|
PR PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 19282
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$65.61
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: BCBS Complete |
$32.43
|
| Rate for Payer: BCBS MAPPO |
$48.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,700.00
|
| Rate for Payer: BCN Commercial |
$252.16
|
| Rate for Payer: BCN Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$65.61
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$30.89
|
| Rate for Payer: Meridian Medicaid |
$32.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$51.41
|
| Rate for Payer: PACE SWMI |
$48.96
|
| Rate for Payer: PHP Medicare Advantage |
$48.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.42
|
| Rate for Payer: Priority Health Medicare |
$48.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$60.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.96
|
| Rate for Payer: UHC Medicare Advantage |
$50.43
|
|
|
PR PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 50436
|
| Min. Negotiated Rate |
$93.29 |
| Max. Negotiated Rate |
$1,729.65 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna Medicare |
$150.38
|
| Rate for Payer: BCBS Complete |
$97.95
|
| Rate for Payer: BCBS MAPPO |
$144.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,729.65
|
| Rate for Payer: BCN Commercial |
$213.06
|
| Rate for Payer: BCN Medicare Advantage |
$144.60
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$208.22
|
| Rate for Payer: Cofinity Commercial |
$193.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.60
|
| Rate for Payer: Mclaren Medicaid |
$93.29
|
| Rate for Payer: Meridian Medicaid |
$97.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$151.83
|
| Rate for Payer: PACE SWMI |
$144.60
|
| Rate for Payer: PHP Medicare Advantage |
$144.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$235.60
|
| Rate for Payer: Priority Health Medicare |
$144.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$235.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.60
|
| Rate for Payer: UHC Medicare Advantage |
$148.94
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Professional
|
Both
|
$965.00
|
|
|
Service Code
|
HCPCS 32557
|
| Min. Negotiated Rate |
$93.08 |
| Max. Negotiated Rate |
$980.78 |
| Rate for Payer: Aetna Commercial |
$196.04
|
| Rate for Payer: Aetna Medicare |
$152.15
|
| Rate for Payer: BCBS Complete |
$97.73
|
| Rate for Payer: BCBS MAPPO |
$146.30
|
| Rate for Payer: BCBS Trust/PPO |
$656.15
|
| Rate for Payer: BCN Commercial |
$980.78
|
| Rate for Payer: BCN Medicare Advantage |
$146.30
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cash Price |
$772.00
|
| Rate for Payer: Cofinity Commercial |
$210.67
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.30
|
| Rate for Payer: Mclaren Medicaid |
$93.08
|
| Rate for Payer: Meridian Medicaid |
$97.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$153.62
|
| Rate for Payer: PACE SWMI |
$146.30
|
| Rate for Payer: PHP Medicare Advantage |
$146.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$93.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$675.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$202.82
|
| Rate for Payer: Priority Health Medicare |
$146.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.30
|
| Rate for Payer: UHC Medicare Advantage |
$150.69
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
|
Professional
|
Both
|
$867.00
|
|
|
Service Code
|
HCPCS 32556
|
| Min. Negotiated Rate |
$77.96 |
| Max. Negotiated Rate |
$1,091.21 |
| Rate for Payer: Aetna Commercial |
$163.72
|
| Rate for Payer: Aetna Medicare |
$127.07
|
| Rate for Payer: BCBS Complete |
$81.86
|
| Rate for Payer: BCBS MAPPO |
$122.18
|
| Rate for Payer: BCBS Trust/PPO |
$507.70
|
| Rate for Payer: BCN Commercial |
$1,091.21
|
| Rate for Payer: BCN Medicare Advantage |
$122.18
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cash Price |
$693.60
|
| Rate for Payer: Cofinity Commercial |
$175.94
|
| Rate for Payer: Cofinity Commercial |
$163.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.18
|
| Rate for Payer: Mclaren Medicaid |
$77.96
|
| Rate for Payer: Meridian Medicaid |
$81.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.29
|
| Rate for Payer: PACE SWMI |
$122.18
|
| Rate for Payer: PHP Medicare Advantage |
$122.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$606.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.01
|
| Rate for Payer: Priority Health Medicare |
$122.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.18
|
| Rate for Payer: UHC Medicare Advantage |
$125.85
