|
PR COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
HCPCS 51729
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$2,879.24 |
| Rate for Payer: Aetna Commercial |
$491.27
|
| Rate for Payer: Aetna Medicare |
$366.62
|
| Rate for Payer: BCBS Complete |
$280.80
|
| Rate for Payer: BCBS MAPPO |
$366.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,879.24
|
| Rate for Payer: BCN Commercial |
$565.89
|
| Rate for Payer: BCN Medicare Advantage |
$366.62
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cash Price |
$561.60
|
| Rate for Payer: Cofinity Commercial |
$527.93
|
| Rate for Payer: Cofinity Commercial |
$491.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$366.62
|
| Rate for Payer: Healthscope Commercial |
$439.94
|
| Rate for Payer: Healthscope Whirlpool |
$439.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$384.95
|
| Rate for Payer: PACE SWMI |
$366.62
|
| Rate for Payer: PHP Medicare Advantage |
$366.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$491.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$625.73
|
| Rate for Payer: Priority Health Medicare |
$366.62
|
| Rate for Payer: Priority Health Narrow Network |
$625.73
|
| Rate for Payer: UHC Medicare Advantage |
$377.62
|
|
|
PR COMPLX INTRACRANIAL ARYSM CAROTID CIRCULATION
|
Professional
|
Both
|
$10,100.00
|
|
|
Service Code
|
HCPCS 61697
|
| Min. Negotiated Rate |
$736.98 |
| Max. Negotiated Rate |
$8,609.74 |
| Rate for Payer: Aetna Commercial |
$5,701.32
|
| Rate for Payer: Aetna Medicare |
$4,254.72
|
| Rate for Payer: BCBS Complete |
$2,859.59
|
| Rate for Payer: BCBS MAPPO |
$4,254.72
|
| Rate for Payer: BCBS Trust/PPO |
$736.98
|
| Rate for Payer: BCN Commercial |
$8,609.74
|
| Rate for Payer: BCN Medicare Advantage |
$4,254.72
|
| Rate for Payer: Cash Price |
$8,080.00
|
| Rate for Payer: Cash Price |
$8,080.00
|
| Rate for Payer: Cofinity Commercial |
$6,126.80
|
| Rate for Payer: Cofinity Commercial |
$5,701.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,254.72
|
| Rate for Payer: Healthscope Commercial |
$5,105.66
|
| Rate for Payer: Healthscope Whirlpool |
$5,105.66
|
| Rate for Payer: Meridian Medicaid |
$2,859.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4,467.46
|
| Rate for Payer: PACE SWMI |
$4,254.72
|
| Rate for Payer: PHP Medicare Advantage |
$4,254.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,723.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7,070.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7,191.03
|
| Rate for Payer: Priority Health Medicare |
$4,254.72
|
| Rate for Payer: Priority Health Narrow Network |
$7,191.03
|
| Rate for Payer: UHC Medicare Advantage |
$4,382.36
|
|
|
PR COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 92557
|
| Min. Negotiated Rate |
$20.02 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$41.46
|
| Rate for Payer: Aetna Medicare |
$30.94
|
| Rate for Payer: BCBS Complete |
$21.02
|
| Rate for Payer: BCBS MAPPO |
$30.94
|
| Rate for Payer: BCBS Trust/PPO |
$196.00
|
| Rate for Payer: BCN Commercial |
$53.75
|
| Rate for Payer: BCN Medicare Advantage |
$30.94
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$44.55
|
| Rate for Payer: Cofinity Commercial |
$41.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.94
|
| Rate for Payer: Healthscope Commercial |
$37.13
|
| Rate for Payer: Healthscope Whirlpool |
$37.13
|
| Rate for Payer: Meridian Medicaid |
$21.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.49
|
| Rate for Payer: PACE SWMI |
$30.94
|
| Rate for Payer: PHP Medicare Advantage |
$30.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.21
|
| Rate for Payer: Priority Health Medicare |
$30.94
|
| Rate for Payer: Priority Health Narrow Network |
$42.21
|
| Rate for Payer: UHC Medicare Advantage |
$31.87
|
|
|
PR COMPRE ELECTROPHYSIOLOGIC ARRHYTHMIA INDUCTION
|
Professional
|
Both
|
$1,293.00
|
|
|
Service Code
|
HCPCS 93620
|
| Min. Negotiated Rate |
$517.20 |
| Max. Negotiated Rate |
$7,115.72 |
| Rate for Payer: Aetna Commercial |
$1,103.18
|
| Rate for Payer: BCBS Complete |
$517.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,200.30
|
| Rate for Payer: BCN Commercial |
