|
PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH
|
Professional
|
Both
|
$1,278.00
|
|
|
Service Code
|
HCPCS 36247
|
| Min. Negotiated Rate |
$185.10 |
| Max. Negotiated Rate |
$2,090.07 |
| Rate for Payer: Aetna Commercial |
$391.95
|
| Rate for Payer: Aetna Medicare |
$304.20
|
| Rate for Payer: BCBS Complete |
$194.36
|
| Rate for Payer: BCBS MAPPO |
$292.50
|
| Rate for Payer: BCBS Trust/PPO |
$1,650.94
|
| Rate for Payer: BCN Commercial |
$2,090.07
|
| Rate for Payer: BCN Medicare Advantage |
$292.50
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cash Price |
$1,022.40
|
| Rate for Payer: Cofinity Commercial |
$421.20
|
| Rate for Payer: Cofinity Commercial |
$391.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$292.50
|
| Rate for Payer: Mclaren Medicaid |
$185.10
|
| Rate for Payer: Meridian Medicaid |
$194.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$307.12
|
| Rate for Payer: PACE SWMI |
$292.50
|
| Rate for Payer: PHP Medicare Advantage |
$292.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$185.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$462.81
|
| Rate for Payer: Priority Health Medicare |
$292.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$462.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$292.50
|
| Rate for Payer: UHC Medicare Advantage |
$301.28
|
|
|
PR SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
HCPCS 36217
|
| Min. Negotiated Rate |
$208.31 |
| Max. Negotiated Rate |
$2,617.35 |
| Rate for Payer: Aetna Commercial |
$435.30
|
| Rate for Payer: Aetna Medicare |
$337.84
|
| Rate for Payer: BCBS Complete |
$218.73
|
| Rate for Payer: BCBS MAPPO |
$324.85
|
| Rate for Payer: BCBS Trust/PPO |
$1,410.56
|
| Rate for Payer: BCN Commercial |
$2,617.35
|
| Rate for Payer: BCN Medicare Advantage |
$324.85
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cash Price |
$1,080.00
|
| Rate for Payer: Cofinity Commercial |
$435.30
|
| Rate for Payer: Cofinity Commercial |
$467.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$324.85
|
| Rate for Payer: Mclaren Medicaid |
$208.31
|
| Rate for Payer: Meridian Medicaid |
$218.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$341.09
|
| Rate for Payer: PACE SWMI |
$324.85
|
| Rate for Payer: PHP Medicare Advantage |
$324.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$945.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.87
|
| Rate for Payer: Priority Health Medicare |
$324.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$324.85
|
| Rate for Payer: UHC Medicare Advantage |
$334.60
|
|
|
PR SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$819.00
|
|
|
Service Code
|
HCPCS 36245
|
| Min. Negotiated Rate |
$146.54 |
| Max. Negotiated Rate |
$1,828.14 |
| Rate for Payer: Aetna Commercial |
$308.98
|
| Rate for Payer: Aetna Medicare |
$239.80
|
| Rate for Payer: BCBS Complete |
$153.87
|
| Rate for Payer: BCBS MAPPO |
$230.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,012.22
|
| Rate for Payer: BCN Commercial |
$1,828.14
|
| Rate for Payer: BCN Medicare Advantage |
$230.58
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cofinity Commercial |
$332.04
|
| Rate for Payer: Cofinity Commercial |
$308.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$230.58
|
| Rate for Payer: Mclaren Medicaid |
$146.54
|
| Rate for Payer: Meridian Medicaid |
$153.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$242.11
|
| Rate for Payer: PACE SWMI |
$230.58
|
| Rate for Payer: PHP Medicare Advantage |
$230.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$573.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$365.46
|
| Rate for Payer: Priority Health Medicare |
$230.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$365.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$230.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$230.58
|
| Rate for Payer: UHC Medicare Advantage |
$237.50
|
|
|
PR SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 36215
|
| Min. Negotiated Rate |
$132.27 |
| Max. Negotiated Rate |
$1,519.78 |
| Rate for Payer: Aetna Commercial |
$277.67
|
| Rate for Payer: Aetna Medicare |
$215.51
|
| Rate for Payer: BCBS Complete |
$138.88
|
| Rate for Payer: BCBS MAPPO |
$207.22
|
| Rate for Payer: BCBS Trust/PPO |
$781.36
|
| Rate for Payer: BCN Commercial |
$1,519.78
|
| Rate for Payer: BCN Medicare Advantage |
$207.22
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cofinity Commercial |
$298.40
|
| Rate for Payer: Cofinity Commercial |
$277.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.22
|
| Rate for Payer: Mclaren Medicaid |
$132.27
|
| Rate for Payer: Meridian Medicaid |
