|
PR VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG
|
Professional
|
Both
|
$2,104.00
|
|
|
Service Code
|
HCPCS 63082
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$1,472.80 |
| Rate for Payer: Aetna Commercial |
$354.20
|
| Rate for Payer: Aetna Medicare |
$274.90
|
| Rate for Payer: BCBS Complete |
$178.03
|
| Rate for Payer: BCBS MAPPO |
$264.33
|
| Rate for Payer: BCBS Trust/PPO |
$385.66
|
| Rate for Payer: BCN Commercial |
$424.54
|
| Rate for Payer: BCN Medicare Advantage |
$264.33
|
| Rate for Payer: Cash Price |
$1,683.20
|
| Rate for Payer: Cash Price |
$1,683.20
|
| Rate for Payer: Cofinity Commercial |
$380.64
|
| Rate for Payer: Cofinity Commercial |
$354.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$264.33
|
| Rate for Payer: Mclaren Medicaid |
$169.55
|
| Rate for Payer: Meridian Medicaid |
$178.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$277.55
|
| Rate for Payer: PACE SWMI |
$264.33
|
| Rate for Payer: PHP Medicare Advantage |
$264.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$169.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,472.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$446.75
|
| Rate for Payer: Priority Health Medicare |
$264.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$446.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$264.33
|
| Rate for Payer: UHC Medicare Advantage |
$272.26
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG
|
Professional
|
Both
|
$6,953.00
|
|
|
Service Code
|
HCPCS 63085
|
| Min. Negotiated Rate |
$420.00 |
| Max. Negotiated Rate |
$4,867.10 |
| Rate for Payer: Aetna Commercial |
$2,579.93
|
| Rate for Payer: Aetna Medicare |
$2,002.33
|
| Rate for Payer: BCBS Complete |
$1,315.06
|
| Rate for Payer: BCBS MAPPO |
$1,925.32
|
| Rate for Payer: BCBS Trust/PPO |
$420.00
|
| Rate for Payer: BCN Commercial |
$3,110.60
|
| Rate for Payer: BCN Medicare Advantage |
$1,925.32
|
| Rate for Payer: Cash Price |
$5,562.40
|
| Rate for Payer: Cash Price |
$5,562.40
|
| Rate for Payer: Cofinity Commercial |
$2,579.93
|
| Rate for Payer: Cofinity Commercial |
$2,772.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,925.32
|
| Rate for Payer: Mclaren Medicaid |
$1,252.44
|
| Rate for Payer: Meridian Medicaid |
$1,315.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,021.59
|
| Rate for Payer: PACE SWMI |
$1,925.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,925.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,252.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,867.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,273.34
|
| Rate for Payer: Priority Health Medicare |
$1,925.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,273.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,925.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,925.32
|
| Rate for Payer: UHC Medicare Advantage |
$1,983.08
|
|
|
PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG
|
Professional
|
Both
|
$2,318.00
|
|
|
Service Code
|
HCPCS 63086
|
| Min. Negotiated Rate |
$122.05 |
| Max. Negotiated Rate |
$1,622.60 |
| Rate for Payer: Aetna Commercial |
$252.68
|
| Rate for Payer: Aetna Medicare |
$196.11
|
| Rate for Payer: BCBS Complete |
$128.15
|
| Rate for Payer: BCBS MAPPO |
$188.57
|
| Rate for Payer: BCBS Trust/PPO |
$985.81
|
| Rate for Payer: BCN Commercial |
$302.94
|
| Rate for Payer: BCN Medicare Advantage |
$188.57
|
| Rate for Payer: Cash Price |
$1,854.40
|
| Rate for Payer: Cash Price |
$1,854.40
|
| Rate for Payer: Cofinity Commercial |
$271.54
|
| Rate for Payer: Cofinity Commercial |
$252.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.57
|
| Rate for Payer: Mclaren Medicaid |
$122.05
|
| Rate for Payer: Meridian Medicaid |
$128.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.00
|
| Rate for Payer: PACE SWMI |
$188.57
|
| Rate for Payer: PHP Medicare Advantage |
$188.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$122.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,622.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$318.78
|
| Rate for Payer: Priority Health Medicare |
$188.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.57
|
| Rate for Payer: UHC Medicare Advantage |
$194.23
|
|
|
PR VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG
|
Professional
|
Both
|
$1,533.00
|
|
|
Service Code
|
HCPCS 63308
|
| Min. Negotiated Rate |
$204.69 |
| Max. Negotiated Rate |
$1,073.10 |
| Rate for Payer: Aetna Commercial |
$428.67
|
| Rate for Payer: Aetna Medicare |
$332.70
|
| Rate for Payer: BCBS Complete |
$214.92
|
| Rate for Payer: BCBS MAPPO |
$319.90
|
