|
PR ESPHGP CGEN DFCT THRC APPR W/O RPR FSTL
|
Professional
|
Both
|
$6,527.00
|
|
|
Service Code
|
HCPCS 43313
|
| Min. Negotiated Rate |
$1,290.11 |
| Max. Negotiated Rate |
$5,080.67 |
| Rate for Payer: Aetna Commercial |
$3,861.48
|
| Rate for Payer: Aetna Medicare |
$2,881.70
|
| Rate for Payer: BCBS Complete |
$1,943.97
|
| Rate for Payer: BCBS MAPPO |
$2,881.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.11
|
| Rate for Payer: BCN Commercial |
$4,222.66
|
| Rate for Payer: BCN Medicare Advantage |
$2,881.70
|
| Rate for Payer: Cash Price |
$5,221.60
|
| Rate for Payer: Cash Price |
$5,221.60
|
| Rate for Payer: Cofinity Commercial |
$4,149.65
|
| Rate for Payer: Cofinity Commercial |
$3,861.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,881.70
|
| Rate for Payer: Healthscope Commercial |
$3,458.04
|
| Rate for Payer: Healthscope Whirlpool |
$3,458.04
|
| Rate for Payer: Meridian Medicaid |
$1,943.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,025.78
|
| Rate for Payer: PACE SWMI |
$2,881.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,881.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,851.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,568.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,080.67
|
| Rate for Payer: Priority Health Medicare |
$2,881.70
|
| Rate for Payer: Priority Health Narrow Network |
$5,080.67
|
| Rate for Payer: UHC Medicare Advantage |
$2,968.15
|
|
|
PR ESPHGP CGEN DFCT THRC APPR W/RPR FSTL
|
Professional
|
Both
|
$7,419.00
|
|
|
Service Code
|
HCPCS 43314
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$5,444.62 |
| Rate for Payer: Aetna Commercial |
$4,146.95
|
| Rate for Payer: Aetna Medicare |
$3,094.74
|
| Rate for Payer: BCBS Complete |
$2,079.72
|
| Rate for Payer: BCBS MAPPO |
$3,094.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,288.00
|
| Rate for Payer: BCN Commercial |
$4,525.16
|
| Rate for Payer: BCN Medicare Advantage |
$3,094.74
|
| Rate for Payer: Cash Price |
$5,935.20
|
| Rate for Payer: Cash Price |
$5,935.20
|
| Rate for Payer: Cofinity Commercial |
$4,146.95
|
| Rate for Payer: Cofinity Commercial |
$4,456.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,094.74
|
| Rate for Payer: Healthscope Commercial |
$3,713.69
|
| Rate for Payer: Healthscope Whirlpool |
$3,713.69
|
| Rate for Payer: Meridian Medicaid |
$2,079.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,249.48
|
| Rate for Payer: PACE SWMI |
$3,094.74
|
| Rate for Payer: PHP Medicare Advantage |
$3,094.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,980.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,193.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,444.62
|
| Rate for Payer: Priority Health Medicare |
$3,094.74
|
| Rate for Payer: Priority Health Narrow Network |
$5,444.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,187.58
|
|
|
PR ESPHGP CRV APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$2,031.00
|
|
|
Service Code
|
HCPCS 43300
|
| Min. Negotiated Rate |
$403.64 |
| Max. Negotiated Rate |
$1,573.28 |
| Rate for Payer: Aetna Commercial |
$826.14
|
| Rate for Payer: Aetna Medicare |
$616.52
|
| Rate for Payer: BCBS Complete |
$423.82
|
| Rate for Payer: BCBS MAPPO |
$616.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,573.28
|
| Rate for Payer: BCN Commercial |
$919.69
|
| Rate for Payer: BCN Medicare Advantage |
$616.52
|
| Rate for Payer: Cash Price |
$1,624.80
|
| Rate for Payer: Cash Price |
$1,624.80
|
| Rate for Payer: Cofinity Commercial |
$887.79
|
| Rate for Payer: Cofinity Commercial |
$826.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$616.52
|
| Rate for Payer: Healthscope Commercial |
$739.82
|
| Rate for Payer: Healthscope Whirlpool |
$739.82
|
| Rate for Payer: Meridian Medicaid |
$423.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$647.35
|
| Rate for Payer: PACE SWMI |
$616.52
|
| Rate for Payer: PHP Medicare Advantage |
$616.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$403.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,421.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,106.57
|
| Rate for Payer: Priority Health Medicare |
$616.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,106.57
|
| Rate for Payer: UHC Medicare Advantage |
$635.02
|
|
|
PR ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$4,879.00
|
|
|
Service Code
|
HCPCS 43310
|
| Min. Negotiated Rate |
