|
PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 99213
|
| Min. Negotiated Rate |
$50.56 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Aetna Commercial |
$76.22
|
| Rate for Payer: Aetna Medicare |
$56.88
|
| Rate for Payer: BCBS Complete |
$53.09
|
| Rate for Payer: BCBS MAPPO |
$56.88
|
| Rate for Payer: BCN Commercial |
$80.24
|
| Rate for Payer: BCN Medicare Advantage |
$56.88
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$81.91
|
| Rate for Payer: Cofinity Commercial |
$76.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.88
|
| Rate for Payer: Healthscope Commercial |
$62.57
|
| Rate for Payer: Healthscope Whirlpool |
$62.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.72
|
| Rate for Payer: Meridian Medicaid |
$53.09
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.57
|
| Rate for Payer: Nomi Health Commercial |
$68.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.25
|
| Rate for Payer: PACE SWMI |
$56.88
|
| Rate for Payer: PHP Medicare Advantage |
$56.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$74.68
|
| Rate for Payer: Priority Health Medicare |
$56.88
|
| Rate for Payer: Priority Health Narrow Network |
$74.68
|
| Rate for Payer: Railroad Medicare Medicare |
$56.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$56.88
|
| Rate for Payer: UHC Exchange |
$72.56
|
| Rate for Payer: UHC Medicaid |
$50.56
|
| Rate for Payer: UHCCP DNSP |
$56.88
|
| Rate for Payer: UHCCP Medicaid |
$50.56
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 99214
|
| Min. Negotiated Rate |
$74.36 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$112.21
|
| Rate for Payer: Aetna Medicare |
$83.74
|
| Rate for Payer: BCBS Complete |
$78.08
|
| Rate for Payer: BCBS MAPPO |
$83.74
|
| Rate for Payer: BCN Commercial |
$116.36
|
| Rate for Payer: BCN Medicare Advantage |
$83.74
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$120.59
|
| Rate for Payer: Cofinity Commercial |
$112.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.74
|
| Rate for Payer: Healthscope Commercial |
$92.11
|
| Rate for Payer: Healthscope Whirlpool |
$92.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.93
|
| Rate for Payer: Meridian Medicaid |
$78.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.11
|
| Rate for Payer: Nomi Health Commercial |
$100.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PACE SWMI |
$83.74
|
| Rate for Payer: PHP Medicare Advantage |
$83.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.94
|
| Rate for Payer: Priority Health Medicare |
$83.74
|
| Rate for Payer: Priority Health Narrow Network |
$109.94
|
| Rate for Payer: Railroad Medicare Medicare |
$83.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$83.74
|
| Rate for Payer: UHC Exchange |
$111.57
|
| Rate for Payer: UHC Medicaid |
$74.36
|
| Rate for Payer: UHCCP DNSP |
$83.74
|
| Rate for Payer: UHCCP Medicaid |
$74.36
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 99212
|
| Min. Negotiated Rate |
$27.33 |
| Max. Negotiated Rate |
$51.06 |
| Rate for Payer: Aetna Commercial |
$41.31
|
| Rate for Payer: Aetna Medicare |
$30.83
|
| Rate for Payer: BCBS Complete |
$28.70
|
| Rate for Payer: BCBS MAPPO |
$30.83
|
| Rate for Payer: BCN Commercial |
$51.06
|
| Rate for Payer: BCN Medicare Advantage |
$30.83
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cofinity Commercial |
$44.40
|
| Rate for Payer: Cofinity Commercial |
$41.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.83
|
| Rate for Payer: Healthscope Commercial |
$33.91
|
| Rate for Payer: Healthscope Whirlpool |
$33.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.37
|
| Rate for Payer: Meridian Medicaid |
$28.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$33.91
|
| Rate for Payer: Nomi Health Commercial |
$37.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.75
|
| Rate for Payer: PACE SWMI |
$30.83
|
| Rate for Payer: PHP Medicare Advantage |
$30.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$39.81
|
| Rate for Payer: Priority Health Medicare |
$30.83
|
| Rate for Payer: Priority Health Narrow Network |
$39.81
|
| Rate for Payer: Railroad Medicare Medicare |
$30.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$30.83
