|
PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 99211
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$2,495.16 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.59
|
| Rate for Payer: BCBS Complete |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCBS Trust/PPO |
$2,495.16
|
| Rate for Payer: BCN Commercial |
$23.28
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Mclaren Medicaid |
$5.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Meridian Medicaid |
$5.82
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health HMO/PPO |
$9.72
|
| Rate for Payer: Priority Health Medicare |
$8.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Exchange |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UHCCP Medicaid |
$5.54
|
|
|
PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 99205
|
| Min. Negotiated Rate |
$115.66 |
| Max. Negotiated Rate |
$2,028.67 |
| Rate for Payer: Aetna Commercial |
$231.78
|
| Rate for Payer: Aetna Medicare |
$179.89
|
| Rate for Payer: BCBS Complete |
$121.44
|
| Rate for Payer: BCBS MAPPO |
$172.97
|
| Rate for Payer: BCBS Trust/PPO |
$2,028.67
|
| Rate for Payer: BCN Commercial |
$209.60
|
| Rate for Payer: BCN Medicare Advantage |
$172.97
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$249.08
|
| Rate for Payer: Cofinity Commercial |
$231.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.97
|
| Rate for Payer: Mclaren Medicaid |
$115.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.62
|
| Rate for Payer: Meridian Medicaid |
$121.44
|
| Rate for Payer: Nomi Health Commercial |
$207.56
|
| Rate for Payer: PACE SWMI |
$172.97
|
| Rate for Payer: PHP Medicare Advantage |
$172.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO |
$201.95
|
| Rate for Payer: Priority Health Medicare |
$174.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$201.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.97
|
| Rate for Payer: UHC Exchange |
$172.97
|
| Rate for Payer: UHC Medicare Advantage |
$172.97
|
| Rate for Payer: UHCCP Medicaid |
$115.66
|
|
|
PR OFFICE OUTPATIENT NEW LEVL I
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 99201
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
|
|
PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99203
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$931.39 |
| Rate for Payer: Aetna Commercial |
$104.73
|
| Rate for Payer: Aetna Medicare |
$81.29
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$78.16
|
| Rate for Payer: BCBS Trust/PPO |
$931.39
|
| Rate for Payer: BCN Commercial |
$108.55
|
| Rate for Payer: BCN Medicare Advantage |
$78.16
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$112.55
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.16
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.07
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Nomi Health Commercial |
$93.79
|
| Rate for Payer: PACE SWMI |
$78.16
|
| Rate for Payer: PHP Medicare Advantage |
$78.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO |
$91.26
|
| Rate for Payer: Priority Health Medicare |
$78.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.16
|
| Rate for Payer: UHC Exchange |
$78.16
|
| Rate for Payer: UHC Medicare Advantage |
$78.16
|
| Rate for Payer: UHCCP Medicaid |
$52.19
|
|
|
PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 99204
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$1,704.30 |
| Rate for Payer: Aetna Commercial |
$170.30
|
| Rate for Payer: Aetna Medicare |
$132.17
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$127.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,704.30
|
| Rate for Payer: BCN Commercial |
$165.88
|
| Rate for Payer: BCN Medicare Advantage |
$127.09
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Cofinity Commercial |
$170.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.09
|
| Rate for Payer: Mclaren Medicaid |
$84.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.44
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Nomi Health Commercial |
$152.51
|
| Rate for Payer: PACE SWMI |
$127.09
|
| Rate for Payer: PHP Medicare Advantage |
$127.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health HMO/PPO |
$148.47
|
| Rate for Payer: Priority Health Medicare |
$128.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.09
|
| Rate for Payer: UHC Exchange |
$127.09
|
| Rate for Payer: UHC Medicare Advantage |
$127.09
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99202
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$706.34 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$46.31
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCBS MAPPO |
$44.53
|
| Rate for Payer: BCBS Trust/PPO |
$706.34
|
| Rate for Payer: BCN Commercial |
$76.66
|
| Rate for Payer: BCN Medicare Advantage |
$44.53
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$64.12
|
| Rate for Payer: Cofinity Commercial |
$59.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.53
|
| Rate for Payer: Mclaren Medicaid |
$29.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.76
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| Rate for Payer: Nomi Health Commercial |
$53.44
|
| Rate for Payer: PACE SWMI |
$44.53
|
| Rate for Payer: PHP Medicare Advantage |
$44.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO |
$52.74
|
| Rate for Payer: Priority Health Medicare |
