|
PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,268.00
|
|
|
Service Code
|
HCPCS 22840
|
| Min. Negotiated Rate |
$481.38 |
| Max. Negotiated Rate |
$21,897.63 |
| Rate for Payer: Aetna Commercial |
$1,011.75
|
| Rate for Payer: Aetna Medicare |
$785.24
|
| Rate for Payer: BCBS Complete |
$505.45
|
| Rate for Payer: BCBS MAPPO |
$755.04
|
| Rate for Payer: BCBS Trust/PPO |
$21,897.63
|
| Rate for Payer: BCN Commercial |
$1,213.35
|
| Rate for Payer: BCN Medicare Advantage |
$755.04
|
| Rate for Payer: Cash Price |
$2,614.40
|
| Rate for Payer: Cash Price |
$2,614.40
|
| Rate for Payer: Cofinity Commercial |
$1,087.26
|
| Rate for Payer: Cofinity Commercial |
$1,011.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$755.04
|
| Rate for Payer: Mclaren Medicaid |
$481.38
|
| Rate for Payer: Meridian Medicaid |
$505.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$792.79
|
| Rate for Payer: PACE SWMI |
$755.04
|
| Rate for Payer: PHP Medicare Advantage |
$755.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$481.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,287.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,151.52
|
| Rate for Payer: Priority Health Medicare |
$755.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,151.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$755.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$755.04
|
| Rate for Payer: UHC Medicare Advantage |
$777.69
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE
|
Professional
|
Both
|
$3,852.00
|
|
|
Service Code
|
HCPCS 22844
|
| Min. Negotiated Rate |
$53.49 |
| Max. Negotiated Rate |
$2,696.40 |
| Rate for Payer: Aetna Commercial |
$1,312.81
|
| Rate for Payer: Aetna Medicare |
$1,018.90
|
| Rate for Payer: BCBS Complete |
$656.42
|
| Rate for Payer: BCBS MAPPO |
$979.71
|
| Rate for Payer: BCBS Trust/PPO |
$53.49
|
| Rate for Payer: BCN Commercial |
$1,576.55
|
| Rate for Payer: BCN Medicare Advantage |
$979.71
|
| Rate for Payer: Cash Price |
$3,081.60
|
| Rate for Payer: Cash Price |
$3,081.60
|
| Rate for Payer: Cofinity Commercial |
$1,312.81
|
| Rate for Payer: Cofinity Commercial |
$1,410.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$979.71
|
| Rate for Payer: Mclaren Medicaid |
$625.16
|
| Rate for Payer: Meridian Medicaid |
$656.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,028.70
|
| Rate for Payer: PACE SWMI |
$979.71
|
| Rate for Payer: PHP Medicare Advantage |
$979.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$625.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,696.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,496.20
|
| Rate for Payer: Priority Health Medicare |
$979.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,496.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$979.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$979.71
|
| Rate for Payer: UHC Medicare Advantage |
$1,009.10
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,647.00
|
|
|
Service Code
|
HCPCS 22842
|
| Min. Negotiated Rate |
$483.43 |
| Max. Negotiated Rate |
$2,552.90 |
| Rate for Payer: Aetna Commercial |
$1,019.85
|
| Rate for Payer: Aetna Medicare |
$791.52
|
| Rate for Payer: BCBS Complete |
$510.14
|
| Rate for Payer: BCBS MAPPO |
$761.08
|
| Rate for Payer: BCBS Trust/PPO |
$483.43
|
| Rate for Payer: BCN Commercial |
$1,222.50
|
| Rate for Payer: BCN Medicare Advantage |
$761.08
|
| Rate for Payer: Cash Price |
$2,917.60
|
| Rate for Payer: Cash Price |
$2,917.60
|
| Rate for Payer: Cofinity Commercial |
$1,019.85
|
| Rate for Payer: Cofinity Commercial |
$1,095.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$761.08
|
| Rate for Payer: Mclaren Medicaid |
$485.85
|
| Rate for Payer: Meridian Medicaid |
$510.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$799.13
|
| Rate for Payer: PACE SWMI |
$761.08
|
| Rate for Payer: PHP Medicare Advantage |
$761.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$485.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,552.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,160.20
|
| Rate for Payer: Priority Health Medicare |
$761.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,160.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$761.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$761.08
