|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$185.15
|
|
|
Service Code
|
NDC 00713053612
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$166.63 |
| Rate for Payer: Aetna Commercial |
$157.38
|
| Rate for Payer: Aetna Medicare |
$92.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.35
|
| Rate for Payer: BCBS Complete |
$74.06
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cofinity Advantage |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$159.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.12
|
| Rate for Payer: Healthscope Commercial |
$166.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.86
|
| Rate for Payer: PHP Commercial |
$157.38
|
| Rate for Payer: Priority Health SBD |
$116.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.35
|
| Rate for Payer: UHC Core |
$96.46
|
| Rate for Payer: UHC Exchange |
$72.76
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$20.84
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$18.76 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$18.74
|
| Rate for Payer: Aetna Commercial |
$18.93
|
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Medicare |
$8.43
|
| Rate for Payer: Aetna Medicare |
$10.42
|
| Rate for Payer: Aetna Medicare |
$11.03
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: Aetna Medicare |
$11.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.33
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS Complete |
$8.91
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS Complete |
$8.34
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS Complete |
$8.89
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: Cash Price |
$17.80
|
| 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 |
$13.48
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cofinity Advantage |
$11.79
|
| Rate for Payer: Cofinity Advantage |
$15.57
|
| Rate for Payer: Cofinity Advantage |
$15.56
|
| Rate for Payer: Cofinity Advantage |
$15.59
|
| Rate for Payer: Cofinity Advantage |
$15.44
|
| Rate for Payer: Cofinity Advantage |
$14.59
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$17.92
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.78
|
| 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 |
$16.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$20.01
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$18.76
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: PHP Commercial |
$18.90
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$18.74
|
| Rate for Payer: PHP Commercial |
$14.32
|
| Rate for Payer: PHP Commercial |
$18.93
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health SBD |
$14.02
|
| Rate for Payer: Priority Health SBD |
$13.13
|
| Rate for Payer: Priority Health SBD |
$14.03
|
| Rate for Payer: Priority Health SBD |
$14.00
|
| Rate for Payer: Priority Health SBD |
$13.89
|
| Rate for Payer: Priority Health SBD |
$10.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$6.55
|
| Rate for Payer: UHC Core |
$6.55
|
| Rate for Payer: UHC Core |
$6.55
|
| Rate for Payer: UHC Core |
$6.55
|
| Rate for Payer: UHC Core |
$6.55
|
| Rate for Payer: UHC Core |
$6.55
|
| Rate for Payer: UHC Exchange |
$6.55
|
| Rate for Payer: UHC Exchange |
$6.55
|
| Rate for Payer: UHC Exchange |
$6.55
|
| Rate for Payer: UHC Exchange |
$6.55
|
| Rate for Payer: UHC Exchange |
$6.55
|
| Rate for Payer: UHC Exchange |
$6.55
|
|
|
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 |
$17.71
|
| Rate for Payer: Aetna Commercial |
$18.90
|
| 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 New Business (MI Preferred) |
$14.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cofinity Advantage |
$15.59
|
| Rate for Payer: Cofinity Advantage |
$15.56
|
| Rate for Payer: Cofinity Advantage |
$15.57
|
| Rate for Payer: Cofinity Advantage |
$15.44
|
| Rate for Payer: Cofinity Advantage |
$14.59
|
| Rate for Payer: Cofinity Advantage |
$11.79
|
| Rate for Payer: Cofinity Commercial |
$19.12
|
| Rate for Payer: Cofinity Commercial |
$18.96
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$17.92
|
| Rate for Payer: Cofinity Commercial |
$19.15
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$20.04
|
| Rate for Payer: Healthscope Commercial |
$19.84
|
| Rate for Payer: Healthscope Commercial |
$18.76
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$20.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| 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 |
$18.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.63
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$14.32
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$18.93
|
| Rate for Payer: PHP Commercial |
$18.74
|
| Rate for Payer: PHP Commercial |
$18.90
|
| Rate for Payer: Priority Health SBD |
$14.03
|
| Rate for Payer: Priority Health SBD |
$13.89
|
| Rate for Payer: Priority Health SBD |
$14.00
|
| Rate for Payer: Priority Health SBD |
$10.62
|
| Rate for Payer: Priority Health SBD |
$13.13
|
| Rate for Payer: Priority Health SBD |
$14.02
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$145.28
|
|
|
Service Code
|
NDC 00713052612
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.53 |
| Max. Negotiated Rate |
$130.75 |
| Rate for Payer: Aetna Commercial |
