|
PR ECOG IMPLANTED BRAIN NPGT W/REC I&R <30 DAYS
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 95836
|
| Min. Negotiated Rate |
$66.67 |
| Max. Negotiated Rate |
$658.26 |
| Rate for Payer: Aetna Commercial |
$116.64
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS Trust/PPO |
$658.26
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Mclaren Medicaid |
$66.67
|
| Rate for Payer: Meridian Medicaid |
$70.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.14
|
| Rate for Payer: Priority Health Narrow Network |
$140.14
|
| Rate for Payer: Priority Health SBD |
$140.14
|
|
|
PR EDG US EXAM SURGICAL ALTER STOM DUODENUM/JEJUNUM
|
Professional
|
Both
|
$978.00
|
|
|
Service Code
|
HCPCS 43259
|
| Min. Negotiated Rate |
$141.65 |
| Max. Negotiated Rate |
$946.19 |
| Rate for Payer: Aetna Commercial |
$300.25
|
| Rate for Payer: BCBS Complete |
$148.73
|
| Rate for Payer: BCBS Trust/PPO |
$946.19
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Mclaren Medicaid |
$141.65
|
| Rate for Payer: Meridian Medicaid |
$148.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$141.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$684.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$388.07
|
| Rate for Payer: Priority Health Narrow Network |
$388.07
|
| Rate for Payer: Priority Health SBD |
$388.07
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$100.87
|
|
|
Service Code
|
NDC 61314-637-05
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.55 |
| Max. Negotiated Rate |
$90.78 |
| Rate for Payer: Aetna Commercial |
$85.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cofinity Commercial |
$70.61
|
| Rate for Payer: Cofinity Commercial |
$86.75
|
| Rate for Payer: Healthscope Commercial |
$90.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$85.74
|
| Rate for Payer: PHP Commercial |
$85.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.61
|
| Rate for Payer: Priority Health SBD |
$63.55
|
|
|
PREDNISOLONE ACETATE 1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$422.91
|
|
|
Service Code
|
NDC 11980-180-05
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.43 |
| Max. Negotiated Rate |
$380.62 |
| Rate for Payer: Aetna Commercial |
$359.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$274.89
|
| Rate for Payer: Cash Price |
$338.33
|
| Rate for Payer: Cofinity Commercial |
$296.04
|
| Rate for Payer: Cofinity Commercial |
$363.70
|
| Rate for Payer: Healthscope Commercial |
$380.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.47
|
| Rate for Payer: PHP Commercial |
$359.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.04
|
| Rate for Payer: Priority Health SBD |
$266.43
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLUTION
|
Facility
|
IP
|
$774.17
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
29302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$487.73 |
| Max. Negotiated Rate |
$696.75 |
| Rate for Payer: Aetna Commercial |
$658.04
|
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.19
|
| Rate for Payer: Cash Price |
$619.34
|
| Rate for Payer: Cash Price |
$6.39
|
| Rate for Payer: Cofinity Commercial |
$665.79
|
| Rate for Payer: Cofinity Commercial |
$6.87
|
| Rate for Payer: Cofinity Commercial |
$541.92
|
| Rate for Payer: Cofinity Commercial |
$5.59
|
| Rate for Payer: Healthscope Commercial |
$696.75
|
| Rate for Payer: Healthscope Commercial |
$7.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$658.04
|
| Rate for Payer: PHP Commercial |
$658.04
|
| Rate for Payer: PHP Commercial |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$541.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.59
|
| Rate for Payer: Priority Health SBD |
$487.73
|
| Rate for Payer: Priority Health SBD |
$5.03
|
|
|
PREDNISONE 10 MG TABLET
|
Facility
|
IP
|
$267.90
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6494
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.78 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$227.72
|
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna Commercial |
$361.55
|
| Rate for Payer: Aetna Commercial |
$39.75
|
| Rate for Payer: Aetna Commercial |
$279.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.14
|
| Rate for Payer: Cash Price |
$37.42
|
| Rate for Payer: Cash Price |
$214.32
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cash Price |
$263.20
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Cofinity Commercial |
$40.22
|
| Rate for Payer: Cofinity Commercial |
$187.53
|
| Rate for Payer: Cofinity Commercial |
$230.39
|
| Rate for Payer: Cofinity Commercial |
$230.30
|
| Rate for Payer: Cofinity Commercial |
$282.94
|
| Rate for Payer: Cofinity Commercial |
$266.49
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Cofinity Commercial |
$297.74
|
| Rate for Payer: Cofinity Commercial |
$365.80
|
