|
PR PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH
|
Professional
|
Both
|
$1,110.00
|
|
|
Service Code
|
HCPCS 92921
|
| Min. Negotiated Rate |
$208.27 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Aetna Commercial |
$300.69
|
| Rate for Payer: Aetna Medicare |
$555.00
|
| Rate for Payer: BCBS Complete |
$444.00
|
| Rate for Payer: BCN Commercial |
$208.27
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Cash Price |
$888.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$832.50
|
|
|
PR PRQ TRLUML CORONARY BYP GRFT REVASC ADDL VESSEL
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 92938
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$316.80 |
| Rate for Payer: Aetna Commercial |
$316.80
|
| Rate for Payer: Aetna Medicare |
$144.50
|
| Rate for Payer: BCBS Complete |
$115.60
|
| Rate for Payer: BCN Commercial |
$231.26
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
|
|
PR PRQ TRLUML CORONARY STENT/ATH/ANGIO ADDL BRANCH
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 92934
|
| Min. Negotiated Rate |
$259.76 |
| Max. Negotiated Rate |
$961.50 |
| Rate for Payer: Aetna Commercial |
$273.84
|
| Rate for Payer: Aetna Medicare |
$641.00
|
| Rate for Payer: BCBS Complete |
$512.80
|
| Rate for Payer: BCN Commercial |
$259.76
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$961.50
|
|
|
PR PRQ TRLUML CORONARY STENT W/ANGIO ADDL ART/BRNCH
|
Professional
|
Both
|
$1,249.00
|
|
|
Service Code
|
HCPCS 92929
|
| Min. Negotiated Rate |
$231.39 |
| Max. Negotiated Rate |
$936.75 |
| Rate for Payer: Aetna Commercial |
$352.65
|
| Rate for Payer: Aetna Medicare |
$624.50
|
| Rate for Payer: BCBS Complete |
$499.60
|
| Rate for Payer: BCN Commercial |
$231.39
|
| Rate for Payer: Cash Price |
$999.20
|
| Rate for Payer: Cash Price |
$999.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$936.75
|
|
|
PR PRQ TRLUML MCHNL THRMBC VEIN REPEAT TX
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 37188
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$443.41 |
| Rate for Payer: Aetna Commercial |
$371.46
|
| Rate for Payer: Aetna Medicare |
$279.00
|
| Rate for Payer: BCBS Complete |
$167.74
|
| Rate for Payer: BCN Commercial |
$412.33
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Mclaren Medicaid |
$159.75
|
| Rate for Payer: Meridian Medicaid |
$167.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$418.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$443.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$443.41
|
| Rate for Payer: UHC Medicaid |
$159.75
|
| Rate for Payer: UHCCP Medicaid |
$159.75
|
|
|
PR PRTL ESOPHAGECTOMY CERVICAL W/FREE INTSTINAL GRF
|
Professional
|
Both
|
$9,742.00
|
|
|
Service Code
|
HCPCS 43116
|
| Min. Negotiated Rate |
$2,919.59 |
| Max. Negotiated Rate |
$8,882.93 |
| Rate for Payer: Aetna Commercial |
$6,701.66
|
| Rate for Payer: Aetna Medicare |
$4,871.00
|
| Rate for Payer: BCBS Complete |
$3,065.57
|
| Rate for Payer: BCN Commercial |
$7,290.44
|
| Rate for Payer: Cash Price |
$7,793.60
|
| Rate for Payer: Cash Price |
$7,793.60
|
| Rate for Payer: Mclaren Medicaid |
$2,919.59
|
| Rate for Payer: Meridian Medicaid |
$3,065.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,306.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,919.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$8,882.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8,882.93
|
| Rate for Payer: UHC Medicaid |
$2,919.59
|
| Rate for Payer: UHCCP Medicaid |
$2,919.59
|
|
|
PR PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY
|
Professional
|
Both
|
$6,190.00
|
|
|
Service Code
|
HCPCS 43121
|
| Min. Negotiated Rate |
$1,708.26 |
| Max. Negotiated Rate |
$5,133.16 |
| Rate for Payer: Aetna Commercial |
$3,841.89
|
| Rate for Payer: Aetna Medicare |
$3,095.00
|
| Rate for Payer: BCBS Complete |
$1,793.67
|
| Rate for Payer: BCN Commercial |
$4,212.92
|
| Rate for Payer: Cash Price |
$4,952.00
|
| Rate for Payer: Cash Price |
$4,952.00
|
| Rate for Payer: Mclaren Medicaid |
$1,708.26
|
| Rate for Payer: Meridian Medicaid |
$1,793.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,642.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,708.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,133.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,133.16
|
| Rate for Payer: UHC Medicaid |
$1,708.26
|
| Rate for Payer: UHCCP Medicaid |
$1,708.26
|
|
|
PR PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY
|
