|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$165.78
|
|
|
Service Code
|
NDC 00904670506
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.31 |
| Max. Negotiated Rate |
$165.78 |
| Rate for Payer: Aetna Commercial |
$149.20
|
| Rate for Payer: Aetna Medicare |
$82.89
|
| Rate for Payer: ASR ASR |
$160.81
|
| Rate for Payer: ASR Commercial |
$160.81
|
| Rate for Payer: BCBS Complete |
$66.31
|
| Rate for Payer: BCBS Trust/PPO |
$135.76
|
| Rate for Payer: BCN Commercial |
$128.53
|
| 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 |
$165.78
|
| Rate for Payer: Healthscope Whirlpool |
$160.81
|
| 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: Priority Health Cigna Priority Health |
$107.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.26
|
| Rate for Payer: Priority Health Narrow Network |
$116.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.89
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$165.78
|
|
|
Service Code
|
NDC 00904670506
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.76 |
| Max. Negotiated Rate |
$165.78 |
| Rate for Payer: Aetna Commercial |
$149.20
|
| Rate for Payer: ASR ASR |
$160.81
|
| Rate for Payer: ASR Commercial |
$160.81
|
| Rate for Payer: BCBS Trust/PPO |
$135.09
|
| Rate for Payer: BCN Commercial |
$128.53
|
| 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 |
$165.78
|
| Rate for Payer: Healthscope Whirlpool |
$160.81
|
| 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: Priority Health Cigna Priority Health |
$107.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.89
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$300.80
|
|
|
Service Code
|
NDC 69238207801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.52 |
| Max. Negotiated Rate |
$300.80 |
| Rate for Payer: Aetna Commercial |
$270.72
|
| Rate for Payer: ASR ASR |
$291.78
|
| Rate for Payer: ASR Commercial |
$291.78
|
| Rate for Payer: BCBS Trust/PPO |
$245.12
|
| Rate for Payer: BCN Commercial |
$233.21
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$282.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$300.80
|
| Rate for Payer: Healthscope Whirlpool |
$291.78
|
| Rate for Payer: Mclaren Commercial |
$270.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: Nomi Health Commercial |
$246.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.70
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$4.17
|
|
|
Service Code
|
NDC 60687059811
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: Aetna Medicare |
$2.08
|
| Rate for Payer: ASR ASR |
$4.04
|
| Rate for Payer: ASR Commercial |
$4.04
|
| Rate for Payer: BCBS Complete |
$1.67
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Commercial |
$3.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$4.17
|
| Rate for Payer: Healthscope Whirlpool |
$4.04
|
| Rate for Payer: Mclaren Commercial |
$3.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.65
|
| Rate for Payer: Priority Health Narrow Network |
$2.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.67
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$42.30
|
|
|
Service Code
|
NDC 23155011101
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: ASR ASR |
$41.03
|
| Rate for Payer: ASR Commercial |
$41.03
|
| Rate for Payer: BCBS Trust/PPO |
$34.47
|
| Rate for Payer: BCN Commercial |
$32.80
|
| 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 |
$42.30
|
| Rate for Payer: Healthscope Whirlpool |
$41.03
|
| Rate for Payer: Mclaren Commercial |
$38.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.96
|
| Rate for Payer: Nomi Health Commercial |
$34.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.22
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$4.17
|
|
|
Service Code
|
NDC 60687059811
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$4.17 |
| Rate for Payer: Aetna Commercial |
$3.75
|
| Rate for Payer: ASR ASR |
$4.04
|
| Rate for Payer: ASR Commercial |
$4.04
|
| Rate for Payer: BCBS Trust/PPO |
$3.40
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Commercial |
$3.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$4.17
|
| Rate for Payer: Healthscope Whirlpool |
$4.04
|
| Rate for Payer: Mclaren Commercial |
$3.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.54
|
| Rate for Payer: Nomi Health Commercial |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.67
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$42.30
|
|
|
Service Code
|
NDC 23155011101
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.92 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: Aetna Medicare |
$21.15
|
| Rate for Payer: ASR ASR |
$41.03
|
| Rate for Payer: ASR Commercial |
$41.03
|
| Rate for Payer: BCBS Complete |
$16.92
|
| Rate for Payer: BCBS Trust/PPO |
