|
PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 99245
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$306.40 |
| Rate for Payer: Aetna Commercial |
$196.80
|
| Rate for Payer: BCBS Complete |
$119.88
|
| Rate for Payer: BCBS Trust/PPO |
$202.34
|
| Rate for Payer: BCN Commercial |
$306.40
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Mclaren Medicaid |
$114.17
|
| Rate for Payer: Meridian Medicaid |
$119.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$229.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$229.16
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 99243
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$1,523.62 |
| Rate for Payer: Aetna Commercial |
$98.89
|
| Rate for Payer: BCBS Complete |
$58.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,523.62
|
| Rate for Payer: BCN Commercial |
$164.69
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Mclaren Medicaid |
$55.81
|
| Rate for Payer: Meridian Medicaid |
$58.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$112.21
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 99244
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$722.19 |
| Rate for Payer: Aetna Commercial |
$159.16
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$722.19
|
| Rate for Payer: BCN Commercial |
$235.54
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Mclaren Medicaid |
$84.99
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.33
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 99242
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$158.49 |
| Rate for Payer: Aetna Commercial |
$70.73
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$158.49
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Mclaren Medicaid |
$35.36
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.10
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 99215
|
| Min. Negotiated Rate |
$123.62 |
| Max. Negotiated Rate |
$1,816.82 |
| Rate for Payer: Aetna Commercial |
$187.80
|
| Rate for Payer: Aetna Medicare |
$145.76
|
| Rate for Payer: BCBS Complete |
$129.80
|
| Rate for Payer: BCBS MAPPO |
$140.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.82
|
| Rate for Payer: BCN Commercial |
$154.50
|
| Rate for Payer: BCN Medicare Advantage |
$140.15
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$187.80
|
| Rate for Payer: Cofinity Commercial |
$201.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.15
|
| Rate for Payer: Mclaren Medicaid |
$123.62
|
| Rate for Payer: Meridian Medicaid |
$129.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.16
|
| Rate for Payer: PACE SWMI |
$140.15
|
| Rate for Payer: PHP Medicare Advantage |
$140.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.20
|
| Rate for Payer: Priority Health Medicare |
$140.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.15
|
| Rate for Payer: UHC Medicare Advantage |
$144.35
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99213
|
| Min. Negotiated Rate |
$56.48 |
| Max. Negotiated Rate |
$1,305.96 |
| Rate for Payer: Aetna Commercial |
$86.67
|
| Rate for Payer: Aetna Medicare |
$67.27
|
| Rate for Payer: BCBS Complete |
$59.30
|
| Rate for Payer: BCBS MAPPO |
$64.68
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.96
|
| Rate for Payer: BCN Commercial |
$79.38
|
| Rate for Payer: BCN Medicare Advantage |
$64.68
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$93.14
|
| Rate for Payer: Cofinity Commercial |
$86.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.68
|
| Rate for Payer: Mclaren Medicaid |
$56.48
|
| Rate for Payer: Meridian Medicaid |
$59.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.91
|
| Rate for Payer: PACE SWMI |
$64.68
|
| Rate for Payer: PHP Medicare Advantage |
$64.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.86
|
| Rate for Payer: Priority Health Medicare |
$64.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.68
|
| Rate for Payer: UHC Medicare Advantage |
$66.62
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99214
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$1,340.83 |
| Rate for Payer: Aetna Commercial |
$127.94
|
| Rate for Payer: Aetna Medicare |
$99.30
|
| Rate for Payer: BCBS Complete |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$95.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,340.83
|
| Rate for Payer: BCN Commercial |
$115.12
|
| Rate for Payer: BCN Medicare Advantage |
$95.48
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$137.49
|
| Rate for Payer: Cofinity Commercial |
$127.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.48
|
| Rate for Payer: Mclaren Medicaid |
$83.28
|
| Rate for Payer: Meridian Medicaid |
