|
PR NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS
|
Professional
|
Both
|
$800.00
|
|
|
Service Code
|
HCPCS 62160
|
| Min. Negotiated Rate |
$120.35 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$254.01
|
| Rate for Payer: Aetna Medicare |
$197.14
|
| Rate for Payer: BCBS Complete |
$126.37
|
| Rate for Payer: BCBS MAPPO |
$189.56
|
| Rate for Payer: BCBS Trust/PPO |
$437.96
|
| Rate for Payer: BCN Commercial |
$381.67
|
| Rate for Payer: BCN Medicare Advantage |
$189.56
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cash Price |
$640.00
|
| Rate for Payer: Cofinity Commercial |
$272.97
|
| Rate for Payer: Cofinity Commercial |
$254.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.56
|
| Rate for Payer: Mclaren Medicaid |
$120.35
|
| Rate for Payer: Meridian Medicaid |
$126.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$199.04
|
| Rate for Payer: PACE SWMI |
$189.56
|
| Rate for Payer: PHP Medicare Advantage |
$189.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$120.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$560.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.78
|
| Rate for Payer: Priority Health Medicare |
$189.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.56
|
| Rate for Payer: UHC Medicare Advantage |
$195.25
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 99316
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$1,849.05 |
| Rate for Payer: Aetna Commercial |
$171.96
|
| Rate for Payer: Aetna Medicare |
$133.46
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: BCBS MAPPO |
$128.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,849.05
|
| Rate for Payer: BCN Commercial |
$189.61
|
| Rate for Payer: BCN Medicare Advantage |
$128.33
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$171.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.33
|
| Rate for Payer: Mclaren Medicaid |
$112.38
|
| Rate for Payer: Meridian Medicaid |
$118.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.75
|
| Rate for Payer: PACE SWMI |
$128.33
|
| Rate for Payer: PHP Medicare Advantage |
$128.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.19
|
| Rate for Payer: Priority Health Medicare |
$128.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.33
|
| Rate for Payer: UHC Medicare Advantage |
$132.18
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 99315
|
| Min. Negotiated Rate |
$70.02 |
| Max. Negotiated Rate |
$402.56 |
| Rate for Payer: Aetna Commercial |
$106.50
|
| Rate for Payer: Aetna Medicare |
$82.66
|
| Rate for Payer: BCBS Complete |
$73.52
|
| Rate for Payer: BCBS MAPPO |
$79.48
|
| Rate for Payer: BCBS Trust/PPO |
$402.56
|
| Rate for Payer: BCN Commercial |
$117.77
|
| Rate for Payer: BCN Medicare Advantage |
$79.48
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$114.45
|
| Rate for Payer: Cofinity Commercial |
$106.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.48
|
| Rate for Payer: Mclaren Medicaid |
$70.02
|
| Rate for Payer: Meridian Medicaid |
$73.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.45
|
| Rate for Payer: PACE SWMI |
$79.48
|
| Rate for Payer: PHP Medicare Advantage |
$79.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.23
|
| Rate for Payer: Priority Health Medicare |
$79.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$103.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.48
|
| Rate for Payer: UHC Medicare Advantage |
$81.86
|
|
|
PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 94690
|
| Min. Negotiated Rate |
$44.16 |
| Max. Negotiated Rate |
$603.85 |
| Rate for Payer: Aetna Commercial |
$59.17
|
| Rate for Payer: Aetna Medicare |
$45.93
|
| Rate for Payer: BCBS Complete |
$50.80
|
| Rate for Payer: BCBS MAPPO |
$44.16
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: BCN Commercial |
$69.39
|
| Rate for Payer: BCN Medicare Advantage |
$44.16
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cofinity Commercial |
$63.59
|
| Rate for Payer: Cofinity Commercial |
$59.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.37
|
| Rate for Payer: PACE SWMI |
$44.16
|
| Rate for Payer: PHP Medicare Advantage |
$44.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.78
|
| Rate for Payer: Priority Health Medicare |
$44.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.16
|
| Rate for Payer: UHC Medicare Advantage |
$45.48
|
|
|
PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 94680
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$444.83 |
| Rate for Payer: Aetna Commercial |
$66.30
|
| Rate for Payer: Aetna Medicare |
