|
PROPRANOLOL 40 MG TABLET
|
Facility
|
IP
|
$51.70
|
|
|
Service Code
|
NDC 23155011201
|
| Hospital Charge Code |
6658
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.57 |
| Max. Negotiated Rate |
$46.53 |
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.60
|
| Rate for Payer: Cash Price |
$41.36
|
| Rate for Payer: Cofinity Commercial |
$36.19
|
| Rate for Payer: Cofinity Commercial |
$44.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$41.36
|
| Rate for Payer: Healthscope Commercial |
$46.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.94
|
| Rate for Payer: PHP Commercial |
$43.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health SBD |
$32.57
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$8.77
|
|
|
Service Code
|
NDC 60687021511
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.70
|
| Rate for Payer: BCBS Complete |
$3.51
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$6.14
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.70
|
| Rate for Payer: Priority Health SBD |
$5.53
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$876.48
|
|
|
Service Code
|
NDC 60687021501
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$350.59 |
| Max. Negotiated Rate |
$788.83 |
| Rate for Payer: Aetna Commercial |
$745.01
|
| Rate for Payer: Aetna Medicare |
$438.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.71
|
| Rate for Payer: BCBS Complete |
$350.59
|
| Rate for Payer: Cash Price |
$701.18
|
| Rate for Payer: Cofinity Commercial |
$613.54
|
| Rate for Payer: Cofinity Commercial |
$753.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$613.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.18
|
| Rate for Payer: Healthscope Commercial |
$788.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.01
|
| Rate for Payer: PHP Commercial |
$745.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.71
|
| Rate for Payer: Priority Health SBD |
$552.18
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$243.84
|
|
|
Service Code
|
NDC 51991081701
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.54 |
| Max. Negotiated Rate |
$219.46 |
| Rate for Payer: Aetna Commercial |
$207.26
|
| Rate for Payer: Aetna Medicare |
$121.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.50
|
| Rate for Payer: BCBS Complete |
$97.54
|
| Rate for Payer: Cash Price |
$195.07
|
| Rate for Payer: Cofinity Commercial |
$170.69
|
| Rate for Payer: Cofinity Commercial |
$209.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$219.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.26
|
| Rate for Payer: PHP Commercial |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.50
|
| Rate for Payer: Priority Health SBD |
$153.62
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$876.48
|
|
|
Service Code
|
NDC 60687021501
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$552.18 |
| Max. Negotiated Rate |
$788.83 |
| Rate for Payer: Aetna Commercial |
$745.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$569.71
|
| Rate for Payer: Cash Price |
$701.18
|
| Rate for Payer: Cofinity Commercial |
$613.54
|
| Rate for Payer: Cofinity Commercial |
$753.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$613.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.18
|
| Rate for Payer: Healthscope Commercial |
$788.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.01
|
| Rate for Payer: PHP Commercial |
$745.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.71
|
| Rate for Payer: Priority Health SBD |
$552.18
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$8.77
|
|
|
Service Code
|
NDC 60687021511
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.70
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$6.14
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.70
|
| Rate for Payer: Priority Health SBD |
$5.53
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$243.84
|
|
|
Service Code
|
NDC 51991081701
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.62 |
| Max. Negotiated Rate |
$219.46 |
| Rate for Payer: Aetna Commercial |
$207.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.50
|
| Rate for Payer: Cash Price |
$195.07
|
| Rate for Payer: Cofinity Commercial |
$170.69
|
| Rate for Payer: Cofinity Commercial |
$209.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$170.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$219.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$207.26
|
| Rate for Payer: PHP Commercial |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.50
|
| Rate for Payer: Priority Health SBD |
$153.62
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$441.75
|
|
|
Service Code
|
NDC 62559053101
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$397.58 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna Medicare |
$220.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: BCBS Complete |
$176.70
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health SBD |
$278.30
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$441.75
|
|
|
Service Code
|
NDC 62559053101
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.30 |
| Max. Negotiated Rate |