$7,115.72
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Cash Price |
$1,034.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$905.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,145.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,145.76
|
|
|
PR COMPRE ELECTROPHYSIOL XM W/LEFT ATRIAL PACNG/REC
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 93621
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$1,640.93 |
| Rate for Payer: Aetna Commercial |
$205.99
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,215.62
|
| Rate for Payer: BCN Commercial |
$1,640.93
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.79
|
| Rate for Payer: Priority Health Narrow Network |
$151.79
|
|
|
PR COMPRE EP EVAL ABLTJ 3D MAPG TX SVT
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 93653
|
| Min. Negotiated Rate |
$520.15 |
| Max. Negotiated Rate |
$2,938.40 |
| Rate for Payer: Aetna Commercial |
$1,107.35
|
| Rate for Payer: Aetna Medicare |
$826.38
|
| Rate for Payer: BCBS Complete |
$546.16
|
| Rate for Payer: BCBS MAPPO |
$826.38
|
| Rate for Payer: BCBS Trust/PPO |
$2,938.40
|
| Rate for Payer: BCN Commercial |
$1,207.03
|
| Rate for Payer: BCN Medicare Advantage |
$826.38
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cofinity Commercial |
$1,189.99
|
| Rate for Payer: Cofinity Commercial |
$1,107.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$826.38
|
| Rate for Payer: Healthscope Commercial |
$991.66
|
| Rate for Payer: Healthscope Whirlpool |
$991.66
|
| Rate for Payer: Meridian Medicaid |
$546.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$867.70
|
| Rate for Payer: PACE SWMI |
$826.38
|
| Rate for Payer: PHP Medicare Advantage |
$826.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$520.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,204.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,167.98
|
| Rate for Payer: Priority Health Medicare |
$826.38
|
| Rate for Payer: Priority Health Narrow Network |
$1,167.98
|
| Rate for Payer: UHC Medicare Advantage |
$851.17
|
|
|
PR COMPRE EP EVAL ABLTJ 3D MAPG TX VT
|
Professional
|
Both
|
$2,304.00
|
|
|
Service Code
|
HCPCS 93654
|
| Min. Negotiated Rate |
$626.65 |
| Max. Negotiated Rate |
$3,268.06 |
| Rate for Payer: Aetna Commercial |
$1,334.77
|
| Rate for Payer: Aetna Medicare |
$996.10
|
| Rate for Payer: BCBS Complete |
$657.98
|
| Rate for Payer: BCBS MAPPO |
$996.10
|
| Rate for Payer: BCBS Trust/PPO |
$3,268.06
|
| Rate for Payer: BCN Commercial |
$1,454.79
|
| Rate for Payer: BCN Medicare Advantage |
$996.10
|
| Rate for Payer: Cash Price |
$1,843.20
|
| Rate for Payer: Cash Price |
$1,843.20
|
| Rate for Payer: Cofinity Commercial |
$1,434.38
|
| Rate for Payer: Cofinity Commercial |
$1,334.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$996.10
|
| Rate for Payer: Healthscope Commercial |
$1,195.32
|
| Rate for Payer: Healthscope Whirlpool |
$1,195.32
|
| Rate for Payer: Meridian Medicaid |
$657.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,045.90
|
| Rate for Payer: PACE SWMI |
$996.10
|
| Rate for Payer: PHP Medicare Advantage |
$996.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$626.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,612.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,407.73
|
| Rate for Payer: Priority Health Medicare |
$996.10
|
| Rate for Payer: Priority Health Narrow Network |
$1,407.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,025.98
|
|
|
PR COMPRE EP EVAL ABLTJ ATR FIB PULM VEIN ISOLATION
|
Professional
|
Both
|
$1,806.00
|
|
|
Service Code
|
HCPCS 93656
|
| Min. Negotiated Rate |
$589.80 |
| Max. Negotiated Rate |
$3,385.35 |
| Rate for Payer: Aetna Commercial |
$1,255.73
|
| Rate for Payer: Aetna Medicare |
$937.11
|
| Rate for Payer: BCBS Complete |
$619.29
|
| Rate for Payer: BCBS MAPPO |
$937.11
|
| Rate for Payer: BCBS Trust/PPO |
$3,385.35
|
| Rate for Payer: BCN Commercial |
$1,368.79
|
| Rate for Payer: BCN Medicare Advantage |
$937.11
|
| Rate for Payer: Cash Price |
$1,444.80
|
| Rate for Payer: Cash Price |
$1,444.80
|
| Rate for Payer: Cofinity Commercial |
$1,255.73
|
| Rate for Payer: Cofinity Commercial |
