|
PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 97165
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$178.38 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.20
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$96.42
|
| Rate for Payer: BCN Medicare Advantage |
$96.42
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.42
|
| Rate for Payer: Healthscope Commercial |
$178.38
|
| Rate for Payer: Healthscope Commercial |
$154.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.40
|
| Rate for Payer: Nomi Health Commercial |
$115.70
|
| Rate for Payer: PACE SWMI |
$96.42
|
| Rate for Payer: PHP Medicare Advantage |
$96.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$96.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.42
|
| Rate for Payer: UHC Medicare Advantage |
$96.42
|
|
|
PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 97166
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$178.38 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.20
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS MAPPO |
$96.42
|
| Rate for Payer: BCN Medicare Advantage |
$96.42
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.42
|
| Rate for Payer: Healthscope Commercial |
$154.27
|
| Rate for Payer: Healthscope Commercial |
$178.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.85
|
| Rate for Payer: Nomi Health Commercial |
$115.70
|
| Rate for Payer: PACE SWMI |
$96.42
|
| Rate for Payer: PHP Medicare Advantage |
$96.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Medicare |
$96.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.42
|
| Rate for Payer: UHC Medicare Advantage |
$96.42
|
|
|
PR OCCUPATIONAL THERAPY EVALUATION
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 97003
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
|
|
PR OCCUPATIONAL THERAPY RE-EVALUATION
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 97004
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
|
|
PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 97168
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$122.78 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Aetna Medicare |
$69.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.94
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$66.37
|
| Rate for Payer: BCN Medicare Advantage |
$66.37
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$88.94
|
| Rate for Payer: Cofinity Commercial |
$95.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.37
|
| Rate for Payer: Healthscope Commercial |
$122.78
|
| Rate for Payer: Healthscope Commercial |
$106.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.95
|
| Rate for Payer: Nomi Health Commercial |
$79.64
|
| Rate for Payer: PACE SWMI |
$66.37
|
| Rate for Payer: PHP Medicare Advantage |
$66.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$66.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.37
|
| Rate for Payer: UHC Medicare Advantage |
$66.37
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$367.50
|
|
|
Service Code
|
NDC 00574722612
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Aetna Commercial |
$312.38
|
| Rate for Payer: Aetna Medicare |
$183.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.88
|
| Rate for Payer: BCBS Complete |
$147.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cofinity Commercial |
$257.25
|
| Rate for Payer: Cofinity Commercial |
$316.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$257.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.00
|
| Rate for Payer: Healthscope Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.38
|
| Rate for Payer: PHP Commercial |
$312.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.88
|
| Rate for Payer: Priority Health SBD |
$231.53
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$29.99
|
|
|
Service Code
|
NDC 00713013506
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.00 |
| 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 Commercial |
$20.99
|
| Rate for Payer: Cofinity Commercial |
$25.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.99
|
| 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: PHP Commercial |
$25.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.49
|
| Rate for Payer: Priority Health SBD |
$18.89
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$359.78
|
|
|
Service Code
|
NDC 00713013512
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.91 |
| 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 Commercial |
$251.85
|
| Rate for Payer: Cofinity Commercial |
$309.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.85
|
| 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: PHP Commercial |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.86
|
| Rate for Payer: Priority Health SBD |
$226.66
|
|
|
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 Commercial |
$20.99
|
| Rate for Payer: Cofinity Commercial |
$25.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.99
|
| 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: PHP Commercial |
$25.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.49
|
| Rate for Payer: Priority Health SBD |
$18.89
|
|
|
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 Commercial |
$251.85
|
| Rate for Payer: Cofinity Commercial |
$309.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.85
|
| 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: PHP Commercial |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.86
|
| Rate for Payer: Priority Health SBD |
$226.66
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$367.50
|
|
|
Service Code
|
NDC 00574722612
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.53 |
| 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: Cofinity Medicare Advantage |
$257.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.00
|
| Rate for Payer: Healthscope Commercial |
$330.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.38
|
| Rate for Payer: PHP Commercial |
$312.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.88
|
| Rate for Payer: Priority Health SBD |
$231.53
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$31.70
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Aetna Commercial |
$35.77
|
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$35.84
|
| Rate for Payer: Aetna Commercial |
$24.09
|
| Rate for Payer: Aetna Commercial |