$138.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$217.58
|
| Rate for Payer: PACE SWMI |
$207.22
|
| Rate for Payer: PHP Medicare Advantage |
$207.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$329.81
|
| Rate for Payer: Priority Health Medicare |
$207.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$329.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.22
|
| Rate for Payer: UHC Medicare Advantage |
$213.44
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 36248
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$1,877.58 |
| Rate for Payer: Aetna Commercial |
$63.32
|
| Rate for Payer: Aetna Medicare |
$49.14
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCBS MAPPO |
$47.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,877.58
|
| Rate for Payer: BCN Commercial |
$171.52
|
| Rate for Payer: BCN Medicare Advantage |
$47.25
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$63.32
|
| Rate for Payer: Cofinity Commercial |
$68.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.25
|
| Rate for Payer: Mclaren Medicaid |
$29.82
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.61
|
| Rate for Payer: PACE SWMI |
$47.25
|
| Rate for Payer: PHP Medicare Advantage |
$47.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$47.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.25
|
| Rate for Payer: UHC Medicare Advantage |
$48.67
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 36218
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$489.73 |
| Rate for Payer: Aetna Commercial |
$68.38
|
| Rate for Payer: Aetna Medicare |
$53.07
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS MAPPO |
$51.03
|
| Rate for Payer: BCBS Trust/PPO |
$489.73
|
| Rate for Payer: BCN Commercial |
$304.94
|
| Rate for Payer: BCN Medicare Advantage |
$51.03
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$73.48
|
| Rate for Payer: Cofinity Commercial |
$68.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.03
|
| Rate for Payer: Mclaren Medicaid |
$32.80
|
| Rate for Payer: Meridian Medicaid |
$34.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.58
|
| Rate for Payer: PACE SWMI |
$51.03
|
| Rate for Payer: PHP Medicare Advantage |
$51.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.86
|
| Rate for Payer: Priority Health Medicare |
$51.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.03
|
| Rate for Payer: UHC Medicare Advantage |
$52.56
|
|
|
PR SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART
|
Professional
|
Both
|
$937.00
|
|
|
Service Code
|
HCPCS 36015
|
| Min. Negotiated Rate |
$106.29 |
| Max. Negotiated Rate |
$1,252.48 |
| Rate for Payer: Aetna Commercial |
$223.42
|
| Rate for Payer: Aetna Medicare |
$173.40
|
| Rate for Payer: BCBS Complete |
$111.60
|
| Rate for Payer: BCBS MAPPO |
$166.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,087.24
|
| Rate for Payer: BCN Commercial |
$1,252.48
|
| Rate for Payer: BCN Medicare Advantage |
$166.73
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cash Price |
$749.60
|
| Rate for Payer: Cofinity Commercial |
$240.09
|
| Rate for Payer: Cofinity Commercial |
$223.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$166.73
|
| Rate for Payer: Mclaren Medicaid |
$106.29
|
| Rate for Payer: Meridian Medicaid |
$111.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$175.07
|
| Rate for Payer: PACE SWMI |
$166.73
|
| Rate for Payer: PHP Medicare Advantage |
$166.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$655.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.92
|
| Rate for Payer: Priority Health Medicare |
$166.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$264.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$166.73
|
| Rate for Payer: UHC Medicare Advantage |
$171.73
|
|
|
PR SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
HCPCS 36011
|
| Min. Negotiated Rate |
$96.92 |
| Max. Negotiated Rate |
$2,329.71 |
| Rate for Payer: Aetna Commercial |
$205.14
|
| Rate for Payer: Aetna Medicare |
$159.21
|
| Rate for Payer: BCBS Complete |
$101.77
|
| Rate for Payer: BCBS MAPPO |
$153.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,329.71
|
| Rate for Payer: BCN Commercial |
$1,185.05
|
| Rate for Payer: BCN Medicare Advantage |
$153.09
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cash Price |
$585.60
|
| Rate for Payer: Cofinity Commercial |
$220.45
|
| Rate for Payer: Cofinity Commercial |
$205.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.09
|
| Rate for Payer: Mclaren Medicaid |
$96.92
|
| Rate for Payer: Meridian Medicaid |
$101.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$160.74
|
