|
PROPOFOL INFUSION (SYRINGE PUMP 20ML VIAL)(SHH)
|
Facility
|
OP
|
$76.91
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare |
$28.46
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: BCBS Complete |
$30.76
|
| Rate for Payer: BCBS Trust/PPO |
$63.41
|
| Rate for Payer: BCN Commercial |
$63.41
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$74.60
|
| Rate for Payer: Healthscope Whirlpool |
$76.91
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.38
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
|
PROPOFOL INFUSION (SYRINGE PUMP 20ML VIAL)(SHH)
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: BCBS Trust/PPO |
$63.16
|
| Rate for Payer: BCN Commercial |
$63.16
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$74.60
|
| Rate for Payer: Healthscope Whirlpool |
$76.91
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.38
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
|
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 |
$846.59
|
| 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 |
$1,015.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,015.91
|
| 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: 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/Tiered Network |
$1,461.76
|
| Rate for Payer: Priority Health Medicare |
$846.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,461.76
|
| Rate for Payer: Railroad Medicare Medicare |
$846.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + 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 DNSP |
$846.59
|
| 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 |
$787.02
|
| 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 |
$944.42
|
| Rate for Payer: Healthscope Whirlpool |
$944.42
|
| 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: 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/Tiered Network |
$1,354.78
|
| Rate for Payer: Priority Health Medicare |
$787.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,354.78
|
| Rate for Payer: Railroad Medicare Medicare |
$787.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + 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 DNSP |
$787.02
|
| 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 |
$1,547.52 |
| Rate for Payer: Aetna Commercial |
$1,161.28
|
| Rate for Payer: Aetna Medicare |
$866.63
|
| 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 |
$1,039.96
|
| Rate for Payer: Healthscope Whirlpool |
$1,039.96
|
| 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: 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/Tiered Network |
$1,497.44
|
| Rate for Payer: Priority Health Medicare |
$866.63
|
| Rate for Payer: Priority Health Narrow Network |
$1,497.44
|
| Rate for Payer: Railroad Medicare Medicare |
$866.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + 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 DNSP |
$866.63
|
| Rate for Payer: UHCCP Medicaid |
$575.53
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$422.75
|
|
|
Service Code
|
NDC 60687059801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$317.06 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna Commercial |
$380.48
|
| Rate for Payer: ASR ASR |
$410.07
|
| Rate for Payer: BCBS Trust/PPO |
$347.16
|
| Rate for Payer: BCN Commercial |
$347.16
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cofinity Commercial |
$397.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.20
|
| Rate for Payer: Healthscope Commercial |
$410.07
|
| Rate for Payer: Healthscope Whirlpool |
$422.75
|
| Rate for Payer: Mclaren Commercial |
$380.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.34
|
| Rate for Payer: Nomi Health Commercial |
$346.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.02
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$298.45
|
|
|
Service Code
|
NDC 69238207801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.84 |
| Max. Negotiated Rate |
$298.45 |
| Rate for Payer: Aetna Commercial |
$268.61
|
| Rate for Payer: ASR ASR |
$289.50
|
| Rate for Payer: BCBS Trust/PPO |
$245.09
|
| Rate for Payer: BCN Commercial |
$245.09
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$280.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$289.50
|
| Rate for Payer: Healthscope Whirlpool |
$298.45
|
| Rate for Payer: Mclaren Commercial |
$268.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.64
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$42.30
|
|
|
Service Code
|
NDC 23155011101
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: Aetna Medicare |
$15.65
|
| Rate for Payer: ASR ASR |
$41.03
|
| Rate for Payer: BCBS Complete |
$16.92
|
| Rate for Payer: BCBS Trust/PPO |
$34.88
|
| Rate for Payer: BCN Commercial |
$34.88
