|
PR POLYSOM <6 YRS SLEEP STAGE 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$1,736.00
|
|
|
Service Code
|
HCPCS 95782
|
| Min. Negotiated Rate |
$694.40 |
| Max. Negotiated Rate |
$1,251.98 |
| Rate for Payer: Aetna Commercial |
$1,165.04
|
| Rate for Payer: Aetna Commercial |
$1,165.04
|
| Rate for Payer: Aetna Medicare |
$904.21
|
| Rate for Payer: Aetna Medicare |
$904.21
|
| Rate for Payer: BCBS Complete |
$694.40
|
| Rate for Payer: BCBS Complete |
$103.20
|
| Rate for Payer: BCBS MAPPO |
$869.43
|
| Rate for Payer: BCBS MAPPO |
$869.43
|
| Rate for Payer: BCN Medicare Advantage |
$869.43
|
| Rate for Payer: BCN Medicare Advantage |
$869.43
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$1,388.80
|
| Rate for Payer: Cash Price |
$1,388.80
|
| Rate for Payer: Cofinity Commercial |
$1,251.98
|
| Rate for Payer: Cofinity Commercial |
$1,165.04
|
| Rate for Payer: Cofinity Commercial |
$1,251.98
|
| Rate for Payer: Cofinity Commercial |
$1,165.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$869.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$869.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$912.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$912.90
|
| Rate for Payer: Nomi Health Commercial |
$1,043.32
|
| Rate for Payer: Nomi Health Commercial |
$1,043.32
|
| Rate for Payer: PACE SWMI |
$869.43
|
| Rate for Payer: PACE SWMI |
$869.43
|
| Rate for Payer: PHP Medicare Advantage |
$869.43
|
| Rate for Payer: PHP Medicare Advantage |
$869.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,128.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.70
|
| Rate for Payer: Priority Health Medicare |
$878.12
|
| Rate for Payer: Priority Health Medicare |
$878.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$869.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$869.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$869.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$869.43
|
| Rate for Payer: UHC Exchange |
$869.43
|
| Rate for Payer: UHC Exchange |
$869.43
|
| Rate for Payer: UHC Medicare Advantage |
$869.43
|
| Rate for Payer: UHC Medicare Advantage |
$869.43
|
|
|
PR POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND
|
Professional
|
Both
|
$1,246.00
|
|
|
Service Code
|
HCPCS 95811
|
| Min. Negotiated Rate |
$498.40 |
| Max. Negotiated Rate |
$849.89 |
| Rate for Payer: Aetna Commercial |
$790.87
|
| Rate for Payer: Aetna Commercial |
$790.87
|
| Rate for Payer: Aetna Medicare |
$613.81
|
| Rate for Payer: Aetna Medicare |
$613.81
|
| Rate for Payer: BCBS Complete |
$498.40
|
| Rate for Payer: BCBS Complete |
$200.80
|
| Rate for Payer: BCBS MAPPO |
$590.20
|
| Rate for Payer: BCBS MAPPO |
$590.20
|
| Rate for Payer: BCN Medicare Advantage |
$590.20
|
| Rate for Payer: BCN Medicare Advantage |
$590.20
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cash Price |
$996.80
|
| Rate for Payer: Cofinity Commercial |
$849.89
|
| Rate for Payer: Cofinity Commercial |
$790.87
|
| Rate for Payer: Cofinity Commercial |
$849.89
|
| Rate for Payer: Cofinity Commercial |
$790.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$590.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$590.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$619.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$619.71
|
| Rate for Payer: Nomi Health Commercial |
$708.24
|
| Rate for Payer: Nomi Health Commercial |
$708.24
|
| Rate for Payer: PACE SWMI |
$590.20
|
| Rate for Payer: PACE SWMI |
$590.20
|
| Rate for Payer: PHP Medicare Advantage |
$590.20
|
| Rate for Payer: PHP Medicare Advantage |
$590.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health Medicare |
$596.10
|
| Rate for Payer: Priority Health Medicare |
$596.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$590.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$590.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$590.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$590.20
