|
PR CBHC REPAIR RECEIVER
|
Professional
|
Both
|
$132.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.00
|
|
|
PR CCIIV3 VACCINE ABX FREE 0.5 ML FOR IM USE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 90661
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$51.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.28
|
| Rate for Payer: BCBS MAPPO |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$43.54
|
| Rate for Payer: BCN Commercial |
$31.80
|
| Rate for Payer: BCN Medicare Advantage |
$49.50
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$71.28
|
| Rate for Payer: Cofinity Commercial |
$66.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.50
|
| Rate for Payer: Healthscope Commercial |
$91.58
|
| Rate for Payer: Healthscope Commercial |
$79.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: Nomi Health Commercial |
$59.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: PACE SWMI |
$49.50
|
| Rate for Payer: PHP Medicare Advantage |
$49.50
|
| Rate for Payer: Priority Health Medicare |
$49.50
|
| Rate for Payer: Railroad Medicare Medicare |
$49.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.54
|
| Rate for Payer: UHC Core |
$43.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.50
|
| Rate for Payer: UHC Exchange |
$43.54
|
|
|
PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 90756
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$32.37
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.37
|
| Rate for Payer: BCBS Trust/PPO |
$28.52
|
| Rate for Payer: BCN Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.38
|
| Rate for Payer: UHC Core |
$32.38
|
| Rate for Payer: UHC Exchange |
$32.38
|
|
|
PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 90674
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna Commercial |
$34.17
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.17
|
| Rate for Payer: BCBS Trust/PPO |
$30.10
|
| Rate for Payer: BCN Commercial |
$29.49
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.17
|
| Rate for Payer: UHC Core |
$34.17
|
| Rate for Payer: UHC Exchange |
$34.17
|
|
|
PR CCM/BHI BY RHC/FQHC 20MIN MO
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS G0511
|
| Min. Negotiated Rate |
$48.30 |
| Max. Negotiated Rate |
$194.25 |
| Rate for Payer: Aetna Commercial |
$63.19
|
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.19
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCN Commercial |
$48.30
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$194.25
|
|
|
PR CDP-SOT 6 CONDITIONS W/I&R W/MCT & ADT
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 92549
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$110.33 |
| Rate for Payer: Aetna Commercial |
$79.92
|
| Rate for Payer: Aetna Medicare |
$62.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.88
|
| Rate for Payer: BCBS MAPPO |
$59.64
|
| Rate for Payer: BCN Commercial |
$96.60
|
| Rate for Payer: BCN Medicare Advantage |
$59.64
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$79.92
|
| Rate for Payer: Cofinity Commercial |
$85.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.64
|
| Rate for Payer: Healthscope Commercial |
$95.42
|
| Rate for Payer: Healthscope Commercial |
$110.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.48
|
| Rate for Payer: Nomi Health Commercial |
$71.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.25
|
| Rate for Payer: PACE SWMI |
$59.64
|
| Rate for Payer: PHP Medicare Advantage |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89.09
|
| Rate for Payer: Priority Health Medicare |
$59.64
|
| Rate for Payer: Priority Health SBD |
$89.09
|
| Rate for Payer: Priority Health Tiered Network |
$89.09
|
| Rate for Payer: Railroad Medicare Medicare |
$59.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.14
|
| Rate for Payer: UHC Core |
$100.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.64
|
| Rate for Payer: UHC Exchange |
$100.14
|
|
|
PR CEFTRIAXONE SODIUM INJECTION
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J0696
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$0.58
|
| Rate for Payer: Aetna Medicare |
$0.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.58
|
| Rate for Payer: BCBS MAPPO |
$0.43
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.03
|
| Rate for Payer: BCN Medicare Advantage |
$0.43
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$0.62
|
| Rate for Payer: Cofinity Commercial |
