|
PR PL VITALIZE
|
Professional
|
Both
|
$105.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
|
|
PR PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$3,774.00
|
|
|
Service Code
|
HCPCS 48140
|
| Min. Negotiated Rate |
$928.89 |
| Max. Negotiated Rate |
$2,864.51 |
| Rate for Payer: Aetna Commercial |
$2,112.86
|
| Rate for Payer: Aetna Medicare |
$1,887.00
|
| Rate for Payer: BCBS Complete |
$975.33
|
| Rate for Payer: BCN Commercial |
$2,350.96
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Cash Price |
$3,019.20
|
| Rate for Payer: Mclaren Medicaid |
$928.89
|
| Rate for Payer: Meridian Medicaid |
$975.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,830.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$928.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,864.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,864.51
|
| Rate for Payer: UHC Medicaid |
$928.89
|
| Rate for Payer: UHCCP Medicaid |
$928.89
|
|
|
PR PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$5,729.00
|
|
|
Service Code
|
HCPCS 48150
|
| Min. Negotiated Rate |
$1,830.95 |
| Max. Negotiated Rate |
$5,677.43 |
| Rate for Payer: Aetna Commercial |
$4,213.34
|
| Rate for Payer: Aetna Medicare |
$2,864.50
|
| Rate for Payer: BCBS Complete |
$1,922.50
|
| Rate for Payer: BCN Commercial |
$4,659.61
|
| Rate for Payer: Cash Price |
$4,583.20
|
| Rate for Payer: Cash Price |
$4,583.20
|
| Rate for Payer: Mclaren Medicaid |
$1,830.95
|
| Rate for Payer: Meridian Medicaid |
$1,922.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,296.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,830.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,677.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,677.43
|
| Rate for Payer: UHC Medicaid |
$1,830.95
|
| Rate for Payer: UHCCP Medicaid |
$1,830.95
|
|
|
PR PNCRTECT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$8,552.00
|
|
|
Service Code
|
HCPCS 48153
|
| Min. Negotiated Rate |
$1,825.62 |
| Max. Negotiated Rate |
$6,414.00 |
| Rate for Payer: Aetna Commercial |
$4,201.24
|
| Rate for Payer: Aetna Medicare |
$4,276.00
|
| Rate for Payer: BCBS Complete |
$1,916.90
|
| Rate for Payer: BCN Commercial |
$4,632.22
|
| Rate for Payer: Cash Price |
$6,841.60
|
| Rate for Payer: Cash Price |
$6,841.60
|
| Rate for Payer: Mclaren Medicaid |
$1,825.62
|
| Rate for Payer: Meridian Medicaid |
$1,916.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,414.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,825.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,644.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,644.05
|
| Rate for Payer: UHC Medicaid |
$1,825.62
|
| Rate for Payer: UHCCP Medicaid |
$1,825.62
|
|
|
PR PNEUMOCOCCAL CONJ VACCINE 7 VALENT IM
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 90669
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$89.25 |
| Rate for Payer: Aetna Medicare |
$59.50
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.25
|
|
|
PR PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX
|
Professional
|
Both
|
$2,651.00
|
|
|
Service Code
|
HCPCS 32940
|
| Min. Negotiated Rate |
$749.33 |
| Max. Negotiated Rate |
$1,988.25 |
| Rate for Payer: Aetna Commercial |
$1,590.96
|
| Rate for Payer: Aetna Medicare |
$1,325.50
|
| Rate for Payer: BCBS Complete |
$786.80
|
| Rate for Payer: BCN Commercial |
$1,825.60
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Cash Price |
$2,120.80
|
| Rate for Payer: Mclaren Medicaid |
$749.33
|
| Rate for Payer: Meridian Medicaid |
$786.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,988.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$749.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,719.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,719.17
|
| Rate for Payer: UHC Medicaid |
$749.33
|
| Rate for Payer: UHCCP Medicaid |
$749.33
|
|
|
PR PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST
|
Professional
|
Both
|
$2,811.00
|
|
|
Service Code
|
HCPCS 32200
|
| Min. Negotiated Rate |
$707.16 |
| Max. Negotiated Rate |
$2,108.25 |
| Rate for Payer: Aetna Commercial |
$1,465.11
|
| Rate for Payer: Aetna Medicare |
$1,405.50
|
| Rate for Payer: BCBS Complete |
$742.52
|
| Rate for Payer: BCN Commercial |
$1,696.13
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Cash Price |
$2,248.80
|
| Rate for Payer: Mclaren Medicaid |
$707.16
|
| Rate for Payer: Meridian Medicaid |
$742.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,108.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$707.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,597.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,597.24
|
| Rate for Payer: UHC Medicaid |
$707.16
|
| Rate for Payer: UHCCP Medicaid |
$707.16
|
|
|
PR PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
HCPCS 32960
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Aetna Commercial |
