|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$252.48
|
|
|
Service Code
|
NDC 228234810
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.36 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$227.23
|
| Rate for Payer: ASR ASR |
$244.91
|
| Rate for Payer: BCBS Trust/PPO |
$207.34
|
| Rate for Payer: BCN Commercial |
$207.34
|
| Rate for Payer: Cash Price |
$201.98
|
| Rate for Payer: Cofinity Commercial |
$237.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.98
|
| Rate for Payer: Healthscope Commercial |
$244.91
|
| Rate for Payer: Healthscope Whirlpool |
$252.48
|
| Rate for Payer: Mclaren Commercial |
$227.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.61
|
| Rate for Payer: Nomi Health Commercial |
$207.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.18
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
OP
|
$252.48
|
|
|
Service Code
|
NDC 228234810
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.42 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$227.23
|
| Rate for Payer: Aetna Medicare |
$93.42
|
| Rate for Payer: ASR ASR |
$244.91
|
| Rate for Payer: BCBS Complete |
$100.99
|
| Rate for Payer: BCBS Trust/PPO |
$208.17
|
| Rate for Payer: BCN Commercial |
$208.17
|
| Rate for Payer: Cash Price |
$201.98
|
| Rate for Payer: Cofinity Commercial |
$237.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.98
|
| Rate for Payer: Healthscope Commercial |
$244.91
|
| Rate for Payer: Healthscope Whirlpool |
$252.48
|
| Rate for Payer: Mclaren Commercial |
$227.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.61
|
| Rate for Payer: Nomi Health Commercial |
$207.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$221.22
|
| Rate for Payer: Priority Health Narrow Network |
$176.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.18
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
OP
|
$9.64
|
|
|
Service Code
|
NDC 68084096495
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: Aetna Medicare |
$3.56
|
| Rate for Payer: ASR ASR |
$9.35
|
| Rate for Payer: BCBS Complete |
$3.85
|
| Rate for Payer: BCBS Trust/PPO |
$7.94
|
| Rate for Payer: BCN Commercial |
$7.94
|
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.71
|
| Rate for Payer: Healthscope Commercial |
$9.35
|
| Rate for Payer: Healthscope Whirlpool |
$9.63
|
| Rate for Payer: Mclaren Commercial |
$8.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.19
|
| Rate for Payer: Nomi Health Commercial |
$7.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.44
|
| Rate for Payer: Priority Health Narrow Network |
$6.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.48
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$289.04
|
|
|
Service Code
|
NDC 68084096425
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.78 |
| Max. Negotiated Rate |
$289.04 |
| Rate for Payer: Aetna Commercial |
$260.14
|
| Rate for Payer: ASR ASR |
$280.37
|
| Rate for Payer: BCBS Trust/PPO |
$237.36
|
| Rate for Payer: BCN Commercial |
$237.36
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$271.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$280.37
|
| Rate for Payer: Healthscope Whirlpool |
$289.04
|
| Rate for Payer: Mclaren Commercial |
$260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Nomi Health Commercial |
$237.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.36
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
OP
|
$289.04
|
|
|
Service Code
|
NDC 68084096425
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$289.04 |
| Rate for Payer: Aetna Commercial |
$260.14
|
| Rate for Payer: Aetna Medicare |
$106.95
|
| Rate for Payer: ASR ASR |
$280.37
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: BCBS Trust/PPO |
$238.32
|
| Rate for Payer: BCN Commercial |
$238.32
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Commercial |
$271.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$280.37
|
| Rate for Payer: Healthscope Whirlpool |
