|
PR EKG TRACING FOR INITIAL PREV
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS G0404
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$2,970.10 |
| Rate for Payer: Aetna Commercial |
$7.93
|
| Rate for Payer: Aetna Medicare |
$5.92
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$5.92
|
| Rate for Payer: BCBS Trust/PPO |
$2,970.10
|
| Rate for Payer: BCN Commercial |
$9.29
|
| Rate for Payer: BCN Medicare Advantage |
$5.92
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$8.52
|
| Rate for Payer: Cofinity Commercial |
$7.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.92
|
| Rate for Payer: Healthscope Commercial |
$7.10
|
| Rate for Payer: Healthscope Whirlpool |
$7.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.22
|
| Rate for Payer: PACE SWMI |
$5.92
|
| Rate for Payer: PHP Medicare Advantage |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.99
|
| Rate for Payer: Priority Health Medicare |
$5.92
|
| Rate for Payer: Priority Health Narrow Network |
$8.99
|
| Rate for Payer: UHC Medicare Advantage |
$6.10
|
|
|
PR ELASTIC GARMENT/COVERING
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS A4466
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.90
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 95983
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$205.51 |
| Rate for Payer: Aetna Commercial |
$64.83
|
| Rate for Payer: Aetna Medicare |
$48.38
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$48.38
|
| Rate for Payer: BCBS Trust/PPO |
$205.51
|
| Rate for Payer: BCN Commercial |
$72.82
|
| Rate for Payer: BCN Medicare Advantage |
$48.38
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$64.83
|
| Rate for Payer: Cofinity Commercial |
$69.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.38
|
| Rate for Payer: Healthscope Commercial |
$58.06
|
| Rate for Payer: Healthscope Whirlpool |
$58.06
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$50.80
|
| Rate for Payer: PACE SWMI |
$48.38
|
| Rate for Payer: PHP Medicare Advantage |
$48.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.58
|
| Rate for Payer: Priority Health Medicare |
$48.38
|
| Rate for Payer: Priority Health Narrow Network |
$65.58
|
| Rate for Payer: UHC Medicare Advantage |
$49.83
|
|
|
PR ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 95984
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$269.43 |
| Rate for Payer: Aetna Commercial |
$56.79
|
| Rate for Payer: Aetna Medicare |
$42.38
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS MAPPO |
$42.38
|
| Rate for Payer: BCBS Trust/PPO |
$269.43
|
| Rate for Payer: BCN Commercial |
$63.04
|
| Rate for Payer: BCN Medicare Advantage |
$42.38
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$61.03
|
| Rate for Payer: Cofinity Commercial |
$56.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.38
|
| Rate for Payer: Healthscope Commercial |
$50.86
|
| Rate for Payer: Healthscope Whirlpool |
$50.86
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.50
|
| Rate for Payer: PACE SWMI |
$42.38
|
| Rate for Payer: PHP Medicare Advantage |
$42.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.50
|
| Rate for Payer: Priority Health Medicare |
$42.38
|
| Rate for Payer: Priority Health Narrow Network |
$57.50
|
| Rate for Payer: UHC Medicare Advantage |
$43.65
|
|
|
PR ELEC ALYS IMPLT CPLX CN NPGT PRGRMG
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 95977
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$154.26 |
| Rate for Payer: Aetna Commercial |
$68.38
|
| Rate for Payer: Aetna Medicare |
$51.03
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS MAPPO |
$51.03
|
| Rate for Payer: BCBS Trust/PPO |
$154.26
|
| Rate for Payer: BCN Commercial |
$76.23
|
| Rate for Payer: BCN Medicare Advantage |
$51.03
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$73.48
|
| Rate for Payer: Cofinity Commercial |
$68.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.03
|
| Rate for Payer: Healthscope Commercial |
$61.24
|
| Rate for Payer: Healthscope Whirlpool |
$61.24
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.58
|
| Rate for Payer: PACE SWMI |
$51.03
|
| Rate for Payer: PHP Medicare Advantage |
$51.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.17
|
| Rate for Payer: Priority Health Medicare |
$51.03
|
| Rate for Payer: Priority Health Narrow Network |
