|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 68084015501
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$84.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 68084015501
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna American Axle |
$125.35
|
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$96.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.35
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$135.00
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$135.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$135.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health SBD |
$121.50
|
| Rate for Payer: UMR Bronson Commercial |
$71.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$1.93
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna American Axle |
$1.25
|
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.25
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.64
|
| Rate for Payer: PHP Commercial |
$1.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.25
|
| Rate for Payer: Priority Health SBD |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.45
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
OP
|
$1.93
|
|
|
Service Code
|
NDC 68084015511
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna American Axle |
$1.25
|
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.25
|
| Rate for Payer: BCBS Complete |
$0.77
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.64
|
| Rate for Payer: PHP Commercial |
$1.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.25
|
| Rate for Payer: Priority Health SBD |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.45
|
|
|
PROMETHAZINE 25 MG TABLET
|
Facility
|
IP
|
$89.30
|
|
|
Service Code
|
NDC 53746052101
|
| Hospital Charge Code |
6622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna American Axle |
$58.04
|
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.04
|
| Rate for Payer: Cash Price |
$71.44
|
| Rate for Payer: Cofinity Commercial |
$62.51
|
| Rate for Payer: Cofinity Commercial |
$76.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$62.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.44
|
| Rate for Payer: Healthscope Commercial |
$80.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.90
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.04
|
| Rate for Payer: Priority Health SBD |
$56.26
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.98
|
|
|
PROMETHAZINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.15
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna American Axle |
$15.70
|
| Rate for Payer: Aetna Commercial |
$20.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.70
|
| Rate for Payer: Cash Price |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Cofinity Commercial |
$20.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.32
|
| Rate for Payer: Healthscope Commercial |
$21.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.53
|
| Rate for Payer: PHP Commercial |
$20.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.70
|
| Rate for Payer: Priority Health SBD |
$15.21
|
| Rate for Payer: UMR Bronson Commercial |
$10.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.11
|
|
|
PROMETHAZINE 50 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$24.15
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna American Axle |
$15.70
|
| Rate for Payer: Aetna Commercial |
$20.53
|
| Rate for Payer: Aetna Medicare |
$12.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.70
|
| Rate for Payer: BCBS Complete |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$8.92
|
| Rate for Payer: BCN Commercial |
$8.92
|
| Rate for Payer: Cash Price |
$19.32
|
| Rate for Payer: Cash Price |
$19.32
|
| Rate for Payer: Cofinity Commercial |
$16.90
|
| Rate for Payer: Cofinity Commercial |
$20.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.32
|
| Rate for Payer: Healthscope Commercial |
$21.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.53
|
| Rate for Payer: PHP Commercial |
$20.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.70
|
| Rate for Payer: Priority Health SBD |
$15.21
|
| Rate for Payer: UMR Bronson Commercial |
$8.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.11
|
|
|
PROMETHAZINE 50 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$1,107.61
|
|
|
Service Code
|
NDC 00713013212
|
| Hospital Charge Code |
6624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$409.82 |
| Max. Negotiated Rate |
$996.85 |
| Rate for Payer: Aetna American Axle |
$719.95
|
| Rate for Payer: Aetna Commercial |
$941.47
|
| Rate for Payer: Aetna Medicare |
$553.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.95
|
| Rate for Payer: BCBS Complete |
$443.04
|
| Rate for Payer: Cash Price |
$886.09
|
| Rate for Payer: Cofinity Commercial |
$775.33
|
| Rate for Payer: Cofinity Commercial |
