|
PROBENECID 500 MG TABLET
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 0378-0156-01
|
| Hospital Charge Code |
6561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.22 |
| Max. Negotiated Rate |
$280.32 |
| Rate for Payer: Aetna Commercial |
$252.29
|
| Rate for Payer: ASR ASR |
$271.91
|
| Rate for Payer: BCBS Trust/PPO |
$217.33
|
| Rate for Payer: BCN Commercial |
$217.33
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$263.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$280.32
|
| Rate for Payer: Healthscope Whirlpool |
$271.91
|
| Rate for Payer: Mclaren Commercial |
$252.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.68
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS
|
Professional
|
Both
|
$3,030.00
|
|
|
Service Code
|
HCPCS 33814
|
| Min. Negotiated Rate |
$961.06 |
| Max. Negotiated Rate |
$2,386.90 |
| Rate for Payer: Aetna Commercial |
$2,011.49
|
| Rate for Payer: Aetna Medicare |
$1,501.11
|
| Rate for Payer: BCBS Complete |
$1,009.11
|
| Rate for Payer: BCBS MAPPO |
$1,501.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,770.33
|
| Rate for Payer: BCN Commercial |
$2,192.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,501.11
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cofinity Commercial |
$2,161.60
|
| Rate for Payer: Cofinity Commercial |
$2,011.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,501.11
|
| Rate for Payer: Healthscope Commercial |
$1,801.33
|
| Rate for Payer: Healthscope Whirlpool |
$1,801.33
|
| Rate for Payer: Meridian Medicaid |
$1,009.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,576.17
|
| Rate for Payer: PACE SWMI |
$1,501.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,501.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$961.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,386.90
|
| Rate for Payer: Priority Health Medicare |
$1,501.11
|
| Rate for Payer: Priority Health Narrow Network |
$2,386.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,546.14
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 33813
|
| Min. Negotiated Rate |
$783.20 |
| Max. Negotiated Rate |
$1,945.36 |
| Rate for Payer: Aetna Commercial |
$1,637.64
|
| Rate for Payer: Aetna Medicare |
$1,222.12
|
| Rate for Payer: BCBS Complete |
$822.36
|
| Rate for Payer: BCBS MAPPO |
$1,222.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.52
|
| Rate for Payer: BCN Commercial |
$1,787.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,222.12
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cofinity Commercial |
$1,637.64
|
| Rate for Payer: Cofinity Commercial |
$1,759.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,222.12
|
| Rate for Payer: Healthscope Commercial |
$1,466.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,466.54
|
| Rate for Payer: Meridian Medicaid |
$822.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,283.23
|
| Rate for Payer: PACE SWMI |
$1,222.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,222.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$783.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,945.36
|
| Rate for Payer: Priority Health Medicare |
$1,222.12
|
| Rate for Payer: Priority Health Narrow Network |
$1,945.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,258.78
|
|
|
PR OBSERVATION CARE DISCHARGE MANAGEMENT
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 99217
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$308.53 |
| Rate for Payer: Aetna Commercial |
$23.99
|
| Rate for Payer: Aetna Medicare |
$17.90
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$308.53
|
| Rate for Payer: BCN Commercial |
$42.50
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$25.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Whirlpool |
$21.48
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.38
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow Network |
$23.38
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
|
|
PR OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 58615
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$372.86 |
| Rate for Payer: Aetna Commercial |
$336.42
|
| Rate for Payer: Aetna Medicare |
$251.06
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS MAPPO |
$251.06
|
| Rate for Payer: BCBS Trust/PPO |
$151.62
|
| Rate for Payer: BCN Commercial |
$372.86
|
| Rate for Payer: BCN Medicare Advantage |
$251.06
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$361.53
|
| Rate for Payer: Cofinity Commercial |
$336.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.06
|
| Rate for Payer: Healthscope Commercial |
$301.27
|
| Rate for Payer: Healthscope Whirlpool |
$301.27
|
| Rate for Payer: Meridian Medicaid |
$171.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.61
|
| Rate for Payer: PACE SWMI |
$251.06
|
| Rate for Payer: PHP Medicare Advantage |
$251.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.22
|
| Rate for Payer: Priority Health Medicare |
$251.06
|
| Rate for Payer: Priority Health Narrow Network |
$361.22
|
| Rate for Payer: UHC Medicare Advantage |
$258.59
|
|
|
PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 97165
