|
PR CBHC RECASE ITE
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 00583
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$122.50 |
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
|
|
PR CBHC REPAIR 5 YRS AND OLDER
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
HCPCS 00589
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: BCBS Complete |
$170.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.50
|
|
|
PR CBHC REPAIR DIGITAL/CIC
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00588
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR CBHC REPAIR RECEIVER
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 00587
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
|
|
PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE
|
Professional
|
Both
|
$66.69
|
|
|
Service Code
|
HCPCS 90756
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$46.68 |
| Rate for Payer: Aetna Commercial |
$40.98
|
| Rate for Payer: Aetna Medicare |
$31.80
|
| Rate for Payer: BCBS Complete |
$26.68
|
| Rate for Payer: BCBS MAPPO |
$30.58
|
| Rate for Payer: BCBS Trust/PPO |
$33.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: BCN Medicare Advantage |
$30.58
|
| Rate for Payer: Cash Price |
$53.35
|
| Rate for Payer: Cash Price |
$53.35
|
| Rate for Payer: Cofinity Commercial |
$44.04
|
| Rate for Payer: Cofinity Commercial |
$40.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.11
|
| Rate for Payer: PACE SWMI |
$30.58
|
| Rate for Payer: PHP Medicare Advantage |
$30.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.68
|
| Rate for Payer: Priority Health Medicare |
$30.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.58
|
| Rate for Payer: UHC Medicare Advantage |
$31.50
|
|
|
PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE
|
Professional
|
Both
|
$71.40
|
|
|
Service Code
|
HCPCS 90674
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$49.98 |
| Rate for Payer: Aetna Commercial |
$43.25
|
| Rate for Payer: Aetna Medicare |
$33.57
|
| Rate for Payer: BCBS Complete |
$28.56
|
| Rate for Payer: BCBS MAPPO |
$32.28
|
| Rate for Payer: BCBS Trust/PPO |
$33.98
|
| Rate for Payer: BCN Commercial |
$33.98
|
| Rate for Payer: BCN Medicare Advantage |
$32.28
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cash Price |
$57.12
|
| Rate for Payer: Cofinity Commercial |
$46.48
|
| Rate for Payer: Cofinity Commercial |
$43.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.89
|
| Rate for Payer: PACE SWMI |
$32.28
|
| Rate for Payer: PHP Medicare Advantage |
$32.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.98
|
| Rate for Payer: Priority Health Medicare |
$32.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.28
|
| Rate for Payer: UHC Medicare Advantage |
$33.25
|
|
|
PR Ccm/bhi by rhc/fqhc 20min mo
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS G0511
|
| Min. Negotiated Rate |
$56.54 |
| Max. Negotiated Rate |
$589.58 |
| Rate for Payer: Aetna Commercial |
$63.19
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS Trust/PPO |
$589.58
|
| Rate for Payer: BCN Commercial |
$112.40
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.54
|
|
|
PR CEFTRIAXONE SODIUM INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J0696
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna Commercial |
$0.76
|
| Rate for Payer: Aetna Medicare |
$0.59
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$0.57
|
| Rate for Payer: BCBS Trust/PPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.57
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$0.76
|
| Rate for Payer: Cofinity Commercial |
$0.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.57
|
| Rate for Payer: PHP Medicare Advantage |
$0.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health Medicare |
$0.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.57
|
| Rate for Payer: UHC Medicare Advantage |
$0.59
|
|
|
PR CERCLAGE CERVIX PREGNANCY VAGINAL
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 59320
|
| Min. Negotiated Rate |
$97.13 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$202.55
|
| Rate for Payer: Aetna Medicare |
$157.21
|
| Rate for Payer: BCBS Complete |
$101.99
|
| Rate for Payer: BCBS MAPPO |
$151.16
|
| Rate for Payer: BCBS Trust/PPO |
$213.43
|
| Rate for Payer: BCN Commercial |
$220.88
|
| Rate for Payer: BCN Medicare Advantage |
$151.16
