|
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 |
$2,546.52
|
| Rate for Payer: Aetna Medicare |
$1,976.41
|
| Rate for Payer: BCBS Complete |
$1,262.06
|
| Rate for Payer: BCBS MAPPO |
$1,900.39
|
| Rate for Payer: BCBS Trust/PPO |
$953.05
|
| Rate for Payer: BCN Commercial |
$2,745.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,900.39
|
| Rate for Payer: Cash Price |
$3,197.60
|
| Rate for Payer: Cash Price |
$3,197.60
|
| Rate for Payer: Cofinity Commercial |
$2,736.56
|
| Rate for Payer: Cofinity Commercial |
$2,546.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,900.39
|
| Rate for Payer: Mclaren Medicaid |
$1,201.96
|
| Rate for Payer: Meridian Medicaid |
$1,262.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,995.41
|
| Rate for Payer: PACE SWMI |
$1,900.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,900.39
|
| 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 Medicare |
$1,900.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,988.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,900.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,900.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,957.40
|
|
|
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 |
$1,050.28
|
| Rate for Payer: Aetna Medicare |
$815.14
|
| Rate for Payer: BCBS Complete |
$519.32
|
| Rate for Payer: BCBS MAPPO |
$783.79
|
| Rate for Payer: BCBS Trust/PPO |
$2,852.29
|
| Rate for Payer: BCN Commercial |
$1,130.80
|
| Rate for Payer: BCN Medicare Advantage |
$783.79
|
| Rate for Payer: Cash Price |
$2,509.60
|
| Rate for Payer: Cash Price |
$2,509.60
|
| Rate for Payer: Cofinity Commercial |
$1,128.66
|
| Rate for Payer: Cofinity Commercial |
$1,050.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$783.79
|
| Rate for Payer: Mclaren Medicaid |
$494.59
|
| Rate for Payer: Meridian Medicaid |
$519.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$822.98
|
| Rate for Payer: PACE SWMI |
$783.79
|
| Rate for Payer: PHP Medicare Advantage |
$783.79
|
| 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 Medicare |
$783.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,230.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$783.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$783.79
|
| Rate for Payer: UHC Medicare Advantage |
$807.30
|
|
|
PROPOFOL 10 MG/ML 20 ML VIAL (BULK CHARGE)
|
Facility
|
IP
|
$63.61
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180095
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$57.25 |
| Rate for Payer: Aetna Commercial |
$54.07
|
| Rate for Payer: BCBS Trust/PPO |
$49.16
|
| Rate for Payer: BCN Commercial |
$49.16
|
| Rate for Payer: Cash Price |
$50.89
|
| Rate for Payer: Cofinity Commercial |
$54.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.89
|
| Rate for Payer: Healthscope Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.07
|
| Rate for Payer: PHP Commercial |
$54.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.98
|
| Rate for Payer: UHC Core |
$53.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.71
|
|
|
PROPOFOL 10 MG/ML CONTINUOUS INFUSION
|
Facility
|
IP
|
$77.12
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
151165
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$69.41 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: BCBS Trust/PPO |
$59.60
|
| Rate for Payer: BCN Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.70
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.55
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.87
|
| Rate for Payer: UHC Core |
$64.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.84
|
|
|
PROPOFOL 10 MG/ML INTRAVENOUS EMULSION
|
Facility
|
IP
|
$71.61
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$64.45 |
| Rate for Payer: Aetna Commercial |
$60.87
|
| Rate for Payer: Aetna Commercial |
$67.11
|
| Rate for Payer: Aetna Commercial |
$61.81
|
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Commercial |
$81.16
|
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Aetna Commercial |
$76.47
|
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: BCBS Trust/PPO |
$56.20
|
| Rate for Payer: BCBS Trust/PPO |
$42.15
|
| Rate for Payer: BCBS Trust/PPO |
$79.46
|
| Rate for Payer: BCBS Trust/PPO |
$73.79
|
| Rate for Payer: BCBS Trust/PPO |
$55.34
|
| Rate for Payer: BCBS Trust/PPO |
$69.53
|
| Rate for Payer: BCBS Trust/PPO |
$59.60
|
| Rate for Payer: BCBS Trust/PPO |
$61.01
|
| Rate for Payer: BCN Commercial |
$73.79
|
| Rate for Payer: BCN Commercial |
$79.46
|
| Rate for Payer: BCN Commercial |
$61.01
|
| Rate for Payer: BCN Commercial |
$55.34
|
| Rate for Payer: BCN Commercial |
$69.53
|
| Rate for Payer: BCN Commercial |
$42.15
|
| Rate for Payer: BCN Commercial |
$59.60
|
| Rate for Payer: BCN Commercial |
$56.20
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cash Price |
$57.29
|
| Rate for Payer: Cash Price |
$76.38
|
| Rate for Payer: Cash Price |
$63.16
|
| Rate for Payer: Cash Price |
$43.63
|
| Rate for Payer: Cash Price |
$71.98
|
| Rate for Payer: Cash Price |
