|
PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 90743
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$106.34 |
| Rate for Payer: Aetna Commercial |
$98.95
|
| Rate for Payer: Aetna Medicare |
$76.80
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$73.85
|
| Rate for Payer: BCBS Trust/PPO |
$76.66
|
| Rate for Payer: BCN Commercial |
$65.05
|
| Rate for Payer: BCN Medicare Advantage |
$73.85
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$98.95
|
| Rate for Payer: Cofinity Commercial |
$106.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.54
|
| Rate for Payer: PACE SWMI |
$73.85
|
| Rate for Payer: PHP Medicare Advantage |
$73.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health Medicare |
$73.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.85
|
| Rate for Payer: UHC Medicare Advantage |
$76.06
|
|
|
PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 90739
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$230.81 |
| Rate for Payer: Aetna Commercial |
$214.78
|
| Rate for Payer: Aetna Medicare |
$166.70
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS MAPPO |
$160.28
|
| Rate for Payer: BCBS Trust/PPO |
$166.39
|
| Rate for Payer: BCN Commercial |
$132.46
|
| Rate for Payer: BCN Medicare Advantage |
$160.28
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$230.81
|
| Rate for Payer: Cofinity Commercial |
$214.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$168.30
|
| Rate for Payer: PACE SWMI |
$160.28
|
| Rate for Payer: PHP Medicare Advantage |
$160.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.00
|
| Rate for Payer: Priority Health Medicare |
$160.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.28
|
| Rate for Payer: UHC Medicare Advantage |
$165.09
|
|
|
PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 90746
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$101.34 |
| Rate for Payer: Aetna Commercial |
$94.30
|
| Rate for Payer: Aetna Medicare |
$73.19
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS MAPPO |
$70.38
|
| Rate for Payer: BCBS Trust/PPO |
$73.05
|
| Rate for Payer: BCN Commercial |
$65.05
|
| Rate for Payer: BCN Medicare Advantage |
$70.38
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$101.34
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$73.89
|
| Rate for Payer: PACE SWMI |
$70.38
|
| Rate for Payer: PHP Medicare Advantage |
$70.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health Medicare |
$70.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.38
|
| Rate for Payer: UHC Medicare Advantage |
$72.49
|
|
|
PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 90744
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$43.05 |
| Rate for Payer: Aetna Commercial |
$40.06
|
| Rate for Payer: Aetna Medicare |
$31.09
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS MAPPO |
$29.90
|
| Rate for Payer: BCBS Trust/PPO |
$31.03
|
| Rate for Payer: BCN Commercial |
$25.88
|
| Rate for Payer: BCN Medicare Advantage |
$29.90
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cofinity Commercial |
$40.06
|
| Rate for Payer: Cofinity Commercial |
$43.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.39
|
| Rate for Payer: PACE SWMI |
$29.90
|
| Rate for Payer: PHP Medicare Advantage |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health Medicare |
$29.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.90
|
| Rate for Payer: UHC Medicare Advantage |
$30.79
|
|
|
PR HFO FLEXION GLOVE PRE OTS
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS L3912
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$91.04 |
| Rate for Payer: Aetna Commercial |
$57.75
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCN Commercial |
$91.04
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.90
|
|
|
PR HFO NONTORSION JNTS PRE CST
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS L3929
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$78.93 |
| Rate for Payer: Aetna Commercial |
$50.06
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCN Commercial |
$78.93
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
|
|
PR HFO W/JOINT(S) CF
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
HCPCS L3921
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$277.59 |
| Rate for Payer: Aetna Commercial |
$176.08
|
| Rate for Payer: BCBS Complete |
$117.60
|
| Rate for Payer: BCN Commercial |
$277.59
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.80
|
|
|
PR HFO W/O JOINTS CF
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS L3913
|
| Min. Negotiated Rate |
$99.20 |
| Max. Negotiated Rate |
$234.03 |
| Rate for Payer: Aetna Commercial |
$148.45
|
| Rate for Payer: BCBS Complete |
$99.20
|
| Rate for Payer: BCN Commercial |
$234.03
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Cash Price |
$198.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.60
|
|
|
PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 90748
|
| Min. Negotiated Rate |
$42.06 |
| Max. Negotiated Rate |
$182.00 |
| Rate for Payer: Aetna Commercial |
$42.90
|
| Rate for Payer: BCBS Complete |
$104.00
|
| Rate for Payer: BCBS Trust/PPO |
$42.85
|
| Rate for Payer: BCN Commercial |
$42.06
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.00
|
|
|
PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 90647
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$30.53 |
