|
PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 99213
|
| Min. Negotiated Rate |
$50.56 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Aetna Commercial |
$76.22
|
| Rate for Payer: Aetna Medicare |
$59.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.91
|
| Rate for Payer: BCBS Complete |
$53.09
|
| Rate for Payer: BCBS MAPPO |
$56.88
|
| Rate for Payer: BCN Commercial |
$80.24
|
| Rate for Payer: BCN Medicare Advantage |
$56.88
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$76.22
|
| Rate for Payer: Cofinity Commercial |
$81.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.72
|
| Rate for Payer: Meridian Medicaid |
$53.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.57
|
| Rate for Payer: Nomi Health Commercial |
$68.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.25
|
| Rate for Payer: PACE SWMI |
$56.88
|
| Rate for Payer: PHP Commercial |
$79.63
|
| Rate for Payer: PHP Medicare Advantage |
$56.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$74.68
|
| Rate for Payer: Priority Health Medicare |
$56.88
|
| Rate for Payer: Priority Health SBD |
$74.68
|
| Rate for Payer: Priority Health Tiered Network |
$74.68
|
| Rate for Payer: Railroad Medicare Medicare |
$56.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.56
|
| Rate for Payer: UHC Core |
$72.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.88
|
| Rate for Payer: UHC Exchange |
$72.56
|
| Rate for Payer: UHC Medicaid |
$50.56
|
| Rate for Payer: UHCCP Medicaid |
$50.56
|
| Rate for Payer: UMR Bronson Commercial |
$52.90
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 99214
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$112.21
|
| Rate for Payer: Aetna Medicare |
$87.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.59
|
| Rate for Payer: BCBS Complete |
$78.08
|
| Rate for Payer: BCBS MAPPO |
$83.74
|
| Rate for Payer: BCN Commercial |
$116.36
|
| Rate for Payer: BCN Medicare Advantage |
$83.74
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$112.21
|
| Rate for Payer: Cofinity Commercial |
$120.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.93
|
| Rate for Payer: Meridian Medicaid |
$78.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.11
|
| Rate for Payer: Nomi Health Commercial |
$100.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PACE SWMI |
$83.74
|
| Rate for Payer: PHP Commercial |
$117.24
|
| Rate for Payer: PHP Medicare Advantage |
$83.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$109.94
|
| Rate for Payer: Priority Health Medicare |
$83.74
|
| Rate for Payer: Priority Health SBD |
$109.94
|
| Rate for Payer: Priority Health Tiered Network |
$109.94
|
| Rate for Payer: Railroad Medicare Medicare |
$83.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.57
|
| Rate for Payer: UHC Core |
$111.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.74
|
| Rate for Payer: UHC Exchange |
$111.57
|
| Rate for Payer: UHC Medicaid |
$74.36
|
| Rate for Payer: UHCCP Medicaid |
$74.36
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 99212
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: Aetna Medicare |
$32.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.40
|
| Rate for Payer: BCBS Complete |
$28.70
|
| Rate for Payer: BCBS MAPPO |
$30.83
|
| Rate for Payer: BCN Commercial |
$51.06
|
| Rate for Payer: BCN Medicare Advantage |
$30.83
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$41.31
|
| Rate for Payer: Cofinity Commercial |
$44.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.37
|
| Rate for Payer: Meridian Medicaid |
$28.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.91
|
| Rate for Payer: Nomi Health Commercial |
$37.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PACE SWMI |
$30.83
|
| Rate for Payer: PHP Commercial |
$43.16
|
| Rate for Payer: PHP Medicare Advantage |
$30.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$39.81
|
| Rate for Payer: Priority Health Medicare |
$30.83
|
| Rate for Payer: Priority Health SBD |
$39.81
|
| Rate for Payer: Priority Health Tiered Network |
$39.81
|
| Rate for Payer: Railroad Medicare Medicare |
$30.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.54
|
| Rate for Payer: UHC Core |
$36.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.83
|
| Rate for Payer: UHC Exchange |
$36.54
|
| Rate for Payer: UHC Medicaid |
$27.33
|
| Rate for Payer: UHCCP Medicaid |
$27.33
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
|
|
PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 99211
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$7.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.96
|
| Rate for Payer: BCBS Complete |
$7.10
|
| Rate for Payer: BCBS MAPPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$23.53
|
| Rate for Payer: BCN Medicare Advantage |
$7.61
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.99
|
| Rate for Payer: Meridian Medicaid |
$7.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.37
|
