|
PR DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 90698
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$118.20 |
| Rate for Payer: Aetna Commercial |
$118.20
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: BCBS Trust/PPO |
$109.23
|
| Rate for Payer: BCN Commercial |
$109.23
|
| 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 DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 90696
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$62.89 |
| Rate for Payer: Aetna Commercial |
$62.89
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS Trust/PPO |
$59.91
|
| Rate for Payer: BCN Commercial |
$59.91
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.90
|
|
|
PR DTP/HIB VACCINE,IM
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 90720
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$56.00 |
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
|
|
PR DT VACCINE YOUNGER THAN 7 YRS FOR IM USE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 90702
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.01 |
| Rate for Payer: Aetna Commercial |
$67.16
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$79.01
|
| Rate for Payer: BCN Commercial |
$79.01
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
|
|
PR DUODENAL INTUBAT W/IMAG GUIDED SINGLE SPECIMEN
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 43756
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$409.52 |
| Rate for Payer: Aetna Commercial |
$66.33
|
| Rate for Payer: Aetna Medicare |
$51.48
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$49.50
|
| Rate for Payer: BCBS Trust/PPO |
$194.41
|
| Rate for Payer: BCN Commercial |
$409.52
|
| Rate for Payer: BCN Medicare Advantage |
$49.50
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$71.28
|
| Rate for Payer: Cofinity Commercial |
$66.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.50
|
| Rate for Payer: Mclaren Medicaid |
$32.38
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.98
|
| Rate for Payer: PACE SWMI |
$49.50
|
| Rate for Payer: PHP Medicare Advantage |
$49.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.78
|
| Rate for Payer: Priority Health Medicare |
$49.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.50
|
| Rate for Payer: UHC Medicare Advantage |
$50.98
|
|
|
PR DUODENOTOMY EXPLORATION/BX/FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$2,878.00
|
|
|
Service Code
|
HCPCS 44010
|
| Min. Negotiated Rate |
$542.30 |
| Max. Negotiated Rate |
$2,014.60 |
| Rate for Payer: Aetna Commercial |
$1,124.69
|
| Rate for Payer: Aetna Medicare |
$872.89
|
| Rate for Payer: BCBS Complete |
$569.42
|
| Rate for Payer: BCBS MAPPO |
$839.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,969.50
|
| Rate for Payer: BCN Commercial |
$1,237.34
|
| Rate for Payer: BCN Medicare Advantage |
$839.32
|
| Rate for Payer: Cash Price |
$2,302.40
|
| Rate for Payer: Cash Price |
$2,302.40
|
| Rate for Payer: Cofinity Commercial |
$1,124.69
|
| Rate for Payer: Cofinity Commercial |
$1,208.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$839.32
|
| Rate for Payer: Mclaren Medicaid |
$542.30
|
| Rate for Payer: Meridian Medicaid |
$569.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$881.29
|
| Rate for Payer: PACE SWMI |
$839.32
|
| Rate for Payer: PHP Medicare Advantage |
$839.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$542.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,014.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,488.74
|
| Rate for Payer: Priority Health Medicare |
$839.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,488.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$839.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$839.32
|
| Rate for Payer: UHC Medicare Advantage |
$864.50
|
|
|
PR DUOL EXCLUSION W/GASTROJEJUNOSTOMY PNCRTC INJ
|
Professional
|
Both
|
$6,158.00
|
|
|
Service Code
|
HCPCS 48547
|
| Min. Negotiated Rate |
$749.66 |
| Max. Negotiated Rate |
$4,310.60 |
| Rate for Payer: Aetna Commercial |
$2,391.38
|
| Rate for Payer: Aetna Medicare |
$1,855.99
|
| Rate for Payer: BCBS Complete |
$1,200.11