$289.04
|
| Rate for Payer: Mclaren Commercial |
$260.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Nomi Health Commercial |
$237.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$253.26
|
| Rate for Payer: Priority Health Narrow Network |
$202.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$254.36
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$9.64
|
|
|
Service Code
|
NDC 68084096495
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.23 |
| Max. Negotiated Rate |
$9.63 |
| Rate for Payer: Aetna Commercial |
$8.67
|
| Rate for Payer: ASR ASR |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$7.91
|
| Rate for Payer: BCN Commercial |
$7.91
|
| Rate for Payer: Cash Price |
$7.71
|
| Rate for Payer: Cofinity Commercial |
$9.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.71
|
| Rate for Payer: Healthscope Commercial |
$9.35
|
| Rate for Payer: Healthscope Whirlpool |
$9.63
|
| Rate for Payer: Mclaren Commercial |
$8.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.19
|
| Rate for Payer: Nomi Health Commercial |
$7.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.48
|
|
|
PR ORAL DEXAMETHASONE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J8540
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.75 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.03
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.03
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.03
|
| Rate for Payer: Healthscope Commercial |
$0.04
|
| Rate for Payer: Healthscope Whirlpool |
$0.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.03
|
| Rate for Payer: Nomi Health Commercial |
$0.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.03
|
| Rate for Payer: Priority Health Medicare |
$0.03
|
| Rate for Payer: Railroad Medicare Medicare |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.03
|
| Rate for Payer: UHC Exchange |
$0.01
|
| Rate for Payer: UHCCP DNSP |
$0.03
|
|
|
PR ORAL POLIOVIRUS IMMUNIZATN,LIVE,OPC
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 90712
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$21.75 |
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
|
|
PR ORAL PRESCRIP DRUG NON CHEMO
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J8499
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.00
|
|
|
PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 95933
|
| Min. Negotiated Rate |
$80.04 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Aetna Commercial |
$107.25
|
| Rate for Payer: Aetna Medicare |
$80.04
|
| Rate for Payer: BCBS MAPPO |
$80.04
|
| Rate for Payer: BCN Commercial |
$119.51
|
| Rate for Payer: BCN Medicare Advantage |
$80.04
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$115.26
|
| Rate for Payer: Cofinity Commercial |
$107.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.04
|
| Rate for Payer: Healthscope Commercial |
$96.05
|
| Rate for Payer: Healthscope Whirlpool |
$96.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.04
|
| Rate for Payer: Nomi Health Commercial |
$96.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.75
|
| Rate for Payer: PACE SWMI |
$80.04
|
| Rate for Payer: PHP Medicare Advantage |
$80.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$110.22
|
| Rate for Payer: Priority Health Medicare |
$80.04
|
| Rate for Payer: Priority Health Narrow Network |
$110.22
|
| Rate for Payer: Railroad Medicare Medicare |
$80.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.04
|
| Rate for Payer: UHC Exchange |
$126.98
|
| Rate for Payer: UHCCP DNSP |
$80.04
|
|
|
PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ
|
Professional
|
Both
|
$8,195.00
|
|
|
Service Code
|
HCPCS 61584
|
| Min. Negotiated Rate |
$1,805.60 |
| Max. Negotiated Rate |
$6,146.25 |
| Rate for Payer: Aetna Commercial |
$3,745.76
|
| Rate for Payer: Aetna Medicare |
$2,795.34
|
| Rate for Payer: BCBS Complete |
$1,895.88
|
