|
PR PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
HCPCS 36905
|
| Min. Negotiated Rate |
$275.84 |
| Max. Negotiated Rate |
$3,353.79 |
| Rate for Payer: Aetna Commercial |
$560.37
|
| Rate for Payer: Aetna Medicare |
$434.92
|
| Rate for Payer: BCBS Complete |
$289.63
|
| Rate for Payer: BCBS MAPPO |
$418.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,385.73
|
| Rate for Payer: BCN Commercial |
$3,353.79
|
| Rate for Payer: BCN Medicare Advantage |
$418.19
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cash Price |
$1,057.60
|
| Rate for Payer: Cofinity Commercial |
$602.19
|
| Rate for Payer: Cofinity Commercial |
$560.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$418.19
|
| Rate for Payer: Mclaren Medicaid |
$275.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$439.10
|
| Rate for Payer: Meridian Medicaid |
$289.63
|
| Rate for Payer: Nomi Health Commercial |
$501.83
|
| Rate for Payer: PACE SWMI |
$418.19
|
| Rate for Payer: PHP Medicare Advantage |
$418.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$859.30
|
| Rate for Payer: Priority Health HMO/PPO |
$684.46
|
| Rate for Payer: Priority Health Medicare |
$422.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$684.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$418.19
|
| Rate for Payer: UHC Exchange |
$418.19
|
| Rate for Payer: UHC Medicare Advantage |
$418.19
|
| Rate for Payer: UHCCP Medicaid |
$275.84
|
|
|
PR PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
HCPCS 36904
|
| Min. Negotiated Rate |
$229.19 |
| Max. Negotiated Rate |
$2,663.30 |
| Rate for Payer: Aetna Commercial |
$466.31
|
| Rate for Payer: Aetna Medicare |
$361.91
|
| Rate for Payer: BCBS Complete |
$240.65
|
| Rate for Payer: BCBS MAPPO |
$347.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,699.01
|
| Rate for Payer: BCN Commercial |
$2,663.30
|
| Rate for Payer: BCN Medicare Advantage |
$347.99
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cofinity Commercial |
$466.31
|
| Rate for Payer: Cofinity Commercial |
$501.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$347.99
|
| Rate for Payer: Mclaren Medicaid |
$229.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$365.39
|
| Rate for Payer: Meridian Medicaid |
$240.65
|
| Rate for Payer: Nomi Health Commercial |
$417.59
|
| Rate for Payer: PACE SWMI |
$347.99
|
| Rate for Payer: PHP Medicare Advantage |
$347.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$229.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$576.55
|
| Rate for Payer: Priority Health HMO/PPO |
$570.11
|
| Rate for Payer: Priority Health Medicare |
$351.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$347.99
|
| Rate for Payer: UHC Exchange |
$347.99
|
| Rate for Payer: UHC Medicare Advantage |
$347.99
|
| Rate for Payer: UHCCP Medicaid |
$229.19
|
|
|
PR PERQ TRANSLUMINAL ANGIOPLASTY NATIVE/RECR COA
|
Professional
|
Both
|
$1,244.00
|
|
|
Service Code
|
HCPCS 33897
|
| Min. Negotiated Rate |
$362.10 |
| Max. Negotiated Rate |
$903.04 |
| Rate for Payer: Aetna Commercial |
$740.91
|
| Rate for Payer: Aetna Medicare |
$575.04
|
| Rate for Payer: BCBS Complete |
$380.20
|
| Rate for Payer: BCBS MAPPO |
$552.92
|
| Rate for Payer: BCN Commercial |
$827.82
|
| Rate for Payer: BCN Medicare Advantage |
$552.92
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cash Price |
$995.20
|
| Rate for Payer: Cofinity Commercial |
$796.20
|
| Rate for Payer: Cofinity Commercial |
$740.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$552.92
|
| Rate for Payer: Mclaren Medicaid |
$362.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$580.57
|
| Rate for Payer: Meridian Medicaid |
$380.20
|
| Rate for Payer: Nomi Health Commercial |
$663.50
|
| Rate for Payer: PACE SWMI |
$552.92
|
| Rate for Payer: PHP Medicare Advantage |
$552.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$808.60
|
| Rate for Payer: Priority Health HMO/PPO |
$903.04
|
| Rate for Payer: Priority Health Medicare |
