|
PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99316
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Aetna Commercial |
$165.06
|
| Rate for Payer: Aetna Medicare |
$128.11
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$123.18
|
| Rate for Payer: BCN Medicare Advantage |
$123.18
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$177.38
|
| Rate for Payer: Cofinity Commercial |
$165.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.34
|
| Rate for Payer: Nomi Health Commercial |
$147.82
|
| Rate for Payer: PACE SWMI |
$123.18
|
| Rate for Payer: PHP Medicare Advantage |
$123.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$124.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.18
|
| Rate for Payer: UHC Exchange |
$123.18
|
| Rate for Payer: UHC Medicare Advantage |
$123.18
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99315
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$110.55 |
| Rate for Payer: Aetna Commercial |
$102.87
|
| Rate for Payer: Aetna Medicare |
$79.84
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$76.77
|
| Rate for Payer: BCN Medicare Advantage |
$76.77
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$110.55
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.61
|
| Rate for Payer: Nomi Health Commercial |
$92.12
|
| Rate for Payer: PACE SWMI |
$76.77
|
| Rate for Payer: PHP Medicare Advantage |
$76.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$77.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.77
|
| Rate for Payer: UHC Exchange |
$76.77
|
| Rate for Payer: UHC Medicare Advantage |
$76.77
|
|
|
PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 94690
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare |
$44.82
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$43.10
|
| Rate for Payer: BCN Medicare Advantage |
$43.10
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$62.06
|
| Rate for Payer: Cofinity Commercial |
$57.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.26
|
| Rate for Payer: Nomi Health Commercial |
$51.72
|
| Rate for Payer: PACE SWMI |
$43.10
|
| Rate for Payer: PHP Medicare Advantage |
$43.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$43.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.10
|
| Rate for Payer: UHC Exchange |
$43.10
|
| Rate for Payer: UHC Medicare Advantage |
$43.10
|
|
|
PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 94680
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$63.85
|
| Rate for Payer: Aetna Medicare |
$49.56
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$47.65
|
| Rate for Payer: BCN Medicare Advantage |
$47.65
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$68.62
|
| Rate for Payer: Cofinity Commercial |
$63.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.03
|
| Rate for Payer: Nomi Health Commercial |
$57.18
|
| Rate for Payer: PACE SWMI |
$47.65
|
| Rate for Payer: PHP Medicare Advantage |
$47.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$48.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.65
|
| Rate for Payer: UHC Exchange |
$47.65
|
| Rate for Payer: UHC Medicare Advantage |
$47.65
|
|
|
PROAIR HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
OP
|
$240.10
|
|
|
Service Code
|
NDC 59310057922
|
| Hospital Charge Code |
76821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.02 |
| Max. Negotiated Rate |
$216.09 |
| Rate for Payer: Aetna Commercial |
$204.09
|
| Rate for Payer: Aetna Medicare |
$62.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.03
|
| Rate for Payer: BCBS Complete |
$96.04
|
| Rate for Payer: BCBS MAPPO |
$60.02
|
| Rate for Payer: BCBS Trust/PPO |
$197.39
|
| Rate for Payer: BCN Commercial |
$186.68
|
| Rate for Payer: BCN Medicare Advantage |
$60.02
|
| 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: Health Alliance Plan Medicare Advantage |
$60.02
|
| Rate for Payer: Healthscope Commercial |
$216.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.09
|
| Rate for Payer: Nomi Health Commercial |
$196.88
|
| Rate for Payer: PACE Senior Care Partners |
$57.02
|
| Rate for Payer: PACE SWMI |
$60.02
|
| Rate for Payer: PHP Commercial |
$204.09
|
| Rate for Payer: PHP Medicare Advantage |
$60.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.06
|
| Rate for Payer: Priority Health HMO/PPO |
$208.89
|
| Rate for Payer: Priority Health Medicare |