Professional
|
Both
|
$6,524.00
|
|
|
Service Code
|
HCPCS 43117
|
| Min. Negotiated Rate |
$1,931.27 |
| Max. Negotiated Rate |
$5,864.31 |
| Rate for Payer: Aetna Commercial |
$4,374.05
|
| Rate for Payer: Aetna Medicare |
$3,262.00
|
| Rate for Payer: BCBS Complete |
$2,027.83
|
| Rate for Payer: BCN Commercial |
$4,812.99
|
| Rate for Payer: Cash Price |
$5,219.20
|
| Rate for Payer: Cash Price |
$5,219.20
|
| Rate for Payer: Mclaren Medicaid |
$1,931.27
|
| Rate for Payer: Meridian Medicaid |
$2,027.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,893.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,931.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5,864.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,864.31
|
| Rate for Payer: UHC Medicaid |
$1,931.27
|
| Rate for Payer: UHCCP Medicaid |
$1,931.27
|
|
|
PR PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
HCPCS 28122
|
| Min. Negotiated Rate |
$265.61 |
| Max. Negotiated Rate |
$961.50 |
| Rate for Payer: Aetna Commercial |
$578.62
|
| Rate for Payer: Aetna Medicare |
$641.00
|
| Rate for Payer: BCBS Complete |
$278.89
|
| Rate for Payer: BCN Commercial |
$667.80
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Cash Price |
$1,025.60
|
| Rate for Payer: Mclaren Medicaid |
$265.61
|
| Rate for Payer: Meridian Medicaid |
$278.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$961.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$265.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$713.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$713.86
|
| Rate for Payer: UHC Medicaid |
$265.61
|
| Rate for Payer: UHCCP Medicaid |
$265.61
|
|
|
PR PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA
|
Professional
|
Both
|
$3,402.00
|
|
|
Service Code
|
HCPCS 27360
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna Commercial |
$1,194.20
|
| Rate for Payer: Aetna Medicare |
$1,701.00
|
| Rate for Payer: BCBS Complete |
$573.67
|
| Rate for Payer: BCN Commercial |
$1,367.95
|
| Rate for Payer: Cash Price |
$2,721.60
|
| Rate for Payer: Cash Price |
$2,721.60
|
| Rate for Payer: Mclaren Medicaid |
$546.35
|
| Rate for Payer: Meridian Medicaid |
$573.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,551.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$546.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,462.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,462.31
|
| Rate for Payer: UHC Medicaid |
$546.35
|
| Rate for Payer: UHCCP Medicaid |
$546.35
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV
|
Professional
|
Both
|
$1,823.00
|
|
|
Service Code
|
HCPCS 22100
|
| Min. Negotiated Rate |
$634.10 |
| Max. Negotiated Rate |
$1,554.40 |
| Rate for Payer: Aetna Commercial |
$1,149.22
|
| Rate for Payer: Aetna Medicare |
$911.50
|
| Rate for Payer: BCBS Complete |
$665.80
|
| Rate for Payer: BCN Commercial |
$1,454.10
|
| Rate for Payer: Cash Price |
$1,458.40
|
| Rate for Payer: Cash Price |
$1,458.40
|
| Rate for Payer: Mclaren Medicaid |
$634.10
|
| Rate for Payer: Meridian Medicaid |
$665.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,367.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$634.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,554.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,554.40
|
| Rate for Payer: UHC Medicaid |
$634.10
|
| Rate for Payer: UHCCP Medicaid |
$634.10
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA
|
Professional
|
Both
|
$676.00
|
|
|
Service Code
|
HCPCS 22103
|
| Min. Negotiated Rate |
$73.91 |
| Max. Negotiated Rate |
$507.00 |
| Rate for Payer: Aetna Commercial |
$190.38
|
| Rate for Payer: Aetna Medicare |
$338.00
|
| Rate for Payer: BCBS Complete |
$77.61
|
| Rate for Payer: BCN Commercial |
$198.70
|
| Rate for Payer: Cash Price |
$540.80
|
| Rate for Payer: Cash Price |
$540.80
|
| Rate for Payer: Mclaren Medicaid |
$73.91
|
| Rate for Payer: Meridian Medicaid |
$77.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$73.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$212.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$212.39
|
| Rate for Payer: UHC Medicaid |
$73.91
|
| Rate for Payer: UHCCP Medicaid |
$73.91
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR
|
Professional
|
Both
|
$2,266.00
|
|
|
Service Code
|
HCPCS 22102
|
| Min. Negotiated Rate |
$447.73 |
| Max. Negotiated Rate |
$1,699.50 |
| Rate for Payer: Aetna Commercial |
$1,102.33
|
| Rate for Payer: Aetna Medicare |
$1,133.00
|