|
| Rate for Payer: BCBS MAPPO |
$1,784.61
|
| Rate for Payer: BCBS Trust/PPO |
$749.66
|
| Rate for Payer: BCN Commercial |
$2,612.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,784.61
|
| Rate for Payer: Cash Price |
$4,926.40
|
| Rate for Payer: Cash Price |
$4,926.40
|
| Rate for Payer: Cofinity Commercial |
$2,569.84
|
| Rate for Payer: Cofinity Commercial |
$2,391.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,784.61
|
| Rate for Payer: Mclaren Medicaid |
$1,142.96
|
| Rate for Payer: Meridian Medicaid |
$1,200.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,873.84
|
| Rate for Payer: PACE SWMI |
$1,784.61
|
| Rate for Payer: PHP Medicare Advantage |
$1,784.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,142.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,310.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,143.30
|
| Rate for Payer: Priority Health Medicare |
$1,784.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,143.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,784.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,784.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,838.15
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL BI STD
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 93985
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$363.58 |
| Rate for Payer: Aetna Commercial |
$312.21
|
| Rate for Payer: Aetna Medicare |
$242.31
|
| Rate for Payer: BCBS Complete |
$30.40
|
| Rate for Payer: BCBS MAPPO |
$232.99
|
| Rate for Payer: BCBS Trust/PPO |
$243.55
|
| Rate for Payer: BCN Commercial |
$363.58
|
| Rate for Payer: BCN Medicare Advantage |
$232.99
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$335.51
|
| Rate for Payer: Cofinity Commercial |
$312.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$232.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$244.64
|
| Rate for Payer: PACE SWMI |
$232.99
|
| Rate for Payer: PHP Medicare Advantage |
$232.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.16
|
| Rate for Payer: Priority Health Medicare |
$232.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$334.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$232.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$232.99
|
| Rate for Payer: UHC Medicare Advantage |
$239.98
|
|
|
PR DUPLEX SCAN ARTL INFL&VEN O/F HEMO COMPL UNI STD
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 93986
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$216.49 |
| Rate for Payer: Aetna Commercial |
$185.95
|
| Rate for Payer: Aetna Medicare |
$144.32
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$138.77
|
| Rate for Payer: BCBS Trust/PPO |
$61.81
|
| Rate for Payer: BCN Commercial |
$216.49
|
| Rate for Payer: BCN Medicare Advantage |
$138.77
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$185.95
|
| Rate for Payer: Cofinity Commercial |
$199.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$145.71
|
| Rate for Payer: PACE SWMI |
$138.77
|
| Rate for Payer: PHP Medicare Advantage |
$138.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.97
|
| Rate for Payer: Priority Health Medicare |
$138.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.77
|
| Rate for Payer: UHC Medicare Advantage |
$142.93
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART COMPL BI STUDY
|
Professional
|
Both
|
$435.00
|
|
|
Service Code
|
HCPCS 93880
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$304.50 |
| Rate for Payer: Aetna Commercial |
$241.09
|
| Rate for Payer: Aetna Medicare |
$187.12
|
| Rate for Payer: BCBS Complete |
$174.00
|
| Rate for Payer: BCBS MAPPO |
$179.92
|
| Rate for Payer: BCBS Trust/PPO |
$80.30
|
| Rate for Payer: BCN Commercial |
$280.02
|
| Rate for Payer: BCN Medicare Advantage |
$179.92
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cofinity Commercial |
$259.08
|
| Rate for Payer: Cofinity Commercial |
$241.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$188.92
|
| Rate for Payer: PACE SWMI |
$179.92
|
| Rate for Payer: PHP Medicare Advantage |
$179.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$304.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.35
