|
PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 99244
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$1,873.94 |
| Rate for Payer: Aetna Commercial |
$159.16
|
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$722.19
|
| Rate for Payer: BCN Commercial |
$235.54
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,873.94
|
| Rate for Payer: Priority Health Narrow Network |
$1,873.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$174.00
|
| Rate for Payer: UHC Exchange |
$174.00
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 99242
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$158.49 |
| Rate for Payer: Aetna Commercial |
$70.73
|
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS Trust/PPO |
$158.49
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.49
|
| Rate for Payer: Priority Health Narrow Network |
$74.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.64
|
| Rate for Payer: UHC Exchange |
$78.64
|
| Rate for Payer: UHCCP Medicaid |
$35.15
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 99215
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$1,816.82 |
| Rate for Payer: Aetna Commercial |
$145.41
|
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: BCBS Complete |
$95.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.82
|
| Rate for Payer: BCN Commercial |
$154.50
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Meridian Medicaid |
$95.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.44
|
| Rate for Payer: Priority Health Narrow Network |
$160.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$117.29
|
| Rate for Payer: UHC Exchange |
$117.29
|
| Rate for Payer: UHCCP Medicaid |
$91.38
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99213
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$1,305.96 |
| Rate for Payer: Aetna Commercial |
$66.92
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.96
|
| Rate for Payer: BCN Commercial |
$79.38
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.30
|
| Rate for Payer: Priority Health Narrow Network |
$73.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.02
|
| Rate for Payer: UHC Exchange |
$54.02
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99214
|
| Min. Negotiated Rate |
$61.77 |
| Max. Negotiated Rate |
$1,340.83 |
| Rate for Payer: Aetna Commercial |
$98.82
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,340.83
|
| Rate for Payer: BCN Commercial |
$115.12
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Meridian Medicaid |
$64.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.08
|
| Rate for Payer: Priority Health Narrow Network |
$108.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.04
|
| Rate for Payer: UHC Exchange |
$83.04
|
| Rate for Payer: UHCCP Medicaid |
$61.77
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 99212
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$2,731.31 |
| Rate for Payer: Aetna Commercial |
$35.71
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: BCBS Complete |
$23.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,731.31
|
| Rate for Payer: BCN Commercial |
$50.51
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Meridian Medicaid |
$23.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.27
|
| Rate for Payer: Priority Health Narrow Network |
$39.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$27.42
|
| Rate for Payer: UHC Exchange |
$27.42
|
| Rate for Payer: UHCCP Medicaid |
$22.37
|
|
|
PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 99211
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$2,495.16 |
| Rate for Payer: Aetna Commercial |
$8.94
|
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$2,495.16
|
| Rate for Payer: BCN Commercial |
$23.28
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.72
|
| Rate for Payer: Priority Health Narrow Network |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.08
|
| Rate for Payer: UHC Exchange |
$10.08
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
|
|
PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 99205
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$2,028.67 |
| Rate for Payer: Aetna Commercial |
$183.49
|
| Rate for Payer: Aetna Medicare |
$158.00
|
| Rate for Payer: BCBS Complete |
$121.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,028.67
|
| Rate for Payer: BCN Commercial |
$209.60
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Meridian Medicaid |
$121.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$201.95
|
| Rate for Payer: Priority Health Narrow Network |
$201.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.94
|
| Rate for Payer: UHC Exchange |
$177.94
|
| Rate for Payer: UHCCP Medicaid |
$115.66
|
|
|
PR OFFICE OUTPATIENT NEW LEVL I
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 99201
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
|
|
PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99203
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$931.39 |
| Rate for Payer: Aetna Commercial |
$83.07
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$108.55
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.26
|
| Rate for Payer: Priority Health Narrow Network |
$91.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.50
|
| Rate for Payer: UHC Exchange |
$81.50
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
|
|
PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 99204
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$1,704.30 |
| Rate for Payer: Aetna Commercial |
$135.20
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.30
|
| Rate for Payer: BCN Commercial |
$165.88
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.47
|
| Rate for Payer: Priority Health Narrow Network |
$148.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.03
|
