|
PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM
|
Professional
|
Both
|
$2,191.00
|
|
|
Service Code
|
HCPCS 14061
|
| Min. Negotiated Rate |
$138.90 |
| Max. Negotiated Rate |
$1,533.70 |
| Rate for Payer: Aetna Commercial |
$1,061.55
|
| Rate for Payer: Aetna Medicare |
$792.20
|
| Rate for Payer: BCBS Complete |
$548.61
|
| Rate for Payer: BCBS MAPPO |
$792.20
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$1,452.35
|
| Rate for Payer: BCN Medicare Advantage |
$792.20
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cash Price |
$1,752.80
|
| Rate for Payer: Cofinity Commercial |
$1,140.77
|
| Rate for Payer: Cofinity Commercial |
$1,061.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$792.20
|
| Rate for Payer: Healthscope Commercial |
$950.64
|
| Rate for Payer: Healthscope Whirlpool |
$950.64
|
| Rate for Payer: Meridian Medicaid |
$548.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$831.81
|
| Rate for Payer: PACE SWMI |
$792.20
|
| Rate for Payer: PHP Medicare Advantage |
$792.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$522.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,533.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$998.41
|
| Rate for Payer: Priority Health Medicare |
$792.20
|
| Rate for Payer: Priority Health Narrow Network |
$998.41
|
| Rate for Payer: UHC Medicare Advantage |
$815.97
|
|
|
PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
HCPCS 14302
|
| Min. Negotiated Rate |
$136.32 |
| Max. Negotiated Rate |
$312.75 |
| Rate for Payer: Aetna Commercial |
$284.78
|
| Rate for Payer: Aetna Medicare |
$212.52
|
| Rate for Payer: BCBS Complete |
$143.14
|
| Rate for Payer: BCBS MAPPO |
$212.52
|
| Rate for Payer: BCBS Trust/PPO |
$138.90
|
| Rate for Payer: BCN Commercial |
$312.75
|
| Rate for Payer: BCN Medicare Advantage |
$212.52
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cash Price |
$354.40
|
| Rate for Payer: Cofinity Commercial |
$306.03
|
| Rate for Payer: Cofinity Commercial |
$284.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.52
|
| Rate for Payer: Healthscope Commercial |
$255.02
|
| Rate for Payer: Healthscope Whirlpool |
$255.02
|
| Rate for Payer: Meridian Medicaid |
$143.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$223.15
|
| Rate for Payer: PACE SWMI |
$212.52
|
| Rate for Payer: PHP Medicare Advantage |
$212.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$136.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.07
|
| Rate for Payer: Priority Health Medicare |
$212.52
|
| Rate for Payer: Priority Health Narrow Network |
$263.07
|
| Rate for Payer: UHC Medicare Advantage |
$218.90
|
|
|
PR ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
HCPCS 14020
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$1,028.66 |
| Rate for Payer: Aetna Commercial |
$733.86
|
| Rate for Payer: Aetna Medicare |
$547.66
|
| Rate for Payer: BCBS Complete |
$381.55
|
| Rate for Payer: BCBS MAPPO |
$547.66
|
| Rate for Payer: BCBS Trust/PPO |
$48.14
|
| Rate for Payer: BCN Commercial |
$1,028.66
|
| Rate for Payer: BCN Medicare Advantage |
$547.66
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cofinity Commercial |
$733.86
|
| Rate for Payer: Cofinity Commercial |
$788.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$547.66
|
| Rate for Payer: Healthscope Commercial |
$657.19
|
| Rate for Payer: Healthscope Whirlpool |
$657.19
|
| Rate for Payer: Meridian Medicaid |
$381.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$575.04
|
| Rate for Payer: PACE SWMI |
$547.66
|
| Rate for Payer: PHP Medicare Advantage |
$547.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$802.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$692.60
|
| Rate for Payer: Priority Health Medicare |
$547.66
|
| Rate for Payer: Priority Health Narrow Network |
$692.60
|
| Rate for Payer: UHC Medicare Advantage |
$564.09
|
|
|
PR ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/<
|
Professional
|
Both
|
$2,026.00
|
|
|
Service Code
|
HCPCS 14060
|
| Min. Negotiated Rate |
$206.12 |
| Max. Negotiated Rate |
$1,418.20 |
| Rate for Payer: Aetna Commercial |
$863.52
|
| Rate for Payer: Aetna Medicare |
$644.42
|
| Rate for Payer: BCBS Complete |
$446.19
|
| Rate for Payer: BCBS MAPPO |
$644.42
|
| Rate for Payer: BCBS Trust/PPO |
$206.12
|
| Rate for Payer: BCN Commercial |
$1,122.50
|
| Rate for Payer: BCN Medicare Advantage |
$644.42
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Cash Price |
$1,620.80
|
| Rate for Payer: Cofinity Commercial |
$927.96
|
| Rate for Payer: Cofinity Commercial |
$863.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.42
|
