|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$410.64
|
|
|
Service Code
|
NDC 63323008615
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$151.94 |
| Max. Negotiated Rate |
$410.64 |
| Rate for Payer: Aetna Commercial |
$369.58
|
| Rate for Payer: Aetna Medicare |
$151.94
|
| Rate for Payer: ASR ASR |
$398.32
|
| Rate for Payer: BCBS Complete |
$164.26
|
| Rate for Payer: BCBS Trust/PPO |
$338.57
|
| Rate for Payer: BCN Commercial |
$338.57
|
| Rate for Payer: Cash Price |
$328.51
|
| Rate for Payer: Cofinity Commercial |
$386.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.51
|
| Rate for Payer: Healthscope Commercial |
$398.32
|
| Rate for Payer: Healthscope Whirlpool |
$410.64
|
| Rate for Payer: Mclaren Commercial |
$369.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$328.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.04
|
| Rate for Payer: Nomi Health Commercial |
$336.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$359.80
|
| Rate for Payer: Priority Health Narrow Network |
$287.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.36
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$250.13
|
|
|
Service Code
|
NDC 70069074725
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$250.12 |
| Rate for Payer: Aetna Commercial |
$225.11
|
| Rate for Payer: Aetna Medicare |
$92.55
|
| Rate for Payer: ASR ASR |
$242.62
|
| Rate for Payer: BCBS Complete |
$100.05
|
| Rate for Payer: BCBS Trust/PPO |
$206.23
|
| Rate for Payer: BCN Commercial |
$206.23
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cofinity Commercial |
$235.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.10
|
| Rate for Payer: Healthscope Commercial |
$242.62
|
| Rate for Payer: Healthscope Whirlpool |
$250.12
|
| Rate for Payer: Mclaren Commercial |
$225.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.61
|
| Rate for Payer: Nomi Health Commercial |
$205.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$219.16
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.11
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$250.13
|
|
|
Service Code
|
NDC 70069074701
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$250.12 |
| Rate for Payer: Aetna Commercial |
$225.11
|
| Rate for Payer: Aetna Medicare |
$92.55
|
| Rate for Payer: ASR ASR |
$242.62
|
| Rate for Payer: BCBS Complete |
$100.05
|
| Rate for Payer: BCBS Trust/PPO |
$206.23
|
| Rate for Payer: BCN Commercial |
$206.23
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cofinity Commercial |
$235.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.10
|
| Rate for Payer: Healthscope Commercial |
$242.62
|
| Rate for Payer: Healthscope Whirlpool |
$250.12
|
| Rate for Payer: Mclaren Commercial |
$225.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$200.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$212.61
|
| Rate for Payer: Nomi Health Commercial |
$205.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$219.16
|
| Rate for Payer: Priority Health Narrow Network |
$175.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$220.11
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$77.85
|
|
|
Service Code
|
NDC 63323008605
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$77.85 |
| Rate for Payer: Aetna Commercial |
$70.06
|
| Rate for Payer: ASR ASR |
$75.51
|
| Rate for Payer: BCBS Trust/PPO |
$63.93
|
| Rate for Payer: BCN Commercial |
$63.93
|
| Rate for Payer: Cash Price |
$62.28
|
| Rate for Payer: Cofinity Commercial |
$73.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.28
|
| Rate for Payer: Healthscope Commercial |
$75.51
|
| Rate for Payer: Healthscope Whirlpool |
$77.85
|
| Rate for Payer: Mclaren Commercial |
$70.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.17
|
| Rate for Payer: Nomi Health Commercial |
$63.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.51
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$77.85
|
|
|
Service Code
|
NDC 63323008605
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$77.85 |
| Rate for Payer: Aetna Commercial |
$70.06
|
| Rate for Payer: Aetna Medicare |
$28.80
|
| Rate for Payer: ASR ASR |
$75.51
|
| Rate for Payer: BCBS Complete |
$31.14
|
| Rate for Payer: BCBS Trust/PPO |
$64.19
|
| Rate for Payer: BCN Commercial |
$64.19
|
| Rate for Payer: Cash Price |
$62.28
|
| Rate for Payer: Cofinity Commercial |
$73.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.28
|
| Rate for Payer: Healthscope Commercial |
$75.51
|