$934.86 |
| Max. Negotiated Rate |
$3,415.30 |
| Rate for Payer: Aetna Commercial |
$1,961.32
|
| Rate for Payer: Aetna Medicare |
$1,463.67
|
| Rate for Payer: BCBS Complete |
$981.60
|
| Rate for Payer: BCBS MAPPO |
$1,463.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,024.37
|
| Rate for Payer: BCN Commercial |
$2,135.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,463.67
|
| Rate for Payer: Cash Price |
$3,903.20
|
| Rate for Payer: Cash Price |
$3,903.20
|
| Rate for Payer: Cofinity Commercial |
$2,107.68
|
| Rate for Payer: Cofinity Commercial |
$1,961.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,463.67
|
| Rate for Payer: Healthscope Commercial |
$1,756.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,756.40
|
| Rate for Payer: Meridian Medicaid |
$981.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,536.85
|
| Rate for Payer: PACE SWMI |
$1,463.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,463.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$934.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,415.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,569.44
|
| Rate for Payer: Priority Health Medicare |
$1,463.67
|
| Rate for Payer: Priority Health Narrow Network |
$2,569.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,507.58
|
|
|
PR ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL
|
Professional
|
Both
|
$3,288.00
|
|
|
Service Code
|
HCPCS 43312
|
| Min. Negotiated Rate |
$998.12 |
| Max. Negotiated Rate |
$2,744.65 |
| Rate for Payer: Aetna Commercial |
$2,101.99
|
| Rate for Payer: Aetna Medicare |
$1,568.65
|
| Rate for Payer: BCBS Complete |
$1,048.03
|
| Rate for Payer: BCBS MAPPO |
$1,568.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,130.03
|
| Rate for Payer: BCN Commercial |
$2,281.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,568.65
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cash Price |
$2,630.40
|
| Rate for Payer: Cofinity Commercial |
$2,101.99
|
| Rate for Payer: Cofinity Commercial |
$2,258.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,568.65
|
| Rate for Payer: Healthscope Commercial |
$1,882.38
|
| Rate for Payer: Healthscope Whirlpool |
$1,882.38
|
| Rate for Payer: Meridian Medicaid |
$1,048.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,647.08
|
| Rate for Payer: PACE SWMI |
$1,568.65
|
| Rate for Payer: PHP Medicare Advantage |
$1,568.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$998.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,301.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,744.65
|
| Rate for Payer: Priority Health Medicare |
$1,568.65
|
| Rate for Payer: Priority Health Narrow Network |
$2,744.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,615.71
|
|
|
PR ESRD RELATED SVC <FULL MONTH 20/>YR OLD
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 90970
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$77.13 |
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$9.24
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS MAPPO |
$9.24
|
| Rate for Payer: BCBS Trust/PPO |
$77.13
|
| Rate for Payer: BCN Commercial |
$13.68
|
| Rate for Payer: BCN Medicare Advantage |
$9.24
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$12.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.24
|
| Rate for Payer: Healthscope Commercial |
$11.09
|
| Rate for Payer: Healthscope Whirlpool |
$11.09
|
| Rate for Payer: Meridian Medicaid |
$6.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.70
|
| Rate for Payer: PACE SWMI |
$9.24
|
| Rate for Payer: PHP Medicare Advantage |
$9.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.58
|
| Rate for Payer: Priority Health Medicare |
$9.24
|
| Rate for Payer: Priority Health Narrow Network |
$12.58
|
| Rate for Payer: UHC Medicare Advantage |
$9.52
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/>YR OLD 1 VISIT
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 90962
|
| Min. Negotiated Rate |
$128.23 |
| Max. Negotiated Rate |
$291.25 |
| Rate for Payer: Aetna Commercial |
$262.63
|
| Rate for Payer: Aetna Medicare |
$195.99
|
| Rate for Payer: BCBS Complete |
$134.64
|
| Rate for Payer: BCBS MAPPO |
$195.99
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: BCN Commercial |
$291.25
|
| Rate for Payer: BCN Medicare Advantage |
$195.99
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cofinity Commercial |
$282.23
|
