|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
IP
|
$4.68
|
|
|
Service Code
|
NDC 60687081011
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.21
|
| Rate for Payer: ASR ASR |
$4.54
|
| Rate for Payer: ASR Commercial |
$4.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.81
|
| Rate for Payer: BCN Commercial |
$3.63
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.74
|
| Rate for Payer: Healthscope Commercial |
$4.68
|
| Rate for Payer: Healthscope Whirlpool |
$4.54
|
| Rate for Payer: Mclaren Commercial |
$4.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Nomi Health Commercial |
$3.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.12
|
|
|
POTASSIUM CHLORIDE ER 10 MEQ TABLET,EXTENDED RELEASE
|
Facility
|
OP
|
$2.69
|
|
|
Service Code
|
NDC 00574027500
|
| Hospital Charge Code |
6436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: ASR ASR |
$2.61
|
| Rate for Payer: ASR Commercial |
$2.61
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.09
|
| Rate for Payer: Cash Price |
$2.15
|
| Rate for Payer: Cofinity Commercial |
$2.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.15
|
| Rate for Payer: Healthscope Commercial |
$2.69
|
| Rate for Payer: Healthscope Whirlpool |
$2.61
|
| Rate for Payer: Mclaren Commercial |
$2.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.29
|
| Rate for Payer: Nomi Health Commercial |
$2.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.36
|
| Rate for Payer: Priority Health Narrow Network |
$1.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.37
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET
|
Facility
|
OP
|
$469.30
|
|
|
Service Code
|
NDC 00486111101
|
| Hospital Charge Code |
11087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.72 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$422.37
|
| Rate for Payer: Aetna Medicare |
$234.65
|
| Rate for Payer: ASR ASR |
$455.22
|
| Rate for Payer: ASR Commercial |
$455.22
|
| Rate for Payer: BCBS Complete |
$187.72
|
| Rate for Payer: BCBS Trust/PPO |
$384.31
|
| Rate for Payer: BCN Commercial |
$363.85
|
| Rate for Payer: Cash Price |
$375.44
|
| Rate for Payer: Cofinity Commercial |
$441.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.44
|
| Rate for Payer: Healthscope Commercial |
$469.30
|
| Rate for Payer: Healthscope Whirlpool |
$455.22
|
| Rate for Payer: Mclaren Commercial |
$422.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.90
|
| Rate for Payer: Nomi Health Commercial |
$384.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$411.20
|
| Rate for Payer: Priority Health Narrow Network |
$328.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.98
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET
|
Facility
|
IP
|
$442.70
|
|
|
Service Code
|
NDC 39328000810
|
| Hospital Charge Code |
11087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.75 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: ASR ASR |
$429.42
|
| Rate for Payer: ASR Commercial |
$429.42
|
| Rate for Payer: BCBS Trust/PPO |
$360.76
|
| Rate for Payer: BCN Commercial |
$343.23
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$416.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$442.70
|
| Rate for Payer: Healthscope Whirlpool |
$429.42
|
| Rate for Payer: Mclaren Commercial |
$398.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Nomi Health Commercial |
$363.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.58
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET
|
Facility
|
OP
|
$442.70
|
|
|
Service Code
|
NDC 39328000810
|
| Hospital Charge Code |
11087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.08 |
| Max. Negotiated Rate |
$442.70 |
| Rate for Payer: Aetna Commercial |
$398.43
|
| Rate for Payer: Aetna Medicare |
$221.35
|
| Rate for Payer: ASR ASR |
$429.42
|
| Rate for Payer: ASR Commercial |
$429.42
|
| Rate for Payer: BCBS Complete |
$177.08
|
| Rate for Payer: BCBS Trust/PPO |
$362.53
|
| Rate for Payer: BCN Commercial |
$343.23
|
| Rate for Payer: Cash Price |
$354.16
|
| Rate for Payer: Cofinity Commercial |
