|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$22.05
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.33 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Commercial |
$14.68
|
| Rate for Payer: Aetna Commercial |
$20.15
|
| Rate for Payer: ASR ASR |
$15.82
|
| Rate for Payer: ASR ASR |
$21.39
|
| 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 Trust/PPO |
$18.25
|
| Rate for Payer: BCBS Trust/PPO |
$13.29
|
| Rate for Payer: BCBS Trust/PPO |
$17.97
|
| Rate for Payer: BCN Commercial |
$12.65
|
| Rate for Payer: BCN Commercial |
$17.36
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$13.05
|
| 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 |
$17.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Healthscope Commercial |
$16.31
|
| Rate for Payer: Healthscope Commercial |
$22.05
|
| Rate for Payer: Healthscope Commercial |
$22.39
|
| Rate for Payer: Healthscope Whirlpool |
$21.39
|
| Rate for Payer: Healthscope Whirlpool |
$15.82
|
| Rate for Payer: Healthscope Whirlpool |
$21.72
|
| Rate for Payer: Mclaren Commercial |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$14.68
|
| Rate for Payer: Mclaren Commercial |
$20.15
|
| 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 |
$18.08
|
| Rate for Payer: Nomi Health Commercial |
$13.37
|
| Rate for Payer: Nomi Health Commercial |
$18.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.35
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
NDC 00713052612
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: Aetna Medicare |
$79.50
|
| Rate for Payer: ASR ASR |
$154.23
|
| Rate for Payer: ASR Commercial |
$154.23
|
| Rate for Payer: BCBS Complete |
$63.60
|
| Rate for Payer: BCBS Trust/PPO |
$130.21
|
| Rate for Payer: BCN Commercial |
$123.27
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$149.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
| Rate for Payer: Healthscope Commercial |
$159.00
|
| Rate for Payer: Healthscope Whirlpool |
$154.23
|
| Rate for Payer: Mclaren Commercial |
$143.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.15
|
| Rate for Payer: Nomi Health Commercial |
$130.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.32
|
| Rate for Payer: Priority Health Narrow Network |
$111.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.92
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
NDC 00713052612
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.35 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$143.10
|
| Rate for Payer: ASR ASR |
$154.23
|
| Rate for Payer: ASR Commercial |
$154.23
|
| Rate for Payer: BCBS Trust/PPO |
$129.57
|
| Rate for Payer: BCN Commercial |
$123.27
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$149.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
| Rate for Payer: Healthscope Commercial |
$159.00
|
| Rate for Payer: Healthscope Whirlpool |
$154.23
|
| Rate for Payer: Mclaren Commercial |
$143.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.15
|
| Rate for Payer: Nomi Health Commercial |
$130.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.92
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 00904730461
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$302.44
|
| Rate for Payer: ASR ASR |
$325.97
|
| Rate for Payer: ASR Commercial |
$325.97
|
| Rate for Payer: BCBS Trust/PPO |
$273.85
|
| Rate for Payer: BCN Commercial |
$260.54
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$315.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$336.05
|
| Rate for Payer: Healthscope Whirlpool |
$325.97
|
| Rate for Payer: Mclaren Commercial |
$302.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.72
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 00904730461
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$336.05 |
| Rate for Payer: Aetna Commercial |
$302.44
|
| Rate for Payer: Aetna Medicare |
$168.02
|
| Rate for Payer: ASR ASR |
$325.97
|
| Rate for Payer: ASR Commercial |
$325.97
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: BCBS Trust/PPO |
$275.19
|
| Rate for Payer: BCN Commercial |
$260.54
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$315.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$336.05
|
| Rate for Payer: Healthscope Whirlpool |
$325.97
|
| Rate for Payer: Mclaren Commercial |
$302.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$294.45
|
| Rate for Payer: Priority Health Narrow Network |
