|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,696.32
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
6562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$746.38 |
| Max. Negotiated Rate |
$1,526.69 |
| Rate for Payer: Aetna American Axle |
$1,102.61
|
| Rate for Payer: Aetna American Axle |
$136.97
|
| Rate for Payer: Aetna Commercial |
$1,441.87
|
| Rate for Payer: Aetna Commercial |
$179.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,102.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.97
|
| Rate for Payer: Cash Price |
$1,357.06
|
| Rate for Payer: Cash Price |
$168.58
|
| Rate for Payer: Cofinity Commercial |
$181.23
|
| Rate for Payer: Cofinity Commercial |
$147.51
|
| Rate for Payer: Cofinity Commercial |
$1,187.42
|
| Rate for Payer: Cofinity Commercial |
$1,458.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,187.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$147.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,357.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.58
|
| Rate for Payer: Healthscope Commercial |
$1,526.69
|
| Rate for Payer: Healthscope Commercial |
$189.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,187.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,272.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,441.87
|
| Rate for Payer: PHP Commercial |
$179.12
|
| Rate for Payer: PHP Commercial |
$1,441.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,102.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.97
|
| Rate for Payer: Priority Health SBD |
$1,068.68
|
| Rate for Payer: Priority Health SBD |
$132.76
|
| Rate for Payer: UMR Bronson Commercial |
$746.38
|
| Rate for Payer: UMR Bronson Commercial |
$92.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,272.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.05
|
|
|
PROCAINAMIDE 100 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
OP
|
$216.45
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
181397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.09 |
| Max. Negotiated Rate |
$829.52 |
| Rate for Payer: Aetna American Axle |
$140.69
|
| Rate for Payer: Aetna Commercial |
$183.98
|
| Rate for Payer: Aetna Medicare |
$306.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$368.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$368.36
|
| Rate for Payer: BCBS Complete |
$165.85
|
| Rate for Payer: BCBS MAPPO |
$294.69
|
| Rate for Payer: BCN Medicare Advantage |
$294.69
|
| Rate for Payer: Cash Price |
$173.16
|
| Rate for Payer: Cash Price |
$173.16
|
| Rate for Payer: Cofinity Commercial |
$186.15
|
| Rate for Payer: Cofinity Commercial |
$151.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.69
|
| Rate for Payer: Healthscope Commercial |
$194.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.34
|
| Rate for Payer: Mclaren Medicaid |
$157.95
|
| Rate for Payer: Mclaren Medicare |
$294.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.42
|
| Rate for Payer: Meridian Medicaid |
$165.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.98
|
| Rate for Payer: PACE Medicare |
$279.96
|
| Rate for Payer: PACE SWMI |
$294.69
|
| Rate for Payer: PHP Commercial |
$183.98
|
| Rate for Payer: PHP Medicare Advantage |
$294.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.69
|
| Rate for Payer: Priority Health Medicare |
$294.69
|
| Rate for Payer: Priority Health SBD |
$136.36
|
| Rate for Payer: Railroad Medicare Medicare |
$294.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$829.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.69
|
| Rate for Payer: UHC Exchange |
$563.18
|
| Rate for Payer: UHC Medicare Advantage |
$294.69
|
| Rate for Payer: UHCCP Medicaid |
$157.95
|
| Rate for Payer: UMR Bronson Commercial |
$80.09
|
| Rate for Payer: VA VA |
$294.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.34
|
|
|
PROCAINAMIDE 100 MG/ML INTRAVENOUS SYRINGE
|
Facility
|
IP
|
$216.45
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
181397
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.24 |
| Max. Negotiated Rate |
$194.81 |
| Rate for Payer: Aetna American Axle |
$140.69
|
| Rate for Payer: Aetna Commercial |
$183.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.69
|
| Rate for Payer: Cash Price |
$173.16
|
| Rate for Payer: Cofinity Commercial |
$151.51
|
| Rate for Payer: Cofinity Commercial |
$186.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$151.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.16
|
| Rate for Payer: Healthscope Commercial |
$194.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.98
|
| Rate for Payer: PHP Commercial |
$183.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.69
|
| Rate for Payer: Priority Health SBD |
$136.36
|
| Rate for Payer: UMR Bronson Commercial |
$95.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.34
|
|
|
PR OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 58615
|
| Min. Negotiated Rate |
$179.60 |
| Max. Negotiated Rate |
$347.60 |
| Rate for Payer: Aetna Commercial |
$323.46
|
| Rate for Payer: Aetna Medicare |
$251.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.46
|
| Rate for Payer: BCBS Complete |
$179.60
|
| Rate for Payer: BCBS MAPPO |
$241.39
|
| Rate for Payer: BCN Medicare Advantage |
$241.39
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$347.60
|
| Rate for Payer: Cofinity Commercial |
$323.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.46
