|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.89
|
| Rate for Payer: ASR ASR |
$2.04
|
| Rate for Payer: BCBS Trust/PPO |
$1.72
|
| Rate for Payer: BCN Commercial |
$1.72
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cofinity Commercial |
$1.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.68
|
| Rate for Payer: Healthscope Commercial |
$2.04
|
| Rate for Payer: Healthscope Whirlpool |
$2.10
|
| Rate for Payer: Mclaren Commercial |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.85
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.04 |
| Max. Negotiated Rate |
$251.45 |
| Rate for Payer: Aetna Commercial |
$226.31
|
| Rate for Payer: Aetna Medicare |
$93.04
|
| Rate for Payer: ASR ASR |
$243.91
|
| Rate for Payer: BCBS Complete |
$100.58
|
| Rate for Payer: BCBS Trust/PPO |
$207.32
|
| Rate for Payer: BCN Commercial |
$207.32
|
| 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 |
$243.91
|
| Rate for Payer: Healthscope Whirlpool |
$251.45
|
| Rate for Payer: Mclaren Commercial |
$226.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$220.32
|
| Rate for Payer: Priority Health Narrow Network |
$176.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.28
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.59 |
| Max. Negotiated Rate |
$251.45 |
| Rate for Payer: Aetna Commercial |
$226.31
|
| Rate for Payer: ASR ASR |
$243.91
|
| Rate for Payer: BCBS Trust/PPO |
$206.49
|
| Rate for Payer: BCN Commercial |
$206.49
|
| 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 |
$243.91
|
| Rate for Payer: Healthscope Whirlpool |
$251.45
|
| Rate for Payer: Mclaren Commercial |
$226.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.28
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$343.10
|
|
|
Service Code
|
NDC 904730461
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.32 |
| Max. Negotiated Rate |
$343.10 |
| Rate for Payer: Aetna Commercial |
$308.79
|
| Rate for Payer: ASR ASR |
$332.81
|
| Rate for Payer: BCBS Trust/PPO |
$281.75
|
| Rate for Payer: BCN Commercial |
$281.75
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$322.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$332.81
|
| Rate for Payer: Healthscope Whirlpool |
$343.10
|
| Rate for Payer: Mclaren Commercial |
$308.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Nomi Health Commercial |
$281.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.93
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.89
|
| Rate for Payer: Aetna Medicare |
$0.78
|
| Rate for Payer: ASR ASR |
$2.04
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.73
|
| Rate for Payer: BCN Commercial |
$1.73
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cofinity Commercial |
$1.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.68
|
| Rate for Payer: Healthscope Commercial |
$2.04
|
| Rate for Payer: Healthscope Whirlpool |
$2.10
|
| Rate for Payer: Mclaren Commercial |
$1.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.84
|
| Rate for Payer: Priority Health Narrow Network |
$1.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.85
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$343.10
|
|
|
Service Code
|
NDC 904730461
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.95 |
| Max. Negotiated Rate |
$343.10 |
| Rate for Payer: Aetna Commercial |
$308.79
|
| Rate for Payer: Aetna Medicare |
$126.95
|
| Rate for Payer: ASR ASR |
$332.81
|
| Rate for Payer: BCBS Complete |
$137.24
|
| Rate for Payer: BCBS Trust/PPO |
$282.89
|
| Rate for Payer: BCN Commercial |
$282.89
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$322.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$332.81
|
| Rate for Payer: Healthscope Whirlpool |
$343.10
|
| Rate for Payer: Mclaren Commercial |
$308.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Nomi Health Commercial |
$281.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$300.62
|
| Rate for Payer: Priority Health Narrow Network |
$240.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.93
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
NDC 9900000413
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: Aetna Medicare |
$0.58
|
| Rate for Payer: ASR ASR |
$1.53
|
| Rate for Payer: BCBS Complete |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$1.30
|
| Rate for Payer: BCN Commercial |
$1.30
|
| 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 |
$1.53
|
| Rate for Payer: Healthscope Whirlpool |
$1.57
|
| Rate for Payer: Mclaren Commercial |