| Rate for Payer: Nomi Health Commercial |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: PACE SWMI |
$7.61
|
| Rate for Payer: PHP Commercial |
$10.65
|
| Rate for Payer: PHP Medicare Advantage |
$7.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9.86
|
| Rate for Payer: Priority Health Medicare |
$7.61
|
| Rate for Payer: Priority Health SBD |
$9.86
|
| Rate for Payer: Priority Health Tiered Network |
$9.86
|
| Rate for Payer: Railroad Medicare Medicare |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.02
|
| Rate for Payer: UHC Core |
$13.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.61
|
| Rate for Payer: UHC Exchange |
$13.02
|
| Rate for Payer: UHC Medicaid |
$6.76
|
| Rate for Payer: UHCCP Medicaid |
$6.76
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
|
|
PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 99205
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Aetna Commercial |
$213.25
|
| Rate for Payer: Aetna Medicare |
$165.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.16
|
| Rate for Payer: BCBS Complete |
$148.13
|
| Rate for Payer: BCBS MAPPO |
$159.14
|
| Rate for Payer: BCN Commercial |
$211.86
|
| Rate for Payer: BCN Medicare Advantage |
$159.14
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$213.25
|
| Rate for Payer: Cofinity Commercial |
$229.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.10
|
| Rate for Payer: Meridian Medicaid |
$148.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$175.05
|
| Rate for Payer: Nomi Health Commercial |
$190.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
| Rate for Payer: PACE SWMI |
$159.14
|
| Rate for Payer: PHP Commercial |
$222.80
|
| Rate for Payer: PHP Medicare Advantage |
$159.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$205.84
|
| Rate for Payer: Priority Health Medicare |
$159.14
|
| Rate for Payer: Priority Health SBD |
$205.84
|
| Rate for Payer: Priority Health Tiered Network |
$205.84
|
| Rate for Payer: Railroad Medicare Medicare |
$159.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.16
|
| Rate for Payer: UHC Core |
$239.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$159.14
|
| Rate for Payer: UHC Exchange |
$239.16
|
| Rate for Payer: UHC Medicaid |
$141.08
|
| Rate for Payer: UHCCP Medicaid |
$141.08
|
| Rate for Payer: UMR Bronson Commercial |
$149.50
|
|
|
PR OFFICE OUTPATIENT NEW LEVL I
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 99201
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$54.75 |
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.75
|
| Rate for Payer: UMR Bronson Commercial |
$33.58
|
|
|
PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 99203
|
| Min. Negotiated Rate |
$62.90 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$95.22
|
| Rate for Payer: Aetna Medicare |
$73.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.22
|
| Rate for Payer: BCBS Complete |
$66.05
|
| Rate for Payer: BCBS MAPPO |
$71.06
|
| Rate for Payer: BCN Commercial |
$109.72
|
| Rate for Payer: BCN Medicare Advantage |
$71.06
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$95.22
|
| Rate for Payer: Cofinity Commercial |
$102.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.61
|
| Rate for Payer: Meridian Medicaid |
$66.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.17
|
| Rate for Payer: Nomi Health Commercial |
$85.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PACE SWMI |
$71.06
|
| Rate for Payer: PHP Commercial |
$99.48
|
| Rate for Payer: PHP Medicare Advantage |
$71.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$92.88
|
| Rate for Payer: Priority Health Medicare |
$71.06
|
| Rate for Payer: Priority Health SBD |
$92.88
|
| Rate for Payer: Priority Health Tiered Network |
$92.88
|
| Rate for Payer: Railroad Medicare Medicare |
$71.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.10
|
| Rate for Payer: UHC Core |
$107.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.06
|
| Rate for Payer: UHC Exchange |
$107.10
|
| Rate for Payer: UHC Medicaid |
$62.90
|
| Rate for Payer: UHCCP Medicaid |
$62.90
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 99204
|
| Min. Negotiated Rate |
$102.87 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Commercial |
$155.47
|
| Rate for Payer: Aetna Medicare |
$120.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.07
|
| Rate for Payer: BCBS Complete |
$108.01
|
| Rate for Payer: BCBS MAPPO |
$116.02
|
| Rate for Payer: BCN Commercial |
$167.67
|
| Rate for Payer: BCN Medicare Advantage |
$116.02
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cofinity Commercial |
$155.47
|
| Rate for Payer: Cofinity Commercial |
$167.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.82
|
| Rate for Payer: Meridian Medicaid |
$108.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.62
|
| Rate for Payer: Nomi Health Commercial |
$139.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| Rate for Payer: PACE SWMI |
$116.02
|
