|
PROPYLENE GLYCOL 0.6 % EYE DROPS
|
Facility
|
IP
|
$36.93
|
|
|
Service Code
|
NDC 65048111
|
| Hospital Charge Code |
106794
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.52 |
| Max. Negotiated Rate |
$33.24 |
| Rate for Payer: Aetna Commercial |
$31.39
|
| Rate for Payer: BCBS Trust/PPO |
$28.54
|
| Rate for Payer: BCN Commercial |
$28.54
|
| Rate for Payer: Cash Price |
$29.54
|
| Rate for Payer: Cofinity Commercial |
$31.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.54
|
| Rate for Payer: Healthscope Commercial |
$33.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.39
|
| Rate for Payer: PHP Commercial |
$31.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.50
|
| Rate for Payer: UHC Core |
$30.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.70
|
|
|
PR ORAL DEXAMETHASONE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J8540
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna Medicare |
$0.11
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.10
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.14
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.11
|
| Rate for Payer: PACE SWMI |
$0.10
|
| Rate for Payer: PHP Medicare Advantage |
$0.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health Medicare |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.10
|
| Rate for Payer: UHC Medicare Advantage |
$0.11
|
|
|
PR ORAL POLIOVIRUS IMMUNIZATN,LIVE,OPC
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 90712
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
|
|
PR ORAL PRESCRIP DRUG NON CHEMO
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J8499
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
|
|
PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95933
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$120.21 |
| Rate for Payer: Aetna Commercial |
$104.52
|
| Rate for Payer: Aetna Medicare |
$81.12
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: BCBS MAPPO |
$78.00
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCN Commercial |
$120.21
|
| Rate for Payer: BCN Medicare Advantage |
$78.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$112.32
|
| Rate for Payer: Cofinity Commercial |
$104.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.90
|
| Rate for Payer: PACE SWMI |
$78.00
|
| Rate for Payer: PHP Medicare Advantage |
$78.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.49
|
| Rate for Payer: Priority Health Medicare |
$78.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.00
|
| Rate for Payer: UHC Medicare Advantage |
$80.34
|
|
|
PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ
|
Professional
|
Both
|
$7,800.00
|
|
|
Service Code
|
HCPCS 61584
|
| Min. Negotiated Rate |
$420.53 |
| Max. Negotiated Rate |
$5,935.30 |
| Rate for Payer: Aetna Commercial |
$3,882.05
|
| Rate for Payer: Aetna Medicare |
$3,012.93
|
| Rate for Payer: BCBS Complete |
$1,950.90
|
| Rate for Payer: BCBS MAPPO |
$2,897.05
|
| Rate for Payer: BCBS Trust/PPO |
$420.53
|
| Rate for Payer: BCN Commercial |
$5,935.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,897.05
|
| Rate for Payer: Cash Price |
$6,240.00
|
| Rate for Payer: Cash Price |
$6,240.00
|
| Rate for Payer: Cofinity Commercial |
$4,171.75
|
| Rate for Payer: Cofinity Commercial |
$3,882.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,897.05
|
| Rate for Payer: Mclaren Medicaid |
$1,858.00
|
| Rate for Payer: Meridian Medicaid |
$1,950.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,041.90
|
| Rate for Payer: PACE SWMI |
$2,897.05
|
| Rate for Payer: PHP Medicare Advantage |
$2,897.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,858.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,460.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,957.28
|
| Rate for Payer: Priority Health Medicare |
$2,897.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4,957.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,897.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,897.05
|
| Rate for Payer: UHC Medicare Advantage |
$2,983.96
|
|
|
PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE
|
Professional
|
Both
|
$5,646.00
|
|
|
Service Code
|
HCPCS 61592
|
| Min. Negotiated Rate |
$397.28 |
| Max. Negotiated Rate |
$6,472.23 |
| Rate for Payer: Aetna Commercial |
$4,243.40
|
| Rate for Payer: Aetna Medicare |
$3,293.39
|
| Rate for Payer: BCBS Complete |
$2,148.60
|
| Rate for Payer: BCBS MAPPO |
$3,166.72
|
| Rate for Payer: BCBS Trust/PPO |
$397.28
|
| Rate for Payer: BCN Commercial |
$6,472.23
|
| Rate for Payer: BCN Medicare Advantage |
$3,166.72
|
| Rate for Payer: Cash Price |
$4,516.80
|
| Rate for Payer: Cash Price |
$4,516.80
|
| Rate for Payer: Cofinity Commercial |
$4,243.40
|
| Rate for Payer: Cofinity Commercial |
