|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL
|
Professional
|
Both
|
$2,723.00
|
|
|
Service Code
|
HCPCS 27457
|
| Min. Negotiated Rate |
$619.83 |
| Max. Negotiated Rate |
$170,669.00 |
| Rate for Payer: Aetna Commercial |
$1,235.44
|
| Rate for Payer: Aetna Medicare |
$958.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,235.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,327.64
|
| Rate for Payer: BCBS Complete |
$650.82
|
| Rate for Payer: BCBS MAPPO |
$921.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,269.50
|
| Rate for Payer: BCN Commercial |
$1,408.86
|
| Rate for Payer: BCN Medicare Advantage |
$921.97
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cash Price |
$2,178.40
|
| Rate for Payer: Cofinity Commercial |
$1,327.64
|
| Rate for Payer: Cofinity Commercial |
$1,235.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.97
|
| Rate for Payer: Healthscope Commercial |
$1,705.64
|
| Rate for Payer: Healthscope Commercial |
$1,475.15
|
| Rate for Payer: Mclaren Medicaid |
$619.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$968.07
|
| Rate for Payer: Meridian Medicaid |
$650.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170,669.00
|
| Rate for Payer: Nomi Health Commercial |
$1,106.36
|
| Rate for Payer: PACE SWMI |
$921.97
|
| Rate for Payer: PHP Medicare Advantage |
$921.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,769.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,451.78
|
| Rate for Payer: Priority Health Medicare |
$921.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,451.78
|
| Rate for Payer: Priority Health SBD |
$1,451.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,325.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$921.97
|
| Rate for Payer: UHC Exchange |
$1,325.07
|
| Rate for Payer: UHC Medicare Advantage |
$921.97
|
| Rate for Payer: UHCCP Medicaid |
$619.83
|
|
|
PR OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL
|
Professional
|
Both
|
$2,033.00
|
|
|
Service Code
|
HCPCS 27455
|
| Min. Negotiated Rate |
$623.66 |
| Max. Negotiated Rate |
$170,552.00 |
| Rate for Payer: Aetna Commercial |
$1,238.83
|
| Rate for Payer: Aetna Medicare |
$961.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,238.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,331.28
|
| Rate for Payer: BCBS Complete |
$654.84
|
| Rate for Payer: BCBS MAPPO |
$924.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,212.98
|
| Rate for Payer: BCN Commercial |
$1,412.28
|
| Rate for Payer: BCN Medicare Advantage |
$924.50
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cash Price |
$1,626.40
|
| Rate for Payer: Cofinity Commercial |
$1,331.28
|
| Rate for Payer: Cofinity Commercial |
$1,238.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.50
|
| Rate for Payer: Healthscope Commercial |
$1,710.32
|
| Rate for Payer: Healthscope Commercial |
$1,479.20
|
| Rate for Payer: Mclaren Medicaid |
$623.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.72
|
| Rate for Payer: Meridian Medicaid |
$654.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170,552.00
|
| Rate for Payer: Nomi Health Commercial |
$1,109.40
|
| Rate for Payer: PACE SWMI |
$924.50
|
| Rate for Payer: PHP Medicare Advantage |
$924.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$623.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,321.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,479.77
|
| Rate for Payer: Priority Health Medicare |
$924.50
|
| Rate for Payer: Priority Health Narrow Network |
$1,479.77
|
| Rate for Payer: Priority Health SBD |
$1,479.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,327.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.50
|
| Rate for Payer: UHC Exchange |
$1,327.40
|
| Rate for Payer: UHC Medicare Advantage |
$924.50
|
| Rate for Payer: UHCCP Medicaid |
$623.66
|
|
|
PR OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 28312
|
| Min. Negotiated Rate |
$231.74 |
| Max. Negotiated Rate |
$59,310.00 |
| Rate for Payer: Aetna Commercial |
$455.32
|
| Rate for Payer: Aetna Medicare |
$353.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$455.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$489.30
|
| Rate for Payer: BCBS Complete |
$243.33
|
| Rate for Payer: BCBS MAPPO |
