|
PR OPHTH MEDICAL XM&EVAL INTERMEDIATE NEW PT
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 92002
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$902.86 |
| Rate for Payer: Aetna Commercial |
$50.66
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS Trust/PPO |
$902.86
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Mclaren Medicaid |
$28.54
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.20
|
| Rate for Payer: Priority Health Narrow Network |
$54.20
|
| Rate for Payer: Priority Health SBD |
$54.20
|
|
|
PR OPHTH XM&EVAL ANES W/WO MANJ GLOBE COMPL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 92018
|
| Min. Negotiated Rate |
$87.54 |
| Max. Negotiated Rate |
$7,723.22 |
| Rate for Payer: Aetna Commercial |
$150.76
|
| Rate for Payer: BCBS Complete |
$91.92
|
| Rate for Payer: BCBS Trust/PPO |
$7,723.22
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Mclaren Medicaid |
$87.54
|
| Rate for Payer: Meridian Medicaid |
$91.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.80
|
| Rate for Payer: Priority Health Narrow Network |
$163.80
|
| Rate for Payer: Priority Health SBD |
$163.80
|
|
|
PR OPHTH XM&EVAL ANES W/WO MANJ GLOBE LMTD
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 92019
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$1,793.58 |
| Rate for Payer: Aetna Commercial |
$77.34
|
| Rate for Payer: BCBS Complete |
$48.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,793.58
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Mclaren Medicaid |
$45.80
|
| Rate for Payer: Meridian Medicaid |
$48.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.71
|
| Rate for Payer: Priority Health Narrow Network |
$84.71
|
| Rate for Payer: Priority Health SBD |
$84.71
|
|
|
PR OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ
|
Professional
|
Both
|
$772.00
|
|
|
Service Code
|
HCPCS 34716
|
| Min. Negotiated Rate |
$231.53 |
| Max. Negotiated Rate |
$1,773.50 |
| Rate for Payer: Aetna Commercial |
$499.69
|
| Rate for Payer: BCBS Complete |
$243.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,773.50
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Cash Price |
$617.60
|
| Rate for Payer: Mclaren Medicaid |
$231.53
|
| Rate for Payer: Meridian Medicaid |
$243.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$540.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$577.18
|
| Rate for Payer: Priority Health Narrow Network |
$577.18
|
| Rate for Payer: Priority Health SBD |
$577.18
|
|
|
PR OPN BRACHIAL ARTERY EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 34834
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$1,323.92 |
| Rate for Payer: Aetna Commercial |
$174.94
|
| Rate for Payer: BCBS Complete |
$84.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,323.92
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Mclaren Medicaid |
$80.30
|
| Rate for Payer: Meridian Medicaid |
$84.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.54
|
| Rate for Payer: Priority Health Narrow Network |
$200.54
|
| Rate for Payer: Priority Health SBD |
$200.54
|
|
|
PR OPN FEM ART EXPOS DLVR EVASC PROSTH UNI
|
Professional
|
Both
|
$1,242.00
|
|
|
Service Code
|
HCPCS 34812
|
| Min. Negotiated Rate |
$128.01 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Aetna Commercial |
$278.36
|
| Rate for Payer: BCBS Complete |
$134.41
|
| Rate for Payer: BCBS Trust/PPO |
$498.72
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Cash Price |
$993.60
|
| Rate for Payer: Mclaren Medicaid |
$128.01
|
| Rate for Payer: Meridian Medicaid |
$134.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$869.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.64
|
| Rate for Payer: Priority Health Narrow Network |
$318.64
|
| Rate for Payer: Priority Health SBD |
$318.64
|
|
|
PR OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
HCPCS 34714
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$1,553.20 |
| Rate for Payer: Aetna Commercial |
$363.18
|
| Rate for Payer: BCBS Complete |
$176.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,553.20
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Cash Price |
$445.60
|
| Rate for Payer: Mclaren Medicaid |
$167.63
|
| Rate for Payer: Meridian Medicaid |
$176.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$167.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$417.58
|
| Rate for Payer: Priority Health Narrow Network |
$417.58
|
| Rate for Payer: Priority Health SBD |
$417.58
|
|
|
PR OPN ILIAC ART EXPOS CRTJ PROSTH EST CARD BYP
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 34833
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$1,531.60 |
| Rate for Payer: Aetna Commercial |
$530.13
|
| Rate for Payer: BCBS Complete |
$256.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,407.92