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$648.75 |
| Rate for Payer: Aetna Commercial |
$130.62
|
| Rate for Payer: Aetna Medicare |
$97.48
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$97.48
|
| Rate for Payer: BCBS Trust/PPO |
$648.75
|
| Rate for Payer: BCN Commercial |
$86.71
|
| Rate for Payer: BCN Medicare Advantage |
$97.48
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$140.37
|
| Rate for Payer: Cofinity Commercial |
$130.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.48
|
| Rate for Payer: Healthscope Commercial |
$116.98
|
| Rate for Payer: Healthscope Whirlpool |
$116.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.35
|
| Rate for Payer: PACE SWMI |
$97.48
|
| Rate for Payer: PHP Medicare Advantage |
$97.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.00
|
| Rate for Payer: Priority Health Medicare |
$97.48
|
| Rate for Payer: Priority Health Narrow Network |
$90.00
|
| Rate for Payer: UHC Medicare Advantage |
$100.40
|
|
|
PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 97166
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$1,059.24 |
| Rate for Payer: Aetna Commercial |
$130.62
|
| Rate for Payer: Aetna Medicare |
$97.48
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS MAPPO |
$97.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.24
|
| Rate for Payer: BCN Commercial |
$86.38
|
| Rate for Payer: BCN Medicare Advantage |
$97.48
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$140.37
|
| Rate for Payer: Cofinity Commercial |
$130.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.48
|
| Rate for Payer: Healthscope Commercial |
$116.98
|
| Rate for Payer: Healthscope Whirlpool |
$116.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.35
|
| Rate for Payer: PACE SWMI |
$97.48
|
| Rate for Payer: PHP Medicare Advantage |
$97.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.00
|
| Rate for Payer: Priority Health Medicare |
$97.48
|
| Rate for Payer: Priority Health Narrow Network |
$90.00
|
| Rate for Payer: UHC Medicare Advantage |
$100.40
|
|
|
PR OCCUPATIONAL THERAPY EVALUATION
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 97003
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
|
|
PR OCCUPATIONAL THERAPY RE-EVALUATION
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 97004
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
|
|
PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 97168
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$2,076.22 |
| Rate for Payer: Aetna Commercial |
$89.81
|
| Rate for Payer: Aetna Medicare |
$67.02
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$67.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.22
|
| Rate for Payer: BCN Commercial |
$59.82
|
| Rate for Payer: BCN Medicare Advantage |
$67.02
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$96.51
|
| Rate for Payer: Cofinity Commercial |
$89.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.02
|
| Rate for Payer: Healthscope Commercial |
$80.42
|
| Rate for Payer: Healthscope Whirlpool |
$80.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.37
|
| Rate for Payer: PACE SWMI |
$67.02
|
| Rate for Payer: PHP Medicare Advantage |
$67.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.00
|
| Rate for Payer: Priority Health Medicare |
$67.02
|
| Rate for Payer: Priority Health Narrow Network |
$45.00
|
| Rate for Payer: UHC Medicare Advantage |
$69.03
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$29.98
|
|
|
Service Code
|
NDC 0713-0135-06
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$29.98 |
| Rate for Payer: Aetna Commercial |
$26.98
|
| Rate for Payer: ASR ASR |
$29.08
|
| Rate for Payer: BCBS Trust/PPO |
$23.24
|
| Rate for Payer: BCN Commercial |
$23.24
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$28.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$29.98
|
| Rate for Payer: Healthscope Whirlpool |
$29.08
|
| Rate for Payer: Mclaren Commercial |
$26.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.38
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$359.77
|
|
|
Service Code
|
NDC 0713-0135-12
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.84 |
| Max. Negotiated Rate |
$359.77 |
| Rate for Payer: Aetna Commercial |
$323.79
|
| Rate for Payer: ASR ASR |
$348.98
|
| Rate for Payer: BCBS Trust/PPO |
$278.93
|
| Rate for Payer: BCN Commercial |
$278.93
|
| Rate for Payer: Cash Price |
$287.82
|
| Rate for Payer: Cofinity Commercial |
$338.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.82
|
| Rate for Payer: Healthscope Commercial |
$359.77
|
| Rate for Payer: Healthscope Whirlpool |
$348.98
|
| Rate for Payer: Mclaren Commercial |
$323.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.60
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$32.77
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.94 |
| Max. Negotiated Rate |
$32.77 |
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: Aetna Commercial |
$20.51
|
| Rate for Payer: Aetna Commercial |
$34.95
|
| Rate for Payer: Aetna Commercial |
$33.52
|
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Aetna Commercial |
$29.69
|
| Rate for Payer: Aetna Commercial |
$46.04