$69.17
|
| Rate for Payer: UHC Medicare Advantage |
$52.56
|
|
|
PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95972
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$168.53 |
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Aetna Commercial |
$53.63
|
| Rate for Payer: Aetna Medicare |
$40.02
|
| Rate for Payer: Aetna Medicare |
$40.02
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS MAPPO |
$40.02
|
| Rate for Payer: BCBS MAPPO |
$40.02
|
| Rate for Payer: BCBS Trust/PPO |
$168.53
|
| Rate for Payer: BCBS Trust/PPO |
$168.53
|
| Rate for Payer: BCN Commercial |
$82.09
|
| Rate for Payer: BCN Commercial |
$82.09
|
| Rate for Payer: BCN Medicare Advantage |
$40.02
|
| Rate for Payer: BCN Medicare Advantage |
$40.02
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$376.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$53.63
|
| Rate for Payer: Cofinity Commercial |
$53.63
|
| Rate for Payer: Cofinity Commercial |
$57.63
|
| Rate for Payer: Cofinity Commercial |
$57.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.02
|
| Rate for Payer: Healthscope Commercial |
$48.02
|
| Rate for Payer: Healthscope Commercial |
$48.02
|
| Rate for Payer: Healthscope Whirlpool |
$48.02
|
| Rate for Payer: Healthscope Whirlpool |
$48.02
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.02
|
| Rate for Payer: PACE SWMI |
$40.02
|
| Rate for Payer: PACE SWMI |
$40.02
|
| Rate for Payer: PHP Medicare Advantage |
$40.02
|
| Rate for Payer: PHP Medicare Advantage |
$40.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.89
|
| Rate for Payer: Priority Health Medicare |
$40.02
|
| Rate for Payer: Priority Health Medicare |
$40.02
|
| Rate for Payer: Priority Health Narrow Network |
$53.89
|
| Rate for Payer: Priority Health Narrow Network |
$53.89
|
| Rate for Payer: UHC Medicare Advantage |
$41.22
|
| Rate for Payer: UHC Medicare Advantage |
$41.22
|
|
|
PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 95970
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$219.77 |
| Rate for Payer: Aetna Commercial |
$24.47
|
| Rate for Payer: Aetna Medicare |
$18.26
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS MAPPO |
$18.26
|
| Rate for Payer: BCBS Trust/PPO |
$219.77
|
| Rate for Payer: BCN Commercial |
$27.36
|
| Rate for Payer: BCN Medicare Advantage |
$18.26
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Cofinity Commercial |
$24.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.26
|
| Rate for Payer: Healthscope Commercial |
$21.91
|
| Rate for Payer: Healthscope Whirlpool |
$21.91
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.17
|
| Rate for Payer: PACE SWMI |
$18.26
|
| Rate for Payer: PHP Medicare Advantage |
$18.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.71
|
| Rate for Payer: Priority Health Medicare |
$18.26
|
| Rate for Payer: Priority Health Narrow Network |
$24.71
|
| Rate for Payer: UHC Medicare Advantage |
$18.81
|
|
|
PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95971
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$475.47 |
| Rate for Payer: Aetna Commercial |
$51.26
|
| Rate for Payer: Aetna Medicare |
$38.25
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS MAPPO |
$38.25
|
| Rate for Payer: BCBS Trust/PPO |
$475.47
|
| Rate for Payer: BCN Commercial |
$69.39
|
| Rate for Payer: BCN Medicare Advantage |
$38.25
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$55.08
|
| Rate for Payer: Cofinity Commercial |
$51.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.25
|
| Rate for Payer: Healthscope Commercial |
$45.90
|
| Rate for Payer: Healthscope Whirlpool |
$45.90
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.16
|
| Rate for Payer: PACE SWMI |
$38.25
|
| Rate for Payer: PHP Medicare Advantage |
$38.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.65
|
| Rate for Payer: Priority Health Medicare |
$38.25
|
| Rate for Payer: Priority Health Narrow Network |
$51.65
|
| Rate for Payer: UHC Medicare Advantage |
$39.40
|
|
|
PR ELEC ALYS IMPLT SMPL CN NPGT PRGRMG
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 95976
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$140.93 |
| Rate for Payer: Aetna Commercial |
$51.04
|
| Rate for Payer: Aetna Medicare |
$38.09
|
| Rate for Payer: BCBS Complete |
$25.72
|
| Rate for Payer: BCBS MAPPO |
$38.09
|