|
| Rate for Payer: UHC Exchange |
$590.20
|
| Rate for Payer: UHC Exchange |
$590.20
|
| Rate for Payer: UHC Medicare Advantage |
$590.20
|
| Rate for Payer: UHC Medicare Advantage |
$590.20
|
|
|
PR POLYSOM <6 YRS SLEEP W/CPAP/BILVL VENT 4/> PARAM
|
Professional
|
Both
|
$1,853.00
|
|
|
Service Code
|
HCPCS 95783
|
| Min. Negotiated Rate |
$741.20 |
| Max. Negotiated Rate |
$1,327.02 |
| Rate for Payer: Aetna Commercial |
$1,234.86
|
| Rate for Payer: Aetna Commercial |
$1,234.86
|
| Rate for Payer: Aetna Medicare |
$958.40
|
| Rate for Payer: Aetna Medicare |
$958.40
|
| Rate for Payer: BCBS Complete |
$741.20
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS MAPPO |
$921.54
|
| Rate for Payer: BCBS MAPPO |
$921.54
|
| Rate for Payer: BCN Medicare Advantage |
$921.54
|
| Rate for Payer: BCN Medicare Advantage |
$921.54
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cash Price |
$1,482.40
|
| Rate for Payer: Cofinity Commercial |
$1,327.02
|
| Rate for Payer: Cofinity Commercial |
$1,234.86
|
| Rate for Payer: Cofinity Commercial |
$1,327.02
|
| Rate for Payer: Cofinity Commercial |
$1,234.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$921.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$967.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$967.62
|
| Rate for Payer: Nomi Health Commercial |
$1,105.85
|
| Rate for Payer: Nomi Health Commercial |
$1,105.85
|
| Rate for Payer: PACE SWMI |
$921.54
|
| Rate for Payer: PACE SWMI |
$921.54
|
| Rate for Payer: PHP Medicare Advantage |
$921.54
|
| Rate for Payer: PHP Medicare Advantage |
$921.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health Medicare |
$930.76
|
| Rate for Payer: Priority Health Medicare |
$930.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$921.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$921.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$921.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$921.54
|
| Rate for Payer: UHC Exchange |
$921.54
|
| Rate for Payer: UHC Exchange |
$921.54
|
| Rate for Payer: UHC Medicare Advantage |
$921.54
|
| Rate for Payer: UHC Medicare Advantage |
$921.54
|
|
|
PR POLYSOM ANY AGE SLEEP STAGE 1-3 ADDL PARAM ATTND
|
Professional
|
Both
|
$1,740.00
|
|
|
Service Code
|
HCPCS 95808
|
| Min. Negotiated Rate |
$440.55 |
| Max. Negotiated Rate |
$1,131.00 |
| Rate for Payer: Aetna Commercial |
$590.34
|
| Rate for Payer: Aetna Commercial |
$590.34
|
| Rate for Payer: Aetna Medicare |
$458.17
|
| Rate for Payer: Aetna Medicare |
$458.17
|
| Rate for Payer: BCBS Complete |
$696.00
|
| Rate for Payer: BCBS Complete |
$172.00
|
| Rate for Payer: BCBS MAPPO |
$440.55
|
| Rate for Payer: BCBS MAPPO |
$440.55
|
| Rate for Payer: BCN Medicare Advantage |
$440.55
|
| Rate for Payer: BCN Medicare Advantage |
$440.55
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cash Price |
$1,392.00
|
| Rate for Payer: Cofinity Commercial |
$634.39
|
| Rate for Payer: Cofinity Commercial |
$590.34
|
| Rate for Payer: Cofinity Commercial |
$634.39
|
| Rate for Payer: Cofinity Commercial |
$590.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.58
|
| Rate for Payer: Nomi Health Commercial |
$528.66
|
| Rate for Payer: Nomi Health Commercial |
$528.66
|
| Rate for Payer: PACE SWMI |
$440.55
|
| Rate for Payer: PACE SWMI |
$440.55
|
| Rate for Payer: PHP Medicare Advantage |
$440.55
|
| Rate for Payer: PHP Medicare Advantage |
$440.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,131.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health Medicare |
$444.96
|
| Rate for Payer: Priority Health Medicare |
$444.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$440.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.55
|
| Rate for Payer: UHC Exchange |
$440.55
|
