|
Progesterone Level
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
3551617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.10
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Progesterone Level
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
3551617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$71.72
|
| Rate for Payer: Humana Medicare Advantage |
$49.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.86
|
| Rate for Payer: WPPA Medicare Advantage |
$70.80
|
|
|
Progesterone QST
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
3551617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$71.72
|
| Rate for Payer: Humana Medicare Advantage |
$49.56
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.86
|
| Rate for Payer: WPPA Medicare Advantage |
$70.80
|
|
|
Progesterone QST
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
HCPCS 84144
|
| Hospital Charge Code |
3551617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.20 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: UnitedHealthcare Commercial |
$112.10
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Proinsulin QST
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS 84206
|
| Hospital Charge Code |
3550760
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.69 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$51.06
|
| Rate for Payer: Humana Medicare Advantage |
$126.84
|
| Rate for Payer: UnitedHealthcare Commercial |
$286.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.69
|
| Rate for Payer: WPPA Medicare Advantage |
$181.20
|
|
|
Proinsulin QST
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS 84206
|
| Hospital Charge Code |
3550760
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$271.80 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$286.90
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Prolactin Level
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
3551252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$79.41
|
| Rate for Payer: Humana Medicare Advantage |
$81.48
|
| Rate for Payer: UnitedHealthcare Commercial |
$184.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.38
|
| Rate for Payer: WPPA Medicare Advantage |
$116.40
|
|
|
Prolactin Level
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
3551252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.60 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: UnitedHealthcare Commercial |
$184.30
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Prolactin QST
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
3551252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.38 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$79.41
|
| Rate for Payer: Humana Medicare Advantage |
$90.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$204.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.38
|
| Rate for Payer: WPPA Medicare Advantage |
$129.00
|
|
|
Prolactin QST
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
HCPCS 84146
|
| Hospital Charge Code |
3551252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$193.50 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: UnitedHealthcare Commercial |
$204.25
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
promethazine 12.5 mg Tab [HMC]
|
Facility
|
IP
|
$6.69
|
|
|
Service Code
|
NDC 60687066001
|
| Hospital Charge Code |
3808900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.02
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.36
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
promethazine 12.5 mg Tab [HMC]
|
Facility
|
OP
|
$6.47
|
|
|
Service Code
|
NDC 65162074510
|
| Hospital Charge Code |
3808900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.82
|
| Rate for Payer: Humana Medicare Advantage |
$2.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.59
|
| Rate for Payer: WPPA Medicare Advantage |
$3.88
|
|
|
promethazine 12.5 mg Tab [HMC]
|
Facility
|
OP
|
$6.69
|
|
|
Service Code
|
NDC 60687066001
|
| Hospital Charge Code |
3808900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Aetna Commercial |
$6.02
|
| Rate for Payer: Humana Medicare Advantage |
$2.81
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.68
|
| Rate for Payer: WPPA Medicare Advantage |
$4.01
|
|
|
promethazine 12.5 mg Tab [HMC]
|
Facility
|
OP
|
$6.47
|
|
|
Service Code
|
HCPCS Q0169
|
| Hospital Charge Code |
3808900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$6.15 |
| Rate for Payer: Aetna Commercial |
$5.82
|
| Rate for Payer: Aetna Commercial |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$0.25
|
| Rate for Payer: Humana Medicare Advantage |
$2.81
|
| Rate for Payer: Humana Medicare Advantage |
$2.72
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.36
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.68
|
| Rate for Payer: WPPA Medicare Advantage |
$4.01
|
| Rate for Payer: WPPA Medicare Advantage |
$3.88
|
|
|
promethazine 12.5 mg Tab [HMC]
|
Facility
|
IP
|
$6.69
|
|
|
