|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 99215
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$21,023.00 |
| Rate for Payer: Aetna Commercial |
$182.59
|
| Rate for Payer: Aetna Medicare |
$141.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.21
|
| Rate for Payer: BCBS Complete |
$95.95
|
| Rate for Payer: BCBS MAPPO |
$136.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.82
|
| Rate for Payer: BCN Commercial |
$154.50
|
| Rate for Payer: BCN Medicare Advantage |
$136.26
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$196.21
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.26
|
| Rate for Payer: Healthscope Commercial |
$252.08
|
| Rate for Payer: Healthscope Commercial |
$218.02
|
| Rate for Payer: Mclaren Medicaid |
$91.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.07
|
| Rate for Payer: Meridian Medicaid |
$95.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,023.00
|
| Rate for Payer: Nomi Health Commercial |
$163.51
|
| Rate for Payer: PACE SWMI |
$136.26
|
| Rate for Payer: PHP Medicare Advantage |
$136.26
|
| 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 Medicare |
$136.26
|
| Rate for Payer: Priority Health Narrow Network |
$160.44
|
| Rate for Payer: Priority Health SBD |
$160.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.26
|
| Rate for Payer: UHC Exchange |
$141.29
|
| Rate for Payer: UHC Medicare Advantage |
$136.26
|
| 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 |
$9,702.00 |
| Rate for Payer: Aetna Commercial |
$83.94
|
| Rate for Payer: Aetna Medicare |
$65.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.20
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS MAPPO |
$62.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.96
|
| Rate for Payer: BCN Commercial |
$79.38
|
| Rate for Payer: BCN Medicare Advantage |
$62.64
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$90.20
|
| Rate for Payer: Cofinity Commercial |
$83.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.64
|
| Rate for Payer: Healthscope Commercial |
$115.88
|
| Rate for Payer: Healthscope Commercial |
$100.22
|
| Rate for Payer: Mclaren Medicaid |
$41.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.77
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,702.00
|
| Rate for Payer: Nomi Health Commercial |
$75.17
|
| Rate for Payer: PACE SWMI |
$62.64
|
| Rate for Payer: PHP Medicare Advantage |
$62.64
|
| 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 Medicare |
$62.64
|
| Rate for Payer: Priority Health Narrow Network |
$73.30
|
| Rate for Payer: Priority Health SBD |
$73.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.64
|
| Rate for Payer: UHC Exchange |
$61.76
|
| Rate for Payer: UHC Medicare Advantage |
$62.64
|
| 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 |
$14,322.00 |
| Rate for Payer: Aetna Commercial |
$123.62
|
| Rate for Payer: Aetna Medicare |
$95.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.84
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: BCBS MAPPO |
$92.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,340.83
|
| Rate for Payer: BCN Commercial |
$115.12
|
| Rate for Payer: BCN Medicare Advantage |
$92.25
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Cofinity Commercial |
$123.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.25
|
| Rate for Payer: Healthscope Commercial |
$170.66
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Mclaren Medicaid |
$61.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.86
|
| Rate for Payer: Meridian Medicaid |
$64.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,322.00
|
| Rate for Payer: Nomi Health Commercial |
$110.70
|
| Rate for Payer: PACE SWMI |
$92.25
|
| Rate for Payer: PHP Medicare Advantage |
$92.25
|
| 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 Medicare |
$92.25
|
| Rate for Payer: Priority Health Narrow Network |
$108.08
|
| Rate for Payer: Priority Health SBD |
$108.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.25
|
| Rate for Payer: UHC Exchange |
$96.41
|
| Rate for Payer: UHC Medicare Advantage |
$92.25
|
| 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 |
$5,229.00 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: Aetna Medicare |
$34.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.07
|
| Rate for Payer: BCBS Complete |
$23.49
|
| Rate for Payer: BCBS MAPPO |
$33.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,731.31
|
| Rate for Payer: BCN Commercial |
$50.51
|
| Rate for Payer: BCN Medicare Advantage |
$33.38
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$44.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.38
|
| Rate for Payer: Healthscope Commercial |
$61.75
|
| Rate for Payer: Healthscope Commercial |
$53.41
|
| Rate for Payer: Mclaren Medicaid |
$22.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.05
|
| Rate for Payer: Meridian Medicaid |
$23.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,229.00
|
| Rate for Payer: Nomi Health Commercial |
$40.06
|
| Rate for Payer: PACE SWMI |
$33.38
|
| Rate for Payer: PHP Medicare Advantage |
$33.38
|
| 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 Medicare |
$33.38
|
| Rate for Payer: Priority Health Narrow Network |
$39.27
|
| Rate for Payer: Priority Health SBD |
$39.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.38
|
| Rate for Payer: UHC Exchange |
$43.99
|
| Rate for Payer: UHC Medicare Advantage |
$33.38
|
| 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 |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.89
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,495.16
|
| Rate for Payer: BCN Commercial |
$23.28
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$13.22
|
| Rate for Payer: Mclaren Medicaid |
$5.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,295.00