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Mclaren Medicaid |
$244.10
|
| Rate for Payer: Meridian Medicaid |
$256.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$244.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,531.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$606.96
|
| Rate for Payer: Priority Health Narrow Network |
$606.96
|
| Rate for Payer: Priority Health SBD |
$606.96
|
|
|
PR OPN RPR ARYSM RPR ARTL TRAUMA TUBE PROSTH
|
Professional
|
Both
|
$4,718.00
|
|
|
Service Code
|
HCPCS 34830
|
| Min. Negotiated Rate |
$841.05 |
| Max. Negotiated Rate |
$3,302.60 |
| Rate for Payer: Aetna Commercial |
$2,372.61
|
| Rate for Payer: BCBS Complete |
$1,154.03
|
| Rate for Payer: BCBS Trust/PPO |
$841.05
|
| Rate for Payer: Cash Price |
$3,774.40
|
| Rate for Payer: Cash Price |
$3,774.40
|
| Rate for Payer: Mclaren Medicaid |
$1,099.08
|
| Rate for Payer: Meridian Medicaid |
$1,154.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,099.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,302.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,733.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,733.19
|
| Rate for Payer: Priority Health SBD |
$2,733.19
|
|
|
PR OPN RPR ARYSM RPR ARTL TRMA AORTOBIILIAC PROSTH
|
Professional
|
Both
|
$3,997.00
|
|
|
Service Code
|
HCPCS 34831
|
| Min. Negotiated Rate |
$953.05 |
| Max. Negotiated Rate |
$2,988.53 |
| Rate for Payer: Aetna Commercial |
$2,587.95
|
| Rate for Payer: BCBS Complete |
$1,262.06
|
| Rate for Payer: BCBS Trust/PPO |
$953.05
|
| Rate for Payer: Cash Price |
$3,197.60
|
| Rate for Payer: Cash Price |
$3,197.60
|
| Rate for Payer: Mclaren Medicaid |
$1,201.96
|
| Rate for Payer: Meridian Medicaid |
$1,262.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,201.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,797.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,988.53
|
| Rate for Payer: Priority Health Narrow Network |
$2,988.53
|
| Rate for Payer: Priority Health SBD |
$2,988.53
|
|
|
PR OPN SUBCLA CRTD ART TRPOS NCK INC ULAT
|
Professional
|
Both
|
$3,137.00
|
|
|
Service Code
|
HCPCS 33889
|
| Min. Negotiated Rate |
$494.59 |
| Max. Negotiated Rate |
$2,852.29 |
| Rate for Payer: Aetna Commercial |
$1,063.36
|
| Rate for Payer: BCBS Complete |
$519.32
|
| Rate for Payer: BCBS Trust/PPO |
$2,852.29
|
| Rate for Payer: Cash Price |
$2,509.60
|
| Rate for Payer: Cash Price |
$2,509.60
|
| Rate for Payer: Mclaren Medicaid |
$494.59
|
| Rate for Payer: Meridian Medicaid |
$519.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$494.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,195.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,230.95
|
| Rate for Payer: Priority Health Narrow Network |
$1,230.95
|
| Rate for Payer: Priority Health SBD |
$1,230.95
|
|
|
PROPOFOL 10 MG/ML 20 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$76.22
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$68.60 |
| Rate for Payer: Aetna Commercial |
$64.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.54
|
| Rate for Payer: Cash Price |
$60.98
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Cofinity Commercial |
$65.55
|
| Rate for Payer: Healthscope Commercial |
$68.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$64.79
|
| Rate for Payer: PHP Commercial |
$64.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.35
|
| Rate for Payer: Priority Health SBD |
$48.02
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
IP
|
$82.94
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.25 |
| Max. Negotiated Rate |
$74.65 |
| Rate for Payer: Aetna Commercial |
$70.50
|
| Rate for Payer: Aetna Commercial |
$81.16
|
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.91
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Cofinity Commercial |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$71.33
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$53.98
|
| Rate for Payer: Cofinity Commercial |
$58.06
|
| Rate for Payer: Healthscope Commercial |
$85.93
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$74.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.50
|
| Rate for Payer: PHP Commercial |
$70.50
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: PHP Commercial |
$81.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.84
|
| Rate for Payer: Priority Health SBD |
$60.15
|
| Rate for Payer: Priority Health SBD |
$48.59
|
| Rate for Payer: Priority Health SBD |
$52.25
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
IP
|
$61.53
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$55.38 |
| Rate for Payer: Aetna Commercial |
$52.30
|
| Rate for Payer: Aetna Commercial |
$61.81
|
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Aetna Commercial |