| Rate for Payer: Healthscope Commercial |
$296.10
|
| Rate for Payer: Healthscope Commercial |
$382.82
|
| Rate for Payer: Healthscope Commercial |
$241.11
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Healthscope Commercial |
$42.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$323.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$279.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$361.55
|
| Rate for Payer: PHP Commercial |
$39.75
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: PHP Commercial |
$279.65
|
| Rate for Payer: PHP Commercial |
$227.72
|
| Rate for Payer: PHP Commercial |
$361.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.74
|
| Rate for Payer: Priority Health SBD |
$207.27
|
| Rate for Payer: Priority Health SBD |
$29.47
|
| Rate for Payer: Priority Health SBD |
$267.97
|
| Rate for Payer: Priority Health SBD |
$168.78
|
| Rate for Payer: Priority Health SBD |
$239.84
|
|
|
PREDNISONE 10 MG TABLETS IN A DOSE PACK
|
Facility
|
IP
|
$83.87
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
15853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.84 |
| Max. Negotiated Rate |
$75.48 |
| Rate for Payer: Aetna Commercial |
$71.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.52
|
| Rate for Payer: Cash Price |
$67.10
|
| Rate for Payer: Cofinity Commercial |
$58.71
|
| Rate for Payer: Cofinity Commercial |
$72.13
|
| Rate for Payer: Healthscope Commercial |
$75.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.29
|
| Rate for Payer: PHP Commercial |
$71.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.71
|
| Rate for Payer: Priority Health SBD |
$52.84
|
|
|
PREDNISONE 1 MG TABLET
|
Facility
|
IP
|
$196.65
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6493
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$123.89 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$167.15
|
| Rate for Payer: Aetna Commercial |
$135.83
|
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$103.87
|
| Rate for Payer: Cash Price |
$157.32
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cash Price |
$127.84
|
| Rate for Payer: Cofinity Commercial |
$137.66
|
| Rate for Payer: Cofinity Commercial |
$111.86
|
| Rate for Payer: Cofinity Commercial |
$137.43
|
| Rate for Payer: Cofinity Commercial |
$169.12
|
| Rate for Payer: Cofinity Commercial |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: Healthscope Commercial |
$143.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$375.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$135.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.15
|
| Rate for Payer: PHP Commercial |
$167.15
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: PHP Commercial |
$135.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.66
|
| Rate for Payer: Priority Health SBD |
$278.33
|
| Rate for Payer: Priority Health SBD |
$100.67
|
| Rate for Payer: Priority Health SBD |
$123.89
|
|
|
PREDNISONE 20 MG TABLET
|
Facility
|
IP
|
$338.40
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6496
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$213.19 |
| Max. Negotiated Rate |
$304.56 |
| Rate for Payer: Aetna Commercial |
$287.64
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna Commercial |
$978.78
|
| Rate for Payer: Aetna Commercial |
$393.51
|
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: Aetna Commercial |
$17.12
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$300.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$748.48
|
| Rate for Payer: Cash Price |
$370.36
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cash Price |
$921.20
|
| Rate for Payer: Cash Price |
$16.11
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cash Price |
$270.72
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Cofinity Commercial |
$236.88
|
| Rate for Payer: Cofinity Commercial |
$806.05
|
| Rate for Payer: Cofinity Commercial |
$324.06
|
| Rate for Payer: Cofinity Commercial |
$990.29
|
| Rate for Payer: Cofinity Commercial |
$398.14
|
| Rate for Payer: Cofinity Commercial |
$17.32
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Cofinity Commercial |
$14.10
|
| Rate for Payer: Cofinity Commercial |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$291.02
|
| Rate for Payer: Cofinity Commercial |
$317.48
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Healthscope Commercial |
$18.13
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Healthscope Commercial |
$416.66
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Healthscope Commercial |
$1,036.35
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Healthscope Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$287.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$393.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$263.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$978.78
