|
PR PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY
|
Professional
|
Both
|
$6,010.00
|
|
|
Service Code
|
HCPCS 43121
|
| Min. Negotiated Rate |
$2,404.00 |
| Max. Negotiated Rate |
$3,956.47 |
| Rate for Payer: Aetna Commercial |
$3,681.72
|
| Rate for Payer: Aetna Medicare |
$2,857.45
|
| Rate for Payer: BCBS Complete |
$2,404.00
|
| Rate for Payer: BCBS MAPPO |
$2,747.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,747.55
|
| Rate for Payer: Cash Price |
$4,808.00
|
| Rate for Payer: Cash Price |
$4,808.00
|
| Rate for Payer: Cofinity Commercial |
$3,956.47
|
| Rate for Payer: Cofinity Commercial |
$3,681.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,747.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,884.93
|
| Rate for Payer: Nomi Health Commercial |
$3,297.06
|
| Rate for Payer: PACE SWMI |
$2,747.55
|
| Rate for Payer: PHP Medicare Advantage |
$2,747.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,906.50
|
| Rate for Payer: Priority Health Medicare |
$2,775.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,747.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,747.55
|
| Rate for Payer: UHC Exchange |
$2,747.55
|
| Rate for Payer: UHC Medicare Advantage |
$2,747.55
|
|
|
PR PRTL ESOPHECT DSTL W/WO PROX GASTRECT/PYLORPLSTY
|
Professional
|
Both
|
$6,334.00
|
|
|
Service Code
|
HCPCS 43117
|
| Min. Negotiated Rate |
$2,533.60 |
| Max. Negotiated Rate |
$4,510.90 |
| Rate for Payer: Aetna Commercial |
$4,197.64
|
| Rate for Payer: Aetna Medicare |
$3,257.87
|
| Rate for Payer: BCBS Complete |
$2,533.60
|
| Rate for Payer: BCBS MAPPO |
$3,132.57
|
| Rate for Payer: BCN Medicare Advantage |
$3,132.57
|
| Rate for Payer: Cash Price |
$5,067.20
|
| Rate for Payer: Cash Price |
$5,067.20
|
| Rate for Payer: Cofinity Commercial |
$4,510.90
|
| Rate for Payer: Cofinity Commercial |
$4,197.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,132.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,289.20
|
| Rate for Payer: Nomi Health Commercial |
$3,759.08
|
| Rate for Payer: PACE SWMI |
$3,132.57
|
| Rate for Payer: PHP Medicare Advantage |
$3,132.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,117.10
|
| Rate for Payer: Priority Health Medicare |
$3,163.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,132.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,132.57
|
| Rate for Payer: UHC Exchange |
$3,132.57
|
| Rate for Payer: UHC Medicare Advantage |
$3,132.57
|
|
|
PR PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
HCPCS 28122
|
| Min. Negotiated Rate |
$420.64 |
| Max. Negotiated Rate |
$809.25 |
| Rate for Payer: Aetna Commercial |
$563.66
|
| Rate for Payer: Aetna Medicare |
$437.47
|
| Rate for Payer: BCBS Complete |
$498.00
|
| Rate for Payer: BCBS MAPPO |
$420.64
|
| Rate for Payer: BCN Medicare Advantage |
$420.64
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cofinity Commercial |
$605.72
|
| Rate for Payer: Cofinity Commercial |
$563.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$420.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$441.67
|
| Rate for Payer: Nomi Health Commercial |
$504.77
|
| Rate for Payer: PACE SWMI |
$420.64
|
| Rate for Payer: PHP Medicare Advantage |
$420.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$809.25
|
| Rate for Payer: Priority Health Medicare |
$424.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$420.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$420.64
|
| Rate for Payer: UHC Exchange |
$420.64
|
| Rate for Payer: UHC Medicare Advantage |
$420.64
|
|
|
PR PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA
|
Professional
|
Both
|
$3,303.00
|
|
|
Service Code
|
HCPCS 27360
|
| Min. Negotiated Rate |
$862.21 |
| Max. Negotiated Rate |
$2,146.95 |
| Rate for Payer: Aetna Commercial |
$1,155.36
|
| Rate for Payer: Aetna Medicare |
$896.70
|
| Rate for Payer: BCBS Complete |
$1,321.20
|
| Rate for Payer: BCBS MAPPO |
$862.21
|
| Rate for Payer: BCN Medicare Advantage |
$862.21
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cofinity Commercial |
$1,241.58
|
| Rate for Payer: Cofinity Commercial |