$235.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$295.72
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$251.45 |
| Rate for Payer: Aetna Commercial |
$226.30
|
| Rate for Payer: ASR ASR |
$243.91
|
| Rate for Payer: ASR Commercial |
$243.91
|
| Rate for Payer: BCBS Trust/PPO |
$204.91
|
| Rate for Payer: BCN Commercial |
$194.95
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$236.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$251.45
|
| Rate for Payer: Healthscope Whirlpool |
$243.91
|
| Rate for Payer: Mclaren Commercial |
$226.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.28
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: ASR ASR |
$1.87
|
| Rate for Payer: ASR Commercial |
$1.87
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$1.58
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Healthscope Whirlpool |
$1.87
|
| Rate for Payer: Mclaren Commercial |
$1.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.64
|
| Rate for Payer: Nomi Health Commercial |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.69
|
| Rate for Payer: Priority Health Narrow Network |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.70
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.58 |
| Max. Negotiated Rate |
$251.45 |
| Rate for Payer: Aetna Commercial |
$226.30
|
| Rate for Payer: Aetna Medicare |
$125.72
|
| Rate for Payer: ASR ASR |
$243.91
|
| Rate for Payer: ASR Commercial |
$243.91
|
| Rate for Payer: BCBS Complete |
$100.58
|
| Rate for Payer: BCBS Trust/PPO |
$205.91
|
| Rate for Payer: BCN Commercial |
$194.95
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$236.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$251.45
|
| Rate for Payer: Healthscope Whirlpool |
$243.91
|
| Rate for Payer: Mclaren Commercial |
$226.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: 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
|
$1.93
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.93 |
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: ASR ASR |
$1.87
|
| Rate for Payer: ASR Commercial |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$1.57
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.93
|
| Rate for Payer: Healthscope Whirlpool |
$1.87
|
| Rate for Payer: Mclaren Commercial |
$1.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.64
|
| Rate for Payer: Nomi Health Commercial |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.70
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$1.57
|
|
|
Service Code
|
NDC 09900000413
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna Commercial |
$1.41
|
| Rate for Payer: ASR ASR |
$1.52
|
| Rate for Payer: ASR Commercial |
$1.52
|
| Rate for Payer: BCBS Trust/PPO |
$1.28
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.26
|
| Rate for Payer: Healthscope Commercial |
$1.57
|
| Rate for Payer: Healthscope Whirlpool |
$1.52
|
| Rate for Payer: Mclaren Commercial |
$1.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.33
|
| Rate for Payer: Nomi Health Commercial |
$1.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.38
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
NDC 09900000413
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna Commercial |
$1.41
|
| Rate for Payer: Aetna Medicare |
$0.79
|
| Rate for Payer: ASR ASR |
$1.52
|
| Rate for Payer: ASR Commercial |
$1.52
|
| Rate for Payer: BCBS Complete |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$1.29
|
| Rate for Payer: BCN Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Cofinity Commercial |
$1.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.26
|
| Rate for Payer: Healthscope Commercial |
$1.57
|
| Rate for Payer: Healthscope Whirlpool |
$1.52
|
| Rate for Payer: Mclaren Commercial |
$1.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.33
|
| Rate for Payer: Nomi Health Commercial |
$1.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.02
|
| Rate for Payer: 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 |
$1.38
|
|
|
PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$2,127.00
|
|
|
Service Code
|
HCPCS 49255
|
| Min. Negotiated Rate |
$512.05 |
| Max. Negotiated Rate |
$1,424.67 |
| Rate for Payer: Aetna Commercial |
$1,060.40
|
| Rate for Payer: Aetna Medicare |
$1,063.50
|
| Rate for Payer: BCBS Complete |
$537.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.96
|
| Rate for Payer: BCN Commercial |
$1,157.67
