|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$462.65
|
|
|
Service Code
|
NDC 59746011506
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$300.72 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Aetna Commercial |
$416.38
|
| Rate for Payer: ASR ASR |
$448.77
|
| Rate for Payer: ASR Commercial |
$448.77
|
| Rate for Payer: BCBS Trust/PPO |
$377.01
|
| Rate for Payer: BCN Commercial |
$358.69
|
| Rate for Payer: Cash Price |
$370.12
|
| Rate for Payer: Cofinity Commercial |
$434.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.12
|
| Rate for Payer: Healthscope Commercial |
$462.65
|
| Rate for Payer: Healthscope Whirlpool |
$448.77
|
| Rate for Payer: Mclaren Commercial |
$416.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.25
|
| Rate for Payer: Nomi Health Commercial |
$379.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.13
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$462.65
|
|
|
Service Code
|
NDC 59746011506
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.06 |
| Max. Negotiated Rate |
$462.65 |
| Rate for Payer: Aetna Commercial |
$416.38
|
| Rate for Payer: Aetna Medicare |
$231.32
|
| Rate for Payer: ASR ASR |
$448.77
|
| Rate for Payer: ASR Commercial |
$448.77
|
| Rate for Payer: BCBS Complete |
$185.06
|
| Rate for Payer: BCBS Trust/PPO |
$378.86
|
| Rate for Payer: BCN Commercial |
$358.69
|
| Rate for Payer: Cash Price |
$370.12
|
| Rate for Payer: Cofinity Commercial |
$434.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.12
|
| Rate for Payer: Healthscope Commercial |
$462.65
|
| Rate for Payer: Healthscope Whirlpool |
$448.77
|
| Rate for Payer: Mclaren Commercial |
$416.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$393.25
|
| Rate for Payer: Nomi Health Commercial |
$379.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$405.37
|
| Rate for Payer: Priority Health Narrow Network |
$324.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$407.13
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
NDC 51079054201
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: ASR ASR |
$2.94
|
| Rate for Payer: ASR Commercial |
$2.94
|
| Rate for Payer: BCBS Trust/PPO |
$2.47
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Whirlpool |
$2.94
|
| Rate for Payer: Mclaren Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.67
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
NDC 51079054201
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$3.03 |
| Rate for Payer: Aetna Commercial |
$2.73
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: ASR ASR |
$2.94
|
| Rate for Payer: ASR Commercial |
$2.94
|
| Rate for Payer: BCBS Complete |
$1.21
|
| Rate for Payer: BCBS Trust/PPO |
$2.48
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.42
|
| Rate for Payer: Cofinity Commercial |
$2.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.42
|
| Rate for Payer: Healthscope Commercial |
$3.03
|
| Rate for Payer: Healthscope Whirlpool |
$2.94
|
| Rate for Payer: Mclaren Commercial |
$2.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.58
|
| Rate for Payer: Nomi Health Commercial |
$2.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.65
|
| Rate for Payer: Priority Health Narrow Network |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.67
|
|
|
PROCHLORPERAZINE MALEATE 10 MG TABLET
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
NDC 00904738206
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: ASR ASR |
$238.62
|
| Rate for Payer: ASR Commercial |
$238.62
|
| Rate for Payer: BCBS Trust/PPO |
$200.47
|
| 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: UHC All Payor (Choice/PPO) + Core |
$216.48
|
|
|
PR OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 99241
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$73.45 |
| Rate for Payer: Aetna Medicare |
$56.50
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 99245
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$241.15 |
| Rate for Payer: Aetna Medicare |
$185.50
|
| Rate for Payer: BCBS Complete |
$148.40
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.15
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 99243
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 99244
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$194.35 |
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 99242
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$98.15 |
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40 MIN
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 99215
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$196.21 |
| Rate for Payer: Aetna Commercial |
$182.59
|
| Rate for Payer: Aetna Medicare |
$136.26
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$136.26
|
| Rate for Payer: BCN Medicare Advantage |
$136.26
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$182.59
|
