|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
OP
|
$65.72
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.29 |
| Max. Negotiated Rate |
$65.72 |
| Rate for Payer: Aetna Commercial |
$59.15
|
| Rate for Payer: Aetna Commercial |
$41.92
|
| Rate for Payer: Aetna Commercial |
$49.09
|
| Rate for Payer: Aetna Commercial |
$77.66
|
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: Aetna Commercial |
$67.47
|
| Rate for Payer: Aetna Commercial |
$69.40
|
| Rate for Payer: Aetna Commercial |
$61.67
|
| Rate for Payer: Aetna Commercial |
$65.27
|
| Rate for Payer: Aetna Medicare |
$34.26
|
| Rate for Payer: Aetna Medicare |
$37.48
|
| Rate for Payer: Aetna Medicare |
$23.29
|
| Rate for Payer: Aetna Medicare |
$36.26
|
| Rate for Payer: Aetna Medicare |
$59.67
|
| Rate for Payer: Aetna Medicare |
$43.15
|
| Rate for Payer: Aetna Medicare |
$38.55
|
| Rate for Payer: Aetna Medicare |
$27.27
|
| Rate for Payer: Aetna Medicare |
$32.86
|
| Rate for Payer: ASR ASR |
$74.80
|
| Rate for Payer: ASR ASR |
$83.70
|
| Rate for Payer: ASR ASR |
$52.90
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: ASR ASR |
$63.75
|
| Rate for Payer: ASR ASR |
$45.18
|
| Rate for Payer: ASR ASR |
$70.34
|
| Rate for Payer: ASR ASR |
$72.72
|
| Rate for Payer: ASR ASR |
$66.46
|
| Rate for Payer: ASR Commercial |
$83.70
|
| Rate for Payer: ASR Commercial |
$72.72
|
| Rate for Payer: ASR Commercial |
$66.46
|
| Rate for Payer: ASR Commercial |
$115.76
|
| Rate for Payer: ASR Commercial |
$63.75
|
| Rate for Payer: ASR Commercial |
$52.90
|
| Rate for Payer: ASR Commercial |
$45.18
|
| Rate for Payer: ASR Commercial |
$74.80
|
| Rate for Payer: ASR Commercial |
$70.34
|
| Rate for Payer: BCBS Complete |
$29.01
|
| Rate for Payer: BCBS Complete |
$18.63
|
| Rate for Payer: BCBS Complete |
$29.99
|
| Rate for Payer: BCBS Complete |
$21.82
|
| Rate for Payer: BCBS Complete |
$27.41
|
| Rate for Payer: BCBS Complete |
$34.52
|
| Rate for Payer: BCBS Complete |
$30.84
|
| Rate for Payer: BCBS Complete |
$26.29
|
| Rate for Payer: BCBS Complete |
$47.74
|
| Rate for Payer: BCBS Trust/PPO |
$70.66
|
| Rate for Payer: BCBS Trust/PPO |
$59.39
|
| Rate for Payer: BCBS Trust/PPO |
$53.82
|
| Rate for Payer: BCBS Trust/PPO |
$97.73
|
| Rate for Payer: BCBS Trust/PPO |
$38.14
|
| Rate for Payer: BCBS Trust/PPO |
$44.66
|
| Rate for Payer: BCBS Trust/PPO |
$63.15
|
| Rate for Payer: BCBS Trust/PPO |
$61.39
|
| Rate for Payer: BCBS Trust/PPO |
$56.11
|
| Rate for Payer: BCN Commercial |
$56.22
|
| Rate for Payer: BCN Commercial |
$53.12
|
| Rate for Payer: BCN Commercial |
$66.90
|
| Rate for Payer: BCN Commercial |
$50.95
|
| Rate for Payer: BCN Commercial |
$36.11
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: BCN Commercial |
$42.28
|
| Rate for Payer: BCN Commercial |
$59.78
|
| Rate for Payer: BCN Commercial |
$58.12
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cash Price |
$61.69
|
| Rate for Payer: Cash Price |
$59.97
|
| Rate for Payer: Cash Price |
$54.82
|
| Rate for Payer: Cash Price |
$69.03
|
| Rate for Payer: Cash Price |
$37.27
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cofinity Commercial |
$70.47
|
| Rate for Payer: Cofinity Commercial |
$68.17
|
| Rate for Payer: Cofinity Commercial |
$61.78
|
| Rate for Payer: Cofinity Commercial |
$81.11
|
| Rate for Payer: Cofinity Commercial |
$51.27
|
| Rate for Payer: Cofinity Commercial |
$72.48
|
| Rate for Payer: Cofinity Commercial |
$64.41
|
| Rate for Payer: Cofinity Commercial |
$43.79
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.02
|
| Rate for Payer: Healthscope Commercial |
$74.97
|
| Rate for Payer: Healthscope Commercial |
$65.72
|
| Rate for Payer: Healthscope Commercial |
$54.54
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Commercial |
$72.52
|
| Rate for Payer: Healthscope Commercial |
$77.11
|
| Rate for Payer: Healthscope Commercial |
$46.58
|
| Rate for Payer: Healthscope Commercial |
$86.29
|
| Rate for Payer: Healthscope Commercial |
$68.52
|
| Rate for Payer: Healthscope Whirlpool |
$70.34
|
| Rate for Payer: Healthscope Whirlpool |
$52.90
|
| Rate for Payer: Healthscope Whirlpool |
$45.18
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.75
|
| Rate for Payer: Healthscope Whirlpool |
$66.46
|
| Rate for Payer: Healthscope Whirlpool |
$72.72
|
| Rate for Payer: Healthscope Whirlpool |
$74.80
|
| Rate for Payer: Healthscope Whirlpool |
$83.70
|
| Rate for Payer: Mclaren Commercial |
$65.27
|
| Rate for Payer: Mclaren Commercial |
$61.67
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Mclaren Commercial |
$41.92
|
| Rate for Payer: Mclaren Commercial |
$49.09
|
| Rate for Payer: Mclaren Commercial |
$69.40
|
| Rate for Payer: Mclaren Commercial |
$59.15
|
| Rate for Payer: Mclaren Commercial |
$77.66
|
| Rate for Payer: Mclaren Commercial |