$397.58 |
| Rate for Payer: Aetna Commercial |
$375.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.14
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cofinity Commercial |
$309.22
|
| Rate for Payer: Cofinity Commercial |
$379.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$309.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.40
|
| Rate for Payer: Healthscope Commercial |
$397.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.49
|
| Rate for Payer: PHP Commercial |
$375.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.14
|
| Rate for Payer: Priority Health SBD |
$278.30
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$789.21
|
|
|
Service Code
|
NDC 60687022601
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$497.20 |
| Max. Negotiated Rate |
$710.29 |
| Rate for Payer: Aetna Commercial |
$670.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.99
|
| Rate for Payer: Cash Price |
$631.37
|
| Rate for Payer: Cofinity Commercial |
$552.45
|
| Rate for Payer: Cofinity Commercial |
$678.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$552.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.37
|
| Rate for Payer: Healthscope Commercial |
$710.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.83
|
| Rate for Payer: PHP Commercial |
$670.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.99
|
| Rate for Payer: Priority Health SBD |
$497.20
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$7.90
|
|
|
Service Code
|
NDC 60687022611
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.14
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$5.53
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.72
|
| Rate for Payer: PHP Commercial |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| Rate for Payer: Priority Health SBD |
$4.98
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$789.21
|
|
|
Service Code
|
NDC 60687022601
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.68 |
| Max. Negotiated Rate |
$710.29 |
| Rate for Payer: Aetna Commercial |
$670.83
|
| Rate for Payer: Aetna Medicare |
$394.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$512.99
|
| Rate for Payer: BCBS Complete |
$315.68
|
| Rate for Payer: Cash Price |
$631.37
|
| Rate for Payer: Cofinity Commercial |
$552.45
|
| Rate for Payer: Cofinity Commercial |
$678.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$552.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.37
|
| Rate for Payer: Healthscope Commercial |
$710.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$670.83
|
| Rate for Payer: PHP Commercial |
$670.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.99
|
| Rate for Payer: Priority Health SBD |
$497.20
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 00527411737
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.29 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$7.90
|
|
|
Service Code
|
NDC 60687022611
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.16 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.14
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$5.53
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.72
|
| Rate for Payer: PHP Commercial |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| Rate for Payer: Priority Health SBD |
$4.98
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$195.70
|
|
|
Service Code
|
NDC 00527411737
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.28 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna Medicare |
$97.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.20
|
| Rate for Payer: Priority Health SBD |
$123.29
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$2,594.00 |
| Rate for Payer: Aetna Commercial |
$22.59
|
| Rate for Payer: Aetna Medicare |
$17.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.28
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS MAPPO |
$16.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,260.07
|
| Rate for Payer: BCN Commercial |
$25.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.86
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.86
|
| Rate for Payer: Healthscope Commercial |
$31.19
|
| Rate for Payer: Healthscope Commercial |
$26.98
|
| Rate for Payer: Mclaren Medicaid |
$9.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.70
|
| Rate for Payer: Meridian Medicaid |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,594.00
|
| Rate for Payer: Nomi Health Commercial |
$20.23
|
| Rate for Payer: PACE SWMI |
$16.86
|
| Rate for Payer: PHP Medicare Advantage |
$16.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.97
|
| Rate for Payer: Priority Health Medicare |
$16.86
|
| Rate for Payer: Priority Health Narrow Network |
$23.97
|
| Rate for Payer: Priority Health SBD |
$19.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.86
|
| Rate for Payer: UHC Exchange |
$50.11
|
| Rate for Payer: UHC Medicare Advantage |
$16.86
|
| Rate for Payer: UHCCP Medicaid |
$9.16
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$422.59 |
| Max. Negotiated Rate |
$115,216.00 |
| Rate for Payer: Aetna Commercial |
$836.07
|
