PROPRANOLOL 1 MG/ML SUSP PEDIATRIC
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41655405
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
Rate for Payer: Aetna Government |
$0.50
|
Rate for Payer: Brighton Health Commercial |
$0.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
Rate for Payer: Group Health Inc Commercial |
$0.50
|
Rate for Payer: Group Health Inc Medicare |
$0.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
PROPRANOLOL 1 MG/ML SUSP PEDIATRIC
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41645405
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
Rate for Payer: Aetna Government |
$0.50
|
Rate for Payer: Brighton Health Commercial |
$0.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
Rate for Payer: Group Health Inc Commercial |
$0.50
|
Rate for Payer: Group Health Inc Medicare |
$0.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
PROPRANOLOL 20 MG TAB
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41640704
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
Rate for Payer: Aetna Government |
$0.50
|
Rate for Payer: Brighton Health Commercial |
$0.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
Rate for Payer: Group Health Inc Commercial |
$0.50
|
Rate for Payer: Group Health Inc Medicare |
$0.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
PROPRANOLOL 20 MG TAB
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41650704
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
Rate for Payer: Aetna Government |
$0.50
|
Rate for Payer: Brighton Health Commercial |
$0.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
Rate for Payer: Group Health Inc Commercial |
$0.50
|
Rate for Payer: Group Health Inc Medicare |
$0.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
PROPRANOLOL 40 MG TAB
|
Facility
|
OP
|
$0.11
|
|
Hospital Charge Code |
41655077
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
Rate for Payer: Aetna Government |
$0.06
|
Rate for Payer: Brighton Health Commercial |
$0.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
Rate for Payer: Group Health Inc Commercial |
$0.06
|
Rate for Payer: Group Health Inc Medicare |
$0.04
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
PROPRANOLOL 40 MG TAB
|
Facility
|
OP
|
$0.11
|
|
Hospital Charge Code |
41645077
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.04 |
Max. Negotiated Rate |
$0.09 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
Rate for Payer: Aetna Government |
$0.06
|
Rate for Payer: Brighton Health Commercial |
$0.08
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.09
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
Rate for Payer: Group Health Inc Commercial |
$0.06
|
Rate for Payer: Group Health Inc Medicare |
$0.04
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
PROPRANOLOL 80 MG TAB
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41640805
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
Rate for Payer: Aetna Government |
$0.50
|
Rate for Payer: Brighton Health Commercial |
$0.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
Rate for Payer: Group Health Inc Commercial |
$0.50
|
Rate for Payer: Group Health Inc Medicare |
$0.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
PROPRANOLOL 80 MG TAB
|
Facility
|
OP
|
$1.00
|
|
Hospital Charge Code |
41650805
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.35 |
Max. Negotiated Rate |
$0.80 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
Rate for Payer: Aetna Government |
$0.50
|
Rate for Payer: Brighton Health Commercial |
$0.75
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
Rate for Payer: Group Health Inc Commercial |
$0.50
|
Rate for Payer: Group Health Inc Medicare |
$0.35
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
PROPRANOLOL HCL 10 MG PO TABS [6656]
|
Facility
|
OP
|
$0.35
|
|
Service Code
|
NDC 00904655061
|
Hospital Charge Code |
00904655061
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.12 |
Max. Negotiated Rate |
$0.28 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.19
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.18
|
Rate for Payer: Aetna Government |
$0.18
|
Rate for Payer: Brighton Health Commercial |
$0.26
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.28
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.24
|
Rate for Payer: Group Health Inc Commercial |
$0.18
|
Rate for Payer: Group Health Inc Medicare |
$0.12
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.18
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.18
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.23
|
|
PROPRANOLOL HCL 10 MG PO TABS [6656]
|
Facility
|
OP
|
$0.41
|
|
Service Code
|
NDC 69238207701
|
Hospital Charge Code |
69238207701
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.14 |
Max. Negotiated Rate |
$0.33 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
Rate for Payer: Aetna Government |
$0.20
|
Rate for Payer: Brighton Health Commercial |
$0.31
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
Rate for Payer: Group Health Inc Commercial |
$0.20
|
Rate for Payer: Group Health Inc Medicare |
$0.14
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
