|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,702.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$561.68 |
| Max. Negotiated Rate |
$2,776.50 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Medicare |
$880.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,219.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,134.43
|
| Rate for Payer: BCBS Complete |
$589.76
|
| Rate for Payer: BCBS MAPPO |
$846.59
|
| Rate for Payer: BCN Commercial |
$1,367.46
|
| Rate for Payer: BCN Medicare Advantage |
$846.59
|
| Rate for Payer: Cash Price |
$2,961.60
|
| Rate for Payer: Cash Price |
$2,961.60
|
| Rate for Payer: Cofinity Commercial |
$1,219.09
|
| Rate for Payer: Cofinity Commercial |
$1,134.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$846.59
|
| Rate for Payer: Healthscope Commercial |
$1,566.19
|
| Rate for Payer: Healthscope Commercial |
$1,354.54
|
| Rate for Payer: Mclaren Medicaid |
$561.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$888.92
|
| Rate for Payer: Meridian Medicaid |
$589.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$931.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,603.82
|
| Rate for Payer: Nomi Health Commercial |
$1,015.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,776.50
|
| Rate for Payer: PACE SWMI |
$846.59
|
| Rate for Payer: PHP Medicare Advantage |
$846.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$561.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,461.76
|
| Rate for Payer: Priority Health Medicare |
$846.59
|
| Rate for Payer: Priority Health SBD |
$1,461.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,461.76
|
| Rate for Payer: Railroad Medicare Medicare |
$846.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,494.17
|
| Rate for Payer: UHC Core |
$1,494.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$846.59
|
| Rate for Payer: UHC Exchange |
$1,494.17
|
| Rate for Payer: UHC Medicaid |
$561.68
|
| Rate for Payer: UHCCP Medicaid |
$561.68
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,451.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$523.77 |
| Max. Negotiated Rate |
$1,838.25 |
| Rate for Payer: Aetna Commercial |
$1,054.61
|
| Rate for Payer: Aetna Medicare |
$818.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,054.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,133.31
|
| Rate for Payer: BCBS Complete |
$549.96
|
| Rate for Payer: BCBS MAPPO |
$787.02
|
| Rate for Payer: BCN Commercial |
$1,267.36
|
| Rate for Payer: BCN Medicare Advantage |
$787.02
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cofinity Commercial |
$1,133.31
|
| Rate for Payer: Cofinity Commercial |
$1,054.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$787.02
|
| Rate for Payer: Healthscope Commercial |
$1,455.99
|
| Rate for Payer: Healthscope Commercial |
$1,259.23
|
| Rate for Payer: Mclaren Medicaid |
$523.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$826.37
|
| Rate for Payer: Meridian Medicaid |
$549.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$865.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,481.65
|
| Rate for Payer: Nomi Health Commercial |
$944.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,838.25
|
| Rate for Payer: PACE SWMI |
$787.02
|
| Rate for Payer: PHP Medicare Advantage |
$787.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$523.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,354.78
|
| Rate for Payer: Priority Health Medicare |
$787.02
|
| Rate for Payer: Priority Health SBD |
$1,354.78
|
| Rate for Payer: Priority Health Tiered Network |
$1,354.78
|
| Rate for Payer: Railroad Medicare Medicare |
$787.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,393.03
|
| Rate for Payer: UHC Core |
$1,393.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$787.02
|
| Rate for Payer: UHC Exchange |
$1,393.03
|
| Rate for Payer: UHC Medicaid |
$523.77
|
| Rate for Payer: UHCCP Medicaid |
$523.77
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,587.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$575.53 |
| Max. Negotiated Rate |
$1,639.37 |
| Rate for Payer: Aetna Commercial |
$1,161.28
|
| Rate for Payer: Aetna Medicare |
$901.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,161.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,247.95
|
| Rate for Payer: BCBS Complete |
$604.31
|
| Rate for Payer: BCBS MAPPO |
$866.63
|
| Rate for Payer: BCN Commercial |
$1,400.82
|
| Rate for Payer: BCN Medicare Advantage |
$866.63
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cash Price |
$1,269.60
|
| Rate for Payer: Cofinity Commercial |
$1,247.95
|
| Rate for Payer: Cofinity Commercial |
$1,161.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$866.63
|
| Rate for Payer: Healthscope Commercial |
$1,603.27
|
| Rate for Payer: Healthscope Commercial |
$1,386.61
|
| Rate for Payer: Mclaren Medicaid |
$575.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$909.96
|
| Rate for Payer: Meridian Medicaid |
$604.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$953.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,639.37
|
| Rate for Payer: Nomi Health Commercial |
$1,039.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,190.25
|
| Rate for Payer: PACE SWMI |
$866.63
|
| Rate for Payer: PHP Medicare Advantage |
$866.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$575.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,497.44
|
| Rate for Payer: Priority Health Medicare |
$866.63
|
| Rate for Payer: Priority Health SBD |
$1,497.44
|
| Rate for Payer: Priority Health Tiered Network |
$1,497.44
|
| Rate for Payer: Railroad Medicare Medicare |
$866.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,547.52
|
