|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 33813
|
| Min. Negotiated Rate |
$783.20 |
| Max. Negotiated Rate |
$1,945.36 |
| Rate for Payer: Aetna Commercial |
$1,663.43
|
| Rate for Payer: BCBS Complete |
$822.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.52
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Mclaren Medicaid |
$783.20
|
| Rate for Payer: Meridian Medicaid |
$822.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$783.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,945.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,945.36
|
| Rate for Payer: Priority Health SBD |
$1,945.36
|
|
|
PR OBSERVATION CARE DISCHARGE MANAGEMENT
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 99217
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$308.53 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$308.53
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Mclaren Medicaid |
$11.50
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.38
|
| Rate for Payer: Priority Health Narrow Network |
$23.38
|
| Rate for Payer: Priority Health SBD |
$23.38
|
|
|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$195.11
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
6562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.92 |
| Max. Negotiated Rate |
$175.60 |
| Rate for Payer: Aetna Commercial |
$165.84
|
| Rate for Payer: Aetna Commercial |
$1,328.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.56
|
| Rate for Payer: Cash Price |
$156.09
|
| Rate for Payer: Cash Price |
$1,249.92
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$1,093.68
|
| Rate for Payer: Cofinity Commercial |
$1,343.66
|
| Rate for Payer: Cofinity Commercial |
$136.58
|
| Rate for Payer: Healthscope Commercial |
$1,406.16
|
| Rate for Payer: Healthscope Commercial |
$175.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,328.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.84
|
| Rate for Payer: PHP Commercial |
$165.84
|
| Rate for Payer: PHP Commercial |
$1,328.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,093.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health SBD |
$984.31
|
| Rate for Payer: Priority Health SBD |
$122.92
|
|
|
PR OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 58615
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$361.22 |
| Rate for Payer: Aetna Commercial |
$302.21
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS Trust/PPO |
$151.62
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Mclaren Medicaid |
$163.37
|
| Rate for Payer: Meridian Medicaid |
$171.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.22
|
| Rate for Payer: Priority Health Narrow Network |
$361.22
|
| Rate for Payer: Priority Health SBD |
$361.22
|
|
|
PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 97165
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$648.75 |
| Rate for Payer: Aetna Commercial |
$71.15
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$648.75
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.00
|
| Rate for Payer: Priority Health Narrow Network |
$90.00
|
| Rate for Payer: Priority Health SBD |
$90.00
|
|
|
PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 97166
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$1,059.24 |
| Rate for Payer: Aetna Commercial |
$71.15
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.24
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.00
|
| Rate for Payer: Priority Health Narrow Network |
$90.00
|
| Rate for Payer: Priority Health SBD |
$90.00
|
|
|
PR OCCUPATIONAL THERAPY EVALUATION
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 97003
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
|
|
PR OCCUPATIONAL THERAPY RE-EVALUATION
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 97004
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
|
|
PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 97168
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$2,076.22 |
| Rate for Payer: Aetna Commercial |
$47.84
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.22
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.00
|
| Rate for Payer: Priority Health Narrow Network |
$45.00
|
| Rate for Payer: Priority Health SBD |
$45.00
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$367.50
|
|
|
Service Code
|
NDC 0574-7226-12
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.52 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Aetna Commercial |
$312.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.88
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cofinity Commercial |
$257.25
|
| Rate for Payer: Cofinity Commercial |
$316.05
|
| Rate for Payer: Healthscope Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.38
|
| Rate for Payer: PHP Commercial |
$312.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.25
|
| Rate for Payer: Priority Health SBD |
$231.52
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$359.78
|
|
|
Service Code
|
NDC 0713-0135-12
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$226.66 |
| Max. Negotiated Rate |
$323.80 |
| Rate for Payer: Aetna Commercial |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.86
|
| Rate for Payer: Cash Price |
$287.82
|
| Rate for Payer: Cofinity Commercial |
$251.85
|
| Rate for Payer: Cofinity Commercial |
$309.41
|
| Rate for Payer: Healthscope Commercial |
$323.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.81
|
| Rate for Payer: PHP Commercial |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.85
|
| Rate for Payer: Priority Health SBD |
$226.66
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$29.99
|
|
|
Service Code
|
NDC 0713-0135-06
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.89 |
| Max. Negotiated Rate |
$26.99 |
| Rate for Payer: Aetna Commercial |
$25.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.49
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$20.99
|
| Rate for Payer: Cofinity Commercial |
$25.79
|
| Rate for Payer: Healthscope Commercial |
$26.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.49
|
| Rate for Payer: PHP Commercial |
$25.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.99
|
| Rate for Payer: Priority Health SBD |
$18.89
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$37.25
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.47 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$41.05
|
| Rate for Payer: Aetna Commercial |
$43.48
|
| Rate for Payer: Aetna Commercial |
$49.01
|
| Rate for Payer: Aetna Commercial |
$48.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Cash Price |
$46.13
|
| Rate for Payer: Cash Price |
$40.92
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$26.08
|
| Rate for Payer: Cofinity Commercial |
$32.04
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$33.80
|
| Rate for Payer: Cofinity Commercial |
$41.53
|
| Rate for Payer: Cofinity Commercial |
$35.80
|
| Rate for Payer: Cofinity Commercial |
$43.99
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Cofinity Commercial |
$49.01
|
| Rate for Payer: Cofinity Commercial |
$40.36
|
| Rate for Payer: Cofinity Commercial |
$49.59
|
| Rate for Payer: Healthscope Commercial |
