|
PROPAFENONE 150 MG TABLET
|
Facility
|
OP
|
$241.30
|
|
|
Service Code
|
NDC 53489055101
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.54 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: Aetna Medicare |
$62.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.41
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.41
|
| Rate for Payer: BCBS Complete |
$44.66
|
| Rate for Payer: BCBS MAPPO |
$60.33
|
| Rate for Payer: BCBS Trust/PPO |
$198.37
|
| Rate for Payer: BCN Commercial |
$198.37
|
| Rate for Payer: BCN Medicare Advantage |
$60.33
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.33
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Mclaren Medicaid |
$42.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.34
|
| Rate for Payer: Meridian Medicaid |
$44.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PACE Senior Care Partners |
$57.31
|
| Rate for Payer: PACE SWMI |
$60.33
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: PHP Medicare Advantage |
$60.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Medicare |
$60.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.94
|
| Rate for Payer: Railroad Medicare Medicare |
$60.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: UHC Exchange |
$60.33
|
| Rate for Payer: UHC Medicaid |
$42.54
|
| Rate for Payer: UHC Medicare Advantage |
$60.33
|
| Rate for Payer: UHCCP Medicaid |
$42.54
|
| Rate for Payer: VA VA |
$60.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
PROPAFENONE 150 MG TABLET
|
Facility
|
IP
|
$241.30
|
|
|
Service Code
|
NDC 53489055101
|
| Hospital Charge Code |
11146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.94 |
| Max. Negotiated Rate |
$217.17 |
| Rate for Payer: Aetna Commercial |
$205.10
|
| Rate for Payer: BCBS Trust/PPO |
$199.29
|
| Rate for Payer: BCN Commercial |
$199.29
|
| Rate for Payer: Cash Price |
$193.04
|
| Rate for Payer: Cofinity Commercial |
$207.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.04
|
| Rate for Payer: Healthscope Commercial |
$217.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$180.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.10
|
| Rate for Payer: Nomi Health Commercial |
$197.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.97
|
| Rate for Payer: PHP Commercial |
$205.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$209.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.34
|
| Rate for Payer: UHC Core |
$201.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$180.97
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: Aetna Medicare |
$29.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.54
|
| Rate for Payer: BCBS Complete |
$21.05
|
| Rate for Payer: BCBS MAPPO |
$28.43
|
| Rate for Payer: BCBS Trust/PPO |
$93.49
|
| Rate for Payer: BCN Commercial |
$93.49
|
| Rate for Payer: BCN Medicare Advantage |
$28.43
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.43
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Mclaren Medicaid |
$20.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.85
|
| Rate for Payer: Meridian Medicaid |
$21.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$31.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Nomi Health Commercial |
$93.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.29
|
| Rate for Payer: PACE Senior Care Partners |
$27.01
|
| Rate for Payer: PACE SWMI |
$28.43
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: PHP Medicare Advantage |
$28.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$98.94
|
| Rate for Payer: Priority Health Medicare |
$28.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.15
|
| Rate for Payer: Railroad Medicare Medicare |
$28.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.07
|
| Rate for Payer: UHC Core |
$94.96
|
| Rate for Payer: UHC Exchange |
$28.43
|
