|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT
|
Professional
|
Both
|
$5,599.00
|
|
|
Service Code
|
HCPCS 22318
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$3,919.30 |
| Rate for Payer: Aetna Commercial |
$2,219.92
|
| Rate for Payer: Aetna Medicare |
$1,656.66
|
| Rate for Payer: BCBS Complete |
$1,127.65
|
| Rate for Payer: BCBS MAPPO |
$1,656.66
|
| Rate for Payer: BCBS Trust/PPO |
$33.96
|
| Rate for Payer: BCN Commercial |
$2,682.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,656.66
|
| Rate for Payer: Cash Price |
$4,479.20
|
| Rate for Payer: Cash Price |
$4,479.20
|
| Rate for Payer: Cofinity Commercial |
$2,219.92
|
| Rate for Payer: Cofinity Commercial |
$2,385.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,656.66
|
| Rate for Payer: Healthscope Commercial |
$1,987.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,987.99
|
| Rate for Payer: Meridian Medicaid |
$1,127.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,739.49
|
| Rate for Payer: PACE SWMI |
$1,656.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,656.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,073.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,919.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,545.59
|
| Rate for Payer: Priority Health Medicare |
$1,656.66
|
| Rate for Payer: Priority Health Narrow Network |
$2,545.59
|
| Rate for Payer: UHC Medicare Advantage |
$1,706.36
|
|
|
PR OPTX&/RDCTJ ODNTD FX&/DISLC ANT W/INT FIXJ
|
Professional
|
Both
|
$10,531.00
|
|
|
Service Code
|
HCPCS 22319
|
| Min. Negotiated Rate |
$1,190.67 |
| Max. Negotiated Rate |
$7,371.70 |
| Rate for Payer: Aetna Commercial |
$2,468.44
|
| Rate for Payer: Aetna Medicare |
$1,842.12
|
| Rate for Payer: BCBS Complete |
$1,250.20
|
| Rate for Payer: BCBS MAPPO |
$1,842.12
|
| Rate for Payer: BCBS Trust/PPO |
$5,215.40
|
| Rate for Payer: BCN Commercial |
$2,704.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,842.12
|
| Rate for Payer: Cash Price |
$8,424.80
|
| Rate for Payer: Cash Price |
$8,424.80
|
| Rate for Payer: Cofinity Commercial |
$2,652.65
|
| Rate for Payer: Cofinity Commercial |
$2,468.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,842.12
|
| Rate for Payer: Healthscope Commercial |
$2,210.54
|
| Rate for Payer: Healthscope Whirlpool |
$2,210.54
|
| Rate for Payer: Meridian Medicaid |
$1,250.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,934.23
|
| Rate for Payer: PACE SWMI |
$1,842.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,842.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,190.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,371.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,825.94
|
| Rate for Payer: Priority Health Medicare |
$1,842.12
|
| Rate for Payer: Priority Health Narrow Network |
$2,825.94
|
| Rate for Payer: UHC Medicare Advantage |
$1,897.38
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR
|
Professional
|
Both
|
$3,987.00
|
|
|
Service Code
|
HCPCS 22326
|
| Min. Negotiated Rate |
$979.59 |
| Max. Negotiated Rate |
$2,790.90 |
| Rate for Payer: Aetna Commercial |
$2,023.74
|
| Rate for Payer: Aetna Medicare |
$1,510.25
|
| Rate for Payer: BCBS Complete |
$1,028.57
|
| Rate for Payer: BCBS MAPPO |
$1,510.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,741.59
|
| Rate for Payer: BCN Commercial |
$2,452.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,510.25
|
| Rate for Payer: Cash Price |
$3,189.60
|
| Rate for Payer: Cash Price |
$3,189.60
|
| Rate for Payer: Cofinity Commercial |
$2,174.76
|
| Rate for Payer: Cofinity Commercial |
$2,023.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,510.25
|
| Rate for Payer: Healthscope Commercial |
$1,812.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,812.30
|
| Rate for Payer: Meridian Medicaid |
$1,028.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,585.76
|
| Rate for Payer: PACE SWMI |
$1,510.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,510.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$979.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,790.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,327.03
|
| Rate for Payer: Priority Health Medicare |
$1,510.25
