|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$432.40
|
|
|
Service Code
|
NDC 00603548321
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.26 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UMR Bronson Commercial |
$190.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$39.95
|
|
|
Service Code
|
NDC 23155011101
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$35.96 |
| Rate for Payer: Aetna American Axle |
$25.97
|
| Rate for Payer: Aetna Commercial |
$33.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.97
|
| Rate for Payer: Cash Price |
$31.96
|
| Rate for Payer: Cofinity Commercial |
$27.96
|
| Rate for Payer: Cofinity Commercial |
$34.36
|
| Rate for Payer: 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: Kalamazoo County Sherrif's Dept Commercial |
$27.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.96
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
| Rate for Payer: UMR Bronson Commercial |
$17.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.96
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$300.80
|
|
|
Service Code
|
NDC 69238207801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$270.72 |
| Rate for Payer: Aetna American Axle |
$195.52
|
| Rate for Payer: Aetna Commercial |
$255.68
|
| Rate for Payer: Aetna Medicare |
$150.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.52
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$210.56
|
| Rate for Payer: Cofinity Commercial |
$258.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$210.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$270.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: PHP Commercial |
$255.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health SBD |
$189.50
|
| Rate for Payer: UMR Bronson Commercial |
$111.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.60
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$432.40
|
|
|
Service Code
|
NDC 00603548321
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.99 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Medicare |
$216.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Commercial |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$302.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.06
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UMR Bronson Commercial |
$159.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 00603548421
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.25 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UMR Bronson Commercial |
$82.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 00603548421
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.81 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna American Axle |
$144.50
|
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$155.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$155.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$166.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UMR Bronson Commercial |
$97.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$166.72
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$51.70
|
|
|
Service Code
|
NDC 23155011201
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
| Rate for Payer: UMR Bronson Commercial |
$19.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.78
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 23155011201
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.75 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna American Axle |
$33.60
|
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: 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: Kalamazoo County Sherrif's Dept Commercial |
$36.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.78
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
| Rate for Payer: UMR Bronson Commercial |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.78
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$426.55
|
|
|
Service Code
|
NDC 00591555601
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.82 |
| Max. Negotiated Rate |
$383.90 |
| Rate for Payer: Aetna American Axle |
$277.26
|
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: Aetna Medicare |
$213.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.26
|
| Rate for Payer: BCBS Complete |
$170.62
|
| Rate for Payer: Cash Price |
$341.24
|
| Rate for Payer: Cofinity Commercial |
$298.58
|
| Rate for Payer: Cofinity Commercial |
$366.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.24
|
| Rate for Payer: Healthscope Commercial |
$383.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.57
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.26
|
| Rate for Payer: Priority Health SBD |
$268.73
|
| Rate for Payer: UMR Bronson Commercial |
$157.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.91
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$426.55
|
|
|
Service Code
|
NDC 00591555601
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.68 |
| Max. Negotiated Rate |
$383.90 |
| Rate for Payer: Aetna American Axle |
$277.26
|
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.26
|
| Rate for Payer: Cash Price |
$341.24
|
| Rate for Payer: Cofinity Commercial |
$298.58
|
| Rate for Payer: Cofinity Commercial |
$366.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$298.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.24
|
| Rate for Payer: Healthscope Commercial |
$383.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.57
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.26
|
| Rate for Payer: Priority Health SBD |
$268.73
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.91
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$224.20
|
|
|
Service Code
|
NDC 69238207901
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna Medicare |
$112.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: BCBS Complete |
$89.68
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.73
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$82.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 00115166101
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 00115166101
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: 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: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS 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