$51.29
|
| Rate for Payer: Healthscope Commercial |
$46.04
|
| Rate for Payer: Healthscope Commercial |
$43.46
|
| Rate for Payer: Healthscope Commercial |
$51.89
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.66
|
| Rate for Payer: PHP Commercial |
$48.44
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$43.48
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$49.01
|
| Rate for Payer: PHP Commercial |
$41.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.19
|
| Rate for Payer: Priority Health SBD |
$30.42
|
| Rate for Payer: Priority Health SBD |
$32.22
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: Priority Health SBD |
$35.90
|
| Rate for Payer: Priority Health SBD |
$36.33
|
| Rate for Payer: Priority Health SBD |
$24.47
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$38.84
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: BCBS Complete |
$15.54
|
| Rate for Payer: BCBS Complete |
$14.90
|
| Rate for Payer: BCBS Trust/PPO |
$10.14
|
| Rate for Payer: BCBS Trust/PPO |
$10.14
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$32.04
|
| Rate for Payer: Cofinity Commercial |
$26.08
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.66
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.08
|
| Rate for Payer: Priority Health SBD |
$24.47
|
| Rate for Payer: Priority Health SBD |
$23.47
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$302.88
|
|
|
Service Code
|
NDC 51079-542-20
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.81 |
| Max. Negotiated Rate |
$272.59 |
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.87
|
| Rate for Payer: Cash Price |
$242.30
|
| Rate for Payer: Cofinity Commercial |
$212.02
|
| Rate for Payer: Cofinity Commercial |
$260.48
|
| Rate for Payer: Healthscope Commercial |
$272.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.45
|
| Rate for Payer: PHP Commercial |
$257.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.02
|
| Rate for Payer: Priority Health SBD |
$190.81
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$462.65
|
|
|
Service Code
|
NDC 59746-115-06
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.47 |
| Max. Negotiated Rate |
$416.38 |
| Rate for Payer: Aetna Commercial |
$393.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.72
|
| Rate for Payer: Cash Price |
$370.12
|
| Rate for Payer: Cofinity Commercial |
$397.88
|
| Rate for Payer: Cofinity Commercial |
$323.86
|
| Rate for Payer: Healthscope Commercial |
$416.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$393.25
|
| Rate for Payer: PHP Commercial |
$393.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$323.86
|
| Rate for Payer: Priority Health SBD |
$291.47
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$302.88
|
|
|
Service Code
|
NDC 51079-542-20
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.15 |
| Max. Negotiated Rate |
$272.59 |
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.87
|
| Rate for Payer: BCBS Complete |
$121.15
|
| Rate for Payer: Cash Price |
$242.30
|
| Rate for Payer: Cofinity Commercial |
$212.02
|
| Rate for Payer: Cofinity Commercial |
$260.48
|
| Rate for Payer: Healthscope Commercial |
$272.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.45
|
| Rate for Payer: PHP Commercial |
$257.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.02
|
| Rate for Payer: Priority Health SBD |
$190.81
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 51079-542-01
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.97
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.91
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
NDC 51079-542-01
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.97
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.91
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$286.56
|
|
|
Service Code
|
NDC 50268-685-15
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.53 |
| Max. Negotiated Rate |
$257.90 |
| Rate for Payer: Aetna Commercial |
$243.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.26
|
| Rate for Payer: Cash Price |
$229.25
|
| Rate for Payer: Cofinity Commercial |
$200.59
|
| Rate for Payer: Cofinity Commercial |
$246.44
|
| Rate for Payer: Healthscope Commercial |
$257.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.58
|
| Rate for Payer: PHP Commercial |
$243.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.59
|
| Rate for Payer: Priority Health SBD |
$180.53
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
NDC 50268-685-11
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Aetna Commercial |
$4.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.73
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Healthscope Commercial |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.88
|
| Rate for Payer: PHP Commercial |
$4.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.02
|
| Rate for Payer: Priority Health SBD |
$3.62
|
|
|
PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE
|
Facility
|
OP
|
$7,606.62
|
|
|
Service Code
|
CPT 45505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$594.31 |
| Max. Negotiated Rate |
$7,606.62 |
| Rate for Payer: Aetna Medicare |
$2,598.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,122.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,122.94
|
| Rate for Payer: BCBS Complete |
$1,435.05
|
| Rate for Payer: BCBS MAPPO |
$2,498.35
|
| Rate for Payer: BCBS Trust/PPO |
$1,249.12
|
| Rate for Payer: BCN Medicare Advantage |
$2,498.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,498.35
|
| Rate for Payer: Mclaren Medicaid |
$1,366.60
|
| Rate for Payer: Mclaren Medicare |
$2,498.35
|
| Rate for Payer: Meridian Medicaid |
$1,435.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,623.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,873.10
|
| Rate for Payer: PACE Medicare |
$2,373.43
|
| Rate for Payer: PACE SWMI |
$2,498.35
|
| Rate for Payer: PHP Medicare Advantage |
$2,498.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,366.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,606.62
|
| Rate for Payer: Priority Health Medicare |
$2,498.35
|
| Rate for Payer: Priority Health Narrow Network |
$6,085.30
|
| Rate for Payer: Railroad Medicare Medicare |
$2,498.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$653.74
|
| Rate for Payer: UHC Core |
$5,427.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,498.35
|
| Rate for Payer: UHC Exchange |
$594.31
|
| Rate for Payer: UHC Medicare Advantage |
$2,573.30
|
| Rate for Payer: VA VA |
$2,498.35
|
|
|
PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 99241
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$77.70 |
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 99245
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$254.80 |
| Rate for Payer: Aetna Commercial |
$196.80
|
| Rate for Payer: BCBS Complete |
$119.88
|
| Rate for Payer: BCBS Trust/PPO |
$202.34
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Mclaren Medicaid |
$114.17
|
| Rate for Payer: Meridian Medicaid |
$119.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.16
|
| Rate for Payer: Priority Health Narrow Network |
$229.16
|
| Rate for Payer: Priority Health SBD |
$229.16
|
|