| Rate for Payer: Cofinity Commercial |
$196.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.26
|
| Rate for Payer: Healthscope Commercial |
$149.89
|
| Rate for Payer: Healthscope Whirlpool |
$149.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.07
|
| Rate for Payer: Nomi Health Commercial |
$163.51
|
| Rate for Payer: PACE SWMI |
$136.26
|
| Rate for Payer: PHP Medicare Advantage |
$136.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$136.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.26
|
| Rate for Payer: UHC Medicare Advantage |
$136.26
|
| Rate for Payer: UHCCP DNSP |
$136.26
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20 MIN
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99213
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$90.20 |
| Rate for Payer: Aetna Commercial |
$83.94
|
| Rate for Payer: Aetna Medicare |
$62.64
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$62.64
|
| Rate for Payer: BCN Medicare Advantage |
$62.64
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$90.20
|
| Rate for Payer: Cofinity Commercial |
$83.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.64
|
| Rate for Payer: Healthscope Commercial |
$68.90
|
| Rate for Payer: Healthscope Whirlpool |
$68.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.77
|
| Rate for Payer: Nomi Health Commercial |
$75.17
|
| Rate for Payer: PACE SWMI |
$62.64
|
| Rate for Payer: PHP Medicare Advantage |
$62.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$62.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.64
|
| Rate for Payer: UHC Medicare Advantage |
$62.64
|
| Rate for Payer: UHCCP DNSP |
$62.64
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30 MIN
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99214
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$132.84 |
| Rate for Payer: Aetna Commercial |
$123.61
|
| Rate for Payer: Aetna Medicare |
$92.25
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$92.25
|
| Rate for Payer: BCN Medicare Advantage |
$92.25
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$132.84
|
| Rate for Payer: Cofinity Commercial |
$123.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.25
|
| Rate for Payer: Healthscope Commercial |
$101.47
|
| Rate for Payer: Healthscope Whirlpool |
$101.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.86
|
| Rate for Payer: Nomi Health Commercial |
$110.70
|
| Rate for Payer: PACE SWMI |
$92.25
|
| Rate for Payer: PHP Medicare Advantage |
$92.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health Medicare |
$92.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.25
|
| Rate for Payer: UHC Medicare Advantage |
$92.25
|
| Rate for Payer: UHCCP DNSP |
$92.25
|
|
|
PR OFFICE/OUTPATIENT ESTABLISHED SF MDM 10 MIN
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 99212
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$48.07 |
| Rate for Payer: Aetna Commercial |
$44.73
|
| Rate for Payer: Aetna Medicare |
$33.38
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS MAPPO |
$33.38
|
| Rate for Payer: BCN Medicare Advantage |
$33.38
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$44.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.38
|
| Rate for Payer: Healthscope Commercial |
$36.72
|
| Rate for Payer: Healthscope Whirlpool |
$36.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.05
|
| Rate for Payer: Nomi Health Commercial |
$40.06
|
| Rate for Payer: PACE SWMI |
$33.38
|
| Rate for Payer: PHP Medicare Advantage |
$33.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.95
|
| Rate for Payer: Priority Health Medicare |
$33.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.38
|
| Rate for Payer: UHC Medicare Advantage |
$33.38
|
| Rate for Payer: UHCCP DNSP |
$33.38
|
|
|
PR OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 99211
|
| Min. Negotiated Rate |
$8.26 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Commercial |
$11.07
|
| Rate for Payer: Aetna Medicare |
$8.26
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$8.26
|
| Rate for Payer: BCN Medicare Advantage |
$8.26
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$11.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.09
|
| Rate for Payer: Healthscope Whirlpool |
$9.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.67
|
| Rate for Payer: Nomi Health Commercial |
$9.91
|
| Rate for Payer: PACE SWMI |
$8.26
|
| Rate for Payer: PHP Medicare Advantage |
$8.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$8.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.26
|
| Rate for Payer: UHC Medicare Advantage |
$8.26
|
| Rate for Payer: UHCCP DNSP |
$8.26
|
|
|
PR OFFICE/OUTPATIENT NEW HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 99205
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$249.08 |
| Rate for Payer: Aetna Commercial |
$231.78
|