$67.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.86
|
| Rate for Payer: Nomi Health Commercial |
$97.86
|
| Rate for Payer: Nomi Health Commercial |
$63.23
|
| Rate for Payer: Nomi Health Commercial |
$70.76
|
| Rate for Payer: Nomi Health Commercial |
$59.47
|
| Rate for Payer: Nomi Health Commercial |
$56.19
|
| Rate for Payer: Nomi Health Commercial |
$53.89
|
| Rate for Payer: Nomi Health Commercial |
$61.48
|
| Rate for Payer: Nomi Health Commercial |
$38.20
|
| Rate for Payer: Nomi Health Commercial |
$44.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.81
|
| Rate for Payer: Priority Health Narrow Network |
$50.84
|
| Rate for Payer: Priority Health Narrow Network |
$83.66
|
| Rate for Payer: Priority Health Narrow Network |
$32.65
|
| Rate for Payer: Priority Health Narrow Network |
$54.05
|
| Rate for Payer: Priority Health Narrow Network |
$48.03
|
| Rate for Payer: Priority Health Narrow Network |
$52.55
|
| Rate for Payer: Priority Health Narrow Network |
$46.07
|
| Rate for Payer: Priority Health Narrow Network |
$38.23
|
| Rate for Payer: Priority Health Narrow Network |
$60.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.86
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$65.72
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.72 |
| Max. Negotiated Rate |
$65.72 |
| Rate for Payer: Aetna Commercial |
$59.15
|
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: ASR ASR |
$63.75
|
| Rate for Payer: ASR Commercial |
$115.76
|
| Rate for Payer: ASR Commercial |
$63.75
|
| Rate for Payer: BCBS Trust/PPO |
$97.25
|
| Rate for Payer: BCBS Trust/PPO |
$53.56
|
| Rate for Payer: BCN Commercial |
$50.95
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Cofinity Commercial |
$61.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.58
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Commercial |
$65.72
|
| Rate for Payer: Healthscope Whirlpool |
$63.75
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Mclaren Commercial |
$59.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: Nomi Health Commercial |
$53.89
|
| Rate for Payer: Nomi Health Commercial |
$97.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.83
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
OP
|
$119.34
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.74 |
| Max. Negotiated Rate |
$119.34 |
| Rate for Payer: Aetna Commercial |
$107.41
|
| Rate for Payer: Aetna Commercial |
$59.15
|
| Rate for Payer: Aetna Medicare |
$59.67
|
| Rate for Payer: Aetna Medicare |
$32.86
|
| Rate for Payer: ASR ASR |
$115.76
|
| Rate for Payer: ASR ASR |
$63.75
|
| Rate for Payer: ASR Commercial |
$63.75
|
| Rate for Payer: ASR Commercial |
$115.76
|
| Rate for Payer: BCBS Complete |
$47.74
|
| Rate for Payer: BCBS Complete |
$26.29
|
| Rate for Payer: BCBS Trust/PPO |
$97.73
|
| Rate for Payer: BCBS Trust/PPO |
$53.82
|
| Rate for Payer: BCN Commercial |
$50.95
|
| Rate for Payer: BCN Commercial |
$92.52
|
| Rate for Payer: Cash Price |
$95.47
|
| Rate for Payer: Cash Price |
$52.58
|
| Rate for Payer: Cofinity Commercial |
$112.18
|
| Rate for Payer: Cofinity Commercial |
$61.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.58
|
| Rate for Payer: Healthscope Commercial |
$119.34
|
| Rate for Payer: Healthscope Commercial |
$65.72
|
| Rate for Payer: Healthscope Whirlpool |
$115.76
|
| Rate for Payer: Healthscope Whirlpool |
$63.75
|
| Rate for Payer: Mclaren Commercial |
$107.41
|
| Rate for Payer: Mclaren Commercial |
$59.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.44
|
| Rate for Payer: Nomi Health Commercial |
$97.86
|
| Rate for Payer: Nomi Health Commercial |
$53.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.58
|
| Rate for Payer: Priority Health Narrow Network |
$46.07
|
| Rate for Payer: Priority Health Narrow Network |
$83.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$57.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.02
|
|
|
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 |
$30.76 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare |
$38.45
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Complete |
$30.76
|
| Rate for Payer: BCBS Trust/PPO |
$62.98
|
| Rate for Payer: BCN Commercial |
$59.63
|
| 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 |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.39
|
| Rate for Payer: Priority Health Narrow Network |
$53.91
|
| 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 |
$49.99 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: ASR Commercial |
$74.60
|
| Rate for Payer: BCBS Trust/PPO |
$62.67
|
| Rate for Payer: BCN Commercial |
$59.63
|
| 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 |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.37
|
| Rate for Payer: Nomi Health Commercial |
$63.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,594.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$854.20 |