| Rate for Payer: UHC Core |
$1,547.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$866.63
|
| Rate for Payer: UHC Exchange |
$1,547.52
|
| Rate for Payer: UHC Medicaid |
$575.53
|
| Rate for Payer: UHCCP Medicaid |
$575.53
|
|
|
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 Advantage |
$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: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.90
|
| Rate for Payer: PHP Commercial |
$303.62
|
| 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 |
$140.38 |
| 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 Advantage |
$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: MI Amish Medical Board Commercial |
$285.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.90
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health SBD |
$225.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.18
|
| Rate for Payer: UHC Core |
$186.10
|
| Rate for Payer: UHC Exchange |
$140.38
|
|
|
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 |
$18.13 |
| 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 |
$9.04
|
| Rate for Payer: BCN Commercial |
$9.04
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cofinity Advantage |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.90
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: Priority Health SBD |
$12.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.13
|
| Rate for Payer: UHC Core |
$18.13
|
| Rate for Payer: UHC Exchange |
$18.13
|
|
|
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 Advantage |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| 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: Opus (Opus Packaging Group) HMA |
$14.90
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: Priority Health SBD |
$12.52
|
|
|
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 |
$237.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Advantage |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| 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 |
$237.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health SBD |
$175.96
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$2,888.00
|
|
|
Service Code
|
NDC 00591555510
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,134.98 |
| 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 Advantage |
$2,021.60
|
| Rate for Payer: Cofinity Commercial |
$2,483.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,310.40
|
| Rate for Payer: Healthscope Commercial |
$2,599.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,310.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,454.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,166.00
|
| Rate for Payer: PHP Commercial |
$2,454.80
|
| Rate for Payer: Priority Health SBD |
$1,819.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,877.20
|
| Rate for Payer: UHC Core |
$1,504.65
|
| Rate for Payer: UHC Exchange |
$1,134.98
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$439.45
|
|
|
Service Code
|
NDC 00115166001
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.70 |
| 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 Advantage |
$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: MI Amish Medical Board Commercial |
$351.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.59
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health SBD |
$276.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.64
|
| Rate for Payer: UHC Core |
$228.95
|
| Rate for Payer: UHC Exchange |
$172.70
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904670561
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.76 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.41
|
| 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 Advantage |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$223.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health SBD |
$175.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$181.54
|
| Rate for Payer: UHC Core |
$145.52
|
| Rate for Payer: UHC Exchange |
$109.76
|
|
|
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 Advantage |
$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: Multiplan/Beech St/PHCS Commercial |
$373.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$329.59
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health SBD |
$276.85
|
|
|
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 Advantage |
$2,021.60
|
| Rate for Payer: Cofinity Commercial |
$2,483.68
|
| 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: Opus (Opus Packaging Group) HMA |
$2,166.00
|
| Rate for Payer: PHP Commercial |
$2,454.80
|
| Rate for Payer: Priority Health SBD |
$1,819.44
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$380.95
|
|
|
Service Code
|
NDC 00904746861
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.62
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Advantage |
$266.67
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.71
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health SBD |
$240.00
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$39.95
|
|
|
Service Code
|
NDC 23155011101
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$35.95 |
| 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 Advantage |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health SBD |
$25.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.97
|
| Rate for Payer: UHC Core |
$20.81
|
| Rate for Payer: UHC Exchange |
$15.70
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$380.95
|
|
|
Service Code
|
NDC 00904746861
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.71 |
| Max. Negotiated Rate |
$342.86 |
| Rate for Payer: Aetna Commercial |
$323.81
|
| Rate for Payer: Aetna Medicare |
