|
PROCEDURES FOR OBESITY
|
Facility
|
IP
|
$25,844.36
|
|
|
Service Code
|
APR-DRG 4034
|
| Min. Negotiated Rate |
$24,613.68 |
| Max. Negotiated Rate |
$25,844.36 |
| Rate for Payer: BCBS Complete |
$25,844.36
|
| Rate for Payer: Mclaren Medicaid |
$24,613.68
|
| Rate for Payer: Meridian Medicaid |
$25,844.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$24,613.68
|
| Rate for Payer: UHC Medicaid |
$24,613.68
|
| Rate for Payer: UHCCP Medicaid |
$24,613.68
|
|
|
PROCEDURES FOR OBESITY
|
Facility
|
IP
|
$5,832.18
|
|
|
Service Code
|
APR-DRG 4031
|
| Min. Negotiated Rate |
$5,554.46 |
| Max. Negotiated Rate |
$5,832.18 |
| Rate for Payer: BCBS Complete |
$5,832.18
|
| Rate for Payer: Mclaren Medicaid |
$5,554.46
|
| Rate for Payer: Meridian Medicaid |
$5,832.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,554.46
|
| Rate for Payer: UHC Medicaid |
$5,554.46
|
| Rate for Payer: UHCCP Medicaid |
$5,554.46
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SE
|
Facility
|
IP
|
$15,958.38
|
|
|
Service Code
|
APR-DRG 8502
|
| Min. Negotiated Rate |
$15,198.46 |
| Max. Negotiated Rate |
$15,958.38 |
| Rate for Payer: BCBS Complete |
$15,958.38
|
| Rate for Payer: Mclaren Medicaid |
$15,198.46
|
| Rate for Payer: Meridian Medicaid |
$15,958.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$15,198.46
|
| Rate for Payer: UHC Medicaid |
$15,198.46
|
| Rate for Payer: UHCCP Medicaid |
$15,198.46
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SE
|
Facility
|
IP
|
$26,421.10
|
|
|
Service Code
|
APR-DRG 8503
|
| Min. Negotiated Rate |
$25,162.96 |
| Max. Negotiated Rate |
$26,421.10 |
| Rate for Payer: BCBS Complete |
$26,421.10
|
| Rate for Payer: Mclaren Medicaid |
$25,162.96
|
| Rate for Payer: Meridian Medicaid |
$26,421.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,162.96
|
| Rate for Payer: UHC Medicaid |
$25,162.96
|
| Rate for Payer: UHCCP Medicaid |
$25,162.96
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SE
|
Facility
|
IP
|
$60,309.44
|
|
|
Service Code
|
APR-DRG 8504
|
| Min. Negotiated Rate |
$57,437.56 |
| Max. Negotiated Rate |
$60,309.44 |
| Rate for Payer: BCBS Complete |
$60,309.44
|
| Rate for Payer: Mclaren Medicaid |
$57,437.56
|
| Rate for Payer: Meridian Medicaid |
$60,309.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$57,437.56
|
| Rate for Payer: UHC Medicaid |
$57,437.56
|
| Rate for Payer: UHCCP Medicaid |
$57,437.56
|
|
|
PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SE
|
Facility
|
IP
|
$8,375.34
|
|
|
Service Code
|
APR-DRG 8501
|
| Min. Negotiated Rate |
$7,976.51 |
| Max. Negotiated Rate |
$8,375.34 |
| Rate for Payer: BCBS Complete |
$8,375.34
|
| Rate for Payer: Mclaren Medicaid |
$7,976.51
|
| Rate for Payer: Meridian Medicaid |
$8,375.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$7,976.51
|
| Rate for Payer: UHC Medicaid |
$7,976.51
|
| Rate for Payer: UHCCP Medicaid |
$7,976.51
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$359.78
|
|
|
Service Code
|
NDC 00713013512
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.39 |
| Max. Negotiated Rate |
$323.80 |
| Rate for Payer: Aetna Commercial |
$305.81
|
| Rate for Payer: Aetna Medicare |
$179.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.86
|
| Rate for Payer: BCBS Complete |
$143.91
|
| Rate for Payer: Cash Price |
$287.82
|
| Rate for Payer: Cofinity Advantage |
$251.85
|
| Rate for Payer: Cofinity Commercial |
$309.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.82
|
| Rate for Payer: Healthscope Commercial |
$323.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.83
|
| Rate for Payer: PHP Commercial |
$305.81
|
| Rate for Payer: Priority Health SBD |
$226.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.86
|
| Rate for Payer: UHC Core |
$187.45
|
| Rate for Payer: UHC Exchange |
$141.39
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$335.36
|
|
|
Service Code
|
NDC 00574722612
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.28 |
| Max. Negotiated Rate |
$301.82 |
| Rate for Payer: Aetna Commercial |
$285.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.98
|
| Rate for Payer: Cash Price |
$268.29
|
| Rate for Payer: Cofinity Advantage |
$234.75
|
| Rate for Payer: Cofinity Commercial |
$288.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.29
|
| Rate for Payer: Healthscope Commercial |
$301.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.52
|
| Rate for Payer: PHP Commercial |
$285.06
|
| Rate for Payer: Priority Health SBD |
$211.28
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$335.36
|
|
|
Service Code
|
NDC 00574722612
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$301.82 |
| Rate for Payer: Aetna Commercial |
$285.06
|
| Rate for Payer: Aetna Medicare |
$167.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.98
|
| Rate for Payer: BCBS Complete |