$51.46
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$49.48
|
| Rate for Payer: BCBS Trust/PPO |
$444.83
|
| Rate for Payer: BCN Commercial |
$76.72
|
| Rate for Payer: BCN Medicare Advantage |
$49.48
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$71.25
|
| Rate for Payer: Cofinity Commercial |
$66.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.95
|
| Rate for Payer: PACE SWMI |
$49.48
|
| Rate for Payer: PHP Medicare Advantage |
$49.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.51
|
| Rate for Payer: Priority Health Medicare |
$49.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.48
|
| Rate for Payer: UHC Medicare Advantage |
$50.96
|
|
|
PROAIR HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$240.10
|
|
|
Service Code
|
NDC 59310-579-22
|
| Hospital Charge Code |
76821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.44 |
| Max. Negotiated Rate |
$216.09 |
| Rate for Payer: Aetna Commercial |
$204.08
|
| Rate for Payer: BCBS Trust/PPO |
$185.55
|
| Rate for Payer: BCN Commercial |
$185.55
|
| Rate for Payer: Cash Price |
$192.08
|
| Rate for Payer: Cofinity Commercial |
$206.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.08
|
| Rate for Payer: Healthscope Commercial |
$216.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$204.08
|
| Rate for Payer: PHP Commercial |
$204.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.29
|
| Rate for Payer: UHC Core |
$200.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.08
|
|
|
PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM
|
Professional
|
Both
|
$4,166.00
|
|
|
Service Code
|
HCPCS 59510
|
| Min. Negotiated Rate |
$69.21 |
| Max. Negotiated Rate |
$3,807.26 |
| Rate for Payer: Aetna Commercial |
$3,542.87
|
| Rate for Payer: Aetna Medicare |
$2,749.69
|
| Rate for Payer: BCBS Complete |
$2,607.95
|
| Rate for Payer: BCBS MAPPO |
$2,643.93
|
| Rate for Payer: BCBS Trust/PPO |
$69.21
|
| Rate for Payer: BCN Commercial |
$3,201.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,643.93
|
| Rate for Payer: Cash Price |
$3,332.80
|
| Rate for Payer: Cash Price |
$3,332.80
|
| Rate for Payer: Cofinity Commercial |
$3,807.26
|
| Rate for Payer: Cofinity Commercial |
$3,542.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,643.93
|
| Rate for Payer: Mclaren Medicaid |
$2,483.76
|
| Rate for Payer: Meridian Medicaid |
$2,607.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,776.13
|
| Rate for Payer: PACE SWMI |
$2,643.93
|
| Rate for Payer: PHP Medicare Advantage |
$2,643.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,483.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,916.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,755.20
|
| Rate for Payer: Priority Health Medicare |
$2,643.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,755.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,643.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,643.93
|
| Rate for Payer: UHC Medicare Advantage |
$2,723.25
|
|
|
PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM
|
Professional
|
Both
|
$3,755.00
|
|
|
Service Code
|
HCPCS 59400
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$3,433.33 |
| Rate for Payer: Aetna Commercial |
$3,194.91
|
| Rate for Payer: Aetna Medicare |
$2,479.63
|
| Rate for Payer: BCBS Complete |
$2,336.78
|
| Rate for Payer: BCBS MAPPO |
$2,384.26
|
| Rate for Payer: BCBS Trust/PPO |
$42.26
|
| Rate for Payer: BCN Commercial |
$3,201.80
|
| Rate for Payer: BCN Medicare Advantage |
$2,384.26
|
| Rate for Payer: Cash Price |
$3,004.00
|
| Rate for Payer: Cash Price |
$3,004.00
|
| Rate for Payer: Cofinity Commercial |
$3,433.33
|
| Rate for Payer: Cofinity Commercial |
$3,194.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,384.26
|
| Rate for Payer: Mclaren Medicaid |
$2,225.50
|
| Rate for Payer: Meridian Medicaid |
$2,336.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,503.47
|
| Rate for Payer: PACE SWMI |
$2,384.26
|
| Rate for Payer: PHP Medicare Advantage |
$2,384.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,628.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,393.98
|
| Rate for Payer: Priority Health Medicare |
$2,384.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,393.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,384.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,384.26
|
| Rate for Payer: UHC Medicare Advantage |
$2,455.79
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS
|
Professional
|
Both
|
$3,030.00
|
|
|
Service Code
|
HCPCS 33814
|
| Min. Negotiated Rate |