$29.29
|
| Rate for Payer: Aetna Commercial |
$48.44
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.42
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cash Price |
$22.67
|
| Rate for Payer: Cash Price |
$25.36
|
| Rate for Payer: Cash Price |
$27.57
|
| Rate for Payer: Cash Price |
$61.26
|
| Rate for Payer: Cash Price |
$33.74
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cofinity Commercial |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Cofinity Commercial |
$24.37
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$65.85
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$49.01
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Cofinity Commercial |
$22.19
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Cofinity Commercial |
$36.27
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Cofinity Commercial |
$24.12
|
| Rate for Payer: Cofinity Commercial |
$29.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.26
|
| Rate for Payer: Healthscope Commercial |
$37.95
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$68.91
|
| Rate for Payer: Healthscope Commercial |
$37.87
|
| Rate for Payer: Healthscope Commercial |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Healthscope Commercial |
$25.51
|
| Rate for Payer: Healthscope Commercial |
$51.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$29.29
|
| Rate for Payer: PHP Commercial |
$65.08
|
| Rate for Payer: PHP Commercial |
$35.77
|
| Rate for Payer: PHP Commercial |
$48.44
|
| Rate for Payer: PHP Commercial |
$35.84
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$26.95
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: PHP Commercial |
$24.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health SBD |
$26.57
|
| Rate for Payer: Priority Health SBD |
$21.71
|
| Rate for Payer: Priority Health SBD |
$48.24
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: Priority Health SBD |
$19.97
|
| Rate for Payer: Priority Health SBD |
$17.85
|
| Rate for Payer: Priority Health SBD |
$24.47
|
| Rate for Payer: Priority Health SBD |
$26.51
|
| Rate for Payer: Priority Health SBD |
$35.90
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$42.08
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$37.87 |
| Rate for Payer: Aetna Commercial |
$35.77
|
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Aetna Commercial |
$35.84
|
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Aetna Commercial |
$29.29
|
| Rate for Payer: Aetna Commercial |
$25.35
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$24.09
|
| Rate for Payer: Aetna Commercial |
$48.44
|
| Rate for Payer: Aetna Medicare |
$14.17
|
| Rate for Payer: Aetna Medicare |
$17.23
|
| Rate for Payer: Aetna Medicare |
$19.42
|
| Rate for Payer: Aetna Medicare |
$21.09
|
| Rate for Payer: Aetna Medicare |
$28.50
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Aetna Medicare |
$21.04
|
| Rate for Payer: Aetna Medicare |
$15.85
|
| Rate for Payer: Aetna Medicare |
$14.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.04
|
| Rate for Payer: BCBS Complete |
$11.34
|
| Rate for Payer: BCBS Complete |
$16.83
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS Complete |
$11.93
|
| Rate for Payer: BCBS Complete |
$30.63
|
| Rate for Payer: BCBS Complete |
$12.68
|
| Rate for Payer: BCBS Complete |
$15.54
|
| Rate for Payer: BCBS Complete |
$13.78
|
| Rate for Payer: BCBS Complete |
$16.87
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Cash Price |
$25.36
|
| Rate for Payer: Cash Price |
$61.26
|
| Rate for Payer: Cash Price |
$22.67
|
| Rate for Payer: Cash Price |
$45.59
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$23.86
|
| Rate for Payer: Cash Price |
$27.57
|
| Rate for Payer: Cash Price |
$33.74
|
| Rate for Payer: Cofinity Commercial |
$36.27
|
| Rate for Payer: Cofinity Commercial |
$29.64
|
| Rate for Payer: Cofinity Commercial |
$19.84
|
| Rate for Payer: Cofinity Commercial |
$24.37
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$25.65
|
| Rate for Payer: Cofinity Commercial |
$22.19
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Cofinity Commercial |
$24.12
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$65.85
|
| Rate for Payer: Cofinity Commercial |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$49.01
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Cofinity Commercial |
$29.46
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$29.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$39.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$29.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.26
|
| Rate for Payer: Healthscope Commercial |
$25.51
|
| Rate for Payer: Healthscope Commercial |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$26.84
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$37.87
|
| Rate for Payer: Healthscope Commercial |
$37.95
|
| Rate for Payer: Healthscope Commercial |
$51.29
|
| Rate for Payer: Healthscope Commercial |
$68.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.08
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$48.44
|
| Rate for Payer: PHP Commercial |
$35.84
|
| Rate for Payer: PHP Commercial |
$26.95
|
| Rate for Payer: PHP Commercial |
$25.35
|
| Rate for Payer: PHP Commercial |
$24.09
|
| Rate for Payer: PHP Commercial |
$29.29
|
| Rate for Payer: PHP Commercial |
$35.77
|
| Rate for Payer: PHP Commercial |
$65.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.41
|
| Rate for Payer: Priority Health SBD |
$48.24
|
| Rate for Payer: Priority Health SBD |
$24.47
|
| Rate for Payer: Priority Health SBD |
$26.57
|
| Rate for Payer: Priority Health SBD |
$17.85
|
| Rate for Payer: Priority Health SBD |
$18.79
|
| Rate for Payer: Priority Health SBD |
$21.71
|
| Rate for Payer: Priority Health SBD |
$19.97
|
| Rate for Payer: Priority Health SBD |
$26.51
|
| Rate for Payer: Priority Health SBD |
$35.90
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
NDC 51079054201
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| 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 Commercial |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.12
|
| 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: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health SBD |
$1.91
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$5.41
|
|
|
Service Code
|