| Rate for Payer: BCBS Trust/PPO |
$257.81
|
| Rate for Payer: BCN Commercial |
$512.78
|
| Rate for Payer: BCN Medicare Advantage |
$319.90
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cash Price |
$1,226.40
|
| Rate for Payer: Cofinity Commercial |
$460.66
|
| Rate for Payer: Cofinity Commercial |
$428.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.90
|
| Rate for Payer: Mclaren Medicaid |
$204.69
|
| Rate for Payer: Meridian Medicaid |
$214.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$335.90
|
| Rate for Payer: PACE SWMI |
$319.90
|
| Rate for Payer: PHP Medicare Advantage |
$319.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$204.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,073.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.62
|
| Rate for Payer: Priority Health Medicare |
$319.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$539.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$319.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$319.90
|
| Rate for Payer: UHC Medicare Advantage |
$329.50
|
|
|
PR VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL
|
Professional
|
Both
|
$1,723.00
|
|
|
Service Code
|
HCPCS 22512
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$1,206.10 |
| Rate for Payer: Aetna Commercial |
$273.94
|
| Rate for Payer: Aetna Medicare |
$212.61
|
| Rate for Payer: BCBS Complete |
$137.10
|
| Rate for Payer: BCBS MAPPO |
$204.43
|
| Rate for Payer: BCBS Trust/PPO |
$214.49
|
| Rate for Payer: BCN Commercial |
$1,078.02
|
| Rate for Payer: BCN Medicare Advantage |
$204.43
|
| Rate for Payer: Cash Price |
$1,378.40
|
| Rate for Payer: Cash Price |
$1,378.40
|
| Rate for Payer: Cofinity Commercial |
$294.38
|
| Rate for Payer: Cofinity Commercial |
$273.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.43
|
| Rate for Payer: Mclaren Medicaid |
$130.57
|
| Rate for Payer: Meridian Medicaid |
$137.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$214.65
|
| Rate for Payer: PACE SWMI |
$204.43
|
| Rate for Payer: PHP Medicare Advantage |
$204.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,206.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.01
|
| Rate for Payer: Priority Health Medicare |
$204.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$312.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$204.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.43
|
| Rate for Payer: UHC Medicare Advantage |
$210.56
|
|
|
PR VESICULOTOMY COMPLICATED
|
Professional
|
Both
|
$814.00
|
|
|
Service Code
|
HCPCS 55605
|
| Min. Negotiated Rate |
$335.69 |
| Max. Negotiated Rate |
$2,259.54 |
| Rate for Payer: Aetna Commercial |
$685.79
|
| Rate for Payer: Aetna Medicare |
$532.25
|
| Rate for Payer: BCBS Complete |
$352.47
|
| Rate for Payer: BCBS MAPPO |
$511.78
|
| Rate for Payer: BCBS Trust/PPO |
$2,259.54
|
| Rate for Payer: BCN Commercial |
$758.92
|
| Rate for Payer: BCN Medicare Advantage |
$511.78
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cash Price |
$651.20
|
| Rate for Payer: Cofinity Commercial |
$736.96
|
| Rate for Payer: Cofinity Commercial |
$685.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$511.78
|
| Rate for Payer: Mclaren Medicaid |
$335.69
|
| Rate for Payer: Meridian Medicaid |
$352.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$537.37
|
| Rate for Payer: PACE SWMI |
$511.78
|
| Rate for Payer: PHP Medicare Advantage |
$511.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$335.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$569.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$839.18
|
| Rate for Payer: Priority Health Medicare |
$511.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$839.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$511.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$511.78
|
| Rate for Payer: UHC Medicare Advantage |
$527.13
|
|
|
PR VESSEL MAPPING HEMO ACCESS
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS G0365
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$251.30 |
| Rate for Payer: BCBS Complete |
$143.60
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.30
|
|
|
PR VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV
|
Professional
|
Both
|
$3,558.00
|
|
|
Service Code
|
HCPCS 43640
|
| Min. Negotiated Rate |
$762.75 |
| Max. Negotiated Rate |
$2,490.60 |
| Rate for Payer: Aetna Commercial |
$1,589.35
|
| Rate for Payer: Aetna Medicare |
$1,233.52
|
| Rate for Payer: BCBS Complete |
$800.89
|
| Rate for Payer: BCBS MAPPO |
$1,186.08
|
| Rate for Payer: BCBS Trust/PPO |
$864.30
|
| Rate for Payer: BCN Commercial |
$1,740.67
|