$44.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.53
|
| Rate for Payer: UHC Exchange |
$44.53
|
| Rate for Payer: UHC Medicare Advantage |
$44.53
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
|
|
PR OMALIZUMAB INJECTION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J2357
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$58.41 |
| Rate for Payer: Aetna Commercial |
$54.35
|
| Rate for Payer: Aetna Medicare |
$42.19
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$40.56
|
| Rate for Payer: BCBS Trust/PPO |
$40.20
|
| Rate for Payer: BCN Commercial |
$38.63
|
| Rate for Payer: BCN Medicare Advantage |
$40.56
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$58.41
|
| Rate for Payer: Cofinity Commercial |
$54.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.59
|
| Rate for Payer: Nomi Health Commercial |
$48.68
|
| Rate for Payer: PACE SWMI |
$40.56
|
| Rate for Payer: PHP Medicare Advantage |
$40.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$40.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.56
|
| Rate for Payer: UHC Exchange |
$40.56
|
| Rate for Payer: UHC Medicare Advantage |
$40.56
|
|
|
PR OMENTAL FLAP INTRA-ABDOMINAL
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 49905
|
| Min. Negotiated Rate |
$223.44 |
| Max. Negotiated Rate |
$4,973.94 |
| Rate for Payer: Aetna Commercial |
$456.14
|
| Rate for Payer: Aetna Medicare |
$354.02
|
| Rate for Payer: BCBS Complete |
$234.61
|
| Rate for Payer: BCBS MAPPO |
$340.40
|
| Rate for Payer: BCBS Trust/PPO |
$4,973.94
|
| Rate for Payer: BCN Commercial |
$510.66
|
| Rate for Payer: BCN Medicare Advantage |
$340.40
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cofinity Commercial |
$490.18
|
| Rate for Payer: Cofinity Commercial |
$456.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.40
|
| Rate for Payer: Mclaren Medicaid |
$223.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$357.42
|
| Rate for Payer: Meridian Medicaid |
$234.61
|
| Rate for Payer: Nomi Health Commercial |
$408.48
|
| Rate for Payer: PACE SWMI |
$340.40
|
| Rate for Payer: PHP Medicare Advantage |
$340.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.30
|
| Rate for Payer: Priority Health HMO/PPO |
$624.63
|
| Rate for Payer: Priority Health Medicare |
$343.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$624.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$340.40
|
| Rate for Payer: UHC Exchange |
$340.40
|
| Rate for Payer: UHC Medicare Advantage |
$340.40
|
| Rate for Payer: UHCCP Medicaid |
$223.44
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$183.02
|
|
|
Service Code
|
NDC 00713053612
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.96 |
| Max. Negotiated Rate |
$164.72 |
| Rate for Payer: Aetna Commercial |
$155.57
|
| Rate for Payer: BCBS Trust/PPO |
$149.40
|
| Rate for Payer: BCN Commercial |
$141.44
|
| Rate for Payer: Cash Price |
$146.42
|
| Rate for Payer: Cofinity Commercial |
$157.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.42
|
| Rate for Payer: Healthscope Commercial |
$164.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.57
|
| Rate for Payer: Nomi Health Commercial |
$150.08
|
| Rate for Payer: PHP Commercial |
$155.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.96
|
| Rate for Payer: Priority Health HMO/PPO |
$159.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.06
|
| Rate for Payer: UHC Core |
$152.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.26
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$183.02
|
|
|
Service Code
|
NDC 00713053612
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.47 |
| Max. Negotiated Rate |
$164.72 |
| Rate for Payer: Aetna Commercial |
$155.57
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.19
|
| Rate for Payer: BCBS Complete |
$73.21
|
| Rate for Payer: BCBS MAPPO |
$45.76
|
| Rate for Payer: BCBS Trust/PPO |
$150.46
|
| Rate for Payer: BCN Commercial |
$142.30
|
| Rate for Payer: BCN Medicare Advantage |
$45.76
|
| Rate for Payer: Cash Price |
$146.42
|
| Rate for Payer: Cofinity Commercial |
$157.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.76
|
| Rate for Payer: Healthscope Commercial |
$164.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.57
|
| Rate for Payer: Nomi Health Commercial |
$150.08
|
| Rate for Payer: PACE Senior Care Partners |
$43.47
|
| Rate for Payer: PACE SWMI |
$45.76
|
| Rate for Payer: PHP Commercial |
$155.57
|
| Rate for Payer: PHP Medicare Advantage |
$45.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.96
|
| Rate for Payer: Priority Health HMO/PPO |
$159.23
|
| Rate for Payer: Priority Health Medicare |
$46.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.62
|
| Rate for Payer: Railroad Medicare Medicare |
$45.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.06
|
| Rate for Payer: UHC Core |
$152.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.76
|
| Rate for Payer: UHC Exchange |
$45.76
|
| Rate for Payer: UHC Medicare Advantage |
$45.76
|
| Rate for Payer: VA VA |
$45.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.26
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
OP
|
$3.98
|
|
|
Service Code
|
NDC 60687066011
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.24
|
| Rate for Payer: BCBS Complete |
$1.59
|
| Rate for Payer: BCBS MAPPO |