NDC 50268068511
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna Commercial |
$4.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.52
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Cofinity Commercial |
$4.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.33
|
| Rate for Payer: Healthscope Commercial |
$4.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.60
|
| Rate for Payer: PHP Commercial |
$4.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health SBD |
$3.41
|
|
|
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 Commercial |
$212.02
|
| Rate for Payer: Cofinity Commercial |
$260.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.02
|
| 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: PHP Commercial |
$257.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.87
|
| Rate for Payer: Priority Health SBD |
$190.81
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$302.88
|
|
|
Service Code
|
NDC 51079054220
|
| 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 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 Commercial |
$212.02
|
| Rate for Payer: Cofinity Commercial |
$260.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.02
|
| 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: PHP Commercial |
$257.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.87
|
| Rate for Payer: Priority Health SBD |
$190.81
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$270.48
|
|
|
Service Code
|
NDC 50268068515
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$243.43 |
| Rate for Payer: Aetna Commercial |
$229.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.81
|
| Rate for Payer: Cash Price |
$216.38
|
| Rate for Payer: Cofinity Commercial |
$189.34
|
| Rate for Payer: Cofinity Commercial |
$232.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.38
|
| Rate for Payer: Healthscope Commercial |
$243.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.91
|
| Rate for Payer: PHP Commercial |
$229.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.81
|
| Rate for Payer: Priority Health SBD |
$170.40
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$5.41
|
|
|
Service Code
|
NDC 50268068511
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna Commercial |
$4.60
|
| Rate for Payer: Aetna Medicare |
$2.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.52
|
| Rate for Payer: BCBS Complete |
$2.16
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Cofinity Commercial |
$4.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.33
|
| Rate for Payer: Healthscope Commercial |
$4.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.60
|
| Rate for Payer: PHP Commercial |
$4.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health SBD |
$3.41
|
|
|
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 Commercial |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.12
|
| 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: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health SBD |
$1.91
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$270.48
|
|
|
Service Code
|
NDC 50268068515
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.19 |
| Max. Negotiated Rate |
$243.43 |
| Rate for Payer: Aetna Commercial |
$229.91
|
| Rate for Payer: Aetna Medicare |
$135.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.81
|
| Rate for Payer: BCBS Complete |
$108.19
|
| Rate for Payer: Cash Price |
$216.38
|
| Rate for Payer: Cofinity Commercial |
$189.34
|
| Rate for Payer: Cofinity Commercial |
$232.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.38
|
| Rate for Payer: Healthscope Commercial |
$243.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.91
|
| Rate for Payer: PHP Commercial |
$229.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.81
|
| Rate for Payer: Priority Health SBD |
$170.40
|
|
|
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 Commercial |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$397.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$323.86
|
| 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: PHP Commercial |
$393.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.72
|
| Rate for Payer: Priority Health SBD |
$291.47
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$462.65
|
|
|
Service Code
|
NDC 59746011506
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.06 |
| 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 Commercial |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$397.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$323.86
|
| 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: PHP Commercial |
$393.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.72
|
| Rate for Payer: Priority Health SBD |
$291.47
|
|
|
PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE
|
Facility
|
OP
|
$7,528.73
|
|
|
Service Code
|
CPT 45505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,433.59 |
| Max. Negotiated Rate |
$7,528.73 |
| Rate for Payer: Aetna Medicare |
$2,781.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,343.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,343.25
|
| Rate for Payer: BCBS Complete |
$1,505.26
|
| Rate for Payer: BCBS MAPPO |
$2,674.60
|
| Rate for Payer: BCN Medicare Advantage |
$2,674.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,674.60
|
| Rate for Payer: Mclaren Medicaid |
$1,433.59
|
| Rate for Payer: Mclaren Medicare |
$2,674.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,808.33
|
| Rate for Payer: Meridian Medicaid |
$1,505.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,075.79
|
| Rate for Payer: PACE Medicare |
$2,540.87
|
| Rate for Payer: PACE SWMI |
$2,674.60
|
| Rate for Payer: PHP Medicare Advantage |
$2,674.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,433.59
|
| Rate for Payer: Priority Health Medicare |
$2,674.60
|
| Rate for Payer: Railroad Medicare Medicare |
$2,674.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7,528.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,674.60
|
| Rate for Payer: UHC Medicare Advantage |
$2,674.60
|
| Rate for Payer: UHCCP Medicaid |
$1,505.80
|
| Rate for Payer: VA VA |
$2,674.60
|
|
|
PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 99241
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Medicare |
$56.50
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
|