| Rate for Payer: BCBS Complete |
$470.12
|
| Rate for Payer: BCN Commercial |
$1,155.31
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Mclaren Medicaid |
$447.73
|
| Rate for Payer: Meridian Medicaid |
$470.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,699.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$447.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,235.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,235.00
|
| Rate for Payer: UHC Medicaid |
$447.73
|
| Rate for Payer: UHCCP Medicaid |
$447.73
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC
|
Professional
|
Both
|
$2,338.00
|
|
|
Service Code
|
HCPCS 22101
|
| Min. Negotiated Rate |
$553.37 |
| Max. Negotiated Rate |
$1,753.50 |
| Rate for Payer: Aetna Commercial |
$1,154.53
|
| Rate for Payer: Aetna Medicare |
$1,169.00
|
| Rate for Payer: BCBS Complete |
$581.04
|
| Rate for Payer: BCN Commercial |
$1,361.48
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Cash Price |
$1,870.40
|
| Rate for Payer: Mclaren Medicaid |
$553.37
|
| Rate for Payer: Meridian Medicaid |
$581.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,753.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$553.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,455.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,455.38
|
| Rate for Payer: UHC Medicaid |
$553.37
|
| Rate for Payer: UHCCP Medicaid |
$553.37
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV
|
Professional
|
Both
|
$3,362.00
|
|
|
Service Code
|
HCPCS 22110
|
| Min. Negotiated Rate |
$649.86 |
| Max. Negotiated Rate |
$2,521.50 |
| Rate for Payer: Aetna Commercial |
$1,399.72
|
| Rate for Payer: Aetna Medicare |
$1,681.00
|
| Rate for Payer: BCBS Complete |
$682.35
|
| Rate for Payer: BCN Commercial |
$1,770.86
|
| Rate for Payer: Cash Price |
$2,689.60
|
| Rate for Payer: Cash Price |
$2,689.60
|
| Rate for Payer: Mclaren Medicaid |
$649.86
|
| Rate for Payer: Meridian Medicaid |
$682.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,521.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$649.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,723.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,723.15
|
| Rate for Payer: UHC Medicaid |
$649.86
|
| Rate for Payer: UHCCP Medicaid |
$649.86
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA
|
Professional
|
Both
|
$827.00
|
|
|
Service Code
|
HCPCS 22116
|
| Min. Negotiated Rate |
$80.30 |
| Max. Negotiated Rate |
$620.25 |
| Rate for Payer: Aetna Commercial |
$190.52
|
| Rate for Payer: Aetna Medicare |
$413.50
|
| Rate for Payer: BCBS Complete |
$84.31
|
| Rate for Payer: BCN Commercial |
$213.13
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Mclaren Medicaid |
$80.30
|
| Rate for Payer: Meridian Medicaid |
$84.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$620.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$80.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$227.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.83
|
| Rate for Payer: UHC Medicaid |
$80.30
|
| Rate for Payer: UHCCP Medicaid |
$80.30
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR
|
Professional
|
Both
|
$2,505.00
|
|
|
Service Code
|
HCPCS 22114
|
| Min. Negotiated Rate |
$746.78 |
| Max. Negotiated Rate |
$1,878.75 |
| Rate for Payer: Aetna Commercial |
$1,505.09
|
| Rate for Payer: Aetna Medicare |
$1,252.50
|
| Rate for Payer: BCBS Complete |
$784.12
|
| Rate for Payer: BCN Commercial |
$1,744.93
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Mclaren Medicaid |
$746.78
|
| Rate for Payer: Meridian Medicaid |
$784.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,878.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$746.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,865.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,865.27
|
| Rate for Payer: UHC Medicaid |
$746.78
|
| Rate for Payer: UHCCP Medicaid |
$746.78
|
|
|
PR PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$4,087.00
|
|
|
Service Code
|
HCPCS 60210
|
| Min. Negotiated Rate |
$412.79 |
| Max. Negotiated Rate |
$3,065.25 |
| Rate for Payer: Aetna Commercial |
$910.33
|
| Rate for Payer: Aetna Medicare |
$2,043.50
|
| Rate for Payer: BCBS Complete |
$433.43
|
| Rate for Payer: BCN Commercial |
$1,069.16
|
| Rate for Payer: Cash Price |
$3,269.60
|
| Rate for Payer: Cash Price |
$3,269.60
|
| Rate for Payer: Mclaren Medicaid |
$412.79
|
| Rate for Payer: Meridian Medicaid |