$82.26
|
| Rate for Payer: Cash Price |
$61.70
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Cofinity Commercial |
$88.43
|
| Rate for Payer: Cofinity Commercial |
$82.11
|
| Rate for Payer: Cofinity Commercial |
$77.37
|
| Rate for Payer: Cofinity Commercial |
$46.90
|
| Rate for Payer: Cofinity Commercial |
$67.90
|
| Rate for Payer: Cofinity Commercial |
$61.58
|
| Rate for Payer: Cofinity Commercial |
$66.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.29
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$49.09
|
| Rate for Payer: Healthscope Commercial |
$64.45
|
| Rate for Payer: Healthscope Commercial |
$65.45
|
| Rate for Payer: Healthscope Commercial |
$69.41
|
| Rate for Payer: Healthscope Commercial |
$80.97
|
| Rate for Payer: Healthscope Commercial |
$85.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$67.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$46.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$76.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$81.16
|
| Rate for Payer: PHP Commercial |
$87.40
|
| Rate for Payer: PHP Commercial |
$61.81
|
| Rate for Payer: PHP Commercial |
$67.11
|
| Rate for Payer: PHP Commercial |
$76.47
|
| Rate for Payer: PHP Commercial |
$60.87
|
| Rate for Payer: PHP Commercial |
$81.16
|
| Rate for Payer: PHP Commercial |
$46.36
|
| Rate for Payer: PHP Commercial |
$65.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$47.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.48
|
| Rate for Payer: UHC Core |
$65.92
|
| Rate for Payer: UHC Core |
$45.54
|
| Rate for Payer: UHC Core |
$79.73
|
| Rate for Payer: UHC Core |
$85.85
|
| Rate for Payer: UHC Core |
$59.79
|
| Rate for Payer: UHC Core |
$60.72
|
| Rate for Payer: UHC Core |
$75.12
|
| Rate for Payer: UHC Core |
$64.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$67.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.61
|
|
|
PROPOFOL 10 MG/ML IV (CODE)
|
Facility
|
IP
|
$72.72
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
163729
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$65.45 |
| Rate for Payer: Aetna Commercial |
$61.81
|
| Rate for Payer: BCBS Trust/PPO |
$56.20
|
| Rate for Payer: BCN Commercial |
$56.20
|
| Rate for Payer: Cash Price |
$58.18
|
| Rate for Payer: Cofinity Commercial |
$62.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.18
|
| Rate for Payer: Healthscope Commercial |
$65.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.81
|
| Rate for Payer: PHP Commercial |
$61.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.99
|
| Rate for Payer: UHC Core |
$60.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.54
|
|
|
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 |
$1,193.95
|
| Rate for Payer: Aetna Medicare |
$926.65
|
| Rate for Payer: BCBS Complete |
$615.93
|
| Rate for Payer: BCBS MAPPO |
$891.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.26
|
| Rate for Payer: BCN Commercial |
$1,346.31
|
| Rate for Payer: BCN Medicare Advantage |
$891.01
|
| Rate for Payer: Cash Price |
$2,819.20
|
| Rate for Payer: Cash Price |
$2,819.20
|
| Rate for Payer: Cofinity Commercial |
$1,283.05
|
| Rate for Payer: Cofinity Commercial |
$1,193.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$891.01
|
| Rate for Payer: Mclaren Medicaid |
$586.60
|
| Rate for Payer: Meridian Medicaid |
$615.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$935.56
|
| Rate for Payer: PACE SWMI |
$891.01
|
| Rate for Payer: PHP Medicare Advantage |
$891.01
|
| 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 Medicare |
$891.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,406.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$891.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$891.01
|
| Rate for Payer: UHC Medicare Advantage |
$917.74
|
|
|
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 |
$1,103.01
|
| Rate for Payer: Aetna Medicare |
$856.07
|
| Rate for Payer: BCBS Complete |
$570.09
|
| Rate for Payer: BCBS MAPPO |
$823.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.11
|
| Rate for Payer: BCN Commercial |
$1,246.61
|
| Rate for Payer: BCN Medicare Advantage |
$823.14
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cofinity Commercial |
$1,185.32
|
| Rate for Payer: Cofinity Commercial |
$1,103.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.14
|
| Rate for Payer: Mclaren Medicaid |
$542.94
|
| Rate for Payer: Meridian Medicaid |
$570.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$864.30
|
| Rate for Payer: PACE SWMI |
$823.14
|
| Rate for Payer: PHP Medicare Advantage |
$823.14
|
| 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 Medicare |
$823.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,302.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$823.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$823.14
|
| Rate for Payer: UHC Medicare Advantage |
$847.83
|
|
|
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 |
$1,220.42
|
| Rate for Payer: Aetna Medicare |
$947.19
|