PROPRANOLOL HCL 10 MG PO TABS [6656]
|
Facility
|
OP
|
$0.41
|
|
Service Code
|
NDC 00378018201
|
Hospital Charge Code |
00378018201
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.14 |
Max. Negotiated Rate |
$0.33 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
Rate for Payer: Aetna Government |
$0.20
|
Rate for Payer: Brighton Health Commercial |
$0.31
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
Rate for Payer: Group Health Inc Commercial |
$0.20
|
Rate for Payer: Group Health Inc Medicare |
$0.14
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
PROPRANOLOL HCL 10 MG PO TABS [6656]
|
Facility
|
OP
|
$0.41
|
|
Service Code
|
NDC 00603548221
|
Hospital Charge Code |
00603548221
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.14 |
Max. Negotiated Rate |
$0.33 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.22
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.20
|
Rate for Payer: Aetna Government |
$0.20
|
Rate for Payer: Brighton Health Commercial |
$0.31
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
Rate for Payer: Group Health Inc Commercial |
$0.20
|
Rate for Payer: Group Health Inc Medicare |
$0.14
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.20
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.20
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
PROPRANOLOL HCL 1 MG/ML IV SOLN [29335]
|
Facility
|
IP
|
$12.08
|
|
Service Code
|
HCPCS J1800
|
Hospital Charge Code |
63323060401
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$6.04 |
Max. Negotiated Rate |
$6.04 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.04
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.04
|
|
PROPRANOLOL HCL 1 MG/ML IV SOLN [29335]
|
Facility
|
OP
|
$12.08
|
|
Service Code
|
HCPCS J1800
|
Hospital Charge Code |
63323060401
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.23 |
Max. Negotiated Rate |
$12.69 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.65
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.62
|
Rate for Payer: Aetna Government |
$6.62
|
Rate for Payer: Brighton Health Commercial |
$7.25
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.04
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.95
|
Rate for Payer: EmblemHealth Commercial |
$6.04
|
Rate for Payer: Fidelis Medicare Advantage |
$12.69
|
Rate for Payer: Group Health Inc Commercial |
$6.04
|
Rate for Payer: Group Health Inc Medicare |
$4.23
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.04
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$6.04
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$7.85
|
|
PROPRANOLOL HCL 1 MG/ML IV SOLN [29335]
|
Facility
|
OP
|
$9.60
|
|
Service Code
|
HCPCS J1800
|
Hospital Charge Code |
00143987210
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$3.36 |
Max. Negotiated Rate |
$10.08 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.28
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.62
|
Rate for Payer: Aetna Government |
$6.62
|
Rate for Payer: Brighton Health Commercial |
$5.76
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.80
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.52
|
Rate for Payer: EmblemHealth Commercial |
$4.80
|
Rate for Payer: Fidelis Medicare Advantage |
$10.08
|
Rate for Payer: Group Health Inc Commercial |
$4.80
|
Rate for Payer: Group Health Inc Medicare |
$3.36
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4.80
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.24
|
|
PROPRANOLOL HCL 1 MG/ML IV SOLN [29335]
|
Facility
|
IP
|
$9.60
|
|
Service Code
|
HCPCS J1800
|
Hospital Charge Code |
00143987210
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4.80 |
Max. Negotiated Rate |
$4.80 |
Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.80
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$4.80
|
|
PROPRANOLOL HCL 20 MG/5ML PO SOLN [6654]
|
Facility
|
OP
|
$0.84
|
|
Service Code
|
NDC 00121090805
|
Hospital Charge Code |
00121090805
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.30 |
Max. Negotiated Rate |
$0.68 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.46
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.42
|
Rate for Payer: Aetna Government |
$0.42
|
Rate for Payer: Brighton Health Commercial |
$0.63
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.68
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.57
|
Rate for Payer: Group Health Inc Commercial |
$0.42
|
Rate for Payer: Group Health Inc Medicare |
$0.30
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.42
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.42
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.55
|
|
PROPRANOLOL HCL 20 MG/5ML PO SOLN [6654]
|
Facility
|
OP
|
$0.13
|
|
Service Code
|
NDC 09999123472
|
Hospital Charge Code |
00054372763
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.05 |
Max. Negotiated Rate |
$0.11 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
Rate for Payer: Aetna Government |
$0.07
|
Rate for Payer: Brighton Health Commercial |
$0.10
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.11
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
Rate for Payer: Group Health Inc Commercial |