| Rate for Payer: BCN Medicare Advantage |
$1,186.08
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cash Price |
$2,846.40
|
| Rate for Payer: Cofinity Commercial |
$1,707.96
|
| Rate for Payer: Cofinity Commercial |
$1,589.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,186.08
|
| Rate for Payer: Mclaren Medicaid |
$762.75
|
| Rate for Payer: Meridian Medicaid |
$800.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,245.38
|
| Rate for Payer: PACE SWMI |
$1,186.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,186.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$762.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,490.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,094.36
|
| Rate for Payer: Priority Health Medicare |
$1,186.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,094.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,186.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,186.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,221.66
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 34845
|
| Min. Negotiated Rate |
$597.80 |
| Max. Negotiated Rate |
$2,929.49 |
| Rate for Payer: Aetna Commercial |
$2,344.71
|
| Rate for Payer: BCBS Complete |
$1,424.60
|
| Rate for Payer: BCBS Trust/PPO |
$660.38
|
| Rate for Payer: BCN Commercial |
$1,812.17
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Cash Price |
$683.20
|
| Rate for Payer: Mclaren Medicaid |
$1,356.76
|
| Rate for Payer: Meridian Medicaid |
$1,424.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,356.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$597.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,929.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,929.49
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 34846
|
| Min. Negotiated Rate |
$1,492.43 |
| Max. Negotiated Rate |
$3,102.91 |
| Rate for Payer: Aetna Commercial |
$2,496.07
|
| Rate for Payer: BCBS Complete |
$1,567.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,564.30
|
| Rate for Payer: BCN Commercial |
$2,013.51
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Mclaren Medicaid |
$1,492.43
|
| Rate for Payer: Meridian Medicaid |
$1,567.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,492.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,100.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,102.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,102.91
|
|
|
PR VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS
|
Professional
|
Both
|
$5,000.00
|
|
|
Service Code
|
HCPCS 34847
|
| Min. Negotiated Rate |
$1,628.11 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$2,642.90
|
| Rate for Payer: BCBS Complete |
$1,709.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,672.07
|
| Rate for Payer: BCN Commercial |
$2,416.22
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Cash Price |
$4,000.00
|
| Rate for Payer: Mclaren Medicaid |
$1,628.11
|
| Rate for Payer: Meridian Medicaid |
$1,709.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,628.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,500.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,284.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,284.31
|
|
|
PR VISCO GEL SPACER - LARGE
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00039
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
|
|
PR VISCO GEL SPACER - MEDIUM
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00038
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
|
|
PR VISCO GEL SPACER - SMALL
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 00037
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.90 |
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
|
|
PR VISION EXAM
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.64
|
| Rate for Payer: BCN Commercial |
$38.64
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
PR VISION EXAM
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 99173
|
| Hospital Charge Code |
51000008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$42.50
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.62
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$12.50
|
| Rate for Payer: BCBS Trust/PPO |
$38.88
|
| Rate for Payer: BCN Commercial |
$38.88
|
| Rate for Payer: BCN Medicare Advantage |
$12.50
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$43.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.50
|
| Rate for Payer: Healthscope Commercial |
$45.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.50
|
| Rate for Payer: PACE Senior Care Partners |
$11.88
|
| Rate for Payer: PACE SWMI |
$12.50
|