$34.64
|
| Rate for Payer: BCN Commercial |
$32.80
|
| 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 |
$42.30
|
| Rate for Payer: Healthscope Whirlpool |
$41.03
|
| Rate for Payer: Mclaren Commercial |
$38.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.96
|
| Rate for Payer: Nomi Health Commercial |
$34.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.50
|
| Rate for Payer: 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
|
$437.10
|
|
|
Service Code
|
NDC 00115166001
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.12 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: ASR Commercial |
$423.99
|
| Rate for Payer: BCBS Trust/PPO |
$356.19
|
| Rate for Payer: BCN Commercial |
$338.88
|
| 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 |
$437.10
|
| Rate for Payer: Healthscope Whirlpool |
$423.99
|
| 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: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$300.80
|
|
|
Service Code
|
NDC 69238207801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.32 |
| Max. Negotiated Rate |
$300.80 |
| Rate for Payer: Aetna Commercial |
$270.72
|
| Rate for Payer: Aetna Medicare |
$150.40
|
| Rate for Payer: ASR ASR |
$291.78
|
| Rate for Payer: ASR Commercial |
$291.78
|
| Rate for Payer: BCBS Complete |
$120.32
|
| Rate for Payer: BCBS Trust/PPO |
$246.33
|
| Rate for Payer: BCN Commercial |
$233.21
|
| Rate for Payer: Cash Price |
$240.64
|
| Rate for Payer: Cofinity Commercial |
$282.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.64
|
| Rate for Payer: Healthscope Commercial |
$300.80
|
| Rate for Payer: Healthscope Whirlpool |
$291.78
|
| Rate for Payer: Mclaren Commercial |
$270.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$255.68
|
| Rate for Payer: Nomi Health Commercial |
$246.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.56
|
| Rate for Payer: Priority Health Narrow Network |
$210.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.70
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$417.05
|
|
|
Service Code
|
NDC 60687059801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.82 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Aetna Commercial |
$375.34
|
| Rate for Payer: Aetna Medicare |
$208.52
|
| Rate for Payer: ASR ASR |
$404.54
|
| Rate for Payer: ASR Commercial |
$404.54
|
| Rate for Payer: BCBS Complete |
$166.82
|
| Rate for Payer: BCBS Trust/PPO |
$341.52
|
| Rate for Payer: BCN Commercial |
$323.34
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$392.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$417.05
|
| Rate for Payer: Healthscope Whirlpool |
$404.54
|
| Rate for Payer: Mclaren Commercial |
$375.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.42
|
| Rate for Payer: Priority Health Narrow Network |
$292.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$367.00
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 60687059801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.08 |
| Max. Negotiated Rate |
$417.05 |
| Rate for Payer: Aetna Commercial |
$375.34
|
| Rate for Payer: ASR ASR |
$404.54
|
| Rate for Payer: ASR Commercial |
$404.54
|
| Rate for Payer: BCBS Trust/PPO |
$339.85
|
| Rate for Payer: BCN Commercial |
$323.34
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$392.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$417.05
|
| Rate for Payer: Healthscope Whirlpool |
$404.54
|
| Rate for Payer: Mclaren Commercial |
$375.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$367.00
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 00115166001
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.84 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: ASR Commercial |
$423.99
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS Trust/PPO |
$357.94
|
| Rate for Payer: BCN Commercial |
$338.88
|
| 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 |
$437.10
|
| Rate for Payer: Healthscope Whirlpool |
$423.99
|
| 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: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: 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 ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$876.48
|
|
|
Service Code
|
NDC 60687021501
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$350.59 |
| Max. Negotiated Rate |
$876.48 |
| Rate for Payer: Aetna Commercial |
$788.83
|
| Rate for Payer: Aetna Medicare |
$438.24
|
| Rate for Payer: ASR ASR |
$850.19
|
| Rate for Payer: ASR Commercial |
$850.19
|
| Rate for Payer: BCBS Complete |
$350.59
|
| Rate for Payer: BCBS Trust/PPO |
$717.75
|
| Rate for Payer: BCN Commercial |
$679.53
|
| Rate for Payer: Cash Price |
$701.18
|
| Rate for Payer: Cofinity Commercial |
$823.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.18