|
| Rate for Payer: Priority Health Medicare |
$179.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.92
|
| Rate for Payer: UHC Medicare Advantage |
$185.32
|
|
|
PR DUPLEX SCAN EXTRACRANIAL ART UNI/LMTD STUDY
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
HCPCS 93882
|
| Min. Negotiated Rate |
$116.85 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$156.58
|
| Rate for Payer: Aetna Medicare |
$121.52
|
| Rate for Payer: BCBS Complete |
$124.80
|
| Rate for Payer: BCBS MAPPO |
$116.85
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$181.79
|
| Rate for Payer: BCN Medicare Advantage |
$116.85
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cofinity Commercial |
$168.26
|
| Rate for Payer: Cofinity Commercial |
$156.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$122.69
|
| Rate for Payer: PACE SWMI |
$116.85
|
| Rate for Payer: PHP Medicare Advantage |
$116.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$218.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.08
|
| Rate for Payer: Priority Health Medicare |
$116.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.85
|
| Rate for Payer: UHC Medicare Advantage |
$120.36
|
|
|
PR DUPLEX SCAN HEMODIALYSIS ACCESS
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 93990
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$214.53 |
| Rate for Payer: Aetna Commercial |
$184.37
|
| Rate for Payer: Aetna Commercial |
$184.37
|
| Rate for Payer: Aetna Medicare |
$143.09
|
| Rate for Payer: Aetna Medicare |
$143.09
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$136.00
|
| Rate for Payer: BCBS MAPPO |
$137.59
|
| Rate for Payer: BCBS MAPPO |
$137.59
|
| Rate for Payer: BCBS Trust/PPO |
$16.91
|
| Rate for Payer: BCBS Trust/PPO |
$16.91
|
| Rate for Payer: BCN Commercial |
$214.53
|
| Rate for Payer: BCN Commercial |
$214.53
|
| Rate for Payer: BCN Medicare Advantage |
$137.59
|
| Rate for Payer: BCN Medicare Advantage |
$137.59
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$198.13
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Cofinity Commercial |
$184.37
|
| Rate for Payer: Cofinity Commercial |
$198.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$144.47
|
| Rate for Payer: PACE SWMI |
$137.59
|
| Rate for Payer: PACE SWMI |
$137.59
|
| Rate for Payer: PHP Medicare Advantage |
$137.59
|
| Rate for Payer: PHP Medicare Advantage |
$137.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.17
|
| Rate for Payer: Priority Health Medicare |
$137.59
|
| Rate for Payer: Priority Health Medicare |
$137.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.59
|
| Rate for Payer: UHC Medicare Advantage |
$141.72
|
| Rate for Payer: UHC Medicare Advantage |
$141.72
|
|
|
PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS COMPLETE
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 93978
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$228.08
|
| Rate for Payer: Aetna Commercial |
$228.08
|
| Rate for Payer: Aetna Medicare |
$177.02
|
| Rate for Payer: Aetna Medicare |
$177.02
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS Complete |
$156.00
|
| Rate for Payer: BCBS MAPPO |
$170.21
|
| Rate for Payer: BCBS MAPPO |
$170.21
|
| Rate for Payer: BCBS Trust/PPO |
$430.56
|
| Rate for Payer: BCBS Trust/PPO |
$430.56
|
| Rate for Payer: BCN Commercial |
$264.37
|
| Rate for Payer: BCN Commercial |
$264.37
|
| Rate for Payer: BCN Medicare Advantage |
$170.21
|
| Rate for Payer: BCN Medicare Advantage |
$170.21
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cofinity Commercial |
$228.08
|
| Rate for Payer: Cofinity Commercial |
$228.08
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Cofinity Commercial |
$245.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$178.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$178.72
|
| Rate for Payer: PACE SWMI |
$170.21
|
| Rate for Payer: PACE SWMI |
$170.21
|
| Rate for Payer: PHP Medicare Advantage |
$170.21
|
| Rate for Payer: PHP Medicare Advantage |
$170.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.99
|
| Rate for Payer: Priority Health Medicare |