$117.78
|
| Rate for Payer: Aetna Medicare |
$159.00
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCN Commercial |
$133.96
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Mclaren Medicaid |
$52.40
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$126.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.14
|
| Rate for Payer: UHC Medicaid |
$52.40
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
|
|
PR PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 55000
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$107.54
|
| Rate for Payer: Aetna Medicare |
$114.00
|
| Rate for Payer: BCBS Complete |
$51.66
|
| Rate for Payer: BCN Commercial |
$126.49
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Mclaren Medicaid |
$49.20
|
| Rate for Payer: Meridian Medicaid |
$51.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$137.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.79
|
| Rate for Payer: UHC Medicaid |
$49.20
|
| Rate for Payer: UHCCP Medicaid |
$49.20
|
|
|
PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 90713
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: BCBS Trust/PPO |
$47.81
|
| Rate for Payer: BCN Commercial |
$43.89
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
|
|
PR POLLICIZATION DIGIT
|
Professional
|
Both
|
$2,851.00
|
|
|
Service Code
|
HCPCS 26550
|
| Min. Negotiated Rate |
$981.08 |
| Max. Negotiated Rate |
$2,651.00 |
| Rate for Payer: Aetna Commercial |
$2,222.53
|
| Rate for Payer: Aetna Medicare |
$1,425.50
|
| Rate for Payer: BCBS Complete |
$1,030.13
|
| Rate for Payer: BCN Commercial |
$2,479.95
|
| Rate for Payer: Cash Price |
$2,280.80
|
| Rate for Payer: Cash Price |
$2,280.80
|
| Rate for Payer: Mclaren Medicaid |
$981.08
|
| Rate for Payer: Meridian Medicaid |
$1,030.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,138.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$981.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,651.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,651.00
|
| Rate for Payer: UHC Medicaid |
$981.08
|
| Rate for Payer: UHCCP Medicaid |
$981.08
|
|
|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$1,027.00
|
|
|
Service Code
|
HCPCS 95810
|
| Min. Negotiated Rate |
$513.50 |
| Max. Negotiated Rate |
$863.84 |
| Rate for Payer: Aetna Commercial |
$639.21
|
| Rate for Payer: Aetna Commercial |
$639.21
|
| Rate for Payer: Aetna Medicare |
$244.00
|
| Rate for Payer: Aetna Medicare |
$513.50
|
| Rate for Payer: BCN Commercial |
$738.67
|
| Rate for Payer: BCN Commercial |
$738.67
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Cash Price |
$821.60
|
| Rate for Payer: Cash Price |
$821.60
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$770.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$863.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$863.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$863.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$863.84
|
|
|
PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 95782
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$1,451.62 |
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Aetna Commercial |
$958.65
|
| Rate for Payer: Aetna Medicare |
$894.00
|
| Rate for Payer: Aetna Medicare |
$133.00
|
| Rate for Payer: BCN Commercial |
$1,451.62
|
| Rate for Payer: BCN Commercial |
$1,451.62
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$1,430.40
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,341.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,338.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,338.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,338.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,338.70
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$1,283.00
|
|
|
Service Code
|
HCPCS 95811
|
| Min. Negotiated Rate |
$641.50 |
| Max. Negotiated Rate |
$962.25 |
| Rate for Payer: Aetna Commercial |
$667.17
|
| Rate for Payer: Aetna Commercial |
$667.17
|
| Rate for Payer: Aetna Medicare |
$641.50
|
| Rate for Payer: Aetna Medicare |
$258.50
|
| Rate for Payer: BCN Commercial |
$773.62
|
| Rate for Payer: BCN Commercial |
$773.62
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$1,026.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$962.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$904.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$904.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$904.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$904.72
|
|
|
PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
|
Professional
|
Both
|
$1,909.00
|
|
|
Service Code
|
HCPCS 95783
|
| Min. Negotiated Rate |
$954.50 |
| Max. Negotiated Rate |
$1,538.26 |
| Rate for Payer: Aetna Commercial |
$1,016.43
|
| Rate for Payer: Aetna Commercial |
$1,016.43
|
| Rate for Payer: Aetna Medicare |