$961.06 |
| Max. Negotiated Rate |
$2,386.90 |
| Rate for Payer: Aetna Commercial |
$2,011.49
|
| Rate for Payer: Aetna Medicare |
$1,561.15
|
| Rate for Payer: BCBS Complete |
$1,009.11
|
| Rate for Payer: BCBS MAPPO |
$1,501.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,770.33
|
| Rate for Payer: BCN Commercial |
$2,192.69
|
| Rate for Payer: BCN Medicare Advantage |
$1,501.11
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cofinity Commercial |
$2,161.60
|
| Rate for Payer: Cofinity Commercial |
$2,011.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,501.11
|
| Rate for Payer: Mclaren Medicaid |
$961.06
|
| Rate for Payer: Meridian Medicaid |
$1,009.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,576.17
|
| Rate for Payer: PACE SWMI |
$1,501.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,501.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$961.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,386.90
|
| Rate for Payer: Priority Health Medicare |
$1,501.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,386.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,501.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,501.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,546.14
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 33813
|
| Min. Negotiated Rate |
$783.20 |
| Max. Negotiated Rate |
$1,945.36 |
| Rate for Payer: Aetna Commercial |
$1,637.64
|
| Rate for Payer: Aetna Medicare |
$1,271.00
|
| Rate for Payer: BCBS Complete |
$822.36
|
| Rate for Payer: BCBS MAPPO |
$1,222.12
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.52
|
| Rate for Payer: BCN Commercial |
$1,787.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,222.12
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cofinity Commercial |
$1,637.64
|
| Rate for Payer: Cofinity Commercial |
$1,759.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,222.12
|
| Rate for Payer: Mclaren Medicaid |
$783.20
|
| Rate for Payer: Meridian Medicaid |
$822.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,283.23
|
| Rate for Payer: PACE SWMI |
$1,222.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,222.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$783.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,945.36
|
| Rate for Payer: Priority Health Medicare |
$1,222.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,945.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,222.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,222.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,258.78
|
|
|
PR OBSERVATION CARE DISCHARGE MANAGEMENT
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 99217
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$308.53 |
| Rate for Payer: Aetna Commercial |
$23.99
|
| Rate for Payer: Aetna Medicare |
$18.62
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$17.90
|
| Rate for Payer: BCBS Trust/PPO |
$308.53
|
| Rate for Payer: BCN Commercial |
$42.50
|
| Rate for Payer: BCN Medicare Advantage |
$17.90
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$25.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.90
|
| Rate for Payer: Mclaren Medicaid |
$11.50
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.80
|
| Rate for Payer: PACE SWMI |
$17.90
|
| Rate for Payer: PHP Medicare Advantage |
$17.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.38
|
| Rate for Payer: Priority Health Medicare |
$17.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.90
|
| Rate for Payer: UHC Medicare Advantage |
$18.44
|
|
|
PR OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
HCPCS 58615
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$372.86 |
| Rate for Payer: Aetna Commercial |
$336.42
|
| Rate for Payer: Aetna Medicare |
$261.10
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS MAPPO |
$251.06
|
| Rate for Payer: BCBS Trust/PPO |
$151.62
|
| Rate for Payer: BCN Commercial |
$372.86
|
| Rate for Payer: BCN Medicare Advantage |
$251.06
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cofinity Commercial |
$361.53
|
| Rate for Payer: Cofinity Commercial |
$336.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.06
|
| Rate for Payer: Mclaren Medicaid |
$163.37
|
| Rate for Payer: Meridian Medicaid |
$171.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.61
|
| Rate for Payer: PACE SWMI |
$251.06
|
| Rate for Payer: PHP Medicare Advantage |
$251.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.22
|
| Rate for Payer: Priority Health Medicare |
