|
PR DISPENSING FEE, MONAURAL
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS V5241
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
|
|
PR DISP FEE CONTRALATERAL BINAU
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS V5240
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$248.26
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
|
|
PR DISP FEE CONTRALATERAL MONAU
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS V5200
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$239.68 |
| Rate for Payer: Aetna Commercial |
$239.68
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 38542
|
| Min. Negotiated Rate |
$336.75 |
| Max. Negotiated Rate |
$1,136.49 |
| Rate for Payer: Aetna Commercial |
$691.15
|
| Rate for Payer: Aetna Medicare |
$515.78
|
| Rate for Payer: BCBS Complete |
$353.59
|
| Rate for Payer: BCBS MAPPO |
$515.78
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$766.73
|
| Rate for Payer: BCN Medicare Advantage |
$515.78
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$691.15
|
| Rate for Payer: Cofinity Commercial |
$742.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$515.78
|
| Rate for Payer: Healthscope Commercial |
$618.94
|
| Rate for Payer: Healthscope Whirlpool |
$618.94
|
| Rate for Payer: Meridian Medicaid |
$353.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$541.57
|
| Rate for Payer: PACE SWMI |
$515.78
|
| Rate for Payer: PHP Medicare Advantage |
$515.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.49
|
| Rate for Payer: Priority Health Medicare |
$515.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,136.49
|
| Rate for Payer: UHC Medicare Advantage |
$531.25
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
OP
|
$920.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$644.00 |
| Max. Negotiated Rate |
$6,411.01 |
| Rate for Payer: Aetna Commercial |
$828.00
|
| Rate for Payer: Aetna Medicare |
$5,128.81
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,411.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,411.01
|
| Rate for Payer: ASR ASR |
$892.40
|
| Rate for Payer: BCBS Complete |
$2,945.99
|
| Rate for Payer: BCBS MAPPO |
$5,128.81
|
| Rate for Payer: BCBS Trust/PPO |
$713.28
|
| Rate for Payer: BCN Commercial |
$713.28
|
| Rate for Payer: BCN Medicare Advantage |
$5,128.81
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$864.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,128.81
|
| Rate for Payer: Healthscope Commercial |
$920.00
|
| Rate for Payer: Healthscope Whirlpool |
$892.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$5,128.81
|
| Rate for Payer: Mclaren Commercial |
$828.00
|
| Rate for Payer: Mclaren Medicaid |
$2,805.46
|
| Rate for Payer: Mclaren Medicare |
$5,128.81
|
| Rate for Payer: Meridian Medicaid |
$2,945.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5,385.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,898.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$782.00
|
| Rate for Payer: PACE Medicare |
$4,872.37
|
| Rate for Payer: PACE SWMI |
$5,128.81
|
| Rate for Payer: PHP Commercial |
$5,641.69
|
| Rate for Payer: PHP Medicaid |
$2,805.46
|
| Rate for Payer: PHP Medicare Advantage |
$5,128.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,805.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$837.20
|
| Rate for Payer: Priority Health Medicare |
$5,128.81
|
| Rate for Payer: Priority Health Narrow Network |
$653.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5,128.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$809.60
|
| Rate for Payer: UHC Medicare Advantage |
$5,282.67
|
| Rate for Payer: VA VA |
$5,128.81
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Facility
|
IP
|
$920.00
|
|
|
Service Code
|
CPT 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$644.00 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$828.00
|
| Rate for Payer: ASR ASR |
$892.40
|
| Rate for Payer: BCBS Trust/PPO |
$713.28
|
| Rate for Payer: BCN Commercial |
$713.28
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$864.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$736.00
|
| Rate for Payer: Healthscope Commercial |
$920.00
|
| Rate for Payer: Healthscope Whirlpool |
$892.40
|
| Rate for Payer: Mclaren Commercial |