| Rate for Payer: Healthscope Whirlpool |
$77.85
|
| Rate for Payer: Mclaren Commercial |
$70.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.17
|
| Rate for Payer: Nomi Health Commercial |
$63.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.21
|
| Rate for Payer: Priority Health Narrow Network |
$54.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.51
|
|
|
PR 1 STAGE PROX PENILE/PENOSCROTAL HYPOSPADIAS RPR
|
Professional
|
Both
|
$2,161.00
|
|
|
Service Code
|
HCPCS 54332
|
| Min. Negotiated Rate |
$578.30 |
| Max. Negotiated Rate |
$1,789.21 |
| Rate for Payer: Aetna Commercial |
$1,201.51
|
| Rate for Payer: Aetna Medicare |
$896.65
|
| Rate for Payer: BCBS Complete |
$607.22
|
| Rate for Payer: BCBS MAPPO |
$896.65
|
| Rate for Payer: BCN Commercial |
$1,508.88
|
| Rate for Payer: BCN Medicare Advantage |
$896.65
|
| Rate for Payer: Cash Price |
$1,728.80
|
| Rate for Payer: Cash Price |
$1,728.80
|
| Rate for Payer: Cofinity Commercial |
$1,291.18
|
| Rate for Payer: Cofinity Commercial |
$1,201.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$896.65
|
| Rate for Payer: Healthscope Commercial |
$1,075.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,075.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$941.48
|
| Rate for Payer: Meridian Medicaid |
$607.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$986.32
|
| Rate for Payer: Nomi Health Commercial |
$1,075.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,620.75
|
| Rate for Payer: PACE SWMI |
$896.65
|
| Rate for Payer: PHP Medicare Advantage |
$896.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$578.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,643.67
|
| Rate for Payer: Priority Health Medicare |
$896.65
|
| Rate for Payer: Priority Health Narrow Network |
$1,643.67
|
| Rate for Payer: Railroad Medicare Medicare |
$896.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,789.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$896.65
|
| Rate for Payer: UHC Exchange |
$1,789.21
|
| Rate for Payer: UHC Medicaid |
$578.30
|
| Rate for Payer: UHCCP DNSP |
$896.65
|
| Rate for Payer: UHCCP Medicaid |
$578.30
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS
|
Professional
|
Both
|
$1,827.00
|
|
|
Service Code
|
HCPCS 54326
|
| Min. Negotiated Rate |
$540.59 |
| Max. Negotiated Rate |
$1,668.02 |
| Rate for Payer: Aetna Commercial |
$1,122.30
|
| Rate for Payer: Aetna Medicare |
$837.54
|
| Rate for Payer: BCBS Complete |
$567.62
|
| Rate for Payer: BCBS MAPPO |
$837.54
|
| Rate for Payer: BCN Commercial |
$1,408.29
|
| Rate for Payer: BCN Medicare Advantage |
$837.54
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cofinity Commercial |
$1,206.06
|
| Rate for Payer: Cofinity Commercial |
$1,122.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$837.54
|
| Rate for Payer: Healthscope Commercial |
$1,005.05
|
| Rate for Payer: Healthscope Whirlpool |
$1,005.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$879.42
|
| Rate for Payer: Meridian Medicaid |
$567.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$921.29
|
| Rate for Payer: Nomi Health Commercial |
$1,005.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,370.25
|
| Rate for Payer: PACE SWMI |
$837.54
|
| Rate for Payer: PHP Medicare Advantage |
$837.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$540.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,534.09
|
| Rate for Payer: Priority Health Medicare |
$837.54
|
| Rate for Payer: Priority Health Narrow Network |
$1,534.09
|
| Rate for Payer: Railroad Medicare Medicare |
$837.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,668.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$837.54
|
| Rate for Payer: UHC Exchange |
$1,668.02
|
| Rate for Payer: UHC Medicaid |
$540.59
|
| Rate for Payer: UHCCP DNSP |
$837.54
|
| Rate for Payer: UHCCP Medicaid |
$540.59
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT
|
Professional
|
Both
|
$5,150.00
|
|
|
Service Code
|
HCPCS 54322
|
| Min. Negotiated Rate |
$449.43 |
| Max. Negotiated Rate |
$3,862.50 |
| Rate for Payer: Aetna Commercial |
$932.21
|
| Rate for Payer: Aetna Medicare |
$695.68
|
| Rate for Payer: BCBS Complete |
$471.90
|
| Rate for Payer: BCBS MAPPO |
$695.68
|
| Rate for Payer: BCN Commercial |
$1,169.25
|
| Rate for Payer: BCN Medicare Advantage |
$695.68
|
| Rate for Payer: Cash Price |
$4,120.00
|
| Rate for Payer: Cash Price |
$4,120.00
|
| Rate for Payer: Cofinity Commercial |
$932.21
|
| Rate for Payer: Cofinity Commercial |