$0.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.43
|
| Rate for Payer: Healthscope Commercial |
$0.69
|
| Rate for Payer: Healthscope Commercial |
$0.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$0.47
|
| Rate for Payer: Nomi Health Commercial |
$0.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: PACE SWMI |
$0.43
|
| Rate for Payer: PHP Medicare Advantage |
$0.43
|
| Rate for Payer: Priority Health Medicare |
$0.43
|
| Rate for Payer: Railroad Medicare Medicare |
$0.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.46
|
| Rate for Payer: UHC Core |
$0.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.43
|
| Rate for Payer: UHC Exchange |
$0.46
|
|
|
PR CERCLAGE CERVIX PREGNANCY VAGINAL
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
HCPCS 59320
|
| Min. Negotiated Rate |
$87.54 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Aetna Commercial |
$185.01
|
| Rate for Payer: Aetna Medicare |
$143.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.82
|
| Rate for Payer: BCBS Complete |
$91.92
|
| Rate for Payer: BCBS MAPPO |
$138.07
|
| Rate for Payer: BCN Commercial |
$228.07
|
| Rate for Payer: BCN Medicare Advantage |
$138.07
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cofinity Commercial |
$198.82
|
| Rate for Payer: Cofinity Commercial |
$185.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.07
|
| Rate for Payer: Healthscope Commercial |
$255.43
|
| Rate for Payer: Healthscope Commercial |
$220.91
|
| Rate for Payer: Mclaren Medicaid |
$87.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.97
|
| Rate for Payer: Meridian Medicaid |
$91.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$151.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$272.09
|
| Rate for Payer: Nomi Health Commercial |
$165.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$567.00
|
| Rate for Payer: PACE SWMI |
$138.07
|
| Rate for Payer: PHP Medicare Advantage |
$138.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$215.31
|
| Rate for Payer: Priority Health Medicare |
$138.07
|
| Rate for Payer: Priority Health SBD |
$215.31
|
| Rate for Payer: Priority Health Tiered Network |
$215.31
|
| Rate for Payer: Railroad Medicare Medicare |
$138.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$268.38
|
| Rate for Payer: UHC Core |
$268.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$138.07
|
| Rate for Payer: UHC Exchange |
$268.38
|
| Rate for Payer: UHC Medicaid |
$87.54
|
| Rate for Payer: UHCCP Medicaid |
$87.54
|
|
|
PR CERCLAGE UTERINE CERVIX NONOBSTETRICAL
|
Professional
|
Both
|
$852.00
|
|
|
Service Code
|
HCPCS 57700
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$639.00 |
| Rate for Payer: Aetna Commercial |
$413.59
|
| Rate for Payer: Aetna Medicare |
$321.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$413.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$444.46
|
| Rate for Payer: BCBS Complete |
$213.36
|
| Rate for Payer: BCBS MAPPO |
$308.65
|
| Rate for Payer: BCN Commercial |
$534.33
|
| Rate for Payer: BCN Medicare Advantage |
$308.65
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cash Price |
$681.60
|
| Rate for Payer: Cofinity Commercial |
$444.46
|
| Rate for Payer: Cofinity Commercial |
$413.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.65
|
| Rate for Payer: Healthscope Commercial |
$571.00
|
| Rate for Payer: Healthscope Commercial |
$493.84
|
| Rate for Payer: Mclaren Medicaid |
$203.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.08
|
| Rate for Payer: Meridian Medicaid |
$213.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$339.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.89
|
| Rate for Payer: Nomi Health Commercial |
$370.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$639.00
|
| Rate for Payer: PACE SWMI |
$308.65
|
| Rate for Payer: PHP Medicare Advantage |
$308.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$203.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$541.17
|
| Rate for Payer: Priority Health Medicare |
$308.65
|
| Rate for Payer: Priority Health SBD |
$541.17
|
| Rate for Payer: Priority Health Tiered Network |
$541.17
|
| Rate for Payer: Railroad Medicare Medicare |
$308.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$582.90
|
| Rate for Payer: UHC Core |
$582.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$308.65
|
| Rate for Payer: UHC Exchange |
$582.90
|
| Rate for Payer: UHC Medicaid |
