|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI
|
Professional
|
Both
|
$1,260.00
|
|
|
Service Code
|
HCPCS 58600
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$882.00 |
| Rate for Payer: Aetna Commercial |
$492.81
|
| Rate for Payer: Aetna Medicare |
$382.48
|
| Rate for Payer: BCBS Complete |
$251.16
|
| Rate for Payer: BCBS MAPPO |
$367.77
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCN Commercial |
$545.36
|
| Rate for Payer: BCN Medicare Advantage |
$367.77
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Cofinity Commercial |
$529.59
|
| Rate for Payer: Cofinity Commercial |
$492.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$367.77
|
| Rate for Payer: Mclaren Medicaid |
$239.20
|
| Rate for Payer: Meridian Medicaid |
$251.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$386.16
|
| Rate for Payer: PACE SWMI |
$367.77
|
| Rate for Payer: PHP Medicare Advantage |
$367.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$882.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$528.34
|
| Rate for Payer: Priority Health Medicare |
$367.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$528.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$367.77
|
| Rate for Payer: UHC Medicare Advantage |
$378.80
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS 58605
|
| Min. Negotiated Rate |
$217.47 |
| Max. Negotiated Rate |
$593.60 |
| Rate for Payer: Aetna Commercial |
$447.81
|
| Rate for Payer: Aetna Medicare |
$347.56
|
| Rate for Payer: BCBS Complete |
$228.34
|
| Rate for Payer: BCBS MAPPO |
$334.19
|
| Rate for Payer: BCBS Trust/PPO |
$264.15
|
| Rate for Payer: BCN Commercial |
$496.00
|
| Rate for Payer: BCN Medicare Advantage |
$334.19
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cash Price |
$678.40
|
| Rate for Payer: Cofinity Commercial |
$481.23
|
| Rate for Payer: Cofinity Commercial |
$447.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$334.19
|
| Rate for Payer: Mclaren Medicaid |
$217.47
|
| Rate for Payer: Meridian Medicaid |
$228.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$350.90
|
| Rate for Payer: PACE SWMI |
$334.19
|
| Rate for Payer: PHP Medicare Advantage |
$334.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$593.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.53
|
| Rate for Payer: Priority Health Medicare |
$334.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$480.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$334.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$334.19
|
| Rate for Payer: UHC Medicare Advantage |
$344.22
|
|
|
PR LILETTA, 52 MG
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
HCPCS J7297
|
| Min. Negotiated Rate |
$604.10 |
| Max. Negotiated Rate |
$887.36 |
| Rate for Payer: Aetna Commercial |
$845.10
|
| Rate for Payer: BCBS Complete |
$887.36
|
| Rate for Payer: BCBS Trust/PPO |
$856.93
|
| Rate for Payer: BCN Commercial |
$856.93
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Mclaren Medicaid |
$845.10
|
| Rate for Payer: Meridian Medicaid |
$887.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$845.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$604.10
|
|
|
PR LINCOMYCIN INJECTION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS J2010
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$14.39 |
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Aetna Medicare |
$10.39
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$9.99
|
| Rate for Payer: BCBS Trust/PPO |
$7.48
|
| Rate for Payer: BCN Commercial |
$7.86
|
| Rate for Payer: BCN Medicare Advantage |
$9.99
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$14.39
|
| Rate for Payer: Cofinity Commercial |
$13.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.49
|
| Rate for Payer: PACE SWMI |
$9.99
|
| Rate for Payer: PHP Medicare Advantage |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health Medicare |
$9.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.99
|
| Rate for Payer: UHC Medicare Advantage |
$10.29
|
|
|
PR LITHOLAPAXY COMP/LG > 2.5 CM
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 52318
|
| Min. Negotiated Rate |
$296.92 |
| Max. Negotiated Rate |
$1,353.50 |
| Rate for Payer: Aetna Commercial |
$616.21
|
| Rate for Payer: Aetna Medicare |
$478.25
|
| Rate for Payer: BCBS Complete |
$311.77
|
| Rate for Payer: BCBS MAPPO |
$459.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,353.50
|
| Rate for Payer: BCN Commercial |
$674.37
|
| Rate for Payer: BCN Medicare Advantage |
$459.86
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$662.20
|
| Rate for Payer: Cofinity Commercial |
$616.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$459.86
|
| Rate for Payer: Mclaren Medicaid |
$296.92
|
| Rate for Payer: Meridian Medicaid |