$1,001.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.68
|
| Rate for Payer: Healthscope Commercial |
$834.82
|
| Rate for Payer: Healthscope Whirlpool |
$834.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$730.46
|
| Rate for Payer: Meridian Medicaid |
$471.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$765.25
|
| Rate for Payer: Nomi Health Commercial |
$834.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,862.50
|
| Rate for Payer: PACE SWMI |
$695.68
|
| Rate for Payer: PHP Medicare Advantage |
$695.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$449.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,273.71
|
| Rate for Payer: Priority Health Medicare |
$695.68
|
| Rate for Payer: Priority Health Narrow Network |
$1,273.71
|
| Rate for Payer: Railroad Medicare Medicare |
$695.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,380.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$695.68
|
| Rate for Payer: UHC Exchange |
$1,380.52
|
| Rate for Payer: UHC Medicaid |
$449.43
|
| Rate for Payer: UHCCP DNSP |
$695.68
|
| Rate for Payer: UHCCP Medicaid |
$449.43
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS
|
Professional
|
Both
|
$2,072.00
|
|
|
Service Code
|
HCPCS 54324
|
| Min. Negotiated Rate |
$554.65 |
| Max. Negotiated Rate |
$1,710.70 |
| Rate for Payer: Aetna Commercial |
$1,151.88
|
| Rate for Payer: Aetna Medicare |
$859.61
|
| Rate for Payer: BCBS Complete |
$582.38
|
| Rate for Payer: BCBS MAPPO |
$859.61
|
| Rate for Payer: BCN Commercial |
$1,446.63
|
| Rate for Payer: BCN Medicare Advantage |
$859.61
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cash Price |
$1,657.60
|
| Rate for Payer: Cofinity Commercial |
$1,237.84
|
| Rate for Payer: Cofinity Commercial |
$1,151.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$859.61
|
| Rate for Payer: Healthscope Commercial |
$1,031.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,031.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$902.59
|
| Rate for Payer: Meridian Medicaid |
$582.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$945.57
|
| Rate for Payer: Nomi Health Commercial |
$1,031.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,554.00
|
| Rate for Payer: PACE SWMI |
$859.61
|
| Rate for Payer: PHP Medicare Advantage |
$859.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$554.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,575.86
|
| Rate for Payer: Priority Health Medicare |
$859.61
|
| Rate for Payer: Priority Health Narrow Network |
$1,575.86
|
| Rate for Payer: Railroad Medicare Medicare |
$859.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,710.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$859.61
|
| Rate for Payer: UHC Exchange |
$1,710.70
|
| Rate for Payer: UHC Medicaid |
$554.65
|
| Rate for Payer: UHCCP DNSP |
$859.61
|
| Rate for Payer: UHCCP Medicaid |
$554.65
|
|
|
PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 99460
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$136.44 |
| Rate for Payer: Aetna Commercial |
$107.52
|
| Rate for Payer: Aetna Medicare |
$80.24
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS MAPPO |
$80.24
|
| Rate for Payer: BCN Commercial |
$136.44
|
| Rate for Payer: BCN Medicare Advantage |
$80.24
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$115.55
|
| Rate for Payer: Cofinity Commercial |
$107.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.24
|
| Rate for Payer: Healthscope Commercial |
$88.26
|
| Rate for Payer: Healthscope Whirlpool |
$88.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.25
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.26
|
| Rate for Payer: Nomi Health Commercial |
$96.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.25
|
| Rate for Payer: PACE SWMI |
$80.24
|
| Rate for Payer: PHP Medicare Advantage |
$80.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$122.73
|
| Rate for Payer: Priority Health Medicare |
$80.24
|
| Rate for Payer: Priority Health Narrow Network |
$122.73
|
| Rate for Payer: Railroad Medicare Medicare |
$80.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.24
|
| Rate for Payer: UHC Exchange |
$135.48
|
| Rate for Payer: UHC Medicaid |
$51.55
|
| Rate for Payer: UHCCP DNSP |
$80.24
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
|
|
PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 99463
|
| Min. Negotiated Rate |
$60.49 |
| Max. Negotiated Rate |
$159.85 |
| Rate for Payer: Aetna Commercial |