| Rate for Payer: PACE SWMI |
$153.09
|
| Rate for Payer: PHP Medicare Advantage |
$153.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.58
|
| Rate for Payer: Priority Health Medicare |
$153.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.09
|
| Rate for Payer: UHC Medicare Advantage |
$157.68
|
|
|
PR SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC
|
Professional
|
Both
|
$961.00
|
|
|
Service Code
|
HCPCS 36012
|
| Min. Negotiated Rate |
$107.99 |
| Max. Negotiated Rate |
$1,531.54 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Aetna Medicare |
$176.02
|
| Rate for Payer: BCBS Complete |
$113.39
|
| Rate for Payer: BCBS MAPPO |
$169.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,531.54
|
| Rate for Payer: BCN Commercial |
$1,227.56
|
| Rate for Payer: BCN Medicare Advantage |
$169.25
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cash Price |
$768.80
|
| Rate for Payer: Cofinity Commercial |
$226.80
|
| Rate for Payer: Cofinity Commercial |
$243.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.25
|
| Rate for Payer: Mclaren Medicaid |
$107.99
|
| Rate for Payer: Meridian Medicaid |
$113.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$177.71
|
| Rate for Payer: PACE SWMI |
$169.25
|
| Rate for Payer: PHP Medicare Advantage |
$169.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$672.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.10
|
| Rate for Payer: Priority Health Medicare |
$169.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$268.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.25
|
| Rate for Payer: UHC Medicare Advantage |
$174.33
|
|
|
PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$1,753.00
|
|
|
Service Code
|
HCPCS 36225
|
| Min. Negotiated Rate |
$205.55 |
| Max. Negotiated Rate |
$2,276.75 |
| Rate for Payer: Aetna Commercial |
$429.08
|
| Rate for Payer: Aetna Medicare |
$333.02
|
| Rate for Payer: BCBS Complete |
$215.83
|
| Rate for Payer: BCBS MAPPO |
$320.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,878.11
|
| Rate for Payer: BCN Commercial |
$2,276.75
|
| Rate for Payer: BCN Medicare Advantage |
$320.21
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Cash Price |
$1,402.40
|
| Rate for Payer: Cofinity Commercial |
$461.10
|
| Rate for Payer: Cofinity Commercial |
$429.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$320.21
|
| Rate for Payer: Mclaren Medicaid |
$205.55
|
| Rate for Payer: Meridian Medicaid |
$215.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$336.22
|
| Rate for Payer: PACE SWMI |
$320.21
|
| Rate for Payer: PHP Medicare Advantage |
$320.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$205.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,227.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$506.96
|
| Rate for Payer: Priority Health Medicare |
$320.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$506.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$320.21
|
| Rate for Payer: UHC Medicare Advantage |
$329.82
|
|
|
PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$1,235.00
|
|
|
Service Code
|
HCPCS 36226
|
| Min. Negotiated Rate |
$231.32 |
| Max. Negotiated Rate |
$2,912.03 |
| Rate for Payer: Aetna Commercial |
$483.86
|
| Rate for Payer: Aetna Medicare |
$375.53
|
| Rate for Payer: BCBS Complete |
$242.89
|
| Rate for Payer: BCBS MAPPO |
$361.09
|
| Rate for Payer: BCBS Trust/PPO |
$726.41
|
| Rate for Payer: BCN Commercial |
$2,912.03
|
| Rate for Payer: BCN Medicare Advantage |
$361.09
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cash Price |
$988.00
|
| Rate for Payer: Cofinity Commercial |
$519.97
|
| Rate for Payer: Cofinity Commercial |
$483.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.09
|
| Rate for Payer: Mclaren Medicaid |
$231.32
|
| Rate for Payer: Meridian Medicaid |
$242.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$379.14
|
| Rate for Payer: PACE SWMI |
$361.09
|
| Rate for Payer: PHP Medicare Advantage |
$361.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$231.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$864.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$572.39
|
| Rate for Payer: Priority Health Medicare |
$361.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$572.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$361.09
|
| Rate for Payer: UHC Medicare Advantage |
$371.92
|
|
|
PR SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
HCPCS 36227
|
| Min. Negotiated Rate |
$76.25 |
| Max. Negotiated Rate |
$1,296.45 |
| Rate for Payer: Aetna Commercial |
$159.31
|
| Rate for Payer: Aetna Medicare |
$123.65
|
| Rate for Payer: BCBS Complete |