|
| Rate for Payer: UMR Bronson Commercial |
$99.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$224.20
|
|
|
Service Code
|
NDC 69238207901
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$201.78 |
| Rate for Payer: Aetna American Axle |
$145.73
|
| Rate for Payer: Aetna Commercial |
$190.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.73
|
| Rate for Payer: Cash Price |
$179.36
|
| Rate for Payer: Cofinity Commercial |
$156.94
|
| Rate for Payer: Cofinity Commercial |
$192.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$156.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.36
|
| Rate for Payer: Healthscope Commercial |
$201.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.57
|
| Rate for Payer: PHP Commercial |
$190.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.73
|
| Rate for Payer: Priority Health SBD |
$141.25
|
| Rate for Payer: UMR Bronson Commercial |
$98.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.15
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 00527411637
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$243.84
|
|
|
Service Code
|
NDC 51991081701
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.22 |
| Max. Negotiated Rate |
$219.46 |
| Rate for Payer: Aetna American Axle |
$158.50
|
| 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 Commercial |
$170.69
|
| Rate for Payer: Cofinity Commercial |
$209.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$219.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.26
|
| Rate for Payer: PHP Commercial |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.50
|
| Rate for Payer: Priority Health SBD |
$153.62
|
| Rate for Payer: UMR Bronson Commercial |
$90.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.88
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$243.84
|
|
|
Service Code
|
NDC 51991081701
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.29 |
| Max. Negotiated Rate |
$219.46 |
| Rate for Payer: Aetna American Axle |
$158.50
|
| Rate for Payer: Aetna Commercial |
$207.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.50
|
| Rate for Payer: Cash Price |
$195.07
|
| Rate for Payer: Cofinity Commercial |
$170.69
|
| Rate for Payer: Cofinity Commercial |
$209.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$219.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.26
|
| Rate for Payer: PHP Commercial |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.50
|
| Rate for Payer: Priority Health SBD |
$153.62
|
| Rate for Payer: UMR Bronson Commercial |
$107.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.88
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$729.12
|
|
|
Service Code
|
NDC 00228277811
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$320.81 |
| Max. Negotiated Rate |
$656.21 |
| Rate for Payer: Cofinity Commercial |
$510.38
|
| Rate for Payer: Aetna American Axle |
$473.93
|
| Rate for Payer: Aetna Commercial |
$619.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.93
|
| Rate for Payer: Cash Price |
$583.30
|
| Rate for Payer: Cofinity Commercial |
$627.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.30
|
| Rate for Payer: Healthscope Commercial |
$656.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.75
|
| Rate for Payer: PHP Commercial |
$619.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.93
|
| Rate for Payer: Priority Health SBD |
$459.35
|
| Rate for Payer: UMR Bronson Commercial |
$320.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.84
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 62559053001
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 00527411637
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 62559053001
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$729.12
|
|
|
Service Code
|
NDC 00228277811
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.77 |
| Max. Negotiated Rate |
$656.21 |
| Rate for Payer: Aetna American Axle |
$473.93
|
| Rate for Payer: Aetna Commercial |
$619.75
|
| Rate for Payer: Aetna Medicare |
$364.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.93
|
| Rate for Payer: BCBS Complete |
$291.65
|
| Rate for Payer: Cash Price |
$583.30
|
| Rate for Payer: Cofinity Commercial |
$510.38
|
| Rate for Payer: Cofinity Commercial |
$627.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$510.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$583.30
|
| Rate for Payer: Healthscope Commercial |
$656.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$510.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$546.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$619.75
|
| Rate for Payer: PHP Commercial |
$619.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.93
|
| Rate for Payer: Priority Health SBD |
$459.35
|
| Rate for Payer: UMR Bronson Commercial |
$269.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$546.84
|
|
|
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 |
$105.49 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna American Axle |
$185.33
|
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna Medicare |
$142.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.33
|
| Rate for Payer: BCBS Complete |
$114.05
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$199.58
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.33
|
| Rate for Payer: Priority Health SBD |
$179.63
|
| Rate for Payer: UMR Bronson Commercial |
$105.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.84
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00527411737
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.41 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UMR Bronson Commercial |
$72.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
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 |
$125.45 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna American Axle |
$185.33
|
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.33
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$199.58
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$199.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$199.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.33
|
| Rate for Payer: Priority Health SBD |
$179.63
|
| Rate for Payer: UMR Bronson Commercial |
$125.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.84
|
|