|
|
|
PR PERQ NL/PL LITHOTRP COMPLEX >2 CM MLT LOCATIONS
|
Professional
|
Both
|
$2,400.00
|
|
|
Service Code
|
HCPCS 50081
|
| Min. Negotiated Rate |
$712.27 |
| Max. Negotiated Rate |
$2,246.86 |
| Rate for Payer: Aetna Commercial |
$1,472.77
|
| Rate for Payer: Aetna Medicare |
$1,143.04
|
| Rate for Payer: BCBS Complete |
$747.88
|
| Rate for Payer: BCBS MAPPO |
$1,099.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,246.86
|
| Rate for Payer: BCN Commercial |
$1,618.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,099.08
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Cofinity Commercial |
$1,582.68
|
| Rate for Payer: Cofinity Commercial |
$1,472.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,099.08
|
| Rate for Payer: Mclaren Medicaid |
$712.27
|
| Rate for Payer: Meridian Medicaid |
$747.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,154.03
|
| Rate for Payer: PACE SWMI |
$1,099.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,099.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$712.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,680.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,789.13
|
| Rate for Payer: Priority Health Medicare |
$1,099.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,789.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,099.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,099.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,132.05
|
|
|
PR PERQ NL/PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION
|
Professional
|
Both
|
$1,631.00
|
|
|
Service Code
|
HCPCS 50080
|
| Min. Negotiated Rate |
$442.83 |
| Max. Negotiated Rate |
$1,141.70 |
| Rate for Payer: Aetna Commercial |
$911.41
|
| Rate for Payer: Aetna Medicare |
$707.37
|
| Rate for Payer: BCBS Complete |
$464.97
|
| Rate for Payer: BCBS MAPPO |
$680.16
|
| Rate for Payer: BCBS Trust/PPO |
$652.45
|
| Rate for Payer: BCN Commercial |
$1,004.24
|
| Rate for Payer: BCN Medicare Advantage |
$680.16
|
| Rate for Payer: Cash Price |
$1,304.80
|
| Rate for Payer: Cash Price |
$1,304.80
|
| Rate for Payer: Cofinity Commercial |
$911.41
|
| Rate for Payer: Cofinity Commercial |
$979.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$680.16
|
| Rate for Payer: Mclaren Medicaid |
$442.83
|
| Rate for Payer: Meridian Medicaid |
$464.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$714.17
|
| Rate for Payer: PACE SWMI |
$680.16
|
| Rate for Payer: PHP Medicare Advantage |
$680.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$442.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,141.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.43
|
| Rate for Payer: Priority Health Medicare |
$680.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,110.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$680.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$680.16
|
| Rate for Payer: UHC Medicare Advantage |
$700.56
|
|
|
PR PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$498.00
|
|
|
Service Code
|
HCPCS 33017
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$750.19 |
| Rate for Payer: Aetna Commercial |
$323.86
|
| Rate for Payer: Aetna Medicare |
$251.36
|
| Rate for Payer: BCBS Complete |
$162.15
|
| Rate for Payer: BCBS MAPPO |
$241.69
|
| Rate for Payer: BCBS Trust/PPO |
$750.19
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: BCN Medicare Advantage |
$241.69
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cofinity Commercial |
$348.03
|
| Rate for Payer: Cofinity Commercial |
$323.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$241.69
|
| Rate for Payer: Mclaren Medicaid |
$154.43
|
| Rate for Payer: Meridian Medicaid |
$162.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$253.77
|
| Rate for Payer: PACE SWMI |
$241.69
|
| Rate for Payer: PHP Medicare Advantage |
$241.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$154.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$348.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$383.01
|
| Rate for Payer: Priority Health Medicare |
$241.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$383.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$241.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$241.69
|
| Rate for Payer: UHC Medicare Advantage |
$248.94
|
|
|
PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
HCPCS 43762
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$334.75 |
| Rate for Payer: Aetna Commercial |
$49.02
|
| Rate for Payer: Aetna Medicare |
$38.04
|
| Rate for Payer: BCBS Complete |
$24.82
|
| Rate for Payer: BCBS MAPPO |
$36.58
|