$339.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,771.92
|
| Rate for Payer: BCN Commercial |
$777.49
|
| Rate for Payer: BCN Medicare Advantage |
$339.79
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$489.30
|
| Rate for Payer: Cofinity Commercial |
$455.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.79
|
| Rate for Payer: Healthscope Commercial |
$628.61
|
| Rate for Payer: Healthscope Commercial |
$543.66
|
| Rate for Payer: Mclaren Medicaid |
$231.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$356.78
|
| Rate for Payer: Meridian Medicaid |
$243.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59,310.00
|
| Rate for Payer: Nomi Health Commercial |
$407.75
|
| Rate for Payer: PACE SWMI |
$339.79
|
| Rate for Payer: PHP Medicare Advantage |
$339.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$527.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$533.28
|
| Rate for Payer: Priority Health Medicare |
$339.79
|
| Rate for Payer: Priority Health Narrow Network |
$533.28
|
| Rate for Payer: Priority Health SBD |
$533.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.79
|
| Rate for Payer: UHC Exchange |
$539.29
|
| Rate for Payer: UHC Medicare Advantage |
$339.79
|
| Rate for Payer: UHCCP Medicaid |
$231.74
|
|
|
PR OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE
|
Professional
|
Both
|
$956.00
|
|
|
Service Code
|
HCPCS 28310
|
| Min. Negotiated Rate |
$238.77 |
| Max. Negotiated Rate |
$63,531.00 |
| Rate for Payer: Aetna Commercial |
$471.40
|
| Rate for Payer: Aetna Medicare |
$365.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.58
|
| Rate for Payer: BCBS Complete |
$250.71
|
| Rate for Payer: BCBS MAPPO |
$351.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,691.62
|
| Rate for Payer: BCN Commercial |
$790.19
|
| Rate for Payer: BCN Medicare Advantage |
$351.79
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cash Price |
$764.80
|
| Rate for Payer: Cofinity Commercial |
$506.58
|
| Rate for Payer: Cofinity Commercial |
$471.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.79
|
| Rate for Payer: Healthscope Commercial |
$650.81
|
| Rate for Payer: Healthscope Commercial |
$562.86
|
| Rate for Payer: Mclaren Medicaid |
$238.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.38
|
| Rate for Payer: Meridian Medicaid |
$250.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63,531.00
|
| Rate for Payer: Nomi Health Commercial |
$422.15
|
| Rate for Payer: PACE SWMI |
$351.79
|
| Rate for Payer: PHP Medicare Advantage |
$351.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$238.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$621.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.27
|
| Rate for Payer: Priority Health Medicare |
$351.79
|
| Rate for Payer: Priority Health Narrow Network |
$561.27
|
| Rate for Payer: Priority Health SBD |
$561.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$591.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.79
|
| Rate for Payer: UHC Exchange |
$591.95
|
| Rate for Payer: UHC Medicare Advantage |
$351.79
|
| Rate for Payer: UHCCP Medicaid |
$238.77
|
|
|
PR OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM
|
Professional
|
Both
|
$2,637.00
|
|
|
Service Code
|
HCPCS 22216
|
| Min. Negotiated Rate |
$106.88 |
| Max. Negotiated Rate |
$64,917.00 |
| Rate for Payer: Aetna Commercial |
$473.88
|
| Rate for Payer: Aetna Medicare |
$367.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$473.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.24
|
| Rate for Payer: BCBS Complete |
$243.78
|
| Rate for Payer: BCBS MAPPO |
$353.64
|
| Rate for Payer: BCBS Trust/PPO |
$106.88
|
| Rate for Payer: BCN Commercial |
$580.04
|
| Rate for Payer: BCN Medicare Advantage |
$353.64
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cash Price |
$2,109.60
|
| Rate for Payer: Cofinity Commercial |
$509.24
|
| Rate for Payer: Cofinity Commercial |
$473.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.64
|
| Rate for Payer: Healthscope Commercial |
$654.23
|
| Rate for Payer: Healthscope Commercial |
$565.82
|
| Rate for Payer: Mclaren Medicaid |
$232.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.32
|
| Rate for Payer: Meridian Medicaid |
$243.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64,917.00
|