$4,560.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,166.72
|
| Rate for Payer: Mclaren Medicaid |
$2,046.29
|
| Rate for Payer: Meridian Medicaid |
$2,148.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,325.06
|
| Rate for Payer: PACE SWMI |
$3,166.72
|
| Rate for Payer: PHP Medicare Advantage |
$3,166.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,046.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,952.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,405.73
|
| Rate for Payer: Priority Health Medicare |
$3,166.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,405.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,166.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,166.72
|
| Rate for Payer: UHC Medicare Advantage |
$3,261.72
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN
|
Professional
|
Both
|
$3,518.00
|
|
|
Service Code
|
HCPCS 67445
|
| Min. Negotiated Rate |
$348.68 |
| Max. Negotiated Rate |
$2,656.05 |
| Rate for Payer: Aetna Commercial |
$1,965.58
|
| Rate for Payer: Aetna Medicare |
$1,525.52
|
| Rate for Payer: BCBS Complete |
$1,017.61
|
| Rate for Payer: BCBS MAPPO |
$1,466.85
|
| Rate for Payer: BCBS Trust/PPO |
$348.68
|
| Rate for Payer: BCN Commercial |
$2,217.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,466.85
|
| Rate for Payer: Cash Price |
$2,814.40
|
| Rate for Payer: Cash Price |
$2,814.40
|
| Rate for Payer: Cofinity Commercial |
$2,112.26
|
| Rate for Payer: Cofinity Commercial |
$1,965.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.85
|
| Rate for Payer: Mclaren Medicaid |
$969.15
|
| Rate for Payer: Meridian Medicaid |
$1,017.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,540.19
|
| Rate for Payer: PACE SWMI |
$1,466.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,466.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$969.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,462.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,656.05
|
| Rate for Payer: Priority Health Medicare |
$1,466.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,656.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,466.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,466.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,510.86
|
|
|
PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY
|
Professional
|
Both
|
$1,629.00
|
|
|
Service Code
|
HCPCS 67400
|
| Min. Negotiated Rate |
$359.77 |
| Max. Negotiated Rate |
$1,807.79 |
| Rate for Payer: Aetna Commercial |
$1,329.36
|
| Rate for Payer: Aetna Medicare |
$1,031.74
|
| Rate for Payer: BCBS Complete |
$691.97
|
| Rate for Payer: BCBS MAPPO |
$992.06
|
| Rate for Payer: BCBS Trust/PPO |
$359.77
|
| Rate for Payer: BCN Commercial |
$1,509.04
|
| Rate for Payer: BCN Medicare Advantage |
$992.06
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,303.20
|
| Rate for Payer: Cofinity Commercial |
$1,329.36
|
| Rate for Payer: Cofinity Commercial |
$1,428.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$992.06
|
| Rate for Payer: Mclaren Medicaid |
$659.02
|
| Rate for Payer: Meridian Medicaid |
$691.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,041.66
|
| Rate for Payer: PACE SWMI |
$992.06
|
| Rate for Payer: PHP Medicare Advantage |
$992.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$659.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,140.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,807.79
|
| Rate for Payer: Priority Health Medicare |
$992.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,807.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$992.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$992.06
|
| Rate for Payer: UHC Medicare Advantage |
$1,021.82
|
|
|
PR ORCHIECTOMY PARTIAL
|
Professional
|
Both
|
$1,081.00
|
|
|
Service Code
|
HCPCS 54522
|
| Min. Negotiated Rate |
$374.88 |
| Max. Negotiated Rate |
$1,501.96 |
| Rate for Payer: Aetna Commercial |
$769.04
|
| Rate for Payer: Aetna Medicare |
$596.87
|
| Rate for Payer: BCBS Complete |
$393.62
|
| Rate for Payer: BCBS MAPPO |
$573.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,501.96
|
| Rate for Payer: BCN Commercial |
$848.84
|
| Rate for Payer: BCN Medicare Advantage |
$573.91
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cash Price |
$864.80
|
| Rate for Payer: Cofinity Commercial |
$826.43
|
| Rate for Payer: Cofinity Commercial |
$769.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$573.91
|
| Rate for Payer: Mclaren Medicaid |
$374.88
|
| Rate for Payer: Meridian Medicaid |
$393.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$602.61
|
| Rate for Payer: PACE SWMI |
$573.91
|
| Rate for Payer: PHP Medicare Advantage |
$573.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$756.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$938.60