| Rate for Payer: BCBS Trust/PPO |
$210.26
|
| Rate for Payer: BCN Commercial |
$334.75
|
| Rate for Payer: BCN Medicare Advantage |
$36.58
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cofinity Commercial |
$52.68
|
| Rate for Payer: Cofinity Commercial |
$49.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.58
|
| Rate for Payer: Mclaren Medicaid |
$23.64
|
| Rate for Payer: Meridian Medicaid |
$24.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$38.41
|
| Rate for Payer: PACE SWMI |
$36.58
|
| Rate for Payer: PHP Medicare Advantage |
$36.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.09
|
| Rate for Payer: Priority Health Medicare |
$36.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.58
|
| Rate for Payer: UHC Medicare Advantage |
$37.68
|
|
|
PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 43763
|
| Min. Negotiated Rate |
$55.59 |
| Max. Negotiated Rate |
$750.19 |
| Rate for Payer: Aetna Commercial |
$114.86
|
| Rate for Payer: Aetna Medicare |
$89.15
|
| Rate for Payer: BCBS Complete |
$58.37
|
| Rate for Payer: BCBS MAPPO |
$85.72
|
| Rate for Payer: BCBS Trust/PPO |
$750.19
|
| Rate for Payer: BCN Commercial |
$496.49
|
| Rate for Payer: BCN Medicare Advantage |
$85.72
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$114.86
|
| Rate for Payer: Cofinity Commercial |
$123.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.72
|
| Rate for Payer: Mclaren Medicaid |
$55.59
|
| Rate for Payer: Meridian Medicaid |
$58.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$90.01
|
| Rate for Payer: PACE SWMI |
$85.72
|
| Rate for Payer: PHP Medicare Advantage |
$85.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$441.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$152.29
|
| Rate for Payer: Priority Health Medicare |
$85.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.72
|
| Rate for Payer: UHC Medicare Advantage |
$88.29
|
|
|
PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS
|
Professional
|
Both
|
$2,396.00
|
|
|
Service Code
|
HCPCS 0201T
|
| Min. Negotiated Rate |
$237.73 |
| Max. Negotiated Rate |
$6,118.53 |
| Rate for Payer: Aetna Commercial |
$2,396.07
|
| Rate for Payer: BCBS Complete |
$249.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,600.00
|
| Rate for Payer: BCN Commercial |
$6,118.53
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Mclaren Medicaid |
$237.73
|
| Rate for Payer: Meridian Medicaid |
$249.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,677.20
|
|
|
PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL
|
Professional
|
Both
|
$2,272.00
|
|
|
Service Code
|
HCPCS 0200T
|
| Min. Negotiated Rate |
$64.33 |
| Max. Negotiated Rate |
$6,118.53 |
| Rate for Payer: Aetna Commercial |
$2,325.11
|
| Rate for Payer: BCBS Complete |
$249.62
|
| Rate for Payer: BCBS Trust/PPO |
$64.33
|
| Rate for Payer: BCN Commercial |
$6,118.53
|
| Rate for Payer: Cash Price |
$1,817.60
|
| Rate for Payer: Cash Price |
$1,817.60
|
| Rate for Payer: Mclaren Medicaid |
$237.73
|
| Rate for Payer: Meridian Medicaid |
$249.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$237.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,590.40
|
|
|
PR PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS
|
Professional
|
Both
|
$3,110.00
|
|
|
Service Code
|
HCPCS 27216
|
| Min. Negotiated Rate |
$571.69 |
| Max. Negotiated Rate |
$2,177.00 |
| Rate for Payer: Aetna Commercial |
$1,191.27
|
| Rate for Payer: BCBS Complete |
$600.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,616.07
|
| Rate for Payer: BCN Commercial |
$1,302.33
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Cash Price |
$2,488.00
|
| Rate for Payer: Mclaren Medicaid |
$571.69
|
| Rate for Payer: Meridian Medicaid |
$600.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$571.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,177.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,360.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,360.88
|
|
|
PR PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP
|
Professional
|
Both
|
$1,906.00
|
|
|
Service Code
|
HCPCS 25606
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$1,334.20 |
| Rate for Payer: Aetna Commercial |
$882.66
|
| Rate for Payer: Aetna Medicare |
$685.05
|
| Rate for Payer: BCBS Complete |
$458.03
|
| Rate for Payer: BCBS MAPPO |
$658.70
|
| Rate for Payer: BCBS Trust/PPO |
$72.38
|
| Rate for Payer: BCN Commercial |
$988.59
|
| Rate for Payer: BCN Medicare Advantage |
$658.70
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cash Price |
$1,524.80
|
| Rate for Payer: Cofinity Commercial |
$948.53
