|
PR PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 34839
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$1,815.77 |
| Rate for Payer: Aetna Commercial |
$240.00
|
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,815.77
|
| Rate for Payer: BCN Commercial |
$145.07
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
|
|
PR PL REJUV/PERFECT
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 00071
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
|
|
PR PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
HCPCS 40720
|
| Min. Negotiated Rate |
$656.04 |
| Max. Negotiated Rate |
$1,805.08 |
| Rate for Payer: Aetna Commercial |
$1,349.47
|
| Rate for Payer: Aetna Medicare |
$1,047.35
|
| Rate for Payer: BCBS Complete |
$688.84
|
| Rate for Payer: BCBS MAPPO |
$1,007.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,487.69
|
| Rate for Payer: BCN Commercial |
$1,500.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,007.07
|
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Cash Price |
$1,476.80
|
| Rate for Payer: Cofinity Commercial |
$1,450.18
|
| Rate for Payer: Cofinity Commercial |
$1,349.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,007.07
|
| Rate for Payer: Mclaren Medicaid |
$656.04
|
| Rate for Payer: Meridian Medicaid |
$688.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,057.42
|
| Rate for Payer: PACE SWMI |
$1,007.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,007.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$656.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,292.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,805.08
|
| Rate for Payer: Priority Health Medicare |
$1,007.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,805.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,007.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,007.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,037.28
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM
|
Professional
|
Both
|
$855.00
|
|
|
Service Code
|
HCPCS 42500
|
| Min. Negotiated Rate |
$223.01 |
| Max. Negotiated Rate |
$1,052.90 |
| Rate for Payer: Aetna Commercial |
$453.34
|
| Rate for Payer: Aetna Medicare |
$351.84
|
| Rate for Payer: BCBS Complete |
$234.16
|
| Rate for Payer: BCBS MAPPO |
$338.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,052.90
|
| Rate for Payer: BCN Commercial |
$664.60
|
| Rate for Payer: BCN Medicare Advantage |
$338.31
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cofinity Commercial |
$487.17
|
| Rate for Payer: Cofinity Commercial |
$453.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.31
|
| Rate for Payer: Mclaren Medicaid |
$223.01
|
| Rate for Payer: Meridian Medicaid |
$234.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$355.23
|
| Rate for Payer: PACE SWMI |
$338.31
|
| Rate for Payer: PHP Medicare Advantage |
$338.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$612.66
|
| Rate for Payer: Priority Health Medicare |
$338.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$612.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.31
|
| Rate for Payer: UHC Medicare Advantage |
$348.46
|
|
|
PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP
|
Professional
|
Both
|
$1,090.00
|
|
|
Service Code
|
HCPCS 42505
|
| Min. Negotiated Rate |
$296.07 |
| Max. Negotiated Rate |
$848.84 |
| Rate for Payer: Aetna Commercial |
$603.91
|
| Rate for Payer: Aetna Medicare |
$468.71
|
| Rate for Payer: BCBS Complete |
$310.87
|
| Rate for Payer: BCBS MAPPO |
$450.68
|
| Rate for Payer: BCBS Trust/PPO |
$318.04
|
| Rate for Payer: BCN Commercial |
$848.84
|
| Rate for Payer: BCN Medicare Advantage |
$450.68
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cash Price |
$872.00
|
| Rate for Payer: Cofinity Commercial |
$648.98
|
| Rate for Payer: Cofinity Commercial |
$603.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$450.68
|
| Rate for Payer: Mclaren Medicaid |
$296.07
|
| Rate for Payer: Meridian Medicaid |
$310.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$473.21
|
| Rate for Payer: PACE SWMI |
$450.68
|
| Rate for Payer: PHP Medicare Advantage |
$450.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$296.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$763.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$812.58
|
| Rate for Payer: Priority Health Medicare |
$450.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$812.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$450.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$450.68
|
| Rate for Payer: UHC Medicare Advantage |