$125.60
|
| Rate for Payer: Aetna Medicare |
$93.73
|
| Rate for Payer: BCBS Complete |
$63.51
|
| Rate for Payer: BCBS MAPPO |
$93.73
|
| Rate for Payer: BCN Commercial |
$159.85
|
| Rate for Payer: BCN Medicare Advantage |
$93.73
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$134.97
|
| Rate for Payer: Cofinity Commercial |
$125.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.73
|
| Rate for Payer: Healthscope Commercial |
$103.10
|
| Rate for Payer: Healthscope Whirlpool |
$103.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.42
|
| Rate for Payer: Meridian Medicaid |
$63.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$103.10
|
| Rate for Payer: Nomi Health Commercial |
$112.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.75
|
| Rate for Payer: PACE SWMI |
$93.73
|
| Rate for Payer: PHP Medicare Advantage |
$93.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.79
|
| Rate for Payer: Priority Health Medicare |
$93.73
|
| Rate for Payer: Priority Health Narrow Network |
$143.79
|
| Rate for Payer: Railroad Medicare Medicare |
$93.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.14
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$93.73
|
| Rate for Payer: UHC Exchange |
$156.14
|
| Rate for Payer: UHC Medicaid |
$60.49
|
| Rate for Payer: UHCCP DNSP |
$93.73
|
| Rate for Payer: UHCCP Medicaid |
$60.49
|
|
|
PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
HCPCS 99223
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$285.78 |
| Rate for Payer: Aetna Commercial |
$207.58
|
| Rate for Payer: Aetna Medicare |
$154.91
|
| Rate for Payer: BCBS Complete |
$104.66
|
| Rate for Payer: BCBS MAPPO |
$154.91
|
| Rate for Payer: BCN Commercial |
$187.79
|
| Rate for Payer: BCN Medicare Advantage |
$154.91
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cash Price |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$223.07
|
| Rate for Payer: Cofinity Commercial |
$207.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$154.91
|
| Rate for Payer: Healthscope Commercial |
$170.40
|
| Rate for Payer: Healthscope Whirlpool |
$170.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.66
|
| Rate for Payer: Meridian Medicaid |
$104.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$170.40
|
| Rate for Payer: Nomi Health Commercial |
$185.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.00
|
| Rate for Payer: PACE SWMI |
$154.91
|
| Rate for Payer: PHP Medicare Advantage |
$154.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$99.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$231.58
|
| Rate for Payer: Priority Health Medicare |
$154.91
|
| Rate for Payer: Priority Health Narrow Network |
$231.58
|
| Rate for Payer: Railroad Medicare Medicare |
$154.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$154.91
|
| Rate for Payer: UHC Exchange |
$285.78
|
| Rate for Payer: UHC Medicaid |
$99.68
|
| Rate for Payer: UHCCP DNSP |
$154.91
|
| Rate for Payer: UHCCP Medicaid |
$99.68
|
|
|
PR 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS 99222
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$194.72 |
| Rate for Payer: Aetna Commercial |
$155.37
|
| Rate for Payer: Aetna Medicare |
$115.95
|
| Rate for Payer: BCBS Complete |
$78.28
|
| Rate for Payer: BCBS MAPPO |
$115.95
|
| Rate for Payer: BCN Commercial |
$140.94
|
| Rate for Payer: BCN Medicare Advantage |
$115.95
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cofinity Commercial |
$166.97
|
| Rate for Payer: Cofinity Commercial |
$155.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.95
|
| Rate for Payer: Healthscope Commercial |
$127.55
|
| Rate for Payer: Healthscope Whirlpool |
$127.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.75
|
| Rate for Payer: Meridian Medicaid |
$78.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$127.55
|
| Rate for Payer: Nomi Health Commercial |
$139.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.00
|
| Rate for Payer: PACE SWMI |
$115.95
|
| Rate for Payer: PHP Medicare Advantage |
$115.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$173.80
|
| Rate for Payer: Priority Health Medicare |
$115.95
|
| Rate for Payer: Priority Health Narrow Network |
$173.80
|
| Rate for Payer: Railroad Medicare Medicare |
$115.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$115.95
|
| Rate for Payer: UHC Exchange |
$194.72
|
| Rate for Payer: UHC Medicaid |
$74.55
|
| Rate for Payer: UHCCP DNSP |
$115.95
|
| Rate for Payer: UHCCP Medicaid |
