|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$223.73
|
|
|
Service Code
|
NDC 50268070115
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.14 |
| Max. Negotiated Rate |
$201.36 |
| Rate for Payer: Aetna Commercial |
$190.17
|
| Rate for Payer: Aetna Medicare |
$58.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$69.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$69.92
|
| Rate for Payer: BCBS Complete |
$89.49
|
| Rate for Payer: BCBS MAPPO |
$55.93
|
| Rate for Payer: BCBS Trust/PPO |
$183.93
|
| Rate for Payer: BCN Commercial |
$173.95
|
| Rate for Payer: BCN Medicare Advantage |
$55.93
|
| 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: Health Alliance Plan Medicare Advantage |
$55.93
|
| Rate for Payer: Healthscope Commercial |
$201.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.17
|
| Rate for Payer: Nomi Health Commercial |
$183.46
|
| Rate for Payer: PACE Senior Care Partners |
$53.14
|
| Rate for Payer: PACE SWMI |
$55.93
|
| Rate for Payer: PHP Commercial |
$190.17
|
| Rate for Payer: PHP Medicare Advantage |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.42
|
| Rate for Payer: Priority Health HMO/PPO |
$194.65
|
| Rate for Payer: Priority Health Medicare |
$56.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.90
|
| Rate for Payer: Railroad Medicare Medicare |
$55.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.88
|
| Rate for Payer: UHC Core |
$186.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.93
|
| Rate for Payer: UHC Exchange |
$55.93
|
| Rate for Payer: UHC Medicare Advantage |
$55.93
|
| Rate for Payer: VA VA |
$55.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.80
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$315.40
|
|
|
Service Code
|
NDC 00378018301
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna Medicare |
$82.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.56
|
| Rate for Payer: BCBS Complete |
$126.16
|
| Rate for Payer: BCBS MAPPO |
$78.85
|
| Rate for Payer: BCBS Trust/PPO |
$259.29
|
| Rate for Payer: BCN Commercial |
$245.22
|
| Rate for Payer: BCN Medicare Advantage |
$78.85
|
| 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: Health Alliance Plan Medicare Advantage |
$78.85
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.09
|
| Rate for Payer: Nomi Health Commercial |
$258.63
|
| Rate for Payer: PACE Senior Care Partners |
$74.91
|
| Rate for Payer: PACE SWMI |
$78.85
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: PHP Medicare Advantage |
$78.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health HMO/PPO |
$274.40
|
| Rate for Payer: Priority Health Medicare |
$79.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.32
|
| Rate for Payer: Railroad Medicare Medicare |
$78.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.55
|
| Rate for Payer: UHC Core |
$263.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.85
|
| Rate for Payer: UHC Exchange |
$78.85
|
| Rate for Payer: UHC Medicare Advantage |
$78.85
|
| Rate for Payer: VA VA |
$78.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$4.48
|
|
|
Service Code
|
NDC 50268070111
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: BCBS Trust/PPO |
$3.66
|
| 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 Commercial |
$3.81
|
| Rate for Payer: Nomi Health Commercial |
$3.67
|
| Rate for Payer: PHP Commercial |
$3.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.91
|
| Rate for Payer: Priority Health HMO/PPO |
$3.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.00
|
| 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
|
OP
|
$279.30
|
|
|
Service Code
|
NDC 00904670561
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.33 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna Commercial |
$237.40
|
| Rate for Payer: Aetna Medicare |
$72.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.28
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.28
|
| Rate for Payer: BCBS Complete |
$111.72
|
| Rate for Payer: BCBS MAPPO |
$69.82
|
| Rate for Payer: BCBS Trust/PPO |
$229.61
|
| Rate for Payer: BCN Commercial |
$217.16
|
| Rate for Payer: BCN Medicare Advantage |
$69.82
|
| 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: Health Alliance Plan Medicare Advantage |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$251.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$237.40
|
| Rate for Payer: Nomi Health Commercial |
$229.03
