|
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 |
$2,076.22 |
| 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: BCBS Trust/PPO |
$2,076.22
|
| Rate for Payer: BCN Commercial |
$59.82
|
| 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 HMO/PPO |
$46.35
|
| Rate for Payer: Priority Health Medicare |
$67.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.35
|
| 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 |
$319.72
|
| 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
|
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 |
$319.72
|
| 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 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 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 |
$26.94
|
| 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 |
$23.78
|
| 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 |
$26.94
|
| 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 |
$26.94
|
| 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 |
$20.60
|
| 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 |
$23.78
|
| 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 |
$20.60 |
| Max. Negotiated Rate |
$28.53 |
| Rate for Payer: Aetna Commercial |
$26.94
|
| 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 |
$23.78
|
| 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 |
$26.94
|
| 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 |
$26.94
|
| 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 |
$20.60
|
| 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 |
$23.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.13
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
NDC 00904738106
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.20 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: BCBS Trust/PPO |
$186.12
|
| Rate for Payer: BCN Commercial |
$176.20
|
| 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: Healthscope Commercial |
$205.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.80
|
| Rate for Payer: Nomi Health Commercial |
$186.96
|
| Rate for Payer: PHP Commercial |
$193.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.20
|
| Rate for Payer: Priority Health HMO/PPO |
$198.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.64
|
| Rate for Payer: UHC Core |
$190.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.00
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
OP
|
$250.80
|
|
|
Service Code
|
NDC 50268068415
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.56 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: Aetna Medicare |
$65.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.38
|
| Rate for Payer: BCBS Complete |
$100.32
|
| Rate for Payer: BCBS MAPPO |
$62.70
|
| Rate for Payer: BCBS Trust/PPO |
$206.18
|
| Rate for Payer: BCN Commercial |
$195.00
|
| Rate for Payer: BCN Medicare Advantage |
$62.70
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.70
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.18
|
| Rate for Payer: Nomi Health Commercial |
$205.66
|
| Rate for Payer: PACE Senior Care Partners |
$59.56
|
| Rate for Payer: PACE SWMI |
$62.70
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: PHP Medicare Advantage |
$62.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.02
|
| Rate for Payer: Priority Health HMO/PPO |
$218.20
|
| Rate for Payer: Priority Health Medicare |
$63.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.04
|
| Rate for Payer: Railroad Medicare Medicare |
$62.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.70
|
| Rate for Payer: UHC Core |
$209.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.70
|
| Rate for Payer: UHC Exchange |
$62.70
|
| Rate for Payer: UHC Medicare Advantage |
$62.70
|
| Rate for Payer: VA VA |
$62.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$250.80
|
|
|
Service Code
|
NDC 50268068415
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.02 |
| Max. Negotiated Rate |
$225.72 |
| Rate for Payer: Aetna Commercial |
$213.18
|
| Rate for Payer: BCBS Trust/PPO |
$204.73
|
| Rate for Payer: BCN Commercial |
$193.82
|
| Rate for Payer: Cash Price |
$200.64
|
| Rate for Payer: Cofinity Commercial |
$215.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.64
|
| Rate for Payer: Healthscope Commercial |
$225.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.18
|
| Rate for Payer: Nomi Health Commercial |
$205.66
|
| Rate for Payer: PHP Commercial |
$213.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.02
|
| Rate for Payer: Priority Health HMO/PPO |
$218.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.70
|
| Rate for Payer: UHC Core |
$209.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.10
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$307.80
|
|
|
Service Code
|
NDC 59746011306
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.07 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: BCBS Trust/PPO |
$251.26
|
| Rate for Payer: BCN Commercial |
$237.87
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Nomi Health Commercial |
$252.40
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.07
|
| Rate for Payer: Priority Health HMO/PPO |
$267.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.86
|
| Rate for Payer: UHC Core |
$257.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
OP
|
$307.80
|
|
|
Service Code
|
NDC 59746011306
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$80.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.19
