|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$38.84
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna American Axle |
$25.25
|
| Rate for Payer: Aetna American Axle |
$23.72
|
| Rate for Payer: Aetna American Axle |
$20.70
|
| Rate for Payer: Aetna American Axle |
$21.44
|
| Rate for Payer: Aetna American Axle |
$22.56
|
| Rate for Payer: Aetna American Axle |
$14.55
|
| Rate for Payer: Aetna American Axle |
$49.77
|
| Rate for Payer: Aetna American Axle |
$35.14
|
| Rate for Payer: Aetna American Axle |
$29.01
|
| Rate for Payer: Aetna American Axle |
$29.00
|
| Rate for Payer: Aetna Commercial |
$37.92
|
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: Aetna Commercial |
$28.04
|
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$45.95
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Commercial |
$37.94
|
| Rate for Payer: Aetna Commercial |
$29.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.44
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$29.19
|
| Rate for Payer: Cash Price |
$27.77
|
| Rate for Payer: Cash Price |
$61.26
|
| Rate for Payer: Cash Price |
$35.69
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cash Price |
$43.25
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cofinity Advantage |
$15.67
|
| Rate for Payer: Cofinity Advantage |
$22.29
|
| Rate for Payer: Cofinity Advantage |
$24.30
|
| Rate for Payer: Cofinity Advantage |
$23.09
|
| Rate for Payer: Cofinity Advantage |
$25.54
|
| Rate for Payer: Cofinity Advantage |
$27.19
|
| Rate for Payer: Cofinity Advantage |
$31.23
|
| Rate for Payer: Cofinity Advantage |
$31.24
|
| Rate for Payer: Cofinity Advantage |
$37.84
|
| Rate for Payer: Cofinity Advantage |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$31.38
|
| Rate for Payer: Cofinity Commercial |
$38.36
|
| Rate for Payer: Cofinity Commercial |
$46.49
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$65.85
|
| Rate for Payer: Cofinity Commercial |
$28.37
|
| Rate for Payer: Cofinity Commercial |
$29.85
|
| Rate for Payer: Cofinity Commercial |
$38.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Healthscope Commercial |
$48.65
|
| Rate for Payer: Healthscope Commercial |
$32.84
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$31.24
|
| Rate for Payer: Healthscope Commercial |
$28.66
|
| Rate for Payer: Healthscope Commercial |
$29.69
|
| Rate for Payer: Healthscope Commercial |
$68.91
|
| Rate for Payer: Healthscope Commercial |
$40.17
|
| Rate for Payer: Healthscope Commercial |
$40.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.03
|
| Rate for Payer: PHP Commercial |
$65.08
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$37.92
|
| Rate for Payer: PHP Commercial |
$31.02
|
| Rate for Payer: PHP Commercial |
$37.94
|
| Rate for Payer: PHP Commercial |
$45.95
|
| Rate for Payer: PHP Commercial |
$29.50
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$28.04
|
| Rate for Payer: Priority Health SBD |
$28.10
|
| Rate for Payer: Priority Health SBD |
$34.06
|
| Rate for Payer: Priority Health SBD |
$48.24
|
| Rate for Payer: Priority Health SBD |
$20.78
|
| Rate for Payer: Priority Health SBD |
$28.12
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$20.06
|
| Rate for Payer: Priority Health SBD |
$22.99
|
| Rate for Payer: Priority Health SBD |
$24.47
|
| Rate for Payer: Priority Health SBD |
$21.87
|
| Rate for Payer: UMR Bronson Commercial |
$14.01
|
| Rate for Payer: UMR Bronson Commercial |
$33.69
|
| Rate for Payer: UMR Bronson Commercial |
$14.52
|
| Rate for Payer: UMR Bronson Commercial |
$9.85
|
| Rate for Payer: UMR Bronson Commercial |
$16.06
|
| Rate for Payer: UMR Bronson Commercial |
$23.79
|
| Rate for Payer: UMR Bronson Commercial |
$15.27
|
| Rate for Payer: UMR Bronson Commercial |
$17.09
|
| Rate for Payer: UMR Bronson Commercial |
$19.63
|
| Rate for Payer: UMR Bronson Commercial |
$19.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.55
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 51079054201
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna American Axle |
$1.97
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.97
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health SBD |
$1.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$462.65
|
|
|
Service Code
|
NDC 59746011506
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.57 |
| Max. Negotiated Rate |
$416.38 |
| Rate for Payer: Aetna American Axle |
$300.72
|
| Rate for Payer: Aetna Commercial |
$393.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.72
|
| Rate for Payer: Cash Price |
$370.12
|
