|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 60687059811
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.32
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: BCBS MAPPO |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| Rate for Payer: BCN Commercial |
$3.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.06
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.06
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Mclaren Medicaid |
$0.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.11
|
| Rate for Payer: Meridian Medicaid |
$0.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.17
|
| Rate for Payer: PACE Senior Care Partners |
$1.00
|
| Rate for Payer: PACE SWMI |
$1.06
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: PHP Medicare Advantage |
$1.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.68
|
| Rate for Payer: Priority Health Medicare |
$1.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.94
|
| Rate for Payer: Railroad Medicare Medicare |
$1.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: UHC Exchange |
$1.06
|
| Rate for Payer: UHC Medicaid |
$0.75
|
| Rate for Payer: UHC Medicare Advantage |
$1.06
|
| Rate for Payer: UHCCP Medicaid |
$0.75
|
| Rate for Payer: VA VA |
$1.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$165.78
|
|
|
Service Code
|
NDC 00904670506
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.38 |
| Max. Negotiated Rate |
$149.20 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: BCBS Trust/PPO |
$136.92
|
| Rate for Payer: BCN Commercial |
$136.92
|
| Rate for Payer: Cash Price |
$132.62
|
| Rate for Payer: Cofinity Commercial |
$142.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.62
|
| Rate for Payer: Healthscope Commercial |
$149.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.91
|
| Rate for Payer: Nomi Health Commercial |
$135.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.33
|
| Rate for Payer: PHP Commercial |
$140.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$144.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.89
|
| Rate for Payer: UHC Core |
$138.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.33
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$165.78
|
|
|
Service Code
|
NDC 00904670506
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.23 |
| Max. Negotiated Rate |
$149.20 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: Aetna Medicare |
$43.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.81
|
| Rate for Payer: BCBS Complete |
$30.69
|
| Rate for Payer: BCBS MAPPO |
$41.45
|
| Rate for Payer: BCBS Trust/PPO |
$136.29
|
| Rate for Payer: BCN Commercial |
$136.29
|
| Rate for Payer: BCN Medicare Advantage |
$41.45
|
| Rate for Payer: Cash Price |
$132.62
|
| Rate for Payer: Cofinity Commercial |
$142.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.45
|
| Rate for Payer: Healthscope Commercial |
$149.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.33
|
| Rate for Payer: Mclaren Medicaid |
$29.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.52
|
| Rate for Payer: Meridian Medicaid |
$30.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.91
|
| Rate for Payer: Nomi Health Commercial |
$135.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.33
|
| Rate for Payer: PACE Senior Care Partners |
$39.37
|
| Rate for Payer: PACE SWMI |
$41.45
|
| Rate for Payer: PHP Commercial |
$140.91
|
| Rate for Payer: PHP Medicare Advantage |
$41.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$144.23
|
| Rate for Payer: Priority Health Medicare |
$41.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.38
|
| Rate for Payer: Railroad Medicare Medicare |
$41.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.89
|
| Rate for Payer: UHC Core |
$138.43
|
| Rate for Payer: UHC Exchange |
$41.45
|
| Rate for Payer: UHC Medicaid |
$29.23
|
| Rate for Payer: UHC Medicare Advantage |
$41.45
|
| Rate for Payer: UHCCP Medicaid |
$29.23
|
| Rate for Payer: VA VA |
$41.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.33
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 60687059811
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$3.81 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: BCBS Trust/PPO |
$3.49
|
| Rate for Payer: BCN Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$3.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.60
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.17
|
| Rate for Payer: PHP Commercial |
$3.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.72
|
| Rate for Payer: UHC Core |
$3.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.17
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 00904670561
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.41
|
| Rate for Payer: BCBS Trust/PPO |
$230.67
|
| Rate for Payer: BCN Commercial |
$230.67
|
| Rate for Payer: Cash Price |
