|
PR RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON
|
Professional
|
Both
|
$947.00
|
|
|
Service Code
|
HCPCS 28210
|
| Min. Negotiated Rate |
$273.07 |
| Max. Negotiated Rate |
$912.90 |
| Rate for Payer: Aetna Commercial |
$539.78
|
| Rate for Payer: Aetna Medicare |
$418.93
|
| Rate for Payer: BCBS Complete |
$286.72
|
| Rate for Payer: BCBS MAPPO |
$402.82
|
| Rate for Payer: BCBS Trust/PPO |
$912.90
|
| Rate for Payer: BCN Commercial |
$867.89
|
| Rate for Payer: BCN Medicare Advantage |
$402.82
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cash Price |
$757.60
|
| Rate for Payer: Cofinity Commercial |
$580.06
|
| Rate for Payer: Cofinity Commercial |
$539.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.82
|
| Rate for Payer: Mclaren Medicaid |
$273.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$422.96
|
| Rate for Payer: Meridian Medicaid |
$286.72
|
| Rate for Payer: Nomi Health Commercial |
$483.38
|
| Rate for Payer: PACE SWMI |
$402.82
|
| Rate for Payer: PHP Medicare Advantage |
$402.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$273.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$615.55
|
| Rate for Payer: Priority Health HMO/PPO |
$653.37
|
| Rate for Payer: Priority Health Medicare |
$406.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$653.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$402.82
|
| Rate for Payer: UHC Exchange |
$402.82
|
| Rate for Payer: UHC Medicare Advantage |
$402.82
|
| Rate for Payer: UHCCP Medicaid |
$273.07
|
|
|
PR RPR THORACOABDOMINAL AORTIC ANEURYS W/WO BYPASS
|
Professional
|
Both
|
$8,690.00
|
|
|
Service Code
|
HCPCS 33877
|
| Min. Negotiated Rate |
$2,114.78 |
| Max. Negotiated Rate |
$5,648.50 |
| Rate for Payer: Aetna Commercial |
$4,636.05
|
| Rate for Payer: Aetna Medicare |
$3,598.13
|
| Rate for Payer: BCBS Complete |
$2,367.78
|
| Rate for Payer: BCBS MAPPO |
$3,459.74
|
| Rate for Payer: BCBS Trust/PPO |
$2,114.78
|
| Rate for Payer: BCN Commercial |
$5,146.27
|
| Rate for Payer: BCN Medicare Advantage |
$3,459.74
|
| Rate for Payer: Cash Price |
$6,952.00
|
| Rate for Payer: Cash Price |
$6,952.00
|
| Rate for Payer: Cofinity Commercial |
$4,982.03
|
| Rate for Payer: Cofinity Commercial |
$4,636.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,459.74
|
| Rate for Payer: Mclaren Medicaid |
$2,255.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,632.73
|
| Rate for Payer: Meridian Medicaid |
$2,367.78
|
| Rate for Payer: Nomi Health Commercial |
$4,151.69
|
| Rate for Payer: PACE SWMI |
$3,459.74
|
| Rate for Payer: PHP Medicare Advantage |
$3,459.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,255.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,648.50
|
| Rate for Payer: Priority Health HMO/PPO |
$5,617.67
|
| Rate for Payer: Priority Health Medicare |
$3,494.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5,617.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,459.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,459.74
|
| Rate for Payer: UHC Exchange |
$3,459.74
|
| Rate for Payer: UHC Medicare Advantage |
$3,459.74
|
| Rate for Payer: UHCCP Medicaid |
$2,255.03
|
|
|
PR RPR TUNICA VAGINALIS HYDROCELE BOTTLE TYPE
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
HCPCS 55060
|
| Min. Negotiated Rate |
$245.38 |
| Max. Negotiated Rate |
$1,220.90 |
| Rate for Payer: Aetna Commercial |
$487.24
|
| Rate for Payer: Aetna Medicare |
$378.15
|
| Rate for Payer: BCBS Complete |
$257.65
|
| Rate for Payer: BCBS MAPPO |
$363.61
|
| Rate for Payer: BCBS Trust/PPO |
$1,220.90
|
| Rate for Payer: BCN Commercial |
$551.23
|
| Rate for Payer: BCN Medicare Advantage |
$363.61
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cofinity Commercial |
$523.60
|
| Rate for Payer: Cofinity Commercial |
$487.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$363.61
|
| Rate for Payer: Mclaren Medicaid |