|
| Rate for Payer: UHC Medicare Advantage |
$783.91
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG
|
Professional
|
Both
|
$4,011.00
|
|
|
Service Code
|
HCPCS 22843
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$2,807.70 |
| Rate for Payer: Aetna Commercial |
$1,091.70
|
| Rate for Payer: Aetna Medicare |
$847.29
|
| Rate for Payer: BCBS Complete |
$546.38
|
| Rate for Payer: BCBS MAPPO |
$814.70
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$1,308.59
|
| Rate for Payer: BCN Medicare Advantage |
$814.70
|
| Rate for Payer: Cash Price |
$3,208.80
|
| Rate for Payer: Cash Price |
$3,208.80
|
| Rate for Payer: Cofinity Commercial |
$1,173.17
|
| Rate for Payer: Cofinity Commercial |
$1,091.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$814.70
|
| Rate for Payer: Mclaren Medicaid |
$520.36
|
| Rate for Payer: Meridian Medicaid |
$546.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$855.44
|
| Rate for Payer: PACE SWMI |
$814.70
|
| Rate for Payer: PHP Medicare Advantage |
$814.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$520.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,807.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,241.91
|
| Rate for Payer: Priority Health Medicare |
$814.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,241.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$814.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$814.70
|
| Rate for Payer: UHC Medicare Advantage |
$839.14
|
|
|
PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 59430
|
| Min. Negotiated Rate |
$23.25 |
| Max. Negotiated Rate |
$309.12 |
| Rate for Payer: Aetna Commercial |
$242.23
|
| Rate for Payer: Aetna Medicare |
$188.00
|
| Rate for Payer: BCBS Complete |
$174.81
|
| Rate for Payer: BCBS MAPPO |
$180.77
|
| Rate for Payer: BCBS Trust/PPO |
$23.25
|
| Rate for Payer: BCN Commercial |
$309.12
|
| Rate for Payer: BCN Medicare Advantage |
$180.77
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$260.31
|
| Rate for Payer: Cofinity Commercial |
$242.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.77
|
| Rate for Payer: Mclaren Medicaid |
$166.49
|
| Rate for Payer: Meridian Medicaid |
$174.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$189.81
|
| Rate for Payer: PACE SWMI |
$180.77
|
| Rate for Payer: PHP Medicare Advantage |
$180.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$166.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.02
|
| Rate for Payer: Priority Health Medicare |
$180.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$254.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.77
|
| Rate for Payer: UHC Medicare Advantage |
$186.19
|
|
|
PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 64566
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$861.13 |
| Rate for Payer: Aetna Commercial |
$39.84
|
| Rate for Payer: Aetna Medicare |
$30.92
|
| Rate for Payer: BCBS Complete |
$20.13
|
| Rate for Payer: BCBS MAPPO |
$29.73
|
| Rate for Payer: BCBS Trust/PPO |
$861.13
|
| Rate for Payer: BCN Commercial |
$171.52
|
| Rate for Payer: BCN Medicare Advantage |
$29.73
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Cofinity Commercial |
$42.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.73
|
| Rate for Payer: Mclaren Medicaid |
$19.17
|
| Rate for Payer: Meridian Medicaid |
$20.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.22
|
| Rate for Payer: PACE SWMI |
$29.73
|
| Rate for Payer: PHP Medicare Advantage |
$29.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.39
|
| Rate for Payer: Priority Health Medicare |
$29.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.73
|
| Rate for Payer: UHC Medicare Advantage |
$30.62
|
|
|
PR POTASSIUM HYDROXIDE PREPS
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS Q0112
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$334.41 |
| Rate for Payer: Aetna Commercial |
$7.81
|
| Rate for Payer: Aetna Medicare |
$6.06
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$5.83
|
| Rate for Payer: BCBS Trust/PPO |
$334.41
|
| Rate for Payer: BCN Commercial |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$5.83
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.12
|
| Rate for Payer: PACE SWMI |