|
| Rate for Payer: Priority Health Narrow Network |
$2,327.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.56
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA
|
Professional
|
Both
|
$1,148.00
|
|
|
Service Code
|
HCPCS 22328
|
| Min. Negotiated Rate |
$179.35 |
| Max. Negotiated Rate |
$950.50 |
| Rate for Payer: Aetna Commercial |
$378.93
|
| Rate for Payer: Aetna Medicare |
$282.78
|
| Rate for Payer: BCBS Complete |
$188.32
|
| Rate for Payer: BCBS MAPPO |
$282.78
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: BCN Commercial |
$453.59
|
| Rate for Payer: BCN Medicare Advantage |
$282.78
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: Cash Price |
$918.40
|
| Rate for Payer: Cofinity Commercial |
$378.93
|
| Rate for Payer: Cofinity Commercial |
$407.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$282.78
|
| Rate for Payer: Healthscope Commercial |
$339.34
|
| Rate for Payer: Healthscope Whirlpool |
$339.34
|
| Rate for Payer: Meridian Medicaid |
$188.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$296.92
|
| Rate for Payer: PACE SWMI |
$282.78
|
| Rate for Payer: PHP Medicare Advantage |
$282.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$803.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$430.48
|
| Rate for Payer: Priority Health Medicare |
$282.78
|
| Rate for Payer: Priority Health Narrow Network |
$430.48
|
| Rate for Payer: UHC Medicare Advantage |
$291.26
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM
|
Professional
|
Both
|
$3,668.00
|
|
|
Service Code
|
HCPCS 22325
|
| Min. Negotiated Rate |
$957.44 |
| Max. Negotiated Rate |
$17,177.60 |
| Rate for Payer: Aetna Commercial |
$1,969.25
|
| Rate for Payer: Aetna Medicare |
$1,469.59
|
| Rate for Payer: BCBS Complete |
$1,005.31
|
| Rate for Payer: BCBS MAPPO |
$1,469.59
|
| Rate for Payer: BCBS Trust/PPO |
$17,177.60
|
| Rate for Payer: BCN Commercial |
$2,172.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,469.59
|
| Rate for Payer: Cash Price |
$2,934.40
|
| Rate for Payer: Cash Price |
$2,934.40
|
| Rate for Payer: Cofinity Commercial |
$2,116.21
|
| Rate for Payer: Cofinity Commercial |
$1,969.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,469.59
|
| Rate for Payer: Healthscope Commercial |
$1,763.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,763.51
|
| Rate for Payer: Meridian Medicaid |
$1,005.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,543.07
|
| Rate for Payer: PACE SWMI |
$1,469.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,469.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$957.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,567.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,270.34
|
| Rate for Payer: Priority Health Medicare |
$1,469.59
|
| Rate for Payer: Priority Health Narrow Network |
$2,270.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,513.68
|
|
|
PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH
|
Professional
|
Both
|
$3,828.00
|
|
|
Service Code
|
HCPCS 22327
|
| Min. Negotiated Rate |
$950.50 |
| Max. Negotiated Rate |
$2,679.60 |
| Rate for Payer: Aetna Commercial |
$2,053.39
|
| Rate for Payer: Aetna Medicare |
$1,532.38
|
| Rate for Payer: BCBS Complete |
$1,047.57
|
| Rate for Payer: BCBS MAPPO |
$1,532.38
|
| Rate for Payer: BCBS Trust/PPO |
$950.50
|
| Rate for Payer: BCN Commercial |
$2,264.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,532.38
|
| Rate for Payer: Cash Price |
$3,062.40
|
| Rate for Payer: Cash Price |
$3,062.40
|
| Rate for Payer: Cofinity Commercial |
$2,206.63
|
| Rate for Payer: Cofinity Commercial |
$2,053.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,532.38
|
| Rate for Payer: Healthscope Commercial |
$1,838.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,838.86
|
| Rate for Payer: Meridian Medicaid |
$1,047.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,609.00
|
| Rate for Payer: PACE SWMI |
$1,532.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,532.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$997.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,679.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,365.84
|
| Rate for Payer: Priority Health Medicare |