$123.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.43
|
| Rate for Payer: Cash Price |
$116.22
|
| Rate for Payer: Cofinity Advantage |
$101.70
|
| Rate for Payer: Cofinity Commercial |
$124.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.22
|
| Rate for Payer: Healthscope Commercial |
$130.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.96
|
| Rate for Payer: PHP Commercial |
$123.49
|
| Rate for Payer: Priority Health SBD |
$91.53
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$145.28
|
|
|
Service Code
|
NDC 00713052612
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$130.75 |
| Rate for Payer: Aetna Commercial |
$123.49
|
| Rate for Payer: Aetna Medicare |
$72.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.43
|
| Rate for Payer: BCBS Complete |
$58.11
|
| Rate for Payer: Cash Price |
$116.22
|
| Rate for Payer: Cofinity Advantage |
$101.70
|
| Rate for Payer: Cofinity Commercial |
$124.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.22
|
| Rate for Payer: Healthscope Commercial |
$130.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.96
|
| Rate for Payer: PHP Commercial |
$123.49
|
| Rate for Payer: Priority Health SBD |
$91.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.43
|
| Rate for Payer: UHC Core |
$75.69
|
| Rate for Payer: UHC Exchange |
$57.10
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.41 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.44
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Advantage |
$176.01
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.59
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health SBD |
$158.41
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.82 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$125.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$163.44
|
| Rate for Payer: BCBS Complete |
$100.58
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Advantage |
$176.01
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.59
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health SBD |
$158.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.44
|
| Rate for Payer: UHC Core |
$131.01
|
| Rate for Payer: UHC Exchange |
$98.82
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$103.40
|
|
|
Service Code
|
NDC 10702000301
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.14 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Advantage |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health SBD |
$65.14
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$103.40
|
|
|
Service Code
|
NDC 10702000301
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.64 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna Medicare |
$51.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: BCBS Complete |
$41.36
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Advantage |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.55
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.21
|
| Rate for Payer: UHC Core |
$53.87
|
| Rate for Payer: UHC Exchange |
$40.64
|
|
|
PROMETHAZINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$23.74
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$21.37 |
| Rate for Payer: Aetna Commercial |
$20.18
|
| Rate for Payer: Aetna Medicare |
$11.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.43
|
| Rate for Payer: BCBS Complete |
$9.50
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cofinity Advantage |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.99
|
| Rate for Payer: Healthscope Commercial |
$21.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.80
|
| Rate for Payer: PHP Commercial |
$20.18
|
| Rate for Payer: Priority Health SBD |
$14.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$6.55
|
| Rate for Payer: UHC Exchange |
$6.55
|
|
|
PROMETHAZINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.74
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$21.37 |
| Rate for Payer: Aetna Commercial |
$20.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.43
|
| Rate for Payer: Cash Price |
$18.99
|
| Rate for Payer: Cofinity Advantage |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$20.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.99
|
| Rate for Payer: Healthscope Commercial |
$21.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.80
|
| Rate for Payer: PHP Commercial |
$20.18
|
| Rate for Payer: Priority Health SBD |
$14.96
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$389.05
|
|
|
Service Code
|
NDC 60432060816
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.10 |
| Max. Negotiated Rate |
$350.14 |
| Rate for Payer: Aetna Commercial |
$330.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.88
|
| Rate for Payer: Cash Price |
$311.24
|
| Rate for Payer: Cofinity Advantage |
$272.33
|
| Rate for Payer: Cofinity Commercial |
$334.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.24
|
| Rate for Payer: Healthscope Commercial |
$350.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.79
|
| Rate for Payer: PHP Commercial |
$330.69
|
| Rate for Payer: Priority Health SBD |
$245.10
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$206.94
|
|
|
Service Code
|
NDC 00121092716
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.37 |