$87.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$100.25
|
| Rate for Payer: PACE SWMI |
$95.48
|
| Rate for Payer: PHP Medicare Advantage |
$95.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.23
|
| Rate for Payer: Priority Health Medicare |
$95.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.48
|
| Rate for Payer: UHC Medicare Advantage |
$98.34
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 99212
|
| Min. Negotiated Rate |
$30.26 |
| Max. Negotiated Rate |
$2,731.31 |
| Rate for Payer: Aetna Commercial |
$46.71
|
| Rate for Payer: Aetna Medicare |
$36.25
|
| Rate for Payer: BCBS Complete |
$31.77
|
| Rate for Payer: BCBS MAPPO |
$34.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,731.31
|
| Rate for Payer: BCN Commercial |
$50.51
|
| Rate for Payer: BCN Medicare Advantage |
$34.86
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$50.20
|
| Rate for Payer: Cofinity Commercial |
$46.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.86
|
| Rate for Payer: Mclaren Medicaid |
$30.26
|
| Rate for Payer: Meridian Medicaid |
$31.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.60
|
| Rate for Payer: PACE SWMI |
$34.86
|
| Rate for Payer: PHP Medicare Advantage |
$34.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.54
|
| Rate for Payer: Priority Health Medicare |
$34.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.86
|
| Rate for Payer: UHC Medicare Advantage |
$35.91
|
|
|
PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 99211
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$2,495.16 |
| Rate for Payer: Aetna Commercial |
$11.56
|
| Rate for Payer: Aetna Medicare |
$8.98
|
| Rate for Payer: BCBS Complete |
$7.86
|
| Rate for Payer: BCBS MAPPO |
$8.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,495.16
|
| Rate for Payer: BCN Commercial |
$23.28
|
| Rate for Payer: BCN Medicare Advantage |
$8.63
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$11.56
|
| Rate for Payer: Cofinity Commercial |
$12.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.63
|
| Rate for Payer: Mclaren Medicaid |
$7.49
|
| Rate for Payer: Meridian Medicaid |
$7.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.06
|
| Rate for Payer: PACE SWMI |
$8.63
|
| Rate for Payer: PHP Medicare Advantage |
$8.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$7.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.05
|
| Rate for Payer: Priority Health Medicare |
$8.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.63
|
| Rate for Payer: UHC Medicare Advantage |
$8.89
|
|
|
PR OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 99205
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$2,028.67 |
| Rate for Payer: Aetna Commercial |
$237.78
|
| Rate for Payer: Aetna Medicare |
$184.55
|
| Rate for Payer: BCBS Complete |
$163.38
|
| Rate for Payer: BCBS MAPPO |
$177.45
|
| Rate for Payer: BCBS Trust/PPO |
$2,028.67
|
| Rate for Payer: BCN Commercial |
$209.60
|
| Rate for Payer: BCN Medicare Advantage |
$177.45
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$237.78
|
| Rate for Payer: Cofinity Commercial |
$255.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.45
|
| Rate for Payer: Mclaren Medicaid |
$155.60
|
| Rate for Payer: Meridian Medicaid |
$163.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$186.32
|
| Rate for Payer: PACE SWMI |
$177.45
|
| Rate for Payer: PHP Medicare Advantage |
$177.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.19
|
| Rate for Payer: Priority Health Medicare |
$177.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$186.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.45
|
| Rate for Payer: UHC Medicare Advantage |
$182.77
|
|
|
PR OFFICE OUTPATIENT NEW LEVL I
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 99201
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
|
|
PR OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 99203
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$931.39 |
| Rate for Payer: Aetna Commercial |
$109.09
|
| Rate for Payer: Aetna Medicare |
$84.67
|
| Rate for Payer: BCBS Complete |
$73.83
|
| Rate for Payer: BCBS MAPPO |
$81.41
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$108.55
|
| Rate for Payer: BCN Medicare Advantage |
$81.41
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$117.23
|
| Rate for Payer: Cofinity Commercial |
$109.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.41
|
| Rate for Payer: Mclaren Medicaid |
$70.31
|
| Rate for Payer: Meridian Medicaid |
$73.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.48
|
| Rate for Payer: PACE SWMI |
$81.41
|
| Rate for Payer: PHP Medicare Advantage |
$81.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.26
|