$558.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$903.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$552.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$552.92
|
| Rate for Payer: UHC Exchange |
$552.92
|
| Rate for Payer: UHC Medicare Advantage |
$552.92
|
| Rate for Payer: UHCCP Medicaid |
$362.10
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
HCPCS 22513
|
| Min. Negotiated Rate |
$219.77 |
| Max. Negotiated Rate |
$8,492.73 |
| Rate for Payer: Aetna Commercial |
$653.48
|
| Rate for Payer: Aetna Medicare |
$507.18
|
| Rate for Payer: BCBS Complete |
$341.07
|
| Rate for Payer: BCBS MAPPO |
$487.67
|
| Rate for Payer: BCBS Trust/PPO |
$219.77
|
| Rate for Payer: BCN Commercial |
$8,492.73
|
| Rate for Payer: BCN Medicare Advantage |
$487.67
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cash Price |
$1,236.80
|
| Rate for Payer: Cofinity Commercial |
$702.24
|
| Rate for Payer: Cofinity Commercial |
$653.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$487.67
|
| Rate for Payer: Mclaren Medicaid |
$324.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.05
|
| Rate for Payer: Meridian Medicaid |
$341.07
|
| Rate for Payer: Nomi Health Commercial |
$585.20
|
| Rate for Payer: PACE SWMI |
$487.67
|
| Rate for Payer: PHP Medicare Advantage |
$487.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$324.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,004.90
|
| Rate for Payer: Priority Health HMO/PPO |
$773.97
|
| Rate for Payer: Priority Health Medicare |
$492.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$773.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$487.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$487.67
|
| Rate for Payer: UHC Exchange |
$487.67
|
| Rate for Payer: UHC Medicare Advantage |
$487.67
|
| Rate for Payer: UHCCP Medicaid |
$324.83
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
HCPCS 22515
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$4,362.91 |
| Rate for Payer: Aetna Commercial |
$280.40
|
| Rate for Payer: Aetna Medicare |
$217.62
|
| Rate for Payer: BCBS Complete |
$144.92
|
| Rate for Payer: BCBS MAPPO |
$209.25
|
| Rate for Payer: BCBS Trust/PPO |
$57.48
|
| Rate for Payer: BCN Commercial |
$4,362.91
|
| Rate for Payer: BCN Medicare Advantage |
$209.25
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cash Price |
$644.80
|
| Rate for Payer: Cofinity Commercial |
$301.32
|
| Rate for Payer: Cofinity Commercial |
$280.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.25
|
| Rate for Payer: Mclaren Medicaid |
$138.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.71
|
| Rate for Payer: Meridian Medicaid |
$144.92
|
| Rate for Payer: Nomi Health Commercial |
$251.10
|
| Rate for Payer: PACE SWMI |
$209.25
|
| Rate for Payer: PHP Medicare Advantage |
$209.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$523.90
|
| Rate for Payer: Priority Health HMO/PPO |
$328.21
|
| Rate for Payer: Priority Health Medicare |
$211.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$209.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.25
|
| Rate for Payer: UHC Exchange |
$209.25
|
| Rate for Payer: UHC Medicare Advantage |
$209.25
|
| Rate for Payer: UHCCP Medicaid |
$138.02
|
|
|
PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
HCPCS 22514
|
| Min. Negotiated Rate |
$303.53 |
| Max. Negotiated Rate |
$8,451.68 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Medicare |
$473.58
|
| Rate for Payer: BCBS Complete |
$318.71
|
| Rate for Payer: BCBS MAPPO |
$455.37
|
| Rate for Payer: BCBS Trust/PPO |
$3,205.12
|
| Rate for Payer: BCN Commercial |
$8,451.68
|
| Rate for Payer: BCN Medicare Advantage |
$455.37
|
| Rate for Payer: Cash Price |
$1,155.20
|
| Rate for Payer: Cash Price |
$1,155.20
|
| Rate for Payer: Cofinity Commercial |
$655.73
|
| Rate for Payer: Cofinity Commercial |
$610.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.37
|
| Rate for Payer: Mclaren Medicaid |
$303.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$478.14
|
| Rate for Payer: Meridian Medicaid |
$318.71
|
| Rate for Payer: Nomi Health Commercial |
