|
PR RX RIB FRACTURE W EXTERN FIXATN
|
Professional
|
Both
|
$1,317.00
|
|
|
Service Code
|
HCPCS 21810
|
| Min. Negotiated Rate |
$526.80 |
| Max. Negotiated Rate |
$856.05 |
| Rate for Payer: Aetna Medicare |
$658.50
|
| Rate for Payer: BCBS Complete |
$526.80
|
| Rate for Payer: Cash Price |
$1,053.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$856.05
|
|
|
PR SACRAL NERVE STIM TEST LEAD
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS A4290
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$902.34 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS Trust/PPO |
$902.34
|
| Rate for Payer: BCN Commercial |
$22.50
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
|
|
PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX
|
Professional
|
Both
|
$1,749.00
|
|
|
Service Code
|
HCPCS 58700
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$1,199.44 |
| Rate for Payer: Aetna Commercial |
$1,033.18
|
| Rate for Payer: Aetna Medicare |
$801.87
|
| Rate for Payer: BCBS Complete |
$541.45
|
| Rate for Payer: BCBS MAPPO |
$771.03
|
| Rate for Payer: BCBS Trust/PPO |
$138.94
|
| Rate for Payer: BCN Commercial |
$1,174.29
|
| Rate for Payer: BCN Medicare Advantage |
$771.03
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cash Price |
$1,399.20
|
| Rate for Payer: Cofinity Commercial |
$1,110.28
|
| Rate for Payer: Cofinity Commercial |
$1,033.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$771.03
|
| Rate for Payer: Mclaren Medicaid |
$515.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$809.58
|
| Rate for Payer: Meridian Medicaid |
$541.45
|
| Rate for Payer: Nomi Health Commercial |
$925.24
|
| Rate for Payer: PACE SWMI |
$771.03
|
| Rate for Payer: PHP Medicare Advantage |
$771.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$515.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.85
|
| Rate for Payer: Priority Health HMO/PPO |
$1,199.44
|
| Rate for Payer: Priority Health Medicare |
$778.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,199.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$771.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$771.03
|
| Rate for Payer: UHC Exchange |
$771.03
|
| Rate for Payer: UHC Medicare Advantage |
$771.03
|
| Rate for Payer: UHCCP Medicaid |
$515.67
|
|
|
PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX
|
Professional
|
Both
|
$2,041.00
|
|
|
Service Code
|
HCPCS 58720
|
| Min. Negotiated Rate |
$429.51 |
| Max. Negotiated Rate |
$1,326.65 |
| Rate for Payer: Aetna Commercial |
$977.72
|
| Rate for Payer: Aetna Medicare |
$758.83
|
| Rate for Payer: BCBS Complete |
$513.50
|
| Rate for Payer: BCBS MAPPO |
$729.64
|
| Rate for Payer: BCBS Trust/PPO |
$429.51
|
| Rate for Payer: BCN Commercial |
$1,111.74
|
| Rate for Payer: BCN Medicare Advantage |
$729.64
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cash Price |
$1,632.80
|
| Rate for Payer: Cofinity Commercial |
$977.72
|
| Rate for Payer: Cofinity Commercial |
$1,050.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$729.64
|
| Rate for Payer: Mclaren Medicaid |
$489.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$766.12
|
| Rate for Payer: Meridian Medicaid |
$513.50
|
| Rate for Payer: Nomi Health Commercial |
$875.57
|
| Rate for Payer: PACE SWMI |
$729.64
|
| Rate for Payer: PHP Medicare Advantage |
$729.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$489.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,326.65
|
| Rate for Payer: Priority Health HMO/PPO |
$1,138.92
|
| Rate for Payer: Priority Health Medicare |
$736.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,138.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$729.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$729.64
|
| Rate for Payer: UHC Exchange |
$729.64
|
| Rate for Payer: UHC Medicare Advantage |
$729.64
|
| Rate for Payer: UHCCP Medicaid |
$489.05
|
|
|
PR SALPINGOSTOMY
|
Professional
|
Both
|
$2,727.00
|
|
|
Service Code
|
HCPCS 58770
|
| Min. Negotiated Rate |
$209.21 |
| Max. Negotiated Rate |
$1,772.55 |
| Rate for Payer: Aetna Commercial |
$1,108.02
|
| Rate for Payer: Aetna Medicare |
$859.96
|
| Rate for Payer: BCBS Complete |
$579.47
|
| Rate for Payer: BCBS MAPPO |
$826.88
|
| Rate for Payer: BCBS Trust/PPO |
$209.21
|
| Rate for Payer: BCN Commercial |
$1,266.17
|
| Rate for Payer: BCN Medicare Advantage |
$826.88
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cofinity Commercial |
$1,190.71
|
| Rate for Payer: Cofinity Commercial |