|
| Rate for Payer: PACE Senior Care Partners |
$66.33
|
| Rate for Payer: PACE SWMI |
$69.82
|
| Rate for Payer: PHP Commercial |
$237.40
|
| Rate for Payer: PHP Medicare Advantage |
$69.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$181.54
|
| Rate for Payer: Priority Health HMO/PPO |
$242.99
|
| Rate for Payer: Priority Health Medicare |
$70.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.13
|
| Rate for Payer: Railroad Medicare Medicare |
$69.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.78
|
| Rate for Payer: UHC Core |
$233.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.82
|
| Rate for Payer: UHC Exchange |
$69.82
|
| Rate for Payer: UHC Medicare Advantage |
$69.82
|
| Rate for Payer: VA VA |
$69.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.48
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$417.05
|
|
|
Service Code
|
NDC 60687059801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.08 |
| Max. Negotiated Rate |
$375.34 |
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: BCBS Trust/PPO |
$340.44
|
| Rate for Payer: BCN Commercial |
$322.30
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Healthscope Commercial |
$375.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.08
|
| Rate for Payer: Priority Health HMO/PPO |
$362.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.00
|
| Rate for Payer: UHC Core |
$348.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
OP
|
$417.05
|
|
|
Service Code
|
NDC 60687059801
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.05 |
| Max. Negotiated Rate |
$375.34 |
| Rate for Payer: Aetna Commercial |
$354.49
|
| Rate for Payer: Aetna Medicare |
$108.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.33
|
| Rate for Payer: BCBS Complete |
$166.82
|
| Rate for Payer: BCBS MAPPO |
$104.26
|
| Rate for Payer: BCBS Trust/PPO |
$342.86
|
| Rate for Payer: BCN Commercial |
$324.26
|
| Rate for Payer: BCN Medicare Advantage |
$104.26
|
| Rate for Payer: Cash Price |
$333.64
|
| Rate for Payer: Cofinity Commercial |
$358.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$333.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.26
|
| Rate for Payer: Healthscope Commercial |
$375.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$354.49
|
| Rate for Payer: Nomi Health Commercial |
$341.98
|
| Rate for Payer: PACE Senior Care Partners |
$99.05
|
| Rate for Payer: PACE SWMI |
$104.26
|
| Rate for Payer: PHP Commercial |
$354.49
|
| Rate for Payer: PHP Medicare Advantage |
$104.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.08
|
| Rate for Payer: Priority Health HMO/PPO |
$362.83
|
| Rate for Payer: Priority Health Medicare |
$105.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.42
|
| Rate for Payer: Railroad Medicare Medicare |
$104.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.00
|
| Rate for Payer: UHC Core |
$348.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.26
|
| Rate for Payer: UHC Exchange |
$104.26
|
| Rate for Payer: UHC Medicare Advantage |
$104.26
|
| Rate for Payer: VA VA |
$104.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.79
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$4.18
|
|
|
Service Code
|
NDC 60687059811
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Aetna Commercial |
$3.55
|
| Rate for Payer: BCBS Trust/PPO |
$3.41
|
| Rate for Payer: BCN Commercial |
$3.23
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Cofinity Commercial |
$3.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.34
|
| Rate for Payer: Healthscope Commercial |
$3.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.55
|
| Rate for Payer: Nomi Health Commercial |
$3.43
|
| Rate for Payer: PHP Commercial |
$3.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.68
|
| Rate for Payer: UHC Core |
$3.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$223.73
|
|
|
Service Code
|
NDC 50268070115
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.42 |
| Max. Negotiated Rate |
$201.36 |
| Rate for Payer: Aetna Commercial |
$190.17
|
| Rate for Payer: BCBS Trust/PPO |
$182.63
|
| 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 Commercial |
$190.17
|
| Rate for Payer: Nomi Health Commercial |
$183.46
|
| Rate for Payer: PHP Commercial |
$190.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.42
|
| Rate for Payer: Priority Health HMO/PPO |
$194.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.90
|