| Rate for Payer: BCBS Complete |
$630.24
|
| Rate for Payer: BCBS MAPPO |
$910.76
|
| Rate for Payer: BCBS Trust/PPO |
$977.36
|
| Rate for Payer: BCN Commercial |
$1,377.09
|
| Rate for Payer: BCN Medicare Advantage |
$910.76
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cofinity Commercial |
$1,311.49
|
| Rate for Payer: Cofinity Commercial |
$1,220.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$910.76
|
| Rate for Payer: Mclaren Medicaid |
$600.23
|
| Rate for Payer: Meridian Medicaid |
$630.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$956.30
|
| Rate for Payer: PACE SWMI |
$910.76
|
| Rate for Payer: PHP Medicare Advantage |
$910.76
|
| 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 Medicare |
$910.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,439.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$910.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$910.76
|
| Rate for Payer: UHC Medicare Advantage |
$938.08
|
|
|
PROPRANOLOL 10 MG TABLET
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
NDC 0115-1659-01
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.99 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: BCBS Trust/PPO |
$272.41
|
| Rate for Payer: BCN Commercial |
$272.41
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$299.62
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$306.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.20
|
| Rate for Payer: UHC Core |
$294.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
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 |
$217.86 |
| Max. Negotiated Rate |
$321.48 |
| Rate for Payer: Aetna Commercial |
$303.62
|
| Rate for Payer: BCBS Trust/PPO |
$276.04
|
| Rate for Payer: BCN Commercial |
$276.04
|
| Rate for Payer: Cash Price |
$285.76
|
| Rate for Payer: Cofinity Commercial |
$307.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$285.76
|
| Rate for Payer: Healthscope Commercial |
$321.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$267.90
|
| 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 HMO/PPO/Tiered Network |
$310.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$314.34
|
| Rate for Payer: UHC Core |
$298.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$267.90
|
|
|
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 |
$12.12 |
| Max. Negotiated Rate |
$17.88 |
| Rate for Payer: Aetna Commercial |
$16.89
|
| Rate for Payer: Aetna Commercial |
$23.41
|
| Rate for Payer: BCBS Trust/PPO |
$21.28
|
| Rate for Payer: BCBS Trust/PPO |
$15.36
|
| Rate for Payer: BCN Commercial |
$15.36
|
| Rate for Payer: BCN Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$22.03
|
| Rate for Payer: Cofinity Commercial |
$17.09
|
| Rate for Payer: Cofinity Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.03
|
| Rate for Payer: Healthscope Commercial |
$24.79
|
| Rate for Payer: Healthscope Commercial |
$17.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.89
|
| Rate for Payer: PHP Commercial |
$16.89
|
| Rate for Payer: PHP Commercial |
$23.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.24
|
| Rate for Payer: UHC Core |
$16.59
|
| Rate for Payer: UHC Core |
$23.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.66
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$223.73
|
|
|
Service Code
|
NDC 50268-701-15
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.45 |
| Max. Negotiated Rate |
$201.36 |
| Rate for Payer: Aetna Commercial |
$190.17
|
| Rate for Payer: BCBS Trust/PPO |
$172.90
|
| Rate for Payer: BCN Commercial |
$172.90
|
| Rate for Payer: Cash Price |
$178.98
|
| Rate for Payer: Cofinity Commercial |
$192.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.98
|
| Rate for Payer: Healthscope Commercial |
$201.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.17
|
| Rate for Payer: PHP Commercial |
$190.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.88
|
| Rate for Payer: UHC Core |
$186.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.80
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$165.78
|
|
|
Service Code
|
NDC 0904-6705-06
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.11 |
| Max. Negotiated Rate |
$149.20 |
| Rate for Payer: Aetna Commercial |
$140.91
|
| Rate for Payer: BCBS Trust/PPO |
$128.11
|
| Rate for Payer: BCN Commercial |
$128.11
|
| Rate for Payer: Cash Price |
$132.62
|
| Rate for Payer: Cofinity Commercial |
$142.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.62
|
| Rate for Payer: Healthscope Commercial |
$149.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.91
|
| Rate for Payer: PHP Commercial |
$140.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.89
|
| Rate for Payer: UHC Core |
$138.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.34
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$4.48
|
|
|
Service Code
|
NDC 50268-701-11
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: BCBS Trust/PPO |
$3.46
|
| Rate for Payer: BCN Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cofinity Commercial |
