|
PR OPTX SHO DISLC W/FX GR HUMERAL TUBRST INT FIXJ
|
Professional
|
Both
|
$2,939.00
|
|
|
Service Code
|
HCPCS 23670
|
| Min. Negotiated Rate |
$843.41 |
| Max. Negotiated Rate |
$1,910.35 |
| Rate for Payer: Aetna Commercial |
$1,130.17
|
| Rate for Payer: Aetna Medicare |
$843.41
|
| Rate for Payer: BCBS Complete |
$1,175.60
|
| Rate for Payer: BCBS MAPPO |
$843.41
|
| Rate for Payer: BCN Medicare Advantage |
$843.41
|
| Rate for Payer: Cash Price |
$2,351.20
|
| Rate for Payer: Cash Price |
$2,351.20
|
| Rate for Payer: Cofinity Commercial |
$1,214.51
|
| Rate for Payer: Cofinity Commercial |
$1,130.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$843.41
|
| Rate for Payer: Healthscope Commercial |
$1,012.09
|
| Rate for Payer: Healthscope Whirlpool |
$1,012.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$885.58
|
| Rate for Payer: Nomi Health Commercial |
$1,012.09
|
| Rate for Payer: PACE SWMI |
$843.41
|
| Rate for Payer: PHP Medicare Advantage |
$843.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,910.35
|
| Rate for Payer: Priority Health Medicare |
$843.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$843.41
|
| Rate for Payer: UHC Medicare Advantage |
$843.41
|
| Rate for Payer: UHCCP DNSP |
$843.41
|
|
|
PR OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ
|
Professional
|
Both
|
$1,655.00
|
|
|
Service Code
|
HCPCS 23680
|
| Min. Negotiated Rate |
$662.00 |
| Max. Negotiated Rate |
$1,294.33 |
| Rate for Payer: Aetna Commercial |
$1,204.45
|
| Rate for Payer: Aetna Medicare |
$898.84
|
| Rate for Payer: BCBS Complete |
$662.00
|
| Rate for Payer: BCBS MAPPO |
$898.84
|
| Rate for Payer: BCN Medicare Advantage |
$898.84
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cash Price |
$1,324.00
|
| Rate for Payer: Cofinity Commercial |
$1,294.33
|
| Rate for Payer: Cofinity Commercial |
$1,204.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$898.84
|
| Rate for Payer: Healthscope Commercial |
$1,078.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,078.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$943.78
|
| Rate for Payer: Nomi Health Commercial |
$1,078.61
|
| Rate for Payer: PACE SWMI |
$898.84
|
| Rate for Payer: PHP Medicare Advantage |
$898.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,075.75
|
| Rate for Payer: Priority Health Medicare |
$898.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$898.84
|
| Rate for Payer: UHC Medicare Advantage |
$898.84
|
| Rate for Payer: UHCCP DNSP |
$898.84
|
|
|
PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN
|
Professional
|
Both
|
$1,647.00
|
|
|
Service Code
|
HCPCS 27178
|
| Min. Negotiated Rate |
$658.80 |
| Max. Negotiated Rate |
$1,281.67 |
| Rate for Payer: Aetna Commercial |
$1,192.67
|
| Rate for Payer: Aetna Medicare |
$890.05
|
| Rate for Payer: BCBS Complete |
$658.80
|
| Rate for Payer: BCBS MAPPO |
$890.05
|
| Rate for Payer: BCN Medicare Advantage |
$890.05
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cash Price |
$1,317.60
|
| Rate for Payer: Cofinity Commercial |
$1,281.67
|
| Rate for Payer: Cofinity Commercial |
$1,192.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$890.05
|
| Rate for Payer: Healthscope Commercial |
$1,068.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,068.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$934.55
|
| Rate for Payer: Nomi Health Commercial |
$1,068.06
|
| Rate for Payer: PACE SWMI |
$890.05
|
| Rate for Payer: PHP Medicare Advantage |
$890.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,070.55
|
| Rate for Payer: Priority Health Medicare |
$890.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$890.05
|
| Rate for Payer: UHC Medicare Advantage |
$890.05
|
| Rate for Payer: UHCCP DNSP |