| Rate for Payer: Nomi Health Commercial |
$424.37
|
| Rate for Payer: PACE SWMI |
$353.64
|
| Rate for Payer: PHP Medicare Advantage |
$353.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$232.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,714.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$550.08
|
| Rate for Payer: Priority Health Medicare |
$353.64
|
| Rate for Payer: Priority Health Narrow Network |
$550.08
|
| Rate for Payer: Priority Health SBD |
$550.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$447.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$353.64
|
| Rate for Payer: UHC Exchange |
$447.25
|
| Rate for Payer: UHC Medicare Advantage |
$353.64
|
| Rate for Payer: UHCCP Medicaid |
$232.17
|
|
|
PR OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 28305
|
| Min. Negotiated Rate |
$436.22 |
| Max. Negotiated Rate |
$118,604.00 |
| Rate for Payer: Aetna Commercial |
$866.93
|
| Rate for Payer: Aetna Medicare |
$672.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$866.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$931.62
|
| Rate for Payer: BCBS Complete |
$458.03
|
| Rate for Payer: BCBS MAPPO |
$646.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,202.94
|
| Rate for Payer: BCN Commercial |
$979.31
|
| Rate for Payer: BCN Medicare Advantage |
$646.96
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cofinity Commercial |
$931.62
|
| Rate for Payer: Cofinity Commercial |
$866.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$646.96
|
| Rate for Payer: Healthscope Commercial |
$1,196.88
|
| Rate for Payer: Healthscope Commercial |
$1,035.14
|
| Rate for Payer: Mclaren Medicaid |
$436.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$679.31
|
| Rate for Payer: Meridian Medicaid |
$458.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118,604.00
|
| Rate for Payer: Nomi Health Commercial |
$776.35
|
| Rate for Payer: PACE SWMI |
$646.96
|
| Rate for Payer: PHP Medicare Advantage |
$646.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,119.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,038.08
|
| Rate for Payer: Priority Health Medicare |
$646.96
|
| Rate for Payer: Priority Health Narrow Network |
$1,038.08
|
| Rate for Payer: Priority Health SBD |
$1,038.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$981.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$646.96
|
| Rate for Payer: UHC Exchange |
$981.74
|
| Rate for Payer: UHC Medicare Advantage |
$646.96
|
| Rate for Payer: UHCCP Medicaid |
$436.22
|
|
|
PR OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT
|
Professional
|
Both
|
$3,962.00
|
|
|
Service Code
|
HCPCS 28309
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$159,395.00 |
| Rate for Payer: Aetna Commercial |
$1,166.72
|
| Rate for Payer: Aetna Medicare |
$905.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,166.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,253.79
|
| Rate for Payer: BCBS Complete |
$615.93
|
| Rate for Payer: BCBS MAPPO |
$870.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,728.07
|
| Rate for Payer: BCN Commercial |
$1,315.04
|
| Rate for Payer: BCN Medicare Advantage |
$870.69
|
| Rate for Payer: Cash Price |
$3,169.60
|
| Rate for Payer: Cash Price |
$3,169.60
|
| Rate for Payer: Cofinity Commercial |
$1,253.79
|
| Rate for Payer: Cofinity Commercial |
$1,166.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.69
|
| Rate for Payer: Healthscope Commercial |
$1,610.78
|
| Rate for Payer: Healthscope Commercial |
$1,393.10
|
| Rate for Payer: Mclaren Medicaid |
$586.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$914.22
|
| Rate for Payer: Meridian Medicaid |
$615.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159,395.00
|
| Rate for Payer: Nomi Health Commercial |
$1,044.83
|
| Rate for Payer: PACE SWMI |
$870.69
|
| Rate for Payer: PHP Medicare Advantage |
$870.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,575.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,391.22
|
| Rate for Payer: Priority Health Medicare |
$870.69
|
| Rate for Payer: Priority Health Narrow Network |
$1,391.22
|
| Rate for Payer: Priority Health SBD |
$1,391.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$987.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$870.69
|
| Rate for Payer: UHC Exchange |
