|
PR RSV MONOC ANTB SEASN 1 ML IM
|
Professional
|
Both
|
$1,277.00
|
|
|
Service Code
|
HCPCS 90381
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$893.90 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: BCBS Complete |
$510.80
|
| Rate for Payer: BCBS Trust/PPO |
$504.90
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
|
|
PR RSV MONOC ANTB SEASN .5ML IM
|
Professional
|
Both
|
$1,277.00
|
|
|
Service Code
|
HCPCS 90380
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$893.90 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: BCBS Complete |
$510.80
|
| Rate for Payer: BCBS Trust/PPO |
$504.90
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Cash Price |
$1,021.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$893.90
|
|
|
PR RSV VACCINE PREF RECOMB SUBUNIT ADJUVANTED FOR IM USE
|
Professional
|
Both
|
$781.20
|
|
|
Service Code
|
HCPCS 90679
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$546.84 |
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: BCBS Complete |
$312.48
|
| Rate for Payer: BCBS Trust/PPO |
$285.60
|
| Rate for Payer: Cash Price |
$624.96
|
| Rate for Payer: Cash Price |
$624.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.84
|
|
|
PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE
|
Professional
|
Both
|
$823.05
|
|
|
Service Code
|
HCPCS 90678
|
| Min. Negotiated Rate |
$300.90 |
| Max. Negotiated Rate |
$576.14 |
| Rate for Payer: Aetna Commercial |
$300.90
|
| Rate for Payer: BCBS Complete |
$329.22
|
| Rate for Payer: BCBS Trust/PPO |
$347.00
|
| Rate for Payer: Cash Price |
$658.44
|
| Rate for Payer: Cash Price |
$658.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.14
|
|
|
PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$2,888.00
|
|
|
Service Code
|
HCPCS 37193
|
| Min. Negotiated Rate |
$214.92 |
| Max. Negotiated Rate |
$2,206.87 |
| Rate for Payer: Aetna Commercial |
$453.59
|
| Rate for Payer: Aetna Medicare |
$352.04
|
| Rate for Payer: BCBS Complete |
$225.67
|
| Rate for Payer: BCBS MAPPO |
$338.50
|
| Rate for Payer: BCBS Trust/PPO |
$524.07
|
| Rate for Payer: BCN Commercial |
$2,206.87
|
| Rate for Payer: BCN Medicare Advantage |
$338.50
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cash Price |
$2,310.40
|
| Rate for Payer: Cofinity Commercial |
$453.59
|
| Rate for Payer: Cofinity Commercial |
$487.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$338.50
|
| Rate for Payer: Mclaren Medicaid |
$214.92
|
| Rate for Payer: Meridian Medicaid |
$225.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$355.42
|
| Rate for Payer: PACE SWMI |
$338.50
|
| Rate for Payer: PHP Medicare Advantage |
$338.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$214.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,021.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.74
|
| Rate for Payer: Priority Health Medicare |
$338.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$536.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$338.50
|
| Rate for Payer: UHC Medicare Advantage |
$348.66
|
|
|
PR RUBELLA IMMUNIZATION, SUBCUT
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 90706
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
|
|
PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 90681
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$137.29 |
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS Trust/PPO |
$129.14
|
| Rate for Payer: BCN Commercial |
$129.14
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
|
|
PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 90680
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$91.96
|
| Rate for Payer: BCN Commercial |
$91.96
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.80
|
|
|
PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY
|
Professional
|
Both
|
$3,080.00
|
|
|
Service Code
|
HCPCS 33476
|
| Min. Negotiated Rate |
$684.68 |
| Max. Negotiated Rate |
$2,385.29 |
| Rate for Payer: Aetna Commercial |
$2,010.25
|
| Rate for Payer: Aetna Medicare |
$1,560.20
|
| Rate for Payer: BCBS Complete |
$1,008.44
|
| Rate for Payer: BCBS MAPPO |
$1,500.19
|
| Rate for Payer: BCBS Trust/PPO |
$684.68
|
| Rate for Payer: BCN Commercial |
$2,191.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,500.19
|
| Rate for Payer: Cash Price |
$2,464.00
|
| Rate for Payer: Cash Price |
$2,464.00
|
| Rate for Payer: Cofinity Commercial |
$2,010.25
|
| Rate for Payer: Cofinity Commercial |
$2,160.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,500.19
|
| Rate for Payer: Mclaren Medicaid |
$960.42
|
| Rate for Payer: Meridian Medicaid |