$60.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.87
|
| Rate for Payer: Railroad Medicare Medicare |
$60.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.29
|
| Rate for Payer: UHC Core |
$200.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.02
|
| Rate for Payer: UHC Exchange |
$60.02
|
| Rate for Payer: UHC Medicare Advantage |
$60.02
|
| Rate for Payer: VA VA |
$60.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.07
|
|
|
PROAIR HFA 90 MCG/ACTUATION AEROSOL INHALER
|
Facility
|
IP
|
$240.10
|
|
|
Service Code
|
NDC 59310057922
|
| Hospital Charge Code |
76821
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.06 |
| Max. Negotiated Rate |
$216.09 |
| Rate for Payer: Aetna Commercial |
$204.09
|
| Rate for Payer: BCBS Trust/PPO |
$195.99
|
| 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 |
$180.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.09
|
| Rate for Payer: Nomi Health Commercial |
$196.88
|
| Rate for Payer: PHP Commercial |
$204.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.06
|
| Rate for Payer: Priority Health HMO/PPO |
$208.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.87
|
| 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 |
$180.07
|
|
|
PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM
|
Professional
|
Both
|
$4,249.00
|
|
|
Service Code
|
HCPCS 59510
|
| Min. Negotiated Rate |
$1,699.60 |
| Max. Negotiated Rate |
$3,752.73 |
| Rate for Payer: Aetna Commercial |
$3,492.12
|
| Rate for Payer: Aetna Medicare |
$2,710.30
|
| Rate for Payer: BCBS Complete |
$1,699.60
|
| Rate for Payer: BCBS MAPPO |
$2,606.06
|
| Rate for Payer: BCN Medicare Advantage |
$2,606.06
|
| Rate for Payer: Cash Price |
$3,399.20
|
| Rate for Payer: Cash Price |
$3,399.20
|
| Rate for Payer: Cofinity Commercial |
$3,752.73
|
| Rate for Payer: Cofinity Commercial |
$3,492.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,606.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,736.36
|
| Rate for Payer: Nomi Health Commercial |
$3,127.27
|
| Rate for Payer: PACE SWMI |
$2,606.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,606.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,761.85
|
| Rate for Payer: Priority Health Medicare |
$2,632.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,606.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,606.06
|
| Rate for Payer: UHC Exchange |
$2,606.06
|
| Rate for Payer: UHC Medicare Advantage |
$2,606.06
|
|
|
PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM
|
Professional
|
Both
|
$3,830.00
|
|
|
Service Code
|
HCPCS 59400
|
| Min. Negotiated Rate |
$1,532.00 |
| Max. Negotiated Rate |
$3,366.16 |
| Rate for Payer: Aetna Commercial |
$3,132.40
|
| Rate for Payer: Aetna Medicare |
$2,431.11
|
| Rate for Payer: BCBS Complete |
$1,532.00
|
| Rate for Payer: BCBS MAPPO |
$2,337.61
|
| Rate for Payer: BCN Medicare Advantage |
$2,337.61
|
| Rate for Payer: Cash Price |
$3,064.00
|
| Rate for Payer: Cash Price |
$3,064.00
|
| Rate for Payer: Cofinity Commercial |
$3,366.16
|
| Rate for Payer: Cofinity Commercial |
$3,132.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,337.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,454.49
|
| Rate for Payer: Nomi Health Commercial |
$2,805.13
|
| Rate for Payer: PACE SWMI |
$2,337.61
|
| Rate for Payer: PHP Medicare Advantage |
$2,337.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,489.50
|
| Rate for Payer: Priority Health Medicare |
$2,360.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,337.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,337.61
|
| Rate for Payer: UHC Exchange |
$2,337.61
|
| Rate for Payer: UHC Medicare Advantage |
$2,337.61
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 33813
|
| Min. Negotiated Rate |
$962.40 |
| Max. Negotiated Rate |
$1,563.90 |
| Rate for Payer: Aetna Medicare |
$1,203.00
|
| Rate for Payer: BCBS Complete |
$962.40
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,563.90
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DFCT W/CARD BYPASS
|
Professional
|
Both
|
$3,091.00
|
|
|
Service Code
|
HCPCS 33814
|
| Min. Negotiated Rate |
$1,236.40 |
| Max. Negotiated Rate |
$2,111.28 |
| Rate for Payer: Aetna Commercial |
$1,964.67
|
| Rate for Payer: Aetna Medicare |
$1,524.82
|
| Rate for Payer: BCBS Complete |
$1,236.40
|