$1,349.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$937.11
|
| Rate for Payer: Healthscope Commercial |
$1,124.53
|
| Rate for Payer: Healthscope Whirlpool |
$1,124.53
|
| Rate for Payer: Meridian Medicaid |
$619.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$983.97
|
| Rate for Payer: PACE SWMI |
$937.11
|
| Rate for Payer: PHP Medicare Advantage |
$937.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$589.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,264.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,324.50
|
| Rate for Payer: Priority Health Medicare |
$937.11
|
| Rate for Payer: Priority Health Narrow Network |
$1,324.50
|
| Rate for Payer: UHC Medicare Advantage |
$965.22
|
|
|
PR CONDITIONING PLAY AUDIOMETRY
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS 92582
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$2,061.43 |
| Rate for Payer: Aetna Commercial |
$101.42
|
| Rate for Payer: Aetna Medicare |
$75.69
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS MAPPO |
$75.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,061.43
|
| Rate for Payer: BCN Commercial |
$119.72
|
| Rate for Payer: BCN Medicare Advantage |
$75.69
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$108.99
|
| Rate for Payer: Cofinity Commercial |
$101.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.69
|
| Rate for Payer: Healthscope Commercial |
$90.83
|
| Rate for Payer: Healthscope Whirlpool |
$90.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.47
|
| Rate for Payer: PACE SWMI |
$75.69
|
| Rate for Payer: PHP Medicare Advantage |
$75.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.04
|
| Rate for Payer: Priority Health Medicare |
$75.69
|
| Rate for Payer: Priority Health Narrow Network |
$110.04
|
| Rate for Payer: UHC Medicare Advantage |
$77.96
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
IP
|
$906.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
57522
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$634.20 |
| Max. Negotiated Rate |
$906.00 |
| Rate for Payer: Aetna Commercial |
$815.40
|
| Rate for Payer: ASR ASR |
$878.82
|
| Rate for Payer: BCBS Trust/PPO |
$702.42
|
| Rate for Payer: BCN Commercial |
$702.42
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$851.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.80
|
| Rate for Payer: Healthscope Commercial |
$906.00
|
| Rate for Payer: Healthscope Whirlpool |
$878.82
|
| Rate for Payer: Mclaren Commercial |
$815.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$797.28
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Facility
|
OP
|
$906.00
|
|
|
Service Code
|
CPT 57522
|
| Hospital Charge Code |
57522
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$322.14 |
| Max. Negotiated Rate |
$3,473.69 |
| Rate for Payer: Aetna Commercial |
$815.40
|
| Rate for Payer: Aetna Medicare |
$2,778.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,473.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,473.69
|
| Rate for Payer: ASR ASR |
$878.82
|
| Rate for Payer: BCBS Complete |
$1,596.23
|
| Rate for Payer: BCBS MAPPO |
$2,778.95
|
| Rate for Payer: BCBS Trust/PPO |
$702.42
|
| Rate for Payer: BCCCP Commercial |
$322.14
|
| Rate for Payer: BCN Commercial |
$702.42
|
| Rate for Payer: BCN Medicare Advantage |
$2,778.95
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$851.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$724.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,778.95
|
| Rate for Payer: Healthscope Commercial |
$906.00
|
| Rate for Payer: Healthscope Whirlpool |
$878.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$2,778.95
|
| Rate for Payer: Mclaren Commercial |
$815.40
|
| Rate for Payer: Mclaren Medicaid |
$1,520.09
|
| Rate for Payer: Mclaren Medicare |
$2,778.95
|
| Rate for Payer: Meridian Medicaid |
$1,596.23
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,917.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$770.10
|
| Rate for Payer: PACE Medicare |
$2,640.00
|
| Rate for Payer: PACE SWMI |
$2,778.95
|
| Rate for Payer: PHP Commercial |
$3,056.84
|
| Rate for Payer: PHP Medicaid |
$1,520.09
|