| Rate for Payer: Aetna Medicare |
$648.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$836.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$898.46
|
| Rate for Payer: BCBS Complete |
$443.72
|
| Rate for Payer: BCBS MAPPO |
$623.93
|
| Rate for Payer: BCBS Trust/PPO |
$455.39
|
| Rate for Payer: BCN Commercial |
$956.34
|
| Rate for Payer: BCN Medicare Advantage |
$623.93
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$898.46
|
| Rate for Payer: Cofinity Commercial |
$836.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.93
|
| Rate for Payer: Healthscope Commercial |
$998.29
|
| Rate for Payer: Healthscope Commercial |
$1,154.27
|
| Rate for Payer: Mclaren Medicaid |
$422.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.13
|
| Rate for Payer: Meridian Medicaid |
$443.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115,216.00
|
| Rate for Payer: Nomi Health Commercial |
$748.72
|
| Rate for Payer: PACE SWMI |
$623.93
|
| Rate for Payer: PHP Medicare Advantage |
$623.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$422.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,007.04
|
| Rate for Payer: Priority Health Medicare |
$623.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,007.04
|
| Rate for Payer: Priority Health SBD |
$1,007.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$785.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.93
|
| Rate for Payer: UHC Exchange |
$785.16
|
| Rate for Payer: UHC Medicare Advantage |
$623.93
|
| Rate for Payer: UHCCP Medicaid |
$422.59
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$3,890.00
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$333,119.00 |
| Rate for Payer: Aetna Commercial |
$2,421.25
|
| Rate for Payer: Aetna Medicare |
$1,879.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,421.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,601.94
|
| Rate for Payer: BCBS Complete |
$1,268.77
|
| Rate for Payer: BCBS MAPPO |
$1,806.90
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: BCN Commercial |
$2,737.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,806.90
|
| Rate for Payer: Cash Price |
$3,112.00
|
| Rate for Payer: Cash Price |
$3,112.00
|
| Rate for Payer: Cofinity Commercial |
$2,601.94
|
| Rate for Payer: Cofinity Commercial |
$2,421.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,806.90
|
| Rate for Payer: Healthscope Commercial |
$3,342.76
|
| Rate for Payer: Healthscope Commercial |
$2,891.04
|
| Rate for Payer: Mclaren Medicaid |
$1,208.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,897.24
|
| Rate for Payer: Meridian Medicaid |
$1,268.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333,119.00
|
| Rate for Payer: Nomi Health Commercial |
$2,168.28
|
| Rate for Payer: PACE SWMI |
$1,806.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,806.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,208.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,528.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,865.40
|
| Rate for Payer: Priority Health Medicare |
$1,806.90
|
| Rate for Payer: Priority Health Narrow Network |
$2,865.40
|
| Rate for Payer: Priority Health SBD |
$2,865.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,006.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,806.90
|
| Rate for Payer: UHC Exchange |
$2,006.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,806.90
|
| Rate for Payer: UHCCP Medicaid |
$1,208.35
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$4,665.00
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$1,064.79 |
| Max. Negotiated Rate |
$292,612.00 |
| Rate for Payer: Aetna Commercial |
$2,130.67
|
| Rate for Payer: Aetna Medicare |
$1,653.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,130.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,289.67
|
| Rate for Payer: BCBS Complete |
$1,118.03
|
| Rate for Payer: BCBS MAPPO |
$1,590.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.43
|
| Rate for Payer: BCN Commercial |
$2,406.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,590.05
|
| Rate for Payer: Cash Price |
$3,732.00
|
| Rate for Payer: Cash Price |
$3,732.00
|
| Rate for Payer: Cofinity Commercial |
$2,289.67
|
| Rate for Payer: Cofinity Commercial |
$2,130.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,590.05
|
| Rate for Payer: Healthscope Commercial |
$2,941.59
|
| Rate for Payer: Healthscope Commercial |
$2,544.08
|
| Rate for Payer: Mclaren Medicaid |
$1,064.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,669.55
|
| Rate for Payer: Meridian Medicaid |
$1,118.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$292,612.00
|
| Rate for Payer: Nomi Health Commercial |
$1,908.06
|
| Rate for Payer: PACE SWMI |
$1,590.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,590.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,064.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,032.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,522.92
|
| Rate for Payer: Priority Health Medicare |
$1,590.05
|
| Rate for Payer: Priority Health Narrow Network |
$2,522.92
|
| Rate for Payer: Priority Health SBD |