|
| Rate for Payer: Priority Health Medicare |
$573.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$938.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$573.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$573.91
|
| Rate for Payer: UHC Medicare Advantage |
$591.13
|
|
|
PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Professional
|
Both
|
$950.00
|
|
|
Service Code
|
HCPCS 54530
|
| Min. Negotiated Rate |
$325.89 |
| Max. Negotiated Rate |
$2,667.39 |
| Rate for Payer: Aetna Commercial |
$665.95
|
| Rate for Payer: Aetna Medicare |
$516.86
|
| Rate for Payer: BCBS Complete |
$342.18
|
| Rate for Payer: BCBS MAPPO |
$496.98
|
| Rate for Payer: BCBS Trust/PPO |
$2,667.39
|
| Rate for Payer: BCN Commercial |
$736.93
|
| Rate for Payer: BCN Medicare Advantage |
$496.98
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cash Price |
$760.00
|
| Rate for Payer: Cofinity Commercial |
$715.65
|
| Rate for Payer: Cofinity Commercial |
$665.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$496.98
|
| Rate for Payer: Mclaren Medicaid |
$325.89
|
| Rate for Payer: Meridian Medicaid |
$342.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$521.83
|
| Rate for Payer: PACE SWMI |
$496.98
|
| Rate for Payer: PHP Medicare Advantage |
$496.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$325.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$665.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$814.86
|
| Rate for Payer: Priority Health Medicare |
$496.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$814.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$496.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$496.98
|
| Rate for Payer: UHC Medicare Advantage |
$511.89
|
|
|
PR ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL
|
Professional
|
Both
|
$1,374.00
|
|
|
Service Code
|
HCPCS 54535
|
| Min. Negotiated Rate |
$474.14 |
| Max. Negotiated Rate |
$3,333.04 |
| Rate for Payer: Aetna Commercial |
$973.83
|
| Rate for Payer: Aetna Medicare |
$755.81
|
| Rate for Payer: BCBS Complete |
$497.85
|
| Rate for Payer: BCBS MAPPO |
$726.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,333.04
|
| Rate for Payer: BCN Commercial |
$1,073.63
|
| Rate for Payer: BCN Medicare Advantage |
$726.74
|
| Rate for Payer: Cash Price |
$1,099.20
|
| Rate for Payer: Cash Price |
$1,099.20
|
| Rate for Payer: Cofinity Commercial |
$973.83
|
| Rate for Payer: Cofinity Commercial |
$1,046.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$726.74
|
| Rate for Payer: Mclaren Medicaid |
$474.14
|
| Rate for Payer: Meridian Medicaid |
$497.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$763.08
|
| Rate for Payer: PACE SWMI |
$726.74
|
| Rate for Payer: PHP Medicare Advantage |
$726.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$474.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$961.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,187.16
|
| Rate for Payer: Priority Health Medicare |
$726.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,187.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$726.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$726.74
|
| Rate for Payer: UHC Medicare Advantage |
$748.54
|
|
|
PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Professional
|
Both
|
$603.00
|
|
|
Service Code
|
HCPCS 54520
|
| Min. Negotiated Rate |
$210.66 |
| Max. Negotiated Rate |
$2,233.12 |
| Rate for Payer: Aetna Commercial |
$429.09
|
| Rate for Payer: Aetna Medicare |
$333.03
|
| Rate for Payer: BCBS Complete |
$221.19
|
| Rate for Payer: BCBS MAPPO |
$320.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,233.12
|
| Rate for Payer: BCN Commercial |
$475.49
|
| Rate for Payer: BCN Medicare Advantage |
$320.22
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cofinity Commercial |
$429.09
|
| Rate for Payer: Cofinity Commercial |
$461.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.22
|
| Rate for Payer: Mclaren Medicaid |
$210.66
|
| Rate for Payer: Meridian Medicaid |
$221.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$336.23
|
| Rate for Payer: PACE SWMI |
$320.22
|
| Rate for Payer: PHP Medicare Advantage |
$320.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$525.76
|
| Rate for Payer: Priority Health Medicare |
$320.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$525.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.22
|
| Rate for Payer: UHC Medicare Advantage |
$329.83
|
|
|
PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$1,470.00
|
|
|
Service Code
|
HCPCS 54650
|
| Min. Negotiated Rate |
$454.54 |
| Max. Negotiated Rate |
$2,517.35 |
| Rate for Payer: Aetna Commercial |
$931.94
|
| Rate for Payer: Aetna Medicare |
$723.30
|
| Rate for Payer: BCBS Complete |
$477.27
|
| Rate for Payer: BCBS MAPPO |