$1.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.27
|
| Rate for Payer: BCN Commercial |
$3.09
|
| Rate for Payer: BCN Medicare Advantage |
$1.00
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$3.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.38
|
| Rate for Payer: Nomi Health Commercial |
$3.26
|
| Rate for Payer: PACE Senior Care Partners |
$0.95
|
| Rate for Payer: PACE SWMI |
$1.00
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: PHP Medicare Advantage |
$1.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.59
|
| Rate for Payer: Priority Health HMO/PPO |
$3.46
|
| Rate for Payer: Priority Health Medicare |
$1.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.67
|
| Rate for Payer: Railroad Medicare Medicare |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.50
|
| Rate for Payer: UHC Core |
$3.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.00
|
| Rate for Payer: UHC Exchange |
$1.00
|
| Rate for Payer: UHC Medicare Advantage |
$1.00
|
| Rate for Payer: VA VA |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.98
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
OP
|
$397.10
|
|
|
Service Code
|
NDC 60687066001
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.31 |
| Max. Negotiated Rate |
$357.39 |
| Rate for Payer: Aetna Commercial |
$337.54
|
| Rate for Payer: Aetna Medicare |
$103.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$124.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$124.09
|
| Rate for Payer: BCBS Complete |
$158.84
|
| Rate for Payer: BCBS MAPPO |
$99.28
|
| Rate for Payer: BCBS Trust/PPO |
$326.46
|
| Rate for Payer: BCN Commercial |
$308.75
|
| Rate for Payer: BCN Medicare Advantage |
$99.28
|
| Rate for Payer: Cash Price |
$317.68
|
| Rate for Payer: Cofinity Commercial |
$341.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.28
|
| Rate for Payer: Healthscope Commercial |
$357.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$114.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.54
|
| Rate for Payer: Nomi Health Commercial |
$325.62
|
| Rate for Payer: PACE Senior Care Partners |
$94.31
|
| Rate for Payer: PACE SWMI |
$99.28
|
| Rate for Payer: PHP Commercial |
$337.54
|
| Rate for Payer: PHP Medicare Advantage |
$99.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.12
|
| Rate for Payer: Priority Health HMO/PPO |
$345.48
|
| Rate for Payer: Priority Health Medicare |
$100.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.06
|
| Rate for Payer: Railroad Medicare Medicare |
$99.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.45
|
| Rate for Payer: UHC Core |
$331.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.28
|
| Rate for Payer: UHC Exchange |
$99.28
|
| Rate for Payer: UHC Medicare Advantage |
$99.28
|
| Rate for Payer: VA VA |
$99.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.82
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$397.10
|
|
|
Service Code
|
NDC 60687066001
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.12 |
| Max. Negotiated Rate |
$357.39 |
| Rate for Payer: Aetna Commercial |
$337.54
|
| Rate for Payer: BCBS Trust/PPO |
$324.15
|
| Rate for Payer: BCN Commercial |
$306.88
|
| Rate for Payer: Cash Price |
$317.68
|
| Rate for Payer: Cofinity Commercial |
$341.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.68
|
| Rate for Payer: Healthscope Commercial |
$357.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.54
|
| Rate for Payer: Nomi Health Commercial |
$325.62
|
| Rate for Payer: PHP Commercial |
$337.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.12
|
| Rate for Payer: Priority Health HMO/PPO |
$345.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$266.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.45
|
| Rate for Payer: UHC Core |
$331.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.82
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$3.98
|
|
|
Service Code
|
NDC 60687066011
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: BCBS Trust/PPO |
$3.25
|
| Rate for Payer: BCN Commercial |
$3.08
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Cofinity Commercial |
$3.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.18
|
| Rate for Payer: Healthscope Commercial |
$3.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.38
|
| Rate for Payer: Nomi Health Commercial |
$3.26
|
| Rate for Payer: PHP Commercial |
$3.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.59
|
| Rate for Payer: Priority Health HMO/PPO |
$3.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.50
|
| Rate for Payer: UHC Core |
$3.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.98
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$14.69 |
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: BCBS Trust/PPO |
$13.32
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCN Commercial |
$12.61
|
| Rate for Payer: BCN Commercial |
$17.19
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: Nomi Health Commercial |
$18.24
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health HMO/PPO |
$19.36
|
| Rate for Payer: Priority Health HMO/PPO |
$14.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$22.25
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$20.02 |
| Rate for Payer: Aetna Commercial |
$18.91
|
| Rate for Payer: Aetna Commercial |