| Max. Negotiated Rate |
$186.25 |
| Rate for Payer: Aetna Commercial |
$175.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.51
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cofinity Advantage |
$144.86
|
| Rate for Payer: Cofinity Commercial |
$177.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.55
|
| Rate for Payer: Healthscope Commercial |
$186.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.21
|
| Rate for Payer: PHP Commercial |
$175.90
|
| Rate for Payer: Priority Health SBD |
$130.37
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$206.94
|
|
|
Service Code
|
NDC 00121092716
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.33 |
| Max. Negotiated Rate |
$186.25 |
| Rate for Payer: Aetna Commercial |
$175.90
|
| Rate for Payer: Aetna Medicare |
$103.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.51
|
| Rate for Payer: BCBS Complete |
$82.78
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cofinity Advantage |
$144.86
|
| Rate for Payer: Cofinity Commercial |
$177.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.55
|
| Rate for Payer: Healthscope Commercial |
$186.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$165.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.21
|
| Rate for Payer: PHP Commercial |
$175.90
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.51
|
| Rate for Payer: UHC Core |
$107.82
|
| Rate for Payer: UHC Exchange |
$81.33
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$389.05
|
|
|
Service Code
|
NDC 60432060816
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.90 |
| Max. Negotiated Rate |
$350.14 |
| Rate for Payer: Aetna Commercial |
$330.69
|
| Rate for Payer: Aetna Medicare |
$194.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.88
|
| Rate for Payer: BCBS Complete |
$155.62
|
| Rate for Payer: Cash Price |
$311.24
|
| Rate for Payer: Cofinity Advantage |
$272.33
|
| Rate for Payer: Cofinity Commercial |
$334.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.24
|
| Rate for Payer: Healthscope Commercial |
$350.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$311.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.79
|
| Rate for Payer: PHP Commercial |
$330.69
|
| Rate for Payer: Priority Health SBD |
$245.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.88
|
| Rate for Payer: UHC Core |
$202.70
|
| Rate for Payer: UHC Exchange |
$152.90
|
|
|
PROMETHAZINE-DM 6.25 MG-15 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$766.97
|
|
|
Service Code
|
NDC 60432060416
|
| Hospital Charge Code |
11145
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$483.19 |
| Max. Negotiated Rate |
$690.27 |
| Rate for Payer: Aetna Commercial |
$651.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.53
|
| Rate for Payer: Cash Price |
$613.58
|
| Rate for Payer: Cofinity Advantage |
$536.88
|
| Rate for Payer: Cofinity Commercial |
$659.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$613.58
|
| Rate for Payer: Healthscope Commercial |
$690.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$575.23
|
| Rate for Payer: PHP Commercial |
$651.92
|
| Rate for Payer: Priority Health SBD |
$483.19
|
|
|
PROMETHAZINE-DM 6.25 MG-15 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$766.97
|
|
|
Service Code
|
NDC 60432060416
|
| Hospital Charge Code |
11145
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.42 |
| Max. Negotiated Rate |
$690.27 |
| Rate for Payer: Aetna Commercial |
$651.92
|
| Rate for Payer: Aetna Medicare |
$383.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$498.53
|
| Rate for Payer: BCBS Complete |
$306.79
|
| Rate for Payer: Cash Price |
$613.58
|
| Rate for Payer: Cofinity Advantage |
$536.88
|
| Rate for Payer: Cofinity Commercial |
$659.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$613.58
|
| Rate for Payer: Healthscope Commercial |
$690.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$613.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$651.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$575.23
|
| Rate for Payer: PHP Commercial |
$651.92
|
| Rate for Payer: Priority Health SBD |
$483.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.53
|
| Rate for Payer: UHC Core |
$399.59
|
| Rate for Payer: UHC Exchange |
$301.42
|
|
|
PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$2,191.00
|
|
|
Service Code
|
HCPCS 49255
|
| Min. Negotiated Rate |
$479.46 |
| Max. Negotiated Rate |
$1,643.25 |
| Rate for Payer: Aetna Commercial |
$995.18
|
| Rate for Payer: Aetna Medicare |
$772.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,069.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$995.18
|
| Rate for Payer: BCBS Complete |
$503.43
|
| Rate for Payer: BCBS MAPPO |
$742.67
|
| Rate for Payer: BCN Commercial |
$1,197.15
|
| Rate for Payer: BCN Medicare Advantage |
$742.67
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cofinity Commercial |
$995.18
|
| Rate for Payer: Cofinity Commercial |
$1,069.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$742.67
|
| Rate for Payer: Healthscope Commercial |
$1,373.94
|
| Rate for Payer: Healthscope Commercial |
$1,188.27
|
| Rate for Payer: Mclaren Medicaid |
$479.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$779.80