| Rate for Payer: BCBS MAPPO |
$2,795.34
|
| Rate for Payer: BCN Commercial |
$6,003.94
|
| Rate for Payer: BCN Medicare Advantage |
$2,795.34
|
| Rate for Payer: Cash Price |
$6,556.00
|
| Rate for Payer: Cash Price |
$6,556.00
|
| Rate for Payer: Cofinity Commercial |
$4,025.29
|
| Rate for Payer: Cofinity Commercial |
$3,745.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,795.34
|
| Rate for Payer: Healthscope Commercial |
$3,354.41
|
| Rate for Payer: Healthscope Whirlpool |
$3,354.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,935.11
|
| Rate for Payer: Meridian Medicaid |
$1,895.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,074.87
|
| Rate for Payer: Nomi Health Commercial |
$3,354.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,146.25
|
| Rate for Payer: PACE SWMI |
$2,795.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,795.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,805.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,047.66
|
| Rate for Payer: Priority Health Medicare |
$2,795.34
|
| Rate for Payer: Priority Health Narrow Network |
$5,047.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2,795.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,033.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,795.34
|
| Rate for Payer: UHC Exchange |
$5,033.00
|
| Rate for Payer: UHC Medicaid |
$1,805.60
|
| Rate for Payer: UHCCP DNSP |
$2,795.34
|
| Rate for Payer: UHCCP Medicaid |
$1,805.60
|
|
|
PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE
|
Professional
|
Both
|
$5,932.00
|
|
|
Service Code
|
HCPCS 61592
|
| Min. Negotiated Rate |
$1,934.47 |
| Max. Negotiated Rate |
$6,587.35 |
| Rate for Payer: Aetna Commercial |
$4,030.59
|
| Rate for Payer: Aetna Medicare |
$3,007.90
|
| Rate for Payer: BCBS Complete |
$2,031.19
|
| Rate for Payer: BCBS MAPPO |
$3,007.90
|
| Rate for Payer: BCN Commercial |
$6,587.35
|
| Rate for Payer: BCN Medicare Advantage |
$3,007.90
|
| Rate for Payer: Cash Price |
$4,745.60
|
| Rate for Payer: Cash Price |
$4,745.60
|
| Rate for Payer: Cofinity Commercial |
$4,331.38
|
| Rate for Payer: Cofinity Commercial |
$4,030.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,007.90
|
| Rate for Payer: Healthscope Commercial |
$3,609.48
|
| Rate for Payer: Healthscope Whirlpool |
$3,609.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,158.30
|
| Rate for Payer: Meridian Medicaid |
$2,031.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,308.69
|
| Rate for Payer: Nomi Health Commercial |
$3,609.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,449.00
|
| Rate for Payer: PACE SWMI |
$3,007.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,007.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,934.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,538.14
|
| Rate for Payer: Priority Health Medicare |
$3,007.90
|
| Rate for Payer: Priority Health Narrow Network |
$5,538.14
|
| Rate for Payer: Railroad Medicare Medicare |
$3,007.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,580.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,007.90
|
| Rate for Payer: UHC Exchange |
$5,580.65
|
| Rate for Payer: UHC Medicaid |
$1,934.47
|
| Rate for Payer: UHCCP DNSP |
$3,007.90
|
| Rate for Payer: UHCCP Medicaid |
$1,934.47
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN
|
Professional
|
Both
|
$3,696.00
|
|
|
Service Code
|
HCPCS 67445
|
| Min. Negotiated Rate |
$836.45 |
| Max. Negotiated Rate |
$2,772.00 |
| Rate for Payer: Aetna Commercial |
$1,692.55
|
| Rate for Payer: Aetna Medicare |
$1,263.10
|
| Rate for Payer: BCBS Complete |
$878.27
|
| Rate for Payer: BCBS MAPPO |
$1,263.10
|
| Rate for Payer: BCN Commercial |
$2,240.91
|
| Rate for Payer: BCN Medicare Advantage |
$1,263.10
|
| Rate for Payer: Cash Price |
$2,956.80
|
| Rate for Payer: Cash Price |
$2,956.80
|
| Rate for Payer: Cofinity Commercial |
$1,818.86
|
| Rate for Payer: Cofinity Commercial |
