|
PR HOME/RES VISIT EST PATIENT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 99349
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$172.89 |
| Rate for Payer: Aetna Commercial |
$160.88
|
| Rate for Payer: Aetna Medicare |
$124.86
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: BCBS MAPPO |
$120.06
|
| Rate for Payer: BCN Medicare Advantage |
$120.06
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$172.89
|
| Rate for Payer: Cofinity Commercial |
$160.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.06
|
| Rate for Payer: Nomi Health Commercial |
$144.07
|
| Rate for Payer: PACE SWMI |
$120.06
|
| Rate for Payer: PHP Medicare Advantage |
$120.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.00
|
| Rate for Payer: Priority Health Medicare |
$121.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.06
|
| Rate for Payer: UHC Exchange |
$120.06
|
| Rate for Payer: UHC Medicare Advantage |
$120.06
|
|
|
PR HOME/RES VISIT EST PATIENT SF MDM 20 MINUTES
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 99347
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$65.65 |
| Rate for Payer: Aetna Commercial |
$57.23
|
| Rate for Payer: Aetna Medicare |
$44.42
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$42.71
|
| Rate for Payer: BCN Medicare Advantage |
$42.71
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$61.50
|
| Rate for Payer: Cofinity Commercial |
$57.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.85
|
| Rate for Payer: Nomi Health Commercial |
$51.25
|
| Rate for Payer: PACE SWMI |
$42.71
|
| Rate for Payer: PHP Medicare Advantage |
$42.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.65
|
| Rate for Payer: Priority Health Medicare |
$43.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.71
|
| Rate for Payer: UHC Exchange |
$42.71
|
| Rate for Payer: UHC Medicare Advantage |
$42.71
|
|
|
PR HOME/RES VISIT NEW PATIENT HIGH MDM 75 MINUTES
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 99345
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$273.31 |
| Rate for Payer: Aetna Commercial |
$254.33
|
| Rate for Payer: Aetna Medicare |
$197.39
|
| Rate for Payer: BCBS Complete |
$161.60
|
| Rate for Payer: BCBS MAPPO |
$189.80
|
| Rate for Payer: BCN Medicare Advantage |
$189.80
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$273.31
|
| Rate for Payer: Cofinity Commercial |
$254.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$199.29
|
| Rate for Payer: Nomi Health Commercial |
$227.76
|
| Rate for Payer: PACE SWMI |
$189.80
|
| Rate for Payer: PHP Medicare Advantage |
$189.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.60
|
| Rate for Payer: Priority Health Medicare |
$191.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.80
|
| Rate for Payer: UHC Exchange |
$189.80
|
| Rate for Payer: UHC Medicare Advantage |
$189.80
|
|
|
PR HOME/RES VISIT NEW PATIENT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 99342
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$106.99 |
| Rate for Payer: Aetna Commercial |
$99.56
|
| Rate for Payer: Aetna Medicare |
$77.27
|
| Rate for Payer: BCBS Complete |
$64.80
|
| Rate for Payer: BCBS MAPPO |
$74.30
|
| Rate for Payer: BCN Medicare Advantage |
$74.30
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cofinity Commercial |
$99.56
|
| Rate for Payer: Cofinity Commercial |
$106.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.02
|
| Rate for Payer: Nomi Health Commercial |
$89.16
|
| Rate for Payer: PACE SWMI |
$74.30
|
| Rate for Payer: PHP Medicare Advantage |
$74.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health Medicare |
$75.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$74.30
|
| Rate for Payer: UHC Exchange |
$74.30
|
| Rate for Payer: UHC Medicare Advantage |
$74.30
|
|
|
PR HOME/RES VISIT NEW PATIENT MOD MDM 60 MINUTES
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 99344
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$179.92
|
| Rate for Payer: Aetna Medicare |
$139.64
|
| Rate for Payer: BCBS Complete |
$126.00
|
| Rate for Payer: BCBS MAPPO |
$134.27
|
| Rate for Payer: BCN Medicare Advantage |
$134.27
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cofinity Commercial |
$193.35
|
| Rate for Payer: Cofinity Commercial |
$179.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.98
|
| Rate for Payer: Nomi Health Commercial |
$161.12
|
| Rate for Payer: PACE SWMI |
$134.27
|
| Rate for Payer: PHP Medicare Advantage |
$134.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.75
|
| Rate for Payer: Priority Health Medicare |
$135.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.27
|
| Rate for Payer: UHC Exchange |
$134.27
|
| Rate for Payer: UHC Medicare Advantage |
$134.27
|
|
|
PR HOME/RES VISIT NEW PATIENT SF MDM 15 MINUTES