$80.06
|
| Rate for Payer: BCBS MAPPO |
$118.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,296.45
|
| Rate for Payer: BCN Commercial |
$351.85
|
| Rate for Payer: BCN Medicare Advantage |
$118.89
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cofinity Commercial |
$159.31
|
| Rate for Payer: Cofinity Commercial |
$171.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.89
|
| Rate for Payer: Mclaren Medicaid |
$76.25
|
| Rate for Payer: Meridian Medicaid |
$80.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$124.83
|
| Rate for Payer: PACE SWMI |
$118.89
|
| Rate for Payer: PHP Medicare Advantage |
$118.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$76.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$188.31
|
| Rate for Payer: Priority Health Medicare |
$118.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.89
|
| Rate for Payer: UHC Medicare Advantage |
$122.46
|
|
|
PR SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
HCPCS 95806
|
| Min. Negotiated Rate |
$87.73 |
| Max. Negotiated Rate |
$410.49 |
| Rate for Payer: Aetna Commercial |
$117.56
|
| Rate for Payer: Aetna Commercial |
$117.56
|
| Rate for Payer: Aetna Medicare |
$91.24
|
| Rate for Payer: Aetna Medicare |
$91.24
|
| Rate for Payer: BCBS Complete |
$222.40
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS MAPPO |
$87.73
|
| Rate for Payer: BCBS MAPPO |
$87.73
|
| Rate for Payer: BCBS Trust/PPO |
$410.49
|
| Rate for Payer: BCBS Trust/PPO |
$410.49
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Medicare Advantage |
$87.73
|
| Rate for Payer: BCN Medicare Advantage |
$87.73
|
| Rate for Payer: Cash Price |
$444.80
|
| Rate for Payer: Cash Price |
$444.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$126.33
|
| Rate for Payer: Cofinity Commercial |
$117.56
|
| Rate for Payer: Cofinity Commercial |
$126.33
|
| Rate for Payer: Cofinity Commercial |
$117.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.12
|
| Rate for Payer: PACE SWMI |
$87.73
|
| Rate for Payer: PACE SWMI |
$87.73
|
| Rate for Payer: PHP Medicare Advantage |
$87.73
|
| Rate for Payer: PHP Medicare Advantage |
$87.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$389.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.06
|
| Rate for Payer: Priority Health Medicare |
$87.73
|
| Rate for Payer: Priority Health Medicare |
$87.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.73
|
| Rate for Payer: UHC Medicare Advantage |
$90.36
|
| Rate for Payer: UHC Medicare Advantage |
$90.36
|
|
|
PR SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
HCPCS 95807
|
| Min. Negotiated Rate |
$78.19 |
| Max. Negotiated Rate |
$1,022.00 |
| Rate for Payer: Aetna Commercial |
$484.02
|
| Rate for Payer: Aetna Commercial |
$484.02
|
| Rate for Payer: Aetna Medicare |
$375.66
|
| Rate for Payer: Aetna Medicare |
$375.66
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS Complete |
$584.00
|
| Rate for Payer: BCBS MAPPO |
$361.21
|
| Rate for Payer: BCBS MAPPO |
$361.21
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCBS Trust/PPO |
$78.19
|
| Rate for Payer: BCN Commercial |
$453.53
|
| Rate for Payer: BCN Commercial |
$453.53
|
| Rate for Payer: BCN Medicare Advantage |
$361.21
|
| Rate for Payer: BCN Medicare Advantage |
$361.21
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$1,168.00
|
| Rate for Payer: Cofinity Commercial |
$484.02
|
| Rate for Payer: Cofinity Commercial |
$484.02
|
| Rate for Payer: Cofinity Commercial |
$520.14
|
| Rate for Payer: Cofinity Commercial |
$520.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$361.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$379.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$379.27
|
| Rate for Payer: PACE SWMI |
$361.21
|
| Rate for Payer: PACE SWMI |
$361.21
|
| Rate for Payer: PHP Medicare Advantage |
$361.21
|
| Rate for Payer: PHP Medicare Advantage |
$361.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,022.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$518.76
|
| Rate for Payer: Priority Health Medicare |
$361.21
|
| Rate for Payer: Priority Health Medicare |
$361.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$518.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$518.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$361.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$361.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$361.21
|
| Rate for Payer: UHC Medicare Advantage |
$372.05
|
| Rate for Payer: UHC Medicare Advantage |
$372.05
|
|
|
PR SLING OPERATION STRESS INCONTINENCE
|
Professional
|
Both
|
$2,235.00
|
|
|
Service Code
|
HCPCS 57288
|