| Rate for Payer: UHC Medicaid |
$20.05
|
| Rate for Payer: UHC Medicare Advantage |
$28.43
|
| Rate for Payer: UHCCP Medicaid |
$20.05
|
| Rate for Payer: VA VA |
$28.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
OP
|
$99.54
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$89.59 |
| Rate for Payer: Aetna Commercial |
$84.61
|
| Rate for Payer: Aetna Medicare |
$25.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.11
|
| Rate for Payer: BCBS Complete |
$18.42
|
| Rate for Payer: BCBS MAPPO |
$24.89
|
| Rate for Payer: BCBS Trust/PPO |
$81.83
|
| Rate for Payer: BCN Commercial |
$81.83
|
| Rate for Payer: BCN Medicare Advantage |
$24.89
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.89
|
| Rate for Payer: Healthscope Commercial |
$89.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.66
|
| Rate for Payer: Mclaren Medicaid |
$17.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.13
|
| Rate for Payer: Meridian Medicaid |
$18.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$28.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$27.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.61
|
| Rate for Payer: Nomi Health Commercial |
$81.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.66
|
| Rate for Payer: PACE Senior Care Partners |
$23.64
|
| Rate for Payer: PACE SWMI |
$24.89
|
| Rate for Payer: PHP Commercial |
$84.61
|
| Rate for Payer: PHP Medicare Advantage |
$24.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$86.60
|
| Rate for Payer: Priority Health Medicare |
$25.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.28
|
| Rate for Payer: Railroad Medicare Medicare |
$24.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.60
|
| Rate for Payer: UHC Core |
$83.12
|
| Rate for Payer: UHC Exchange |
$24.89
|
| Rate for Payer: UHC Medicaid |
$17.55
|
| Rate for Payer: UHC Medicare Advantage |
$24.89
|
| Rate for Payer: UHCCP Medicaid |
$17.55
|
| Rate for Payer: VA VA |
$24.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.66
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$113.72
|
|
|
Service Code
|
NDC 17478026312
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.15 |
| Max. Negotiated Rate |
$102.35 |
| Rate for Payer: Aetna Commercial |
$96.66
|
| Rate for Payer: BCBS Trust/PPO |
$93.92
|
| Rate for Payer: BCN Commercial |
$93.92
|
| Rate for Payer: Cash Price |
$90.98
|
| Rate for Payer: Cofinity Commercial |
$97.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.98
|
| Rate for Payer: Healthscope Commercial |
$102.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.66
|
| Rate for Payer: Nomi Health Commercial |
$93.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.29
|
| Rate for Payer: PHP Commercial |
$96.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$98.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.07
|
| Rate for Payer: UHC Core |
$94.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.29
|
|
|
PROPARACAINE 0.5 % EYE DROPS
|
Facility
|
IP
|
$99.54
|
|
|
Service Code
|
NDC 61314001601
|
| Hospital Charge Code |
6644
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$89.59 |
| Rate for Payer: Aetna Commercial |
$84.61
|
| Rate for Payer: BCBS Trust/PPO |
$82.21
|
| Rate for Payer: BCN Commercial |
$82.21
|
| Rate for Payer: Cash Price |
$79.63
|
| Rate for Payer: Cofinity Commercial |
$85.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.63
|
| Rate for Payer: Healthscope Commercial |
$89.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.61
|
| Rate for Payer: Nomi Health Commercial |
$81.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.66
|
| Rate for Payer: PHP Commercial |
$84.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$86.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.60
|
| Rate for Payer: UHC Core |
$83.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.66