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Commercial |
$39.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$41.03
|
| Rate for Payer: Healthscope Whirlpool |
$42.30
|
| Rate for Payer: Mclaren Commercial |
$38.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.95
|
| Rate for Payer: Nomi Health Commercial |
$34.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.06
|
| Rate for Payer: Priority Health Narrow Network |
$29.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.22
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$165.78
|
|
|
Service Code
|
NDC 904670506
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.33 |
| Max. Negotiated Rate |
$165.78 |
| Rate for Payer: Aetna Commercial |
$149.20
|
| Rate for Payer: ASR ASR |
$160.80
|
| Rate for Payer: BCBS Trust/PPO |
$136.13
|
| Rate for Payer: BCN Commercial |
$136.13
|
| Rate for Payer: Cash Price |
$132.62
|
| Rate for Payer: Cofinity Commercial |
$155.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.62
|
| Rate for Payer: Healthscope Commercial |
$160.80
|
| Rate for Payer: Healthscope Whirlpool |
$165.78
|
| Rate for Payer: Mclaren Commercial |
$149.20
|
| 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: UHC All Payor (Choice/PPO) + Core |
$145.88
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$422.75
|
|
|
Service Code
|
NDC 60687059801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.42 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna Commercial |
$380.48
|
| Rate for Payer: Aetna Medicare |
$156.42
|
| Rate for Payer: ASR ASR |
$410.07
|
| Rate for Payer: BCBS Complete |
$169.10
|
| Rate for Payer: BCBS Trust/PPO |
$348.56
|
| Rate for Payer: BCN Commercial |
$348.56
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cofinity Commercial |
$397.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.20
|
| Rate for Payer: Healthscope Commercial |
$410.07
|
| Rate for Payer: Healthscope Whirlpool |
$422.75
|
| Rate for Payer: Mclaren Commercial |
$380.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.34
|
| Rate for Payer: Nomi Health Commercial |
$346.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$370.41
|
| Rate for Payer: Priority Health Narrow Network |
$296.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$372.02
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 115166001
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$327.82 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: BCBS Trust/PPO |
$358.95
|
| Rate for Payer: BCN Commercial |
$358.95
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$423.99
|
| Rate for Payer: Healthscope Whirlpool |
$437.10
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$4.23
|
|
|
Service Code
|
NDC 60687059811
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: ASR ASR |
$4.10
|
| Rate for Payer: BCBS Complete |
$1.69
|
| 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 |
$3.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$4.10
|
| Rate for Payer: Healthscope Whirlpool |
$4.23
|
| Rate for Payer: Mclaren Commercial |
$3.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.59
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.70
|
| Rate for Payer: Priority Health Narrow Network |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.72
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 69238207801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.43 |
| Max. Negotiated Rate |
$298.45 |
| Rate for Payer: Aetna Commercial |
$268.61
|
| Rate for Payer: Aetna Medicare |
$110.43
|
| Rate for Payer: ASR ASR |
$289.50
|
| Rate for Payer: BCBS Complete |
$119.38
|
| Rate for Payer: BCBS Trust/PPO |
$246.07
|
| Rate for Payer: BCN Commercial |
$246.07
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Commercial |
$280.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$289.50
|
| Rate for Payer: Healthscope Whirlpool |
$298.45
|
| Rate for Payer: Mclaren Commercial |
$268.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Nomi Health Commercial |
$244.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$261.50
|
| Rate for Payer: Priority Health Narrow Network |
$209.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.64
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$4.23
|
|
|
Service Code
|
NDC 60687059811
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: ASR ASR |
$4.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.47
|
| Rate for Payer: BCN Commercial |
$3.47
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cofinity Commercial |
$3.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.38
|
| Rate for Payer: Healthscope Commercial |
$4.10
|
| Rate for Payer: Healthscope Whirlpool |
$4.23
|
| Rate for Payer: Mclaren Commercial |