|
| Rate for Payer: BCBS Complete |
$123.12
|
| Rate for Payer: BCBS MAPPO |
$76.95
|
| Rate for Payer: BCBS Trust/PPO |
$253.04
|
| Rate for Payer: BCN Commercial |
$239.31
|
| Rate for Payer: BCN Medicare Advantage |
$76.95
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Commercial |
$264.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.95
|
| Rate for Payer: Healthscope Commercial |
$277.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Nomi Health Commercial |
$252.40
|
| Rate for Payer: PACE Senior Care Partners |
$73.10
|
| Rate for Payer: PACE SWMI |
$76.95
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: PHP Medicare Advantage |
$76.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.07
|
| Rate for Payer: Priority Health HMO/PPO |
$267.79
|
| Rate for Payer: Priority Health Medicare |
$77.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.23
|
| Rate for Payer: Railroad Medicare Medicare |
$76.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.86
|
| Rate for Payer: UHC Core |
$257.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.95
|
| Rate for Payer: UHC Exchange |
$76.95
|
| Rate for Payer: UHC Medicare Advantage |
$76.95
|
| Rate for Payer: VA VA |
$76.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
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
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
OP
|
$5.02
|
|
|
Service Code
|
NDC 50268068411
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: Aetna Medicare |
$1.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.57
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.57
|
| Rate for Payer: BCBS Complete |
$2.01
|
| Rate for Payer: BCBS MAPPO |
$1.26
|
| Rate for Payer: BCBS Trust/PPO |
$4.13
|
| Rate for Payer: BCN Commercial |
$3.90
|
| Rate for Payer: BCN Medicare Advantage |
$1.26
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cofinity Commercial |
$4.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.26
|
| Rate for Payer: Healthscope Commercial |
$4.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.27
|
| Rate for Payer: Nomi Health Commercial |
$4.12
|
| Rate for Payer: PACE Senior Care Partners |
$1.19
|
| Rate for Payer: PACE SWMI |
$1.26
|
| Rate for Payer: PHP Commercial |
$4.27
|
| Rate for Payer: PHP Medicare Advantage |
$1.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.26
|
| Rate for Payer: Priority Health HMO/PPO |
$4.37
|
| Rate for Payer: Priority Health Medicare |
$1.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.36
|
| Rate for Payer: Railroad Medicare Medicare |
$1.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC Core |
$4.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.26
|
| Rate for Payer: UHC Exchange |
$1.26
|
| Rate for Payer: UHC Medicare Advantage |
$1.26
|
| Rate for Payer: VA VA |
$1.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.76
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$5.02
|
|
|
Service Code
|
NDC 50268068411
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Aetna Commercial |
$4.27
|
| Rate for Payer: BCBS Trust/PPO |
$4.10
|
| Rate for Payer: BCN Commercial |
$3.88
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cofinity Commercial |
$4.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.02
|
| Rate for Payer: Healthscope Commercial |
$4.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.27
|
| Rate for Payer: Nomi Health Commercial |
$4.12
|
| Rate for Payer: PHP Commercial |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.26
|
| Rate for Payer: Priority Health HMO/PPO |
$4.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.42
|
| Rate for Payer: UHC Core |
$4.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.76
|
|
|
PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 99241
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Medicare |
$56.50
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 99245
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$306.40 |
| Rate for Payer: Aetna Commercial |
$196.80
|
| Rate for Payer: Aetna Medicare |
$185.50
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCBS Trust/PPO |
$202.34
|
| Rate for Payer: BCN Commercial |
$306.40
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Mclaren Medicaid |
$113.96
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.15
|
| Rate for Payer: Priority Health HMO/PPO |
$240.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.51
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 99243
|
| Min. Negotiated Rate |
$56.02 |
| Max. Negotiated Rate |
$1,523.62 |
| Rate for Payer: Aetna Commercial |
$98.89
|
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$58.82
|
| Rate for Payer: BCBS Trust/PPO |
$1,523.62
|
| Rate for Payer: BCN Commercial |
$164.69
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Mclaren Medicaid |
$56.02
|
| Rate for Payer: Meridian Medicaid |
$58.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO |
$117.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.56
|
| Rate for Payer: UHCCP Medicaid |
$56.02
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 99244
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$1,873.94 |
| Rate for Payer: Aetna Commercial |
$159.16
|
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS Trust/PPO |
$722.19
|
| Rate for Payer: BCN Commercial |
$235.54
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Mclaren Medicaid |
