|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
HCPCS 93312
|
| Min. Negotiated Rate |
$66.46 |
| Max. Negotiated Rate |
$1,669.96 |
| Rate for Payer: Aetna Commercial |
$320.26
|
| Rate for Payer: Aetna Medicare |
$277.50
|
| Rate for Payer: BCBS Complete |
$69.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.96
|
| Rate for Payer: BCN Commercial |
$345.01
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Meridian Medicaid |
$69.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.42
|
| Rate for Payer: Priority Health Narrow Network |
$146.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$385.13
|
| Rate for Payer: UHC Exchange |
$385.13
|
| Rate for Payer: UHCCP Medicaid |
$66.46
|
|
|
PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 93307
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$1,789.88 |
| Rate for Payer: Aetna Commercial |
$184.71
|
| Rate for Payer: Aetna Commercial |
$184.71
|
| Rate for Payer: Aetna Medicare |
$246.00
|
| Rate for Payer: Aetna Medicare |
$169.50
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCN Commercial |
$199.86
|
| Rate for Payer: BCN Commercial |
$199.86
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.80
|
| Rate for Payer: Priority Health Narrow Network |
$59.80
|
| Rate for Payer: Priority Health Narrow Network |
$59.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$190.66
|
| Rate for Payer: UHC Exchange |
$190.66
|
| Rate for Payer: UHC Exchange |
$190.66
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
|
|
PR ECHO TRANSTHORC R-T 2D W/WO M-MODE REC F-UP/LMTD
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 93308
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$1,789.88 |
| Rate for Payer: Aetna Commercial |
$128.91
|
| Rate for Payer: Aetna Commercial |
$128.91
|
| Rate for Payer: Aetna Medicare |
$88.50
|
| Rate for Payer: Aetna Medicare |
$145.00
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCBS Trust/PPO |
$1,789.88
|
| Rate for Payer: BCN Commercial |
$143.67
|
| Rate for Payer: BCN Commercial |
$143.67
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.37
|
| Rate for Payer: Priority Health Narrow Network |
$34.37
|
| Rate for Payer: Priority Health Narrow Network |
$34.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.85
|
| Rate for Payer: UHC Exchange |
$127.85
|
| Rate for Payer: UHC Exchange |
$127.85
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE COMPLETE REST&ST
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 93350
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$1,950.48 |
| Rate for Payer: Aetna Commercial |
$248.38
|
| Rate for Payer: Aetna Commercial |
$248.38
|
| Rate for Payer: Aetna Medicare |
$74.00
|
| Rate for Payer: Aetna Medicare |
$226.00
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,950.48
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.11
|
| Rate for Payer: Priority Health Narrow Network |
$95.11
|
| Rate for Payer: Priority Health Narrow Network |
$95.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.46
|
| Rate for Payer: UHC Exchange |
$252.46
|
| Rate for Payer: UHC Exchange |
$252.46
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
|
|
PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 93306
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$1,092.00 |
| Rate for Payer: Aetna Commercial |
$262.11
|
| Rate for Payer: Aetna Commercial |
$262.11
|
| Rate for Payer: Aetna Medicare |
$135.00
|
| Rate for Payer: Aetna Medicare |
$500.00
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,092.00
|
| Rate for Payer: BCN Commercial |
$286.36
|
| Rate for Payer: BCN Commercial |
$286.36
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$650.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.11
|
| Rate for Payer: Priority Health Narrow Network |
$95.11
|
| Rate for Payer: Priority Health Narrow Network |
$95.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$294.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$294.25
|
| Rate for Payer: UHC Exchange |
$294.25
|
| Rate for Payer: UHC Exchange |
$294.25
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
|
|
PR ECMO/ECLS DAILY MANAGEMENT EA DAY VENO-ARTERIAL
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 33949
