|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
IP
|
$67.83
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.73 |
| Max. Negotiated Rate |
$61.05 |
| Rate for Payer: Aetna Commercial |
$57.66
|
| Rate for Payer: Aetna Commercial |
$52.30
|
| Rate for Payer: Aetna Commercial |
$49.93
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Aetna Commercial |
$76.47
|
| Rate for Payer: Aetna Commercial |
$73.36
|
| Rate for Payer: Aetna Commercial |
$63.72
|
| Rate for Payer: Aetna Commercial |
$71.86
|
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.10
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$67.63
|
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$54.26
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$45.52
|
| Rate for Payer: Cofinity Commercial |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$47.48
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Commercial |
$52.48
|
| Rate for Payer: Cofinity Commercial |
$64.47
|
| Rate for Payer: Cofinity Commercial |
$53.98
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Commercial |
$72.70
|
| Rate for Payer: Cofinity Commercial |
$60.41
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Cofinity Commercial |
$62.98
|
| Rate for Payer: Cofinity Commercial |
$77.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$38.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| 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 |
$71.98
|
| Rate for Payer: Healthscope Commercial |
$49.09
|
| Rate for Payer: Healthscope Commercial |
$61.05
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$52.87
|
| Rate for Payer: Healthscope Commercial |
$77.67
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Healthscope Commercial |
$80.97
|
| Rate for Payer: Healthscope Commercial |
$67.47
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$55.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$76.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: PHP Commercial |
$57.66
|
| Rate for Payer: PHP Commercial |
$63.72
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: PHP Commercial |
$71.86
|
| Rate for Payer: PHP Commercial |
$76.47
|
| Rate for Payer: PHP Commercial |
$73.36
|
| Rate for Payer: PHP Commercial |
$52.30
|
| Rate for Payer: PHP Commercial |
$46.36
|
| Rate for Payer: PHP Commercial |
$49.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.45
|
| Rate for Payer: Priority Health SBD |
$56.68
|
| Rate for Payer: Priority Health SBD |
$47.23
|
| Rate for Payer: Priority Health SBD |
$42.73
|
| Rate for Payer: Priority Health SBD |
$54.37
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: Priority Health SBD |
$34.36
|
| Rate for Payer: Priority Health SBD |
$38.76
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: Priority Health SBD |
$48.59
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$58.74
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$52.87 |
| Rate for Payer: Aetna Commercial |
$49.93
|
| Rate for Payer: Aetna Commercial |
$73.36
|
| Rate for Payer: Aetna Commercial |
$71.86
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.13
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$72.70
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Cofinity Commercial |
$45.52
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$53.98
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Cofinity Commercial |
$60.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.04
|
| Rate for Payer: Healthscope Commercial |
$77.67
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Healthscope Commercial |
$52.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.36
|
| Rate for Payer: PHP Commercial |
$71.86
|
| Rate for Payer: PHP Commercial |
$73.36
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: PHP Commercial |
$49.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: Priority Health SBD |
$48.59
|
| Rate for Payer: Priority Health SBD |
$54.37
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$77.12
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$69.41 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Commercial |
$73.36
|
| Rate for Payer: Aetna Commercial |
$49.93
|
| Rate for Payer: Aetna Commercial |
$71.86
|
| Rate for Payer: Aetna Commercial |
$55.28
|
| Rate for Payer: Aetna Medicare |
$42.27
|
| Rate for Payer: Aetna Medicare |
$38.56
|
| Rate for Payer: Aetna Medicare |
$29.37
|
| Rate for Payer: Aetna Medicare |
$32.52
|
| Rate for Payer: Aetna Medicare |
$43.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.13
|
| Rate for Payer: BCBS Complete |
$23.50
|
| Rate for Payer: BCBS Complete |
$34.52
|
| Rate for Payer: BCBS Complete |
$30.85
|
| Rate for Payer: BCBS Complete |
$33.82
|
| Rate for Payer: BCBS Complete |
$26.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$67.63
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$69.04
|
| Rate for Payer: Cash Price |
$52.02
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Cofinity Commercial |
$60.41
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$45.52
|
| Rate for Payer: Cofinity Commercial |
$55.93
|
| Rate for Payer: Cofinity Commercial |
$53.98
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Commercial |
$72.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$45.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$60.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.63
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$77.67
|
| Rate for Payer: Healthscope Commercial |
$58.53
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Healthscope Commercial |
$52.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.86
|
| Rate for Payer: PHP Commercial |
$73.36
|
| Rate for Payer: PHP Commercial |
$49.93
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: PHP Commercial |
$55.28
|
| Rate for Payer: PHP Commercial |
$71.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: Priority Health SBD |
$40.97
|
| Rate for Payer: Priority Health SBD |
$48.59
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: Priority Health SBD |
$54.37
|
| Rate for Payer: Priority Health SBD |
$53.26
|
|
|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,594.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$584.90 |
| Max. Negotiated Rate |
$160,382.00 |