|
| Rate for Payer: UHC Exchange |
$36.54
|
| Rate for Payer: UHC Medicaid |
$27.33
|
| Rate for Payer: UHCCP DNSP |
$30.83
|
| Rate for Payer: UHCCP Medicaid |
$27.33
|
|
|
PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 99211
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna Commercial |
$10.20
|
| Rate for Payer: Aetna Medicare |
$7.61
|
| Rate for Payer: BCBS Complete |
$7.10
|
| Rate for Payer: BCBS MAPPO |
$7.61
|
| Rate for Payer: BCN Commercial |
$23.53
|
| Rate for Payer: BCN Medicare Advantage |
$7.61
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$10.96
|
| Rate for Payer: Cofinity Commercial |
$10.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.61
|
| Rate for Payer: Healthscope Commercial |
$8.37
|
| Rate for Payer: Healthscope Whirlpool |
$8.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.99
|
| Rate for Payer: Meridian Medicaid |
$7.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.37
|
| Rate for Payer: Nomi Health Commercial |
$9.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: PACE SWMI |
$7.61
|
| Rate for Payer: PHP Medicare Advantage |
$7.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$6.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$9.86
|
| Rate for Payer: Priority Health Medicare |
$7.61
|
| Rate for Payer: Priority Health Narrow Network |
$9.86
|
| Rate for Payer: Railroad Medicare Medicare |
$7.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7.61
|
| Rate for Payer: UHC Exchange |
$13.02
|
| Rate for Payer: UHC Medicaid |
$6.76
|
| Rate for Payer: UHCCP DNSP |
$7.61
|
| Rate for Payer: UHCCP Medicaid |
$6.76
|
|
|
PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 99205
|
| Min. Negotiated Rate |
$141.08 |
| Max. Negotiated Rate |
$243.75 |
| Rate for Payer: Aetna Commercial |
$213.25
|
| Rate for Payer: Aetna Medicare |
$159.14
|
| Rate for Payer: BCBS Complete |
$148.13
|
| Rate for Payer: BCBS MAPPO |
$159.14
|
| Rate for Payer: BCN Commercial |
$211.86
|
| Rate for Payer: BCN Medicare Advantage |
$159.14
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$229.16
|
| Rate for Payer: Cofinity Commercial |
$213.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.14
|
| Rate for Payer: Healthscope Commercial |
$175.05
|
| Rate for Payer: Healthscope Whirlpool |
$175.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.10
|
| Rate for Payer: Meridian Medicaid |
$148.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$175.05
|
| Rate for Payer: Nomi Health Commercial |
$190.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.75
|
| Rate for Payer: PACE SWMI |
$159.14
|
| Rate for Payer: PHP Medicare Advantage |
$159.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$205.84
|
| Rate for Payer: Priority Health Medicare |
$159.14
|
| Rate for Payer: Priority Health Narrow Network |
$205.84
|
| Rate for Payer: Railroad Medicare Medicare |
$159.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$159.14
|
| Rate for Payer: UHC Exchange |
$239.16
|
| Rate for Payer: UHC Medicaid |
$141.08
|
| Rate for Payer: UHCCP DNSP |
$159.14
|
| Rate for Payer: UHCCP Medicaid |
$141.08
|
|
|
PR OFFICE OUTPATIENT NEW LEVL I
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 99201
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$54.75 |
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.75
|
|
|
PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 99203
|
| Min. Negotiated Rate |
$62.90 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna Commercial |
$95.22
|
| Rate for Payer: Aetna Medicare |
$71.06
|
| Rate for Payer: BCBS Complete |
$66.05
|
| Rate for Payer: BCBS MAPPO |
$71.06
|
| Rate for Payer: BCN Commercial |
$109.72
|
| Rate for Payer: BCN Medicare Advantage |
$71.06
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$102.33
|
| Rate for Payer: Cofinity Commercial |
$95.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.06
|
| Rate for Payer: Healthscope Commercial |
$78.17
|
| Rate for Payer: Healthscope Whirlpool |
$78.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.61
|
| Rate for Payer: Meridian Medicaid |
$66.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.17
|
| Rate for Payer: Nomi Health Commercial |