$245.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$381.79
|
| Rate for Payer: Meridian Medicaid |
$257.65
|
| Rate for Payer: Nomi Health Commercial |
$436.33
|
| Rate for Payer: PACE SWMI |
$363.61
|
| Rate for Payer: PHP Medicare Advantage |
$363.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$245.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$409.50
|
| Rate for Payer: Priority Health HMO/PPO |
$609.30
|
| Rate for Payer: Priority Health Medicare |
$367.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$609.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$363.61
|
| Rate for Payer: UHC Exchange |
$363.61
|
| Rate for Payer: UHC Medicare Advantage |
$363.61
|
| Rate for Payer: UHCCP Medicaid |
$245.38
|
|
|
PR RPR TUN/NON-TUN CTR VAD CATH W/O SUBQ PORT/PMP
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
HCPCS 36575
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$1,177.58 |
| Rate for Payer: Aetna Commercial |
$42.48
|
| Rate for Payer: Aetna Medicare |
$32.97
|
| Rate for Payer: BCBS Complete |
$22.14
|
| Rate for Payer: BCBS MAPPO |
$31.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,177.58
|
| Rate for Payer: BCN Commercial |
$212.57
|
| Rate for Payer: BCN Medicare Advantage |
$31.70
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cash Price |
$358.40
|
| Rate for Payer: Cofinity Commercial |
$45.65
|
| Rate for Payer: Cofinity Commercial |
$42.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.70
|
| Rate for Payer: Mclaren Medicaid |
$21.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.28
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: Nomi Health Commercial |
$38.04
|
| Rate for Payer: PACE SWMI |
$31.70
|
| Rate for Payer: PHP Medicare Advantage |
$31.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.20
|
| Rate for Payer: Priority Health HMO/PPO |
$52.12
|
| Rate for Payer: Priority Health Medicare |
$32.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.70
|
| Rate for Payer: UHC Exchange |
$31.70
|
| Rate for Payer: UHC Medicare Advantage |
$31.70
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS INCARCERATED
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 49582
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Aetna Medicare |
$731.50
|
| Rate for Payer: BCBS Complete |
$585.20
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
|
|
PR RPR UMBILICAL HERNIA < 5 YRS REDUCIBLE
|
Professional
|
Both
|
$1,268.00
|
|
|
Service Code
|
HCPCS 49580
|
| Min. Negotiated Rate |
$507.20 |
| Max. Negotiated Rate |
$824.20 |
| Rate for Payer: Aetna Medicare |
$634.00
|
| Rate for Payer: BCBS Complete |
$507.20
|
| Rate for Payer: Cash Price |
$1,014.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$824.20
|
|
|
PR RPR UMBILICAL HERNIA AGE 5 YRS/> INCARCERATED
|
Professional
|
Both
|
$1,685.00
|
|
|
Service Code
|
HCPCS 49587
|
| Min. Negotiated Rate |
$674.00 |
| Max. Negotiated Rate |
$1,095.25 |
| Rate for Payer: Aetna Medicare |
$842.50
|
| Rate for Payer: BCBS Complete |
$674.00
|
| Rate for Payer: Cash Price |
$1,348.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,095.25
|
|
|
PR RPR UMBILICAL HRNA 5 YRS/> REDUCIBLE
|
Professional
|
Both
|
$1,463.00
|
|
|
Service Code
|
HCPCS 49585
|
| Min. Negotiated Rate |
$585.20 |
| Max. Negotiated Rate |
$950.95 |
| Rate for Payer: Aetna Medicare |
$731.50
|
| Rate for Payer: BCBS Complete |
$585.20
|
| Rate for Payer: Cash Price |
$1,170.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$950.95
|
|
|
PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC
|
Professional
|
Both
|
$8,041.00
|
|
|
Service Code
|
HCPCS 33414
|
| Min. Negotiated Rate |
$509.28 |
| Max. Negotiated Rate |
$5,226.65 |
| Rate for Payer: Aetna Commercial |
$2,762.72
|
| Rate for Payer: Aetna Medicare |
$2,144.20
|
| Rate for Payer: BCBS Complete |
$1,416.83
|
| Rate for Payer: BCBS MAPPO |
$2,061.73
|
| Rate for Payer: BCBS Trust/PPO |
$509.28
|