$1,692.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,263.10
|
| Rate for Payer: Healthscope Commercial |
$1,515.72
|
| Rate for Payer: Healthscope Whirlpool |
$1,515.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,326.26
|
| Rate for Payer: Meridian Medicaid |
$878.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,389.41
|
| Rate for Payer: Nomi Health Commercial |
$1,515.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,772.00
|
| Rate for Payer: PACE SWMI |
$1,263.10
|
| Rate for Payer: PHP Medicare Advantage |
$1,263.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,624.87
|
| Rate for Payer: Priority Health Medicare |
$1,263.10
|
| Rate for Payer: Priority Health Narrow Network |
$2,624.87
|
| Rate for Payer: Railroad Medicare Medicare |
$1,263.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,505.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,263.10
|
| Rate for Payer: UHC Exchange |
$2,505.10
|
| Rate for Payer: UHC Medicaid |
$836.45
|
| Rate for Payer: UHCCP DNSP |
$1,263.10
|
| Rate for Payer: UHCCP Medicaid |
$836.45
|
|
|
PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY
|
Professional
|
Both
|
$1,712.00
|
|
|
Service Code
|
HCPCS 67400
|
| Min. Negotiated Rate |
$581.06 |
| Max. Negotiated Rate |
$1,780.84 |
| Rate for Payer: Aetna Commercial |
$1,165.88
|
| Rate for Payer: Aetna Medicare |
$870.06
|
| Rate for Payer: BCBS Complete |
$610.11
|
| Rate for Payer: BCBS MAPPO |
$870.06
|
| Rate for Payer: BCN Commercial |
$1,520.34
|
| Rate for Payer: BCN Medicare Advantage |
$870.06
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cash Price |
$1,369.60
|
| Rate for Payer: Cofinity Commercial |
$1,252.89
|
| Rate for Payer: Cofinity Commercial |
$1,165.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$870.06
|
| Rate for Payer: Healthscope Commercial |
$1,044.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,044.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$913.56
|
| Rate for Payer: Meridian Medicaid |
$610.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$957.07
|
| Rate for Payer: Nomi Health Commercial |
$1,044.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,284.00
|
| Rate for Payer: PACE SWMI |
$870.06
|
| Rate for Payer: PHP Medicare Advantage |
$870.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$581.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,780.84
|
| Rate for Payer: Priority Health Medicare |
$870.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,780.84
|
| Rate for Payer: Railroad Medicare Medicare |
$870.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,665.63
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$870.06
|
| Rate for Payer: UHC Exchange |
$1,665.63
|
| Rate for Payer: UHC Medicaid |
$581.06
|
| Rate for Payer: UHCCP DNSP |
$870.06
|
| Rate for Payer: UHCCP Medicaid |
$581.06
|
|
|
PR ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$2,732.00
|
|
|
Service Code
|
HCPCS 67413
|
| Min. Negotiated Rate |
$540.17 |
| Max. Negotiated Rate |
$2,049.00 |
| Rate for Payer: Aetna Commercial |
$1,082.89
|
| Rate for Payer: Aetna Medicare |
$808.13
|
| Rate for Payer: BCBS Complete |
$567.18
|
| Rate for Payer: BCBS MAPPO |
$808.13
|
| Rate for Payer: BCN Commercial |
$1,412.27
|
| Rate for Payer: BCN Medicare Advantage |
$808.13
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Cofinity Commercial |
$1,163.71
|
| Rate for Payer: Cofinity Commercial |
$1,082.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$808.13
|
| Rate for Payer: Healthscope Commercial |
$969.76
|
| Rate for Payer: Healthscope Whirlpool |
$969.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$848.54
|
| Rate for Payer: Meridian Medicaid |
$567.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$888.94
|
| Rate for Payer: Nomi Health Commercial |
$969.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,049.00
|
| Rate for Payer: PACE SWMI |
$808.13
|