$5.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health Medicare |
$5.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.83
|
| Rate for Payer: UHC Medicare Advantage |
$6.00
|
|
|
PR PPPS, INITIAL VISIT
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS G0438
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$387.24 |
| Rate for Payer: Aetna Commercial |
$214.98
|
| Rate for Payer: Aetna Medicare |
$166.85
|
| Rate for Payer: BCBS Complete |
$101.60
|
| Rate for Payer: BCBS MAPPO |
$160.43
|
| Rate for Payer: BCBS Trust/PPO |
$387.24
|
| Rate for Payer: BCN Commercial |
$239.95
|
| Rate for Payer: BCN Medicare Advantage |
$160.43
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$231.02
|
| Rate for Payer: Cofinity Commercial |
$214.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$168.45
|
| Rate for Payer: PACE SWMI |
$160.43
|
| Rate for Payer: PHP Medicare Advantage |
$160.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$214.49
|
| Rate for Payer: Priority Health Medicare |
$160.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$214.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.43
|
| Rate for Payer: UHC Medicare Advantage |
$165.24
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS G0439
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$167.51
|
| Rate for Payer: Aetna Medicare |
$130.01
|
| Rate for Payer: BCBS Complete |
$68.80
|
| Rate for Payer: BCBS MAPPO |
$125.01
|
| Rate for Payer: BCBS Trust/PPO |
$728.00
|
| Rate for Payer: BCN Commercial |
$187.65
|
| Rate for Payer: BCN Medicare Advantage |
$125.01
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$180.01
|
| Rate for Payer: Cofinity Commercial |
$167.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.26
|
| Rate for Payer: PACE SWMI |
$125.01
|
| Rate for Payer: PHP Medicare Advantage |
$125.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.75
|
| Rate for Payer: Priority Health Medicare |
$125.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$167.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.01
|
| Rate for Payer: UHC Medicare Advantage |
$128.76
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 90732
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$218.03 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: Aetna Medicare |
$138.81
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS MAPPO |
$133.47
|
| Rate for Payer: BCBS Trust/PPO |
$138.56
|
| Rate for Payer: BCN Commercial |
$218.03
|
| Rate for Payer: BCN Medicare Advantage |
$133.47
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$178.85
|
| Rate for Payer: Cofinity Commercial |
$192.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.15
|
| Rate for Payer: PACE SWMI |
$133.47
|
| Rate for Payer: PHP Medicare Advantage |
$133.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$133.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.47
|
| Rate for Payer: UHC Medicare Advantage |
$137.48
|
|
|
PR PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX
|
Professional
|
Both
|
$4,561.00
|
|
|
Service Code
|
HCPCS 45112
|
| Min. Negotiated Rate |
$234.04 |
| Max. Negotiated Rate |
$3,192.70 |
| Rate for Payer: Aetna Commercial |
$2,385.94
|
| Rate for Payer: Aetna Medicare |
$1,851.77
|
| Rate for Payer: BCBS Complete |
$1,203.91
|
| Rate for Payer: BCBS MAPPO |
$1,780.55
|
| Rate for Payer: BCBS Trust/PPO |
$234.04
|
| Rate for Payer: BCN Commercial |
$2,621.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,780.55
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cash Price |
$3,648.80
|
| Rate for Payer: Cofinity Commercial |
$2,563.99
|
| Rate for Payer: Cofinity Commercial |
$2,385.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,780.55
|
| Rate for Payer: Mclaren Medicaid |
$1,146.58
|
| Rate for Payer: Meridian Medicaid |
$1,203.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,869.58
|
| Rate for Payer: PACE SWMI |
$1,780.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,780.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,146.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,192.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,153.89
|
| Rate for Payer: Priority Health Medicare |