$85.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PACE SWMI |
$71.06
|
| Rate for Payer: PHP Medicare Advantage |
$71.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$92.88
|
| Rate for Payer: Priority Health Medicare |
$71.06
|
| Rate for Payer: Priority Health Narrow Network |
$92.88
|
| Rate for Payer: Railroad Medicare Medicare |
$71.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.06
|
| Rate for Payer: UHC Exchange |
$107.10
|
| Rate for Payer: UHC Medicaid |
$62.90
|
| Rate for Payer: UHCCP DNSP |
$71.06
|
| Rate for Payer: UHCCP Medicaid |
$62.90
|
|
|
PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 99204
|
| Min. Negotiated Rate |
$102.87 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Commercial |
$155.47
|
| Rate for Payer: Aetna Medicare |
$116.02
|
| Rate for Payer: BCBS Complete |
$108.01
|
| Rate for Payer: BCBS MAPPO |
$116.02
|
| Rate for Payer: BCN Commercial |
$167.67
|
| Rate for Payer: BCN Medicare Advantage |
$116.02
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cofinity Commercial |
$167.07
|
| Rate for Payer: Cofinity Commercial |
$155.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.02
|
| Rate for Payer: Healthscope Commercial |
$127.62
|
| Rate for Payer: Healthscope Whirlpool |
$127.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.82
|
| Rate for Payer: Meridian Medicaid |
$108.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.62
|
| Rate for Payer: Nomi Health Commercial |
$139.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| Rate for Payer: PACE SWMI |
$116.02
|
| Rate for Payer: PHP Medicare Advantage |
$116.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$102.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.25
|
| Rate for Payer: Priority Health Medicare |
$116.02
|
| Rate for Payer: Priority Health Narrow Network |
$151.25
|
| Rate for Payer: Railroad Medicare Medicare |
$116.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$116.02
|
| Rate for Payer: UHC Exchange |
$183.15
|
| Rate for Payer: UHC Medicaid |
$102.87
|
| Rate for Payer: UHCCP DNSP |
$116.02
|
| Rate for Payer: UHCCP Medicaid |
$102.87
|
|
|
PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 99202
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$86.25 |
| Rate for Payer: Aetna Commercial |
$54.56
|
| Rate for Payer: Aetna Medicare |
$40.72
|
| Rate for Payer: BCBS Complete |
$37.96
|
| Rate for Payer: BCBS MAPPO |
$40.72
|
| Rate for Payer: BCN Commercial |
$77.49
|
| Rate for Payer: BCN Medicare Advantage |
$40.72
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$58.64
|
| Rate for Payer: Cofinity Commercial |
$54.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.72
|
| Rate for Payer: Healthscope Commercial |
$44.79
|
| Rate for Payer: Healthscope Whirlpool |
$44.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.76
|
| Rate for Payer: Meridian Medicaid |
$37.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$44.79
|
| Rate for Payer: Nomi Health Commercial |
$48.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.25
|
| Rate for Payer: PACE SWMI |
$40.72
|
| Rate for Payer: PHP Medicare Advantage |
$40.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$53.08
|
| Rate for Payer: Priority Health Medicare |
$40.72
|
| Rate for Payer: Priority Health Narrow Network |
$53.08
|
| Rate for Payer: Railroad Medicare Medicare |
$40.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$40.72
|
| Rate for Payer: UHC Exchange |
$71.50
|
| Rate for Payer: UHC Medicaid |
$36.15
|
| Rate for Payer: UHCCP DNSP |
$40.72
|
| Rate for Payer: UHCCP Medicaid |
$36.15
|
|
|
PROLASTIN/ARALAST (ALPHA-1 PROTEINASE INHIBITOR) 1,000 MG IV SOLUTION
|
Facility
|
IP
|
$1.34
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
36577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: ASR ASR |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.10
|
| Rate for Payer: BCN Commercial |
$1.10
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$1.30
|
| Rate for Payer: Healthscope Whirlpool |
$1.34
|
| Rate for Payer: Mclaren Commercial |
$1.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.18
|
|
|
PROLASTIN/ARALAST (ALPHA-1 PROTEINASE INHIBITOR) 1,000 MG IV SOLUTION
|
Facility