| Rate for Payer: PHP Medicare Advantage |
$808.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$540.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,654.26
|
| Rate for Payer: Priority Health Medicare |
$808.13
|
| Rate for Payer: Priority Health Narrow Network |
$1,654.26
|
| Rate for Payer: Railroad Medicare Medicare |
$808.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,541.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$808.13
|
| Rate for Payer: UHC Exchange |
$1,541.57
|
| Rate for Payer: UHC Medicaid |
$540.17
|
| Rate for Payer: UHCCP DNSP |
$808.13
|
| Rate for Payer: UHCCP Medicaid |
$540.17
|
|
|
PR ORCHIECTOMY PARTIAL
|
Professional
|
Both
|
$1,136.00
|
|
|
Service Code
|
HCPCS 54522
|
| Min. Negotiated Rate |
$341.23 |
| Max. Negotiated Rate |
$1,038.24 |
| Rate for Payer: Aetna Commercial |
$706.01
|
| Rate for Payer: Aetna Medicare |
$526.87
|
| Rate for Payer: BCBS Complete |
$358.29
|
| Rate for Payer: BCBS MAPPO |
$526.87
|
| Rate for Payer: BCN Commercial |
$882.42
|
| Rate for Payer: BCN Medicare Advantage |
$526.87
|
| Rate for Payer: Cash Price |
$908.80
|
| Rate for Payer: Cash Price |
$908.80
|
| Rate for Payer: Cofinity Commercial |
$758.69
|
| Rate for Payer: Cofinity Commercial |
$706.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$526.87
|
| Rate for Payer: Healthscope Commercial |
$632.24
|
| Rate for Payer: Healthscope Whirlpool |
$632.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$553.21
|
| Rate for Payer: Meridian Medicaid |
$358.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$579.56
|
| Rate for Payer: Nomi Health Commercial |
$632.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$852.00
|
| Rate for Payer: PACE SWMI |
$526.87
|
| Rate for Payer: PHP Medicare Advantage |
$526.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$341.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$961.24
|
| Rate for Payer: Priority Health Medicare |
$526.87
|
| Rate for Payer: Priority Health Narrow Network |
$961.24
|
| Rate for Payer: Railroad Medicare Medicare |
$526.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,038.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$526.87
|
| Rate for Payer: UHC Exchange |
$1,038.24
|
| Rate for Payer: UHC Medicaid |
$341.23
|
| Rate for Payer: UHCCP DNSP |
$526.87
|
| Rate for Payer: UHCCP Medicaid |
$341.23
|
|
|
PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH
|
Professional
|
Both
|
$998.00
|
|
|
Service Code
|
HCPCS 54530
|
| Min. Negotiated Rate |
$299.27 |
| Max. Negotiated Rate |
$891.05 |
| Rate for Payer: Aetna Commercial |
$616.99
|
| Rate for Payer: Aetna Medicare |
$460.44
|
| Rate for Payer: BCBS Complete |
$314.23
|
| Rate for Payer: BCBS MAPPO |
$460.44
|
| Rate for Payer: BCN Commercial |
$767.39
|
| Rate for Payer: BCN Medicare Advantage |
$460.44
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cash Price |
$798.40
|
| Rate for Payer: Cofinity Commercial |
$663.03
|
| Rate for Payer: Cofinity Commercial |
$616.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$460.44
|
| Rate for Payer: Healthscope Commercial |
$552.53
|
| Rate for Payer: Healthscope Whirlpool |
$552.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$483.46
|
| Rate for Payer: Meridian Medicaid |
$314.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$506.48
|
| Rate for Payer: Nomi Health Commercial |
$552.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$748.50
|
| Rate for Payer: PACE SWMI |
$460.44
|
| Rate for Payer: PHP Medicare Advantage |
$460.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$299.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$835.94
|
| Rate for Payer: Priority Health Medicare |
$460.44
|
| Rate for Payer: Priority Health Narrow Network |
$835.94
|
| Rate for Payer: Railroad Medicare Medicare |
$460.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$891.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$460.44
|