|
| Rate for Payer: Nomi Health Commercial |
$289.67
|
| Rate for Payer: PACE SWMI |
$241.39
|
| Rate for Payer: PHP Commercial |
$337.95
|
| Rate for Payer: PHP Medicare Advantage |
$241.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$241.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.39
|
| Rate for Payer: UHC Medicare Advantage |
$241.39
|
| Rate for Payer: UMR Bronson Commercial |
$206.54
|
|
|
PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 97165
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$138.84 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.20
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$96.42
|
| Rate for Payer: BCN Medicare Advantage |
$96.42
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.24
|
| Rate for Payer: Nomi Health Commercial |
$115.70
|
| Rate for Payer: PACE SWMI |
$96.42
|
| Rate for Payer: PHP Commercial |
$134.99
|
| Rate for Payer: PHP Medicare Advantage |
$96.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$96.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.42
|
| Rate for Payer: UHC Medicare Advantage |
$96.42
|
| Rate for Payer: UMR Bronson Commercial |
$71.76
|
|
|
PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 97166
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$138.84 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.20
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS MAPPO |
$96.42
|
| Rate for Payer: BCN Medicare Advantage |
$96.42
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.24
|
| Rate for Payer: Nomi Health Commercial |
$115.70
|
| Rate for Payer: PACE SWMI |
$96.42
|
| Rate for Payer: PHP Commercial |
$134.99
|
| Rate for Payer: PHP Medicare Advantage |
$96.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Medicare |
$96.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.42
|
| Rate for Payer: UHC Medicare Advantage |
$96.42
|
| Rate for Payer: UMR Bronson Commercial |
$68.54
|
|
|
PR OCCUPATIONAL THERAPY EVALUATION
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 97003
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
PR OCCUPATIONAL THERAPY RE-EVALUATION
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 97004
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: UMR Bronson Commercial |
$33.58
|
|
|
PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 97168
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$95.57 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Aetna Medicare |
$69.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.94
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$66.37
|
| Rate for Payer: BCN Medicare Advantage |
$66.37
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$88.94
|
| Rate for Payer: Cofinity Commercial |
$95.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.69
|
| Rate for Payer: Nomi Health Commercial |
$79.64
|
| Rate for Payer: PACE SWMI |
$66.37
|
| Rate for Payer: PHP Commercial |
$92.92
|
| Rate for Payer: PHP Medicare Advantage |
$66.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$66.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.37
|
| Rate for Payer: UHC Medicare Advantage |
$66.37
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$367.50
|
|
|
Service Code
|
NDC 00574722612
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Aetna American Axle |
$238.88
|
| Rate for Payer: Aetna Commercial |
$312.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.88
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cofinity Commercial |
$257.25
|
| Rate for Payer: Cofinity Commercial |
$316.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$257.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.00
|
| Rate for Payer: Healthscope Commercial |
$330.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.38
|
| Rate for Payer: PHP Commercial |
$312.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.88
|
| Rate for Payer: Priority Health SBD |
$231.53
|
| Rate for Payer: UMR Bronson Commercial |
$161.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.62
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$367.50
|
|
|
Service Code
|
NDC 00574722612
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.97 |
| Max. Negotiated Rate |
$330.75 |
| Rate for Payer: Aetna American Axle |
$238.88
|
| Rate for Payer: Aetna Commercial |
$312.38
|
| Rate for Payer: Aetna Medicare |
$183.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.88
|
| Rate for Payer: BCBS Complete |
$147.00
|
| Rate for Payer: Cash Price |
$294.00
|
| Rate for Payer: Cofinity Commercial |
$257.25
|
| Rate for Payer: Cofinity Commercial |
$316.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$257.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$294.00
|
| Rate for Payer: Healthscope Commercial |
$330.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$257.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$312.38
|
| Rate for Payer: PHP Commercial |
$312.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.88
|
| Rate for Payer: Priority Health SBD |
$231.53
|
| Rate for Payer: UMR Bronson Commercial |
$135.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.62
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$359.78
|
|
|
Service Code
|
NDC 00713013512
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.30 |
| Max. Negotiated Rate |
$323.80 |
| Rate for Payer: Aetna American Axle |
$233.86
|
| Rate for Payer: Aetna Commercial |