$987.19
|
| Rate for Payer: UHC Medicare Advantage |
$870.69
|
| Rate for Payer: UHCCP Medicaid |
$586.60
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR
|
Professional
|
Both
|
$1,417.00
|
|
|
Service Code
|
HCPCS 28306
|
| Min. Negotiated Rate |
$264.76 |
| Max. Negotiated Rate |
$71,392.00 |
| Rate for Payer: Aetna Commercial |
$523.06
|
| Rate for Payer: Aetna Medicare |
$405.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$523.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$562.09
|
| Rate for Payer: BCBS Complete |
$278.00
|
| Rate for Payer: BCBS MAPPO |
$390.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,500.90
|
| Rate for Payer: BCN Commercial |
$886.46
|
| Rate for Payer: BCN Medicare Advantage |
$390.34
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cash Price |
$1,133.60
|
| Rate for Payer: Cofinity Commercial |
$562.09
|
| Rate for Payer: Cofinity Commercial |
$523.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.34
|
| Rate for Payer: Healthscope Commercial |
$722.13
|
| Rate for Payer: Healthscope Commercial |
$624.54
|
| Rate for Payer: Mclaren Medicaid |
$264.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.86
|
| Rate for Payer: Meridian Medicaid |
$278.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71,392.00
|
| Rate for Payer: Nomi Health Commercial |
$468.41
|
| Rate for Payer: PACE SWMI |
$390.34
|
| Rate for Payer: PHP Medicare Advantage |
$390.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$264.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$921.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$628.95
|
| Rate for Payer: Priority Health Medicare |
$390.34
|
| Rate for Payer: Priority Health Narrow Network |
$628.95
|
| Rate for Payer: Priority Health SBD |
$628.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$657.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.34
|
| Rate for Payer: UHC Exchange |
$657.28
|
| Rate for Payer: UHC Medicare Advantage |
$390.34
|
| Rate for Payer: UHCCP Medicaid |
$264.76
|
|
|
PR OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
HCPCS 28308
|
| Min. Negotiated Rate |
$252.83 |
| Max. Negotiated Rate |
$67,756.00 |
| Rate for Payer: Aetna Commercial |
$497.23
|
| Rate for Payer: Aetna Medicare |
$385.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$497.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.34
|
| Rate for Payer: BCBS Complete |
$265.47
|
| Rate for Payer: BCBS MAPPO |
$371.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,566.94
|
| Rate for Payer: BCN Commercial |
$829.77
|
| Rate for Payer: BCN Medicare Advantage |
$371.07
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cofinity Commercial |
$534.34
|
| Rate for Payer: Cofinity Commercial |
$497.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$371.07
|
| Rate for Payer: Healthscope Commercial |
$686.48
|
| Rate for Payer: Healthscope Commercial |
$593.71
|
| Rate for Payer: Mclaren Medicaid |
$252.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$389.62
|
| Rate for Payer: Meridian Medicaid |
$265.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67,756.00
|
| Rate for Payer: Nomi Health Commercial |
$445.28
|
| Rate for Payer: PACE SWMI |
$371.07
|
| Rate for Payer: PHP Medicare Advantage |
$371.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$252.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$599.44
|
| Rate for Payer: Priority Health Medicare |
$371.07
|
| Rate for Payer: Priority Health Narrow Network |
$599.44
|
| Rate for Payer: Priority Health SBD |
$599.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$578.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$371.07
|
| Rate for Payer: UHC Exchange |
$578.29
|
| Rate for Payer: UHC Medicare Advantage |
$371.07
|
| Rate for Payer: UHCCP Medicaid |
$252.83
|
|
|
PR OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX
|
Professional
|
Both
|
$1,270.00
|
|
|
Service Code
|
HCPCS 63295
|
| Min. Negotiated Rate |
$212.57 |
| Max. Negotiated Rate |
$59,920.00 |
| Rate for Payer: Aetna Commercial |
$438.74
|
| Rate for Payer: Aetna Medicare |
$340.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.48
|
| Rate for Payer: BCBS Complete |
$223.20
|
| Rate for Payer: BCBS MAPPO |
$327.42
|
| Rate for Payer: BCBS Trust/PPO |
$256.75
|