| Rate for Payer: PHP Medicare Advantage |
$2,778.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,520.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$824.46
|
| Rate for Payer: Priority Health Medicare |
$2,778.95
|
| Rate for Payer: Priority Health Narrow Network |
$643.26
|
| Rate for Payer: Railroad Medicare Medicare |
$2,778.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$797.28
|
| Rate for Payer: UHC Medicare Advantage |
$2,862.32
|
| Rate for Payer: VA VA |
$2,778.95
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 57522
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$3,117.50 |
| Rate for Payer: Aetna Commercial |
$336.54
|
| Rate for Payer: Aetna Medicare |
$251.15
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCBS MAPPO |
$251.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,117.50
|
| Rate for Payer: BCN Commercial |
$447.14
|
| Rate for Payer: BCN Medicare Advantage |
$251.15
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$361.66
|
| Rate for Payer: Cofinity Commercial |
$336.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.15
|
| Rate for Payer: Healthscope Commercial |
$301.38
|
| Rate for Payer: Healthscope Whirlpool |
$301.38
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.71
|
| Rate for Payer: PACE SWMI |
$251.15
|
| Rate for Payer: PHP Medicare Advantage |
$251.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.11
|
| Rate for Payer: Priority Health Medicare |
$251.15
|
| Rate for Payer: Priority Health Narrow Network |
$363.11
|
| Rate for Payer: UHC Medicare Advantage |
$258.68
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR ELTRD EXC
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
HCPCS 57522
|
| Hospital Charge Code |
57522
|
| Min. Negotiated Rate |
$164.86 |
| Max. Negotiated Rate |
$3,117.50 |
| Rate for Payer: Aetna Commercial |
$336.54
|
| Rate for Payer: Aetna Medicare |
$251.15
|
| Rate for Payer: BCBS Complete |
$173.10
|
| Rate for Payer: BCBS MAPPO |
$251.15
|
| Rate for Payer: BCBS Trust/PPO |
$3,117.50
|
| Rate for Payer: BCN Commercial |
$447.14
|
| Rate for Payer: BCN Medicare Advantage |
$251.15
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cofinity Commercial |
$361.66
|
| Rate for Payer: Cofinity Commercial |
$336.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.15
|
| Rate for Payer: Healthscope Commercial |
$301.38
|
| Rate for Payer: Healthscope Whirlpool |
$301.38
|
| Rate for Payer: Meridian Medicaid |
$173.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$263.71
|
| Rate for Payer: PACE SWMI |
$251.15
|
| Rate for Payer: PHP Medicare Advantage |
$251.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$634.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$363.11
|
| Rate for Payer: Priority Health Medicare |
$251.15
|
| Rate for Payer: Priority Health Narrow Network |
$363.11
|
| Rate for Payer: UHC Medicare Advantage |
$258.68
|
|
|
PR CONIZATION CERVIX W/WO D&C RPR KNIFE/LASER
|
Professional
|
Both
|
$1,019.00
|
|
|
Service Code
|
HCPCS 57520
|
| Min. Negotiated Rate |
$191.70 |
| Max. Negotiated Rate |
$1,148.52 |
| Rate for Payer: Aetna Commercial |
$390.62
|
| Rate for Payer: Aetna Medicare |
$291.51
|
| Rate for Payer: BCBS Complete |
$201.28
|
| Rate for Payer: BCBS MAPPO |
$291.51
|
| Rate for Payer: BCBS Trust/PPO |
$1,148.52
|
| Rate for Payer: BCN Commercial |
$520.93
|
| Rate for Payer: BCN Medicare Advantage |
$291.51
|
| Rate for Payer: Cash Price |
$815.20
|
| Rate for Payer: Cash Price |
$815.20
|
| Rate for Payer: Cofinity Commercial |
$419.77
|
| Rate for Payer: Cofinity Commercial |
$390.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$291.51
|
| Rate for Payer: Healthscope Commercial |
$349.81
|
| Rate for Payer: Healthscope Whirlpool |
$349.81
|
| Rate for Payer: Meridian Medicaid |
$201.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$306.09
|
| Rate for Payer: PACE SWMI |
$291.51
|
| Rate for Payer: PHP Medicare Advantage |
$291.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$422.29
|
| Rate for Payer: Priority Health Medicare |
$291.51
|
| Rate for Payer: Priority Health Narrow Network |
$422.29
|
| Rate for Payer: UHC Medicare Advantage |