|
OP
|
$1.34
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
36577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.42
|
| Rate for Payer: ASR ASR |
$1.30
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: BCBS MAPPO |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| Rate for Payer: BCN Medicare Advantage |
$5.14
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.14
|
| Rate for Payer: Healthscope Commercial |
$1.30
|
| Rate for Payer: Healthscope Whirlpool |
$1.34
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.14
|
| Rate for Payer: Mclaren Commercial |
$1.21
|
| Rate for Payer: Mclaren Medicaid |
$5.14
|
| Rate for Payer: Mclaren Medicare |
$5.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.40
|
| Rate for Payer: Meridian Medicaid |
$2.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.01
|
| Rate for Payer: PACE Medicare |
$4.88
|
| Rate for Payer: PACE SWMI |
$5.14
|
| Rate for Payer: PHP Commercial |
$5.65
|
| Rate for Payer: PHP Medicaid |
$2.76
|
| Rate for Payer: PHP Medicare Advantage |
$5.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.57
|
| Rate for Payer: Priority Health Medicare |
$5.14
|
| Rate for Payer: Priority Health Narrow Network |
$4.46
|
| Rate for Payer: Railroad Medicare Medicare |
$5.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.14
|
| Rate for Payer: UHC Exchange |
$7.97
|
| Rate for Payer: UHC Medicaid |
$2.69
|
| Rate for Payer: UHCCP DNSP |
$5.14
|
| Rate for Payer: UHCCP Medicaid |
$2.69
|
| Rate for Payer: VA VA |
$5.14
|
|
|
PR OMALIZUMAB INJECTION
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J2357
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$60.22 |
| Rate for Payer: Aetna Commercial |
$56.04
|
| Rate for Payer: Aetna Medicare |
$41.82
|
| Rate for Payer: BCBS MAPPO |
$41.82
|
| Rate for Payer: BCBS Trust/PPO |
$46.35
|
| Rate for Payer: BCN Commercial |
$40.87
|
| Rate for Payer: BCN Medicare Advantage |
$41.82
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$56.04
|
| Rate for Payer: Cofinity Commercial |
$60.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.82
|
| Rate for Payer: Healthscope Commercial |
$50.18
|
| Rate for Payer: Healthscope Whirlpool |
$50.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.00
|
| Rate for Payer: Nomi Health Commercial |
$50.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: PACE SWMI |
$41.82
|
| Rate for Payer: PHP Medicare Advantage |
$41.82
|
| Rate for Payer: Priority Health Medicare |
$41.82
|
| Rate for Payer: Railroad Medicare Medicare |
$41.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$41.82
|
| Rate for Payer: UHC Exchange |
$45.50
|
| Rate for Payer: UHCCP DNSP |
$41.82
|
|
|
PR OMENTAL FLAP INTRA-ABDOMINAL
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 49905
|
| Min. Negotiated Rate |
$200.86 |
| Max. Negotiated Rate |
$636.48 |
| Rate for Payer: Aetna Commercial |
$424.50
|
| Rate for Payer: Aetna Medicare |
$316.79
|
| Rate for Payer: BCBS Complete |
$210.90
|
| Rate for Payer: BCBS MAPPO |
$316.79
|
| Rate for Payer: BCN Commercial |
$522.38
|
| Rate for Payer: BCN Medicare Advantage |
$316.79
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cofinity Commercial |
$456.18
|
| Rate for Payer: Cofinity Commercial |
$424.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.79
|
| Rate for Payer: Healthscope Commercial |
$380.15
|
| Rate for Payer: Healthscope Whirlpool |
$380.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.63
|
| Rate for Payer: Meridian Medicaid |
$210.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$348.47
|
| Rate for Payer: Nomi Health Commercial |
$380.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$495.75
|
| Rate for Payer: PACE SWMI |
$316.79
|
| Rate for Payer: PHP Medicare Advantage |
$316.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$200.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$636.48
|
| Rate for Payer: Priority Health Medicare |
$316.79
|
| Rate for Payer: Priority Health Narrow Network |
$636.48
|
| Rate for Payer: Railroad Medicare Medicare |
$316.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$634.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$316.79
|
| Rate for Payer: UHC Exchange |