$1.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.34
|
| Rate for Payer: Nomi Health Commercial |
$1.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.38
|
| Rate for Payer: Priority Health Narrow Network |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.39
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
NDC 9900000413
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna Commercial |
$1.42
|
| Rate for Payer: ASR ASR |
$1.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.29
|
| Rate for Payer: BCN Commercial |
$1.29
|
| 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 |
$1.53
|
| Rate for Payer: Healthscope Whirlpool |
$1.57
|
| Rate for Payer: Mclaren Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.34
|
| Rate for Payer: Nomi Health Commercial |
$1.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.39
|
|
|
PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$2,191.00
|
|
|
Service Code
|
HCPCS 49255
|
| Min. Negotiated Rate |
$479.46 |
| Max. Negotiated Rate |
$1,643.25 |
| Rate for Payer: Aetna Commercial |
$995.18
|
| Rate for Payer: Aetna Medicare |
$742.67
|
| Rate for Payer: BCBS Complete |
$503.43
|
| Rate for Payer: BCBS MAPPO |
$742.67
|
| Rate for Payer: BCN Commercial |
$1,197.15
|
| Rate for Payer: BCN Medicare Advantage |
$742.67
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cofinity Commercial |
$995.18
|
| Rate for Payer: Cofinity Commercial |
$1,069.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$742.67
|
| Rate for Payer: Healthscope Commercial |
$891.20
|
| Rate for Payer: Healthscope Whirlpool |
$891.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$779.80
|
| Rate for Payer: Meridian Medicaid |
$503.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$816.94
|
| Rate for Payer: Nomi Health Commercial |
$891.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,643.25
|
| Rate for Payer: PACE SWMI |
$742.67
|
| Rate for Payer: PHP Medicare Advantage |
$742.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,458.65
|
| Rate for Payer: Priority Health Medicare |
$742.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,458.65
|
| Rate for Payer: Railroad Medicare Medicare |
$742.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,394.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$742.67
|
| Rate for Payer: UHC Exchange |
$1,394.14
|
| Rate for Payer: UHC Medicaid |
$479.46
|
| Rate for Payer: UHCCP DNSP |
$742.67
|
| Rate for Payer: UHCCP Medicaid |
$479.46
|
|
|
PR ONDANSETRON HCL INJECTION
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J2405
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$0.11
|
| Rate for Payer: Healthscope Whirlpool |
$0.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.10
|
| Rate for Payer: Nomi Health Commercial |
$0.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.09
|
| Rate for Payer: UHCCP DNSP |
$0.09
|
|
|
PR ONE AREA LIPOSUCTION - 1 AREA 1.0 HR
|
Professional
|
Both
|
$1,803.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$721.20 |
| Max. Negotiated Rate |
$1,352.25 |
| Rate for Payer: BCBS Complete |
$721.20
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,352.25
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99422
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$29.71
|
| Rate for Payer: Aetna Medicare |
$22.17
|
| Rate for Payer: BCBS Complete |
$20.67
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCN Commercial |
$49.00
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$29.71
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$24.39
|
| Rate for Payer: Healthscope Whirlpool |
$24.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.28
|
| Rate for Payer: Meridian Medicaid |
$20.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.39
|
| Rate for Payer: Nomi Health Commercial |
$26.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.81
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health Narrow Network |
$28.81
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.17
|
| Rate for Payer: UHC Exchange |
$38.03
|
| Rate for Payer: UHC Medicaid |
$19.69
|
| Rate for Payer: UHCCP DNSP |
$22.17
|
| Rate for Payer: UHCCP Medicaid |
$19.69
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$60.56 |
| Rate for Payer: Aetna Commercial |
$46.51
|
| Rate for Payer: Aetna Medicare |
$34.71
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS MAPPO |
$34.71
|
| Rate for Payer: BCN Commercial |
$50.49
|
| Rate for Payer: BCN Medicare Advantage |
$34.71