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cash Price |
$576.00
|
| Rate for Payer: Cofinity Commercial |
$217.67
|
| Rate for Payer: Cofinity Commercial |
$202.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.16
|
| Rate for Payer: Mclaren Medicaid |
$97.13
|
| Rate for Payer: Meridian Medicaid |
$101.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.72
|
| Rate for Payer: PACE SWMI |
$151.16
|
| Rate for Payer: PHP Medicare Advantage |
$151.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$504.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.42
|
| Rate for Payer: Priority Health Medicare |
$151.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.16
|
| Rate for Payer: UHC Medicare Advantage |
$155.69
|
|
|
PR CERCLAGE UTERINE CERVIX NONOBSTETRICAL
|
Professional
|
Both
|
$811.00
|
|
|
Service Code
|
HCPCS 57700
|
| Min. Negotiated Rate |
$230.89 |
| Max. Negotiated Rate |
$915.54 |
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna Medicare |
$363.94
|
| Rate for Payer: BCBS Complete |
$242.43
|
| Rate for Payer: BCBS MAPPO |
$349.94
|
| Rate for Payer: BCBS Trust/PPO |
$915.54
|
| Rate for Payer: BCN Commercial |
$526.80
|
| Rate for Payer: BCN Medicare Advantage |
$349.94
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cash Price |
$648.80
|
| Rate for Payer: Cofinity Commercial |
$468.92
|
| Rate for Payer: Cofinity Commercial |
$503.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.94
|
| Rate for Payer: Mclaren Medicaid |
$230.89
|
| Rate for Payer: Meridian Medicaid |
$242.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$367.44
|
| Rate for Payer: PACE SWMI |
$349.94
|
| Rate for Payer: PHP Medicare Advantage |
$349.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$230.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$510.35
|
| Rate for Payer: Priority Health Medicare |
$349.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$510.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.94
|
| Rate for Payer: UHC Medicare Advantage |
$360.44
|
|
|
PR CERTOLIZUMAB PEGOL INJ 1MG
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0717
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.31 |
| Rate for Payer: Aetna Commercial |
$6.80
|
| Rate for Payer: Aetna Medicare |
$5.28
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$5.07
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCN Commercial |
$5.06
|
| Rate for Payer: BCN Medicare Advantage |
$5.07
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$7.31
|
| Rate for Payer: Cofinity Commercial |
$6.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.33
|
| Rate for Payer: PACE SWMI |
$5.07
|
| Rate for Payer: PHP Medicare Advantage |
$5.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$5.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.07
|
| Rate for Payer: UHC Medicare Advantage |
$5.23
|
|
|
PR CERV FLEX N/ADJ FOAM PRE OTS
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS L0120
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCN Commercial |
$25.11
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
|
|
PR CERVICAL CAP CONTRACEPTIVE
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS A4261
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$1,481.35 |
| Rate for Payer: Aetna Commercial |
$26.50
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,481.35
|
| Rate for Payer: BCN Commercial |
$78.84
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
|
|
PR CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ
|
Professional
|
Both
|
$3,917.00
|
|
|
Service Code
|
HCPCS 38724
|
| Min. Negotiated Rate |
$928.68 |
| Max. Negotiated Rate |
$3,145.81 |
| Rate for Payer: Aetna Commercial |
$1,920.58
|
| Rate for Payer: Aetna Medicare |
$1,490.60
|
| Rate for Payer: BCBS Complete |
$975.11
|
| Rate for Payer: BCBS MAPPO |
$1,433.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,321.28
|
| Rate for Payer: BCN Commercial |
$2,122.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,433.27
|
| Rate for Payer: Cash Price |
$3,133.60
|
| Rate for Payer: Cash Price |
$3,133.60
|
| Rate for Payer: Cofinity Commercial |
$2,063.91
|
| Rate for Payer: Cofinity Commercial |
$1,920.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,433.27
|
| Rate for Payer: Mclaren Medicaid |
$928.68
|
| Rate for Payer: Meridian Medicaid |
$975.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,504.93
|