|
| Rate for Payer: Aetna Commercial |
$28.66
|
| Rate for Payer: Aetna Commercial |
$47.37
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: ASR ASR |
$22.11
|
| Rate for Payer: ASR ASR |
$49.62
|
| Rate for Payer: ASR ASR |
$42.22
|
| Rate for Payer: ASR ASR |
$36.13
|
| Rate for Payer: ASR ASR |
$37.67
|
| Rate for Payer: ASR ASR |
$31.79
|
| Rate for Payer: ASR ASR |
$51.05
|
| Rate for Payer: ASR ASR |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$24.69
|
| Rate for Payer: BCBS Trust/PPO |
$30.10
|
| Rate for Payer: BCBS Trust/PPO |
$17.67
|
| Rate for Payer: BCBS Trust/PPO |
$40.80
|
| Rate for Payer: BCBS Trust/PPO |
$25.41
|
| Rate for Payer: BCBS Trust/PPO |
$39.66
|
| Rate for Payer: BCBS Trust/PPO |
$25.58
|
| Rate for Payer: BCBS Trust/PPO |
$33.75
|
| Rate for Payer: BCBS Trust/PPO |
$28.88
|
| Rate for Payer: BCN Commercial |
$17.67
|
| Rate for Payer: BCN Commercial |
$40.80
|
| Rate for Payer: BCN Commercial |
$24.69
|
| Rate for Payer: BCN Commercial |
$30.10
|
| Rate for Payer: BCN Commercial |
$28.88
|
| Rate for Payer: BCN Commercial |
$33.75
|
| Rate for Payer: BCN Commercial |
$25.58
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Commercial |
$39.66
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$26.22
|
| Rate for Payer: Cash Price |
$40.92
|
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cash Price |
$34.82
|
| Rate for Payer: Cash Price |
$31.06
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$40.92
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$49.47
|
| Rate for Payer: Cofinity Commercial |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$48.08
|
| Rate for Payer: Cofinity Commercial |
$31.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$51.15
|
| Rate for Payer: Healthscope Commercial |
$22.79
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$37.25
|
| Rate for Payer: Healthscope Commercial |
$38.83
|
| Rate for Payer: Healthscope Commercial |
$43.53
|
| Rate for Payer: Healthscope Commercial |
$52.63
|
| Rate for Payer: Healthscope Whirlpool |
$31.79
|
| Rate for Payer: Healthscope Whirlpool |
$22.11
|
| Rate for Payer: Healthscope Whirlpool |
$37.67
|
| Rate for Payer: Healthscope Whirlpool |
$32.00
|
| Rate for Payer: Healthscope Whirlpool |
$36.13
|
| Rate for Payer: Healthscope Whirlpool |
$42.22
|
| Rate for Payer: Healthscope Whirlpool |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$51.05
|
| Rate for Payer: Healthscope Whirlpool |
$49.62
|
| Rate for Payer: Mclaren Commercial |
$33.52
|
| Rate for Payer: Mclaren Commercial |
$46.04
|
| Rate for Payer: Mclaren Commercial |
$20.51
|
| Rate for Payer: Mclaren Commercial |
$29.49
|
| Rate for Payer: Mclaren Commercial |
$34.95
|
| Rate for Payer: Mclaren Commercial |
$28.66
|
| Rate for Payer: Mclaren Commercial |
$29.69
|
| Rate for Payer: Mclaren Commercial |
$39.18
|
| Rate for Payer: Mclaren Commercial |
$47.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$46.31
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 51079-542-01
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: ASR ASR |
$2.94
|
| Rate for Payer: BCBS Trust/PPO |
$2.35
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Whirlpool |
$2.94
|
| Rate for Payer: Mclaren Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.67
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$462.65
|
|
|
Service Code
|
NDC 59746-115-06
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.86 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Aetna Commercial |
$416.38
|
| Rate for Payer: ASR ASR |
$448.77
|
| Rate for Payer: BCBS Trust/PPO |
$358.69
|
| Rate for Payer: BCN Commercial |
$358.69
|
| Rate for Payer: Cash Price |
$370.12
|
| Rate for Payer: Cofinity Commercial |
$434.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.12
|
| Rate for Payer: Healthscope Commercial |
$462.65
|
| Rate for Payer: Healthscope Whirlpool |
$448.77
|
| Rate for Payer: Mclaren Commercial |
$416.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$393.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.13
|
|
|
PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 99241
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$77.70 |
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 99245
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$306.40 |
| Rate for Payer: Aetna Commercial |
$196.80
|
| Rate for Payer: BCBS Complete |
$119.88
|
| Rate for Payer: BCBS Trust/PPO |
$202.34
|
| Rate for Payer: BCN Commercial |
$306.40
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Meridian Medicaid |
$119.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.16
|
| Rate for Payer: Priority Health Narrow Network |
$229.16
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 99243
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$1,523.62 |
| Rate for Payer: Aetna Commercial |
$98.89
|
| Rate for Payer: BCBS Complete |
$58.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,523.62
|
| Rate for Payer: BCN Commercial |
$164.69
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Meridian Medicaid |
$58.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.21
|