|
| Min. Negotiated Rate |
$146.33 |
| Max. Negotiated Rate |
$1,551.62 |
| Rate for Payer: Aetna Commercial |
$311.32
|
| Rate for Payer: Aetna Medicare |
$396.00
|
| Rate for Payer: BCBS Complete |
$153.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,551.62
|
| Rate for Payer: BCN Commercial |
$329.86
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Meridian Medicaid |
$153.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$362.18
|
| Rate for Payer: Priority Health Narrow Network |
$362.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$319.01
|
| Rate for Payer: UHC Exchange |
$319.01
|
| Rate for Payer: UHCCP Medicaid |
$146.33
|
|
|
PR ECMO/ECLS INITIATION VENO-ARTERIAL
|
Professional
|
Both
|
$1,051.00
|
|
|
Service Code
|
HCPCS 33947
|
| Min. Negotiated Rate |
$214.92 |
| Max. Negotiated Rate |
$1,408.45 |
| Rate for Payer: Aetna Commercial |
$463.16
|
| Rate for Payer: Aetna Medicare |
$525.50
|
| Rate for Payer: BCBS Complete |
$225.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,408.45
|
| Rate for Payer: BCN Commercial |
$489.17
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Cash Price |
$840.80
|
| Rate for Payer: Meridian Medicaid |
$225.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$533.96
|
| Rate for Payer: Priority Health Narrow Network |
$533.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$458.88
|
| Rate for Payer: UHC Exchange |
$458.88
|
| Rate for Payer: UHCCP Medicaid |
$214.92
|
|
|
PR ECMO/ECLS INITIATION VENO-VENOUS
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 33946
|
| Min. Negotiated Rate |
$193.83 |
| Max. Negotiated Rate |
$1,643.01 |
| Rate for Payer: Aetna Commercial |
$416.54
|
| Rate for Payer: Aetna Medicare |
$237.50
|
| Rate for Payer: BCBS Complete |
$203.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.01
|
| Rate for Payer: BCN Commercial |
$442.25
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Meridian Medicaid |
$203.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$482.37
|
| Rate for Payer: Priority Health Narrow Network |
$482.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.43
|
| Rate for Payer: UHC Exchange |
$415.43
|
| Rate for Payer: UHCCP Medicaid |
$193.83
|
|
|
PR ECMO/ECLS INSJ OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$2,607.00
|
|
|
Service Code
|
HCPCS 33956
|
| Min. Negotiated Rate |
$521.00 |
| Max. Negotiated Rate |
$3,231.61 |
| Rate for Payer: Aetna Commercial |
$1,124.07
|
| Rate for Payer: Aetna Medicare |
$1,303.50
|
| Rate for Payer: BCBS Complete |
$547.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,231.61
|
| Rate for Payer: BCN Commercial |
$1,192.37
|
| Rate for Payer: Cash Price |
$2,085.60
|
| Rate for Payer: Cash Price |
$2,085.60
|
| Rate for Payer: Meridian Medicaid |
$547.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$521.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,694.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,300.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,300.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,139.09
|
| Rate for Payer: UHC Exchange |
$1,139.09
|
| Rate for Payer: UHCCP Medicaid |
$521.00
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER OPEN
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
HCPCS 33954
|
| Min. Negotiated Rate |
$297.77 |
| Max. Negotiated Rate |
$4,413.95 |
| Rate for Payer: Aetna Commercial |
$640.79
|
| Rate for Payer: Aetna Medicare |
$482.00
|
| Rate for Payer: BCBS Complete |
$312.66
|
| Rate for Payer: BCBS Trust/PPO |
$4,413.95
|
| Rate for Payer: BCN Commercial |
$678.28
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Meridian Medicaid |
$312.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.30
|
| Rate for Payer: Priority Health Narrow Network |
$740.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$648.98
|
| Rate for Payer: UHC Exchange |
$648.98
|
| Rate for Payer: UHCCP Medicaid |
$297.77
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA 6 YRS&OLDER PERQ
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
HCPCS 33952
|
| Min. Negotiated Rate |
$266.46 |
| Max. Negotiated Rate |
$3,277.57 |
| Rate for Payer: Aetna Commercial |
$574.93
|
| Rate for Payer: Aetna Medicare |
$449.50
|