|
| Rate for Payer: Healthscope Commercial |
$876.48
|
| Rate for Payer: Healthscope Whirlpool |
$850.19
|
| Rate for Payer: Mclaren Commercial |
$788.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.01
|
| Rate for Payer: Nomi Health Commercial |
$718.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$767.97
|
| Rate for Payer: Priority Health Narrow Network |
$614.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$771.30
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$8.77
|
|
|
Service Code
|
NDC 60687021511
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$8.77 |
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: ASR ASR |
$8.51
|
| Rate for Payer: ASR Commercial |
$8.51
|
| Rate for Payer: BCBS Complete |
$3.51
|
| Rate for Payer: BCBS Trust/PPO |
$7.18
|
| Rate for Payer: BCN Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cofinity Commercial |
$8.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$8.77
|
| Rate for Payer: Healthscope Whirlpool |
$8.51
|
| Rate for Payer: Mclaren Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: Nomi Health Commercial |
$7.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.68
|
| Rate for Payer: Priority Health Narrow Network |
$6.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.72
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$8.77
|
|
|
Service Code
|
NDC 60687021511
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$8.77 |
| Rate for Payer: Aetna Commercial |
$7.89
|
| Rate for Payer: ASR ASR |
$8.51
|
| Rate for Payer: ASR Commercial |
$8.51
|
| Rate for Payer: BCBS Trust/PPO |
$7.15
|
| Rate for Payer: BCN Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$7.01
|
| Rate for Payer: Cofinity Commercial |
$8.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$8.77
|
| Rate for Payer: Healthscope Whirlpool |
$8.51
|
| Rate for Payer: Mclaren Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: Nomi Health Commercial |
$7.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.72
|
|
|
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 |
$158.50 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna Commercial |
$219.46
|
| Rate for Payer: ASR ASR |
$236.52
|
| Rate for Payer: ASR Commercial |
$236.52
|
| Rate for Payer: BCBS Trust/PPO |
$198.71
|
| Rate for Payer: BCN Commercial |
$189.05
|
| 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 |
$243.84
|
| Rate for Payer: Healthscope Whirlpool |
$236.52
|
| 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: Priority Health Cigna Priority Health |
$158.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.58
|
|
|
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 |
$97.54 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna Commercial |
$219.46
|
| Rate for Payer: Aetna Medicare |
$121.92
|
| Rate for Payer: ASR ASR |
$236.52
|
| Rate for Payer: ASR Commercial |
$236.52
|
| Rate for Payer: BCBS Complete |
$97.54
|
| Rate for Payer: BCBS Trust/PPO |
$199.68
|
| Rate for Payer: BCN Commercial |
$189.05
|
| 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 |
$243.84
|
| Rate for Payer: Healthscope Whirlpool |
$236.52
|
| 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: Priority Health Cigna Priority Health |
$158.50
|
| Rate for Payer: 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
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$876.48
|
|
|
Service Code
|
NDC 60687021501
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$569.71 |
| Max. Negotiated Rate |
$876.48 |
| Rate for Payer: Aetna Commercial |
$788.83
|
| Rate for Payer: ASR ASR |
$850.19
|
| Rate for Payer: ASR Commercial |
$850.19
|
| Rate for Payer: BCBS Trust/PPO |
$714.24
|
| Rate for Payer: BCN Commercial |
$679.53
|
| Rate for Payer: Cash Price |
$701.18
|
| Rate for Payer: Cofinity Commercial |
$823.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.18
|
| Rate for Payer: Healthscope Commercial |
$876.48
|
| Rate for Payer: Healthscope Whirlpool |
$850.19
|
| Rate for Payer: Mclaren Commercial |
$788.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.01
|
| Rate for Payer: Nomi Health Commercial |
$718.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$771.30
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$2,260.07 |
| Rate for Payer: Aetna Commercial |
$19.86
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,260.07
|
| Rate for Payer: BCN Commercial |
$25.90
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Meridian Medicaid |
$9.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.00
|
| Rate for Payer: Priority Health Narrow Network |
$19.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.31
|
| Rate for Payer: UHC Exchange |
$43.31
|
| Rate for Payer: UHCCP Medicaid |
$9.16
