|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 53746074501
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.95 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: BCBS Trust/PPO |
$128.10
|
| Rate for Payer: BCN Commercial |
$128.10
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.49
|
| Rate for Payer: UHC Core |
$129.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 53746074501
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$40.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.47
|
| Rate for Payer: BCBS Complete |
$28.71
|
| Rate for Payer: BCBS MAPPO |
$38.77
|
| Rate for Payer: BCBS Trust/PPO |
$127.51
|
| Rate for Payer: BCN Commercial |
$127.51
|
| Rate for Payer: BCN Medicare Advantage |
$38.77
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.77
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: Mclaren Medicaid |
$27.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.71
|
| Rate for Payer: Meridian Medicaid |
$28.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PACE Senior Care Partners |
$36.84
|
| Rate for Payer: PACE SWMI |
$38.77
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: PHP Medicare Advantage |
$38.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$134.94
|
| Rate for Payer: Priority Health Medicare |
$39.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.95
|
| Rate for Payer: Railroad Medicare Medicare |
$38.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.49
|
| Rate for Payer: UHC Core |
$129.51
|
| Rate for Payer: UHC Exchange |
$38.77
|
| Rate for Payer: UHC Medicaid |
$27.34
|
| Rate for Payer: UHC Medicare Advantage |
$38.77
|
| Rate for Payer: UHCCP Medicaid |
$27.34
|
| Rate for Payer: VA VA |
$38.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$4.02
|
|
|
Service Code
|
NDC 60687066011
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.42
|
| Rate for Payer: Nomi Health Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.54
|
| Rate for Payer: UHC Core |
$3.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.02
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$20.84
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$18.76 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: BCBS Trust/PPO |
$17.21
|
| Rate for Payer: BCBS Trust/PPO |
$18.38
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: BCN Commercial |
$18.38
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$17.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.67
|
| Rate for Payer: Healthscope Commercial |
$18.76
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Nomi Health Commercial |
$17.09
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC Core |
$17.40
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$20.84
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$18.76 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Medicare |
$5.79
|
| Rate for Payer: Aetna Medicare |
$5.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.95
|
| Rate for Payer: BCBS Complete |
$3.86
|
| Rate for Payer: BCBS Complete |
$4.12
|
| Rate for Payer: BCBS MAPPO |
$5.21
|
| Rate for Payer: BCBS MAPPO |
$5.56
|
| Rate for Payer: BCBS Trust/PPO |
$17.13
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCN Commercial |
$18.29
|
| Rate for Payer: BCN Commercial |
$17.13
|
| Rate for Payer: BCN Medicare Advantage |
$5.56
|
| Rate for Payer: BCN Medicare Advantage |
$5.21
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$17.92
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.21
|
| Rate for Payer: Healthscope Commercial |
$18.76
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Mclaren Medicaid |
$3.92
|
| Rate for Payer: Mclaren Medicaid |
$3.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.47
|
| Rate for Payer: Meridian Medicaid |
$3.86
|
| Rate for Payer: Meridian Medicaid |
$4.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Nomi Health Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$17.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.69
|
| Rate for Payer: PACE Senior Care Partners |
$5.28
|
| Rate for Payer: PACE Senior Care Partners |
$4.95
|
| Rate for Payer: PACE SWMI |
$5.56
|
| Rate for Payer: PACE SWMI |
$5.21
|
| Rate for Payer: PHP Commercial |
$17.71
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Medicare Advantage |
$5.21
|
| Rate for Payer: PHP Medicare Advantage |
$5.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$19.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.13
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Medicare |
$5.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.49
|
| Rate for Payer: Railroad Medicare Medicare |
$5.21
|
| Rate for Payer: Railroad Medicare Medicare |
$5.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: UHC Core |
$17.40
|
| Rate for Payer: UHC Exchange |
$5.56
|
| Rate for Payer: UHC Exchange |