$1,008.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,575.20
|
| Rate for Payer: PACE SWMI |
$1,500.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,500.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$960.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,156.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,385.29
|
| Rate for Payer: Priority Health Medicare |
$1,500.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,385.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,500.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,500.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,545.20
|
|
|
PR RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 92310
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$145.62
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Mclaren Medicaid |
$36.00
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.85
|
|
|
PR RX&FTG CONTACT CORNEAL LENS EYES XCPT APHAKIA
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 92314
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$686.79 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS Trust/PPO |
$686.79
|
| Rate for Payer: BCN Commercial |
$126.57
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.15
|
|
|
PR RX RIB FRACTURE W EXTERN FIXATN
|
Professional
|
Both
|
$1,291.00
|
|
|
Service Code
|
HCPCS 21810
|
| Min. Negotiated Rate |
$516.40 |
| Max. Negotiated Rate |
$903.70 |
| Rate for Payer: BCBS Complete |
$516.40
|
| Rate for Payer: Cash Price |
$1,032.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$903.70
|
|
|
PR SACRAL NERVE STIM TEST LEAD
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS A4290
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$902.34 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS Trust/PPO |
$902.34
|
| Rate for Payer: BCN Commercial |
$22.50
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
|
|
PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$1,715.00
|
|
|
Service Code
|
HCPCS 58700
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$1,200.50 |
| Rate for Payer: Aetna Commercial |
$1,064.08
|
| Rate for Payer: Aetna Medicare |
$825.85
|
| Rate for Payer: BCBS Complete |
$540.78
|
| Rate for Payer: BCBS MAPPO |
$794.09
|
| Rate for Payer: BCBS Trust/PPO |
$138.94
|
| Rate for Payer: BCN Commercial |
$1,174.29
|
| Rate for Payer: BCN Medicare Advantage |
$794.09
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cash Price |
$1,372.00
|
| Rate for Payer: Cofinity Commercial |
$1,143.49
|
| Rate for Payer: Cofinity Commercial |
$1,064.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$794.09
|
| Rate for Payer: Mclaren Medicaid |
$515.03
|
| Rate for Payer: Meridian Medicaid |
$540.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$833.79
|
| Rate for Payer: PACE SWMI |
$794.09
|
| Rate for Payer: PHP Medicare Advantage |
$794.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$515.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,200.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,137.64
|
| Rate for Payer: Priority Health Medicare |
$794.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,137.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$794.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$794.09
|
| Rate for Payer: UHC Medicare Advantage |
$817.91
|
|
|
PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX
|
Professional
|
Both
|
$2,001.00
|
|
|
Service Code
|
HCPCS 58720
|
| Min. Negotiated Rate |
$429.51 |
| Max. Negotiated Rate |
$1,400.70 |
| Rate for Payer: Aetna Commercial |
$1,005.83
|
| Rate for Payer: Aetna Medicare |
$780.64
|
| Rate for Payer: BCBS Complete |
$513.50
|
| Rate for Payer: BCBS MAPPO |
$750.62
|
| Rate for Payer: BCBS Trust/PPO |
$429.51
|
| Rate for Payer: BCN Commercial |
$1,111.74
|
| Rate for Payer: BCN Medicare Advantage |
$750.62
|
| Rate for Payer: Cash Price |
$1,600.80
|
| Rate for Payer: Cash Price |
$1,600.80
|
| Rate for Payer: Cofinity Commercial |
$1,080.89
|
| Rate for Payer: Cofinity Commercial |
$1,005.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$750.62
|
| Rate for Payer: Mclaren Medicaid |
$489.05
|
| Rate for Payer: Meridian Medicaid |
$513.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$788.15
|
| Rate for Payer: PACE SWMI |
$750.62
|
| Rate for Payer: PHP Medicare Advantage |
$750.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,400.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,077.03
|
| Rate for Payer: Priority Health Medicare |
$750.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,077.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$750.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$750.62