$1,532.38
|
| Rate for Payer: Priority Health Narrow Network |
$2,365.84
|
| Rate for Payer: UHC Medicare Advantage |
$1,578.35
|
|
|
PR OPTX SHO DISLC W/FX GR HUMERAL TUBRST INT FIXJ
|
Professional
|
Both
|
$2,881.00
|
|
|
Service Code
|
HCPCS 23670
|
| Min. Negotiated Rate |
$196.12 |
| Max. Negotiated Rate |
$2,016.70 |
| Rate for Payer: Aetna Commercial |
$1,150.87
|
| Rate for Payer: Aetna Medicare |
$858.86
|
| Rate for Payer: BCBS Complete |
$592.00
|
| Rate for Payer: BCBS MAPPO |
$858.86
|
| Rate for Payer: BCBS Trust/PPO |
$196.12
|
| Rate for Payer: BCN Commercial |
$1,279.85
|
| Rate for Payer: BCN Medicare Advantage |
$858.86
|
| Rate for Payer: Cash Price |
$2,304.80
|
| Rate for Payer: Cash Price |
$2,304.80
|
| Rate for Payer: Cofinity Commercial |
$1,236.76
|
| Rate for Payer: Cofinity Commercial |
$1,150.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.86
|
| Rate for Payer: Healthscope Commercial |
$1,030.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,030.63
|
| Rate for Payer: Meridian Medicaid |
$592.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$901.80
|
| Rate for Payer: PACE SWMI |
$858.86
|
| Rate for Payer: PHP Medicare Advantage |
$858.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$563.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,016.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,337.40
|
| Rate for Payer: Priority Health Medicare |
$858.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,337.40
|
| Rate for Payer: UHC Medicare Advantage |
$884.63
|
|
|
PR OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ
|
Professional
|
Both
|
$1,623.00
|
|
|
Service Code
|
HCPCS 23680
|
| Min. Negotiated Rate |
$228.81 |
| Max. Negotiated Rate |
$1,427.27 |
| Rate for Payer: Aetna Commercial |
$1,229.07
|
| Rate for Payer: Aetna Medicare |
$917.22
|
| Rate for Payer: BCBS Complete |
$623.98
|
| Rate for Payer: BCBS MAPPO |
$917.22
|
| Rate for Payer: BCBS Trust/PPO |
$228.81
|
| Rate for Payer: BCN Commercial |
$1,365.86
|
| Rate for Payer: BCN Medicare Advantage |
$917.22
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cash Price |
$1,298.40
|
| Rate for Payer: Cofinity Commercial |
$1,320.80
|
| Rate for Payer: Cofinity Commercial |
$1,229.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$917.22
|
| Rate for Payer: Healthscope Commercial |
$1,100.66
|
| Rate for Payer: Healthscope Whirlpool |
$1,100.66
|
| Rate for Payer: Meridian Medicaid |
$623.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$963.08
|
| Rate for Payer: PACE SWMI |
$917.22
|
| Rate for Payer: PHP Medicare Advantage |
$917.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$594.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,427.27
|
| Rate for Payer: Priority Health Medicare |
$917.22
|
| Rate for Payer: Priority Health Narrow Network |
$1,427.27
|
| Rate for Payer: UHC Medicare Advantage |
$944.74
|
|
|
PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 27178
|
| Min. Negotiated Rate |
$595.12 |
| Max. Negotiated Rate |
$1,416.03 |
| Rate for Payer: Aetna Commercial |
$1,218.89
|
| Rate for Payer: Aetna Medicare |
$909.62
|
| Rate for Payer: BCBS Complete |
$624.88
|
| Rate for Payer: BCBS MAPPO |
$909.62
|
| Rate for Payer: BCBS Trust/PPO |
$969.43
|
| Rate for Payer: BCN Commercial |
$1,355.11
|
| Rate for Payer: BCN Medicare Advantage |
$909.62
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cofinity Commercial |
$1,309.85
|
| Rate for Payer: Cofinity Commercial |
$1,218.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$909.62
|
| Rate for Payer: Healthscope Commercial |
$1,091.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,091.54
|
| Rate for Payer: Meridian Medicaid |
$624.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$955.10
|
| Rate for Payer: PACE SWMI |
$909.62
|
| Rate for Payer: PHP Medicare Advantage |
$909.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$595.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,130.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,416.03
|
| Rate for Payer: Priority Health Medicare |
$909.62
|
| Rate for Payer: Priority Health Narrow Network |
$1,416.03
|
| Rate for Payer: UHC Medicare Advantage |
$936.91