$890.05
|
|
|
PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ
|
Professional
|
Both
|
$2,351.00
|
|
|
Service Code
|
HCPCS 27181
|
| Min. Negotiated Rate |
$940.40 |
| Max. Negotiated Rate |
$1,555.17 |
| Rate for Payer: Aetna Commercial |
$1,447.17
|
| Rate for Payer: Aetna Medicare |
$1,079.98
|
| Rate for Payer: BCBS Complete |
$940.40
|
| Rate for Payer: BCBS MAPPO |
$1,079.98
|
| Rate for Payer: BCN Medicare Advantage |
$1,079.98
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cash Price |
$1,880.80
|
| Rate for Payer: Cofinity Commercial |
$1,555.17
|
| Rate for Payer: Cofinity Commercial |
$1,447.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,079.98
|
| Rate for Payer: Healthscope Commercial |
$1,295.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,295.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,133.98
|
| Rate for Payer: Nomi Health Commercial |
$1,295.98
|
| Rate for Payer: PACE SWMI |
$1,079.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,079.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,528.15
|
| Rate for Payer: Priority Health Medicare |
$1,079.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,079.98
|
| Rate for Payer: UHC Medicare Advantage |
$1,079.98
|
| Rate for Payer: UHCCP DNSP |
$1,079.98
|
|
|
PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT
|
Professional
|
Both
|
$1,991.00
|
|
|
Service Code
|
HCPCS 27177
|
| Min. Negotiated Rate |
$796.40 |
| Max. Negotiated Rate |
$1,548.73 |
| Rate for Payer: Aetna Commercial |
$1,441.18
|
| Rate for Payer: Aetna Medicare |
$1,075.51
|
| Rate for Payer: BCBS Complete |
$796.40
|
| Rate for Payer: BCBS MAPPO |
$1,075.51
|
| Rate for Payer: BCN Medicare Advantage |
$1,075.51
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cash Price |
$1,592.80
|
| Rate for Payer: Cofinity Commercial |
$1,548.73
|
| Rate for Payer: Cofinity Commercial |
$1,441.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,075.51
|
| Rate for Payer: Healthscope Commercial |
$1,290.61
|
| Rate for Payer: Healthscope Whirlpool |
$1,290.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,129.29
|
| Rate for Payer: Nomi Health Commercial |
$1,290.61
|
| Rate for Payer: PACE SWMI |
$1,075.51
|
| Rate for Payer: PHP Medicare Advantage |
$1,075.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,294.15
|
| Rate for Payer: Priority Health Medicare |
$1,075.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,075.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,075.51
|
| Rate for Payer: UHCCP DNSP |
$1,075.51
|
|
|
PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM
|
Professional
|
Both
|
$1,986.00
|
|
|
Service Code
|
HCPCS 27258
|
| Min. Negotiated Rate |
$794.40 |
| Max. Negotiated Rate |
$1,542.44 |
| Rate for Payer: Aetna Commercial |
$1,435.33
|
| Rate for Payer: Aetna Medicare |
$1,071.14
|
| Rate for Payer: BCBS Complete |
$794.40
|
| Rate for Payer: BCBS MAPPO |
$1,071.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,071.14
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cash Price |
$1,588.80
|
| Rate for Payer: Cofinity Commercial |
$1,542.44
|
| Rate for Payer: Cofinity Commercial |
$1,435.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,071.14
|
| Rate for Payer: Healthscope Commercial |
$1,285.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,285.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,124.70
|
| Rate for Payer: Nomi Health Commercial |
$1,285.37
|
| Rate for Payer: PACE SWMI |
$1,071.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,071.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,290.90
|
| Rate for Payer: Priority Health Medicare |
$1,071.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,071.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,071.14
