|
PR BREATHING RESPONSE TO HYPOXIA
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
HCPCS 94450
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$1,113.66 |
| Rate for Payer: Aetna Commercial |
$103.26
|
| Rate for Payer: Aetna Medicare |
$80.14
|
| Rate for Payer: BCBS Complete |
$70.40
|
| Rate for Payer: BCBS MAPPO |
$77.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.66
|
| Rate for Payer: BCN Commercial |
$119.72
|
| Rate for Payer: BCN Medicare Advantage |
$77.06
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$110.97
|
| Rate for Payer: Cofinity Commercial |
$103.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80.91
|
| Rate for Payer: PACE SWMI |
$77.06
|
| Rate for Payer: PHP Medicare Advantage |
$77.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.04
|
| Rate for Payer: Priority Health Medicare |
$77.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.06
|
| Rate for Payer: UHC Medicare Advantage |
$79.37
|
|
|
PR BRIEF CHECK IN BY MD/QHP
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS G2012
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$403.09 |
| Rate for Payer: Aetna Commercial |
$16.47
|
| Rate for Payer: Aetna Medicare |
$12.78
|
| Rate for Payer: BCBS Complete |
$8.49
|
| Rate for Payer: BCBS MAPPO |
$12.29
|
| Rate for Payer: BCBS Trust/PPO |
$403.09
|
| Rate for Payer: BCN Commercial |
$20.53
|
| Rate for Payer: BCN Medicare Advantage |
$12.29
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$17.70
|
| Rate for Payer: Cofinity Commercial |
$16.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.29
|
| Rate for Payer: Mclaren Medicaid |
$8.09
|
| Rate for Payer: Meridian Medicaid |
$8.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.90
|
| Rate for Payer: PACE SWMI |
$12.29
|
| Rate for Payer: PHP Medicare Advantage |
$12.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.85
|
| Rate for Payer: Priority Health Medicare |
$12.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.29
|
| Rate for Payer: UHC Medicare Advantage |
$12.66
|
|
|
PR BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 94060
|
| Min. Negotiated Rate |
$36.28 |
| Max. Negotiated Rate |
$1,399.47 |
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Aetna Commercial |
$48.62
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: Aetna Medicare |
$37.73
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$36.28
|
| Rate for Payer: BCBS MAPPO |
$36.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,399.47
|
| Rate for Payer: BCN Commercial |
$56.19
|
| Rate for Payer: BCN Commercial |
$56.19
|
| Rate for Payer: BCN Medicare Advantage |
$36.28
|
| Rate for Payer: BCN Medicare Advantage |
$36.28
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$48.62
|
| Rate for Payer: Cofinity Commercial |
$52.24
|
| Rate for Payer: Cofinity Commercial |
$48.62
|
| Rate for Payer: Cofinity Commercial |
$52.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.09
|
| Rate for Payer: PACE SWMI |
$36.28
|
| Rate for Payer: PACE SWMI |
$36.28
|
| Rate for Payer: PHP Medicare Advantage |
$36.28
|
| Rate for Payer: PHP Medicare Advantage |
$36.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.70
|
| Rate for Payer: Priority Health Medicare |
$36.28
|
| Rate for Payer: Priority Health Medicare |
$36.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.28
|
| Rate for Payer: UHC Medicare Advantage |
$37.37
|
| Rate for Payer: UHC Medicare Advantage |
$37.37
|
|
|
PR BRNCHSC BRUSHING/PROTECTED BRUSHINGS
|
Professional
|
Both
|
$636.00
|
|
|
Service Code
|
HCPCS 31623
|
| Min. Negotiated Rate |
$82.43 |
| Max. Negotiated Rate |
$720.60 |
| Rate for Payer: Aetna Commercial |
$171.13
|
| Rate for Payer: Aetna Medicare |
$132.82
|
| Rate for Payer: BCBS Complete |
$86.55
|
| Rate for Payer: BCBS MAPPO |
$127.71
|
| Rate for Payer: BCBS Trust/PPO |
$720.60
|
| Rate for Payer: BCN Commercial |
$399.74
|
| Rate for Payer: BCN Medicare Advantage |
$127.71
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cofinity Commercial |
$183.90
|
| Rate for Payer: Cofinity Commercial |
$171.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.71
|
| Rate for Payer: Mclaren Medicaid |
$82.43
|
| Rate for Payer: Meridian Medicaid |