$305.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.86
|
| Rate for Payer: Cash Price |
$287.82
|
| Rate for Payer: Cofinity Commercial |
$251.85
|
| Rate for Payer: Cofinity Commercial |
$309.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.82
|
| Rate for Payer: Healthscope Commercial |
$323.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.81
|
| Rate for Payer: PHP Commercial |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.86
|
| Rate for Payer: Priority Health SBD |
$226.66
|
| Rate for Payer: UMR Bronson Commercial |
$158.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.83
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$359.78
|
|
|
Service Code
|
NDC 00713013512
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.12 |
| Max. Negotiated Rate |
$323.80 |
| Rate for Payer: Aetna American Axle |
$233.86
|
| Rate for Payer: Aetna Commercial |
$305.81
|
| Rate for Payer: Aetna Medicare |
$179.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.86
|
| Rate for Payer: BCBS Complete |
$143.91
|
| Rate for Payer: Cash Price |
$287.82
|
| Rate for Payer: Cofinity Commercial |
$251.85
|
| Rate for Payer: Cofinity Commercial |
$309.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$251.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.82
|
| Rate for Payer: Healthscope Commercial |
$323.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.81
|
| Rate for Payer: PHP Commercial |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.86
|
| Rate for Payer: Priority Health SBD |
$226.66
|
| Rate for Payer: UMR Bronson Commercial |
$133.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.83
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$34.46
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$31.01 |
| Rate for Payer: Aetna American Axle |
$22.40
|
| Rate for Payer: Aetna American Axle |
$20.70
|
| Rate for Payer: Aetna American Axle |
$21.44
|
| Rate for Payer: Aetna American Axle |
$25.25
|
| Rate for Payer: Aetna American Axle |
$29.01
|
| Rate for Payer: Aetna American Axle |
$34.93
|
| Rate for Payer: Aetna American Axle |
$28.96
|
| Rate for Payer: Aetna American Axle |
$22.98
|
| Rate for Payer: Aetna American Axle |
$49.77
|
| Rate for Payer: Aetna American Axle |
$14.55
|
| Rate for Payer: Aetna Commercial |
$29.29
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Commercial |
$28.04
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Aetna Commercial |
$45.68
|
| Rate for Payer: Aetna Commercial |
$37.94
|
| Rate for Payer: Aetna Commercial |
$37.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.40
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Cash Price |
$61.26
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cash Price |
$35.64
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Cash Price |
$27.57
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$29.64
|
| Rate for Payer: Cofinity Commercial |
$24.12
|
| Rate for Payer: Cofinity Commercial |
$23.09
|
| Rate for Payer: Cofinity Commercial |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$28.37
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$24.75
|
| Rate for Payer: Cofinity Commercial |
$30.41
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$31.18
|
| Rate for Payer: Cofinity Commercial |
$38.31
|
| Rate for Payer: Cofinity Commercial |
$31.24
|
| Rate for Payer: Cofinity Commercial |
$38.38
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$65.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$28.66
|
| Rate for Payer: Healthscope Commercial |
$29.69
|
| Rate for Payer: Healthscope Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$40.09
|
| Rate for Payer: Healthscope Commercial |
$68.91
|
| Rate for Payer: Healthscope Commercial |
$48.37
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$40.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.68
|
| Rate for Payer: PHP Commercial |
$45.68
|
| Rate for Payer: PHP Commercial |
$29.29
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$65.08
|
| Rate for Payer: PHP Commercial |
$37.94
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$28.04
|
| Rate for Payer: PHP Commercial |
$37.87
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health SBD |
$28.07
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$20.06
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: Priority Health SBD |
$20.78
|
| Rate for Payer: Priority Health SBD |
$28.12
|
| Rate for Payer: Priority Health SBD |
$48.24
|
| Rate for Payer: Priority Health SBD |
$21.71
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$24.47
|
| Rate for Payer: UMR Bronson Commercial |
$15.16
|
| Rate for Payer: UMR Bronson Commercial |
$23.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.85
|
| Rate for Payer: UMR Bronson Commercial |
$33.69
|
| Rate for Payer: UMR Bronson Commercial |
$19.64
|
| Rate for Payer: UMR Bronson Commercial |
$15.56
|
| Rate for Payer: UMR Bronson Commercial |
$19.60
|
| Rate for Payer: UMR Bronson Commercial |
$17.09
|
| Rate for Payer: UMR Bronson Commercial |
$14.52
|
| Rate for Payer: UMR Bronson Commercial |
$14.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.74
|
| 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 |
$29.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.47
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$34.46
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$31.01 |
| Rate for Payer: Aetna American Axle |