$464.20
|
|
|
PR PL VITALIZE
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 00070
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
|
|
PR PNCRTECT DSTL STOT W/O PNCRTCOJEJUNOSTOMY
|
Professional
|
Both
|
$3,592.00
|
|
|
Service Code
|
HCPCS 48140
|
| Min. Negotiated Rate |
$1,000.67 |
| Max. Negotiated Rate |
$2,748.78 |
| Rate for Payer: Aetna Commercial |
$2,088.18
|
| Rate for Payer: Aetna Medicare |
$1,620.67
|
| Rate for Payer: BCBS Complete |
$1,050.70
|
| Rate for Payer: BCBS MAPPO |
$1,558.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,200.30
|
| Rate for Payer: BCN Commercial |
$2,284.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,558.34
|
| Rate for Payer: Cash Price |
$2,873.60
|
| Rate for Payer: Cash Price |
$2,873.60
|
| Rate for Payer: Cofinity Commercial |
$2,088.18
|
| Rate for Payer: Cofinity Commercial |
$2,244.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,558.34
|
| Rate for Payer: Mclaren Medicaid |
$1,000.67
|
| Rate for Payer: Meridian Medicaid |
$1,050.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,636.26
|
| Rate for Payer: PACE SWMI |
$1,558.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,558.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,000.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,514.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,748.78
|
| Rate for Payer: Priority Health Medicare |
$1,558.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,748.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,558.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,558.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,605.09
|
|
|
PR PNCRTECT PROX STOT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$5,453.00
|
|
|
Service Code
|
HCPCS 48150
|
| Min. Negotiated Rate |
$711.62 |
| Max. Negotiated Rate |
$5,455.20 |
| Rate for Payer: Aetna Commercial |
$4,147.90
|
| Rate for Payer: Aetna Medicare |
$3,219.27
|
| Rate for Payer: BCBS Complete |
$2,084.42
|
| Rate for Payer: BCBS MAPPO |
$3,095.45
|
| Rate for Payer: BCBS Trust/PPO |
$711.62
|
| Rate for Payer: BCN Commercial |
$4,533.95
|
| Rate for Payer: BCN Medicare Advantage |
$3,095.45
|
| Rate for Payer: Cash Price |
$4,362.40
|
| Rate for Payer: Cash Price |
$4,362.40
|
| Rate for Payer: Cofinity Commercial |
$4,457.45
|
| Rate for Payer: Cofinity Commercial |
$4,147.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,095.45
|
| Rate for Payer: Mclaren Medicaid |
$1,985.16
|
| Rate for Payer: Meridian Medicaid |
$2,084.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,250.22
|
| Rate for Payer: PACE SWMI |
$3,095.45
|
| Rate for Payer: PHP Medicare Advantage |
$3,095.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,985.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,817.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,455.20
|
| Rate for Payer: Priority Health Medicare |
$3,095.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,455.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,095.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,095.45
|
| Rate for Payer: UHC Medicare Advantage |
$3,188.31
|
|
|
PR PNCRTECT W/PANCREATOJEJUNOSTOMY
|
Professional
|
Both
|
$8,140.00
|
|
|
Service Code
|
HCPCS 48153
|
| Min. Negotiated Rate |
$747.02 |
| Max. Negotiated Rate |
$5,698.00 |
| Rate for Payer: Aetna Commercial |
$4,136.63
|
| Rate for Payer: Aetna Medicare |
$3,210.52
|
| Rate for Payer: BCBS Complete |
$2,075.69
|
| Rate for Payer: BCBS MAPPO |
$3,087.04
|
| Rate for Payer: BCBS Trust/PPO |
$747.02
|
| Rate for Payer: BCN Commercial |
$4,519.29
|
| Rate for Payer: BCN Medicare Advantage |
$3,087.04
|
| Rate for Payer: Cash Price |
$6,512.00
|
| Rate for Payer: Cash Price |
$6,512.00
|
| Rate for Payer: Cofinity Commercial |
$4,445.34
|
| Rate for Payer: Cofinity Commercial |
$4,136.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,087.04
|
| Rate for Payer: Mclaren Medicaid |
$1,976.85
|
| Rate for Payer: Meridian Medicaid |
$2,075.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,241.39
|
| Rate for Payer: PACE SWMI |
$3,087.04
|
| Rate for Payer: PHP Medicare Advantage |
$3,087.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,976.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,698.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,437.58
|
| Rate for Payer: Priority Health Medicare |
$3,087.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,437.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,087.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,087.04
|
| Rate for Payer: UHC Medicare Advantage |
