|
PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM
|
Professional
|
Both
|
$3,755.00
|
|
|
Service Code
|
HCPCS 59400
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$3,393.98 |
| Rate for Payer: Aetna Commercial |
$2,150.00
|
| Rate for Payer: BCBS Complete |
$2,336.78
|
| Rate for Payer: BCBS Trust/PPO |
$42.26
|
| Rate for Payer: Cash Price |
$3,004.00
|
| Rate for Payer: Cash Price |
$3,004.00
|
| Rate for Payer: Meridian Medicaid |
$2,336.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,225.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,628.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,393.98
|
| Rate for Payer: Priority Health Narrow Network |
$3,393.98
|
| Rate for Payer: Priority Health SBD |
$3,393.98
|
| Rate for Payer: UMR Bronson Commercial |
$1,727.30
|
|
|
PROBENECID 500 MG-COLCHICINE 0.5 MG TABLET
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 0591-5325-01
|
| Hospital Charge Code |
9675
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna American Axle |
$234.00
|
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.00
|
| Rate for Payer: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health SBD |
$226.80
|
| Rate for Payer: UMR Bronson Commercial |
$158.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.00
|
|
|
PROBENECID 500 MG TABLET
|
Facility
|
IP
|
$541.92
|
|
|
Service Code
|
NDC 0527-1367-01
|
| Hospital Charge Code |
6561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.44 |
| Max. Negotiated Rate |
$487.73 |
| Rate for Payer: Aetna American Axle |
$352.25
|
| Rate for Payer: Aetna Commercial |
$460.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.25
|
| Rate for Payer: Cash Price |
$433.54
|
| Rate for Payer: Cofinity Commercial |
$379.34
|
| Rate for Payer: Cofinity Commercial |
$466.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.54
|
| Rate for Payer: Healthscope Commercial |
$487.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.63
|
| Rate for Payer: PHP Commercial |
$460.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.34
|
| Rate for Payer: Priority Health SBD |
$341.41
|
| Rate for Payer: UMR Bronson Commercial |
$238.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.44
|
|
|
PROBENECID 500 MG TABLET
|
Facility
|
IP
|
$280.32
|
|
|
Service Code
|
NDC 0378-0156-01
|
| Hospital Charge Code |
6561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.34 |
| Max. Negotiated Rate |
$252.29 |
| Rate for Payer: Aetna American Axle |
$182.21
|
| Rate for Payer: Aetna Commercial |
$238.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.21
|
| Rate for Payer: Cash Price |
$224.26
|
| Rate for Payer: Cofinity Commercial |
$196.22
|
| Rate for Payer: Cofinity Commercial |
$241.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.26
|
| Rate for Payer: Healthscope Commercial |
$252.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.27
|
| Rate for Payer: PHP Commercial |
$238.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.22
|
| Rate for Payer: Priority Health SBD |
$176.60
|
| Rate for Payer: UMR Bronson Commercial |
$123.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.24
|
|
|
PROBENECID 500 MG TABLET
|
Facility
|
IP
|
$265.44
|
|
|
Service Code
|
NDC 0591-5347-01
|
| Hospital Charge Code |
6561
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.79 |
| Max. Negotiated Rate |
$238.90 |
| Rate for Payer: Aetna American Axle |
$172.54
|
| Rate for Payer: Aetna Commercial |
$225.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.54
|
| Rate for Payer: Cash Price |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$185.81
|
| Rate for Payer: Cofinity Commercial |
$228.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.35
|
| Rate for Payer: Healthscope Commercial |
$238.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$199.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.62
|
| Rate for Payer: PHP Commercial |
$225.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.81
|
| Rate for Payer: Priority Health SBD |
$167.23
|
| Rate for Payer: UMR Bronson Commercial |
$116.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$199.08
|
|
|
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH INSERTION OF TUBE OR STENT
|
Facility
|
OP
|
$6,538.91
|
|
|
Service Code
|
CPT 68815
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$216.77 |
| Max. Negotiated Rate |
$6,538.91 |
| Rate for Payer: Aetna Medicare |
$2,160.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,596.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,596.41
|
| Rate for Payer: BCBS Complete |
$1,193.10
|
| Rate for Payer: BCBS MAPPO |
$2,077.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,796.37
|
| Rate for Payer: BCN Medicare Advantage |
$2,077.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,077.13
|
| Rate for Payer: Mclaren Medicaid |
$1,136.19
|
| Rate for Payer: Mclaren Medicare |
$2,077.13
|
| Rate for Payer: Meridian Medicaid |
$1,193.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,180.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,388.70
|
| Rate for Payer: PACE Medicare |
$1,973.27
|
| Rate for Payer: PACE SWMI |
$2,077.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,077.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,136.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6,538.91
|
| Rate for Payer: Priority Health Medicare |
$2,077.13
|
| Rate for Payer: Priority Health Narrow Network |