|
| Rate for Payer: UHCCP DNSP |
$1,071.14
|
|
|
PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF
|
Professional
|
Both
|
$2,138.00
|
|
|
Service Code
|
HCPCS 23532
|
| Min. Negotiated Rate |
$607.54 |
| Max. Negotiated Rate |
$1,389.70 |
| Rate for Payer: Aetna Commercial |
$814.10
|
| Rate for Payer: Aetna Medicare |
$607.54
|
| Rate for Payer: BCBS Complete |
$855.20
|
| Rate for Payer: BCBS MAPPO |
$607.54
|
| Rate for Payer: BCN Medicare Advantage |
$607.54
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cash Price |
$1,710.40
|
| Rate for Payer: Cofinity Commercial |
$874.86
|
| Rate for Payer: Cofinity Commercial |
$814.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$607.54
|
| Rate for Payer: Healthscope Commercial |
$729.05
|
| Rate for Payer: Healthscope Whirlpool |
$729.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$637.92
|
| Rate for Payer: Nomi Health Commercial |
$729.05
|
| Rate for Payer: PACE SWMI |
$607.54
|
| Rate for Payer: PHP Medicare Advantage |
$607.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,389.70
|
| Rate for Payer: Priority Health Medicare |
$607.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$607.54
|
| Rate for Payer: UHC Medicare Advantage |
$607.54
|
| Rate for Payer: UHCCP DNSP |
$607.54
|
|
|
PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ
|
Professional
|
Both
|
$3,097.00
|
|
|
Service Code
|
HCPCS 27536
|
| Min. Negotiated Rate |
$1,144.56 |
| Max. Negotiated Rate |
$2,013.05 |
| Rate for Payer: Aetna Commercial |
$1,533.71
|
| Rate for Payer: Aetna Medicare |
$1,144.56
|
| Rate for Payer: BCBS Complete |
$1,238.80
|
| Rate for Payer: BCBS MAPPO |
$1,144.56
|
| Rate for Payer: BCN Medicare Advantage |
$1,144.56
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cash Price |
$2,477.60
|
| Rate for Payer: Cofinity Commercial |
$1,648.17
|
| Rate for Payer: Cofinity Commercial |
$1,533.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,144.56
|
| Rate for Payer: Healthscope Commercial |
$1,373.47
|
| Rate for Payer: Healthscope Whirlpool |
$1,373.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,201.79
|
| Rate for Payer: Nomi Health Commercial |
$1,373.47
|
| Rate for Payer: PACE SWMI |
$1,144.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,144.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,013.05
|
| Rate for Payer: Priority Health Medicare |
$1,144.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,144.56
|
| Rate for Payer: UHC Medicare Advantage |
$1,144.56
|
| Rate for Payer: UHCCP DNSP |
$1,144.56
|
|
|
PR OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE
|
Professional
|
Both
|
$3,586.00
|
|
|
Service Code
|
HCPCS 27758
|
| Min. Negotiated Rate |
$864.20 |
| Max. Negotiated Rate |
$2,330.90 |
| Rate for Payer: Aetna Commercial |
$1,158.03
|
| Rate for Payer: Aetna Medicare |
$864.20
|
| Rate for Payer: BCBS Complete |
$1,434.40
|
| Rate for Payer: BCBS MAPPO |
$864.20
|
| Rate for Payer: BCN Medicare Advantage |
$864.20
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cash Price |
$2,868.80
|
| Rate for Payer: Cofinity Commercial |
$1,244.45
|
| Rate for Payer: Cofinity Commercial |
$1,158.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$864.20
|
| Rate for Payer: Healthscope Commercial |
$1,037.04
|
| Rate for Payer: Healthscope Whirlpool |
$1,037.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$907.41
|
| Rate for Payer: Nomi Health Commercial |
$1,037.04
|
| Rate for Payer: PACE SWMI |
$864.20
|
| Rate for Payer: PHP Medicare Advantage |
$864.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,330.90
|
| Rate for Payer: Priority Health Medicare |
$864.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$864.20