$1,155.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$862.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$905.32
|
| Rate for Payer: Nomi Health Commercial |
$1,034.65
|
| Rate for Payer: PACE SWMI |
$862.21
|
| Rate for Payer: PHP Medicare Advantage |
$862.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,146.95
|
| Rate for Payer: Priority Health Medicare |
$870.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$862.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$862.21
|
| Rate for Payer: UHC Exchange |
$862.21
|
| Rate for Payer: UHC Medicare Advantage |
$862.21
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV
|
Professional
|
Both
|
$1,770.00
|
|
|
Service Code
|
HCPCS 22100
|
| Min. Negotiated Rate |
$708.00 |
| Max. Negotiated Rate |
$1,339.82 |
| Rate for Payer: Aetna Commercial |
$1,246.78
|
| Rate for Payer: Aetna Medicare |
$967.65
|
| Rate for Payer: BCBS Complete |
$708.00
|
| Rate for Payer: BCBS MAPPO |
$930.43
|
| Rate for Payer: BCN Medicare Advantage |
$930.43
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cash Price |
$1,416.00
|
| Rate for Payer: Cofinity Commercial |
$1,339.82
|
| Rate for Payer: Cofinity Commercial |
$1,246.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$930.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$976.95
|
| Rate for Payer: Nomi Health Commercial |
$1,116.52
|
| Rate for Payer: PACE SWMI |
$930.43
|
| Rate for Payer: PHP Medicare Advantage |
$930.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,150.50
|
| Rate for Payer: Priority Health Medicare |
$939.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$930.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$930.43
|
| Rate for Payer: UHC Exchange |
$930.43
|
| Rate for Payer: UHC Medicare Advantage |
$930.43
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
HCPCS 22103
|
| Min. Negotiated Rate |
$129.06 |
| Max. Negotiated Rate |
$426.40 |
| Rate for Payer: Aetna Commercial |
$172.94
|
| Rate for Payer: Aetna Medicare |
$134.22
|
| Rate for Payer: BCBS Complete |
$262.40
|
| Rate for Payer: BCBS MAPPO |
$129.06
|
| Rate for Payer: BCN Medicare Advantage |
$129.06
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cofinity Commercial |
$185.85
|
| Rate for Payer: Cofinity Commercial |
$172.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.51
|
| Rate for Payer: Nomi Health Commercial |
$154.87
|
| Rate for Payer: PACE SWMI |
$129.06
|
| Rate for Payer: PHP Medicare Advantage |
$129.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$426.40
|
| Rate for Payer: Priority Health Medicare |
$130.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.06
|
| Rate for Payer: UHC Exchange |
$129.06
|
| Rate for Payer: UHC Medicare Advantage |
$129.06
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR
|
Professional
|
Both
|
$2,200.00
|
|
|
Service Code
|
HCPCS 22102
|
| Min. Negotiated Rate |
$733.51 |
| Max. Negotiated Rate |
$1,430.00 |
| Rate for Payer: Aetna Commercial |
$982.90
|
| Rate for Payer: Aetna Medicare |
$762.85
|
| Rate for Payer: BCBS Complete |
$880.00
|
| Rate for Payer: BCBS MAPPO |
$733.51
|
| Rate for Payer: BCN Medicare Advantage |
$733.51
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cash Price |
$1,760.00
|
| Rate for Payer: Cofinity Commercial |
$982.90
|
| Rate for Payer: Cofinity Commercial |
$1,056.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$733.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$770.19
|
| Rate for Payer: Nomi Health Commercial |
$880.21
|
| Rate for Payer: PACE SWMI |
$733.51
|
| Rate for Payer: PHP Medicare Advantage |
$733.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,430.00
|
| Rate for Payer: Priority Health Medicare |
$740.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$733.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$733.51
|
| Rate for Payer: UHC Exchange |
$733.51
|
| Rate for Payer: UHC Medicare Advantage |
$733.51
|
|
|
PR PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC
|
Professional
|
Both
|
$2,270.00
|
|
|
Service Code
|
HCPCS 22101
|
| Min. Negotiated Rate |
$868.48 |