$2,522.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,850.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,590.05
|
| Rate for Payer: UHC Exchange |
$1,850.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,590.05
|
| Rate for Payer: UHCCP Medicaid |
$1,064.79
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$471.37 |
| Max. Negotiated Rate |
$127,541.00 |
| Rate for Payer: Aetna Commercial |
$934.96
|
| Rate for Payer: Aetna Medicare |
$725.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,004.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$934.96
|
| Rate for Payer: BCBS Complete |
$494.94
|
| Rate for Payer: BCBS MAPPO |
$697.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,258.80
|
| Rate for Payer: BCN Commercial |
$1,056.52
|
| Rate for Payer: BCN Medicare Advantage |
$697.73
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$934.96
|
| Rate for Payer: Cofinity Commercial |
$1,004.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.73
|
| Rate for Payer: Healthscope Commercial |
$1,290.80
|
| Rate for Payer: Healthscope Commercial |
$1,116.37
|
| Rate for Payer: Mclaren Medicaid |
$471.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.62
|
| Rate for Payer: Meridian Medicaid |
$494.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127,541.00
|
| Rate for Payer: Nomi Health Commercial |
$837.28
|
| Rate for Payer: PACE SWMI |
$697.73
|
| Rate for Payer: PHP Medicare Advantage |
$697.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,123.57
|
| Rate for Payer: Priority Health Medicare |
$697.73
|
| Rate for Payer: Priority Health Narrow Network |
$1,123.57
|
| Rate for Payer: Priority Health SBD |
$1,123.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.73
|
| Rate for Payer: UHC Exchange |
$959.20
|
| Rate for Payer: UHC Medicare Advantage |
$697.73
|
| Rate for Payer: UHCCP Medicaid |
$471.37
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$3,247.00
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$516.95 |
| Max. Negotiated Rate |
$139,414.00 |
| Rate for Payer: Aetna Commercial |
$1,027.24
|
| Rate for Payer: Aetna Medicare |
$797.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,027.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,103.90
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: BCBS MAPPO |
$766.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.99
|
| Rate for Payer: BCN Commercial |
$1,152.30
|
| Rate for Payer: BCN Medicare Advantage |
$766.60
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cofinity Commercial |
$1,103.90
|
| Rate for Payer: Cofinity Commercial |
$1,027.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.60
|
| Rate for Payer: Healthscope Commercial |
$1,418.21
|
| Rate for Payer: Healthscope Commercial |
$1,226.56
|
| Rate for Payer: Mclaren Medicaid |
$516.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.93
|
| Rate for Payer: Meridian Medicaid |
$542.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139,414.00
|
| Rate for Payer: Nomi Health Commercial |
$919.92
|
| Rate for Payer: PACE SWMI |
$766.60
|
| Rate for Payer: PHP Medicare Advantage |
$766.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,110.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,216.18
|
| Rate for Payer: Priority Health Medicare |
$766.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,216.18
|
| Rate for Payer: Priority Health SBD |
$1,216.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,021.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.60
|
| Rate for Payer: UHC Exchange |
$1,021.04
|
| Rate for Payer: UHC Medicare Advantage |
$766.60
|
| Rate for Payer: UHCCP Medicaid |
$516.95
|
|
|
PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS 27217
|
| Min. Negotiated Rate |
$538.68 |
| Max. Negotiated Rate |
$148,696.00 |
| Rate for Payer: Aetna Commercial |
$1,119.55
|
| Rate for Payer: Aetna Medicare |
$1,567.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,119.55
|
| Rate for Payer: BCBS Complete |
$565.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,869.65
|
| Rate for Payer: BCN Commercial |
$1,224.63
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Mclaren Medicaid |
$538.68
|
| Rate for Payer: Meridian Medicaid |
$565.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148,696.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$538.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,284.37
|
| Rate for Payer: Priority Health Narrow Network |
$1,284.37
|
| Rate for Payer: Priority Health SBD |
$1,284.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,340.64
|
| Rate for Payer: UHC Exchange |
$1,340.64
|
| Rate for Payer: UHCCP Medicaid |
$538.68
|
|
|
PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ
|
Professional
|
Both
|
$3,239.00
|
|
|
Service Code
|
HCPCS 26686
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$110,842.00 |
| Rate for Payer: Aetna Commercial |
$807.95
|
| Rate for Payer: Aetna Medicare |
$627.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$807.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$868.25
|
| Rate for Payer: BCBS Complete |