$13.87
|
| Rate for Payer: Aetna Medicare |
$5.78
|
| Rate for Payer: Aetna Medicare |
$4.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.10
|
| Rate for Payer: BCBS Complete |
$6.53
|
| Rate for Payer: BCBS Complete |
$8.90
|
| Rate for Payer: BCBS MAPPO |
$4.08
|
| Rate for Payer: BCBS MAPPO |
$5.56
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$17.30
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: BCN Medicare Advantage |
$5.56
|
| Rate for Payer: BCN Medicare Advantage |
$4.08
|
| Rate for Payer: Cash Price |
$17.80
|
| Rate for Payer: Cash Price |
$13.06
|
| Rate for Payer: Cofinity Commercial |
$14.04
|
| Rate for Payer: Cofinity Commercial |
$19.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$20.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.87
|
| Rate for Payer: Nomi Health Commercial |
$18.24
|
| Rate for Payer: Nomi Health Commercial |
$13.38
|
| Rate for Payer: PACE Senior Care Partners |
$5.28
|
| Rate for Payer: PACE Senior Care Partners |
$3.88
|
| Rate for Payer: PACE SWMI |
$5.56
|
| Rate for Payer: PACE SWMI |
$4.08
|
| Rate for Payer: PHP Commercial |
$18.91
|
| Rate for Payer: PHP Commercial |
$13.87
|
| Rate for Payer: PHP Medicare Advantage |
$4.08
|
| Rate for Payer: PHP Medicare Advantage |
$5.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.61
|
| Rate for Payer: Priority Health HMO/PPO |
$14.20
|
| Rate for Payer: Priority Health HMO/PPO |
$19.36
|
| Rate for Payer: Priority Health Medicare |
$5.62
|
| Rate for Payer: Priority Health Medicare |
$4.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.93
|
| Rate for Payer: Railroad Medicare Medicare |
$4.08
|
| Rate for Payer: Railroad Medicare Medicare |
$5.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.58
|
| Rate for Payer: UHC Core |
$18.58
|
| Rate for Payer: UHC Core |
$13.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.08
|
| Rate for Payer: UHC Exchange |
$4.08
|
| Rate for Payer: UHC Exchange |
$5.56
|
| Rate for Payer: UHC Medicare Advantage |
$4.08
|
| Rate for Payer: UHC Medicare Advantage |
$5.56
|
| Rate for Payer: VA VA |
$4.08
|
| Rate for Payer: VA VA |
$5.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.24
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.60
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: BCBS MAPPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.59
|
| Rate for Payer: BCN Commercial |
$1.50
|
| Rate for Payer: BCN Medicare Advantage |
$0.48
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.48
|
| Rate for Payer: Healthscope Commercial |
$1.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.64
|
| Rate for Payer: Nomi Health Commercial |
$1.58
|
| Rate for Payer: PACE Senior Care Partners |
$0.46
|
| Rate for Payer: PACE SWMI |
$0.48
|
| Rate for Payer: PHP Commercial |
$1.64
|
| Rate for Payer: PHP Medicare Advantage |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1.68
|
| Rate for Payer: Priority Health Medicare |
$0.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.29
|
| Rate for Payer: Railroad Medicare Medicare |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.70
|
| Rate for Payer: UHC Core |
$1.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.48
|
| Rate for Payer: VA VA |
$0.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.45
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$336.05
|
|
|
Service Code
|
NDC 00904730461
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.81 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: Aetna Medicare |
$87.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.02
|
| Rate for Payer: BCBS Complete |
$134.42
|
| Rate for Payer: BCBS MAPPO |
$84.01
|
| Rate for Payer: BCBS Trust/PPO |
$276.27
|
| Rate for Payer: BCN Commercial |
$261.28
|
| Rate for Payer: BCN Medicare Advantage |
$84.01
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.01
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$96.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: PACE Senior Care Partners |
$79.81
|
| Rate for Payer: PACE SWMI |
$84.01
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: PHP Medicare Advantage |
$84.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health HMO/PPO |
$292.36
|
| Rate for Payer: Priority Health Medicare |
$84.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.15
|
| Rate for Payer: Railroad Medicare Medicare |
$84.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Core |
$280.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.01
|
| Rate for Payer: UHC Exchange |
$84.01
|
| Rate for Payer: UHC Medicare Advantage |
$84.01
|
| Rate for Payer: VA VA |
$84.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 68084015501
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$50.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.27
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: BCBS MAPPO |
$48.21
|
| Rate for Payer: BCBS Trust/PPO |
$158.54
|
| Rate for Payer: BCN Commercial |
$149.94
|
| Rate for Payer: BCN Medicare Advantage |
$48.21
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.21
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: PACE Senior Care Partners |
$45.80
|
| Rate for Payer: PACE SWMI |
$48.21
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: PHP Medicare Advantage |
$48.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Medicare |