$1,780.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,153.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,780.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,780.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,833.97
|
|
|
PR PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST
|
Professional
|
Both
|
$4,632.00
|
|
|
Service Code
|
HCPCS 45110
|
| Min. Negotiated Rate |
$389.36 |
| Max. Negotiated Rate |
$3,242.40 |
| Rate for Payer: Aetna Commercial |
$2,400.34
|
| Rate for Payer: Aetna Medicare |
$1,862.95
|
| Rate for Payer: BCBS Complete |
$1,209.73
|
| Rate for Payer: BCBS MAPPO |
$1,791.30
|
| Rate for Payer: BCBS Trust/PPO |
$389.36
|
| Rate for Payer: BCN Commercial |
$2,639.84
|
| Rate for Payer: BCN Medicare Advantage |
$1,791.30
|
| Rate for Payer: Cash Price |
$3,705.60
|
| Rate for Payer: Cash Price |
$3,705.60
|
| Rate for Payer: Cofinity Commercial |
$2,400.34
|
| Rate for Payer: Cofinity Commercial |
$2,579.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,791.30
|
| Rate for Payer: Mclaren Medicaid |
$1,152.12
|
| Rate for Payer: Meridian Medicaid |
$1,209.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,880.86
|
| Rate for Payer: PACE SWMI |
$1,791.30
|
| Rate for Payer: PHP Medicare Advantage |
$1,791.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,152.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,242.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,176.24
|
| Rate for Payer: Priority Health Medicare |
$1,791.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,176.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,791.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,791.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,845.04
|
|
|
PR PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS
|
Professional
|
Both
|
$4,895.00
|
|
|
Service Code
|
HCPCS 45120
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$3,426.50 |
| Rate for Payer: Aetna Commercial |
$2,132.82
|
| Rate for Payer: Aetna Medicare |
$1,655.33
|
| Rate for Payer: BCBS Complete |
$1,073.74
|
| Rate for Payer: BCBS MAPPO |
$1,591.66
|
| Rate for Payer: BCBS Trust/PPO |
$234.57
|
| Rate for Payer: BCN Commercial |
$2,334.90
|
| Rate for Payer: BCN Medicare Advantage |
$1,591.66
|
| Rate for Payer: Cash Price |
$3,916.00
|
| Rate for Payer: Cash Price |
$3,916.00
|
| Rate for Payer: Cofinity Commercial |
$2,291.99
|
| Rate for Payer: Cofinity Commercial |
$2,132.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,591.66
|
| Rate for Payer: Mclaren Medicaid |
$1,022.61
|
| Rate for Payer: Meridian Medicaid |
$1,073.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,671.24
|
| Rate for Payer: PACE SWMI |
$1,591.66
|
| Rate for Payer: PHP Medicare Advantage |
$1,591.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,022.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,426.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,809.33
|
| Rate for Payer: Priority Health Medicare |
$1,591.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,809.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,591.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,591.66
|
| Rate for Payer: UHC Medicare Advantage |
$1,639.41
|
|
|
PR PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS
|
Professional
|
Both
|
$4,804.00
|
|
|
Service Code
|
HCPCS 45121
|
| Min. Negotiated Rate |
$188.07 |
| Max. Negotiated Rate |
$3,362.80 |
| Rate for Payer: Aetna Commercial |
$2,328.63
|
| Rate for Payer: Aetna Medicare |
$1,807.29
|
| Rate for Payer: BCBS Complete |
$1,171.71
|
| Rate for Payer: BCBS MAPPO |
$1,737.78
|
| Rate for Payer: BCBS Trust/PPO |
$188.07
|
| Rate for Payer: BCN Commercial |
$2,547.48
|
| Rate for Payer: BCN Medicare Advantage |
$1,737.78
|
| Rate for Payer: Cash Price |
$3,843.20
|
| Rate for Payer: Cash Price |
$3,843.20
|
| Rate for Payer: Cofinity Commercial |
$2,328.63
|
| Rate for Payer: Cofinity Commercial |
$2,502.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,737.78
|
| Rate for Payer: Mclaren Medicaid |
$1,115.91
|
| Rate for Payer: Meridian Medicaid |
$1,171.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,824.67
|
| Rate for Payer: PACE SWMI |
$1,737.78
|
| Rate for Payer: PHP Medicare Advantage |
$1,737.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,115.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,362.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,065.10