|
|
|
PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ
|
Professional
|
Both
|
$2,305.00
|
|
|
Service Code
|
HCPCS 27181
|
| Min. Negotiated Rate |
$381.43 |
| Max. Negotiated Rate |
$1,714.25 |
| Rate for Payer: Aetna Commercial |
$1,478.45
|
| Rate for Payer: Aetna Medicare |
$1,103.32
|
| Rate for Payer: BCBS Complete |
$757.06
|
| Rate for Payer: BCBS MAPPO |
$1,103.32
|
| Rate for Payer: BCBS Trust/PPO |
$381.43
|
| Rate for Payer: BCN Commercial |
$1,640.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,103.32
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Cash Price |
$1,844.00
|
| Rate for Payer: Cofinity Commercial |
$1,588.78
|
| Rate for Payer: Cofinity Commercial |
$1,478.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,103.32
|
| Rate for Payer: Healthscope Commercial |
$1,323.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,323.98
|
| Rate for Payer: Meridian Medicaid |
$757.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,158.49
|
| Rate for Payer: PACE SWMI |
$1,103.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,103.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$721.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,613.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,714.25
|
| Rate for Payer: Priority Health Medicare |
$1,103.32
|
| Rate for Payer: Priority Health Narrow Network |
$1,714.25
|
| Rate for Payer: UHC Medicare Advantage |
$1,136.42
|
|
|
PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT
|
Professional
|
Both
|
$1,952.00
|
|
|
Service Code
|
HCPCS 27177
|
| Min. Negotiated Rate |
$718.02 |
| Max. Negotiated Rate |
$1,708.64 |
| Rate for Payer: Aetna Commercial |
$1,473.45
|
| Rate for Payer: Aetna Medicare |
$1,099.59
|
| Rate for Payer: BCBS Complete |
$753.92
|
| Rate for Payer: BCBS MAPPO |
$1,099.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,238.86
|
| Rate for Payer: BCN Commercial |
$1,635.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.59
|
| Rate for Payer: Cash Price |
$1,561.60
|
| Rate for Payer: Cash Price |
$1,561.60
|
| Rate for Payer: Cofinity Commercial |
$1,583.41
|
| Rate for Payer: Cofinity Commercial |
$1,473.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.59
|
| Rate for Payer: Healthscope Commercial |
$1,319.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,319.51
|
| Rate for Payer: Meridian Medicaid |
$753.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,154.57
|
| Rate for Payer: PACE SWMI |
$1,099.59
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$718.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,366.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,708.64
|
| Rate for Payer: Priority Health Medicare |
$1,099.59
|
| Rate for Payer: Priority Health Narrow Network |
$1,708.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,132.58
|
|
|
PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM
|
Professional
|
Both
|
$1,947.00
|
|
|
Service Code
|
HCPCS 27258
|
| Min. Negotiated Rate |
$715.04 |
| Max. Negotiated Rate |
$2,598.71 |
| Rate for Payer: Aetna Commercial |
$1,468.10
|
| Rate for Payer: Aetna Medicare |
$1,095.60
|
| Rate for Payer: BCBS Complete |
$750.79
|
| Rate for Payer: BCBS MAPPO |
$1,095.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,598.71
|
| Rate for Payer: BCN Commercial |
$1,628.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,095.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cash Price |
$1,557.60
|
| Rate for Payer: Cofinity Commercial |
$1,468.10
|
| Rate for Payer: Cofinity Commercial |
$1,577.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,095.60
|
| Rate for Payer: Healthscope Commercial |
$1,314.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,314.72
|
| Rate for Payer: Meridian Medicaid |
$750.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,150.38
|
| Rate for Payer: PACE SWMI |
$1,095.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,095.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$715.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,362.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,701.48
|
| Rate for Payer: Priority Health Medicare |
$1,095.60
|
| Rate for Payer: Priority Health Narrow Network |
