|
PROPOFOL INFUSION (SYRINGE PUMP 20ML VIAL)(SHH)
|
Facility
|
IP
|
$76.91
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
180332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.84 |
| Max. Negotiated Rate |
$76.91 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: ASR ASR |
$74.60
|
| Rate for Payer: BCBS Trust/PPO |
$59.63
|
| Rate for Payer: BCN Commercial |
$59.63
|
| Rate for Payer: Cash Price |
$61.53
|
| Rate for Payer: Cofinity Commercial |
$72.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.53
|
| Rate for Payer: Healthscope Commercial |
$76.91
|
| Rate for Payer: Healthscope Whirlpool |
$74.60
|
| Rate for Payer: Mclaren Commercial |
$69.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$67.68
|
|
|
PR OPPONENSPLASTY OTHER METHODS
|
Professional
|
Both
|
$3,524.00
|
|
|
Service Code
|
HCPCS 26496
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$2,466.80 |
| Rate for Payer: Aetna Commercial |
$1,193.95
|
| Rate for Payer: Aetna Medicare |
$891.01
|
| Rate for Payer: BCBS Complete |
$615.93
|
| Rate for Payer: BCBS MAPPO |
$891.01
|
| Rate for Payer: BCBS Trust/PPO |
$1,834.26
|
| Rate for Payer: BCN Commercial |
$1,346.31
|
| Rate for Payer: BCN Medicare Advantage |
$891.01
|
| Rate for Payer: Cash Price |
$2,819.20
|
| Rate for Payer: Cash Price |
$2,819.20
|
| Rate for Payer: Cofinity Commercial |
$1,283.05
|
| Rate for Payer: Cofinity Commercial |
$1,193.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$891.01
|
| Rate for Payer: Healthscope Commercial |
$1,069.21
|
| Rate for Payer: Healthscope Whirlpool |
$1,069.21
|
| Rate for Payer: Meridian Medicaid |
$615.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$935.56
|
| Rate for Payer: PACE SWMI |
$891.01
|
| Rate for Payer: PHP Medicare Advantage |
$891.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$586.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,466.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,406.84
|
| Rate for Payer: Priority Health Medicare |
$891.01
|
| Rate for Payer: Priority Health Narrow Network |
$1,406.84
|
| Rate for Payer: UHC Medicare Advantage |
$917.74
|
|
|
PR OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN
|
Professional
|
Both
|
$2,333.00
|
|
|
Service Code
|
HCPCS 26490
|
| Min. Negotiated Rate |
$542.94 |
| Max. Negotiated Rate |
$1,633.10 |
| Rate for Payer: Aetna Commercial |
$1,103.01
|
| Rate for Payer: Aetna Medicare |
$823.14
|
| Rate for Payer: BCBS Complete |
$570.09
|
| Rate for Payer: BCBS MAPPO |
$823.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.11
|
| Rate for Payer: BCN Commercial |
$1,246.61
|
| Rate for Payer: BCN Medicare Advantage |
$823.14
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cash Price |
$1,866.40
|
| Rate for Payer: Cofinity Commercial |
$1,103.01
|
| Rate for Payer: Cofinity Commercial |
$1,185.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$823.14
|
| Rate for Payer: Healthscope Commercial |
$987.77
|
| Rate for Payer: Healthscope Whirlpool |
$987.77
|
| Rate for Payer: Meridian Medicaid |
$570.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$864.30
|
| Rate for Payer: PACE SWMI |
$823.14
|
| Rate for Payer: PHP Medicare Advantage |
$823.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,633.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,302.66
|
| Rate for Payer: Priority Health Medicare |
$823.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,302.66
|
| Rate for Payer: UHC Medicare Advantage |
$847.83
|
|
|
PR OPPONENSPLASTY TDN TR W/GRF EA TDN
|
Professional
|
Both
|
$1,511.00
|
|
|
Service Code
|
HCPCS 26492
|
| Min. Negotiated Rate |
$600.23 |
| Max. Negotiated Rate |
$1,439.01 |
| Rate for Payer: Aetna Commercial |
$1,220.42
|
| Rate for Payer: Aetna Medicare |
$910.76
|
| Rate for Payer: BCBS Complete |
$630.24
|
| Rate for Payer: BCBS MAPPO |
$910.76
|
| Rate for Payer: BCBS Trust/PPO |
$977.36
|
| Rate for Payer: BCN Commercial |
$1,377.09
|
| Rate for Payer: BCN Medicare Advantage |
$910.76
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cash Price |
$1,208.80
|
| Rate for Payer: Cofinity Commercial |