$311.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$482.85
|
| Rate for Payer: PACE SWMI |
$459.86
|
| Rate for Payer: PHP Medicare Advantage |
$459.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$642.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$745.69
|
| Rate for Payer: Priority Health Medicare |
$459.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$745.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$459.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$459.86
|
| Rate for Payer: UHC Medicare Advantage |
$473.66
|
|
|
PR LITHOLAPAXY SMPL/SM <2.5 CM
|
Professional
|
Both
|
$1,625.00
|
|
|
Service Code
|
HCPCS 52317
|
| Min. Negotiated Rate |
$217.26 |
| Max. Negotiated Rate |
$1,298.41 |
| Rate for Payer: Aetna Commercial |
$451.26
|
| Rate for Payer: Aetna Medicare |
$350.23
|
| Rate for Payer: BCBS Complete |
$228.12
|
| Rate for Payer: BCBS MAPPO |
$336.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,148.52
|
| Rate for Payer: BCN Commercial |
$1,298.41
|
| Rate for Payer: BCN Medicare Advantage |
$336.76
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cash Price |
$1,300.00
|
| Rate for Payer: Cofinity Commercial |
$484.93
|
| Rate for Payer: Cofinity Commercial |
$451.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$336.76
|
| Rate for Payer: Mclaren Medicaid |
$217.26
|
| Rate for Payer: Meridian Medicaid |
$228.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$353.60
|
| Rate for Payer: PACE SWMI |
$336.76
|
| Rate for Payer: PHP Medicare Advantage |
$336.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$217.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,137.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$546.30
|
| Rate for Payer: Priority Health Medicare |
$336.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$546.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$336.76
|
| Rate for Payer: UHC Medicare Advantage |
$346.86
|
|
|
PR LITHOTRIPSY XTRCORP SHOCK WAVE
|
Professional
|
Both
|
$1,517.00
|
|
|
Service Code
|
HCPCS 50590
|
| Min. Negotiated Rate |
$365.30 |
| Max. Negotiated Rate |
$1,184.30 |
| Rate for Payer: Aetna Commercial |
$745.96
|
| Rate for Payer: Aetna Medicare |
$578.96
|
| Rate for Payer: BCBS Complete |
$383.56
|
| Rate for Payer: BCBS MAPPO |
$556.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.83
|
| Rate for Payer: BCN Commercial |
$1,184.30
|
| Rate for Payer: BCN Medicare Advantage |
$556.69
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cash Price |
$1,213.60
|
| Rate for Payer: Cofinity Commercial |
$801.63
|
| Rate for Payer: Cofinity Commercial |
$745.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$556.69
|
| Rate for Payer: Mclaren Medicaid |
$365.30
|
| Rate for Payer: Meridian Medicaid |
$383.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$584.52
|
| Rate for Payer: PACE SWMI |
$556.69
|
| Rate for Payer: PHP Medicare Advantage |
$556.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$365.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$911.59
|
| Rate for Payer: Priority Health Medicare |
$556.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$911.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$556.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$556.69
|
| Rate for Payer: UHC Medicare Advantage |
$573.39
|
|
|
PR LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC
|
Professional
|
Both
|
$3,865.00
|
|
|
Service Code
|
HCPCS 38562
|
| Min. Negotiated Rate |
$453.26 |
| Max. Negotiated Rate |
$2,705.50 |
| Rate for Payer: Aetna Commercial |
$930.20
|
| Rate for Payer: Aetna Medicare |
$721.95
|
| Rate for Payer: BCBS Complete |
$475.92
|
| Rate for Payer: BCBS MAPPO |
$694.18
|
| Rate for Payer: BCBS Trust/PPO |
$667.24
|
| Rate for Payer: BCN Commercial |
$1,029.16
|
| Rate for Payer: BCN Medicare Advantage |
$694.18
|
| Rate for Payer: Cash Price |
$3,092.00
|
| Rate for Payer: Cash Price |
$3,092.00
|
| Rate for Payer: Cofinity Commercial |
$999.62
|
| Rate for Payer: Cofinity Commercial |
$930.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$694.18
|
| Rate for Payer: Mclaren Medicaid |
$453.26
|
| Rate for Payer: Meridian Medicaid |
$475.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$728.89
|
| Rate for Payer: PACE SWMI |
$694.18
|
| Rate for Payer: PHP Medicare Advantage |
$694.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,705.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,525.45
|
| Rate for Payer: Priority Health Medicare |
$694.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,525.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$694.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$694.18
|
| Rate for Payer: UHC Medicare Advantage |
$715.01
|
|
|