| Rate for Payer: BCN Commercial |
$483.30
|
| Rate for Payer: BCN Medicare Advantage |
$327.42
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cofinity Commercial |
$471.48
|
| Rate for Payer: Cofinity Commercial |
$438.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.42
|
| Rate for Payer: Healthscope Commercial |
$605.73
|
| Rate for Payer: Healthscope Commercial |
$523.87
|
| Rate for Payer: Mclaren Medicaid |
$212.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$343.79
|
| Rate for Payer: Meridian Medicaid |
$223.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59,920.00
|
| Rate for Payer: Nomi Health Commercial |
$392.90
|
| Rate for Payer: PACE SWMI |
$327.42
|
| Rate for Payer: PHP Medicare Advantage |
$327.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$825.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$561.89
|
| Rate for Payer: Priority Health Medicare |
$327.42
|
| Rate for Payer: Priority Health Narrow Network |
$561.89
|
| Rate for Payer: Priority Health SBD |
$561.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.42
|
| Rate for Payer: UHC Exchange |
$400.27
|
| Rate for Payer: UHC Medicare Advantage |
$327.42
|
| Rate for Payer: UHCCP Medicaid |
$212.57
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$135.40
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$121.86 |
| Rate for Payer: Aetna Commercial |
$115.09
|
| Rate for Payer: Aetna Commercial |
$38.32
|
| Rate for Payer: Aetna Medicare |
$22.54
|
| Rate for Payer: Aetna Medicare |
$67.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.30
|
| Rate for Payer: BCBS Complete |
$18.03
|
| Rate for Payer: BCBS Complete |
$54.16
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: BCN Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cofinity Commercial |
$94.78
|
| Rate for Payer: Cofinity Commercial |
$116.44
|
| Rate for Payer: Cofinity Commercial |
$31.56
|
| Rate for Payer: Cofinity Commercial |
$38.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.06
|
| Rate for Payer: Healthscope Commercial |
$40.57
|
| Rate for Payer: Healthscope Commercial |
$121.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.09
|
| Rate for Payer: PHP Commercial |
$38.32
|
| Rate for Payer: PHP Commercial |
$115.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.01
|
| Rate for Payer: Priority Health SBD |
$28.40
|
| Rate for Payer: Priority Health SBD |
$85.30
|
|
|
PROTAMINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$45.08
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
6677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$40.57 |
| Rate for Payer: Aetna Commercial |
$38.32
|
| Rate for Payer: Aetna Commercial |
$115.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.30
|
| Rate for Payer: Cash Price |
$108.32
|
| Rate for Payer: Cash Price |
$36.06
|
| Rate for Payer: Cofinity Commercial |
$38.77
|
| Rate for Payer: Cofinity Commercial |
$31.56
|
| Rate for Payer: Cofinity Commercial |
$116.44
|
| Rate for Payer: Cofinity Commercial |
$94.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$31.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$36.06
|
| Rate for Payer: Healthscope Commercial |
$40.57
|
| Rate for Payer: Healthscope Commercial |
$121.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$38.32
|
| Rate for Payer: PHP Commercial |
$38.32
|
| Rate for Payer: PHP Commercial |
$115.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.30
|
| Rate for Payer: Priority Health SBD |
$85.30
|
| Rate for Payer: Priority Health SBD |
$28.40
|
|
|
PROTEIN SUPPLEMENT ORAL
|
Facility
|
OP
|
$3.43
|
|
|
Service Code
|
NDC 43900028430
|
| Hospital Charge Code |
150950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: BCBS Complete |
$1.37
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
|
|
PROTEIN SUPPLEMENT ORAL
|
Facility
|
IP
|
$3.43
|
|
|
Service Code
|
NDC 43900028430
|
| Hospital Charge Code |
150950
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$3.09 |
| Rate for Payer: Aetna Commercial |
$2.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.23
|
| Rate for Payer: Cash Price |
$2.74
|
| Rate for Payer: Cofinity Commercial |
$2.40
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$3.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.92
|
| Rate for Payer: PHP Commercial |