|
| Rate for Payer: UHC Medicare Advantage |
$864.20
|
| Rate for Payer: UHCCP DNSP |
$864.20
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$245.53
|
|
|
Service Code
|
NDC 68084096425
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.59 |
| Max. Negotiated Rate |
$245.53 |
| Rate for Payer: Aetna Commercial |
$220.98
|
| Rate for Payer: ASR ASR |
$238.16
|
| Rate for Payer: ASR Commercial |
$238.16
|
| Rate for Payer: BCBS Trust/PPO |
$200.08
|
| Rate for Payer: BCN Commercial |
$190.36
|
| Rate for Payer: Cash Price |
$196.43
|
| Rate for Payer: Cofinity Commercial |
$230.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.42
|
| Rate for Payer: Healthscope Commercial |
$245.53
|
| Rate for Payer: Healthscope Whirlpool |
$238.16
|
| Rate for Payer: Mclaren Commercial |
$220.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.70
|
| Rate for Payer: Nomi Health Commercial |
$201.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.07
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
OP
|
$252.48
|
|
|
Service Code
|
NDC 00228234810
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.99 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$227.23
|
| Rate for Payer: Aetna Medicare |
$126.24
|
| Rate for Payer: ASR ASR |
$244.91
|
| Rate for Payer: ASR Commercial |
$244.91
|
| Rate for Payer: BCBS Complete |
$100.99
|
| Rate for Payer: BCBS Trust/PPO |
$206.76
|
| Rate for Payer: BCN Commercial |
$195.75
|
| 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 |
$252.48
|
| Rate for Payer: Healthscope Whirlpool |
$244.91
|
| 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: Priority Health Cigna Priority Health |
$164.11
|
| Rate for Payer: 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
|
$8.19
|
|
|
Service Code
|
NDC 68084096495
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Aetna Commercial |
$7.37
|
| Rate for Payer: Aetna Medicare |
$4.09
|
| Rate for Payer: ASR ASR |
$7.94
|
| Rate for Payer: ASR Commercial |
$7.94
|
| Rate for Payer: BCBS Complete |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$6.71
|
| Rate for Payer: BCN Commercial |
$6.35
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$7.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.55
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Whirlpool |
$7.94
|
| Rate for Payer: Mclaren Commercial |
$7.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.96
|
| Rate for Payer: Nomi Health Commercial |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.18
|
| Rate for Payer: Priority Health Narrow Network |
$5.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.21
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$8.19
|
|
|
Service Code
|
NDC 68084096495
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Aetna Commercial |
$7.37
|
| Rate for Payer: ASR ASR |
$7.94
|
| Rate for Payer: ASR Commercial |
$7.94
|
| Rate for Payer: BCBS Trust/PPO |
$6.67
|
| Rate for Payer: BCN Commercial |
$6.35
|
| Rate for Payer: Cash Price |
$6.55
|
| Rate for Payer: Cofinity Commercial |
$7.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.55
|
| Rate for Payer: Healthscope Commercial |
$8.19
|
| Rate for Payer: Healthscope Whirlpool |
$7.94
|
| Rate for Payer: Mclaren Commercial |
$7.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.96
|
| Rate for Payer: Nomi Health Commercial |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.21
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
OP
|
$245.53
|
|
|
Service Code
|
NDC 68084096425
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.21 |
| Max. Negotiated Rate |
$245.53 |
| Rate for Payer: Aetna Commercial |
$220.98
|
| Rate for Payer: Aetna Medicare |
$122.77
|
| Rate for Payer: ASR ASR |