| Rate for Payer: Cofinity Advantage |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$397.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.12
|
| Rate for Payer: Healthscope Commercial |
$416.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.99
|
| Rate for Payer: PHP Commercial |
$393.25
|
| Rate for Payer: Priority Health SBD |
$291.47
|
| Rate for Payer: UMR Bronson Commercial |
$203.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.99
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$462.65
|
|
|
Service Code
|
NDC 59746011506
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.18 |
| Max. Negotiated Rate |
$416.38 |
| Rate for Payer: Aetna American Axle |
$300.72
|
| Rate for Payer: Aetna Commercial |
$393.25
|
| Rate for Payer: Aetna Medicare |
$231.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.72
|
| Rate for Payer: BCBS Complete |
$185.06
|
| Rate for Payer: Cash Price |
$370.12
|
| Rate for Payer: Cofinity Advantage |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$397.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.12
|
| Rate for Payer: Healthscope Commercial |
$416.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.99
|
| Rate for Payer: PHP Commercial |
$393.25
|
| Rate for Payer: Priority Health SBD |
$291.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.72
|
| Rate for Payer: UHC Core |
$241.04
|
| Rate for Payer: UHC Exchange |
$181.82
|
| Rate for Payer: UMR Bronson Commercial |
$171.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.99
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$462.65
|
|
|
Service Code
|
NDC 70710166801
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.18 |
| Max. Negotiated Rate |
$416.38 |
| Rate for Payer: Aetna American Axle |
$300.72
|
| Rate for Payer: Aetna Commercial |
$393.25
|
| Rate for Payer: Aetna Medicare |
$231.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.72
|
| Rate for Payer: BCBS Complete |
$185.06
|
| Rate for Payer: Cash Price |
$370.12
|
| Rate for Payer: Cofinity Advantage |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$397.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.12
|
| Rate for Payer: Healthscope Commercial |
$416.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$370.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.99
|
| Rate for Payer: PHP Commercial |
$393.25
|
| Rate for Payer: Priority Health SBD |
$291.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.72
|
| Rate for Payer: UHC Core |
$241.04
|
| Rate for Payer: UHC Exchange |
$181.82
|
| Rate for Payer: UMR Bronson Commercial |
$171.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.99
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$6.46
|
|
|
Service Code
|
NDC 50268068511
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna American Axle |
$4.20
|
| Rate for Payer: Aetna Commercial |
$5.49
|
| Rate for Payer: Aetna Medicare |
$3.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.20
|
| Rate for Payer: BCBS Complete |
$2.58
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cofinity Advantage |
$4.52
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.17
|
| Rate for Payer: Healthscope Commercial |
$5.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.84
|
| Rate for Payer: PHP Commercial |
$5.49
|
| Rate for Payer: Priority Health SBD |
$4.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.20
|
| Rate for Payer: UHC Core |
$3.37
|
| Rate for Payer: UHC Exchange |
$2.54
|
| Rate for Payer: UMR Bronson Commercial |
$2.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.84
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$322.80
|
|
|
Service Code
|
NDC 50268068515
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.44 |
| Max. Negotiated Rate |
$290.52 |
| Rate for Payer: Aetna American Axle |
$209.82
|
| Rate for Payer: Aetna Commercial |
$274.38
|
| Rate for Payer: Aetna Medicare |
$161.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.82
|
| Rate for Payer: BCBS Complete |
$129.12
|
| Rate for Payer: Cash Price |
$258.24
|
| Rate for Payer: Cofinity Advantage |
$225.96
|
| Rate for Payer: Cofinity Commercial |
$277.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.24
|
| Rate for Payer: Healthscope Commercial |
$290.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$258.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.10
|
| Rate for Payer: PHP Commercial |
$274.38
|
| Rate for Payer: Priority Health SBD |
$203.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.82
|
| Rate for Payer: UHC Core |
$168.18
|
| Rate for Payer: UHC Exchange |
$126.86
|
| Rate for Payer: UMR Bronson Commercial |