| Rate for Payer: UHC Exchange |
$440.55
|
| Rate for Payer: UHC Medicare Advantage |
$440.55
|
| Rate for Payer: UHC Medicare Advantage |
$440.55
|
|
|
PR PORTOENETEROSTOMY
|
Professional
|
Both
|
$4,815.00
|
|
|
Service Code
|
HCPCS 47701
|
| Min. Negotiated Rate |
$1,683.55 |
| Max. Negotiated Rate |
$3,129.75 |
| Rate for Payer: Aetna Commercial |
$2,255.96
|
| Rate for Payer: Aetna Medicare |
$1,750.89
|
| Rate for Payer: BCBS Complete |
$1,926.00
|
| Rate for Payer: BCBS MAPPO |
$1,683.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,683.55
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Cash Price |
$3,852.00
|
| Rate for Payer: Cofinity Commercial |
$2,424.31
|
| Rate for Payer: Cofinity Commercial |
$2,255.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,683.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,767.73
|
| Rate for Payer: Nomi Health Commercial |
$2,020.26
|
| Rate for Payer: PACE SWMI |
$1,683.55
|
| Rate for Payer: PHP Medicare Advantage |
$1,683.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,129.75
|
| Rate for Payer: Priority Health Medicare |
$1,700.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,683.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,683.55
|
| Rate for Payer: UHC Exchange |
$1,683.55
|
| Rate for Payer: UHC Medicare Advantage |
$1,683.55
|
|
|
PR POSITIONAL NYSTAGMUS TEST
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 92542
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$38.72 |
| Rate for Payer: Aetna Commercial |
$36.03
|
| Rate for Payer: Aetna Medicare |
$27.97
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS MAPPO |
$26.89
|
| Rate for Payer: BCN Medicare Advantage |
$26.89
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cofinity Commercial |
$38.72
|
| Rate for Payer: Cofinity Commercial |
$36.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.23
|
| Rate for Payer: Nomi Health Commercial |
$32.27
|
| Rate for Payer: PACE SWMI |
$26.89
|
| Rate for Payer: PHP Medicare Advantage |
$26.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Medicare |
$27.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.89
|
| Rate for Payer: UHC Exchange |
$26.89
|
| Rate for Payer: UHC Medicare Advantage |
$26.89
|
|
|
PR POST-CATARACT LASER SURGERY
|
Professional
|
Both
|
$574.00
|
|
|
Service Code
|
HCPCS 66821
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$409.32 |
| Rate for Payer: Aetna Commercial |
$380.89
|
| Rate for Payer: Aetna Medicare |
$295.62
|
| Rate for Payer: BCBS Complete |
$229.60
|
| Rate for Payer: BCBS MAPPO |
$284.25
|
| Rate for Payer: BCN Medicare Advantage |
$284.25
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cash Price |
$459.20
|
| Rate for Payer: Cofinity Commercial |
$409.32
|
| Rate for Payer: Cofinity Commercial |
$380.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$284.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.46
|
| Rate for Payer: Nomi Health Commercial |
$341.10
|
| Rate for Payer: PACE SWMI |
$284.25
|
| Rate for Payer: PHP Medicare Advantage |
$284.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.10
|
| Rate for Payer: Priority Health Medicare |
$287.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$284.25
|
| Rate for Payer: UHC Exchange |
$284.25
|
| Rate for Payer: UHC Medicare Advantage |
$284.25
|
|
|
PR POST COLPORRHAPHY RECTOCELE W/WO PERINEORRHAPHY
|
Professional
|
Both
|
$1,407.00
|
|
|
Service Code
|
HCPCS 57250
|
| Min. Negotiated Rate |
$562.80 |
| Max. Negotiated Rate |
$914.55 |
| Rate for Payer: Aetna Commercial |
$790.04
|
| Rate for Payer: Aetna Medicare |
$613.16
|
| Rate for Payer: BCBS Complete |
$562.80
|
| Rate for Payer: BCBS MAPPO |
$589.58
|
| Rate for Payer: BCN Medicare Advantage |
$589.58
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cash Price |
$1,125.60
|
| Rate for Payer: Cofinity Commercial |