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$46.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.71
|
| Rate for Payer: Healthscope Commercial |
$38.18
|
| Rate for Payer: Healthscope Whirlpool |
$38.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.45
|
| Rate for Payer: Meridian Medicaid |
$32.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.18
|
| Rate for Payer: Nomi Health Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$34.71
|
| Rate for Payer: PHP Medicare Advantage |
$34.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$44.73
|
| Rate for Payer: Priority Health Medicare |
$34.71
|
| Rate for Payer: Priority Health Narrow Network |
$44.73
|
| Rate for Payer: Railroad Medicare Medicare |
$34.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.71
|
| Rate for Payer: UHC Exchange |
$60.56
|
| Rate for Payer: UHC Medicaid |
$30.86
|
| Rate for Payer: UHCCP DNSP |
$34.71
|
| Rate for Payer: UHCCP Medicaid |
$30.86
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: Aetna Medicare |
$10.93
|
| Rate for Payer: BCBS Complete |
$10.19
|
| Rate for Payer: BCBS MAPPO |
$10.93
|
| Rate for Payer: BCN Commercial |
$22.41
|
| Rate for Payer: BCN Medicare Advantage |
$10.93
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$12.02
|
| Rate for Payer: Healthscope Whirlpool |
$12.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.48
|
| Rate for Payer: Meridian Medicaid |
$10.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.02
|
| Rate for Payer: Nomi Health Commercial |
$13.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$10.93
|
| Rate for Payer: PHP Medicare Advantage |
$10.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.41
|
| Rate for Payer: Priority Health Medicare |
$10.93
|
| Rate for Payer: Priority Health Narrow Network |
$14.41
|
| Rate for Payer: Railroad Medicare Medicare |
$10.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.93
|
| Rate for Payer: UHC Exchange |
$18.53
|
| Rate for Payer: UHC Medicaid |
$9.70
|
| Rate for Payer: UHCCP DNSP |
$10.93
|
| Rate for Payer: UHCCP Medicaid |
$9.70
|
|
|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,904.00
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$328.66 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna Commercial |
$677.85
|
| Rate for Payer: Aetna Medicare |
$505.86
|
| Rate for Payer: BCBS Complete |
$345.09
|
| Rate for Payer: BCBS MAPPO |
$505.86
|
| Rate for Payer: BCN Commercial |
$836.61
|
| Rate for Payer: BCN Medicare Advantage |
$505.86
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cofinity Commercial |
$728.44
|
| Rate for Payer: Cofinity Commercial |
$677.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.86
|
| Rate for Payer: Healthscope Commercial |
$607.03
|
| Rate for Payer: Healthscope Whirlpool |
$607.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.15
|
| Rate for Payer: Meridian Medicaid |
$345.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$556.45
|
| Rate for Payer: Nomi Health Commercial |
$607.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,178.00
|
| Rate for Payer: PACE SWMI |
$505.86
|
| Rate for Payer: PHP Medicare Advantage |
$505.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$847.30
|
| Rate for Payer: Priority Health Medicare |
$505.86
|
| Rate for Payer: Priority Health Narrow Network |
$847.30
|
| Rate for Payer: Railroad Medicare Medicare |
$505.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$950.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$505.86
|
| Rate for Payer: UHC Exchange |
$950.86
|
| Rate for Payer: UHC Medicaid |
$328.66
|
| Rate for Payer: UHCCP DNSP |
$505.86
|
| Rate for Payer: UHCCP Medicaid |
$328.66
|
|
|
PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 58943
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$2,055.74 |
| Rate for Payer: Aetna Commercial |
$1,498.63
|
| Rate for Payer: Aetna Medicare |
$1,118.38
|
| Rate for Payer: BCBS Complete |
$756.39
|
| Rate for Payer: BCBS MAPPO |
$1,118.38
|
| Rate for Payer: BCN Commercial |
$1,805.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cofinity Commercial |
$1,610.47
|
| Rate for Payer: Cofinity Commercial |
$1,498.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,118.38
|
| Rate for Payer: Healthscope Commercial |
$1,342.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,342.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,174.30
|
| Rate for Payer: Meridian Medicaid |
$756.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,230.22