$48.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: Railroad Medicare Medicare |
$48.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.21
|
| Rate for Payer: UHC Exchange |
$48.21
|
| Rate for Payer: UHC Medicare Advantage |
$48.21
|
| Rate for Payer: VA VA |
$48.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.72 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: Aetna Medicare |
$65.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$78.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$78.58
|
| Rate for Payer: BCBS Complete |
$100.58
|
| Rate for Payer: BCBS MAPPO |
$62.86
|
| Rate for Payer: BCBS Trust/PPO |
$206.72
|
| Rate for Payer: BCN Commercial |
$195.50
|
| Rate for Payer: BCN Medicare Advantage |
$62.86
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.86
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: PACE Senior Care Partners |
$59.72
|
| Rate for Payer: PACE SWMI |
$62.86
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: PHP Medicare Advantage |
$62.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Medicare |
$63.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| Rate for Payer: Railroad Medicare Medicare |
$62.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.86
|
| Rate for Payer: UHC Exchange |
$62.86
|
| Rate for Payer: UHC Medicare Advantage |
$62.86
|
| Rate for Payer: VA VA |
$62.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 68084015501
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.35 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: BCBS Trust/PPO |
$157.42
|
| Rate for Payer: BCN Commercial |
$149.03
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$336.05
|
|
|
Service Code
|
NDC 00904730461
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.43 |
| Max. Negotiated Rate |
$302.44 |
| Rate for Payer: Aetna Commercial |
$285.64
|
| Rate for Payer: BCBS Trust/PPO |
$274.32
|
| Rate for Payer: BCN Commercial |
$259.70
|
| Rate for Payer: Cash Price |
$268.84
|
| Rate for Payer: Cofinity Commercial |
$289.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$268.84
|
| Rate for Payer: Healthscope Commercial |
$302.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$285.64
|
| Rate for Payer: Nomi Health Commercial |
$275.56
|
| Rate for Payer: PHP Commercial |
$285.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.43
|
| Rate for Payer: Priority Health HMO/PPO |
$292.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$225.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.72
|
| Rate for Payer: UHC Core |
$280.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.04
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$1.93
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: BCBS Trust/PPO |
$1.58
|
| Rate for Payer: BCN Commercial |
$1.49
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.64
|
| Rate for Payer: Nomi Health Commercial |
$1.58
|
| Rate for Payer: PHP Commercial |
$1.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.70
|
| Rate for Payer: UHC Core |
$1.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.45
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 00904646161
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$226.30 |
| Rate for Payer: Aetna Commercial |
$213.73
|
| Rate for Payer: BCBS Trust/PPO |
$205.26
|
| Rate for Payer: BCN Commercial |
$194.32
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$216.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$226.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$188.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: PHP Commercial |
$213.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health HMO/PPO |
$218.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.28
|
| Rate for Payer: UHC Core |
$209.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$188.59
|
|
|
PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$2,127.00
|
|
|
Service Code
|
HCPCS 49255
|
| Min. Negotiated Rate |
$512.05 |
| Max. Negotiated Rate |
$1,424.67 |
| Rate for Payer: Aetna Commercial |
$1,028.83
|
| Rate for Payer: Aetna Medicare |
$798.49
|
| Rate for Payer: BCBS Complete |
$537.65
|
| Rate for Payer: BCBS MAPPO |
$767.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.96
|
| Rate for Payer: BCN Commercial |
$1,157.67
|
| Rate for Payer: BCN Medicare Advantage |
$767.78
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cofinity Commercial |
$1,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,028.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$767.78
|
| Rate for Payer: Mclaren Medicaid |
$512.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$806.17
|
| Rate for Payer: Meridian Medicaid |
$537.65
|
| Rate for Payer: Nomi Health Commercial |
$921.34
|
| Rate for Payer: PACE SWMI |
$767.78
|
| Rate for Payer: PHP Medicare Advantage |
$767.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,382.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,424.67
|
| Rate for Payer: Priority Health Medicare |
$775.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,424.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$767.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$767.78
|
| Rate for Payer: UHC Exchange |
$767.78
|
| Rate for Payer: UHC Medicare Advantage |
$767.78
|
| Rate for Payer: UHCCP Medicaid |
$512.05
|
|