| Rate for Payer: Cofinity Commercial |
$262.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$195.99
|
| Rate for Payer: Healthscope Commercial |
$235.19
|
| Rate for Payer: Healthscope Whirlpool |
$235.19
|
| Rate for Payer: Meridian Medicaid |
$134.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$205.79
|
| Rate for Payer: PACE SWMI |
$195.99
|
| Rate for Payer: PHP Medicare Advantage |
$195.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$128.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$267.69
|
| Rate for Payer: Priority Health Medicare |
$195.99
|
| Rate for Payer: Priority Health Narrow Network |
$267.69
|
| Rate for Payer: UHC Medicare Advantage |
$201.87
|
|
|
PR ESRD RELATED SVC MONTHLY 20/>YR OLD 2/3 VISITS
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 90961
|
| Min. Negotiated Rate |
$103.02 |
| Max. Negotiated Rate |
$423.20 |
| Rate for Payer: Aetna Commercial |
$383.09
|
| Rate for Payer: Aetna Medicare |
$285.89
|
| Rate for Payer: BCBS Complete |
$195.03
|
| Rate for Payer: BCBS MAPPO |
$285.89
|
| Rate for Payer: BCBS Trust/PPO |
$103.02
|
| Rate for Payer: BCN Commercial |
$423.20
|
| Rate for Payer: BCN Medicare Advantage |
$285.89
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$411.68
|
| Rate for Payer: Cofinity Commercial |
$383.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.89
|
| Rate for Payer: Healthscope Commercial |
$343.07
|
| Rate for Payer: Healthscope Whirlpool |
$343.07
|
| Rate for Payer: Meridian Medicaid |
$195.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$300.18
|
| Rate for Payer: PACE SWMI |
$285.89
|
| Rate for Payer: PHP Medicare Advantage |
$285.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$185.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$388.95
|
| Rate for Payer: Priority Health Medicare |
$285.89
|
| Rate for Payer: Priority Health Narrow Network |
$388.95
|
| Rate for Payer: UHC Medicare Advantage |
$294.47
|
|
|
PR ESRD RELATED SVC MONTHLY 20&/> YR OLD 4/> VISITS
|
Professional
|
Both
|
$482.00
|
|
|
Service Code
|
HCPCS 90960
|
| Min. Negotiated Rate |
$223.65 |
| Max. Negotiated Rate |
$508.71 |
| Rate for Payer: Aetna Commercial |
$460.99
|
| Rate for Payer: Aetna Medicare |
$344.02
|
| Rate for Payer: BCBS Complete |
$234.83
|
| Rate for Payer: BCBS MAPPO |
$344.02
|
| Rate for Payer: BCBS Trust/PPO |
$226.11
|
| Rate for Payer: BCN Commercial |
$508.71
|
| Rate for Payer: BCN Medicare Advantage |
$344.02
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cash Price |
$385.60
|
| Rate for Payer: Cofinity Commercial |
$495.39
|
| Rate for Payer: Cofinity Commercial |
$460.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$344.02
|
| Rate for Payer: Healthscope Commercial |
$412.82
|
| Rate for Payer: Healthscope Whirlpool |
$412.82
|
| Rate for Payer: Meridian Medicaid |
$234.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$361.22
|
| Rate for Payer: PACE SWMI |
$344.02
|
| Rate for Payer: PHP Medicare Advantage |
$344.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$223.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$467.56
|
| Rate for Payer: Priority Health Medicare |
$344.02
|
| Rate for Payer: Priority Health Narrow Network |
$467.56
|
| Rate for Payer: UHC Medicare Advantage |
$354.34
|
|
|
PR ESRD SVC HOME DIALYSIS FULL MONTH 20 YR OLD
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
HCPCS 90966
|
| Min. Negotiated Rate |
$185.74 |
| Max. Negotiated Rate |
$422.71 |
| Rate for Payer: Aetna Commercial |
$382.69
|
| Rate for Payer: Aetna Medicare |
$285.59
|
| Rate for Payer: BCBS Complete |
$195.03
|
| Rate for Payer: BCBS MAPPO |
$285.59
|
| Rate for Payer: BCBS Trust/PPO |
$211.32
|
| Rate for Payer: BCN Commercial |
$422.71
|
| Rate for Payer: BCN Medicare Advantage |
$285.59
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cash Price |
$333.60
|
| Rate for Payer: Cofinity Commercial |
$382.69
|
| Rate for Payer: Cofinity Commercial |
$411.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$285.59
|
| Rate for Payer: Healthscope Commercial |
$342.71
|
| Rate for Payer: Healthscope Whirlpool |
$342.71
|
| Rate for Payer: Meridian Medicaid |
$195.03
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$299.87
|
| Rate for Payer: PACE SWMI |
$285.59
|
| Rate for Payer: PHP Medicare Advantage |
$285.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$185.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$388.50