| Rate for Payer: BCBS Trust/PPO |
$140.93
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: BCN Medicare Advantage |
$38.09
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$54.85
|
| Rate for Payer: Cofinity Commercial |
$51.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.09
|
| Rate for Payer: Healthscope Commercial |
$45.71
|
| Rate for Payer: Healthscope Whirlpool |
$45.71
|
| Rate for Payer: Meridian Medicaid |
$25.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.99
|
| Rate for Payer: PACE SWMI |
$38.09
|
| Rate for Payer: PHP Medicare Advantage |
$38.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.65
|
| Rate for Payer: Priority Health Medicare |
$38.09
|
| Rate for Payer: Priority Health Narrow Network |
$51.65
|
| Rate for Payer: UHC Medicare Advantage |
$39.23
|
|
|
PR ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
HCPCS 95974
|
| Min. Negotiated Rate |
$376.00 |
| Max. Negotiated Rate |
$658.00 |
| Rate for Payer: BCBS Complete |
$376.00
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$658.00
|
|
|
PR ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH EA 30 MIN
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 95973
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$115.50 |
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
|
|
PR ELEC STIM OTHER THAN WOUND
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS G0283
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$367.70 |
| Rate for Payer: Aetna Commercial |
$15.69
|
| Rate for Payer: Aetna Medicare |
$11.71
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$11.71
|
| Rate for Payer: BCBS Trust/PPO |
$367.70
|
| Rate for Payer: BCN Commercial |
$11.75
|
| Rate for Payer: BCN Medicare Advantage |
$11.71
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$16.86
|
| Rate for Payer: Cofinity Commercial |
$15.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.71
|
| Rate for Payer: Healthscope Commercial |
$14.05
|
| Rate for Payer: Healthscope Whirlpool |
$14.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.30
|
| Rate for Payer: PACE SWMI |
$11.71
|
| Rate for Payer: PHP Medicare Advantage |
$11.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.99
|
| Rate for Payer: Priority Health Medicare |
$11.71
|
| Rate for Payer: Priority Health Narrow Network |
$11.99
|
| Rate for Payer: UHC Medicare Advantage |
$12.06
|
|
|
PR ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 62368
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$144.20 |
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Medicare |
$33.96
|
| Rate for Payer: BCBS Complete |
$22.82
|
| Rate for Payer: BCBS MAPPO |
$33.96
|
| Rate for Payer: BCBS Trust/PPO |
$45.43
|
| Rate for Payer: BCN Commercial |
$64.02
|
| Rate for Payer: BCN Medicare Advantage |
$33.96
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$45.51
|
| Rate for Payer: Cofinity Commercial |
$48.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$40.75
|
| Rate for Payer: Healthscope Whirlpool |
$40.75
|
| Rate for Payer: Meridian Medicaid |
$22.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35.66
|
| Rate for Payer: PACE SWMI |
$33.96
|
| Rate for Payer: PHP Medicare Advantage |
$33.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.75
|
| Rate for Payer: Priority Health Medicare |
$33.96
|
| Rate for Payer: Priority Health Narrow Network |
$57.75
|
| Rate for Payer: UHC Medicare Advantage |
$34.98
|
|
|
PR ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 62367
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$32.59
|
| Rate for Payer: Aetna Medicare |
$24.32
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$24.32
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$46.43
|
| Rate for Payer: BCN Medicare Advantage |
$24.32
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cofinity Commercial |
$35.02
|
| Rate for Payer: Cofinity Commercial |
$32.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.32
|
| Rate for Payer: Healthscope Commercial |
$29.18
|
| Rate for Payer: Healthscope Whirlpool |
$29.18
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.54
|
| Rate for Payer: PACE SWMI |
$24.32
|
| Rate for Payer: PHP Medicare Advantage |
$24.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.34
|
| Rate for Payer: Priority Health Medicare |
$24.32
|
| Rate for Payer: Priority Health Narrow Network |