$1,108.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$826.88
|
| Rate for Payer: Mclaren Medicaid |
$551.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$868.22
|
| Rate for Payer: Meridian Medicaid |
$579.47
|
| Rate for Payer: Nomi Health Commercial |
$992.26
|
| Rate for Payer: PACE SWMI |
$826.88
|
| Rate for Payer: PHP Medicare Advantage |
$826.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$551.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,772.55
|
| Rate for Payer: Priority Health HMO/PPO |
$1,288.73
|
| Rate for Payer: Priority Health Medicare |
$835.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,288.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$826.88
|
| Rate for Payer: UHC Exchange |
$826.88
|
| Rate for Payer: UHC Medicare Advantage |
$826.88
|
| Rate for Payer: UHCCP Medicaid |
$551.88
|
|
|
PR SARSCOV2 VACC 10MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 91319
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$142.35 |
| Rate for Payer: Aetna Commercial |
$117.63
|
| Rate for Payer: Aetna Medicare |
$91.29
|
| Rate for Payer: BCBS Complete |
$87.60
|
| Rate for Payer: BCBS MAPPO |
$87.78
|
| Rate for Payer: BCBS Trust/PPO |
$78.54
|
| Rate for Payer: BCN Medicare Advantage |
$87.78
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$117.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.17
|
| Rate for Payer: Nomi Health Commercial |
$105.34
|
| Rate for Payer: PACE SWMI |
$87.78
|
| Rate for Payer: PHP Medicare Advantage |
$87.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.35
|
| Rate for Payer: Priority Health Medicare |
$88.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.78
|
| Rate for Payer: UHC Exchange |
$87.78
|
| Rate for Payer: UHC Medicare Advantage |
$87.78
|
|
|
PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 91320
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$224.49 |
| Rate for Payer: Aetna Commercial |
$208.90
|
| Rate for Payer: Aetna Medicare |
$162.13
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS MAPPO |
$155.90
|
| Rate for Payer: BCBS Trust/PPO |
$125.00
|
| Rate for Payer: BCN Medicare Advantage |
$155.90
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$224.49
|
| Rate for Payer: Cofinity Commercial |
$208.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.69
|
| Rate for Payer: Nomi Health Commercial |
$187.07
|
| Rate for Payer: PACE SWMI |
$155.90
|
| Rate for Payer: PHP Medicare Advantage |
$155.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health Medicare |
$157.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.90
|
| Rate for Payer: UHC Exchange |
$155.90
|
| Rate for Payer: UHC Medicare Advantage |
$155.90
|
|
|
PR SARSCOV2 VACC 3MCG/0.3ML TRIS-SUCROSE IM USE
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 91318
|
| Min. Negotiated Rate |
$58.65 |
| Max. Negotiated Rate |
$106.60 |
| Rate for Payer: Aetna Commercial |
$87.84
|
| Rate for Payer: Aetna Medicare |
$68.17
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS MAPPO |
$65.55
|
| Rate for Payer: BCBS Trust/PPO |
$58.65
|
| Rate for Payer: BCN Medicare Advantage |
$65.55
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$94.39
|
| Rate for Payer: Cofinity Commercial |
$87.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.83
|
| Rate for Payer: Nomi Health Commercial |
$78.66
|
| Rate for Payer: PACE SWMI |
$65.55
|
| Rate for Payer: PHP Medicare Advantage |
$65.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.60
|
| Rate for Payer: Priority Health Medicare |
$66.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$65.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.55
|
| Rate for Payer: UHC Exchange |
$65.55
|
| Rate for Payer: UHC Medicare Advantage |
$65.55
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 99233
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$1,858.56 |
| Rate for Payer: Aetna Commercial |
$150.19
|
| Rate for Payer: Aetna Medicare |
$116.56
|
| Rate for Payer: BCBS Complete |
$78.73
|
| Rate for Payer: BCBS MAPPO |
$112.08
|
| Rate for Payer: BCBS Trust/PPO |
$1,858.56
|
| Rate for Payer: BCN Commercial |
$126.11
|
| Rate for Payer: BCN Medicare Advantage |
$112.08
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$161.40
|
| Rate for Payer: Cofinity Commercial |
$150.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.08
|
| Rate for Payer: Mclaren Medicaid |
$74.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.68
|
| Rate for Payer: Meridian Medicaid |
$78.73
|