| Rate for Payer: PACE SWMI |
$1,433.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,433.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$928.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,741.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,145.81
|
| Rate for Payer: Priority Health Medicare |
$1,433.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,145.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,433.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,433.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,476.27
|
|
|
PR CERVICAL LYMPHADENECTOMY
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 38720
|
| Min. Negotiated Rate |
$671.47 |
| Max. Negotiated Rate |
$2,903.16 |
| Rate for Payer: Aetna Commercial |
$1,774.07
|
| Rate for Payer: Aetna Medicare |
$1,376.89
|
| Rate for Payer: BCBS Complete |
$903.55
|
| Rate for Payer: BCBS MAPPO |
$1,323.93
|
| Rate for Payer: BCBS Trust/PPO |
$671.47
|
| Rate for Payer: BCN Commercial |
$1,958.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,323.93
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Cofinity Commercial |
$1,906.46
|
| Rate for Payer: Cofinity Commercial |
$1,774.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,323.93
|
| Rate for Payer: Mclaren Medicaid |
$860.52
|
| Rate for Payer: Meridian Medicaid |
$903.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,390.13
|
| Rate for Payer: PACE SWMI |
$1,323.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,323.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$860.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,903.16
|
| Rate for Payer: Priority Health Medicare |
$1,323.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,903.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,323.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,323.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,363.65
|
|
|
PR CESAREAN DELIVERY ATTEMPTED VBAC
|
Professional
|
Both
|
$2,450.00
|
|
|
Service Code
|
HCPCS 59620
|
| Min. Negotiated Rate |
$873.68 |
| Max. Negotiated Rate |
$1,715.00 |
| Rate for Payer: Aetna Commercial |
$1,265.75
|
| Rate for Payer: Aetna Medicare |
$982.37
|
| Rate for Payer: BCBS Complete |
$917.36
|
| Rate for Payer: BCBS MAPPO |
$944.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,066.64
|
| Rate for Payer: BCN Commercial |
$1,636.60
|
| Rate for Payer: BCN Medicare Advantage |
$944.59
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cofinity Commercial |
$1,360.21
|
| Rate for Payer: Cofinity Commercial |
$1,265.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$944.59
|
| Rate for Payer: Mclaren Medicaid |
$873.68
|
| Rate for Payer: Meridian Medicaid |
$917.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$991.82
|
| Rate for Payer: PACE SWMI |
$944.59
|
| Rate for Payer: PHP Medicare Advantage |
$944.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$873.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,715.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,325.39
|
| Rate for Payer: Priority Health Medicare |
$944.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,325.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$944.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$944.59
|
| Rate for Payer: UHC Medicare Advantage |
$972.93
|
|
|
PR CESAREAN DELIVERY ONLY
|
Professional
|
Both
|
$2,275.00
|
|
|
Service Code
|
HCPCS 59514
|
| Min. Negotiated Rate |
$164.30 |
| Max. Negotiated Rate |
$1,592.50 |
| Rate for Payer: Aetna Commercial |
$1,222.48
|
| Rate for Payer: Aetna Medicare |
$948.79
|
| Rate for Payer: BCBS Complete |
$884.87
|
| Rate for Payer: BCBS MAPPO |
$912.30
|
| Rate for Payer: BCBS Trust/PPO |
$164.30
|
| Rate for Payer: BCN Commercial |
$1,558.66
|
| Rate for Payer: BCN Medicare Advantage |
$912.30
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: Cash Price |
$1,820.00
|
| Rate for Payer: Cofinity Commercial |
$1,313.71
|
| Rate for Payer: Cofinity Commercial |
$1,222.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$912.30
|
| Rate for Payer: Mclaren Medicaid |
$842.73
|
| Rate for Payer: Meridian Medicaid |
$884.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$957.92
|
| Rate for Payer: PACE SWMI |
$912.30
|
| Rate for Payer: PHP Medicare Advantage |
$912.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$842.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,592.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,281.01