| 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
|
$315.40
|
|
|
Service Code
|
NDC 00378018301
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.01 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: BCBS Trust/PPO |
$257.46
|
| 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 Commercial |
$268.09
|
| Rate for Payer: Nomi Health Commercial |
$258.63
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health HMO/PPO |
$274.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.32
|
| 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 20 MG TABLET
|
Facility
|
OP
|
$4.48
|
|
|
Service Code
|
NDC 50268070111
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.40
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: BCBS MAPPO |
$1.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.68
|
| Rate for Payer: BCN Commercial |
$3.48
|
| Rate for Payer: BCN Medicare Advantage |
$1.12
|
| 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: Health Alliance Plan Medicare Advantage |
$1.12
|
| Rate for Payer: Healthscope Commercial |
$4.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.81
|
| Rate for Payer: Nomi Health Commercial |
$3.67
|
| Rate for Payer: PACE Senior Care Partners |
$1.06
|
| Rate for Payer: PACE SWMI |
$1.12
|
| Rate for Payer: PHP Commercial |
$3.81
|
| Rate for Payer: PHP Medicare Advantage |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.91
|
| Rate for Payer: Priority Health HMO/PPO |
$3.90
|
| Rate for Payer: Priority Health Medicare |
$1.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.00
|
| Rate for Payer: Railroad Medicare Medicare |
$1.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.94
|
| Rate for Payer: UHC Core |
$3.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.12
|
| Rate for Payer: UHC Exchange |
$1.12
|
| Rate for Payer: UHC Medicare Advantage |
$1.12
|
| Rate for Payer: VA VA |
$1.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.36
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$876.48
|
|
|
Service Code
|
NDC 60687021501
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.16 |
| Max. Negotiated Rate |
$788.83 |
| Rate for Payer: Aetna Commercial |
$745.01
|
| Rate for Payer: Aetna Medicare |
$227.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$273.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$273.90
|
| Rate for Payer: BCBS Complete |
$350.59
|
| Rate for Payer: BCBS MAPPO |
$219.12
|
| Rate for Payer: BCBS Trust/PPO |
$720.55
|
| Rate for Payer: BCN Commercial |
$681.46
|
| Rate for Payer: BCN Medicare Advantage |
$219.12
|
| Rate for Payer: Cash Price |
$701.18
|
| Rate for Payer: Cofinity Commercial |
$753.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$219.12
|
| Rate for Payer: Healthscope Commercial |
$788.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$230.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.01
|
| Rate for Payer: Nomi Health Commercial |
$718.71
|
| Rate for Payer: PACE Senior Care Partners |
$208.16
|
| Rate for Payer: PACE SWMI |
$219.12
|
| Rate for Payer: PHP Commercial |
$745.01
|
| Rate for Payer: PHP Medicare Advantage |
$219.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.71
|
| Rate for Payer: Priority Health HMO/PPO |
$762.54
|
| Rate for Payer: Priority Health Medicare |
$221.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$587.24
|
| Rate for Payer: Railroad Medicare Medicare |
$219.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$771.30
|
| Rate for Payer: UHC Core |
$731.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$219.12
|
| Rate for Payer: UHC Exchange |
$219.12
|
| Rate for Payer: UHC Medicare Advantage |
$219.12
|
| Rate for Payer: VA VA |
$219.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.36
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$876.48
|
|
|
Service Code
|
NDC 60687021501
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$569.71 |
| Max. Negotiated Rate |
$788.83 |
| Rate for Payer: Aetna Commercial |
$745.01
|
| Rate for Payer: BCBS Trust/PPO |
$715.47
|
| Rate for Payer: BCN Commercial |
$677.34
|
| Rate for Payer: Cash Price |
$701.18
|
| Rate for Payer: Cofinity Commercial |
$753.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$701.18
|
| Rate for Payer: Healthscope Commercial |
$788.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$657.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$745.01
|
| Rate for Payer: Nomi Health Commercial |