$5,231.13
|
| Rate for Payer: Railroad Medicare Medicare |
$2,077.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.45
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,077.13
|
| Rate for Payer: UHC Exchange |
$216.77
|
| Rate for Payer: UHC Medicare Advantage |
$2,139.44
|
| Rate for Payer: VA VA |
$2,077.13
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/BYPASS
|
Professional
|
Both
|
$3,030.00
|
|
|
Service Code
|
HCPCS 33814
|
| Min. Negotiated Rate |
$961.06 |
| Max. Negotiated Rate |
$2,386.90 |
| Rate for Payer: Aetna Commercial |
$2,044.47
|
| Rate for Payer: BCBS Complete |
$1,009.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,770.33
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Cash Price |
$2,424.00
|
| Rate for Payer: Meridian Medicaid |
$1,009.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$961.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,386.90
|
| Rate for Payer: Priority Health Narrow Network |
$2,386.90
|
| Rate for Payer: Priority Health SBD |
$2,386.90
|
| Rate for Payer: UMR Bronson Commercial |
$1,393.80
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS
|
Professional
|
Both
|
$2,359.00
|
|
|
Service Code
|
HCPCS 33813
|
| Min. Negotiated Rate |
$783.20 |
| Max. Negotiated Rate |
$1,945.36 |
| Rate for Payer: Aetna Commercial |
$1,663.43
|
| Rate for Payer: BCBS Complete |
$822.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,540.52
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Cash Price |
$1,887.20
|
| Rate for Payer: Meridian Medicaid |
$822.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$783.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,651.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,945.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,945.36
|
| Rate for Payer: Priority Health SBD |
$1,945.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,085.14
|
|
|
PR OBSERVATION CARE DISCHARGE MANAGEMENT
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 99217
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$308.53 |
| Rate for Payer: Aetna Commercial |
$18.73
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$308.53
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.38
|
| Rate for Payer: Priority Health Narrow Network |
$23.38
|
| Rate for Payer: Priority Health SBD |
$23.38
|
| Rate for Payer: UMR Bronson Commercial |
$33.12
|
|
|
PROCAINAMIDE 100 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,562.40
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
6562
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$687.46 |
| Max. Negotiated Rate |
$1,406.16 |
| Rate for Payer: Aetna American Axle |
$1,015.56
|
| Rate for Payer: Aetna American Axle |
$126.82
|
| Rate for Payer: Aetna Commercial |
$165.84
|
| Rate for Payer: Aetna Commercial |
$1,328.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,015.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.82
|
| Rate for Payer: Cash Price |
$156.09
|
| Rate for Payer: Cash Price |
$1,249.92
|
| Rate for Payer: Cofinity Commercial |
$1,093.68
|
| Rate for Payer: Cofinity Commercial |
$167.79
|
| Rate for Payer: Cofinity Commercial |
$136.58
|
| Rate for Payer: Cofinity Commercial |
$1,343.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,249.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.09
|
| Rate for Payer: Healthscope Commercial |
$1,406.16
|
| Rate for Payer: Healthscope Commercial |
$175.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,093.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,171.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,328.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.84
|
| Rate for Payer: PHP Commercial |
$165.84
|
| Rate for Payer: PHP Commercial |
$1,328.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,093.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.58
|
| Rate for Payer: Priority Health SBD |
$984.31
|
| Rate for Payer: Priority Health SBD |
$122.92
|
| Rate for Payer: UMR Bronson Commercial |
$687.46
|
| Rate for Payer: UMR Bronson Commercial |
$85.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,171.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.33
|
|
|
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 |
$194.80 |
| 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 |
$151.52
|
| Rate for Payer: Cofinity Commercial |
$186.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.16
|
| Rate for Payer: Healthscope Commercial |
$194.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$183.98
|
| Rate for Payer: PHP Commercial |
$183.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.52
|
| 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
|
$440.00
|
|
|
Service Code
|
HCPCS 58615
|
| Min. Negotiated Rate |
$151.62 |
| Max. Negotiated Rate |
$361.22 |
| Rate for Payer: Aetna Commercial |
$302.21
|
| Rate for Payer: BCBS Complete |
$171.54
|
| Rate for Payer: BCBS Trust/PPO |
$151.62
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Cash Price |
$352.00
|
| Rate for Payer: Meridian Medicaid |
$171.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$163.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.22
|
| Rate for Payer: Priority Health Narrow Network |
$361.22
|
| Rate for Payer: Priority Health SBD |
$361.22
|
| Rate for Payer: UMR Bronson Commercial |
$202.40
|
|
|
PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 97165