$1,220.42
|
| Rate for Payer: Cofinity Commercial |
$1,311.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$910.76
|
| Rate for Payer: Healthscope Commercial |
$1,092.91
|
| Rate for Payer: Healthscope Whirlpool |
$1,092.91
|
| Rate for Payer: Meridian Medicaid |
$630.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$956.30
|
| Rate for Payer: PACE SWMI |
$910.76
|
| Rate for Payer: PHP Medicare Advantage |
$910.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$600.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,057.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,439.01
|
| Rate for Payer: Priority Health Medicare |
$910.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,439.01
|
| Rate for Payer: UHC Medicare Advantage |
$938.08
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 0115-1660-01
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.97 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: BCBS Trust/PPO |
$338.88
|
| Rate for Payer: BCN Commercial |
$338.88
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$437.10
|
| Rate for Payer: Healthscope Whirlpool |
$423.99
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$165.78
|
|
|
Service Code
|
NDC 0904-6705-06
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.05 |
| Max. Negotiated Rate |
$165.78 |
| Rate for Payer: Aetna Commercial |
$149.20
|
| Rate for Payer: ASR ASR |
$160.81
|
| Rate for Payer: BCBS Trust/PPO |
$128.53
|
| Rate for Payer: BCN Commercial |
$128.53
|
| Rate for Payer: Cash Price |
$132.62
|
| Rate for Payer: Cofinity Commercial |
$155.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.62
|
| Rate for Payer: Healthscope Commercial |
$165.78
|
| Rate for Payer: Healthscope Whirlpool |
$160.81
|
| Rate for Payer: Mclaren Commercial |
$149.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.89
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$293.75
|
|
|
Service Code
|
NDC 69238-2078-1
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.62 |
| Max. Negotiated Rate |
$293.75 |
| Rate for Payer: Aetna Commercial |
$264.38
|
| Rate for Payer: ASR ASR |
$284.94
|
| Rate for Payer: BCBS Trust/PPO |
$227.74
|
| Rate for Payer: BCN Commercial |
$227.74
|
| Rate for Payer: Cash Price |
$235.00
|
| Rate for Payer: Cofinity Commercial |
$276.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$235.00
|
| Rate for Payer: Healthscope Commercial |
$293.75
|
| Rate for Payer: Healthscope Whirlpool |
$284.94
|
| Rate for Payer: Mclaren Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$249.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$258.50
|
|
|
PROPRANOLOL 20 MG TABLET
|
Facility
|
IP
|
$42.30
|
|
|
Service Code
|
NDC 23155-111-01
|
| Hospital Charge Code |
6657
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna Commercial |
$38.07
|
| Rate for Payer: ASR ASR |
$41.03
|
| Rate for Payer: BCBS Trust/PPO |
$32.80
|
| Rate for Payer: BCN Commercial |
$32.80
|
| Rate for Payer: Cash Price |
$33.84
|
| Rate for Payer: Cofinity Commercial |
$39.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.84
|
| Rate for Payer: Healthscope Commercial |
$42.30
|
| Rate for Payer: Healthscope Whirlpool |
$41.03
|
| Rate for Payer: Mclaren Commercial |
$38.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$35.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.22
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$8.54
|
|
|
Service Code
|
NDC 60687-215-11
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$8.54 |
| Rate for Payer: Aetna Commercial |
$7.69
|
| Rate for Payer: ASR ASR |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.62
|
| Rate for Payer: BCN Commercial |
$6.62
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Cofinity Commercial |
$8.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.83
|
| Rate for Payer: Healthscope Commercial |
$8.54
|
| Rate for Payer: Healthscope Whirlpool |
$8.28
|
| Rate for Payer: Mclaren Commercial |
$7.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.52
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$853.44
|
|
|