| Max. Negotiated Rate |
$1,475.50 |
| Rate for Payer: Aetna Commercial |
$1,163.76
|
| Rate for Payer: Aetna Medicare |
$903.22
|
| Rate for Payer: BCBS Complete |
$908.00
|
| Rate for Payer: BCBS MAPPO |
$868.48
|
| Rate for Payer: BCN Medicare Advantage |
$868.48
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cash Price |
$1,816.00
|
| Rate for Payer: Cofinity Commercial |
$1,250.61
|
| Rate for Payer: Cofinity Commercial |
$1,163.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.90
|
| Rate for Payer: Nomi Health Commercial |
$1,042.18
|
| Rate for Payer: PACE SWMI |
$868.48
|
| Rate for Payer: PHP Medicare Advantage |
$868.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,475.50
|
| Rate for Payer: Priority Health Medicare |
$877.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$868.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.48
|
| Rate for Payer: UHC Exchange |
$868.48
|
| Rate for Payer: UHC Medicare Advantage |
$868.48
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV
|
Professional
|
Both
|
$3,264.00
|
|
|
Service Code
|
HCPCS 22110
|
| Min. Negotiated Rate |
$1,033.24 |
| Max. Negotiated Rate |
$2,121.60 |
| Rate for Payer: Aetna Commercial |
$1,384.54
|
| Rate for Payer: Aetna Medicare |
$1,074.57
|
| Rate for Payer: BCBS Complete |
$1,305.60
|
| Rate for Payer: BCBS MAPPO |
$1,033.24
|
| Rate for Payer: BCN Medicare Advantage |
$1,033.24
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cash Price |
$2,611.20
|
| Rate for Payer: Cofinity Commercial |
$1,487.87
|
| Rate for Payer: Cofinity Commercial |
$1,384.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,033.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,084.90
|
| Rate for Payer: Nomi Health Commercial |
$1,239.89
|
| Rate for Payer: PACE SWMI |
$1,033.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,033.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,121.60
|
| Rate for Payer: Priority Health Medicare |
$1,043.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,033.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,033.24
|
| Rate for Payer: UHC Exchange |
$1,033.24
|
| Rate for Payer: UHC Medicare Advantage |
$1,033.24
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 22116
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$521.95 |
| Rate for Payer: Aetna Commercial |
$186.93
|
| Rate for Payer: Aetna Medicare |
$145.08
|
| Rate for Payer: BCBS Complete |
$321.20
|
| Rate for Payer: BCBS MAPPO |
$139.50
|
| Rate for Payer: BCN Medicare Advantage |
$139.50
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cofinity Commercial |
$200.88
|
| Rate for Payer: Cofinity Commercial |
$186.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$139.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$146.47
|
| Rate for Payer: Nomi Health Commercial |
$167.40
|
| Rate for Payer: PACE SWMI |
$139.50
|
| Rate for Payer: PHP Medicare Advantage |
$139.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: Priority Health Medicare |
$140.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$139.50
|
| Rate for Payer: UHC Exchange |
$139.50
|
| Rate for Payer: UHC Medicare Advantage |
$139.50
|
|
|
PR PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR
|
Professional
|
Both
|
$2,432.00
|
|
|
Service Code
|
HCPCS 22114
|
| Min. Negotiated Rate |
$972.80 |
| Max. Negotiated Rate |
$1,615.74 |
| Rate for Payer: Aetna Commercial |
$1,503.53
|
| Rate for Payer: Aetna Medicare |
$1,166.92
|
| Rate for Payer: BCBS Complete |
$972.80
|
| Rate for Payer: BCBS MAPPO |
$1,122.04
|
| Rate for Payer: BCN Medicare Advantage |
$1,122.04
|
| Rate for Payer: Cash Price |
$1,945.60
|
| Rate for Payer: Cash Price |
$1,945.60
|
| Rate for Payer: Cofinity Commercial |
$1,615.74
|
| Rate for Payer: Cofinity Commercial |
$1,503.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,122.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,178.14
|
| Rate for Payer: Nomi Health Commercial |
$1,346.45
|
| Rate for Payer: PACE SWMI |
$1,122.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,122.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,580.80