$119.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.10
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$302.88
|
|
|
Service Code
|
NDC 51079054220
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.07 |
| Max. Negotiated Rate |
$272.59 |
| Rate for Payer: Aetna American Axle |
$196.87
|
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna Medicare |
$151.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.87
|
| Rate for Payer: BCBS Complete |
$121.15
|
| Rate for Payer: Cash Price |
$242.30
|
| Rate for Payer: Cofinity Advantage |
$212.02
|
| Rate for Payer: Cofinity Commercial |
$260.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.30
|
| Rate for Payer: Healthscope Commercial |
$272.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.16
|
| Rate for Payer: PHP Commercial |
$257.45
|
| Rate for Payer: Priority Health SBD |
$190.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.87
|
| Rate for Payer: UHC Core |
$157.80
|
| Rate for Payer: UHC Exchange |
$119.03
|
| Rate for Payer: UMR Bronson Commercial |
$112.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.16
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$6.46
|
|
|
Service Code
|
NDC 50268068511
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$5.81 |
| Rate for Payer: Aetna American Axle |
$4.20
|
| Rate for Payer: Aetna Commercial |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.20
|
| Rate for Payer: Cash Price |
$5.17
|
| Rate for Payer: Cofinity Advantage |
$4.52
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.17
|
| Rate for Payer: Healthscope Commercial |
$5.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.84
|
| Rate for Payer: PHP Commercial |
$5.49
|
| Rate for Payer: Priority Health SBD |
$4.07
|
| Rate for Payer: UMR Bronson Commercial |
$2.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.84
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$310.65
|
|
|
Service Code
|
NDC 27241028701
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.94 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna American Axle |
$201.92
|
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna Medicare |
$155.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: BCBS Complete |
$124.26
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Advantage |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.99
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.92
|
| Rate for Payer: UHC Core |
$161.85
|
| Rate for Payer: UHC Exchange |
$122.09
|
| Rate for Payer: UMR Bronson Commercial |
$114.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
NDC 51079054201
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna American Axle |
$1.97
|
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.97
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Advantage |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$2.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.27
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health SBD |
$1.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.97
|
| Rate for Payer: UHC Core |
$1.58
|
| Rate for Payer: UHC Exchange |
$1.19
|
| Rate for Payer: UMR Bronson Commercial |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$462.65
|
|
|
Service Code
|
NDC 70710166801
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.57 |
| Max. Negotiated Rate |
$416.38 |
| Rate for Payer: Aetna American Axle |
$300.72
|
| Rate for Payer: Aetna Commercial |
$393.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.72
|
| Rate for Payer: Cash Price |
$370.12
|
| Rate for Payer: Cofinity Advantage |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$397.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.12
|
| Rate for Payer: Healthscope Commercial |
$416.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$323.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$346.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$346.99
|
| Rate for Payer: PHP Commercial |
$393.25
|
| Rate for Payer: Priority Health SBD |
$291.47
|
| Rate for Payer: UMR Bronson Commercial |
$203.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$346.99
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$302.88
|
|
|
Service Code
|
NDC 51079054220
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.27 |
| Max. Negotiated Rate |
$272.59 |
| Rate for Payer: Aetna American Axle |
$196.87
|
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.87
|
| Rate for Payer: Cash Price |
$242.30
|
| Rate for Payer: Cofinity Advantage |
$212.02
|
| Rate for Payer: Cofinity Commercial |
$260.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.30
|