$81.16
|
| Rate for Payer: Aetna Commercial |
$49.93
|
| Rate for Payer: Aetna Commercial |
$76.47
|
| Rate for Payer: Aetna Commercial |
$71.86
|
| Rate for Payer: Aetna Commercial |
$70.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.48
|
| Rate for Payer: Cash Price |
$66.35
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cash Price |
$67.63
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cofinity Commercial |
$71.33
|
| Rate for Payer: Cofinity Commercial |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$43.07
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$50.90
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Cofinity Commercial |
$53.98
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Cofinity Commercial |
$58.06
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Commercial |
$72.70
|
| Rate for Payer: Cofinity Commercial |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$62.98
|
| Rate for Payer: Cofinity Commercial |
$77.37
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Healthscope Commercial |
$74.65
|
| Rate for Payer: Healthscope Commercial |
$65.45
|
| Rate for Payer: Healthscope Commercial |
$80.97
|
| Rate for Payer: Healthscope Commercial |
$85.93
|
| Rate for Payer: Healthscope Commercial |
$52.87
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$55.38
|
| Rate for Payer: Healthscope Commercial |
$49.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.16
|
| Rate for Payer: PHP Commercial |
$81.16
|
| Rate for Payer: PHP Commercial |
$76.47
|
| Rate for Payer: PHP Commercial |
$71.86
|
| Rate for Payer: PHP Commercial |
$52.30
|
| Rate for Payer: PHP Commercial |
$46.36
|
| Rate for Payer: PHP Commercial |
$61.81
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: PHP Commercial |
$70.50
|
| Rate for Payer: PHP Commercial |
$49.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: Priority Health SBD |
$34.36
|
| Rate for Payer: Priority Health SBD |
$38.76
|
| Rate for Payer: Priority Health SBD |
$45.81
|
| Rate for Payer: Priority Health SBD |
$48.59
|
| Rate for Payer: Priority Health SBD |
$52.25
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: Priority Health SBD |
$56.68
|
| Rate for Payer: Priority Health SBD |
$60.15
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$58.74
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.01 |
| Max. Negotiated Rate |
$52.87 |
| Rate for Payer: Aetna Commercial |
$49.93
|
| Rate for Payer: Aetna Commercial |
$71.86
|
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Commercial |
$81.16
|
| Rate for Payer: Aetna Commercial |
$61.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.13
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cash Price |
$46.99
|
| Rate for Payer: Cash Price |
$67.63
|
| Rate for Payer: Cofinity Commercial |
$41.12
|
| Rate for Payer: Cofinity Commercial |
$59.18
|
| Rate for Payer: Cofinity Commercial |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$50.90
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Cofinity Commercial |
$72.70
|
| Rate for Payer: Cofinity Commercial |
$53.98
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$52.87
|
| Rate for Payer: Healthscope Commercial |
$65.45
|
| Rate for Payer: Healthscope Commercial |
$76.09
|
| Rate for Payer: Healthscope Commercial |
$85.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.16
|
| Rate for Payer: PHP Commercial |
$49.93
|
| Rate for Payer: PHP Commercial |
$71.86
|
| Rate for Payer: PHP Commercial |
$61.81
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: PHP Commercial |
$81.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.84
|
| Rate for Payer: Priority Health SBD |
$45.81
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: Priority Health SBD |
$60.15
|
| Rate for Payer: Priority Health SBD |
$37.01
|
| Rate for Payer: Priority Health SBD |
$48.59
|
|
|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,524.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$2,466.80 |
| Rate for Payer: Aetna Commercial |
$1,203.70
|
| Rate for Payer: BCBS Complete |
$615.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.26
|
| Rate for Payer: Cash Price |
$2,819.20
|
| Rate for Payer: Cash Price |
$2,819.20
|
| Rate for Payer: Mclaren Medicaid |
$586.60
|
| Rate for Payer: Meridian Medicaid |
$615.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,466.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,406.84
|
| Rate for Payer: Priority Health Narrow Network |
$1,406.84
|
| Rate for Payer: Priority Health SBD |
$1,406.84
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,333.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$542.94 |
| Max. Negotiated Rate |
$1,633.10 |
| Rate for Payer: Aetna Commercial |
$1,112.25
|
| Rate for Payer: BCBS Complete |