|
| Rate for Payer: Priority Health Medicare |
$1,737.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,065.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,737.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,737.78
|
| Rate for Payer: UHC Medicare Advantage |
$1,789.91
|
|
|
PR PRCTECT PRTL RESCJ RECTUM TABDL APPR
|
Professional
|
Both
|
$1,934.00
|
|
|
Service Code
|
HCPCS 45111
|
| Min. Negotiated Rate |
$283.70 |
| Max. Negotiated Rate |
$1,896.21 |
| Rate for Payer: Aetna Commercial |
$1,432.81
|
| Rate for Payer: Aetna Medicare |
$1,112.03
|
| Rate for Payer: BCBS Complete |
$727.99
|
| Rate for Payer: BCBS MAPPO |
$1,069.26
|
| Rate for Payer: BCBS Trust/PPO |
$283.70
|
| Rate for Payer: BCN Commercial |
$1,575.99
|
| Rate for Payer: BCN Medicare Advantage |
$1,069.26
|
| Rate for Payer: Cash Price |
$1,547.20
|
| Rate for Payer: Cash Price |
$1,547.20
|
| Rate for Payer: Cofinity Commercial |
$1,539.73
|
| Rate for Payer: Cofinity Commercial |
$1,432.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,069.26
|
| Rate for Payer: Mclaren Medicaid |
$693.32
|
| Rate for Payer: Meridian Medicaid |
$727.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,122.72
|
| Rate for Payer: PACE SWMI |
$1,069.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,069.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$693.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,353.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,896.21
|
| Rate for Payer: Priority Health Medicare |
$1,069.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,896.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,069.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,069.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,101.34
|
|
|
PR PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH
|
Professional
|
Both
|
$3,195.00
|
|
|
Service Code
|
HCPCS 45114
|
| Min. Negotiated Rate |
$86.17 |
| Max. Negotiated Rate |
$3,185.05 |
| Rate for Payer: Aetna Commercial |
$2,423.23
|
| Rate for Payer: Aetna Medicare |
$1,880.72
|
| Rate for Payer: BCBS Complete |
$1,216.66
|
| Rate for Payer: BCBS MAPPO |
$1,808.38
|
| Rate for Payer: BCBS Trust/PPO |
$86.17
|
| Rate for Payer: BCN Commercial |
$2,647.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,808.38
|
| Rate for Payer: Cash Price |
$2,556.00
|
| Rate for Payer: Cash Price |
$2,556.00
|
| Rate for Payer: Cofinity Commercial |
$2,423.23
|
| Rate for Payer: Cofinity Commercial |
$2,604.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,808.38
|
| Rate for Payer: Mclaren Medicaid |
$1,158.72
|
| Rate for Payer: Meridian Medicaid |
$1,216.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,898.80
|
| Rate for Payer: PACE SWMI |
$1,808.38
|
| Rate for Payer: PHP Medicare Advantage |
$1,808.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,158.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,236.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,185.05
|
| Rate for Payer: Priority Health Medicare |
$1,808.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,185.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,808.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,808.38
|
| Rate for Payer: UHC Medicare Advantage |
$1,862.63
|
|
|
PR PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY
|
Professional
|
Both
|
$3,736.00
|
|
|
Service Code
|
HCPCS 45116
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$2,687.04 |
| Rate for Payer: Aetna Commercial |
$2,029.94
|
| Rate for Payer: Aetna Medicare |
$1,575.48
|
| Rate for Payer: BCBS Complete |
$1,026.77
|
| Rate for Payer: BCBS MAPPO |
$1,514.88
|
| Rate for Payer: BCBS Trust/PPO |
$187.02
|
| Rate for Payer: BCN Commercial |
$2,233.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,514.88
|
| Rate for Payer: Cash Price |
$2,988.80
|
| Rate for Payer: Cash Price |
$2,988.80
|
| Rate for Payer: Cofinity Commercial |
$2,181.43
|
| Rate for Payer: Cofinity Commercial |
$2,029.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,514.88
|
| Rate for Payer: Mclaren Medicaid |
$977.88
|
| Rate for Payer: Meridian Medicaid |
$1,026.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,590.62
|
| Rate for Payer: PACE SWMI |