|
| Rate for Payer: Priority Health Medicare |
$1,133.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,122.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,122.04
|
| Rate for Payer: UHC Exchange |
$1,122.04
|
| Rate for Payer: UHC Medicare Advantage |
$1,122.04
|
|
|
PR PRTL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY
|
Professional
|
Both
|
$3,968.00
|
|
|
Service Code
|
HCPCS 60210
|
| Min. Negotiated Rate |
$684.32 |
| Max. Negotiated Rate |
$2,579.20 |
| Rate for Payer: Aetna Commercial |
$916.99
|
| Rate for Payer: Aetna Medicare |
$711.69
|
| Rate for Payer: BCBS Complete |
$1,587.20
|
| Rate for Payer: BCBS MAPPO |
$684.32
|
| Rate for Payer: BCN Medicare Advantage |
$684.32
|
| Rate for Payer: Cash Price |
$3,174.40
|
| Rate for Payer: Cash Price |
$3,174.40
|
| Rate for Payer: Cofinity Commercial |
$985.42
|
| Rate for Payer: Cofinity Commercial |
$916.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$684.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$718.54
|
| Rate for Payer: Nomi Health Commercial |
$821.18
|
| Rate for Payer: PACE SWMI |
$684.32
|
| Rate for Payer: PHP Medicare Advantage |
$684.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,579.20
|
| Rate for Payer: Priority Health Medicare |
$691.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$684.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$684.32
|
| Rate for Payer: UHC Exchange |
$684.32
|
| Rate for Payer: UHC Medicare Advantage |
$684.32
|
|
|
PR PRTL THYROID LOBEC UNI W/CONTRATLAT STOT LOBEC
|
Professional
|
Both
|
$1,831.00
|
|
|
Service Code
|
HCPCS 60212
|
| Min. Negotiated Rate |
$732.40 |
| Max. Negotiated Rate |
$1,435.84 |
| Rate for Payer: Aetna Commercial |
$1,336.13
|
| Rate for Payer: Aetna Medicare |
$1,036.99
|
| Rate for Payer: BCBS Complete |
$732.40
|
| Rate for Payer: BCBS MAPPO |
$997.11
|
| Rate for Payer: BCN Medicare Advantage |
$997.11
|
| Rate for Payer: Cash Price |
$1,464.80
|
| Rate for Payer: Cash Price |
$1,464.80
|
| Rate for Payer: Cofinity Commercial |
$1,435.84
|
| Rate for Payer: Cofinity Commercial |
$1,336.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$997.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,046.97
|
| Rate for Payer: Nomi Health Commercial |
$1,196.53
|
| Rate for Payer: PACE SWMI |
$997.11
|
| Rate for Payer: PHP Medicare Advantage |
$997.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,190.15
|
| Rate for Payer: Priority Health Medicare |
$1,007.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$997.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$997.11
|
| Rate for Payer: UHC Exchange |
$997.11
|
| Rate for Payer: UHC Medicare Advantage |
$997.11
|
|
|
PR PSA SCREENING
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS G0103
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$39.65 |
| Rate for Payer: Aetna Commercial |
$25.88
|
| Rate for Payer: Aetna Medicare |
$20.08
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$19.31
|
| Rate for Payer: BCN Medicare Advantage |
$19.31
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$27.81
|
| Rate for Payer: Cofinity Commercial |
$25.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.28
|
| Rate for Payer: Nomi Health Commercial |
$23.17
|
| Rate for Payer: PACE SWMI |
$19.31
|
| Rate for Payer: PHP Medicare Advantage |
$19.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health Medicare |
$19.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.31
|
| Rate for Payer: UHC Exchange |
$19.31
|
| Rate for Payer: UHC Medicare Advantage |
$19.31
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVALUATION
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 90791
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$204.70 |
| Rate for Payer: Aetna Commercial |
$190.48
|
| Rate for Payer: Aetna Medicare |
$147.84
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$142.15
|
| Rate for Payer: BCN Medicare Advantage |
$142.15
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$204.70
|
| Rate for Payer: Cofinity Commercial |
$190.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.26