| Rate for Payer: PHP Commercial |
$162.43
|
| Rate for Payer: PHP Medicare Advantage |
$116.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$151.25
|
| Rate for Payer: Priority Health Medicare |
$116.02
|
| Rate for Payer: Priority Health SBD |
$151.25
|
| Rate for Payer: Priority Health Tiered Network |
$151.25
|
| Rate for Payer: Railroad Medicare Medicare |
$116.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.15
|
| Rate for Payer: UHC Core |
$183.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$116.02
|
| Rate for Payer: UHC Exchange |
$183.15
|
| Rate for Payer: UHC Medicaid |
$102.87
|
| Rate for Payer: UHCCP Medicaid |
$102.87
|
| Rate for Payer: UMR Bronson Commercial |
$120.98
|
|
|
PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 99202
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Aetna Commercial |
$54.56
|
| Rate for Payer: Aetna Medicare |
$42.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.64
|
| Rate for Payer: BCBS Complete |
$37.96
|
| Rate for Payer: BCBS MAPPO |
$40.72
|
| Rate for Payer: BCN Commercial |
$77.49
|
| Rate for Payer: BCN Medicare Advantage |
$40.72
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$54.56
|
| Rate for Payer: Cofinity Commercial |
$58.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.76
|
| Rate for Payer: Meridian Medicaid |
$37.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.79
|
| Rate for Payer: Nomi Health Commercial |
$48.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.25
|
| Rate for Payer: PACE SWMI |
$40.72
|
| Rate for Payer: PHP Commercial |
$57.01
|
| Rate for Payer: PHP Medicare Advantage |
$40.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$53.08
|
| Rate for Payer: Priority Health Medicare |
$40.72
|
| Rate for Payer: Priority Health SBD |
$53.08
|
| Rate for Payer: Priority Health Tiered Network |
$53.08
|
| Rate for Payer: Railroad Medicare Medicare |
$40.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.50
|
| Rate for Payer: UHC Core |
$71.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.72
|
| Rate for Payer: UHC Exchange |
$71.50
|
| Rate for Payer: UHC Medicaid |
$36.15
|
| Rate for Payer: UHCCP Medicaid |
$36.15
|
| Rate for Payer: UMR Bronson Commercial |
$52.90
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
OP
|
$256.80
|
|
|
Service Code
|
NDC 17478076610
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.02 |
| Max. Negotiated Rate |
$231.12 |
| Rate for Payer: Aetna American Axle |
$166.92
|
| Rate for Payer: Aetna Commercial |
$218.28
|
| Rate for Payer: Aetna Medicare |
$128.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.92
|
| Rate for Payer: BCBS Complete |
$102.72
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cofinity Advantage |
$179.76
|
| Rate for Payer: Cofinity Commercial |
$220.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.44
|
| Rate for Payer: Healthscope Commercial |
$231.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.60
|
| Rate for Payer: PHP Commercial |
$218.28
|
| Rate for Payer: Priority Health SBD |
$161.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.92
|
| Rate for Payer: UHC Core |
$133.79
|
| Rate for Payer: UHC Exchange |
$100.92
|
| Rate for Payer: UMR Bronson Commercial |
$95.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.60
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 59651015201
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.32 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UMR Bronson Commercial |
$192.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$1,804.64
|
|
|
Service Code
|
NDC 72989037230
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$794.04 |
| Max. Negotiated Rate |
$1,624.18 |
| Rate for Payer: Aetna American Axle |
$1,173.02
|
| Rate for Payer: Aetna Commercial |
$1,533.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,173.02
|
| Rate for Payer: Cash Price |
$1,443.71
|
| Rate for Payer: Cofinity Advantage |
$1,263.25
|
| Rate for Payer: Cofinity Commercial |
$1,551.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,443.71
|
| Rate for Payer: Healthscope Commercial |
$1,624.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,263.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,353.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,533.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.48
|
| Rate for Payer: PHP Commercial |
$1,533.94
|
| Rate for Payer: Priority Health SBD |
$1,136.92
|
| Rate for Payer: UMR Bronson Commercial |
$794.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,353.48
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
IP
|
$256.80
|
|
|
Service Code
|
NDC 17478076610
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$231.12 |
| Rate for Payer: Aetna American Axle |
$166.92
|
| Rate for Payer: Aetna Commercial |
$218.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.92
|
| Rate for Payer: Cash Price |
$205.44
|
| Rate for Payer: Cofinity Advantage |
$179.76
|
