|
PR ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 51102
|
| Min. Negotiated Rate |
$89.67 |
| Max. Negotiated Rate |
$1,872.30 |
| Rate for Payer: Aetna Commercial |
$185.74
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,872.30
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Meridian Medicaid |
$94.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$89.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.75
|
| Rate for Payer: Priority Health Narrow Network |
$224.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$178.39
|
| Rate for Payer: UHC Exchange |
$178.39
|
| Rate for Payer: UHCCP Medicaid |
$89.67
|
|
|
PR ASPIRATION BLADDER NEEDLE
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 51100
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$2,925.20 |
| Rate for Payer: Aetna Commercial |
$49.74
|
| Rate for Payer: Aetna Medicare |
$62.00
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,925.20
|
| Rate for Payer: BCN Commercial |
$107.02
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.78
|
| Rate for Payer: Priority Health Narrow Network |
$61.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.25
|
| Rate for Payer: UHC Exchange |
$47.25
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
|
|
PR ASPIRATION BLADDER TROCAR/INTRACATHETER
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
HCPCS 51101
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$2,914.10 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Medicare |
$193.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,914.10
|
| Rate for Payer: BCN Commercial |
$226.26
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.42
|
| Rate for Payer: Priority Health Narrow Network |
$80.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$62.88
|
| Rate for Payer: UHC Exchange |
$62.88
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
|
|
PR ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 20612
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$2,114.22 |
| Rate for Payer: Aetna Commercial |
$55.18
|
| Rate for Payer: Aetna Medicare |
$67.50
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,114.22
|
| Rate for Payer: BCN Commercial |
$93.82
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.58
|
| Rate for Payer: Priority Health Narrow Network |
$62.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$49.18
|
| Rate for Payer: UHC Exchange |
$49.18
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
PR ASSESSMENT APHASIA W/INTERP & REPORT PER HOUR
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 96105
|
| Min. Negotiated Rate |
$77.24 |
| Max. Negotiated Rate |
$332.30 |
| Rate for Payer: Aetna Commercial |
$109.95
|
| Rate for Payer: Aetna Medicare |
$101.50
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS Trust/PPO |
$332.30
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.27
|
| Rate for Payer: Priority Health Narrow Network |
$130.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.24
|
| Rate for Payer: UHC Exchange |
$77.24
|
|
|
PR ASSESSMENT FOR HEARING AID
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS V5010
|
| Min. Negotiated Rate |
$47.05 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Aetna Commercial |
$47.05
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$50.28
|
| Rate for Payer: UHC Exchange |
$50.28
|
|
|
PR ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 99483
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$405.21 |
| Rate for Payer: Aetna Commercial |
$195.52
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$128.60
|
| Rate for Payer: BCBS Trust/PPO |
$405.21
|
| Rate for Payer: BCN Commercial |
$288.40
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Meridian Medicaid |
$128.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.57
|
| Rate for Payer: Priority Health Narrow Network |
$257.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.21
|
| Rate for Payer: UHC Exchange |
$200.21
|
| Rate for Payer: UHCCP Medicaid |
$122.48
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
OP
|
$109.72
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.89 |
| Max. Negotiated Rate |
$109.72 |
| Rate for Payer: Aetna Commercial |
$98.75
|
| Rate for Payer: Aetna Medicare |
$54.86
|
| Rate for Payer: ASR ASR |
$106.43
|
| Rate for Payer: ASR Commercial |
$106.43
|
| Rate for Payer: BCBS Complete |
$43.89
|
| Rate for Payer: BCBS Trust/PPO |
$89.85
|
| Rate for Payer: BCN Commercial |
$85.07
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$103.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$109.72
|
| Rate for Payer: Healthscope Whirlpool |
$106.43
|
| Rate for Payer: Mclaren Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.26
|
| Rate for Payer: Nomi Health Commercial |
$89.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.14
|
| Rate for Payer: Priority Health Narrow Network |
$76.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.55
|
|
|
PRASUGREL 10 MG TABLET
|
Facility
|
IP
|
$109.72
|
|
|
Service Code
|
NDC 60505464303
|
| Hospital Charge Code |
98373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.32 |
| Max. Negotiated Rate |
$109.72 |
| Rate for Payer: Aetna Commercial |
$98.75
|
| Rate for Payer: ASR ASR |
$106.43
|
| Rate for Payer: ASR Commercial |
$106.43
|
| Rate for Payer: BCBS Trust/PPO |
$89.41
|
| Rate for Payer: BCN Commercial |
$85.07
|
| Rate for Payer: Cash Price |
$87.78
|
| Rate for Payer: Cofinity Commercial |
$103.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.78
|
| Rate for Payer: Healthscope Commercial |
$109.72
|
| Rate for Payer: Healthscope Whirlpool |