| Rate for Payer: BCBS MAPPO |
$1,466.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,466.17
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cofinity Commercial |
$2,111.28
|
| Rate for Payer: Cofinity Commercial |
$1,964.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,539.48
|
| Rate for Payer: Nomi Health Commercial |
$1,759.40
|
| Rate for Payer: PACE SWMI |
$1,466.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,466.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,009.15
|
| Rate for Payer: Priority Health Medicare |
$1,480.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,466.17
|
| Rate for Payer: UHC Exchange |
$1,466.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.17
|
|
|
PR OBSERVATION CARE DISCHARGE MANAGEMENT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99217
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Commercial |
$22.98
|
| Rate for Payer: Aetna Medicare |
$17.84
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$17.15
|
| Rate for Payer: BCN Medicare Advantage |
$17.15
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.01
|
| Rate for Payer: Nomi Health Commercial |
$20.58
|
| Rate for Payer: PACE SWMI |
$17.15
|
| Rate for Payer: PHP Medicare Advantage |
$17.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health Medicare |
$17.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.15
|
| Rate for Payer: UHC Exchange |
$17.15
|
| Rate for Payer: UHC Medicare Advantage |
$17.15
|
|
|
PR OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 58615
|
| Min. Negotiated Rate |
$179.60 |
| Max. Negotiated Rate |
$347.60 |
| Rate for Payer: Aetna Commercial |
$323.46
|
| Rate for Payer: Aetna Medicare |
$251.05
|
| Rate for Payer: BCBS Complete |
$179.60
|
| Rate for Payer: BCBS MAPPO |
$241.39
|
| Rate for Payer: BCN Medicare Advantage |
$241.39
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$323.46
|
| Rate for Payer: Cofinity Commercial |
$347.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.46
|
| Rate for Payer: Nomi Health Commercial |
$289.67
|
| Rate for Payer: PACE SWMI |
$241.39
|
| Rate for Payer: PHP Medicare Advantage |
$241.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$243.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.39
|
| Rate for Payer: UHC Exchange |
$241.39
|
| Rate for Payer: UHC Medicare Advantage |
$241.39
|
|
|
PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 97165
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$138.84 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$96.42
|
| Rate for Payer: BCN Medicare Advantage |
$96.42
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.24
|
| Rate for Payer: Nomi Health Commercial |
$115.70
|
| Rate for Payer: PACE SWMI |
$96.42
|
| Rate for Payer: PHP Medicare Advantage |
$96.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$97.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.42
|
| Rate for Payer: UHC Exchange |
$96.42
|
| Rate for Payer: UHC Medicare Advantage |
$96.42
|
|
|
PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 97166
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$138.84 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS MAPPO |
$96.42
|
| Rate for Payer: BCN Medicare Advantage |
$96.42
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.24
|
| Rate for Payer: Nomi Health Commercial |
$115.70
|
| Rate for Payer: PACE SWMI |
$96.42
|
| Rate for Payer: PHP Medicare Advantage |
$96.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Medicare |
$97.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.42
|
| Rate for Payer: UHC Exchange |
$96.42
|
| Rate for Payer: UHC Medicare Advantage |
$96.42
|
|
|
PR OCCUPATIONAL THERAPY EVALUATION
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 97003
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
|
|
PR OCCUPATIONAL THERAPY RE-EVALUATION
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 97004
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
|
|
PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 97168
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$95.57 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Aetna Medicare |
$69.02
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$66.37
|
| Rate for Payer: BCN Medicare Advantage |
$66.37
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$95.57
|
