|
PR NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG
|
Professional
|
Both
|
$7,834.00
|
|
|
Service Code
|
HCPCS 62162
|
| Min. Negotiated Rate |
$1,875.84 |
| Max. Negotiated Rate |
$5,092.10 |
| Rate for Payer: Aetna Commercial |
$2,513.63
|
| Rate for Payer: Aetna Medicare |
$1,875.84
|
| Rate for Payer: BCBS Complete |
$3,133.60
|
| Rate for Payer: BCBS MAPPO |
$1,875.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,875.84
|
| Rate for Payer: Cash Price |
$6,267.20
|
| Rate for Payer: Cash Price |
$6,267.20
|
| Rate for Payer: Cofinity Commercial |
$2,701.21
|
| Rate for Payer: Cofinity Commercial |
$2,513.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,875.84
|
| Rate for Payer: Healthscope Commercial |
$2,251.01
|
| Rate for Payer: Healthscope Whirlpool |
$2,251.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,969.63
|
| Rate for Payer: Nomi Health Commercial |
$2,251.01
|
| Rate for Payer: PACE SWMI |
$1,875.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,875.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,092.10
|
| Rate for Payer: Priority Health Medicare |
$1,875.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,875.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,875.84
|
| Rate for Payer: UHCCP DNSP |
$1,875.84
|
|
|
PR NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
HCPCS 62160
|
| Min. Negotiated Rate |
$186.44 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Aetna Commercial |
$249.83
|
| Rate for Payer: Aetna Medicare |
$186.44
|
| Rate for Payer: BCBS Complete |
$326.40
|
| Rate for Payer: BCBS MAPPO |
$186.44
|
| Rate for Payer: BCN Medicare Advantage |
$186.44
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cofinity Commercial |
$268.47
|
| Rate for Payer: Cofinity Commercial |
$249.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.44
|
| Rate for Payer: Healthscope Commercial |
$223.73
|
| Rate for Payer: Healthscope Whirlpool |
$223.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$195.76
|
| Rate for Payer: Nomi Health Commercial |
$223.73
|
| Rate for Payer: PACE SWMI |
$186.44
|
| Rate for Payer: PHP Medicare Advantage |
$186.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$530.40
|
| Rate for Payer: Priority Health Medicare |
$186.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.44
|
| Rate for Payer: UHC Medicare Advantage |
$186.44
|
| Rate for Payer: UHCCP DNSP |
$186.44
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99316
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$177.38 |
| Rate for Payer: Aetna Commercial |
$165.06
|
| Rate for Payer: Aetna Medicare |
$123.18
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$123.18
|
| Rate for Payer: BCN Medicare Advantage |
$123.18
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$177.38
|
| Rate for Payer: Cofinity Commercial |
$165.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.18
|
| Rate for Payer: Healthscope Commercial |
$135.50
|
| Rate for Payer: Healthscope Whirlpool |
$135.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.34
|
| Rate for Payer: Nomi Health Commercial |
$147.82
|
| Rate for Payer: PACE SWMI |
$123.18
|
| Rate for Payer: PHP Medicare Advantage |
$123.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$123.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.18
|
| Rate for Payer: UHC Medicare Advantage |
$123.18
|
| Rate for Payer: UHCCP DNSP |
$123.18
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
HCPCS 99315
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$110.55 |
| Rate for Payer: Aetna Commercial |
$102.87
|
| Rate for Payer: Aetna Medicare |
$76.77
|
| Rate for Payer: BCBS Complete |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$76.77
|
| Rate for Payer: BCN Medicare Advantage |
$76.77
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cofinity Commercial |
$110.55
|
| Rate for Payer: Cofinity Commercial |
$102.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.77
|
| Rate for Payer: Healthscope Commercial |
$84.45
|
| Rate for Payer: Healthscope Whirlpool |