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 99341
|
| Min. Negotiated Rate |
$46.54 |
| Max. Negotiated Rate |
$84.50 |
| Rate for Payer: Aetna Commercial |
$62.36
|
| Rate for Payer: Aetna Medicare |
$48.40
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$46.54
|
| Rate for Payer: BCN Medicare Advantage |
$46.54
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$67.02
|
| Rate for Payer: Cofinity Commercial |
$62.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.87
|
| Rate for Payer: Nomi Health Commercial |
$55.85
|
| Rate for Payer: PACE SWMI |
$46.54
|
| Rate for Payer: PHP Medicare Advantage |
$46.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$47.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.54
|
| Rate for Payer: UHC Exchange |
$46.54
|
| Rate for Payer: UHC Medicare Advantage |
$46.54
|
|
|
PR HOME SLEEP TEST/TYPE 3 PORTA
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS G0399
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$230.75 |
| Rate for Payer: Aetna Medicare |
$177.50
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
|
|
PR HOME SLEEP TEST/TYPE 4 PORTA
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS G0400
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$135.85 |
| Rate for Payer: Aetna Medicare |
$104.50
|
| Rate for Payer: Aetna Medicare |
$73.00
|
| Rate for Payer: Aetna Medicare |
$177.50
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS Complete |
$83.60
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.75
|
|
|
PR HOME VENTILATOR MGMT CARE OVERSIGHT 30 MIN/>
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 94005
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$124.15 |
| Rate for Payer: Aetna Medicare |
$95.50
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
|
|
PR HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 99343
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Aetna Medicare |
$119.50
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
|
|
PR HOPD MNTL HLT, 15-29 MIN
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS C7900
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR HOPD MNTL HLT, 30-60 MIN
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS C7901
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR HOPD MNTL HLT, EA ADDL
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS C7902
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Aetna Medicare |
$25.50
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
|
|
PR HOSPICE CARE SUPERVISION
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS G0182
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$141.03 |
| Rate for Payer: Aetna Commercial |
$131.24
|
| Rate for Payer: Aetna Medicare |
$101.86
|
| Rate for Payer: BCBS Complete |
$76.40
|
| Rate for Payer: BCBS MAPPO |
$97.94
|
| Rate for Payer: BCN Medicare Advantage |
$97.94
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cofinity Commercial |
$141.03
|
| Rate for Payer: Cofinity Commercial |
$131.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.84
|
| Rate for Payer: Nomi Health Commercial |
$117.53
|
| Rate for Payer: PACE SWMI |
$97.94
|
| Rate for Payer: PHP Medicare Advantage |
$97.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
| Rate for Payer: Priority Health Medicare |
$98.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.94
|
| Rate for Payer: UHC Exchange |
$97.94
|
| Rate for Payer: UHC Medicare Advantage |
$97.94
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN
|
Professional
|
Both
|
$392.00
|
|
|
Service Code
|
HCPCS 99236
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$283.67 |
| Rate for Payer: Aetna Commercial |
$263.97
|
| Rate for Payer: Aetna Medicare |
$204.87
|
| Rate for Payer: BCBS Complete |
$156.80
|
| Rate for Payer: BCBS MAPPO |
$196.99
|
| Rate for Payer: BCN Medicare Advantage |
$196.99
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cash Price |
$313.60
|
| Rate for Payer: Cofinity Commercial |
$263.97
|
| Rate for Payer: Cofinity Commercial |
$283.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.84
|
| Rate for Payer: Nomi Health Commercial |
$236.39
|
| Rate for Payer: PACE SWMI |
$196.99
|
| Rate for Payer: PHP Medicare Advantage |
$196.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$254.80
|
| Rate for Payer: Priority Health Medicare |
$198.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.99
|
| Rate for Payer: UHC Exchange |
$196.99
|
| Rate for Payer: UHC Medicare Advantage |
$196.99
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 99235
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$216.65 |
| Rate for Payer: Aetna Commercial |
$201.60
|
| Rate for Payer: Aetna Medicare |
$156.47
|
| Rate for Payer: BCBS Complete |
$126.40
|
| Rate for Payer: BCBS MAPPO |
$150.45
|
| Rate for Payer: BCN Medicare Advantage |