| Rate for Payer: Cofinity Commercial |
$88.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.69
|
| Rate for Payer: Nomi Health Commercial |
$79.64
|
| Rate for Payer: PACE SWMI |
$66.37
|
| Rate for Payer: PHP Medicare Advantage |
$66.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$67.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.37
|
| Rate for Payer: UHC Exchange |
$66.37
|
| Rate for Payer: UHC Medicare Advantage |
$66.37
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$367.50
|
|
|
Service Code
|
NDC 00574722612
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.88 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Aetna Commercial |
$312.38
|
| Rate for Payer: BCBS Trust/PPO |
$299.99
|
| 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 Commercial |
$312.38
|
| Rate for Payer: Nomi Health Commercial |
$301.35
|
| Rate for Payer: PHP Commercial |
$312.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.88
|
| Rate for Payer: Priority Health HMO/PPO |
$319.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.22
|
| 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 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$29.99
|
|
|
Service Code
|
NDC 00713013506
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$26.99 |
| Rate for Payer: Aetna Commercial |
$25.49
|
| Rate for Payer: Aetna Medicare |
$7.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.37
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$7.50
|
| Rate for Payer: BCBS Trust/PPO |
$24.65
|
| Rate for Payer: BCN Commercial |
$23.32
|
| Rate for Payer: BCN Medicare Advantage |
$7.50
|
| 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: Health Alliance Plan Medicare Advantage |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$26.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.49
|
| Rate for Payer: Nomi Health Commercial |
$24.59
|
| Rate for Payer: PACE Senior Care Partners |
$7.12
|
| Rate for Payer: PACE SWMI |
$7.50
|
| Rate for Payer: PHP Commercial |
$25.49
|
| Rate for Payer: PHP Medicare Advantage |
$7.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.49
|
| Rate for Payer: Priority Health HMO/PPO |
$26.09
|
| Rate for Payer: Priority Health Medicare |
$7.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.09
|
| Rate for Payer: Railroad Medicare Medicare |
$7.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.39
|
| Rate for Payer: UHC Core |
$25.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.50
|
| Rate for Payer: UHC Exchange |
$7.50
|
| Rate for Payer: UHC Medicare Advantage |
$7.50
|
| Rate for Payer: VA VA |
$7.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.49
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$29.99
|
|
|
Service Code
|
NDC 00713013506
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$26.99 |
| Rate for Payer: Aetna Commercial |
$25.49
|
| Rate for Payer: BCBS Trust/PPO |
$24.48
|
| 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 Commercial |
$25.49
|
| Rate for Payer: Nomi Health Commercial |
$24.59
|
| Rate for Payer: PHP Commercial |
$25.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.49
|
| Rate for Payer: Priority Health HMO/PPO |
$26.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.09
|
| 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
|
OP
|
$367.50
|
|
|
Service Code
|
NDC 00574722612
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.28 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Aetna Commercial |
$312.38
|
| Rate for Payer: Aetna Medicare |
$95.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.84
|
| Rate for Payer: BCBS Complete |
$147.00
|
| Rate for Payer: BCBS MAPPO |
$91.88
|
| Rate for Payer: BCBS Trust/PPO |
$302.12
|
| Rate for Payer: BCN Commercial |
$285.73
|
| Rate for Payer: BCN Medicare Advantage |
$91.88
|
| 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: Health Alliance Plan Medicare Advantage |
$91.88
|
| Rate for Payer: Healthscope Commercial |
$330.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.38
|
| Rate for Payer: Nomi Health Commercial |
$301.35
|
| Rate for Payer: PACE Senior Care Partners |
$87.28
|
| Rate for Payer: PACE SWMI |
$91.88
|
| Rate for Payer: PHP Commercial |
$312.38
|
| Rate for Payer: PHP Medicare Advantage |
$91.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.88
|
| Rate for Payer: Priority Health HMO/PPO |