Service Code
|
NDC 60687-215-01
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$597.41 |
| Max. Negotiated Rate |
$853.44 |
| Rate for Payer: Aetna Commercial |
$768.10
|
| Rate for Payer: ASR ASR |
$827.84
|
| Rate for Payer: BCBS Trust/PPO |
$661.67
|
| Rate for Payer: BCN Commercial |
$661.67
|
| Rate for Payer: Cash Price |
$682.75
|
| Rate for Payer: Cofinity Commercial |
$802.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$682.75
|
| Rate for Payer: Healthscope Commercial |
$853.44
|
| Rate for Payer: Healthscope Whirlpool |
$827.84
|
| Rate for Payer: Mclaren Commercial |
$768.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$725.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$751.03
|
|
|
PROPRANOLOL ER 60 MG CAPSULE,24 HR,EXTENDED RELEASE
|
Facility
|
IP
|
$243.84
|
|
|
Service Code
|
NDC 51991-817-01
|
| Hospital Charge Code |
38224
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.69 |
| Max. Negotiated Rate |
$243.84 |
| Rate for Payer: Aetna Commercial |
$219.46
|
| Rate for Payer: ASR ASR |
$236.52
|
| Rate for Payer: BCBS Trust/PPO |
$189.05
|
| Rate for Payer: BCN Commercial |
$189.05
|
| Rate for Payer: Cash Price |
$195.07
|
| Rate for Payer: Cofinity Commercial |
$229.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.07
|
| Rate for Payer: Healthscope Commercial |
$243.84
|
| Rate for Payer: Healthscope Whirlpool |
$236.52
|
| Rate for Payer: Mclaren Commercial |
$219.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.58
|
|
|
PR OPTKINETIC NYSTAG BIDIR/FOVEAL/PERIPH STIM W/REC
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 92544
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$2,260.07 |
| Rate for Payer: Aetna Commercial |
$23.17
|
| Rate for Payer: Aetna Medicare |
$17.29
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS MAPPO |
$17.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,260.07
|
| Rate for Payer: BCN Commercial |
$25.90
|
| Rate for Payer: BCN Medicare Advantage |
$17.29
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cofinity Commercial |
$24.90
|
| Rate for Payer: Cofinity Commercial |
$23.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.29
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Whirlpool |
$20.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.15
|
| Rate for Payer: PACE SWMI |
$17.29
|
| Rate for Payer: PHP Medicare Advantage |
$17.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.80
|
| Rate for Payer: Priority Health Medicare |
$17.29
|
| Rate for Payer: Priority Health Narrow Network |
$23.80
|
| Rate for Payer: UHC Medicare Advantage |
$17.81
|
|
|
PR OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$3,403.00
|
|
|
Service Code
|
HCPCS 23552
|
| Min. Negotiated Rate |
$421.53 |
| Max. Negotiated Rate |
$2,382.10 |
| Rate for Payer: Aetna Commercial |
$857.72
|
| Rate for Payer: Aetna Medicare |
$640.09
|
| Rate for Payer: BCBS Complete |
$442.61
|
| Rate for Payer: BCBS MAPPO |
$640.09
|
| Rate for Payer: BCBS Trust/PPO |
$455.39
|
| Rate for Payer: BCN Commercial |
$956.34
|
| Rate for Payer: BCN Medicare Advantage |
$640.09
|
| Rate for Payer: Cash Price |
$2,722.40
|
| Rate for Payer: Cash Price |
$2,722.40
|
| Rate for Payer: Cofinity Commercial |
$857.72
|
| Rate for Payer: Cofinity Commercial |
$921.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.09
|
| Rate for Payer: Healthscope Commercial |
$768.11
|
| Rate for Payer: Healthscope Whirlpool |
$768.11
|
| Rate for Payer: Meridian Medicaid |
$442.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$672.09
|
| Rate for Payer: PACE SWMI |
$640.09
|
| Rate for Payer: PHP Medicare Advantage |
$640.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$421.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,382.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$999.34
|
| Rate for Payer: Priority Health Medicare |
$640.09
|
| Rate for Payer: Priority Health Narrow Network |
$999.34
|
| Rate for Payer: UHC Medicare Advantage |
$659.29
|
|
|
PR OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT
|
Professional
|
Both
|
$3,813.42
|
|
|