$1,514.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,514.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$977.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,615.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,687.04
|
| Rate for Payer: Priority Health Medicare |
$1,514.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,687.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,514.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,514.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,560.33
|
|
|
PR PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR
|
Professional
|
Both
|
$5,348.00
|
|
|
Service Code
|
HCPCS 45113
|
| Min. Negotiated Rate |
$234.57 |
| Max. Negotiated Rate |
$3,743.60 |
| Rate for Payer: Aetna Commercial |
$2,450.22
|
| Rate for Payer: Aetna Medicare |
$1,901.66
|
| Rate for Payer: BCBS Complete |
$1,237.68
|
| Rate for Payer: BCBS MAPPO |
$1,828.52
|
| Rate for Payer: BCBS Trust/PPO |
$234.57
|
| Rate for Payer: BCN Commercial |
$2,697.01
|
| Rate for Payer: BCN Medicare Advantage |
$1,828.52
|
| Rate for Payer: Cash Price |
$4,278.40
|
| Rate for Payer: Cash Price |
$4,278.40
|
| Rate for Payer: Cofinity Commercial |
$2,633.07
|
| Rate for Payer: Cofinity Commercial |
$2,450.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,828.52
|
| Rate for Payer: Mclaren Medicaid |
$1,178.74
|
| Rate for Payer: Meridian Medicaid |
$1,237.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,919.95
|
| Rate for Payer: PACE SWMI |
$1,828.52
|
| Rate for Payer: PHP Medicare Advantage |
$1,828.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,178.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,743.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,245.01
|
| Rate for Payer: Priority Health Medicare |
$1,828.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,245.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,828.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,828.52
|
| Rate for Payer: UHC Medicare Advantage |
$1,883.38
|
|
|
PR PRCTECT PRTL W/O ANAST PRNL APPR
|
Professional
|
Both
|
$2,987.00
|
|
|
Service Code
|
HCPCS 45123
|
| Min. Negotiated Rate |
$707.59 |
| Max. Negotiated Rate |
$2,090.90 |
| Rate for Payer: Aetna Commercial |
$1,474.16
|
| Rate for Payer: Aetna Medicare |
$1,144.12
|
| Rate for Payer: BCBS Complete |
$742.97
|
| Rate for Payer: BCBS MAPPO |
$1,100.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,046.11
|
| Rate for Payer: BCN Commercial |
$1,621.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,100.12
|
| Rate for Payer: Cash Price |
$2,389.60
|
| Rate for Payer: Cash Price |
$2,389.60
|
| Rate for Payer: Cofinity Commercial |
$1,474.16
|
| Rate for Payer: Cofinity Commercial |
$1,584.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,100.12
|
| Rate for Payer: Mclaren Medicaid |
$707.59
|
| Rate for Payer: Meridian Medicaid |
$742.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,155.13
|
| Rate for Payer: PACE SWMI |
$1,100.12
|
| Rate for Payer: PHP Medicare Advantage |
$1,100.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$707.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,090.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,951.49
|
| Rate for Payer: Priority Health Medicare |
$1,100.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,951.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,100.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,100.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,133.12
|
|
|
PR PREDNISONE IR OR DR ORAL 1MG
|
Professional
|
Both
|
$0.50
|
|
|
Service Code
|
HCPCS J7512
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: Aetna Medicare |
$0.01
|
| Rate for Payer: BCBS Complete |
$0.20
|
| Rate for Payer: BCBS MAPPO |
$0.01
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.01
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cash Price |
$0.40
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Cofinity Commercial |
$0.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.01
|
| Rate for Payer: PACE SWMI |
$0.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.35
|
| Rate for Payer: Priority Health Medicare |
$0.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.01
|
| Rate for Payer: UHC Medicare Advantage |
$0.01
|
|
|