$2.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.23
|
| Rate for Payer: Priority Health SBD |
$2.16
|
|
|
PR OTHER CRANIAL DECOMPRESSION POSTERIOR FOSSA
|
Professional
|
Both
|
$4,482.00
|
|
|
Service Code
|
HCPCS 61345
|
| Min. Negotiated Rate |
$660.90 |
| Max. Negotiated Rate |
$370,519.00 |
| Rate for Payer: Aetna Commercial |
$2,717.29
|
| Rate for Payer: Aetna Medicare |
$2,108.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,717.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,920.08
|
| Rate for Payer: BCBS Complete |
$1,397.81
|
| Rate for Payer: BCBS MAPPO |
$2,027.83
|
| Rate for Payer: BCBS Trust/PPO |
$660.90
|
| Rate for Payer: BCN Commercial |
$4,181.49
|
| Rate for Payer: BCN Medicare Advantage |
$2,027.83
|
| Rate for Payer: Cash Price |
$3,585.60
|
| Rate for Payer: Cash Price |
$3,585.60
|
| Rate for Payer: Cofinity Commercial |
$2,920.08
|
| Rate for Payer: Cofinity Commercial |
$2,717.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,027.83
|
| Rate for Payer: Healthscope Commercial |
$3,751.49
|
| Rate for Payer: Healthscope Commercial |
$3,244.53
|
| Rate for Payer: Mclaren Medicaid |
$1,331.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,129.22
|
| Rate for Payer: Meridian Medicaid |
$1,397.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$370,519.00
|
| Rate for Payer: Nomi Health Commercial |
$2,433.40
|
| Rate for Payer: PACE SWMI |
$2,027.83
|
| Rate for Payer: PHP Medicare Advantage |
$2,027.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,331.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,913.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,538.55
|
| Rate for Payer: Priority Health Medicare |
$2,027.83
|
| Rate for Payer: Priority Health Narrow Network |
$3,538.55
|
| Rate for Payer: Priority Health SBD |
$3,538.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,243.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,027.83
|
| Rate for Payer: UHC Exchange |
$2,243.39
|
| Rate for Payer: UHC Medicare Advantage |
$2,027.83
|
| Rate for Payer: UHCCP Medicaid |
$1,331.25
|
|
|
PR OTOLARYNGOLOGIC EXAM UNDER GENERAL ANESTHESIA
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
HCPCS 92502
|
| Min. Negotiated Rate |
$60.92 |
| Max. Negotiated Rate |
$13,779.00 |
| Rate for Payer: Aetna Commercial |
$119.89
|
| Rate for Payer: Aetna Medicare |
$93.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$119.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$128.84
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS MAPPO |
$89.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,298.03
|
| Rate for Payer: BCN Commercial |
$137.32
|
| Rate for Payer: BCN Medicare Advantage |
$89.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cofinity Commercial |
$128.84
|
| Rate for Payer: Cofinity Commercial |
$119.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.47
|
| Rate for Payer: Healthscope Commercial |
$165.52
|
| Rate for Payer: Healthscope Commercial |
$143.15
|
| Rate for Payer: Mclaren Medicaid |
$60.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.94
|
| Rate for Payer: Meridian Medicaid |
$63.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,779.00
|
| Rate for Payer: Nomi Health Commercial |
$107.36
|
| Rate for Payer: PACE SWMI |
$89.47
|
| Rate for Payer: PHP Medicare Advantage |
$89.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.91
|
| Rate for Payer: Priority Health Medicare |
$89.47
|
| Rate for Payer: Priority Health Narrow Network |
$128.91
|
| Rate for Payer: Priority Health SBD |
$128.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.47
|
| Rate for Payer: UHC Exchange |
$116.87
|
| Rate for Payer: UHC Medicare Advantage |
$89.47
|
| Rate for Payer: UHCCP Medicaid |
$60.92
|
|
|
PR OTOPLASTY PROTRUDING EAR W/WO SIZE RDCTJ
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
HCPCS 69300
|
| Min. Negotiated Rate |
$304.16 |
| Max. Negotiated Rate |
$82,597.00 |
| Rate for Payer: Aetna Commercial |
$599.15
|
| Rate for Payer: Aetna Medicare |
$465.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$643.87
|
| Rate for Payer: BCBS Complete |
$319.37
|
| Rate for Payer: BCBS MAPPO |
$447.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,934.63
|
| Rate for Payer: BCN Commercial |
$958.30
|