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$648.75 |
| Rate for Payer: Aetna Commercial |
$71.15
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Trust/PPO |
$648.75
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.00
|
| Rate for Payer: Priority Health Narrow Network |
$90.00
|
| Rate for Payer: Priority Health SBD |
$90.00
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 97166
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$1,059.24 |
| Rate for Payer: Aetna Commercial |
$71.15
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,059.24
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.00
|
| Rate for Payer: Priority Health Narrow Network |
$90.00
|
| Rate for Payer: Priority Health SBD |
$90.00
|
| Rate for Payer: UMR Bronson Commercial |
$67.16
|
|
|
PR OCCUPATIONAL THERAPY EVALUATION
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS 97003
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$86.10 |
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
|
|
PR OCCUPATIONAL THERAPY RE-EVALUATION
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 97004
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$33.12
|
|
|
PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 97168
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$2,076.22 |
| Rate for Payer: Aetna Commercial |
$47.84
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,076.22
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.00
|
| Rate for Payer: Priority Health Narrow Network |
$45.00
|
| Rate for Payer: Priority Health SBD |
$45.00
|
| Rate for Payer: UMR Bronson Commercial |
$46.46
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$359.78
|
|
|
Service Code
|
NDC 0713-0135-12
|
| 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: 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 |
$269.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$305.81
|
| Rate for Payer: PHP Commercial |
$305.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.85
|
| 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 |
$269.84
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$367.50
|
|
|
Service Code
|
NDC 0574-7226-12
|
| 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: 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 Multiplan/Beech St/PHCS |
$312.38
|
| Rate for Payer: PHP Commercial |
$312.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.25
|
| Rate for Payer: Priority Health SBD |
$231.52
|
| Rate for Payer: UMR Bronson Commercial |
$161.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.62
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$37.25
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Aetna American Axle |
$24.21
|
| Rate for Payer: Aetna American Axle |
$25.25
|
| Rate for Payer: Aetna American Axle |
$31.39
|
| Rate for Payer: Aetna Commercial |
$41.05
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.39
|
| Rate for Payer: BCBS Complete |
$14.90
|
| Rate for Payer: BCBS Complete |
$15.54
|
| Rate for Payer: BCBS Complete |
$19.32
|
| Rate for Payer: BCBS Trust/PPO |
$11.07
|
| Rate for Payer: BCBS Trust/PPO |
$11.07
|
| Rate for Payer: BCBS Trust/PPO |
$11.07
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$29.80
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$31.07
|
| Rate for Payer: Cash Price |
$38.63
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$33.80
|
| Rate for Payer: Cofinity Commercial |
$26.08
|
| Rate for Payer: Cofinity Commercial |
$41.53
|
| Rate for Payer: Cofinity Commercial |
$32.04
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$43.46
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$41.05
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$41.05
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.19
|
| Rate for Payer: Priority Health SBD |
$30.42
|
| Rate for Payer: Priority Health SBD |
$24.47
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: UMR Bronson Commercial |
$17.87
|
| Rate for Payer: UMR Bronson Commercial |
$14.37
|
| Rate for Payer: UMR Bronson Commercial |
$13.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.22
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$43.53
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$39.18 |
| Rate for Payer: Aetna American Axle |
$28.29
|
| Rate for Payer: Aetna American Axle |
$20.70
|
| Rate for Payer: Aetna American Axle |
$21.44
|
| Rate for Payer: Aetna American Axle |
$37.48
|
| Rate for Payer: Aetna American Axle |
$22.98
|
| Rate for Payer: Aetna American Axle |
$34.22
|
| Rate for Payer: Aetna American Axle |
$24.21
|
| Rate for Payer: Aetna American Axle |
$25.25
|
| Rate for Payer: Aetna American Axle |
$29.01
|
| Rate for Payer: Aetna Commercial |
$31.66
|
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Commercial |
$37.00
|
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Aetna Commercial |
$37.94
|
| Rate for Payer: Aetna Commercial |
$27.06
|
| Rate for Payer: Aetna Commercial |
$33.01
|
| Rate for Payer: Aetna Commercial |
$28.04
|
| Rate for Payer: Aetna Commercial |
$49.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.21
|
| 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) |
$34.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.25
|
| Rate for Payer: Cash Price |
$28.29
|
| Rate for Payer: Cash Price |
$46.13
|
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cash Price |
$34.82
|