$86.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.10
|
| Rate for Payer: PACE SWMI |
$127.71
|
| Rate for Payer: PHP Medicare Advantage |
$127.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.81
|
| Rate for Payer: Priority Health Medicare |
$127.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$177.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.71
|
| Rate for Payer: UHC Medicare Advantage |
$131.54
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 1/2 NODE STATION/STRUX
|
Professional
|
Both
|
$473.00
|
|
|
Service Code
|
HCPCS 31652
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$1,843.29 |
| Rate for Payer: Aetna Commercial |
$287.16
|
| Rate for Payer: Aetna Medicare |
$222.87
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$214.30
|
| Rate for Payer: BCBS Trust/PPO |
$853.73
|
| Rate for Payer: BCN Commercial |
$1,843.29
|
| Rate for Payer: BCN Medicare Advantage |
$214.30
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cash Price |
$378.40
|
| Rate for Payer: Cofinity Commercial |
$287.16
|
| Rate for Payer: Cofinity Commercial |
$308.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$214.30
|
| Rate for Payer: Mclaren Medicaid |
$137.39
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$225.02
|
| Rate for Payer: PACE SWMI |
$214.30
|
| Rate for Payer: PHP Medicare Advantage |
$214.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.73
|
| Rate for Payer: Priority Health Medicare |
$214.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$297.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$214.30
|
| Rate for Payer: UHC Medicare Advantage |
$220.73
|
|
|
PR BRNCHSC EBUS GUIDED SAMPL 3/> NODE STATION/STRUX
|
Professional
|
Both
|
$522.00
|
|
|
Service Code
|
HCPCS 31653
|
| Min. Negotiated Rate |
$152.30 |
| Max. Negotiated Rate |
$1,916.10 |
| Rate for Payer: Aetna Commercial |
$318.52
|
| Rate for Payer: Aetna Medicare |
$247.21
|
| Rate for Payer: BCBS Complete |
$159.92
|
| Rate for Payer: BCBS MAPPO |
$237.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,172.30
|
| Rate for Payer: BCN Commercial |
$1,916.10
|
| Rate for Payer: BCN Medicare Advantage |
$237.70
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cofinity Commercial |
$318.52
|
| Rate for Payer: Cofinity Commercial |
$342.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.70
|
| Rate for Payer: Mclaren Medicaid |
$152.30
|
| Rate for Payer: Meridian Medicaid |
$159.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$249.58
|
| Rate for Payer: PACE SWMI |
$237.70
|
| Rate for Payer: PHP Medicare Advantage |
$237.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$152.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$330.16
|
| Rate for Payer: Priority Health Medicare |
$237.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.70
|
| Rate for Payer: UHC Medicare Advantage |
$244.83
|
|
|
PR BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX
|
Professional
|
Both
|
$584.00
|
|
|
Service Code
|
HCPCS 31622
|
| Min. Negotiated Rate |
$83.07 |
| Max. Negotiated Rate |
$408.80 |
| Rate for Payer: Aetna Commercial |
$171.67
|
| Rate for Payer: Aetna Medicare |
$133.23
|
| Rate for Payer: BCBS Complete |
$87.22
|
| Rate for Payer: BCBS MAPPO |
$128.11
|
| Rate for Payer: BCBS Trust/PPO |
$372.29
|
| Rate for Payer: BCN Commercial |
$397.64
|
| Rate for Payer: BCN Medicare Advantage |
$128.11
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cofinity Commercial |
$171.67
|
| Rate for Payer: Cofinity Commercial |
$184.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.11
|
| Rate for Payer: Mclaren Medicaid |
$83.07
|
| Rate for Payer: Meridian Medicaid |
$87.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.52
|
| Rate for Payer: PACE SWMI |
$128.11
|
| Rate for Payer: PHP Medicare Advantage |
$128.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$408.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.28
|
| Rate for Payer: Priority Health Medicare |
$128.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$128.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$128.11
|
| Rate for Payer: UHC Medicare Advantage |
$131.95
|
|
|
PR BRNCHSC W/BRNCL ALVEOLAR LAVAGE