| Rate for Payer: Healthscope Commercial |
$773.30
|
| Rate for Payer: Healthscope Whirlpool |
$773.30
|
| Rate for Payer: Meridian Medicaid |
$446.19
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$676.64
|
| Rate for Payer: PACE SWMI |
$644.42
|
| Rate for Payer: PHP Medicare Advantage |
$644.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$424.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,418.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$812.62
|
| Rate for Payer: Priority Health Medicare |
$644.42
|
| Rate for Payer: Priority Health Narrow Network |
$812.62
|
| Rate for Payer: UHC Medicare Advantage |
$663.75
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
OP
|
$1,274.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$886.68 |
| Max. Negotiated Rate |
$2,433.07 |
| Rate for Payer: Aetna Commercial |
$1,146.60
|
| Rate for Payer: Aetna Medicare |
$1,620.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,026.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,026.22
|
| Rate for Payer: ASR ASR |
$1,235.78
|
| Rate for Payer: BCBS Complete |
$931.09
|
| Rate for Payer: BCBS MAPPO |
$1,620.98
|
| Rate for Payer: BCBS Trust/PPO |
$987.73
|
| Rate for Payer: BCN Commercial |
$987.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,620.98
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$1,197.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,019.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,620.98
|
| Rate for Payer: Healthscope Commercial |
$1,274.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,235.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,620.98
|
| Rate for Payer: Mclaren Commercial |
$1,146.60
|
| Rate for Payer: Mclaren Medicaid |
$886.68
|
| Rate for Payer: Mclaren Medicare |
$1,620.98
|
| Rate for Payer: Meridian Medicaid |
$931.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,702.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,864.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,082.90
|
| Rate for Payer: PACE Medicare |
$1,539.93
|
| Rate for Payer: PACE SWMI |
$1,620.98
|
| Rate for Payer: PHP Commercial |
$1,783.08
|
| Rate for Payer: PHP Medicaid |
$886.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,620.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$886.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,433.07
|
| Rate for Payer: Priority Health Medicare |
$1,620.98
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.46
|
| Rate for Payer: Railroad Medicare Medicare |
$1,620.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,121.12
|
| Rate for Payer: UHC Medicare Advantage |
$1,669.61
|
| Rate for Payer: VA VA |
$1,620.98
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 14040
|
| Hospital Charge Code |
14040
|
| Min. Negotiated Rate |
$344.90 |
| Max. Negotiated Rate |
$1,110.28 |
| Rate for Payer: Aetna Commercial |
$809.95
|
| Rate for Payer: Aetna Medicare |
$604.44
|
| Rate for Payer: BCBS Complete |
$418.90
|
| Rate for Payer: BCBS MAPPO |
$604.44
|
| Rate for Payer: BCBS Trust/PPO |
$344.90
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: BCN Medicare Advantage |
$604.44
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$809.95
|
| Rate for Payer: Cofinity Commercial |
$870.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.44
|
| Rate for Payer: Healthscope Commercial |
$725.33
|
| Rate for Payer: Healthscope Whirlpool |
$725.33
|
| Rate for Payer: Meridian Medicaid |
$418.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$634.66
|
| Rate for Payer: PACE SWMI |
$604.44
|
| Rate for Payer: PHP Medicare Advantage |
$604.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$762.07
|
| Rate for Payer: Priority Health Medicare |
$604.44
|
| Rate for Payer: Priority Health Narrow Network |
$762.07
|
| Rate for Payer: UHC Medicare Advantage |
$622.57
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Facility
|
IP
|
$1,274.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
14040
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$891.80 |
| Max. Negotiated Rate |
$1,274.00 |
| Rate for Payer: Aetna Commercial |
$1,146.60
|
| Rate for Payer: ASR ASR |
$1,235.78
|
| Rate for Payer: BCBS Trust/PPO |
$987.73
|
| Rate for Payer: BCN Commercial |
$987.73
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$1,197.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,019.20
|
| Rate for Payer: Healthscope Commercial |
$1,274.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,235.78
|
| Rate for Payer: Mclaren Commercial |
$1,146.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,082.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,121.12