$952.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$775.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$886.09
|
| Rate for Payer: Healthscope Commercial |
$996.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$775.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$941.47
|
| Rate for Payer: PHP Commercial |
$941.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.95
|
| Rate for Payer: Priority Health SBD |
$697.79
|
| Rate for Payer: UMR Bronson Commercial |
$409.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.71
|
|
|
PROMETHAZINE 50 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$1,107.61
|
|
|
Service Code
|
NDC 00713013212
|
| Hospital Charge Code |
6624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$487.35 |
| Max. Negotiated Rate |
$996.85 |
| Rate for Payer: Aetna American Axle |
$719.95
|
| Rate for Payer: Aetna Commercial |
$941.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$719.95
|
| Rate for Payer: Cash Price |
$886.09
|
| Rate for Payer: Cofinity Commercial |
$775.33
|
| Rate for Payer: Cofinity Commercial |
$952.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$775.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$886.09
|
| Rate for Payer: Healthscope Commercial |
$996.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$775.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$830.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$941.47
|
| Rate for Payer: PHP Commercial |
$941.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$719.95
|
| Rate for Payer: Priority Health SBD |
$697.79
|
| Rate for Payer: UMR Bronson Commercial |
$487.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$830.71
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$206.94
|
|
|
Service Code
|
NDC 70752013812
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.05 |
| Max. Negotiated Rate |
$186.25 |
| Rate for Payer: Aetna American Axle |
$134.51
|
| Rate for Payer: Aetna Commercial |
$175.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.51
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cofinity Commercial |
$144.86
|
| Rate for Payer: Cofinity Commercial |
$177.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.55
|
| Rate for Payer: Healthscope Commercial |
$186.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.90
|
| Rate for Payer: PHP Commercial |
$175.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.51
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: UMR Bronson Commercial |
$91.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$653.93
|
|
|
Service Code
|
NDC 70408014634
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.95 |
| Max. Negotiated Rate |
$588.54 |
| Rate for Payer: Aetna American Axle |
$425.05
|
| Rate for Payer: Aetna Commercial |
$555.84
|
| Rate for Payer: Aetna Medicare |
$326.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.05
|
| Rate for Payer: BCBS Complete |
$261.57
|
| Rate for Payer: Cash Price |
$523.14
|
| Rate for Payer: Cofinity Commercial |
$457.75
|
| Rate for Payer: Cofinity Commercial |
$562.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$457.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.14
|
| Rate for Payer: Healthscope Commercial |
$588.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$457.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$555.84
|
| Rate for Payer: PHP Commercial |
$555.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.05
|
| Rate for Payer: Priority Health SBD |
$411.98
|
| Rate for Payer: UMR Bronson Commercial |
$241.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.45
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$653.93
|
|
|
Service Code
|
NDC 70408014634
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.73 |
| Max. Negotiated Rate |
$588.54 |
| Rate for Payer: Aetna American Axle |
$425.05
|
| Rate for Payer: Aetna Commercial |
$555.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.05
|
| Rate for Payer: Cash Price |
$523.14
|
| Rate for Payer: Cofinity Commercial |
$457.75
|
| Rate for Payer: Cofinity Commercial |
$562.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$457.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$523.14
|
| Rate for Payer: Healthscope Commercial |
$588.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$457.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$490.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$555.84
|
| Rate for Payer: PHP Commercial |
$555.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$425.05
|
| Rate for Payer: Priority Health SBD |
$411.98
|
| Rate for Payer: UMR Bronson Commercial |
$287.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$490.45
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$389.05
|
|
|
Service Code
|
NDC 60432060816
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.18 |