| Rate for Payer: Nomi Health Commercial |
$134.50
|
| Rate for Payer: PACE SWMI |
$112.08
|
| Rate for Payer: PHP Medicare Advantage |
$112.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO |
$157.94
|
| Rate for Payer: Priority Health Medicare |
$113.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.08
|
| Rate for Payer: UHC Exchange |
$112.08
|
| Rate for Payer: UHC Medicare Advantage |
$112.08
|
| Rate for Payer: UHCCP Medicaid |
$74.98
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 99232
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$2,072.52 |
| Rate for Payer: Aetna Commercial |
$100.79
|
| Rate for Payer: Aetna Medicare |
$78.23
|
| Rate for Payer: BCBS Complete |
$52.78
|
| Rate for Payer: BCBS MAPPO |
$75.22
|
| Rate for Payer: BCBS Trust/PPO |
$2,072.52
|
| Rate for Payer: BCN Commercial |
$83.83
|
| Rate for Payer: BCN Medicare Advantage |
$75.22
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$108.32
|
| Rate for Payer: Cofinity Commercial |
$100.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.22
|
| Rate for Payer: Mclaren Medicaid |
$50.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.98
|
| Rate for Payer: Meridian Medicaid |
$52.78
|
| Rate for Payer: Nomi Health Commercial |
$90.26
|
| Rate for Payer: PACE SWMI |
$75.22
|
| Rate for Payer: PHP Medicare Advantage |
$75.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health HMO/PPO |
$105.00
|
| Rate for Payer: Priority Health Medicare |
$75.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.22
|
| Rate for Payer: UHC Exchange |
$75.22
|
| Rate for Payer: UHC Medicare Advantage |
$75.22
|
| Rate for Payer: UHCCP Medicaid |
$50.27
|
|
|
PR SBSQ HOSPITAL IP/OBS CARE SF/LOW MDM 25 MINUTES
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
HCPCS 99231
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$1,703.77 |
| Rate for Payer: Aetna Commercial |
$62.42
|
| Rate for Payer: Aetna Medicare |
$48.44
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$46.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,703.77
|
| Rate for Payer: BCN Commercial |
$52.66
|
| Rate for Payer: BCN Medicare Advantage |
$46.58
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cofinity Commercial |
$67.08
|
| Rate for Payer: Cofinity Commercial |
$62.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.58
|
| Rate for Payer: Mclaren Medicaid |
$31.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.91
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Nomi Health Commercial |
$55.90
|
| Rate for Payer: PACE SWMI |
$46.58
|
| Rate for Payer: PHP Medicare Advantage |
$46.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.70
|
| Rate for Payer: Priority Health HMO/PPO |
$65.96
|
| Rate for Payer: Priority Health Medicare |
$47.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.58
|
| Rate for Payer: UHC Exchange |
$46.58
|
| Rate for Payer: UHC Medicare Advantage |
$46.58
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
|
|
PR SBSQ NURSING FACILITY CARE HIGH MDM 45 MINUTES
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 99310
|
| Min. Negotiated Rate |
$97.77 |
| Max. Negotiated Rate |
$500.83 |
| Rate for Payer: Aetna Commercial |
$194.31
|
| Rate for Payer: Aetna Medicare |
$150.81
|
| Rate for Payer: BCBS Complete |
$102.66
|
| Rate for Payer: BCBS MAPPO |
$145.01
|
| Rate for Payer: BCBS Trust/PPO |
$500.83
|
| Rate for Payer: BCN Commercial |
$221.37
|
| Rate for Payer: BCN Medicare Advantage |
$145.01
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$208.81
|
| Rate for Payer: Cofinity Commercial |
$194.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.01
|
| Rate for Payer: Mclaren Medicaid |
$97.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.26
|
| Rate for Payer: Meridian Medicaid |
$102.66
|
| Rate for Payer: Nomi Health Commercial |
$174.01
|
| Rate for Payer: PACE SWMI |
$145.01
|
| Rate for Payer: PHP Medicare Advantage |
$145.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$97.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO |
$205.52
|
| Rate for Payer: Priority Health Medicare |
$146.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.01
|
| Rate for Payer: UHC Exchange |
$145.01
|
| Rate for Payer: UHC Medicare Advantage |
$145.01
|
| Rate for Payer: UHCCP Medicaid |
$97.77
|
|
|
PR SBSQ NURSING FACILITY CARE LOW MDM 20 MINUTES
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 99308
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$2,410.10 |
| Rate for Payer: Aetna Commercial |
