|
PR INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ
|
Professional
|
Both
|
$2,909.00
|
|
|
Service Code
|
HCPCS 44615
|
| Min. Negotiated Rate |
$190.72 |
| Max. Negotiated Rate |
$2,036.30 |
| Rate for Payer: Aetna Commercial |
$1,414.68
|
| Rate for Payer: Aetna Medicare |
$1,097.96
|
| Rate for Payer: BCBS Complete |
$714.34
|
| Rate for Payer: BCBS MAPPO |
$1,055.73
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$1,550.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,055.73
|
| Rate for Payer: Cash Price |
$2,327.20
|
| Rate for Payer: Cash Price |
$2,327.20
|
| Rate for Payer: Cofinity Commercial |
$1,414.68
|
| Rate for Payer: Cofinity Commercial |
$1,520.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,055.73
|
| Rate for Payer: Mclaren Medicaid |
$680.32
|
| Rate for Payer: Meridian Medicaid |
$714.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,108.52
|
| Rate for Payer: PACE SWMI |
$1,055.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,055.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$680.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,036.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,865.64
|
| Rate for Payer: Priority Health Medicare |
$1,055.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,865.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,055.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,055.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,087.40
|
|
|
PR INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 31500
|
| Min. Negotiated Rate |
$88.82 |
| Max. Negotiated Rate |
$1,530.49 |
| Rate for Payer: Aetna Commercial |
$187.85
|
| Rate for Payer: Aetna Medicare |
$145.80
|
| Rate for Payer: BCBS Complete |
$93.26
|
| Rate for Payer: BCBS MAPPO |
$140.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,530.49
|
| Rate for Payer: BCN Commercial |
$203.78
|
| Rate for Payer: BCN Medicare Advantage |
$140.19
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$201.87
|
| Rate for Payer: Cofinity Commercial |
$187.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.19
|
| Rate for Payer: Mclaren Medicaid |
$88.82
|
| Rate for Payer: Meridian Medicaid |
$93.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.20
|
| Rate for Payer: PACE SWMI |
$140.19
|
| Rate for Payer: PHP Medicare Advantage |
$140.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$88.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$249.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.09
|
| Rate for Payer: Priority Health Medicare |
$140.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.19
|
| Rate for Payer: UHC Medicare Advantage |
$144.40
|
|
|
PR IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 95940
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$595.92 |
| Rate for Payer: Aetna Commercial |
$42.02
|
| Rate for Payer: Aetna Medicare |
$32.61
|
| Rate for Payer: BCBS Complete |
$21.25
|
| Rate for Payer: BCBS MAPPO |
$31.36
|
| Rate for Payer: BCBS Trust/PPO |
$595.92
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: BCN Medicare Advantage |
$31.36
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$42.02
|
| Rate for Payer: Cofinity Commercial |
$45.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.36
|
| Rate for Payer: Mclaren Medicaid |
$20.24
|
| Rate for Payer: Meridian Medicaid |
$21.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.93
|
| Rate for Payer: PACE SWMI |
$31.36
|
| Rate for Payer: PHP Medicare Advantage |
$31.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.66
|
| Rate for Payer: Priority Health Medicare |
$31.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.36
|
| Rate for Payer: UHC Medicare Advantage |
$32.30
|
|
|
PR IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 95941
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$299.74 |
| Rate for Payer: Aetna Commercial |
$299.74
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Trust/PPO |
$126.79
|
| Rate for Payer: BCN Commercial |
$104.76
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT HIGH MDM 80 MINUTES
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
HCPCS 99255
|
| Min. Negotiated Rate |
$75.02 |
| Max. Negotiated Rate |
$269.75 |
| Rate for Payer: Aetna Commercial |
$208.05
|
| Rate for Payer: BCBS Complete |
$123.68
|
| Rate for Payer: BCBS Trust/PPO |
$75.02
|
| Rate for Payer: BCN Commercial |
$269.75
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Mclaren Medicaid |
$117.79
|
| Rate for Payer: Meridian Medicaid |
$123.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$117.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$236.44
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
HCPCS 99253
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$286.87 |
| Rate for Payer: Aetna Commercial |
$119.14
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS Trust/PPO |
$286.87
|
| Rate for Payer: BCN Commercial |
$144.65
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Cash Price |
$164.00
|
| Rate for Payer: Mclaren Medicaid |
$63.05
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.79
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 99254
|
| Min. Negotiated Rate |
$87.54 |
| Max. Negotiated Rate |
$245.66 |
| Rate for Payer: Aetna Commercial |
$172.55
|
| Rate for Payer: BCBS Complete |
$91.92
|
| Rate for Payer: BCBS Trust/PPO |
$245.66
|
| Rate for Payer: BCN Commercial |
$201.34
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Mclaren Medicaid |
$87.54
|
| Rate for Payer: Meridian Medicaid |
$91.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.47