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| 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 Medicare |
$8.26
|
| Rate for Payer: Priority Health Narrow Network |
$9.72
|
| Rate for Payer: Priority Health SBD |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Exchange |
$24.88
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| 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 |
$26,618.00 |
| Rate for Payer: Aetna Commercial |
$231.78
|
| Rate for Payer: Aetna Medicare |
$179.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$249.08
|
| Rate for Payer: BCBS Complete |
$121.44
|
| Rate for Payer: BCBS MAPPO |
$172.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,028.67
|
| Rate for Payer: BCN Commercial |
$209.60
|
| Rate for Payer: BCN Medicare Advantage |
$172.97
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$249.08
|
| Rate for Payer: Cofinity Commercial |
$231.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.97
|
| Rate for Payer: Healthscope Commercial |
$319.99
|
| Rate for Payer: Healthscope Commercial |
$276.75
|
| Rate for Payer: Mclaren Medicaid |
$115.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.62
|
| Rate for Payer: Meridian Medicaid |
$121.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,618.00
|
| Rate for Payer: Nomi Health Commercial |
$207.56
|
| Rate for Payer: PACE SWMI |
$172.97
|
| Rate for Payer: PHP Medicare Advantage |
$172.97
|
| 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 Medicare |
$172.97
|
| Rate for Payer: Priority Health Narrow Network |
$201.95
|
| Rate for Payer: Priority Health SBD |
$201.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.97
|
| Rate for Payer: UHC Exchange |
$203.49
|
| Rate for Payer: UHC Medicare Advantage |
$172.97
|
| 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: Multiplan/Beech St/PHCS Commercial |
$46.15
|
| 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 |
$12,212.00 |
| Rate for Payer: Aetna Commercial |
$104.73
|
| Rate for Payer: Aetna Medicare |
$81.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.55
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$78.16
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$108.55
|
| Rate for Payer: BCN Medicare Advantage |
$78.16
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$112.55
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.16
|
| Rate for Payer: Healthscope Commercial |
$144.60
|
| Rate for Payer: Healthscope Commercial |
$125.06
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.07
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,212.00
|
| Rate for Payer: Nomi Health Commercial |
$93.79
|
| Rate for Payer: PACE SWMI |
$78.16
|
| Rate for Payer: PHP Medicare Advantage |
$78.16
|
| 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 Medicare |
$78.16
|
| Rate for Payer: Priority Health Narrow Network |
$91.26
|
| Rate for Payer: Priority Health SBD |
$91.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.16
|
| Rate for Payer: UHC Exchange |
$111.96
|
| Rate for Payer: UHC Medicare Advantage |
$78.16
|
| 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 |
$19,614.00 |
| Rate for Payer: Aetna Commercial |
$170.30
|
| Rate for Payer: Aetna Medicare |
$132.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.01
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$127.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.30
|
| Rate for Payer: BCN Commercial |
$165.88
|
| Rate for Payer: BCN Medicare Advantage |
$127.09
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Cofinity Commercial |
$170.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.09
|
| Rate for Payer: Healthscope Commercial |
$235.12
|
| Rate for Payer: Healthscope Commercial |
$203.34
|
| Rate for Payer: Mclaren Medicaid |
$84.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.44
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19,614.00
|
| Rate for Payer: Nomi Health Commercial |
$152.51
|
| Rate for Payer: PACE SWMI |
$127.09
|
| Rate for Payer: PHP Medicare Advantage |
$127.09
|
| 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 Medicare |
$127.09
|
| Rate for Payer: Priority Health Narrow Network |
$148.47
|
| Rate for Payer: Priority Health SBD |
$148.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.09
|
| Rate for Payer: UHC Exchange |
$152.73
|
| Rate for Payer: UHC Medicare Advantage |
$127.09
|
| 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 |
$7,064.00 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$46.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.12
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCBS MAPPO |
$44.53
|
| Rate for Payer: BCBS Trust/PPO |
$706.34
|
| Rate for Payer: BCN Commercial |
$76.66
|
| Rate for Payer: BCN Medicare Advantage |
$44.53
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$64.12
|
| Rate for Payer: Cofinity Commercial |
$59.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.53
|
| Rate for Payer: Healthscope Commercial |
$82.38
|
| Rate for Payer: Healthscope Commercial |
$71.25
|
| Rate for Payer: Mclaren Medicaid |
$29.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.76
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,064.00
|
| Rate for Payer: Nomi Health Commercial |
$53.44
|
| Rate for Payer: PACE SWMI |
$44.53
|
| Rate for Payer: PHP Medicare Advantage |
$44.53
|
| 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 Medicare |
$44.53
|
| Rate for Payer: Priority Health Narrow Network |
$52.74
|
| Rate for Payer: Priority Health SBD |
$52.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.53
|
| Rate for Payer: UHC Exchange |
$75.53
|
| Rate for Payer: UHC Medicare Advantage |
$44.53
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
OP
|
$353.40
|
|
|
Service Code
|
NDC 65162080710
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna Medicare |