| Rate for Payer: BCN Commercial |
$3,076.23
|
| Rate for Payer: BCN Medicare Advantage |
$2,061.73
|
| Rate for Payer: Cash Price |
$6,432.80
|
| Rate for Payer: Cash Price |
$6,432.80
|
| Rate for Payer: Cofinity Commercial |
$2,762.72
|
| Rate for Payer: Cofinity Commercial |
$2,968.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,061.73
|
| Rate for Payer: Mclaren Medicaid |
$1,349.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,164.82
|
| Rate for Payer: Meridian Medicaid |
$1,416.83
|
| Rate for Payer: Nomi Health Commercial |
$2,474.08
|
| Rate for Payer: PACE SWMI |
$2,061.73
|
| Rate for Payer: PHP Medicare Advantage |
$2,061.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,349.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,226.65
|
| Rate for Payer: Priority Health HMO/PPO |
$3,361.66
|
| Rate for Payer: Priority Health Medicare |
$2,082.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,361.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,061.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,061.73
|
| Rate for Payer: UHC Exchange |
$2,061.73
|
| Rate for Payer: UHC Medicare Advantage |
$2,061.73
|
| Rate for Payer: UHCCP Medicaid |
$1,349.36
|
|
|
PR RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER
|
Professional
|
Both
|
$2,823.00
|
|
|
Service Code
|
HCPCS 26428
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$1,834.95 |
| Rate for Payer: Aetna Commercial |
$997.83
|
| Rate for Payer: Aetna Medicare |
$774.44
|
| Rate for Payer: BCBS Complete |
$539.22
|
| Rate for Payer: BCBS MAPPO |
$744.65
|
| Rate for Payer: BCBS Trust/PPO |
$98.26
|
| Rate for Payer: BCN Commercial |
$1,186.02
|
| Rate for Payer: BCN Medicare Advantage |
$744.65
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Cofinity Commercial |
$997.83
|
| Rate for Payer: Cofinity Commercial |
$1,072.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$744.65
|
| Rate for Payer: Mclaren Medicaid |
$513.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$781.88
|
| Rate for Payer: Meridian Medicaid |
$539.22
|
| Rate for Payer: Nomi Health Commercial |
$893.58
|
| Rate for Payer: PACE SWMI |
$744.65
|
| Rate for Payer: PHP Medicare Advantage |
$744.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$513.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,834.95
|
| Rate for Payer: Priority Health HMO/PPO |
$1,232.46
|
| Rate for Payer: Priority Health Medicare |
$752.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,232.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$744.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$744.65
|
| Rate for Payer: UHC Exchange |
$744.65
|
| Rate for Payer: UHC Medicare Advantage |
$744.65
|
| Rate for Payer: UHCCP Medicaid |
$513.54
|
|
|
PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR
|
Professional
|
Both
|
$1,983.00
|
|
|
Service Code
|
HCPCS 26426
|
| Min. Negotiated Rate |
$195.47 |
| Max. Negotiated Rate |
$1,288.95 |
| Rate for Payer: Aetna Commercial |
$654.16
|
| Rate for Payer: Aetna Medicare |
$507.71
|
| Rate for Payer: BCBS Complete |
$349.11
|
| Rate for Payer: BCBS MAPPO |
$488.18
|
| Rate for Payer: BCBS Trust/PPO |
$195.47
|
| Rate for Payer: BCN Commercial |
$747.19
|
| Rate for Payer: BCN Medicare Advantage |
$488.18
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cash Price |
$1,586.40
|
| Rate for Payer: Cofinity Commercial |
$702.98
|
| Rate for Payer: Cofinity Commercial |
$654.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$488.18
|
| Rate for Payer: Mclaren Medicaid |
$332.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$512.59
|
| Rate for Payer: Meridian Medicaid |
$349.11
|
| Rate for Payer: Nomi Health Commercial |
$585.82
|
| Rate for Payer: PACE SWMI |
$488.18
|
| Rate for Payer: PHP Medicare Advantage |
$488.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$332.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,288.95
|
