|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$581.87
|
| Rate for Payer: Aetna Medicare |
$451.60
|
| Rate for Payer: BCBS Complete |
$303.71
|
| Rate for Payer: BCBS MAPPO |
$434.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$649.94
|
| Rate for Payer: BCN Medicare Advantage |
$434.23
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cofinity Commercial |
$625.29
|
| Rate for Payer: Cofinity Commercial |
$581.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.23
|
| Rate for Payer: Mclaren Medicaid |
$289.25
|
| Rate for Payer: Meridian Medicaid |
$303.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$455.94
|
| Rate for Payer: PACE SWMI |
$434.23
|
| Rate for Payer: PHP Medicare Advantage |
$434.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$703.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$679.16
|
| Rate for Payer: Priority Health Medicare |
$434.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$679.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.23
|
| Rate for Payer: UHC Medicare Advantage |
$447.26
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$1,469.20 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.20
|
| Rate for Payer: BCN Commercial |
$21.88
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.97
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$4,626.85 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,626.85
|
| Rate for Payer: BCN Commercial |
$21.88
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.97
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0009
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$1,331.32 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,331.32
|
| Rate for Payer: BCN Commercial |
$21.88
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.97
|
|
|
PR ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP
|
Professional
|
Both
|
$83.04
|
|
|
Service Code
|
HCPCS 96380
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$58.13 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: BCBS Complete |
$33.22
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
|
|
PR ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX
|
Professional
|
Both
|
$83.04
|
|
|
Service Code
|
HCPCS 96381
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$58.13 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: BCBS Complete |
$33.22
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
|
|
PR ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR
|
Professional
|
Both
|
$4,350.00
|
|
|
Service Code
|
HCPCS 60545
|
| Min. Negotiated Rate |
$341.28 |
| Max. Negotiated Rate |
$3,045.00 |
| Rate for Payer: Aetna Commercial |
$1,658.04
|
| Rate for Payer: Aetna Medicare |
$1,286.83
|
| Rate for Payer: BCBS Complete |
$838.91
|
| Rate for Payer: BCBS MAPPO |
$1,237.34
|
| Rate for Payer: BCBS Trust/PPO |
$341.28
|
| Rate for Payer: BCN Commercial |
$1,817.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,237.34
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,658.04
|
| Rate for Payer: Cofinity Commercial |
$1,781.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,237.34
|
| Rate for Payer: Mclaren Medicaid |
$798.96
|
| Rate for Payer: Meridian Medicaid |
$838.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,299.21
|
| Rate for Payer: PACE SWMI |
$1,237.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,237.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$798.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,045.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,759.61
|
| Rate for Payer: Priority Health Medicare |
$1,237.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,759.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,237.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,237.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,274.46
|
|
|
PR ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX
|
Professional
|
Both
|
$3,303.00
|
|
|
Service Code
|
HCPCS 60540
|
| Min. Negotiated Rate |
$432.15 |
| Max. Negotiated Rate |
$2,312.10 |
| Rate for Payer: Aetna Commercial |
$1,427.65
|
| Rate for Payer: Aetna Medicare |
$1,108.03
|
| Rate for Payer: BCBS Complete |
$723.95
|
| Rate for Payer: BCBS MAPPO |
$1,065.41
|
| Rate for Payer: BCBS Trust/PPO |
$432.15
|
| Rate for Payer: BCN Commercial |
$1,567.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,065.41
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cofinity Commercial |
$1,534.19
|
| Rate for Payer: Cofinity Commercial |
$1,427.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,065.41
|
| Rate for Payer: Mclaren Medicaid |
$689.48
|
| Rate for Payer: Meridian Medicaid |
$723.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,118.68
|
| Rate for Payer: PACE SWMI |
$1,065.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,065.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,312.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,517.36
|
| Rate for Payer: Priority Health Medicare |