$176.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: BCBS Complete |
$141.36
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.71
|
| Rate for Payer: Priority Health SBD |
$222.64
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
OP
|
$256.80
|
|
|
Service Code
|
NDC 17478076610
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.72 |
| Max. Negotiated Rate |
$231.12 |
| Rate for Payer: Aetna Commercial |
$218.28
|
| Rate for Payer: Aetna Medicare |
$128.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.92
|
| Rate for Payer: BCBS Complete |
$102.72
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cofinity Commercial |
$179.76
|
| Rate for Payer: Cofinity Commercial |
$220.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.44
|
| Rate for Payer: Healthscope Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.28
|
| Rate for Payer: PHP Commercial |
$218.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health SBD |
$161.78
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 59651015201
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.84 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$256.80
|
|
|
Service Code
|
NDC 17478076610
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.78 |
| Max. Negotiated Rate |
$231.12 |
| Rate for Payer: Aetna Commercial |
$218.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.92
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cofinity Commercial |
$179.76
|
| Rate for Payer: Cofinity Commercial |
$220.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.44
|
| Rate for Payer: Healthscope Commercial |
$231.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.28
|
| Rate for Payer: PHP Commercial |
$218.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.92
|
| Rate for Payer: Priority Health SBD |
$161.78
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 59651015201
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.37 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$305.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health SBD |
$275.37
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$487.68
|
|
|
Service Code
|
NDC 43598034901
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.24 |
| Max. Negotiated Rate |
$438.91 |
| Rate for Payer: Aetna Commercial |
$414.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.99
|
| Rate for Payer: Cash Price |
$390.14
|
| Rate for Payer: Cofinity Commercial |
$341.38
|
| Rate for Payer: Cofinity Commercial |
$419.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.14
|
| Rate for Payer: Healthscope Commercial |
$438.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.53
|
| Rate for Payer: PHP Commercial |
$414.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.99
|
| Rate for Payer: Priority Health SBD |
$307.24
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 65162080710
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.64 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$247.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.71
|
| Rate for Payer: Priority Health SBD |
$222.64
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
OP
|
$487.68
|
|
|
Service Code
|
NDC 43598034901
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.07 |
| Max. Negotiated Rate |
$438.91 |
| Rate for Payer: Aetna Commercial |
$414.53
|
| Rate for Payer: Aetna Medicare |
$243.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.99
|
| Rate for Payer: BCBS Complete |
$195.07
|
| Rate for Payer: Cash Price |
$390.14
|
| Rate for Payer: Cofinity Commercial |
$341.38
|
| Rate for Payer: Cofinity Commercial |
$419.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.14
|
| Rate for Payer: Healthscope Commercial |
$438.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$414.53
|
| Rate for Payer: PHP Commercial |
$414.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.99
|
| Rate for Payer: Priority Health SBD |
$307.24
|
|
|
PR OMALIZUMAB INJECTION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J2357
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$3,909.00 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$42.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.41
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$40.56
|
| Rate for Payer: BCBS Trust/PPO |
$40.20
|
| Rate for Payer: BCN Commercial |
$38.63
|
| Rate for Payer: BCN Medicare Advantage |
$40.56
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Cofinity Commercial |
$54.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.56
|
| Rate for Payer: Healthscope Commercial |
$64.90
|
| Rate for Payer: Healthscope Commercial |
$75.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,909.00
|
| Rate for Payer: Nomi Health Commercial |
$48.68
|
| Rate for Payer: PACE SWMI |
$40.56
|
| Rate for Payer: PHP Medicare Advantage |
$40.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$40.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.56
|
| Rate for Payer: UHC Exchange |
$40.03
|
| Rate for Payer: UHC Medicare Advantage |
$40.56
|
|
|
PR OMENTAL FLAP INTRA-ABDOMINAL
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 49905
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$63,108.00 |
| Rate for Payer: Aetna Commercial |
$456.14
|
| Rate for Payer: Aetna Medicare |
$354.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$490.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.14
|
| Rate for Payer: BCBS Complete |
$234.61
|
| Rate for Payer: BCBS MAPPO |
$340.40
|
| Rate for Payer: BCBS Trust/PPO |
$4,973.94
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: BCN Medicare Advantage |
$340.40
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cofinity Commercial |
$490.18
|
| Rate for Payer: Cofinity Commercial |
$456.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.40
|