$849.00
|
| Rate for Payer: Cofinity Commercial |
$790.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$589.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$619.06
|
| Rate for Payer: Nomi Health Commercial |
$707.50
|
| Rate for Payer: PACE SWMI |
$589.58
|
| Rate for Payer: PHP Medicare Advantage |
$589.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$914.55
|
| Rate for Payer: Priority Health Medicare |
$595.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$589.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$589.58
|
| Rate for Payer: UHC Exchange |
$589.58
|
| Rate for Payer: UHC Medicare Advantage |
$589.58
|
|
|
PR POSTERIOR NON-SEGMENTAL INSTRUMENTATION
|
Professional
|
Both
|
$3,333.00
|
|
|
Service Code
|
HCPCS 22840
|
| Min. Negotiated Rate |
$735.06 |
| Max. Negotiated Rate |
$2,166.45 |
| Rate for Payer: Aetna Commercial |
$984.98
|
| Rate for Payer: Aetna Medicare |
$764.46
|
| Rate for Payer: BCBS Complete |
$1,333.20
|
| Rate for Payer: BCBS MAPPO |
$735.06
|
| Rate for Payer: BCN Medicare Advantage |
$735.06
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cofinity Commercial |
$984.98
|
| Rate for Payer: Cofinity Commercial |
$1,058.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$735.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$771.81
|
| Rate for Payer: Nomi Health Commercial |
$882.07
|
| Rate for Payer: PACE SWMI |
$735.06
|
| Rate for Payer: PHP Medicare Advantage |
$735.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,166.45
|
| Rate for Payer: Priority Health Medicare |
$742.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$735.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$735.06
|
| Rate for Payer: UHC Exchange |
$735.06
|
| Rate for Payer: UHC Medicare Advantage |
$735.06
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE
|
Professional
|
Both
|
$3,929.00
|
|
|
Service Code
|
HCPCS 22844
|
| Min. Negotiated Rate |
$959.85 |
| Max. Negotiated Rate |
$2,553.85 |
| Rate for Payer: Aetna Commercial |
$1,286.20
|
| Rate for Payer: Aetna Medicare |
$998.24
|
| Rate for Payer: BCBS Complete |
$1,571.60
|
| Rate for Payer: BCBS MAPPO |
$959.85
|
| Rate for Payer: BCN Medicare Advantage |
$959.85
|
| Rate for Payer: Cash Price |
$3,143.20
|
| Rate for Payer: Cash Price |
$3,143.20
|
| Rate for Payer: Cofinity Commercial |
$1,382.18
|
| Rate for Payer: Cofinity Commercial |
$1,286.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$959.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,007.84
|
| Rate for Payer: Nomi Health Commercial |
$1,151.82
|
| Rate for Payer: PACE SWMI |
$959.85
|
| Rate for Payer: PHP Medicare Advantage |
$959.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,553.85
|
| Rate for Payer: Priority Health Medicare |
$969.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$959.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$959.85
|
| Rate for Payer: UHC Exchange |
$959.85
|
| Rate for Payer: UHC Medicare Advantage |
$959.85
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG
|
Professional
|
Both
|
$3,720.00
|
|
|
Service Code
|
HCPCS 22842
|
| Min. Negotiated Rate |
$745.29 |
| Max. Negotiated Rate |
$2,418.00 |
| Rate for Payer: Aetna Commercial |
$998.69
|
| Rate for Payer: Aetna Medicare |
$775.10
|
| Rate for Payer: BCBS Complete |
$1,488.00
|
| Rate for Payer: BCBS MAPPO |
$745.29
|
| Rate for Payer: BCN Medicare Advantage |
$745.29
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cash Price |
$2,976.00
|
| Rate for Payer: Cofinity Commercial |
$998.69
|
| Rate for Payer: Cofinity Commercial |
$1,073.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$745.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$782.55
|
| Rate for Payer: Nomi Health Commercial |
$894.35
|
| Rate for Payer: PACE SWMI |
$745.29
|
| Rate for Payer: PHP Medicare Advantage |