$3,179.65
|
|
|
PR PNEUMOCOCCAL CONJ VACCINE 7 VALENT IM
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 90669
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.80
|
|
|
PR PNEUMONOLYSIS XTRPRIOSTEAL W/FILLING/PACKING PX
|
Professional
|
Both
|
$2,524.00
|
|
|
Service Code
|
HCPCS 32940
|
| Min. Negotiated Rate |
$777.45 |
| Max. Negotiated Rate |
$1,774.88 |
| Rate for Payer: Aetna Commercial |
$1,627.22
|
| Rate for Payer: Aetna Medicare |
$1,262.91
|
| Rate for Payer: BCBS Complete |
$816.32
|
| Rate for Payer: BCBS MAPPO |
$1,214.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,049.20
|
| Rate for Payer: BCN Commercial |
$1,774.88
|
| Rate for Payer: BCN Medicare Advantage |
$1,214.34
|
| Rate for Payer: Cash Price |
$2,019.20
|
| Rate for Payer: Cash Price |
$2,019.20
|
| Rate for Payer: Cofinity Commercial |
$1,748.65
|
| Rate for Payer: Cofinity Commercial |
$1,627.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,214.34
|
| Rate for Payer: Mclaren Medicaid |
$777.45
|
| Rate for Payer: Meridian Medicaid |
$816.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,275.06
|
| Rate for Payer: PACE SWMI |
$1,214.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,214.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$777.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,766.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,681.78
|
| Rate for Payer: Priority Health Medicare |
$1,214.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,681.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,214.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,214.34
|
| Rate for Payer: UHC Medicare Advantage |
$1,250.77
|
|
|
PR PNEUMONOSTOMY W/OPEN DRAINAGE ABSCESS/CYST
|
Professional
|
Both
|
$2,675.00
|
|
|
Service Code
|
HCPCS 32200
|
| Min. Negotiated Rate |
$721.86 |
| Max. Negotiated Rate |
$1,872.50 |
| Rate for Payer: Aetna Commercial |
$1,501.23
|
| Rate for Payer: Aetna Medicare |
$1,165.13
|
| Rate for Payer: BCBS Complete |
$757.95
|
| Rate for Payer: BCBS MAPPO |
$1,120.32
|
| Rate for Payer: BCBS Trust/PPO |
$897.05
|
| Rate for Payer: BCN Commercial |
$1,644.40
|
| Rate for Payer: BCN Medicare Advantage |
$1,120.32
|
| Rate for Payer: Cash Price |
$2,140.00
|
| Rate for Payer: Cash Price |
$2,140.00
|
| Rate for Payer: Cofinity Commercial |
$1,613.26
|
| Rate for Payer: Cofinity Commercial |
$1,501.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,120.32
|
| Rate for Payer: Mclaren Medicaid |
$721.86
|
| Rate for Payer: Meridian Medicaid |
$757.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,176.34
|
| Rate for Payer: PACE SWMI |
$1,120.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,120.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$721.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,872.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,558.14
|
| Rate for Payer: Priority Health Medicare |
$1,120.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,558.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,120.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,120.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,153.93
|
|
|
PR PNEUMOTHORAX THER INTRAPLEURAL INJECTION AIR
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS 32960
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$1,588.07 |
| Rate for Payer: Aetna Commercial |
$119.57
|
| Rate for Payer: Aetna Medicare |
$92.80
|
| Rate for Payer: BCBS Complete |
$59.71
|
| Rate for Payer: BCBS MAPPO |
$89.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,588.07
|
| Rate for Payer: BCN Commercial |
$184.23
|
| Rate for Payer: BCN Medicare Advantage |
$89.23
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$128.49
|
| Rate for Payer: Cofinity Commercial |
$119.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.23
|
| Rate for Payer: Mclaren Medicaid |
$56.87
|
| Rate for Payer: Meridian Medicaid |
$59.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.69
|
| Rate for Payer: PACE SWMI |
$89.23
|
| Rate for Payer: PHP Medicare Advantage |
$89.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.10
|
| Rate for Payer: Priority Health Medicare |
$89.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$89.23
|
| Rate for Payer: UHC Medicare Advantage |
$91.91
|
|
|
PR PNXR ASPIR HYDROCELE TUNICA VAGIS W/WO NJX MED
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
HCPCS 55000
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$2,324.52 |
| Rate for Payer: Aetna Commercial |
$110.13
|
| Rate for Payer: Aetna Medicare |
$85.48
|
| Rate for Payer: BCBS Complete |