|
| Rate for Payer: PHP Commercial |
$287.64
|
| Rate for Payer: PHP Commercial |
$978.78
|
| Rate for Payer: PHP Commercial |
$17.12
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: PHP Commercial |
$393.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$236.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$806.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$324.06
|
| Rate for Payer: Priority Health SBD |
$12.69
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: Priority Health SBD |
$725.44
|
| Rate for Payer: Priority Health SBD |
$213.19
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: Priority Health SBD |
$1.96
|
| Rate for Payer: Priority Health SBD |
$291.66
|
|
|
PREDNISONE 50 MG TABLET
|
Facility
|
IP
|
$287.85
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.35 |
| Max. Negotiated Rate |
$259.06 |
| Rate for Payer: Aetna Commercial |
$244.67
|
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.66
|
| Rate for Payer: Cash Price |
$230.28
|
| Rate for Payer: Cash Price |
$237.12
|
| Rate for Payer: Cofinity Commercial |
$247.55
|
| Rate for Payer: Cofinity Commercial |
$254.90
|
| Rate for Payer: Cofinity Commercial |
$207.48
|
| Rate for Payer: Cofinity Commercial |
$201.50
|
| Rate for Payer: Healthscope Commercial |
$259.06
|
| Rate for Payer: Healthscope Commercial |
$266.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$244.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$251.94
|
| Rate for Payer: PHP Commercial |
$244.67
|
| Rate for Payer: PHP Commercial |
$251.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health SBD |
$181.35
|
| Rate for Payer: Priority Health SBD |
$186.73
|
|
|
PREDNISONE 5 MG TABLET
|
Facility
|
IP
|
$43.48
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6497
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.39 |
| Max. Negotiated Rate |
$39.13 |
| Rate for Payer: Aetna Commercial |
$36.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.26
|
| Rate for Payer: Cash Price |
$34.78
|
| Rate for Payer: Cofinity Commercial |
$30.44
|
| Rate for Payer: Cofinity Commercial |
$37.39
|
| Rate for Payer: Healthscope Commercial |
$39.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.96
|
| Rate for Payer: PHP Commercial |
$36.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.44
|
| Rate for Payer: Priority Health SBD |
$27.39
|
|
|
PR EDUCATION&TRAINING SELF-MGMT NONPHYS 1 PT
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 98960
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$505.58 |
| Rate for Payer: Aetna Commercial |
$28.53
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$505.58
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.07
|
| Rate for Payer: Priority Health Narrow Network |
$39.07
|
| Rate for Payer: Priority Health SBD |
$39.07
|
|
|
PR EDUCATION&TRAINING SELF-MGMT NONPHYS 2-4 PTS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 98961
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$656.15 |
| Rate for Payer: Aetna Commercial |
$13.91
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$656.15
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.86
|
| Rate for Payer: Priority Health Narrow Network |
$18.86
|
| Rate for Payer: Priority Health SBD |
$18.86
|
|
|
PR EDUCATION&TRAINING SELF-MGMT NONPHYS 5-8 PTS
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 98962
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$888.07 |
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$888.07
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.93
|
| Rate for Payer: Priority Health Narrow Network |
$13.93
|
| Rate for Payer: Priority Health SBD |
$13.93
|
|
|
PR EEG,ALL NIGHT RECORD
|
Professional
|
Both
|
$1,319.00
|
|
|
Service Code
|
HCPCS 95827
|
| Min. Negotiated Rate |
$527.60 |
| Max. Negotiated Rate |
$923.30 |
| Rate for Payer: BCBS Complete |
$527.60
|
| Rate for Payer: Cash Price |
$1,055.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$923.30
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/O VIDEO
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 95721
|
| Min. Negotiated Rate |
$129.93 |
| Max. Negotiated Rate |
$405.73 |
| Rate for Payer: Aetna Commercial |
$226.71
|
| Rate for Payer: BCBS Complete |
$136.43
|
| Rate for Payer: BCBS Trust/PPO |
$405.73
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Mclaren Medicaid |
$129.93
|
| Rate for Payer: Meridian Medicaid |
$136.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$129.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.48
|
| Rate for Payer: Priority Health Narrow Network |
$269.48
|
| Rate for Payer: Priority Health SBD |
$269.48
|
|
|
PR EEG COMPLETE STD PHYS/QHP>36 HR<60 HR W/VEEG
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
HCPCS 95722
|
| Min. Negotiated Rate |
