|
PR SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS 36245
|
| Min. Negotiated Rate |
$132.06 |
| Max. Negotiated Rate |
$645.00 |
| Rate for Payer: Aetna Commercial |
$315.46
|
| Rate for Payer: Aetna Medicare |
$430.00
|
| Rate for Payer: BCBS Complete |
$138.66
|
| Rate for Payer: BCN Commercial |
$345.10
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Mclaren Medicaid |
$132.06
|
| Rate for Payer: Meridian Medicaid |
$138.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$645.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$132.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$371.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$371.11
|
| Rate for Payer: UHC Medicaid |
$132.06
|
| Rate for Payer: UHCCP Medicaid |
$132.06
|
|
|
PR SLCTV CATHJ EA 1ST ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$946.00
|
|
|
Service Code
|
HCPCS 36215
|
| Min. Negotiated Rate |
$119.92 |
| Max. Negotiated Rate |
$709.50 |
| Rate for Payer: Aetna Commercial |
$283.13
|
| Rate for Payer: Aetna Medicare |
$473.00
|
| Rate for Payer: BCBS Complete |
$125.92
|
| Rate for Payer: BCN Commercial |
$312.73
|
| Rate for Payer: Cash Price |
$756.80
|
| Rate for Payer: Cash Price |
$756.80
|
| Rate for Payer: Mclaren Medicaid |
$119.92
|
| Rate for Payer: Meridian Medicaid |
$125.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$709.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$336.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.31
|
| Rate for Payer: UHC Medicaid |
$119.92
|
| Rate for Payer: UHCCP Medicaid |
$119.92
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD ABDL PEL/LXTR ART BRNCH
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 36248
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$187.50 |
| Rate for Payer: Aetna Commercial |
$65.59
|
| Rate for Payer: Aetna Medicare |
$125.00
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCN Commercial |
$70.71
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$187.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.04
|
| Rate for Payer: UHC Medicaid |
$26.41
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
PR SLCTV CATHJ EA 2ND+ ORD THRC/BRCH/CPHLC BRNCH
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 36218
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$253.50 |
| Rate for Payer: Aetna Commercial |
$67.37
|
| Rate for Payer: Aetna Medicare |
$169.00
|
| Rate for Payer: BCBS Complete |
$31.09
|
| Rate for Payer: BCN Commercial |
$77.18
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Mclaren Medicaid |
$29.61
|
| Rate for Payer: Meridian Medicaid |
$31.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$253.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$83.01
|
| Rate for Payer: UHC Medicaid |
$29.61
|
| Rate for Payer: UHCCP Medicaid |
$29.61
|
|
|
PR SLCTV CATH PLMT SEGMENTAL/SUBSEGMENTAL PULM ART
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
HCPCS 36015
|
| Min. Negotiated Rate |
$95.00 |
| Max. Negotiated Rate |
$738.75 |
| Rate for Payer: Aetna Commercial |
$228.81
|
| Rate for Payer: Aetna Medicare |
$492.50
|
| Rate for Payer: BCBS Complete |
$99.75
|
| Rate for Payer: BCN Commercial |
$252.48
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Mclaren Medicaid |
$95.00
|
| Rate for Payer: Meridian Medicaid |
$99.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$738.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$271.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$271.51
|
| Rate for Payer: UHC Medicaid |
$95.00
|
| Rate for Payer: UHCCP Medicaid |
$95.00
|
|
|
PR SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH
|
Professional
|
Both
|
$769.00
|
|
|
Service Code
|
HCPCS 36011
|
| Min. Negotiated Rate |
$87.12 |
| Max. Negotiated Rate |
$576.75 |
| Rate for Payer: Aetna Commercial |
$211.77
|
| Rate for Payer: Aetna Medicare |
$384.50
|
| Rate for Payer: BCBS Complete |
$91.48
|
| Rate for Payer: BCN Commercial |
$228.07
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Cash Price |
$615.20
|
| Rate for Payer: Mclaren Medicaid |
$87.12
|
| Rate for Payer: Meridian Medicaid |
$91.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$576.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$87.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$245.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.27
|
| Rate for Payer: UHC Medicaid |
$87.12
|
| Rate for Payer: UHCCP Medicaid |
$87.12
|
|
|
PR SLCTV CATH PLMT VEN SYS 2ND ORDER/> SLCTV BRANC
|
Professional
|
Both
|
$1,009.00
|
|
|
Service Code
|
HCPCS 36012
|
| Min. Negotiated Rate |
$97.98 |
| Max. Negotiated Rate |
$756.75 |
| Rate for Payer: Aetna Commercial |
$232.79
|
| Rate for Payer: Aetna Medicare |
$504.50
|
| Rate for Payer: BCBS Complete |
$102.88
|
| Rate for Payer: BCN Commercial |
$255.97
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Cash Price |
$807.20
|
| Rate for Payer: Mclaren Medicaid |
$97.98
|
| Rate for Payer: Meridian Medicaid |
$102.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$756.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$275.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$275.25
|
| Rate for Payer: UHC Medicaid |
$97.98
|
| Rate for Payer: UHCCP Medicaid |
