|
PR FECAL MICROBIOTA PREP INSTIL
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS G0455
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$1,923.54 |
| Rate for Payer: Aetna Commercial |
$93.97
|
| Rate for Payer: Aetna Medicare |
$72.94
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$70.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,923.54
|
| Rate for Payer: BCN Commercial |
$190.10
|
| Rate for Payer: BCN Medicare Advantage |
$70.13
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$93.97
|
| Rate for Payer: Cofinity Commercial |
$100.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.13
|
| Rate for Payer: Mclaren Medicaid |
$44.52
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.64
|
| Rate for Payer: PACE SWMI |
$70.13
|
| Rate for Payer: PHP Medicare Advantage |
$70.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.06
|
| Rate for Payer: Priority Health Medicare |
$70.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.13
|
| Rate for Payer: UHC Medicare Advantage |
$72.23
|
|
|
PR FERN TEST
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS Q0114
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$126.79 |
| Rate for Payer: Aetna Commercial |
$13.05
|
| Rate for Payer: Aetna Medicare |
$10.13
|
| Rate for Payer: BCBS Complete |
$2.40
|
| Rate for Payer: BCBS MAPPO |
$9.74
|
| Rate for Payer: BCBS Trust/PPO |
$126.79
|
| Rate for Payer: BCN Commercial |
$6.80
|
| Rate for Payer: BCN Medicare Advantage |
$9.74
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$14.03
|
| Rate for Payer: Cofinity Commercial |
$13.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.23
|
| Rate for Payer: PACE SWMI |
$9.74
|
| Rate for Payer: PHP Medicare Advantage |
$9.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.20
|
| Rate for Payer: Priority Health Medicare |
$9.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.74
|
| Rate for Payer: UHC Medicare Advantage |
$10.03
|
|
|
PR FETAL CONTRACTION STRESS TEST
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 59020
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$145.28 |
| Rate for Payer: Aetna Commercial |
$91.37
|
| Rate for Payer: Aetna Medicare |
$70.92
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$68.19
|
| Rate for Payer: BCBS Trust/PPO |
$145.28
|
| Rate for Payer: BCN Commercial |
$103.11
|
| Rate for Payer: BCN Medicare Advantage |
$68.19
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$98.19
|
| Rate for Payer: Cofinity Commercial |
$91.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.60
|
| Rate for Payer: PACE SWMI |
$68.19
|
| Rate for Payer: PHP Medicare Advantage |
$68.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.63
|
| Rate for Payer: Priority Health Medicare |
$68.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.19
|
| Rate for Payer: UHC Medicare Advantage |
$70.24
|
|
|
PR FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$825.00
|
|
|
Service Code
|
HCPCS 59074
|
| Min. Negotiated Rate |
$197.24 |
| Max. Negotiated Rate |
$577.50 |
| Rate for Payer: Aetna Commercial |
$413.86
|
| Rate for Payer: Aetna Medicare |
$321.20
|
| Rate for Payer: BCBS Complete |
$207.10
|
| Rate for Payer: BCBS MAPPO |
$308.85
|
| Rate for Payer: BCBS Trust/PPO |
$488.15
|
| Rate for Payer: BCN Commercial |
$561.98
|
| Rate for Payer: BCN Medicare Advantage |
$308.85
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cash Price |
$660.00
|
| Rate for Payer: Cofinity Commercial |
$444.74
|
| Rate for Payer: Cofinity Commercial |
$413.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.85
|
| Rate for Payer: Mclaren Medicaid |
$197.24
|
| Rate for Payer: Meridian Medicaid |
$207.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$324.29
|
| Rate for Payer: PACE SWMI |
$308.85
|
| Rate for Payer: PHP Medicare Advantage |
$308.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$577.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$434.87
|
| Rate for Payer: Priority Health Medicare |
$308.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$434.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.85
|
| Rate for Payer: UHC Medicare Advantage |
$318.12
|
|
|
PR FETAL NONSTRESS TEST
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 59025
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$522.49 |
| Rate for Payer: Aetna Commercial |
$63.52
|
| Rate for Payer: Aetna Medicare |
$49.30
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS MAPPO |
$47.40
|
| Rate for Payer: BCBS Trust/PPO |
$522.49