| Rate for Payer: PHP Commercial |
$42.50
|
| Rate for Payer: PHP Medicare Advantage |
$12.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.50
|
| Rate for Payer: Priority Health Medicare |
$12.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: Railroad Medicare Medicare |
$12.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.00
|
| Rate for Payer: UHC Core |
$41.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.50
|
| Rate for Payer: UHC Medicare Advantage |
$12.88
|
| Rate for Payer: VA VA |
$12.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.50
|
|
|
PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 95930
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$187.60 |
| Rate for Payer: Aetna Commercial |
$83.47
|
| Rate for Payer: Aetna Medicare |
$64.78
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS MAPPO |
$62.29
|
| Rate for Payer: BCBS Trust/PPO |
$64.98
|
| Rate for Payer: BCN Commercial |
$96.76
|
| Rate for Payer: BCN Medicare Advantage |
$62.29
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$83.47
|
| Rate for Payer: Cofinity Commercial |
$89.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.40
|
| Rate for Payer: PACE SWMI |
$62.29
|
| Rate for Payer: PHP Medicare Advantage |
$62.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.93
|
| Rate for Payer: Priority Health Medicare |
$62.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.29
|
| Rate for Payer: UHC Medicare Advantage |
$64.16
|
|
|
PR VISUAL FIELD XM UNI/BI W/INTERP EXTENDED EXAM
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 92083
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$1,352.98 |
| Rate for Payer: Aetna Commercial |
$79.11
|
| Rate for Payer: Aetna Medicare |
$61.40
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS MAPPO |
$59.04
|
| Rate for Payer: BCBS Trust/PPO |
$1,352.98
|
| Rate for Payer: BCN Commercial |
$90.89
|
| Rate for Payer: BCN Medicare Advantage |
$59.04
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$85.02
|
| Rate for Payer: Cofinity Commercial |
$79.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.99
|
| Rate for Payer: PACE SWMI |
$59.04
|
| Rate for Payer: PHP Medicare Advantage |
$59.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.34
|
| Rate for Payer: Priority Health Medicare |
$59.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.04
|
| Rate for Payer: UHC Medicare Advantage |
$60.81
|
|
|
PR VISUAL FIELD XM UNI/BI W/INTERPRETJ LIMITED EXAM
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 92081
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$1,007.47 |
| Rate for Payer: Aetna Commercial |
$42.32
|
| Rate for Payer: Aetna Medicare |
$32.84
|
| Rate for Payer: BCBS Complete |
$30.40
|
| Rate for Payer: BCBS MAPPO |
$31.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,007.47
|
| Rate for Payer: BCN Commercial |
$48.38
|
| Rate for Payer: BCN Medicare Advantage |
$31.58
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cofinity Commercial |
$42.32
|
| Rate for Payer: Cofinity Commercial |
$45.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33.16
|
| Rate for Payer: PACE SWMI |
$31.58
|
| Rate for Payer: PHP Medicare Advantage |
$31.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.75
|
| Rate for Payer: Priority Health Medicare |
$31.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$39.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.58
|
| Rate for Payer: UHC Medicare Advantage |
$32.53
|
|
|
PR VISUAL REINFORCEMENT AUDIOMETRY
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 92579
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$2,273.80 |
| Rate for Payer: Aetna Commercial |
$48.48
|
| Rate for Payer: Aetna Medicare |
$37.63
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$36.18
|
| Rate for Payer: BCBS Trust/PPO |
$2,273.80
|
| Rate for Payer: BCN Commercial |
$65.48
|
| Rate for Payer: BCN Medicare Advantage |
$36.18
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$48.48
|
| Rate for Payer: Cofinity Commercial |
$52.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.99
|
| Rate for Payer: PACE SWMI |
$36.18
|
| Rate for Payer: PHP Medicare Advantage |
$36.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.41
|
| Rate for Payer: Priority Health Medicare |
$36.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.18
|
| Rate for Payer: UHC Medicare Advantage |
$37.27
|
|
|
PR VITAL CAPACITY TOTAL SEPARATE PROCEDURE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 94150
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$1,708.52 |
| Rate for Payer: Aetna Commercial |
$26.29