| Rate for Payer: Healthscope Commercial |
$629.74
|
| Rate for Payer: Healthscope Commercial |
$544.64
|
| Rate for Payer: Mclaren Medicaid |
$223.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$357.42
|
| Rate for Payer: Meridian Medicaid |
$234.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63,108.00
|
| Rate for Payer: Nomi Health Commercial |
$408.48
|
| Rate for Payer: PACE SWMI |
$340.40
|
| Rate for Payer: PHP Medicare Advantage |
$340.40
|
| 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 Medicare |
$340.40
|
| Rate for Payer: Priority Health Narrow Network |
$624.63
|
| Rate for Payer: Priority Health SBD |
$624.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$340.40
|
| Rate for Payer: UHC Exchange |
$463.09
|
| Rate for Payer: UHC Medicare Advantage |
$340.40
|
| Rate for Payer: UHCCP Medicaid |
$223.44
|
|
|
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 |
$115.30 |
| Max. Negotiated Rate |
$164.72 |
| Rate for Payer: Aetna Commercial |
$155.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.96
|
| Rate for Payer: Cash Price |
$146.42
|
| Rate for Payer: Cofinity Commercial |
$128.11
|
| Rate for Payer: Cofinity Commercial |
$157.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.42
|
| Rate for Payer: Healthscope Commercial |
$164.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.57
|
| Rate for Payer: PHP Commercial |
$155.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.96
|
| Rate for Payer: Priority Health SBD |
$115.30
|
|
|
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 |
$164.72 |
| Rate for Payer: Aetna Commercial |
$155.57
|
| Rate for Payer: Aetna Medicare |
$91.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.96
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: Cash Price |
$146.42
|
| Rate for Payer: Cofinity Commercial |
$128.11
|
| Rate for Payer: Cofinity Commercial |
$157.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.42
|
| Rate for Payer: Healthscope Commercial |
$164.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.57
|
| Rate for Payer: PHP Commercial |
$155.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.96
|
| Rate for Payer: Priority Health SBD |
$115.30
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$16.85
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$15.16 |
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Aetna Commercial |
$18.93
|
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna Medicare |
$11.02
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna Medicare |
$8.42
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.95
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$8.89
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS Complete |
$8.91
|
| Rate for Payer: BCBS Trust/PPO |
$9.34
|
| Rate for Payer: BCBS Trust/PPO |
$9.34
|
| Rate for Payer: BCBS Trust/PPO |
$9.34
|
| Rate for Payer: BCBS Trust/PPO |
$9.34
|
| Rate for Payer: BCBS Trust/PPO |
$9.34
|
| Rate for Payer: BCBS Trust/PPO |
$9.34
|
| Rate for Payer: BCN Commercial |
$9.34
|
| Rate for Payer: BCN Commercial |
$9.34
|
| Rate for Payer: BCN Commercial |
$9.34
|
| Rate for Payer: BCN Commercial |
$9.34
|
| Rate for Payer: BCN Commercial |
$9.34
|
| Rate for Payer: BCN Commercial |
$9.34
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Commercial |
$11.80
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$15.56
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$15.59
|
| Rate for Payer: Cofinity Commercial |
$19.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$18.90
|
| Rate for Payer: PHP Commercial |
$18.74
|
| Rate for Payer: PHP Commercial |
$18.93
|
| Rate for Payer: PHP Commercial |
$14.32
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health SBD |
$10.62
|
| Rate for Payer: Priority Health SBD |
$14.00
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$13.89
|
| Rate for Payer: Priority Health SBD |
$14.03
|
| Rate for Payer: Priority Health SBD |
$10.28
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$22.25
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Commercial |
$18.93
|
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.33
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$11.80
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$15.44
|
| Rate for Payer: Cofinity Commercial |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Commercial |
$15.56
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$15.59
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.64
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$20.01
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.90
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: PHP Commercial |
$18.74
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$14.32
|
| Rate for Payer: PHP Commercial |
$18.90
|
| Rate for Payer: PHP Commercial |
$18.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.45
|
| Rate for Payer: Priority Health SBD |
$10.28
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$14.03
|
| Rate for Payer: Priority Health SBD |
$13.89
|
| Rate for Payer: Priority Health SBD |
$10.62
|
| Rate for Payer: Priority Health SBD |
$14.00
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
NDC 00713052612
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna Commercial |
$135.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.35
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$111.30
|
| Rate for Payer: Cofinity Commercial |
$136.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$111.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$127.20
|
| Rate for Payer: Healthscope Commercial |
$143.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$135.15
|
| Rate for Payer: PHP Commercial |
$135.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.35
|
| Rate for Payer: Priority Health SBD |
$100.17
|
|