| Rate for Payer: Aetna Commercial |
$30.53
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Trust/PPO |
$28.36
|
| Rate for Payer: BCN Commercial |
$28.36
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
|
|
PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90648
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$13.32
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$18.57
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
|
|
PR HIB VACCINE, HBOC, IM
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 90645
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$21.70 |
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
|
|
PR HIB VACCINE, PRP-D, IM
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90646
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
|
|
PR HINGE EXTENSION/FLEX WRIST/F
|
Professional
|
Both
|
$1,482.00
|
|
|
Service Code
|
HCPCS L3900
|
| Min. Negotiated Rate |
$592.80 |
| Max. Negotiated Rate |
$1,399.87 |
| Rate for Payer: Aetna Commercial |
$887.96
|
| Rate for Payer: BCBS Complete |
$592.80
|
| Rate for Payer: BCN Commercial |
$1,399.87
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Cash Price |
$1,185.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,037.40
|
|
|
PR HOME HEALTH CARE SUPERVISION
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS G0181
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$150.52 |
| Rate for Payer: Aetna Commercial |
$135.23
|
| Rate for Payer: Aetna Medicare |
$104.96
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$100.92
|
| Rate for Payer: BCBS Trust/PPO |
$90.87
|
| Rate for Payer: BCN Commercial |
$150.52
|
| Rate for Payer: BCN Medicare Advantage |
$100.92
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$145.32
|
| Rate for Payer: Cofinity Commercial |
$135.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.97
|
| Rate for Payer: PACE SWMI |
$100.92
|
| Rate for Payer: PHP Medicare Advantage |
$100.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.33
|
| Rate for Payer: Priority Health Medicare |
$100.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.92
|
| Rate for Payer: UHC Medicare Advantage |
$103.95
|
|
|
PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 99350
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$507.70 |
| Rate for Payer: Aetna Commercial |
$243.95
|
| Rate for Payer: Aetna Medicare |
$189.33
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS MAPPO |
$182.05
|
| Rate for Payer: BCBS Trust/PPO |
$507.70
|
| Rate for Payer: BCN Commercial |
$268.78
|
| Rate for Payer: BCN Medicare Advantage |
$182.05
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$243.95
|
| Rate for Payer: Cofinity Commercial |
$262.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$191.15
|
| Rate for Payer: PACE SWMI |
$182.05
|
| Rate for Payer: PHP Medicare Advantage |
$182.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.58
|
| Rate for Payer: Priority Health Medicare |
$182.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$182.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.05
|
| Rate for Payer: UHC Medicare Advantage |
$187.51
|
|
|
PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 99348
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$125.21 |
| Rate for Payer: Aetna Commercial |
$99.74
|
| Rate for Payer: Aetna Medicare |
$77.41
|
| Rate for Payer: BCBS Complete |
$58.80
|
| Rate for Payer: BCBS MAPPO |
$74.43
|
| Rate for Payer: BCBS Trust/PPO |
$125.21
|
| Rate for Payer: BCN Commercial |
$109.95
|
| Rate for Payer: BCN Medicare Advantage |
$74.43
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$99.74
|
| Rate for Payer: Cofinity Commercial |
$107.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$78.15
|
| Rate for Payer: PACE SWMI |
$74.43
|
| Rate for Payer: PHP Medicare Advantage |
$74.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$96.38
|
| Rate for Payer: Priority Health Medicare |
$74.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.43
|
| Rate for Payer: UHC Medicare Advantage |
$76.66
|
|
|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 99349
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$288.45 |
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: Aetna Medicare |
$129.68
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$124.69
|
| Rate for Payer: BCBS Trust/PPO |
$288.45
|
| Rate for Payer: BCN Commercial |
$184.23
|
| Rate for Payer: BCN Medicare Advantage |
$124.69
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$179.55
|
| Rate for Payer: Cofinity Commercial |
$167.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$130.92
|
| Rate for Payer: PACE SWMI |
$124.69
|
| Rate for Payer: PHP Medicare Advantage |
$124.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.47
|
| Rate for Payer: Priority Health Medicare |
$124.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$161.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.69
|
| Rate for Payer: UHC Medicare Advantage |
$128.43
|
|
|
PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 99347
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$728.53 |
| Rate for Payer: Aetna Commercial |
$58.54
|
| Rate for Payer: Aetna Medicare |
$45.44
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS MAPPO |
$43.69
|
| Rate for Payer: BCBS Trust/PPO |
$728.53
|
| Rate for Payer: BCN Commercial |
$64.51
|
| Rate for Payer: BCN Medicare Advantage |