|
| Rate for Payer: Cofinity Commercial |
$882.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$658.70
|
| Rate for Payer: Mclaren Medicaid |
$436.22
|
| Rate for Payer: Meridian Medicaid |
$458.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$691.64
|
| Rate for Payer: PACE SWMI |
$658.70
|
| Rate for Payer: PHP Medicare Advantage |
$658.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$436.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,334.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,033.05
|
| Rate for Payer: Priority Health Medicare |
$658.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,033.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$658.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$658.70
|
| Rate for Payer: UHC Medicare Advantage |
$678.46
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT
|
Professional
|
Both
|
$1,512.00
|
|
|
Service Code
|
HCPCS 36906
|
| Min. Negotiated Rate |
$316.52 |
| Max. Negotiated Rate |
$7,992.80 |
| Rate for Payer: Aetna Commercial |
$668.34
|
| Rate for Payer: Aetna Medicare |
$518.71
|
| Rate for Payer: BCBS Complete |
$332.35
|
| Rate for Payer: BCBS MAPPO |
$498.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,420.60
|
| Rate for Payer: BCN Commercial |
$7,992.80
|
| Rate for Payer: BCN Medicare Advantage |
$498.76
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cash Price |
$1,209.60
|
| Rate for Payer: Cofinity Commercial |
$718.21
|
| Rate for Payer: Cofinity Commercial |
$668.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.76
|
| Rate for Payer: Mclaren Medicaid |
$316.52
|
| Rate for Payer: Meridian Medicaid |
$332.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$523.70
|
| Rate for Payer: PACE SWMI |
$498.76
|
| Rate for Payer: PHP Medicare Advantage |
$498.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$316.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,058.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$791.02
|
| Rate for Payer: Priority Health Medicare |
$498.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$791.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$498.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$498.76
|
| Rate for Payer: UHC Medicare Advantage |
$513.72
|
|
|
PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP
|
Professional
|
Both
|
$1,296.00
|
|
|
Service Code
|
HCPCS 36905
|
| Min. Negotiated Rate |
$274.13 |
| Max. Negotiated Rate |
$3,353.79 |
| Rate for Payer: Aetna Commercial |
$579.08
|
| Rate for Payer: Aetna Medicare |
$449.44
|
| Rate for Payer: BCBS Complete |
$287.84
|
| Rate for Payer: BCBS MAPPO |
$432.15
|
| Rate for Payer: BCBS Trust/PPO |
$1,385.73
|
| Rate for Payer: BCN Commercial |
$3,353.79
|
| Rate for Payer: BCN Medicare Advantage |
$432.15
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cofinity Commercial |
$579.08
|
| Rate for Payer: Cofinity Commercial |
$622.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$432.15
|
| Rate for Payer: Mclaren Medicaid |
$274.13
|
| Rate for Payer: Meridian Medicaid |
$287.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$453.76
|
| Rate for Payer: PACE SWMI |
$432.15
|
| Rate for Payer: PHP Medicare Advantage |
$432.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$907.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$686.22
|
| Rate for Payer: Priority Health Medicare |
$432.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$686.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$432.15
|
| Rate for Payer: UHC Medicare Advantage |
$445.11
|
|
|
PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
HCPCS 36904
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$2,663.30 |
| Rate for Payer: Aetna Commercial |
$482.28
|
| Rate for Payer: Aetna Medicare |
$374.31
|
| Rate for Payer: BCBS Complete |
$239.76
|
| Rate for Payer: BCBS MAPPO |
$359.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,699.01
|
| Rate for Payer: BCN Commercial |
$2,663.30
|
| Rate for Payer: BCN Medicare Advantage |
$359.91
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cofinity Commercial |
$518.27
|
| Rate for Payer: Cofinity Commercial |
$482.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$359.91
|
| Rate for Payer: Mclaren Medicaid |
$228.34
|
| Rate for Payer: Meridian Medicaid |
$239.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$377.91
|
| Rate for Payer: PACE SWMI |
$359.91
|
| Rate for Payer: PHP Medicare Advantage |
$359.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$228.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.79
|