| Rate for Payer: Aetna Commercial |
$1,144.63
|
| Rate for Payer: Aetna Medicare |
$888.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,230.05
|
| Rate for Payer: BCBS Complete |
$614.14
|
| Rate for Payer: BCBS MAPPO |
$854.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.26
|
| Rate for Payer: BCN Commercial |
$1,346.31
|
| 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: Healthscope Commercial |
$1,580.27
|
| Rate for Payer: Healthscope Commercial |
$1,366.72
|
| Rate for Payer: Mclaren Medicaid |
$584.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$896.91
|
| Rate for Payer: Meridian Medicaid |
$614.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$160,382.00
|
| Rate for Payer: Nomi Health Commercial |
$1,025.04
|
| Rate for Payer: PACE SWMI |
$854.20
|
| Rate for Payer: PHP Medicare Advantage |
$854.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$584.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,336.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,401.41
|
| Rate for Payer: Priority Health Medicare |
$854.20
|
| Rate for Payer: Priority Health Narrow Network |
$1,401.41
|
| Rate for Payer: Priority Health SBD |
$1,401.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,024.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$854.20
|
| Rate for Payer: UHC Exchange |
$1,024.94
|
| Rate for Payer: UHC Medicare Advantage |
$854.20
|
| Rate for Payer: UHCCP Medicaid |
$584.90
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$542.09 |
| Max. Negotiated Rate |
$148,165.00 |
| Rate for Payer: Aetna Commercial |
$1,058.21
|
| Rate for Payer: Aetna Medicare |
$821.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,058.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,137.18
|
| Rate for Payer: BCBS Complete |
$569.19
|
| Rate for Payer: BCBS MAPPO |
$789.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.11
|
| Rate for Payer: BCN Commercial |
$1,246.61
|
| 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: Healthscope Commercial |
$1,460.96
|
| Rate for Payer: Healthscope Commercial |
$1,263.54
|
| Rate for Payer: Mclaren Medicaid |
$542.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$829.20
|
| Rate for Payer: Meridian Medicaid |
$569.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148,165.00
|
| Rate for Payer: Nomi Health Commercial |
$947.65
|
| Rate for Payer: PACE SWMI |
$789.71
|
| Rate for Payer: PHP Medicare Advantage |
$789.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,297.09
|
| Rate for Payer: Priority Health Medicare |
$789.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,297.09
|
| Rate for Payer: Priority Health SBD |
$1,297.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$789.71
|
| Rate for Payer: UHC Exchange |
$959.64
|
| Rate for Payer: UHC Medicare Advantage |
$789.71
|
| Rate for Payer: UHCCP Medicaid |
$542.09
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$599.17 |
| Max. Negotiated Rate |
$163,937.00 |
| Rate for Payer: Aetna Commercial |
$1,171.66
|
| Rate for Payer: Aetna Medicare |
$909.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,171.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,259.09
|
| Rate for Payer: BCBS Complete |
$629.13
|
| Rate for Payer: BCBS MAPPO |
$874.37
|
| Rate for Payer: BCBS Trust/PPO |
$977.36
|
| Rate for Payer: BCN Commercial |
$1,377.09
|
| 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: Healthscope Commercial |
$1,617.58
|
| Rate for Payer: Healthscope Commercial |
$1,398.99
|
| Rate for Payer: Mclaren Medicaid |
$599.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$918.09
|
| Rate for Payer: Meridian Medicaid |
$629.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163,937.00
|
| Rate for Payer: Nomi Health Commercial |
$1,049.24
|
| Rate for Payer: PACE SWMI |
$874.37
|
| Rate for Payer: PHP Medicare Advantage |
$874.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$599.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,433.97
|
| Rate for Payer: Priority Health Medicare |
$874.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.97
|
| Rate for Payer: Priority Health SBD |
$1,433.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,037.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.37
|
| Rate for Payer: UHC Exchange |
$1,037.57
|
| Rate for Payer: UHC Medicare Advantage |
$874.37
|
| Rate for Payer: UHCCP Medicaid |
$599.17
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 00904655061
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.04 |
| Max. Negotiated Rate |
$321.48 |
| 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: 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
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
OP
|
$357.20
|
|
|
Service Code
|
NDC 00904655061
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.88 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna Medicare |
$178.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: BCBS Complete |
$142.88
|
| 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: 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
|
|
|
PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.87
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
29335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.92
|
| Rate for Payer: Priority Health SBD |
$12.52
|
|
|
PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.87
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
29335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Medicare |
$9.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: BCBS Complete |
$7.95
|
| Rate for Payer: BCBS Trust/PPO |
$10.26
|
| Rate for Payer: BCN Commercial |
$10.26
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.92
|
| Rate for Payer: Priority Health SBD |
$12.52
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904670561
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: Aetna Medicare |
$139.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.40
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health SBD |
$175.96
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
NDC 00115166001
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$395.50 |
| 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: Cofinity Medicare Advantage |