$695.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,517.35
|
| Rate for Payer: BCN Commercial |
$1,028.66
|
| Rate for Payer: BCN Medicare Advantage |
$695.48
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cash Price |
$1,176.00
|
| Rate for Payer: Cofinity Commercial |
$931.94
|
| Rate for Payer: Cofinity Commercial |
$1,001.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.48
|
| Rate for Payer: Mclaren Medicaid |
$454.54
|
| Rate for Payer: Meridian Medicaid |
$477.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$730.25
|
| Rate for Payer: PACE SWMI |
$695.48
|
| Rate for Payer: PHP Medicare Advantage |
$695.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$454.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,137.46
|
| Rate for Payer: Priority Health Medicare |
$695.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,137.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.48
|
| Rate for Payer: UHC Medicare Advantage |
$716.34
|
|
|
PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH
|
Professional
|
Both
|
$1,722.00
|
|
|
Service Code
|
HCPCS 54640
|
| Min. Negotiated Rate |
$275.20 |
| Max. Negotiated Rate |
$2,048.75 |
| Rate for Payer: Aetna Commercial |
$566.43
|
| Rate for Payer: Aetna Medicare |
$439.62
|
| Rate for Payer: BCBS Complete |
$288.96
|
| Rate for Payer: BCBS MAPPO |
$422.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,048.75
|
| Rate for Payer: BCN Commercial |
$623.55
|
| Rate for Payer: BCN Medicare Advantage |
$422.71
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cash Price |
$1,377.60
|
| Rate for Payer: Cofinity Commercial |
$608.70
|
| Rate for Payer: Cofinity Commercial |
$566.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.71
|
| Rate for Payer: Mclaren Medicaid |
$275.20
|
| Rate for Payer: Meridian Medicaid |
$288.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$443.85
|
| Rate for Payer: PACE SWMI |
$422.71
|
| Rate for Payer: PHP Medicare Advantage |
$422.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,205.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$689.50
|
| Rate for Payer: Priority Health Medicare |
$422.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$689.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$422.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$422.71
|
| Rate for Payer: UHC Medicare Advantage |
$435.39
|
|
|
PR ORPHENADRINE INJECTION
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS J2360
|
| Min. Negotiated Rate |
$5.01 |
| Max. Negotiated Rate |
$23.81 |
| Rate for Payer: Aetna Commercial |
$22.16
|
| Rate for Payer: Aetna Medicare |
$17.20
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$16.54
|
| Rate for Payer: BCBS Trust/PPO |
$9.88
|
| Rate for Payer: BCN Commercial |
$5.01
|
| Rate for Payer: BCN Medicare Advantage |
$16.54
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$23.81
|
| Rate for Payer: Cofinity Commercial |
$22.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.36
|
| Rate for Payer: PACE SWMI |
$16.54
|
| Rate for Payer: PHP Medicare Advantage |
$16.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health Medicare |
$16.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.54
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
|
|
PR ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 97760
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$466.49 |
| Rate for Payer: Aetna Commercial |
$62.08
|
| Rate for Payer: Aetna Medicare |
$48.18
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS MAPPO |
$46.33
|
| Rate for Payer: BCBS Trust/PPO |
$466.49
|
| Rate for Payer: BCN Commercial |
$70.86
|
| Rate for Payer: BCN Medicare Advantage |
$46.33
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$62.08
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.65
|
| Rate for Payer: PACE SWMI |
$46.33
|
| Rate for Payer: PHP Medicare Advantage |
$46.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$46.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.33
|
| Rate for Payer: UHC Medicare Advantage |
$47.72
|
|
|
PR ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 97763
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$674.11 |
| Rate for Payer: Aetna Commercial |
$67.79
|
| Rate for Payer: Aetna Medicare |
$52.61
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS MAPPO |
$50.59
|
| Rate for Payer: BCBS Trust/PPO |
$674.11
|
| Rate for Payer: BCN Commercial |
$77.70
|
| Rate for Payer: BCN Medicare Advantage |
$50.59
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$67.79
|
| Rate for Payer: Cofinity Commercial |
$72.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.12
|
| Rate for Payer: PACE SWMI |
$50.59
|
| Rate for Payer: PHP Medicare Advantage |