$84.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.61
|
| Rate for Payer: Nomi Health Commercial |
$92.12
|
| Rate for Payer: PACE SWMI |
$76.77
|
| Rate for Payer: PHP Medicare Advantage |
$76.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.50
|
| Rate for Payer: Priority Health Medicare |
$76.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.77
|
| Rate for Payer: UHC Medicare Advantage |
$76.77
|
| Rate for Payer: UHCCP DNSP |
$76.77
|
|
|
PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 94690
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: Aetna Medicare |
$43.10
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$43.10
|
| Rate for Payer: BCN Medicare Advantage |
$43.10
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$62.06
|
| Rate for Payer: Cofinity Commercial |
$57.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.10
|
| Rate for Payer: Healthscope Commercial |
$51.72
|
| Rate for Payer: Healthscope Whirlpool |
$51.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.26
|
| Rate for Payer: Nomi Health Commercial |
$51.72
|
| Rate for Payer: PACE SWMI |
$43.10
|
| Rate for Payer: PHP Medicare Advantage |
$43.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$43.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.10
|
| Rate for Payer: UHC Medicare Advantage |
$43.10
|
| Rate for Payer: UHCCP DNSP |
$43.10
|
|
|
PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMP
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 94680
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$63.85
|
| Rate for Payer: Aetna Medicare |
$47.65
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$47.65
|
| Rate for Payer: BCN Medicare Advantage |
$47.65
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$68.62
|
| Rate for Payer: Cofinity Commercial |
$63.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.65
|
| Rate for Payer: Healthscope Commercial |
$57.18
|
| Rate for Payer: Healthscope Whirlpool |
$57.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.03
|
| Rate for Payer: Nomi Health Commercial |
$57.18
|
| Rate for Payer: PACE SWMI |
$47.65
|
| Rate for Payer: PHP Medicare Advantage |
$47.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$47.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.65
|
| Rate for Payer: UHC Medicare Advantage |
$47.65
|
| Rate for Payer: UHCCP DNSP |
$47.65
|
|
|
PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM
|
Professional
|
Both
|
$4,249.00
|
|
|
Service Code
|
HCPCS 59510
|
| Min. Negotiated Rate |
$1,699.60 |
| Max. Negotiated Rate |
$3,752.73 |
| Rate for Payer: Aetna Commercial |
$3,492.12
|
| Rate for Payer: Aetna Medicare |
$2,606.06
|
| Rate for Payer: BCBS Complete |
$1,699.60
|
| Rate for Payer: BCBS MAPPO |
$2,606.06
|
| Rate for Payer: BCN Medicare Advantage |
$2,606.06
|
| Rate for Payer: Cash Price |
$3,399.20
|
| Rate for Payer: Cash Price |
$3,399.20
|
| Rate for Payer: Cofinity Commercial |
$3,752.73
|
| Rate for Payer: Cofinity Commercial |
$3,492.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,606.06
|
| Rate for Payer: Healthscope Commercial |
$3,127.27
|
| Rate for Payer: Healthscope Whirlpool |
$3,127.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,736.36
|
| Rate for Payer: Nomi Health Commercial |
$3,127.27
|
| Rate for Payer: PACE SWMI |
$2,606.06
|
| Rate for Payer: PHP Medicare Advantage |
$2,606.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,761.85
|
| Rate for Payer: Priority Health Medicare |
$2,606.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,606.06
|
| Rate for Payer: UHC Medicare Advantage |
$2,606.06
|
| Rate for Payer: UHCCP DNSP |
$2,606.06
|
|
|
PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM
|
Professional
|
Both
|
$3,830.00
|
|
|
Service Code
|
HCPCS 59400
|
| Min. Negotiated Rate |
$1,532.00 |
| Max. Negotiated Rate |
$3,366.16 |
| Rate for Payer: Aetna Commercial |
$3,132.40
|
| Rate for Payer: Aetna Medicare |
$2,337.61
|
| Rate for Payer: BCBS Complete |
$1,532.00
|