$74.55
|
|
|
PR 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 99221
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$144.23 |
| Rate for Payer: Aetna Commercial |
$99.31
|
| Rate for Payer: Aetna Medicare |
$74.11
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS MAPPO |
$74.11
|
| Rate for Payer: BCN Commercial |
$89.36
|
| Rate for Payer: BCN Medicare Advantage |
$74.11
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$99.31
|
| Rate for Payer: Cofinity Commercial |
$106.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.11
|
| Rate for Payer: Healthscope Commercial |
$81.52
|
| Rate for Payer: Healthscope Whirlpool |
$81.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.82
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$81.52
|
| Rate for Payer: Nomi Health Commercial |
$88.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.50
|
| Rate for Payer: PACE SWMI |
$74.11
|
| Rate for Payer: PHP Medicare Advantage |
$74.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$110.19
|
| Rate for Payer: Priority Health Medicare |
$74.11
|
| Rate for Payer: Priority Health Narrow Network |
$110.19
|
| Rate for Payer: Railroad Medicare Medicare |
$74.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.11
|
| Rate for Payer: UHC Exchange |
$144.23
|
| Rate for Payer: UHC Medicaid |
$47.50
|
| Rate for Payer: UHCCP DNSP |
$74.11
|
| Rate for Payer: UHCCP Medicaid |
$47.50
|
|
|
PR 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$1,725.00
|
|
|
Service Code
|
HCPCS 99468
|
| Min. Negotiated Rate |
$772.71 |
| Max. Negotiated Rate |
$1,313.18 |
| Rate for Payer: Aetna Commercial |
$1,035.43
|
| Rate for Payer: Aetna Medicare |
$772.71
|
| Rate for Payer: BCBS Complete |
$811.35
|
| Rate for Payer: BCBS MAPPO |
$772.71
|
| Rate for Payer: BCN Commercial |
$1,313.18
|
| Rate for Payer: BCN Medicare Advantage |
$772.71
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cofinity Commercial |
$1,112.70
|
| Rate for Payer: Cofinity Commercial |
$1,035.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$772.71
|
| Rate for Payer: Healthscope Commercial |
$849.98
|
| Rate for Payer: Healthscope Whirlpool |
$849.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$811.35
|
| Rate for Payer: Meridian Medicaid |
$811.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$849.98
|
| Rate for Payer: Nomi Health Commercial |
$927.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,293.75
|
| Rate for Payer: PACE SWMI |
$772.71
|
| Rate for Payer: PHP Medicare Advantage |
$772.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$772.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,181.21
|
| Rate for Payer: Priority Health Medicare |
$772.71
|
| Rate for Payer: Priority Health Narrow Network |
$1,181.21
|
| Rate for Payer: Railroad Medicare Medicare |
$772.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,303.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$772.71
|
| Rate for Payer: UHC Exchange |
$1,303.73
|
| Rate for Payer: UHC Medicaid |
$772.71
|
| Rate for Payer: UHCCP DNSP |
$772.71
|
| Rate for Payer: UHCCP Medicaid |
$772.71
|
|
|
PR 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
HCPCS 99492
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Aetna Commercial |
$109.20
|
| Rate for Payer: Aetna Medicare |
$81.49
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS MAPPO |
$81.49
|
| Rate for Payer: BCN Commercial |
$109.08
|
| Rate for Payer: BCN Medicare Advantage |
$81.49
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$117.35
|
| Rate for Payer: Cofinity Commercial |
$109.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.49
|
| Rate for Payer: Healthscope Commercial |
$89.64
|
| Rate for Payer: Healthscope Whirlpool |
$89.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.56
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$89.64
|
| Rate for Payer: Nomi Health Commercial |
$97.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.00
|
| Rate for Payer: PACE SWMI |
$81.49
|
| Rate for Payer: PHP Medicare Advantage |
$81.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$172.40
|
| Rate for Payer: Priority Health Medicare |
$81.49
|
| Rate for Payer: Priority Health Narrow Network |
$172.40
|
| Rate for Payer: Railroad Medicare Medicare |
$81.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$81.49
|
| Rate for Payer: UHC Exchange |
$125.10
|
| Rate for Payer: UHC Medicaid |
$52.40
|
| Rate for Payer: UHCCP DNSP |
$81.49