$150.45
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$216.65
|
| Rate for Payer: Cofinity Commercial |
$201.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$150.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$157.97
|
| Rate for Payer: Nomi Health Commercial |
$180.54
|
| Rate for Payer: PACE SWMI |
$150.45
|
| Rate for Payer: PHP Medicare Advantage |
$150.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health Medicare |
$151.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$150.45
|
| Rate for Payer: UHC Exchange |
$150.45
|
| Rate for Payer: UHC Medicare Advantage |
$150.45
|
|
|
PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
HCPCS 99234
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$156.65 |
| Rate for Payer: Aetna Commercial |
$124.04
|
| Rate for Payer: Aetna Medicare |
$96.27
|
| Rate for Payer: BCBS Complete |
$96.40
|
| Rate for Payer: BCBS MAPPO |
$92.57
|
| Rate for Payer: BCN Medicare Advantage |
$92.57
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cash Price |
$192.80
|
| Rate for Payer: Cofinity Commercial |
$133.30
|
| Rate for Payer: Cofinity Commercial |
$124.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.20
|
| Rate for Payer: Nomi Health Commercial |
$111.08
|
| Rate for Payer: PACE SWMI |
$92.57
|
| Rate for Payer: PHP Medicare Advantage |
$92.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.65
|
| Rate for Payer: Priority Health Medicare |
$93.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.57
|
| Rate for Payer: UHC Exchange |
$92.57
|
| Rate for Payer: UHC Medicare Advantage |
$92.57
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 99239
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Commercial |
$145.15
|
| Rate for Payer: Aetna Medicare |
$112.65
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS MAPPO |
$108.32
|
| Rate for Payer: BCN Medicare Advantage |
$108.32
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$155.98
|
| Rate for Payer: Cofinity Commercial |
$145.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.74
|
| Rate for Payer: Nomi Health Commercial |
$129.98
|
| Rate for Payer: PACE SWMI |
$108.32
|
| Rate for Payer: PHP Medicare Advantage |
$108.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health Medicare |
$109.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.32
|
| Rate for Payer: UHC Exchange |
$108.32
|
| Rate for Payer: UHC Medicare Advantage |
$108.32
|
|
|
PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 99238
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$110.38 |
| Rate for Payer: Aetna Commercial |
$102.71
|
| Rate for Payer: Aetna Medicare |
$79.72
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$76.65
|
| Rate for Payer: BCN Medicare Advantage |
$76.65
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$110.38
|
| Rate for Payer: Cofinity Commercial |
$102.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.48
|
| Rate for Payer: Nomi Health Commercial |
$91.98
|
| Rate for Payer: PACE SWMI |
$76.65
|
| Rate for Payer: PHP Medicare Advantage |
$76.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$77.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.65
|
| Rate for Payer: UHC Exchange |
$76.65
|
| Rate for Payer: UHC Medicare Advantage |
$76.65
|
|
|
PR HO W/O JOINTS CF
|
Professional
|
Both
|
$253.00
|
|
|
Service Code
|
HCPCS L3919
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$427.62 |
| Rate for Payer: Aetna Commercial |
$397.93
|
| Rate for Payer: Aetna Medicare |
$308.84
|
| Rate for Payer: BCBS Complete |
$101.20
|
| Rate for Payer: BCBS MAPPO |
$296.96
|
| Rate for Payer: BCN Medicare Advantage |
$296.96
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Cofinity Commercial |
$427.62
|
| Rate for Payer: Cofinity Commercial |
$397.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.81
|
| Rate for Payer: Nomi Health Commercial |
$356.35
|
| Rate for Payer: PACE SWMI |
$296.96
|
| Rate for Payer: PHP Medicare Advantage |
$296.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.45
|
| Rate for Payer: Priority Health Medicare |
$299.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$296.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.96
|
| Rate for Payer: UHC Exchange |
$296.96
|
| Rate for Payer: UHC Medicare Advantage |
$296.96
|
|
|
PR HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY
|
Professional
|
Both
|
$1,182.00
|
|
|
Service Code
|
HCPCS 46258
|
| Min. Negotiated Rate |
$466.71 |
| Max. Negotiated Rate |
$768.30 |
| Rate for Payer: Aetna Commercial |
$625.39
|
| Rate for Payer: Aetna Medicare |
$485.38
|
| Rate for Payer: BCBS Complete |
$472.80
|
| Rate for Payer: BCBS MAPPO |
$466.71
|
| Rate for Payer: BCN Medicare Advantage |
$466.71
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cash Price |