$134.14
|
| Rate for Payer: Cash Price |
$268.29
|
| Rate for Payer: Cofinity Advantage |
$234.75
|
| Rate for Payer: Cofinity Commercial |
$288.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.29
|
| Rate for Payer: Healthscope Commercial |
$301.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$268.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.52
|
| Rate for Payer: PHP Commercial |
$285.06
|
| Rate for Payer: Priority Health SBD |
$211.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.98
|
| Rate for Payer: UHC Core |
$174.72
|
| Rate for Payer: UHC Exchange |
$131.80
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$29.99
|
|
|
Service Code
|
NDC 00713013506
|
| 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 Advantage |
$20.99
|
| Rate for Payer: Cofinity Commercial |
$25.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.99
|
| Rate for Payer: Healthscope Commercial |
$26.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.49
|
| Rate for Payer: PHP Commercial |
$25.49
|
| Rate for Payer: Priority Health SBD |
$18.89
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$29.99
|
|
|
Service Code
|
NDC 00713013506
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$26.99 |
| Rate for Payer: Aetna Commercial |
$25.49
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.49
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Cofinity Advantage |
$20.99
|
| Rate for Payer: Cofinity Commercial |
$25.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.99
|
| Rate for Payer: Healthscope Commercial |
$26.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.49
|
| Rate for Payer: PHP Commercial |
$25.49
|
| Rate for Payer: Priority Health SBD |
$18.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.49
|
| Rate for Payer: UHC Core |
$15.62
|
| Rate for Payer: UHC Exchange |
$11.79
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$359.78
|
|
|
Service Code
|
NDC 00713013512
|
| 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 Advantage |
$251.85
|
| Rate for Payer: Cofinity Commercial |
$309.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.82
|
| Rate for Payer: Healthscope Commercial |
$323.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.83
|
| Rate for Payer: PHP Commercial |
$305.81
|
| Rate for Payer: Priority Health SBD |
$226.66
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$29.82
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$26.84 |
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna Commercial |
$23.96
|
| Rate for Payer: Aetna Commercial |
$35.40
|
| Rate for Payer: Aetna Commercial |
$42.70
|
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$29.50
|
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Aetna Medicare |
$19.42
|
| Rate for Payer: Aetna Medicare |
$17.36
|
| Rate for Payer: Aetna Medicare |
$14.10
|
| Rate for Payer: Aetna Medicare |
$14.91
|
| Rate for Payer: Aetna Medicare |
$15.85
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Aetna Medicare |
$25.11
|
| Rate for Payer: Aetna Medicare |
$20.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.07
|
| Rate for Payer: BCBS Complete |
$13.88
|
| Rate for Payer: BCBS Complete |
$20.09
|
| Rate for Payer: BCBS Complete |
$11.93
|
| Rate for Payer: BCBS Complete |
$12.68
|
| Rate for Payer: BCBS Complete |
$16.66
|
| Rate for Payer: BCBS Complete |
$11.28
|
| Rate for Payer: BCBS Complete |
$30.63
|
| Rate for Payer: BCBS Complete |
$15.54
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCBS Trust/PPO |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: BCN Commercial |
$6.30
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$25.36
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cash Price |
$25.36
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$33.32
|
| Rate for Payer: Cash Price |
$33.32
|
| Rate for Payer: Cash Price |
$40.18
|
| Rate for Payer: Cash Price |
$40.18
|
| Rate for Payer: Cash Price |
$61.26
|
| Rate for Payer: Cash Price |
$61.26
|
| Rate for Payer: Cofinity Advantage |
$19.73
|
| Rate for Payer: Cofinity Advantage |
$29.16
|
| Rate for Payer: Cofinity Advantage |
$22.19
|
| Rate for Payer: Cofinity Advantage |
$53.60
|
| Rate for Payer: Cofinity Advantage |
$20.87
|
| Rate for Payer: Cofinity Advantage |
$24.30
|
| Rate for Payer: Cofinity Advantage |
$27.19
|
| Rate for Payer: Cofinity Advantage |
$35.16
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Cofinity Commercial |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$65.85
|
| Rate for Payer: Cofinity Commercial |
$35.82
|
| Rate for Payer: Cofinity Commercial |
$24.24
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.32
|
| Rate for Payer: Healthscope Commercial |
$25.37
|
| Rate for Payer: Healthscope Commercial |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$68.91
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$31.24