$251.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$361.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$251.06
|
| Rate for Payer: UHC Medicare Advantage |
$258.59
|
|
|
PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 97165
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$648.75 |
| Rate for Payer: Aetna Commercial |
$130.62
|
| Rate for Payer: Aetna Medicare |
$101.38
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$97.48
|
| Rate for Payer: BCBS Trust/PPO |
$648.75
|
| Rate for Payer: BCN Commercial |
$86.71
|
| Rate for Payer: BCN Medicare Advantage |
$97.48
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$130.62
|
| Rate for Payer: Cofinity Commercial |
$140.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.35
|
| Rate for Payer: PACE SWMI |
$97.48
|
| Rate for Payer: PHP Medicare Advantage |
$97.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.00
|
| Rate for Payer: Priority Health Medicare |
$97.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.48
|
| Rate for Payer: UHC Medicare Advantage |
$100.40
|
|
|
PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 97166
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$1,059.24 |
| Rate for Payer: Aetna Commercial |
$130.62
|
| Rate for Payer: Aetna Medicare |
$101.38
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS MAPPO |
$97.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.24
|
| Rate for Payer: BCN Commercial |
$86.38
|
| Rate for Payer: BCN Medicare Advantage |
$97.48
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$140.37
|
| Rate for Payer: Cofinity Commercial |
$130.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.35
|
| Rate for Payer: PACE SWMI |
$97.48
|
| Rate for Payer: PHP Medicare Advantage |
$97.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.00
|
| Rate for Payer: Priority Health Medicare |
$97.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.48
|
| Rate for Payer: UHC Medicare Advantage |
$100.40
|
|
|
PR OCCUPATIONAL THERAPY EVALUATION
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 97003
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
|
|
PR OCCUPATIONAL THERAPY RE-EVALUATION
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 97004
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
|
|
PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 97168
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$2,076.22 |
| Rate for Payer: Aetna Commercial |
$89.81
|
| Rate for Payer: Aetna Medicare |
$69.70
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$67.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.22
|
| Rate for Payer: BCN Commercial |
$59.82
|
| Rate for Payer: BCN Medicare Advantage |
$67.02
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$89.81
|
| Rate for Payer: Cofinity Commercial |
$96.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$70.37
|
| Rate for Payer: PACE SWMI |
$67.02
|
| Rate for Payer: PHP Medicare Advantage |
$67.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.00
|
| Rate for Payer: Priority Health Medicare |
$67.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.02
|
| Rate for Payer: UHC Medicare Advantage |
$69.03
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$29.99
|
|
|
Service Code
|
NDC 0713-0135-06
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$26.99 |
| Rate for Payer: Aetna Commercial |
$25.49
|
| Rate for Payer: BCBS Trust/PPO |
$23.18
|
| Rate for Payer: BCN Commercial |
$23.18
|
| Rate for Payer: Cash Price |
$23.99
|
| 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: Lakeland Regional Health Systems Commercial |
$22.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.49
|
| Rate for Payer: PHP Commercial |
$25.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.39
|
| Rate for Payer: UHC Core |
$25.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.49
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$367.50
|
|
|
Service Code
|
NDC 0574-7226-12
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Aetna Commercial |
$312.38
|
| Rate for Payer: BCBS Trust/PPO |
$284.00
|
| Rate for Payer: BCN Commercial |
$284.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cofinity Commercial |
$316.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.00
|
| Rate for Payer: Healthscope Commercial |
$330.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$312.38
|
| Rate for Payer: PHP Commercial |
$312.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$319.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.40
|
| Rate for Payer: UHC Core |
$306.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.62