| 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 |
$29.80
|
| Rate for Payer: Cofinity Commercial |
$24.75
|
| Rate for Payer: Cofinity Commercial |
$49.59
|
| Rate for Payer: Cofinity Commercial |
$40.36
|
| Rate for Payer: Cofinity Commercial |
$23.09
|
| Rate for Payer: Cofinity Commercial |
$28.37
|
| Rate for Payer: Cofinity Commercial |
$30.41
|
| Rate for Payer: Cofinity Commercial |
$37.44
|
| Rate for Payer: Cofinity Commercial |
$45.27
|
| Rate for Payer: Cofinity Commercial |
$36.85
|
| Rate for Payer: Cofinity Commercial |
$26.08
|
| Rate for Payer: Cofinity Commercial |
$32.04
|
| Rate for Payer: Cofinity Commercial |
$30.47
|
| Rate for Payer: Cofinity Commercial |
$38.38
|
| Rate for Payer: Cofinity Commercial |
$31.24
|
| Rate for Payer: Cofinity Commercial |
$27.19
|
| Rate for Payer: Cofinity Commercial |
$33.40
|
| Rate for Payer: Cofinity Commercial |
$22.29
|
| Rate for Payer: Cofinity Commercial |
$27.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.82
|
| 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 |
$31.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.80
|
| Rate for Payer: Healthscope Commercial |
$29.69
|
| Rate for Payer: Healthscope Commercial |
$33.52
|
| Rate for Payer: Healthscope Commercial |
$39.18
|
| Rate for Payer: Healthscope Commercial |
$51.89
|
| Rate for Payer: Healthscope Commercial |
$47.38
|
| Rate for Payer: Healthscope Commercial |
$40.17
|
| Rate for Payer: Healthscope Commercial |
$31.82
|
| Rate for Payer: Healthscope Commercial |
$34.96
|
| Rate for Payer: Healthscope Commercial |
$28.66
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$30.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$31.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$44.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.94
|
| Rate for Payer: PHP Commercial |
$44.74
|
| Rate for Payer: PHP Commercial |
$28.04
|
| Rate for Payer: PHP Commercial |
$37.00
|
| Rate for Payer: PHP Commercial |
$30.06
|
| Rate for Payer: PHP Commercial |
$49.01
|
| Rate for Payer: PHP Commercial |
$33.01
|
| Rate for Payer: PHP Commercial |
$27.06
|
| Rate for Payer: PHP Commercial |
$31.66
|
| Rate for Payer: PHP Commercial |
$37.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.19
|
| Rate for Payer: Priority Health SBD |
$36.33
|
| Rate for Payer: Priority Health SBD |
$23.47
|
| Rate for Payer: Priority Health SBD |
$20.06
|
| Rate for Payer: Priority Health SBD |
$28.12
|
| Rate for Payer: Priority Health SBD |
$24.47
|
| Rate for Payer: Priority Health SBD |
$20.78
|
| Rate for Payer: Priority Health SBD |
$22.28
|
| Rate for Payer: Priority Health SBD |
$33.16
|
| Rate for Payer: Priority Health SBD |
$27.42
|
| Rate for Payer: UMR Bronson Commercial |
$23.16
|
| Rate for Payer: UMR Bronson Commercial |
$14.52
|
| Rate for Payer: UMR Bronson Commercial |
$17.09
|
| Rate for Payer: UMR Bronson Commercial |
$14.01
|
| Rate for Payer: UMR Bronson Commercial |
$19.64
|
| Rate for Payer: UMR Bronson Commercial |
$16.39
|
| Rate for Payer: UMR Bronson Commercial |
$19.15
|
| Rate for Payer: UMR Bronson Commercial |
$15.56
|
| Rate for Payer: UMR Bronson Commercial |
$25.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.52
|
| 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 |
$29.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.24
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$302.88
|
|
|
Service Code
|
NDC 51079-542-20
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.07 |
| Max. Negotiated Rate |
$272.59 |
| Rate for Payer: Aetna American Axle |
$196.87
|
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.87
|
| Rate for Payer: BCBS Complete |
$121.15
|
| Rate for Payer: Cash Price |
$242.30
|
| Rate for Payer: Cofinity Commercial |
$212.02
|
| Rate for Payer: Cofinity Commercial |
$260.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.30
|
| Rate for Payer: Healthscope Commercial |
$272.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.45
|
| Rate for Payer: PHP Commercial |
$257.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.02
|
| Rate for Payer: Priority Health SBD |
$190.81
|
| Rate for Payer: UMR Bronson Commercial |
$112.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.16
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 51079-542-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$2.58
|
| Rate for Payer: PHP Commercial |
$2.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.12
|
| Rate for Payer: Priority Health SBD |
$1.91
|
| Rate for Payer: UMR Bronson Commercial |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.27
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
NDC 50268-685-11
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$5.17 |
| Rate for Payer: Aetna American Axle |
$3.73
|
| Rate for Payer: Aetna Commercial |
$4.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.73
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: Cofinity Commercial |
$4.02
|
| Rate for Payer: Cofinity Commercial |
$4.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.59
|
| Rate for Payer: Healthscope Commercial |
$5.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.88
|
| Rate for Payer: PHP Commercial |
$4.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.02
|
| Rate for Payer: Priority Health SBD |
$3.62
|
| Rate for Payer: UMR Bronson Commercial |
$2.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.30
|
|