|
|
|
PR IP/OBS CONSLTJ NEW/EST PT SF MDM 35 MINUTES
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 99252
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$77.71
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$176.98
|
| Rate for Payer: BCN Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Mclaren Medicaid |
$44.94
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.80
|
|
|
PR IPRATROPIUM BROMIDE NON-COMP
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J7644
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$0.35
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$0.35
|
| Rate for Payer: Cofinity Commercial |
$0.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.27
|
|
|
PR IR DEEP HEAT PAIN RELIEF 15MIN
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00099
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
|
|
PR IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 96523
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$1,469.20 |
| Rate for Payer: Aetna Commercial |
$31.68
|
| Rate for Payer: Aetna Medicare |
$24.59
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS MAPPO |
$23.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.20
|
| Rate for Payer: BCN Commercial |
$37.14
|
| Rate for Payer: BCN Medicare Advantage |
$23.64
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$31.68
|
| Rate for Payer: Cofinity Commercial |
$34.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.82
|
| Rate for Payer: PACE SWMI |
$23.64
|
| Rate for Payer: PHP Medicare Advantage |
$23.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.13
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.64
|
| Rate for Payer: UHC Medicare Advantage |
$24.35
|
|
|
PR IRRIGATION CORPORA CAVERNOSA PRIAPISM
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 54220
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$460.68 |
| Rate for Payer: Aetna Commercial |
$175.54
|
| Rate for Payer: Aetna Medicare |
$136.24
|
| Rate for Payer: BCBS Complete |
$89.91
|
| Rate for Payer: BCBS MAPPO |
$131.00
|
| Rate for Payer: BCBS Trust/PPO |
$460.68
|
| Rate for Payer: BCN Commercial |
$321.55
|
| Rate for Payer: BCN Medicare Advantage |
$131.00
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$188.64
|
| Rate for Payer: Cofinity Commercial |
$175.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.00
|
| Rate for Payer: Mclaren Medicaid |
$85.63
|
| Rate for Payer: Meridian Medicaid |
$89.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.55
|
| Rate for Payer: PACE SWMI |
$131.00
|
| Rate for Payer: PHP Medicare Advantage |
$131.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.91
|
| Rate for Payer: Priority Health Medicare |
$131.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.00
|
| Rate for Payer: UHC Medicare Advantage |
$134.93
|
|
|
PR IRRIGATION TRAY
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4320
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$4.58
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
|
|
PR IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 57150
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$2,018.63 |
| Rate for Payer: Aetna Commercial |
$34.48
|
| Rate for Payer: Aetna Medicare |
$26.76
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,018.63
|
| Rate for Payer: BCN Commercial |
$85.52
|
| Rate for Payer: BCN Medicare Advantage |
$25.73
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$37.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.02
|
| Rate for Payer: PACE SWMI |
$25.73
|
| Rate for Payer: PHP Medicare Advantage |
$25.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.45
|
| Rate for Payer: Priority Health Medicare |
$25.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.73
|
| Rate for Payer: UHC Medicare Advantage |
$26.50
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 93571
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$285.14
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 93572
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Aetna Commercial |
$145.84
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$165.66
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.15
|
|
|
PR IV INFUSION HYDRATION EACH ADDITIONAL HOUR
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 96361
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Aetna Medicare |
$12.54
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$12.06
|
| Rate for Payer: BCBS Trust/PPO |
$22.72
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: BCN Medicare Advantage |
$12.06
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$17.37
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.66
|
| Rate for Payer: PACE SWMI |
$12.06
|
| Rate for Payer: PHP Medicare Advantage |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.07
|
| Rate for Payer: Priority Health Medicare |
$12.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.06
|
| Rate for Payer: UHC Medicare Advantage |
$12.42
|
|
|
PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 96360
|
| Min. Negotiated Rate |
$30.51 |
| Max. Negotiated Rate |
$190.72 |
| Rate for Payer: Aetna Commercial |
$40.88
|
| Rate for Payer: Aetna Medicare |
$31.73
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: BCBS MAPPO |
$30.51
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: BCN Medicare Advantage |
$30.51
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cofinity Commercial |
$40.88
|
| Rate for Payer: Cofinity Commercial |
$43.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.04
|