| Rate for Payer: BCBS MAPPO |
$2,337.61
|
| Rate for Payer: BCN Medicare Advantage |
$2,337.61
|
| Rate for Payer: Cash Price |
$3,064.00
|
| Rate for Payer: Cash Price |
$3,064.00
|
| Rate for Payer: Cofinity Commercial |
$3,366.16
|
| Rate for Payer: Cofinity Commercial |
$3,132.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,337.61
|
| Rate for Payer: Healthscope Commercial |
$2,805.13
|
| Rate for Payer: Healthscope Whirlpool |
$2,805.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,454.49
|
| Rate for Payer: Nomi Health Commercial |
$2,805.13
|
| Rate for Payer: PACE SWMI |
$2,337.61
|
| Rate for Payer: PHP Medicare Advantage |
$2,337.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,489.50
|
| Rate for Payer: Priority Health Medicare |
$2,337.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,337.61
|
| Rate for Payer: UHC Medicare Advantage |
$2,337.61
|
| Rate for Payer: UHCCP DNSP |
$2,337.61
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS
|
Professional
|
Both
|
$2,406.00
|
|
|
Service Code
|
HCPCS 33813
|
| Min. Negotiated Rate |
$962.40 |
| Max. Negotiated Rate |
$1,563.90 |
| Rate for Payer: Aetna Medicare |
$1,203.00
|
| Rate for Payer: BCBS Complete |
$962.40
|
| Rate for Payer: Cash Price |
$1,924.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,563.90
|
|
|
PR OBLTRJ AORTOPULMONARY SEPTAL DFCT W/CARD BYPASS
|
Professional
|
Both
|
$3,091.00
|
|
|
Service Code
|
HCPCS 33814
|
| Min. Negotiated Rate |
$1,236.40 |
| Max. Negotiated Rate |
$2,111.28 |
| Rate for Payer: Aetna Commercial |
$1,964.67
|
| Rate for Payer: Aetna Medicare |
$1,466.17
|
| Rate for Payer: BCBS Complete |
$1,236.40
|
| Rate for Payer: BCBS MAPPO |
$1,466.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,466.17
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cash Price |
$2,472.80
|
| Rate for Payer: Cofinity Commercial |
$2,111.28
|
| Rate for Payer: Cofinity Commercial |
$1,964.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.17
|
| Rate for Payer: Healthscope Commercial |
$1,759.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,759.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,539.48
|
| Rate for Payer: Nomi Health Commercial |
$1,759.40
|
| Rate for Payer: PACE SWMI |
$1,466.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,466.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,009.15
|
| Rate for Payer: Priority Health Medicare |
$1,466.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,466.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,466.17
|
| Rate for Payer: UHCCP DNSP |
$1,466.17
|
|
|
PR OBSERVATION CARE DISCHARGE MANAGEMENT
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99217
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS Q0091
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Commercial |
$22.98
|
| Rate for Payer: Aetna Medicare |
$17.15
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$17.15
|
| Rate for Payer: BCN Medicare Advantage |
$17.15
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$24.70
|
| Rate for Payer: Cofinity Commercial |
$22.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.15
|
| Rate for Payer: Healthscope Commercial |
$20.58
|
| Rate for Payer: Healthscope Whirlpool |
$20.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.01
|
| Rate for Payer: Nomi Health Commercial |
$20.58
|
| Rate for Payer: PACE SWMI |
$17.15
|
| Rate for Payer: PHP Medicare Advantage |
$17.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health Medicare |
$17.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.15
|
| Rate for Payer: UHC Medicare Advantage |
$17.15
|
| Rate for Payer: UHCCP DNSP |
$17.15
|
|
|
PR OCCLUSION FLP TUBE DEV VAG/SUPRAPUBIC APPR
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 58615
|
| Min. Negotiated Rate |
$179.60 |
| Max. Negotiated Rate |
$347.60 |
| Rate for Payer: Aetna Commercial |
$323.46
|
| Rate for Payer: Aetna Medicare |
$241.39
|
| Rate for Payer: BCBS Complete |
$179.60
|
| Rate for Payer: BCBS MAPPO |
$241.39
|
| Rate for Payer: BCN Medicare Advantage |