$22.40
|
| Rate for Payer: Aetna American Axle |
$25.25
|
| Rate for Payer: Aetna American Axle |
$18.42
|
| Rate for Payer: Aetna American Axle |
$22.98
|
| Rate for Payer: Aetna American Axle |
$21.44
|
| Rate for Payer: Aetna American Axle |
$14.55
|
| Rate for Payer: Aetna American Axle |
$49.77
|
| Rate for Payer: Aetna American Axle |
$20.70
|
| Rate for Payer: Aetna American Axle |
$34.93
|
| Rate for Payer: Aetna American Axle |
$29.01
|
| Rate for Payer: Aetna American Axle |
$28.96
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$24.09
|
| Rate for Payer: Aetna Commercial |
$19.03
|
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Commercial |
$65.08
|
| Rate for Payer: Aetna Commercial |
$28.04
|
| Rate for Payer: Aetna Commercial |
$29.29
|
| Rate for Payer: Aetna Commercial |
$37.87
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Commercial |
$37.94
|
| Rate for Payer: Aetna Commercial |
$45.68
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna Medicare |
$15.92
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Aetna Medicare |
$17.68
|
| Rate for Payer: Aetna Medicare |
$11.20
|
| Rate for Payer: Aetna Medicare |
$19.42
|
| Rate for Payer: Aetna Medicare |
$26.87
|
| Rate for Payer: Aetna Medicare |
$17.23
|
| Rate for Payer: Aetna Medicare |
$22.32
|
| Rate for Payer: Aetna Medicare |
$14.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: BCBS Complete |
$17.82
|
| Rate for Payer: BCBS Complete |
$17.85
|
| Rate for Payer: BCBS Complete |
$30.63
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: BCBS Complete |
$15.54
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$12.74
|
| Rate for Payer: BCBS Complete |
$13.78
|
| Rate for Payer: BCBS Complete |
$11.34
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.64
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cash Price |
$22.67
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Cash Price |
$27.57
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$61.26
|
| Rate for Payer: Cofinity Commercial |
$28.37
|
| Rate for Payer: Cofinity Commercial |
$24.12
|
| Rate for Payer: Cofinity Commercial |
$29.64
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$38.38
|
| Rate for Payer: Cofinity Commercial |
$31.24
|
| Rate for Payer: Cofinity Commercial |
$37.62
|
| Rate for Payer: Cofinity Commercial |
$30.41
|
| Rate for Payer: Cofinity Commercial |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Cofinity Commercial |
$15.67
|
| Rate for Payer: Cofinity Commercial |
$38.31
|
| Rate for Payer: Cofinity Commercial |
$31.18
|
| Rate for Payer: Cofinity Commercial |
$46.22
|
| Rate for Payer: Cofinity Commercial |
$23.09
|
| Rate for Payer: Cofinity Commercial |
$24.75
|
| Rate for Payer: Cofinity Commercial |
$24.37
|
| Rate for Payer: Cofinity Commercial |
$65.85
|
| Rate for Payer: Cofinity Commercial |
$19.26
|
| Rate for Payer: Cofinity Commercial |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$19.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$37.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.67
|
| 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 |
$26.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.26
|
| Rate for Payer: Healthscope Commercial |
$28.66
|
| Rate for Payer: Healthscope Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$40.09
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$40.17
|
| Rate for Payer: Healthscope Commercial |
$20.15
|
| Rate for Payer: Healthscope Commercial |
$29.69
|
| Rate for Payer: Healthscope Commercial |
$25.51
|
| Rate for Payer: Healthscope Commercial |
$48.37
|
| Rate for Payer: Healthscope Commercial |
$68.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$37.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$37.94
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$37.87
|
| Rate for Payer: PHP Commercial |
$29.29
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: PHP Commercial |
$19.03
|
| Rate for Payer: PHP Commercial |
$65.08
|
| Rate for Payer: PHP Commercial |
$45.68
|
| Rate for Payer: PHP Commercial |
$24.09
|
| Rate for Payer: PHP Commercial |
$28.04
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.93
|
| Rate for Payer: Priority Health SBD |
$17.85
|
| Rate for Payer: Priority Health SBD |
$24.47
|
| Rate for Payer: Priority Health SBD |
$21.71
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: Priority Health SBD |
$33.86
|
| Rate for Payer: Priority Health SBD |
$28.12
|
| Rate for Payer: Priority Health SBD |
$48.24
|
| Rate for Payer: Priority Health SBD |
$20.06
|
| Rate for Payer: Priority Health SBD |
$14.11
|
| Rate for Payer: Priority Health SBD |
$28.07
|
| Rate for Payer: Priority Health SBD |
$20.78
|
| Rate for Payer: UMR Bronson Commercial |
$16.48
|
| Rate for Payer: UMR Bronson Commercial |
$11.78
|
| Rate for Payer: UMR Bronson Commercial |
$8.28
|
| Rate for Payer: UMR Bronson Commercial |
$14.37
|
| Rate for Payer: UMR Bronson Commercial |
$19.88
|
| Rate for Payer: UMR Bronson Commercial |
$28.33
|
| Rate for Payer: UMR Bronson Commercial |
$12.75
|
| Rate for Payer: UMR Bronson Commercial |
$10.49
|
| Rate for Payer: UMR Bronson Commercial |
$12.21
|
| Rate for Payer: UMR Bronson Commercial |
$13.08
|
| Rate for Payer: UMR Bronson Commercial |
$16.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.25
|
| 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 |
$33.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.52