| Rate for Payer: Priority Health HMO/PPO |
$786.19
|
| Rate for Payer: Priority Health Medicare |
$493.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$786.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$488.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$488.18
|
| Rate for Payer: UHC Exchange |
$488.18
|
| Rate for Payer: UHC Medicare Advantage |
$488.18
|
| Rate for Payer: UHCCP Medicaid |
$332.49
|
|
|
PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD
|
Professional
|
Both
|
$1,297.00
|
|
|
Service Code
|
HCPCS 33226
|
| Min. Negotiated Rate |
$306.72 |
| Max. Negotiated Rate |
$1,099.92 |
| Rate for Payer: Aetna Commercial |
$624.57
|
| Rate for Payer: Aetna Medicare |
$484.74
|
| Rate for Payer: BCBS Complete |
$322.06
|
| Rate for Payer: BCBS MAPPO |
$466.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,099.92
|
| Rate for Payer: BCN Commercial |
$702.72
|
| Rate for Payer: BCN Medicare Advantage |
$466.10
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cash Price |
$1,037.60
|
| Rate for Payer: Cofinity Commercial |
$671.18
|
| Rate for Payer: Cofinity Commercial |
$624.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$466.10
|
| Rate for Payer: Mclaren Medicaid |
$306.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$489.40
|
| Rate for Payer: Meridian Medicaid |
$322.06
|
| Rate for Payer: Nomi Health Commercial |
$559.32
|
| Rate for Payer: PACE SWMI |
$466.10
|
| Rate for Payer: PHP Medicare Advantage |
$466.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$306.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$843.05
|
| Rate for Payer: Priority Health HMO/PPO |
$763.18
|
| Rate for Payer: Priority Health Medicare |
$470.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$763.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$466.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$466.10
|
| Rate for Payer: UHC Exchange |
$466.10
|
| Rate for Payer: UHC Medicare Advantage |
$466.10
|
| Rate for Payer: UHCCP Medicaid |
$306.72
|
|
|
PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE
|
Professional
|
Both
|
$1,029.00
|
|
|
Service Code
|
HCPCS 33215
|
| Min. Negotiated Rate |
$196.17 |
| Max. Negotiated Rate |
$1,453.88 |
| Rate for Payer: Aetna Commercial |
$395.37
|
| Rate for Payer: Aetna Medicare |
$306.85
|
| Rate for Payer: BCBS Complete |
$205.98
|
| Rate for Payer: BCBS MAPPO |
$295.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,453.88
|
| Rate for Payer: BCN Commercial |
$448.61
|
| Rate for Payer: BCN Medicare Advantage |
$295.05
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cash Price |
$823.20
|
| Rate for Payer: Cofinity Commercial |
$424.87
|
| Rate for Payer: Cofinity Commercial |
$395.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.05
|
| Rate for Payer: Mclaren Medicaid |
$196.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.80
|
| Rate for Payer: Meridian Medicaid |
$205.98
|
| Rate for Payer: Nomi Health Commercial |
$354.06
|
| Rate for Payer: PACE SWMI |
$295.05
|
| Rate for Payer: PHP Medicare Advantage |
$295.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$196.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$668.85
|
| Rate for Payer: Priority Health HMO/PPO |
$487.69
|
| Rate for Payer: Priority Health Medicare |
$298.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$487.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.05
|
| Rate for Payer: UHC Exchange |
$295.05
|
| Rate for Payer: UHC Medicare Advantage |
$295.05
|
| Rate for Payer: UHCCP Medicaid |
$196.17
|
|
|
PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 36597
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$578.49 |
| Rate for Payer: Aetna Commercial |
$76.77
|
| Rate for Payer: Aetna Medicare |
$59.58
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCBS MAPPO |
$57.29
|
| Rate for Payer: BCBS Trust/PPO |
$578.49