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 31624
|
| Min. Negotiated Rate |
$83.50 |
| Max. Negotiated Rate |
$1,147.47 |
| Rate for Payer: Aetna Commercial |
$174.25
|
| Rate for Payer: Aetna Medicare |
$135.24
|
| Rate for Payer: BCBS Complete |
$87.68
|
| Rate for Payer: BCBS MAPPO |
$130.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,147.47
|
| Rate for Payer: BCN Commercial |
$371.40
|
| Rate for Payer: BCN Medicare Advantage |
$130.04
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Cofinity Commercial |
$187.26
|
| Rate for Payer: Cofinity Commercial |
$174.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.04
|
| Rate for Payer: Mclaren Medicaid |
$83.50
|
| Rate for Payer: Meridian Medicaid |
$87.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$136.54
|
| Rate for Payer: PACE SWMI |
$130.04
|
| Rate for Payer: PHP Medicare Advantage |
$130.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.05
|
| Rate for Payer: Priority Health Medicare |
$130.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$130.04
|
| Rate for Payer: UHC Medicare Advantage |
$133.94
|
|
|
PR BRNCHSC W/TRACHEAL/BRONCHIAL DILAT/CLSD RDCTJ FX
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 31630
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$786.64 |
| Rate for Payer: Aetna Commercial |
$258.78
|
| Rate for Payer: Aetna Medicare |
$200.84
|
| Rate for Payer: BCBS Complete |
$130.17
|
| Rate for Payer: BCBS MAPPO |
$193.12
|
| Rate for Payer: BCBS Trust/PPO |
$786.64
|
| Rate for Payer: BCN Commercial |
$283.43
|
| Rate for Payer: BCN Medicare Advantage |
$193.12
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$278.09
|
| Rate for Payer: Cofinity Commercial |
$258.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.12
|
| Rate for Payer: Mclaren Medicaid |
$123.97
|
| Rate for Payer: Meridian Medicaid |
$130.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$202.78
|
| Rate for Payer: PACE SWMI |
$193.12
|
| Rate for Payer: PHP Medicare Advantage |
$193.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$123.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.57
|
| Rate for Payer: Priority Health Medicare |
$193.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.12
|
| Rate for Payer: UHC Medicare Advantage |
$198.91
|
|
|
PR BRNCSPSM PROVOCATION EVAL MLT SPMTRY W/ADMN AGT
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 94070
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$1,284.30 |
| Rate for Payer: Aetna Commercial |
$77.93
|
| Rate for Payer: Aetna Commercial |
$77.93
|
| Rate for Payer: Aetna Medicare |
$60.49
|
| Rate for Payer: Aetna Medicare |
$60.49
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS MAPPO |
$58.16
|
| Rate for Payer: BCBS MAPPO |
$58.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,284.30
|
| Rate for Payer: BCN Commercial |
$88.94
|
| Rate for Payer: BCN Commercial |
$88.94
|
| Rate for Payer: BCN Medicare Advantage |
$58.16
|
| Rate for Payer: BCN Medicare Advantage |
$58.16
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$77.93
|
| Rate for Payer: Cofinity Commercial |
$83.75
|
| Rate for Payer: Cofinity Commercial |
$77.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.07
|
| Rate for Payer: PACE SWMI |
$58.16
|
| Rate for Payer: PACE SWMI |
$58.16
|
| Rate for Payer: PHP Medicare Advantage |
$58.16
|
| Rate for Payer: PHP Medicare Advantage |
$58.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.74
|
| Rate for Payer: Priority Health Medicare |
$58.16
|
| Rate for Payer: Priority Health Medicare |
$58.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.16
|
| Rate for Payer: UHC Medicare Advantage |
$59.90
|
| Rate for Payer: UHC Medicare Advantage |
$59.90
|
|
|
PR BRNSCHSC TNDSC EBUS DX/TX INTERVENTION PERPH LES
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 31654
|
| Min. Negotiated Rate |
$41.75 |
| Max. Negotiated Rate |
$791.92 |
| Rate for Payer: Aetna Commercial |
$86.81
|
| Rate for Payer: Aetna Medicare |
$67.37
|
| Rate for Payer: BCBS Complete |
$43.84
|
| Rate for Payer: BCBS MAPPO |
$64.78
|
| Rate for Payer: BCBS Trust/PPO |
$791.92
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: BCN Medicare Advantage |