| Rate for Payer: Priority Health Medicare |
$359.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$359.91
|
| Rate for Payer: UHC Medicare Advantage |
$370.71
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
HCPCS 22513
|
| Min. Negotiated Rate |
$219.77 |
| Max. Negotiated Rate |
$8,492.73 |
| Rate for Payer: Aetna Commercial |
$673.66
|
| Rate for Payer: Aetna Medicare |
$522.84
|
| Rate for Payer: BCBS Complete |
$340.17
|
| Rate for Payer: BCBS MAPPO |
$502.73
|
| Rate for Payer: BCBS Trust/PPO |
$219.77
|
| Rate for Payer: BCN Commercial |
$8,492.73
|
| Rate for Payer: BCN Medicare Advantage |
$502.73
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cash Price |
$1,212.80
|
| Rate for Payer: Cofinity Commercial |
$673.66
|
| Rate for Payer: Cofinity Commercial |
$723.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$502.73
|
| Rate for Payer: Mclaren Medicaid |
$323.97
|
| Rate for Payer: Meridian Medicaid |
$340.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$527.87
|
| Rate for Payer: PACE SWMI |
$502.73
|
| Rate for Payer: PHP Medicare Advantage |
$502.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$323.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,061.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$773.63
|
| Rate for Payer: Priority Health Medicare |
$502.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$773.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$502.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$502.73
|
| Rate for Payer: UHC Medicare Advantage |
$517.81
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
HCPCS 22515
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$4,362.91 |
| Rate for Payer: Aetna Commercial |
$289.32
|
| Rate for Payer: Aetna Medicare |
$224.55
|
| Rate for Payer: BCBS Complete |
$144.26
|
| Rate for Payer: BCBS MAPPO |
$215.91
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$4,362.91
|
| Rate for Payer: BCN Medicare Advantage |
$215.91
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cash Price |
$632.00
|
| Rate for Payer: Cofinity Commercial |
$310.91
|
| Rate for Payer: Cofinity Commercial |
$289.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.91
|
| Rate for Payer: Mclaren Medicaid |
$137.39
|
| Rate for Payer: Meridian Medicaid |
$144.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$226.71
|
| Rate for Payer: PACE SWMI |
$215.91
|
| Rate for Payer: PHP Medicare Advantage |
$215.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$137.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.88
|
| Rate for Payer: Priority Health Medicare |
$215.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$329.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.91
|
| Rate for Payer: UHC Medicare Advantage |
$222.39
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR
|
Professional
|
Both
|
$1,416.00
|
|
|
Service Code
|
HCPCS 22514
|
| Min. Negotiated Rate |
$302.03 |
| Max. Negotiated Rate |
$8,451.68 |
| Rate for Payer: Aetna Commercial |
$627.90
|
| Rate for Payer: Aetna Medicare |
$487.32
|
| Rate for Payer: BCBS Complete |
$317.13
|
| Rate for Payer: BCBS MAPPO |
$468.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,205.12
|
| Rate for Payer: BCN Commercial |
$8,451.68
|
| Rate for Payer: BCN Medicare Advantage |
$468.58
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cash Price |
$1,132.80
|
| Rate for Payer: Cofinity Commercial |
$674.76
|
| Rate for Payer: Cofinity Commercial |
$627.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$468.58
|
| Rate for Payer: Mclaren Medicaid |
$302.03
|
| Rate for Payer: Meridian Medicaid |
$317.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$492.01
|
| Rate for Payer: PACE SWMI |
$468.58
|
| Rate for Payer: PHP Medicare Advantage |
$468.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$302.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$991.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$721.55
|
| Rate for Payer: Priority Health Medicare |
$468.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$721.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$468.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$468.58
|
| Rate for Payer: UHC Medicare Advantage |
$482.64
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL
|
Professional
|
Both
|
$1,036.00
|
|
|
Service Code
|
HCPCS 22511
|
| Min. Negotiated Rate |
$190.19 |
| Max. Negotiated Rate |
$2,669.64 |
| Rate for Payer: Aetna Commercial |
$534.91
|
| Rate for Payer: Aetna Medicare |
$415.16
|
| Rate for Payer: BCBS Complete |
$270.16
|
| Rate for Payer: BCBS MAPPO |
$399.19
|