|
| Rate for Payer: Meridian Medicaid |
$503.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$816.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,411.58
|
| Rate for Payer: Nomi Health Commercial |
$891.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,643.25
|
| Rate for Payer: PACE SWMI |
$742.67
|
| Rate for Payer: PHP Medicare Advantage |
$742.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,458.65
|
| Rate for Payer: Priority Health Medicare |
$742.67
|
| Rate for Payer: Priority Health SBD |
$1,458.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,458.65
|
| Rate for Payer: Railroad Medicare Medicare |
$742.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,394.14
|
| Rate for Payer: UHC Core |
$1,394.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$742.67
|
| Rate for Payer: UHC Exchange |
$1,394.14
|
| Rate for Payer: UHC Medicaid |
$479.46
|
| Rate for Payer: UHCCP Medicaid |
$479.46
|
|
|
PR ONDANSETRON HCL INJECTION
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J2405
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Aetna Medicare |
$0.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.13
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Healthscope Commercial |
$0.17
|
| Rate for Payer: Healthscope Commercial |
$0.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.08
|
| Rate for Payer: Nomi Health Commercial |
$0.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: Railroad Medicare Medicare |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.09
|
| Rate for Payer: UHC Core |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.09
|
| Rate for Payer: UHC Exchange |
$0.09
|
|
|
PR ONE AREA LIPOSUCTION - 1 AREA 1.0 HR
|
Professional
|
Both
|
$1,803.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$721.20 |
| Max. Negotiated Rate |
$1,352.25 |
| Rate for Payer: Aetna Medicare |
$901.50
|
| Rate for Payer: BCBS Complete |
$721.20
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,171.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,352.25
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99422
|
| Min. Negotiated Rate |
$19.69 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$29.71
|
| Rate for Payer: Aetna Medicare |
$23.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.92
|
| Rate for Payer: BCBS Complete |
$20.67
|
| Rate for Payer: BCBS MAPPO |
$22.17
|
| Rate for Payer: BCN Commercial |
$49.00
|
| Rate for Payer: BCN Medicare Advantage |
$22.17
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$31.92
|
| Rate for Payer: Cofinity Commercial |
$29.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.17
|
| Rate for Payer: Healthscope Commercial |
$41.01
|
| Rate for Payer: Healthscope Commercial |
$35.47
|
| Rate for Payer: Mclaren Medicaid |
$19.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.28
|
| Rate for Payer: Meridian Medicaid |
$20.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.34
|
| Rate for Payer: Nomi Health Commercial |
$26.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$22.17
|
| Rate for Payer: PHP Medicare Advantage |
$22.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28.81
|
| Rate for Payer: Priority Health Medicare |
$22.17
|
| Rate for Payer: Priority Health SBD |
$28.81
|
| Rate for Payer: Priority Health Tiered Network |
$28.81
|
| Rate for Payer: Railroad Medicare Medicare |
$22.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.03
|
| Rate for Payer: UHC Core |
$38.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$22.17
|
| Rate for Payer: UHC Exchange |
$38.03
|
| Rate for Payer: UHC Medicaid |
$19.69
|
| Rate for Payer: UHCCP Medicaid |
$19.69
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$64.21 |
| Rate for Payer: Aetna Commercial |
$46.51
|
| Rate for Payer: Aetna Medicare |
$36.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.98
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS MAPPO |
$34.71
|
| Rate for Payer: BCN Commercial |
$50.49
|
| Rate for Payer: BCN Medicare Advantage |
$34.71
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$49.98
|
| Rate for Payer: Cofinity Commercial |
$46.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.71
|
| Rate for Payer: Healthscope Commercial |
$64.21
|
| Rate for Payer: Healthscope Commercial |
$55.54
|
| Rate for Payer: Mclaren Medicaid |
$30.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.45
|
| Rate for Payer: Meridian Medicaid |
$32.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.24
|
| Rate for Payer: Nomi Health Commercial |
$41.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$34.71
|
| Rate for Payer: PHP Medicare Advantage |
$34.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$44.73
|
| Rate for Payer: Priority Health Medicare |
$34.71
|
| Rate for Payer: Priority Health SBD |
$44.73
|
| Rate for Payer: Priority Health Tiered Network |
$44.73
|
| Rate for Payer: Railroad Medicare Medicare |
$34.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.56
|
| Rate for Payer: UHC Core |
$60.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$34.71
|
| Rate for Payer: UHC Exchange |
$60.56
|
| Rate for Payer: UHC Medicaid |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$30.86