$945.60
|
| Rate for Payer: Cofinity Commercial |
$672.06
|
| Rate for Payer: Cofinity Commercial |
$625.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$490.05
|
| Rate for Payer: Nomi Health Commercial |
$560.05
|
| Rate for Payer: PACE SWMI |
$466.71
|
| Rate for Payer: PHP Medicare Advantage |
$466.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$768.30
|
| Rate for Payer: Priority Health Medicare |
$471.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.71
|
| Rate for Payer: UHC Exchange |
$466.71
|
| Rate for Payer: UHC Medicare Advantage |
$466.71
|
|
|
PR HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY
|
Professional
|
Both
|
$1,775.00
|
|
|
Service Code
|
HCPCS 46262
|
| Min. Negotiated Rate |
$567.95 |
| Max. Negotiated Rate |
$1,153.75 |
| Rate for Payer: Aetna Commercial |
$761.05
|
| Rate for Payer: Aetna Medicare |
$590.67
|
| Rate for Payer: BCBS Complete |
$710.00
|
| Rate for Payer: BCBS MAPPO |
$567.95
|
| Rate for Payer: BCN Medicare Advantage |
$567.95
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cash Price |
$1,420.00
|
| Rate for Payer: Cofinity Commercial |
$817.85
|
| Rate for Payer: Cofinity Commercial |
$761.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$596.35
|
| Rate for Payer: Nomi Health Commercial |
$681.54
|
| Rate for Payer: PACE SWMI |
$567.95
|
| Rate for Payer: PHP Medicare Advantage |
$567.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,153.75
|
| Rate for Payer: Priority Health Medicare |
$573.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$567.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$567.95
|
| Rate for Payer: UHC Exchange |
$567.95
|
| Rate for Payer: UHC Medicare Advantage |
$567.95
|
|
|
PR HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU
|
Professional
|
Both
|
$1,732.00
|
|
|
Service Code
|
HCPCS 46261
|
| Min. Negotiated Rate |
$512.00 |
| Max. Negotiated Rate |
$1,125.80 |
| Rate for Payer: Aetna Commercial |
$686.08
|
| Rate for Payer: Aetna Medicare |
$532.48
|
| Rate for Payer: BCBS Complete |
$692.80
|
| Rate for Payer: BCBS MAPPO |
$512.00
|
| Rate for Payer: BCN Medicare Advantage |
$512.00
|
| Rate for Payer: Cash Price |
$1,385.60
|
| Rate for Payer: Cash Price |
$1,385.60
|
| Rate for Payer: Cofinity Commercial |
$737.28
|
| Rate for Payer: Cofinity Commercial |
$686.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$512.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$537.60
|
| Rate for Payer: Nomi Health Commercial |
$614.40
|
| Rate for Payer: PACE SWMI |
$512.00
|
| Rate for Payer: PHP Medicare Advantage |
$512.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,125.80
|
| Rate for Payer: Priority Health Medicare |
$517.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$512.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$512.00
|
| Rate for Payer: UHC Exchange |
$512.00
|
| Rate for Payer: UHC Medicare Advantage |
$512.00
|
|
|
PR HYALGAN SUPARTZ VISCO-3 DOSE
|
Professional
|
Both
|
$303.00
|
|
|
Service Code
|
HCPCS J7321
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$196.95 |
| Rate for Payer: Aetna Commercial |
$95.84
|
| Rate for Payer: Aetna Medicare |
$74.38
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: BCBS MAPPO |
$71.52
|
| Rate for Payer: BCN Medicare Advantage |
$71.52
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cofinity Commercial |
$95.84
|
| Rate for Payer: Cofinity Commercial |
$102.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.10
|
| Rate for Payer: Nomi Health Commercial |
$85.82
|
| Rate for Payer: PACE SWMI |
$71.52
|
| Rate for Payer: PHP Medicare Advantage |
$71.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.95
|
| Rate for Payer: Priority Health Medicare |
$72.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.52
|
| Rate for Payer: UHC Exchange |
$71.52
|
| Rate for Payer: UHC Medicare Advantage |
$71.52
|
|
|
PR HYDROCORTISONE SODIUM SUCC I
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1720
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$30.69 |
| Rate for Payer: Aetna Commercial |
$28.56
|
| Rate for Payer: Aetna Medicare |
$22.16
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$21.31
|
| Rate for Payer: BCN Medicare Advantage |
$21.31
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$30.69
|
| Rate for Payer: Cofinity Commercial |
$28.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.38
|
| Rate for Payer: Nomi Health Commercial |
$25.57
|
| Rate for Payer: PACE SWMI |
$21.31
|
| Rate for Payer: PHP Medicare Advantage |
$21.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
| Rate for Payer: Priority Health Medicare |
$21.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.31
|
| Rate for Payer: UHC Exchange |
$21.31
|
| Rate for Payer: UHC Medicare Advantage |
$21.31
|
|