$93.59
|
| Rate for Payer: Aetna Medicare |
$72.63
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$69.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,410.10
|
| Rate for Payer: BCN Commercial |
$107.51
|
| Rate for Payer: BCN Medicare Advantage |
$69.84
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$93.59
|
| Rate for Payer: Cofinity Commercial |
$100.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.84
|
| Rate for Payer: Mclaren Medicaid |
$47.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.33
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Nomi Health Commercial |
$83.81
|
| Rate for Payer: PACE SWMI |
$69.84
|
| Rate for Payer: PHP Medicare Advantage |
$69.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO |
$105.05
|
| Rate for Payer: Priority Health Medicare |
$70.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.84
|
| Rate for Payer: UHC Exchange |
$69.84
|
| Rate for Payer: UHC Medicare Advantage |
$69.84
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
|
|
PR SBSQ NURSING FACILITY CARE MOD MDM 30 MINUTES
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 99309
|
| Min. Negotiated Rate |
$68.59 |
| Max. Negotiated Rate |
$323.85 |
| Rate for Payer: Aetna Commercial |
$136.02
|
| Rate for Payer: Aetna Medicare |
$105.57
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: BCBS MAPPO |
$101.51
|
| Rate for Payer: BCBS Trust/PPO |
$323.85
|
| Rate for Payer: BCN Commercial |
$153.93
|
| Rate for Payer: BCN Medicare Advantage |
$101.51
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$146.17
|
| Rate for Payer: Cofinity Commercial |
$136.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.51
|
| Rate for Payer: Mclaren Medicaid |
$68.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.59
|
| Rate for Payer: Meridian Medicaid |
$72.02
|
| Rate for Payer: Nomi Health Commercial |
$121.81
|
| Rate for Payer: PACE SWMI |
$101.51
|
| Rate for Payer: PHP Medicare Advantage |
$101.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health HMO/PPO |
$138.47
|
| Rate for Payer: Priority Health Medicare |
$102.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.51
|
| Rate for Payer: UHC Exchange |
$101.51
|
| Rate for Payer: UHC Medicare Advantage |
$101.51
|
| Rate for Payer: UHCCP Medicaid |
$68.59
|
|
|
PR SBSQ NURSING FACILITY CARE SF MDM 10 MINUTES
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 99307
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$2,395.31 |
| Rate for Payer: Aetna Commercial |
$50.14
|
| Rate for Payer: Aetna Medicare |
$38.92
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS MAPPO |
$37.42
|
| Rate for Payer: BCBS Trust/PPO |
$2,395.31
|
| Rate for Payer: BCN Commercial |
$57.17
|
| Rate for Payer: BCN Medicare Advantage |
$37.42
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cofinity Commercial |
$53.88
|
| Rate for Payer: Cofinity Commercial |
$50.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.42
|
| Rate for Payer: Mclaren Medicaid |
$25.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.29
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: Nomi Health Commercial |
$44.90
|
| Rate for Payer: PACE SWMI |
$37.42
|
| Rate for Payer: PHP Medicare Advantage |
$37.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health HMO/PPO |
$53.85
|
| Rate for Payer: Priority Health Medicare |
$37.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.42
|
| Rate for Payer: UHC Exchange |
$37.42
|
| Rate for Payer: UHC Medicare Advantage |
$37.42
|
| Rate for Payer: UHCCP Medicaid |
$25.35
|
|
|
PR SBSQ OBSERVATION CARE/DAY 15 MINUTES
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 99224
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
|
|
PR SBSQ OBSERVATION CARE/DAY 25 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99225
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
|
|
PR SBSQ OBSERVATION CARE/DAY 35 MINUTES
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 99226
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
|
|
PR SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
HCPCS 99493
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$687.85 |
| Rate for Payer: Aetna Commercial |
$130.44
|
| Rate for Payer: Aetna Medicare |
$101.23
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$97.34
|
| Rate for Payer: BCBS Trust/PPO |
$687.85
|
| Rate for Payer: BCN Commercial |
$154.35
|
| Rate for Payer: BCN Medicare Advantage |
$97.34
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cash Price |