$3.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$4.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.81
|
| Rate for Payer: PHP Commercial |
$3.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.94
|
| Rate for Payer: UHC Core |
$3.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.36
|
|
|
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 |
$170.35 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: BCBS Trust/PPO |
$215.84
|
| Rate for Payer: BCN Commercial |
$215.84
|
| Rate for Payer: Cash Price |
$223.44
|
| Rate for Payer: Cofinity Commercial |
$240.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.44
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.48
|
| 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 HMO/PPO/Tiered Network |
$242.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$170.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.48
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$315.40
|
|
|
Service Code
|
NDC 0378-0183-01
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.36 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: BCBS Trust/PPO |
$243.74
|
| Rate for Payer: BCN Commercial |
$243.74
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$268.09
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$274.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.55
|
| Rate for Payer: UHC Core |
$263.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$8.54
|
|
|
Service Code
|
NDC 60687-215-11
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$7.69 |
| Rate for Payer: Aetna Commercial |
$7.26
|
| Rate for Payer: BCBS Trust/PPO |
$6.60
|
| Rate for Payer: BCN Commercial |
$6.60
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cofinity Commercial |
$7.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.83
|
| Rate for Payer: Healthscope Commercial |
$7.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.26
|
| Rate for Payer: PHP Commercial |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.52
|
| Rate for Payer: UHC Core |
$7.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.40
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$853.44
|
|
|
Service Code
|
NDC 60687-215-01
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$520.51 |
| Max. Negotiated Rate |
$768.10 |
| Rate for Payer: Aetna Commercial |
$725.42
|
| Rate for Payer: BCBS Trust/PPO |
$659.54
|
| Rate for Payer: BCN Commercial |
$659.54
|
| Rate for Payer: Cash Price |
$682.75
|
| Rate for Payer: Cofinity Commercial |
$733.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.75
|
| Rate for Payer: Healthscope Commercial |
$768.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$640.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$725.42
|
| Rate for Payer: PHP Commercial |
$725.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$742.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$520.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.03
|
| Rate for Payer: UHC Core |
$712.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$640.08
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$285.12
|
|
|
Service Code
|
NDC 51991-818-01
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.89 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: BCBS Trust/PPO |
$220.34
|
| Rate for Payer: BCN Commercial |
$220.34
|
| Rate for Payer: Cash Price |
$228.10
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$228.10
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$242.35
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.91
|
| Rate for Payer: UHC Core |
$238.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.84
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$2,260.07 |
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: Aetna Medicare |
$17.98
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$17.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,260.07
|
| Rate for Payer: BCN Commercial |
$25.90
|
| Rate for Payer: BCN Medicare Advantage |
$17.29
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$24.90
|
| Rate for Payer: Cofinity Commercial |
$23.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.15
|
| Rate for Payer: PACE SWMI |
$17.29
|
| Rate for Payer: PHP Medicare Advantage |
$17.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.80
|
| Rate for Payer: Priority Health Medicare |
$17.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.29
|
| Rate for Payer: UHC Medicare Advantage |
$17.81
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,403.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$421.53 |
| Max. Negotiated Rate |
$2,382.10 |
| Rate for Payer: Aetna Commercial |
$857.72
|
| Rate for Payer: Aetna Medicare |
$665.69
|
| Rate for Payer: BCBS Complete |
$442.61
|
| Rate for Payer: BCBS MAPPO |
$640.09
|
| Rate for Payer: BCBS Trust/PPO |
$455.39
|
| Rate for Payer: BCN Commercial |
$956.34
|
| Rate for Payer: BCN Medicare Advantage |
$640.09
|
| Rate for Payer: Cash Price |
$2,722.40
|
| Rate for Payer: Cash Price |