$5.21
|
| Rate for Payer: UHC Medicaid |
$3.92
|
| Rate for Payer: UHC Medicaid |
$3.67
|
| Rate for Payer: UHC Medicare Advantage |
$5.21
|
| Rate for Payer: UHC Medicare Advantage |
$5.56
|
| Rate for Payer: UHCCP Medicaid |
$3.67
|
| Rate for Payer: UHCCP Medicaid |
$3.92
|
| Rate for Payer: VA VA |
$5.21
|
| Rate for Payer: VA VA |
$5.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.63
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$12.11
|
|
|
Service Code
|
NDC 00713052606
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.43 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$10.00
|
| Rate for Payer: BCN Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.69
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Nomi Health Commercial |
$9.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.08
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.66
|
| Rate for Payer: UHC Core |
$10.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$145.28
|
|
|
Service Code
|
NDC 00713052612
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.61 |
| Max. Negotiated Rate |
$130.75 |
| Rate for Payer: Aetna Commercial |
$123.49
|
| Rate for Payer: Aetna Medicare |
$37.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.40
|
| Rate for Payer: BCBS Complete |
$26.89
|
| Rate for Payer: BCBS MAPPO |
$36.32
|
| Rate for Payer: BCBS Trust/PPO |
$119.43
|
| Rate for Payer: BCN Commercial |
$119.43
|
| Rate for Payer: BCN Medicare Advantage |
$36.32
|
| Rate for Payer: Cash Price |
$116.22
|
| Rate for Payer: Cofinity Commercial |
$124.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.32
|
| Rate for Payer: Healthscope Commercial |
$130.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.96
|
| Rate for Payer: Mclaren Medicaid |
$25.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.14
|
| Rate for Payer: Meridian Medicaid |
$26.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.49
|
| Rate for Payer: Nomi Health Commercial |
$119.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.96
|
| Rate for Payer: PACE Senior Care Partners |
$34.50
|
| Rate for Payer: PACE SWMI |
$36.32
|
| Rate for Payer: PHP Commercial |
$123.49
|
| Rate for Payer: PHP Medicare Advantage |
$36.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.39
|
| Rate for Payer: Priority Health Medicare |
$36.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.11
|
| Rate for Payer: Railroad Medicare Medicare |
$36.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.85
|
| Rate for Payer: UHC Core |
$121.31
|
| Rate for Payer: UHC Exchange |
$36.32
|
| Rate for Payer: UHC Medicaid |
$25.61
|
| Rate for Payer: UHC Medicare Advantage |
$36.32
|
| Rate for Payer: UHCCP Medicaid |
$25.61
|
| Rate for Payer: VA VA |
$36.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.96
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$12.11
|
|
|
Service Code
|
NDC 00713052606
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Medicare |
$3.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.78
|
| Rate for Payer: BCBS Complete |
$2.24
|
| Rate for Payer: BCBS MAPPO |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$9.96
|
| Rate for Payer: BCN Commercial |
$9.96
|
| Rate for Payer: BCN Medicare Advantage |
$3.03
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Cofinity Commercial |
$10.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.03
|
| Rate for Payer: Healthscope Commercial |
$10.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.08
|
| Rate for Payer: Mclaren Medicaid |
$2.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.18
|
| Rate for Payer: Meridian Medicaid |
$2.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.29
|
| Rate for Payer: Nomi Health Commercial |
$9.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.08
|
| Rate for Payer: PACE Senior Care Partners |
$2.88
|
| Rate for Payer: PACE SWMI |
$3.03
|
| Rate for Payer: PHP Commercial |
$10.29
|
| Rate for Payer: PHP Medicare Advantage |
$3.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$10.54
|
| Rate for Payer: Priority Health Medicare |
$3.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.43
|
| Rate for Payer: Railroad Medicare Medicare |
$3.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.66
|
| Rate for Payer: UHC Core |
$10.11
|
| Rate for Payer: UHC Exchange |
$3.03
|
| Rate for Payer: UHC Medicaid |
$2.13
|
| Rate for Payer: UHC Medicare Advantage |
$3.03
|
| Rate for Payer: UHCCP Medicaid |
$2.13
|
| Rate for Payer: VA VA |
$3.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.08
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$145.28
|
|
|
Service Code
|
NDC 00713052612
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.11 |
| Max. Negotiated Rate |
$130.75 |
| Rate for Payer: Aetna Commercial |
$123.49
|
| Rate for Payer: BCBS Trust/PPO |
$119.99
|
| Rate for Payer: BCN Commercial |