|
|
|
PR ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 14040
|
| Min. Negotiated Rate |
$344.90 |
| Max. Negotiated Rate |
$1,110.28 |
| Rate for Payer: Aetna Commercial |
$809.95
|
| Rate for Payer: Aetna Medicare |
$604.44
|
| Rate for Payer: BCBS Complete |
$418.90
|
| Rate for Payer: BCBS MAPPO |
$604.44
|
| Rate for Payer: BCBS Trust/PPO |
$344.90
|
| Rate for Payer: BCN Commercial |
$1,110.28
|
| Rate for Payer: BCN Medicare Advantage |
$604.44
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$809.95
|
| Rate for Payer: Cofinity Commercial |
$870.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$604.44
|
| Rate for Payer: Healthscope Commercial |
$725.33
|
| Rate for Payer: Healthscope Whirlpool |
$725.33
|
| Rate for Payer: Meridian Medicaid |
$418.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$634.66
|
| Rate for Payer: PACE SWMI |
$604.44
|
| Rate for Payer: PHP Medicare Advantage |
$604.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$398.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$891.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$762.07
|
| Rate for Payer: Priority Health Medicare |
$604.44
|
| Rate for Payer: Priority Health Narrow Network |
$762.07
|
| Rate for Payer: UHC Medicare Advantage |
$622.57
|
|
|
PR ADJUSTMENT GASTRIC BAND
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS S2083
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$486.56 |
| Rate for Payer: Aetna Commercial |
$67.62
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS Trust/PPO |
$486.56
|
| Rate for Payer: BCN Commercial |
$108.60
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
|
|
PR ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES
|
Professional
|
Both
|
$1,005.00
|
|
|
Service Code
|
HCPCS 20693
|
| Min. Negotiated Rate |
$289.25 |
| Max. Negotiated Rate |
$3,350.93 |
| Rate for Payer: Aetna Commercial |
$581.87
|
| Rate for Payer: Aetna Medicare |
$434.23
|
| Rate for Payer: BCBS Complete |
$303.71
|
| Rate for Payer: BCBS MAPPO |
$434.23
|
| Rate for Payer: BCBS Trust/PPO |
$3,350.93
|
| Rate for Payer: BCN Commercial |
$649.94
|
| Rate for Payer: BCN Medicare Advantage |
$434.23
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Cofinity Commercial |
$625.29
|
| Rate for Payer: Cofinity Commercial |
$581.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.23
|
| Rate for Payer: Healthscope Commercial |
$521.08
|
| Rate for Payer: Healthscope Whirlpool |
$521.08
|
| Rate for Payer: Meridian Medicaid |
$303.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$455.94
|
| Rate for Payer: PACE SWMI |
$434.23
|
| Rate for Payer: PHP Medicare Advantage |
$434.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$289.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$703.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$679.16
|
| Rate for Payer: Priority Health Medicare |
$434.23
|
| Rate for Payer: Priority Health Narrow Network |
$679.16
|
| Rate for Payer: UHC Medicare Advantage |
$447.26
|
|
|
PR ADMIN HEPATITIS B VACCINE
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS G0010
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$1,469.20 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.20
|
| Rate for Payer: BCN Commercial |
$21.88
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.97
|
| Rate for Payer: Priority Health Narrow Network |
$39.97
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0008
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$4,626.85 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,626.85
|
| Rate for Payer: BCN Commercial |
$21.88
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.97
|
| Rate for Payer: Priority Health Narrow Network |
$39.97
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS G0009
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$1,331.32 |
| Rate for Payer: Aetna Commercial |
$10.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,331.32
|
| Rate for Payer: BCN Commercial |
$21.88
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.97
|
| Rate for Payer: Priority Health Narrow Network |
$39.97
|
|
|
PR ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP
|
Professional
|
Both
|
$83.04
|
|
|
Service Code
|
HCPCS 96380
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$58.13 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: BCBS Complete |
$33.22
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
|
|
PR ADMN RSV MONOCLONAL ANTB SEASONAL DOSE IM NJX
|
Professional
|
Both
|
$83.04
|
|
|
Service Code
|
HCPCS 96381
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$58.13 |
| Rate for Payer: Aetna Commercial |