| Rate for Payer: Priority Health Medicare |
$81.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.41
|
| Rate for Payer: UHC Medicare Advantage |
$83.85
|
|
|
PR OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 99204
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$1,704.30 |
| Rate for Payer: Aetna Commercial |
$175.22
|
| Rate for Payer: Aetna Medicare |
$135.99
|
| Rate for Payer: BCBS Complete |
$120.12
|
| Rate for Payer: BCBS MAPPO |
$130.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.30
|
| Rate for Payer: BCN Commercial |
$165.88
|
| Rate for Payer: BCN Medicare Advantage |
$130.76
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$188.29
|
| Rate for Payer: Cofinity Commercial |
$175.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.76
|
| Rate for Payer: Mclaren Medicaid |
$114.40
|
| Rate for Payer: Meridian Medicaid |
$120.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.30
|
| Rate for Payer: PACE SWMI |
$130.76
|
| Rate for Payer: PHP Medicare Advantage |
$130.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$114.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.12
|
| Rate for Payer: Priority Health Medicare |
$130.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.76
|
| Rate for Payer: UHC Medicare Advantage |
$134.68
|
|
|
PR OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99202
|
| Min. Negotiated Rate |
$40.63 |
| Max. Negotiated Rate |
$706.34 |
| Rate for Payer: Aetna Commercial |
$63.10
|
| Rate for Payer: Aetna Medicare |
$48.97
|
| Rate for Payer: BCBS Complete |
$42.66
|
| Rate for Payer: BCBS MAPPO |
$47.09
|
| Rate for Payer: BCBS Trust/PPO |
$706.34
|
| Rate for Payer: BCN Commercial |
$76.66
|
| Rate for Payer: BCN Medicare Advantage |
$47.09
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$67.81
|
| Rate for Payer: Cofinity Commercial |
$63.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.09
|
| Rate for Payer: Mclaren Medicaid |
$40.63
|
| Rate for Payer: Meridian Medicaid |
$42.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.44
|
| Rate for Payer: PACE SWMI |
$47.09
|
| Rate for Payer: PHP Medicare Advantage |
$47.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.42
|
| Rate for Payer: Priority Health Medicare |
$47.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.09
|
| Rate for Payer: UHC Medicare Advantage |
$48.50
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 59651-152-01
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.59 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: BCBS Trust/PPO |
$337.79
|
| Rate for Payer: BCN Commercial |
$337.79
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$371.54
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$380.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.65
|
| Rate for Payer: UHC Core |
$364.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$256.80
|
|
|
Service Code
|
NDC 17478-766-10
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.62 |
| Max. Negotiated Rate |
$231.12 |
| Rate for Payer: Aetna Commercial |
$218.28
|
| Rate for Payer: BCBS Trust/PPO |
$198.46
|
| Rate for Payer: BCN Commercial |
$198.46
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cofinity Commercial |
$220.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.44
|
| Rate for Payer: Healthscope Commercial |
$231.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$218.28
|
| Rate for Payer: PHP Commercial |
$218.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$223.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$156.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.98
|
| Rate for Payer: UHC Core |
$214.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.60
|
|
|
PR OMALIZUMAB INJECTION
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J2357
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$56.71 |
| Rate for Payer: Aetna Commercial |
$52.77
|
| Rate for Payer: Aetna Medicare |
$40.96
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$39.38
|
| Rate for Payer: BCBS Trust/PPO |
$40.20
|
| Rate for Payer: BCN Commercial |
$38.63
|
| Rate for Payer: BCN Medicare Advantage |
$39.38
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Cofinity Commercial |
$52.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$41.35
|
| Rate for Payer: PACE SWMI |
$39.38
|
| Rate for Payer: PHP Medicare Advantage |
$39.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Medicare |
$39.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.38
|
| Rate for Payer: UHC Medicare Advantage |
$40.56
|
|
|
PR OMENTAL FLAP INTRA-ABDOMINAL
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
HCPCS 49905
|
| Min. Negotiated Rate |
$223.01 |
| Max. Negotiated Rate |