$241.39
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$347.60
|
| Rate for Payer: Cofinity Commercial |
$323.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.39
|
| Rate for Payer: Healthscope Commercial |
$289.67
|
| Rate for Payer: Healthscope Whirlpool |
$289.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$253.46
|
| Rate for Payer: Nomi Health Commercial |
$289.67
|
| Rate for Payer: PACE SWMI |
$241.39
|
| Rate for Payer: PHP Medicare Advantage |
$241.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$241.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.39
|
| Rate for Payer: UHC Medicare Advantage |
$241.39
|
| Rate for Payer: UHCCP DNSP |
$241.39
|
|
|
PR OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 97165
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$138.84 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$96.42
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS MAPPO |
$96.42
|
| Rate for Payer: BCN Medicare Advantage |
$96.42
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.42
|
| Rate for Payer: Healthscope Commercial |
$115.70
|
| Rate for Payer: Healthscope Whirlpool |
$115.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.24
|
| Rate for Payer: Nomi Health Commercial |
$115.70
|
| Rate for Payer: PACE SWMI |
$96.42
|
| Rate for Payer: PHP Medicare Advantage |
$96.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
| Rate for Payer: Priority Health Medicare |
$96.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.42
|
| Rate for Payer: UHC Medicare Advantage |
$96.42
|
| Rate for Payer: UHCCP DNSP |
$96.42
|
|
|
PR OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 97166
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$138.84 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Medicare |
$96.42
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS MAPPO |
$96.42
|
| Rate for Payer: BCN Medicare Advantage |
$96.42
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$138.84
|
| Rate for Payer: Cofinity Commercial |
$129.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.42
|
| Rate for Payer: Healthscope Commercial |
$115.70
|
| Rate for Payer: Healthscope Whirlpool |
$115.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.24
|
| Rate for Payer: Nomi Health Commercial |
$115.70
|
| Rate for Payer: PACE SWMI |
$96.42
|
| Rate for Payer: PHP Medicare Advantage |
$96.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Medicare |
$96.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.42
|
| Rate for Payer: UHC Medicare Advantage |
$96.42
|
| Rate for Payer: UHCCP DNSP |
$96.42
|
|
|
PR OCCUPATIONAL THERAPY EVALUATION
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 97003
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$81.25 |
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
|
|
PR OCCUPATIONAL THERAPY RE-EVALUATION
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 97004
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
|
|
PR OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 97168
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$95.57 |
| Rate for Payer: Aetna Commercial |
$88.94
|
| Rate for Payer: Aetna Medicare |
$66.37
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$66.37
|
| Rate for Payer: BCN Medicare Advantage |
$66.37
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$95.57
|
| Rate for Payer: Cofinity Commercial |
$88.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.37
|
| Rate for Payer: Healthscope Commercial |
$79.64
|
| Rate for Payer: Healthscope Whirlpool |
$79.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.69
|
| Rate for Payer: Nomi Health Commercial |
$79.64
|
| Rate for Payer: PACE SWMI |
$66.37
|
| Rate for Payer: PHP Medicare Advantage |
$66.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$66.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.37
|
| Rate for Payer: UHC Medicare Advantage |
$66.37
|
| Rate for Payer: UHCCP DNSP |
$66.37
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$359.77