$0.07
|
Rate for Payer: Group Health Inc Medicare |
$0.05
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.07
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.07
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.09
|
|
PROPRANOLOL HCL 20 MG PO TABS [6657]
|
Facility
|
OP
|
$1.34
|
|
Service Code
|
NDC 00904670561
|
Hospital Charge Code |
00904670561
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.47 |
Max. Negotiated Rate |
$1.07 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.74
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.67
|
Rate for Payer: Aetna Government |
$0.67
|
Rate for Payer: Brighton Health Commercial |
$1.00
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.07
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.91
|
Rate for Payer: Group Health Inc Commercial |
$0.67
|
Rate for Payer: Group Health Inc Medicare |
$0.47
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.67
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.67
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.87
|
|
PROPRANOLOL HCL 20 MG PO TABS [6657]
|
Facility
|
OP
|
$0.55
|
|
Service Code
|
NDC 60687059801
|
Hospital Charge Code |
60687059801
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.19 |
Max. Negotiated Rate |
$0.44 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.28
|
Rate for Payer: Aetna Government |
$0.28
|
Rate for Payer: Brighton Health Commercial |
$0.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.38
|
Rate for Payer: Group Health Inc Commercial |
$0.28
|
Rate for Payer: Group Health Inc Medicare |
$0.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.28
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.36
|
|
PROPRANOLOL HCL 20 MG PO TABS [6657]
|
Facility
|
OP
|
$0.55
|
|
Service Code
|
NDC 60687059811
|
Hospital Charge Code |
60687059811
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.19 |
Max. Negotiated Rate |
$0.44 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.28
|
Rate for Payer: Aetna Government |
$0.28
|
Rate for Payer: Brighton Health Commercial |
$0.42
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.44
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.38
|
Rate for Payer: Group Health Inc Commercial |
$0.28
|
Rate for Payer: Group Health Inc Medicare |
$0.19
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.28
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.28
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.36
|
|
PROPRANOLOL HCL 20 MG PO TABS [6657]
|
Facility
|
OP
|
$0.51
|
|
Service Code
|
NDC 00603548321
|
Hospital Charge Code |
00603548321
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.18 |
Max. Negotiated Rate |
$0.41 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.26
|
Rate for Payer: Aetna Government |
$0.26
|
Rate for Payer: Brighton Health Commercial |
$0.38
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.41
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
Rate for Payer: Group Health Inc Commercial |
$0.26
|
Rate for Payer: Group Health Inc Medicare |
$0.18
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
PROPRANOLOL HCL 40 MG PO TABS [6658]
|
Facility
|
OP
|
$0.72
|
|
Service Code
|
NDC 00603548421
|
Hospital Charge Code |
00603548421
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.25 |
Max. Negotiated Rate |
$0.57 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
Rate for Payer: Aetna Government |
$0.36
|
Rate for Payer: Brighton Health Commercial |
$0.54
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.57
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
Rate for Payer: Group Health Inc Commercial |
$0.36
|
Rate for Payer: Group Health Inc Medicare |
$0.25
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.47
|
|
PROPRANOLOL HCL 40 MG PO TABS [6658]
|
Facility
|
OP
|
$0.67
|
|
Service Code
|
NDC 60687060901
|
Hospital Charge Code |
60687060901
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.23 |
Max. Negotiated Rate |
$0.54 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
Rate for Payer: Aetna Government |
$0.34
|
Rate for Payer: Brighton Health Commercial |
$0.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
Rate for Payer: Group Health Inc Commercial |
$0.34
|
Rate for Payer: Group Health Inc Medicare |
$0.23
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|
PROPRANOLOL HCL 40 MG PO TABS [6658]
|
Facility
|
OP
|
$0.67
|
|
Service Code
|
NDC 60687060911
|
Hospital Charge Code |
60687060911
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$0.23 |
Max. Negotiated Rate |
$0.54 |
Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.37
|
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.34
|
Rate for Payer: Aetna Government |
$0.34
|
Rate for Payer: Brighton Health Commercial |
$0.50
|
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.54
|
Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.46
|
Rate for Payer: Group Health Inc Commercial |
$0.34
|
Rate for Payer: Group Health Inc Medicare |
$0.23
|
Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.34
|
Rate for Payer: Hamaspik Choice Inc Medicare |
$0.34
|
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.44
|
|