| Min. Negotiated Rate |
$477.55 |
| Max. Negotiated Rate |
$2,553.80 |
| Rate for Payer: Aetna Commercial |
$982.86
|
| Rate for Payer: Aetna Medicare |
$762.82
|
| Rate for Payer: BCBS Complete |
$501.43
|
| Rate for Payer: BCBS MAPPO |
$733.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,553.80
|
| Rate for Payer: BCN Commercial |
$1,508.40
|
| Rate for Payer: BCN Medicare Advantage |
$733.48
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cofinity Commercial |
$1,056.21
|
| Rate for Payer: Cofinity Commercial |
$982.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.48
|
| Rate for Payer: Mclaren Medicaid |
$477.55
|
| Rate for Payer: Meridian Medicaid |
$501.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$770.15
|
| Rate for Payer: PACE SWMI |
$733.48
|
| Rate for Payer: PHP Medicare Advantage |
$733.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$477.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,564.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,053.37
|
| Rate for Payer: Priority Health Medicare |
$733.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,053.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$733.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.48
|
| Rate for Payer: UHC Medicare Advantage |
$755.48
|
|
|
PR SLING OPRATION CORRJ MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,644.00
|
|
|
Service Code
|
HCPCS 53440
|
| Min. Negotiated Rate |
$479.25 |
| Max. Negotiated Rate |
$2,746.63 |
| Rate for Payer: Aetna Commercial |
$985.09
|
| Rate for Payer: Aetna Medicare |
$764.55
|
| Rate for Payer: BCBS Complete |
$503.21
|
| Rate for Payer: BCBS MAPPO |
$735.14
|
| Rate for Payer: BCBS Trust/PPO |
$2,746.63
|
| Rate for Payer: BCN Commercial |
$1,085.84
|
| Rate for Payer: BCN Medicare Advantage |
$735.14
|
| Rate for Payer: Cash Price |
$1,315.20
|
| Rate for Payer: Cash Price |
$1,315.20
|
| Rate for Payer: Cofinity Commercial |
$985.09
|
| Rate for Payer: Cofinity Commercial |
$1,058.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.14
|
| Rate for Payer: Mclaren Medicaid |
$479.25
|
| Rate for Payer: Meridian Medicaid |
$503.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$771.90
|
| Rate for Payer: PACE SWMI |
$735.14
|
| Rate for Payer: PHP Medicare Advantage |
$735.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$479.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,200.67
|
| Rate for Payer: Priority Health Medicare |
$735.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,200.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$735.14
|
| Rate for Payer: UHC Medicare Advantage |
$757.19
|
|
|
PR SLINGS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS A4565
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCN Commercial |
$7.97
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
|
|
PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
HCPCS 54001
|
| Min. Negotiated Rate |
$90.10 |
| Max. Negotiated Rate |
$1,072.45 |
| Rate for Payer: Aetna Commercial |
$183.16
|
| Rate for Payer: Aetna Medicare |
$142.16
|
| Rate for Payer: BCBS Complete |
$94.60
|
| Rate for Payer: BCBS MAPPO |
$136.69
|
| Rate for Payer: BCBS Trust/PPO |
$1,072.45
|
| Rate for Payer: BCN Commercial |
$289.29
|
| Rate for Payer: BCN Medicare Advantage |
$136.69
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$196.83
|
| Rate for Payer: Cofinity Commercial |
$183.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.69
|
| Rate for Payer: Mclaren Medicaid |
$90.10
|
| Rate for Payer: Meridian Medicaid |
$94.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.52
|
| Rate for Payer: PACE SWMI |
$136.69
|
| Rate for Payer: PHP Medicare Advantage |
$136.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$90.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.79
|
| Rate for Payer: Priority Health Medicare |
$136.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$224.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.69
|
| Rate for Payer: UHC Medicare Advantage |
$140.79
|
|
|
PR SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 95800
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$545.73 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$145.89
|
| Rate for Payer: Aetna Medicare |
$145.89
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS MAPPO |
$140.28
|
| Rate for Payer: BCBS MAPPO |
$140.28
|
| Rate for Payer: BCBS Trust/PPO |
$545.73
|
| Rate for Payer: BCBS Trust/PPO |
$545.73
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Medicare Advantage |
$140.28
|
| Rate for Payer: BCN Medicare Advantage |
$140.28
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$202.00