$745.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,418.00
|
| Rate for Payer: Priority Health Medicare |
$752.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$745.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$745.29
|
| Rate for Payer: UHC Exchange |
$745.29
|
| Rate for Payer: UHC Medicare Advantage |
$745.29
|
|
|
PR POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG
|
Professional
|
Both
|
$4,091.00
|
|
|
Service Code
|
HCPCS 22843
|
| Min. Negotiated Rate |
$798.77 |
| Max. Negotiated Rate |
$2,659.15 |
| Rate for Payer: Aetna Commercial |
$1,070.35
|
| Rate for Payer: Aetna Medicare |
$830.72
|
| Rate for Payer: BCBS Complete |
$1,636.40
|
| Rate for Payer: BCBS MAPPO |
$798.77
|
| Rate for Payer: BCN Medicare Advantage |
$798.77
|
| Rate for Payer: Cash Price |
$3,272.80
|
| Rate for Payer: Cash Price |
$3,272.80
|
| Rate for Payer: Cofinity Commercial |
$1,150.23
|
| Rate for Payer: Cofinity Commercial |
$1,070.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$798.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$838.71
|
| Rate for Payer: Nomi Health Commercial |
$958.52
|
| Rate for Payer: PACE SWMI |
$798.77
|
| Rate for Payer: PHP Medicare Advantage |
$798.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,659.15
|
| Rate for Payer: Priority Health Medicare |
$806.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$798.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$798.77
|
| Rate for Payer: UHC Exchange |
$798.77
|
| Rate for Payer: UHC Medicare Advantage |
$798.77
|
|
|
PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE
|
Professional
|
Both
|
$449.00
|
|
|
Service Code
|
HCPCS 59430
|
| Min. Negotiated Rate |
$174.50 |
| Max. Negotiated Rate |
$291.85 |
| Rate for Payer: Aetna Commercial |
$233.83
|
| Rate for Payer: Aetna Medicare |
$181.48
|
| Rate for Payer: BCBS Complete |
$179.60
|
| Rate for Payer: BCBS MAPPO |
$174.50
|
| Rate for Payer: BCN Medicare Advantage |
$174.50
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cash Price |
$359.20
|
| Rate for Payer: Cofinity Commercial |
$251.28
|
| Rate for Payer: Cofinity Commercial |
$233.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.22
|
| Rate for Payer: Nomi Health Commercial |
$209.40
|
| Rate for Payer: PACE SWMI |
$174.50
|
| Rate for Payer: PHP Medicare Advantage |
$174.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.85
|
| Rate for Payer: Priority Health Medicare |
$176.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.50
|
| Rate for Payer: UHC Exchange |
$174.50
|
| Rate for Payer: UHC Medicare Advantage |
$174.50
|
|
|
PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 64566
|
| Min. Negotiated Rate |
$28.55 |
| Max. Negotiated Rate |
$150.15 |
| Rate for Payer: Aetna Commercial |
$38.26
|
| Rate for Payer: Aetna Medicare |
$29.69
|
| Rate for Payer: BCBS Complete |
$92.40
|
| Rate for Payer: BCBS MAPPO |
$28.55
|
| Rate for Payer: BCN Medicare Advantage |
$28.55
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$41.11
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.98
|
| Rate for Payer: Nomi Health Commercial |
$34.26
|
| Rate for Payer: PACE SWMI |
$28.55
|
| Rate for Payer: PHP Medicare Advantage |
$28.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health Medicare |
$28.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.55
|
| Rate for Payer: UHC Exchange |
$28.55
|
| Rate for Payer: UHC Medicare Advantage |
$28.55
|
|
|
PR POTASSIUM HYDROXIDE PREPS
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS Q0112
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Commercial |
$7.81
|
| Rate for Payer: Aetna Medicare |
$6.06
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$5.83
|
| Rate for Payer: BCN Medicare Advantage |
$5.83
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cofinity Commercial |
$8.40
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.12