$1,065.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,517.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,065.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,065.41
|
| Rate for Payer: UHC Medicare Advantage |
$1,097.37
|
|
|
PR ADRENALIN EPINEPHRINE INJECT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J0171
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$0.98
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.14
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$1.06
|
| Rate for Payer: Cofinity Commercial |
$0.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.75
|
|
|
PR ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 99498
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$533.05 |
| Rate for Payer: Aetna Commercial |
$72.67
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$533.05
|
| Rate for Payer: BCN Commercial |
$75.95
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.17
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$569.51 |
| Rate for Payer: Aetna Commercial |
$99.07
|
| Rate for Payer: Aetna Medicare |
$76.89
|
| Rate for Payer: BCBS Complete |
$50.10
|
| Rate for Payer: BCBS MAPPO |
$73.93
|
| Rate for Payer: BCBS Trust/PPO |
$569.51
|
| Rate for Payer: BCN Commercial |
$87.77
|
| Rate for Payer: BCN Medicare Advantage |
$73.93
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$99.07
|
| Rate for Payer: Cofinity Commercial |
$106.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.93
|
| Rate for Payer: Mclaren Medicaid |
$47.71
|
| Rate for Payer: Meridian Medicaid |
$50.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.63
|
| Rate for Payer: PACE SWMI |
$73.93
|
| Rate for Payer: PHP Medicare Advantage |
$73.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.42
|
| Rate for Payer: Priority Health Medicare |
$73.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.93
|
| Rate for Payer: UHC Medicare Advantage |
$76.15
|
|
|
PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 92651
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$3,831.23 |
| Rate for Payer: Aetna Commercial |
$109.00
|
| Rate for Payer: Aetna Medicare |
$84.59
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$81.34
|
| Rate for Payer: BCBS Trust/PPO |
$3,831.23
|
| Rate for Payer: BCN Commercial |
$123.64
|
| Rate for Payer: BCN Medicare Advantage |
$81.34
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$109.00
|
| Rate for Payer: Cofinity Commercial |
$117.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.41
|
| Rate for Payer: PACE SWMI |
$81.34
|
| Rate for Payer: PHP Medicare Advantage |
$81.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.63
|
| Rate for Payer: Priority Health Medicare |
$81.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.34
|
| Rate for Payer: UHC Medicare Advantage |
$83.78
|
|
|
PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 92653
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$1,917.20 |
| Rate for Payer: Aetna Commercial |
$108.94
|
| Rate for Payer: Aetna Medicare |
$84.55
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS MAPPO |
$81.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,917.20
|
| Rate for Payer: BCN Commercial |
$123.15
|
| Rate for Payer: BCN Medicare Advantage |
$81.30
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$117.07
|
| Rate for Payer: Cofinity Commercial |
$108.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.36
|
| Rate for Payer: PACE SWMI |
$81.30
|
| Rate for Payer: PHP Medicare Advantage |
$81.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.19
|
| Rate for Payer: Priority Health Medicare |
$81.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.30
|
| Rate for Payer: UHC Medicare Advantage |
$83.74
|
|
|
PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 92650
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$1,517.28 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.28
|
| Rate for Payer: BCN Commercial |
$40.56
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.28
|
|
|
PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 92652
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$4,564.51 |
| Rate for Payer: Aetna Commercial |
$146.49
|
| Rate for Payer: Aetna Medicare |
$113.69
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS MAPPO |
$109.32
|
| Rate for Payer: BCBS Trust/PPO |
$4,564.51
|
| Rate for Payer: BCN Commercial |
$165.18
|
| Rate for Payer: BCN Medicare Advantage |
$109.32
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$157.42
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$114.79
|
| Rate for Payer: PACE SWMI |
$109.32
|
| Rate for Payer: PHP Medicare Advantage |
$109.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.81
|
| Rate for Payer: Priority Health Medicare |
$109.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.32
|
| Rate for Payer: UHC Medicare Advantage |
$112.60
|
|
|
PR AFO ANKLE GAUNTLET PRE OTS
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS L1902
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$70.88 |
| Rate for Payer: Aetna Commercial |
$44.96
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: BCN Commercial |