|
| Rate for Payer: Nomi Health Commercial |
$170.58
|
| Rate for Payer: PACE SWMI |
$142.15
|
| Rate for Payer: PHP Medicare Advantage |
$142.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: Priority Health Medicare |
$143.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.15
|
| Rate for Payer: UHC Exchange |
$142.15
|
| Rate for Payer: UHC Medicare Advantage |
$142.15
|
|
|
PR PSYCHIATRIC DIAGNOSTIC EVAL W/MEDICAL SERVICES
|
Professional
|
Both
|
$264.00
|
|
|
Service Code
|
HCPCS 90792
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$233.91 |
| Rate for Payer: Aetna Commercial |
$217.67
|
| Rate for Payer: Aetna Medicare |
$168.94
|
| Rate for Payer: BCBS Complete |
$105.60
|
| Rate for Payer: BCBS MAPPO |
$162.44
|
| Rate for Payer: BCN Medicare Advantage |
$162.44
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cofinity Commercial |
$233.91
|
| Rate for Payer: Cofinity Commercial |
$217.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.56
|
| Rate for Payer: Nomi Health Commercial |
$194.93
|
| Rate for Payer: PACE SWMI |
$162.44
|
| Rate for Payer: PHP Medicare Advantage |
$162.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.60
|
| Rate for Payer: Priority Health Medicare |
$164.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.44
|
| Rate for Payer: UHC Exchange |
$162.44
|
| Rate for Payer: UHC Medicare Advantage |
$162.44
|
|
|
PR PSYCHOANALYSIS
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 90845
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$130.65 |
| Rate for Payer: Aetna Commercial |
$116.16
|
| Rate for Payer: Aetna Medicare |
$90.16
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: BCBS MAPPO |
$86.69
|
| Rate for Payer: BCN Medicare Advantage |
$86.69
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$124.83
|
| Rate for Payer: Cofinity Commercial |
$116.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.02
|
| Rate for Payer: Nomi Health Commercial |
$104.03
|
| Rate for Payer: PACE SWMI |
$86.69
|
| Rate for Payer: PHP Medicare Advantage |
$86.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.65
|
| Rate for Payer: Priority Health Medicare |
$87.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.69
|
| Rate for Payer: UHC Exchange |
$86.69
|
| Rate for Payer: UHC Medicare Advantage |
$86.69
|
|
|
PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP EA ADDL HOUR
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 96131
|
| Min. Negotiated Rate |
$71.99 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna Commercial |
$96.47
|
| Rate for Payer: Aetna Medicare |
$74.87
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS MAPPO |
$71.99
|
| Rate for Payer: BCN Medicare Advantage |
$71.99
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$96.47
|
| Rate for Payer: Cofinity Commercial |
$103.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.59
|
| Rate for Payer: Nomi Health Commercial |
$86.39
|
| Rate for Payer: PACE SWMI |
$71.99
|
| Rate for Payer: PHP Medicare Advantage |
$71.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Medicare |
$72.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$71.99
|
| Rate for Payer: UHC Exchange |
$71.99
|
| Rate for Payer: UHC Medicare Advantage |
$71.99
|
|
|
PR PSYCHOLOGICAL TST EVAL SVC PHYS/QHP FIRST HOUR
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 96130
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Aetna Commercial |
$140.87
|
| Rate for Payer: Aetna Medicare |
$109.34
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: BCBS MAPPO |
$105.13
|
| Rate for Payer: BCN Medicare Advantage |
$105.13
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cofinity Commercial |
$151.39
|
| Rate for Payer: Cofinity Commercial |
$140.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.39
|
| Rate for Payer: Nomi Health Commercial |
$126.16
|
| Rate for Payer: PACE SWMI |
$105.13
|
| Rate for Payer: PHP Medicare Advantage |
$105.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
| Rate for Payer: Priority Health Medicare |
$106.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.13