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: BCN Medicare Advantage |
$57.29
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$82.50
|
| Rate for Payer: Cofinity Commercial |
$76.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.29
|
| Rate for Payer: Mclaren Medicaid |
$37.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.15
|
| Rate for Payer: Meridian Medicaid |
$39.81
|
| Rate for Payer: Nomi Health Commercial |
$68.75
|
| Rate for Payer: PACE SWMI |
$57.29
|
| Rate for Payer: PHP Medicare Advantage |
$57.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.40
|
| Rate for Payer: Priority Health HMO/PPO |
$93.61
|
| Rate for Payer: Priority Health Medicare |
$57.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.29
|
| Rate for Payer: UHC Exchange |
$57.29
|
| Rate for Payer: UHC Medicare Advantage |
$57.29
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
HCPCS 90380
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$846.95 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Medicare |
$651.50
|
| Rate for Payer: BCBS Complete |
$521.20
|
| Rate for Payer: BCBS Trust/PPO |
$504.90
|
| Rate for Payer: Cash Price |
$1,042.40
|
| Rate for Payer: Cash Price |
$1,042.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.95
|
|
|
PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE
|
Professional
|
Both
|
$1,303.00
|
|
|
Service Code
|
HCPCS 90381
|
| Min. Negotiated Rate |
$504.90 |
| Max. Negotiated Rate |
$846.95 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Medicare |
$651.50
|
| Rate for Payer: BCBS Complete |
$521.20
|
| Rate for Payer: BCBS Trust/PPO |
$504.90
|
| Rate for Payer: Cash Price |
$1,042.40
|
| Rate for Payer: Cash Price |
$1,042.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$846.95
|
|
|
PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE
|
Professional
|
Both
|
$840.00
|
|
|
Service Code
|
HCPCS 90678
|
| Min. Negotiated Rate |
$300.90 |
| Max. Negotiated Rate |
$546.00 |
| Rate for Payer: Aetna Commercial |
$300.90
|
| Rate for Payer: Aetna Medicare |
$420.00
|
| Rate for Payer: BCBS Complete |
$336.00
|
| Rate for Payer: BCBS Trust/PPO |
$347.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Cash Price |
$672.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$546.00
|
|
|
PR RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE
|
Professional
|
Both
|
$797.00
|
|
|
Service Code
|
HCPCS 90679
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$518.05 |
| Rate for Payer: Aetna Commercial |
$285.60
|
| Rate for Payer: Aetna Medicare |
$398.50
|
| Rate for Payer: BCBS Complete |
$318.80
|
| Rate for Payer: BCBS Trust/PPO |
$285.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Cash Price |
$637.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$518.05
|
|
|
PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I
|
Professional
|
Both
|
$2,946.00
|
|
|
Service Code
|
HCPCS 37193
|
| Min. Negotiated Rate |
$215.98 |
| Max. Negotiated Rate |
$2,206.87 |
| Rate for Payer: Aetna Commercial |
$439.48
|
| Rate for Payer: Aetna Medicare |
$341.09
|
| Rate for Payer: BCBS Complete |
$226.78
|
| Rate for Payer: BCBS MAPPO |
$327.97
|
| Rate for Payer: BCBS Trust/PPO |
$524.07
|
| Rate for Payer: BCN Commercial |
$2,206.87
|
| Rate for Payer: BCN Medicare Advantage |
$327.97
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cash Price |
$2,356.80
|
| Rate for Payer: Cofinity Commercial |
$472.28
|
| Rate for Payer: Cofinity Commercial |
$439.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$327.97
|
| Rate for Payer: Mclaren Medicaid |
$215.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$344.37
|
| Rate for Payer: Meridian Medicaid |
$226.78
|
| Rate for Payer: Nomi Health Commercial |
$393.56
|
| Rate for Payer: PACE SWMI |
$327.97
|
| Rate for Payer: PHP Medicare Advantage |
$327.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$215.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,914.90
|