| Rate for Payer: Cofinity Commercial |
$220.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$205.44
|
| Rate for Payer: Healthscope Commercial |
$231.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$192.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$218.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$192.60
|
| Rate for Payer: PHP Commercial |
$218.28
|
| Rate for Payer: Priority Health SBD |
$161.78
|
| Rate for Payer: UMR Bronson Commercial |
$112.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$192.60
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 59651015201
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.73 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna American Axle |
$284.12
|
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.12
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Advantage |
$305.97
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$305.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$349.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.82
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health SBD |
$275.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.12
|
| Rate for Payer: UHC Core |
$227.73
|
| Rate for Payer: UHC Exchange |
$171.78
|
| Rate for Payer: UMR Bronson Commercial |
$161.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
PROGESTERONE MICRONIZED 100 MG CAPSULE
|
Facility
|
OP
|
$1,804.64
|
|
|
Service Code
|
NDC 72989037230
|
| Hospital Charge Code |
23122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$667.72 |
| Max. Negotiated Rate |
$1,624.18 |
| Rate for Payer: Aetna American Axle |
$1,173.02
|
| Rate for Payer: Aetna Commercial |
$1,533.94
|
| Rate for Payer: Aetna Medicare |
$902.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,173.02
|
| Rate for Payer: BCBS Complete |
$721.86
|
| Rate for Payer: Cash Price |
$1,443.71
|
| Rate for Payer: Cofinity Advantage |
$1,263.25
|
| Rate for Payer: Cofinity Commercial |
$1,551.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,443.71
|
| Rate for Payer: Healthscope Commercial |
$1,624.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,263.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,353.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,443.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,533.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.48
|
| Rate for Payer: PHP Commercial |
$1,533.94
|
| Rate for Payer: Priority Health SBD |
$1,136.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,173.02
|
| Rate for Payer: UHC Core |
$940.22
|
| Rate for Payer: UHC Exchange |
$709.22
|
| Rate for Payer: UMR Bronson Commercial |
$667.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,353.48
|
|
|
PR OMALIZUMAB INJECTION
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J2357
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$60.22 |
| Rate for Payer: Aetna Commercial |
$56.04
|
| Rate for Payer: Aetna Medicare |
$43.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.04
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$46.35
|
| Rate for Payer: BCN Commercial |
$40.87
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$56.04
|
| Rate for Payer: Cofinity Commercial |
$60.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Commercial |
$58.55
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.50
|
| Rate for Payer: UHC Core |
$45.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$45.50
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
PR OMENTAL FLAP INTRA-ABDOMINAL
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 49905
|
| Min. Negotiated Rate |
$200.86 |
| Max. Negotiated Rate |
$636.48 |
| Rate for Payer: Aetna Commercial |
$424.50
|
| Rate for Payer: Aetna Medicare |
$329.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$456.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.50
|
| Rate for Payer: BCBS Complete |
$210.90
|
| Rate for Payer: BCBS MAPPO |
$316.79
|
| Rate for Payer: BCN Commercial |
$522.38
|
| Rate for Payer: BCN Medicare Advantage |
$316.79
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cofinity Commercial |
$456.18
|
| Rate for Payer: Cofinity Commercial |
$424.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.63
|
| Rate for Payer: Meridian Medicaid |
$210.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$348.47
|
| Rate for Payer: Nomi Health Commercial |
$380.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.75
|
| Rate for Payer: PACE SWMI |
$316.79
|
| Rate for Payer: PHP Commercial |
$443.51
|
| Rate for Payer: PHP Medicare Advantage |
$316.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$636.48
|
| Rate for Payer: Priority Health Medicare |
$316.79
|
| Rate for Payer: Priority Health SBD |
$636.48
|
| Rate for Payer: Priority Health Tiered Network |
$636.48
|
| Rate for Payer: Railroad Medicare Medicare |
$316.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.16
|
| Rate for Payer: UHC Core |