$954.50
|
| Rate for Payer: Aetna Medicare |
$145.00
|
| Rate for Payer: BCN Commercial |
$1,538.26
|
| Rate for Payer: BCN Commercial |
$1,538.26
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$1,527.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,431.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,418.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,418.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,418.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,418.60
|
|
|
PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 95808
|
| Min. Negotiated Rate |
$221.50 |
| Max. Negotiated Rate |
$682.59 |
| Rate for Payer: Aetna Commercial |
$682.59
|
| Rate for Payer: Aetna Commercial |
$682.59
|
| Rate for Payer: Aetna Medicare |
$221.50
|
| Rate for Payer: Aetna Medicare |
$896.00
|
| Rate for Payer: BCN Commercial |
$578.05
|
| Rate for Payer: BCN Commercial |
$578.05
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$1,433.60
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,344.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$332.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$676.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$676.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$676.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$676.01
|
|
|
PR PORTOENETEROSTOMY
|
Professional
|
Both
|
$4,959.00
|
|
|
Service Code
|
HCPCS 47701
|
| Min. Negotiated Rate |
$1,033.26 |
| Max. Negotiated Rate |
$3,719.25 |
| Rate for Payer: Aetna Commercial |
$2,356.00
|
| Rate for Payer: Aetna Medicare |
$2,479.50
|
| Rate for Payer: BCBS Complete |
$1,084.92
|
| Rate for Payer: BCN Commercial |
$2,600.46
|
| Rate for Payer: Cash Price |
$3,967.20
|
| Rate for Payer: Cash Price |
$3,967.20
|
| Rate for Payer: Mclaren Medicaid |
$1,033.26
|
| Rate for Payer: Meridian Medicaid |
$1,084.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,719.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,033.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,168.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,168.48
|
| Rate for Payer: UHC Medicaid |
$1,033.26
|
| Rate for Payer: UHCCP Medicaid |
$1,033.26
|
|
|
PR POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 92542
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$42.82 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Medicare |
$21.50
|
| Rate for Payer: BCN Commercial |
$42.82
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$39.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.50
|
|
|
PR POST-CATARACT LASER SURGERY
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
HCPCS 66821
|
| Min. Negotiated Rate |
$175.51 |
| Max. Negotiated Rate |
$538.97 |
| Rate for Payer: Aetna Commercial |
$402.65
|
| Rate for Payer: Aetna Medicare |
$295.50
|
| Rate for Payer: BCBS Complete |
$184.29
|
| Rate for Payer: BCN Commercial |
$460.13
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Mclaren Medicaid |
$175.51
|
| Rate for Payer: Meridian Medicaid |
$184.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$443.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$175.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$538.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.97
|
| Rate for Payer: UHC Medicaid |
$175.51
|
| Rate for Payer: UHCCP Medicaid |
$175.51
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 57250
|
| Hospital Charge Code |
57250
|
| Min. Negotiated Rate |
$347.83 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Aetna Commercial |
$731.56
|
| Rate for Payer: Aetna Medicare |
$724.50
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCN Commercial |
$924.26
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Mclaren Medicaid |
$347.83
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$936.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$936.07
|
| Rate for Payer: UHC Medicaid |
$347.83
|
| Rate for Payer: UHCCP Medicaid |
$347.83
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,449.00
|
|
|
Service Code
|
HCPCS 57250
|
| Min. Negotiated Rate |
$347.83 |
| Max. Negotiated Rate |
$1,086.75 |
| Rate for Payer: Aetna Commercial |
$731.56
|
| Rate for Payer: Aetna Medicare |
$724.50
|
| Rate for Payer: BCBS Complete |
$365.22
|
| Rate for Payer: BCN Commercial |
$924.26
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Cash Price |
$1,159.20
|
| Rate for Payer: Mclaren Medicaid |
$347.83
|
| Rate for Payer: Meridian Medicaid |
$365.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,086.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$347.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$936.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$936.07
|
| Rate for Payer: UHC Medicaid |
$347.83
|
| Rate for Payer: UHCCP Medicaid |
$347.83
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Facility
|
IP
|