Service Code
|
HCPCS Q0169
|
| Hospital Charge Code |
3808900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$6.02
|
| Rate for Payer: Aetna Commercial |
$5.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.15
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.36
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
promethazine 12.5 mg Tab [HMC]
|
Facility
|
IP
|
$6.47
|
|
|
Service Code
|
NDC 65162074510
|
| Hospital Charge Code |
3808900
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$5.82
|
| Rate for Payer: UnitedHealthcare Commercial |
$6.15
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
promethazine 25 mg/mL Inj Sol [HMC]
|
Facility
|
OP
|
$30.47
|
|
|
Service Code
|
NDC 00641095525
|
| Hospital Charge Code |
3803233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.19 |
| Max. Negotiated Rate |
$28.95 |
| Rate for Payer: Aetna Commercial |
$27.42
|
| Rate for Payer: Humana Medicare Advantage |
$12.80
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.19
|
| Rate for Payer: WPPA Medicare Advantage |
$18.28
|
|
|
promethazine 25 mg/mL Inj Sol [HMC]
|
Facility
|
IP
|
$30.47
|
|
|
Service Code
|
NDC 00641095525
|
| Hospital Charge Code |
3803233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$27.42
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.95
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
promethazine 25 mg/mL Inj Sol [HMC]
|
Facility
|
OP
|
$31.09
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
3803233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$29.54 |
| Rate for Payer: Aetna Commercial |
$27.98
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$36.21
|
| Rate for Payer: Aetna Commercial |
$29.25
|
| Rate for Payer: Aetna Commercial |
$27.42
|
| Rate for Payer: Aetna Commercial |
$28.17
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$3.99
|
| Rate for Payer: Humana Medicare Advantage |
$13.06
|
| Rate for Payer: Humana Medicare Advantage |
$12.18
|
| Rate for Payer: Humana Medicare Advantage |
$12.80
|
| Rate for Payer: Humana Medicare Advantage |
$13.15
|
| Rate for Payer: Humana Medicare Advantage |
$13.65
|
| Rate for Payer: Humana Medicare Advantage |
$16.90
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.22
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.97
|
| Rate for Payer: WPPA Medicare Advantage |
$18.65
|
| Rate for Payer: WPPA Medicare Advantage |
$24.14
|
| Rate for Payer: WPPA Medicare Advantage |
$18.78
|
| Rate for Payer: WPPA Medicare Advantage |
$17.40
|
| Rate for Payer: WPPA Medicare Advantage |
$19.50
|
| Rate for Payer: WPPA Medicare Advantage |
$18.28
|
|
|
promethazine 25 mg/mL Inj Sol [HMC]
|
Facility
|
IP
|
$30.47
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
3803233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$27.42
|
| Rate for Payer: Aetna Commercial |
$27.98
|
| Rate for Payer: Aetna Commercial |
$28.17
|
| Rate for Payer: Aetna Commercial |
$29.25
|
| Rate for Payer: Aetna Commercial |
$36.21
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$28.95
|
| Rate for Payer: UnitedHealthcare Commercial |
$29.73
|
| Rate for Payer: UnitedHealthcare Commercial |
$27.55
|
| Rate for Payer: UnitedHealthcare Commercial |
$30.88
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.22
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
promethazine 25 mg Supp [HMC]
|
Facility
|
IP
|
$40.41
|
|
|
Service Code
|
NDC 45802075930
|
| Hospital Charge Code |
3803217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.39
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
promethazine 25 mg Supp [HMC]
|
Facility
|
OP
|
$40.41
|
|
|
Service Code
|
NDC 00713052612
|
| Hospital Charge Code |
3803217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$38.39 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: Humana Medicare Advantage |
$16.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.16
|
| Rate for Payer: WPPA Medicare Advantage |
$24.25
|
|
|
promethazine 25 mg Supp [HMC]
|
Facility
|
OP
|
$40.41
|
|
|
Service Code
|
NDC 45802075930
|
| Hospital Charge Code |
3803217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$38.39 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: Humana Medicare Advantage |
$16.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.16
|
| Rate for Payer: WPPA Medicare Advantage |
$24.25
|
|
|
promethazine 25 mg Supp [HMC]
|
Facility
|
IP
|
$40.41
|
|
|
Service Code
|
NDC 00713052612
|
| Hospital Charge Code |
3803217
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.37 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$36.37
|
| Rate for Payer: UnitedHealthcare Commercial |
$38.39
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
promethazine 50 mg/mL Sol [HMC]
|
Facility
|
IP
|
$43.07
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
3806771
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$38.76
|
| Rate for Payer: UnitedHealthcare Commercial |
$40.92
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