$828.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$782.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$809.60
|
|
|
PR DISSECTION DEEP JUGULAR NODE
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
HCPCS 38542
|
| Hospital Charge Code |
38542
|
| Min. Negotiated Rate |
$336.75 |
| Max. Negotiated Rate |
$1,136.49 |
| Rate for Payer: Aetna Commercial |
$691.15
|
| Rate for Payer: Aetna Medicare |
$515.78
|
| Rate for Payer: BCBS Complete |
$353.59
|
| Rate for Payer: BCBS MAPPO |
$515.78
|
| Rate for Payer: BCBS Trust/PPO |
$975.24
|
| Rate for Payer: BCN Commercial |
$766.73
|
| Rate for Payer: BCN Medicare Advantage |
$515.78
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cofinity Commercial |
$742.72
|
| Rate for Payer: Cofinity Commercial |
$691.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$515.78
|
| Rate for Payer: Healthscope Commercial |
$618.94
|
| Rate for Payer: Healthscope Whirlpool |
$618.94
|
| Rate for Payer: Meridian Medicaid |
$353.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$541.57
|
| Rate for Payer: PACE SWMI |
$515.78
|
| Rate for Payer: PHP Medicare Advantage |
$515.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$644.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,136.49
|
| Rate for Payer: Priority Health Medicare |
$515.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,136.49
|
| Rate for Payer: UHC Medicare Advantage |
$531.25
|
|
|
PR DIS SITE TELE SVCS RHC/FQHC
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS G2025
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$1,080.37 |
| Rate for Payer: Aetna Commercial |
$95.30
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,080.37
|
| Rate for Payer: BCN Commercial |
$141.72
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
|
|
PR DISTORT PRODUCT EVOKED OTOACOUSTIC EMISNS LIMITD
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 92587
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$1,890.26 |
| Rate for Payer: Aetna Commercial |
$28.45
|
| Rate for Payer: Aetna Medicare |
$21.23
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCBS MAPPO |
$21.23
|
| Rate for Payer: BCBS Trust/PPO |
$1,890.26
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: BCN Medicare Advantage |
$21.23
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cofinity Commercial |
$30.57
|
| Rate for Payer: Cofinity Commercial |
$28.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.23
|
| Rate for Payer: Healthscope Commercial |
$25.48
|
| Rate for Payer: Healthscope Whirlpool |
$25.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$22.29
|
| Rate for Payer: PACE SWMI |
$21.23
|
| Rate for Payer: PHP Medicare Advantage |
$21.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.20
|
| Rate for Payer: Priority Health Medicare |
$21.23
|
| Rate for Payer: Priority Health Narrow Network |
$29.20
|
| Rate for Payer: UHC Medicare Advantage |
$21.87
|
|
|
PR DISTRT PROD EVOKD OTOACOUSTIC EMSNS COMP/DX EVAL
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 92588
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$1,499.32 |
| Rate for Payer: Aetna Commercial |
$37.21
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,499.32
|
| Rate for Payer: BCN Commercial |
$49.36
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.37
|
| Rate for Payer: Priority Health Narrow Network |
$45.37
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR
|
Professional
|
Both
|
$2,389.00
|
|
|
Service Code
|
HCPCS 43130
|
| Min. Negotiated Rate |
$85.32 |
| Max. Negotiated Rate |
$1,672.30 |
| Rate for Payer: Aetna Commercial |
$1,049.30
|
| Rate for Payer: Aetna Medicare |
$783.06
|
| Rate for Payer: BCBS Complete |
$534.74
|
| Rate for Payer: BCBS MAPPO |
$783.06
|
| Rate for Payer: BCBS Trust/PPO |
$85.32
|
| Rate for Payer: BCN Commercial |
$1,160.61
|
| Rate for Payer: BCN Medicare Advantage |
$783.06
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cash Price |
$1,911.20
|
| Rate for Payer: Cofinity Commercial |
$1,049.30
|
| Rate for Payer: Cofinity Commercial |
$1,127.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$783.06
|
| Rate for Payer: Healthscope Commercial |
$939.67
|
| Rate for Payer: Healthscope Whirlpool |
$939.67
|