| Rate for Payer: UHC Exchange |
$138.03
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99202
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$706.34 |
| Rate for Payer: Aetna Commercial |
$49.04
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCBS Trust/PPO |
$706.34
|
| Rate for Payer: BCN Commercial |
$76.66
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.74
|
| Rate for Payer: Priority Health Narrow Network |
$52.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$53.57
|
| Rate for Payer: UHC Exchange |
$53.57
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
|
|
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 |
$0.87 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: ASR ASR |
$1.30
|
| Rate for Payer: ASR Commercial |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.09
|
| 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 Commercial |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.18
|
|
|
PROLASTIN/ARALAST (ALPHA-1 PROTEINASE INHIBITOR) 1,000 MG IV SOLUTION
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
36577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: Aetna Medicare |
$5.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.36
|
| Rate for Payer: ASR ASR |
$1.30
|
| Rate for Payer: ASR Commercial |
$1.30
|
| Rate for Payer: BCBS Complete |
$2.86
|
| Rate for Payer: BCBS MAPPO |
$5.09
|
| Rate for Payer: BCBS Trust/PPO |
$1.10
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.09
|
| Rate for Payer: Cash Price |
$1.08
|
| 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: Health Alliance Plan Medicare Advantage |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Healthscope Whirlpool |
$1.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.09
|
| Rate for Payer: Mclaren Commercial |
$1.21
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Mclaren Medicare |
$5.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.34
|
| Rate for Payer: Meridian Medicaid |
$2.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.10
|
| Rate for Payer: PACE Medicare |
$4.84
|
| Rate for Payer: PACE SWMI |
$5.09
|
| Rate for Payer: PHP Commercial |
$5.60
|
| Rate for Payer: PHP Medicaid |
$2.73
|
| Rate for Payer: PHP Medicare Advantage |
$5.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.35
|
| Rate for Payer: Priority Health Medicare |
$5.09
|
| Rate for Payer: Priority Health Narrow Network |
$4.28
|
| Rate for Payer: Railroad Medicare Medicare |
$5.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.09
|
| Rate for Payer: UHC Exchange |
$7.89
|
| Rate for Payer: UHC Medicare Advantage |
$5.09
|
| Rate for Payer: UHCCP DNSP |
$5.09
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$5.09
|
|
|
PR OMALIZUMAB INJECTION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J2357
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$40.64 |
| Rate for Payer: Aetna Commercial |
$40.64
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$40.20
|
| Rate for Payer: BCN Commercial |
$38.63
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$38.33
|
| Rate for Payer: UHC Exchange |
$38.33
|
|
|
PR OMENTAL FLAP INTRA-ABDOMINAL
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 49905
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$4,973.94 |
| Rate for Payer: Aetna Commercial |
$477.01
|
| Rate for Payer: Aetna Medicare |
$321.00
|
| Rate for Payer: BCBS Complete |
$234.61
|
| Rate for Payer: BCBS Trust/PPO |
$4,973.94
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Meridian Medicaid |
$234.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$624.63
|
| Rate for Payer: Priority Health Narrow Network |
$624.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$439.09
|
| Rate for Payer: UHC Exchange |
$439.09
|
| Rate for Payer: UHCCP Medicaid |
$223.44
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$402.49
|
|
|
Service Code
|
NDC 45802075830
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.62 |
| Max. Negotiated Rate |
$402.49 |
| Rate for Payer: Aetna Commercial |
$362.24
|
| Rate for Payer: ASR ASR |
$390.42
|
| Rate for Payer: ASR Commercial |
$390.42
|
| Rate for Payer: BCBS Trust/PPO |
$327.99
|
| 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 Commercial |
$342.12
|
| Rate for Payer: Nomi Health Commercial |
$330.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$354.19
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$402.49
|
|
|
Service Code
|
NDC 45802075830
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$402.49 |
| Rate for Payer: Aetna Commercial |
$362.24
|
| Rate for Payer: Aetna Medicare |
$201.24
|
| Rate for Payer: ASR ASR |
$390.42
|
| Rate for Payer: ASR Commercial |
$390.42
|
| Rate for Payer: BCBS Complete |
$161.00
|
| Rate for Payer: BCBS Trust/PPO |
$329.60
|
| 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 Commercial |
$342.12
|
| Rate for Payer: Nomi Health Commercial |
$330.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.66
|
| Rate for Payer: Priority Health Narrow Network |
$282.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$354.19
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$15.25
|
|
|
Service Code
|
NDC 00713053606
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna Commercial |
$13.72
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: ASR ASR |
$14.79
|
| Rate for Payer: ASR Commercial |
$14.79
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$12.49
|
| Rate for Payer: BCN Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cofinity Commercial |
$14.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Whirlpool |
$14.79
|
| Rate for Payer: Mclaren Commercial |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.96
|
| Rate for Payer: Nomi Health Commercial |
$12.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.36
|
| Rate for Payer: Priority Health Narrow Network |