|
| Rate for Payer: BCN Commercial |
$71.35
|
| Rate for Payer: BCN Medicare Advantage |
$47.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cofinity Commercial |
$63.52
|
| Rate for Payer: Cofinity Commercial |
$68.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.77
|
| Rate for Payer: PACE SWMI |
$47.40
|
| Rate for Payer: PHP Medicare Advantage |
$47.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.94
|
| Rate for Payer: Priority Health Medicare |
$47.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.40
|
| Rate for Payer: UHC Medicare Advantage |
$48.82
|
|
|
PR FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE
|
Professional
|
Both
|
$1,045.00
|
|
|
Service Code
|
HCPCS 59076
|
| Min. Negotiated Rate |
$125.74 |
| Max. Negotiated Rate |
$759.41 |
| Rate for Payer: Aetna Commercial |
$699.33
|
| Rate for Payer: Aetna Medicare |
$542.77
|
| Rate for Payer: BCBS Complete |
$349.11
|
| Rate for Payer: BCBS MAPPO |
$521.89
|
| Rate for Payer: BCBS Trust/PPO |
$125.74
|
| Rate for Payer: BCN Commercial |
$759.41
|
| Rate for Payer: BCN Medicare Advantage |
$521.89
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cash Price |
$836.00
|
| Rate for Payer: Cofinity Commercial |
$699.33
|
| Rate for Payer: Cofinity Commercial |
$751.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$521.89
|
| Rate for Payer: Mclaren Medicaid |
$332.49
|
| Rate for Payer: Meridian Medicaid |
$349.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$547.98
|
| Rate for Payer: PACE SWMI |
$521.89
|
| Rate for Payer: PHP Medicare Advantage |
$521.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$733.76
|
| Rate for Payer: Priority Health Medicare |
$521.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$733.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$521.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$521.89
|
| Rate for Payer: UHC Medicare Advantage |
$537.55
|
|
|
PR FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE
|
Professional
|
Both
|
$1,268.00
|
|
|
Service Code
|
HCPCS 14350
|
| Min. Negotiated Rate |
$432.18 |
| Max. Negotiated Rate |
$5,240.72 |
| Rate for Payer: Aetna Commercial |
$884.45
|
| Rate for Payer: Aetna Medicare |
$686.44
|
| Rate for Payer: BCBS Complete |
$453.79
|
| Rate for Payer: BCBS MAPPO |
$660.04
|
| Rate for Payer: BCBS Trust/PPO |
$5,240.72
|
| Rate for Payer: BCN Commercial |
$982.24
|
| Rate for Payer: BCN Medicare Advantage |
$660.04
|
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Cofinity Commercial |
$950.46
|
| Rate for Payer: Cofinity Commercial |
$884.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$660.04
|
| Rate for Payer: Mclaren Medicaid |
$432.18
|
| Rate for Payer: Meridian Medicaid |
$453.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$693.04
|
| Rate for Payer: PACE SWMI |
$660.04
|
| Rate for Payer: PHP Medicare Advantage |
$660.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$432.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$887.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$826.18
|
| Rate for Payer: Priority Health Medicare |
$660.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$826.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$660.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$660.04
|
| Rate for Payer: UHC Medicare Advantage |
$679.84
|
|
|
PR FINE NEEDLE ASPIRATION BX W/CT GDN 1ST LESION
|
Professional
|
Both
|
$722.00
|
|
|
Service Code
|
HCPCS 10009
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$513.21 |
| Rate for Payer: Aetna Commercial |
$143.98
|
| Rate for Payer: Aetna Medicare |
$111.75
|
| Rate for Payer: BCBS Complete |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$107.45
|
| Rate for Payer: BCBS Trust/PPO |
$405.74
|
| Rate for Payer: BCN Commercial |
$513.21
|
| Rate for Payer: BCN Medicare Advantage |
$107.45
|
| Rate for Payer: Cash Price |
$577.60
|
| Rate for Payer: Cash Price |
$577.60
|
| Rate for Payer: Cofinity Commercial |
$143.98
|
| Rate for Payer: Cofinity Commercial |
$154.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.45
|
| Rate for Payer: Mclaren Medicaid |
$68.16
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.82
|
| Rate for Payer: PACE SWMI |
$107.45
|
| Rate for Payer: PHP Medicare Advantage |
$107.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$505.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.36
|
| Rate for Payer: Priority Health Medicare |
$107.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.45
|