|
| Rate for Payer: Nomi Health Commercial |
$7.00
|
| Rate for Payer: PACE SWMI |
$5.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Medicare |
$5.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.83
|
| Rate for Payer: UHC Exchange |
$5.83
|
| Rate for Payer: UHC Medicare Advantage |
$5.83
|
|
|
PR PPPS, INITIAL VISIT
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS G0438
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Aetna Commercial |
$207.70
|
| Rate for Payer: Aetna Medicare |
$161.20
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCBS MAPPO |
$155.00
|
| Rate for Payer: BCN Medicare Advantage |
$155.00
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$223.20
|
| Rate for Payer: Cofinity Commercial |
$207.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$162.75
|
| Rate for Payer: Nomi Health Commercial |
$186.00
|
| Rate for Payer: PACE SWMI |
$155.00
|
| Rate for Payer: PHP Medicare Advantage |
$155.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$156.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.00
|
| Rate for Payer: UHC Exchange |
$155.00
|
| Rate for Payer: UHC Medicare Advantage |
$155.00
|
|
|
PR PPPS, SUBSEQ VISIT
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS G0439
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$175.46 |
| Rate for Payer: Aetna Commercial |
$163.28
|
| Rate for Payer: Aetna Medicare |
$126.72
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$121.85
|
| Rate for Payer: BCN Medicare Advantage |
$121.85
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$175.46
|
| Rate for Payer: Cofinity Commercial |
$163.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.94
|
| Rate for Payer: Nomi Health Commercial |
$146.22
|
| Rate for Payer: PACE SWMI |
$121.85
|
| Rate for Payer: PHP Medicare Advantage |
$121.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health Medicare |
$123.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.85
|
| Rate for Payer: UHC Exchange |
$121.85
|
| Rate for Payer: UHC Medicare Advantage |
$121.85
|
|
|
PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 90732
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$192.20 |
| Rate for Payer: Aetna Commercial |
$178.85
|
| Rate for Payer: Aetna Medicare |
$138.81
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS MAPPO |
$133.47
|
| Rate for Payer: BCN Medicare Advantage |
$133.47
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$192.20
|
| Rate for Payer: Cofinity Commercial |
$178.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.14
|
| Rate for Payer: Nomi Health Commercial |
$160.16
|
| Rate for Payer: PACE SWMI |
$133.47
|
| Rate for Payer: PHP Medicare Advantage |
$133.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.90
|
| Rate for Payer: Priority Health Medicare |
$134.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.47
|
| Rate for Payer: UHC Exchange |
$133.47
|
| Rate for Payer: UHC Medicare Advantage |
$133.47
|
|
|
PR PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX
|
Professional
|
Both
|
$4,652.00
|
|
|
Service Code
|
HCPCS 45112
|
| Min. Negotiated Rate |
$1,726.13 |
| Max. Negotiated Rate |
$3,023.80 |
| Rate for Payer: Aetna Commercial |
$2,313.01
|
| Rate for Payer: Aetna Medicare |
$1,795.18
|
| Rate for Payer: BCBS Complete |
$1,860.80
|
| Rate for Payer: BCBS MAPPO |
$1,726.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,726.13
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cash Price |
$3,721.60
|
| Rate for Payer: Cofinity Commercial |
$2,485.63
|
| Rate for Payer: Cofinity Commercial |
$2,313.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,726.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,812.44
|
| Rate for Payer: Nomi Health Commercial |
$2,071.36
|
| Rate for Payer: PACE SWMI |
$1,726.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,726.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,023.80