$56.58
|
| Rate for Payer: BCBS MAPPO |
$82.19
|
| Rate for Payer: BCBS Trust/PPO |
$2,324.52
|
| Rate for Payer: BCN Commercial |
$175.44
|
| Rate for Payer: BCN Medicare Advantage |
$82.19
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cash Price |
$173.60
|
| Rate for Payer: Cofinity Commercial |
$118.35
|
| Rate for Payer: Cofinity Commercial |
$110.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$82.19
|
| Rate for Payer: Mclaren Medicaid |
$53.89
|
| Rate for Payer: Meridian Medicaid |
$56.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$86.30
|
| Rate for Payer: PACE SWMI |
$82.19
|
| Rate for Payer: PHP Medicare Advantage |
$82.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$82.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$82.19
|
| Rate for Payer: UHC Medicare Advantage |
$84.66
|
|
|
PR POLIOVIRUS VACCINE INACTIVATED SUBQ/IM
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 90713
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$43.27 |
| Rate for Payer: Aetna Commercial |
$43.27
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$40.14
|
| Rate for Payer: BCN Commercial |
$40.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
|
|
PR POLLICIZATION DIGIT
|
Professional
|
Both
|
$2,714.00
|
|
|
Service Code
|
HCPCS 26550
|
| Min. Negotiated Rate |
$136.83 |
| Max. Negotiated Rate |
$2,543.55 |
| Rate for Payer: Aetna Commercial |
$2,180.72
|
| Rate for Payer: Aetna Medicare |
$1,692.50
|
| Rate for Payer: BCBS Complete |
$1,114.00
|
| Rate for Payer: BCBS MAPPO |
$1,627.40
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: BCN Commercial |
$2,434.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,627.40
|
| Rate for Payer: Cash Price |
$2,171.20
|
| Rate for Payer: Cash Price |
$2,171.20
|
| Rate for Payer: Cofinity Commercial |
$2,343.46
|
| Rate for Payer: Cofinity Commercial |
$2,180.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,627.40
|
| Rate for Payer: Mclaren Medicaid |
$1,060.95
|
| Rate for Payer: Meridian Medicaid |
$1,114.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,708.77
|
| Rate for Payer: PACE SWMI |
$1,627.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,627.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,060.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,899.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,543.55
|
| Rate for Payer: Priority Health Medicare |
$1,627.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,543.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,627.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,627.40
|
| Rate for Payer: UHC Medicare Advantage |
$1,676.22
|
|
|
PR POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 95810
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$819.63 |
| Rate for Payer: Aetna Commercial |
$762.71
|
| Rate for Payer: Aetna Commercial |
$762.71
|
| Rate for Payer: Aetna Medicare |
$591.96
|
| Rate for Payer: Aetna Medicare |
$591.96
|
| Rate for Payer: BCBS Complete |
$390.80
|
| Rate for Payer: BCBS Complete |
$186.00
|
| Rate for Payer: BCBS MAPPO |
$569.19
|
| Rate for Payer: BCBS MAPPO |
$569.19
|
| Rate for Payer: BCBS Trust/PPO |
$634.49
|
| Rate for Payer: BCBS Trust/PPO |
$634.49
|
| Rate for Payer: BCN Commercial |
$712.68
|
| Rate for Payer: BCN Commercial |
$712.68
|
| Rate for Payer: BCN Medicare Advantage |
$569.19
|
| Rate for Payer: BCN Medicare Advantage |
$569.19
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$781.60
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$819.63
|
| Rate for Payer: Cofinity Commercial |
$762.71
|
| Rate for Payer: Cofinity Commercial |
$762.71
|
| Rate for Payer: Cofinity Commercial |
$819.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$597.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$597.65
|
| Rate for Payer: PACE SWMI |
$569.19
|
| Rate for Payer: PACE SWMI |
$569.19
|
| Rate for Payer: PHP Medicare Advantage |
$569.19
|
| Rate for Payer: PHP Medicare Advantage |
$569.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$683.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$815.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$815.19
|
| Rate for Payer: Priority Health Medicare |
$569.19
|
| Rate for Payer: Priority Health Medicare |
$569.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$815.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$815.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$569.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$569.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$569.19
|