| Rate for Payer: UHC Medicare Advantage |
$110.67
|
|
|
PR FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 10021
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$3,585.00 |
| Rate for Payer: Aetna Commercial |
$72.64
|
| Rate for Payer: Aetna Medicare |
$56.38
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$54.21
|
| Rate for Payer: BCBS Trust/PPO |
$3,585.00
|
| Rate for Payer: BCN Commercial |
$119.76
|
| Rate for Payer: BCN Medicare Advantage |
$54.21
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$78.06
|
| Rate for Payer: Cofinity Commercial |
$72.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.21
|
| Rate for Payer: Mclaren Medicaid |
$34.72
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.92
|
| Rate for Payer: PACE SWMI |
$54.21
|
| Rate for Payer: PHP Medicare Advantage |
$54.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.00
|
| Rate for Payer: Priority Health Medicare |
$54.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.21
|
| Rate for Payer: UHC Medicare Advantage |
$55.84
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 10005
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$97.35
|
| Rate for Payer: Aetna Medicare |
$75.56
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS MAPPO |
$72.65
|
| Rate for Payer: BCBS Trust/PPO |
$28.95
|
| Rate for Payer: BCN Commercial |
$159.81
|
| Rate for Payer: BCN Medicare Advantage |
$72.65
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$104.62
|
| Rate for Payer: Cofinity Commercial |
$97.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.65
|
| Rate for Payer: Mclaren Medicaid |
$46.01
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.28
|
| Rate for Payer: PACE SWMI |
$72.65
|
| Rate for Payer: PHP Medicare Advantage |
$72.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.60
|
| Rate for Payer: Priority Health Medicare |
$72.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.65
|
| Rate for Payer: UHC Medicare Advantage |
$74.83
|
|
|
PR FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 10006
|
| Min. Negotiated Rate |
$31.52 |
| Max. Negotiated Rate |
$349.63 |
| Rate for Payer: Aetna Commercial |
$66.01
|
| Rate for Payer: Aetna Medicare |
$51.23
|
| Rate for Payer: BCBS Complete |
$33.10
|
| Rate for Payer: BCBS MAPPO |
$49.26
|
| Rate for Payer: BCBS Trust/PPO |
$349.63
|
| Rate for Payer: BCN Commercial |
$70.29
|
| Rate for Payer: BCN Medicare Advantage |
$49.26
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$70.93
|
| Rate for Payer: Cofinity Commercial |
$66.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.26
|
| Rate for Payer: Mclaren Medicaid |
$31.52
|
| Rate for Payer: Meridian Medicaid |
$33.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.72
|
| Rate for Payer: PACE SWMI |
$49.26
|
| Rate for Payer: PHP Medicare Advantage |
$49.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.83
|
| Rate for Payer: Priority Health Medicare |
$49.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.26
|
| Rate for Payer: UHC Medicare Advantage |
$50.74
|
|
|
PR FINE NEEDLE ASP;W/IMAGING GUIDANCE
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 10022
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$184.80 |
| Rate for Payer: BCBS Complete |
$105.60
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.80
|
|
|
PR FINGER SPLINT, STATIC
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
|
|
PR FISSURECTOMY INCL SPHINCTEROTOMY WHEN PERFORMED
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
HCPCS 46200
|
| Min. Negotiated Rate |
$218.54 |
| Max. Negotiated Rate |
$1,577.50 |
| Rate for Payer: Aetna Commercial |
$438.89
|
| Rate for Payer: Aetna Medicare |
$340.63
|
| Rate for Payer: BCBS Complete |
$229.47
|
| Rate for Payer: BCBS MAPPO |
$327.53
|
| Rate for Payer: BCBS Trust/PPO |
$1,577.50
|
| Rate for Payer: BCN Commercial |
$699.79
|
| Rate for Payer: BCN Medicare Advantage |
$327.53
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cofinity Commercial |
$438.89
|
| Rate for Payer: Cofinity Commercial |
$471.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.53
|
| Rate for Payer: Mclaren Medicaid |
$218.54
|
| Rate for Payer: Meridian Medicaid |
$229.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$343.91
|
| Rate for Payer: PACE SWMI |
$327.53
|
| Rate for Payer: PHP Medicare Advantage |
$327.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$218.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$660.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.80
|