| Rate for Payer: Meridian Medicaid |
$534.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$822.21
|
| Rate for Payer: PACE SWMI |
$783.06
|
| Rate for Payer: PHP Medicare Advantage |
$783.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$509.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,672.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,396.43
|
| Rate for Payer: Priority Health Medicare |
$783.06
|
| Rate for Payer: Priority Health Narrow Network |
$1,396.43
|
| Rate for Payer: UHC Medicare Advantage |
$806.55
|
|
|
PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR
|
Professional
|
Both
|
$3,105.00
|
|
|
Service Code
|
HCPCS 43135
|
| Min. Negotiated Rate |
$77.66 |
| Max. Negotiated Rate |
$2,546.50 |
| Rate for Payer: Aetna Commercial |
$1,944.66
|
| Rate for Payer: Aetna Medicare |
$1,451.24
|
| Rate for Payer: BCBS Complete |
$972.88
|
| Rate for Payer: BCBS MAPPO |
$1,451.24
|
| Rate for Payer: BCBS Trust/PPO |
$77.66
|
| Rate for Payer: BCN Commercial |
$2,116.46
|
| Rate for Payer: BCN Medicare Advantage |
$1,451.24
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cash Price |
$2,484.00
|
| Rate for Payer: Cofinity Commercial |
$1,944.66
|
| Rate for Payer: Cofinity Commercial |
$2,089.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,451.24
|
| Rate for Payer: Healthscope Commercial |
$1,741.49
|
| Rate for Payer: Healthscope Whirlpool |
$1,741.49
|
| Rate for Payer: Meridian Medicaid |
$972.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,523.80
|
| Rate for Payer: PACE SWMI |
$1,451.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,451.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$926.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,173.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,546.50
|
| Rate for Payer: Priority Health Medicare |
$1,451.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,546.50
|
| Rate for Payer: UHC Medicare Advantage |
$1,494.78
|
|
|
PR DIVISION ABERRANT VESSEL VASCULAR RING
|
Professional
|
Both
|
$4,150.00
|
|
|
Service Code
|
HCPCS 33802
|
| Min. Negotiated Rate |
$686.71 |
| Max. Negotiated Rate |
$2,905.00 |
| Rate for Payer: Aetna Commercial |
$1,431.46
|
| Rate for Payer: Aetna Medicare |
$1,068.25
|
| Rate for Payer: BCBS Complete |
$721.05
|
| Rate for Payer: BCBS MAPPO |
$1,068.25
|
| Rate for Payer: BCBS Trust/PPO |
$1,485.05
|
| Rate for Payer: BCN Commercial |
$1,564.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,068.25
|
| Rate for Payer: Cash Price |
$3,320.00
|
| Rate for Payer: Cash Price |
$3,320.00
|
| Rate for Payer: Cofinity Commercial |
$1,538.28
|
| Rate for Payer: Cofinity Commercial |
$1,431.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,068.25
|
| Rate for Payer: Healthscope Commercial |
$1,281.90
|
| Rate for Payer: Healthscope Whirlpool |
$1,281.90
|
| Rate for Payer: Meridian Medicaid |
$721.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,121.66
|
| Rate for Payer: PACE SWMI |
$1,068.25
|
| Rate for Payer: PHP Medicare Advantage |
$1,068.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$686.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,905.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,702.80
|
| Rate for Payer: Priority Health Medicare |
$1,068.25
|
| Rate for Payer: Priority Health Narrow Network |
$1,702.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,100.30
|
|
|
PR DIVISION PLANTAR FASCIA & MUSCLE SPX
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 28250
|
| Min. Negotiated Rate |
$266.25 |
| Max. Negotiated Rate |
$3,050.93 |
| Rate for Payer: Aetna Commercial |
$539.04
|
| Rate for Payer: Aetna Medicare |
$402.27
|
| Rate for Payer: BCBS Complete |
$279.56
|
| Rate for Payer: BCBS MAPPO |
$402.27
|
| Rate for Payer: BCBS Trust/PPO |
$3,050.93
|
| Rate for Payer: BCN Commercial |
$856.16
|
| Rate for Payer: BCN Medicare Advantage |
$402.27
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cofinity Commercial |
$539.04
|
| Rate for Payer: Cofinity Commercial |
$579.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$402.27
|
| Rate for Payer: Healthscope Commercial |
$482.72
|
| Rate for Payer: Healthscope Whirlpool |
$482.72
|
| Rate for Payer: Meridian Medicaid |
$279.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$422.38