| Max. Negotiated Rate |
$350.14 |
| Rate for Payer: Aetna American Axle |
$252.88
|
| Rate for Payer: Aetna Commercial |
$330.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.88
|
| Rate for Payer: Cash Price |
$311.24
|
| Rate for Payer: Cofinity Commercial |
$272.34
|
| Rate for Payer: Cofinity Commercial |
$334.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.24
|
| Rate for Payer: Healthscope Commercial |
$350.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.69
|
| Rate for Payer: PHP Commercial |
$330.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.88
|
| Rate for Payer: Priority Health SBD |
$245.10
|
| Rate for Payer: UMR Bronson Commercial |
$171.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.79
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$389.05
|
|
|
Service Code
|
NDC 60432060816
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.95 |
| Max. Negotiated Rate |
$350.14 |
| Rate for Payer: Aetna American Axle |
$252.88
|
| Rate for Payer: Aetna Commercial |
$330.69
|
| Rate for Payer: Aetna Medicare |
$194.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.88
|
| Rate for Payer: BCBS Complete |
$155.62
|
| Rate for Payer: Cash Price |
$311.24
|
| Rate for Payer: Cofinity Commercial |
$272.34
|
| Rate for Payer: Cofinity Commercial |
$334.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$272.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.24
|
| Rate for Payer: Healthscope Commercial |
$350.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.69
|
| Rate for Payer: PHP Commercial |
$330.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.88
|
| Rate for Payer: Priority Health SBD |
$245.10
|
| Rate for Payer: UMR Bronson Commercial |
$143.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.79
|
|
|
PROMETHAZINE 6.25 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$206.94
|
|
|
Service Code
|
NDC 70752013812
|
| Hospital Charge Code |
6620
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.57 |
| Max. Negotiated Rate |
$186.25 |
| Rate for Payer: Aetna American Axle |
$134.51
|
| Rate for Payer: Aetna Commercial |
$175.90
|
| Rate for Payer: Aetna Medicare |
$103.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.51
|
| Rate for Payer: BCBS Complete |
$82.78
|
| Rate for Payer: Cash Price |
$165.55
|
| Rate for Payer: Cofinity Commercial |
$144.86
|
| Rate for Payer: Cofinity Commercial |
$177.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.55
|
| Rate for Payer: Healthscope Commercial |
$186.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.90
|
| Rate for Payer: PHP Commercial |
$175.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.51
|
| Rate for Payer: Priority Health SBD |
$130.37
|
| Rate for Payer: UMR Bronson Commercial |
$76.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.20
|
|
|
PR OMNTC EPIPLOECTOMY RESCJ OMENTUM SPX
|
Professional
|
Both
|
$2,127.00
|
|
|
Service Code
|
HCPCS 49255
|
| Min. Negotiated Rate |
$512.05 |
| Max. Negotiated Rate |
$1,424.67 |
| Rate for Payer: Aetna Commercial |
$1,028.83
|
| Rate for Payer: Aetna Medicare |
$798.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,028.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,105.60
|
| Rate for Payer: BCBS Complete |
$537.65
|
| Rate for Payer: BCBS MAPPO |
$767.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,221.96
|
| Rate for Payer: BCN Commercial |
$1,157.67
|
| Rate for Payer: BCN Medicare Advantage |
$767.78
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cash Price |
$1,701.60
|
| Rate for Payer: Cofinity Commercial |
$1,105.60
|
| Rate for Payer: Cofinity Commercial |
$1,028.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$767.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$806.17
|
| Rate for Payer: Meridian Medicaid |
$537.65
|
| Rate for Payer: Nomi Health Commercial |
$921.34
|
| Rate for Payer: PACE SWMI |
$767.78
|
| Rate for Payer: PHP Commercial |
$1,074.89
|
| Rate for Payer: PHP Medicare Advantage |
$767.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$512.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,382.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,424.67
|
| Rate for Payer: Priority Health Medicare |
$767.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,424.67
|
| Rate for Payer: Priority Health SBD |
$1,424.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$767.78
|
| Rate for Payer: UHC Medicare Advantage |
$767.78
|
| Rate for Payer: UHCCP Medicaid |
$512.05
|
| Rate for Payer: UMR Bronson Commercial |
$978.42
|
|
|
PR ONDANSETRON HCL INJECTION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J2405
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$0.12
|
| Rate for Payer: Aetna Medicare |
$0.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.13
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$0.09