$223.44
|
| 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: Lakeland Regional Health Systems Commercial |
$209.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.41
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.47
|
| Rate for Payer: PHP Commercial |
$237.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$242.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.47
|
|
|
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 |
$645.78 |
| Max. Negotiated Rate |
$835.06 |
| Rate for Payer: Aetna Commercial |
$788.66
|
| Rate for Payer: BCBS Trust/PPO |
$766.30
|
| Rate for Payer: BCN Commercial |
$766.30
|
| Rate for Payer: Cash Price |
$742.27
|
| 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: Lakeland Regional Health Systems Commercial |
$695.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.66
|
| Rate for Payer: Nomi Health Commercial |
$760.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.88
|
| Rate for Payer: PHP Commercial |
$788.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$807.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$645.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.50
|
| Rate for Payer: UHC Core |
$774.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.88
|
|
|
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 |
$163.58 |
| Max. Negotiated Rate |
$835.06 |
| Rate for Payer: Aetna Commercial |
$788.66
|
| Rate for Payer: Aetna Medicare |
$241.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$289.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$289.95
|
| Rate for Payer: BCBS Complete |
$171.74
|
| Rate for Payer: BCBS MAPPO |
$231.96
|
| Rate for Payer: BCBS Trust/PPO |
$762.78
|
| Rate for Payer: BCN Commercial |
$762.78
|
| Rate for Payer: BCN Medicare Advantage |
$231.96
|
| Rate for Payer: Cash Price |
$742.27
|
| Rate for Payer: Cofinity Commercial |
$797.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.96
|
| Rate for Payer: Healthscope Commercial |
$835.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$695.88
|
| Rate for Payer: Mclaren Medicaid |
$163.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.56
|
| Rate for Payer: Meridian Medicaid |
$171.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$255.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.66
|
| Rate for Payer: Nomi Health Commercial |
$760.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.88
|
| Rate for Payer: PACE Senior Care Partners |
$220.36
|
| Rate for Payer: PACE SWMI |
$231.96
|
| Rate for Payer: PHP Commercial |
$788.66
|
| Rate for Payer: PHP Medicare Advantage |
$231.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$807.22
|
| Rate for Payer: Priority Health Medicare |
$234.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$645.78
|
| Rate for Payer: Railroad Medicare Medicare |
$231.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$816.50
|
| Rate for Payer: UHC Core |
$774.75
|
| Rate for Payer: UHC Exchange |
$231.96
|
| Rate for Payer: UHC Medicaid |
$163.58
|
| Rate for Payer: UHC Medicare Advantage |
$231.96
|
| Rate for Payer: UHCCP Medicaid |
$163.58
|
| Rate for Payer: VA VA |
$231.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$695.88
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$9.28
|
|
|
Service Code
|
NDC 60687021511
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: BCBS Trust/PPO |
$7.66
|
| Rate for Payer: BCN Commercial |
$7.66
|
| Rate for Payer: Cash Price |
$7.42
|
| 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: Lakeland Regional Health Systems Commercial |
$6.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.89
|
| Rate for Payer: Nomi Health Commercial |
$7.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.96
|
| Rate for Payer: PHP Commercial |
$7.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.17
|
| Rate for Payer: UHC Core |
$7.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.96
|
|
|
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 |
$1.64 |
| Max. Negotiated Rate |
$8.35 |
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: Aetna Medicare |
$2.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.90
|
| Rate for Payer: BCBS Complete |
$1.72
|
| Rate for Payer: BCBS MAPPO |
$2.32
|
| Rate for Payer: BCBS Trust/PPO |
$7.63
|
| Rate for Payer: BCN Commercial |
$7.63
|
| Rate for Payer: BCN Medicare Advantage |
$2.32
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cofinity Commercial |
$7.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.32
|
| Rate for Payer: Healthscope Commercial |
$8.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.96
|
| Rate for Payer: Mclaren Medicaid |
$1.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.44
|
| Rate for Payer: Meridian Medicaid |
$1.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.89
|
| Rate for Payer: Nomi Health Commercial |
$7.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.96