$50.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$50.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.59
|
| Rate for Payer: UHC Medicare Advantage |
$52.11
|
|
|
PR OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC
|
Professional
|
Both
|
$1,900.00
|
|
|
Service Code
|
HCPCS 28114
|
| Min. Negotiated Rate |
$539.10 |
| Max. Negotiated Rate |
$1,554.48 |
| Rate for Payer: Aetna Commercial |
$1,095.24
|
| Rate for Payer: Aetna Medicare |
$850.03
|
| Rate for Payer: BCBS Complete |
$566.06
|
| Rate for Payer: BCBS MAPPO |
$817.34
|
| Rate for Payer: BCBS Trust/PPO |
$864.83
|
| Rate for Payer: BCN Commercial |
$1,554.48
|
| Rate for Payer: BCN Medicare Advantage |
$817.34
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cash Price |
$1,520.00
|
| Rate for Payer: Cofinity Commercial |
$1,176.97
|
| Rate for Payer: Cofinity Commercial |
$1,095.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$817.34
|
| Rate for Payer: Mclaren Medicaid |
$539.10
|
| Rate for Payer: Meridian Medicaid |
$566.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$858.21
|
| Rate for Payer: PACE SWMI |
$817.34
|
| Rate for Payer: PHP Medicare Advantage |
$817.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$539.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,330.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,277.14
|
| Rate for Payer: Priority Health Medicare |
$817.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,277.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$817.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$817.34
|
| Rate for Payer: UHC Medicare Advantage |
$841.86
|
|
|
PR OSTC PRTL EXOSTC/CONDYLC METAR HEAD
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 28288
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$877.67 |
| Rate for Payer: Aetna Commercial |
$565.32
|
| Rate for Payer: Aetna Medicare |
$438.76
|
| Rate for Payer: BCBS Complete |
$295.44
|
| Rate for Payer: BCBS MAPPO |
$421.88
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCN Commercial |
$877.67
|
| Rate for Payer: BCN Medicare Advantage |
$421.88
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$607.51
|
| Rate for Payer: Cofinity Commercial |
$565.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$421.88
|
| Rate for Payer: Mclaren Medicaid |
$281.37
|
| Rate for Payer: Meridian Medicaid |
$295.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$442.97
|
| Rate for Payer: PACE SWMI |
$421.88
|
| Rate for Payer: PHP Medicare Advantage |
$421.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$281.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$678.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$661.81
|
| Rate for Payer: Priority Health Medicare |
$421.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$661.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$421.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$421.88
|
| Rate for Payer: UHC Medicare Advantage |
$434.54
|
|
|
PR OSTECTOMY CALCANEUS
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 28118
|
| Min. Negotiated Rate |
$273.07 |
| Max. Negotiated Rate |
$2,262.71 |
| Rate for Payer: Aetna Commercial |
$550.69
|
| Rate for Payer: Aetna Medicare |
$427.40
|
| Rate for Payer: BCBS Complete |
$286.72
|
| Rate for Payer: BCBS MAPPO |
$410.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,262.71
|
| Rate for Payer: BCN Commercial |
$877.67
|
| Rate for Payer: BCN Medicare Advantage |
$410.96
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cofinity Commercial |
$591.78
|
| Rate for Payer: Cofinity Commercial |
$550.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.96
|
| Rate for Payer: Mclaren Medicaid |
$273.07
|
| Rate for Payer: Meridian Medicaid |
$286.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$431.51
|
| Rate for Payer: PACE SWMI |
$410.96
|
| Rate for Payer: PHP Medicare Advantage |
$410.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$706.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.88
|
| Rate for Payer: Priority Health Medicare |
$410.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$641.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$410.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$410.96
|
| Rate for Payer: UHC Medicare Advantage |
$423.29
|
|
|
PR OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS
|
Professional
|
Both
|
$1,198.00
|
|
|
Service Code
|
HCPCS 28119
|
| Min. Negotiated Rate |
$235.37 |
| Max. Negotiated Rate |
$838.60 |
| Rate for Payer: Aetna Commercial |
$475.08
|
| Rate for Payer: Aetna Medicare |
$368.72
|
| Rate for Payer: BCBS Complete |
$247.14
|
| Rate for Payer: BCBS MAPPO |
$354.54
|
| Rate for Payer: BCBS Trust/PPO |
$811.47
|
| Rate for Payer: BCN Commercial |
$761.85
|
| Rate for Payer: BCN Medicare Advantage |
$354.54
|
| Rate for Payer: Cash Price |
