|
PEG TUBE 20FR MIC* PUSH
|
Facility
|
OP
|
$357.00
|
|
| Hospital Charge Code |
3256040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$339.15 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Humana Medicare Advantage |
$149.94
|
| Rate for Payer: UnitedHealthcare Commercial |
$339.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$142.80
|
| Rate for Payer: WPPA Medicare Advantage |
$214.20
|
|
|
PEG TUBE 20FR MIC* PUSH
|
Facility
|
IP
|
$357.00
|
|
| Hospital Charge Code |
3256040
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$339.15
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Peg Tube 24fr MIC* Pull
|
Facility
|
IP
|
$343.00
|
|
| Hospital Charge Code |
3256046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$308.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.85
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Peg Tube 24fr MIC* Pull
|
Facility
|
OP
|
$343.00
|
|
| Hospital Charge Code |
3256046
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$325.85 |
| Rate for Payer: Aetna Commercial |
$308.70
|
| Rate for Payer: Humana Medicare Advantage |
$144.06
|
| Rate for Payer: UnitedHealthcare Commercial |
$325.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$137.20
|
| Rate for Payer: WPPA Medicare Advantage |
$205.80
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC
|
Facility
|
IP
|
$7,148.25
|
|
|
Service Code
|
MSDRG 734
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$7,148.25 |
| Rate for Payer: UnitedHealthcare Medicaid |
$7,148.25
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$4,511.34
|
|
|
Service Code
|
MSDRG 735
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$4,511.34 |
| Rate for Payer: UnitedHealthcare Medicaid |
$4,511.34
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Pelvic Exam Under Anesthesia
|
Facility
|
IP
|
$2,886.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
3150601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$2,741.70 |
| Rate for Payer: Aetna Commercial |
$2,597.40
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,741.70
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Pelvic Exam Under Anesthesia
|
Facility
|
OP
|
$2,886.00
|
|
|
Service Code
|
HCPCS 57410
|
| Hospital Charge Code |
3150601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,012.78 |
| Max. Negotiated Rate |
$2,741.70 |
| Rate for Payer: Aetna Commercial |
$2,597.40
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$1,538.23
|
| Rate for Payer: Humana Medicare Advantage |
$1,212.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$2,741.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,012.78
|
| Rate for Payer: WPPA Medicare Advantage |
$1,731.60
|
|
|
penicillin G benzathine 1,200,000 units/2 mL Sus [HMC]
|
Facility
|
IP
|
$568.98
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
3804545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$512.08 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$512.08
|
| Rate for Payer: UnitedHealthcare Commercial |
$540.53
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
penicillin G benzathine 1,200,000 units/2 mL Sus [HMC]
|
Facility
|
OP
|
$568.98
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
3804545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.97 |
| Max. Negotiated Rate |
$540.53 |
| Rate for Payer: Aetna Commercial |
$512.08
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$32.82
|
| Rate for Payer: Humana Medicare Advantage |
$238.97
|
| Rate for Payer: UnitedHealthcare Commercial |
$540.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.97
|
| Rate for Payer: WPPA Medicare Advantage |
$341.39
|
|
|
Penicillium Notatum (M1) IgE QST
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
LAB1019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$25.65 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$15.51
|
| Rate for Payer: Humana Medicare Advantage |
$11.34
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.22
|
| Rate for Payer: WPPA Medicare Advantage |
$16.20
|
|
|
Penicillium Notatum (M1) IgE QST
|
Facility
|
IP
|
$27.00
|
|
|
Service Code
|
HCPCS 86003
|
| Hospital Charge Code |
LAB1019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: UnitedHealthcare Commercial |
$25.65
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
PENIS PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$8,164.89
|
|
|
Service Code
|
MSDRG 709
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$8,164.89 |
| Rate for Payer: UnitedHealthcare Medicaid |
$8,164.89
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$4,924.35
|
|
|
Service Code
|
MSDRG 710
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$4,924.35 |
| Rate for Payer: UnitedHealthcare Medicaid |
$4,924.35
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Penrose Drain 1/2
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
3250903
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.70 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.85
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
Penrose Drain 1/2
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
3250903
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Humana Medicare Advantage |
$1.26
|
| Rate for Payer: UnitedHealthcare Commercial |
$2.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.20
|
| Rate for Payer: WPPA Medicare Advantage |
$1.80
|
|
|
Penrose Drain 1/4
|
Facility
|
OP
|
$10.13
|
|
| Hospital Charge Code |
3255630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: Aetna Commercial |
$9.12
|
| Rate for Payer: Humana Medicare Advantage |
$4.25
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.05
|
| Rate for Payer: WPPA Medicare Advantage |
$6.08
|
|
|
Penrose Drain 1/4
|
Facility
|
IP
|
$10.13
|
|
| Hospital Charge Code |
3255630
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$9.12
|
| Rate for Payer: UnitedHealthcare Commercial |
$9.62
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
pentamidine 300 mg Inh Pwdr for Recon [HMC]
|
Facility
|
IP
|
$280.36
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
3852180
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$252.32 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$252.32
|
| Rate for Payer: UnitedHealthcare Commercial |
$266.34
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
pentamidine 300 mg Inh Pwdr for Recon [HMC]
|
Facility
|
OP
|
$280.36
|
|
|
Service Code
|
HCPCS J2545
|
| Hospital Charge Code |
3852180
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.73 |
| Max. Negotiated Rate |
$266.34 |
| Rate for Payer: Aetna Commercial |
$252.32
|
| Rate for Payer: Blue Cross Blue Shield of Kansas Commercial |
$112.04
|
| Rate for Payer: Humana Medicare Advantage |
$117.75
|
| Rate for Payer: UnitedHealthcare Commercial |
$266.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$69.73
|
| Rate for Payer: WPPA Medicare Advantage |
$168.22
|
|
|
pentoxifylline 400 mg ER Tab [HMC]
|
Facility
|
OP
|
$8.42
|
|
|
Service Code
|
NDC 60505003306
|
| Hospital Charge Code |
3800890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: Humana Medicare Advantage |
$3.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.37
|
| Rate for Payer: WPPA Medicare Advantage |
$5.05
|
|
|
pentoxifylline 400 mg ER Tab [HMC]
|
Facility
|
IP
|
$8.42
|
|
|
Service Code
|
NDC 70954066810
|
| Hospital Charge Code |
3800890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.00
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
pentoxifylline 400 mg ER Tab [HMC]
|
Facility
|
OP
|
$6.30
|
|
|
Service Code
|
NDC 68682010110
|
| Hospital Charge Code |
3800890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$5.99 |
| Rate for Payer: Aetna Commercial |
$5.67
|
| Rate for Payer: Humana Medicare Advantage |
$2.65
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.52
|
| Rate for Payer: WPPA Medicare Advantage |
$3.78
|
|
|
pentoxifylline 400 mg ER Tab [HMC]
|
Facility
|
IP
|
$6.30
|
|
|
Service Code
|
NDC 68682010110
|
| Hospital Charge Code |
3800890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$5.67
|
| Rate for Payer: UnitedHealthcare Commercial |
$5.99
|
| Rate for Payer: WPPA Medicare Advantage |
$1,200.00
|
|
|
pentoxifylline 400 mg ER Tab [HMC]
|
Facility
|
OP
|
$8.42
|
|
|
Service Code
|
NDC 70954066810
|
| Hospital Charge Code |
3800890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$7.58
|
| Rate for Payer: Humana Medicare Advantage |
$3.54
|
| Rate for Payer: UnitedHealthcare Commercial |
$8.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.37
|
| Rate for Payer: WPPA Medicare Advantage |
$5.05
|
|