| Rate for Payer: Aetna Medicare |
$172.97
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$172.97
|
| Rate for Payer: BCN Medicare Advantage |
$172.97
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$249.08
|
| Rate for Payer: Cofinity Commercial |
$231.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.97
|
| Rate for Payer: Healthscope Commercial |
$190.27
|
| Rate for Payer: Healthscope Whirlpool |
$190.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.62
|
| Rate for Payer: Nomi Health Commercial |
$207.56
|
| Rate for Payer: PACE SWMI |
$172.97
|
| Rate for Payer: PHP Medicare Advantage |
$172.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$172.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.97
|
| Rate for Payer: UHC Medicare Advantage |
$172.97
|
| Rate for Payer: UHCCP DNSP |
$172.97
|
|
|
PR OFFICE OUTPATIENT NEW LEVL I
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 99201
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
|
|
PR OFFICE/OUTPATIENT NEW LOW MDM 30 MINUTES
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99203
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$112.55 |
| Rate for Payer: Aetna Commercial |
$104.73
|
| Rate for Payer: Aetna Medicare |
$78.16
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$78.16
|
| Rate for Payer: BCN Medicare Advantage |
$78.16
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$112.55
|
| Rate for Payer: Cofinity Commercial |
$104.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.16
|
| Rate for Payer: Healthscope Commercial |
$85.98
|
| Rate for Payer: Healthscope Whirlpool |
$85.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.07
|
| Rate for Payer: Nomi Health Commercial |
$93.79
|
| Rate for Payer: PACE SWMI |
$78.16
|
| Rate for Payer: PHP Medicare Advantage |
$78.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health Medicare |
$78.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.16
|
| Rate for Payer: UHC Medicare Advantage |
$78.16
|
| Rate for Payer: UHCCP DNSP |
$78.16
|
|
|
PR OFFICE/OUTPATIENT NEW MODERATE MDM 45 MINUTES
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 99204
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$183.01 |
| Rate for Payer: Aetna Commercial |
$170.30
|
| Rate for Payer: Aetna Medicare |
$127.09
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS MAPPO |
$127.09
|
| Rate for Payer: BCN Medicare Advantage |
$127.09
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$183.01
|
| Rate for Payer: Cofinity Commercial |
$170.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.09
|
| Rate for Payer: Healthscope Commercial |
$139.80
|
| Rate for Payer: Healthscope Whirlpool |
$139.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.44
|
| Rate for Payer: Nomi Health Commercial |
$152.51
|
| Rate for Payer: PACE SWMI |
$127.09
|
| Rate for Payer: PHP Medicare Advantage |
$127.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health Medicare |
$127.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.09
|
| Rate for Payer: UHC Medicare Advantage |
$127.09
|
| Rate for Payer: UHCCP DNSP |
$127.09
|
|
|
PR OFFICE/OUTPATIENT NEW SF MDM 15 MINUTES
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 99202
|
| Min. Negotiated Rate |
$44.53 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Commercial |
$59.67
|
| Rate for Payer: Aetna Medicare |
$44.53
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$44.53
|
| Rate for Payer: BCN Medicare Advantage |
$44.53
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$64.12
|
| Rate for Payer: Cofinity Commercial |
$59.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.53
|
| Rate for Payer: Healthscope Commercial |
$48.98
|
| Rate for Payer: Healthscope Whirlpool |
$48.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.76
|
| Rate for Payer: Nomi Health Commercial |
$53.44
|
| Rate for Payer: PACE SWMI |
$44.53
|
| Rate for Payer: PHP Medicare Advantage |
$44.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$44.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.53
|
| Rate for Payer: UHC Medicare Advantage |
$44.53
|
| Rate for Payer: UHCCP DNSP |
$44.53
|
|
|
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 |
$0.87 |
| Max. Negotiated Rate |
$8.46 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.83
|
| Rate for Payer: ASR ASR |
$1.30
|
| Rate for Payer: ASR Commercial |
$1.30
|
| Rate for Payer: BCBS Complete |
$3.07
|
| Rate for Payer: BCBS MAPPO |
$5.46
|
| Rate for Payer: BCBS Trust/PPO |
$1.10
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.46
|
| 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 |
$1.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.46
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Healthscope Whirlpool |
$1.30
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.46
|
| Rate for Payer: Mclaren Commercial |