$416.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$442.70
|
| Rate for Payer: Healthscope Whirlpool |
$429.42
|
| Rate for Payer: Mclaren Commercial |
$398.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.30
|
| Rate for Payer: Nomi Health Commercial |
$363.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.89
|
| Rate for Payer: Priority Health Narrow Network |
$310.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.58
|
|
|
POTASSIUM PHOSPHATE, MONOBASIC 500 MG SOLUBLE TABLET
|
Facility
|
IP
|
$469.30
|
|
|
Service Code
|
NDC 00486111101
|
| Hospital Charge Code |
11087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$305.05 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$422.37
|
| Rate for Payer: ASR ASR |
$455.22
|
| Rate for Payer: ASR Commercial |
$455.22
|
| Rate for Payer: BCBS Trust/PPO |
$382.43
|
| Rate for Payer: BCN Commercial |
$363.85
|
| Rate for Payer: Cash Price |
$375.44
|
| Rate for Payer: Cofinity Commercial |
$441.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.44
|
| Rate for Payer: Healthscope Commercial |
$469.30
|
| Rate for Payer: Healthscope Whirlpool |
$455.22
|
| Rate for Payer: Mclaren Commercial |
$422.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$398.90
|
| Rate for Payer: Nomi Health Commercial |
$384.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.98
|
|
|
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 |
$164.26 |
| Max. Negotiated Rate |
$410.64 |
| Rate for Payer: Aetna Commercial |
$369.58
|
| Rate for Payer: Aetna Medicare |
$205.32
|
| Rate for Payer: ASR ASR |
$398.32
|
| Rate for Payer: ASR Commercial |
$398.32
|
| Rate for Payer: BCBS Complete |
$164.26
|
| Rate for Payer: BCBS Trust/PPO |
$336.27
|
| Rate for Payer: BCN Commercial |
$318.37
|
| 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 |
$410.64
|
| Rate for Payer: Healthscope Whirlpool |
$398.32
|
| Rate for Payer: Mclaren Commercial |
$369.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.04
|
| Rate for Payer: Nomi Health Commercial |
$336.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.92
|
| Rate for Payer: 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
|
IP
|
$77.85
|
|
|
Service Code
|
NDC 63323008605
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$77.85 |
| Rate for Payer: Aetna Commercial |
$70.06
|
| Rate for Payer: ASR ASR |
$75.51
|
| Rate for Payer: ASR Commercial |
$75.51
|
| Rate for Payer: BCBS Trust/PPO |
$63.44
|
| Rate for Payer: BCN Commercial |
$60.36
|
| 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 |
$77.85
|
| Rate for Payer: Healthscope Whirlpool |
$75.51
|
| 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: Priority Health Cigna Priority Health |
$50.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.51
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$199.45
|
|
|
Service Code
|
NDC 00409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$199.45 |
| Rate for Payer: Aetna Commercial |
$179.50
|
| Rate for Payer: ASR ASR |
$193.47
|
| Rate for Payer: ASR Commercial |
$193.47
|
| Rate for Payer: BCBS Trust/PPO |
$162.53
|
| Rate for Payer: BCN Commercial |
$154.63
|
| Rate for Payer: Cash Price |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$187.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$199.45
|
| Rate for Payer: Healthscope Whirlpool |
$193.47
|
| Rate for Payer: Mclaren Commercial |
$179.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.53
|
| Rate for Payer: Nomi Health Commercial |
$163.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.52
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$410.64
|
|
|
Service Code
|
NDC 63323008615
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$266.92 |
| Max. Negotiated Rate |
$410.64 |
| Rate for Payer: Aetna Commercial |
$369.58
|
| Rate for Payer: ASR ASR |
$398.32
|
| Rate for Payer: ASR Commercial |
$398.32
|
| Rate for Payer: BCBS Trust/PPO |
$334.63
|
| Rate for Payer: BCN Commercial |
$318.37
|
| 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 |
$410.64
|
| Rate for Payer: Healthscope Whirlpool |
$398.32
|