$319.73
|
| Rate for Payer: Priority Health Medicare |
$92.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$246.22
|
| Rate for Payer: Railroad Medicare Medicare |
$91.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.40
|
| Rate for Payer: UHC Core |
$306.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.88
|
| Rate for Payer: UHC Exchange |
$91.88
|
| Rate for Payer: UHC Medicare Advantage |
$91.88
|
| Rate for Payer: VA VA |
$91.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.62
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$31.84
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$28.66 |
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Aetna Commercial |
$45.68
|
| Rate for Payer: Aetna Commercial |
$29.29
|
| Rate for Payer: Aetna Commercial |
$48.05
|
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Commercial |
$35.77
|
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$47.33
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Aetna Medicare |
$8.28
|
| Rate for Payer: Aetna Medicare |
$14.48
|
| Rate for Payer: Aetna Medicare |
$8.24
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Aetna Medicare |
$9.19
|
| Rate for Payer: Aetna Medicare |
$13.97
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Aetna Medicare |
$19.91
|
| Rate for Payer: Aetna Medicare |
$10.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$23.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$23.93
|
| Rate for Payer: BCBS Complete |
$12.68
|
| Rate for Payer: BCBS Complete |
$12.74
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: BCBS Complete |
$16.83
|
| Rate for Payer: BCBS Complete |
$22.61
|
| Rate for Payer: BCBS Complete |
$30.63
|
| Rate for Payer: BCBS Complete |
$13.78
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS Complete |
$22.27
|
| Rate for Payer: BCBS Complete |
$15.54
|
| Rate for Payer: BCBS MAPPO |
$8.62
|
| Rate for Payer: BCBS MAPPO |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$7.92
|
| Rate for Payer: BCBS MAPPO |
$13.44
|
| Rate for Payer: BCBS MAPPO |
$10.52
|
| Rate for Payer: BCBS MAPPO |
$9.71
|
| Rate for Payer: BCBS MAPPO |
$13.92
|
| Rate for Payer: BCBS MAPPO |
$19.14
|
| Rate for Payer: BCBS MAPPO |
$7.96
|
| Rate for Payer: BCBS MAPPO |
$8.84
|
| Rate for Payer: BCBS MAPPO |
$14.13
|
| Rate for Payer: BCBS Trust/PPO |
$44.18
|
| Rate for Payer: BCBS Trust/PPO |
$62.95
|
| Rate for Payer: BCBS Trust/PPO |
$26.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.41
|
| Rate for Payer: BCBS Trust/PPO |
$31.93
|
| Rate for Payer: BCBS Trust/PPO |
$28.33
|
| Rate for Payer: BCBS Trust/PPO |
$45.77
|
| Rate for Payer: BCBS Trust/PPO |
$46.47
|
| Rate for Payer: BCBS Trust/PPO |
$29.07
|
| Rate for Payer: BCBS Trust/PPO |
$26.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.59
|
| Rate for Payer: BCN Commercial |
$41.78
|
| Rate for Payer: BCN Commercial |
$32.72
|
| Rate for Payer: BCN Commercial |
$43.29
|
| Rate for Payer: BCN Commercial |
$43.95
|
| Rate for Payer: BCN Commercial |
$24.65
|
| Rate for Payer: BCN Commercial |
$17.41
|
| Rate for Payer: BCN Commercial |
$24.76
|
| Rate for Payer: BCN Commercial |
$59.53
|
| Rate for Payer: BCN Commercial |
$30.20
|
| Rate for Payer: BCN Commercial |
$27.49
|
| Rate for Payer: BCN Commercial |
$26.79
|
| Rate for Payer: BCN Medicare Advantage |
$19.14
|
| Rate for Payer: BCN Medicare Advantage |
$13.92
|
| Rate for Payer: BCN Medicare Advantage |
$9.71
|
| Rate for Payer: BCN Medicare Advantage |
$8.62
|
| Rate for Payer: BCN Medicare Advantage |
$7.96
|
| Rate for Payer: BCN Medicare Advantage |
$13.44
|
| Rate for Payer: BCN Medicare Advantage |
$8.84
|
| Rate for Payer: BCN Medicare Advantage |
$10.52
|
| Rate for Payer: BCN Medicare Advantage |
$5.60
|
| Rate for Payer: BCN Medicare Advantage |
$7.92
|
| Rate for Payer: BCN Medicare Advantage |
$14.13
|
| Rate for Payer: Cash Price |
$45.22
|
| Rate for Payer: Cash Price |
$44.54
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$27.57
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$61.26
|
| Rate for Payer: Cash Price |
$25.36
|
| Rate for Payer: Cofinity Commercial |
$29.64
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Cofinity Commercial |
$65.85
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Cofinity Commercial |
$48.62
|
| Rate for Payer: Cofinity Commercial |