$307.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.64
|
| Rate for Payer: Priority Health SBD |
$276.85
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
NDC 23155011101
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$35.96 |
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna Medicare |
$19.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: BCBS Complete |
$15.98
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health SBD |
$25.17
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
NDC 00115166001
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.78 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna Medicare |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.64
|
| Rate for Payer: BCBS Complete |
$175.78
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$307.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$351.56
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.64
|
| Rate for Payer: Priority Health SBD |
$276.85
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$2,888.00
|
|
|
Service Code
|
NDC 00591555510
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,155.20 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Aetna Commercial |
$2,454.80
|
| Rate for Payer: Aetna Medicare |
$1,444.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,877.20
|
| Rate for Payer: BCBS Complete |
$1,155.20
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cofinity Commercial |
$2,021.60
|
| Rate for Payer: Cofinity Commercial |
$2,483.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,021.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,310.40
|
| Rate for Payer: Healthscope Commercial |
$2,599.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,454.80
|
| Rate for Payer: PHP Commercial |
$2,454.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,877.20
|
| Rate for Payer: Priority Health SBD |
$1,819.44
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$2,888.00
|
|
|
Service Code
|
NDC 00591555510
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,819.44 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Aetna Commercial |
$2,454.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,877.20
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cofinity Commercial |
$2,021.60
|
| Rate for Payer: Cofinity Commercial |
$2,483.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,021.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,310.40
|
| Rate for Payer: Healthscope Commercial |
$2,599.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,454.80
|
| Rate for Payer: PHP Commercial |
$2,454.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,877.20
|
| Rate for Payer: Priority Health SBD |
$1,819.44
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 23155011101
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$35.96 |
| 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: Cofinity Medicare Advantage |
$27.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.97
|
| Rate for Payer: Priority Health SBD |
$25.17
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904670561
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.96 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$195.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.40
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health SBD |
$175.96
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 23155011201
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.57 |
| Max. Negotiated Rate |
$46.53 |
| 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: 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: Multiplan/Beech St/PHCS Commercial |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$32.57
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$2.43
|
|
|
Service Code
|
NDC 50268070211
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.58
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health SBD |
$1.53
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
NDC 23155011201
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna Commercial |
$43.94
|
| 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: Multiplan/Beech St/PHCS Commercial |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$32.57
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$121.20
|
|
|
Service Code
|
NDC 50268070215
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.36 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$103.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.78
|
| Rate for Payer: Cash Price |
$96.96
|
| Rate for Payer: Cofinity Commercial |
$104.23
|
| Rate for Payer: Cofinity Commercial |
$84.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$84.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.96
|
| Rate for Payer: Healthscope Commercial |
$109.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.02
|
| Rate for Payer: PHP Commercial |
$103.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.78
|
| Rate for Payer: Priority Health SBD |
$76.36
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$2.43
|
|
|
Service Code
|
NDC 50268070211
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$2.19 |
| Rate for Payer: Aetna Commercial |
$2.07
|
| Rate for Payer: Aetna Medicare |
$1.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.58
|
| Rate for Payer: BCBS Complete |
$0.97
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cofinity Commercial |
$1.70
|
| Rate for Payer: Cofinity Commercial |
$2.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.94
|
| Rate for Payer: Healthscope Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health SBD |
$1.53
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 00115166101
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.84 |
| Max. Negotiated Rate |
$202.64 |
| 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: Cofinity Medicare Advantage |
$157.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| 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
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 00115166101
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.06 |
| Max. Negotiated Rate |
$202.64 |
| 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 |
$202.64
|
| 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
|
|
