|
PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 99211
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$2,495.16 |
| Rate for Payer: Aetna Commercial |
$11.56
|
| Rate for Payer: Aetna Medicare |
$8.63
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS MAPPO |
$8.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,495.16
|
| Rate for Payer: BCN Commercial |
$23.28
|
| Rate for Payer: BCN Medicare Advantage |
$8.63
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$12.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.63
|
| Rate for Payer: Healthscope Commercial |
$9.49
|
| Rate for Payer: Healthscope Whirlpool |
$9.49
|
| Rate for Payer: Meridian Medicaid |
$7.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.06
|
| Rate for Payer: PACE SWMI |
$8.63
|
| Rate for Payer: PHP Medicare Advantage |
$8.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.05
|
| Rate for Payer: Priority Health Medicare |
$8.63
|
| Rate for Payer: Priority Health Narrow Network |
$9.05
|
| Rate for Payer: UHC Medicare Advantage |
$8.89
|
|
|
PR OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 99205
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$2,028.67 |
| Rate for Payer: Aetna Commercial |
$237.78
|
| Rate for Payer: Aetna Medicare |
$177.45
|
| Rate for Payer: BCBS Complete |
$163.38
|
| Rate for Payer: BCBS MAPPO |
$177.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,028.67
|
| Rate for Payer: BCN Commercial |
$209.60
|
| Rate for Payer: BCN Medicare Advantage |
$177.45
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$255.53
|
| Rate for Payer: Cofinity Commercial |
$237.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.45
|
| Rate for Payer: Healthscope Commercial |
$195.20
|
| Rate for Payer: Healthscope Whirlpool |
$195.20
|
| Rate for Payer: Meridian Medicaid |
$163.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.32
|
| Rate for Payer: PACE SWMI |
$177.45
|
| Rate for Payer: PHP Medicare Advantage |
$177.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.19
|
| Rate for Payer: Priority Health Medicare |
$177.45
|
| Rate for Payer: Priority Health Narrow Network |
$186.19
|
| Rate for Payer: UHC Medicare Advantage |
$182.77
|
|
|
PR OFFICE OUTPATIENT NEW LEVL I
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 99201
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
|
|
PR OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99203
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$931.39 |
| Rate for Payer: Aetna Commercial |
$109.09
|
| Rate for Payer: Aetna Medicare |
$81.41
|
| Rate for Payer: BCBS Complete |
$73.83
|
| Rate for Payer: BCBS MAPPO |
$81.41
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$108.55
|
| Rate for Payer: BCN Medicare Advantage |
$81.41
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$117.23
|
| Rate for Payer: Cofinity Commercial |
$109.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.41
|
| Rate for Payer: Healthscope Commercial |
$89.55
|
| Rate for Payer: Healthscope Whirlpool |
$89.55
|
| Rate for Payer: Meridian Medicaid |
$73.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.48
|
| Rate for Payer: PACE SWMI |
$81.41
|
| Rate for Payer: PHP Medicare Advantage |
$81.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.26
|
| Rate for Payer: Priority Health Medicare |
$81.41
|
| Rate for Payer: Priority Health Narrow Network |
$85.26
|
| Rate for Payer: UHC Medicare Advantage |
$83.85
|
|
|
PR OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 99204
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$1,704.30 |
| Rate for Payer: Aetna Commercial |
$175.22
|
| Rate for Payer: Aetna Medicare |
$130.76
|
| Rate for Payer: BCBS Complete |
$120.12
|
| Rate for Payer: BCBS MAPPO |
$130.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.30
|
| Rate for Payer: BCN Commercial |
$165.88
|
| Rate for Payer: BCN Medicare Advantage |
$130.76
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$188.29
|
| Rate for Payer: Cofinity Commercial |
$175.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.76
|
| Rate for Payer: Healthscope Commercial |
$143.84
|
| Rate for Payer: Healthscope Whirlpool |
$143.84
|
| Rate for Payer: Meridian Medicaid |
$120.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.30
|
| Rate for Payer: PACE SWMI |
$130.76
|
| Rate for Payer: PHP Medicare Advantage |
$130.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.12
|
| Rate for Payer: Priority Health Medicare |
$130.76
|
| Rate for Payer: Priority Health Narrow Network |
$137.12
|
| Rate for Payer: UHC Medicare Advantage |
$134.68
|
|
|
PR OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99202
|
| Min. Negotiated Rate |
$40.63 |
| Max. Negotiated Rate |
$706.34 |
| Rate for Payer: Aetna Commercial |
$63.10
|
| Rate for Payer: Aetna Medicare |
$47.09
|
| Rate for Payer: BCBS Complete |
$42.66
|
| Rate for Payer: BCBS MAPPO |
$47.09
|
| Rate for Payer: BCBS Trust/PPO |
$706.34
|
| Rate for Payer: BCN Commercial |
$76.66
|
| Rate for Payer: BCN Medicare Advantage |
$47.09
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$63.10
|