$3.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.59
|
| Rate for Payer: Nomi Health Commercial |
$3.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.72
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$42.30
|
|
|
Service Code
|
NDC 23155011101
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: ASR ASR |
$41.03
|
| Rate for Payer: BCBS Trust/PPO |
$34.74
|
| Rate for Payer: BCN Commercial |
$34.74
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Commercial |
$39.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$41.03
|
| Rate for Payer: Healthscope Whirlpool |
$42.30
|
| Rate for Payer: Mclaren Commercial |
$38.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.95
|
| Rate for Payer: Nomi Health Commercial |
$34.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.22
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 115166001
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: Aetna Medicare |
$161.73
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS Trust/PPO |
$360.39
|
| Rate for Payer: BCN Commercial |
$360.39
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$423.99
|
| Rate for Payer: Healthscope Whirlpool |
$437.10
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health Narrow Network |
$306.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$165.78
|
|
|
Service Code
|
NDC 904670506
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.34 |
| Max. Negotiated Rate |
$165.78 |
| Rate for Payer: Aetna Commercial |
$149.20
|
| Rate for Payer: Aetna Medicare |
$61.34
|
| Rate for Payer: ASR ASR |
$160.80
|
| Rate for Payer: BCBS Complete |
$66.31
|
| Rate for Payer: BCBS Trust/PPO |
$136.68
|
| Rate for Payer: BCN Commercial |
$136.68
|
| Rate for Payer: Cash Price |
$132.62
|
| Rate for Payer: Cofinity Commercial |
$155.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.62
|
| Rate for Payer: Healthscope Commercial |
$160.80
|
| Rate for Payer: Healthscope Whirlpool |
$165.78
|
| Rate for Payer: Mclaren Commercial |
$149.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$132.62
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$145.25
|
| Rate for Payer: Priority Health Narrow Network |
$116.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.88
|
|
|
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 |
$6.96 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$8.35
|
| Rate for Payer: ASR ASR |
$9.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.62
|
| Rate for Payer: BCN Commercial |
$7.62
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cofinity Commercial |
$8.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.42
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Healthscope Whirlpool |
$9.28
|
| Rate for Payer: Mclaren Commercial |
$8.35
|
| 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: UHC All Payor (Choice/PPO) + Core |
$8.17
|
|
|
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 |
$182.88 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna Commercial |
$219.46
|
| Rate for Payer: ASR ASR |
$236.52
|
| Rate for Payer: BCBS Trust/PPO |
$200.24
|
| Rate for Payer: BCN Commercial |
$200.24
|
| Rate for Payer: Cash Price |
$195.07
|
| Rate for Payer: Cofinity Commercial |
$229.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$236.52
|
| Rate for Payer: Healthscope Whirlpool |
$243.84
|
| Rate for Payer: Mclaren Commercial |
$219.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.26
|
| Rate for Payer: Nomi Health Commercial |
$199.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.58
|
|
|
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 |
$343.30 |
| Max. Negotiated Rate |
$927.84 |
| Rate for Payer: Aetna Commercial |
$835.06
|
| Rate for Payer: Aetna Medicare |
$343.30
|
| Rate for Payer: ASR ASR |
$900.00
|
| Rate for Payer: BCBS Complete |
$371.14
|
| Rate for Payer: BCBS Trust/PPO |
$765.00
|
| Rate for Payer: BCN Commercial |
$765.00
|
| Rate for Payer: Cash Price |
$742.27
|
| Rate for Payer: Cofinity Commercial |
$872.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.27
|
| Rate for Payer: Healthscope Commercial |
$900.00
|
| Rate for Payer: Healthscope Whirlpool |
$927.84
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$760.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$695.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$812.97
|
| Rate for Payer: Priority Health Narrow Network |
$650.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$816.50
|
|
|
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 |
$3.43 |
| Max. Negotiated Rate |
$9.28 |
| Rate for Payer: Aetna Commercial |
$8.35
|
| Rate for Payer: Aetna Medicare |
$3.43
|
| Rate for Payer: ASR ASR |
$9.00
|
| Rate for Payer: BCBS Complete |
$3.71
|
| Rate for Payer: BCBS Trust/PPO |