$106.43
|
| Rate for Payer: Mclaren Commercial |
$98.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.26
|
| Rate for Payer: Nomi Health Commercial |
$89.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$96.55
|
|
|
PR ATRIA ABLATE & RCNSTJ W/OTHER PROCEDURE LIMITE
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 33257
|
| Min. Negotiated Rate |
$369.77 |
| Max. Negotiated Rate |
$2,631.46 |
| Rate for Payer: Aetna Commercial |
$778.27
|
| Rate for Payer: Aetna Medicare |
$762.50
|
| Rate for Payer: BCBS Complete |
$388.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,631.46
|
| Rate for Payer: BCN Commercial |
$838.57
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Meridian Medicaid |
$388.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$369.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$917.40
|
| Rate for Payer: Priority Health Narrow Network |
$917.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$757.06
|
| Rate for Payer: UHC Exchange |
$757.06
|
| Rate for Payer: UHCCP Medicaid |
$369.77
|
|
|
PR ATRIA ABLTJ & RCNSTJ W/OTHER PX EXTEN W/BYPASS
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
HCPCS 33259
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$5,209.57 |
| Rate for Payer: Aetna Commercial |
$1,129.42
|
| Rate for Payer: Aetna Medicare |
$1,151.50
|
| Rate for Payer: BCBS Complete |
$563.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,209.57
|
| Rate for Payer: BCN Commercial |
$1,216.32
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Cash Price |
$1,842.40
|
| Rate for Payer: Meridian Medicaid |
$563.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$536.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,496.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,332.74
|
| Rate for Payer: Priority Health Narrow Network |
$1,332.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,102.09
|
| Rate for Payer: UHC Exchange |
$1,102.09
|
| Rate for Payer: UHCCP Medicaid |
$536.76
|
|
|
PR ATTN AT DELIVERY 1ST STABILIZATION OF NEWBORN
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 99464
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$1,378.86 |
| Rate for Payer: Aetna Commercial |
$73.65
|
| Rate for Payer: Aetna Medicare |
$205.00
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,378.86
|
| Rate for Payer: BCN Commercial |
$105.06
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.47
|
| Rate for Payer: Priority Health Narrow Network |
$96.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.82
|
| Rate for Payer: UHC Exchange |
$79.82
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
PR AUDIOMETRY FOR HEARING AID
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS S0618
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Aetna Commercial |
$43.02
|
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
|
|
PR AUDITORY EVOKED POTENTIAL
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 92585
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$221.65 |
| Rate for Payer: Aetna Medicare |
$170.50
|
| Rate for Payer: BCBS Complete |
$136.40
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.65
|
|
|
PR AUDITORY EVOKED POTENTIAL, LIMITED
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 92586
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
|
|
PR AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC
|
Professional
|
Both
|
$1,210.00
|
|
|
Service Code
|
HCPCS 20938
|
| Min. Negotiated Rate |
$116.94 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$248.13
|
| Rate for Payer: Aetna Medicare |
$605.00
|
| Rate for Payer: BCBS Complete |
$122.79
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$292.71
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Cash Price |
$968.00
|
| Rate for Payer: Meridian Medicaid |
$122.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$786.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$279.37
|
| Rate for Payer: Priority Health Narrow Network |
$279.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.75
|
| Rate for Payer: UHC Exchange |
$220.75
|
| Rate for Payer: UHCCP Medicaid |
$116.94
|
|
|
PR AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
HCPCS 20936
|
| Min. Negotiated Rate |
$150.61 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$165.78
|
| Rate for Payer: Aetna Medicare |
$372.00
|
| Rate for Payer: BCBS Complete |
$297.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$182.92
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Cash Price |
$595.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.32
|
| Rate for Payer: Priority Health Narrow Network |
$190.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.61
|
| Rate for Payer: UHC Exchange |
$150.61
|
|
|
PR AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 20937
|
| Min. Negotiated Rate |
$106.93 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$224.25
|
| Rate for Payer: Aetna Medicare |
$485.50
|
| Rate for Payer: BCBS Complete |
$112.28
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$267.42
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Meridian Medicaid |
$112.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.41
|
| Rate for Payer: Priority Health Narrow Network |
$253.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.90
|
| Rate for Payer: UHC Exchange |
$201.90
|
| Rate for Payer: UHCCP Medicaid |
$106.93
|
|
|
PR AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE
|
Professional
|
Both
|
$3,381.00
|
|
|
Service Code
|
HCPCS 27412
|
| Min. Negotiated Rate |
$149.51 |
| Max. Negotiated Rate |
$2,522.42 |