|
| Rate for Payer: BCBS Trust/PPO |
$0.05
|
| Rate for Payer: BCN Commercial |
$0.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.09
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| Rate for Payer: Cofinity Commercial |
$0.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.10
|
| Rate for Payer: Nomi Health Commercial |
$0.11
|
| Rate for Payer: PACE SWMI |
$0.09
|
| Rate for Payer: PHP Commercial |
$0.13
|
| Rate for Payer: PHP Medicare Advantage |
$0.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$0.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.09
|
| Rate for Payer: UHC Medicare Advantage |
$0.09
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
PR ONE AREA LIPOSUCTION - 1 AREA 1.0 HR
|
Professional
|
Both
|
$2,040.00
|
|
|
Service Code
|
HCPCS 00527
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$816.00 |
| Max. Negotiated Rate |
$1,326.00 |
| Rate for Payer: Aetna Medicare |
$1,020.00
|
| Rate for Payer: BCBS Complete |
$816.00
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.00
|
| Rate for Payer: UMR Bronson Commercial |
$938.40
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 11-20 MINUTES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99422
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$32.39
|
| Rate for Payer: Aetna Medicare |
$25.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.80
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS MAPPO |
$24.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$42.64
|
| Rate for Payer: BCN Medicare Advantage |
$24.17
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$34.80
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.38
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$29.00
|
| Rate for Payer: PACE SWMI |
$24.17
|
| Rate for Payer: PHP Commercial |
$33.84
|
| Rate for Payer: PHP Medicare Advantage |
$24.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.06
|
| Rate for Payer: Priority Health Medicare |
$24.17
|
| Rate for Payer: Priority Health Narrow Network |
$28.06
|
| Rate for Payer: Priority Health SBD |
$28.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.17
|
| Rate for Payer: UHC Medicare Advantage |
$24.17
|
| Rate for Payer: UHCCP Medicaid |
$16.19
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 21+ MINUTES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99423
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$873.28 |
| Rate for Payer: Aetna Commercial |
$50.13
|
| Rate for Payer: Aetna Medicare |
$38.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.87
|
| Rate for Payer: BCBS Complete |
$26.39
|
| Rate for Payer: BCBS MAPPO |
$37.41
|
| Rate for Payer: BCBS Trust/PPO |
$873.28
|
| Rate for Payer: BCN Commercial |
$49.79
|
| Rate for Payer: BCN Medicare Advantage |
$37.41
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$50.13
|
| Rate for Payer: Cofinity Commercial |
$53.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.28
|
| Rate for Payer: Meridian Medicaid |
$26.39
|
| Rate for Payer: Nomi Health Commercial |
$44.89
|
| Rate for Payer: PACE SWMI |
$37.41
|
| Rate for Payer: PHP Commercial |
$52.37
|
| Rate for Payer: PHP Medicare Advantage |
$37.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.89
|
| Rate for Payer: Priority Health Medicare |
$37.41
|
| Rate for Payer: Priority Health Narrow Network |
$44.89
|
| Rate for Payer: Priority Health SBD |
$44.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.41
|
| Rate for Payer: UHC Medicare Advantage |
$37.41
|
| Rate for Payer: UHCCP Medicaid |
$25.13
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR ONLINE DIGITAL E/M SVC EST PT <7 D 5-10 MINUTES
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 99421
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$1,630.70 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Medicare |
$12.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.41
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$12.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,630.70
|
| Rate for Payer: BCN Commercial |
$21.51
|
| Rate for Payer: BCN Medicare Advantage |
$12.09
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.69
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Nomi Health Commercial |
$14.51
|
| Rate for Payer: PACE SWMI |
$12.09
|
| Rate for Payer: PHP Commercial |
$16.93
|
| Rate for Payer: PHP Medicare Advantage |
$12.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.22
|
| Rate for Payer: Priority Health Medicare |
$12.09
|
| Rate for Payer: Priority Health Narrow Network |
$14.22
|
| Rate for Payer: Priority Health SBD |
$14.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.09
|
| Rate for Payer: UHC Medicare Advantage |
$12.09
|
| Rate for Payer: UHCCP Medicaid |
$8.09
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR OOPHORECTOMY PARTIAL/TOTAL UNI/BI
|