$718.71
|
| Rate for Payer: PHP Commercial |
$745.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.71
|
| Rate for Payer: Priority Health HMO/PPO |
$762.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$587.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$771.30
|
| Rate for Payer: UHC Core |
$731.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$657.36
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$8.77
|
|
|
Service Code
|
NDC 60687021511
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.70 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: BCBS Trust/PPO |
$7.16
|
| Rate for Payer: BCN Commercial |
$6.78
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: Nomi Health Commercial |
$7.19
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.70
|
| Rate for Payer: Priority Health HMO/PPO |
$7.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.72
|
| Rate for Payer: UHC Core |
$7.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.58
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$8.77
|
|
|
Service Code
|
NDC 60687021511
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna Medicare |
$2.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.74
|
| Rate for Payer: BCBS Complete |
$3.51
|
| Rate for Payer: BCBS MAPPO |
$2.19
|
| Rate for Payer: BCBS Trust/PPO |
$7.21
|
| Rate for Payer: BCN Commercial |
$6.82
|
| Rate for Payer: BCN Medicare Advantage |
$2.19
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Cofinity Commercial |
$7.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.19
|
| Rate for Payer: Healthscope Commercial |
$7.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.45
|
| Rate for Payer: Nomi Health Commercial |
$7.19
|
| Rate for Payer: PACE Senior Care Partners |
$2.08
|
| Rate for Payer: PACE SWMI |
$2.19
|
| Rate for Payer: PHP Commercial |
$7.45
|
| Rate for Payer: PHP Medicare Advantage |
$2.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.70
|
| Rate for Payer: Priority Health HMO/PPO |
$7.63
|
| Rate for Payer: Priority Health Medicare |
$2.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.88
|
| Rate for Payer: Railroad Medicare Medicare |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.72
|
| Rate for Payer: UHC Core |
$7.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.19
|
| Rate for Payer: UHC Exchange |
$2.19
|
| Rate for Payer: UHC Medicare Advantage |
$2.19
|
| Rate for Payer: VA VA |
$2.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.58
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$285.12
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.33 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: BCBS Trust/PPO |
$232.74
|
| 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 Commercial |
$242.35
|
| Rate for Payer: Nomi Health Commercial |
$233.80
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.33
|
| Rate for Payer: Priority Health HMO/PPO |
$248.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.03
|
| 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
|
|
|
PROPRANOLOL ER 80 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
OP
|
$285.12
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.72 |
| Max. Negotiated Rate |
$256.61 |
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Aetna Medicare |
$74.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$89.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$89.10
|
| Rate for Payer: BCBS Complete |
$114.05
|
| Rate for Payer: BCBS MAPPO |
$71.28
|
| Rate for Payer: BCBS Trust/PPO |
$234.40
|
| Rate for Payer: BCN Commercial |
$221.68
|
| Rate for Payer: BCN Medicare Advantage |
$71.28
|
| 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: Health Alliance Plan Medicare Advantage |
$71.28
|
| Rate for Payer: Healthscope Commercial |
$256.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$242.35
|
| Rate for Payer: Nomi Health Commercial |
$233.80
|
| Rate for Payer: PACE Senior Care Partners |
$67.72
|
| Rate for Payer: PACE SWMI |
$71.28
|
| Rate for Payer: PHP Commercial |
$242.35
|
| Rate for Payer: PHP Medicare Advantage |
$71.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.33
|
| Rate for Payer: Priority Health HMO/PPO |
$248.05
|
| Rate for Payer: Priority Health Medicare |
$71.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.03
|
| Rate for Payer: Railroad Medicare Medicare |
$71.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.91