| Rate for Payer: BCBS Complete |
$279.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,277.57
|
| Rate for Payer: BCN Commercial |
$609.87
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Cash Price |
$719.20
|
| Rate for Payer: Meridian Medicaid |
$279.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$584.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$664.77
|
| Rate for Payer: Priority Health Narrow Network |
$664.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$580.84
|
| Rate for Payer: UHC Exchange |
$580.84
|
| Rate for Payer: UHCCP Medicaid |
$266.46
|
|
|
PR ECMO/ECLS INSJ OF PRPH CANNULA BIRTH-5 YRS OPEN
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
HCPCS 33953
|
| Min. Negotiated Rate |
$294.37 |
| Max. Negotiated Rate |
$3,959.61 |
| Rate for Payer: Aetna Commercial |
$637.46
|
| Rate for Payer: Aetna Medicare |
$362.00
|
| Rate for Payer: BCBS Complete |
$309.09
|
| Rate for Payer: BCBS Trust/PPO |
$3,959.61
|
| Rate for Payer: BCN Commercial |
$672.91
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Cash Price |
$579.20
|
| Rate for Payer: Meridian Medicaid |
$309.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$294.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$470.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.25
|
| Rate for Payer: Priority Health Narrow Network |
$731.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$666.10
|
| Rate for Payer: UHC Exchange |
$666.10
|
| Rate for Payer: UHCCP Medicaid |
$294.37
|
|
|
PR ECMO/ECLS RMVL OF CENTRAL CANNULA 6 YRS & OLDER
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
HCPCS 33986
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$814.75 |
| Rate for Payer: Aetna Commercial |
$704.51
|
| Rate for Payer: Aetna Medicare |
$550.00
|
| Rate for Payer: BCBS Complete |
$344.64
|
| Rate for Payer: BCBS Trust/PPO |
$128.38
|
| Rate for Payer: BCN Commercial |
$747.19
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Cash Price |
$880.00
|
| Rate for Payer: Meridian Medicaid |
$344.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$814.75
|
| Rate for Payer: Priority Health Narrow Network |
$814.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.80
|
| Rate for Payer: UHC Exchange |
$704.80
|
| Rate for Payer: UHCCP Medicaid |
$328.23
|
|
|
PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 95836
|
| Min. Negotiated Rate |
$67.10 |
| Max. Negotiated Rate |
$658.26 |
| Rate for Payer: Aetna Commercial |
$116.64
|
| Rate for Payer: Aetna Medicare |
$115.00
|
| Rate for Payer: BCBS Complete |
$70.46
|
| Rate for Payer: BCBS Trust/PPO |
$658.26
|
| Rate for Payer: BCN Commercial |
$152.47
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Meridian Medicaid |
$70.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.57
|
| Rate for Payer: Priority Health Narrow Network |
$141.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$121.36
|
| Rate for Payer: UHC Exchange |
$121.36
|
| Rate for Payer: UHCCP Medicaid |
$67.10
|
|
|
PR EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
HCPCS 43259
|
| Min. Negotiated Rate |
$142.50 |
| Max. Negotiated Rate |
$946.19 |
| Rate for Payer: Aetna Commercial |
$300.25
|
| Rate for Payer: Aetna Medicare |
$499.00
|
| Rate for Payer: BCBS Complete |
$149.62
|
| Rate for Payer: BCBS Trust/PPO |
$946.19
|
| Rate for Payer: BCN Commercial |
$322.53
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Meridian Medicaid |
$149.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$142.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$648.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.73
|
| Rate for Payer: Priority Health Narrow Network |
$396.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$382.84
|
| Rate for Payer: UHC Exchange |
$382.84
|
| Rate for Payer: UHCCP Medicaid |
$142.50
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$5.99
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.89 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: ASR ASR |
$5.81
|
| Rate for Payer: ASR Commercial |
$5.81
|
| Rate for Payer: BCBS Trust/PPO |
$4.88
|
| Rate for Payer: BCN Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Commercial |
$5.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$5.99