$201.60
|
| Rate for Payer: Cofinity Commercial |
$130.44
|
| Rate for Payer: Cofinity Commercial |
$140.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.34
|
| Rate for Payer: Mclaren Medicaid |
$65.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.21
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Nomi Health Commercial |
$116.81
|
| Rate for Payer: PACE SWMI |
$97.34
|
| Rate for Payer: PHP Medicare Advantage |
$97.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO |
$154.29
|
| Rate for Payer: Priority Health Medicare |
$98.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.34
|
| Rate for Payer: UHC Exchange |
$97.34
|
| Rate for Payer: UHC Medicare Advantage |
$97.34
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
|
|
PR SCLEROTHERAPY FLUID COLLECTION PRQ W/IMG GID
|
Professional
|
Both
|
$2,267.00
|
|
|
Service Code
|
HCPCS 49185
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$1,875.55 |
| Rate for Payer: Aetna Commercial |
$152.02
|
| Rate for Payer: Aetna Medicare |
$117.99
|
| Rate for Payer: BCBS Complete |
$79.17
|
| Rate for Payer: BCBS MAPPO |
$113.45
|
| Rate for Payer: BCBS Trust/PPO |
$585.36
|
| Rate for Payer: BCN Commercial |
$1,875.55
|
| Rate for Payer: BCN Medicare Advantage |
$113.45
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cash Price |
$1,813.60
|
| Rate for Payer: Cofinity Commercial |
$163.37
|
| Rate for Payer: Cofinity Commercial |
$152.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.45
|
| Rate for Payer: Mclaren Medicaid |
$75.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.12
|
| Rate for Payer: Meridian Medicaid |
$79.17
|
| Rate for Payer: Nomi Health Commercial |
$136.14
|
| Rate for Payer: PACE SWMI |
$113.45
|
| Rate for Payer: PHP Medicare Advantage |
$113.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,473.55
|
| Rate for Payer: Priority Health HMO/PPO |
$208.21
|
| Rate for Payer: Priority Health Medicare |
$114.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.45
|
| Rate for Payer: UHC Exchange |
$113.45
|
| Rate for Payer: UHC Medicare Advantage |
$113.45
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
|
|
PR SCREENING PAP SMEAR BY PHYS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS P3001
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$2,624.07 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$23.85
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS MAPPO |
$22.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,624.07
|
| Rate for Payer: BCN Commercial |
$33.23
|
| Rate for Payer: BCN Medicare Advantage |
$22.93
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Cofinity Commercial |
$30.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.08
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: PACE SWMI |
$22.93
|
| Rate for Payer: PHP Medicare Advantage |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Medicare |
$23.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.93
|
| Rate for Payer: UHC Exchange |
$22.93
|
| Rate for Payer: UHC Medicare Advantage |
$22.93
|
|
|
PR SCREENING PROCTOSCOPY
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS S0601
|
| Min. Negotiated Rate |
$24.45 |
| Max. Negotiated Rate |
$100.10 |
| Rate for Payer: Aetna Commercial |
$24.45
|
| Rate for Payer: Aetna Medicare |
$77.00
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: BCBS Trust/PPO |
$45.43
|
| Rate for Payer: BCN Commercial |
$67.02
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
|
|
PR SCREENING TEST PURE TONE AIR ONLY
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 92551
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$1,709.05 |
| Rate for Payer: Aetna Commercial |
$12.13
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,709.05
|
| Rate for Payer: BCN Commercial |
$17.59
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health HMO/PPO |
$17.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.19
|
|
|
PR SCREENING TEST VISUAL ACUITY QUANTITATIVE BILAT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 99173
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$1,121.05 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,121.05
|
| Rate for Payer: BCN Commercial |
$4.39
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO |
$4.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.52
|
|
|
PR SCR MAMMO BI INCL CAD
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS G0202
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
|