$7.65
|
| Rate for Payer: BCN Commercial |
$7.65
|
| Rate for Payer: Cash Price |
$7.42
|
| Rate for Payer: Cofinity Commercial |
$8.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.42
|
| Rate for Payer: Healthscope Commercial |
$9.00
|
| Rate for Payer: Healthscope Whirlpool |
$9.28
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$7.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.13
|
| Rate for Payer: Priority Health Narrow Network |
$6.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.17
|
|
|
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 |
$695.88 |
| Max. Negotiated Rate |
$927.84 |
| Rate for Payer: Aetna Commercial |
$835.06
|
| Rate for Payer: ASR ASR |
$900.00
|
| Rate for Payer: BCBS Trust/PPO |
$761.94
|
| Rate for Payer: BCN Commercial |
$761.94
|
| Rate for Payer: Cash Price |
$742.27
|
| Rate for Payer: Cofinity Commercial |
$872.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$742.27
|
| Rate for Payer: Healthscope Commercial |
$900.00
|
| Rate for Payer: Healthscope Whirlpool |
$927.84
|
| Rate for Payer: Mclaren Commercial |
$835.06
|
| 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: UHC All Payor (Choice/PPO) + Core |
$816.50
|
|
|
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 |
$243.84 |
| Rate for Payer: Aetna Commercial |
$219.46
|
| Rate for Payer: Aetna Medicare |
$90.22
|
| Rate for Payer: ASR ASR |
$236.52
|
| Rate for Payer: BCBS Complete |
$97.54
|
| Rate for Payer: BCBS Trust/PPO |
$201.05
|
| Rate for Payer: BCN Commercial |
$201.05
|
| Rate for Payer: Cash Price |
$195.07
|
| Rate for Payer: Cofinity Commercial |
$229.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$236.52
|
| Rate for Payer: Healthscope Whirlpool |
$243.84
|
| Rate for Payer: Mclaren 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: Nomi Health Commercial |
$199.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$213.65
|
| Rate for Payer: Priority Health Narrow Network |
$170.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.58
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$28.01 |
| Rate for Payer: Aetna Commercial |
$22.86
|
| Rate for Payer: Aetna Medicare |
$17.06
|
| Rate for Payer: BCBS MAPPO |
$17.06
|
| Rate for Payer: BCN Commercial |
$26.89
|
| Rate for Payer: BCN Medicare Advantage |
$17.06
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$22.86
|
| Rate for Payer: Cofinity Commercial |
$24.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.06
|
| Rate for Payer: Healthscope Commercial |
$20.47
|
| Rate for Payer: Healthscope Whirlpool |
$20.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.77
|
| Rate for Payer: Nomi Health Commercial |
$20.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: PACE SWMI |
$17.06
|
| Rate for Payer: PHP Medicare Advantage |
$17.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24.80
|
| Rate for Payer: Priority Health Medicare |
$17.06
|
| Rate for Payer: Priority Health Narrow Network |
$24.80
|
| Rate for Payer: Railroad Medicare Medicare |
$17.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.06
|
| Rate for Payer: UHC Exchange |
$28.01
|
| Rate for Payer: UHCCP DNSP |
$17.06
|
|
|
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 |
$798.85
|
| Rate for Payer: Aetna Medicare |
$596.16
|
| Rate for Payer: BCBS Complete |
$409.95
|
| Rate for Payer: BCBS MAPPO |
$596.16
|
| Rate for Payer: BCN Commercial |
$988.00
|
| Rate for Payer: BCN Medicare Advantage |
$596.16
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Cash Price |
$2,860.00
|
| Rate for Payer: Cofinity Commercial |
$858.47
|
| Rate for Payer: Cofinity Commercial |
$798.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$596.16
|
| Rate for Payer: Healthscope Commercial |
$715.39
|
| Rate for Payer: Healthscope Whirlpool |
$715.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$625.97
|
| Rate for Payer: Meridian Medicaid |
$409.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$655.78
|
| Rate for Payer: Nomi Health Commercial |
$715.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,681.25
|
| Rate for Payer: PACE SWMI |
$596.16
|
| Rate for Payer: PHP Medicare Advantage |
$596.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$390.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,056.13
|
| Rate for Payer: Priority Health Medicare |
$596.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,056.13
|
| Rate for Payer: Railroad Medicare Medicare |
$596.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,138.40
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$596.16
|
| Rate for Payer: UHC Exchange |
$1,138.40
|
| Rate for Payer: UHC Medicaid |
$390.43
|
| Rate for Payer: UHCCP DNSP |
$596.16
|
| Rate for Payer: UHCCP Medicaid |
$390.43
|
|