|
| Rate for Payer: UHC Core |
$238.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.28
|
| Rate for Payer: UHC Exchange |
$71.28
|
| Rate for Payer: UHC Medicare Advantage |
$71.28
|
| Rate for Payer: VA VA |
$71.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.84
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$9.16 |
| Max. Negotiated Rate |
$2,260.07 |
| Rate for Payer: Aetna Commercial |
$22.59
|
| Rate for Payer: Aetna Medicare |
$17.53
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: BCBS MAPPO |
$16.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,260.07
|
| Rate for Payer: BCN Commercial |
$25.90
|
| Rate for Payer: BCN Medicare Advantage |
$16.86
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$24.28
|
| Rate for Payer: Cofinity Commercial |
$22.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.86
|
| Rate for Payer: Mclaren Medicaid |
$9.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.70
|
| Rate for Payer: Meridian Medicaid |
$9.62
|
| Rate for Payer: Nomi Health Commercial |
$20.23
|
| Rate for Payer: PACE SWMI |
$16.86
|
| Rate for Payer: PHP Medicare Advantage |
$16.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO |
$19.00
|
| Rate for Payer: Priority Health Medicare |
$17.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.86
|
| Rate for Payer: UHC Exchange |
$16.86
|
| Rate for Payer: UHC Medicare Advantage |
$16.86
|
| Rate for Payer: UHCCP Medicaid |
$9.16
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,471.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$422.59 |
| Max. Negotiated Rate |
$2,256.15 |
| Rate for Payer: Aetna Commercial |
$836.07
|
| Rate for Payer: Aetna Medicare |
$648.89
|
| Rate for Payer: BCBS Complete |
$443.72
|
| Rate for Payer: BCBS MAPPO |
$623.93
|
| Rate for Payer: BCBS Trust/PPO |
$455.39
|
| Rate for Payer: BCN Commercial |
$956.34
|
| Rate for Payer: BCN Medicare Advantage |
$623.93
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cash Price |
$2,776.80
|
| Rate for Payer: Cofinity Commercial |
$898.46
|
| Rate for Payer: Cofinity Commercial |
$836.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.93
|
| Rate for Payer: Mclaren Medicaid |
$422.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$655.13
|
| Rate for Payer: Meridian Medicaid |
$443.72
|
| Rate for Payer: Nomi Health Commercial |
$748.72
|
| Rate for Payer: PACE SWMI |
$623.93
|
| Rate for Payer: PHP Medicare Advantage |
$623.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$422.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.15
|
| Rate for Payer: Priority Health HMO/PPO |
$1,007.04
|
| Rate for Payer: Priority Health Medicare |
$630.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,007.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$623.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$623.93
|
| Rate for Payer: UHC Exchange |
$623.93
|
| Rate for Payer: UHC Medicare Advantage |
$623.93
|
| Rate for Payer: UHCCP Medicaid |
$422.59
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$3,890.00
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$2,865.40 |
| Rate for Payer: Aetna Commercial |
$2,421.25
|
| Rate for Payer: Aetna Medicare |
$1,879.18
|
| Rate for Payer: BCBS Complete |
$1,268.77
|
| Rate for Payer: BCBS MAPPO |
$1,806.90
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: BCN Commercial |
$2,737.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,806.90
|
| Rate for Payer: Cash Price |
$3,112.00
|
| Rate for Payer: Cash Price |
$3,112.00
|
| Rate for Payer: Cofinity Commercial |
$2,601.94
|
| Rate for Payer: Cofinity Commercial |
$2,421.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,806.90
|
| Rate for Payer: Mclaren Medicaid |
$1,208.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,897.24
|
| Rate for Payer: Meridian Medicaid |
$1,268.77
|
| Rate for Payer: Nomi Health Commercial |
$2,168.28
|
| Rate for Payer: PACE SWMI |
$1,806.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,806.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,208.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,528.50
|
| Rate for Payer: Priority Health HMO/PPO |
$2,865.40
|
| Rate for Payer: Priority Health Medicare |
$1,824.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,865.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,806.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,806.90
|
| Rate for Payer: UHC Exchange |