| Rate for Payer: BCN Medicare Advantage |
$447.13
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cash Price |
$1,264.80
|
| Rate for Payer: Cofinity Commercial |
$643.87
|
| Rate for Payer: Cofinity Commercial |
$599.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.13
|
| Rate for Payer: Healthscope Commercial |
$827.19
|
| Rate for Payer: Healthscope Commercial |
$715.41
|
| Rate for Payer: Mclaren Medicaid |
$304.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.49
|
| Rate for Payer: Meridian Medicaid |
$319.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82,597.00
|
| Rate for Payer: Nomi Health Commercial |
$536.56
|
| Rate for Payer: PACE SWMI |
$447.13
|
| Rate for Payer: PHP Medicare Advantage |
$447.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,027.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$691.63
|
| Rate for Payer: Priority Health Medicare |
$447.13
|
| Rate for Payer: Priority Health Narrow Network |
$691.63
|
| Rate for Payer: Priority Health SBD |
$691.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$561.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$447.13
|
| Rate for Payer: UHC Exchange |
$561.50
|
| Rate for Payer: UHC Medicare Advantage |
$447.13
|
| Rate for Payer: UHCCP Medicaid |
$304.16
|
|
|
PR OVARIAN CYSTECTOMY UNI/BI
|
Professional
|
Both
|
$2,385.00
|
|
|
Service Code
|
HCPCS 58925
|
| Min. Negotiated Rate |
$164.83 |
| Max. Negotiated Rate |
$137,173.00 |
| Rate for Payer: Aetna Commercial |
$991.29
|
| Rate for Payer: Aetna Medicare |
$769.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,065.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$991.29
|
| Rate for Payer: BCBS Complete |
$519.32
|
| Rate for Payer: BCBS MAPPO |
$739.77
|
| Rate for Payer: BCBS Trust/PPO |
$164.83
|
| Rate for Payer: BCN Commercial |
$1,126.89
|
| Rate for Payer: BCN Medicare Advantage |
$739.77
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cash Price |
$1,908.00
|
| Rate for Payer: Cofinity Commercial |
$991.29
|
| Rate for Payer: Cofinity Commercial |
$1,065.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$739.77
|
| Rate for Payer: Healthscope Commercial |
$1,368.57
|
| Rate for Payer: Healthscope Commercial |
$1,183.63
|
| Rate for Payer: Mclaren Medicaid |
$494.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$776.76
|
| Rate for Payer: Meridian Medicaid |
$519.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137,173.00
|
| Rate for Payer: Nomi Health Commercial |
$887.72
|
| Rate for Payer: PACE SWMI |
$739.77
|
| Rate for Payer: PHP Medicare Advantage |
$739.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$494.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,550.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,148.85
|
| Rate for Payer: Priority Health Medicare |
$739.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,148.85
|
| Rate for Payer: Priority Health SBD |
$1,148.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,062.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$739.77
|
| Rate for Payer: UHC Exchange |
$1,062.54
|
| Rate for Payer: UHC Medicare Advantage |
$739.77
|
| Rate for Payer: UHCCP Medicaid |
$494.59
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$116.90
|
|
|
Service Code
|
NDC 00781729685
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$105.21 |
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: Aetna Medicare |
$58.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.98
|
| Rate for Payer: BCBS Complete |
$46.76
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Commercial |
$100.53
|
| Rate for Payer: Cofinity Commercial |
$81.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$105.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.36
|
| Rate for Payer: PHP Commercial |
$99.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.98
|
| Rate for Payer: Priority Health SBD |
$73.65
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$50.40
|
|
|
Service Code
|
NDC 69097014260
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$45.36 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna Medicare |
$25.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.76
|
| Rate for Payer: BCBS Complete |
$20.16
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Cofinity Commercial |
$35.28
|