|
|
|
PR OPEN ABLATION 1/>RENAL MASS LESION CRYOSURGICAL
|
Professional
|
Both
|
$2,603.00
|
|
|
Service Code
|
HCPCS 50250
|
| Min. Negotiated Rate |
$693.95 |
| Max. Negotiated Rate |
$1,974.03 |
| Rate for Payer: Aetna Commercial |
$1,561.74
|
| Rate for Payer: Aetna Medicare |
$1,301.50
|
| Rate for Payer: BCBS Complete |
$728.65
|
| Rate for Payer: BCN Commercial |
$1,812.15
|
| Rate for Payer: Cash Price |
$2,082.40
|
| Rate for Payer: Cash Price |
$2,082.40
|
| Rate for Payer: Mclaren Medicaid |
$693.95
|
| Rate for Payer: Meridian Medicaid |
$728.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,952.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$693.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,974.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,974.03
|
| Rate for Payer: UHC Medicaid |
$693.95
|
| Rate for Payer: UHCCP Medicaid |
$693.95
|
|
|
PR OPEN BIOPSY/EXCISION INGUINOFEMORAL NODES
|
Professional
|
Both
|
$928.00
|
|
|
Service Code
|
HCPCS 38531
|
| Min. Negotiated Rate |
$275.84 |
| Max. Negotiated Rate |
$900.48 |
| Rate for Payer: Aetna Commercial |
$551.41
|
| Rate for Payer: Aetna Medicare |
$464.00
|
| Rate for Payer: BCBS Complete |
$289.63
|
| Rate for Payer: BCN Commercial |
$676.75
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Cash Price |
$742.40
|
| Rate for Payer: Mclaren Medicaid |
$275.84
|
| Rate for Payer: Meridian Medicaid |
$289.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$696.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$900.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$900.48
|
| Rate for Payer: UHC Medicaid |
$275.84
|
| Rate for Payer: UHCCP Medicaid |
$275.84
|
|
|
PR OPEN CLOSURE MAJOR BRONCHIAL FISTULA
|
Professional
|
Both
|
$4,925.00
|
|
|
Service Code
|
HCPCS 32815
|
| Min. Negotiated Rate |
$1,676.52 |
| Max. Negotiated Rate |
$4,126.27 |
| Rate for Payer: Aetna Commercial |
$3,626.68
|
| Rate for Payer: Aetna Medicare |
$2,462.50
|
| Rate for Payer: BCBS Complete |
$1,760.35
|
| Rate for Payer: BCN Commercial |
$4,126.27
|
| Rate for Payer: Cash Price |
$3,940.00
|
| Rate for Payer: Cash Price |
$3,940.00
|
| Rate for Payer: Mclaren Medicaid |
$1,676.52
|
| Rate for Payer: Meridian Medicaid |
$1,760.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,693.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,676.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,885.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,885.72
|
| Rate for Payer: UHC Medicaid |
$1,676.52
|
| Rate for Payer: UHCCP Medicaid |
$1,676.52
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 10.1-20 CM
|
Professional
|
Both
|
$4,192.00
|
|
|
Service Code
|
HCPCS 49188
|
| Min. Negotiated Rate |
$1,181.30 |
| Max. Negotiated Rate |
$3,659.96 |
| Rate for Payer: Aetna Medicare |
$2,096.00
|
| Rate for Payer: BCBS Complete |
$1,240.37
|
| Rate for Payer: BCN Commercial |
$3,003.82
|
| Rate for Payer: Cash Price |
$3,353.60
|
| Rate for Payer: Cash Price |
$3,353.60
|
| Rate for Payer: Mclaren Medicaid |
$1,181.30
|
| Rate for Payer: Meridian Medicaid |
$1,240.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,144.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,181.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,659.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,659.96
|
| Rate for Payer: UHC Medicaid |
$1,181.30
|
| Rate for Payer: UHCCP Medicaid |
$1,181.30
|
|
|
PR OPEN EXC/DSTRJ INTRA-ABDL TUMOR/CST 5 CM OR LESS
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 49186
|
| Min. Negotiated Rate |
$778.94 |
| Max. Negotiated Rate |
$2,396.70 |
| Rate for Payer: Aetna Medicare |
$1,387.50
|
| Rate for Payer: BCBS Complete |
$817.89
|
| Rate for Payer: BCN Commercial |
$1,967.02
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Mclaren Medicaid |
$778.94