$64.78
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$86.81
|
| Rate for Payer: Cofinity Commercial |
$93.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.78
|
| Rate for Payer: Mclaren Medicaid |
$41.75
|
| Rate for Payer: Meridian Medicaid |
$43.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$68.02
|
| Rate for Payer: PACE SWMI |
$64.78
|
| Rate for Payer: PHP Medicare Advantage |
$64.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.83
|
| Rate for Payer: Priority Health Medicare |
$64.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.78
|
| Rate for Payer: UHC Medicare Advantage |
$66.72
|
|
|
PR BRONCHOPLASTY GRAFT REPAIR
|
Professional
|
Both
|
$2,895.00
|
|
|
Service Code
|
HCPCS 31770
|
| Min. Negotiated Rate |
$835.81 |
| Max. Negotiated Rate |
$2,026.50 |
| Rate for Payer: Aetna Commercial |
$1,754.26
|
| Rate for Payer: Aetna Medicare |
$1,361.52
|
| Rate for Payer: BCBS Complete |
$877.60
|
| Rate for Payer: BCBS MAPPO |
$1,309.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,379.92
|
| Rate for Payer: BCN Commercial |
$1,909.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,309.15
|
| Rate for Payer: Cash Price |
$2,316.00
|
| Rate for Payer: Cash Price |
$2,316.00
|
| Rate for Payer: Cofinity Commercial |
$1,754.26
|
| Rate for Payer: Cofinity Commercial |
$1,885.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,309.15
|
| Rate for Payer: Mclaren Medicaid |
$835.81
|
| Rate for Payer: Meridian Medicaid |
$877.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,374.61
|
| Rate for Payer: PACE SWMI |
$1,309.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,309.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$835.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,026.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,809.58
|
| Rate for Payer: Priority Health Medicare |
$1,309.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,809.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,309.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,309.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,348.42
|
|
|
PR BRONCHOSCOPY BRONCHIAL/ENDOBRNCL BX 1+ SITES
|
Professional
|
Both
|
$635.00
|
|
|
Service Code
|
HCPCS 31625
|
| Min. Negotiated Rate |
$97.55 |
| Max. Negotiated Rate |
$508.71 |
| Rate for Payer: Aetna Commercial |
$202.55
|
| Rate for Payer: Aetna Medicare |
$157.21
|
| Rate for Payer: BCBS Complete |
$102.43
|
| Rate for Payer: BCBS MAPPO |
$151.16
|
| Rate for Payer: BCBS Trust/PPO |
$463.32
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: BCN Medicare Advantage |
$151.16
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cash Price |
$508.00
|
| Rate for Payer: Cofinity Commercial |
$217.67
|
| Rate for Payer: Cofinity Commercial |
$202.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.16
|
| Rate for Payer: Mclaren Medicaid |
$97.55
|
| Rate for Payer: Meridian Medicaid |
$102.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$158.72
|
| Rate for Payer: PACE SWMI |
$151.16
|
| Rate for Payer: PHP Medicare Advantage |
$151.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$444.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.23
|
| Rate for Payer: Priority Health Medicare |
$151.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.16
|
| Rate for Payer: UHC Medicare Advantage |
$155.69
|
|
|
PR BRONCHOSCOPY NEEDLE BX TRACHEA MAIN STEM&/BRON
|
Professional
|
Both
|
$1,234.00
|
|
|
Service Code
|
HCPCS 31629
|
| Min. Negotiated Rate |
$116.51 |
| Max. Negotiated Rate |
$863.80 |
| Rate for Payer: Aetna Commercial |
$242.41
|
| Rate for Payer: Aetna Medicare |
$188.14
|
| Rate for Payer: BCBS Complete |
$122.34
|
| Rate for Payer: BCBS MAPPO |
$180.90
|
| Rate for Payer: BCBS Trust/PPO |
$499.77
|
| Rate for Payer: BCN Commercial |
$661.18
|
| Rate for Payer: BCN Medicare Advantage |
$180.90
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cash Price |
$987.20
|
| Rate for Payer: Cofinity Commercial |
$260.50
|
| Rate for Payer: Cofinity Commercial |
$242.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.90
|
| Rate for Payer: Mclaren Medicaid |
$116.51
|
| Rate for Payer: Meridian Medicaid |
$122.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$189.94