|
| Rate for Payer: Cofinity Commercial |
$187.98
|
| Rate for Payer: Cofinity Commercial |
$187.98
|
| Rate for Payer: Cofinity Commercial |
$202.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$147.29
|
| Rate for Payer: PACE SWMI |
$140.28
|
| Rate for Payer: PACE SWMI |
$140.28
|
| Rate for Payer: PHP Medicare Advantage |
$140.28
|
| Rate for Payer: PHP Medicare Advantage |
$140.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.87
|
| Rate for Payer: Priority Health Medicare |
$140.28
|
| Rate for Payer: Priority Health Medicare |
$140.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$199.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.28
|
| Rate for Payer: UHC Medicare Advantage |
$144.49
|
| Rate for Payer: UHC Medicare Advantage |
$144.49
|
|
|
PR SMOKE/TOBACCO COUNSELNG 3-10
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS G0375
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
|
|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$517.72 |
| Rate for Payer: Aetna Commercial |
$78.64
|
| Rate for Payer: Aetna Medicare |
$61.04
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$58.69
|
| Rate for Payer: BCBS Trust/PPO |
$517.72
|
| Rate for Payer: BCN Commercial |
$167.13
|
| Rate for Payer: BCN Medicare Advantage |
$58.69
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$84.51
|
| Rate for Payer: Cofinity Commercial |
$78.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.69
|
| Rate for Payer: Mclaren Medicaid |
$37.49
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.62
|
| Rate for Payer: PACE SWMI |
$58.69
|
| Rate for Payer: PHP Medicare Advantage |
$58.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.93
|
| Rate for Payer: Priority Health Medicare |
$58.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.69
|
| Rate for Payer: UHC Medicare Advantage |
$60.45
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$561.29 |
| Rate for Payer: Aetna Commercial |
$126.98
|
| Rate for Payer: Aetna Medicare |
$98.55
|
| Rate for Payer: BCBS Complete |
$63.29
|
| Rate for Payer: BCBS MAPPO |
$94.76
|
| Rate for Payer: BCBS Trust/PPO |
$561.29
|
| Rate for Payer: BCN Commercial |
$259.49
|
| Rate for Payer: BCN Medicare Advantage |
$94.76
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cash Price |
$449.60
|
| Rate for Payer: Cofinity Commercial |
$126.98
|
| Rate for Payer: Cofinity Commercial |
$136.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.76
|
| Rate for Payer: Mclaren Medicaid |
$60.28
|
| Rate for Payer: Meridian Medicaid |
$63.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.50
|
| Rate for Payer: PACE SWMI |
$94.76
|
| Rate for Payer: PHP Medicare Advantage |
$94.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$393.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.50
|
| Rate for Payer: Priority Health Medicare |
$94.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.76
|
| Rate for Payer: UHC Medicare Advantage |
$97.60
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$717.00
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$73.70 |
| Max. Negotiated Rate |
$525.42 |
| Rate for Payer: Aetna Commercial |
$156.23
|
| Rate for Payer: Aetna Medicare |
$121.25
|
| Rate for Payer: BCBS Complete |
$77.38
|
| Rate for Payer: BCBS MAPPO |
$116.59
|
| Rate for Payer: BCBS Trust/PPO |
$525.42
|
| Rate for Payer: BCN Commercial |
$301.51
|
| Rate for Payer: BCN Medicare Advantage |
$116.59
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cofinity Commercial |
$167.89
|
| Rate for Payer: Cofinity Commercial |
$156.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.59
|
| Rate for Payer: Mclaren Medicaid |
$73.70
|
| Rate for Payer: Meridian Medicaid |
$77.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$122.42
|
| Rate for Payer: PACE SWMI |
$116.59
|
| Rate for Payer: PHP Medicare Advantage |
$116.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$501.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.22
|
| Rate for Payer: Priority Health Medicare |
$116.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.59
|
| Rate for Payer: UHC Medicare Advantage |
$120.09
|
|
|
PR SO 8 ABD RESTRAINT PRE OTS
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS L3650
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$62.27 |
| Rate for Payer: Aetna Commercial |
$39.50
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCN Commercial |
$62.27
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
|
|
PR SPECIAL CASTING MATERIAL
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS A4590
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
