|
PR IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90685
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$27.34 |
| Rate for Payer: Aetna Commercial |
$19.36
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$22.05
|
| Rate for Payer: BCN Commercial |
$22.05
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.34
|
| Rate for Payer: UHC Exchange |
$27.34
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90687
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$10.44
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$10.78
|
| Rate for Payer: BCN Commercial |
$10.78
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.53
|
| Rate for Payer: UHC Exchange |
$12.53
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 90688
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$25.06 |
| Rate for Payer: Aetna Commercial |
$20.88
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$21.56
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.06
|
| Rate for Payer: UHC Exchange |
$25.06
|
|
|
PR IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 90653
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$100.19 |
| Rate for Payer: Aetna Commercial |
$54.02
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$60.56
|
| Rate for Payer: BCN Commercial |
$60.56
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.19
|
| Rate for Payer: UHC Exchange |
$100.19
|
|
|
PR IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 90662
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$100.19 |
| Rate for Payer: Aetna Commercial |
$73.40
|
| Rate for Payer: Aetna Medicare |
$55.50
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS Trust/PPO |
$73.62
|
| Rate for Payer: BCN Commercial |
$73.62
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.19
|
| Rate for Payer: UHC Exchange |
$100.19
|
|
|
PR ILEOSCOPY STOMA W/BALLOON DILATION
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 44381
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$1,457.24 |
| Rate for Payer: Aetna Commercial |
$110.61
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS Trust/PPO |
$282.11
|
| Rate for Payer: BCN Commercial |
$1,457.24
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.33
|
| Rate for Payer: Priority Health Narrow Network |
$150.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.94
|
| Rate for Payer: UHC Exchange |
$120.94
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
|
|
PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
HCPCS 44382
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$609.05 |
| Rate for Payer: Aetna Commercial |
$97.19
|
| Rate for Payer: Aetna Medicare |
$468.50
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$440.79
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.25
|
| Rate for Payer: Priority Health Narrow Network |
$131.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.26
|
| Rate for Payer: UHC Exchange |
$103.26
|
| Rate for Payer: UHCCP Medicaid |
$47.07
|
|
|
PR ILEOSCOPY STOMA W/PLMT OF ENDOSCOPIC STENT
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 44384
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$402.56 |
| Rate for Payer: Aetna Commercial |
$205.72
|
| Rate for Payer: Aetna Medicare |
$120.00
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS Trust/PPO |
$402.56
|
| Rate for Payer: BCN Commercial |
$222.35
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.46
|
| Rate for Payer: Priority Health Narrow Network |
$268.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.21
|
| Rate for Payer: UHC Exchange |
$216.21
|
| Rate for Payer: UHCCP Medicaid |
$96.70
|
|
|
PR ILEOSCOPY THRU STOMA DX W/COLLJ SPEC WHEN PRFMD
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 44380
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$544.70 |
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Medicare |
$419.00
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS Trust/PPO |
$247.77
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.01
|
| Rate for Payer: Priority Health Narrow Network |
$102.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.31
|
| Rate for Payer: UHC Exchange |
$85.31
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
|
|
PR ILEOSCOPY,THRU STOMA,TRANSENDO STENT
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 44383
|
| Min. Negotiated Rate |
$434.80 |
| Max. Negotiated Rate |
$706.55 |
| Rate for Payer: Aetna Medicare |
$543.50
|
| Rate for Payer: BCBS Complete |
$434.80
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.55
|
|
|
PR ILEOSTOMY/JEJUNOSTOMY NON-TUBE
|
Professional
|
Both
|
$2,554.00
|
|
|
Service Code
|
HCPCS 44310
|
| Min. Negotiated Rate |
$81.93 |
| Max. Negotiated Rate |
$1,855.41 |
| Rate for Payer: Aetna Commercial |
$1,396.74
|
| Rate for Payer: Aetna Medicare |
$1,277.00
|
| Rate for Payer: BCBS Complete |
$699.13
|
| Rate for Payer: BCBS Trust/PPO |
$81.93
|
| Rate for Payer: BCN Commercial |
$1,512.46
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Cash Price |
$2,043.20
|
| Rate for Payer: Meridian Medicaid |
$699.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$665.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,660.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,855.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,855.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,261.65
|
| Rate for Payer: UHC Exchange |
$1,261.65
|
| Rate for Payer: UHCCP Medicaid |
$665.84
|
|
|
PR ILIAC ART ANGIO,CARDIAC CATH
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS G0278
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$17.94
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$152.15
|
| Rate for Payer: BCN Commercial |
$19.55
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.54
|
| Rate for Payer: Priority Health Narrow Network |
$20.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.26
|
| Rate for Payer: UHC Exchange |
$15.26
|
|
|
PR IM ADM INTRANSL/ORAL 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90473
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$611.77 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$611.77
|
| Rate for Payer: BCN Commercial |
$19.24
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Narrow Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.44
|
| Rate for Payer: UHC Exchange |
$8.44
|
|
|
PR IM ADM INTRANSL/ORAL EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90474
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$652.45 |
| Rate for Payer: Aetna Commercial |
$5.00
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$652.45
|
| Rate for Payer: BCN Commercial |
$13.75
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.28
|
| Rate for Payer: Priority Health Narrow Network |
$16.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.70
|
| Rate for Payer: UHC Exchange |
$7.70
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90471