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Meridian Medicaid |
$537.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,382.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,424.67
|
| Rate for Payer: Priority Health Narrow Network |
$1,424.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$946.71
|
| Rate for Payer: UHC Exchange |
$946.71
|
| Rate for Payer: UHCCP Medicaid |
$512.05
|
|
|
PR ONDANSETRON HCL INJECTION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J2405
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$0.10
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.04
|
| 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 |
$1.43
|
| Rate for Payer: UHC Exchange |
$1.43
|
|
|
PR ONE AREA LIPOSUCTION - 1 AREA 1.0 HR
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 00527
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Medicare |
$1,020.00
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99422
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$25.74
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$42.64
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.06
|
| Rate for Payer: Priority Health Narrow Network |
$28.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.67
|
| Rate for Payer: UHC Exchange |
$30.67
|
| Rate for Payer: UHCCP Medicaid |
$16.19
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$873.28 |
| Rate for Payer: Aetna Commercial |
$40.51
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$26.39
|
| Rate for Payer: BCBS Trust/PPO |
$873.28
|
| Rate for Payer: BCN Commercial |
$49.79
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Meridian Medicaid |
$26.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.89
|
| Rate for Payer: Priority Health Narrow Network |
$44.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$48.84
|
| Rate for Payer: UHC Exchange |
$48.84
|
| Rate for Payer: UHCCP Medicaid |
$25.13
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$1,630.70 |
| Rate for Payer: Aetna Commercial |
$12.71
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,630.70
|
| Rate for Payer: BCN Commercial |
$21.51
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.22
|
| Rate for Payer: Priority Health Narrow Network |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.92
|
| Rate for Payer: UHC Exchange |
$14.92
|
| Rate for Payer: UHCCP Medicaid |
$8.09
|
|
|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,819.00
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$1,832.35 |
| Rate for Payer: Aetna Commercial |
$655.82
|
| Rate for Payer: Aetna Medicare |
$1,409.50
|
| Rate for Payer: BCBS Complete |
$375.73
|
| Rate for Payer: BCBS Trust/PPO |
$144.75
|
| Rate for Payer: BCN Commercial |
$818.04
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Meridian Medicaid |
$375.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,832.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$833.36
|
| Rate for Payer: Priority Health Narrow Network |
$833.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$579.53
|
| Rate for Payer: UHC Exchange |
$579.53
|
| Rate for Payer: UHCCP Medicaid |
$357.84
|
|
|
PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY
|
Professional
|
Both
|
$2,306.00
|
|
|
Service Code
|
HCPCS 58943
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$1,797.18 |
| Rate for Payer: Aetna Commercial |
$1,398.24
|
| Rate for Payer: Aetna Medicare |
$1,153.00
|
| Rate for Payer: BCBS Complete |
$810.96
|
| Rate for Payer: BCBS Trust/PPO |
$132.60
|
| Rate for Payer: BCN Commercial |
$1,713.79
|
| Rate for Payer: Cash Price |
$1,844.80
|
| Rate for Payer: Cash Price |
$1,844.80
|
| Rate for Payer: Meridian Medicaid |
$810.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,498.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,797.18
|
| Rate for Payer: Priority Health Narrow Network |
$1,797.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,286.47
|
| Rate for Payer: UHC Exchange |
$1,286.47
|
| Rate for Payer: UHCCP Medicaid |
$772.34
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.49 |
| Max. Negotiated Rate |
$113.72 |
| Rate for Payer: Aetna Commercial |
$102.35
|
| Rate for Payer: Aetna Medicare |
$56.86
|
| Rate for Payer: ASR ASR |
$110.31
|
| Rate for Payer: ASR Commercial |
$110.31
|
| Rate for Payer: BCBS Complete |
$45.49
|
| Rate for Payer: BCBS Trust/PPO |
$93.13
|
| Rate for Payer: BCN Commercial |
$88.17
|