|
| Rate for Payer: Priority Health Medicare |
$285.59
|
| Rate for Payer: Priority Health Narrow Network |
$388.50
|
| Rate for Payer: UHC Medicare Advantage |
$294.16
|
|
|
PR ESW BY PHYS W/ANES INVG LAT HUMERL EPICONDYLE
|
Professional
|
Both
|
$2,603.00
|
|
|
Service Code
|
HCPCS 0102T
|
| Min. Negotiated Rate |
$132.14 |
| Max. Negotiated Rate |
$2,753.41 |
| Rate for Payer: Aetna Commercial |
$391.44
|
| Rate for Payer: BCBS Complete |
$1,041.20
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$2,753.41
|
| Rate for Payer: Cash Price |
$2,082.40
|
| Rate for Payer: Cash Price |
$2,082.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,822.10
|
|
|
PR ETHMOIDECTOMY INTRANASAL ANTERIOR
|
Professional
|
Both
|
$2,500.00
|
|
|
Service Code
|
HCPCS 31200
|
| Min. Negotiated Rate |
$402.57 |
| Max. Negotiated Rate |
$1,750.00 |
| Rate for Payer: Aetna Commercial |
$803.02
|
| Rate for Payer: Aetna Medicare |
$599.27
|
| Rate for Payer: BCBS Complete |
$422.70
|
| Rate for Payer: BCBS MAPPO |
$599.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,062.94
|
| Rate for Payer: BCN Commercial |
$920.18
|
| Rate for Payer: BCN Medicare Advantage |
$599.27
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cash Price |
$2,000.00
|
| Rate for Payer: Cofinity Commercial |
$862.95
|
| Rate for Payer: Cofinity Commercial |
$803.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$599.27
|
| Rate for Payer: Healthscope Commercial |
$719.12
|
| Rate for Payer: Healthscope Whirlpool |
$719.12
|
| Rate for Payer: Meridian Medicaid |
$422.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$629.23
|
| Rate for Payer: PACE SWMI |
$599.27
|
| Rate for Payer: PHP Medicare Advantage |
$599.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$402.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,750.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$871.92
|
| Rate for Payer: Priority Health Medicare |
$599.27
|
| Rate for Payer: Priority Health Narrow Network |
$871.92
|
| Rate for Payer: UHC Medicare Advantage |
$617.25
|
|
|
PR ETHMOIDECTOMY INTRANASAL TOTAL
|
Professional
|
Both
|
$1,504.00
|
|
|
Service Code
|
HCPCS 31201
|
| Min. Negotiated Rate |
$501.62 |
| Max. Negotiated Rate |
$1,178.69 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Aetna Medicare |
$777.76
|
| Rate for Payer: BCBS Complete |
$526.70
|
| Rate for Payer: BCBS MAPPO |
$777.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.51
|
| Rate for Payer: BCN Commercial |
$1,178.69
|
| Rate for Payer: BCN Medicare Advantage |
$777.76
|
| Rate for Payer: Cash Price |
$1,203.20
|
| Rate for Payer: Cash Price |
$1,203.20
|
| Rate for Payer: Cofinity Commercial |
$1,119.97
|
| Rate for Payer: Cofinity Commercial |
$1,042.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$777.76
|
| Rate for Payer: Healthscope Commercial |
$933.31
|
| Rate for Payer: Healthscope Whirlpool |
$933.31
|
| Rate for Payer: Meridian Medicaid |
$526.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$816.65
|
| Rate for Payer: PACE SWMI |
$777.76
|
| Rate for Payer: PHP Medicare Advantage |
$777.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$501.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,052.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,116.87
|
| Rate for Payer: Priority Health Medicare |
$777.76
|
| Rate for Payer: Priority Health Narrow Network |
$1,116.87
|
| Rate for Payer: UHC Medicare Advantage |
$801.09
|
|
|
PR EVACUATION SUBUNGUAL HEMATOMA
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 11740
|
| Min. Negotiated Rate |
$20.66 |
| Max. Negotiated Rate |
$116.11 |
| Rate for Payer: Aetna Commercial |
$41.10
|
| Rate for Payer: Aetna Medicare |
$30.67
|
| Rate for Payer: BCBS Complete |
$21.69
|
| Rate for Payer: BCBS MAPPO |
$30.67
|
| Rate for Payer: BCBS Trust/PPO |
$116.11
|
| Rate for Payer: BCN Commercial |
$67.15
|
| Rate for Payer: BCN Medicare Advantage |
$30.67
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$44.16
|
| Rate for Payer: Cofinity Commercial |
$41.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.67
|
| Rate for Payer: Healthscope Commercial |
$36.80
|
| Rate for Payer: Healthscope Whirlpool |
$36.80
|
| Rate for Payer: Meridian Medicaid |
$21.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.20
|
| Rate for Payer: PACE SWMI |
$30.67
|
| Rate for Payer: PHP Medicare Advantage |