$433.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,065.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$412.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,159.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,159.34
|
| Rate for Payer: UHC Medicaid |
$412.79
|
| Rate for Payer: UHCCP Medicaid |
$412.79
|
|
|
PR PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC
|
Professional
|
Both
|
$1,886.00
|
|
|
Service Code
|
HCPCS 60212
|
| Min. Negotiated Rate |
$620.47 |
| Max. Negotiated Rate |
$1,675.56 |
| Rate for Payer: Aetna Commercial |
$1,335.39
|
| Rate for Payer: Aetna Medicare |
$943.00
|
| Rate for Payer: BCBS Complete |
$651.49
|
| Rate for Payer: BCN Commercial |
$1,545.24
|
| Rate for Payer: Cash Price |
$1,508.80
|
| Rate for Payer: Cash Price |
$1,508.80
|
| Rate for Payer: Mclaren Medicaid |
$620.47
|
| Rate for Payer: Meridian Medicaid |
$651.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,414.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$620.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,675.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,675.56
|
| Rate for Payer: UHC Medicaid |
$620.47
|
| Rate for Payer: UHCCP Medicaid |
$620.47
|
|
|
PR PSA SCREENING
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS G0103
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna Commercial |
$18.34
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: BCN Commercial |
$14.48
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.18
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 90791
|
| Min. Negotiated Rate |
$136.50 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Medicare |
$136.50
|
| Rate for Payer: BCBS Complete |
$143.47
|
| Rate for Payer: BCN Commercial |
$173.57
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Mclaren Medicaid |
$136.64
|
| Rate for Payer: Meridian Medicaid |
$143.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$194.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.98
|
| Rate for Payer: UHC Medicaid |
$136.64
|
| Rate for Payer: UHCCP Medicaid |
$136.64
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 90792
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$213.34 |
| Rate for Payer: Aetna Commercial |
$163.88
|
| Rate for Payer: Aetna Medicare |
$136.00
|
| Rate for Payer: BCBS Complete |
$166.72
|
| Rate for Payer: BCN Commercial |
$198.71
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Mclaren Medicaid |
$158.78
|
| Rate for Payer: Meridian Medicaid |
$166.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$213.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$213.34
|
| Rate for Payer: UHC Medicaid |
$158.78
|
| Rate for Payer: UHCCP Medicaid |
$158.78
|
|
|
PR PSYCHOANALYSIS
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 90845
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$155.25 |
| Rate for Payer: Aetna Commercial |
$96.55
|
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCN Commercial |
$98.08
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$155.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$115.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.44
|
|
|
PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 96131
|
| Min. Negotiated Rate |
$44.73 |
| Max. Negotiated Rate |
$140.25 |
| Rate for Payer: Aetna Commercial |
$90.37
|
| Rate for Payer: Aetna Medicare |
$93.50
|
| Rate for Payer: BCBS Complete |
$46.97
|
| Rate for Payer: BCN Commercial |
$127.49
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Mclaren Medicaid |
$44.73
|
| Rate for Payer: Meridian Medicaid |
$46.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$140.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$102.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.88
|
| Rate for Payer: UHC Medicaid |
$44.73
|
| Rate for Payer: UHCCP Medicaid |
$44.73
|
|
|
PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 96130
|
| Min. Negotiated Rate |
$63.47 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna Commercial |
$119.92
|
| Rate for Payer: Aetna Medicare |
$123.00
|
| Rate for Payer: BCBS Complete |
$66.64
|
| Rate for Payer: BCN Commercial |
$180.76
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Mclaren Medicaid |
$63.47
|
| Rate for Payer: Meridian Medicaid |
$66.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$150.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.64
|
| Rate for Payer: UHC Medicaid |
$63.47
|
| Rate for Payer: UHCCP Medicaid |
$63.47
|
|