$1,806.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,806.90
|
| Rate for Payer: UHCCP Medicaid |
$1,208.35
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$4,665.00
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$1,064.79 |
| Max. Negotiated Rate |
$3,032.25 |
| Rate for Payer: Aetna Commercial |
$2,130.67
|
| Rate for Payer: Aetna Medicare |
$1,653.65
|
| Rate for Payer: BCBS Complete |
$1,118.03
|
| Rate for Payer: BCBS MAPPO |
$1,590.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.43
|
| Rate for Payer: BCN Commercial |
$2,406.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,590.05
|
| Rate for Payer: Cash Price |
$3,732.00
|
| Rate for Payer: Cash Price |
$3,732.00
|
| Rate for Payer: Cofinity Commercial |
$2,289.67
|
| Rate for Payer: Cofinity Commercial |
$2,130.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,590.05
|
| Rate for Payer: Mclaren Medicaid |
$1,064.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,669.55
|
| Rate for Payer: Meridian Medicaid |
$1,118.03
|
| Rate for Payer: Nomi Health Commercial |
$1,908.06
|
| Rate for Payer: PACE SWMI |
$1,590.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,590.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,064.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,032.25
|
| Rate for Payer: Priority Health HMO/PPO |
$2,522.92
|
| Rate for Payer: Priority Health Medicare |
$1,605.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,522.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,590.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,590.05
|
| Rate for Payer: UHC Exchange |
$1,590.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,590.05
|
| Rate for Payer: UHCCP Medicaid |
$1,064.79
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$3,005.00
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$471.37 |
| Max. Negotiated Rate |
$1,953.25 |
| Rate for Payer: Aetna Commercial |
$934.96
|
| Rate for Payer: Aetna Medicare |
$725.64
|
| Rate for Payer: BCBS Complete |
$494.94
|
| Rate for Payer: BCBS MAPPO |
$697.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,258.80
|
| Rate for Payer: BCN Commercial |
$1,056.52
|
| Rate for Payer: BCN Medicare Advantage |
$697.73
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cash Price |
$2,404.00
|
| Rate for Payer: Cofinity Commercial |
$934.96
|
| Rate for Payer: Cofinity Commercial |
$1,004.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$697.73
|
| Rate for Payer: Mclaren Medicaid |
$471.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$732.62
|
| Rate for Payer: Meridian Medicaid |
$494.94
|
| Rate for Payer: Nomi Health Commercial |
$837.28
|
| Rate for Payer: PACE SWMI |
$697.73
|
| Rate for Payer: PHP Medicare Advantage |
$697.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$471.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,953.25
|
| Rate for Payer: Priority Health HMO/PPO |
$1,123.57
|
| Rate for Payer: Priority Health Medicare |
$704.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,123.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$697.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$697.73
|
| Rate for Payer: UHC Exchange |
$697.73
|
| Rate for Payer: UHC Medicare Advantage |
$697.73
|
| Rate for Payer: UHCCP Medicaid |
$471.37
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$3,247.00
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$516.95 |
| Max. Negotiated Rate |
$2,110.55 |
| Rate for Payer: Aetna Commercial |
$1,027.24
|
| Rate for Payer: Aetna Medicare |
$797.26
|
| Rate for Payer: BCBS Complete |
$542.80
|
| Rate for Payer: BCBS MAPPO |
$766.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.99
|
| Rate for Payer: BCN Commercial |
$1,152.30
|
| Rate for Payer: BCN Medicare Advantage |
$766.60
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cash Price |
$2,597.60
|
| Rate for Payer: Cofinity Commercial |
$1,103.90
|
| Rate for Payer: Cofinity Commercial |
$1,027.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$766.60
|
| Rate for Payer: Mclaren Medicaid |
$516.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$804.93
|
| Rate for Payer: Meridian Medicaid |
$542.80
|
| Rate for Payer: Nomi Health Commercial |
$919.92
|
| Rate for Payer: PACE SWMI |
$766.60
|
| Rate for Payer: PHP Medicare Advantage |
$766.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$516.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,110.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,216.18