$157.62 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$276.49
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS Trust/PPO |
$240.38
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Cash Price |
$408.00
|
| Rate for Payer: Mclaren Medicaid |
$157.62
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$328.33
|
| Rate for Payer: Priority Health Narrow Network |
$328.33
|
| Rate for Payer: Priority Health SBD |
$328.33
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/O VIDEO
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS 95723
|
| Min. Negotiated Rate |
$157.62 |
| Max. Negotiated Rate |
$364.70 |
| Rate for Payer: Aetna Commercial |
$280.96
|
| Rate for Payer: BCBS Complete |
$165.50
|
| Rate for Payer: BCBS Trust/PPO |
$282.64
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Cash Price |
$416.80
|
| Rate for Payer: Mclaren Medicaid |
$157.62
|
| Rate for Payer: Meridian Medicaid |
$165.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$157.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$364.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.67
|
| Rate for Payer: Priority Health Narrow Network |
$329.67
|
| Rate for Payer: Priority Health SBD |
$329.67
|
|
|
PR EEG COMPLETE STD PHYS/QHP>60 HR<84 HR W/VEEG
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
HCPCS 95724
|
| Min. Negotiated Rate |
$198.30 |
| Max. Negotiated Rate |
$455.70 |
| Rate for Payer: Aetna Commercial |
$352.81
|
| Rate for Payer: BCBS Complete |
$208.22
|
| Rate for Payer: BCBS Trust/PPO |
$438.49
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Mclaren Medicaid |
$198.30
|
| Rate for Payer: Meridian Medicaid |
$208.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$198.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$415.91
|
| Rate for Payer: Priority Health Narrow Network |
$415.91
|
| Rate for Payer: Priority Health SBD |
$415.91
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/O VID
|
Professional
|
Both
|
$595.00
|
|
|
Service Code
|
HCPCS 95725
|
| Min. Negotiated Rate |
$181.90 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$320.41
|
| Rate for Payer: BCBS Complete |
$191.00
|
| Rate for Payer: BCBS Trust/PPO |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Mclaren Medicaid |
$181.90
|
| Rate for Payer: Meridian Medicaid |
$191.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$181.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$376.38
|
| Rate for Payer: Priority Health Narrow Network |
$376.38
|
| Rate for Payer: Priority Health SBD |
$376.38
|
|
|
PR EEG COMPLETE STD PHYS/QHP>84 HR W/VEEG
|
Professional
|
Both
|
$823.00
|
|
|
Service Code
|
HCPCS 95726
|
| Min. Negotiated Rate |
$254.11 |
| Max. Negotiated Rate |
$576.10 |
| Rate for Payer: Aetna Commercial |
$446.61
|
| Rate for Payer: BCBS Complete |
$266.82
|
| Rate for Payer: BCBS Trust/PPO |
$530.41
|
| Rate for Payer: Cash Price |
$658.40
|
| Rate for Payer: Cash Price |
$658.40
|
| Rate for Payer: Mclaren Medicaid |
$254.11
|
| Rate for Payer: Meridian Medicaid |
$266.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$254.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$528.19
|
| Rate for Payer: Priority Health Narrow Network |
$528.19
|
| Rate for Payer: Priority Health SBD |
$528.19
|
|
|
PR EEG EXTENDED MONITORING 61-119 MINUTES
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 95813
|
| Min. Negotiated Rate |
$112.29 |
| Max. Negotiated Rate |
$692.07 |
| Rate for Payer: Aetna Commercial |
$449.62
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS Trust/PPO |
$692.07
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.29
|
| Rate for Payer: Priority Health Narrow Network |
$112.29
|
| Rate for Payer: Priority Health SBD |
$575.80
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, ATTENDED BY TECH/NURSE
|
Professional
|
Both
|
$2,832.00
|
|
|
Service Code
|
HCPCS 95956
|
| Min. Negotiated Rate |
$1,132.80 |
| Max. Negotiated Rate |
$1,982.40 |
| Rate for Payer: BCBS Complete |
$1,132.80
|
| Rate for Payer: Cash Price |
$2,265.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,982.40
|
|
|
PR EEG MONITORING/COMPUTER, EA 24 HOURS, UNATTENDED
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
HCPCS 95953
|
| Min. Negotiated Rate |
$292.80 |
| Max. Negotiated Rate |
$512.40 |
| Rate for Payer: BCBS Complete |
$292.80
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.40
|
|
|
PR EEG MONITORING/VIDEORECORD
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
HCPCS 95951
|
| Min. Negotiated Rate |
$610.00 |
| Max. Negotiated Rate |
$1,067.50 |
| Rate for Payer: BCBS Complete |
$610.00
|
| Rate for Payer: BCBS Complete |
$1,216.40
|
| Rate for Payer: Cash Price |
$1,220.00
|
| Rate for Payer: Cash Price |
$2,432.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,067.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,128.70
|
|