|
| Rate for Payer: Priority Health Medicare |
$912.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,281.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$912.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$912.30
|
| Rate for Payer: UHC Medicare Advantage |
$939.67
|
|
|
PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE
|
Professional
|
Both
|
$2,542.00
|
|
|
Service Code
|
HCPCS 59515
|
| Min. Negotiated Rate |
$181.74 |
| Max. Negotiated Rate |
$1,885.36 |
| Rate for Payer: Aetna Commercial |
$1,754.44
|
| Rate for Payer: Aetna Medicare |
$1,361.65
|
| Rate for Payer: BCBS Complete |
$1,307.82
|
| Rate for Payer: BCBS MAPPO |
$1,309.28
|
| Rate for Payer: BCBS Trust/PPO |
$181.74
|
| Rate for Payer: BCN Commercial |
$1,809.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,309.28
|
| Rate for Payer: Cash Price |
$2,033.60
|
| Rate for Payer: Cash Price |
$2,033.60
|
| Rate for Payer: Cofinity Commercial |
$1,885.36
|
| Rate for Payer: Cofinity Commercial |
$1,754.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,309.28
|
| Rate for Payer: Mclaren Medicaid |
$1,245.54
|
| Rate for Payer: Meridian Medicaid |
$1,307.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,374.74
|
| Rate for Payer: PACE SWMI |
$1,309.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,309.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,245.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,779.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,844.78
|
| Rate for Payer: Priority Health Medicare |
$1,309.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,844.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,309.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,348.56
|
|
|
PR CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA
|
Professional
|
Both
|
$2,717.00
|
|
|
Service Code
|
HCPCS 59622
|
| Min. Negotiated Rate |
$1,128.98 |
| Max. Negotiated Rate |
$1,956.53 |
| Rate for Payer: Aetna Commercial |
$1,820.66
|
| Rate for Payer: Aetna Medicare |
$1,413.05
|
| Rate for Payer: BCBS Complete |
$1,355.37
|
| Rate for Payer: BCBS MAPPO |
$1,358.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,128.98
|
| Rate for Payer: BCN Commercial |
$1,899.65
|
| Rate for Payer: BCN Medicare Advantage |
$1,358.70
|
| Rate for Payer: Cash Price |
$2,173.60
|
| Rate for Payer: Cash Price |
$2,173.60
|
| Rate for Payer: Cofinity Commercial |
$1,956.53
|
| Rate for Payer: Cofinity Commercial |
$1,820.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,358.70
|
| Rate for Payer: Mclaren Medicaid |
$1,290.83
|
| Rate for Payer: Meridian Medicaid |
$1,355.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,426.64
|
| Rate for Payer: PACE SWMI |
$1,358.70
|
| Rate for Payer: PHP Medicare Advantage |
$1,358.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,290.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,901.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,915.60
|
| Rate for Payer: Priority Health Medicare |
$1,358.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,915.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,358.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,358.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,399.46
|
|
|
PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 37214
|
| Min. Negotiated Rate |
$75.62 |
| Max. Negotiated Rate |
$705.28 |
| Rate for Payer: Aetna Commercial |
$160.56
|
| Rate for Payer: Aetna Medicare |
$124.61
|
| Rate for Payer: BCBS Complete |
$79.40
|
| Rate for Payer: BCBS MAPPO |
$119.82
|
| Rate for Payer: BCBS Trust/PPO |
$705.28
|
| Rate for Payer: BCN Commercial |
$173.96
|
| Rate for Payer: BCN Medicare Advantage |
$119.82
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$160.56
|
| Rate for Payer: Cofinity Commercial |
$172.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.82
|
| Rate for Payer: Mclaren Medicaid |
$75.62
|
| Rate for Payer: Meridian Medicaid |
$79.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.81
|
| Rate for Payer: PACE SWMI |
$119.82
|
| Rate for Payer: PHP Medicare Advantage |
$119.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.38
|
| Rate for Payer: Priority Health Medicare |
$119.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.82
|
| Rate for Payer: UHC Medicare Advantage |