Professional
|
Both
|
$2,819.00
|
|
|
Service Code
|
HCPCS 58940
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$1,832.35 |
| Rate for Payer: Aetna Commercial |
$712.57
|
| Rate for Payer: Aetna Medicare |
$553.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$712.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$765.75
|
| Rate for Payer: BCBS Complete |
$375.73
|
| Rate for Payer: BCBS MAPPO |
$531.77
|
| Rate for Payer: BCBS Trust/PPO |
$144.75
|
| Rate for Payer: BCN Commercial |
$818.04
|
| Rate for Payer: BCN Medicare Advantage |
$531.77
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Cash Price |
$2,255.20
|
| Rate for Payer: Cofinity Commercial |
$712.57
|
| Rate for Payer: Cofinity Commercial |
$765.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$531.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.36
|
| Rate for Payer: Meridian Medicaid |
$375.73
|
| Rate for Payer: Nomi Health Commercial |
$638.12
|
| Rate for Payer: PACE SWMI |
$531.77
|
| Rate for Payer: PHP Commercial |
$744.48
|
| Rate for Payer: PHP Medicare Advantage |
$531.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$357.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,832.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$833.36
|
| Rate for Payer: Priority Health Medicare |
$531.77
|
| Rate for Payer: Priority Health Narrow Network |
$833.36
|
| Rate for Payer: Priority Health SBD |
$833.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$531.77
|
| Rate for Payer: UHC Medicare Advantage |
$531.77
|
| Rate for Payer: UHCCP Medicaid |
$357.84
|
| Rate for Payer: UMR Bronson Commercial |
$1,296.74
|
|
|
PR OOPHORECTOMY PRTL/TOT UNI/BI OVARIAN MALIGNANCY
|
Professional
|
Both
|
$2,306.00
|
|
|
Service Code
|
HCPCS 58943
|
| Min. Negotiated Rate |
$132.60 |
| Max. Negotiated Rate |
$1,797.18 |
| Rate for Payer: Aetna Commercial |
$1,544.22
|
| Rate for Payer: Aetna Medicare |
$1,198.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,544.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,659.46
|
| Rate for Payer: BCBS Complete |
$810.96
|
| Rate for Payer: BCBS MAPPO |
$1,152.40
|
| Rate for Payer: BCBS Trust/PPO |
$132.60
|
| Rate for Payer: BCN Commercial |
$1,713.79
|
| Rate for Payer: BCN Medicare Advantage |
$1,152.40
|
| Rate for Payer: Cash Price |
$1,844.80
|
| Rate for Payer: Cash Price |
$1,844.80
|
| Rate for Payer: Cofinity Commercial |
$1,544.22
|
| Rate for Payer: Cofinity Commercial |
$1,659.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,152.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,210.02
|
| Rate for Payer: Meridian Medicaid |
$810.96
|
| Rate for Payer: Nomi Health Commercial |
$1,382.88
|
| Rate for Payer: PACE SWMI |
$1,152.40
|
| Rate for Payer: PHP Commercial |
$1,613.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,152.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,498.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,797.18
|
| Rate for Payer: Priority Health Medicare |
$1,152.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,797.18
|
| Rate for Payer: Priority Health SBD |
$1,797.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,152.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,152.40
|
| Rate for Payer: UHCCP Medicaid |
$772.34
|
| Rate for Payer: UMR Bronson Commercial |
$1,060.76
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$236.55
|
|
|
Service Code
|
NDC 62559023001
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.52 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna American Axle |
$153.76
|
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: Aetna Medicare |
$118.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.76
|
| Rate for Payer: BCBS Complete |
$94.62
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.07
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.76
|
| Rate for Payer: Priority Health SBD |
$149.03
|
| Rate for Payer: UMR Bronson Commercial |
$87.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$236.55
|
|
|
Service Code
|
NDC 62559023001
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.08 |
| Max. Negotiated Rate |
$212.90 |
| Rate for Payer: Aetna American Axle |
$153.76
|
| Rate for Payer: Aetna Commercial |
$201.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.76
|
| Rate for Payer: Cash Price |
$189.24
|
| Rate for Payer: Cofinity Commercial |
$165.58
|
| Rate for Payer: Cofinity Commercial |
$203.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.24
|
| Rate for Payer: Healthscope Commercial |
$212.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.07
|
| Rate for Payer: PHP Commercial |
$201.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.76
|
| Rate for Payer: Priority Health SBD |
$149.03
|
| Rate for Payer: UMR Bronson Commercial |
$104.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.41
|
|