|
|
|
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 |
$23.69 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$43.48
|
| Rate for Payer: Aetna Commercial |
$48.02
|
| Rate for Payer: Aetna Commercial |
$48.07
|
| Rate for Payer: Aetna Commercial |
$49.01
|
| Rate for Payer: BCBS Trust/PPO |
$24.61
|
| Rate for Payer: BCBS Trust/PPO |
$44.56
|
| Rate for Payer: BCBS Trust/PPO |
$43.70
|
| Rate for Payer: BCBS Trust/PPO |
$28.79
|
| Rate for Payer: BCBS Trust/PPO |
$39.53
|
| Rate for Payer: BCBS Trust/PPO |
$43.66
|
| Rate for Payer: BCBS Trust/PPO |
$30.02
|
| Rate for Payer: BCN Commercial |
$43.70
|
| Rate for Payer: BCN Commercial |
$24.61
|
| Rate for Payer: BCN Commercial |
$39.53
|
| Rate for Payer: BCN Commercial |
$43.66
|
| Rate for Payer: BCN Commercial |
$44.56
|
| Rate for Payer: BCN Commercial |
$28.79
|
| Rate for Payer: BCN Commercial |
$30.02
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$45.20
|
| Rate for Payer: Cash Price |
$46.13
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$45.24
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$40.92
|
| Rate for Payer: Cofinity Commercial |
$32.04
|
| Rate for Payer: Cofinity Commercial |
$49.59
|
| Rate for Payer: Cofinity Commercial |
$48.59
|
| Rate for Payer: Cofinity Commercial |
$48.63
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Cofinity Commercial |
$43.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Healthscope Commercial |
$50.90
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$46.04
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$51.89
|
| Rate for Payer: Healthscope Commercial |
$28.66
|
| Rate for Payer: Healthscope Commercial |
$50.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$48.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.01
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$48.07
|
| Rate for Payer: PHP Commercial |
$49.01
|
| Rate for Payer: PHP Commercial |
$48.02
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$43.48
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.76
|
| Rate for Payer: UHC Core |
$47.22
|
| Rate for Payer: UHC Core |
$42.71
|
| Rate for Payer: UHC Core |
$31.10
|
| Rate for Payer: UHC Core |
$32.43
|
| Rate for Payer: UHC Core |
$48.15
|
| Rate for Payer: UHC Core |
$26.59
|
| Rate for Payer: UHC Core |
$47.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.24
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$5.32
|
|
|
Service Code
|
NDC 50268-684-11
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$4.79 |
| Rate for Payer: Aetna Commercial |
$4.52
|
| Rate for Payer: BCBS Trust/PPO |
$4.11
|
| Rate for Payer: BCN Commercial |
$4.11
|
| Rate for Payer: Cash Price |
$4.26
|
| Rate for Payer: Cofinity Commercial |
$4.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.26
|
| Rate for Payer: Healthscope Commercial |
$4.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.52
|
| Rate for Payer: PHP Commercial |
$4.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.68
|
| Rate for Payer: UHC Core |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.99
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$307.80
|
|
|
Service Code
|
NDC 59746-113-06
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.73 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: BCBS Trust/PPO |
$237.87
|
| Rate for Payer: BCN Commercial |
$237.87
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$261.63
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.86
|
| Rate for Payer: UHC Core |
$257.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$265.68
|
|
|
Service Code
|
NDC 50268-684-15
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.04 |
| Max. Negotiated Rate |
$239.11 |
| Rate for Payer: Aetna Commercial |
$225.83
|
| Rate for Payer: BCBS Trust/PPO |
$205.32
|
| Rate for Payer: BCN Commercial |
$205.32
|
| Rate for Payer: Cash Price |
$212.54
|
| Rate for Payer: Cofinity Commercial |
$228.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.54
|
| Rate for Payer: Healthscope Commercial |
$239.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.83
|
| Rate for Payer: PHP Commercial |
$225.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$231.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.80
|
| Rate for Payer: UHC Core |
$221.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.26
|
|
|
PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 99241
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$77.70 |
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
|