| Rate for Payer: UHC Medicare Advantage |
$586.27
|
| Rate for Payer: UHC Medicare Advantage |
$586.27
|
|
|
PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS 95782
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$1,387.84 |
| Rate for Payer: Aetna Commercial |
$1,187.82
|
| Rate for Payer: Aetna Commercial |
$1,187.82
|
| Rate for Payer: Aetna Medicare |
$921.89
|
| Rate for Payer: Aetna Medicare |
$921.89
|
| Rate for Payer: BCBS Complete |
$101.20
|
| Rate for Payer: BCBS Complete |
$680.80
|
| Rate for Payer: BCBS MAPPO |
$886.43
|
| Rate for Payer: BCBS MAPPO |
$886.43
|
| Rate for Payer: BCBS Trust/PPO |
$567.92
|
| Rate for Payer: BCBS Trust/PPO |
$567.92
|
| Rate for Payer: BCN Commercial |
$1,387.84
|
| Rate for Payer: BCN Commercial |
$1,387.84
|
| Rate for Payer: BCN Medicare Advantage |
$886.43
|
| Rate for Payer: BCN Medicare Advantage |
$886.43
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$1,361.60
|
| Rate for Payer: Cash Price |
$1,361.60
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cofinity Commercial |
$1,276.46
|
| Rate for Payer: Cofinity Commercial |
$1,187.82
|
| Rate for Payer: Cofinity Commercial |
$1,276.46
|
| Rate for Payer: Cofinity Commercial |
$1,187.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$886.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$886.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$930.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$930.75
|
| Rate for Payer: PACE SWMI |
$886.43
|
| Rate for Payer: PACE SWMI |
$886.43
|
| Rate for Payer: PHP Medicare Advantage |
$886.43
|
| Rate for Payer: PHP Medicare Advantage |
$886.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,191.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,275.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,275.57
|
| Rate for Payer: Priority Health Medicare |
$886.43
|
| Rate for Payer: Priority Health Medicare |
$886.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,275.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,275.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$886.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$886.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$886.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$886.43
|
| Rate for Payer: UHC Medicare Advantage |
$913.02
|
| Rate for Payer: UHC Medicare Advantage |
$913.02
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 95811
|
| Min. Negotiated Rate |
$196.80 |
| Max. Negotiated Rate |
$1,013.28 |
| Rate for Payer: Aetna Commercial |
$798.10
|
| Rate for Payer: Aetna Commercial |
$798.10
|
| Rate for Payer: Aetna Medicare |
$619.42
|
| Rate for Payer: Aetna Medicare |
$619.42
|
| Rate for Payer: BCBS Complete |
$196.80
|
| Rate for Payer: BCBS Complete |
$488.80
|
| Rate for Payer: BCBS MAPPO |
$595.60
|
| Rate for Payer: BCBS MAPPO |
$595.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,013.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,013.28
|
| Rate for Payer: BCN Commercial |
$745.67
|
| Rate for Payer: BCN Commercial |
$745.67
|
| Rate for Payer: BCN Medicare Advantage |
$595.60
|
| Rate for Payer: BCN Medicare Advantage |
$595.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$977.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$977.60
|
| Rate for Payer: Cofinity Commercial |
$857.66
|
| Rate for Payer: Cofinity Commercial |
$798.10
|
| Rate for Payer: Cofinity Commercial |
$857.66
|
| Rate for Payer: Cofinity Commercial |
$798.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$595.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$625.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$625.38
|
| Rate for Payer: PACE SWMI |
$595.60
|
| Rate for Payer: PACE SWMI |
$595.60
|
| Rate for Payer: PHP Medicare Advantage |
$595.60
|
| Rate for Payer: PHP Medicare Advantage |
$595.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$855.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$852.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$852.92
|
| Rate for Payer: Priority Health Medicare |
$595.60
|
| Rate for Payer: Priority Health Medicare |
$595.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$852.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$852.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$595.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$595.60
|
| Rate for Payer: UHC Medicare Advantage |
$613.47
|
| Rate for Payer: UHC Medicare Advantage |
$613.47
|
|
|
PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
|
Professional
|
Both
|
$1,817.00
|
|
|
Service Code
|