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,708.52
|
| Rate for Payer: BCN Commercial |
$36.16
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.24
|
|
|
PR VITAMIN B12 INJECTION
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3420
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$1.76
|
| Rate for Payer: Aetna Medicare |
$1.36
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$1.31
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.12
|
| Rate for Payer: BCN Medicare Advantage |
$1.31
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$1.89
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.31
|
| Rate for Payer: PHP Medicare Advantage |
$1.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$1.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.31
|
| Rate for Payer: UHC Medicare Advantage |
$1.35
|
|
|
PR VITAMIN K PHYTONADIONE INJ
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J3430
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.14 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$2.99
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$2.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.70
|
| Rate for Payer: BCN Medicare Advantage |
$2.87
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$3.85
|
| Rate for Payer: Cofinity Commercial |
$4.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.02
|
| Rate for Payer: PACE SWMI |
$2.87
|
| Rate for Payer: PHP Medicare Advantage |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$2.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.87
|
| Rate for Payer: UHC Medicare Advantage |
$2.96
|
|
|
PR VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING
|
Professional
|
Both
|
$5,023.80
|
|
|
Service Code
|
HCPCS 33427
|
| Min. Negotiated Rate |
$359.24 |
| Max. Negotiated Rate |
$3,796.58 |
| Rate for Payer: Aetna Commercial |
$3,209.31
|
| Rate for Payer: Aetna Medicare |
$2,490.81
|
| Rate for Payer: BCBS Complete |
$1,602.68
|
| Rate for Payer: BCBS MAPPO |
$2,395.01
|
| Rate for Payer: BCBS Trust/PPO |
$359.24
|
| Rate for Payer: BCN Commercial |
$3,487.69
|
| Rate for Payer: BCN Medicare Advantage |
$2,395.01
|
| Rate for Payer: Cash Price |
$4,019.04
|
| Rate for Payer: Cash Price |
$4,019.04
|
| Rate for Payer: Cofinity Commercial |
$3,448.81
|
| Rate for Payer: Cofinity Commercial |
$3,209.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,395.01
|
| Rate for Payer: Mclaren Medicaid |
$1,526.36
|
| Rate for Payer: Meridian Medicaid |
$1,602.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,514.76
|
| Rate for Payer: PACE SWMI |
$2,395.01
|
| Rate for Payer: PHP Medicare Advantage |
$2,395.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,526.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,516.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,796.58
|
| Rate for Payer: Priority Health Medicare |
$2,395.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,796.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,395.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,395.01
|
| Rate for Payer: UHC Medicare Advantage |
$2,466.86
|
|
|
PR VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING
|
Professional
|
Both
|
$8,728.00
|
|
|
Service Code
|
HCPCS 33426
|
| Min. Negotiated Rate |
$951.47 |
| Max. Negotiated Rate |
$6,109.60 |
| Rate for Payer: Aetna Commercial |
$3,137.40
|
| Rate for Payer: Aetna Medicare |
$2,434.99
|
| Rate for Payer: BCBS Complete |
$1,567.34
|
| Rate for Payer: BCBS MAPPO |
$2,341.34
|
| Rate for Payer: BCBS Trust/PPO |
$951.47
|
| Rate for Payer: BCN Commercial |
$3,410.48
|
| Rate for Payer: BCN Medicare Advantage |
$2,341.34
|
| Rate for Payer: Cash Price |
$6,982.40
|
| Rate for Payer: Cash Price |
$6,982.40
|
| Rate for Payer: Cofinity Commercial |
$3,371.53
|
| Rate for Payer: Cofinity Commercial |
$3,137.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,341.34
|
| Rate for Payer: Mclaren Medicaid |
$1,492.70
|
| Rate for Payer: Meridian Medicaid |
$1,567.34
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,458.41
|
| Rate for Payer: PACE SWMI |
$2,341.34
|
| Rate for Payer: PHP Medicare Advantage |
$2,341.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,492.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,109.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,712.54
|
| Rate for Payer: Priority Health Medicare |
$2,341.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,712.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,341.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,341.34
|
| Rate for Payer: UHC Medicare Advantage |
$2,411.58
|
|