$41.34
|
| Rate for Payer: UHC Medicare Advantage |
$25.05
|
|
|
PR ELECTROACOUS EVAL HEARING AID BINAURAL
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 92595
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$338.64 |
| Rate for Payer: Aetna Commercial |
$49.30
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS Trust/PPO |
$338.64
|
| Rate for Payer: BCN Commercial |
$64.31
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.54
|
| Rate for Payer: Priority Health Narrow Network |
$61.54
|
|
|
PR ELECTROACOUS EVAL HEARING AID MONAURAL
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 92594
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$231.15 |
| Rate for Payer: Aetna Commercial |
$22.43
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$231.15
|
| Rate for Payer: BCN Commercial |
$64.31
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.75
|
| Rate for Payer: Priority Health Narrow Network |
$28.75
|
|
|
PR ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS 95824
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$502.89 |
| Rate for Payer: Aetna Commercial |
$106.88
|
| Rate for Payer: BCBS Complete |
$78.80
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: BCN Commercial |
$502.89
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$131.15
|
| Rate for Payer: Priority Health Narrow Network |
$131.15
|
|
|
PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN
|
Professional
|
Both
|
$738.00
|
|
|
Service Code
|
HCPCS 95812
|
| Min. Negotiated Rate |
$295.20 |
| Max. Negotiated Rate |
$1,286.41 |
| Rate for Payer: Aetna Commercial |
$431.88
|
| Rate for Payer: Aetna Medicare |
$322.30
|
| Rate for Payer: BCBS Complete |
$295.20
|
| Rate for Payer: BCBS MAPPO |
$322.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,286.41
|
| Rate for Payer: BCN Commercial |
$504.32
|
| Rate for Payer: BCN Medicare Advantage |
$322.30
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cash Price |
$590.40
|
| Rate for Payer: Cofinity Commercial |
$464.11
|
| Rate for Payer: Cofinity Commercial |
$431.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.30
|
| Rate for Payer: Healthscope Commercial |
$386.76
|
| Rate for Payer: Healthscope Whirlpool |
$386.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$338.42
|
| Rate for Payer: PACE SWMI |
$322.30
|
| Rate for Payer: PHP Medicare Advantage |
$322.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$463.52
|
| Rate for Payer: Priority Health Medicare |
$322.30
|
| Rate for Payer: Priority Health Narrow Network |
$463.52
|
| Rate for Payer: UHC Medicare Advantage |
$331.97
|
|
|
PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
HCPCS 95822
|
| Min. Negotiated Rate |
$144.00 |
| Max. Negotiated Rate |
$614.41 |
| Rate for Payer: Aetna Commercial |
$519.16
|
| Rate for Payer: Aetna Medicare |
$387.43
|
| Rate for Payer: BCBS Complete |
$144.00
|
| Rate for Payer: BCBS MAPPO |
$387.43
|
| Rate for Payer: BCBS Trust/PPO |
$614.41
|
| Rate for Payer: BCN Commercial |
$607.43
|
| Rate for Payer: BCN Medicare Advantage |
$387.43
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$519.16
|
| Rate for Payer: Cofinity Commercial |
$557.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$387.43
|
| Rate for Payer: Healthscope Commercial |
$464.92
|
| Rate for Payer: Healthscope Whirlpool |
$464.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$406.80
|
| Rate for Payer: PACE SWMI |
$387.43
|
| Rate for Payer: PHP Medicare Advantage |
$387.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$558.29
|
| Rate for Payer: Priority Health Medicare |
$387.43
|
| Rate for Payer: Priority Health Narrow Network |
$558.29
|
| Rate for Payer: UHC Medicare Advantage |
$399.05
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 95819
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$648.47 |
| Rate for Payer: Aetna Commercial |
$553.92
|
| Rate for Payer: Aetna Commercial |
$553.92
|
| Rate for Payer: Aetna Medicare |
$413.37
|
| Rate for Payer: Aetna Medicare |
$413.37
|
| Rate for Payer: BCBS Complete |
$311.20
|
| Rate for Payer: BCBS Complete |
$80.80
|
| Rate for Payer: BCBS MAPPO |
$413.37
|
| Rate for Payer: BCBS MAPPO |
$413.37
|
| Rate for Payer: BCBS Trust/PPO |
$150.04
|
| Rate for Payer: BCBS Trust/PPO |
$150.04
|
| Rate for Payer: BCN Commercial |
$648.47
|