|
| Rate for Payer: PACE SWMI |
$180.90
|
| Rate for Payer: PHP Medicare Advantage |
$180.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$116.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$863.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$251.44
|
| Rate for Payer: Priority Health Medicare |
$180.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.90
|
| Rate for Payer: UHC Medicare Advantage |
$186.33
|
|
|
PR BRONCHOSCOPY W/CPTR-ASST IMAGE-GUIDED NAVIGATION
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
HCPCS 31627
|
| Min. Negotiated Rate |
$60.07 |
| Max. Negotiated Rate |
$1,591.62 |
| Rate for Payer: Aetna Commercial |
$125.41
|
| Rate for Payer: Aetna Medicare |
$97.33
|
| Rate for Payer: BCBS Complete |
$63.07
|
| Rate for Payer: BCBS MAPPO |
$93.59
|
| Rate for Payer: BCBS Trust/PPO |
$684.15
|
| Rate for Payer: BCN Commercial |
$1,591.62
|
| Rate for Payer: BCN Medicare Advantage |
$93.59
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cofinity Commercial |
$134.77
|
| Rate for Payer: Cofinity Commercial |
$125.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.59
|
| Rate for Payer: Mclaren Medicaid |
$60.07
|
| Rate for Payer: Meridian Medicaid |
$63.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.27
|
| Rate for Payer: PACE SWMI |
$93.59
|
| Rate for Payer: PHP Medicare Advantage |
$93.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.65
|
| Rate for Payer: Priority Health Medicare |
$93.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.59
|
| Rate for Payer: UHC Medicare Advantage |
$96.40
|
|
|
PR BRONCHOSCOPY W/EXCISION TUMOR
|
Professional
|
Both
|
$511.00
|
|
|
Service Code
|
HCPCS 31640
|
| Min. Negotiated Rate |
$154.21 |
| Max. Negotiated Rate |
$852.15 |
| Rate for Payer: Aetna Commercial |
$323.66
|
| Rate for Payer: Aetna Medicare |
$251.20
|
| Rate for Payer: BCBS Complete |
$161.92
|
| Rate for Payer: BCBS MAPPO |
$241.54
|
| Rate for Payer: BCBS Trust/PPO |
$852.15
|
| Rate for Payer: BCN Commercial |
$354.29
|
| Rate for Payer: BCN Medicare Advantage |
$241.54
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cash Price |
$408.80
|
| Rate for Payer: Cofinity Commercial |
$347.82
|
| Rate for Payer: Cofinity Commercial |
$323.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.54
|
| Rate for Payer: Mclaren Medicaid |
$154.21
|
| Rate for Payer: Meridian Medicaid |
$161.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$253.62
|
| Rate for Payer: PACE SWMI |
$241.54
|
| Rate for Payer: PHP Medicare Advantage |
$241.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$335.70
|
| Rate for Payer: Priority Health Medicare |
$241.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$335.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.54
|
| Rate for Payer: UHC Medicare Advantage |
$248.79
|
|
|
PR BRONCHOSCOPY W/REMOVAL FOREIGN BODY
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
HCPCS 31635
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$972.60 |
| Rate for Payer: Aetna Commercial |
$227.49
|
| Rate for Payer: Aetna Medicare |
$176.56
|
| Rate for Payer: BCBS Complete |
$115.18
|
| Rate for Payer: BCBS MAPPO |
$169.77
|
| Rate for Payer: BCBS Trust/PPO |
$972.60
|
| Rate for Payer: BCN Commercial |
$425.15
|
| Rate for Payer: BCN Medicare Advantage |
$169.77
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cofinity Commercial |
$244.47
|
| Rate for Payer: Cofinity Commercial |
$227.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.77
|
| Rate for Payer: Mclaren Medicaid |
$109.70
|
| Rate for Payer: Meridian Medicaid |
$115.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$178.26
|
| Rate for Payer: PACE SWMI |
$169.77
|
| Rate for Payer: PHP Medicare Advantage |
$169.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$780.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.15
|
| Rate for Payer: Priority Health Medicare |
$169.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.77
|
| Rate for Payer: UHC Medicare Advantage |
$174.86
|
|
|
PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE 1ST
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 31645
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$667.24 |