HCPCS 95783
|
| Min. Negotiated Rate |
$686.79 |
| Max. Negotiated Rate |
$1,470.43 |
| Rate for Payer: Aetna Commercial |
$1,258.88
|
| Rate for Payer: Aetna Commercial |
$1,258.88
|
| Rate for Payer: Aetna Medicare |
$977.04
|
| Rate for Payer: Aetna Medicare |
$977.04
|
| Rate for Payer: BCBS Complete |
$110.40
|
| Rate for Payer: BCBS Complete |
$726.80
|
| Rate for Payer: BCBS MAPPO |
$939.46
|
| Rate for Payer: BCBS MAPPO |
$939.46
|
| Rate for Payer: BCBS Trust/PPO |
$686.79
|
| Rate for Payer: BCBS Trust/PPO |
$686.79
|
| Rate for Payer: BCN Commercial |
$1,470.43
|
| Rate for Payer: BCN Commercial |
$1,470.43
|
| Rate for Payer: BCN Medicare Advantage |
$939.46
|
| Rate for Payer: BCN Medicare Advantage |
$939.46
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$1,453.60
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$1,258.88
|
| Rate for Payer: Cofinity Commercial |
$1,352.82
|
| Rate for Payer: Cofinity Commercial |
$1,258.88
|
| Rate for Payer: Cofinity Commercial |
$1,352.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$939.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$986.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$986.43
|
| Rate for Payer: PACE SWMI |
$939.46
|
| Rate for Payer: PACE SWMI |
$939.46
|
| Rate for Payer: PHP Medicare Advantage |
$939.46
|
| Rate for Payer: PHP Medicare Advantage |
$939.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,271.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,351.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,351.48
|
| Rate for Payer: Priority Health Medicare |
$939.46
|
| Rate for Payer: Priority Health Medicare |
$939.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,351.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,351.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$939.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$939.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$939.46
|
| Rate for Payer: UHC Medicare Advantage |
$967.64
|
| Rate for Payer: UHC Medicare Advantage |
$967.64
|
|
|
PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 95808
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$769.73 |
| Rate for Payer: Aetna Commercial |
$687.22
|
| Rate for Payer: Aetna Commercial |
$687.22
|
| Rate for Payer: Aetna Medicare |
$533.36
|
| Rate for Payer: Aetna Medicare |
$533.36
|
| Rate for Payer: BCBS Complete |
$168.80
|
| Rate for Payer: BCBS Complete |
$682.40
|
| Rate for Payer: BCBS MAPPO |
$512.85
|
| Rate for Payer: BCBS MAPPO |
$512.85
|
| Rate for Payer: BCBS Trust/PPO |
$769.73
|
| Rate for Payer: BCBS Trust/PPO |
$769.73
|
| Rate for Payer: BCN Commercial |
$644.36
|
| Rate for Payer: BCN Commercial |
$644.36
|
| Rate for Payer: BCN Medicare Advantage |
$512.85
|
| Rate for Payer: BCN Medicare Advantage |
$512.85
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$1,364.80
|
| Rate for Payer: Cash Price |
$1,364.80
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$687.22
|
| Rate for Payer: Cofinity Commercial |
$738.50
|
| Rate for Payer: Cofinity Commercial |
$687.22
|
| Rate for Payer: Cofinity Commercial |
$738.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$538.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$538.49
|
| Rate for Payer: PACE SWMI |
$512.85
|
| Rate for Payer: PACE SWMI |
$512.85
|
| Rate for Payer: PHP Medicare Advantage |
$512.85
|
| Rate for Payer: PHP Medicare Advantage |
$512.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,194.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$737.04
|
| Rate for Payer: Priority Health Medicare |
$512.85
|
| Rate for Payer: Priority Health Medicare |
$512.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$737.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$737.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$512.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$512.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$512.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$512.85
|
| Rate for Payer: UHC Medicare Advantage |
$528.24
|
| Rate for Payer: UHC Medicare Advantage |
$528.24
|
|
|
PR PORTOENETEROSTOMY
|
Professional
|
Both
|
$4,721.00
|
|
|
Service Code
|
HCPCS 47701
|
| Min. Negotiated Rate |
$362.41 |
| Max. Negotiated Rate |
$3,304.70 |
| Rate for Payer: Aetna Commercial |
$2,315.37
|
| Rate for Payer: Aetna Medicare |
$1,797.01
|
| Rate for Payer: BCBS Complete |
$1,163.87
|
| Rate for Payer: BCBS MAPPO |
$1,727.89
|
| Rate for Payer: BCBS Trust/PPO |
$362.41
|
| Rate for Payer: BCN Commercial |
$2,534.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,727.89