$570.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.11
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Mclaren Medicaid |
$542.94
|
| Rate for Payer: Meridian Medicaid |
$570.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,633.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,302.66
|
| Rate for Payer: Priority Health Narrow Network |
$1,302.66
|
| Rate for Payer: Priority Health SBD |
$1,302.66
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,511.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$600.23 |
| Max. Negotiated Rate |
$1,439.01 |
| Rate for Payer: Aetna Commercial |
$1,229.30
|
| Rate for Payer: BCBS Complete |
$630.24
|
| Rate for Payer: BCBS Trust/PPO |
$977.36
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Mclaren Medicaid |
$600.23
|
| Rate for Payer: Meridian Medicaid |
$630.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$600.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,057.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,439.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,439.01
|
| Rate for Payer: Priority Health SBD |
$1,439.01
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$357.20
|
|
|
Service Code
|
NDC 0904-6550-61
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$225.04 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.18
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$250.04
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$303.62
|
| Rate for Payer: PHP Commercial |
$303.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$250.04
|
| Rate for Payer: Priority Health SBD |
$225.04
|
|
|
PROPRANOLOL 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.87
|
|
|
Service Code
|
HCPCS J1800
|
| Hospital Charge Code |
29335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.92
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cofinity Commercial |
$13.91
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.89
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.91
|
| Rate for Payer: Priority Health SBD |
$12.52
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 60687-306-11
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.43
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.62
|
| Rate for Payer: Priority Health SBD |
$2.36
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$439.45
|
|
|
Service Code
|
NDC 0115-1660-01
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$395.50 |
| Rate for Payer: Aetna Commercial |
$373.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$285.64
|
| Rate for Payer: Cash Price |
$351.56
|
| Rate for Payer: Cofinity Commercial |
$307.62
|
| Rate for Payer: Cofinity Commercial |
$377.93
|
| Rate for Payer: Healthscope Commercial |
$395.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$373.53
|
| Rate for Payer: PHP Commercial |
$373.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.62
|
| Rate for Payer: Priority Health SBD |
$276.85
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$2,888.00
|
|
|
Service Code
|
NDC 0591-5555-10
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,819.44 |
| Max. Negotiated Rate |
$2,599.20 |
| Rate for Payer: Aetna Commercial |
$2,454.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,877.20
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cofinity Commercial |
$2,021.60
|
| Rate for Payer: Cofinity Commercial |
$2,483.68
|
| Rate for Payer: Healthscope Commercial |
$2,599.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,454.80
|
| Rate for Payer: PHP Commercial |
$2,454.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,021.60
|
| Rate for Payer: Priority Health SBD |
$1,819.44
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$373.92
|
|
|
Service Code
|
NDC 60687-306-01
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$235.57 |
| Max. Negotiated Rate |
$336.53 |
| Rate for Payer: Aetna Commercial |
$317.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.05
|
| Rate for Payer: Cash Price |
$299.14
|
| Rate for Payer: Cofinity Commercial |
$261.74
|
| Rate for Payer: Cofinity Commercial |
$321.57
|
| Rate for Payer: Healthscope Commercial |
$336.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$317.83
|
| Rate for Payer: PHP Commercial |
$317.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.74
|
| Rate for Payer: Priority Health SBD |
$235.57
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
NDC 0904-6705-61
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.96 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.54
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$195.51
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$237.40
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.51
|
| Rate for Payer: Priority Health SBD |
$175.96
|
|