Service Code
|
HCPCS 27228
|
| Min. Negotiated Rate |
$70.26 |
| Max. Negotiated Rate |
$2,860.15 |
| Rate for Payer: Aetna Commercial |
$2,479.88
|
| Rate for Payer: Aetna Medicare |
$1,850.66
|
| Rate for Payer: BCBS Complete |
$1,259.37
|
| Rate for Payer: BCBS MAPPO |
$1,850.66
|
| Rate for Payer: BCBS Trust/PPO |
$70.26
|
| Rate for Payer: BCN Commercial |
$2,737.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,850.66
|
| Rate for Payer: Cash Price |
$3,050.74
|
| Rate for Payer: Cash Price |
$3,050.74
|
| Rate for Payer: Cofinity Commercial |
$2,664.95
|
| Rate for Payer: Cofinity Commercial |
$2,479.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,850.66
|
| Rate for Payer: Healthscope Commercial |
$2,220.79
|
| Rate for Payer: Healthscope Whirlpool |
$2,220.79
|
| Rate for Payer: Meridian Medicaid |
$1,259.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,943.19
|
| Rate for Payer: PACE SWMI |
$1,850.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,850.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,199.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,669.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,860.15
|
| Rate for Payer: Priority Health Medicare |
$1,850.66
|
| Rate for Payer: Priority Health Narrow Network |
$2,860.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,906.18
|
|
|
PR OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT
|
Professional
|
Both
|
$4,574.00
|
|
|
Service Code
|
HCPCS 27227
|
| Min. Negotiated Rate |
$1,056.05 |
| Max. Negotiated Rate |
$3,201.80 |
| Rate for Payer: Aetna Commercial |
$2,178.33
|
| Rate for Payer: Aetna Medicare |
$1,625.62
|
| Rate for Payer: BCBS Complete |
$1,108.85
|
| Rate for Payer: BCBS MAPPO |
$1,625.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,137.43
|
| Rate for Payer: BCN Commercial |
$2,406.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,625.62
|
| Rate for Payer: Cash Price |
$3,659.20
|
| Rate for Payer: Cash Price |
$3,659.20
|
| Rate for Payer: Cofinity Commercial |
$2,178.33
|
| Rate for Payer: Cofinity Commercial |
$2,340.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,625.62
|
| Rate for Payer: Healthscope Commercial |
$1,950.74
|
| Rate for Payer: Healthscope Whirlpool |
$1,950.74
|
| Rate for Payer: Meridian Medicaid |
$1,108.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,706.90
|
| Rate for Payer: PACE SWMI |
$1,625.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,625.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,056.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,201.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,514.94
|
| Rate for Payer: Priority Health Medicare |
$1,625.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,514.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,674.39
|
|
|
PR OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ
|
Professional
|
Both
|
$2,946.00
|
|
|
Service Code
|
HCPCS 27846
|
| Min. Negotiated Rate |
$470.30 |
| Max. Negotiated Rate |
$2,062.20 |
| Rate for Payer: Aetna Commercial |
$949.47
|
| Rate for Payer: Aetna Medicare |
$708.56
|
| Rate for Payer: BCBS Complete |
$493.82
|
| Rate for Payer: BCBS MAPPO |
$708.56
|
| Rate for Payer: BCBS Trust/PPO |
$1,258.80
|
| Rate for Payer: BCN Commercial |
$1,056.52
|
| Rate for Payer: BCN Medicare Advantage |
$708.56
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cofinity Commercial |
$949.47
|
| Rate for Payer: Cofinity Commercial |
$1,020.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.56
|
| Rate for Payer: Healthscope Commercial |
$850.27
|
| Rate for Payer: Healthscope Whirlpool |
$850.27
|
| Rate for Payer: Meridian Medicaid |
$493.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$743.99
|
| Rate for Payer: PACE SWMI |
$708.56
|
| Rate for Payer: PHP Medicare Advantage |
$708.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$470.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,062.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,104.02
|
| Rate for Payer: Priority Health Medicare |
$708.56
|
| Rate for Payer: Priority Health Narrow Network |