$300.26
|
|
|
PR CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT
|
Professional
|
Both
|
$1,668.00
|
|
|
Service Code
|
HCPCS 57291
|
| Min. Negotiated Rate |
$354.43 |
| Max. Negotiated Rate |
$1,525.20 |
| Rate for Payer: Aetna Commercial |
$729.21
|
| Rate for Payer: Aetna Medicare |
$544.19
|
| Rate for Payer: BCBS Complete |
$372.15
|
| Rate for Payer: BCBS MAPPO |
$544.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,525.20
|
| Rate for Payer: BCN Commercial |
$807.78
|
| Rate for Payer: BCN Medicare Advantage |
$544.19
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cash Price |
$1,334.40
|
| Rate for Payer: Cofinity Commercial |
$729.21
|
| Rate for Payer: Cofinity Commercial |
$783.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$544.19
|
| Rate for Payer: Healthscope Commercial |
$653.03
|
| Rate for Payer: Healthscope Whirlpool |
$653.03
|
| Rate for Payer: Meridian Medicaid |
$372.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$571.40
|
| Rate for Payer: PACE SWMI |
$544.19
|
| Rate for Payer: PHP Medicare Advantage |
$544.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$354.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,167.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$782.58
|
| Rate for Payer: Priority Health Medicare |
$544.19
|
| Rate for Payer: Priority Health Narrow Network |
$782.58
|
| Rate for Payer: UHC Medicare Advantage |
$560.52
|
|
|
PR CONSULTS
|
Professional
|
Both
|
$500.00
|
|
|
Service Code
|
HCPCS 00125
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: BCBS Complete |
$200.00
|
| Rate for Payer: Cash Price |
$400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$350.00
|
|
|
PR CONT GLUC MNTR PHYSICIAN/QHP PROVIDED EQUIPMENT
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 95250
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$424.22 |
| Rate for Payer: Aetna Commercial |
$179.83
|
| Rate for Payer: Aetna Medicare |
$134.20
|
| Rate for Payer: BCBS Complete |
$107.60
|
| Rate for Payer: BCBS MAPPO |
$134.20
|
| Rate for Payer: BCBS Trust/PPO |
$424.22
|
| Rate for Payer: BCN Commercial |
$212.08
|
| Rate for Payer: BCN Medicare Advantage |
$134.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$193.25
|
| Rate for Payer: Cofinity Commercial |
$179.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.20
|
| Rate for Payer: Healthscope Commercial |
$161.04
|
| Rate for Payer: Healthscope Whirlpool |
$161.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$140.91
|
| Rate for Payer: PACE SWMI |
$134.20
|
| Rate for Payer: PHP Medicare Advantage |
$134.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$194.93
|
| Rate for Payer: Priority Health Medicare |
$134.20
|
| Rate for Payer: Priority Health Narrow Network |
$194.93
|
| Rate for Payer: UHC Medicare Advantage |
$138.23
|
|
|
PR CONT GLUC MONITORING PATIENT PROVIDED EQUIPMENT
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 95249
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$234.04 |
| Rate for Payer: Aetna Commercial |
$75.59
|
| Rate for Payer: Aetna Medicare |
$56.41
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$56.41
|
| Rate for Payer: BCBS Trust/PPO |
$234.04
|
| Rate for Payer: BCN Medicare Advantage |
$56.41
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cofinity Commercial |
$75.59
|
| Rate for Payer: Cofinity Commercial |
$81.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.41
|
| Rate for Payer: Healthscope Commercial |
$67.69
|
| Rate for Payer: Healthscope Whirlpool |
$67.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$59.23
|
| Rate for Payer: PACE SWMI |
$56.41
|
| Rate for Payer: PHP Medicare Advantage |
$56.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.74
|
| Rate for Payer: Priority Health Medicare |
$56.41
|
| Rate for Payer: Priority Health Narrow Network |
$81.74
|
| Rate for Payer: UHC Medicare Advantage |
$58.10
|
|
|
PR CONTINENT DVRJ W/INT ANAST ANY SGM SM&/LG INTSTN
|
Professional
|
Both
|
$3,367.00
|
|
|
Service Code
|
HCPCS 50825
|
| Min. Negotiated Rate |
$1,040.51 |
| Max. Negotiated Rate |
$3,355.23 |
| Rate for Payer: Aetna Commercial |
$2,151.04
|