|
| Rate for Payer: Healthscope Whirlpool |
$5.81
|
| Rate for Payer: Mclaren Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Nomi Health Commercial |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.27
|
|
|
PREDNISOLONE 15 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$5.99
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
11117
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Aetna Medicare |
$3.00
|
| Rate for Payer: ASR ASR |
$5.81
|
| Rate for Payer: ASR Commercial |
$5.81
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS Trust/PPO |
$4.91
|
| Rate for Payer: BCN Commercial |
$4.64
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cash Price |
$4.79
|
| Rate for Payer: Cofinity Commercial |
$5.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.79
|
| Rate for Payer: Healthscope Commercial |
$5.99
|
| Rate for Payer: Healthscope Whirlpool |
$5.81
|
| Rate for Payer: Mclaren Commercial |
$5.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.09
|
| Rate for Payer: Nomi Health Commercial |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.50
|
| Rate for Payer: Priority Health Narrow Network |
$0.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.27
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$845.84
|
|
|
Service Code
|
NDC 11980018010
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$338.34 |
| Max. Negotiated Rate |
$845.84 |
| Rate for Payer: Aetna Commercial |
$761.26
|
| Rate for Payer: Aetna Medicare |
$422.92
|
| Rate for Payer: ASR ASR |
$820.46
|
| Rate for Payer: ASR Commercial |
$820.46
|
| Rate for Payer: BCBS Complete |
$338.34
|
| Rate for Payer: BCBS Trust/PPO |
$692.66
|
| Rate for Payer: BCN Commercial |
$655.78
|
| Rate for Payer: Cash Price |
$676.68
|
| Rate for Payer: Cofinity Commercial |
$795.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.67
|
| Rate for Payer: Healthscope Commercial |
$845.84
|
| Rate for Payer: Healthscope Whirlpool |
$820.46
|
| Rate for Payer: Mclaren Commercial |
$761.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.96
|
| Rate for Payer: Nomi Health Commercial |
$693.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$741.13
|
| Rate for Payer: Priority Health Narrow Network |
$592.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.34
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.95 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: ASR ASR |
$99.91
|
| Rate for Payer: ASR Commercial |
$99.91
|
| Rate for Payer: BCBS Trust/PPO |
$83.93
|
| Rate for Payer: BCN Commercial |
$79.86
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$96.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.40
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Healthscope Whirlpool |
$99.91
|
| Rate for Payer: Mclaren Commercial |
$92.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.55
|
| Rate for Payer: Nomi Health Commercial |
$84.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.64
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$103.00 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Medicare |
$51.50
|
| Rate for Payer: ASR ASR |
$99.91
|
| Rate for Payer: ASR Commercial |
$99.91
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS Trust/PPO |
$84.35
|
| Rate for Payer: BCN Commercial |
$79.86
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$96.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.40
|
| Rate for Payer: Healthscope Commercial |
$103.00
|
| Rate for Payer: Healthscope Whirlpool |
$99.91
|
| Rate for Payer: Mclaren Commercial |
$92.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.55
|
| Rate for Payer: Nomi Health Commercial |
$84.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.25
|
| Rate for Payer: Priority Health Narrow Network |
$72.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.64
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$845.84
|
|
|
Service Code
|
NDC 11980018010
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$549.80 |
| Max. Negotiated Rate |
$845.84 |
| Rate for Payer: Aetna Commercial |
$761.26
|
| Rate for Payer: ASR ASR |
$820.46
|
| Rate for Payer: ASR Commercial |
$820.46
|
| Rate for Payer: BCBS Trust/PPO |
$689.28
|
| Rate for Payer: BCN Commercial |