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$422.59 |
| Max. Negotiated Rate |
$2,256.15 |
| Rate for Payer: Aetna Commercial |
$873.19
|
| Rate for Payer: Aetna Medicare |
$1,735.50
|
| Rate for Payer: BCBS Complete |
$443.72
|
| Rate for Payer: BCBS Trust/PPO |
$455.39
|
| Rate for Payer: BCN Commercial |
$956.34
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Meridian Medicaid |
$443.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$422.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,007.04
|
| Rate for Payer: Priority Health Narrow Network |
$1,007.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$747.70
|
| Rate for Payer: UHC Exchange |
$747.70
|
| Rate for Payer: UHCCP Medicaid |
$422.59
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$3,890.00
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$2,865.40 |
| Rate for Payer: Aetna Commercial |
$2,513.09
|
| Rate for Payer: Aetna Medicare |
$1,945.00
|
| Rate for Payer: BCBS Complete |
$1,268.77
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: BCN Commercial |
$2,737.08
|
| Rate for Payer: Cash Price |
$3,112.00
|
| Rate for Payer: Cash Price |
$3,112.00
|
| Rate for Payer: Meridian Medicaid |
$1,268.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,208.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,528.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,865.40
|
| Rate for Payer: Priority Health Narrow Network |
$2,865.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,223.78
|
| Rate for Payer: UHC Exchange |
$2,223.78
|
| Rate for Payer: UHCCP Medicaid |
$1,208.35
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$4,665.00
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$1,064.79 |
| Max. Negotiated Rate |
$3,032.25 |
| Rate for Payer: Aetna Commercial |
$2,211.26
|
| Rate for Payer: Aetna Medicare |
$2,332.50
|
| Rate for Payer: BCBS Complete |
$1,118.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.43
|
| Rate for Payer: BCN Commercial |
$2,406.74
|
| Rate for Payer: Cash Price |
$3,732.00
|
| Rate for Payer: Cash Price |
$3,732.00
|
| Rate for Payer: Meridian Medicaid |
$1,118.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,064.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,032.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,522.92
|
| Rate for Payer: Priority Health Narrow Network |
$2,522.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,942.99
|
| Rate for Payer: UHC Exchange |
$1,942.99
|
| Rate for Payer: UHCCP Medicaid |
$1,064.79
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$471.37 |
| Max. Negotiated Rate |
$1,953.25 |
| Rate for Payer: Aetna Commercial |
$956.02
|
| Rate for Payer: Aetna Medicare |
$1,502.50
|
| Rate for Payer: BCBS Complete |
$494.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,258.80
|
| Rate for Payer: BCN Commercial |
$1,056.52
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Meridian Medicaid |
$494.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,123.57
|
| Rate for Payer: Priority Health Narrow Network |
$1,123.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$846.04
|
| Rate for Payer: UHC Exchange |
$846.04
|
| Rate for Payer: UHCCP Medicaid |
$471.37
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$3,247.00
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$516.95 |
| Max. Negotiated Rate |
$2,110.55 |
| Rate for Payer: Aetna Commercial |
$1,065.44
|
| Rate for Payer: Aetna Medicare |
$1,623.50
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.99
|
| Rate for Payer: BCN Commercial |
$1,152.30
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Meridian Medicaid |
$542.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,110.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,216.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,216.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$955.99
|
| Rate for Payer: UHC Exchange |
$955.99
|
| Rate for Payer: UHCCP Medicaid |
$516.95
|
|
|
PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS 27217
|
| Min. Negotiated Rate |
$538.68 |
| Max. Negotiated Rate |
$2,037.10 |
| Rate for Payer: Aetna Commercial |
$1,119.55
|
| Rate for Payer: Aetna Medicare |
$1,567.00
|
| Rate for Payer: BCBS Complete |
$565.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,869.65
|
| Rate for Payer: BCN Commercial |
$1,224.63
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Meridian Medicaid |
$565.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$538.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,284.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,284.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,068.65
|
| Rate for Payer: UHC Exchange |
$1,068.65
|
| Rate for Payer: UHCCP Medicaid |
$538.68
|
|