| Rate for Payer: Cofinity Commercial |
$67.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.09
|
| Rate for Payer: Healthscope Commercial |
$51.80
|
| Rate for Payer: Healthscope Whirlpool |
$51.80
|
| Rate for Payer: Meridian Medicaid |
$42.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.44
|
| Rate for Payer: PACE SWMI |
$47.09
|
| Rate for Payer: PHP Medicare Advantage |
$47.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.42
|
| Rate for Payer: Priority Health Medicare |
$47.09
|
| Rate for Payer: Priority Health Narrow Network |
$49.42
|
| Rate for Payer: UHC Medicare Advantage |
$48.50
|
|
|
PROLASTIN/ARALAST (ALPHA-1 PROTEINASE INHIBITOR) 1,000 MG IV SOLUTION
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
36577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: ASR ASR |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.04
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.07
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Healthscope Whirlpool |
$1.30
|
| Rate for Payer: Mclaren Commercial |
$1.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.18
|
|
|
PR OMALIZUMAB INJECTION
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J2357
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$56.71 |
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Medicare |
$39.38
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$39.38
|
| Rate for Payer: BCBS Trust/PPO |
$40.20
|
| Rate for Payer: BCN Commercial |
$38.63
|
| Rate for Payer: BCN Medicare Advantage |
$39.38
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$52.77
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.38
|
| Rate for Payer: Healthscope Commercial |
$47.26
|
| Rate for Payer: Healthscope Whirlpool |
$47.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.35
|
| Rate for Payer: PACE SWMI |
$39.38
|
| Rate for Payer: PHP Medicare Advantage |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Medicare |
$39.38
|
| Rate for Payer: UHC Medicare Advantage |
$40.56
|
|
|
PR OMENTAL FLAP INTRA-ABDOMINAL
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
HCPCS 49905
|
| Min. Negotiated Rate |
$223.01 |
| Max. Negotiated Rate |
$4,973.94 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Medicare |
$350.60
|
| Rate for Payer: BCBS Complete |
$234.16
|
| Rate for Payer: BCBS MAPPO |
$350.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,973.94
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: BCN Medicare Advantage |
$350.60
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Cofinity Commercial |
$504.86
|
| Rate for Payer: Cofinity Commercial |
$469.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.60
|
| Rate for Payer: Healthscope Commercial |
$420.72
|
| Rate for Payer: Healthscope Whirlpool |
$420.72
|
| Rate for Payer: Meridian Medicaid |
$234.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$368.13
|
| Rate for Payer: PACE SWMI |
$350.60
|
| Rate for Payer: PHP Medicare Advantage |
$350.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.43
|
| Rate for Payer: Priority Health Medicare |
$350.60
|
| Rate for Payer: Priority Health Narrow Network |
$614.43
|
| Rate for Payer: UHC Medicare Advantage |
$361.12
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$15.09
|
|
|
Service Code
|
NDC 0713-0536-06
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$15.09 |
| Rate for Payer: Aetna Commercial |
$13.58
|
| Rate for Payer: ASR ASR |
$14.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.70
|
| Rate for Payer: BCN Commercial |
$11.70
|
| Rate for Payer: Cash Price |
$12.07
|
| Rate for Payer: Cofinity Commercial |
$14.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.07
|
| Rate for Payer: Healthscope Commercial |
$15.09
|
| Rate for Payer: Healthscope Whirlpool |
$14.64
|
| Rate for Payer: Mclaren Commercial |
$13.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.28
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$181.02
|
|
|
Service Code
|
NDC 0713-0536-12
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.71 |
| Max. Negotiated Rate |
$181.02 |
| Rate for Payer: Aetna Commercial |
$162.92
|
| Rate for Payer: ASR ASR |
$175.59
|
| Rate for Payer: BCBS Trust/PPO |
$140.34
|
| Rate for Payer: BCN Commercial |
$140.34
|
| Rate for Payer: Cash Price |
$144.82
|
| Rate for Payer: Cofinity Commercial |
$170.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.82
|
| Rate for Payer: Healthscope Commercial |
$181.02
|
| Rate for Payer: Healthscope Whirlpool |
$175.59
|
| Rate for Payer: Mclaren Commercial |
$162.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.30
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$402.49
|
|
|
Service Code
|
NDC 45802-758-30
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.74 |
| Max. Negotiated Rate |
$402.49 |
| Rate for Payer: Aetna Commercial |
$362.24
|
| Rate for Payer: ASR ASR |
$390.42
|
| Rate for Payer: BCBS Trust/PPO |
$312.05
|
| Rate for Payer: BCN Commercial |
$312.05
|
| Rate for Payer: Cash Price |
$321.99
|
| Rate for Payer: Cofinity Commercial |
$378.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.99
|