$170.21
|
| Rate for Payer: Priority Health Medicare |
$170.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$170.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.21
|
| Rate for Payer: UHC Medicare Advantage |
$175.32
|
| Rate for Payer: UHC Medicare Advantage |
$175.32
|
|
|
PR DUP-SCAN AORTA IVC ILIAC VASCL/BPGS UNI/LMTD
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 93979
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Aetna Commercial |
$147.67
|
| Rate for Payer: Aetna Commercial |
$147.67
|
| Rate for Payer: Aetna Medicare |
$114.61
|
| Rate for Payer: Aetna Medicare |
$114.61
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$110.20
|
| Rate for Payer: BCBS MAPPO |
$110.20
|
| Rate for Payer: BCBS Trust/PPO |
$84.00
|
| Rate for Payer: BCBS Trust/PPO |
$84.00
|
| Rate for Payer: BCN Commercial |
$171.52
|
| Rate for Payer: BCN Commercial |
$171.52
|
| Rate for Payer: BCN Medicare Advantage |
$110.20
|
| Rate for Payer: BCN Medicare Advantage |
$110.20
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cofinity Commercial |
$158.69
|
| Rate for Payer: Cofinity Commercial |
$147.67
|
| Rate for Payer: Cofinity Commercial |
$158.69
|
| Rate for Payer: Cofinity Commercial |
$147.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$115.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$115.71
|
| Rate for Payer: PACE SWMI |
$110.20
|
| Rate for Payer: PACE SWMI |
$110.20
|
| Rate for Payer: PHP Medicare Advantage |
$110.20
|
| Rate for Payer: PHP Medicare Advantage |
$110.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.64
|
| Rate for Payer: Priority Health Medicare |
$110.20
|
| Rate for Payer: Priority Health Medicare |
$110.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.20
|
| Rate for Payer: UHC Medicare Advantage |
$113.51
|
| Rate for Payer: UHC Medicare Advantage |
$113.51
|
|
|
PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN COM
|
Professional
|
Both
|
$607.00
|
|
|
Service Code
|
HCPCS 93975
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$424.90 |
| Rate for Payer: Aetna Commercial |
$335.84
|
| Rate for Payer: Aetna Commercial |
$335.84
|
| Rate for Payer: Aetna Medicare |
$260.66
|
| Rate for Payer: Aetna Medicare |
$260.66
|
| Rate for Payer: BCBS Complete |
$242.80
|
| Rate for Payer: BCBS Complete |
$101.20
|
| Rate for Payer: BCBS MAPPO |
$250.63
|
| Rate for Payer: BCBS MAPPO |
$250.63
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: BCN Commercial |
$389.96
|
| Rate for Payer: BCN Commercial |
$389.96
|
| Rate for Payer: BCN Medicare Advantage |
$250.63
|
| Rate for Payer: BCN Medicare Advantage |
$250.63
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$485.60
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cofinity Commercial |
$360.91
|
| Rate for Payer: Cofinity Commercial |
$335.84
|
| Rate for Payer: Cofinity Commercial |
$360.91
|
| Rate for Payer: Cofinity Commercial |
$335.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$250.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.16
|
| Rate for Payer: PACE SWMI |
$250.63
|
| Rate for Payer: PACE SWMI |
$250.63
|
| Rate for Payer: PHP Medicare Advantage |
$250.63
|
| Rate for Payer: PHP Medicare Advantage |
$250.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$424.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.42
|
| Rate for Payer: Priority Health Medicare |
$250.63
|
| Rate for Payer: Priority Health Medicare |
$250.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$358.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$250.63
|
| Rate for Payer: UHC Medicare Advantage |
$258.15
|
| Rate for Payer: UHC Medicare Advantage |
$258.15
|
|
|
PR DUP-SCAN ARTL FLO ABDL/PEL/SCROT&/RPR ORGN LMT
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 93976
|
| Min. Negotiated Rate |
$149.39 |
| Max. Negotiated Rate |
$547.85 |
| Rate for Payer: Aetna Commercial |
$200.18
|
| Rate for Payer: Aetna Commercial |
$200.18
|
| Rate for Payer: Aetna Medicare |
$155.37
|
| Rate for Payer: Aetna Medicare |
$155.37
|
| Rate for Payer: BCBS Complete |
$70.80
|
| Rate for Payer: BCBS Complete |