| Rate for Payer: Mclaren Commercial |
$369.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$349.04
|
| Rate for Payer: Nomi Health Commercial |
$336.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.36
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.45
|
|
|
Service Code
|
NDC 00409729511
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$199.45 |
| Rate for Payer: Aetna Commercial |
$179.50
|
| Rate for Payer: Aetna Medicare |
$99.72
|
| Rate for Payer: ASR ASR |
$193.47
|
| Rate for Payer: ASR Commercial |
$193.47
|
| Rate for Payer: BCBS Complete |
$79.78
|
| Rate for Payer: BCBS Trust/PPO |
$163.33
|
| Rate for Payer: BCN Commercial |
$154.63
|
| Rate for Payer: Cash Price |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$187.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$199.45
|
| Rate for Payer: Healthscope Whirlpool |
$193.47
|
| Rate for Payer: Mclaren Commercial |
$179.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.53
|
| Rate for Payer: Nomi Health Commercial |
$163.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.76
|
| Rate for Payer: Priority Health Narrow Network |
$139.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.52
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$199.45
|
|
|
Service Code
|
NDC 00409729511
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$199.45 |
| Rate for Payer: Aetna Commercial |
$179.50
|
| Rate for Payer: ASR ASR |
$193.47
|
| Rate for Payer: ASR Commercial |
$193.47
|
| Rate for Payer: BCBS Trust/PPO |
$162.53
|
| Rate for Payer: BCN Commercial |
$154.63
|
| Rate for Payer: Cash Price |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$187.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$199.45
|
| Rate for Payer: Healthscope Whirlpool |
$193.47
|
| Rate for Payer: Mclaren Commercial |
$179.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.53
|
| Rate for Payer: Nomi Health Commercial |
$163.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.52
|
|
|
POTASSIUM PHOSPHATES-MBASIC AND DIBASIC 3 MMOL/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$199.45
|
|
|
Service Code
|
NDC 00409729501
|
| Hospital Charge Code |
6451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$79.78 |
| Max. Negotiated Rate |
$199.45 |
| Rate for Payer: Aetna Commercial |
$179.50
|
| Rate for Payer: Aetna Medicare |
$99.72
|
| Rate for Payer: ASR ASR |
$193.47
|
| Rate for Payer: ASR Commercial |
$193.47
|
| Rate for Payer: BCBS Complete |
$79.78
|
| Rate for Payer: BCBS Trust/PPO |
$163.33
|
| Rate for Payer: BCN Commercial |
$154.63
|
| Rate for Payer: Cash Price |
$159.56
|
| Rate for Payer: Cofinity Commercial |
$187.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$159.56
|
| Rate for Payer: Healthscope Commercial |
$199.45
|
| Rate for Payer: Healthscope Whirlpool |
$193.47
|
| Rate for Payer: Mclaren Commercial |
$179.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.53
|
| Rate for Payer: Nomi Health Commercial |
$163.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.76
|
| Rate for Payer: Priority Health Narrow Network |
$139.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$175.52
|
|
|
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 |
$31.14 |
| Max. Negotiated Rate |
$77.85 |
| Rate for Payer: Aetna Commercial |
$70.06
|
| Rate for Payer: Aetna Medicare |
$38.92
|
| Rate for Payer: ASR ASR |
$75.51
|
| Rate for Payer: ASR Commercial |
$75.51
|
| Rate for Payer: BCBS Complete |
$31.14
|
| Rate for Payer: BCBS Trust/PPO |
$63.75
|
| Rate for Payer: BCN Commercial |
$60.36
|
| 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 |
$77.85
|
| Rate for Payer: Healthscope Whirlpool |
$75.51
|
| 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: Priority Health Cigna Priority Health |
$50.60
|
| Rate for Payer: 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
|
$2,098.00
|
|
|
Service Code
|
HCPCS 54332
|
| Min. Negotiated Rate |
$839.20 |
| Max. Negotiated Rate |
$1,389.10 |
| Rate for Payer: Aetna Commercial |
$1,292.63
|
| Rate for Payer: Aetna Medicare |
$964.65
|
| Rate for Payer: BCBS Complete |