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
|
|
PR 1ST/SBSQ PSYCH COLLAB CARE MGMT EA ADDL 30 MINS
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 99494
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$47.91
|
| Rate for Payer: Aetna Medicare |
$35.75
|
| Rate for Payer: BCBS Complete |
$24.15
|
| Rate for Payer: BCBS MAPPO |
$35.75
|
| Rate for Payer: BCN Commercial |
$53.02
|
| Rate for Payer: BCN Medicare Advantage |
$35.75
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$51.48
|
| Rate for Payer: Cofinity Commercial |
$47.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.75
|
| Rate for Payer: Healthscope Commercial |
$39.33
|
| Rate for Payer: Healthscope Whirlpool |
$39.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.54
|
| Rate for Payer: Meridian Medicaid |
$24.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$39.33
|
| Rate for Payer: Nomi Health Commercial |
$42.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$99.75
|
| Rate for Payer: PACE SWMI |
$35.75
|
| Rate for Payer: PHP Medicare Advantage |
$35.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$82.71
|
| Rate for Payer: Priority Health Medicare |
$35.75
|
| Rate for Payer: Priority Health Narrow Network |
$82.71
|
| Rate for Payer: Railroad Medicare Medicare |
$35.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$60.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$35.75
|
| Rate for Payer: UHC Exchange |
$60.05
|
| Rate for Payer: UHC Medicaid |
$23.00
|
| Rate for Payer: UHCCP DNSP |
$35.75
|
| Rate for Payer: UHCCP Medicaid |
$23.00
|
|
|
PR 2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 90650
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$215.25 |
| Rate for Payer: Aetna Commercial |
$141.25
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: BCBS Trust/PPO |
$133.16
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$215.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$158.96
|
| Rate for Payer: UHC Exchange |
$158.96
|
|
|
PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 90649
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$203.25 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: BCBS Complete |
$108.40
|
| Rate for Payer: BCBS Trust/PPO |
$160.17
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$203.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$164.98
|
| Rate for Payer: UHC Exchange |
$164.98
|
|
|
PR 5% DEXTROSE IN LAC RINGERS
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS J7121
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$7.42
|
| Rate for Payer: BCBS Trust/PPO |
$1.84
|
| Rate for Payer: BCN Commercial |
$1.85
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.98
|
| Rate for Payer: UHC Exchange |
$7.98
|
|
|
PR 9VHPV VACC 2/3 DOSE SCHED IM USE
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 90651
|
| Min. Negotiated Rate |
$228.75 |
| Max. Negotiated Rate |
$329.09 |
| Rate for Payer: Aetna Commercial |
$293.16
|
| Rate for Payer: BCBS Trust/PPO |
$329.09
|
| Rate for Payer: BCN Commercial |
$310.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$329.09
|
| Rate for Payer: UHC Exchange |
$329.09
|
|
|
PR AAA REPAIR,AORTO-AORTIC TUBE PROSTH
|
Professional
|
Both
|
$4,055.00
|
|
|
Service Code
|
HCPCS 34800
|
| Min. Negotiated Rate |
$1,622.00 |
| Max. Negotiated Rate |
$3,041.25 |
| Rate for Payer: BCBS Complete |
$1,622.00
|
| Rate for Payer: Cash Price |
$3,244.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,041.25
|
|
|
PR AAA REPAIR,MODULR BIFURCATED PROSTH
|
Professional
|
Both
|
$2,632.00
|
|
|
Service Code
|
HCPCS 34802
|
| Min. Negotiated Rate |
$1,052.80 |
| Max. Negotiated Rate |
$1,974.00 |
| Rate for Payer: BCBS Complete |
$1,052.80
|
| Rate for Payer: Cash Price |
$2,105.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,974.00
|
|
|
PR AAA REPAIR,MODULR BIFUR PROSTH,2-DOCK
|
Professional
|
Both
|
$2,701.00
|
|
|
Service Code
|
HCPCS 34803
|
| Min. Negotiated Rate |
$1,080.40 |
| Max. Negotiated Rate |
$2,025.75 |
| Rate for Payer: BCBS Complete |
$1,080.40
|
| Rate for Payer: Cash Price |
$2,160.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,025.75
|
|
|
PR AAA REPAIR,UNIBODY BIFURCATED PROSTH
|
Professional
|
Both
|
$5,677.00
|
|
|
Service Code
|
HCPCS 34804
|
| Min. Negotiated Rate |
$2,270.80 |
| Max. Negotiated Rate |
$4,257.75 |
| Rate for Payer: BCBS Complete |
$2,270.80
|
| Rate for Payer: Cash Price |
$4,541.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,257.75
|
|