$655.78
|
| Rate for Payer: Cash Price |
$676.68
|
| Rate for Payer: Cofinity Commercial |
$795.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$676.67
|
| Rate for Payer: Healthscope Commercial |
$845.84
|
| Rate for Payer: Healthscope Whirlpool |
$820.46
|
| Rate for Payer: Mclaren Commercial |
$761.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$718.96
|
| Rate for Payer: Nomi Health Commercial |
$693.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$549.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$744.34
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$143.22
|
|
|
Service Code
|
NDC 60758011905
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.29 |
| Max. Negotiated Rate |
$143.22 |
| Rate for Payer: Aetna Commercial |
$128.90
|
| Rate for Payer: Aetna Medicare |
$71.61
|
| Rate for Payer: ASR ASR |
$138.92
|
| Rate for Payer: ASR Commercial |
$138.92
|
| Rate for Payer: BCBS Complete |
$57.29
|
| Rate for Payer: BCBS Trust/PPO |
$117.28
|
| Rate for Payer: BCN Commercial |
$111.04
|
| Rate for Payer: Cash Price |
$114.58
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.58
|
| Rate for Payer: Healthscope Commercial |
$143.22
|
| Rate for Payer: Healthscope Whirlpool |
$138.92
|
| Rate for Payer: Mclaren Commercial |
$128.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.74
|
| Rate for Payer: Nomi Health Commercial |
$117.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.49
|
| Rate for Payer: Priority Health Narrow Network |
$100.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.03
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$173.25
|
|
|
Service Code
|
NDC 61314063710
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna Commercial |
$155.92
|
| Rate for Payer: Aetna Medicare |
$86.62
|
| Rate for Payer: ASR ASR |
$168.05
|
| Rate for Payer: ASR Commercial |
$168.05
|
| Rate for Payer: BCBS Complete |
$69.30
|
| Rate for Payer: BCBS Trust/PPO |
$141.87
|
| Rate for Payer: BCN Commercial |
$134.32
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$162.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.60
|
| Rate for Payer: Healthscope Commercial |
$173.25
|
| Rate for Payer: Healthscope Whirlpool |
$168.05
|
| Rate for Payer: Mclaren Commercial |
$155.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.26
|
| Rate for Payer: Nomi Health Commercial |
$142.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.80
|
| Rate for Payer: Priority Health Narrow Network |
$121.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.46
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$173.25
|
|
|
Service Code
|
NDC 61314063710
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.61 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna Commercial |
$155.92
|
| Rate for Payer: ASR ASR |
$168.05
|
| Rate for Payer: ASR Commercial |
$168.05
|
| Rate for Payer: BCBS Trust/PPO |
$141.18
|
| Rate for Payer: BCN Commercial |
$134.32
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$162.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.60
|
| Rate for Payer: Healthscope Commercial |
$173.25
|
| Rate for Payer: Healthscope Whirlpool |
$168.05
|
| Rate for Payer: Mclaren Commercial |
$155.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.26
|
| Rate for Payer: Nomi Health Commercial |
$142.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.46
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$143.22
|
|
|
Service Code
|
NDC 60758011905
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.09 |
| Max. Negotiated Rate |
$143.22 |
| Rate for Payer: Aetna Commercial |
$128.90
|
| Rate for Payer: ASR ASR |
$138.92
|
| Rate for Payer: ASR Commercial |
$138.92
|
| Rate for Payer: BCBS Trust/PPO |
$116.71
|
| Rate for Payer: BCN Commercial |
$111.04
|
| Rate for Payer: Cash Price |
$114.58
|
| Rate for Payer: Cofinity Commercial |
$134.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.58
|
| Rate for Payer: Healthscope Commercial |
$143.22
|
| Rate for Payer: Healthscope Whirlpool |
$138.92
|
| Rate for Payer: Mclaren Commercial |
$128.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.74
|
| Rate for Payer: Nomi Health Commercial |
$117.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.03
|
|