$203.20
|
| Rate for Payer: UHCCP Medicaid |
$203.20
|
|
|
PR CERTOLIZUMAB PEGOL INJ 1MG
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0717
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$5.08
|
| Rate for Payer: Aetna Medicare |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.46
|
| Rate for Payer: BCBS MAPPO |
$3.79
|
| Rate for Payer: BCBS Trust/PPO |
$3.93
|
| Rate for Payer: BCN Commercial |
$4.05
|
| Rate for Payer: BCN Medicare Advantage |
$3.79
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$5.08
|
| Rate for Payer: Cofinity Commercial |
$5.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.79
|
| Rate for Payer: Healthscope Commercial |
$7.01
|
| Rate for Payer: Healthscope Commercial |
$6.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.90
|
| Rate for Payer: Nomi Health Commercial |
$4.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
| Rate for Payer: PACE SWMI |
$3.79
|
| Rate for Payer: PHP Medicare Advantage |
$3.79
|
| Rate for Payer: Priority Health Medicare |
$3.79
|
| Rate for Payer: Railroad Medicare Medicare |
$3.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.87
|
| Rate for Payer: UHC Core |
$3.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3.79
|
| Rate for Payer: UHC Exchange |
$3.87
|
|
|
PR CERV FLEX N/ADJ FOAM PRE OTS
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS L0120
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$60.14 |
| Rate for Payer: Aetna Commercial |
$43.56
|
| Rate for Payer: Aetna Medicare |
$33.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.81
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$32.51
|
| Rate for Payer: BCN Commercial |
$31.12
|
| Rate for Payer: BCN Medicare Advantage |
$32.51
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$46.81
|
| Rate for Payer: Cofinity Commercial |
$43.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.51
|
| Rate for Payer: Healthscope Commercial |
$52.02
|
| Rate for Payer: Healthscope Commercial |
$60.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.33
|
| Rate for Payer: Nomi Health Commercial |
$39.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
| Rate for Payer: PACE SWMI |
$32.51
|
| Rate for Payer: PHP Medicare Advantage |
$32.51
|
| Rate for Payer: Priority Health Medicare |
$32.51
|
| Rate for Payer: Railroad Medicare Medicare |
$32.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.60
|
| Rate for Payer: UHC Core |
$10.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.51
|
| Rate for Payer: UHC Exchange |
$10.60
|
|
|
PR CERVICAL CAP CONTRACEPTIVE
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS A4261
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$78.84 |
| Rate for Payer: Aetna Commercial |
$26.50
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.50
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCN Commercial |
$78.84
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
|
|
PR CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ
|
Professional
|
Both
|
$4,115.00
|
|
|
Service Code
|
HCPCS 38724
|
| Min. Negotiated Rate |
$805.14 |
| Max. Negotiated Rate |
$3,086.25 |
| Rate for Payer: Aetna Commercial |
$1,671.23
|
| Rate for Payer: Aetna Medicare |
$1,297.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,795.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,671.23
|
| Rate for Payer: BCBS Complete |
$845.40
|
| Rate for Payer: BCBS MAPPO |
$1,247.19
|
| Rate for Payer: BCN Commercial |
$2,178.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,247.19
|
| Rate for Payer: Cash Price |
$3,292.00
|
| Rate for Payer: Cash Price |
$3,292.00
|
| Rate for Payer: Cofinity Commercial |
$1,795.95
|
| Rate for Payer: Cofinity Commercial |
$1,671.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,247.19
|
| Rate for Payer: Healthscope Commercial |
$2,307.30
|
| Rate for Payer: Healthscope Commercial |
$1,995.50
|
| Rate for Payer: Mclaren Medicaid |
$805.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,309.55
|
| Rate for Payer: Meridian Medicaid |
$845.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,371.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,579.89
|
| Rate for Payer: Nomi Health Commercial |
$1,496.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,086.25
|
| Rate for Payer: PACE SWMI |
$1,247.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,247.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$805.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,898.89