| Rate for Payer: Aetna Commercial |
$190.71
|
| Rate for Payer: Aetna Medicare |
$148.01
|
| Rate for Payer: BCBS Complete |
$96.62
|
| Rate for Payer: BCBS MAPPO |
$142.32
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$397.30
|
| Rate for Payer: BCN Medicare Advantage |
$142.32
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$190.71
|
| Rate for Payer: Cofinity Commercial |
$204.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.32
|
| Rate for Payer: Mclaren Medicaid |
$92.02
|
| Rate for Payer: Meridian Medicaid |
$96.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$149.44
|
| Rate for Payer: PACE SWMI |
$142.32
|
| Rate for Payer: PHP Medicare Advantage |
$142.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.19
|
| Rate for Payer: Priority Health Medicare |
$142.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.32
|
| Rate for Payer: UHC Medicare Advantage |
$146.59
|
|
|
PR BRONCHOSCOPY W/THER ASPIR TRACHBRNCL TREE SBSQ
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 31646
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$184.04
|
| Rate for Payer: Aetna Medicare |
$142.83
|
| Rate for Payer: BCBS Complete |
$93.26
|
| Rate for Payer: BCBS MAPPO |
$137.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,008.00
|
| Rate for Payer: BCN Commercial |
$201.83
|
| Rate for Payer: BCN Medicare Advantage |
$137.34
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cofinity Commercial |
$197.77
|
| Rate for Payer: Cofinity Commercial |
$184.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.34
|
| Rate for Payer: Mclaren Medicaid |
$88.82
|
| Rate for Payer: Meridian Medicaid |
$93.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.21
|
| Rate for Payer: PACE SWMI |
$137.34
|
| Rate for Payer: PHP Medicare Advantage |
$137.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$421.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.23
|
| Rate for Payer: Priority Health Medicare |
$137.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$191.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.34
|
| Rate for Payer: UHC Medicare Advantage |
$141.46
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX 1 LOBE
|
Professional
|
Both
|
$745.00
|
|
|
Service Code
|
HCPCS 31628
|
| Min. Negotiated Rate |
$109.70 |
| Max. Negotiated Rate |
$915.54 |
| Rate for Payer: Aetna Commercial |
$228.39
|
| Rate for Payer: Aetna Medicare |
$177.26
|
| Rate for Payer: BCBS Complete |
$115.18
|
| Rate for Payer: BCBS MAPPO |
$170.44
|
| Rate for Payer: BCBS Trust/PPO |
$915.54
|
| Rate for Payer: BCN Commercial |
$597.26
|
| Rate for Payer: BCN Medicare Advantage |
$170.44
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cash Price |
$596.00
|
| Rate for Payer: Cofinity Commercial |
$245.43
|
| Rate for Payer: Cofinity Commercial |
$228.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.44
|
| Rate for Payer: Mclaren Medicaid |
$109.70
|
| Rate for Payer: Meridian Medicaid |
$115.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$178.96
|
| Rate for Payer: PACE SWMI |
$170.44
|
| Rate for Payer: PHP Medicare Advantage |
$170.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$109.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.08
|
| Rate for Payer: Priority Health Medicare |
$170.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$237.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.44
|
| Rate for Payer: UHC Medicare Advantage |
$175.55
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCHIAL LUNG BX EACH LOBE
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 31632
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$996.90 |
| Rate for Payer: Aetna Commercial |
$63.94
|
| Rate for Payer: BCBS Complete |
$31.98
|
| Rate for Payer: BCBS Trust/PPO |
$996.90
|
| Rate for Payer: BCN Commercial |
$93.82
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Mclaren Medicaid |
$30.46
|
| Rate for Payer: Meridian Medicaid |
$31.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.68
|
|
|
PR BRONCHOSCOPY W/TRANSBRONCL NDL ASPIR BX EA LOBE
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 31633
|
| Min. Negotiated Rate |
$39.19 |
| Max. Negotiated Rate |