| Rate for Payer: Priority Health Medicare |
$327.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$596.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.53
|
| Rate for Payer: UHC Medicare Advantage |
$337.36
|
|
|
PR FIT CONTACT LENS TX OCULAR SURFACE DISEASE
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 92071
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$664.07 |
| Rate for Payer: Aetna Commercial |
$41.92
|
| Rate for Payer: Aetna Medicare |
$32.53
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$31.28
|
| Rate for Payer: BCBS Trust/PPO |
$664.07
|
| Rate for Payer: BCN Commercial |
$52.78
|
| Rate for Payer: BCN Medicare Advantage |
$31.28
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cofinity Commercial |
$41.92
|
| Rate for Payer: Cofinity Commercial |
$45.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.28
|
| Rate for Payer: Mclaren Medicaid |
$20.24
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.84
|
| Rate for Payer: PACE SWMI |
$31.28
|
| Rate for Payer: PHP Medicare Advantage |
$31.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.14
|
| Rate for Payer: Priority Health Medicare |
$31.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.28
|
| Rate for Payer: UHC Medicare Advantage |
$32.22
|
|
|
PR FIT&INSJ PESSARY/OTH INTRAVAGINAL SUPPORT DEVI
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 57160
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$2,269.05 |
| Rate for Payer: Aetna Commercial |
$61.32
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS MAPPO |
$45.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,269.05
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: BCN Medicare Advantage |
$45.76
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$65.89
|
| Rate for Payer: Cofinity Commercial |
$61.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.76
|
| Rate for Payer: Mclaren Medicaid |
$29.18
|
| Rate for Payer: Meridian Medicaid |
$30.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$48.05
|
| Rate for Payer: PACE SWMI |
$45.76
|
| Rate for Payer: PHP Medicare Advantage |
$45.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.87
|
| Rate for Payer: Priority Health Medicare |
$45.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.76
|
| Rate for Payer: UHC Medicare Advantage |
$47.13
|
|
|
PR FITTING CONTACT LENS FOR MNGT OF KERATOCONUS
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 92072
|
| Min. Negotiated Rate |
$58.58 |
| Max. Negotiated Rate |
$900.75 |
| Rate for Payer: Aetna Commercial |
$123.12
|
| Rate for Payer: Aetna Medicare |
$95.56
|
| Rate for Payer: BCBS Complete |
$61.51
|
| Rate for Payer: BCBS MAPPO |
$91.88
|
| Rate for Payer: BCBS Trust/PPO |
$900.75
|
| Rate for Payer: BCN Commercial |
$183.25
|
| Rate for Payer: BCN Medicare Advantage |
$91.88
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$123.12
|
| Rate for Payer: Cofinity Commercial |
$132.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.88
|
| Rate for Payer: Mclaren Medicaid |
$58.58
|
| Rate for Payer: Meridian Medicaid |
$61.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$96.47
|
| Rate for Payer: PACE SWMI |
$91.88
|
| Rate for Payer: PHP Medicare Advantage |
$91.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.61
|
| Rate for Payer: Priority Health Medicare |
$91.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.88
|
| Rate for Payer: UHC Medicare Advantage |
$94.64
|
|
|
PR FIXATION CONTRALATERAL TESTIS SEPARATE PROCEDURE
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 54620
|
| Min. Negotiated Rate |
$190.21 |
| Max. Negotiated Rate |
$3,422.86 |
| Rate for Payer: Aetna Commercial |
$391.12
|
| Rate for Payer: Aetna Medicare |
$303.56
|
| Rate for Payer: BCBS Complete |
$199.72
|
| Rate for Payer: BCBS MAPPO |
$291.88
|
| Rate for Payer: BCBS Trust/PPO |
$3,422.86
|
| Rate for Payer: BCN Commercial |
$431.50
|
| Rate for Payer: BCN Medicare Advantage |
$291.88
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$420.31
|
| Rate for Payer: Cofinity Commercial |
$391.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.88
|
| Rate for Payer: Mclaren Medicaid |
$190.21
|
| Rate for Payer: Meridian Medicaid |
$199.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$306.47
|
| Rate for Payer: PACE SWMI |
$291.88
|
| Rate for Payer: PHP Medicare Advantage |
$291.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$190.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$477.13
|
| Rate for Payer: Priority Health Medicare |