PR PREDNISONE ORAL
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS J7506
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.70 |
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.70
|
|
|
PR PREPARE FECAL MICROBIOTA FOR INSTILLATION
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 44705
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$96.49
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: BCBS Trust/PPO |
$252.00
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Mclaren Medicaid |
$45.16
|
| Rate for Payer: Meridian Medicaid |
$47.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$125.83
|
|
|
PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA
|
Professional
|
Both
|
$924.00
|
|
|
Service Code
|
HCPCS 49013
|
| Min. Negotiated Rate |
$288.83 |
| Max. Negotiated Rate |
$794.36 |
| Rate for Payer: Aetna Commercial |
$608.20
|
| Rate for Payer: Aetna Medicare |
$472.04
|
| Rate for Payer: BCBS Complete |
$303.27
|
| Rate for Payer: BCBS MAPPO |
$453.88
|
| Rate for Payer: BCBS Trust/PPO |
$562.11
|
| Rate for Payer: BCN Commercial |
$660.20
|
| Rate for Payer: BCN Medicare Advantage |
$453.88
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cash Price |
$739.20
|
| Rate for Payer: Cofinity Commercial |
$653.59
|
| Rate for Payer: Cofinity Commercial |
$608.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$453.88
|
| Rate for Payer: Mclaren Medicaid |
$288.83
|
| Rate for Payer: Meridian Medicaid |
$303.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$476.57
|
| Rate for Payer: PACE SWMI |
$453.88
|
| Rate for Payer: PHP Medicare Advantage |
$453.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$646.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$794.36
|
| Rate for Payer: Priority Health Medicare |
$453.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$794.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$453.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$453.88
|
| Rate for Payer: UHC Medicare Advantage |
$467.50
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT
|
Professional
|
Both
|
$657.00
|
|
|
Service Code
|
HCPCS 15004
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$576.64 |
| Rate for Payer: Aetna Commercial |
$342.25
|
| Rate for Payer: Aetna Medicare |
$265.63
|
| Rate for Payer: BCBS Complete |
$172.43
|
| Rate for Payer: BCBS MAPPO |
$255.41
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$576.64
|
| Rate for Payer: BCN Medicare Advantage |
$255.41
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cash Price |
$525.60
|
| Rate for Payer: Cofinity Commercial |
$367.79
|
| Rate for Payer: Cofinity Commercial |
$342.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.41
|
| Rate for Payer: Mclaren Medicaid |
$164.22
|
| Rate for Payer: Meridian Medicaid |
$172.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.18
|
| Rate for Payer: PACE SWMI |
$255.41
|
| Rate for Payer: PHP Medicare Advantage |
$255.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$316.91
|
| Rate for Payer: Priority Health Medicare |
$255.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$316.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$255.41
|
| Rate for Payer: UHC Medicare Advantage |
$263.07
|
|
|
PR PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 15005
|
| Min. Negotiated Rate |
$56.66 |
| Max. Negotiated Rate |
$206.12 |
| Rate for Payer: Aetna Commercial |
$118.42
|
| Rate for Payer: Aetna Medicare |
$91.90
|
| Rate for Payer: BCBS Complete |
$59.49
|
| Rate for Payer: BCBS MAPPO |
$88.37
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$169.57
|
| Rate for Payer: BCN Medicare Advantage |
$88.37
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$127.25
|
| Rate for Payer: Cofinity Commercial |
$118.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.37
|
| Rate for Payer: Mclaren Medicaid |
$56.66
|
| Rate for Payer: Meridian Medicaid |
$59.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.79
|
| Rate for Payer: PACE SWMI |
$88.37
|
| Rate for Payer: PHP Medicare Advantage |
$88.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.92
|
| Rate for Payer: Priority Health Medicare |
$88.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.37
|
| Rate for Payer: UHC Medicare Advantage |
$91.02
|
|