|
|
|
Service Code
|
NDC 00713013512
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.85 |
| Max. Negotiated Rate |
$359.77 |
| Rate for Payer: Aetna Commercial |
$323.79
|
| Rate for Payer: ASR ASR |
$348.98
|
| Rate for Payer: ASR Commercial |
$348.98
|
| Rate for Payer: BCBS Trust/PPO |
$293.18
|
| Rate for Payer: BCN Commercial |
$278.93
|
| Rate for Payer: Cash Price |
$287.82
|
| Rate for Payer: Cofinity Commercial |
$338.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.82
|
| Rate for Payer: Healthscope Commercial |
$359.77
|
| Rate for Payer: Healthscope Whirlpool |
$348.98
|
| Rate for Payer: Mclaren Commercial |
$323.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.80
|
| Rate for Payer: Nomi Health Commercial |
$295.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.60
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$359.77
|
|
|
Service Code
|
NDC 00713013512
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.91 |
| Max. Negotiated Rate |
$359.77 |
| Rate for Payer: Aetna Commercial |
$323.79
|
| Rate for Payer: Aetna Medicare |
$179.88
|
| Rate for Payer: ASR ASR |
$348.98
|
| Rate for Payer: ASR Commercial |
$348.98
|
| Rate for Payer: BCBS Complete |
$143.91
|
| Rate for Payer: BCBS Trust/PPO |
$294.62
|
| Rate for Payer: BCN Commercial |
$278.93
|
| Rate for Payer: Cash Price |
$287.82
|
| Rate for Payer: Cofinity Commercial |
$338.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.82
|
| Rate for Payer: Healthscope Commercial |
$359.77
|
| Rate for Payer: Healthscope Whirlpool |
$348.98
|
| Rate for Payer: Mclaren Commercial |
$323.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.80
|
| Rate for Payer: Nomi Health Commercial |
$295.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$315.23
|
| Rate for Payer: Priority Health Narrow Network |
$252.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.60
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$29.98
|
|
|
Service Code
|
NDC 00713013506
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$29.98 |
| Rate for Payer: Aetna Commercial |
$26.98
|
| Rate for Payer: Aetna Medicare |
$14.99
|
| Rate for Payer: ASR ASR |
$29.08
|
| Rate for Payer: ASR Commercial |
$29.08
|
| Rate for Payer: BCBS Complete |
$11.99
|
| Rate for Payer: BCBS Trust/PPO |
$24.55
|
| Rate for Payer: BCN Commercial |
$23.24
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$28.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$29.98
|
| Rate for Payer: Healthscope Whirlpool |
$29.08
|
| Rate for Payer: Mclaren Commercial |
$26.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.48
|
| Rate for Payer: Nomi Health Commercial |
$24.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.27
|
| Rate for Payer: Priority Health Narrow Network |
$21.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.38
|
|
|
PROCHLORPERAZINE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$29.98
|
|
|
Service Code
|
NDC 00713013506
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$29.98 |
| Rate for Payer: Aetna Commercial |
$26.98
|
| Rate for Payer: ASR ASR |
$29.08
|
| Rate for Payer: ASR Commercial |
$29.08
|
| Rate for Payer: BCBS Trust/PPO |
$24.43
|
| Rate for Payer: BCN Commercial |
$23.24
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Cofinity Commercial |
$28.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$29.98
|
| Rate for Payer: Healthscope Whirlpool |
$29.08
|
| Rate for Payer: Mclaren Commercial |
$26.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.48
|
| Rate for Payer: Nomi Health Commercial |
$24.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.38
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
OP
|
$31.84
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$31.84 |
| Rate for Payer: Aetna Commercial |
$28.66
|
| Rate for Payer: Aetna Commercial |
$34.95
|
| Rate for Payer: Aetna Commercial |
$31.00
|
| Rate for Payer: Aetna Commercial |
$37.87
|
| Rate for Payer: Aetna Commercial |
$29.69
|
| Rate for Payer: Aetna Commercial |
$48.37
|