|
| Rate for Payer: Meridian Medicaid |
$817.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,081.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$778.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,396.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,396.70
|
| Rate for Payer: UHC Medicaid |
$778.94
|
| Rate for Payer: UHCCP Medicaid |
$778.94
|
|
|
PR OPEN HARVEST UPPER EXTREMITY ART 1 SEGMENT CAB
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS 35600
|
| Min. Negotiated Rate |
$107.78 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Aetna Commercial |
$345.32
|
| Rate for Payer: Aetna Medicare |
$663.00
|
| Rate for Payer: BCBS Complete |
$113.17
|
| Rate for Payer: BCN Commercial |
$271.40
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Cash Price |
$1,060.80
|
| Rate for Payer: Mclaren Medicaid |
$107.78
|
| Rate for Payer: Meridian Medicaid |
$113.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$994.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$291.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.86
|
| Rate for Payer: UHC Medicaid |
$107.78
|
| Rate for Payer: UHCCP Medicaid |
$107.78
|
|
|
PR OPEN IMPLANTATION CRANIAL NERVE NEA & PULSE GEN
|
Professional
|
Both
|
$1,996.00
|
|
|
Service Code
|
HCPCS 64568
|
| Min. Negotiated Rate |
$420.89 |
| Max. Negotiated Rate |
$1,497.00 |
| Rate for Payer: Aetna Commercial |
$795.28
|
| Rate for Payer: Aetna Medicare |
$998.00
|
| Rate for Payer: BCBS Complete |
$441.93
|
| Rate for Payer: BCN Commercial |
$913.79
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Cash Price |
$1,596.80
|
| Rate for Payer: Mclaren Medicaid |
$420.89
|
| Rate for Payer: Meridian Medicaid |
$441.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,497.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,061.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,061.36
|
| Rate for Payer: UHC Medicaid |
$420.89
|
| Rate for Payer: UHCCP Medicaid |
$420.89
|
|
|
PR OPEN IMPLANTATION NEA PERIPHERAL NERVE
|
Professional
|
Both
|
$1,025.00
|
|
|
Service Code
|
HCPCS 64575
|
| Min. Negotiated Rate |
$187.23 |
| Max. Negotiated Rate |
$768.75 |
| Rate for Payer: Aetna Commercial |
$428.44
|
| Rate for Payer: Aetna Medicare |
$512.50
|
| Rate for Payer: BCBS Complete |
$196.59
|
| Rate for Payer: BCN Commercial |
$474.58
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Mclaren Medicaid |
$187.23
|
| Rate for Payer: Meridian Medicaid |
$196.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$768.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$551.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$551.21
|
| Rate for Payer: UHC Medicaid |
$187.23
|
| Rate for Payer: UHCCP Medicaid |
$187.23
|
|
|
PR OPEN IMPLANTATION NEA SACRAL NERVE
|
Professional
|
Both
|
$1,563.00
|
|
|
Service Code
|
HCPCS 64581
|
| Min. Negotiated Rate |
$374.88 |
| Max. Negotiated Rate |
$1,172.25 |
| Rate for Payer: Aetna Commercial |
$851.71
|
| Rate for Payer: Aetna Medicare |
$781.50
|
| Rate for Payer: BCBS Complete |
$393.62
|
| Rate for Payer: BCN Commercial |
$982.02
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Cash Price |
$1,250.40
|
| Rate for Payer: Mclaren Medicaid |
$374.88
|
| Rate for Payer: Meridian Medicaid |
$393.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,172.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$374.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,140.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,140.59
|
| Rate for Payer: UHC Medicaid |
$374.88
|
| Rate for Payer: UHCCP Medicaid |
$374.88
|
|
|
PR OPEN IMPLTJ HPGLSL NRV NSTIM RA PG&RESPIR SENSOR
|
Professional
|
Both
|
$1,804.00
|
|
|
Service Code
|
HCPCS 64582
|
| Min. Negotiated Rate |
$460.93 |
| Max. Negotiated Rate |
$1,458.72 |
| Rate for Payer: Aetna Commercial |
$1,116.01
|