|
| Rate for Payer: Cash Price |
$3,776.80
|
| Rate for Payer: Cash Price |
$3,776.80
|
| Rate for Payer: Cofinity Commercial |
$2,488.16
|
| Rate for Payer: Cofinity Commercial |
$2,315.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,727.89
|
| Rate for Payer: Mclaren Medicaid |
$1,108.45
|
| Rate for Payer: Meridian Medicaid |
$1,163.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,814.28
|
| Rate for Payer: PACE SWMI |
$1,727.89
|
| Rate for Payer: PHP Medicare Advantage |
$1,727.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,108.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,304.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,049.23
|
| Rate for Payer: Priority Health Medicare |
$1,727.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,049.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,727.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,727.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,779.73
|
|
|
PR POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 92542
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$1,840.07 |
| Rate for Payer: Aetna Commercial |
$37.67
|
| Rate for Payer: Aetna Medicare |
$29.23
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$28.11
|
| Rate for Payer: BCBS Trust/PPO |
$1,840.07
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Medicare Advantage |
$28.11
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$40.48
|
| Rate for Payer: Cofinity Commercial |
$37.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.52
|
| Rate for Payer: PACE SWMI |
$28.11
|
| Rate for Payer: PHP Medicare Advantage |
$28.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.62
|
| Rate for Payer: Priority Health Medicare |
$28.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.11
|
| Rate for Payer: UHC Medicare Advantage |
$28.95
|
|
|
PR POST-CATARACT LASER SURGERY
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
HCPCS 66821
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$538.00 |
| Rate for Payer: Aetna Commercial |
$395.86
|
| Rate for Payer: Aetna Medicare |
$307.24
|
| Rate for Payer: BCBS Complete |
$207.77
|
| Rate for Payer: BCBS MAPPO |
$295.42
|
| Rate for Payer: BCBS Trust/PPO |
$417.89
|
| Rate for Payer: BCN Commercial |
$483.30
|
| Rate for Payer: BCN Medicare Advantage |
$295.42
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cash Price |
$450.40
|
| Rate for Payer: Cofinity Commercial |
$395.86
|
| Rate for Payer: Cofinity Commercial |
$425.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.42
|
| Rate for Payer: Mclaren Medicaid |
$197.88
|
| Rate for Payer: Meridian Medicaid |
$207.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$310.19
|
| Rate for Payer: PACE SWMI |
$295.42
|
| Rate for Payer: PHP Medicare Advantage |
$295.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$197.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$538.00
|
| Rate for Payer: Priority Health Medicare |
$295.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$538.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.42
|
| Rate for Payer: UHC Medicare Advantage |
$304.28
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,379.00
|
|
|
Service Code
|
HCPCS 57250
|
| Min. Negotiated Rate |
$395.97 |
| Max. Negotiated Rate |
$1,809.43 |
| Rate for Payer: Aetna Commercial |
$818.03
|
| Rate for Payer: Aetna Medicare |
$634.89
|
| Rate for Payer: BCBS Complete |
$415.77
|
| Rate for Payer: BCBS MAPPO |
$610.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,809.43
|
| Rate for Payer: BCN Commercial |
$904.06
|
| Rate for Payer: BCN Medicare Advantage |
$610.47
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cash Price |
$1,103.20
|
| Rate for Payer: Cofinity Commercial |
$879.08
|
| Rate for Payer: Cofinity Commercial |
$818.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$610.47
|
| Rate for Payer: Mclaren Medicaid |
$395.97
|
| Rate for Payer: Meridian Medicaid |
$415.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$640.99
|
| Rate for Payer: PACE SWMI |
$610.47
|
| Rate for Payer: PHP Medicare Advantage |
$610.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$395.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$965.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$875.83
|
| Rate for Payer: Priority Health Medicare |
$610.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$875.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$610.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$610.47
|
| Rate for Payer: UHC Medicare Advantage |
$628.78
|
|