|
| Rate for Payer: Nomi Health Commercial |
$1,342.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,781.25
|
| Rate for Payer: PACE SWMI |
$1,118.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,118.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,828.76
|
| Rate for Payer: Priority Health Medicare |
$1,118.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,828.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,118.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,055.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,118.38
|
| Rate for Payer: UHC Exchange |
$2,055.74
|
| Rate for Payer: UHC Medicaid |
$720.37
|
| Rate for Payer: UHCCP DNSP |
$1,118.38
|
| Rate for Payer: UHCCP Medicaid |
$720.37
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$114.19
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.64 |
| Max. Negotiated Rate |
$114.19 |
| Rate for Payer: Aetna Commercial |
$102.77
|
| Rate for Payer: ASR ASR |
$110.76
|
| Rate for Payer: BCBS Trust/PPO |
$93.77
|
| Rate for Payer: BCN Commercial |
$93.77
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cofinity Commercial |
$107.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.35
|
| Rate for Payer: Healthscope Commercial |
$110.76
|
| Rate for Payer: Healthscope Whirlpool |
$114.19
|
| Rate for Payer: Mclaren Commercial |
$102.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.06
|
| Rate for Payer: Nomi Health Commercial |
$93.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.49
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.29 |
| Max. Negotiated Rate |
$113.72 |
| Rate for Payer: Aetna Commercial |
$102.34
|
| Rate for Payer: ASR ASR |
$110.30
|
| Rate for Payer: BCBS Trust/PPO |
$93.38
|
| Rate for Payer: BCN Commercial |
$93.38
|
| Rate for Payer: Cash Price |
$90.97
|
| Rate for Payer: Cofinity Commercial |
$106.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.97
|
| Rate for Payer: Healthscope Commercial |
$110.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.72
|
| Rate for Payer: Mclaren Commercial |
$102.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Nomi Health Commercial |
$93.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.07
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$99.54
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.83 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: Aetna Medicare |
$36.83
|
| Rate for Payer: ASR ASR |
$96.55
|
| Rate for Payer: BCBS Complete |
$39.82
|
| Rate for Payer: BCBS Trust/PPO |
$82.07
|
| Rate for Payer: BCN Commercial |
$82.07
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Cofinity Commercial |
$93.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.63
|
| Rate for Payer: Healthscope Commercial |
$96.55
|
| Rate for Payer: Healthscope Whirlpool |
$99.54
|
| Rate for Payer: Mclaren Commercial |
$89.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.61
|
| Rate for Payer: Nomi Health Commercial |
$81.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$87.22
|
| Rate for Payer: Priority Health Narrow Network |
$69.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.60
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$131.09
|
|
|
Service Code
|
NDC 998001615
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$131.09 |
| Rate for Payer: Aetna Commercial |
$117.98
|
| Rate for Payer: ASR ASR |
$127.16
|
| Rate for Payer: BCBS Trust/PPO |
$107.65
|
| Rate for Payer: BCN Commercial |
$107.65
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$123.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$127.16
|
| Rate for Payer: Healthscope Whirlpool |
$131.09
|
| Rate for Payer: Mclaren Commercial |
$117.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.36
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$131.09
|
|
|
Service Code
|
NDC 998001615
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$131.09 |
| Rate for Payer: Aetna Commercial |
$117.98
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: ASR ASR |
$127.16
|
| Rate for Payer: BCBS Complete |
$52.44
|
| Rate for Payer: BCBS Trust/PPO |
$108.09
|
| Rate for Payer: BCN Commercial |
$108.09
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$123.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$127.16
|
| Rate for Payer: Healthscope Whirlpool |
$131.09
|
| Rate for Payer: Mclaren Commercial |
$117.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$114.86
|
| Rate for Payer: Priority Health Narrow Network |