| Rate for Payer: Aetna Medicare |
$902.00
|
| Rate for Payer: BCBS Complete |
$483.98
|
| Rate for Payer: BCN Commercial |
$1,255.91
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Cash Price |
$1,443.20
|
| Rate for Payer: Mclaren Medicaid |
$460.93
|
| Rate for Payer: Meridian Medicaid |
$483.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,458.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,458.72
|
| Rate for Payer: UHC Medicaid |
$460.93
|
| Rate for Payer: UHCCP Medicaid |
$460.93
|
|
|
PR OPEN INSJ/RPLCMT INTEGRATED NSTIMJ SYS PTN SUBQ
|
Professional
|
Both
|
$792.00
|
|
|
Service Code
|
HCPCS 0816T
|
| Min. Negotiated Rate |
$316.80 |
| Max. Negotiated Rate |
$20,050.50 |
| Rate for Payer: Aetna Medicare |
$396.00
|
| Rate for Payer: BCBS Complete |
$316.80
|
| Rate for Payer: BCN Commercial |
$20,050.50
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$594.00
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASC STENT SAME EA ADDL
|
Professional
|
Both
|
$659.00
|
|
|
Service Code
|
HCPCS 37239
|
| Min. Negotiated Rate |
$83.92 |
| Max. Negotiated Rate |
$494.25 |
| Rate for Payer: Aetna Commercial |
$204.11
|
| Rate for Payer: Aetna Medicare |
$329.50
|
| Rate for Payer: BCBS Complete |
$88.12
|
| Rate for Payer: BCN Commercial |
$220.11
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Mclaren Medicaid |
$83.92
|
| Rate for Payer: Meridian Medicaid |
$88.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$494.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$236.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.70
|
| Rate for Payer: UHC Medicaid |
$83.92
|
| Rate for Payer: UHCCP Medicaid |
$83.92
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
HCPCS 37237
|
| Min. Negotiated Rate |
$119.71 |
| Max. Negotiated Rate |
$392.25 |
| Rate for Payer: Aetna Commercial |
$283.76
|
| Rate for Payer: Aetna Medicare |
$261.50
|
| Rate for Payer: BCBS Complete |
$125.70
|
| Rate for Payer: BCN Commercial |
$307.25
|
| Rate for Payer: Cash Price |
$418.40
|
| Rate for Payer: Cash Price |
$418.40
|
| Rate for Payer: Mclaren Medicaid |
$119.71
|
| Rate for Payer: Meridian Medicaid |
$125.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$392.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$330.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.42
|
| Rate for Payer: UHC Medicaid |
$119.71
|
| Rate for Payer: UHCCP Medicaid |
$119.71
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL
|
Professional
|
Both
|
$1,247.00
|
|
|
Service Code
|
HCPCS 37236
|
| Min. Negotiated Rate |
$248.78 |
| Max. Negotiated Rate |
$935.25 |
| Rate for Payer: Aetna Commercial |
$595.20
|
| Rate for Payer: Aetna Medicare |
$623.50
|
| Rate for Payer: BCBS Complete |
$261.22
|
| Rate for Payer: BCN Commercial |
$641.40
|
| Rate for Payer: Cash Price |
$997.60
|
| Rate for Payer: Cash Price |
$997.60
|
| Rate for Payer: Mclaren Medicaid |
$248.78
|
| Rate for Payer: Meridian Medicaid |
$261.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$935.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$248.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$689.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$689.74
|
| Rate for Payer: UHC Medicaid |
$248.78
|
| Rate for Payer: UHCCP Medicaid |
$248.78
|
|
|
PR OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST
|
Professional
|
Both
|
$1,324.00
|
|
|
Service Code
|
HCPCS 37238
|
| Min. Negotiated Rate |
$172.74 |
| Max. Negotiated Rate |
$993.00 |
| Rate for Payer: Aetna Commercial |
$412.29
|
| Rate for Payer: Aetna Medicare |
$662.00
|
| Rate for Payer: BCBS Complete |
$181.38
|
| Rate for Payer: BCN Commercial |
$447.18
|
| Rate for Payer: Cash Price |
$1,059.20
|
| Rate for Payer: Cash Price |
$1,059.20
|
| Rate for Payer: Mclaren Medicaid |
$172.74
|
| Rate for Payer: Meridian Medicaid |