$119.99
|
| Rate for Payer: Cash Price |
$116.22
|
| Rate for Payer: Cofinity Commercial |
$124.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.22
|
| Rate for Payer: Healthscope Commercial |
$130.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.49
|
| Rate for Payer: Nomi Health Commercial |
$119.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.96
|
| Rate for Payer: PHP Commercial |
$123.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.85
|
| Rate for Payer: UHC Core |
$121.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.96
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$209.95
|
|
|
Service Code
|
NDC 68084015501
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.13 |
| Max. Negotiated Rate |
$188.96 |
| Rate for Payer: Aetna Commercial |
$178.46
|
| Rate for Payer: BCBS Trust/PPO |
$173.40
|
| Rate for Payer: BCN Commercial |
$173.40
|
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Cofinity Commercial |
$180.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.96
|
| Rate for Payer: Healthscope Commercial |
$188.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.46
|
| Rate for Payer: Nomi Health Commercial |
$172.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.46
|
| Rate for Payer: PHP Commercial |
$178.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$182.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.76
|
| Rate for Payer: UHC Core |
$175.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.46
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$2.10
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$1.73
|
| Rate for Payer: BCN Commercial |
$1.73
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.68
|
| Rate for Payer: Healthscope Commercial |
$1.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.57
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.85
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.57
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$209.95
|
|
|
Service Code
|
NDC 68084015501
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$188.96 |
| Rate for Payer: Aetna Commercial |
$178.46
|
| Rate for Payer: Aetna Medicare |
$54.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.61
|
| Rate for Payer: BCBS Complete |
$38.86
|
| Rate for Payer: BCBS MAPPO |
$52.49
|
| Rate for Payer: BCBS Trust/PPO |
$172.60
|
| Rate for Payer: BCN Commercial |
$172.60
|
| Rate for Payer: BCN Medicare Advantage |
$52.49
|
| Rate for Payer: Cash Price |
$167.96
|
| Rate for Payer: Cofinity Commercial |
$180.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.49
|
| Rate for Payer: Healthscope Commercial |
$188.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.46
|
| Rate for Payer: Mclaren Medicaid |
$37.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.11
|
| Rate for Payer: Meridian Medicaid |
$38.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$57.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.46
|
| Rate for Payer: Nomi Health Commercial |
$172.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.46
|
| Rate for Payer: PACE Senior Care Partners |
$49.86
|
| Rate for Payer: PACE SWMI |
$52.49
|
| Rate for Payer: PHP Commercial |
$178.46
|
| Rate for Payer: PHP Medicare Advantage |
$52.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$182.66
|
| Rate for Payer: Priority Health Medicare |
$53.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.13
|
| Rate for Payer: Railroad Medicare Medicare |
$52.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.76
|
| Rate for Payer: UHC Core |
$175.31
|
| Rate for Payer: UHC Exchange |
$52.49
|
| Rate for Payer: UHC Medicaid |
$37.01
|
| Rate for Payer: UHC Medicare Advantage |
$52.49
|
| Rate for Payer: UHCCP Medicaid |
$37.01
|
| Rate for Payer: VA VA |
$52.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.46
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$2.10
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.89 |
| Rate for Payer: Aetna Commercial |
$1.78
|
| Rate for Payer: Aetna Medicare |
$0.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.66
|
| Rate for Payer: BCBS Complete |
$0.39
|
| Rate for Payer: BCBS MAPPO |
$0.53
|
| Rate for Payer: BCBS Trust/PPO |
$1.73
|
| Rate for Payer: BCN Commercial |
$1.73
|
| Rate for Payer: BCN Medicare Advantage |
$0.53
|
| Rate for Payer: Cash Price |
$1.68
|
| Rate for Payer: Cofinity Commercial |
$1.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.53
|
| Rate for Payer: Healthscope Commercial |
$1.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.57
|
| Rate for Payer: Mclaren Medicaid |
$0.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.55
|
| Rate for Payer: Meridian Medicaid |
$0.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.78
|
| Rate for Payer: Nomi Health Commercial |
$1.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.57