$634.16
|
| Rate for Payer: UHC Medicaid |
$200.86
|
| Rate for Payer: UHCCP DNSP |
$316.79
|
| Rate for Payer: UHCCP Medicaid |
$200.86
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$402.49
|
|
|
Service Code
|
NDC 45802075830
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.92 |
| Max. Negotiated Rate |
$402.49 |
| Rate for Payer: Aetna Commercial |
$362.24
|
| Rate for Payer: Aetna Medicare |
$148.92
|
| Rate for Payer: ASR ASR |
$390.41
|
| Rate for Payer: BCBS Complete |
$160.99
|
| Rate for Payer: BCBS Trust/PPO |
$331.85
|
| Rate for Payer: BCN Commercial |
$331.85
|
| Rate for Payer: Cash Price |
$321.99
|
| Rate for Payer: Cofinity Commercial |
$378.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.99
|
| Rate for Payer: Healthscope Commercial |
$390.41
|
| Rate for Payer: Healthscope Whirlpool |
$402.49
|
| Rate for Payer: Mclaren Commercial |
$362.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$321.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.11
|
| Rate for Payer: Nomi Health Commercial |
$330.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$352.66
|
| Rate for Payer: Priority Health Narrow Network |
$282.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$354.19
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$402.49
|
|
|
Service Code
|
NDC 45802075830
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$301.86 |
| Max. Negotiated Rate |
$402.49 |
| Rate for Payer: Aetna Commercial |
$362.24
|
| Rate for Payer: ASR ASR |
$390.41
|
| Rate for Payer: BCBS Trust/PPO |
$330.52
|
| Rate for Payer: BCN Commercial |
$330.52
|
| Rate for Payer: Cash Price |
$321.99
|
| Rate for Payer: Cofinity Commercial |
$378.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.99
|
| Rate for Payer: Healthscope Commercial |
$390.41
|
| Rate for Payer: Healthscope Whirlpool |
$402.49
|
| Rate for Payer: Mclaren Commercial |
$362.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.11
|
| Rate for Payer: Nomi Health Commercial |
$330.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$354.19
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$15.43
|
|
|
Service Code
|
NDC 713053606
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$15.43 |
| Rate for Payer: Aetna Commercial |
$13.89
|
| Rate for Payer: ASR ASR |
$14.97
|
| Rate for Payer: BCBS Trust/PPO |
$12.67
|
| Rate for Payer: BCN Commercial |
$12.67
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cofinity Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Healthscope Commercial |
$14.97
|
| Rate for Payer: Healthscope Whirlpool |
$15.43
|
| Rate for Payer: Mclaren Commercial |
$13.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.11
|
| Rate for Payer: Nomi Health Commercial |
$12.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.58
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$33.54
|
|
|
Service Code
|
NDC 45802075800
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.41 |
| Max. Negotiated Rate |
$33.54 |
| Rate for Payer: Aetna Commercial |
$30.19
|
| Rate for Payer: Aetna Medicare |
$12.41
|
| Rate for Payer: ASR ASR |
$32.53
|
| Rate for Payer: BCBS Complete |
$13.42
|
| Rate for Payer: BCBS Trust/PPO |
$27.65
|
| Rate for Payer: BCN Commercial |
$27.65
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.83
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Healthscope Whirlpool |
$33.54
|
| Rate for Payer: Mclaren Commercial |
$30.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.51
|
| Rate for Payer: Nomi Health Commercial |
$27.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$29.39
|
| Rate for Payer: Priority Health Narrow Network |
$23.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.52
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$33.54
|
|
|
Service Code
|
NDC 45802075800
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$33.54 |
| Rate for Payer: Aetna Commercial |
$30.19
|
| Rate for Payer: ASR ASR |
$32.53
|
| Rate for Payer: BCBS Trust/PPO |
$27.54
|
| Rate for Payer: BCN Commercial |
$27.54
|
| Rate for Payer: Cash Price |
$26.83
|
| Rate for Payer: Cofinity Commercial |
$31.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.83
|
| Rate for Payer: Healthscope Commercial |