$1,701.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,128.47
|
|
|
PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$2,096.00
|
|
|
Service Code
|
HCPCS 23532
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$1,467.20 |
| Rate for Payer: Aetna Commercial |
$829.90
|
| Rate for Payer: Aetna Medicare |
$619.33
|
| Rate for Payer: BCBS Complete |
$428.06
|
| Rate for Payer: BCBS MAPPO |
$619.33
|
| Rate for Payer: BCBS Trust/PPO |
$525.66
|
| Rate for Payer: BCN Commercial |
$926.54
|
| Rate for Payer: BCN Medicare Advantage |
$619.33
|
| Rate for Payer: Cash Price |
$1,676.80
|
| Rate for Payer: Cash Price |
$1,676.80
|
| Rate for Payer: Cofinity Commercial |
$891.84
|
| Rate for Payer: Cofinity Commercial |
$829.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$619.33
|
| Rate for Payer: Healthscope Commercial |
$743.20
|
| Rate for Payer: Healthscope Whirlpool |
$743.20
|
| Rate for Payer: Meridian Medicaid |
$428.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$650.30
|
| Rate for Payer: PACE SWMI |
$619.33
|
| Rate for Payer: PHP Medicare Advantage |
$619.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$407.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,467.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$968.19
|
| Rate for Payer: Priority Health Medicare |
$619.33
|
| Rate for Payer: Priority Health Narrow Network |
$968.19
|
| Rate for Payer: UHC Medicare Advantage |
$637.91
|
|
|
PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$3,036.00
|
|
|
Service Code
|
HCPCS 27536
|
| Min. Negotiated Rate |
$763.39 |
| Max. Negotiated Rate |
$2,125.20 |
| Rate for Payer: Aetna Commercial |
$1,566.97
|
| Rate for Payer: Aetna Medicare |
$1,169.38
|
| Rate for Payer: BCBS Complete |
$801.56
|
| Rate for Payer: BCBS MAPPO |
$1,169.38
|
| Rate for Payer: BCBS Trust/PPO |
$803.02
|
| Rate for Payer: BCN Commercial |
$1,737.25
|
| Rate for Payer: BCN Medicare Advantage |
$1,169.38
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cash Price |
$2,428.80
|
| Rate for Payer: Cofinity Commercial |
$1,683.91
|
| Rate for Payer: Cofinity Commercial |
$1,566.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,169.38
|
| Rate for Payer: Healthscope Commercial |
$1,403.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,403.26
|
| Rate for Payer: Meridian Medicaid |
$801.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,227.85
|
| Rate for Payer: PACE SWMI |
$1,169.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,169.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$763.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,125.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,815.36
|
| Rate for Payer: Priority Health Medicare |
$1,169.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,815.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,204.46
|
|
|
PR OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,516.00
|
|
|
Service Code
|
HCPCS 27758
|
| Min. Negotiated Rate |
$578.72 |
| Max. Negotiated Rate |
$2,461.20 |
| Rate for Payer: Aetna Commercial |
$1,183.70
|
| Rate for Payer: Aetna Medicare |
$883.36
|
| Rate for Payer: BCBS Complete |
$607.66
|
| Rate for Payer: BCBS MAPPO |
$883.36
|
| Rate for Payer: BCBS Trust/PPO |
$623.39
|
| Rate for Payer: BCN Commercial |
$1,316.50
|
| Rate for Payer: BCN Medicare Advantage |
$883.36
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cash Price |
$2,812.80
|
| Rate for Payer: Cofinity Commercial |
$1,183.70
|
| Rate for Payer: Cofinity Commercial |
$1,272.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$883.36
|
| Rate for Payer: Healthscope Commercial |
$1,060.03
|
| Rate for Payer: Healthscope Whirlpool |
$1,060.03
|
| Rate for Payer: Meridian Medicaid |
$607.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$927.53
|
| Rate for Payer: PACE SWMI |
$883.36
|
| Rate for Payer: PHP Medicare Advantage |
$883.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,461.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,375.69
|
| Rate for Payer: Priority Health Medicare |
$883.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,375.69
|
| Rate for Payer: UHC Medicare Advantage |
$909.86