| Rate for Payer: Cofinity Commercial |
$43.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.32
|
| Rate for Payer: Healthscope Commercial |
$45.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.84
|
| Rate for Payer: PHP Commercial |
$42.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.76
|
| Rate for Payer: Priority Health SBD |
$31.75
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$116.90
|
|
|
Service Code
|
NDC 00781729685
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.65 |
| Max. Negotiated Rate |
$105.21 |
| Rate for Payer: Aetna Commercial |
$99.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.98
|
| Rate for Payer: Cash Price |
$93.52
|
| Rate for Payer: Cofinity Commercial |
$100.53
|
| Rate for Payer: Cofinity Commercial |
$81.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.52
|
| Rate for Payer: Healthscope Commercial |
$105.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.36
|
| Rate for Payer: PHP Commercial |
$99.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.98
|
| Rate for Payer: Priority Health SBD |
$73.65
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$102.90
|
|
|
Service Code
|
NDC 66993001968
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.83 |
| Max. Negotiated Rate |
$92.61 |
| Rate for Payer: Aetna Commercial |
$87.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.88
|
| Rate for Payer: Cash Price |
$82.32
|
| Rate for Payer: Cofinity Commercial |
$72.03
|
| Rate for Payer: Cofinity Commercial |
$88.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.32
|
| Rate for Payer: Healthscope Commercial |
$92.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.46
|
| Rate for Payer: PHP Commercial |
$87.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.88
|
| Rate for Payer: Priority Health SBD |
$64.83
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$149.10
|
|
|
Service Code
|
NDC 00085113204
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$134.19 |
| Rate for Payer: Aetna Commercial |
$126.74
|
| Rate for Payer: Aetna Medicare |
$74.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.92
|
| Rate for Payer: BCBS Complete |
$59.64
|
| Rate for Payer: Cash Price |
$119.28
|
| Rate for Payer: Cofinity Commercial |
$104.37
|
| Rate for Payer: Cofinity Commercial |
$128.23
|
| Rate for Payer: Cofinity Medicare Advantage |
$104.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.28
|
| Rate for Payer: Healthscope Commercial |
$134.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$126.74
|
| Rate for Payer: PHP Commercial |
$126.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.92
|
| Rate for Payer: Priority Health SBD |
$93.93
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
OP
|
$114.80
|
|
|
Service Code
|
NDC 00254100752
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.92 |
| Max. Negotiated Rate |
$103.32 |
| Rate for Payer: Aetna Commercial |
$97.58
|
| Rate for Payer: Aetna Medicare |
$57.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.62
|
| Rate for Payer: BCBS Complete |
$45.92
|
| Rate for Payer: Cash Price |
$91.84
|
| Rate for Payer: Cofinity Commercial |
$80.36
|
| Rate for Payer: Cofinity Commercial |
$98.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.84
|
| Rate for Payer: Healthscope Commercial |
$103.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.58
|
| Rate for Payer: PHP Commercial |
$97.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.62
|
| Rate for Payer: Priority Health SBD |
$72.32
|
|
|
PROVENTIL HFA 90 MCG/ACTUATION AEROSOL COMMON CANISTER INHALER
|
Facility
|
IP
|
$114.80
|
|
|
Service Code
|
NDC 00254100752
|
| Hospital Charge Code |
300058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.32 |
| Max. Negotiated Rate |
$103.32 |
| Rate for Payer: Aetna Commercial |
$97.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.62
|
| Rate for Payer: Cash Price |
$91.84
|
| Rate for Payer: Cofinity Commercial |
$80.36
|
| Rate for Payer: Cofinity Commercial |
$98.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.84
|
| Rate for Payer: Healthscope Commercial |
$103.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.58
|
| Rate for Payer: PHP Commercial |
$97.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.62
|
| Rate for Payer: Priority Health SBD |
$72.32
|
|