|
| Rate for Payer: PACE Senior Care Partners |
$2.20
|
| Rate for Payer: PACE SWMI |
$2.32
|
| Rate for Payer: PHP Commercial |
$7.89
|
| Rate for Payer: PHP Medicare Advantage |
$2.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8.07
|
| Rate for Payer: Priority Health Medicare |
$2.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.17
|
| Rate for Payer: UHC Core |
$7.75
|
| Rate for Payer: UHC Exchange |
$2.32
|
| Rate for Payer: UHC Medicaid |
$1.64
|
| Rate for Payer: UHC Medicare Advantage |
$2.32
|
| Rate for Payer: UHCCP Medicaid |
$1.64
|
| Rate for Payer: VA VA |
$2.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.96
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$285.12
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna Medicare |
$74.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.10
|
| Rate for Payer: BCBS Complete |
$52.78
|
| Rate for Payer: BCBS MAPPO |
$71.28
|
| Rate for Payer: BCBS Trust/PPO |
$234.40
|
| Rate for Payer: BCN Commercial |
$234.40
|
| Rate for Payer: BCN Medicare Advantage |
$71.28
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.28
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.84
|
| Rate for Payer: Mclaren Medicaid |
$50.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.84
|
| Rate for Payer: Meridian Medicaid |
$52.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: Nomi Health Commercial |
$233.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.84
|
| Rate for Payer: PACE Senior Care Partners |
$67.72
|
| Rate for Payer: PACE SWMI |
$71.28
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: PHP Medicare Advantage |
$71.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.05
|
| Rate for Payer: Priority Health Medicare |
$71.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.44
|
| Rate for Payer: Railroad Medicare Medicare |
$71.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.91
|
| Rate for Payer: UHC Core |
$238.08
|
| Rate for Payer: UHC Exchange |
$71.28
|
| Rate for Payer: UHC Medicaid |
$50.27
|
| Rate for Payer: UHC Medicare Advantage |
$71.28
|
| Rate for Payer: UHCCP Medicaid |
$50.27
|
| Rate for Payer: VA VA |
$71.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.84
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
NDC 00527411737
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.19 |
| Max. Negotiated Rate |
$178.69 |
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: BCBS Trust/PPO |
$163.98
|
| Rate for Payer: BCN Commercial |
$163.98
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Nomi Health Commercial |
$162.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.91
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$172.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.72
|
| Rate for Payer: UHC Core |
$165.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$285.12
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.44 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: BCBS Trust/PPO |
$235.48
|
| Rate for Payer: BCN Commercial |
$235.48
|
| Rate for Payer: Cash Price |
$228.10
|
| 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: Lakeland Regional Health Systems Commercial |
$213.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: Nomi Health Commercial |
$233.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.84
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$248.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.91
|
| Rate for Payer: UHC Core |
$238.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.84
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$198.55
|
|
|
Service Code
|
NDC 00527411737
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$178.69 |
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna Medicare |
$51.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.05
|
| Rate for Payer: BCBS Complete |
$36.75
|
| Rate for Payer: BCBS MAPPO |
$49.64
|
| Rate for Payer: BCBS Trust/PPO |
$163.23
|
| Rate for Payer: BCN Commercial |
$163.23
|
| Rate for Payer: BCN Medicare Advantage |
$49.64
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.64
|
| Rate for Payer: Healthscope Commercial |
$178.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Mclaren Medicaid |
$35.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.12
|
| Rate for Payer: Meridian Medicaid |
$36.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.77
|
| Rate for Payer: Nomi Health Commercial |
$162.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.91
|
| Rate for Payer: PACE Senior Care Partners |
$47.16
|
| Rate for Payer: PACE SWMI |
$49.64
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: PHP Medicare Advantage |
$49.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$172.74
|
| Rate for Payer: Priority Health Medicare |
$50.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.19
|