| Rate for Payer: PACE SWMI |
$30.51
|
| Rate for Payer: PHP Medicare Advantage |
$30.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.57
|
| Rate for Payer: Priority Health Medicare |
$30.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.51
|
| Rate for Payer: UHC Medicare Advantage |
$31.43
|
|
|
PR IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 96365
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$80.16
|
| Rate for Payer: Aetna Medicare |
$62.21
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$59.82
|
| Rate for Payer: BCBS Trust/PPO |
$168.00
|
| Rate for Payer: BCN Commercial |
$93.34
|
| Rate for Payer: BCN Medicare Advantage |
$59.82
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$80.16
|
| Rate for Payer: Cofinity Commercial |
$86.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.81
|
| Rate for Payer: PACE SWMI |
$59.82
|
| Rate for Payer: PHP Medicare Advantage |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.78
|
| Rate for Payer: Priority Health Medicare |
$59.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.82
|
| Rate for Payer: UHC Medicare Advantage |
$61.61
|
|
|
PR IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 96366
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$1,006.94 |
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: Aetna Medicare |
$20.21
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$19.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.94
|
| Rate for Payer: BCN Commercial |
$29.81
|
| Rate for Payer: BCN Medicare Advantage |
$19.43
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$26.04
|
| Rate for Payer: Cofinity Commercial |
$27.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.40
|
| Rate for Payer: PACE SWMI |
$19.43
|
| Rate for Payer: PHP Medicare Advantage |
$19.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.40
|
| Rate for Payer: Priority Health Medicare |
$19.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$27.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.43
|
| Rate for Payer: UHC Medicare Advantage |
$20.01
|
|
|
PR IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 96367
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$1,165.43 |
| Rate for Payer: Aetna Commercial |
$36.42
|
| Rate for Payer: Aetna Medicare |
$28.27
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS MAPPO |
$27.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.43
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Medicare Advantage |
$27.18
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Cofinity Commercial |
$36.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.54
|
| Rate for Payer: PACE SWMI |
$27.18
|
| Rate for Payer: PHP Medicare Advantage |
$27.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.62
|
| Rate for Payer: Priority Health Medicare |
$27.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.18
|
| Rate for Payer: UHC Medicare Advantage |
$28.00
|
|
|
PR IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 15860
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$10,615.31 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Medicare |
$109.67
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS MAPPO |
$105.45
|
| Rate for Payer: BCBS Trust/PPO |
$10,615.31
|
| Rate for Payer: BCN Commercial |
$154.42
|
| Rate for Payer: BCN Medicare Advantage |
$105.45
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$151.85
|
| Rate for Payer: Cofinity Commercial |
$141.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.45
|
| Rate for Payer: Mclaren Medicaid |
$67.31
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$110.72
|
| Rate for Payer: PACE SWMI |
$105.45
|
| Rate for Payer: PHP Medicare Advantage |
$105.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.88
|
| Rate for Payer: Priority Health Medicare |
$105.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.45
|
| Rate for Payer: UHC Medicare Advantage |
$108.61
|
|
|
PR IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 96368
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$1,117.88 |
| Rate for Payer: Aetna Commercial |
$25.17
|
| Rate for Payer: Aetna Medicare |
$19.53
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$18.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.88
|
| Rate for Payer: BCN Commercial |
$28.83
|
| Rate for Payer: BCN Medicare Advantage |
$18.78
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$27.04
|
| Rate for Payer: Cofinity Commercial |
$25.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.72
|
| Rate for Payer: PACE SWMI |
$18.78
|
| Rate for Payer: PHP Medicare Advantage |
$18.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.49
|
| Rate for Payer: Priority Health Medicare |
$18.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.78
|
| Rate for Payer: UHC Medicare Advantage |
$19.34
|
|
|
PR IV ULTRASOUND,FIRST VESSEL
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 37250
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR KETOROLAC TROMETHAMINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1885
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$0.73
|
| Rate for Payer: Aetna Medicare |
$0.57
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$0.55
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: BCN Medicare Advantage |
$0.55
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Cofinity Commercial |
$0.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: PACE SWMI |
$0.55
|
| Rate for Payer: PHP Medicare Advantage |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.56
|
|