|
| Rate for Payer: UHC Medicare Advantage |
$773.14
|
|
|
PR SALPINGOSTOMY
|
Professional
|
Both
|
$2,674.00
|
|
|
Service Code
|
HCPCS 58770
|
| Min. Negotiated Rate |
$209.21 |
| Max. Negotiated Rate |
$1,871.80 |
| Rate for Payer: Aetna Commercial |
$1,149.80
|
| Rate for Payer: Aetna Medicare |
$892.38
|
| Rate for Payer: BCBS Complete |
$581.04
|
| Rate for Payer: BCBS MAPPO |
$858.06
|
| Rate for Payer: BCBS Trust/PPO |
$209.21
|
| Rate for Payer: BCN Commercial |
$1,266.17
|
| Rate for Payer: BCN Medicare Advantage |
$858.06
|
| Rate for Payer: Cash Price |
$2,139.20
|
| Rate for Payer: Cash Price |
$2,139.20
|
| Rate for Payer: Cofinity Commercial |
$1,149.80
|
| Rate for Payer: Cofinity Commercial |
$1,235.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$858.06
|
| Rate for Payer: Mclaren Medicaid |
$553.37
|
| Rate for Payer: Meridian Medicaid |
$581.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$900.96
|
| Rate for Payer: PACE SWMI |
$858.06
|
| Rate for Payer: PHP Medicare Advantage |
$858.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,871.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,226.65
|
| Rate for Payer: Priority Health Medicare |
$858.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,226.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$858.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$858.06
|
| Rate for Payer: UHC Medicare Advantage |
$883.80
|
|
|
PR SARSCOV2 VACC 10MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$214.83
|
|
|
Service Code
|
HCPCS 91319
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$150.38 |
| Rate for Payer: Aetna Commercial |
$87.78
|
| Rate for Payer: BCBS Complete |
$85.93
|
| Rate for Payer: BCBS Trust/PPO |
$78.54
|
| Rate for Payer: Cash Price |
$171.86
|
| Rate for Payer: Cash Price |
$171.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.38
|
|
|
PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$320.85
|
|
|
Service Code
|
HCPCS 91320
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$224.60 |
| Rate for Payer: Aetna Commercial |
$131.10
|
| Rate for Payer: BCBS Complete |
$128.34
|
| Rate for Payer: BCBS Trust/PPO |
$125.00
|
| Rate for Payer: Cash Price |
$256.68
|
| Rate for Payer: Cash Price |
$256.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.60
|
|
|
PR SARSCOV2 VACC 3MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$160.44
|
|
|
Service Code
|
HCPCS 91318
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$112.31 |
| Rate for Payer: Aetna Commercial |
$65.36
|
| Rate for Payer: BCBS Complete |
$64.18
|
| Rate for Payer: BCBS Trust/PPO |
$58.65
|
| Rate for Payer: Cash Price |
$128.35
|
| Rate for Payer: Cash Price |
$128.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.31
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 99233
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$1,858.56 |
| Rate for Payer: Aetna Commercial |
$156.66
|
| Rate for Payer: Aetna Medicare |
$121.59
|
| Rate for Payer: BCBS Complete |
$78.73
|
| Rate for Payer: BCBS MAPPO |
$116.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,858.56
|
| Rate for Payer: BCN Commercial |
$126.11
|
| Rate for Payer: BCN Medicare Advantage |
$116.91
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$156.66
|
| Rate for Payer: Cofinity Commercial |
$168.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.91
|
| Rate for Payer: Mclaren Medicaid |
$74.98
|
| Rate for Payer: Meridian Medicaid |
$78.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$122.76
|
| Rate for Payer: PACE SWMI |
$116.91
|
| Rate for Payer: PHP Medicare Advantage |
$116.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$150.77
|
| Rate for Payer: Priority Health Medicare |
$116.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.91
|
| Rate for Payer: UHC Medicare Advantage |
$120.42
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$49.84 |
| Max. Negotiated Rate |
$2,072.52 |
| Rate for Payer: Aetna Commercial |
$104.13
|
| Rate for Payer: Aetna Medicare |
$80.82
|
| Rate for Payer: BCBS Complete |
$52.33
|
| Rate for Payer: BCBS MAPPO |
$77.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,072.52
|
| Rate for Payer: BCN Commercial |
$83.83
|
| Rate for Payer: BCN Medicare Advantage |
$77.71
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$111.90
|
| Rate for Payer: Cofinity Commercial |
$104.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.71
|
| Rate for Payer: Mclaren Medicaid |
$49.84
|
| Rate for Payer: Meridian Medicaid |