|
| Rate for Payer: Healthscope Commercial |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.03
|
| Rate for Payer: PHP Commercial |
$26.95
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$23.96
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: PHP Commercial |
$42.70
|
| Rate for Payer: PHP Commercial |
$29.50
|
| Rate for Payer: PHP Commercial |
$65.08
|
| Rate for Payer: PHP Commercial |
$35.40
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: Priority Health SBD |
$48.24
|
| Rate for Payer: Priority Health SBD |
$26.24
|
| Rate for Payer: Priority Health SBD |
$19.97
|
| Rate for Payer: Priority Health SBD |
$24.47
|
| Rate for Payer: Priority Health SBD |
$31.64
|
| Rate for Payer: Priority Health SBD |
$17.76
|
| Rate for Payer: Priority Health SBD |
$21.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.16
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
| Rate for Payer: UHC Exchange |
$4.16
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$38.84
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$29.50
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Aetna Commercial |
$23.96
|
| Rate for Payer: Aetna Commercial |
$42.70
|
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Aetna Commercial |
$35.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.32
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cash Price |
$25.36
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Cash Price |
$61.26
|
| Rate for Payer: Cash Price |
$40.18
|
| Rate for Payer: Cash Price |
$33.32
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cofinity Advantage |
$22.19
|
| Rate for Payer: Cofinity Advantage |
$35.16
|
| Rate for Payer: Cofinity Advantage |
$24.30
|
| Rate for Payer: Cofinity Advantage |
$19.73
|
| Rate for Payer: Cofinity Advantage |
$20.87
|
| Rate for Payer: Cofinity Advantage |
$53.60
|
| Rate for Payer: Cofinity Advantage |
$27.19
|
| Rate for Payer: Cofinity Advantage |
$29.16
|
| Rate for Payer: Cofinity Commercial |
$24.24
|
| Rate for Payer: Cofinity Commercial |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$35.82
|
| Rate for Payer: Cofinity Commercial |
$65.85
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.26
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Healthscope Commercial |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$45.21
|
| Rate for Payer: Healthscope Commercial |
$25.37
|
| Rate for Payer: Healthscope Commercial |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$31.24
|
| Rate for Payer: Healthscope Commercial |
$68.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.43
|
| Rate for Payer: PHP Commercial |
$65.08
|
| Rate for Payer: PHP Commercial |
$23.96
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: PHP Commercial |
$26.95
|
| Rate for Payer: PHP Commercial |
$29.50
|
| Rate for Payer: PHP Commercial |
$42.70
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$35.40
|
| Rate for Payer: Priority Health SBD |
$21.87
|
| Rate for Payer: Priority Health SBD |
$31.64
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: Priority Health SBD |
$17.76
|
| Rate for Payer: Priority Health SBD |
$19.97
|
| Rate for Payer: Priority Health SBD |
$24.47
|
| Rate for Payer: Priority Health SBD |
$48.24
|
| Rate for Payer: Priority Health SBD |
$26.24
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$462.65
|
|
|
Service Code
|
NDC 59746011506
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.82 |
| Max. Negotiated Rate |
$416.38 |
| Rate for Payer: Aetna Commercial |
$393.25
|
| Rate for Payer: Aetna Medicare |
$231.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.72
|
| Rate for Payer: BCBS Complete |
$185.06
|
| Rate for Payer: Cash Price |
$370.12
|
| Rate for Payer: Cofinity Advantage |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$397.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.12
|
| Rate for Payer: Healthscope Commercial |
$416.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.99
|
| Rate for Payer: PHP Commercial |
$393.25
|
| Rate for Payer: Priority Health SBD |
$291.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.72
|
| Rate for Payer: UHC Core |
$241.04
|
| Rate for Payer: UHC Exchange |
$181.82
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 51079054201
|
| 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 Advantage |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health SBD |
$1.91
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$6.46
|
|
|
Service Code
|
NDC 50268068511
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna Commercial |
$5.49
|
| Rate for Payer: Aetna Medicare |
$3.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.20
|
| Rate for Payer: BCBS Complete |
$2.58
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cofinity Advantage |
$4.52