|
| Rate for Payer: PACE Senior Care Partners |
$0.50
|
| Rate for Payer: PACE SWMI |
$0.53
|
| Rate for Payer: PHP Commercial |
$1.78
|
| Rate for Payer: PHP Medicare Advantage |
$0.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.83
|
| Rate for Payer: Priority Health Medicare |
$0.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.85
|
| Rate for Payer: UHC Core |
$1.75
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UHC Medicaid |
$0.37
|
| Rate for Payer: UHC Medicare Advantage |
$0.53
|
| Rate for Payer: UHCCP Medicaid |
$0.37
|
| Rate for Payer: VA VA |
$0.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.57
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$343.10
|
|
|
Service Code
|
NDC 00904730461
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna Commercial |
$291.63
|
| Rate for Payer: Aetna Medicare |
$89.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.22
|
| Rate for Payer: BCBS Complete |
$63.51
|
| Rate for Payer: BCBS MAPPO |
$85.78
|
| Rate for Payer: BCBS Trust/PPO |
$282.06
|
| Rate for Payer: BCN Commercial |
$282.06
|
| Rate for Payer: BCN Medicare Advantage |
$85.78
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.78
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: Mclaren Medicaid |
$60.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.06
|
| Rate for Payer: Meridian Medicaid |
$63.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$98.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$94.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Nomi Health Commercial |
$281.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: PACE Senior Care Partners |
$81.49
|
| Rate for Payer: PACE SWMI |
$85.78
|
| Rate for Payer: PHP Commercial |
$291.63
|
| Rate for Payer: PHP Medicare Advantage |
$85.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$298.50
|
| Rate for Payer: Priority Health Medicare |
$86.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.80
|
| Rate for Payer: Railroad Medicare Medicare |
$85.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.93
|
| Rate for Payer: UHC Core |
$286.49
|
| Rate for Payer: UHC Exchange |
$85.78
|
| Rate for Payer: UHC Medicaid |
$60.49
|
| Rate for Payer: UHC Medicare Advantage |
$85.78
|
| Rate for Payer: UHCCP Medicaid |
$60.49
|
| Rate for Payer: VA VA |
$85.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$65.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.58
|
| Rate for Payer: BCBS Complete |
$46.54
|
| Rate for Payer: BCBS MAPPO |
$62.86
|
| Rate for Payer: BCBS Trust/PPO |
$206.72
|
| Rate for Payer: BCN Commercial |
$206.72
|
| Rate for Payer: BCN Medicare Advantage |
$62.86
|
| 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: Health Alliance Plan Medicare Advantage |
$62.86
|
| Rate for Payer: Healthscope Commercial |
$226.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Mclaren Medicaid |
$44.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.01
|
| Rate for Payer: Meridian Medicaid |
$46.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$69.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.59
|
| Rate for Payer: PACE Senior Care Partners |
$59.72
|
| Rate for Payer: PACE SWMI |
$62.86
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: PHP Medicare Advantage |
$62.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Medicare |
$63.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.01
|
| Rate for Payer: Railroad Medicare Medicare |
$62.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: UHC Exchange |
$62.86
|
| Rate for Payer: UHC Medicaid |
$44.33
|
| Rate for Payer: UHC Medicare Advantage |
$62.86
|
| Rate for Payer: UHCCP Medicaid |
$44.33
|
| Rate for Payer: VA VA |
$62.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$343.10
|
|
|
Service Code
|
NDC 00904730461
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$308.79 |
| Rate for Payer: Aetna Commercial |
$291.63
|
| Rate for Payer: BCBS Trust/PPO |
$283.37
|
| Rate for Payer: BCN Commercial |
$283.37
|
| Rate for Payer: Cash Price |
$274.48
|
| Rate for Payer: Cofinity Commercial |
$295.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$274.48
|
| Rate for Payer: Healthscope Commercial |
$308.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$257.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$291.63
|
| Rate for Payer: Nomi Health Commercial |
$281.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$257.32
|
| Rate for Payer: PHP Commercial |
$291.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$298.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$238.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.93
|
| Rate for Payer: UHC Core |
$286.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$257.32
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.01 |
| Max. Negotiated Rate |