|
| Rate for Payer: UHC Exchange |
$105.13
|
| Rate for Payer: UHC Medicare Advantage |
$105.13
|
|
|
PR PSYCHOLOGIC TESTING ADMIN BY COMPUTER
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 96103
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
|
|
PR PSYCHOLOGIC TESTING BY PSYCH/PHYS
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 96101
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$96.85 |
| Rate for Payer: Aetna Medicare |
$74.50
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
|
|
PR PSYCHOTHERAPY COMPLEX INTERACTIVE
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 90785
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna Commercial |
$16.39
|
| Rate for Payer: Aetna Medicare |
$12.72
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS MAPPO |
$12.23
|
| Rate for Payer: BCN Medicare Advantage |
$12.23
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$16.39
|
| Rate for Payer: Cofinity Commercial |
$17.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.84
|
| Rate for Payer: Nomi Health Commercial |
$14.68
|
| Rate for Payer: PACE SWMI |
$12.23
|
| Rate for Payer: PHP Medicare Advantage |
$12.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health Medicare |
$12.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.23
|
| Rate for Payer: UHC Exchange |
$12.23
|
| Rate for Payer: UHC Medicare Advantage |
$12.23
|
|
|
PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 90840
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$92.40 |
| Rate for Payer: Aetna Commercial |
$85.99
|
| Rate for Payer: Aetna Medicare |
$66.74
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$64.17
|
| Rate for Payer: BCN Medicare Advantage |
$64.17
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$92.40
|
| Rate for Payer: Cofinity Commercial |
$85.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.38
|
| Rate for Payer: Nomi Health Commercial |
$77.00
|
| Rate for Payer: PACE SWMI |
$64.17
|
| Rate for Payer: PHP Medicare Advantage |
$64.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.70
|
| Rate for Payer: Priority Health Medicare |
$64.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$64.17
|
| Rate for Payer: UHC Exchange |
$64.17
|
| Rate for Payer: UHC Medicare Advantage |
$64.17
|
|
|
PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 90839
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$186.45 |
| Rate for Payer: Aetna Commercial |
$173.50
|
| Rate for Payer: Aetna Medicare |
$134.66
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$129.48
|
| Rate for Payer: BCN Medicare Advantage |
$129.48
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$186.45
|
| Rate for Payer: Cofinity Commercial |
$173.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$135.95
|
| Rate for Payer: Nomi Health Commercial |
$155.38
|
| Rate for Payer: PACE SWMI |
$129.48
|
| Rate for Payer: PHP Medicare Advantage |
$129.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health Medicare |
$130.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$129.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$129.48
|
| Rate for Payer: UHC Exchange |
$129.48
|
| Rate for Payer: UHC Medicare Advantage |
$129.48
|
|
|
PR PSYCHOTHERAPY W/PATIENT 30 MINUTES
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 90832
|
| Min. Negotiated Rate |
$44.40 |
| Max. Negotiated Rate |
$98.58 |
| Rate for Payer: Aetna Commercial |
$91.74
|
| Rate for Payer: Aetna Medicare |
$71.20
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$68.46
|
| Rate for Payer: BCN Medicare Advantage |
$68.46
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$98.58
|
| Rate for Payer: Cofinity Commercial |
$91.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.88
|
| Rate for Payer: Nomi Health Commercial |
$82.15
|
| Rate for Payer: PACE SWMI |
$68.46
|
| Rate for Payer: PHP Medicare Advantage |
$68.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$69.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.46
|
| Rate for Payer: UHC Exchange |
$68.46
|
| Rate for Payer: UHC Medicare Advantage |
$68.46
|
|