$190.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.62
|
| Rate for Payer: BCBS Complete |
$152.38
|
| Rate for Payer: Cash Price |
$304.76
|
| Rate for Payer: Cofinity Advantage |
$266.67
|
| Rate for Payer: Cofinity Commercial |
$327.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.76
|
| Rate for Payer: Healthscope Commercial |
$342.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.71
|
| Rate for Payer: PHP Commercial |
$323.81
|
| Rate for Payer: Priority Health SBD |
$240.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.62
|
| Rate for Payer: UHC Core |
$198.47
|
| Rate for Payer: UHC Exchange |
$149.71
|
|
|
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 |
$35.95 |
| 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 Advantage |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.96
|
| Rate for Payer: Healthscope Commercial |
$35.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.96
|
| Rate for Payer: PHP Commercial |
$33.96
|
| Rate for Payer: Priority Health SBD |
$25.17
|
|
|
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 |
$43.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Advantage |
$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: Multiplan/Beech St/PHCS Commercial |
$43.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.77
|
| Rate for Payer: PHP Commercial |
$43.95
|
| Rate for Payer: Priority Health SBD |
$32.57
|
|
|
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 |
$202.63 |
| 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 Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| 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 |
$88.48 |
| Max. Negotiated Rate |
$202.63 |
| 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 Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.35
|
| Rate for Payer: UHC Core |
$117.30
|
| Rate for Payer: UHC Exchange |
$88.48
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
NDC 23155011201
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna Commercial |
$43.95
|
| Rate for Payer: Aetna Medicare |
$25.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: BCBS Complete |
$20.68
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$41.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.77
|
| Rate for Payer: PHP Commercial |
$43.95
|
| Rate for Payer: Priority Health SBD |
$32.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.60
|
| Rate for Payer: UHC Core |
$26.94
|
| Rate for Payer: UHC Exchange |
$20.32
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$243.84
|
|
|
Service Code
|
NDC 51991081701
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.83 |
| Max. Negotiated Rate |
$219.46 |
| Rate for Payer: Aetna Commercial |
$207.26
|
| Rate for Payer: Aetna Medicare |
$121.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.50
|
| Rate for Payer: BCBS Complete |
$97.54
|
| Rate for Payer: Cash Price |
$195.07
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$195.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.88
|
| Rate for Payer: PHP Commercial |
$207.26
|
| Rate for Payer: Priority Health SBD |
$153.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.50
|
| Rate for Payer: UHC Core |
$127.04
|
| Rate for Payer: UHC Exchange |
$95.83
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$927.84
|
|
|
Service Code
|
NDC 60687021501
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$584.54 |
| Max. Negotiated Rate |
$835.06 |
| Rate for Payer: Aetna Commercial |
$788.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.10
|
| Rate for Payer: Cash Price |
$742.27
|
| Rate for Payer: Cofinity Advantage |
$649.49
|
| Rate for Payer: Cofinity Commercial |
$797.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.27
|
| Rate for Payer: Healthscope Commercial |
$835.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.88
|
| Rate for Payer: PHP Commercial |
$788.66
|
| Rate for Payer: Priority Health SBD |
$584.54
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$927.84
|
|
|
Service Code
|
NDC 60687021501
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$364.64 |
| Max. Negotiated Rate |
$835.06 |
| Rate for Payer: Aetna Commercial |
$788.66
|
| Rate for Payer: Aetna Medicare |
$463.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$603.10
|
| Rate for Payer: BCBS Complete |
$371.14
|
| Rate for Payer: Cash Price |
$742.27
|
| Rate for Payer: Cofinity Advantage |
$649.49
|
| Rate for Payer: Cofinity Commercial |
$797.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.27
|
| Rate for Payer: Healthscope Commercial |
$835.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$742.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.88
|
| Rate for Payer: PHP Commercial |
$788.66
|
| Rate for Payer: Priority Health SBD |
$584.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$603.10
|
| Rate for Payer: UHC Core |
$483.40
|
| Rate for Payer: UHC Exchange |
$364.64
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$9.28
|
|
|
Service Code
|
NDC 60687021511
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: Aetna Medicare |
$4.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.03
|
| Rate for Payer: BCBS Complete |
$3.71
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cofinity Advantage |
$6.50
|
| Rate for Payer: Cofinity Commercial |
$7.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.42
|
| Rate for Payer: Healthscope Commercial |
$8.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.96
|
| Rate for Payer: PHP Commercial |
$7.89
|
| Rate for Payer: Priority Health SBD |
$5.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.03
|
| Rate for Payer: UHC Core |
$4.83
|
| Rate for Payer: UHC Exchange |
$3.65
|
|
