|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 0603-5482-21
|
| 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: 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 Multiplan/Beech St/PHCS |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.04
|
| 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
|
$357.20
|
|
|
Service Code
|
NDC 0904-6550-61
|
| 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: 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 Multiplan/Beech St/PHCS |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.04
|
| 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
|
$352.50
|
|
|
Service Code
|
NDC 0115-1659-01
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna American Axle |
$229.12
|
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$246.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.75
|
| Rate for Payer: Priority Health SBD |
$222.08
|
| Rate for Payer: UMR Bronson Commercial |
$155.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$27.54
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
29335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$24.79 |
| Rate for Payer: Aetna American Axle |
$17.90
|
| Rate for Payer: Aetna American Axle |
$12.92
|
| Rate for Payer: Aetna American Axle |
$17.17
|
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.17
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$21.14
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$22.72
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$19.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$23.78
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.46
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: PHP Commercial |
$22.46
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.49
|
| Rate for Payer: Priority Health SBD |
$17.35
|
| Rate for Payer: Priority Health SBD |
$16.64
|
| Rate for Payer: Priority Health SBD |
$12.52
|
| Rate for Payer: UMR Bronson Commercial |
$8.74
|
| Rate for Payer: UMR Bronson Commercial |
$11.62
|
| Rate for Payer: UMR Bronson Commercial |
$12.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
|
|
PROPRANOLOL 20 MG/5 ML (4 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$1,045.75
|
|
|
Service Code
|
NDC 0054-3727-63
|
| Hospital Charge Code |
6654
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$460.13 |
| Max. Negotiated Rate |
$941.18 |
| Rate for Payer: Aetna American Axle |
$679.74
|
| Rate for Payer: Aetna Commercial |
$888.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$679.74
|
| Rate for Payer: Cash Price |
$836.60
|
| Rate for Payer: Cofinity Commercial |
$732.02
|
| Rate for Payer: Cofinity Commercial |
$899.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$836.60
|
| Rate for Payer: Healthscope Commercial |
$941.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$732.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$784.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$888.89
|
| Rate for Payer: PHP Commercial |
$888.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$732.02
|
| Rate for Payer: Priority Health SBD |
$658.82
|
| Rate for Payer: UMR Bronson Commercial |
$460.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$784.31
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$293.75
|
|
|
Service Code
|
NDC 69238-2078-1
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.25 |
| Max. Negotiated Rate |
$264.38 |
| Rate for Payer: Aetna American Axle |
$190.94
|
| Rate for Payer: Aetna Commercial |
$249.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.94
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$205.62
|
| Rate for Payer: Cofinity Commercial |
$252.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$264.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$205.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$220.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.69
|
| Rate for Payer: PHP Commercial |
$249.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.62
|
| Rate for Payer: Priority Health SBD |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$129.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$220.31
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 23155-111-01
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$35.96 |
| Rate for Payer: Aetna American Axle |
$25.97
|
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.96
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: UMR Bronson Commercial |
$17.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.96
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$432.40
|
|
|
Service Code
|
NDC 0603-5483-21
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.26 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$367.54
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.68
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UMR Bronson Commercial |
$190.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
NDC 0115-1660-01
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.36 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna American Axle |
$285.64
|
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.64
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$307.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$329.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.53
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.62
|
| Rate for Payer: Priority Health SBD |
$276.85
|
| Rate for Payer: UMR Bronson Commercial |
$193.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$329.59
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 0603-5484-21
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| 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 Multiplan/Beech St/PHCS |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.61
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UMR Bronson Commercial |
$97.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 69238-2079-1
|
| 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: 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 Multiplan/Beech St/PHCS |
$190.57
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.94
|
| 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
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 0115-1661-01
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| 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 Multiplan/Beech St/PHCS |
$191.38
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.60
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$99.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$426.55