| Rate for Payer: Healthscope Commercial |
$402.49
|
| Rate for Payer: Healthscope Whirlpool |
$390.42
|
| Rate for Payer: Mclaren Commercial |
$362.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$342.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$281.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$354.19
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$33.54
|
|
|
Service Code
|
NDC 45802-758-00
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$33.54 |
| Rate for Payer: Aetna Commercial |
$30.19
|
| Rate for Payer: ASR ASR |
$32.53
|
| Rate for Payer: BCBS Trust/PPO |
$26.00
|
| Rate for Payer: BCN Commercial |
$26.00
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.83
|
| Rate for Payer: Healthscope Commercial |
$33.54
|
| Rate for Payer: Healthscope Whirlpool |
$32.53
|
| Rate for Payer: Mclaren Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.52
|
|
|
PROMETHAZINE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$22.05
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.44 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Commercial |
$14.68
|
| Rate for Payer: Aetna Commercial |
$20.15
|
| Rate for Payer: ASR ASR |
$21.72
|
| Rate for Payer: ASR ASR |
$15.82
|
| Rate for Payer: ASR ASR |
$21.39
|
| Rate for Payer: BCBS Trust/PPO |
$12.65
|
| Rate for Payer: BCBS Trust/PPO |
$17.10
|
| Rate for Payer: BCBS Trust/PPO |
$17.36
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: BCN Commercial |
$17.36
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$20.73
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$22.39
|
| Rate for Payer: Healthscope Commercial |
$22.05
|
| Rate for Payer: Healthscope Whirlpool |
$21.39
|
| Rate for Payer: Healthscope Whirlpool |
$15.82
|
| Rate for Payer: Healthscope Whirlpool |
$21.72
|
| Rate for Payer: Mclaren Commercial |
$20.15
|
| Rate for Payer: Mclaren Commercial |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$14.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.70
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$153.98
|
|
|
Service Code
|
NDC 0713-0526-12
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.79 |
| Max. Negotiated Rate |
$153.98 |
| Rate for Payer: Aetna Commercial |
$138.58
|
| Rate for Payer: ASR ASR |
$149.36
|
| Rate for Payer: BCBS Trust/PPO |
$119.38
|
| Rate for Payer: BCN Commercial |
$119.38
|
| Rate for Payer: Cash Price |
$123.18
|
| Rate for Payer: Cofinity Commercial |
$144.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$123.18
|
| Rate for Payer: Healthscope Commercial |
$153.98
|
| Rate for Payer: Healthscope Whirlpool |
$149.36
|
| Rate for Payer: Mclaren Commercial |
$138.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$130.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.50
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 0904-6461-61
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.02 |
| Max. Negotiated Rate |
$251.45 |
| Rate for Payer: Aetna Commercial |
$226.30
|
| Rate for Payer: ASR ASR |
$243.91
|
| Rate for Payer: BCBS Trust/PPO |
$194.95
|
| Rate for Payer: BCN Commercial |
$194.95
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$236.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$251.45
|
| Rate for Payer: Healthscope Whirlpool |
$243.91
|
| Rate for Payer: Mclaren Commercial |
$226.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.28
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$448.85
|
|
|
Service Code
|
NDC 68084-155-11
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.20 |
| Max. Negotiated Rate |
$448.85 |
| Rate for Payer: Aetna Commercial |
$403.96
|
| Rate for Payer: ASR ASR |
$435.38
|
| Rate for Payer: BCBS Trust/PPO |
$347.99
|
| Rate for Payer: BCN Commercial |
$347.99
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Commercial |
$421.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$448.85
|
| Rate for Payer: Healthscope Whirlpool |
$435.38
|
| Rate for Payer: Mclaren Commercial |
$403.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$394.99
|
|
|
PROMETHAZINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.14
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$24.14 |
| Rate for Payer: Aetna Commercial |
$21.73
|
| Rate for Payer: ASR ASR |
$23.42
|
| Rate for Payer: BCBS Trust/PPO |
$18.72
|
| Rate for Payer: BCN Commercial |
$18.72
|
| Rate for Payer: Cash Price |
$19.31
|
| Rate for Payer: Cofinity Commercial |
$22.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$24.14
|
| Rate for Payer: Healthscope Whirlpool |
$23.42
|
| Rate for Payer: Mclaren Commercial |
$21.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.24
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$1.57
|
|
|
Service Code
|
NDC 9900-0004-13
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna Commercial |
$1.41
|
| Rate for Payer: ASR ASR |
$1.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.22
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.26
|
| Rate for Payer: Healthscope Commercial |
$1.57
|
| Rate for Payer: Healthscope Whirlpool |
$1.52
|
| Rate for Payer: Mclaren Commercial |
$1.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.38