|
| Rate for Payer: Priority Health Medicare |
$774.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,216.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$766.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$766.60
|
| Rate for Payer: UHC Exchange |
$766.60
|
| Rate for Payer: UHC Medicare Advantage |
$766.60
|
| Rate for Payer: UHCCP Medicaid |
$516.95
|
|
|
PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR
|
Professional
|
Both
|
$3,134.00
|
|
|
Service Code
|
HCPCS 27217
|
| Min. Negotiated Rate |
$538.68 |
| Max. Negotiated Rate |
$2,037.10 |
| Rate for Payer: Aetna Commercial |
$1,119.55
|
| Rate for Payer: Aetna Medicare |
$1,567.00
|
| Rate for Payer: BCBS Complete |
$565.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,869.65
|
| Rate for Payer: BCN Commercial |
$1,224.63
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Cash Price |
$2,507.20
|
| Rate for Payer: Mclaren Medicaid |
$538.68
|
| Rate for Payer: Meridian Medicaid |
$565.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$538.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,037.10
|
| Rate for Payer: Priority Health HMO/PPO |
$1,284.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,284.37
|
| Rate for Payer: UHCCP Medicaid |
$538.68
|
|
|
PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ
|
Professional
|
Both
|
$3,239.00
|
|
|
Service Code
|
HCPCS 26686
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$2,105.35 |
| Rate for Payer: Aetna Commercial |
$807.95
|
| Rate for Payer: Aetna Medicare |
$627.07
|
| Rate for Payer: BCBS Complete |
$428.96
|
| Rate for Payer: BCBS MAPPO |
$602.95
|
| Rate for Payer: BCBS Trust/PPO |
$75.56
|
| Rate for Payer: BCN Commercial |
$921.16
|
| Rate for Payer: BCN Medicare Advantage |
$602.95
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cash Price |
$2,591.20
|
| Rate for Payer: Cofinity Commercial |
$868.25
|
| Rate for Payer: Cofinity Commercial |
$807.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$602.95
|
| Rate for Payer: Mclaren Medicaid |
$408.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$633.10
|
| Rate for Payer: Meridian Medicaid |
$428.96
|
| Rate for Payer: Nomi Health Commercial |
$723.54
|
| Rate for Payer: PACE SWMI |
$602.95
|
| Rate for Payer: PHP Medicare Advantage |
$602.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,105.35
|
| Rate for Payer: Priority Health HMO/PPO |
$967.86
|
| Rate for Payer: Priority Health Medicare |
$608.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$967.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$602.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$602.95
|
| Rate for Payer: UHC Exchange |
$602.95
|
| Rate for Payer: UHC Medicare Advantage |
$602.95
|
| Rate for Payer: UHCCP Medicaid |
$408.53
|
|
|
PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
|
Professional
|
Both
|
$2,461.00
|
|
|
Service Code
|
HCPCS 21470
|
| Min. Negotiated Rate |
$749.97 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$1,484.79
|
| Rate for Payer: Aetna Medicare |
$1,152.37
|
| Rate for Payer: BCBS Complete |
$787.47
|
| Rate for Payer: BCBS MAPPO |
$1,108.05
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$1,692.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,108.05
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cash Price |
$1,968.80
|
| Rate for Payer: Cofinity Commercial |
$1,595.59
|
| Rate for Payer: Cofinity Commercial |
$1,484.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,108.05
|
| Rate for Payer: Mclaren Medicaid |
$749.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,163.45
|
| Rate for Payer: Meridian Medicaid |
$787.47
|
| Rate for Payer: Nomi Health Commercial |
$1,329.66
|
| Rate for Payer: PACE SWMI |
$1,108.05
|
| Rate for Payer: PHP Medicare Advantage |
$1,108.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$749.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,599.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,780.00
|
| Rate for Payer: Priority Health Medicare |
$1,119.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,780.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,108.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,108.05
|
| Rate for Payer: UHC Exchange |
$1,108.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,108.05
|
| Rate for Payer: UHCCP Medicaid |
$749.97
|
|