$30.41
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.44
|
| Rate for Payer: Healthscope Commercial |
$48.37
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$50.88
|
| Rate for Payer: Healthscope Commercial |
$37.87
|
| Rate for Payer: Healthscope Commercial |
$50.11
|
| Rate for Payer: Healthscope Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$28.66
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$68.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.29
|
| Rate for Payer: Nomi Health Commercial |
$28.26
|
| Rate for Payer: Nomi Health Commercial |
$31.85
|
| Rate for Payer: Nomi Health Commercial |
$46.35
|
| Rate for Payer: Nomi Health Commercial |
$34.51
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: Nomi Health Commercial |
$18.36
|
| Rate for Payer: Nomi Health Commercial |
$44.07
|
| Rate for Payer: Nomi Health Commercial |
$25.99
|
| Rate for Payer: Nomi Health Commercial |
$45.66
|
| Rate for Payer: Nomi Health Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$26.11
|
| Rate for Payer: PACE Senior Care Partners |
$12.76
|
| Rate for Payer: PACE Senior Care Partners |
$9.22
|
| Rate for Payer: PACE Senior Care Partners |
$5.32
|
| Rate for Payer: PACE Senior Care Partners |
$8.18
|
| Rate for Payer: PACE Senior Care Partners |
$18.19
|
| Rate for Payer: PACE Senior Care Partners |
$9.99
|
| Rate for Payer: PACE Senior Care Partners |
$13.43
|
| Rate for Payer: PACE Senior Care Partners |
$8.40
|
| Rate for Payer: PACE Senior Care Partners |
$7.56
|
| Rate for Payer: PACE Senior Care Partners |
$13.22
|
| Rate for Payer: PACE Senior Care Partners |
$7.53
|
| Rate for Payer: PACE SWMI |
$10.52
|
| Rate for Payer: PACE SWMI |
$5.60
|
| Rate for Payer: PACE SWMI |
$7.96
|
| Rate for Payer: PACE SWMI |
$9.71
|
| Rate for Payer: PACE SWMI |
$8.62
|
| Rate for Payer: PACE SWMI |
$7.92
|
| Rate for Payer: PACE SWMI |
$13.92
|
| Rate for Payer: PACE SWMI |
$19.14
|
| Rate for Payer: PACE SWMI |
$8.84
|
| Rate for Payer: PACE SWMI |
$14.13
|
| Rate for Payer: PACE SWMI |
$13.44
|
| Rate for Payer: PHP Commercial |
$48.05
|
| Rate for Payer: PHP Commercial |
$26.95
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$29.29
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$35.77
|
| Rate for Payer: PHP Commercial |
$45.68
|
| Rate for Payer: PHP Commercial |
$47.33
|
| Rate for Payer: PHP Commercial |
$65.08
|
| Rate for Payer: PHP Medicare Advantage |
$5.60
|
| Rate for Payer: PHP Medicare Advantage |
$14.13
|
| Rate for Payer: PHP Medicare Advantage |
$7.96
|
| Rate for Payer: PHP Medicare Advantage |
$10.52
|
| Rate for Payer: PHP Medicare Advantage |
$8.62
|
| Rate for Payer: PHP Medicare Advantage |
$13.92
|
| Rate for Payer: PHP Medicare Advantage |
$9.71
|
| Rate for Payer: PHP Medicare Advantage |
$7.92
|
| Rate for Payer: PHP Medicare Advantage |
$13.44
|
| Rate for Payer: PHP Medicare Advantage |
$8.84
|
| Rate for Payer: PHP Medicare Advantage |
$19.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO |
$36.61
|
| Rate for Payer: Priority Health HMO/PPO |
$29.98
|
| Rate for Payer: Priority Health HMO/PPO |
$27.58
|
| Rate for Payer: Priority Health HMO/PPO |
$48.44
|
| Rate for Payer: Priority Health HMO/PPO |
$27.70
|
| Rate for Payer: Priority Health HMO/PPO |
$46.75
|
| Rate for Payer: Priority Health HMO/PPO |
$19.48
|
| Rate for Payer: Priority Health HMO/PPO |
$30.76
|
| Rate for Payer: Priority Health HMO/PPO |
$49.18
|
| Rate for Payer: Priority Health HMO/PPO |
$33.79
|
| Rate for Payer: Priority Health HMO/PPO |
$66.62
|
| Rate for Payer: Priority Health Medicare |
$14.27
|
| Rate for Payer: Priority Health Medicare |
$9.81
|
| Rate for Payer: Priority Health Medicare |
$13.57
|
| Rate for Payer: Priority Health Medicare |
$19.33
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: Priority Health Medicare |
$14.06
|
| Rate for Payer: Priority Health Medicare |
$8.00
|
| Rate for Payer: Priority Health Medicare |
$5.65
|
| Rate for Payer: Priority Health Medicare |
$8.70
|
| Rate for Payer: Priority Health Medicare |
$10.63
|
| Rate for Payer: Priority Health Medicare |
$8.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.24
|
| Rate for Payer: Railroad Medicare Medicare |
$8.84
|
| Rate for Payer: Railroad Medicare Medicare |
$13.44
|
| Rate for Payer: Railroad Medicare Medicare |
$19.14
|