|
| Rate for Payer: Priority Health Medicare |
$1,247.19
|
| Rate for Payer: Priority Health SBD |
$2,898.89
|
| Rate for Payer: Priority Health Tiered Network |
$2,898.89
|
| Rate for Payer: Railroad Medicare Medicare |
$1,247.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,533.42
|
| Rate for Payer: UHC Core |
$2,533.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,247.19
|
| Rate for Payer: UHC Exchange |
$2,533.42
|
| Rate for Payer: UHC Medicaid |
$805.14
|
| Rate for Payer: UHCCP Medicaid |
$805.14
|
|
|
PR CERVICAL LYMPHADENECTOMY
|
Professional
|
Both
|
$2,517.00
|
|
|
Service Code
|
HCPCS 38720
|
| Min. Negotiated Rate |
$762.11 |
| Max. Negotiated Rate |
$2,688.19 |
| Rate for Payer: Aetna Commercial |
$1,582.26
|
| Rate for Payer: Aetna Medicare |
$1,228.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,582.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,700.34
|
| Rate for Payer: BCBS Complete |
$800.22
|
| Rate for Payer: BCBS MAPPO |
$1,180.79
|
| Rate for Payer: BCN Commercial |
$2,020.31
|
| Rate for Payer: BCN Medicare Advantage |
$1,180.79
|
| Rate for Payer: Cash Price |
$2,013.60
|
| Rate for Payer: Cash Price |
$2,013.60
|
| Rate for Payer: Cofinity Commercial |
$1,700.34
|
| Rate for Payer: Cofinity Commercial |
$1,582.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,180.79
|
| Rate for Payer: Healthscope Commercial |
$2,184.46
|
| Rate for Payer: Healthscope Commercial |
$1,889.26
|
| Rate for Payer: Mclaren Medicaid |
$762.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,239.83
|
| Rate for Payer: Meridian Medicaid |
$800.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,298.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,383.07
|
| Rate for Payer: Nomi Health Commercial |
$1,416.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,887.75
|
| Rate for Payer: PACE SWMI |
$1,180.79
|
| Rate for Payer: PHP Medicare Advantage |
$1,180.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,688.19
|
| Rate for Payer: Priority Health Medicare |
$1,180.79
|
| Rate for Payer: Priority Health SBD |
$2,688.19
|
| Rate for Payer: Priority Health Tiered Network |
$2,688.19
|
| Rate for Payer: Railroad Medicare Medicare |
$1,180.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,349.59
|
| Rate for Payer: UHC Core |
$2,349.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,180.79
|
| Rate for Payer: UHC Exchange |
$2,349.59
|
| Rate for Payer: UHC Medicaid |
$762.11
|
| Rate for Payer: UHCCP Medicaid |
$762.11
|
|
|
PR CESAREAN DELIVERY ATTEMPTED VBAC
|
Professional
|
Both
|
$2,574.00
|
|
|
Service Code
|
HCPCS 59620
|
| Min. Negotiated Rate |
$821.48 |
| Max. Negotiated Rate |
$1,930.50 |
| Rate for Payer: Aetna Commercial |
$1,159.23
|
| Rate for Payer: Aetna Medicare |
$899.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,245.74
|
| Rate for Payer: BCBS Complete |
$862.55
|
| Rate for Payer: BCBS MAPPO |
$865.10
|
| Rate for Payer: BCN Commercial |
$1,674.98
|
| Rate for Payer: BCN Medicare Advantage |
$865.10
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cash Price |
$2,059.20
|
| Rate for Payer: Cofinity Commercial |
$1,245.74
|
| Rate for Payer: Cofinity Commercial |
$1,159.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$865.10
|
| Rate for Payer: Healthscope Commercial |
$1,600.43
|
| Rate for Payer: Healthscope Commercial |
$1,384.16
|
| Rate for Payer: Mclaren Medicaid |
$821.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$908.36
|
| Rate for Payer: Meridian Medicaid |
$862.55
|
| Rate for Payer: Molina Medicare/Medicaid |
$951.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,700.26
|
| Rate for Payer: Nomi Health Commercial |
$1,038.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,930.50
|
| Rate for Payer: PACE SWMI |
$865.10
|
| Rate for Payer: PHP Medicare Advantage |
$865.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$821.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,323.31
|
| Rate for Payer: Priority Health Medicare |
$865.10
|
| Rate for Payer: Priority Health SBD |
$1,323.31
|
| Rate for Payer: Priority Health Tiered Network |
$1,323.31
|
| Rate for Payer: Railroad Medicare Medicare |
$865.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,208.80
|
| Rate for Payer: UHC Core |
$1,208.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$865.10
|
| Rate for Payer: UHC Exchange |
$1,208.80