$724.83 |
| Rate for Payer: Aetna Commercial |
$81.94
|
| Rate for Payer: Aetna Medicare |
$63.60
|
| Rate for Payer: BCBS Complete |
$41.15
|
| Rate for Payer: BCBS MAPPO |
$61.15
|
| Rate for Payer: BCBS Trust/PPO |
$724.83
|
| Rate for Payer: BCN Commercial |
$115.82
|
| Rate for Payer: BCN Medicare Advantage |
$61.15
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$88.06
|
| Rate for Payer: Cofinity Commercial |
$81.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.15
|
| Rate for Payer: Mclaren Medicaid |
$39.19
|
| Rate for Payer: Meridian Medicaid |
$41.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$64.21
|
| Rate for Payer: PACE SWMI |
$61.15
|
| Rate for Payer: PHP Medicare Advantage |
$61.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.73
|
| Rate for Payer: Priority Health Medicare |
$61.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.15
|
| Rate for Payer: UHC Medicare Advantage |
$62.98
|
|
|
PR BROWLIFT
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
HCPCS 00532
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$1,040.00 |
| Max. Negotiated Rate |
$1,820.00 |
| Rate for Payer: BCBS Complete |
$1,040.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,820.00
|
|
|
PR BSO W/OMENTECTOMY TAH DEBULKING W/LMPHADECTOMY
|
Professional
|
Both
|
$5,875.00
|
|
|
Service Code
|
HCPCS 58954
|
| Min. Negotiated Rate |
$131.02 |
| Max. Negotiated Rate |
$4,112.50 |
| Rate for Payer: Aetna Commercial |
$2,870.28
|
| Rate for Payer: Aetna Medicare |
$2,227.68
|
| Rate for Payer: BCBS Complete |
$1,458.87
|
| Rate for Payer: BCBS MAPPO |
$2,142.00
|
| Rate for Payer: BCBS Trust/PPO |
$131.02
|
| Rate for Payer: BCN Commercial |
$3,158.81
|
| Rate for Payer: BCN Medicare Advantage |
$2,142.00
|
| Rate for Payer: Cash Price |
$4,700.00
|
| Rate for Payer: Cash Price |
$4,700.00
|
| Rate for Payer: Cofinity Commercial |
$3,084.48
|
| Rate for Payer: Cofinity Commercial |
$2,870.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,142.00
|
| Rate for Payer: Mclaren Medicaid |
$1,389.40
|
| Rate for Payer: Meridian Medicaid |
$1,458.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,249.10
|
| Rate for Payer: PACE SWMI |
$2,142.00
|
| Rate for Payer: PHP Medicare Advantage |
$2,142.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,389.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,112.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,060.22
|
| Rate for Payer: Priority Health Medicare |
$2,142.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,060.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,142.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,142.00
|
| Rate for Payer: UHC Medicare Advantage |
$2,206.26
|
|
|
PR BSO W/OMENTECTOMY TAH&RAD DEBULKING DISSECTION
|
Professional
|
Both
|
$5,137.00
|
|
|
Service Code
|
HCPCS 58953
|
| Min. Negotiated Rate |
$131.55 |
| Max. Negotiated Rate |
$3,595.90 |
| Rate for Payer: Aetna Commercial |
$2,653.78
|
| Rate for Payer: Aetna Medicare |
$2,059.65
|
| Rate for Payer: BCBS Complete |
$1,348.16
|
| Rate for Payer: BCBS MAPPO |
$1,980.43
|
| Rate for Payer: BCBS Trust/PPO |
$131.55
|
| Rate for Payer: BCN Commercial |
$2,921.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,980.43
|
| Rate for Payer: Cash Price |
$4,109.60
|
| Rate for Payer: Cash Price |
$4,109.60
|
| Rate for Payer: Cofinity Commercial |
$2,851.82
|
| Rate for Payer: Cofinity Commercial |
$2,653.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,980.43
|
| Rate for Payer: Mclaren Medicaid |
$1,283.96
|
| Rate for Payer: Meridian Medicaid |
$1,348.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,079.45
|
| Rate for Payer: PACE SWMI |
$1,980.43
|
| Rate for Payer: PHP Medicare Advantage |
$1,980.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,283.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,595.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,830.61
|
| Rate for Payer: Priority Health Medicare |
$1,980.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,830.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,980.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,980.43
|
| Rate for Payer: UHC Medicare Advantage |
$2,039.84
|
|