$226.31 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: BCBS Trust/PPO |
$207.67
|
| Rate for Payer: BCN Commercial |
$207.67
|
| 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 |
$226.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.59
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.01
|
| 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
|
|
|
PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$2,191.00
|
|
|
Service Code
|
HCPCS 49255
|
| Min. Negotiated Rate |
$479.46 |
| Max. Negotiated Rate |
$1,643.25 |
| Rate for Payer: Aetna Commercial |
$1,060.40
|
| Rate for Payer: Aetna Medicare |
$1,095.50
|
| Rate for Payer: BCBS Complete |
$503.43
|
| Rate for Payer: BCN Commercial |
$1,197.15
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Mclaren Medicaid |
$479.46
|
| Rate for Payer: Meridian Medicaid |
$503.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,643.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,458.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,458.65
|
| Rate for Payer: UHC Medicaid |
$479.46
|
| Rate for Payer: UHCCP Medicaid |
$479.46
|
|
|
PR ONDANSETRON HCL INJECTION
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J2405
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$0.10
|
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$0.02
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
|
|
PR ONE AREA LIPOSUCTION - 1 AREA 1.0 HR
|
Professional
|
Both
|
$1,803.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$721.20 |
| Max. Negotiated Rate |
$1,352.25 |
| Rate for Payer: Aetna Medicare |
$901.50
|
| Rate for Payer: BCBS Complete |
$721.20
|
| Rate for Payer: Cash Price |
$1,442.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,352.25
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99422
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$25.74
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$20.67
|
| Rate for Payer: BCN Commercial |
$49.00
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Mclaren Medicaid |
$19.69
|
| Rate for Payer: Meridian Medicaid |
$20.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$28.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.81
|
| Rate for Payer: UHC Medicaid |
$19.69
|
| Rate for Payer: UHCCP Medicaid |
$19.69
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Aetna Commercial |
$40.51
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCN Commercial |
$50.49
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Mclaren Medicaid |
$30.86
|
| Rate for Payer: Meridian Medicaid |
$32.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$44.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.73
|
| Rate for Payer: UHC Medicaid |
$30.86
|
| Rate for Payer: UHCCP Medicaid |
$30.86
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$12.71
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$10.19
|
| Rate for Payer: BCN Commercial |
$22.41
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Mclaren Medicaid |
$9.70
|
| Rate for Payer: Meridian Medicaid |
$10.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.41
|
| Rate for Payer: UHC Medicaid |
$9.70
|
| Rate for Payer: UHCCP Medicaid |
$9.70
|
|
|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,904.00
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$328.66 |
| Max. Negotiated Rate |
$2,178.00 |
| Rate for Payer: Aetna Commercial |
$655.82
|
| Rate for Payer: Aetna Medicare |
$1,452.00
|
| Rate for Payer: BCBS Complete |
$345.09
|
| Rate for Payer: BCN Commercial |
$836.61
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Cash Price |
$2,323.20
|
| Rate for Payer: Mclaren Medicaid |
$328.66
|
| Rate for Payer: Meridian Medicaid |
$345.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,178.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$328.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$847.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$847.30
|
| Rate for Payer: UHC Medicaid |
$328.66
|
| Rate for Payer: UHCCP Medicaid |
$328.66
|
|
|
PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY
|
Professional
|
Both
|
$2,375.00
|
|
|
Service Code
|
HCPCS 58943
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$1,828.76 |
| Rate for Payer: Aetna Commercial |
$1,398.24
|
| Rate for Payer: Aetna Medicare |
$1,187.50
|
| Rate for Payer: BCBS Complete |
$756.39
|
| Rate for Payer: BCN Commercial |
$1,805.68
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Cash Price |
$1,900.00
|
| Rate for Payer: Mclaren Medicaid |
$720.37
|
| Rate for Payer: Meridian Medicaid |
$756.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,781.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$720.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,828.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,828.76
|
| Rate for Payer: UHC Medicaid |
$720.37
|
| Rate for Payer: UHCCP Medicaid |
$720.37
|
|