| Rate for Payer: Healthscope Commercial |
$272.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.16
|
| Rate for Payer: PHP Commercial |
$257.45
|
| Rate for Payer: Priority Health SBD |
$190.81
|
| Rate for Payer: UMR Bronson Commercial |
$133.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.16
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$322.80
|
|
|
Service Code
|
NDC 50268068515
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.03 |
| Max. Negotiated Rate |
$290.52 |
| Rate for Payer: Aetna American Axle |
$209.82
|
| Rate for Payer: Aetna Commercial |
$274.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.82
|
| Rate for Payer: Cash Price |
$258.24
|
| Rate for Payer: Cofinity Advantage |
$225.96
|
| Rate for Payer: Cofinity Commercial |
$277.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.24
|
| Rate for Payer: Healthscope Commercial |
$290.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$225.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$274.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.10
|
| Rate for Payer: PHP Commercial |
$274.38
|
| Rate for Payer: Priority Health SBD |
$203.36
|
| Rate for Payer: UMR Bronson Commercial |
$142.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.10
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$310.65
|
|
|
Service Code
|
NDC 27241028701
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.69 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna American Axle |
$201.92
|
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.92
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Advantage |
$217.46
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.99
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health SBD |
$195.71
|
| Rate for Payer: UMR Bronson Commercial |
$136.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$307.80
|
|
|
Service Code
|
NDC 70710166701
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.43 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Advantage |
$215.46
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.85
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UMR Bronson Commercial |
$135.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
IP
|
$307.80
|
|
|
Service Code
|
NDC 59746011306
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.43 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Advantage |
$215.46
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.85
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UMR Bronson Commercial |
$135.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
PROCHLORPERAZINE MALEATE 5 MG TABLET
|
Facility
|
OP
|
$307.80
|
|
|
Service Code
|
NDC 70710166701
|
| Hospital Charge Code |
6583
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.89 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$153.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: BCBS Complete |
$123.12
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Advantage |
$215.46
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.85
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.07
|
| Rate for Payer: UHC Core |
$160.36
|
| Rate for Payer: UHC Exchange |
$120.97
|
| Rate for Payer: UMR Bronson Commercial |
$113.89
|
| 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 |
$113.89 |
| Max. Negotiated Rate |
$277.02 |
| Rate for Payer: Aetna American Axle |
$200.07
|
| Rate for Payer: Aetna Commercial |
$261.63
|
| Rate for Payer: Aetna Medicare |
$153.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.07
|
| Rate for Payer: BCBS Complete |
$123.12
|
| Rate for Payer: Cash Price |
$246.24
|
| Rate for Payer: Cofinity Advantage |
$215.46
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.85
|
| Rate for Payer: PHP Commercial |
$261.63
|
| Rate for Payer: Priority Health SBD |
$193.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.07
|
| Rate for Payer: UHC Core |
$160.36
|
| Rate for Payer: UHC Exchange |
$120.97
|
| Rate for Payer: UMR Bronson Commercial |
$113.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.85
|
|
|
PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 99241
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$87.00 |
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.00
|
| Rate for Payer: UMR Bronson Commercial |
$53.36
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS 99245
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$286.50 |
| Rate for Payer: Aetna Commercial |
$196.80
|
| Rate for Payer: Aetna Medicare |
$191.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.80
|
| Rate for Payer: BCBS Complete |
$119.66
|