$1,104.02
|
| Rate for Payer: UHC Medicare Advantage |
$729.82
|
|
|
PR OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ
|
Professional
|
Both
|
$3,183.00
|
|
|
Service Code
|
HCPCS 27848
|
| Min. Negotiated Rate |
$509.07 |
| Max. Negotiated Rate |
$2,228.10 |
| Rate for Payer: Aetna Commercial |
$1,037.86
|
| Rate for Payer: Aetna Medicare |
$774.52
|
| Rate for Payer: BCBS Complete |
$534.52
|
| Rate for Payer: BCBS MAPPO |
$774.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,309.99
|
| Rate for Payer: BCN Commercial |
$1,152.30
|
| Rate for Payer: BCN Medicare Advantage |
$774.52
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Cash Price |
$2,546.40
|
| Rate for Payer: Cofinity Commercial |
$1,115.31
|
| Rate for Payer: Cofinity Commercial |
$1,037.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$774.52
|
| Rate for Payer: Healthscope Commercial |
$929.42
|
| Rate for Payer: Healthscope Whirlpool |
$929.42
|
| Rate for Payer: Meridian Medicaid |
$534.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$813.25
|
| Rate for Payer: PACE SWMI |
$774.52
|
| Rate for Payer: PHP Medicare Advantage |
$774.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,228.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,204.11
|
| Rate for Payer: Priority Health Medicare |
$774.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,204.11
|
| Rate for Payer: UHC Medicare Advantage |
$797.76
|
|
|
PR OPTX ANT PELVIC BONE FX&/DISLC INT FIXJ IF PFR
|
Professional
|
Both
|
$3,073.00
|
|
|
Service Code
|
HCPCS 27217
|
| Min. Negotiated Rate |
$537.61 |
| Max. Negotiated Rate |
$2,151.10 |
| Rate for Payer: Aetna Commercial |
$1,119.55
|
| Rate for Payer: BCBS Complete |
$564.49
|
| Rate for Payer: BCBS Trust/PPO |
$1,869.65
|
| Rate for Payer: BCN Commercial |
$1,224.63
|
| Rate for Payer: Cash Price |
$2,458.40
|
| Rate for Payer: Cash Price |
$2,458.40
|
| Rate for Payer: Meridian Medicaid |
$564.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$537.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,151.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,279.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,279.68
|
|
|
PR OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ
|
Professional
|
Both
|
$3,175.00
|
|
|
Service Code
|
HCPCS 26686
|
| Min. Negotiated Rate |
$75.56 |
| Max. Negotiated Rate |
$2,222.50 |
| Rate for Payer: Aetna Commercial |
$825.16
|
| Rate for Payer: Aetna Medicare |
$615.79
|
| Rate for Payer: BCBS Complete |
$425.39
|
| Rate for Payer: BCBS MAPPO |
$615.79
|
| Rate for Payer: BCBS Trust/PPO |
$75.56
|
| Rate for Payer: BCN Commercial |
$921.16
|
| Rate for Payer: BCN Medicare Advantage |
$615.79
|
| Rate for Payer: Cash Price |
$2,540.00
|
| Rate for Payer: Cash Price |
$2,540.00
|
| Rate for Payer: Cofinity Commercial |
$886.74
|
| Rate for Payer: Cofinity Commercial |
$825.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.79
|
| Rate for Payer: Healthscope Commercial |
$738.95
|
| Rate for Payer: Healthscope Whirlpool |
$738.95
|
| Rate for Payer: Meridian Medicaid |
$425.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$646.58
|
| Rate for Payer: PACE SWMI |
$615.79
|
| Rate for Payer: PHP Medicare Advantage |
$615.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$405.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,222.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$962.57
|
| Rate for Payer: Priority Health Medicare |
$615.79
|
| Rate for Payer: Priority Health Narrow Network |
$962.57
|
| Rate for Payer: UHC Medicare Advantage |
$634.26
|
|
|
PR OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION
|
Professional
|
Both
|
$2,413.00
|
|
|
Service Code
|
HCPCS 21470
|
| Min. Negotiated Rate |
$745.07 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$1,520.52
|
| Rate for Payer: Aetna Medicare |
$1,134.72
|
| Rate for Payer: BCBS Complete |
$782.32
|
| Rate for Payer: BCBS MAPPO |
$1,134.72
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$1,692.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,134.72
|
| Rate for Payer: Cash Price |