| Rate for Payer: UHC Exchange |
$891.05
|
| Rate for Payer: UHC Medicaid |
$299.27
|
| Rate for Payer: UHCCP DNSP |
$460.44
|
| Rate for Payer: UHCCP Medicaid |
$299.27
|
|
|
PR ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL
|
Professional
|
Both
|
$1,443.00
|
|
|
Service Code
|
HCPCS 54535
|
| Min. Negotiated Rate |
$429.62 |
| Max. Negotiated Rate |
$1,313.09 |
| Rate for Payer: Aetna Commercial |
$890.24
|
| Rate for Payer: Aetna Medicare |
$664.36
|
| Rate for Payer: BCBS Complete |
$451.10
|
| Rate for Payer: BCBS MAPPO |
$664.36
|
| Rate for Payer: BCN Commercial |
$1,114.98
|
| Rate for Payer: BCN Medicare Advantage |
$664.36
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cofinity Commercial |
$956.68
|
| Rate for Payer: Cofinity Commercial |
$890.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.36
|
| Rate for Payer: Healthscope Commercial |
$797.23
|
| Rate for Payer: Healthscope Whirlpool |
$797.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.58
|
| Rate for Payer: Meridian Medicaid |
$451.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$730.80
|
| Rate for Payer: Nomi Health Commercial |
$797.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,082.25
|
| Rate for Payer: PACE SWMI |
$664.36
|
| Rate for Payer: PHP Medicare Advantage |
$664.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$429.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,214.58
|
| Rate for Payer: Priority Health Medicare |
$664.36
|
| Rate for Payer: Priority Health Narrow Network |
$1,214.58
|
| Rate for Payer: Railroad Medicare Medicare |
$664.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,313.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$664.36
|
| Rate for Payer: UHC Exchange |
$1,313.09
|
| Rate for Payer: UHC Medicaid |
$429.62
|
| Rate for Payer: UHCCP DNSP |
$664.36
|
| Rate for Payer: UHCCP Medicaid |
$429.62
|
|
|
PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH
|
Professional
|
Both
|
$633.00
|
|
|
Service Code
|
HCPCS 54520
|
| Min. Negotiated Rate |
$194.90 |
| Max. Negotiated Rate |
$571.83 |
| Rate for Payer: Aetna Commercial |
$401.09
|
| Rate for Payer: Aetna Medicare |
$299.32
|
| Rate for Payer: BCBS Complete |
$204.65
|
| Rate for Payer: BCBS MAPPO |
$299.32
|
| Rate for Payer: BCN Commercial |
$495.49
|
| Rate for Payer: BCN Medicare Advantage |
$299.32
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cofinity Commercial |
$431.02
|
| Rate for Payer: Cofinity Commercial |
$401.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.32
|
| Rate for Payer: Healthscope Commercial |
$359.18
|
| Rate for Payer: Healthscope Whirlpool |
$359.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.29
|
| Rate for Payer: Meridian Medicaid |
$204.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$329.25
|
| Rate for Payer: Nomi Health Commercial |
$359.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$474.75
|
| Rate for Payer: PACE SWMI |
$299.32
|
| Rate for Payer: PHP Medicare Advantage |
$299.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$539.75
|
| Rate for Payer: Priority Health Medicare |
$299.32
|
| Rate for Payer: Priority Health Narrow Network |
$539.75
|
| Rate for Payer: Railroad Medicare Medicare |
$299.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$571.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$299.32
|
| Rate for Payer: UHC Exchange |
$571.83
|
| Rate for Payer: UHC Medicaid |
$194.90
|
| Rate for Payer: UHCCP DNSP |
$299.32
|
| Rate for Payer: UHCCP Medicaid |
$194.90
|
|
|
PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS
|
Professional
|
Both
|
$1,544.00
|
|
|
Service Code
|
HCPCS 54650
|
| Min. Negotiated Rate |
$413.22 |
| Max. Negotiated Rate |
$1,254.38 |
| Rate for Payer: Aetna Commercial |
$854.68
|
| Rate for Payer: Aetna Medicare |
$637.82
|
| Rate for Payer: BCBS Complete |
$433.88
|
| Rate for Payer: BCBS MAPPO |
$637.82
|
| Rate for Payer: BCN Commercial |