| Rate for Payer: Cash Price |
$90.97
|
| Rate for Payer: Cofinity Commercial |
$106.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$113.72
|
| Rate for Payer: Healthscope Whirlpool |
$110.31
|
| Rate for Payer: Mclaren Commercial |
$102.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Nomi Health Commercial |
$93.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.64
|
| Rate for Payer: Priority Health Narrow Network |
$79.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.07
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$131.09
|
|
|
Service Code
|
NDC 00998001615
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.21 |
| Max. Negotiated Rate |
$131.09 |
| Rate for Payer: Aetna Commercial |
$117.98
|
| Rate for Payer: ASR ASR |
$127.16
|
| Rate for Payer: ASR Commercial |
$127.16
|
| Rate for Payer: BCBS Trust/PPO |
$106.83
|
| Rate for Payer: BCN Commercial |
$101.63
|
| Rate for Payer: Cash Price |
$104.87
|
| Rate for Payer: Cofinity Commercial |
$123.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.87
|
| Rate for Payer: Healthscope Commercial |
$131.09
|
| Rate for Payer: Healthscope Whirlpool |
$127.16
|
| Rate for Payer: Mclaren Commercial |
$117.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$107.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.36
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$97.65
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$87.88
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: ASR Commercial |
$94.72
|
| Rate for Payer: BCBS Trust/PPO |
$79.57
|
| Rate for Payer: BCN Commercial |
$75.71
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$97.65
|
| Rate for Payer: Healthscope Whirlpool |
$94.72
|
| Rate for Payer: Mclaren Commercial |
$87.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$97.65
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.06 |
| Max. Negotiated Rate |
$97.65 |
| Rate for Payer: Aetna Commercial |
$87.88
|
| Rate for Payer: Aetna Medicare |
$48.82
|
| Rate for Payer: ASR ASR |
$94.72
|
| Rate for Payer: ASR Commercial |
$94.72
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: BCBS Trust/PPO |
$79.97
|
| Rate for Payer: BCN Commercial |
$75.71
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$91.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.12
|
| Rate for Payer: Healthscope Commercial |
$97.65
|
| Rate for Payer: Healthscope Whirlpool |
$94.72
|
| Rate for Payer: Mclaren Commercial |
$87.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.00
|
| Rate for Payer: Nomi Health Commercial |
$80.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.56
|
| Rate for Payer: Priority Health Narrow Network |
$68.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.93
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$116.71
|
|
|
Service Code
|
NDC 24208073006
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$116.71 |
| Rate for Payer: Aetna Commercial |
$105.04
|
| Rate for Payer: Aetna Medicare |
$58.36
|
| Rate for Payer: ASR ASR |
$113.21
|
| Rate for Payer: ASR Commercial |
$113.21
|
| Rate for Payer: BCBS Complete |
$46.68
|
| Rate for Payer: BCBS Trust/PPO |
$95.57
|
| Rate for Payer: BCN Commercial |
$90.49
|
| Rate for Payer: Cash Price |
$93.37
|
| Rate for Payer: Cofinity Commercial |
$109.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.37
|
| Rate for Payer: Healthscope Commercial |
$116.71
|
| Rate for Payer: Healthscope Whirlpool |
$113.21
|
| Rate for Payer: Mclaren Commercial |
$105.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.20
|
| Rate for Payer: Nomi Health Commercial |
$95.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.26
|
| Rate for Payer: Priority Health Narrow Network |
$81.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.70
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$113.72 |
| Rate for Payer: Aetna Commercial |
$102.35
|
| Rate for Payer: ASR ASR |
$110.31
|
| Rate for Payer: ASR Commercial |
$110.31
|
| Rate for Payer: BCBS Trust/PPO |
$92.67
|
| Rate for Payer: BCN Commercial |
$88.17
|
| Rate for Payer: Cash Price |
$90.97
|
| Rate for Payer: Cofinity Commercial |
$106.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$113.72
|
| Rate for Payer: Healthscope Whirlpool |
$110.31
|
| Rate for Payer: Mclaren Commercial |
$102.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Nomi Health Commercial |
$93.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.07
|
|