| Rate for Payer: Railroad Medicare Medicare |
$10.52
|
| Rate for Payer: Railroad Medicare Medicare |
$8.62
|
| Rate for Payer: Railroad Medicare Medicare |
$9.71
|
| Rate for Payer: Railroad Medicare Medicare |
$13.92
|
| Rate for Payer: Railroad Medicare Medicare |
$7.92
|
| Rate for Payer: Railroad Medicare Medicare |
$14.13
|
| Rate for Payer: Railroad Medicare Medicare |
$7.96
|
| Rate for Payer: Railroad Medicare Medicare |
$5.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.12
|
| Rate for Payer: UHC Core |
$44.87
|
| Rate for Payer: UHC Core |
$46.49
|
| Rate for Payer: UHC Core |
$47.20
|
| Rate for Payer: UHC Core |
$63.94
|
| Rate for Payer: UHC Core |
$28.77
|
| Rate for Payer: UHC Core |
$26.59
|
| Rate for Payer: UHC Core |
$29.53
|
| Rate for Payer: UHC Core |
$18.70
|
| Rate for Payer: UHC Core |
$26.47
|
| Rate for Payer: UHC Core |
$35.14
|
| Rate for Payer: UHC Core |
$32.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.60
|
| Rate for Payer: UHC Exchange |
$10.52
|
| Rate for Payer: UHC Exchange |
$9.71
|
| Rate for Payer: UHC Exchange |
$13.44
|
| Rate for Payer: UHC Exchange |
$8.84
|
| Rate for Payer: UHC Exchange |
$8.62
|
| Rate for Payer: UHC Exchange |
$13.92
|
| Rate for Payer: UHC Exchange |
$7.96
|
| Rate for Payer: UHC Exchange |
$7.92
|
| Rate for Payer: UHC Exchange |
$14.13
|
| Rate for Payer: UHC Exchange |
$5.60
|
| Rate for Payer: UHC Exchange |
$19.14
|
| Rate for Payer: UHC Medicare Advantage |
$19.14
|
| Rate for Payer: UHC Medicare Advantage |
$7.92
|
| Rate for Payer: UHC Medicare Advantage |
$13.92
|
| Rate for Payer: UHC Medicare Advantage |
$5.60
|
| Rate for Payer: UHC Medicare Advantage |
$8.62
|
| Rate for Payer: UHC Medicare Advantage |
$10.52
|
| Rate for Payer: UHC Medicare Advantage |
$13.44
|
| Rate for Payer: UHC Medicare Advantage |
$8.84
|
| Rate for Payer: UHC Medicare Advantage |
$7.96
|
| Rate for Payer: UHC Medicare Advantage |
$14.13
|
| Rate for Payer: UHC Medicare Advantage |
$9.71
|
| Rate for Payer: VA VA |
$5.60
|
| Rate for Payer: VA VA |
$10.52
|
| Rate for Payer: VA VA |
$14.13
|
| Rate for Payer: VA VA |
$7.92
|
| Rate for Payer: VA VA |
$7.96
|
| Rate for Payer: VA VA |
$13.92
|
| Rate for Payer: VA VA |
$19.14
|
| Rate for Payer: VA VA |
$8.62
|
| Rate for Payer: VA VA |
$8.84
|
| Rate for Payer: VA VA |
$13.44
|
| Rate for Payer: VA VA |
$9.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.30
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$31.70
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.61 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: Aetna Commercial |
$26.95
|
| Rate for Payer: Aetna Commercial |
$29.29
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$35.77
|
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Commercial |
$45.68
|
| Rate for Payer: Aetna Commercial |
$47.33
|
| Rate for Payer: Aetna Commercial |
$48.05
|
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: BCBS Trust/PPO |
$34.35
|
| Rate for Payer: BCBS Trust/PPO |
$43.87
|
| Rate for Payer: BCBS Trust/PPO |
$25.99
|
| Rate for Payer: BCBS Trust/PPO |
$62.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.71
|
| Rate for Payer: BCBS Trust/PPO |
$28.13
|
| Rate for Payer: BCBS Trust/PPO |
$25.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.28
|
| Rate for Payer: BCBS Trust/PPO |
$46.15
|
| Rate for Payer: BCBS Trust/PPO |
$28.86
|
| Rate for Payer: BCBS Trust/PPO |
$45.45
|
| Rate for Payer: BCN Commercial |
$26.63
|
| Rate for Payer: BCN Commercial |
$30.02
|
| Rate for Payer: BCN Commercial |
$32.52
|
| Rate for Payer: BCN Commercial |
$27.33
|
| Rate for Payer: BCN Commercial |
$43.03
|
| Rate for Payer: BCN Commercial |
$43.69
|
| Rate for Payer: BCN Commercial |
$59.17
|
| Rate for Payer: BCN Commercial |
$41.53
|
| Rate for Payer: BCN Commercial |
$24.61
|
| Rate for Payer: BCN Commercial |
$17.30
|
| Rate for Payer: BCN Commercial |
$24.50
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$25.36
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$27.57
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$61.26
|
| Rate for Payer: Cash Price |
$45.22
|
| Rate for Payer: Cash Price |
$44.54
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$65.85
|
| Rate for Payer: Cofinity Commercial |
$29.64
|
| Rate for Payer: Cofinity Commercial |
$47.88
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$27.26