| Max. Negotiated Rate |
$2,336.10 |
| Rate for Payer: Aetna Commercial |
$1,144.63
|
| Rate for Payer: Aetna Medicare |
$854.20
|
| Rate for Payer: BCBS Complete |
$1,437.60
|
| Rate for Payer: BCBS MAPPO |
$854.20
|
| Rate for Payer: BCN Medicare Advantage |
$854.20
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Cash Price |
$2,875.20
|
| Rate for Payer: Cofinity Commercial |
$1,230.05
|
| Rate for Payer: Cofinity Commercial |
$1,144.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$854.20
|
| Rate for Payer: Healthscope Commercial |
$1,025.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,025.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$896.91
|
| Rate for Payer: Nomi Health Commercial |
$1,025.04
|
| Rate for Payer: PACE SWMI |
$854.20
|
| Rate for Payer: PHP Medicare Advantage |
$854.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,336.10
|
| Rate for Payer: Priority Health Medicare |
$854.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$854.20
|
| Rate for Payer: UHC Medicare Advantage |
$854.20
|
| Rate for Payer: UHCCP DNSP |
$854.20
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,380.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$789.71 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna Commercial |
$1,058.21
|
| Rate for Payer: Aetna Medicare |
$789.71
|
| Rate for Payer: BCBS Complete |
$952.00
|
| Rate for Payer: BCBS MAPPO |
$789.71
|
| Rate for Payer: BCN Medicare Advantage |
$789.71
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cash Price |
$1,904.00
|
| Rate for Payer: Cofinity Commercial |
$1,137.18
|
| Rate for Payer: Cofinity Commercial |
$1,058.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$789.71
|
| Rate for Payer: Healthscope Commercial |
$947.65
|
| Rate for Payer: Healthscope Whirlpool |
$947.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$829.20
|
| Rate for Payer: Nomi Health Commercial |
$947.65
|
| Rate for Payer: PACE SWMI |
$789.71
|
| Rate for Payer: PHP Medicare Advantage |
$789.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,547.00
|
| Rate for Payer: Priority Health Medicare |
$789.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$789.71
|
| Rate for Payer: UHC Medicare Advantage |
$789.71
|
| Rate for Payer: UHCCP DNSP |
$789.71
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,541.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$616.40 |
| Max. Negotiated Rate |
$1,259.09 |
| Rate for Payer: Aetna Commercial |
$1,171.66
|
| Rate for Payer: Aetna Medicare |
$874.37
|
| Rate for Payer: BCBS Complete |
$616.40
|
| Rate for Payer: BCBS MAPPO |
$874.37
|
| Rate for Payer: BCN Medicare Advantage |
$874.37
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cash Price |
$1,232.80
|
| Rate for Payer: Cofinity Commercial |
$1,259.09
|
| Rate for Payer: Cofinity Commercial |
$1,171.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$874.37
|
| Rate for Payer: Healthscope Commercial |
$1,049.24
|
| Rate for Payer: Healthscope Whirlpool |
$1,049.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$918.09
|
| Rate for Payer: Nomi Health Commercial |
$1,049.24
|
| Rate for Payer: PACE SWMI |
$874.37
|
| Rate for Payer: PHP Medicare Advantage |
$874.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,001.65
|
| Rate for Payer: Priority Health Medicare |
$874.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$874.37
|
| Rate for Payer: UHC Medicare Advantage |
$874.37
|
| Rate for Payer: UHCCP DNSP |
$874.37
|
|
|
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
|
$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
|
$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
|
$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 |
$35.95
|
| 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
|
$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
|
$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
|
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 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 |
$375.35
|
| Rate for Payer: Aetna Medicare |
$208.53
|
| 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 |
$375.35
|
| 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 |
$375.35
|
| 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 |
$375.35
|
| 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
|
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
|
$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 |
$35.95
|
| 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
|
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 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
|
$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
|
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
|
$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
|
|