| Rate for Payer: Aetna Commercial |
$20.51
|
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: Aetna Commercial |
$26.83
|
| Rate for Payer: Aetna Medicare |
$14.90
|
| Rate for Payer: Aetna Medicare |
$22.27
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: Aetna Medicare |
$21.04
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna Medicare |
$15.92
|
| Rate for Payer: Aetna Medicare |
$17.23
|
| Rate for Payer: Aetna Medicare |
$19.41
|
| Rate for Payer: Aetna Medicare |
$16.39
|
| Rate for Payer: Aetna Medicare |
$26.87
|
| Rate for Payer: ASR ASR |
$31.79
|
| Rate for Payer: ASR ASR |
$22.11
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: ASR ASR |
$40.82
|
| Rate for Payer: ASR ASR |
$37.67
|
| Rate for Payer: ASR ASR |
$43.20
|
| Rate for Payer: ASR ASR |
$32.00
|
| Rate for Payer: ASR ASR |
$52.13
|
| Rate for Payer: ASR ASR |
$33.42
|
| Rate for Payer: ASR ASR |
$28.92
|
| Rate for Payer: ASR Commercial |
$52.13
|
| Rate for Payer: ASR Commercial |
$28.92
|
| Rate for Payer: ASR Commercial |
$30.88
|
| Rate for Payer: ASR Commercial |
$31.79
|
| Rate for Payer: ASR Commercial |
$22.11
|
| Rate for Payer: ASR Commercial |
$32.00
|
| Rate for Payer: ASR Commercial |
$43.20
|
| Rate for Payer: ASR Commercial |
$40.82
|
| Rate for Payer: ASR Commercial |
$37.67
|
| Rate for Payer: ASR Commercial |
$33.42
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: BCBS Complete |
$17.82
|
| Rate for Payer: BCBS Complete |
$21.50
|
| Rate for Payer: BCBS Complete |
$11.92
|
| Rate for Payer: BCBS Complete |
$13.78
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Complete |
$12.74
|
| Rate for Payer: BCBS Complete |
$13.11
|
| Rate for Payer: BCBS Complete |
$16.83
|
| Rate for Payer: BCBS Complete |
$15.53
|
| Rate for Payer: BCBS Trust/PPO |
$26.07
|
| Rate for Payer: BCBS Trust/PPO |
$26.84
|
| Rate for Payer: BCBS Trust/PPO |
$18.66
|
| Rate for Payer: BCBS Trust/PPO |
$24.41
|
| Rate for Payer: BCBS Trust/PPO |
$27.02
|
| Rate for Payer: BCBS Trust/PPO |
$28.21
|
| Rate for Payer: BCBS Trust/PPO |
$31.80
|
| Rate for Payer: BCBS Trust/PPO |
$34.46
|
| Rate for Payer: BCBS Trust/PPO |
$36.47
|
| Rate for Payer: BCBS Trust/PPO |
$44.01
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Commercial |
$25.58
|
| Rate for Payer: BCN Commercial |
$17.67
|
| Rate for Payer: BCN Commercial |
$26.71
|
| Rate for Payer: BCN Commercial |
$32.62
|
| Rate for Payer: BCN Commercial |
$34.53
|
| Rate for Payer: BCN Commercial |
$24.69
|
| Rate for Payer: BCN Commercial |
$41.66
|
| Rate for Payer: BCN Commercial |
$23.11
|
| Rate for Payer: BCN Commercial |
$30.10
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$35.64
|
| Rate for Payer: Cash Price |
$26.22
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Cash Price |
$31.06
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cofinity Commercial |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$32.38
|
| Rate for Payer: Cofinity Commercial |
$28.02
|
| Rate for Payer: Cofinity Commercial |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.66
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$38.83
|
| Rate for Payer: Healthscope Commercial |
$42.08
|
| Rate for Payer: Healthscope Commercial |
$34.45
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Healthscope Commercial |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$53.74
|
| Rate for Payer: Healthscope Commercial |
$29.81
|
| Rate for Payer: Healthscope Commercial |
$22.79
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Healthscope Whirlpool |
$52.13
|
| Rate for Payer: Healthscope Whirlpool |
$37.67
|
| Rate for Payer: Healthscope Whirlpool |
$43.20
|
| Rate for Payer: Healthscope Whirlpool |
$40.82
|
| Rate for Payer: Healthscope Whirlpool |
$31.79
|
| Rate for Payer: Healthscope Whirlpool |
$32.00
|
| Rate for Payer: Healthscope Whirlpool |
$33.42
|
| Rate for Payer: Healthscope Whirlpool |
$22.11
|
| Rate for Payer: Healthscope Whirlpool |
$28.92
|
| Rate for Payer: Healthscope Whirlpool |
$30.88
|
| Rate for Payer: Mclaren Commercial |