|
| Rate for Payer: PACE SWMI |
$402.27
|
| Rate for Payer: PHP Medicare Advantage |
$402.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$266.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$899.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$627.58
|
| Rate for Payer: Priority Health Medicare |
$402.27
|
| Rate for Payer: Priority Health Narrow Network |
$627.58
|
| Rate for Payer: UHC Medicare Advantage |
$414.34
|
|
|
PR DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB
|
Professional
|
Both
|
$1,097.00
|
|
|
Service Code
|
HCPCS 21705
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$804.78 |
| Rate for Payer: Aetna Commercial |
$710.09
|
| Rate for Payer: Aetna Medicare |
$529.92
|
| Rate for Payer: BCBS Complete |
$354.49
|
| Rate for Payer: BCBS MAPPO |
$529.92
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$770.16
|
| Rate for Payer: BCN Medicare Advantage |
$529.92
|
| Rate for Payer: Cash Price |
$877.60
|
| Rate for Payer: Cash Price |
$877.60
|
| Rate for Payer: Cofinity Commercial |
$763.08
|
| Rate for Payer: Cofinity Commercial |
$710.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$529.92
|
| Rate for Payer: Healthscope Commercial |
$635.90
|
| Rate for Payer: Healthscope Whirlpool |
$635.90
|
| Rate for Payer: Meridian Medicaid |
$354.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$556.42
|
| Rate for Payer: PACE SWMI |
$529.92
|
| Rate for Payer: PHP Medicare Advantage |
$529.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$337.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$767.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$804.78
|
| Rate for Payer: Priority Health Medicare |
$529.92
|
| Rate for Payer: Priority Health Narrow Network |
$804.78
|
| Rate for Payer: UHC Medicare Advantage |
$545.82
|
|
|
PR DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
HCPCS 21700
|
| Min. Negotiated Rate |
$226.42 |
| Max. Negotiated Rate |
$1,117.06 |
| Rate for Payer: Aetna Commercial |
$473.88
|
| Rate for Payer: Aetna Medicare |
$353.64
|
| Rate for Payer: BCBS Complete |
$237.74
|
| Rate for Payer: BCBS MAPPO |
$353.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.06
|
| Rate for Payer: BCN Commercial |
$516.04
|
| Rate for Payer: BCN Medicare Advantage |
$353.64
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cash Price |
$1,215.20
|
| Rate for Payer: Cofinity Commercial |
$509.24
|
| Rate for Payer: Cofinity Commercial |
$473.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.64
|
| Rate for Payer: Healthscope Commercial |
$424.37
|
| Rate for Payer: Healthscope Whirlpool |
$424.37
|
| Rate for Payer: Meridian Medicaid |
$237.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.32
|
| Rate for Payer: PACE SWMI |
$353.64
|
| Rate for Payer: PHP Medicare Advantage |
$353.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$226.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,063.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$539.25
|
| Rate for Payer: Priority Health Medicare |
$353.64
|
| Rate for Payer: Priority Health Narrow Network |
$539.25
|
| Rate for Payer: UHC Medicare Advantage |
$364.25
|
|
|
PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL
|
Professional
|
Both
|
$1,648.00
|
|
|
Service Code
|
HCPCS 34710
|
| Min. Negotiated Rate |
$496.29 |
| Max. Negotiated Rate |
$1,852.75 |
| Rate for Payer: Aetna Commercial |
$1,046.23
|
| Rate for Payer: Aetna Medicare |
$780.77
|
| Rate for Payer: BCBS Complete |
$521.10
|
| Rate for Payer: BCBS MAPPO |
$780.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,852.75
|
| Rate for Payer: BCN Commercial |
$1,133.25
|
| Rate for Payer: BCN Medicare Advantage |
$780.77
|
| Rate for Payer: Cash Price |
$1,318.40
|
| Rate for Payer: Cash Price |
$1,318.40
|
| Rate for Payer: Cofinity Commercial |
$1,046.23
|
| Rate for Payer: Cofinity Commercial |
$1,124.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$780.77
|
| Rate for Payer: Healthscope Commercial |
$936.92
|
| Rate for Payer: Healthscope Whirlpool |
$936.92
|
| Rate for Payer: Meridian Medicaid |
$521.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$819.81
|
| Rate for Payer: PACE SWMI |
$780.77
|
| Rate for Payer: PHP Medicare Advantage |