$84.99
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO |
$1,873.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,873.94
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 99242
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$158.49 |
| Rate for Payer: Aetna Commercial |
$70.73
|
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS Trust/PPO |
$158.49
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Mclaren Medicaid |
$35.15
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health HMO/PPO |
$74.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.49
|
| Rate for Payer: UHCCP Medicaid |
$35.15
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 99215
|
| Min. Negotiated Rate |
$91.38 |
| Max. Negotiated Rate |
$1,816.82 |
| Rate for Payer: Aetna Commercial |
$182.59
|
| Rate for Payer: Aetna Medicare |
$141.71
|
| Rate for Payer: BCBS Complete |
$95.95
|
| Rate for Payer: BCBS MAPPO |
$136.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,816.82
|
| Rate for Payer: BCN Commercial |
$154.50
|
| Rate for Payer: BCN Medicare Advantage |
$136.26
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$196.21
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.26
|
| Rate for Payer: Mclaren Medicaid |
$91.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.07
|
| Rate for Payer: Meridian Medicaid |
$95.95
|
| Rate for Payer: Nomi Health Commercial |
$163.51
|
| Rate for Payer: PACE SWMI |
$136.26
|
| Rate for Payer: PHP Medicare Advantage |
$136.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$91.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO |
$160.44
|
| Rate for Payer: Priority Health Medicare |
$137.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.26
|
| Rate for Payer: UHC Exchange |
$136.26
|
| Rate for Payer: UHC Medicare Advantage |
$136.26
|
| Rate for Payer: UHCCP Medicaid |
$91.38
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99213
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$1,305.96 |
| Rate for Payer: Aetna Commercial |
$83.94
|
| Rate for Payer: Aetna Medicare |
$65.15
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS MAPPO |
$62.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,305.96
|
| Rate for Payer: BCN Commercial |
$79.38
|
| Rate for Payer: BCN Medicare Advantage |
$62.64
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$90.20
|
| Rate for Payer: Cofinity Commercial |
$83.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.64
|
| Rate for Payer: Mclaren Medicaid |
$41.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.77
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Nomi Health Commercial |
$75.17
|
| Rate for Payer: PACE SWMI |
$62.64
|
| Rate for Payer: PHP Medicare Advantage |
$62.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO |
$73.30
|
| Rate for Payer: Priority Health Medicare |
$63.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.64
|
| Rate for Payer: UHC Exchange |
$62.64
|
| Rate for Payer: UHC Medicare Advantage |
$62.64
|
| Rate for Payer: UHCCP Medicaid |
$41.96
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99214
|
| Min. Negotiated Rate |
$61.77 |
| Max. Negotiated Rate |
$1,340.83 |
| Rate for Payer: Aetna Commercial |
$123.62
|
| Rate for Payer: Aetna Medicare |
$95.94
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: BCBS MAPPO |
$92.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,340.83
|
| Rate for Payer: BCN Commercial |
$115.12
|
| Rate for Payer: BCN Medicare Advantage |
$92.25
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Cofinity Commercial |
$123.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.25
|
| Rate for Payer: Mclaren Medicaid |
$61.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.86
|
| Rate for Payer: Meridian Medicaid |
$64.86
|
| Rate for Payer: Nomi Health Commercial |
$110.70
|
| Rate for Payer: PACE SWMI |
$92.25
|
| Rate for Payer: PHP Medicare Advantage |
$92.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO |
$108.08
|
| Rate for Payer: Priority Health Medicare |
$93.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.25
|
| Rate for Payer: UHC Exchange |
$92.25
|
| Rate for Payer: UHC Medicare Advantage |
$92.25
|
| Rate for Payer: UHCCP Medicaid |
$61.77
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 99212
|
| Min. Negotiated Rate |
$22.37 |
| Max. Negotiated Rate |
$2,731.31 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: Aetna Medicare |
$34.72
|
| Rate for Payer: BCBS Complete |
$23.49
|
| Rate for Payer: BCBS MAPPO |
$33.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,731.31
|
| Rate for Payer: BCN Commercial |
$50.51
|
| Rate for Payer: BCN Medicare Advantage |
$33.38
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$44.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.38
|
| Rate for Payer: Mclaren Medicaid |
$22.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.05
|
| Rate for Payer: Meridian Medicaid |
$23.49
|
| Rate for Payer: Nomi Health Commercial |
$40.06
|
| Rate for Payer: PACE SWMI |
$33.38
|
| Rate for Payer: PHP Medicare Advantage |
$33.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.95
|
| Rate for Payer: Priority Health HMO/PPO |
$39.27
|
| Rate for Payer: Priority Health Medicare |
$33.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.38
|
| Rate for Payer: UHC Exchange |
$33.38
|
| Rate for Payer: UHC Medicare Advantage |
$33.38
|
| Rate for Payer: UHCCP Medicaid |
$22.37
|
|