| Rate for Payer: Priority Health Narrow Network |
$112.21
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 99244
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$722.19 |
| Rate for Payer: Aetna Commercial |
$159.16
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$722.19
|
| Rate for Payer: BCN Commercial |
$235.54
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.33
|
| Rate for Payer: Priority Health Narrow Network |
$171.33
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 99242
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$158.49 |
| Rate for Payer: Aetna Commercial |
$70.73
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$158.49
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.10
|
| Rate for Payer: Priority Health Narrow Network |
$71.10
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 99215
|
| Min. Negotiated Rate |
$123.62 |
| Max. Negotiated Rate |
$1,816.82 |
| Rate for Payer: Aetna Commercial |
$187.80
|
| Rate for Payer: Aetna Medicare |
$140.15
|
| Rate for Payer: BCBS Complete |
$129.80
|
| Rate for Payer: BCBS MAPPO |
$140.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.82
|
| Rate for Payer: BCN Commercial |
$154.50
|
| Rate for Payer: BCN Medicare Advantage |
$140.15
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$201.82
|
| Rate for Payer: Cofinity Commercial |
$187.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.15
|
| Rate for Payer: Healthscope Commercial |
$154.16
|
| Rate for Payer: Healthscope Whirlpool |
$154.16
|
| Rate for Payer: Meridian Medicaid |
$129.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.16
|
| Rate for Payer: PACE SWMI |
$140.15
|
| Rate for Payer: PHP Medicare Advantage |
$140.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.20
|
| Rate for Payer: Priority Health Medicare |
$140.15
|
| Rate for Payer: Priority Health Narrow Network |
$147.20
|
| Rate for Payer: UHC Medicare Advantage |
$144.35
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99213
|
| Min. Negotiated Rate |
$56.48 |
| Max. Negotiated Rate |
$1,305.96 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$64.68
|
| Rate for Payer: BCBS Complete |
$59.30
|
| Rate for Payer: BCBS MAPPO |
$64.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.96
|
| Rate for Payer: BCN Commercial |
$79.38
|
| Rate for Payer: BCN Medicare Advantage |
$64.68
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$93.14
|
| Rate for Payer: Cofinity Commercial |
$86.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.68
|
| Rate for Payer: Healthscope Commercial |
$71.15
|
| Rate for Payer: Healthscope Whirlpool |
$71.15
|
| Rate for Payer: Meridian Medicaid |
$59.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.91
|
| Rate for Payer: PACE SWMI |
$64.68
|
| Rate for Payer: PHP Medicare Advantage |
$64.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.86
|
| Rate for Payer: Priority Health Medicare |
$64.68
|
| Rate for Payer: Priority Health Narrow Network |
$67.86
|
| Rate for Payer: UHC Medicare Advantage |
$66.62
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99214
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$1,340.83 |
| Rate for Payer: Aetna Commercial |
$127.94
|
| Rate for Payer: Aetna Medicare |
$95.48
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$95.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,340.83
|
| Rate for Payer: BCN Commercial |
$115.12
|
| Rate for Payer: BCN Medicare Advantage |
$95.48
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.49
|
| Rate for Payer: Cofinity Commercial |
$127.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.48
|
| Rate for Payer: Healthscope Commercial |
$105.03
|
| Rate for Payer: Healthscope Whirlpool |
$105.03
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.25
|
| Rate for Payer: PACE SWMI |
$95.48
|
| Rate for Payer: PHP Medicare Advantage |
$95.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.23
|
| Rate for Payer: Priority Health Medicare |
$95.48
|
| Rate for Payer: Priority Health Narrow Network |
$100.23
|
| Rate for Payer: UHC Medicare Advantage |
$98.34
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 99212
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$2,731.31 |
| Rate for Payer: Aetna Commercial |
$46.71
|
| Rate for Payer: Aetna Medicare |
$34.86
|
| Rate for Payer: BCBS Complete |
$31.77
|
| Rate for Payer: BCBS MAPPO |
$34.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,731.31
|
| Rate for Payer: BCN Commercial |
$50.51
|
| Rate for Payer: BCN Medicare Advantage |
$34.86
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$50.20
|
| Rate for Payer: Cofinity Commercial |
$46.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.86
|
| Rate for Payer: Healthscope Commercial |
$38.35
|
| Rate for Payer: Healthscope Whirlpool |
$38.35
|
| Rate for Payer: Meridian Medicaid |
$31.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.60
|
| Rate for Payer: PACE SWMI |
$34.86
|
| Rate for Payer: PHP Medicare Advantage |
$34.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health Medicare |
$34.86
|
| Rate for Payer: Priority Health Narrow Network |
$36.54
|
| Rate for Payer: UHC Medicare Advantage |
$35.91
|
|