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.17
|
| Rate for Payer: Healthscope Commercial |
$5.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.84
|
| Rate for Payer: PHP Commercial |
$5.49
|
| Rate for Payer: Priority Health SBD |
$4.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.20
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Exchange |
$2.54
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$302.88
|
|
|
Service Code
|
NDC 51079054220
|
| 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 Advantage |
$212.02
|
| Rate for Payer: Cofinity Commercial |
$260.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.30
|
| Rate for Payer: Healthscope Commercial |
$272.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.16
|
| Rate for Payer: PHP Commercial |
$257.45
|
| Rate for Payer: Priority Health SBD |
$190.81
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$322.80
|
|
|
Service Code
|
NDC 50268068515
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.36 |
| Max. Negotiated Rate |
$290.52 |
| Rate for Payer: Aetna Commercial |
$274.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.82
|
| Rate for Payer: Cash Price |
$258.24
|
| Rate for Payer: Cofinity Advantage |
$225.96
|
| Rate for Payer: Cofinity Commercial |
$277.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.24
|
| Rate for Payer: Healthscope Commercial |
$290.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.10
|
| Rate for Payer: PHP Commercial |
$274.38
|
| Rate for Payer: Priority Health SBD |
$203.36
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$322.80
|
|
|
Service Code
|
NDC 50268068515
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.86 |
| Max. Negotiated Rate |
$290.52 |
| Rate for Payer: Aetna Commercial |
$274.38
|
| Rate for Payer: Aetna Medicare |
$161.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.82
|
| Rate for Payer: BCBS Complete |
$129.12
|
| Rate for Payer: Cash Price |
$258.24
|
| Rate for Payer: Cofinity Advantage |
$225.96
|
| Rate for Payer: Cofinity Commercial |
$277.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.24
|
| Rate for Payer: Healthscope Commercial |
$290.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.10
|
| Rate for Payer: PHP Commercial |
$274.38
|
| Rate for Payer: Priority Health SBD |
$203.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.82
|
| Rate for Payer: UHC Core |
$168.18
|
| Rate for Payer: UHC Exchange |
$126.86
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$302.88
|
|
|
Service Code
|
NDC 51079054220
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.03 |
| Max. Negotiated Rate |
$272.59 |
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna Medicare |
$151.44
|
| 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 Advantage |
$212.02
|
| Rate for Payer: Cofinity Commercial |
$260.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.30
|
| Rate for Payer: Healthscope Commercial |
$272.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.16
|
| Rate for Payer: PHP Commercial |
$257.45
|
| Rate for Payer: Priority Health SBD |
$190.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.87
|
| Rate for Payer: UHC Core |
$157.80
|
| Rate for Payer: UHC Exchange |
$119.03
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$462.65
|
|
|
Service Code
|
NDC 59746011506
|
| 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 Advantage |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$397.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.12
|
| Rate for Payer: Healthscope Commercial |
$416.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.99
|
| Rate for Payer: PHP Commercial |
$393.25
|
| Rate for Payer: Priority Health SBD |
$291.47
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$6.46
|
|
|
Service Code
|
NDC 50268068511
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.07 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna Commercial |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.20
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cofinity Advantage |
$4.52
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.17
|
| Rate for Payer: Healthscope Commercial |
$5.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.84
|
| Rate for Payer: PHP Commercial |
$5.49
|
| Rate for Payer: Priority Health SBD |
$4.07
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
NDC 51079054201
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| 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 Advantage |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health SBD |
$1.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.97
|
| Rate for Payer: UHC Core |
$1.58
|
| Rate for Payer: UHC Exchange |
$1.19
|
|
|
PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 99241
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.00
|
|