|
| Rate for Payer: UHC Medicaid |
$821.48
|
| Rate for Payer: UHCCP Medicaid |
$821.48
|
|
|
PR CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$2,391.00
|
|
|
Service Code
|
HCPCS 59514
|
| Min. Negotiated Rate |
$792.56 |
| Max. Negotiated Rate |
$1,793.25 |
| Rate for Payer: Aetna Commercial |
$1,118.93
|
| Rate for Payer: Aetna Medicare |
$868.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,118.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,202.43
|
| Rate for Payer: BCBS Complete |
$832.19
|
| Rate for Payer: BCBS MAPPO |
$835.02
|
| Rate for Payer: BCN Commercial |
$1,595.20
|
| Rate for Payer: BCN Medicare Advantage |
$835.02
|
| Rate for Payer: Cash Price |
$1,912.80
|
| Rate for Payer: Cash Price |
$1,912.80
|
| Rate for Payer: Cofinity Commercial |
$1,202.43
|
| Rate for Payer: Cofinity Commercial |
$1,118.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.02
|
| Rate for Payer: Healthscope Commercial |
$1,544.79
|
| Rate for Payer: Healthscope Commercial |
$1,336.03
|
| Rate for Payer: Mclaren Medicaid |
$792.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$876.77
|
| Rate for Payer: Meridian Medicaid |
$832.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$918.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,642.14
|
| Rate for Payer: Nomi Health Commercial |
$1,002.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,793.25
|
| Rate for Payer: PACE SWMI |
$835.02
|
| Rate for Payer: PHP Medicare Advantage |
$835.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$792.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,279.13
|
| Rate for Payer: Priority Health Medicare |
$835.02
|
| Rate for Payer: Priority Health SBD |
$1,279.13
|
| Rate for Payer: Priority Health Tiered Network |
$1,279.13
|
| Rate for Payer: Railroad Medicare Medicare |
$835.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,166.31
|
| Rate for Payer: UHC Core |
$1,166.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$835.02
|
| Rate for Payer: UHC Exchange |
$1,166.31
|
| Rate for Payer: UHC Medicaid |
$792.56
|
| Rate for Payer: UHCCP Medicaid |
$792.56
|
|
|
PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,671.00
|
|
|
Service Code
|
HCPCS 59515
|
| Min. Negotiated Rate |
$1,175.02 |
| Max. Negotiated Rate |
$2,356.70 |
| Rate for Payer: Aetna Commercial |
$1,657.39
|
| Rate for Payer: Aetna Medicare |
$1,286.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,657.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,781.08
|
| Rate for Payer: BCBS Complete |
$1,233.77
|
| Rate for Payer: BCBS MAPPO |
$1,236.86
|
| Rate for Payer: BCN Commercial |
$1,851.61
|
| Rate for Payer: BCN Medicare Advantage |
$1,236.86
|
| Rate for Payer: Cash Price |
$2,136.80
|
| Rate for Payer: Cash Price |
$2,136.80
|
| Rate for Payer: Cofinity Commercial |
$1,781.08
|
| Rate for Payer: Cofinity Commercial |
$1,657.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,236.86
|
| Rate for Payer: Healthscope Commercial |
$2,288.19
|
| Rate for Payer: Healthscope Commercial |
$1,978.98
|
| Rate for Payer: Mclaren Medicaid |
$1,175.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,298.70
|
| Rate for Payer: Meridian Medicaid |
$1,233.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,360.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,356.70
|
| Rate for Payer: Nomi Health Commercial |
$1,484.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,003.25
|
| Rate for Payer: PACE SWMI |
$1,236.86
|
| Rate for Payer: PHP Medicare Advantage |
$1,236.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,175.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,894.48
|
| Rate for Payer: Priority Health Medicare |
$1,236.86
|
| Rate for Payer: Priority Health SBD |
$1,894.48
|
| Rate for Payer: Priority Health Tiered Network |
$1,894.48
|
| Rate for Payer: Railroad Medicare Medicare |
$1,236.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,614.17
|
| Rate for Payer: UHC Core |
$1,614.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,236.86
|
| Rate for Payer: UHC Exchange |
$1,614.17
|
| Rate for Payer: UHC Medicaid |
$1,175.02
|
| Rate for Payer: UHCCP Medicaid |
$1,175.02
|
|
|
PR CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA
|
Professional
|
Both
|
$2,854.00
|
|
|
Service Code
|
HCPCS 59622
|
| Min. Negotiated Rate |
$1,211.94 |
| Max. Negotiated Rate |
$2,445.66 |
| Rate for Payer: Aetna Commercial |
$1,708.47
|