$91.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.36
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$99.54
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.66 |
| Max. Negotiated Rate |
$99.54 |
| Rate for Payer: Aetna Commercial |
$89.59
|
| Rate for Payer: ASR ASR |
$96.55
|
| Rate for Payer: BCBS Trust/PPO |
$81.74
|
| Rate for Payer: BCN Commercial |
$81.74
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Cofinity Commercial |
$93.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.63
|
| Rate for Payer: Healthscope Commercial |
$96.55
|
| Rate for Payer: Healthscope Whirlpool |
$99.54
|
| Rate for Payer: Mclaren Commercial |
$89.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.61
|
| Rate for Payer: Nomi Health Commercial |
$81.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.60
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$114.19
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.25 |
| Max. Negotiated Rate |
$114.19 |
| Rate for Payer: Aetna Commercial |
$102.77
|
| Rate for Payer: Aetna Medicare |
$42.25
|
| Rate for Payer: ASR ASR |
$110.76
|
| Rate for Payer: BCBS Complete |
$45.68
|
| Rate for Payer: BCBS Trust/PPO |
$94.15
|
| Rate for Payer: BCN Commercial |
$94.15
|
| Rate for Payer: Cash Price |
$91.35
|
| Rate for Payer: Cofinity Commercial |
$107.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.35
|
| Rate for Payer: Healthscope Commercial |
$110.76
|
| Rate for Payer: Healthscope Whirlpool |
$114.19
|
| Rate for Payer: Mclaren Commercial |
$102.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.06
|
| Rate for Payer: Nomi Health Commercial |
$93.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$100.05
|
| Rate for Payer: Priority Health Narrow Network |
$80.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.49
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.07 |
| Max. Negotiated Rate |
$113.72 |
| Rate for Payer: Aetna Commercial |
$102.34
|
| Rate for Payer: Aetna Medicare |
$42.07
|
| Rate for Payer: ASR ASR |
$110.30
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: BCBS Trust/PPO |
$93.76
|
| Rate for Payer: BCN Commercial |
$93.76
|
| Rate for Payer: Cash Price |
$90.97
|
| Rate for Payer: Cofinity Commercial |
$106.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.97
|
| Rate for Payer: Healthscope Commercial |
$110.30
|
| Rate for Payer: Healthscope Whirlpool |
$113.72
|
| Rate for Payer: Mclaren Commercial |
$102.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Nomi Health Commercial |
$93.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$99.64
|
| Rate for Payer: Priority Health Narrow Network |
$79.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.07
|
|
|
PR OPEN ABLATION 1/>RENAL MASS LESION CRYOSURGICAL
|
Professional
|
Both
|
$2,603.00
|
|
|
Service Code
|
HCPCS 50250
|
| Min. Negotiated Rate |
$693.95 |
| Max. Negotiated Rate |
$2,151.20 |
| Rate for Payer: Aetna Commercial |
$1,442.55
|
| Rate for Payer: Aetna Medicare |
$1,076.53
|
| Rate for Payer: BCBS Complete |
$728.65
|
| Rate for Payer: BCBS MAPPO |
$1,076.53
|
| Rate for Payer: BCN Commercial |
$1,812.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,076.53
|
| Rate for Payer: Cash Price |
$2,082.40
|
| Rate for Payer: Cash Price |
$2,082.40
|
| Rate for Payer: Cofinity Commercial |
$1,550.20
|
| Rate for Payer: Cofinity Commercial |
$1,442.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,076.53
|
| Rate for Payer: Healthscope Commercial |
$1,291.84
|
| Rate for Payer: Healthscope Whirlpool |
$1,291.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,130.36
|
| Rate for Payer: Meridian Medicaid |
$728.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,184.18
|
| Rate for Payer: Nomi Health Commercial |
$1,291.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,952.25
|
| Rate for Payer: PACE SWMI |
$1,076.53
|
| Rate for Payer: PHP Medicare Advantage |
$1,076.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$693.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,974.03
|
| Rate for Payer: Priority Health Medicare |
$1,076.53
|
| Rate for Payer: Priority Health Narrow Network |
$1,974.03
|
| Rate for Payer: Railroad Medicare Medicare |
$1,076.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,151.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,076.53
|
| Rate for Payer: UHC Exchange |
$2,151.20
|
| Rate for Payer: UHC Medicaid |
$693.95
|
| Rate for Payer: UHCCP DNSP |
$1,076.53
|
| Rate for Payer: UHCCP Medicaid |
$693.95
|
|