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$5.41
|
|
|
Service Code
|
NDC 50268068511
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna American Axle |
$3.52
|
| Rate for Payer: Aetna Commercial |
$4.60
|
| Rate for Payer: Aetna Medicare |
$2.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.52
|
| Rate for Payer: BCBS Complete |
$2.16
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Cofinity Commercial |
$4.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.33
|
| Rate for Payer: Healthscope Commercial |
$4.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.60
|
| Rate for Payer: PHP Commercial |
$4.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health SBD |
$3.41
|
| Rate for Payer: UMR Bronson Commercial |
$2.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.06
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$5.41
|
|
|
Service Code
|
NDC 50268068511
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna American Axle |
$3.52
|
| Rate for Payer: Aetna Commercial |
$4.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.52
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cofinity Commercial |
$3.79
|
| Rate for Payer: Cofinity Commercial |
$4.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.33
|
| Rate for Payer: Healthscope Commercial |
$4.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.60
|
| Rate for Payer: PHP Commercial |
$4.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health SBD |
$3.41
|
| Rate for Payer: UMR Bronson Commercial |
$2.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.06
|
|
|
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 Commercial |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$397.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$323.86
|
| 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: PHP Commercial |
$393.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.72
|
| 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
|
$312.55
|
|
|
Service Code
|
NDC 27241028701
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.52 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UMR Bronson Commercial |
$137.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
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 Commercial |
$212.02
|
| Rate for Payer: Cofinity Commercial |
$260.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$212.02
|
| 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: PHP Commercial |
$257.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.87
|
| 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
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 27241028701
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna Medicare |
$156.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UMR Bronson Commercial |
$115.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$270.48
|
|
|
Service Code
|
NDC 50268068515
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.01 |
| Max. Negotiated Rate |
$243.43 |
| Rate for Payer: Aetna American Axle |
$175.81
|
| Rate for Payer: Aetna Commercial |
$229.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.81
|
| Rate for Payer: Cash Price |
$216.38
|
| Rate for Payer: Cofinity Commercial |
$189.34
|
| Rate for Payer: Cofinity Commercial |
$232.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.38
|
| Rate for Payer: Healthscope Commercial |
$243.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.91
|
| Rate for Payer: PHP Commercial |
$229.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.81
|
| Rate for Payer: Priority Health SBD |
$170.40
|
| Rate for Payer: UMR Bronson Commercial |
$119.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.86
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$270.48
|
|
|
Service Code
|
NDC 50268068515
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.08 |
| Max. Negotiated Rate |
$243.43 |
| Rate for Payer: Aetna American Axle |
$175.81
|
| Rate for Payer: Aetna Commercial |
$229.91
|
| Rate for Payer: Aetna Medicare |
$135.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.81
|
| Rate for Payer: BCBS Complete |
$108.19
|
| Rate for Payer: Cash Price |
$216.38
|
| Rate for Payer: Cofinity Commercial |
$189.34
|
| Rate for Payer: Cofinity Commercial |
$232.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$189.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.38
|
| Rate for Payer: Healthscope Commercial |
$243.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.91
|
| Rate for Payer: PHP Commercial |
$229.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.81
|
| Rate for Payer: Priority Health SBD |
$170.40
|
| Rate for Payer: UMR Bronson Commercial |
$100.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.86
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 70710166801
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.52 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.16
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UMR Bronson Commercial |
$137.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
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 Commercial |
$2.12
|
| Rate for Payer: Cofinity Commercial |
$2.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.12
|
| 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: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| 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
|
|