$546.44
|
| Rate for Payer: PACE SWMI |
$455.37
|
| Rate for Payer: PHP Medicare Advantage |
$455.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$303.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$938.60
|
| Rate for Payer: Priority Health HMO/PPO |
$721.57
|
| Rate for Payer: Priority Health Medicare |
$459.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$721.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$455.37
|
| Rate for Payer: UHC Exchange |
$455.37
|
| Rate for Payer: UHC Medicare Advantage |
$455.37
|
| Rate for Payer: UHCCP Medicaid |
$303.53
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL
|
Professional
|
Both
|
$1,057.00
|
|
|
Service Code
|
HCPCS 22511
|
| Min. Negotiated Rate |
$190.19 |
| Max. Negotiated Rate |
$2,669.64 |
| Rate for Payer: Aetna Commercial |
$520.64
|
| Rate for Payer: Aetna Medicare |
$404.08
|
| Rate for Payer: BCBS Complete |
$272.18
|
| Rate for Payer: BCBS MAPPO |
$388.54
|
| Rate for Payer: BCBS Trust/PPO |
$190.19
|
| Rate for Payer: BCN Commercial |
$2,669.64
|
| Rate for Payer: BCN Medicare Advantage |
$388.54
|
| Rate for Payer: Cash Price |
$845.60
|
| Rate for Payer: Cash Price |
$845.60
|
| Rate for Payer: Cofinity Commercial |
$559.50
|
| Rate for Payer: Cofinity Commercial |
$520.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.54
|
| Rate for Payer: Mclaren Medicaid |
$259.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.97
|
| Rate for Payer: Meridian Medicaid |
$272.18
|
| Rate for Payer: Nomi Health Commercial |
$466.25
|
| Rate for Payer: PACE SWMI |
$388.54
|
| Rate for Payer: PHP Medicare Advantage |
$388.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$259.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$687.05
|
| Rate for Payer: Priority Health HMO/PPO |
$614.70
|
| Rate for Payer: Priority Health Medicare |
$392.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$388.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$388.54
|
| Rate for Payer: UHC Exchange |
$388.54
|
| Rate for Payer: UHC Medicare Advantage |
$388.54
|
| Rate for Payer: UHCCP Medicaid |
$259.22
|
|
|
PR PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC
|
Professional
|
Both
|
$3,421.00
|
|
|
Service Code
|
HCPCS 22510
|
| Min. Negotiated Rate |
$275.20 |
| Max. Negotiated Rate |
$2,683.33 |
| Rate for Payer: Aetna Commercial |
$553.47
|
| Rate for Payer: Aetna Medicare |
$429.56
|
| Rate for Payer: BCBS Complete |
$288.96
|
| Rate for Payer: BCBS MAPPO |
$413.04
|
| Rate for Payer: BCBS Trust/PPO |
$825.51
|
| Rate for Payer: BCN Commercial |
$2,683.33
|
| Rate for Payer: BCN Medicare Advantage |
$413.04
|
| Rate for Payer: Cash Price |
$2,736.80
|
| Rate for Payer: Cash Price |
$2,736.80
|
| Rate for Payer: Cofinity Commercial |
$594.78
|
| Rate for Payer: Cofinity Commercial |
$553.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.04
|
| Rate for Payer: Mclaren Medicaid |
$275.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$433.69
|
| Rate for Payer: Meridian Medicaid |
$288.96
|
| Rate for Payer: Nomi Health Commercial |
$495.65
|
| Rate for Payer: PACE SWMI |
$413.04
|
| Rate for Payer: PHP Medicare Advantage |
$413.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$275.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,223.65
|
| Rate for Payer: Priority Health HMO/PPO |
$652.87
|
| Rate for Payer: Priority Health Medicare |
$417.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$652.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$413.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$413.04
|
| Rate for Payer: UHC Exchange |
$413.04
|
| Rate for Payer: UHC Medicare Advantage |
$413.04
|
| Rate for Payer: UHCCP Medicaid |
$275.20
|
|
|
PR PESSARY REUSABLE NONRUBBER
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4562
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$56.07 |
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCN Commercial |
$56.07
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR PESSARY REUSABLE RUB ANYTYPE