| Rate for Payer: BCN Commercial |
$648.47
|
| Rate for Payer: BCN Medicare Advantage |
$413.37
|
| Rate for Payer: BCN Medicare Advantage |
$413.37
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$622.40
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$553.92
|
| Rate for Payer: Cofinity Commercial |
$553.92
|
| Rate for Payer: Cofinity Commercial |
$595.25
|
| Rate for Payer: Cofinity Commercial |
$595.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$413.37
|
| Rate for Payer: Healthscope Commercial |
$496.04
|
| Rate for Payer: Healthscope Commercial |
$496.04
|
| Rate for Payer: Healthscope Whirlpool |
$496.04
|
| Rate for Payer: Healthscope Whirlpool |
$496.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$434.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$434.04
|
| Rate for Payer: PACE SWMI |
$413.37
|
| Rate for Payer: PACE SWMI |
$413.37
|
| Rate for Payer: PHP Medicare Advantage |
$413.37
|
| Rate for Payer: PHP Medicare Advantage |
$413.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.01
|
| Rate for Payer: Priority Health Medicare |
$413.37
|
| Rate for Payer: Priority Health Medicare |
$413.37
|
| Rate for Payer: Priority Health Narrow Network |
$596.01
|
| Rate for Payer: Priority Health Narrow Network |
$596.01
|
| Rate for Payer: UHC Medicare Advantage |
$425.77
|
| Rate for Payer: UHC Medicare Advantage |
$425.77
|
|
|
PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
HCPCS 95816
|
| Min. Negotiated Rate |
$231.92 |
| Max. Negotiated Rate |
$559.05 |
| Rate for Payer: Aetna Commercial |
$478.21
|
| Rate for Payer: Aetna Commercial |
$478.21
|
| Rate for Payer: Aetna Medicare |
$356.87
|
| Rate for Payer: Aetna Medicare |
$356.87
|
| Rate for Payer: BCBS Complete |
$271.20
|
| Rate for Payer: BCBS Complete |
$110.40
|
| Rate for Payer: BCBS MAPPO |
$356.87
|
| Rate for Payer: BCBS MAPPO |
$356.87
|
| Rate for Payer: BCBS Trust/PPO |
$231.92
|
| Rate for Payer: BCBS Trust/PPO |
$231.92
|
| Rate for Payer: BCN Commercial |
$559.05
|
| Rate for Payer: BCN Commercial |
$559.05
|
| Rate for Payer: BCN Medicare Advantage |
$356.87
|
| Rate for Payer: BCN Medicare Advantage |
$356.87
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$478.21
|
| Rate for Payer: Cofinity Commercial |
$513.89
|
| Rate for Payer: Cofinity Commercial |
$478.21
|
| Rate for Payer: Cofinity Commercial |
$513.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.87
|
| Rate for Payer: Healthscope Commercial |
$428.24
|
| Rate for Payer: Healthscope Commercial |
$428.24
|
| Rate for Payer: Healthscope Whirlpool |
$428.24
|
| Rate for Payer: Healthscope Whirlpool |
$428.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$374.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$374.71
|
| Rate for Payer: PACE SWMI |
$356.87
|
| Rate for Payer: PACE SWMI |
$356.87
|
| Rate for Payer: PHP Medicare Advantage |
$356.87
|
| Rate for Payer: PHP Medicare Advantage |
$356.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$474.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.82
|
| Rate for Payer: Priority Health Medicare |
$356.87
|
| Rate for Payer: Priority Health Medicare |
$356.87
|
| Rate for Payer: Priority Health Narrow Network |
$513.82
|
| Rate for Payer: Priority Health Narrow Network |
$513.82
|
| Rate for Payer: UHC Medicare Advantage |
$367.58
|
| Rate for Payer: UHC Medicare Advantage |
$367.58
|
|
|
PR ELECTROGASTROGRAPHY DX TRANSCUTANEOUS
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS 91132
|
| Min. Negotiated Rate |
$110.40 |
| Max. Negotiated Rate |
$652.87 |
| Rate for Payer: Aetna Commercial |
$555.00
|
| Rate for Payer: Aetna Medicare |
$414.18
|
| Rate for Payer: BCBS Complete |
$110.40
|
| Rate for Payer: BCBS MAPPO |
$414.18
|
| Rate for Payer: BCBS Trust/PPO |
$538.87
|
| Rate for Payer: BCN Commercial |
$652.87
|
| Rate for Payer: BCN Medicare Advantage |
$414.18
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$555.00
|
| Rate for Payer: Cofinity Commercial |
$596.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.18
|
| Rate for Payer: Healthscope Commercial |
$497.02
|
| Rate for Payer: Healthscope Whirlpool |
$497.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$434.89
|
| Rate for Payer: PACE SWMI |
$414.18
|
| Rate for Payer: PHP Medicare Advantage |
$414.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$600.05