| Rate for Payer: Aetna Commercial |
$2,202.92
|
| Rate for Payer: Aetna Medicare |
$1,690.50
|
| Rate for Payer: BCBS Complete |
$1,117.80
|
| Rate for Payer: BCBS Trust/PPO |
$149.51
|
| Rate for Payer: BCN Commercial |
$2,406.25
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Cash Price |
$2,704.80
|
| Rate for Payer: Meridian Medicaid |
$1,117.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,064.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,197.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,522.42
|
| Rate for Payer: Priority Health Narrow Network |
$2,522.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,914.58
|
| Rate for Payer: UHC Exchange |
$1,914.58
|
| Rate for Payer: UHCCP Medicaid |
$1,064.57
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Medicare |
$161.50
|
| Rate for Payer: ASR ASR |
$313.31
|
| Rate for Payer: ASR Commercial |
$313.31
|
| Rate for Payer: BCBS Complete |
$129.20
|
| Rate for Payer: BCBS Trust/PPO |
$264.50
|
| Rate for Payer: BCN Commercial |
$250.42
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$303.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$323.00
|
| Rate for Payer: Healthscope Whirlpool |
$313.31
|
| Rate for Payer: Mclaren Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: Nomi Health Commercial |
$264.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$283.01
|
| Rate for Payer: Priority Health Narrow Network |
$226.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.24
|
|
|
PRAVASTATIN 10 MG TABLET
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
NDC 00904589161
|
| Hospital Charge Code |
11110
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.95 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: ASR ASR |
$313.31
|
| Rate for Payer: ASR Commercial |
$313.31
|
| Rate for Payer: BCBS Trust/PPO |
$263.21
|
| Rate for Payer: BCN Commercial |
$250.42
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$303.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.40
|
| Rate for Payer: Healthscope Commercial |
$323.00
|
| Rate for Payer: Healthscope Whirlpool |
$313.31
|
| Rate for Payer: Mclaren Commercial |
$290.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.55
|
| Rate for Payer: Nomi Health Commercial |
$264.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.24
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$137.52
|
|
|
Service Code
|
NDC 50268066715
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.01 |
| Max. Negotiated Rate |
$137.52 |
| Rate for Payer: Aetna Commercial |
$123.77
|
| Rate for Payer: Aetna Medicare |
$68.76
|
| Rate for Payer: ASR ASR |
$133.39
|
| Rate for Payer: ASR Commercial |
$133.39
|
| Rate for Payer: BCBS Complete |
$55.01
|
| Rate for Payer: BCBS Trust/PPO |
$112.62
|
| Rate for Payer: BCN Commercial |
$106.62
|
| Rate for Payer: Cash Price |
$110.02
|
| Rate for Payer: Cofinity Commercial |
$129.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.02
|
| Rate for Payer: Healthscope Commercial |
$137.52
|
| Rate for Payer: Healthscope Whirlpool |
$133.39
|
| Rate for Payer: Mclaren Commercial |
$123.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.89
|
| Rate for Payer: Nomi Health Commercial |
$112.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.50
|
| Rate for Payer: Priority Health Narrow Network |
$96.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.02
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$284.16
|
|
|
Service Code
|
NDC 00904589361
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.70 |
| Max. Negotiated Rate |
$284.16 |
| Rate for Payer: Aetna Commercial |
$255.74
|
| Rate for Payer: ASR ASR |
$275.64
|
| Rate for Payer: ASR Commercial |
$275.64
|
| Rate for Payer: BCBS Trust/PPO |
$231.56
|
| Rate for Payer: BCN Commercial |
$220.31
|
| Rate for Payer: Cash Price |
$227.33
|
| Rate for Payer: Cofinity Commercial |
$267.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.33
|
| Rate for Payer: Healthscope Commercial |
$284.16
|
| Rate for Payer: Healthscope Whirlpool |
$275.64
|
| Rate for Payer: Mclaren Commercial |
$255.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.54
|
| Rate for Payer: Nomi Health Commercial |
$233.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.06
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
IP
|
$2.75
|
|
|
Service Code
|
NDC 50268066711
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: ASR ASR |
$2.67
|
| Rate for Payer: ASR Commercial |
$2.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.24
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Healthscope Whirlpool |
$2.67
|
| Rate for Payer: Mclaren Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.34
|
| Rate for Payer: Nomi Health Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.42
|
|
|
PRAVASTATIN 40 MG TABLET
|
Facility
|
OP
|
$2.75
|
|
|
Service Code
|
NDC 50268066711
|
| Hospital Charge Code |
11112
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: ASR ASR |
$2.67
|
| Rate for Payer: ASR Commercial |
$2.67
|
| Rate for Payer: BCBS Complete |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$2.25
|
| Rate for Payer: BCN Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.20
|
| Rate for Payer: Healthscope Commercial |
$2.75
|
| Rate for Payer: Healthscope Whirlpool |
$2.67
|
| Rate for Payer: Mclaren Commercial |
$2.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.34
|
| Rate for Payer: Nomi Health Commercial |
$2.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.41
|
| Rate for Payer: Priority Health Narrow Network |
$1.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.42
|
|