$252.00
|
| Rate for Payer: BCBS MAPPO |
$149.39
|
| Rate for Payer: BCBS MAPPO |
$149.39
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCN Commercial |
$232.12
|
| Rate for Payer: BCN Commercial |
$232.12
|
| Rate for Payer: BCN Medicare Advantage |
$149.39
|
| Rate for Payer: BCN Medicare Advantage |
$149.39
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$200.18
|
| Rate for Payer: Cofinity Commercial |
$215.12
|
| Rate for Payer: Cofinity Commercial |
$200.18
|
| Rate for Payer: Cofinity Commercial |
$215.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.86
|
| Rate for Payer: PACE SWMI |
$149.39
|
| Rate for Payer: PACE SWMI |
$149.39
|
| Rate for Payer: PHP Medicare Advantage |
$149.39
|
| Rate for Payer: PHP Medicare Advantage |
$149.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.34
|
| Rate for Payer: Priority Health Medicare |
$149.39
|
| Rate for Payer: Priority Health Medicare |
$149.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.39
|
| Rate for Payer: UHC Medicare Advantage |
$153.87
|
| Rate for Payer: UHC Medicare Advantage |
$153.87
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 93925
|
| Min. Negotiated Rate |
$160.60 |
| Max. Negotiated Rate |
$351.85 |
| Rate for Payer: Aetna Commercial |
$301.82
|
| Rate for Payer: Aetna Commercial |
$301.82
|
| Rate for Payer: Aetna Medicare |
$234.25
|
| Rate for Payer: Aetna Medicare |
$234.25
|
| Rate for Payer: BCBS Complete |
$168.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS MAPPO |
$225.24
|
| Rate for Payer: BCBS MAPPO |
$225.24
|
| Rate for Payer: BCBS Trust/PPO |
$160.60
|
| Rate for Payer: BCBS Trust/PPO |
$160.60
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: BCN Medicare Advantage |
$225.24
|
| Rate for Payer: BCN Medicare Advantage |
$225.24
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$301.82
|
| Rate for Payer: Cofinity Commercial |
$301.82
|
| Rate for Payer: Cofinity Commercial |
$324.35
|
| Rate for Payer: Cofinity Commercial |
$324.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$225.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$236.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$236.50
|
| Rate for Payer: PACE SWMI |
$225.24
|
| Rate for Payer: PACE SWMI |
$225.24
|
| Rate for Payer: PHP Medicare Advantage |
$225.24
|
| Rate for Payer: PHP Medicare Advantage |
$225.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$323.39
|
| Rate for Payer: Priority Health Medicare |
$225.24
|
| Rate for Payer: Priority Health Medicare |
$225.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$323.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$225.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$225.24
|
| Rate for Payer: UHC Medicare Advantage |
$232.00
|
| Rate for Payer: UHC Medicare Advantage |
$232.00
|
|
|
PR DUP-SCAN LXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 93926
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$416.83 |
| Rate for Payer: Aetna Commercial |
$179.52
|
| Rate for Payer: Aetna Commercial |
$179.52
|
| Rate for Payer: Aetna Medicare |
$139.33
|
| Rate for Payer: Aetna Medicare |
$139.33
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$133.97
|
| Rate for Payer: BCBS MAPPO |
$133.97
|
| Rate for Payer: BCBS Trust/PPO |
$416.83
|
| Rate for Payer: BCBS Trust/PPO |
$416.83
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: BCN Medicare Advantage |
$133.97
|
| Rate for Payer: BCN Medicare Advantage |
$133.97
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$192.92
|
| Rate for Payer: Cofinity Commercial |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$192.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.67
|
| Rate for Payer: PACE SWMI |
$133.97
|
| Rate for Payer: PACE SWMI |
$133.97
|
| Rate for Payer: PHP Medicare Advantage |
$133.97
|
| Rate for Payer: PHP Medicare Advantage |
$133.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.24
|
| Rate for Payer: Priority Health Medicare |
$133.97
|
| Rate for Payer: Priority Health Medicare |
$133.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$192.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.97