$12.00
|
| Rate for Payer: BCBS Complete |
$33.22
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Cash Price |
$66.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.13
|
|
|
PR ADRENALECTOMY EXPL W/EXC RETROPERTINEAL TUMOR
|
Professional
|
Both
|
$4,350.00
|
|
|
Service Code
|
HCPCS 60545
|
| Min. Negotiated Rate |
$341.28 |
| Max. Negotiated Rate |
$3,045.00 |
| Rate for Payer: Aetna Commercial |
$1,658.04
|
| Rate for Payer: Aetna Medicare |
$1,237.34
|
| Rate for Payer: BCBS Complete |
$838.91
|
| Rate for Payer: BCBS MAPPO |
$1,237.34
|
| Rate for Payer: BCBS Trust/PPO |
$341.28
|
| Rate for Payer: BCN Commercial |
$1,817.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,237.34
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cash Price |
$3,480.00
|
| Rate for Payer: Cofinity Commercial |
$1,781.77
|
| Rate for Payer: Cofinity Commercial |
$1,658.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,237.34
|
| Rate for Payer: Healthscope Commercial |
$1,484.81
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.81
|
| Rate for Payer: Meridian Medicaid |
$838.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,299.21
|
| Rate for Payer: PACE SWMI |
$1,237.34
|
| Rate for Payer: PHP Medicare Advantage |
$1,237.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$798.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,045.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,759.61
|
| Rate for Payer: Priority Health Medicare |
$1,237.34
|
| Rate for Payer: Priority Health Narrow Network |
$1,759.61
|
| Rate for Payer: UHC Medicare Advantage |
$1,274.46
|
|
|
PR ADRENALECTOMY W/EXPL W/WO BX ABDL/LMBR/DRSAL SPX
|
Professional
|
Both
|
$3,303.00
|
|
|
Service Code
|
HCPCS 60540
|
| Min. Negotiated Rate |
$432.15 |
| Max. Negotiated Rate |
$2,312.10 |
| Rate for Payer: Aetna Commercial |
$1,427.65
|
| Rate for Payer: Aetna Medicare |
$1,065.41
|
| Rate for Payer: BCBS Complete |
$723.95
|
| Rate for Payer: BCBS MAPPO |
$1,065.41
|
| Rate for Payer: BCBS Trust/PPO |
$432.15
|
| Rate for Payer: BCN Commercial |
$1,567.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,065.41
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cash Price |
$2,642.40
|
| Rate for Payer: Cofinity Commercial |
$1,534.19
|
| Rate for Payer: Cofinity Commercial |
$1,427.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,065.41
|
| Rate for Payer: Healthscope Commercial |
$1,278.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,278.49
|
| Rate for Payer: Meridian Medicaid |
$723.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,118.68
|
| Rate for Payer: PACE SWMI |
$1,065.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,065.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$689.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,312.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,517.36
|
| Rate for Payer: Priority Health Medicare |
$1,065.41
|
| Rate for Payer: Priority Health Narrow Network |
$1,517.36
|
| Rate for Payer: UHC Medicare Advantage |
$1,097.37
|
|
|
PR ADRENALIN EPINEPHRINE INJECT
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J0171
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna Commercial |
$0.98
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: BCBS MAPPO |
$0.73
|
| Rate for Payer: BCBS Trust/PPO |
$0.15
|
| Rate for Payer: BCN Commercial |
$0.14
|
| Rate for Payer: BCN Medicare Advantage |
$0.73
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Cofinity Commercial |
$0.98
|
| Rate for Payer: Cofinity Commercial |
$1.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.73
|
| Rate for Payer: Healthscope Commercial |
$0.88
|
| Rate for Payer: Healthscope Whirlpool |
$0.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.77
|
| Rate for Payer: PACE SWMI |
$0.73
|
| Rate for Payer: PHP Medicare Advantage |
$0.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$0.73
|
| Rate for Payer: UHC Medicare Advantage |
$0.75
|
|
|
PR ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 99498
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$533.05 |
| Rate for Payer: Aetna Commercial |
$72.67
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$533.05
|
| Rate for Payer: BCN Commercial |
$75.95
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.17
|
| Rate for Payer: Priority Health Narrow Network |
$92.17
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$569.51 |
| Rate for Payer: Aetna Commercial |
$99.07
|
| Rate for Payer: Aetna Medicare |
$73.93
|
| Rate for Payer: BCBS Complete |
$50.10
|
| Rate for Payer: BCBS MAPPO |
$73.93
|
| Rate for Payer: BCBS Trust/PPO |
$569.51
|