$20.51
|
| Rate for Payer: Mclaren Commercial |
$31.00
|
| Rate for Payer: Mclaren Commercial |
$29.69
|
| Rate for Payer: Mclaren Commercial |
$40.09
|
| Rate for Payer: Mclaren Commercial |
$34.95
|
| Rate for Payer: Mclaren Commercial |
$48.37
|
| Rate for Payer: Mclaren Commercial |
$37.87
|
| Rate for Payer: Mclaren Commercial |
$29.49
|
| Rate for Payer: Mclaren Commercial |
$28.66
|
| Rate for Payer: Mclaren Commercial |
$26.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Nomi Health Commercial |
$44.07
|
| Rate for Payer: Nomi Health Commercial |
$24.44
|
| Rate for Payer: Nomi Health Commercial |
$18.69
|
| Rate for Payer: Nomi Health Commercial |
$31.84
|
| Rate for Payer: Nomi Health Commercial |
$36.52
|
| Rate for Payer: Nomi Health Commercial |
$26.11
|
| Rate for Payer: Nomi Health Commercial |
$34.51
|
| Rate for Payer: Nomi Health Commercial |
$27.05
|
| Rate for Payer: Nomi Health Commercial |
$26.87
|
| Rate for Payer: Nomi Health Commercial |
$28.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.12
|
| Rate for Payer: Priority Health Narrow Network |
$24.15
|
| Rate for Payer: Priority Health Narrow Network |
$22.97
|
| Rate for Payer: Priority Health Narrow Network |
$27.22
|
| Rate for Payer: Priority Health Narrow Network |
$29.50
|
| Rate for Payer: Priority Health Narrow Network |
$23.13
|
| Rate for Payer: Priority Health Narrow Network |
$20.90
|
| Rate for Payer: Priority Health Narrow Network |
$37.67
|
| Rate for Payer: Priority Health Narrow Network |
$15.98
|
| Rate for Payer: Priority Health Narrow Network |
$22.32
|
| Rate for Payer: Priority Health Narrow Network |
$31.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.03
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$44.54
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
155387
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$44.54 |
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Commercial |
$48.37
|
| Rate for Payer: Aetna Commercial |
$29.49
|
| Rate for Payer: Aetna Commercial |
$29.69
|
| Rate for Payer: Aetna Commercial |
$26.83
|
| Rate for Payer: Aetna Commercial |
$28.66
|
| Rate for Payer: Aetna Commercial |
$20.51
|
| Rate for Payer: Aetna Commercial |
$31.00
|
| Rate for Payer: Aetna Commercial |
$37.87
|
| Rate for Payer: Aetna Commercial |
$34.95
|
| Rate for Payer: ASR ASR |
$37.67
|
| Rate for Payer: ASR ASR |
$33.42
|
| Rate for Payer: ASR ASR |
$30.88
|
| Rate for Payer: ASR ASR |
$32.00
|
| Rate for Payer: ASR ASR |
$31.79
|
| Rate for Payer: ASR ASR |
$28.92
|
| Rate for Payer: ASR ASR |
$22.11
|
| Rate for Payer: ASR ASR |
$52.13
|
| Rate for Payer: ASR ASR |
$43.20
|
| Rate for Payer: ASR ASR |
$40.82
|
| Rate for Payer: ASR Commercial |
$52.13
|
| Rate for Payer: ASR Commercial |
$37.67
|
| Rate for Payer: ASR Commercial |
$32.00
|
| Rate for Payer: ASR Commercial |
$43.20
|
| Rate for Payer: ASR Commercial |
$33.42
|
| Rate for Payer: ASR Commercial |
$30.88
|
| Rate for Payer: ASR Commercial |
$40.82
|
| Rate for Payer: ASR Commercial |
$22.11
|
| Rate for Payer: ASR Commercial |
$28.92
|
| Rate for Payer: ASR Commercial |
$31.79
|
| Rate for Payer: BCBS Trust/PPO |
$26.70
|
| Rate for Payer: BCBS Trust/PPO |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.57
|
| Rate for Payer: BCBS Trust/PPO |
$24.29
|
| Rate for Payer: BCBS Trust/PPO |
$25.95
|
| Rate for Payer: BCBS Trust/PPO |
$28.07
|
| Rate for Payer: BCBS Trust/PPO |
$31.64
|
| Rate for Payer: BCBS Trust/PPO |
$34.29
|
| Rate for Payer: BCBS Trust/PPO |
$36.30
|
| Rate for Payer: BCBS Trust/PPO |
$43.79
|
| Rate for Payer: BCN Commercial |
$26.71
|
| Rate for Payer: BCN Commercial |
$41.66
|
| Rate for Payer: BCN Commercial |
$25.58
|
| Rate for Payer: BCN Commercial |
$17.67
|
| Rate for Payer: BCN Commercial |
$23.11
|
| Rate for Payer: BCN Commercial |
$34.53
|
| Rate for Payer: BCN Commercial |
$24.69
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Commercial |
$32.62
|
| Rate for Payer: BCN Commercial |
$30.10
|
| Rate for Payer: Cash Price |