|
| Rate for Payer: UHC Medicare Advantage |
$137.99
|
| Rate for Payer: UHC Medicare Advantage |
$137.99
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS COMPL BI STUDY
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 93930
|
| Min. Negotiated Rate |
$21.13 |
| Max. Negotiated Rate |
$286.85 |
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna Commercial |
$246.96
|
| Rate for Payer: Aetna Medicare |
$191.67
|
| Rate for Payer: Aetna Medicare |
$191.67
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS Complete |
$159.20
|
| Rate for Payer: BCBS MAPPO |
$184.30
|
| Rate for Payer: BCBS MAPPO |
$184.30
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCBS Trust/PPO |
$21.13
|
| Rate for Payer: BCN Commercial |
$286.85
|
| Rate for Payer: BCN Commercial |
$286.85
|
| Rate for Payer: BCN Medicare Advantage |
$184.30
|
| Rate for Payer: BCN Medicare Advantage |
$184.30
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$318.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$265.39
|
| Rate for Payer: Cofinity Commercial |
$246.96
|
| Rate for Payer: Cofinity Commercial |
$265.39
|
| Rate for Payer: Cofinity Commercial |
$246.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$184.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$193.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$193.52
|
| Rate for Payer: PACE SWMI |
$184.30
|
| Rate for Payer: PACE SWMI |
$184.30
|
| Rate for Payer: PHP Medicare Advantage |
$184.30
|
| Rate for Payer: PHP Medicare Advantage |
$184.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.65
|
| Rate for Payer: Priority Health Medicare |
$184.30
|
| Rate for Payer: Priority Health Medicare |
$184.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$263.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$184.30
|
| Rate for Payer: UHC Medicare Advantage |
$189.83
|
| Rate for Payer: UHC Medicare Advantage |
$189.83
|
|
|
PR DUP-SCAN UXTR ART/ARTL BPGS UNI/LMTD STUDY
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 93931
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$186.90 |
| Rate for Payer: Aetna Commercial |
$155.53
|
| Rate for Payer: Aetna Commercial |
$155.53
|
| Rate for Payer: Aetna Medicare |
$120.71
|
| Rate for Payer: Aetna Medicare |
$120.71
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: BCBS MAPPO |
$116.07
|
| Rate for Payer: BCBS MAPPO |
$116.07
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCN Commercial |
$180.81
|
| Rate for Payer: BCN Commercial |
$180.81
|
| Rate for Payer: BCN Medicare Advantage |
$116.07
|
| Rate for Payer: BCN Medicare Advantage |
$116.07
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$155.53
|
| Rate for Payer: Cofinity Commercial |
$167.14
|
| Rate for Payer: Cofinity Commercial |
$155.53
|
| Rate for Payer: Cofinity Commercial |
$167.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$121.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$121.87
|
| Rate for Payer: PACE SWMI |
$116.07
|
| Rate for Payer: PACE SWMI |
$116.07
|
| Rate for Payer: PHP Medicare Advantage |
$116.07
|
| Rate for Payer: PHP Medicare Advantage |
$116.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$166.18
|
| Rate for Payer: Priority Health Medicare |
$116.07
|
| Rate for Payer: Priority Health Medicare |
$116.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.07
|
| Rate for Payer: UHC Medicare Advantage |
$119.55
|
| Rate for Payer: UHC Medicare Advantage |
$119.55
|
|
|
PR DUP-SCAN XTR VEINS COMPLETE BILATERAL STUDY
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 93970
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna Commercial |
$237.30
|
| Rate for Payer: Aetna Medicare |
$184.17
|
| Rate for Payer: Aetna Medicare |
$184.17
|
| Rate for Payer: BCBS Complete |
$165.60
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS MAPPO |
$177.09
|
| Rate for Payer: BCBS MAPPO |
$177.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.98
|
| Rate for Payer: BCBS Trust/PPO |
$8.98
|
| Rate for Payer: BCN Commercial |
$276.10
|
| Rate for Payer: BCN Commercial |
$276.10
|
| Rate for Payer: BCN Medicare Advantage |