| Rate for Payer: BCN Commercial |
$87.77
|
| Rate for Payer: BCN Medicare Advantage |
$73.93
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$106.46
|
| Rate for Payer: Cofinity Commercial |
$99.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.93
|
| Rate for Payer: Healthscope Commercial |
$81.32
|
| Rate for Payer: Healthscope Whirlpool |
$81.32
|
| Rate for Payer: Meridian Medicaid |
$50.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$77.63
|
| Rate for Payer: PACE SWMI |
$73.93
|
| Rate for Payer: PHP Medicare Advantage |
$73.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.42
|
| Rate for Payer: Priority Health Medicare |
$73.93
|
| Rate for Payer: Priority Health Narrow Network |
$97.42
|
| Rate for Payer: UHC Medicare Advantage |
$76.15
|
|
|
PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 92651
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$3,831.23 |
| Rate for Payer: Aetna Commercial |
$109.00
|
| Rate for Payer: Aetna Medicare |
$81.34
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$81.34
|
| Rate for Payer: BCBS Trust/PPO |
$3,831.23
|
| Rate for Payer: BCN Commercial |
$123.64
|
| Rate for Payer: BCN Medicare Advantage |
$81.34
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$109.00
|
| Rate for Payer: Cofinity Commercial |
$117.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.34
|
| Rate for Payer: Healthscope Commercial |
$97.61
|
| Rate for Payer: Healthscope Whirlpool |
$97.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.41
|
| Rate for Payer: PACE SWMI |
$81.34
|
| Rate for Payer: PHP Medicare Advantage |
$81.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.63
|
| Rate for Payer: Priority Health Medicare |
$81.34
|
| Rate for Payer: Priority Health Narrow Network |
$113.63
|
| Rate for Payer: UHC Medicare Advantage |
$83.78
|
|
|
PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 92653
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$1,917.20 |
| Rate for Payer: Aetna Commercial |
$108.94
|
| Rate for Payer: Aetna Medicare |
$81.30
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS MAPPO |
$81.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,917.20
|
| Rate for Payer: BCN Commercial |
$123.15
|
| Rate for Payer: BCN Medicare Advantage |
$81.30
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$117.07
|
| Rate for Payer: Cofinity Commercial |
$108.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.30
|
| Rate for Payer: Healthscope Commercial |
$97.56
|
| Rate for Payer: Healthscope Whirlpool |
$97.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.36
|
| Rate for Payer: PACE SWMI |
$81.30
|
| Rate for Payer: PHP Medicare Advantage |
$81.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$113.19
|
| Rate for Payer: Priority Health Medicare |
$81.30
|
| Rate for Payer: Priority Health Narrow Network |
$113.19
|
| Rate for Payer: UHC Medicare Advantage |
$83.74
|
|
|
PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 92650
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$1,517.28 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,517.28
|
| Rate for Payer: BCN Commercial |
$40.56
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.28
|
| Rate for Payer: Priority Health Narrow Network |
$37.28
|
|
|
PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 92652
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$4,564.51 |
| Rate for Payer: Aetna Commercial |
$146.49
|
| Rate for Payer: Aetna Medicare |
$109.32
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS MAPPO |
$109.32
|
| Rate for Payer: BCBS Trust/PPO |
$4,564.51
|
| Rate for Payer: BCN Commercial |
$165.18
|
| Rate for Payer: BCN Medicare Advantage |
$109.32
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Cofinity Commercial |
$157.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.32
|
| Rate for Payer: Healthscope Commercial |
$131.18
|
| Rate for Payer: Healthscope Whirlpool |
$131.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$114.79
|
| Rate for Payer: PACE SWMI |
$109.32
|
| Rate for Payer: PHP Medicare Advantage |
$109.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.81
|
| Rate for Payer: Priority Health Medicare |
$109.32
|
| Rate for Payer: Priority Health Narrow Network |
$151.81
|
| Rate for Payer: UHC Medicare Advantage |
$112.60
|
|
|
PR AFO ANKLE GAUNTLET PRE OTS
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS L1902
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$70.88 |
| Rate for Payer: Aetna Commercial |
$44.96
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: BCN Commercial |
$70.88
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
|