$238.16
|
| Rate for Payer: ASR Commercial |
$238.16
|
| Rate for Payer: BCBS Complete |
$98.21
|
| Rate for Payer: BCBS Trust/PPO |
$201.06
|
| Rate for Payer: BCN Commercial |
$190.36
|
| Rate for Payer: Cash Price |
$196.43
|
| Rate for Payer: Cofinity Commercial |
$230.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.42
|
| Rate for Payer: Healthscope Commercial |
$245.53
|
| Rate for Payer: Healthscope Whirlpool |
$238.16
|
| Rate for Payer: Mclaren Commercial |
$220.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.70
|
| Rate for Payer: Nomi Health Commercial |
$201.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$215.13
|
| Rate for Payer: Priority Health Narrow Network |
$172.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$216.07
|
|
|
PROPYLTHIOURACIL 50 MG TABLET
|
Facility
|
IP
|
$252.48
|
|
|
Service Code
|
NDC 00228234810
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.11 |
| Max. Negotiated Rate |
$252.48 |
| Rate for Payer: Aetna Commercial |
$227.23
|
| Rate for Payer: ASR ASR |
$244.91
|
| Rate for Payer: ASR Commercial |
$244.91
|
| Rate for Payer: BCBS Trust/PPO |
$205.75
|
| Rate for Payer: BCN Commercial |
$195.75
|
| 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 |
$252.48
|
| Rate for Payer: Healthscope Whirlpool |
$244.91
|
| 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: Priority Health Cigna Priority Health |
$164.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.18
|
|
|
PR ORAL DEXAMETHASONE
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J8540
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Aetna Commercial |
$0.03
|
| Rate for Payer: Aetna Medicare |
$0.02
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.02
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Cofinity Commercial |
$0.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.02
|
| Rate for Payer: Healthscope Commercial |
$0.02
|
| Rate for Payer: Healthscope Whirlpool |
$0.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.02
|
| Rate for Payer: Nomi Health Commercial |
$0.02
|
| Rate for Payer: PACE SWMI |
$0.02
|
| Rate for Payer: PHP Medicare Advantage |
$0.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.65
|
| Rate for Payer: Priority Health Medicare |
$0.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.02
|
| Rate for Payer: UHC Medicare Advantage |
$0.02
|
| Rate for Payer: UHCCP DNSP |
$0.02
|
|
|
PR ORAL POLIOVIRUS IMMUNIZATN,LIVE,OPC
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 90712
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
|
|
PR ORAL PRESCRIP DRUG NON CHEMO
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J8499
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Aetna Medicare |
$2.00
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.60
|
|
|
PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 95933
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$97.50
|
| Rate for Payer: Aetna Medicare |
$72.76
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$72.76
|
| Rate for Payer: BCN Medicare Advantage |
$72.76
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$97.50
|
| Rate for Payer: Cofinity Commercial |
$104.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.76
|
| Rate for Payer: Healthscope Commercial |
$87.31
|
| Rate for Payer: Healthscope Whirlpool |
$87.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.40
|
| Rate for Payer: Nomi Health Commercial |
$87.31
|
| Rate for Payer: PACE SWMI |
$72.76
|
| Rate for Payer: PHP Medicare Advantage |
$72.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Medicare |
$72.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.76
|
| Rate for Payer: UHC Medicare Advantage |
$72.76
|
| Rate for Payer: UHCCP DNSP |