$70.88
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
|
|
PR AFO MULTILIG ANK SUP PRE OTS
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS L1906
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$106.78 |
| Rate for Payer: Aetna Commercial |
$67.73
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: BCN Commercial |
$106.78
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
|
|
PR AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE
|
Professional
|
Both
|
$178.26
|
|
|
Service Code
|
HCPCS 90694
|
| Min. Negotiated Rate |
$71.30 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna Commercial |
$96.05
|
| Rate for Payer: Aetna Medicare |
$74.55
|
| Rate for Payer: BCBS Complete |
$71.30
|
| Rate for Payer: BCBS MAPPO |
$71.68
|
| Rate for Payer: BCBS Trust/PPO |
$77.36
|
| Rate for Payer: BCN Commercial |
$71.68
|
| Rate for Payer: BCN Medicare Advantage |
$71.68
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cash Price |
$142.61
|
| Rate for Payer: Cofinity Commercial |
$96.05
|
| Rate for Payer: Cofinity Commercial |
$103.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.27
|
| Rate for Payer: PACE SWMI |
$71.68
|
| Rate for Payer: PHP Medicare Advantage |
$71.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.78
|
| Rate for Payer: Priority Health Medicare |
$71.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.68
|
| Rate for Payer: UHC Medicare Advantage |
$73.83
|
|
|
PR AK SLEEVE SUSP NEOPRENE/EQUA
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS L5695
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$171.39 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCN Commercial |
$171.39
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
|
|
PR ALBUTEROL IPRATROP NON-COMP
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7620
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna Commercial |
$0.18
|
| Rate for Payer: Aetna Medicare |
$0.14
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.02
|
| Rate for Payer: BCN Medicare Advantage |
$0.13
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.14
|
| Rate for Payer: PACE SWMI |
$0.13
|
| Rate for Payer: PHP Medicare Advantage |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health Medicare |
$0.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.13
|
| Rate for Payer: UHC Medicare Advantage |
$0.13
|
|
|
PR ALBUTEROL NON-COMP CON
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7611
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna Commercial |
$0.18
|
| Rate for Payer: Aetna Medicare |
$0.14
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.13
|
| Rate for Payer: BCN Commercial |
$0.06
|
| Rate for Payer: BCN Medicare Advantage |
$0.13
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.19
|
| Rate for Payer: Cofinity Commercial |
$0.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.14
|
| Rate for Payer: PACE SWMI |
$0.13
|
| Rate for Payer: PHP Medicare Advantage |
$0.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health Medicare |
$0.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.13
|
| Rate for Payer: UHC Medicare Advantage |
$0.14
|
|
|
PR ALBUTEROL NON-COMP UNIT
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J7613
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna Commercial |
$0.04
|
| Rate for Payer: Aetna Medicare |
$0.03
|
| Rate for Payer: BCBS Complete |
$0.80
|
| Rate for Payer: BCBS MAPPO |
$0.03
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.03
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Cofinity Commercial |
$0.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.03
|
| Rate for Payer: PACE SWMI |
$0.03
|
| Rate for Payer: PHP Medicare Advantage |
$0.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.40
|
| Rate for Payer: Priority Health Medicare |
$0.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.03
|
| Rate for Payer: UHC Medicare Advantage |
$0.03
|
|
|
PR ALCOHOL AND/OR DRUG SERVICES
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS H0015
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$169.40 |
| Rate for Payer: Aetna Commercial |
$134.33
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 99408
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$1,099.92 |
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: BCBS Complete |
$21.02
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.92
|
| Rate for Payer: BCN Commercial |
$50.33
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Mclaren Medicaid |
$20.02
|
| Rate for Payer: Meridian Medicaid |
$21.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.26
|
|
|
PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 99409
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$1,109.43 |
| Rate for Payer: Aetna Commercial |
$67.61
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,109.43
|
| Rate for Payer: BCN Commercial |
$96.27
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Mclaren Medicaid |
$40.04
|
| Rate for Payer: Meridian Medicaid |
$42.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.53
|
|