| Rate for Payer: Aetna Medicare |
$1,605.25
|
| Rate for Payer: BCBS Complete |
$1,092.54
|
| Rate for Payer: BCBS MAPPO |
$1,605.25
|
| Rate for Payer: BCBS Trust/PPO |
$3,355.23
|
| Rate for Payer: BCN Commercial |
$2,362.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,605.25
|
| Rate for Payer: Cash Price |
$2,693.60
|
| Rate for Payer: Cash Price |
$2,693.60
|
| Rate for Payer: Cofinity Commercial |
$2,151.04
|
| Rate for Payer: Cofinity Commercial |
$2,311.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,605.25
|
| Rate for Payer: Healthscope Commercial |
$1,926.30
|
| Rate for Payer: Healthscope Whirlpool |
$1,926.30
|
| Rate for Payer: Meridian Medicaid |
$1,092.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,685.51
|
| Rate for Payer: PACE SWMI |
$1,605.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,605.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,040.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,356.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,612.09
|
| Rate for Payer: Priority Health Medicare |
$1,605.25
|
| Rate for Payer: Priority Health Narrow Network |
$2,612.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,653.41
|
|
|
PR CONTINENT ILEOSTOMY KOCK PROCEDURE SPX
|
Professional
|
Both
|
$3,962.00
|
|
|
Service Code
|
HCPCS 44316
|
| Min. Negotiated Rate |
$202.06 |
| Max. Negotiated Rate |
$2,773.40 |
| Rate for Payer: Aetna Commercial |
$1,887.47
|
| Rate for Payer: Aetna Medicare |
$1,408.56
|
| Rate for Payer: BCBS Complete |
$949.62
|
| Rate for Payer: BCBS MAPPO |
$1,408.56
|
| Rate for Payer: BCBS Trust/PPO |
$202.06
|
| Rate for Payer: BCN Commercial |
$2,064.66
|
| Rate for Payer: BCN Medicare Advantage |
$1,408.56
|
| Rate for Payer: Cash Price |
$3,169.60
|
| Rate for Payer: Cash Price |
$3,169.60
|
| Rate for Payer: Cofinity Commercial |
$2,028.33
|
| Rate for Payer: Cofinity Commercial |
$1,887.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,408.56
|
| Rate for Payer: Healthscope Commercial |
$1,690.27
|
| Rate for Payer: Healthscope Whirlpool |
$1,690.27
|
| Rate for Payer: Meridian Medicaid |
$949.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,478.99
|
| Rate for Payer: PACE SWMI |
$1,408.56
|
| Rate for Payer: PHP Medicare Advantage |
$1,408.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$904.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,773.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,484.18
|
| Rate for Payer: Priority Health Medicare |
$1,408.56
|
| Rate for Payer: Priority Health Narrow Network |
$2,484.18
|
| Rate for Payer: UHC Medicare Advantage |
$1,450.82
|
|
|
PR CONT INTRAOP NEURO MONITOR
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS G0453
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$1,643.01 |
| Rate for Payer: Aetna Commercial |
$41.61
|
| Rate for Payer: Aetna Medicare |
$31.05
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$31.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,643.01
|
| Rate for Payer: BCN Commercial |
$45.94
|
| Rate for Payer: BCN Medicare Advantage |
$31.05
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$41.61
|
| Rate for Payer: Cofinity Commercial |
$44.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.05
|
| Rate for Payer: Healthscope Commercial |
$37.26
|
| Rate for Payer: Healthscope Whirlpool |
$37.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.60
|
| Rate for Payer: PACE SWMI |
$31.05
|
| Rate for Payer: PHP Medicare Advantage |
$31.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.21
|
| Rate for Payer: Priority Health Medicare |
$31.05
|
| Rate for Payer: Priority Health Narrow Network |
$42.21
|
| Rate for Payer: UHC Medicare Advantage |
$31.98
|
|
|
PR CONTINUOUS GLUCOSE MONITORING ANALYSIS I&R
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 95251
|
| Min. Negotiated Rate |
$21.94 |
| Max. Negotiated Rate |
$534.11 |
| Rate for Payer: Aetna Commercial |
$45.32
|
| Rate for Payer: Aetna Medicare |
$33.82
|
| Rate for Payer: BCBS Complete |
$23.04
|
| Rate for Payer: BCBS MAPPO |
$33.82
|
| Rate for Payer: BCBS Trust/PPO |
$534.11
|
| Rate for Payer: BCN Commercial |
$49.85
|