$72.76
|
|
|
PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ
|
Professional
|
Both
|
$7,956.00
|
|
|
Service Code
|
HCPCS 61584
|
| Min. Negotiated Rate |
$2,802.64 |
| Max. Negotiated Rate |
$5,171.40 |
| Rate for Payer: Aetna Commercial |
$3,755.54
|
| Rate for Payer: Aetna Medicare |
$2,802.64
|
| Rate for Payer: BCBS Complete |
$3,182.40
|
| Rate for Payer: BCBS MAPPO |
$2,802.64
|
| Rate for Payer: BCN Medicare Advantage |
$2,802.64
|
| Rate for Payer: Cash Price |
$6,364.80
|
| Rate for Payer: Cash Price |
$6,364.80
|
| Rate for Payer: Cofinity Commercial |
$4,035.80
|
| Rate for Payer: Cofinity Commercial |
$3,755.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,802.64
|
| Rate for Payer: Healthscope Commercial |
$3,363.17
|
| Rate for Payer: Healthscope Whirlpool |
$3,363.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,942.77
|
| Rate for Payer: Nomi Health Commercial |
$3,363.17
|
| Rate for Payer: PACE SWMI |
$2,802.64
|
| Rate for Payer: PHP Medicare Advantage |
$2,802.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,171.40
|
| Rate for Payer: Priority Health Medicare |
$2,802.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,802.64
|
| Rate for Payer: UHC Medicare Advantage |
$2,802.64
|
| Rate for Payer: UHCCP DNSP |
$2,802.64
|
|
|
PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE
|
Professional
|
Both
|
$5,759.00
|
|
|
Service Code
|
HCPCS 61592
|
| Min. Negotiated Rate |
$2,303.60 |
| Max. Negotiated Rate |
$4,440.38 |
| Rate for Payer: Aetna Commercial |
$4,132.02
|
| Rate for Payer: Aetna Medicare |
$3,083.60
|
| Rate for Payer: BCBS Complete |
$2,303.60
|
| Rate for Payer: BCBS MAPPO |
$3,083.60
|
| Rate for Payer: BCN Medicare Advantage |
$3,083.60
|
| Rate for Payer: Cash Price |
$4,607.20
|
| Rate for Payer: Cash Price |
$4,607.20
|
| Rate for Payer: Cofinity Commercial |
$4,440.38
|
| Rate for Payer: Cofinity Commercial |
$4,132.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,083.60
|
| Rate for Payer: Healthscope Commercial |
$3,700.32
|
| Rate for Payer: Healthscope Whirlpool |
$3,700.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,237.78
|
| Rate for Payer: Nomi Health Commercial |
$3,700.32
|
| Rate for Payer: PACE SWMI |
$3,083.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,083.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,743.35
|
| Rate for Payer: Priority Health Medicare |
$3,083.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,083.60
|
| Rate for Payer: UHC Medicare Advantage |
$3,083.60
|
| Rate for Payer: UHCCP DNSP |
$3,083.60
|
|
|
PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN
|
Professional
|
Both
|
$3,588.00
|
|
|
Service Code
|
HCPCS 67445
|
| Min. Negotiated Rate |
$1,394.99 |
| Max. Negotiated Rate |
$2,332.20 |
| Rate for Payer: Aetna Commercial |
$1,869.29
|
| Rate for Payer: Aetna Medicare |
$1,394.99
|
| Rate for Payer: BCBS Complete |
$1,435.20
|
| Rate for Payer: BCBS MAPPO |
$1,394.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,394.99
|
| Rate for Payer: Cash Price |
$2,870.40
|
| Rate for Payer: Cash Price |
$2,870.40
|
| Rate for Payer: Cofinity Commercial |
$2,008.79
|
| Rate for Payer: Cofinity Commercial |
$1,869.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,394.99
|
| Rate for Payer: Healthscope Commercial |
$1,673.99
|
| Rate for Payer: Healthscope Whirlpool |
$1,673.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,464.74
|
| Rate for Payer: Nomi Health Commercial |
$1,673.99
|
| Rate for Payer: PACE SWMI |
$1,394.99
|
| Rate for Payer: PHP Medicare Advantage |
$1,394.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,332.20
|
| Rate for Payer: Priority Health Medicare |
$1,394.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,394.99