|
|
|
PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$2,085.00
|
|
|
Service Code
|
HCPCS 49255
|
| Min. Negotiated Rate |
$508.64 |
| Max. Negotiated Rate |
$1,459.50 |
| Rate for Payer: Aetna Commercial |
$1,050.84
|
| Rate for Payer: Aetna Medicare |
$784.21
|
| Rate for Payer: BCBS Complete |
$534.07
|
| Rate for Payer: BCBS MAPPO |
$784.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.96
|
| Rate for Payer: BCN Commercial |
$1,157.67
|
| Rate for Payer: BCN Medicare Advantage |
$784.21
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cofinity Commercial |
$1,129.26
|
| Rate for Payer: Cofinity Commercial |
$1,050.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$784.21
|
| Rate for Payer: Healthscope Commercial |
$941.05
|
| Rate for Payer: Healthscope Whirlpool |
$941.05
|
| Rate for Payer: Meridian Medicaid |
$534.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$823.42
|
| Rate for Payer: PACE SWMI |
$784.21
|
| Rate for Payer: PHP Medicare Advantage |
$784.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$508.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,459.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,392.91
|
| Rate for Payer: Priority Health Medicare |
$784.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,392.91
|
| Rate for Payer: UHC Medicare Advantage |
$807.74
|
|
|
PR ONDANSETRON HCL INJECTION
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J2405
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$0.15
|
| Rate for Payer: Aetna Medicare |
$0.11
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$0.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.11
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$0.16
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.11
|
| Rate for Payer: Healthscope Commercial |
$0.13
|
| Rate for Payer: Healthscope Whirlpool |
$0.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.12
|
| Rate for Payer: PACE SWMI |
$0.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Medicare |
$0.11
|
| Rate for Payer: UHC Medicare Advantage |
$0.11
|
|
|
PR ONE AREA LIPOSUCTION - 1 AREA 1.0 HR
|
Professional
|
Both
|
$2,000.00
|
|
|
Service Code
|
HCPCS 00527
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$800.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: BCBS Complete |
$800.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.00
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99422
|
| Min. Negotiated Rate |
$21.61 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$33.35
|
| Rate for Payer: Aetna Medicare |
$24.89
|
| Rate for Payer: BCBS Complete |
$22.69
|
| Rate for Payer: BCBS MAPPO |
$24.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$42.64
|
| Rate for Payer: BCN Medicare Advantage |
$24.89
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$35.84
|
| Rate for Payer: Cofinity Commercial |
$33.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$27.38
|
| Rate for Payer: Healthscope Whirlpool |
$27.38
|
| Rate for Payer: Meridian Medicaid |
$22.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$26.13
|
| Rate for Payer: PACE SWMI |
$24.89
|
| Rate for Payer: PHP Medicare Advantage |
$24.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.11
|
| Rate for Payer: Priority Health Medicare |
$24.89
|
| Rate for Payer: Priority Health Narrow Network |
$26.11
|
| Rate for Payer: UHC Medicare Advantage |
$25.64
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$873.28 |
| Rate for Payer: Aetna Commercial |
$52.92
|
| Rate for Payer: Aetna Medicare |
$39.49
|
| Rate for Payer: BCBS Complete |
$36.31
|
| Rate for Payer: BCBS MAPPO |
$39.49
|
| Rate for Payer: BCBS Trust/PPO |
$873.28
|
| Rate for Payer: BCN Commercial |
$49.79
|
| Rate for Payer: BCN Medicare Advantage |
$39.49
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$56.87
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.49
|
| Rate for Payer: Healthscope Commercial |
$43.44
|
| Rate for Payer: Healthscope Whirlpool |
$43.44
|
| Rate for Payer: Meridian Medicaid |
$36.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.46
|
| Rate for Payer: PACE SWMI |
$39.49
|
| Rate for Payer: PHP Medicare Advantage |
$39.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.42
|
| Rate for Payer: Priority Health Medicare |
$39.49
|
| Rate for Payer: Priority Health Narrow Network |
$41.42
|
| Rate for Payer: UHC Medicare Advantage |
$40.67
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$10.95 |
| Max. Negotiated Rate |
$1,630.70 |
| Rate for Payer: Aetna Commercial |
$16.88
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: BCBS Complete |
$11.50
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,630.70
|
| Rate for Payer: BCN Commercial |
$21.51
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$16.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Healthscope Whirlpool |
$13.86
|
| Rate for Payer: Meridian Medicaid |
$11.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.23
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow Network |
$13.23
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
|