|
|
|
Service Code
|
NDC 0591-5556-01
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.68 |
| Max. Negotiated Rate |
$383.90 |
| Rate for Payer: Aetna American Axle |
$277.26
|
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.26
|
| Rate for Payer: Cash Price |
$341.24
|
| Rate for Payer: Cofinity Commercial |
$298.58
|
| Rate for Payer: Cofinity Commercial |
$366.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.24
|
| Rate for Payer: Healthscope Commercial |
$383.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$362.57
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.58
|
| Rate for Payer: Priority Health SBD |
$268.73
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.91
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 23155-112-01
|
| 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 |
$43.94
|
| 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: 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 |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.19
|
| 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 |
$38.78
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$729.12
|
|
|
Service Code
|
NDC 0228-2778-11
|
| 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: 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 Multiplan/Beech St/PHCS |
$619.75
|
| Rate for Payer: PHP Commercial |
$619.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$510.38
|
| 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 62559-530-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.97
|
| 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
|
IP
|
$243.84
|
|
|
Service Code
|
NDC 51991-817-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$207.26
|
| Rate for Payer: PHP Commercial |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.69
|
| 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
|
$441.80
|
|
|
Service Code
|
NDC 0527-4116-37
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna American Axle |
$287.17
|
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.17
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$375.53
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.26
|
| Rate for Payer: Priority Health SBD |
$278.33
|
| Rate for Payer: UMR Bronson Commercial |
$194.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.35
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$285.12
|
|
|
Service Code
|
NDC 51991-818-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$242.35
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.58
|
| 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
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$2,260.07 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,260.07
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.94
|
| Rate for Payer: Priority Health Narrow Network |
$4.94
|
| Rate for Payer: Priority Health SBD |
$23.80
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,403.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$421.53 |
| Max. Negotiated Rate |
$2,382.10 |
| Rate for Payer: Aetna Commercial |
$873.19
|
| Rate for Payer: BCBS Complete |
$442.61
|
| Rate for Payer: BCBS Trust/PPO |
$455.39
|
| Rate for Payer: Cash Price |
$2,722.40
|
| Rate for Payer: Cash Price |
$2,722.40
|
| Rate for Payer: Meridian Medicaid |
$442.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$421.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,382.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$999.34
|
| Rate for Payer: Priority Health Narrow Network |
$999.34
|
| Rate for Payer: Priority Health SBD |
$999.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,565.38
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$3,813.42
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$2,860.15 |
| Rate for Payer: Aetna Commercial |
$2,513.09
|
| Rate for Payer: BCBS Complete |
$1,259.37
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: Cash Price |
$3,050.74
|
| Rate for Payer: Cash Price |
$3,050.74
|
| Rate for Payer: Meridian Medicaid |
$1,259.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,199.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,669.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,860.15
|
| Rate for Payer: Priority Health Narrow Network |
$2,860.15
|
| Rate for Payer: Priority Health SBD |
$2,860.15
|
| Rate for Payer: UMR Bronson Commercial |
$1,754.17
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$4,574.00
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$1,056.05 |
| Max. Negotiated Rate |
$3,201.80 |
| Rate for Payer: Aetna Commercial |
$2,211.26
|
| Rate for Payer: BCBS Complete |
$1,108.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.43
|
| Rate for Payer: Cash Price |
$3,659.20
|
| Rate for Payer: Cash Price |
$3,659.20
|
| Rate for Payer: Meridian Medicaid |
$1,108.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,056.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,201.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,514.94
|
| Rate for Payer: Priority Health Narrow Network |
$2,514.94
|
| Rate for Payer: Priority Health SBD |
$2,514.94
|
| Rate for Payer: UMR Bronson Commercial |
$2,104.04
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$2,946.00
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$470.30 |
| Max. Negotiated Rate |
$2,062.20 |
| Rate for Payer: Aetna Commercial |
$956.02
|
| Rate for Payer: BCBS Complete |
$493.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,258.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Meridian Medicaid |
$493.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,062.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,104.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,104.02
|
| Rate for Payer: Priority Health SBD |
$1,104.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,355.16
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$3,183.00
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$509.07 |
| Max. Negotiated Rate |
$2,228.10 |
| Rate for Payer: Aetna Commercial |
$1,065.44
|
| Rate for Payer: BCBS Complete |
$534.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.99
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Meridian Medicaid |
$534.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,228.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,204.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,204.11
|
| Rate for Payer: Priority Health SBD |
$1,204.11
|
| Rate for Payer: UMR Bronson Commercial |
$1,464.18
|
|