$780.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$496.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,153.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,233.60
|
| Rate for Payer: Priority Health Medicare |
$780.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,233.60
|
| Rate for Payer: UHC Medicare Advantage |
$804.19
|
|
|
PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL
|
Professional
|
Both
|
$617.00
|
|
|
Service Code
|
HCPCS 34711
|
| Min. Negotiated Rate |
$182.75 |
| Max. Negotiated Rate |
$1,060.83 |
| Rate for Payer: Aetna Commercial |
$388.84
|
| Rate for Payer: Aetna Medicare |
$290.18
|
| Rate for Payer: BCBS Complete |
$191.89
|
| Rate for Payer: BCBS MAPPO |
$290.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,060.83
|
| Rate for Payer: BCN Commercial |
$418.30
|
| Rate for Payer: BCN Medicare Advantage |
$290.18
|
| Rate for Payer: Cash Price |
$493.60
|
| Rate for Payer: Cash Price |
$493.60
|
| Rate for Payer: Cofinity Commercial |
$388.84
|
| Rate for Payer: Cofinity Commercial |
$417.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.18
|
| Rate for Payer: Healthscope Commercial |
$348.22
|
| Rate for Payer: Healthscope Whirlpool |
$348.22
|
| Rate for Payer: Meridian Medicaid |
$191.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$304.69
|
| Rate for Payer: PACE SWMI |
$290.18
|
| Rate for Payer: PHP Medicare Advantage |
$290.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$182.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$455.35
|
| Rate for Payer: Priority Health Medicare |
$290.18
|
| Rate for Payer: Priority Health Narrow Network |
$455.35
|
| Rate for Payer: UHC Medicare Advantage |
$298.89
|
|
|
PR DOG EAR REVISION
|
Professional
|
Both
|
$1,809.00
|
|
|
Service Code
|
HCPCS 00565
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$723.60 |
| Max. Negotiated Rate |
$1,266.30 |
| Rate for Payer: BCBS Complete |
$723.60
|
| Rate for Payer: Cash Price |
$1,447.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,266.30
|
|
|
PR DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 99324
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
|
|
PR DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 99335
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$98.00 |
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
|
|
PR DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 99336
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.60
|
|
|
PR DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 99334
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$62.30 |
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
|
|
PR DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 99337
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$198.10 |
| Rate for Payer: BCBS Complete |
$113.20
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.10
|
|
|
PR DOP ECHOCARD COLOR FLOW VELOCITY MAPPING
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
93325
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$364.81 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Commercial |
$291.60
|
| Rate for Payer: ASR ASR |
$314.28
|
| Rate for Payer: ASR ASR |
$191.09
|
| Rate for Payer: BCBS Complete |
$129.60
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS Trust/PPO |
$251.20
|
| Rate for Payer: BCBS Trust/PPO |
$152.73
|
| Rate for Payer: BCN Commercial |
$251.20
|
| Rate for Payer: BCN Commercial |
$152.73
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$185.18
|
| Rate for Payer: Cofinity Commercial |
$304.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.60
|
| Rate for Payer: Healthscope Commercial |
$197.00
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Healthscope Whirlpool |
$191.09
|
| Rate for Payer: Healthscope Whirlpool |
$314.28
|
| Rate for Payer: Mclaren Commercial |
$291.60
|
| Rate for Payer: Mclaren Commercial |
$177.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$167.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.81
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$364.81
|
| Rate for Payer: Priority Health Narrow Network |
$291.85
|
| Rate for Payer: Priority Health Narrow Network |
$291.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.12
|
|