| Rate for Payer: Railroad Medicare Medicare |
$49.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.72
|
| Rate for Payer: UHC Core |
$165.79
|
| Rate for Payer: UHC Exchange |
$49.64
|
| Rate for Payer: UHC Medicaid |
$35.00
|
| Rate for Payer: UHC Medicare Advantage |
$49.64
|
| Rate for Payer: UHCCP Medicaid |
$35.00
|
| Rate for Payer: VA VA |
$49.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$26.89 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.80
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,575.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$390.43 |
| Max. Negotiated Rate |
$2,681.25 |
| Rate for Payer: Aetna Commercial |
$873.19
|
| Rate for Payer: Aetna Medicare |
$1,787.50
|
| Rate for Payer: BCBS Complete |
$409.95
|
| Rate for Payer: BCN Commercial |
$988.00
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Mclaren Medicaid |
$390.43
|
| Rate for Payer: Meridian Medicaid |
$409.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,681.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,056.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,056.13
|
| Rate for Payer: UHC Medicaid |
$390.43
|
| Rate for Payer: UHCCP Medicaid |
$390.43
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$4,007.00
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$1,075.01 |
| Max. Negotiated Rate |
$3,019.90 |
| Rate for Payer: Aetna Commercial |
$2,513.09
|
| Rate for Payer: Aetna Medicare |
$2,003.50
|
| Rate for Payer: BCBS Complete |
$1,128.76
|
| Rate for Payer: BCN Commercial |
$2,825.05
|
| Rate for Payer: Cash Price |
$3,205.60
|
| Rate for Payer: Cash Price |
$3,205.60
|
| Rate for Payer: Mclaren Medicaid |
$1,075.01
|
| Rate for Payer: Meridian Medicaid |
$1,128.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,005.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,075.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,019.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,019.90
|
| Rate for Payer: UHC Medicaid |
$1,075.01
|
| Rate for Payer: UHCCP Medicaid |
$1,075.01
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$4,805.00
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$949.77 |
| Max. Negotiated Rate |
$3,603.75 |
| Rate for Payer: Aetna Commercial |
$2,211.26
|
| Rate for Payer: Aetna Medicare |
$2,402.50
|
| Rate for Payer: BCBS Complete |
$997.26
|
| Rate for Payer: BCN Commercial |
$2,489.41
|
| Rate for Payer: Cash Price |
$3,844.00
|
| Rate for Payer: Cash Price |
$3,844.00
|
| Rate for Payer: Mclaren Medicaid |
$949.77
|
| Rate for Payer: Meridian Medicaid |
$997.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,603.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$949.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,661.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,661.10
|
| Rate for Payer: UHC Medicaid |
$949.77
|
| Rate for Payer: UHCCP Medicaid |
$949.77
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$3,095.00
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$430.47 |
| Max. Negotiated Rate |
$2,321.25 |
| Rate for Payer: Aetna Commercial |
$956.02
|
| Rate for Payer: Aetna Medicare |
$1,547.50
|
| Rate for Payer: BCBS Complete |
$451.99
|
| Rate for Payer: BCN Commercial |
$1,102.03
|
| Rate for Payer: Cash Price |
$2,476.00
|
| Rate for Payer: Cash Price |
$2,476.00
|
| Rate for Payer: Mclaren Medicaid |
$430.47
|
| Rate for Payer: Meridian Medicaid |
$451.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,321.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$430.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,178.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,178.04
|
| Rate for Payer: UHC Medicaid |
$430.47
|
| Rate for Payer: UHCCP Medicaid |
$430.47
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$3,344.00
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$470.52 |
| Max. Negotiated Rate |
$2,508.00 |
| Rate for Payer: Aetna Commercial |
$1,065.44
|
| Rate for Payer: Aetna Medicare |
$1,672.00
|
| Rate for Payer: BCBS Complete |
$494.05
|
| Rate for Payer: BCN Commercial |
$1,208.60
|
| Rate for Payer: Cash Price |
$2,675.20
|
| Rate for Payer: Cash Price |
$2,675.20
|
| Rate for Payer: Mclaren Medicaid |
$470.52
|
| Rate for Payer: Meridian Medicaid |
$494.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,508.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,291.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,291.96
|
| Rate for Payer: UHC Medicaid |
$470.52
|
| Rate for Payer: UHCCP Medicaid |
$470.52
|
|
|
PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR
|
Professional
|
Both
|
$3,228.00
|
|
|
Service Code
|
HCPCS 27217
|
| Min. Negotiated Rate |
$478.40 |
| Max. Negotiated Rate |
$2,421.00 |
| Rate for Payer: Aetna Commercial |
$1,119.55
|
| Rate for Payer: Aetna Medicare |
$1,614.00
|
| Rate for Payer: BCBS Complete |
$502.32
|
| Rate for Payer: BCN Commercial |