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS A4561
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCN Commercial |
$22.57
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
PR PHALANGECTOMY TOE EACH TOE
|
Professional
|
Both
|
$849.00
|
|
|
Service Code
|
HCPCS 28150
|
| Min. Negotiated Rate |
$182.12 |
| Max. Negotiated Rate |
$1,132.15 |
| Rate for Payer: Aetna Commercial |
$358.81
|
| Rate for Payer: Aetna Medicare |
$278.48
|
| Rate for Payer: BCBS Complete |
$191.23
|
| Rate for Payer: BCBS MAPPO |
$267.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,132.15
|
| Rate for Payer: BCN Commercial |
$607.43
|
| Rate for Payer: BCN Medicare Advantage |
$267.77
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Cofinity Commercial |
$385.59
|
| Rate for Payer: Cofinity Commercial |
$358.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.77
|
| Rate for Payer: Mclaren Medicaid |
$182.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.16
|
| Rate for Payer: Meridian Medicaid |
$191.23
|
| Rate for Payer: Nomi Health Commercial |
$321.32
|
| Rate for Payer: PACE SWMI |
$267.77
|
| Rate for Payer: PHP Medicare Advantage |
$267.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.85
|
| Rate for Payer: Priority Health HMO/PPO |
$431.01
|
| Rate for Payer: Priority Health Medicare |
$270.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$431.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.77
|
| Rate for Payer: UHC Exchange |
$267.77
|
| Rate for Payer: UHC Medicare Advantage |
$267.77
|
| Rate for Payer: UHCCP Medicaid |
$182.12
|
|
|
PR PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 90863
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$1,062.41 |
| Rate for Payer: Aetna Commercial |
$31.40
|
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.41
|
| Rate for Payer: BCN Commercial |
$70.30
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: Priority Health HMO/PPO |
$41.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.86
|
|
|
PR PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX
|
Professional
|
Both
|
$1,441.00
|
|
|
Service Code
|
HCPCS 42950
|
| Min. Negotiated Rate |
$509.50 |
| Max. Negotiated Rate |
$1,429.44 |
| Rate for Payer: Aetna Commercial |
$990.39
|
| Rate for Payer: Aetna Medicare |
$768.66
|
| Rate for Payer: BCBS Complete |
$534.98
|
| Rate for Payer: BCBS MAPPO |
$739.10
|
| Rate for Payer: BCBS Trust/PPO |
$665.13
|
| Rate for Payer: BCN Commercial |
$1,175.76
|
| Rate for Payer: BCN Medicare Advantage |
$739.10
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,152.80
|
| Rate for Payer: Cofinity Commercial |
$990.39
|
| Rate for Payer: Cofinity Commercial |
$1,064.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$739.10
|
| Rate for Payer: Mclaren Medicaid |
$509.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$776.06
|
| Rate for Payer: Meridian Medicaid |
$534.98
|
| Rate for Payer: Nomi Health Commercial |
$886.92
|
| Rate for Payer: PACE SWMI |
$739.10
|
| Rate for Payer: PHP Medicare Advantage |
$739.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$936.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,429.44
|
| Rate for Payer: Priority Health Medicare |
$746.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,429.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$739.10
|
| Rate for Payer: UHC Exchange |
$739.10
|
| Rate for Payer: UHC Medicare Advantage |
$739.10
|
| Rate for Payer: UHCCP Medicaid |
$509.50
|
|
|
PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
HCPCS 99195
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$587.47 |
| Rate for Payer: Aetna Commercial |
$106.68
|
| Rate for Payer: Aetna Medicare |
$82.79
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS MAPPO |
$79.61
|
| Rate for Payer: BCBS Trust/PPO |
$587.47
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: BCN Medicare Advantage |
$79.61
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$114.64
|
| Rate for Payer: Cofinity Commercial |
$106.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.59