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$14.65
|
| Rate for Payer: Aetna Medicare |
$11.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.74
|
| Rate for Payer: BCBS Complete |
$10.19
|
| Rate for Payer: BCBS MAPPO |
$10.93
|
| Rate for Payer: BCN Commercial |
$22.41
|
| Rate for Payer: BCN Medicare Advantage |
$10.93
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$15.74
|
| Rate for Payer: Cofinity Commercial |
$14.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.93
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Healthscope Commercial |
$17.49
|
| Rate for Payer: Mclaren Medicaid |
$9.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.48
|
| Rate for Payer: Meridian Medicaid |
$10.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.90
|
| Rate for Payer: Nomi Health Commercial |
$13.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: PACE SWMI |
$10.93
|
| Rate for Payer: PHP Medicare Advantage |
$10.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14.41
|
| Rate for Payer: Priority Health Medicare |
$10.93
|
| Rate for Payer: Priority Health SBD |
$14.41
|
| Rate for Payer: Priority Health Tiered Network |
$14.41
|
| Rate for Payer: Railroad Medicare Medicare |
$10.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.53
|
| Rate for Payer: UHC Core |
$18.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10.93
|
| Rate for Payer: UHC Exchange |
$18.53
|
| Rate for Payer: UHC Medicaid |
$9.70
|
| Rate for Payer: UHCCP Medicaid |
$9.70
|
|
|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,904.00
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$328.66 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna Commercial |
$677.85
|
| Rate for Payer: Aetna Medicare |
$526.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$677.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$728.44
|
| Rate for Payer: BCBS Complete |
$345.09
|
| Rate for Payer: BCBS MAPPO |
$505.86
|
| Rate for Payer: BCN Commercial |
$836.61
|
| Rate for Payer: BCN Medicare Advantage |
$505.86
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cofinity Commercial |
$728.44
|
| Rate for Payer: Cofinity Commercial |
$677.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$505.86
|
| Rate for Payer: Healthscope Commercial |
$935.84
|
| Rate for Payer: Healthscope Commercial |
$809.38
|
| Rate for Payer: Mclaren Medicaid |
$328.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$531.15
|
| Rate for Payer: Meridian Medicaid |
$345.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$556.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$990.43
|
| Rate for Payer: Nomi Health Commercial |
$607.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,178.00
|
| Rate for Payer: PACE SWMI |
$505.86
|
| Rate for Payer: PHP Medicare Advantage |
$505.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$847.30
|
| Rate for Payer: Priority Health Medicare |
$505.86
|
| Rate for Payer: Priority Health SBD |
$847.30
|
| Rate for Payer: Priority Health Tiered Network |
$847.30
|
| Rate for Payer: Railroad Medicare Medicare |
$505.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$950.86
|
| Rate for Payer: UHC Core |
$950.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$505.86
|
| Rate for Payer: UHC Exchange |
$950.86
|
| Rate for Payer: UHC Medicaid |
$328.66
|
| Rate for Payer: UHCCP Medicaid |
$328.66
|
|
|
PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 58943
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$2,088.05 |
| Rate for Payer: Aetna Commercial |
$1,498.63
|
| Rate for Payer: Aetna Medicare |
$1,163.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,498.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,610.47
|
| Rate for Payer: BCBS Complete |
$756.39
|
| Rate for Payer: BCBS MAPPO |
$1,118.38
|
| Rate for Payer: BCN Commercial |
$1,805.68
|
| Rate for Payer: BCN Medicare Advantage |
$1,118.38
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cofinity Commercial |
$1,610.47
|
| Rate for Payer: Cofinity Commercial |
$1,498.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,118.38
|
| Rate for Payer: Healthscope Commercial |
$2,069.00
|
| Rate for Payer: Healthscope Commercial |
$1,789.41
|
| Rate for Payer: Mclaren Medicaid |
$720.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,174.30
|
| Rate for Payer: Meridian Medicaid |
$756.39
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,230.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,088.05
|
| Rate for Payer: Nomi Health Commercial |
$1,342.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,781.25
|
| Rate for Payer: PACE SWMI |
$1,118.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,118.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,828.76
|
| Rate for Payer: Priority Health Medicare |
$1,118.38
|
| Rate for Payer: Priority Health SBD |
$1,828.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,828.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,118.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,055.74
|
| Rate for Payer: UHC Core |
$2,055.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,118.38
|
| Rate for Payer: UHC Exchange |
$2,055.74
|
| Rate for Payer: UHC Medicaid |
$720.37
|
| Rate for Payer: UHCCP Medicaid |
$720.37
|
|