$1,259.40
|
| Rate for Payer: Cash Price |
$2,582.40
|
| Rate for Payer: Cash Price |
$2,582.40
|
| Rate for Payer: Mclaren Medicaid |
$478.40
|
| Rate for Payer: Meridian Medicaid |
$502.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,421.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$478.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,346.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,346.25
|
| Rate for Payer: UHC Medicaid |
$478.40
|
| Rate for Payer: UHCCP Medicaid |
$478.40
|
|
|
PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ
|
Professional
|
Both
|
$3,336.00
|
|
|
Service Code
|
HCPCS 26686
|
| Min. Negotiated Rate |
$377.86 |
| Max. Negotiated Rate |
$2,502.00 |
| Rate for Payer: Aetna Commercial |
$833.37
|
| Rate for Payer: Aetna Medicare |
$1,668.00
|
| Rate for Payer: BCBS Complete |
$396.75
|
| Rate for Payer: BCN Commercial |
$955.13
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Cash Price |
$2,668.80
|
| Rate for Payer: Mclaren Medicaid |
$377.86
|
| Rate for Payer: Meridian Medicaid |
$396.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,502.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$377.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,021.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,021.01
|
| Rate for Payer: UHC Medicaid |
$377.86
|
| Rate for Payer: UHCCP Medicaid |
$377.86
|
|
|
PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
|
Professional
|
Both
|
$2,535.00
|
|
|
Service Code
|
HCPCS 21470
|
| Min. Negotiated Rate |
$662.86 |
| Max. Negotiated Rate |
$1,901.25 |
| Rate for Payer: Aetna Commercial |
$1,539.08
|
| Rate for Payer: Aetna Medicare |
$1,267.50
|
| Rate for Payer: BCBS Complete |
$696.00
|
| Rate for Payer: BCN Commercial |
$1,753.39
|
| Rate for Payer: Cash Price |
$2,028.00
|
| Rate for Payer: Cash Price |
$2,028.00
|
| Rate for Payer: Mclaren Medicaid |
$662.86
|
| Rate for Payer: Meridian Medicaid |
$696.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,901.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$662.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,874.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,874.33
|
| Rate for Payer: UHC Medicaid |
$662.86
|
| Rate for Payer: UHCCP Medicaid |
$662.86
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,493.00
|
|
|
Service Code
|
HCPCS 25608
|
| Min. Negotiated Rate |
$492.24 |
| Max. Negotiated Rate |
$1,869.75 |
| Rate for Payer: Aetna Commercial |
$1,100.22
|
| Rate for Payer: Aetna Medicare |
$1,246.50
|
| Rate for Payer: BCBS Complete |
$516.85
|
| Rate for Payer: BCN Commercial |
$1,268.36
|
| Rate for Payer: Cash Price |
$1,994.40
|
| Rate for Payer: Cash Price |
$1,994.40
|
| Rate for Payer: Mclaren Medicaid |
$492.24
|
| Rate for Payer: Meridian Medicaid |
$516.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,869.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$492.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,355.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,355.85
|
| Rate for Payer: UHC Medicaid |
$492.24
|
| Rate for Payer: UHCCP Medicaid |
$492.24
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3+ FRAG
|
Professional
|
Both
|
$3,048.00
|
|
|
Service Code
|
HCPCS 25609
|
| Min. Negotiated Rate |
$617.49 |
| Max. Negotiated Rate |
$2,286.00 |
| Rate for Payer: Aetna Commercial |
$1,398.32
|
| Rate for Payer: Aetna Medicare |
$1,524.00
|
| Rate for Payer: BCBS Complete |
$648.36
|
| Rate for Payer: BCN Commercial |
$1,607.48
|
| Rate for Payer: Cash Price |
$2,438.40
|
| Rate for Payer: Cash Price |
$2,438.40
|
| Rate for Payer: Mclaren Medicaid |
$617.49
|
| Rate for Payer: Meridian Medicaid |
$648.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,286.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$617.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,718.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,718.36
|
| Rate for Payer: UHC Medicaid |
$617.49
|
| Rate for Payer: UHCCP Medicaid |
$617.49
|
|
|
PR OPTX DSTL RDL X-ARTIC FX/EPIPHYSL SEPARATION
|
Professional
|
Both
|
$2,002.00
|
|
|
Service Code
|
HCPCS 25607
|
| Min. Negotiated Rate |
$444.74 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna Commercial |
$981.85
|
| Rate for Payer: Aetna Medicare |
$1,001.00
|
| Rate for Payer: BCBS Complete |
$466.98
|
| Rate for Payer: BCN Commercial |
$1,138.89
|
| Rate for Payer: Cash Price |
$1,601.60
|
| Rate for Payer: Cash Price |
$1,601.60
|
| Rate for Payer: Mclaren Medicaid |
$444.74
|
| Rate for Payer: Meridian Medicaid |
$466.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,501.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$444.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,217.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,217.43
|
| Rate for Payer: UHC Medicaid |
$444.74
|
| Rate for Payer: UHCCP Medicaid |
$444.74
|
|