$1,930.40
|
| Rate for Payer: Cash Price |
$1,930.40
|
| Rate for Payer: Cofinity Commercial |
$1,520.52
|
| Rate for Payer: Cofinity Commercial |
$1,634.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,134.72
|
| Rate for Payer: Healthscope Commercial |
$1,361.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,361.66
|
| Rate for Payer: Meridian Medicaid |
$782.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,191.46
|
| Rate for Payer: PACE SWMI |
$1,134.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,134.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$745.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,689.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,768.38
|
| Rate for Payer: Priority Health Medicare |
$1,134.72
|
| Rate for Payer: Priority Health Narrow Network |
$1,768.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,168.76
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG
|
Professional
|
Both
|
$2,373.00
|
|
|
Service Code
|
HCPCS 25608
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$1,661.10 |
| Rate for Payer: Aetna Commercial |
$1,093.64
|
| Rate for Payer: Aetna Medicare |
$816.15
|
| Rate for Payer: BCBS Complete |
$564.27
|
| Rate for Payer: BCBS MAPPO |
$816.15
|
| Rate for Payer: BCBS Trust/PPO |
$25.36
|
| Rate for Payer: BCN Commercial |
$1,220.23
|
| Rate for Payer: BCN Medicare Advantage |
$816.15
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Cash Price |
$1,898.40
|
| Rate for Payer: Cofinity Commercial |
$1,175.26
|
| Rate for Payer: Cofinity Commercial |
$1,093.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$816.15
|
| Rate for Payer: Healthscope Commercial |
$979.38
|
| Rate for Payer: Healthscope Whirlpool |
$979.38
|
| Rate for Payer: Meridian Medicaid |
$564.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$856.96
|
| Rate for Payer: PACE SWMI |
$816.15
|
| Rate for Payer: PHP Medicare Advantage |
$816.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$537.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,661.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,275.09
|
| Rate for Payer: Priority Health Medicare |
$816.15
|
| Rate for Payer: Priority Health Narrow Network |
$1,275.09
|
| Rate for Payer: UHC Medicare Advantage |
$840.63
|
|
|
PR OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG
|
Professional
|
Both
|
$2,901.00
|
|
|
Service Code
|
HCPCS 25609
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$2,030.70 |
| Rate for Payer: Aetna Commercial |
$1,388.27
|
| Rate for Payer: Aetna Medicare |
$1,036.02
|
| Rate for Payer: BCBS Complete |
$714.34
|
| Rate for Payer: BCBS MAPPO |
$1,036.02
|
| Rate for Payer: BCBS Trust/PPO |
$166.94
|
| Rate for Payer: BCN Commercial |
$1,547.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,036.02
|
| Rate for Payer: Cash Price |
$2,320.80
|
| Rate for Payer: Cash Price |
$2,320.80
|
| Rate for Payer: Cofinity Commercial |
$1,491.87
|
| Rate for Payer: Cofinity Commercial |
$1,388.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,036.02
|
| Rate for Payer: Healthscope Commercial |
$1,243.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,243.22
|
| Rate for Payer: Meridian Medicaid |
$714.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,087.82
|
| Rate for Payer: PACE SWMI |
$1,036.02
|
| Rate for Payer: PHP Medicare Advantage |
$1,036.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,030.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,616.72
|
| Rate for Payer: Priority Health Medicare |
$1,036.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,616.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,067.10
|
|
|
PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,906.00
|
|
|
Service Code
|
HCPCS 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$1,334.20 |
| Rate for Payer: Aetna Commercial |
$977.89
|
| Rate for Payer: Aetna Medicare |
$729.77
|
| Rate for Payer: BCBS Complete |
$505.45
|
| Rate for Payer: BCBS MAPPO |
$729.77
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCN Commercial |
$1,093.17
|