$839.20
|
| Rate for Payer: BCBS MAPPO |
$964.65
|
| Rate for Payer: BCN Medicare Advantage |
$964.65
|
| Rate for Payer: Cash Price |
$1,678.40
|
| Rate for Payer: Cash Price |
$1,678.40
|
| Rate for Payer: Cofinity Commercial |
$1,389.10
|
| Rate for Payer: Cofinity Commercial |
$1,292.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$964.65
|
| Rate for Payer: Healthscope Commercial |
$1,157.58
|
| Rate for Payer: Healthscope Whirlpool |
$1,157.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,012.88
|
| Rate for Payer: Nomi Health Commercial |
$1,157.58
|
| Rate for Payer: PACE SWMI |
$964.65
|
| Rate for Payer: PHP Medicare Advantage |
$964.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,363.70
|
| Rate for Payer: Priority Health Medicare |
$964.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$964.65
|
| Rate for Payer: UHC Medicare Advantage |
$964.65
|
| Rate for Payer: UHCCP DNSP |
$964.65
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR URTP SKN FLAPS
|
Professional
|
Both
|
$1,774.00
|
|
|
Service Code
|
HCPCS 54326
|
| Min. Negotiated Rate |
$709.60 |
| Max. Negotiated Rate |
$1,295.71 |
| Rate for Payer: Aetna Commercial |
$1,205.73
|
| Rate for Payer: Aetna Medicare |
$899.80
|
| Rate for Payer: BCBS Complete |
$709.60
|
| Rate for Payer: BCBS MAPPO |
$899.80
|
| Rate for Payer: BCN Medicare Advantage |
$899.80
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cash Price |
$1,419.20
|
| Rate for Payer: Cofinity Commercial |
$1,295.71
|
| Rate for Payer: Cofinity Commercial |
$1,205.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$899.80
|
| Rate for Payer: Healthscope Commercial |
$1,079.76
|
| Rate for Payer: Healthscope Whirlpool |
$1,079.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$944.79
|
| Rate for Payer: Nomi Health Commercial |
$1,079.76
|
| Rate for Payer: PACE SWMI |
$899.80
|
| Rate for Payer: PHP Medicare Advantage |
$899.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,153.10
|
| Rate for Payer: Priority Health Medicare |
$899.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$899.80
|
| Rate for Payer: UHC Medicare Advantage |
$899.80
|
| Rate for Payer: UHCCP DNSP |
$899.80
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/SMPL MEATAL ADVMNT
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 54322
|
| Min. Negotiated Rate |
$746.55 |
| Max. Negotiated Rate |
$3,250.00 |
| Rate for Payer: Aetna Commercial |
$1,000.38
|
| Rate for Payer: Aetna Medicare |
$746.55
|
| Rate for Payer: BCBS Complete |
$2,000.00
|
| Rate for Payer: BCBS MAPPO |
$746.55
|
| Rate for Payer: BCN Medicare Advantage |
$746.55
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cofinity Commercial |
$1,075.03
|
| Rate for Payer: Cofinity Commercial |
$1,000.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$746.55
|
| Rate for Payer: Healthscope Commercial |
$895.86
|
| Rate for Payer: Healthscope Whirlpool |
$895.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$783.88
|
| Rate for Payer: Nomi Health Commercial |
$895.86
|
| Rate for Payer: PACE SWMI |
$746.55
|
| Rate for Payer: PHP Medicare Advantage |
$746.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,250.00
|
| Rate for Payer: Priority Health Medicare |
$746.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$746.55
|
| Rate for Payer: UHC Medicare Advantage |
$746.55
|
| Rate for Payer: UHCCP DNSP |
$746.55
|
|
|
PR 1 STG DSTL HYPOSPADIAS RPR W/URTP SKIN FLAPS
|
Professional
|
Both
|
$2,012.00
|
|
|
Service Code
|
HCPCS 54324
|
| Min. Negotiated Rate |
$804.80 |
| Max. Negotiated Rate |
$1,331.44 |
| Rate for Payer: Aetna Commercial |
$1,238.98
|
| Rate for Payer: Aetna Medicare |
$924.61
|
| Rate for Payer: BCBS Complete |
$804.80
|
| Rate for Payer: BCBS MAPPO |
$924.61
|
| Rate for Payer: BCN Medicare Advantage |
$924.61
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cofinity Commercial |
$1,331.44
|
| Rate for Payer: Cofinity Commercial |
$1,238.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$924.61
|
| Rate for Payer: Healthscope Commercial |