$291.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$477.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$291.88
|
| Rate for Payer: UHC Medicare Advantage |
$300.64
|
|
|
PR FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY
|
Professional
|
Both
|
$1,699.00
|
|
|
Service Code
|
HCPCS 15740
|
| Min. Negotiated Rate |
$538.89 |
| Max. Negotiated Rate |
$1,709.25 |
| Rate for Payer: Aetna Commercial |
$1,097.89
|
| Rate for Payer: Aetna Medicare |
$852.09
|
| Rate for Payer: BCBS Complete |
$565.83
|
| Rate for Payer: BCBS MAPPO |
$819.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.25
|
| Rate for Payer: BCN Commercial |
$1,478.74
|
| Rate for Payer: BCN Medicare Advantage |
$819.32
|
| Rate for Payer: Cash Price |
$1,359.20
|
| Rate for Payer: Cash Price |
$1,359.20
|
| Rate for Payer: Cofinity Commercial |
$1,097.89
|
| Rate for Payer: Cofinity Commercial |
$1,179.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$819.32
|
| Rate for Payer: Mclaren Medicaid |
$538.89
|
| Rate for Payer: Meridian Medicaid |
$565.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$860.29
|
| Rate for Payer: PACE SWMI |
$819.32
|
| Rate for Payer: PHP Medicare Advantage |
$819.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$538.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,189.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,030.47
|
| Rate for Payer: Priority Health Medicare |
$819.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,030.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$819.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$819.32
|
| Rate for Payer: UHC Medicare Advantage |
$843.90
|
|
|
PR FLUORESCEIN ANGIOSCOPY INTERPRETATION & REPORT
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 92230
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$1,393.66 |
| Rate for Payer: Aetna Commercial |
$44.92
|
| Rate for Payer: Aetna Medicare |
$34.86
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: BCBS MAPPO |
$33.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,393.66
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: BCN Medicare Advantage |
$33.52
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$48.27
|
| Rate for Payer: Cofinity Commercial |
$44.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.52
|
| Rate for Payer: Mclaren Medicaid |
$21.73
|
| Rate for Payer: Meridian Medicaid |
$22.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.20
|
| Rate for Payer: PACE SWMI |
$33.52
|
| Rate for Payer: PHP Medicare Advantage |
$33.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.94
|
| Rate for Payer: Priority Health Medicare |
$33.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.52
|
| Rate for Payer: UHC Medicare Advantage |
$34.53
|
|
|
PR FLUPHENAZINE DECANOATE 25 MG
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS J2680
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Aetna Commercial |
$14.68
|
| Rate for Payer: Aetna Medicare |
$11.39
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS MAPPO |
$10.95
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$5.76
|
| Rate for Payer: BCN Medicare Advantage |
$10.95
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.50
|
| Rate for Payer: PACE SWMI |
$10.95
|
| Rate for Payer: PHP Medicare Advantage |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health Medicare |
$10.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.95
|
| Rate for Payer: UHC Medicare Advantage |
$11.28
|
|
|
PR FLUVIRIN VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS Q2037
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
|
|
PR FLUZONE VACC, 3 YRS & >, IM
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS Q2038
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$17.50 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$17.00
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
|
|
PR FOLLOW-UP/REASSESSMENT
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS S0316
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: Aetna Commercial |
$20.00
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Trust/PPO |
$53.36
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR FO NONTORSION JOINT CF
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS L3935
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$190.90 |
| Rate for Payer: Aetna Commercial |
$121.09
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCN Commercial |
$190.90
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.10
|
|