PR LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC
|
Professional
|
Both
|
$2,775.00
|
|
|
Service Code
|
HCPCS 38564
|
| Min. Negotiated Rate |
$448.58 |
| Max. Negotiated Rate |
$1,942.50 |
| Rate for Payer: Aetna Commercial |
$931.34
|
| Rate for Payer: Aetna Medicare |
$722.83
|
| Rate for Payer: BCBS Complete |
$471.01
|
| Rate for Payer: BCBS MAPPO |
$695.03
|
| Rate for Payer: BCBS Trust/PPO |
$543.62
|
| Rate for Payer: BCN Commercial |
$1,024.27
|
| Rate for Payer: BCN Medicare Advantage |
$695.03
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cash Price |
$2,220.00
|
| Rate for Payer: Cofinity Commercial |
$931.34
|
| Rate for Payer: Cofinity Commercial |
$1,000.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$695.03
|
| Rate for Payer: Mclaren Medicaid |
$448.58
|
| Rate for Payer: Meridian Medicaid |
$471.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$729.78
|
| Rate for Payer: PACE SWMI |
$695.03
|
| Rate for Payer: PHP Medicare Advantage |
$695.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$448.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,942.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,518.23
|
| Rate for Payer: Priority Health Medicare |
$695.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,518.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$695.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$695.03
|
| Rate for Payer: UHC Medicare Advantage |
$715.88
|
|
|
PR LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN
|
Professional
|
Both
|
$1,588.00
|
|
|
Service Code
|
HCPCS 25280
|
| Min. Negotiated Rate |
$368.92 |
| Max. Negotiated Rate |
$1,111.60 |
| Rate for Payer: Aetna Commercial |
$748.52
|
| Rate for Payer: Aetna Medicare |
$580.94
|
| Rate for Payer: BCBS Complete |
$387.37
|
| Rate for Payer: BCBS MAPPO |
$558.60
|
| Rate for Payer: BCBS Trust/PPO |
$760.22
|
| Rate for Payer: BCN Commercial |
$837.11
|
| Rate for Payer: BCN Medicare Advantage |
$558.60
|
| Rate for Payer: Cash Price |
$1,270.40
|
| Rate for Payer: Cash Price |
$1,270.40
|
| Rate for Payer: Cofinity Commercial |
$804.38
|
| Rate for Payer: Cofinity Commercial |
$748.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$558.60
|
| Rate for Payer: Mclaren Medicaid |
$368.92
|
| Rate for Payer: Meridian Medicaid |
$387.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$586.53
|
| Rate for Payer: PACE SWMI |
$558.60
|
| Rate for Payer: PHP Medicare Advantage |
$558.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$368.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,111.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$874.75
|
| Rate for Payer: Priority Health Medicare |
$558.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$874.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$558.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$558.60
|
| Rate for Payer: UHC Medicare Advantage |
$575.36
|
|
|
PR LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA
|
Professional
|
Both
|
$1,335.00
|
|
|
Service Code
|
HCPCS 27686
|
| Min. Negotiated Rate |
$344.21 |
| Max. Negotiated Rate |
$2,402.18 |
| Rate for Payer: Aetna Commercial |
$694.29
|
| Rate for Payer: Aetna Medicare |
$538.86
|
| Rate for Payer: BCBS Complete |
$361.42
|
| Rate for Payer: BCBS MAPPO |
$518.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,402.18
|
| Rate for Payer: BCN Commercial |
$773.09
|
| Rate for Payer: BCN Medicare Advantage |
$518.13
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cash Price |
$1,068.00
|
| Rate for Payer: Cofinity Commercial |
$694.29
|
| Rate for Payer: Cofinity Commercial |
$746.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.13
|
| Rate for Payer: Mclaren Medicaid |
$344.21
|
| Rate for Payer: Meridian Medicaid |
$361.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$544.04
|
| Rate for Payer: PACE SWMI |
$518.13
|
| Rate for Payer: PHP Medicare Advantage |
$518.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$344.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$934.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$807.86
|
| Rate for Payer: Priority Health Medicare |
$518.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$807.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$518.13
|
| Rate for Payer: UHC Medicare Advantage |
$533.67
|
|
|
PR LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX
|
Professional
|
Both
|
$1,785.00
|
|
|
Service Code
|
HCPCS 27685
|
| Min. Negotiated Rate |
$301.82 |
| Max. Negotiated Rate |
$3,119.66 |
| Rate for Payer: Aetna Commercial |
$612.10
|
| Rate for Payer: Aetna Medicare |
$475.06
|
| Rate for Payer: BCBS Complete |
$316.91
|
| Rate for Payer: BCBS MAPPO |
$456.79
|
| Rate for Payer: BCBS Trust/PPO |
$3,119.66
|