$1,109.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,109.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$970.84
|
| Rate for Payer: Nomi Health Commercial |
$1,109.53
|
| Rate for Payer: PACE SWMI |
$924.61
|
| Rate for Payer: PHP Medicare Advantage |
$924.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,307.80
|
| Rate for Payer: Priority Health Medicare |
$924.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$924.61
|
| Rate for Payer: UHC Medicare Advantage |
$924.61
|
| Rate for Payer: UHCCP DNSP |
$924.61
|
|
|
PR 1ST HOSP/BIRTHING CENTER CARE PER DAY NML NB
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 99460
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$125.81 |
| Rate for Payer: Aetna Commercial |
$117.08
|
| Rate for Payer: Aetna Medicare |
$87.37
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$87.37
|
| Rate for Payer: BCN Medicare Advantage |
$87.37
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$125.81
|
| Rate for Payer: Cofinity Commercial |
$117.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.37
|
| Rate for Payer: Healthscope Commercial |
$96.11
|
| Rate for Payer: Healthscope Whirlpool |
$96.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.74
|
| Rate for Payer: Nomi Health Commercial |
$104.84
|
| Rate for Payer: PACE SWMI |
$87.37
|
| Rate for Payer: PHP Medicare Advantage |
$87.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$87.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.37
|
| Rate for Payer: UHC Medicare Advantage |
$87.37
|
| Rate for Payer: UHCCP DNSP |
$87.37
|
|
|
PR 1ST HOSP/BIRTHING CENTER NB ADMIT & DSCHG SM DAT
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 99463
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna Commercial |
$136.79
|
| Rate for Payer: Aetna Medicare |
$102.08
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: BCBS MAPPO |
$102.08
|
| Rate for Payer: BCN Medicare Advantage |
$102.08
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$147.00
|
| Rate for Payer: Cofinity Commercial |
$136.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.08
|
| Rate for Payer: Healthscope Commercial |
$112.29
|
| Rate for Payer: Healthscope Whirlpool |
$112.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.18
|
| Rate for Payer: Nomi Health Commercial |
$122.50
|
| Rate for Payer: PACE SWMI |
$102.08
|
| Rate for Payer: PHP Medicare Advantage |
$102.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.80
|
| Rate for Payer: Priority Health Medicare |
$102.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.08
|
| Rate for Payer: UHC Medicare Advantage |
$102.08
|
| Rate for Payer: UHCCP DNSP |
$102.08
|
|
|
PR 1ST HOSPITAL IP/OBS CARE HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 99223
|
| Min. Negotiated Rate |
$141.20 |
| Max. Negotiated Rate |
$237.31 |
| Rate for Payer: Aetna Commercial |
$220.83
|
| Rate for Payer: Aetna Medicare |
$164.80
|
| Rate for Payer: BCBS Complete |
$141.20
|
| Rate for Payer: BCBS MAPPO |
$164.80
|
| Rate for Payer: BCN Medicare Advantage |
$164.80
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cofinity Commercial |
$237.31
|
| Rate for Payer: Cofinity Commercial |
$220.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.80
|
| Rate for Payer: Healthscope Commercial |
$181.28
|
| Rate for Payer: Healthscope Whirlpool |
$181.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.04
|
| Rate for Payer: Nomi Health Commercial |
$197.76
|
| Rate for Payer: PACE SWMI |
$164.80
|
| Rate for Payer: PHP Medicare Advantage |
$164.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.45
|
| Rate for Payer: Priority Health Medicare |
$164.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.80
|
| Rate for Payer: UHC Medicare Advantage |
$164.80
|
| Rate for Payer: UHCCP DNSP |
$164.80
|
|
|
PR 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 99222
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$178.10 |
| Rate for Payer: Aetna Commercial |
$165.73
|
| Rate for Payer: Aetna Medicare |
$123.68
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$123.68
|