$97.98
|
|
|
PR SLCTV CATH SUBCLAVIAN ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$1,842.00
|
|
|
Service Code
|
HCPCS 36225
|
| Min. Negotiated Rate |
$187.65 |
| Max. Negotiated Rate |
$1,381.50 |
| Rate for Payer: Aetna Commercial |
$427.29
|
| Rate for Payer: Aetna Medicare |
$921.00
|
| Rate for Payer: BCBS Complete |
$197.03
|
| Rate for Payer: BCN Commercial |
$486.53
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Mclaren Medicaid |
$187.65
|
| Rate for Payer: Meridian Medicaid |
$197.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,381.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$187.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$523.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$523.21
|
| Rate for Payer: UHC Medicaid |
$187.65
|
| Rate for Payer: UHCCP Medicaid |
$187.65
|
|
|
PR SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
HCPCS 36226
|
| Min. Negotiated Rate |
$210.02 |
| Max. Negotiated Rate |
$973.50 |
| Rate for Payer: Aetna Commercial |
$479.28
|
| Rate for Payer: Aetna Medicare |
$649.00
|
| Rate for Payer: BCBS Complete |
$220.52
|
| Rate for Payer: BCN Commercial |
$545.79
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Cash Price |
$1,038.40
|
| Rate for Payer: Mclaren Medicaid |
$210.02
|
| Rate for Payer: Meridian Medicaid |
$220.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$973.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$210.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$586.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$586.93
|
| Rate for Payer: UHC Medicaid |
$210.02
|
| Rate for Payer: UHCCP Medicaid |
$210.02
|
|
|
PR SLCTV CATH XTRNL CAROTID ANGIO XTRNL CAROTD CIRC
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
HCPCS 36227
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$307.50 |
| Rate for Payer: Aetna Commercial |
$158.05
|
| Rate for Payer: Aetna Medicare |
$205.00
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCN Commercial |
$179.77
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Cash Price |
$328.00
|
| Rate for Payer: Mclaren Medicaid |
$69.01
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$193.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.32
|
| Rate for Payer: UHC Medicaid |
$69.01
|
| Rate for Payer: UHCCP Medicaid |
$69.01
|
|
|
PR SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 95806
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$173.02 |
| Rate for Payer: Aetna Commercial |
$106.13
|
| Rate for Payer: Aetna Commercial |
$106.13
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: Aetna Medicare |
$292.00
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Cash Price |
$467.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$132.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.27
|
|
|
PR SLEEP STD REC VNTJ RESPIR ECG/HRT RATE&O2 ATTN
|
Professional
|
Both
|
$1,534.00
|
|
|
Service Code
|
HCPCS 95807
|
| Min. Negotiated Rate |
$412.45 |
| Max. Negotiated Rate |
$1,150.50 |
| Rate for Payer: Aetna Commercial |
$412.45
|
| Rate for Payer: Aetna Commercial |
$412.45
|
| Rate for Payer: Aetna Medicare |
$76.00
|
| Rate for Payer: Aetna Medicare |
$767.00
|
| Rate for Payer: BCN Commercial |
$487.73
|
| Rate for Payer: BCN Commercial |
$487.73
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cash Price |
$1,227.20
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,150.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$114.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$570.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$570.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$570.38
|
|
|
PR SLING OPERATION STRESS INCONTINENCE
|
Professional
|
Both
|
$2,348.00
|
|
|
Service Code
|
HCPCS 57288
|
| Min. Negotiated Rate |
$423.23 |
| Max. Negotiated Rate |
$1,761.00 |
| Rate for Payer: Aetna Commercial |
$881.31
|
| Rate for Payer: Aetna Medicare |
$1,174.00
|
| Rate for Payer: BCBS Complete |
$444.39
|
| Rate for Payer: BCN Commercial |
$1,543.82
|
| Rate for Payer: Cash Price |
$1,878.40
|
| Rate for Payer: Cash Price |
$1,878.40
|
| Rate for Payer: Mclaren Medicaid |
$423.23
|
| Rate for Payer: Meridian Medicaid |
$444.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,761.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$423.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,131.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,131.76
|
| Rate for Payer: UHC Medicaid |
$423.23
|
| Rate for Payer: UHCCP Medicaid |
$423.23
|
|
|
PR SLING OPRATION CORRJ MALE URINARY INCONTINENCE
|
Professional
|
Both
|
$1,727.00
|
|
|
Service Code
|
HCPCS 53440
|
| Min. Negotiated Rate |
$434.52 |
| Max. Negotiated Rate |
$1,295.25 |
| Rate for Payer: Aetna Commercial |
$966.60
|
| Rate for Payer: Aetna Medicare |
$863.50
|
| Rate for Payer: BCBS Complete |
$456.25
|
| Rate for Payer: BCN Commercial |
$1,127.43
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Cash Price |
$1,381.60
|
| Rate for Payer: Mclaren Medicaid |
$434.52
|
| Rate for Payer: Meridian Medicaid |
$456.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,295.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$434.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,228.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,228.13