| Rate for Payer: BCN Commercial |
$962.69
|
| Rate for Payer: BCN Medicare Advantage |
$456.79
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cash Price |
$1,428.00
|
| Rate for Payer: Cofinity Commercial |
$612.10
|
| Rate for Payer: Cofinity Commercial |
$657.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$456.79
|
| Rate for Payer: Mclaren Medicaid |
$301.82
|
| Rate for Payer: Meridian Medicaid |
$316.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$479.63
|
| Rate for Payer: PACE SWMI |
$456.79
|
| Rate for Payer: PHP Medicare Advantage |
$456.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$301.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,249.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$713.88
|
| Rate for Payer: Priority Health Medicare |
$456.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$713.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$456.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$456.79
|
| Rate for Payer: UHC Medicare Advantage |
$470.49
|
|
|
PR LOCM 250-299MG/ML IODINE,1ML
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS Q9948
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
|
|
PR LORAZEPAM INJECTION
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J2060
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: Aetna Commercial |
$1.14
|
| Rate for Payer: Aetna Medicare |
$0.89
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.48
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$1.23
|
| Rate for Payer: Cofinity Commercial |
$1.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
| Rate for Payer: Priority Health Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.85
|
| Rate for Payer: UHC Medicare Advantage |
$0.88
|
|
|
PR LOWER LID BLEPHAROPLASTY
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 00531
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$720.00 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: BCBS Complete |
$720.00
|
| Rate for Payer: Cash Price |
$1,440.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,260.00
|
|
|
PR LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 20979
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$3,247.68 |
| Rate for Payer: Aetna Commercial |
$42.97
|
| Rate for Payer: Aetna Medicare |
$33.35
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$32.07
|
| Rate for Payer: BCBS Trust/PPO |
$3,247.68
|
| Rate for Payer: BCN Commercial |
$82.58
|
| Rate for Payer: BCN Medicare Advantage |
$32.07
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cofinity Commercial |
$42.97
|
| Rate for Payer: Cofinity Commercial |
$46.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.67
|
| Rate for Payer: PACE SWMI |
$32.07
|
| Rate for Payer: PHP Medicare Advantage |
$32.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.02
|
| Rate for Payer: Priority Health Medicare |
$32.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.07
|
| Rate for Payer: UHC Medicare Advantage |
$33.03
|
|
|
PR LT COMPRES BAND >=3 <5/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6449
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.63
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCN Commercial |
$1.93
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
|
|
PR LT COMPRES BAND <3/YD
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
HCPCS A6448
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.10 |
| Rate for Payer: Aetna Commercial |
$1.07
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCN Commercial |
$1.27
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.10
|
|
|
PR LT COMPRES BAND >=5/YD
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS A6450
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$1.63
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCN Commercial |
$1.93
|
| 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 LUX IR ABD/BACK
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00097
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR LUX IR ARMS
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 00095
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
|
|
PR LUX IR BUTTOCKS
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 00098
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
|
PR LUX IR CHEST
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 00094
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
|
PR LUX IR FACE & NECK
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00093
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
|
PR LUX IR UP LEGS
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 00096
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$175.00 |
| Rate for Payer: BCBS Complete |
$100.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
|