$958.40
|
| Rate for Payer: Cash Price |
$958.40
|
| Rate for Payer: Cofinity Commercial |
$510.54
|
| Rate for Payer: Cofinity Commercial |
$475.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.54
|
| Rate for Payer: Mclaren Medicaid |
$235.37
|
| Rate for Payer: Meridian Medicaid |
$247.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$372.27
|
| Rate for Payer: PACE SWMI |
$354.54
|
| Rate for Payer: PHP Medicare Advantage |
$354.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$235.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$838.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$553.55
|
| Rate for Payer: Priority Health Medicare |
$354.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$553.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$354.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$354.54
|
| Rate for Payer: UHC Medicare Advantage |
$365.18
|
|
|
PR OSTECTOMY COMPLETE 1ST METATARSAL HEAD
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
HCPCS 28111
|
| Min. Negotiated Rate |
$205.33 |
| Max. Negotiated Rate |
$693.44 |
| Rate for Payer: Aetna Commercial |
$419.02
|
| Rate for Payer: Aetna Medicare |
$325.21
|
| Rate for Payer: BCBS Complete |
$215.60
|
| Rate for Payer: BCBS MAPPO |
$312.70
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$693.44
|
| Rate for Payer: BCN Medicare Advantage |
$312.70
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cofinity Commercial |
$450.29
|
| Rate for Payer: Cofinity Commercial |
$419.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.70
|
| Rate for Payer: Mclaren Medicaid |
$205.33
|
| Rate for Payer: Meridian Medicaid |
$215.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$328.34
|
| Rate for Payer: PACE SWMI |
$312.70
|
| Rate for Payer: PHP Medicare Advantage |
$312.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$570.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$486.66
|
| Rate for Payer: Priority Health Medicare |
$312.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$486.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$312.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$312.70
|
| Rate for Payer: UHC Medicare Advantage |
$322.08
|
|
|
PR OSTECTOMY COMPLETE 5TH METATARSAL HEAD
|
Professional
|
Both
|
$1,014.00
|
|
|
Service Code
|
HCPCS 28113
|
| Min. Negotiated Rate |
$275.41 |
| Max. Negotiated Rate |
$850.30 |
| Rate for Payer: Aetna Commercial |
$554.89
|
| Rate for Payer: Aetna Medicare |
$430.66
|
| Rate for Payer: BCBS Complete |
$289.18
|
| Rate for Payer: BCBS MAPPO |
$414.10
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: BCN Commercial |
$850.30
|
| Rate for Payer: BCN Medicare Advantage |
$414.10
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cofinity Commercial |
$554.89
|
| Rate for Payer: Cofinity Commercial |
$596.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.10
|
| Rate for Payer: Mclaren Medicaid |
$275.41
|
| Rate for Payer: Meridian Medicaid |
$289.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$434.80
|
| Rate for Payer: PACE SWMI |
$414.10
|
| Rate for Payer: PHP Medicare Advantage |
$414.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$709.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$649.04
|
| Rate for Payer: Priority Health Medicare |
$414.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$649.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$414.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$414.10
|
| Rate for Payer: UHC Medicare Advantage |
$426.52
|
|
|
PR OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4
|
Professional
|
Both
|
$952.00
|
|
|
Service Code
|
HCPCS 28112
|
| Min. Negotiated Rate |
$202.14 |
| Max. Negotiated Rate |
$1,106.26 |
| Rate for Payer: Aetna Commercial |
$409.73
|
| Rate for Payer: Aetna Medicare |
$318.00
|
| Rate for Payer: BCBS Complete |
$212.25
|
| Rate for Payer: BCBS MAPPO |
$305.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,106.26
|
| Rate for Payer: BCN Commercial |
$702.23
|
| Rate for Payer: BCN Medicare Advantage |
$305.77
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cofinity Commercial |
$440.31
|
| Rate for Payer: Cofinity Commercial |
$409.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.77
|
| Rate for Payer: Mclaren Medicaid |
$202.14
|
| Rate for Payer: Meridian Medicaid |
$212.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$321.06
|
| Rate for Payer: PACE SWMI |
$305.77
|
| Rate for Payer: PHP Medicare Advantage |
$305.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$202.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.96
|
| Rate for Payer: Priority Health Medicare |
$305.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$305.77
|
| Rate for Payer: UHC Medicare Advantage |
$314.94
|
|