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$239.87
|
|
|
Service Code
|
NDC 68084-964-25
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.91 |
| Max. Negotiated Rate |
$239.87 |
| Rate for Payer: Aetna Commercial |
$215.88
|
| Rate for Payer: ASR ASR |
$232.67
|
| Rate for Payer: BCBS Trust/PPO |
$185.97
|
| Rate for Payer: BCN Commercial |
$185.97
|
| Rate for Payer: Cash Price |
$191.90
|
| Rate for Payer: Cofinity Commercial |
$225.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.90
|
| Rate for Payer: Healthscope Commercial |
$239.87
|
| Rate for Payer: Healthscope Whirlpool |
$232.67
|
| Rate for Payer: Mclaren Commercial |
$215.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.09
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 68084-964-95
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: ASR ASR |
$7.76
|
| Rate for Payer: BCBS Trust/PPO |
$6.20
|
| Rate for Payer: BCN Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$7.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.40
|
| Rate for Payer: Healthscope Commercial |
$8.00
|
| Rate for Payer: Healthscope Whirlpool |
$7.76
|
| Rate for Payer: Mclaren Commercial |
$7.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.04
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$251.04
|
|
|
Service Code
|
NDC 0228-2348-10
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.73 |
| Max. Negotiated Rate |
$251.04 |
| Rate for Payer: Aetna Commercial |
$225.94
|
| Rate for Payer: ASR ASR |
$243.51
|
| Rate for Payer: BCBS Trust/PPO |
$194.63
|
| Rate for Payer: BCN Commercial |
$194.63
|
| Rate for Payer: Cash Price |
$200.83
|
| Rate for Payer: Cofinity Commercial |
$235.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.83
|
| Rate for Payer: Healthscope Commercial |
$251.04
|
| Rate for Payer: Healthscope Whirlpool |
$243.51
|
| Rate for Payer: Mclaren Commercial |
$225.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$213.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.92
|
|
|
PR ORAL DEXAMETHASONE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J8540
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna Medicare |
$0.10
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.10
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.10
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Cofinity Commercial |
$0.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.10
|
| Rate for Payer: Healthscope Commercial |
$0.12
|
| Rate for Payer: Healthscope Whirlpool |
$0.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.11
|
| Rate for Payer: PACE SWMI |
$0.10
|
| Rate for Payer: PHP Medicare Advantage |
$0.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
| Rate for Payer: Priority Health Medicare |
$0.10
|
| Rate for Payer: UHC Medicare Advantage |
$0.11
|
|
|
PR ORAL POLIOVIRUS IMMUNIZATN,LIVE,OPC
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 90712
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
|
|
PR ORAL PRESCRIP DRUG NON CHEMO
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J8499
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
|
|
PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95933
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$120.21 |
| Rate for Payer: Aetna Commercial |
$104.52
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: BCBS MAPPO |
$78.00
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: BCN Commercial |
$120.21
|
| Rate for Payer: BCN Medicare Advantage |
$78.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$112.32
|
| Rate for Payer: Cofinity Commercial |
$104.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.00
|
| Rate for Payer: Healthscope Commercial |
$93.60
|
| Rate for Payer: Healthscope Whirlpool |
$93.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.90
|
| Rate for Payer: PACE SWMI |
$78.00
|
| Rate for Payer: PHP Medicare Advantage |
$78.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.49
|
| Rate for Payer: Priority Health Medicare |
$78.00
|
| Rate for Payer: Priority Health Narrow Network |
$110.49
|
| Rate for Payer: UHC Medicare Advantage |
$80.34
|
|
|
PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ
|
Professional
|
Both
|
$7,800.00
|
|
|
Service Code