$177.09
|
| Rate for Payer: BCN Medicare Advantage |
$177.09
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Cofinity Commercial |
$255.01
|
| Rate for Payer: Cofinity Commercial |
$255.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$177.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$185.94
|
| Rate for Payer: PACE SWMI |
$177.09
|
| Rate for Payer: PACE SWMI |
$177.09
|
| Rate for Payer: PHP Medicare Advantage |
$177.09
|
| Rate for Payer: PHP Medicare Advantage |
$177.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$253.76
|
| Rate for Payer: Priority Health Medicare |
$177.09
|
| Rate for Payer: Priority Health Medicare |
$177.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$177.09
|
| Rate for Payer: UHC Medicare Advantage |
$182.40
|
| Rate for Payer: UHC Medicare Advantage |
$182.40
|
|
|
PR DUP-SCAN XTR VEINS UNILATERAL/LIMITED STUDY
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 93971
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$174.95 |
| Rate for Payer: Aetna Commercial |
$150.36
|
| Rate for Payer: Aetna Commercial |
$150.36
|
| Rate for Payer: Aetna Medicare |
$116.70
|
| Rate for Payer: Aetna Medicare |
$116.70
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCBS MAPPO |
$112.21
|
| Rate for Payer: BCBS MAPPO |
$112.21
|
| Rate for Payer: BCBS Trust/PPO |
$100.91
|
| Rate for Payer: BCBS Trust/PPO |
$100.91
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: BCN Medicare Advantage |
$112.21
|
| Rate for Payer: BCN Medicare Advantage |
$112.21
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$150.36
|
| Rate for Payer: Cofinity Commercial |
$150.36
|
| Rate for Payer: Cofinity Commercial |
$161.58
|
| Rate for Payer: Cofinity Commercial |
$161.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.82
|
| Rate for Payer: PACE SWMI |
$112.21
|
| Rate for Payer: PACE SWMI |
$112.21
|
| Rate for Payer: PHP Medicare Advantage |
$112.21
|
| Rate for Payer: PHP Medicare Advantage |
$112.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.80
|
| Rate for Payer: Priority Health Medicare |
$112.21
|
| Rate for Payer: Priority Health Medicare |
$112.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.21
|
| Rate for Payer: UHC Medicare Advantage |
$115.58
|
| Rate for Payer: UHC Medicare Advantage |
$115.58
|
|
|
PR DURAL GRAFT SPINAL
|
Professional
|
Both
|
$4,992.00
|
|
|
Service Code
|
HCPCS 63710
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$3,494.40 |
| Rate for Payer: Aetna Commercial |
$1,440.18
|
| Rate for Payer: Aetna Medicare |
$1,117.75
|
| Rate for Payer: BCBS Complete |
$736.03
|
| Rate for Payer: BCBS MAPPO |
$1,074.76
|
| Rate for Payer: BCBS Trust/PPO |
$172.75
|
| Rate for Payer: BCN Commercial |
$1,749.81
|
| Rate for Payer: BCN Medicare Advantage |
$1,074.76
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cash Price |
$3,993.60
|
| Rate for Payer: Cofinity Commercial |
$1,440.18
|
| Rate for Payer: Cofinity Commercial |
$1,547.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,074.76
|
| Rate for Payer: Mclaren Medicaid |
$700.98
|
| Rate for Payer: Meridian Medicaid |
$736.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,128.50
|
| Rate for Payer: PACE SWMI |
$1,074.76
|
| Rate for Payer: PHP Medicare Advantage |
$1,074.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$700.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,494.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,841.36
|
| Rate for Payer: Priority Health Medicare |
$1,074.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,841.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,074.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,074.76
|
| Rate for Payer: UHC Medicare Advantage |
$1,107.00
|
|
|
PR DYSPORT
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 00385
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
|
|
PR EAR MOLD/INSERT
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS V5264
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$57.45 |
| Rate for Payer: Aetna Commercial |
$57.45
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
|