$4,973.94 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Medicare |
$364.62
|
| Rate for Payer: BCBS Complete |
$234.16
|
| Rate for Payer: BCBS MAPPO |
$350.60
|
| Rate for Payer: BCBS Trust/PPO |
$4,973.94
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: BCN Medicare Advantage |
$350.60
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Cofinity Commercial |
$504.86
|
| Rate for Payer: Cofinity Commercial |
$469.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$350.60
|
| Rate for Payer: Mclaren Medicaid |
$223.01
|
| Rate for Payer: Meridian Medicaid |
$234.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$368.13
|
| Rate for Payer: PACE SWMI |
$350.60
|
| Rate for Payer: PHP Medicare Advantage |
$350.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$440.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.43
|
| Rate for Payer: Priority Health Medicare |
$350.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$614.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$350.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$350.60
|
| Rate for Payer: UHC Medicare Advantage |
$361.12
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$181.02
|
|
|
Service Code
|
NDC 0713-0536-12
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$162.92 |
| Rate for Payer: Aetna Commercial |
$153.87
|
| Rate for Payer: BCBS Trust/PPO |
$139.89
|
| Rate for Payer: BCN Commercial |
$139.89
|
| Rate for Payer: Cash Price |
$144.82
|
| Rate for Payer: Cofinity Commercial |
$155.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.82
|
| Rate for Payer: Healthscope Commercial |
$162.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.87
|
| Rate for Payer: PHP Commercial |
$153.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.30
|
| Rate for Payer: UHC Core |
$151.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.76
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$397.10
|
|
|
Service Code
|
NDC 60687-660-01
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$242.19 |
| Max. Negotiated Rate |
$357.39 |
| Rate for Payer: Aetna Commercial |
$337.54
|
| Rate for Payer: BCBS Trust/PPO |
$306.88
|
| Rate for Payer: BCN Commercial |
$306.88
|
| Rate for Payer: Cash Price |
$317.68
|
| Rate for Payer: Cofinity Commercial |
$341.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.68
|
| Rate for Payer: Healthscope Commercial |
$357.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$337.54
|
| Rate for Payer: PHP Commercial |
$337.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$345.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.45
|
| Rate for Payer: UHC Core |
$331.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.82
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$3.98
|
|
|
Service Code
|
NDC 60687-660-11
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: BCBS Trust/PPO |
$3.08
|
| Rate for Payer: BCN Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.38
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.50
|
| Rate for Payer: UHC Core |
$3.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.98
|
|
|
PROMETHAZINE 25 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: BCBS Trust/PPO |
$17.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.61
|
| Rate for Payer: BCN Commercial |
$12.61
|
| Rate for Payer: BCN Commercial |
$17.19
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.87
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 0904-6461-61
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.36 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: BCBS Trust/PPO |
$194.32
|
| Rate for Payer: BCN Commercial |
$194.32
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.73
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$448.85
|
|
|
Service Code
|
NDC 68084-155-11
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: BCBS Trust/PPO |
$346.87
|
| Rate for Payer: BCN Commercial |
$346.87
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.52
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.99
|
| Rate for Payer: UHC Core |
$374.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$448.85
|
|
|
Service Code
|
NDC 68084-155-01
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.75 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: BCBS Trust/PPO |
$346.87
|
| Rate for Payer: BCN Commercial |
$346.87
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$381.52
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$314.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$390.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.99
|
| Rate for Payer: UHC Core |
$374.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