|
| Rate for Payer: UHC Medicaid |
$434.52
|
| Rate for Payer: UHCCP Medicaid |
$434.52
|
|
|
PR SLINGS
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS A4565
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Aetna Commercial |
$7.22
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCN Commercial |
$10.51
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.00
|
|
|
PR SLITTING PREPUCE DORSAL/LAT SPX XCP NEWBORN
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
HCPCS 54001
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$258.75 |
| Rate for Payer: Aetna Commercial |
$178.45
|
| Rate for Payer: Aetna Medicare |
$172.50
|
| Rate for Payer: BCBS Complete |
$86.77
|
| Rate for Payer: BCN Commercial |
$212.64
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Mclaren Medicaid |
$82.64
|
| Rate for Payer: Meridian Medicaid |
$86.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$231.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.63
|
| Rate for Payer: UHC Medicaid |
$82.64
|
| Rate for Payer: UHCCP Medicaid |
$82.64
|
|
|
PR SLP STDY UNATND W/HRT RATE/O2 SAT/RESP/SLP TIME
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 95800
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Commercial |
$173.67
|
| Rate for Payer: Aetna Commercial |
$173.67
|
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: BCN Commercial |
$173.02
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$176.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.80
|
|
|
PR SMOKE/TOBACCO COUNSELNG 3-10
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0375
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Medicare |
$10.50
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
|
|
PR SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
HCPCS 12002
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$236.25 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Medicare |
$157.50
|
| Rate for Payer: BCBS Complete |
$38.47
|
| Rate for Payer: BCN Commercial |
$87.65
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Mclaren Medicaid |
$36.64
|
| Rate for Payer: Meridian Medicaid |
$38.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$80.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$80.22
|
| Rate for Payer: UHC Medicaid |
$36.64
|
| Rate for Payer: UHCCP Medicaid |
$36.64
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
HCPCS 12005
|
| Min. Negotiated Rate |
$57.30 |
| Max. Negotiated Rate |
$442.50 |
| Rate for Payer: Aetna Commercial |
$105.98
|
| Rate for Payer: Aetna Medicare |
$295.00
|
| Rate for Payer: BCBS Complete |
$60.16
|
| Rate for Payer: BCN Commercial |
$140.43
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Mclaren Medicaid |
$57.30
|
| Rate for Payer: Meridian Medicaid |
$60.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$442.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$128.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.53
|
| Rate for Payer: UHC Medicaid |
$57.30
|
| Rate for Payer: UHCCP Medicaid |
$57.30
|
|
|
PR SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
HCPCS 12006
|
| Min. Negotiated Rate |
$69.65 |
| Max. Negotiated Rate |
$564.75 |
| Rate for Payer: Aetna Commercial |
$129.27
|
| Rate for Payer: Aetna Medicare |
$376.50
|
| Rate for Payer: BCBS Complete |
$73.13
|
| Rate for Payer: BCN Commercial |
$173.80
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Mclaren Medicaid |
$69.65
|
| Rate for Payer: Meridian Medicaid |
$73.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$564.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$159.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$159.07
|
| Rate for Payer: UHC Medicaid |
$69.65
|
| Rate for Payer: UHCCP Medicaid |
$69.65
|
|
|
PR SO 8 ABD RESTRAINT PRE OTS
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS L3650
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$77.17 |
| Rate for Payer: Aetna Commercial |
$39.50
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCN Commercial |
$77.17
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
|
|
PR SPECIAL CASTING MATERIAL
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS A4590
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$59.25 |
| Rate for Payer: Aetna Commercial |
$19.84
|
| Rate for Payer: Aetna Medicare |
$39.50
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCN Commercial |
$25.00
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.25
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 92555
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$45.32 |
| Rate for Payer: Aetna Commercial |
$25.66
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCN Commercial |
$45.32
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.80
|
|
|
PR SPEECH AUDIOMETRY THRESHOLD SPEECH RECOGNIJ
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 92556
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$70.22 |
| Rate for Payer: Aetna Commercial |
$40.61
|
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCN Commercial |
$70.22
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$64.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.76
|
|