| Rate for Payer: BCN Medicare Advantage |
$33.82
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$48.70
|
| Rate for Payer: Cofinity Commercial |
$45.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.82
|
| Rate for Payer: Healthscope Commercial |
$40.58
|
| Rate for Payer: Healthscope Whirlpool |
$40.58
|
| Rate for Payer: Meridian Medicaid |
$23.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.51
|
| Rate for Payer: PACE SWMI |
$33.82
|
| Rate for Payer: PHP Medicare Advantage |
$33.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.81
|
| Rate for Payer: Priority Health Medicare |
$33.82
|
| Rate for Payer: Priority Health Narrow Network |
$45.81
|
| Rate for Payer: UHC Medicare Advantage |
$34.83
|
|
|
PR CONTINUOUS INHALATION TREATMENT 1ST HR
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 94644
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$270.49 |
| Rate for Payer: Aetna Commercial |
$73.71
|
| Rate for Payer: Aetna Medicare |
$55.01
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$55.01
|
| Rate for Payer: BCBS Trust/PPO |
$270.49
|
| Rate for Payer: BCN Commercial |
$86.99
|
| Rate for Payer: BCN Medicare Advantage |
$55.01
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$73.71
|
| Rate for Payer: Cofinity Commercial |
$79.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.01
|
| Rate for Payer: Healthscope Commercial |
$66.01
|
| Rate for Payer: Healthscope Whirlpool |
$66.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.76
|
| Rate for Payer: PACE SWMI |
$55.01
|
| Rate for Payer: PHP Medicare Advantage |
$55.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.95
|
| Rate for Payer: Priority Health Medicare |
$55.01
|
| Rate for Payer: Priority Health Narrow Network |
$79.95
|
| Rate for Payer: UHC Medicare Advantage |
$56.66
|
|
|
PR CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI TUBE
|
Professional
|
Both
|
$60.68
|
|
|
Service Code
|
HCPCS 49465
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$1,618.71 |
| Rate for Payer: Aetna Commercial |
$40.19
|
| Rate for Payer: Aetna Medicare |
$29.99
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS MAPPO |
$29.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,618.71
|
| Rate for Payer: BCN Commercial |
$200.85
|
| Rate for Payer: BCN Medicare Advantage |
$29.99
|
| Rate for Payer: Cash Price |
$48.54
|
| Rate for Payer: Cash Price |
$48.54
|
| Rate for Payer: Cofinity Commercial |
$40.19
|
| Rate for Payer: Cofinity Commercial |
$43.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.99
|
| Rate for Payer: Healthscope Commercial |
$35.99
|
| Rate for Payer: Healthscope Whirlpool |
$35.99
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.49
|
| Rate for Payer: PACE SWMI |
$29.99
|
| Rate for Payer: PHP Medicare Advantage |
$29.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.92
|
| Rate for Payer: Priority Health Medicare |
$29.99
|
| Rate for Payer: Priority Health Narrow Network |
$52.92
|
| Rate for Payer: UHC Medicare Advantage |
$30.89
|
|
|
PR CONTROL NASAL HEMORRHAGE ANTERIOR COMPLEX
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 30903
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$798.79 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna Medicare |
$77.41
|
| Rate for Payer: BCBS Complete |
$51.44
|
| Rate for Payer: BCBS MAPPO |
$77.41
|
| Rate for Payer: BCBS Trust/PPO |
$798.79
|
| Rate for Payer: BCN Commercial |
$363.58
|
| Rate for Payer: BCN Medicare Advantage |
$77.41
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$111.47
|
| Rate for Payer: Cofinity Commercial |
$103.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.41
|
| Rate for Payer: Healthscope Commercial |
$92.89
|
| Rate for Payer: Healthscope Whirlpool |
$92.89
|
| Rate for Payer: Meridian Medicaid |
$51.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.28
|
| Rate for Payer: PACE SWMI |
$77.41
|
| Rate for Payer: PHP Medicare Advantage |
$77.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.96
|
| Rate for Payer: Priority Health Medicare |
$77.41
|
| Rate for Payer: Priority Health Narrow Network |
$106.96
|
| Rate for Payer: UHC Medicare Advantage |
$79.73
|
|