$428.96
|
| Rate for Payer: BCBS MAPPO |
$602.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.56
|
| Rate for Payer: BCN Commercial |
$921.16
|
| Rate for Payer: BCN Medicare Advantage |
$602.95
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cofinity Commercial |
$868.25
|
| Rate for Payer: Cofinity Commercial |
$807.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.95
|
| Rate for Payer: Healthscope Commercial |
$964.72
|
| Rate for Payer: Healthscope Commercial |
$1,115.46
|
| Rate for Payer: Mclaren Medicaid |
$408.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.10
|
| Rate for Payer: Meridian Medicaid |
$428.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$110,842.00
|
| Rate for Payer: Nomi Health Commercial |
$723.54
|
| Rate for Payer: PACE SWMI |
$602.95
|
| Rate for Payer: PHP Medicare Advantage |
$602.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,105.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$967.86
|
| Rate for Payer: Priority Health Medicare |
$602.95
|
| Rate for Payer: Priority Health Narrow Network |
$967.86
|
| Rate for Payer: Priority Health SBD |
$967.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$728.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.95
|
| Rate for Payer: UHC Exchange |
$728.87
|
| Rate for Payer: UHC Medicare Advantage |
$602.95
|
| Rate for Payer: UHCCP Medicaid |
$408.53
|
|
|
PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
|
Professional
|
Both
|
$2,461.00
|
|
|
Service Code
|
HCPCS 21470
|
| Min. Negotiated Rate |
$749.97 |
| Max. Negotiated Rate |
$204,250.00 |
| Rate for Payer: Aetna Commercial |
$1,484.79
|
| Rate for Payer: Aetna Medicare |
$1,152.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,484.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,595.59
|
| Rate for Payer: BCBS Complete |
$787.47
|
| Rate for Payer: BCBS MAPPO |
$1,108.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$1,692.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,108.05
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cofinity Commercial |
$1,595.59
|
| Rate for Payer: Cofinity Commercial |
$1,484.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,108.05
|
| Rate for Payer: Healthscope Commercial |
$2,049.89
|
| Rate for Payer: Healthscope Commercial |
$1,772.88
|
| Rate for Payer: Mclaren Medicaid |
$749.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,163.45
|
| Rate for Payer: Meridian Medicaid |
$787.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204,250.00
|
| Rate for Payer: Nomi Health Commercial |
$1,329.66
|
| Rate for Payer: PACE SWMI |
$1,108.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,108.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$749.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,599.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,780.00
|
| Rate for Payer: Priority Health Medicare |
$1,108.05
|
| Rate for Payer: Priority Health Narrow Network |
$1,780.00
|
| Rate for Payer: Priority Health SBD |
$1,780.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,357.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,108.05
|
| Rate for Payer: UHC Exchange |
$1,357.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,108.05
|
| Rate for Payer: UHCCP Medicaid |
$749.97
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,420.00
|
|
|
Service Code
|
HCPCS 25608
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$146,907.00 |
| Rate for Payer: Aetna Commercial |
$1,072.74
|
| Rate for Payer: Aetna Medicare |
$832.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,072.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,152.79
|
| Rate for Payer: BCBS Complete |
$569.64
|
| Rate for Payer: BCBS MAPPO |
$800.55
|
| Rate for Payer: BCBS Trust/PPO |
$25.36
|
| Rate for Payer: BCN Commercial |
$1,220.23
|
| Rate for Payer: BCN Medicare Advantage |
$800.55
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cash Price |
$1,936.00
|
| Rate for Payer: Cofinity Commercial |
$1,152.79
|
| Rate for Payer: Cofinity Commercial |
$1,072.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$800.55
|
| Rate for Payer: Healthscope Commercial |
$1,481.02
|
| Rate for Payer: Healthscope Commercial |
$1,280.88
|
| Rate for Payer: Mclaren Medicaid |
$542.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$840.58
|
| Rate for Payer: Meridian Medicaid |
$569.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146,907.00
|
| Rate for Payer: Nomi Health Commercial |
$960.66
|
| Rate for Payer: PACE SWMI |
$800.55
|
| Rate for Payer: PHP Medicare Advantage |
$800.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,573.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,283.85
|
| Rate for Payer: Priority Health Medicare |
$800.55
|
| Rate for Payer: Priority Health Narrow Network |
$1,283.85
|
| Rate for Payer: Priority Health SBD |
$1,283.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$877.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$800.55
|
| Rate for Payer: UHC Exchange |
$877.24
|
| Rate for Payer: UHC Medicare Advantage |
$800.55
|
| Rate for Payer: UHCCP Medicaid |
$542.51
|
|