$43.69
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$58.54
|
| Rate for Payer: Cofinity Commercial |
$62.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.87
|
| Rate for Payer: PACE SWMI |
$43.69
|
| Rate for Payer: PHP Medicare Advantage |
$43.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.54
|
| Rate for Payer: Priority Health Medicare |
$43.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$56.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.69
|
| Rate for Payer: UHC Medicare Advantage |
$45.00
|
|
|
PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
HCPCS 99345
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$321.73 |
| Rate for Payer: Aetna Commercial |
$264.93
|
| Rate for Payer: Aetna Medicare |
$205.62
|
| Rate for Payer: BCBS Complete |
$158.40
|
| Rate for Payer: BCBS MAPPO |
$197.71
|
| Rate for Payer: BCBS Trust/PPO |
$321.73
|
| Rate for Payer: BCN Commercial |
$292.23
|
| Rate for Payer: BCN Medicare Advantage |
$197.71
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Commercial |
$264.93
|
| Rate for Payer: Cofinity Commercial |
$284.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$207.60
|
| Rate for Payer: PACE SWMI |
$197.71
|
| Rate for Payer: PHP Medicare Advantage |
$197.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$256.14
|
| Rate for Payer: Priority Health Medicare |
$197.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$256.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.71
|
| Rate for Payer: UHC Medicare Advantage |
$203.64
|
|
|
PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 99342
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$133.13 |
| Rate for Payer: Aetna Commercial |
$102.42
|
| Rate for Payer: Aetna Medicare |
$79.49
|
| Rate for Payer: BCBS Complete |
$63.60
|
| Rate for Payer: BCBS MAPPO |
$76.43
|
| Rate for Payer: BCBS Trust/PPO |
$133.13
|
| Rate for Payer: BCN Commercial |
$112.40
|
| Rate for Payer: BCN Medicare Advantage |
$76.43
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cofinity Commercial |
$110.06
|
| Rate for Payer: Cofinity Commercial |
$102.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$80.25
|
| Rate for Payer: PACE SWMI |
$76.43
|
| Rate for Payer: PHP Medicare Advantage |
$76.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.51
|
| Rate for Payer: Priority Health Medicare |
$76.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.43
|
| Rate for Payer: UHC Medicare Advantage |
$78.72
|
|
|
PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 99344
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$216.30 |
| Rate for Payer: Aetna Commercial |
$188.77
|
| Rate for Payer: Aetna Medicare |
$146.50
|
| Rate for Payer: BCBS Complete |
$123.60
|
| Rate for Payer: BCBS MAPPO |
$140.87
|
| Rate for Payer: BCBS Trust/PPO |
$178.57
|
| Rate for Payer: BCN Commercial |
$207.69
|
| Rate for Payer: BCN Medicare Advantage |
$140.87
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cofinity Commercial |
$202.85
|
| Rate for Payer: Cofinity Commercial |
$188.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.91
|
| Rate for Payer: PACE SWMI |
$140.87
|
| Rate for Payer: PHP Medicare Advantage |
$140.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.04
|
| Rate for Payer: Priority Health Medicare |
$140.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$182.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.87
|
| Rate for Payer: UHC Medicare Advantage |
$145.10
|
|
|
PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES
|
Professional
|
Both
|
$127.00
|
|
|
Service Code
|
HCPCS 99341
|
| Min. Negotiated Rate |
$47.69 |
| Max. Negotiated Rate |
$431.62 |
| Rate for Payer: Aetna Commercial |
$63.90
|
| Rate for Payer: Aetna Medicare |
$49.60
|
| Rate for Payer: BCBS Complete |
$50.80
|
| Rate for Payer: BCBS MAPPO |
$47.69
|
| Rate for Payer: BCBS Trust/PPO |
$431.62
|
| Rate for Payer: BCN Commercial |
$70.37
|
| Rate for Payer: BCN Medicare Advantage |
$47.69
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cash Price |
$101.60
|
| Rate for Payer: Cofinity Commercial |
$63.90
|
| Rate for Payer: Cofinity Commercial |
$68.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.07
|
| Rate for Payer: PACE SWMI |
$47.69
|
| Rate for Payer: PHP Medicare Advantage |
$47.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.68
|
| Rate for Payer: Priority Health Medicare |
$47.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.69
|
| Rate for Payer: UHC Medicare Advantage |
$49.12
|
|
|
PR HOME SLEEP TEST/TYPE 3 PORTA
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS G0399
|
| Min. Negotiated Rate |
$136.09 |
| Max. Negotiated Rate |
$1,157.51 |
| Rate for Payer: Aetna Commercial |
$187.42
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,157.51
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.09
|
|
|
PR HOME SLEEP TEST/TYPE 4 PORTA
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS G0400
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$1,317.05 |
| Rate for Payer: Aetna Commercial |
$162.24
|
| Rate for Payer: Aetna Commercial |
$162.24
|
| Rate for Payer: Aetna Commercial |
$162.24
|
| Rate for Payer: BCBS Complete |
$82.00
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,317.05
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$243.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.63
|
|