$1,069.16
|
| Rate for Payer: BCN Medicare Advantage |
$637.82
|
| Rate for Payer: Cash Price |
$1,235.20
|
| Rate for Payer: Cash Price |
$1,235.20
|
| Rate for Payer: Cofinity Commercial |
$918.46
|
| Rate for Payer: Cofinity Commercial |
$854.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$637.82
|
| Rate for Payer: Healthscope Commercial |
$765.38
|
| Rate for Payer: Healthscope Whirlpool |
$765.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$669.71
|
| Rate for Payer: Meridian Medicaid |
$433.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$701.60
|
| Rate for Payer: Nomi Health Commercial |
$765.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,158.00
|
| Rate for Payer: PACE SWMI |
$637.82
|
| Rate for Payer: PHP Medicare Advantage |
$637.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$413.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,164.67
|
| Rate for Payer: Priority Health Medicare |
$637.82
|
| Rate for Payer: Priority Health Narrow Network |
$1,164.67
|
| Rate for Payer: Railroad Medicare Medicare |
$637.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,254.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$637.82
|
| Rate for Payer: UHC Exchange |
$1,254.38
|
| Rate for Payer: UHC Medicaid |
$413.22
|
| Rate for Payer: UHCCP DNSP |
$637.82
|
| Rate for Payer: UHCCP Medicaid |
$413.22
|
|
|
PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH
|
Professional
|
Both
|
$1,809.00
|
|
|
Service Code
|
HCPCS 54640
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$1,356.75 |
| Rate for Payer: Aetna Commercial |
$521.29
|
| Rate for Payer: Aetna Medicare |
$389.02
|
| Rate for Payer: BCBS Complete |
$263.69
|
| Rate for Payer: BCBS MAPPO |
$389.02
|
| Rate for Payer: BCN Commercial |
$650.37
|
| Rate for Payer: BCN Medicare Advantage |
$389.02
|
| Rate for Payer: Cash Price |
$1,447.20
|
| Rate for Payer: Cash Price |
$1,447.20
|
| Rate for Payer: Cofinity Commercial |
$560.19
|
| Rate for Payer: Cofinity Commercial |
$521.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.02
|
| Rate for Payer: Healthscope Commercial |
$466.82
|
| Rate for Payer: Healthscope Whirlpool |
$466.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.47
|
| Rate for Payer: Meridian Medicaid |
$263.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$427.92
|
| Rate for Payer: Nomi Health Commercial |
$466.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,356.75
|
| Rate for Payer: PACE SWMI |
$389.02
|
| Rate for Payer: PHP Medicare Advantage |
$389.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$251.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$708.46
|
| Rate for Payer: Priority Health Medicare |
$389.02
|
| Rate for Payer: Priority Health Narrow Network |
$708.46
|
| Rate for Payer: Railroad Medicare Medicare |
$389.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$767.43
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$389.02
|
| Rate for Payer: UHC Exchange |
$767.43
|
| Rate for Payer: UHC Medicaid |
$251.13
|
| Rate for Payer: UHCCP DNSP |
$389.02
|
| Rate for Payer: UHCCP Medicaid |
$251.13
|
|
|
PR ORPHENADRINE INJECTION
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS J2360
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna Commercial |
$11.01
|
| Rate for Payer: Aetna Medicare |
$8.22
|
| Rate for Payer: BCBS MAPPO |
$8.22
|
| Rate for Payer: BCBS Trust/PPO |
$5.31
|
| Rate for Payer: BCN Commercial |
$10.25
|
| Rate for Payer: BCN Medicare Advantage |
$8.22
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$11.84
|
| Rate for Payer: Cofinity Commercial |
$11.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.22
|
| Rate for Payer: Healthscope Commercial |
$9.86
|
| Rate for Payer: Healthscope Whirlpool |
$9.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.04
|
| Rate for Payer: Nomi Health Commercial |
$9.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.25
|