| Rate for Payer: BCBS Trust/PPO |
$190.19
|
| Rate for Payer: BCN Commercial |
$2,669.64
|
| Rate for Payer: BCN Medicare Advantage |
$399.19
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cash Price |
$828.80
|
| Rate for Payer: Cofinity Commercial |
$534.91
|
| Rate for Payer: Cofinity Commercial |
$574.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$399.19
|
| Rate for Payer: Mclaren Medicaid |
$257.30
|
| Rate for Payer: Meridian Medicaid |
$270.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$419.15
|
| Rate for Payer: PACE SWMI |
$399.19
|
| Rate for Payer: PHP Medicare Advantage |
$399.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$257.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$725.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$614.31
|
| Rate for Payer: Priority Health Medicare |
$399.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$614.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$399.19
|
| Rate for Payer: UHC Medicare Advantage |
$411.17
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC
|
Professional
|
Both
|
$3,354.00
|
|
|
Service Code
|
HCPCS 22510
|
| Min. Negotiated Rate |
$273.28 |
| Max. Negotiated Rate |
$2,683.33 |
| Rate for Payer: Aetna Commercial |
$570.57
|
| Rate for Payer: Aetna Medicare |
$442.83
|
| Rate for Payer: BCBS Complete |
$286.94
|
| Rate for Payer: BCBS MAPPO |
$425.80
|
| Rate for Payer: BCBS Trust/PPO |
$825.51
|
| Rate for Payer: BCN Commercial |
$2,683.33
|
| Rate for Payer: BCN Medicare Advantage |
$425.80
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cash Price |
$2,683.20
|
| Rate for Payer: Cofinity Commercial |
$613.15
|
| Rate for Payer: Cofinity Commercial |
$570.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$425.80
|
| Rate for Payer: Mclaren Medicaid |
$273.28
|
| Rate for Payer: Meridian Medicaid |
$286.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$447.09
|
| Rate for Payer: PACE SWMI |
$425.80
|
| Rate for Payer: PHP Medicare Advantage |
$425.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,347.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$654.65
|
| Rate for Payer: Priority Health Medicare |
$425.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$654.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$425.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$425.80
|
| Rate for Payer: UHC Medicare Advantage |
$438.57
|
|
|
PR PESSARY, NON RUBBER,ANY TYPE
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS A4562
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCN Commercial |
$56.07
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
PR PESSARY RUBBER, ANY TYPE
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS A4561
|
| Min. Negotiated Rate |
$19.09 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$19.09
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCN Commercial |
$22.57
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
PR PHALANGECTOMY TOE EACH TOE
|
Professional
|
Both
|
$832.00
|
|
|
Service Code
|
HCPCS 28150
|
| Min. Negotiated Rate |
$180.41 |
| Max. Negotiated Rate |
$1,132.15 |
| Rate for Payer: Aetna Commercial |
$363.45
|
| Rate for Payer: Aetna Medicare |
$282.08
|
| Rate for Payer: BCBS Complete |
$189.43
|
| Rate for Payer: BCBS MAPPO |
$271.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.15
|
| Rate for Payer: BCN Commercial |
$607.43
|
| Rate for Payer: BCN Medicare Advantage |
$271.23
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cash Price |
$665.60
|
| Rate for Payer: Cofinity Commercial |
$390.57
|
| Rate for Payer: Cofinity Commercial |
$363.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$271.23
|
| Rate for Payer: Mclaren Medicaid |
$180.41
|
| Rate for Payer: Meridian Medicaid |
$189.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$284.79
|
| Rate for Payer: PACE SWMI |
$271.23
|
| Rate for Payer: PHP Medicare Advantage |
$271.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$180.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$582.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$423.83
|
| Rate for Payer: Priority Health Medicare |
$271.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$423.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$271.23
|
| Rate for Payer: UHC Medicare Advantage |
$279.37
|
|
|
PR PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 90863
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$1,062.41 |
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.41
|
| Rate for Payer: BCN Commercial |
$70.30
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.86
|
|