| Rate for Payer: BCN Medicare Advantage |
$729.77
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$977.89
|
| Rate for Payer: Cofinity Commercial |
$1,050.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$729.77
|
| Rate for Payer: Healthscope Commercial |
$875.72
|
| Rate for Payer: Healthscope Whirlpool |
$875.72
|
| Rate for Payer: Meridian Medicaid |
$505.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$766.26
|
| Rate for Payer: PACE SWMI |
$729.77
|
| Rate for Payer: PHP Medicare Advantage |
$729.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$481.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,142.33
|
| Rate for Payer: Priority Health Medicare |
$729.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.33
|
| Rate for Payer: UHC Medicare Advantage |
$751.66
|
|
|
PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 25607
|
| Hospital Charge Code |
25607
|
| Min. Negotiated Rate |
$1,334.20 |
| Max. Negotiated Rate |
$7,948.86 |
| Rate for Payer: Aetna Commercial |
$1,715.40
|
| Rate for Payer: Aetna Medicare |
$6,359.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7,948.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7,948.86
|
| Rate for Payer: ASR ASR |
$1,848.82
|
| Rate for Payer: BCBS Complete |
$3,652.66
|
| Rate for Payer: BCBS MAPPO |
$6,359.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.72
|
| Rate for Payer: BCN Commercial |
$1,477.72
|
| Rate for Payer: BCN Medicare Advantage |
$6,359.09
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$1,791.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,524.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,359.09
|
| Rate for Payer: Healthscope Commercial |
$1,906.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,848.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$6,359.09
|
| Rate for Payer: Mclaren Commercial |
$1,715.40
|
| Rate for Payer: Mclaren Medicaid |
$3,478.42
|
| Rate for Payer: Mclaren Medicare |
$6,359.09
|
| Rate for Payer: Meridian Medicaid |
$3,652.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,677.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,312.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,620.10
|
| Rate for Payer: PACE Medicare |
$6,041.14
|
| Rate for Payer: PACE SWMI |
$6,359.09
|
| Rate for Payer: PHP Commercial |
$6,995.00
|
| Rate for Payer: PHP Medicaid |
$3,478.42
|
| Rate for Payer: PHP Medicare Advantage |
$6,359.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,478.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,734.46
|
| Rate for Payer: Priority Health Medicare |
$6,359.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,353.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6,359.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,677.28
|
| Rate for Payer: UHC Medicare Advantage |
$6,549.86
|
| Rate for Payer: VA VA |
$6,359.09
|
|
|
PR OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,906.00
|
|
|
Service Code
|
HCPCS 25607
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$1,334.20 |
| Rate for Payer: Aetna Commercial |
$977.89
|
| Rate for Payer: Aetna Medicare |
$729.77
|
| Rate for Payer: BCBS Complete |
$505.45
|
| Rate for Payer: BCBS MAPPO |
$729.77
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCN Commercial |
$1,093.17
|
| Rate for Payer: BCN Medicare Advantage |
$729.77
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$977.89
|
| Rate for Payer: Cofinity Commercial |
$1,050.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$729.77
|
| Rate for Payer: Healthscope Commercial |
$875.72
|
| Rate for Payer: Healthscope Whirlpool |
$875.72
|
| Rate for Payer: Meridian Medicaid |
$505.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$766.26
|
| Rate for Payer: PACE SWMI |
$729.77
|
| Rate for Payer: PHP Medicare Advantage |
$729.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$481.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,142.33
|
| Rate for Payer: Priority Health Medicare |
$729.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,142.33
|
| Rate for Payer: UHC Medicare Advantage |
$751.66
|
|