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$593.28 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$593.28
|
| Rate for Payer: BCN Commercial |
$26.78
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Narrow Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.21
|
| Rate for Payer: UHC Exchange |
$21.21
|
|
|
PR IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90472
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$1,006.41 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.41
|
| Rate for Payer: BCN Commercial |
$16.88
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.91
|
| Rate for Payer: Priority Health Narrow Network |
$19.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.06
|
| Rate for Payer: UHC Exchange |
$8.06
|
|
|
PR IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 90460
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$519.85 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$519.85
|
| Rate for Payer: BCN Commercial |
$25.68
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.75
|
| Rate for Payer: Priority Health Narrow Network |
$26.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.40
|
| Rate for Payer: UHC Exchange |
$24.40
|
|
|
PR IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 90461
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$544.68 |
| Rate for Payer: Aetna Commercial |
$7.00
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$544.68
|
| Rate for Payer: BCN Commercial |
$13.65
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.75
|
| Rate for Payer: Priority Health Narrow Network |
$11.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.32
|
| Rate for Payer: UHC Exchange |
$12.32
|
|
|
PR IMBRICATION DIAPHRAGM EVENTRATION
|
Professional
|
Both
|
$5,419.00
|
|
|
Service Code
|
HCPCS 39545
|
| Min. Negotiated Rate |
$571.91 |
| Max. Negotiated Rate |
$3,522.35 |
| Rate for Payer: Aetna Commercial |
$914.62
|
| Rate for Payer: Aetna Medicare |
$2,709.50
|
| Rate for Payer: BCBS Complete |
$600.51
|
| Rate for Payer: BCBS Trust/PPO |
$671.47
|
| Rate for Payer: BCN Commercial |
$1,295.97
|
| Rate for Payer: Cash Price |
$4,335.20
|
| Rate for Payer: Cash Price |
$4,335.20
|
| Rate for Payer: Meridian Medicaid |
$600.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,522.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,418.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,418.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,042.87
|
| Rate for Payer: UHC Exchange |
$1,042.87
|
| Rate for Payer: UHCCP Medicaid |
$571.91
|
|
|
PR IMG-GUIDED FLU COLLJ DRG CATH SOFT TISS PERQ
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
HCPCS 10030
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$2,625.00 |
| Rate for Payer: Aetna Commercial |
$148.19
|
| Rate for Payer: Aetna Medicare |
$377.00
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$2,625.00
|
| Rate for Payer: BCN Commercial |
$952.93
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.25
|
| Rate for Payer: Priority Health Narrow Network |
$179.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.59
|
| Rate for Payer: UHC Exchange |
$179.59
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 49406
|
| Min. Negotiated Rate |
$121.62 |
| Max. Negotiated Rate |
$2,515.24 |
| Rate for Payer: Aetna Commercial |
$260.75
|
| Rate for Payer: Aetna Medicare |
$204.00
|
| Rate for Payer: BCBS Complete |
$127.70
|
| Rate for Payer: BCBS Trust/PPO |
$2,515.24
|
| Rate for Payer: BCN Commercial |
$1,311.61
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Meridian Medicaid |
$127.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.27
|
| Rate for Payer: Priority Health Narrow Network |
$338.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$282.64
|
| Rate for Payer: UHC Exchange |
$282.64
|
| Rate for Payer: UHCCP Medicaid |
$121.62
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$4.45
|
|
|
Service Code
|
NDC 50268068711
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna Medicare |
$2.22
|
| Rate for Payer: ASR ASR |
$4.32
|
| Rate for Payer: ASR Commercial |
$4.32
|
| Rate for Payer: BCBS Complete |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.64
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$4.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Healthscope Commercial |
$4.45
|
| Rate for Payer: Healthscope Whirlpool |
$4.32
|
| Rate for Payer: Mclaren Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Nomi Health Commercial |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.90
|
| Rate for Payer: Priority Health Narrow Network |
$3.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.92
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 50268068715
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.50 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$200.07
|
| Rate for Payer: ASR ASR |
$215.63
|
| Rate for Payer: ASR Commercial |
$215.63
|
| Rate for Payer: BCBS Trust/PPO |
$181.15
|
| Rate for Payer: BCN Commercial |
$172.35
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$208.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Healthscope Whirlpool |
$215.63
|
| Rate for Payer: Mclaren Commercial |
$200.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Nomi Health Commercial |
$182.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.62
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 50268068715
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$200.07
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: ASR ASR |
$215.63
|
| Rate for Payer: ASR Commercial |
$215.63
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: BCBS Trust/PPO |
$182.04
|
| Rate for Payer: BCN Commercial |
$172.35
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Commercial |
$208.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$222.30
|
| Rate for Payer: Healthscope Whirlpool |
$215.63
|
| Rate for Payer: Mclaren Commercial |
$200.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Nomi Health Commercial |
$182.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.78
|
| Rate for Payer: Priority Health Narrow Network |
$155.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$195.62
|
|
|
PRIMIDONE 250 MG TABLET
|
Facility
|
IP
|
$4.45
|
|
|
Service Code
|
NDC 50268068711
|
| Hospital Charge Code |
6544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: ASR ASR |
$4.32
|
| Rate for Payer: ASR Commercial |
$4.32
|
| Rate for Payer: BCBS Trust/PPO |
$3.63
|
| Rate for Payer: BCN Commercial |
$3.45
|
| Rate for Payer: Cash Price |
$3.56
|
| Rate for Payer: Cofinity Commercial |
$4.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.56
|
| Rate for Payer: Healthscope Commercial |
$4.45
|
| Rate for Payer: Healthscope Whirlpool |
$4.32
|
| Rate for Payer: Mclaren Commercial |
$4.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.78
|
| Rate for Payer: Nomi Health Commercial |
$3.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.92
|
|