$52.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.60
|
| Rate for Payer: PACE SWMI |
$77.71
|
| Rate for Payer: PHP Medicare Advantage |
$77.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.23
|
| Rate for Payer: Priority Health Medicare |
$77.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.71
|
| Rate for Payer: UHC Medicare Advantage |
$80.04
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$1,703.77 |
| Rate for Payer: Aetna Commercial |
$65.61
|
| Rate for Payer: Aetna Medicare |
$50.92
|
| Rate for Payer: BCBS Complete |
$32.88
|
| Rate for Payer: BCBS MAPPO |
$48.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.77
|
| Rate for Payer: BCN Commercial |
$52.66
|
| Rate for Payer: BCN Medicare Advantage |
$48.96
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$70.50
|
| Rate for Payer: Cofinity Commercial |
$65.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.96
|
| Rate for Payer: Mclaren Medicaid |
$31.31
|
| Rate for Payer: Meridian Medicaid |
$32.88
|
| 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 |
$31.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.96
|
| Rate for Payer: Priority Health Medicare |
$48.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.96
|
| 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 SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$131.97 |
| Max. Negotiated Rate |
$500.83 |
| Rate for Payer: Aetna Commercial |
$200.13
|
| Rate for Payer: Aetna Medicare |
$155.32
|
| Rate for Payer: BCBS Complete |
$138.57
|
| Rate for Payer: BCBS MAPPO |
$149.35
|
| Rate for Payer: BCBS Trust/PPO |
$500.83
|
| Rate for Payer: BCN Commercial |
$221.37
|
| Rate for Payer: BCN Medicare Advantage |
$149.35
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$215.06
|
| Rate for Payer: Cofinity Commercial |
$200.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.35
|
| Rate for Payer: Mclaren Medicaid |
$131.97
|
| Rate for Payer: Meridian Medicaid |
$138.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.82
|
| Rate for Payer: PACE SWMI |
$149.35
|
| Rate for Payer: PHP Medicare Advantage |
$149.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$131.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.03
|
| Rate for Payer: Priority Health Medicare |
$149.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.35
|
| Rate for Payer: UHC Medicare Advantage |
$153.83
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 15 MINUTES
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$63.97 |
| Max. Negotiated Rate |
$2,410.10 |
| Rate for Payer: Aetna Commercial |
$97.02
|
| Rate for Payer: Aetna Medicare |
$75.30
|
| Rate for Payer: BCBS Complete |
$67.17
|
| Rate for Payer: BCBS MAPPO |
$72.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,410.10
|
| Rate for Payer: BCN Commercial |
$107.51
|
| Rate for Payer: BCN Medicare Advantage |
$72.40
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$97.02
|
| Rate for Payer: Cofinity Commercial |
$104.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.40
|
| Rate for Payer: Mclaren Medicaid |
$63.97
|
| Rate for Payer: Meridian Medicaid |
$67.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.02
|
| Rate for Payer: PACE SWMI |
$72.40
|
| Rate for Payer: PHP Medicare Advantage |
$72.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.05
|
| Rate for Payer: Priority Health Medicare |
$72.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.40
|
| Rate for Payer: UHC Medicare Advantage |
$74.57
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$323.85 |
| Rate for Payer: Aetna Commercial |
$138.97
|
| Rate for Payer: Aetna Medicare |
$107.86
|
| Rate for Payer: BCBS Complete |
$97.12
|
| Rate for Payer: BCBS MAPPO |
$103.71
|
| Rate for Payer: BCBS Trust/PPO |
$323.85
|
| Rate for Payer: BCN Commercial |
$153.93
|
| Rate for Payer: BCN Medicare Advantage |
$103.71
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$149.34
|
| Rate for Payer: Cofinity Commercial |
$138.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.71
|
| Rate for Payer: Mclaren Medicaid |
$92.50
|
| Rate for Payer: Meridian Medicaid |
$97.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$108.90
|
| Rate for Payer: PACE SWMI |
$103.71
|
| Rate for Payer: PHP Medicare Advantage |
$103.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$92.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.88
|
| Rate for Payer: Priority Health Medicare |
$103.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$131.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.71
|
| Rate for Payer: UHC Medicare Advantage |
$106.82
|
|