| Rate for Payer: BCN Medicare Advantage |
$123.68
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$178.10
|
| Rate for Payer: Cofinity Commercial |
$165.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.68
|
| Rate for Payer: Healthscope Commercial |
$136.05
|
| Rate for Payer: Healthscope Whirlpool |
$136.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.86
|
| Rate for Payer: Nomi Health Commercial |
$148.42
|
| Rate for Payer: PACE SWMI |
$123.68
|
| Rate for Payer: PHP Medicare Advantage |
$123.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$123.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.68
|
| Rate for Payer: UHC Medicare Advantage |
$123.68
|
| Rate for Payer: UHCCP DNSP |
$123.68
|
|
|
PR 1ST HOSPITAL IP/OBS CARE SF/LOW MDM 40 MINUTES
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 99221
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$115.05 |
| Rate for Payer: Aetna Commercial |
$105.35
|
| Rate for Payer: Aetna Medicare |
$78.62
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS MAPPO |
$78.62
|
| Rate for Payer: BCN Medicare Advantage |
$78.62
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$113.21
|
| Rate for Payer: Cofinity Commercial |
$105.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.62
|
| Rate for Payer: Healthscope Commercial |
$86.48
|
| Rate for Payer: Healthscope Whirlpool |
$86.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.55
|
| Rate for Payer: Nomi Health Commercial |
$94.34
|
| Rate for Payer: PACE SWMI |
$78.62
|
| Rate for Payer: PHP Medicare Advantage |
$78.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.05
|
| Rate for Payer: Priority Health Medicare |
$78.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.62
|
| Rate for Payer: UHC Medicare Advantage |
$78.62
|
| Rate for Payer: UHCCP DNSP |
$78.62
|
|
|
PR 1ST INPATIENT CRITICAL CARE PR DAY AGE 28 DAYS/<
|
Professional
|
Both
|
$1,675.00
|
|
|
Service Code
|
HCPCS 99468
|
| Min. Negotiated Rate |
$670.00 |
| Max. Negotiated Rate |
$1,210.87 |
| Rate for Payer: Aetna Commercial |
$1,126.78
|
| Rate for Payer: Aetna Medicare |
$840.88
|
| Rate for Payer: BCBS Complete |
$670.00
|
| Rate for Payer: BCBS MAPPO |
$840.88
|
| Rate for Payer: BCN Medicare Advantage |
$840.88
|
| Rate for Payer: Cash Price |
$1,340.00
|
| Rate for Payer: Cash Price |
$1,340.00
|
| Rate for Payer: Cofinity Commercial |
$1,210.87
|
| Rate for Payer: Cofinity Commercial |
$1,126.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$840.88
|
| Rate for Payer: Healthscope Commercial |
$924.97
|
| Rate for Payer: Healthscope Whirlpool |
$924.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$882.92
|
| Rate for Payer: Nomi Health Commercial |
$1,009.06
|
| Rate for Payer: PACE SWMI |
$840.88
|
| Rate for Payer: PHP Medicare Advantage |
$840.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,088.75
|
| Rate for Payer: Priority Health Medicare |
$840.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$840.88
|
| Rate for Payer: UHC Medicare Advantage |
$840.88
|
| Rate for Payer: UHCCP DNSP |
$840.88
|
|
|
PR 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 99492
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$119.69
|
| Rate for Payer: Aetna Medicare |
$89.32
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: BCBS MAPPO |
$89.32
|
| Rate for Payer: BCN Medicare Advantage |
$89.32
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$128.62
|
| Rate for Payer: Cofinity Commercial |
$119.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.32
|
| Rate for Payer: Healthscope Commercial |
$98.25
|
| Rate for Payer: Healthscope Whirlpool |
$98.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.79
|
| Rate for Payer: Nomi Health Commercial |
$107.18
|
| Rate for Payer: PACE SWMI |
$89.32
|
| Rate for Payer: PHP Medicare Advantage |
$89.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| Rate for Payer: Priority Health Medicare |
$89.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.32
|
| Rate for Payer: UHC Medicare Advantage |
$89.32
|
| Rate for Payer: UHCCP DNSP |
$89.32
|
|