| Rate for Payer: Priority Health HMO/PPO |
$536.61
|
| Rate for Payer: Priority Health Medicare |
$331.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$536.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$327.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$327.97
|
| Rate for Payer: UHC Exchange |
$327.97
|
| Rate for Payer: UHC Medicare Advantage |
$327.97
|
| Rate for Payer: UHCCP Medicaid |
$215.98
|
|
|
PR RUBELLA IMMUNIZATION, SUBCUT
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 90706
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
HCPCS 90681
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$137.29 |
| Rate for Payer: Aetna Commercial |
$137.29
|
| Rate for Payer: Aetna Medicare |
$79.50
|
| Rate for Payer: BCBS Complete |
$63.60
|
| Rate for Payer: BCBS Trust/PPO |
$129.14
|
| Rate for Payer: BCN Commercial |
$129.14
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.35
|
|
|
PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
HCPCS 90680
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Aetna Commercial |
$97.75
|
| Rate for Payer: Aetna Medicare |
$48.00
|
| Rate for Payer: BCBS Complete |
$38.40
|
| Rate for Payer: BCBS Trust/PPO |
$91.96
|
| Rate for Payer: BCN Commercial |
$91.96
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.40
|
|
|
PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY
|
Professional
|
Both
|
$3,142.00
|
|
|
Service Code
|
HCPCS 33476
|
| Min. Negotiated Rate |
$684.68 |
| Max. Negotiated Rate |
$2,397.99 |
| Rate for Payer: Aetna Commercial |
$1,963.48
|
| Rate for Payer: Aetna Medicare |
$1,523.89
|
| Rate for Payer: BCBS Complete |
$1,012.24
|
| Rate for Payer: BCBS MAPPO |
$1,465.28
|
| Rate for Payer: BCBS Trust/PPO |
$684.68
|
| Rate for Payer: BCN Commercial |
$2,191.23
|
| Rate for Payer: BCN Medicare Advantage |
$1,465.28
|
| Rate for Payer: Cash Price |
$2,513.60
|
| Rate for Payer: Cash Price |
$2,513.60
|
| Rate for Payer: Cofinity Commercial |
$2,110.00
|
| Rate for Payer: Cofinity Commercial |
$1,963.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,465.28
|
| Rate for Payer: Mclaren Medicaid |
$964.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,538.54
|
| Rate for Payer: Meridian Medicaid |
$1,012.24
|
| Rate for Payer: Nomi Health Commercial |
$1,758.34
|
| Rate for Payer: PACE SWMI |
$1,465.28
|
| Rate for Payer: PHP Medicare Advantage |
$1,465.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$964.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,042.30
|
| Rate for Payer: Priority Health HMO/PPO |
$2,397.99
|
| Rate for Payer: Priority Health Medicare |
$1,479.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,397.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,465.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,465.28
|
| Rate for Payer: UHC Exchange |
$1,465.28
|
| Rate for Payer: UHC Medicare Advantage |
$1,465.28
|
| Rate for Payer: UHCCP Medicaid |
$964.04
|
|
|
PR RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 92310
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$64.40
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$145.62
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Mclaren Medicaid |
$36.00
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.25
|
| Rate for Payer: Priority Health HMO/PPO |
$70.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.18
|
| Rate for Payer: UHCCP Medicaid |
$36.00
|
|
|
PR RX&FITG C-LENS TECH CRNL LENS OU XCPT APHAKIA
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 92314
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$686.79 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Medicare |
$68.50
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS Trust/PPO |
$686.79
|
| Rate for Payer: BCN Commercial |
$126.57
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health HMO/PPO |
$41.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.53
|
|