|
| Rate for Payer: Priority Health Medicare |
$1,743.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,726.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,726.13
|
| Rate for Payer: UHC Exchange |
$1,726.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,726.13
|
|
|
PR PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST
|
Professional
|
Both
|
$4,725.00
|
|
|
Service Code
|
HCPCS 45110
|
| Min. Negotiated Rate |
$1,731.08 |
| Max. Negotiated Rate |
$3,071.25 |
| Rate for Payer: Aetna Commercial |
$2,319.65
|
| Rate for Payer: Aetna Medicare |
$1,800.32
|
| Rate for Payer: BCBS Complete |
$1,890.00
|
| Rate for Payer: BCBS MAPPO |
$1,731.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,731.08
|
| Rate for Payer: Cash Price |
$3,780.00
|
| Rate for Payer: Cash Price |
$3,780.00
|
| Rate for Payer: Cofinity Commercial |
$2,492.76
|
| Rate for Payer: Cofinity Commercial |
$2,319.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,731.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,817.63
|
| Rate for Payer: Nomi Health Commercial |
$2,077.30
|
| Rate for Payer: PACE SWMI |
$1,731.08
|
| Rate for Payer: PHP Medicare Advantage |
$1,731.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,071.25
|
| Rate for Payer: Priority Health Medicare |
$1,748.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,731.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,731.08
|
| Rate for Payer: UHC Exchange |
$1,731.08
|
| Rate for Payer: UHC Medicare Advantage |
$1,731.08
|
|
|
PR PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS
|
Professional
|
Both
|
$4,993.00
|
|
|
Service Code
|
HCPCS 45120
|
| Min. Negotiated Rate |
$1,555.36 |
| Max. Negotiated Rate |
$3,245.45 |
| Rate for Payer: Aetna Commercial |
$2,084.18
|
| Rate for Payer: Aetna Medicare |
$1,617.57
|
| Rate for Payer: BCBS Complete |
$1,997.20
|
| Rate for Payer: BCBS MAPPO |
$1,555.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,555.36
|
| Rate for Payer: Cash Price |
$3,994.40
|
| Rate for Payer: Cash Price |
$3,994.40
|
| Rate for Payer: Cofinity Commercial |
$2,239.72
|
| Rate for Payer: Cofinity Commercial |
$2,084.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,555.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,633.13
|
| Rate for Payer: Nomi Health Commercial |
$1,866.43
|
| Rate for Payer: PACE SWMI |
$1,555.36
|
| Rate for Payer: PHP Medicare Advantage |
$1,555.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,245.45
|
| Rate for Payer: Priority Health Medicare |
$1,570.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,555.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,555.36
|
| Rate for Payer: UHC Exchange |
$1,555.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,555.36
|
|
|
PR PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS
|
Professional
|
Both
|
$4,900.00
|
|
|
Service Code
|
HCPCS 45121
|
| Min. Negotiated Rate |
$1,696.93 |
| Max. Negotiated Rate |
$3,185.00 |
| Rate for Payer: Aetna Commercial |
$2,273.89
|
| Rate for Payer: Aetna Medicare |
$1,764.81
|
| Rate for Payer: BCBS Complete |
$1,960.00
|
| Rate for Payer: BCBS MAPPO |
$1,696.93
|
| Rate for Payer: BCN Medicare Advantage |
$1,696.93
|
| Rate for Payer: Cash Price |
$3,920.00
|
| Rate for Payer: Cash Price |
$3,920.00
|
| Rate for Payer: Cofinity Commercial |
$2,443.58
|
| Rate for Payer: Cofinity Commercial |
$2,273.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,696.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,781.78
|
| Rate for Payer: Nomi Health Commercial |
$2,036.32
|
| Rate for Payer: PACE SWMI |
$1,696.93
|
| Rate for Payer: PHP Medicare Advantage |
$1,696.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,185.00
|
| Rate for Payer: Priority Health Medicare |
