rate for Payer: UMR Bronson Commercial |
$534.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$910.59
|
|
|
PROPAFENONE ER 325 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$275.62
|
|
|
Service Code
|
NDC 69680-131-60
|
| Hospital Charge Code |
37644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.27 |
| Max. Negotiated Rate |
$248.06 |
| Rate for Payer: Aetna American Axle |
$179.15
|
| Rate for Payer: Aetna Commercial |
$234.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.15
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cofinity Commercial |
$192.93
|
| Rate for Payer: Cofinity Commercial |
$237.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.50
|
| Rate for Payer: Healthscope Commercial |
$248.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$192.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$206.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$234.28
|
| Rate for Payer: PHP Commercial |
$234.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.93
|
| Rate for Payer: Priority Health SBD |
$173.64
|
| Rate for Payer: UMR Bronson Commercial |
$121.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$206.72
|
|
|
PROPAFENONE ER 425 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$3,151.07
|
|
|
Service Code
|
NDC 0173-0826-18
|
| Hospital Charge Code |
37645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,386.47 |
| Max. Negotiated Rate |
$2,835.96 |
| Rate for Payer: Aetna American Axle |
$2,048.20
|
| Rate for Payer: Aetna Commercial |
$2,678.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,048.20
|
| Rate for Payer: Cash Price |
$2,520.86
|
| Rate for Payer: Cofinity Commercial |
$2,205.75
|
| Rate for Payer: Cofinity Commercial |
$2,709.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,520.86
|
| Rate for Payer: Healthscope Commercial |
$2,835.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,205.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,363.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,678.41
|
| Rate for Payer: PHP Commercial |
$2,678.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,205.75
|
| Rate for Payer: Priority Health SBD |
$1,985.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,386.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,363.30
|
|
|
PROPAFENONE ER 425 MG CAPSULE,EXTENDED RELEASE 12 HR
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 64380-186-01
|
| Hospital Charge Code |
37645
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.66
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.49
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$124.85
|
|
|
Service Code
|
NDC 0998-0016-15
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.93 |
| Max. Negotiated Rate |
$112.36 |
| Rate for Payer: Aetna American Axle |
$81.15
|
| Rate for Payer: Aetna Commercial |
$106.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.15
|
| Rate for Payer: Cash Price |
$99.88
|
| Rate for Payer: Cofinity Commercial |
$107.37
|
| Rate for Payer: Cofinity Commercial |
$87.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.88
|
| Rate for Payer: Healthscope Commercial |
$112.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$106.12
|
| Rate for Payer: PHP Commercial |
$106.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.40
|
| Rate for Payer: Priority Health SBD |
$78.66
|
| Rate for Payer: UMR Bronson Commercial |
$54.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.64
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.72
|
|
|
Service Code
|
NDC 17478-263-12
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.04 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna American Axle |
$73.92
|
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.92
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$79.60
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.66
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.60
|
| Rate for Payer: Priority Health SBD |
$71.64
|
| Rate for Payer: UMR Bronson Commercial |
$50.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$116.71
|
|
|
Service Code
|
NDC 24208-730-06
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$105.04 |
| Rate for Payer: Aetna American Axle |
$75.86
|
| Rate for Payer: Aetna Commercial |
$99.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.86
|
| Rate for Payer: Cash Price |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$100.37
|
| Rate for Payer: Cofinity Commercial |
$81.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.37
|
| Rate for Payer: Healthscope Commercial |
$105.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$99.20
|
| Rate for Payer: PHP Commercial |
$99.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.70
|
| Rate for Payer: Priority Health SBD |
$73.53
|
| Rate for Payer: UMR Bronson Commercial |
$51.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.53
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$96.50
|
|
|
Service Code
|
NDC 61314-016-01
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.46 |
| Max. Negotiated Rate |
$86.85 |
| Rate for Payer: Aetna American Axle |
$62.72
|
| Rate for Payer: Aetna Commercial |
$82.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.72
|
| Rate for Payer: Cash Price |
$77.20
|
| Rate for Payer: Cofinity Commercial |
$67.55
|
| Rate for Payer: Cofinity Commercial |
$82.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.20
|
| Rate for Payer: Healthscope Commercial |
$86.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$82.02
|
| Rate for Payer: PHP Commercial |
$82.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.55
|
| Rate for Payer: Priority Health SBD |
$60.80
|
| Rate for Payer: UMR Bronson Commercial |
$42.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.38
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$8.69
|
|
|
Service Code
|
NDC 9900-0003-94
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna American Axle |
$5.65
|
| Rate for Payer: Aetna Commercial |
$7.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.65
|
| Rate for Payer: Cash Price |
$6.95
|
| Rate for Payer: Cofinity Commercial |
$6.08
|
| Rate for Payer: Cofinity Commercial |
$7.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.95
|
| Rate for Payer: Healthscope Commercial |
$7.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.39
|
| Rate for Payer: PHP Commercial |
$7.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.08
|
| Rate for Payer: Priority Health SBD |
$5.47
|
| Rate for Payer: UMR Bronson Commercial |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.52
|
|
|
PR OPEN ABLATION RENAL MASS CRYOSURG ULTRASOUND
|
Professional
|
Both
|
$2,477.00
|
|
|
Service Code
|
HCPCS 50250
|
| Min. Negotiated Rate |
$770.63 |
| Max. Negotiated Rate |
$4,748.36 |
| Rate for Payer: Aetna Commercial |
$1,561.74
|
| Rate for Payer: BCBS Complete |
$809.16
|
| Rate for Payer: BCBS Trust/PPO |
$4,748.36
|
| Rate for Payer: Cash Price |
$1,981.60
|
| Rate for Payer: Cash Price |
$1,981.60
|
| Rate for Payer: Meridian Medicaid |
$809.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$770.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,733.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,933.39
|
| Rate for Payer: Priority Health Narrow Network |
$1,933.39
|
| Rate for Payer: Priority Health SBD |
$1,933.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,139.42
|
|