| Rate for Payer: BCN Commercial |
$266.42
|
| Rate for Payer: Cash Price |
$305.60
|
| Rate for Payer: Cash Price |
$305.60
|
| Rate for Payer: Meridian Medicaid |
$119.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$286.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$239.64
|
| Rate for Payer: Priority Health SBD |
$239.64
|
| Rate for Payer: Priority Health Tiered Network |
$239.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.26
|
| Rate for Payer: UHC Core |
$273.26
|
| Rate for Payer: UHC Exchange |
$273.26
|
| Rate for Payer: UHC Medicaid |
$113.96
|
| Rate for Payer: UHCCP Medicaid |
$113.96
|
| Rate for Payer: UMR Bronson Commercial |
$175.72
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 99243
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$98.89
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.89
|
| Rate for Payer: BCBS Complete |
$58.60
|
| Rate for Payer: BCN Commercial |
$130.97
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Meridian Medicaid |
$58.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$117.81
|
| Rate for Payer: Priority Health SBD |
$117.81
|
| Rate for Payer: Priority Health Tiered Network |
$117.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.31
|
| Rate for Payer: UHC Core |
$137.31
|
| Rate for Payer: UHC Exchange |
$137.31
|
| Rate for Payer: UHC Medicaid |
$55.81
|
| Rate for Payer: UHCCP Medicaid |
$55.81
|
| Rate for Payer: UMR Bronson Commercial |
$96.60
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 99244
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Aetna Commercial |
$159.16
|
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.16
|
| Rate for Payer: BCBS Complete |
$89.46
|
| Rate for Payer: BCN Commercial |
$198.70
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Meridian Medicaid |
$89.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$178.72
|
| Rate for Payer: Priority Health SBD |
$178.72
|
| Rate for Payer: Priority Health Tiered Network |
$178.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.02
|
| Rate for Payer: UHC Core |
$221.02
|
| Rate for Payer: UHC Exchange |
$221.02
|
| Rate for Payer: UHC Medicaid |
$85.20
|
| Rate for Payer: UHCCP Medicaid |
$85.20
|
| Rate for Payer: UMR Bronson Commercial |
$141.68
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 99242
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$70.73
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.73
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCN Commercial |
$82.17
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$73.91
|
| Rate for Payer: Priority Health SBD |
$73.91
|
| Rate for Payer: Priority Health Tiered Network |
$73.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.22
|
| Rate for Payer: UHC Core |
$98.22
|
| Rate for Payer: UHC Exchange |
$98.22
|
| Rate for Payer: UHC Medicaid |
$35.36
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
| Rate for Payer: UMR Bronson Commercial |
$71.76
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 99215
|
| Min. Negotiated Rate |
$102.12 |
| Max. Negotiated Rate |
$179.01 |
| Rate for Payer: Aetna Commercial |
$166.58
|
| Rate for Payer: Aetna Medicare |
$129.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.01
|
| Rate for Payer: BCBS Complete |
$116.05
|
| Rate for Payer: BCBS MAPPO |
$124.31
|
| Rate for Payer: BCN Commercial |
$157.73
|
| Rate for Payer: BCN Medicare Advantage |
$124.31
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cofinity Commercial |
$179.01
|
| Rate for Payer: Cofinity Commercial |
$166.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.53
|
| Rate for Payer: Meridian Medicaid |
$116.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$136.74
|
| Rate for Payer: Nomi Health Commercial |
$149.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.50
|
| Rate for Payer: PACE SWMI |
$124.31
|
| Rate for Payer: PHP Commercial |
$174.03
|
| Rate for Payer: PHP Medicare Advantage |
$124.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$110.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$162.63
|
| Rate for Payer: Priority Health Medicare |
$124.31
|
| Rate for Payer: Priority Health SBD |
$162.63
|
| Rate for Payer: Priority Health Tiered Network |
$162.63
|
| Rate for Payer: Railroad Medicare Medicare |
$124.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.55
|
| Rate for Payer: UHC Core |
$157.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$124.31
|
| Rate for Payer: UHC Exchange |
$157.55
|
| Rate for Payer: UHC Medicaid |
$110.52
|
| Rate for Payer: UHCCP Medicaid |
$110.52
|
| Rate for Payer: UMR Bronson Commercial |
$102.12
|
|