|
| Rate for Payer: UHC Medicare Advantage |
$1,394.99
|
| Rate for Payer: UHCCP DNSP |
$1,394.99
|
|
|
PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY
|
Professional
|
Both
|
$1,662.00
|
|
|
Service Code
|
HCPCS 67400
|
| Min. Negotiated Rate |
$664.80 |
| Max. Negotiated Rate |
$1,352.66 |
| Rate for Payer: Aetna Commercial |
$1,258.73
|
| Rate for Payer: Aetna Medicare |
$939.35
|
| Rate for Payer: BCBS Complete |
$664.80
|
| Rate for Payer: BCBS MAPPO |
$939.35
|
| Rate for Payer: BCN Medicare Advantage |
$939.35
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cash Price |
$1,329.60
|
| Rate for Payer: Cofinity Commercial |
$1,352.66
|
| Rate for Payer: Cofinity Commercial |
$1,258.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.35
|
| Rate for Payer: Healthscope Commercial |
$1,127.22
|
| Rate for Payer: Healthscope Whirlpool |
$1,127.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$986.32
|
| Rate for Payer: Nomi Health Commercial |
$1,127.22
|
| Rate for Payer: PACE SWMI |
$939.35
|
| Rate for Payer: PHP Medicare Advantage |
$939.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.30
|
| Rate for Payer: Priority Health Medicare |
$939.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.35
|
| Rate for Payer: UHC Medicare Advantage |
$939.35
|
| Rate for Payer: UHCCP DNSP |
$939.35
|
|
|
PR ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY
|
Professional
|
Both
|
$2,652.00
|
|
|
Service Code
|
HCPCS 67413
|
| Min. Negotiated Rate |
$871.96 |
| Max. Negotiated Rate |
$1,723.80 |
| Rate for Payer: Aetna Commercial |
$1,168.43
|
| Rate for Payer: Aetna Medicare |
$871.96
|
| Rate for Payer: BCBS Complete |
$1,060.80
|
| Rate for Payer: BCBS MAPPO |
$871.96
|
| Rate for Payer: BCN Medicare Advantage |
$871.96
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cash Price |
$2,121.60
|
| Rate for Payer: Cofinity Commercial |
$1,255.62
|
| Rate for Payer: Cofinity Commercial |
$1,168.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$871.96
|
| Rate for Payer: Healthscope Commercial |
$1,046.35
|
| Rate for Payer: Healthscope Whirlpool |
$1,046.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.56
|
| Rate for Payer: Nomi Health Commercial |
$1,046.35
|
| Rate for Payer: PACE SWMI |
$871.96
|
| Rate for Payer: PHP Medicare Advantage |
$871.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$871.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$871.96
|
| Rate for Payer: UHC Medicare Advantage |
$871.96
|
| Rate for Payer: UHCCP DNSP |
$871.96
|
|
|
PR ORCHIECTOMY PARTIAL
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS 54522
|
| Min. Negotiated Rate |
$441.20 |
| Max. Negotiated Rate |
$809.67 |
| Rate for Payer: Aetna Commercial |
$753.44
|
| Rate for Payer: Aetna Medicare |
$562.27
|
| Rate for Payer: BCBS Complete |
$441.20
|
| Rate for Payer: BCBS MAPPO |
$562.27
|
| Rate for Payer: BCN Medicare Advantage |
$562.27
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cash Price |
$882.40
|
| Rate for Payer: Cofinity Commercial |
$809.67
|
| Rate for Payer: Cofinity Commercial |
$753.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$562.27
|
| Rate for Payer: Healthscope Commercial |
$674.72
|
| Rate for Payer: Healthscope Whirlpool |
$674.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$590.38
|
| Rate for Payer: Nomi Health Commercial |
$674.72
|
| Rate for Payer: PACE SWMI |
$562.27
|
| Rate for Payer: PHP Medicare Advantage |
$562.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$716.95
|
| Rate for Payer: Priority Health Medicare |
$562.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$562.27
|
| Rate for Payer: UHC Medicare Advantage |
$562.27
|
| Rate for Payer: UHCCP DNSP |
$562.27
|
|