| Rate for Payer: Aetna Medicare |
$1,325.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,708.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,835.97
|
| Rate for Payer: BCBS Complete |
$1,272.54
|
| Rate for Payer: BCBS MAPPO |
$1,274.98
|
| Rate for Payer: BCN Commercial |
$1,944.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,274.98
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Cash Price |
$2,283.20
|
| Rate for Payer: Cofinity Commercial |
$1,835.97
|
| Rate for Payer: Cofinity Commercial |
$1,708.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,274.98
|
| Rate for Payer: Healthscope Commercial |
$2,358.71
|
| Rate for Payer: Healthscope Commercial |
$2,039.97
|
| Rate for Payer: Mclaren Medicaid |
$1,211.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,338.73
|
| Rate for Payer: Meridian Medicaid |
$1,272.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,402.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,445.66
|
| Rate for Payer: Nomi Health Commercial |
$1,529.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,140.50
|
| Rate for Payer: PACE SWMI |
$1,274.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,274.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,211.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,960.30
|
| Rate for Payer: Priority Health Medicare |
$1,274.98
|
| Rate for Payer: Priority Health SBD |
$1,960.30
|
| Rate for Payer: Priority Health Tiered Network |
$1,960.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,274.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,667.42
|
| Rate for Payer: UHC Core |
$1,667.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,274.98
|
| Rate for Payer: UHC Exchange |
$1,667.42
|
| Rate for Payer: UHC Medicaid |
$1,211.94
|
| Rate for Payer: UHCCP Medicaid |
$1,211.94
|
|
|
PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 37214
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$220.53 |
| Rate for Payer: Aetna Commercial |
$145.18
|
| Rate for Payer: Aetna Medicare |
$112.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.01
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS MAPPO |
$108.34
|
| Rate for Payer: BCN Commercial |
$178.77
|
| Rate for Payer: BCN Medicare Advantage |
$108.34
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$156.01
|
| Rate for Payer: Cofinity Commercial |
$145.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.34
|
| Rate for Payer: Healthscope Commercial |
$200.43
|
| Rate for Payer: Healthscope Commercial |
$173.34
|
| Rate for Payer: Mclaren Medicaid |
$68.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.76
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$119.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.68
|
| Rate for Payer: Nomi Health Commercial |
$130.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.50
|
| Rate for Payer: PACE SWMI |
$108.34
|
| Rate for Payer: PHP Medicare Advantage |
$108.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$192.24
|
| Rate for Payer: Priority Health Medicare |
$108.34
|
| Rate for Payer: Priority Health SBD |
$192.24
|
| Rate for Payer: Priority Health Tiered Network |
$192.24
|
| Rate for Payer: Railroad Medicare Medicare |
$108.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.53
|
| Rate for Payer: UHC Core |
$220.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$108.34
|
| Rate for Payer: UHC Exchange |
$220.53
|
| Rate for Payer: UHC Medicaid |
$68.37
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
PR CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Professional
|
Both
|
$351.00
|
|
|
Service Code
|
HCPCS 51710
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$263.25 |
| Rate for Payer: Aetna Commercial |
$96.28
|
| Rate for Payer: Aetna Medicare |
$74.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.28
|
| Rate for Payer: BCBS Complete |
$48.98
|
| Rate for Payer: BCBS MAPPO |
$71.85
|
| Rate for Payer: BCN Commercial |
$119.51
|
| Rate for Payer: BCN Medicare Advantage |
$71.85
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cofinity Commercial |
$96.28
|
| Rate for Payer: Cofinity Commercial |
$103.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.85
|
| Rate for Payer: Healthscope Commercial |
$132.92
|
| Rate for Payer: Healthscope Commercial |
$114.96
|
| Rate for Payer: Mclaren Medicaid |
$46.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.44
|
| Rate for Payer: Meridian Medicaid |