$1,713.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,696.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,696.93
|
| Rate for Payer: UHC Exchange |
$1,696.93
|
| Rate for Payer: UHC Medicare Advantage |
$1,696.93
|
|
|
PR PRCTECT PRTL RESCJ RECTUM TABDL APPR
|
Professional
|
Both
|
$1,973.00
|
|
|
Service Code
|
HCPCS 45111
|
| Min. Negotiated Rate |
$789.20 |
| Max. Negotiated Rate |
$1,500.64 |
| Rate for Payer: Aetna Commercial |
$1,396.43
|
| Rate for Payer: Aetna Medicare |
$1,083.79
|
| Rate for Payer: BCBS Complete |
$789.20
|
| Rate for Payer: BCBS MAPPO |
$1,042.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,042.11
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cash Price |
$1,578.40
|
| Rate for Payer: Cofinity Commercial |
$1,500.64
|
| Rate for Payer: Cofinity Commercial |
$1,396.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,042.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,094.22
|
| Rate for Payer: Nomi Health Commercial |
$1,250.53
|
| Rate for Payer: PACE SWMI |
$1,042.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,042.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,282.45
|
| Rate for Payer: Priority Health Medicare |
$1,052.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,042.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,042.11
|
| Rate for Payer: UHC Exchange |
$1,042.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,042.11
|
|
|
PR PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH
|
Professional
|
Both
|
$3,259.00
|
|
|
Service Code
|
HCPCS 45114
|
| Min. Negotiated Rate |
$1,303.60 |
| Max. Negotiated Rate |
$2,544.12 |
| Rate for Payer: Aetna Commercial |
$2,367.45
|
| Rate for Payer: Aetna Medicare |
$1,837.42
|
| Rate for Payer: BCBS Complete |
$1,303.60
|
| Rate for Payer: BCBS MAPPO |
$1,766.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,766.75
|
| Rate for Payer: Cash Price |
$2,607.20
|
| Rate for Payer: Cash Price |
$2,607.20
|
| Rate for Payer: Cofinity Commercial |
$2,544.12
|
| Rate for Payer: Cofinity Commercial |
$2,367.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,766.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,855.09
|
| Rate for Payer: Nomi Health Commercial |
$2,120.10
|
| Rate for Payer: PACE SWMI |
$1,766.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,766.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,118.35
|
| Rate for Payer: Priority Health Medicare |
$1,784.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,766.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,766.75
|
| Rate for Payer: UHC Exchange |
$1,766.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,766.75
|
|
|
PR PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY
|
Professional
|
Both
|
$3,811.00
|
|
|
Service Code
|
HCPCS 45116
|
| Min. Negotiated Rate |
$1,469.87 |
| Max. Negotiated Rate |
$2,477.15 |
| Rate for Payer: Aetna Commercial |
$1,969.63
|
| Rate for Payer: Aetna Medicare |
$1,528.66
|
| Rate for Payer: BCBS Complete |
$1,524.40
|
| Rate for Payer: BCBS MAPPO |
$1,469.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,469.87
|
| Rate for Payer: Cash Price |
$3,048.80
|
| Rate for Payer: Cash Price |
$3,048.80
|
| Rate for Payer: Cofinity Commercial |
$2,116.61
|
| Rate for Payer: Cofinity Commercial |
$1,969.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,469.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,543.36
|
| Rate for Payer: Nomi Health Commercial |
$1,763.84
|
| Rate for Payer: PACE SWMI |
$1,469.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,469.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,477.15
|
| Rate for Payer: Priority Health Medicare |
$1,484.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,469.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,469.87
|
| Rate for Payer: UHC Exchange |
$1,469.87
|
| Rate for Payer: UHC Medicare Advantage |
$1,469.87
|
|