$1.21
|
| Rate for Payer: Mclaren Medicaid |
$2.93
|
| Rate for Payer: Mclaren Medicare |
$5.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.73
|
| Rate for Payer: Meridian Medicaid |
$3.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.14
|
| Rate for Payer: Nomi Health Commercial |
$1.10
|
| Rate for Payer: PACE Medicare |
$5.19
|
| Rate for Payer: PACE SWMI |
$5.46
|
| Rate for Payer: PHP Commercial |
$6.01
|
| Rate for Payer: PHP Medicaid |
$2.93
|
| Rate for Payer: PHP Medicare Advantage |
$5.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.17
|
| Rate for Payer: Priority Health Medicare |
$5.46
|
| Rate for Payer: Priority Health Narrow Network |
$0.94
|
| Rate for Payer: Railroad Medicare Medicare |
$5.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.46
|
| Rate for Payer: UHC Exchange |
$8.46
|
| Rate for Payer: UHC Medicare Advantage |
$5.46
|
| Rate for Payer: UHCCP DNSP |
$5.46
|
| Rate for Payer: UHCCP Medicaid |
$2.93
|
| Rate for Payer: VA VA |
$5.46
|
|
|
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 |
$0.87 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: ASR ASR |
$1.30
|
| Rate for Payer: ASR Commercial |
$1.30
|
| Rate for Payer: BCBS Trust/PPO |
$1.09
|
| Rate for Payer: BCN Commercial |
$1.04
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$1.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.07
|
| Rate for Payer: Healthscope Commercial |
$1.34
|
| Rate for Payer: Healthscope Whirlpool |
$1.30
|
| 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: Priority Health Cigna Priority Health |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.18
|
|
|
PR OMALIZUMAB INJECTION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J2357
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$64.22 |
| Rate for Payer: Aetna Commercial |
$59.76
|
| Rate for Payer: Aetna Medicare |
$44.60
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$44.60
|
| Rate for Payer: BCN Medicare Advantage |
$44.60
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$64.22
|
| Rate for Payer: Cofinity Commercial |
$59.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.60
|
| Rate for Payer: Healthscope Commercial |
$53.52
|
| Rate for Payer: Healthscope Whirlpool |
$53.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.83
|
| Rate for Payer: Nomi Health Commercial |
$53.52
|
| Rate for Payer: PACE SWMI |
$44.60
|
| Rate for Payer: PHP Medicare Advantage |
$44.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$44.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.60
|
| Rate for Payer: UHC Medicare Advantage |
$44.60
|
| Rate for Payer: UHCCP DNSP |
$44.60
|
|
|
PR OMENTAL FLAP INTRA-ABDOMINAL
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
HCPCS 49905
|
| Min. Negotiated Rate |
$256.80 |
| Max. Negotiated Rate |
$490.18 |
| Rate for Payer: Aetna Commercial |
$456.14
|
| Rate for Payer: Aetna Medicare |
$340.40
|
| Rate for Payer: BCBS Complete |
$256.80
|
| Rate for Payer: BCBS MAPPO |
$340.40
|
| Rate for Payer: BCN Medicare Advantage |
$340.40
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cofinity Commercial |
$490.18
|
| Rate for Payer: Cofinity Commercial |
$456.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$340.40
|
| Rate for Payer: Healthscope Commercial |
$408.48
|
| Rate for Payer: Healthscope Whirlpool |
$408.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$357.42
|
| Rate for Payer: Nomi Health Commercial |
$408.48
|
| Rate for Payer: PACE SWMI |
$340.40
|
| Rate for Payer: PHP Medicare Advantage |
$340.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.30
|
| Rate for Payer: Priority Health Medicare |
$340.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$340.40
|
| Rate for Payer: UHC Medicare Advantage |
$340.40
|
| Rate for Payer: UHCCP DNSP |
$340.40
|
|
|
PROMETHAZINE 12.5 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$15.25
|
|
|
Service Code
|
NDC 00713053606
|
| Hospital Charge Code |
11143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna Commercial |
$13.72
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: ASR ASR |
$14.79
|
| Rate for Payer: ASR Commercial |
$14.79
|
| Rate for Payer: BCBS Complete |
$6.10
|
| Rate for Payer: BCBS Trust/PPO |
$12.49
|
| Rate for Payer: BCN Commercial |
$11.82
|
| Rate for Payer: Cash Price |
$12.20
|
| Rate for Payer: Cofinity Commercial |
$14.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.20
|
| Rate for Payer: Healthscope Commercial |
$15.25
|
| Rate for Payer: Healthscope Whirlpool |
$14.79
|
| Rate for Payer: Mclaren Commercial |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.96
|
| Rate for Payer: Nomi Health Commercial |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.36
|
| Rate for Payer: Priority Health Narrow Network |
$10.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.42
|
|