|
| Rate for Payer: Nomi Health Commercial |
$95.53
|
| Rate for Payer: PACE SWMI |
$79.61
|
| Rate for Payer: PHP Medicare Advantage |
$79.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health HMO/PPO |
$129.82
|
| Rate for Payer: Priority Health Medicare |
$80.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.61
|
| Rate for Payer: UHC Exchange |
$79.61
|
| Rate for Payer: UHC Medicare Advantage |
$79.61
|
|
|
PR PHTFAC ARMS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00079
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR PHTFAC CHEST/SHLD
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 00077
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$83.20 |
| Rate for Payer: Aetna Medicare |
$64.00
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.20
|
|
|
PR PHTFAC FACE & NECK/ FL ARMS
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 00076
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
PR PHTFAC FL LEGS
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 00080
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
|
|
PR PHTFAC HANDS
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 00078
|
|
Hospital Revenue Code
|
990
|
| 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 PHTFAC HEMANGIOMAS/WARTS
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 00083
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR PHTFAC NASAL VEIN
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 00082
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
|
|
PR PHTFAC SNGL PIGMENT
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 00081
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
PR PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 97750
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$708.45 |
| Rate for Payer: Aetna Commercial |
$42.52
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$31.73
|
| Rate for Payer: BCBS Trust/PPO |
$708.45
|
| Rate for Payer: BCN Commercial |
$32.95
|
| Rate for Payer: BCN Medicare Advantage |
$31.73
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$42.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.32
|
| Rate for Payer: Nomi Health Commercial |
$38.08
|
| Rate for Payer: PACE SWMI |
$31.73
|
| Rate for Payer: PHP Medicare Advantage |
$31.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health HMO/PPO |
$77.25
|
| Rate for Payer: Priority Health Medicare |
$32.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.73
|
| Rate for Payer: UHC Exchange |
$31.73
|
| Rate for Payer: UHC Medicare Advantage |
$31.73
|
|
|
PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 93464
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$740.15 |
| Rate for Payer: Aetna Commercial |
$262.55
|
| Rate for Payer: Aetna Medicare |
$203.77
|
| Rate for Payer: BCBS Complete |
$58.60
|
| Rate for Payer: BCBS MAPPO |
$195.93
|
| Rate for Payer: BCBS Trust/PPO |
$740.15
|
| Rate for Payer: BCN Commercial |
$319.60
|
| Rate for Payer: BCN Medicare Advantage |
$195.93
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$282.14
|
| Rate for Payer: Cofinity Commercial |
$262.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.93
|
| Rate for Payer: Mclaren Medicaid |
$55.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$205.73
|
| Rate for Payer: Meridian Medicaid |
$58.60
|
| Rate for Payer: Nomi Health Commercial |
$235.12
|
| Rate for Payer: PACE SWMI |
$195.93
|
| Rate for Payer: PHP Medicare Advantage |
$195.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health HMO/PPO |
$121.94
|
| Rate for Payer: Priority Health Medicare |
$197.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$195.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$195.93
|
| Rate for Payer: UHC Exchange |
$195.93
|
| Rate for Payer: UHC Medicare Advantage |
$195.93
|
| Rate for Payer: UHCCP Medicaid |
$55.81
|
|
|
PR PHYSIOL SUPPORT HARVEST ORGAN FROM BRAIN-DEAD PT
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 01990
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
|