$634.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$316.79
|
| Rate for Payer: UHC Exchange |
$634.16
|
| Rate for Payer: UHC Medicaid |
$200.86
|
| Rate for Payer: UHCCP Medicaid |
$200.86
|
| Rate for Payer: UMR Bronson Commercial |
$304.06
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 65162074510
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.03
|
| Rate for Payer: UHC Core |
$90.60
|
| Rate for Payer: UHC Exchange |
$68.34
|
| Rate for Payer: UMR Bronson Commercial |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.43
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 53746074501
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.39 |
| Max. Negotiated Rate |
$139.59 |
| Rate for Payer: Aetna American Axle |
$100.81
|
| Rate for Payer: Aetna Commercial |
$131.84
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.81
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Advantage |
$108.57
|
| Rate for Payer: Cofinity Commercial |
$133.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$139.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.33
|
| Rate for Payer: PHP Commercial |
$131.84
|
| Rate for Payer: Priority Health SBD |
$97.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.81
|
| Rate for Payer: UHC Core |
$80.81
|
| Rate for Payer: UHC Exchange |
$60.95
|
| Rate for Payer: UMR Bronson Commercial |
$57.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.33
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
OP
|
$131.60
|
|
|
Service Code
|
NDC 10702000201
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna Medicare |
$65.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: BCBS Complete |
$52.64
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.54
|
| Rate for Payer: UHC Core |
$68.56
|
| Rate for Payer: UHC Exchange |
$51.72
|
| Rate for Payer: UMR Bronson Commercial |
$48.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$152.75
|
|
|
Service Code
|
NDC 68382004001
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna American Axle |
$99.29
|
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Advantage |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health SBD |
$96.23
|
| Rate for Payer: UMR Bronson Commercial |
$67.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 60687066001
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.81 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna American Axle |
$261.20
|
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Advantage |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health SBD |
$253.17
|
| Rate for Payer: UMR Bronson Commercial |
$176.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.39
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$131.60
|
|
|
Service Code
|
NDC 10702000201
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.90 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna American Axle |
$85.54
|
| Rate for Payer: Aetna Commercial |
$111.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.54
|
| Rate for Payer: Cash Price |
$105.28
|
| Rate for Payer: Cofinity Advantage |
$92.12
|
| Rate for Payer: Cofinity Commercial |
$113.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$118.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.70
|
| Rate for Payer: PHP Commercial |
$111.86
|
| Rate for Payer: Priority Health SBD |
$82.91
|
| Rate for Payer: UMR Bronson Commercial |
$57.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.70
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
IP
|
$4.02
|
|
|
Service Code
|
NDC 60687066011
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna American Axle |
$2.61
|
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.61
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Advantage |
$2.81
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.42
|
| Rate for Payer: Priority Health SBD |
$2.53
|
| Rate for Payer: UMR Bronson Commercial |
$1.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.02
|
|
|
PROMETHAZINE 12.5 MG TABLET
|
Facility
|
OP
|
$152.75
|
|
|
Service Code
|
NDC 68382004001
|
| Hospital Charge Code |
6621
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.52 |
| Max. Negotiated Rate |
$137.47 |
| Rate for Payer: Aetna American Axle |
$99.29
|
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: Aetna Medicare |
$76.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.29
|
| Rate for Payer: BCBS Complete |
$61.10
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Advantage |
$106.92
|
| Rate for Payer: Cofinity Commercial |
$131.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$122.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.56
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health SBD |
$96.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$99.29
|
| Rate for Payer: UHC Core |
$79.58
|
| Rate for Payer: UHC Exchange |
$60.03
|
| Rate for Payer: UMR Bronson Commercial |
$56.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