$10.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.42
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$183.02
|
|
|
Service Code
|
NDC 00713053612
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.21 |
| Max. Negotiated Rate |
$183.02 |
| Rate for Payer: Aetna Commercial |
$164.72
|
| Rate for Payer: Aetna Medicare |
$91.51
|
| Rate for Payer: ASR ASR |
$177.53
|
| Rate for Payer: ASR Commercial |
$177.53
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS Trust/PPO |
$149.88
|
| Rate for Payer: BCN Commercial |
$141.90
|
| Rate for Payer: Cash Price |
$146.41
|
| Rate for Payer: Cofinity Commercial |
$172.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.42
|
| Rate for Payer: Healthscope Commercial |
$183.02
|
| Rate for Payer: Healthscope Whirlpool |
$177.53
|
| Rate for Payer: Mclaren Commercial |
$164.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.57
|
| Rate for Payer: Nomi Health Commercial |
$150.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.36
|
| Rate for Payer: Priority Health Narrow Network |
$128.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.06
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$183.02
|
|
|
Service Code
|
NDC 00713053612
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.96 |
| Max. Negotiated Rate |
$183.02 |
| Rate for Payer: Aetna Commercial |
$164.72
|
| Rate for Payer: ASR ASR |
$177.53
|
| Rate for Payer: ASR Commercial |
$177.53
|
| Rate for Payer: BCBS Trust/PPO |
$149.14
|
| Rate for Payer: BCN Commercial |
$141.90
|
| Rate for Payer: Cash Price |
$146.41
|
| Rate for Payer: Cofinity Commercial |
$172.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.42
|
| Rate for Payer: Healthscope Commercial |
$183.02
|
| Rate for Payer: Healthscope Whirlpool |
$177.53
|
| Rate for Payer: Mclaren Commercial |
$164.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.57
|
| Rate for Payer: Nomi Health Commercial |
$150.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.06
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$15.25
|
|
|
Service Code
|
NDC 00713053606
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna Commercial |
$13.72
|
| Rate for Payer: ASR ASR |
$14.79
|
| Rate for Payer: ASR Commercial |
$14.79
|
| Rate for Payer: BCBS Trust/PPO |
$12.43
|
| Rate for Payer: BCN Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cofinity Commercial |
$14.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Whirlpool |
$14.79
|
| Rate for Payer: Mclaren Commercial |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.96
|
| Rate for Payer: Nomi Health Commercial |
$12.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.42
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$33.54
|
|
|
Service Code
|
NDC 45802075800
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$33.54 |
| Rate for Payer: Aetna Commercial |
$30.19
|
| Rate for Payer: Aetna Medicare |
$16.77
|
| Rate for Payer: ASR ASR |
$32.53
|
| Rate for Payer: ASR Commercial |
$32.53
|
| Rate for Payer: BCBS Complete |
$13.42
|
| Rate for Payer: BCBS Trust/PPO |
$27.47
|
| 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 Commercial |
$28.51
|
| Rate for Payer: Nomi Health Commercial |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.39
|
| Rate for Payer: Priority Health Narrow Network |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.52
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$33.54
|
|
|
Service Code
|
NDC 45802075800
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$33.54 |
| Rate for Payer: Aetna Commercial |
$30.19
|
| Rate for Payer: ASR ASR |
$32.53
|
| Rate for Payer: ASR Commercial |
$32.53
|
| Rate for Payer: BCBS Trust/PPO |
$27.33
|
| 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 Commercial |
$28.51
|
| Rate for Payer: Nomi Health Commercial |
$27.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.52
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$16.31
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Aetna Commercial |
$14.68
|
| Rate for Payer: Aetna Commercial |
$20.15
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna Medicare |
$11.02
|
| Rate for Payer: ASR ASR |
$21.39
|
| Rate for Payer: ASR ASR |
$15.82
|
| Rate for Payer: ASR ASR |
$21.72
|
| Rate for Payer: ASR Commercial |
$21.39
|
| Rate for Payer: ASR Commercial |
$15.82
|
| Rate for Payer: ASR Commercial |
$21.72
|
| Rate for Payer: BCBS Complete |
$6.52
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS Trust/PPO |
$18.34
|
| Rate for Payer: BCBS Trust/PPO |
$13.36
|
| Rate for Payer: BCBS Trust/PPO |
$18.06
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: BCN Commercial |
$17.36
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cofinity Commercial |
$21.05
|
| Rate for Payer: Cofinity Commercial |
$15.33
|
| Rate for Payer: Cofinity Commercial |
$20.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.64
|
| Rate for Payer: Healthscope Commercial |
$22.39
|
| Rate for Payer: Healthscope Commercial |
$22.05
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Healthscope Whirlpool |
$21.72
|
| Rate for Payer: Healthscope Whirlpool |
$21.39
|
| Rate for Payer: Healthscope Whirlpool |
$15.82
|
| Rate for Payer: Mclaren Commercial |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$20.15
|
| Rate for Payer: Mclaren Commercial |
$14.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.86
|
| Rate for Payer: Nomi Health Commercial |
$13.37
|
| Rate for Payer: Nomi Health Commercial |
$18.36
|
| Rate for Payer: Nomi Health Commercial |
$18.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.44
|
| Rate for Payer: Priority Health Narrow Network |
$2.75
|
| Rate for Payer: Priority Health Narrow Network |
$2.75
|
| Rate for Payer: Priority Health Narrow Network |
$2.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.70
|
|