| Rate for Payer: PACE SWMI |
$8.22
|
| Rate for Payer: PHP Medicare Advantage |
$8.22
|
| Rate for Payer: Priority Health Medicare |
$8.22
|
| Rate for Payer: Railroad Medicare Medicare |
$8.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.22
|
| Rate for Payer: UHC Exchange |
$6.39
|
| Rate for Payer: UHCCP DNSP |
$8.22
|
|
|
PR ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 97760
|
| Min. Negotiated Rate |
$43.05 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$58.44
|
| Rate for Payer: Aetna Medicare |
$43.61
|
| Rate for Payer: BCBS MAPPO |
$43.61
|
| Rate for Payer: BCN Commercial |
$70.71
|
| Rate for Payer: BCN Medicare Advantage |
$43.61
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$58.44
|
| Rate for Payer: Cofinity Commercial |
$62.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.61
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Healthscope Whirlpool |
$52.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.97
|
| Rate for Payer: Nomi Health Commercial |
$52.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.50
|
| Rate for Payer: PACE SWMI |
$43.61
|
| Rate for Payer: PHP Medicare Advantage |
$43.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$43.61
|
| Rate for Payer: Priority Health Narrow Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$43.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$43.61
|
| Rate for Payer: UHC Exchange |
$43.05
|
| Rate for Payer: UHCCP DNSP |
$43.61
|
|
|
PR ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 97763
|
| Min. Negotiated Rate |
$45.96 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$63.26
|
| Rate for Payer: Aetna Medicare |
$47.21
|
| Rate for Payer: BCBS MAPPO |
$47.21
|
| Rate for Payer: BCN Commercial |
$77.18
|
| Rate for Payer: BCN Medicare Advantage |
$47.21
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cofinity Commercial |
$63.26
|
| Rate for Payer: Cofinity Commercial |
$67.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.21
|
| Rate for Payer: Healthscope Commercial |
$56.65
|
| Rate for Payer: Healthscope Whirlpool |
$56.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.93
|
| Rate for Payer: Nomi Health Commercial |
$56.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.75
|
| Rate for Payer: PACE SWMI |
$47.21
|
| Rate for Payer: PHP Medicare Advantage |
$47.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$89.48
|
| Rate for Payer: Priority Health Medicare |
$47.21
|
| Rate for Payer: Priority Health Narrow Network |
$89.48
|
| Rate for Payer: Railroad Medicare Medicare |
$47.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.21
|
| Rate for Payer: UHC Exchange |
$45.96
|
| Rate for Payer: UHCCP DNSP |
$47.21
|
|
|
PR ORTHOVISC INJ PER DOSE
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS J7324
|
| Min. Negotiated Rate |
$109.09 |
| Max. Negotiated Rate |
$157.09 |
| Rate for Payer: Aetna Commercial |
$146.18
|
| Rate for Payer: Aetna Medicare |
$109.09
|
| Rate for Payer: BCBS MAPPO |
$109.09
|
| Rate for Payer: BCBS Trust/PPO |
$113.35
|
| Rate for Payer: BCN Commercial |
$130.97
|
| Rate for Payer: BCN Medicare Advantage |
$109.09
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$146.18
|
| Rate for Payer: Cofinity Commercial |
$157.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.09
|
| Rate for Payer: Healthscope Commercial |
$130.91
|
| Rate for Payer: Healthscope Whirlpool |
$130.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$120.00
|
| Rate for Payer: Nomi Health Commercial |
$130.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.25
|
| Rate for Payer: PACE SWMI |
$109.09
|
| Rate for Payer: PHP Medicare Advantage |
$109.09
|
| Rate for Payer: Priority Health Medicare |
$109.09
|
| Rate for Payer: Railroad Medicare Medicare |
$109.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$109.09
|
| Rate for Payer: UHC Exchange |
$111.26
|
| Rate for Payer: UHCCP DNSP |
$109.09
|
|