$32.53
|
| Rate for Payer: Healthscope Whirlpool |
$33.54
|
| Rate for Payer: Mclaren Commercial |
$30.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.51
|
| Rate for Payer: Nomi Health Commercial |
$27.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.52
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$185.15
|
|
|
Service Code
|
NDC 713053612
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.50 |
| Max. Negotiated Rate |
$185.15 |
| Rate for Payer: Aetna Commercial |
$166.63
|
| Rate for Payer: Aetna Medicare |
$68.50
|
| Rate for Payer: ASR ASR |
$179.59
|
| Rate for Payer: BCBS Complete |
$74.06
|
| Rate for Payer: BCBS Trust/PPO |
$152.65
|
| Rate for Payer: BCN Commercial |
$152.65
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cofinity Commercial |
$174.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.12
|
| Rate for Payer: Healthscope Commercial |
$179.59
|
| Rate for Payer: Healthscope Whirlpool |
$185.15
|
| Rate for Payer: Mclaren Commercial |
$166.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.38
|
| Rate for Payer: Nomi Health Commercial |
$151.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.23
|
| Rate for Payer: Priority Health Narrow Network |
$129.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.93
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$185.15
|
|
|
Service Code
|
NDC 713053612
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.86 |
| Max. Negotiated Rate |
$185.15 |
| Rate for Payer: Aetna Commercial |
$166.63
|
| Rate for Payer: ASR ASR |
$179.59
|
| Rate for Payer: BCBS Trust/PPO |
$152.04
|
| Rate for Payer: BCN Commercial |
$152.04
|
| Rate for Payer: Cash Price |
$148.12
|
| Rate for Payer: Cofinity Commercial |
$174.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.12
|
| Rate for Payer: Healthscope Commercial |
$179.59
|
| Rate for Payer: Healthscope Whirlpool |
$185.15
|
| Rate for Payer: Mclaren Commercial |
$166.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.38
|
| Rate for Payer: Nomi Health Commercial |
$151.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.93
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$15.43
|
|
|
Service Code
|
NDC 713053606
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$15.43 |
| Rate for Payer: Aetna Commercial |
$13.89
|
| Rate for Payer: Aetna Medicare |
$5.71
|
| Rate for Payer: ASR ASR |
$14.97
|
| Rate for Payer: BCBS Complete |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.72
|
| Rate for Payer: Cash Price |
$12.34
|
| Rate for Payer: Cofinity Commercial |
$14.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.34
|
| Rate for Payer: Healthscope Commercial |
$14.97
|
| Rate for Payer: Healthscope Whirlpool |
$15.43
|
| Rate for Payer: Mclaren Commercial |
$13.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.11
|
| Rate for Payer: Nomi Health Commercial |
$12.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.52
|
| Rate for Payer: Priority Health Narrow Network |
$10.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.58
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$20.84
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Commercial |
$20.15
|
| Rate for Payer: Aetna Medicare |
$8.16
|
| Rate for Payer: Aetna Medicare |
$7.71
|
| Rate for Payer: Aetna Medicare |
$8.28
|
| Rate for Payer: ASR ASR |
$21.72
|
| Rate for Payer: ASR ASR |
$20.21
|
| Rate for Payer: ASR ASR |
$21.38
|
| Rate for Payer: BCBS Complete |
$8.33
|
| Rate for Payer: BCBS Complete |
$8.96
|
| Rate for Payer: BCBS Complete |
$8.82
|
| Rate for Payer: BCBS Trust/PPO |
$17.18
|
| Rate for Payer: BCBS Trust/PPO |
$18.18
|
| Rate for Payer: BCBS Trust/PPO |
$18.46
|
| Rate for Payer: BCN Commercial |
$17.18
|
| Rate for Payer: BCN Commercial |
$18.18
|
| Rate for Payer: BCN Commercial |
$18.46
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$19.59
|
| Rate for Payer: Cofinity Commercial |
$21.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.64
|
| Rate for Payer: Healthscope Commercial |
$21.72
|
| Rate for Payer: Healthscope Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Whirlpool |
$22.05
|
| Rate for Payer: Healthscope Whirlpool |
$20.84
|