$123.41
|
|
|
PR CHANGE CYSTOSTOMY TUBE COMPLICATED
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 51710
|
| Min. Negotiated Rate |
$50.91 |
| Max. Negotiated Rate |
$2,051.39 |
| Rate for Payer: Aetna Commercial |
$104.43
|
| Rate for Payer: Aetna Medicare |
$81.05
|
| Rate for Payer: BCBS Complete |
$53.46
|
| Rate for Payer: BCBS MAPPO |
$77.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,051.39
|
| Rate for Payer: BCN Commercial |
$198.89
|
| Rate for Payer: BCN Medicare Advantage |
$77.93
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cofinity Commercial |
$104.43
|
| Rate for Payer: Cofinity Commercial |
$112.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.93
|
| Rate for Payer: Mclaren Medicaid |
$50.91
|
| Rate for Payer: Meridian Medicaid |
$53.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.83
|
| Rate for Payer: PACE SWMI |
$77.93
|
| Rate for Payer: PHP Medicare Advantage |
$77.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$127.52
|
| Rate for Payer: Priority Health Medicare |
$77.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.93
|
| Rate for Payer: UHC Medicare Advantage |
$80.27
|
|
|
PR CHANGE CYSTOSTOMY TUBE SIMPLE
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 51705
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$1,992.75 |
| Rate for Payer: Aetna Commercial |
$67.34
|
| Rate for Payer: Aetna Medicare |
$52.26
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS MAPPO |
$50.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,992.75
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: BCN Medicare Advantage |
$50.25
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$72.36
|
| Rate for Payer: Cofinity Commercial |
$67.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.25
|
| Rate for Payer: Mclaren Medicaid |
$32.80
|
| Rate for Payer: Meridian Medicaid |
$34.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.76
|
| Rate for Payer: PACE SWMI |
$50.25
|
| Rate for Payer: PHP Medicare Advantage |
$50.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.14
|
| Rate for Payer: Priority Health Medicare |
$50.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.25
|
| Rate for Payer: UHC Medicare Advantage |
$51.76
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 43760
|
| Hospital Charge Code |
43760
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$573.30 |
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
43760
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$194.51 |
| Max. Negotiated Rate |
$737.10 |
| Rate for Payer: Aetna Commercial |
$696.15
|
| Rate for Payer: Aetna Medicare |
$212.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$255.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$255.94
|
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: BCBS MAPPO |
$204.75
|
| Rate for Payer: BCBS Trust/PPO |
$636.77
|
| Rate for Payer: BCN Commercial |
$636.77
|
| Rate for Payer: BCN Medicare Advantage |
$204.75
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$704.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$655.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.75
|
| Rate for Payer: Healthscope Commercial |
$737.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$614.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$214.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$235.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$696.15
|
| Rate for Payer: PACE Senior Care Partners |
$194.51
|
| Rate for Payer: PACE SWMI |
$204.75
|
| Rate for Payer: PHP Commercial |
$696.15
|
| Rate for Payer: PHP Medicare Advantage |
$204.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$712.53
|
| Rate for Payer: Priority Health Medicare |
$204.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$499.51
|
| Rate for Payer: Railroad Medicare Medicare |
$204.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$720.72
|
| Rate for Payer: UHC Core |
$683.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.75
|
| Rate for Payer: UHC Medicare Advantage |
$210.89
|
| Rate for Payer: VA VA |
$204.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$614.25
|
|
|
PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 43760
|
| Min. Negotiated Rate |
$327.60 |
| Max. Negotiated Rate |
$573.30 |
| Rate for Payer: BCBS Complete |
$327.60
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
|