$1,407.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
57250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$979.27 |
| Max. Negotiated Rate |
$1,266.30 |
| Rate for Payer: Aetna Commercial |
$1,195.95
|
| Rate for Payer: BCBS Trust/PPO |
$1,162.04
|
| Rate for Payer: BCN Commercial |
$1,162.04
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,210.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.60
|
| Rate for Payer: Healthscope Commercial |
$1,266.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,055.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.95
|
| Rate for Payer: Nomi Health Commercial |
$1,153.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,055.25
|
| Rate for Payer: PHP Commercial |
$1,195.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,224.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$979.27
|
| Rate for Payer: UHC Core |
$1,174.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,055.25
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
CPT 57250
|
| Hospital Charge Code |
57250
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$248.05 |
| Max. Negotiated Rate |
$1,266.30 |
| Rate for Payer: Aetna Commercial |
$1,195.95
|
| Rate for Payer: Aetna Medicare |
$365.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$439.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$439.69
|
| Rate for Payer: BCBS Complete |
$260.44
|
| Rate for Payer: BCBS MAPPO |
$351.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,156.69
|
| Rate for Payer: BCN Commercial |
$1,156.69
|
| Rate for Payer: BCN Medicare Advantage |
$351.75
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$1,210.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,125.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.75
|
| Rate for Payer: Healthscope Commercial |
$1,266.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,055.25
|
| Rate for Payer: Mclaren Medicaid |
$248.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.34
|
| Rate for Payer: Meridian Medicaid |
$260.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$404.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$386.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,195.95
|
| Rate for Payer: Nomi Health Commercial |
$1,153.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,055.25
|
| Rate for Payer: PACE Senior Care Partners |
$334.16
|
| Rate for Payer: PACE SWMI |
$351.75
|
| Rate for Payer: PHP Commercial |
$1,195.95
|
| Rate for Payer: PHP Medicare Advantage |
$351.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$248.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,224.09
|
| Rate for Payer: Priority Health Medicare |
$355.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$979.27
|
| Rate for Payer: Railroad Medicare Medicare |
$351.75
|
| Rate for Payer: UHC Core |
$1,174.85
|
| Rate for Payer: UHC Exchange |
$351.75
|
| Rate for Payer: UHC Medicaid |
$248.05
|
| Rate for Payer: UHC Medicare Advantage |
$351.75
|
| Rate for Payer: UHCCP Medicaid |
$248.05
|
| Rate for Payer: VA VA |
$351.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,055.25
|
|
|
PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,433.00
|
|
|
Service Code
|
HCPCS 22840
|
| Min. Negotiated Rate |
$426.21 |
| Max. Negotiated Rate |
$2,574.75 |
| Rate for Payer: Aetna Commercial |
$1,021.35
|
| Rate for Payer: Aetna Medicare |
$1,716.50
|
| Rate for Payer: BCBS Complete |
$447.52
|
| Rate for Payer: BCN Commercial |
$1,238.57
|
| Rate for Payer: Cash Price |
$2,746.40
|
| Rate for Payer: Cash Price |
$2,746.40
|
| Rate for Payer: Mclaren Medicaid |
$426.21
|
| Rate for Payer: Meridian Medicaid |
$447.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,574.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$426.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,205.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,205.18
|
| Rate for Payer: UHC Medicaid |
$426.21
|
| Rate for Payer: UHCCP Medicaid |
$426.21
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE
|
Professional
|
Both
|
$4,047.00
|
|
|
Service Code
|
HCPCS 22844
|
| Min. Negotiated Rate |
$558.06 |
| Max. Negotiated Rate |
$3,035.25 |
| Rate for Payer: Aetna Commercial |
$1,328.64
|
| Rate for Payer: Aetna Medicare |
$2,023.50
|
| Rate for Payer: BCBS Complete |
$585.96
|
| Rate for Payer: BCN Commercial |
$1,619.33
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Cash Price |
$3,237.60
|
| Rate for Payer: Mclaren Medicaid |
$558.06
|
| Rate for Payer: Meridian Medicaid |
$585.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,035.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$558.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,575.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,575.70
|
| Rate for Payer: UHC Medicaid |
$558.06
|
| Rate for Payer: UHCCP Medicaid |
$558.06
|
|