$181.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$993.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$172.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$480.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$480.89
|
| Rate for Payer: UHC Medicaid |
$172.74
|
| Rate for Payer: UHCCP Medicaid |
$172.74
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF ACUTE
|
Professional
|
Both
|
$2,694.00
|
|
|
Service Code
|
HCPCS 23410
|
| Min. Negotiated Rate |
$487.77 |
| Max. Negotiated Rate |
$2,020.50 |
| Rate for Payer: Aetna Commercial |
$1,094.22
|
| Rate for Payer: Aetna Medicare |
$1,347.00
|
| Rate for Payer: BCBS Complete |
$512.16
|
| Rate for Payer: BCN Commercial |
$1,248.44
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Cash Price |
$2,155.20
|
| Rate for Payer: Mclaren Medicaid |
$487.77
|
| Rate for Payer: Meridian Medicaid |
$512.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,020.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$487.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,334.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,334.55
|
| Rate for Payer: UHC Medicaid |
$487.77
|
| Rate for Payer: UHCCP Medicaid |
$487.77
|
|
|
PR OPEN REPAIR OF ROTATOR CUFF CHRONIC
|
Professional
|
Both
|
$3,213.00
|
|
|
Service Code
|
HCPCS 23412
|
| Min. Negotiated Rate |
$504.81 |
| Max. Negotiated Rate |
$2,409.75 |
| Rate for Payer: Aetna Commercial |
$1,137.14
|
| Rate for Payer: Aetna Medicare |
$1,606.50
|
| Rate for Payer: BCBS Complete |
$530.05
|
| Rate for Payer: BCN Commercial |
$1,425.12
|
| Rate for Payer: Cash Price |
$2,570.40
|
| Rate for Payer: Cash Price |
$2,570.40
|
| Rate for Payer: Mclaren Medicaid |
$504.81
|
| Rate for Payer: Meridian Medicaid |
$530.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,409.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$504.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,386.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,386.72
|
| Rate for Payer: UHC Medicaid |
$504.81
|
| Rate for Payer: UHCCP Medicaid |
$504.81
|
|
|
PR OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE
|
Professional
|
Both
|
$3,095.00
|
|
|
Service Code
|
HCPCS 27814
|
| Min. Negotiated Rate |
$455.61 |
| Max. Negotiated Rate |
$2,321.25 |
| Rate for Payer: Aetna Commercial |
$1,021.13
|
| Rate for Payer: Aetna Medicare |
$1,547.50
|
| Rate for Payer: BCBS Complete |
$478.39
|
| Rate for Payer: BCN Commercial |
$1,161.79
|
| Rate for Payer: Cash Price |
$2,476.00
|
| Rate for Payer: Cash Price |
$2,476.00
|
| Rate for Payer: Mclaren Medicaid |
$455.61
|
| Rate for Payer: Meridian Medicaid |
$478.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,321.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$455.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,241.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,241.91
|
| Rate for Payer: UHC Medicaid |
$455.61
|
| Rate for Payer: UHCCP Medicaid |
$455.61
|
|
|
PR OPEN TREATMENT CALCANEAL FRACTURE
|
Professional
|
Both
|
$3,467.00
|
|
|
Service Code
|
HCPCS 28415
|
| Min. Negotiated Rate |
$668.82 |
| Max. Negotiated Rate |
$2,600.25 |
| Rate for Payer: Aetna Commercial |
$1,498.02
|
| Rate for Payer: Aetna Medicare |
$1,733.50
|
| Rate for Payer: BCBS Complete |
$702.26
|
| Rate for Payer: BCN Commercial |
$1,695.62
|
| Rate for Payer: Cash Price |
$2,773.60
|
| Rate for Payer: Cash Price |
$2,773.60
|
| Rate for Payer: Mclaren Medicaid |
$668.82
|
| Rate for Payer: Meridian Medicaid |
$702.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,600.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$668.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,812.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,812.58
|
| Rate for Payer: UHC Medicaid |
$668.82
|
| Rate for Payer: UHCCP Medicaid |
$668.82
|
|