|
| Rate for Payer: Cofinity Commercial |
$30.41
|
| Rate for Payer: Cofinity Commercial |
$48.62
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Healthscope Commercial |
$50.11
|
| Rate for Payer: Healthscope Commercial |
$50.88
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$28.66
|
| Rate for Payer: Healthscope Commercial |
$28.53
|
| Rate for Payer: Healthscope Commercial |
$37.87
|
| Rate for Payer: Healthscope Commercial |
$48.37
|
| Rate for Payer: Healthscope Commercial |
$68.91
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$31.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$47.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.08
|
| Rate for Payer: Nomi Health Commercial |
$28.26
|
| Rate for Payer: Nomi Health Commercial |
$45.66
|
| Rate for Payer: Nomi Health Commercial |
$31.85
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: Nomi Health Commercial |
$44.07
|
| Rate for Payer: Nomi Health Commercial |
$34.51
|
| Rate for Payer: Nomi Health Commercial |
$46.35
|
| Rate for Payer: Nomi Health Commercial |
$62.79
|
| Rate for Payer: Nomi Health Commercial |
$18.36
|
| Rate for Payer: Nomi Health Commercial |
$25.99
|
| Rate for Payer: Nomi Health Commercial |
$26.11
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$26.95
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$29.29
|
| Rate for Payer: PHP Commercial |
$48.05
|
| Rate for Payer: PHP Commercial |
$65.08
|
| Rate for Payer: PHP Commercial |
$35.77
|
| Rate for Payer: PHP Commercial |
$45.68
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: PHP Commercial |
$47.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.77
|
| Rate for Payer: Priority Health HMO/PPO |
$19.48
|
| Rate for Payer: Priority Health HMO/PPO |
$30.76
|
| Rate for Payer: Priority Health HMO/PPO |
$48.44
|
| Rate for Payer: Priority Health HMO/PPO |
$29.98
|
| Rate for Payer: Priority Health HMO/PPO |
$33.79
|
| Rate for Payer: Priority Health HMO/PPO |
$49.18
|
| Rate for Payer: Priority Health HMO/PPO |
$36.61
|
| Rate for Payer: Priority Health HMO/PPO |
$66.62
|
| Rate for Payer: Priority Health HMO/PPO |
$27.58
|
| Rate for Payer: Priority Health HMO/PPO |
$27.70
|
| Rate for Payer: Priority Health HMO/PPO |
$46.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$28.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$21.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.29
|
| Rate for Payer: UHC Core |
$46.49
|
| Rate for Payer: UHC Core |
$26.47
|
| Rate for Payer: UHC Core |
$63.94
|
| Rate for Payer: UHC Core |
$44.87
|
| Rate for Payer: UHC Core |
$26.59
|
| Rate for Payer: UHC Core |
$32.43
|
| Rate for Payer: UHC Core |
$47.20
|
| Rate for Payer: UHC Core |
$18.70
|
| Rate for Payer: UHC Core |
$28.77
|
| Rate for Payer: UHC Core |
$35.14
|
| Rate for Payer: UHC Core |
$29.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.13
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
NDC 00904738106
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.15 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Medicare |
$59.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.25
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS MAPPO |
$57.00
|
| Rate for Payer: BCBS Trust/PPO |
$187.44
|
| Rate for Payer: BCN Commercial |
$177.27
|
| Rate for Payer: BCN Medicare Advantage |
$57.00
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$196.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.00
|
| Rate for Payer: Healthscope Commercial |
$205.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Nomi Health Commercial |
$186.96
|
| Rate for Payer: PACE Senior Care Partners |
$54.15
|
| Rate for Payer: PACE SWMI |
$57.00
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: PHP Medicare Advantage |
$57.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health HMO/PPO |
$198.36
|
| Rate for Payer: Priority Health Medicare |
$57.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.76
|
| Rate for Payer: Railroad Medicare Medicare |
$57.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.64
|
| Rate for Payer: UHC Core |
$190.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.00
|
| Rate for Payer: UHC Exchange |
$57.00
|
| Rate for Payer: UHC Medicare Advantage |
$57.00
|
| Rate for Payer: VA VA |
$57.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