|
| Rate for Payer: Priority Health Medicare |
$414.18
|
| Rate for Payer: Priority Health Narrow Network |
$600.05
|
| Rate for Payer: UHC Medicare Advantage |
$426.61
|
|
|
PR ELECTRONIC ANALYSIS ANTITACHY PACEMAKER SYSTEM
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
HCPCS 93724
|
| Min. Negotiated Rate |
$99.85 |
| Max. Negotiated Rate |
$409.52 |
| Rate for Payer: Aetna Commercial |
$367.74
|
| Rate for Payer: Aetna Medicare |
$274.43
|
| Rate for Payer: BCBS Complete |
$224.00
|
| Rate for Payer: BCBS MAPPO |
$274.43
|
| Rate for Payer: BCBS Trust/PPO |
$99.85
|
| Rate for Payer: BCN Commercial |
$409.52
|
| Rate for Payer: BCN Medicare Advantage |
$274.43
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cash Price |
$448.00
|
| Rate for Payer: Cofinity Commercial |
$367.74
|
| Rate for Payer: Cofinity Commercial |
$395.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.43
|
| Rate for Payer: Healthscope Commercial |
$329.32
|
| Rate for Payer: Healthscope Whirlpool |
$329.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$288.15
|
| Rate for Payer: PACE SWMI |
$274.43
|
| Rate for Payer: PHP Medicare Advantage |
$274.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$392.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$396.26
|
| Rate for Payer: Priority Health Medicare |
$274.43
|
| Rate for Payer: Priority Health Narrow Network |
$396.26
|
| Rate for Payer: UHC Medicare Advantage |
$282.66
|
|
|
PR ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL
|
Professional
|
Both
|
$4,063.00
|
|
|
Service Code
|
HCPCS 62000
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$2,844.10 |
| Rate for Payer: Aetna Commercial |
$1,396.67
|
| Rate for Payer: Aetna Medicare |
$1,042.29
|
| Rate for Payer: BCBS Complete |
$708.75
|
| Rate for Payer: BCBS MAPPO |
$1,042.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.99
|
| Rate for Payer: BCN Commercial |
$1,533.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,042.29
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Cash Price |
$3,250.40
|
| Rate for Payer: Cofinity Commercial |
$1,500.90
|
| Rate for Payer: Cofinity Commercial |
$1,396.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,042.29
|
| Rate for Payer: Healthscope Commercial |
$1,250.75
|
| Rate for Payer: Healthscope Whirlpool |
$1,250.75
|
| Rate for Payer: Meridian Medicaid |
$708.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,094.40
|
| Rate for Payer: PACE SWMI |
$1,042.29
|
| Rate for Payer: PHP Medicare Advantage |
$1,042.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$675.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,844.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,776.81
|
| Rate for Payer: Priority Health Medicare |
$1,042.29
|
| Rate for Payer: Priority Health Narrow Network |
$1,776.81
|
| Rate for Payer: UHC Medicare Advantage |
$1,073.56
|
|
|
PR ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL
|
Professional
|
Both
|
$5,136.00
|
|
|
Service Code
|
HCPCS 62005
|
| Min. Negotiated Rate |
$829.00 |
| Max. Negotiated Rate |
$3,595.20 |
| Rate for Payer: Aetna Commercial |
$1,719.05
|
| Rate for Payer: Aetna Medicare |
$1,282.87
|
| Rate for Payer: BCBS Complete |
$870.45
|
| Rate for Payer: BCBS MAPPO |
$1,282.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,278.49
|
| Rate for Payer: BCN Commercial |
$2,612.76
|
| Rate for Payer: BCN Medicare Advantage |
$1,282.87
|
| Rate for Payer: Cash Price |
$4,108.80
|
| Rate for Payer: Cash Price |
$4,108.80
|
| Rate for Payer: Cofinity Commercial |
$1,719.05
|
| Rate for Payer: Cofinity Commercial |
$1,847.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,282.87
|
| Rate for Payer: Healthscope Commercial |
$1,539.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,539.44
|
| Rate for Payer: Meridian Medicaid |
$870.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,347.01
|
| Rate for Payer: PACE SWMI |
$1,282.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,282.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$829.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,595.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,182.22
|
| Rate for Payer: Priority Health Medicare |
$1,282.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,182.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,321.36
|
|