$48.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.27
|
| Rate for Payer: Nomi Health Commercial |
$86.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$263.25
|
| Rate for Payer: PACE SWMI |
$71.85
|
| Rate for Payer: PHP Medicare Advantage |
$71.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$130.19
|
| Rate for Payer: Priority Health Medicare |
$71.85
|
| Rate for Payer: Priority Health SBD |
$130.19
|
| Rate for Payer: Priority Health Tiered Network |
$130.19
|
| Rate for Payer: Railroad Medicare Medicare |
$71.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.01
|
| Rate for Payer: UHC Core |
$139.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.85
|
| Rate for Payer: UHC Exchange |
$139.01
|
| Rate for Payer: UHC Medicaid |
$46.65
|
| Rate for Payer: UHCCP Medicaid |
$46.65
|
|
|
PR CHANGE CYSTOSTOMY TUBE SIMPLE
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 51705
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna Commercial |
$62.20
|
| Rate for Payer: Aetna Medicare |
$48.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.84
|
| Rate for Payer: BCBS Complete |
$31.53
|
| Rate for Payer: BCBS MAPPO |
$46.42
|
| Rate for Payer: BCN Commercial |
$78.18
|
| Rate for Payer: BCN Medicare Advantage |
$46.42
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$66.84
|
| Rate for Payer: Cofinity Commercial |
$62.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.42
|
| Rate for Payer: Healthscope Commercial |
$85.88
|
| Rate for Payer: Healthscope Commercial |
$74.27
|
| Rate for Payer: Mclaren Medicaid |
$30.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.74
|
| Rate for Payer: Meridian Medicaid |
$31.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.45
|
| Rate for Payer: Nomi Health Commercial |
$55.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.00
|
| Rate for Payer: PACE SWMI |
$46.42
|
| Rate for Payer: PHP Medicare Advantage |
$46.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$85.16
|
| Rate for Payer: Priority Health Medicare |
$46.42
|
| Rate for Payer: Priority Health SBD |
$85.16
|
| Rate for Payer: Priority Health Tiered Network |
$85.16
|
| Rate for Payer: Railroad Medicare Medicare |
$46.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.58
|
| Rate for Payer: UHC Core |
$91.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.42
|
| Rate for Payer: UHC Exchange |
$91.58
|
| Rate for Payer: UHC Medicaid |
$30.03
|
| Rate for Payer: UHCCP Medicaid |
$30.03
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
43760
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$645.00 |
| Rate for Payer: Aetna Medicare |
$430.00
|
| Rate for Payer: BCBS Complete |
$344.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.00
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
IP
|
$860.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$541.80 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Aetna Commercial |
$731.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cofinity Advantage |
$602.00
|
| Rate for Payer: Cofinity Commercial |
$739.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.00
|
| Rate for Payer: Healthscope Commercial |
$774.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.00
|
| Rate for Payer: PHP Commercial |
$731.00
|
| Rate for Payer: Priority Health SBD |
$541.80
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
OP
|
$860.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$774.00 |
| Rate for Payer: Aetna Commercial |
$731.00
|
| Rate for Payer: Aetna Medicare |
$430.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$559.00
|
| Rate for Payer: BCBS Complete |
$344.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cofinity Advantage |
$602.00
|
| Rate for Payer: Cofinity Commercial |
$739.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$688.00
|
| Rate for Payer: Healthscope Commercial |
$774.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$688.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.00
|
| Rate for Payer: PHP Commercial |
$731.00
|
| Rate for Payer: Priority Health SBD |
$541.80
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 43760
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$645.00 |
| Rate for Payer: Aetna Medicare |
$430.00
|
| Rate for Payer: BCBS Complete |
$344.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$559.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.00
|
|