$26.39
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$25.47
|
| Rate for Payer: Cash Price |
$42.99
|
| Rate for Payer: Cash Price |
$35.64
|
| Rate for Payer: Cash Price |
$26.22
|
| Rate for Payer: Cash Price |
$31.06
|
| Rate for Payer: Cash Price |
$27.56
|
| Rate for Payer: Cash Price |
$33.66
|
| Rate for Payer: Cofinity Commercial |
$30.80
|
| Rate for Payer: Cofinity Commercial |
$41.87
|
| Rate for Payer: Cofinity Commercial |
$28.02
|
| Rate for Payer: Cofinity Commercial |
$39.56
|
| Rate for Payer: Cofinity Commercial |
$31.01
|
| Rate for Payer: Cofinity Commercial |
$36.50
|
| Rate for Payer: Cofinity Commercial |
$32.38
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$29.93
|
| Rate for Payer: Cofinity Commercial |
$21.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.63
|
| 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 |
$18.23
|
| Rate for Payer: Healthscope Commercial |
$29.81
|
| Rate for Payer: Healthscope Commercial |
$32.99
|
| Rate for Payer: Healthscope Commercial |
$34.45
|
| Rate for Payer: Healthscope Commercial |
$38.83
|
| Rate for Payer: Healthscope Commercial |
$42.08
|
| Rate for Payer: Healthscope Commercial |
$44.54
|
| Rate for Payer: Healthscope Commercial |
$53.74
|
| Rate for Payer: Healthscope Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$32.77
|
| Rate for Payer: Healthscope Commercial |
$22.79
|
| Rate for Payer: Healthscope Whirlpool |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$40.82
|
| Rate for Payer: Healthscope Whirlpool |
$52.13
|
| Rate for Payer: Healthscope Whirlpool |
$33.42
|
| Rate for Payer: Healthscope Whirlpool |
$32.00
|
| Rate for Payer: Healthscope Whirlpool |
$28.92
|
| Rate for Payer: Healthscope Whirlpool |
$22.11
|
| Rate for Payer: Healthscope Whirlpool |
$37.67
|
| Rate for Payer: Healthscope Whirlpool |
$31.79
|
| Rate for Payer: Healthscope Whirlpool |
$43.20
|
| Rate for Payer: Mclaren Commercial |
$34.95
|
| Rate for Payer: Mclaren Commercial |
$37.87
|
| Rate for Payer: Mclaren Commercial |
$31.00
|
| Rate for Payer: Mclaren Commercial |
$48.37
|
| Rate for Payer: Mclaren Commercial |
$40.09
|
| Rate for Payer: Mclaren Commercial |
$29.69
|
| Rate for Payer: Mclaren Commercial |
$26.83
|
| Rate for Payer: Mclaren Commercial |
$28.66
|
| Rate for Payer: Mclaren Commercial |
$20.51
|
| Rate for Payer: Mclaren Commercial |
$29.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.28
|
| Rate for Payer: Nomi Health Commercial |
$28.25
|
| Rate for Payer: Nomi Health Commercial |
$31.84
|
| Rate for Payer: Nomi Health Commercial |
$27.05
|
| Rate for Payer: Nomi Health Commercial |
$34.51
|
| Rate for Payer: Nomi Health Commercial |
$18.69
|
| Rate for Payer: Nomi Health Commercial |
$44.07
|
| Rate for Payer: Nomi Health Commercial |
$36.52
|
| Rate for Payer: Nomi Health Commercial |
$26.11
|
| Rate for Payer: Nomi Health Commercial |
$24.44
|
| Rate for Payer: Nomi Health Commercial |
$26.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$30.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$39.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$29.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$26.23
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
NDC 00904738206
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Medicare |
$123.00
|
| Rate for Payer: ASR ASR |
$238.62
|
| Rate for Payer: ASR Commercial |
$238.62
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS Trust/PPO |
$201.45
|
| Rate for Payer: BCN Commercial |
$190.72
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$231.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Healthscope Commercial |
$246.00
|
| Rate for Payer: Healthscope Whirlpool |
$238.62
|
| Rate for Payer: Mclaren Commercial |
$221.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.10
|
| Rate for Payer: Nomi Health Commercial |
$201.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.55
|
| Rate for Payer: Priority Health Narrow Network |
$172.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.48
|
|