$2,722.40
|
| Rate for Payer: Cofinity Commercial |
$921.73
|
| Rate for Payer: Cofinity Commercial |
$857.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.09
|
| Rate for Payer: Mclaren Medicaid |
$421.53
|
| Rate for Payer: Meridian Medicaid |
$442.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$672.09
|
| Rate for Payer: PACE SWMI |
$640.09
|
| Rate for Payer: PHP Medicare Advantage |
$640.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$421.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,382.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$999.34
|
| Rate for Payer: Priority Health Medicare |
$640.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$999.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$640.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$640.09
|
| Rate for Payer: UHC Medicare Advantage |
$659.29
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$3,813.42
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$2,860.15 |
| Rate for Payer: Aetna Commercial |
$2,479.88
|
| Rate for Payer: Aetna Medicare |
$1,924.69
|
| Rate for Payer: BCBS Complete |
$1,259.37
|
| Rate for Payer: BCBS MAPPO |
$1,850.66
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: BCN Commercial |
$2,737.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.66
|
| Rate for Payer: Cash Price |
$3,050.74
|
| Rate for Payer: Cash Price |
$3,050.74
|
| Rate for Payer: Cofinity Commercial |
$2,479.88
|
| Rate for Payer: Cofinity Commercial |
$2,664.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.66
|
| Rate for Payer: Mclaren Medicaid |
$1,199.40
|
| Rate for Payer: Meridian Medicaid |
$1,259.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,943.19
|
| Rate for Payer: PACE SWMI |
$1,850.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,199.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,669.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,860.15
|
| Rate for Payer: Priority Health Medicare |
$1,850.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,860.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,850.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,850.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,906.18
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$4,574.00
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$1,056.05 |
| Max. Negotiated Rate |
$3,201.80 |
| Rate for Payer: Aetna Commercial |
$2,178.33
|
| Rate for Payer: Aetna Medicare |
$1,690.64
|
| Rate for Payer: BCBS Complete |
$1,108.85
|
| Rate for Payer: BCBS MAPPO |
$1,625.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.43
|
| Rate for Payer: BCN Commercial |
$2,406.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,625.62
|
| Rate for Payer: Cash Price |
$3,659.20
|
| Rate for Payer: Cash Price |
$3,659.20
|
| Rate for Payer: Cofinity Commercial |
$2,340.89
|
| Rate for Payer: Cofinity Commercial |
$2,178.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,625.62
|
| Rate for Payer: Mclaren Medicaid |
$1,056.05
|
| Rate for Payer: Meridian Medicaid |
$1,108.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,706.90
|
| Rate for Payer: PACE SWMI |
$1,625.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,625.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,056.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,201.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,514.94
|
| Rate for Payer: Priority Health Medicare |
$1,625.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,514.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,625.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,625.62
|
| Rate for Payer: UHC Medicare Advantage |
$1,674.39
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$2,946.00
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$470.30 |
| Max. Negotiated Rate |
$2,062.20 |
| Rate for Payer: Aetna Commercial |
$949.47
|
| Rate for Payer: Aetna Medicare |
$736.90
|
| Rate for Payer: BCBS Complete |
$493.82
|
| Rate for Payer: BCBS MAPPO |
$708.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,258.80
|
| Rate for Payer: BCN Commercial |
$1,056.52
|
| Rate for Payer: BCN Medicare Advantage |
$708.56
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cofinity Commercial |
$1,020.33
|
| Rate for Payer: Cofinity Commercial |
$949.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.56
|
| Rate for Payer: Mclaren Medicaid |
$470.30
|
| Rate for Payer: Meridian Medicaid |
$493.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$743.99
|
| Rate for Payer: PACE SWMI |
$708.56
|
| Rate for Payer: PHP Medicare Advantage |
$708.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,062.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,104.02
|
| Rate for Payer: Priority Health Medicare |
$708.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,104.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$708.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$708.56
|
| Rate for Payer: UHC Medicare Advantage |
$729.82
|
|