|
HCPCS 61584
|
| Min. Negotiated Rate |
$420.53 |
| Max. Negotiated Rate |
$5,935.30 |
| Rate for Payer: Aetna Commercial |
$3,882.05
|
| Rate for Payer: Aetna Medicare |
$2,897.05
|
| Rate for Payer: BCBS Complete |
$1,950.90
|
| Rate for Payer: BCBS MAPPO |
$2,897.05
|
| Rate for Payer: BCBS Trust/PPO |
$420.53
|
| Rate for Payer: BCN Commercial |
$5,935.30
|
| Rate for Payer: BCN Medicare Advantage |
$2,897.05
|
| Rate for Payer: Cash Price |
$6,240.00
|
| Rate for Payer: Cash Price |
$6,240.00
|
| Rate for Payer: Cofinity Commercial |
$4,171.75
|
| Rate for Payer: Cofinity Commercial |
$3,882.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,897.05
|
| Rate for Payer: Healthscope Commercial |
$3,476.46
|
| Rate for Payer: Healthscope Whirlpool |
$3,476.46
|
| Rate for Payer: Meridian Medicaid |
$1,950.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,041.90
|
| Rate for Payer: PACE SWMI |
$2,897.05
|
| Rate for Payer: PHP Medicare Advantage |
$2,897.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,858.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,460.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,957.28
|
| Rate for Payer: Priority Health Medicare |
$2,897.05
|
| Rate for Payer: Priority Health Narrow Network |
$4,957.28
|
| Rate for Payer: UHC Medicare Advantage |
$2,983.96
|
|
|
PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE
|
Professional
|
Both
|
$5,646.00
|
|
|
Service Code
|
HCPCS 61592
|
| Min. Negotiated Rate |
$397.28 |
| Max. Negotiated Rate |
$6,472.23 |
| Rate for Payer: Aetna Commercial |
$4,243.40
|
| Rate for Payer: Aetna Medicare |
$3,166.72
|
| Rate for Payer: BCBS Complete |
$2,148.60
|
| Rate for Payer: BCBS MAPPO |
$3,166.72
|
| Rate for Payer: BCBS Trust/PPO |
$397.28
|
| Rate for Payer: BCN Commercial |
$6,472.23
|
| Rate for Payer: BCN Medicare Advantage |
$3,166.72
|
| Rate for Payer: Cash Price |
$4,516.80
|
| Rate for Payer: Cash Price |
$4,516.80
|
| Rate for Payer: Cofinity Commercial |
$4,243.40
|
| Rate for Payer: Cofinity Commercial |
$4,560.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,166.72
|
| Rate for Payer: Healthscope Commercial |
$3,800.06
|
| Rate for Payer: Healthscope Whirlpool |
$3,800.06
|
| Rate for Payer: Meridian Medicaid |
$2,148.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,325.06
|
| Rate for Payer: PACE SWMI |
$3,166.72
|
| Rate for Payer: PHP Medicare Advantage |
$3,166.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,046.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,952.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,405.73
|
| Rate for Payer: Priority Health Medicare |
$3,166.72
|
| Rate for Payer: Priority Health Narrow Network |
$5,405.73
|
| Rate for Payer: UHC Medicare Advantage |
$3,261.72
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN
|
Professional
|
Both
|
$3,518.00
|
|
|
Service Code
|
HCPCS 67445
|
| Min. Negotiated Rate |
$348.68 |
| Max. Negotiated Rate |
$2,656.05 |
| Rate for Payer: Aetna Commercial |
$1,965.58
|
| Rate for Payer: Aetna Medicare |
$1,466.85
|
| Rate for Payer: BCBS Complete |
$1,017.61
|
| Rate for Payer: BCBS MAPPO |
$1,466.85
|
| Rate for Payer: BCBS Trust/PPO |
$348.68
|
| Rate for Payer: BCN Commercial |
$2,217.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,466.85
|
| Rate for Payer: Cash Price |
$2,814.40
|
| Rate for Payer: Cash Price |
$2,814.40
|
| Rate for Payer: Cofinity Commercial |
$2,112.26
|
| Rate for Payer: Cofinity Commercial |
$1,965.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,466.85
|
| Rate for Payer: Healthscope Commercial |
$1,760.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,760.22
|
| Rate for Payer: Meridian Medicaid |
$1,017.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,540.19
|
| Rate for Payer: PACE SWMI |
$1,466.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,466.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$969.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,462.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,656.05
|
| Rate for Payer: Priority Health Medicare |
$1,466.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,656.05
|
| Rate for Payer: UHC Medicare Advantage |
$1,510.86
|
|