| Rate for Payer: Healthscope Whirlpool |
$22.39
|
| Rate for Payer: Mclaren Commercial |
$20.15
|
| Rate for Payer: Mclaren Commercial |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$18.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Nomi Health Commercial |
$18.36
|
| Rate for Payer: Nomi Health Commercial |
$17.09
|
| Rate for Payer: Nomi Health Commercial |
$18.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.12
|
| Rate for Payer: Priority Health Narrow Network |
$3.30
|
| Rate for Payer: Priority Health Narrow Network |
$3.30
|
| Rate for Payer: Priority Health Narrow Network |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.34
|
|
|
PROMETHAZINE 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$20.84
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
6618
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$20.84 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Commercial |
$20.15
|
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: ASR ASR |
$21.72
|
| Rate for Payer: ASR ASR |
$20.21
|
| Rate for Payer: ASR ASR |
$21.38
|
| Rate for Payer: BCBS Trust/PPO |
$18.39
|
| Rate for Payer: BCBS Trust/PPO |
$17.11
|
| Rate for Payer: BCBS Trust/PPO |
$18.10
|
| Rate for Payer: BCN Commercial |
$18.10
|
| Rate for Payer: BCN Commercial |
$17.11
|
| Rate for Payer: BCN Commercial |
$18.39
|
| Rate for Payer: Cash Price |
$17.91
|
| Rate for Payer: Cash Price |
$16.67
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Cofinity Commercial |
$19.59
|
| Rate for Payer: Cofinity Commercial |
$20.72
|
| Rate for Payer: Cofinity Commercial |
$21.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.64
|
| Rate for Payer: Healthscope Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$20.21
|
| Rate for Payer: Healthscope Commercial |
$21.72
|
| Rate for Payer: Healthscope Whirlpool |
$22.05
|
| Rate for Payer: Healthscope Whirlpool |
$22.39
|
| Rate for Payer: Healthscope Whirlpool |
$20.84
|
| Rate for Payer: Mclaren Commercial |
$19.84
|
| Rate for Payer: Mclaren Commercial |
$18.75
|
| Rate for Payer: Mclaren Commercial |
$20.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.71
|
| Rate for Payer: Nomi Health Commercial |
$18.08
|
| Rate for Payer: Nomi Health Commercial |
$17.09
|
| Rate for Payer: Nomi Health Commercial |
$18.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.34
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$145.28
|
|
|
Service Code
|
NDC 713052612
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$145.28 |
| Rate for Payer: Aetna Commercial |
$130.75
|
| Rate for Payer: Aetna Medicare |
$53.75
|
| Rate for Payer: ASR ASR |
$140.92
|
| Rate for Payer: BCBS Complete |
$58.11
|
| Rate for Payer: BCBS Trust/PPO |
$119.78
|
| Rate for Payer: BCN Commercial |
$119.78
|
| Rate for Payer: Cash Price |
$116.22
|
| Rate for Payer: Cofinity Commercial |
$136.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.22
|
| Rate for Payer: Healthscope Commercial |
$140.92
|
| Rate for Payer: Healthscope Whirlpool |
$145.28
|
| Rate for Payer: Mclaren Commercial |
$130.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.49
|
| Rate for Payer: Nomi Health Commercial |
$119.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$127.29
|
| Rate for Payer: Priority Health Narrow Network |
$101.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.84
|
|
|
PROMETHAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$145.28
|
|
|
Service Code
|
NDC 713052612
|
| Hospital Charge Code |
11144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.96 |
| Max. Negotiated Rate |
$145.28 |
| Rate for Payer: Aetna Commercial |
$130.75
|
| Rate for Payer: ASR ASR |
$140.92
|
| Rate for Payer: BCBS Trust/PPO |
$119.30
|
| Rate for Payer: BCN Commercial |
$119.30
|
| Rate for Payer: Cash Price |
$116.22
|
| Rate for Payer: Cofinity Commercial |
$136.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.22
|
| Rate for Payer: Healthscope Commercial |
$140.92
|
| Rate for Payer: Healthscope Whirlpool |
$145.28
|
| Rate for Payer: Mclaren Commercial |
$130.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.49
|
| Rate for Payer: Nomi Health Commercial |
$119.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.84
|
|