$30.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.05
|
| Rate for Payer: Priority Health Medicare |
$30.67
|
| Rate for Payer: Priority Health Narrow Network |
$39.05
|
| Rate for Payer: UHC Medicare Advantage |
$31.59
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT 1ST 60 MIN
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 92620
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$295.85 |
| Rate for Payer: Aetna Commercial |
$103.73
|
| Rate for Payer: Aetna Medicare |
$77.41
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: BCBS MAPPO |
$77.41
|
| Rate for Payer: BCBS Trust/PPO |
$295.85
|
| Rate for Payer: BCN Commercial |
$129.01
|
| Rate for Payer: BCN Medicare Advantage |
$77.41
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| 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 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 Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.54
|
| Rate for Payer: Priority Health Medicare |
$77.41
|
| Rate for Payer: Priority Health Narrow Network |
$105.54
|
| Rate for Payer: UHC Medicare Advantage |
$79.73
|
|
|
PR EVAL CENTRAL AUDITORY FUNCJ W/REPRT EA 15 MIN
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 92621
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$24.24
|
| Rate for Payer: Aetna Medicare |
$18.09
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$18.09
|
| Rate for Payer: BCBS Trust/PPO |
$281.58
|
| Rate for Payer: BCN Commercial |
$31.76
|
| Rate for Payer: BCN Medicare Advantage |
$18.09
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$24.24
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.09
|
| Rate for Payer: Healthscope Commercial |
$21.71
|
| Rate for Payer: Healthscope Whirlpool |
$21.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.99
|
| Rate for Payer: PACE SWMI |
$18.09
|
| Rate for Payer: PHP Medicare Advantage |
$18.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.71
|
| Rate for Payer: Priority Health Medicare |
$18.09
|
| Rate for Payer: Priority Health Narrow Network |
$24.71
|
| Rate for Payer: UHC Medicare Advantage |
$18.63
|
|
|
PR EVAL OF ORTHOTIC/PROSTH USE, EA 15 MIN
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 97762
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$51.80 |
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
|
|
PR EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 92523
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$1,440.15 |
| Rate for Payer: Aetna Commercial |
$297.16
|
| Rate for Payer: Aetna Medicare |
$221.76
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS MAPPO |
$221.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,440.15
|
| Rate for Payer: BCN Commercial |
$331.82
|
| Rate for Payer: BCN Medicare Advantage |
$221.76
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$319.33
|
| Rate for Payer: Cofinity Commercial |
$297.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$221.76
|
| Rate for Payer: Healthscope Commercial |
$266.11
|
| Rate for Payer: Healthscope Whirlpool |
$266.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$232.85
|
| Rate for Payer: PACE SWMI |
$221.76
|
| Rate for Payer: PHP Medicare Advantage |
$221.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.96
|
| Rate for Payer: Priority Health Medicare |
$221.76
|
| Rate for Payer: Priority Health Narrow Network |
$304.96
|
| Rate for Payer: UHC Medicare Advantage |
$228.41
|
|
|
PR EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 92521
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$1,170.71 |
| Rate for Payer: Aetna Commercial |
$173.32
|
| Rate for Payer: Aetna Medicare |
$129.34
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS MAPPO |
$129.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,170.71
|
| Rate for Payer: BCN Commercial |
$193.52
|
| Rate for Payer: BCN Medicare Advantage |
$129.34
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$173.32
|
| Rate for Payer: Cofinity Commercial |
$186.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$129.34
|
| Rate for Payer: Healthscope Commercial |
$155.21
|
| Rate for Payer: Healthscope Whirlpool |
$155.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$135.81
|
| Rate for Payer: PACE SWMI |
$129.34
|
| Rate for Payer: PHP Medicare Advantage |
$129.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$177.86
|
| Rate for Payer: Priority Health Medicare |
$129.34
|
| Rate for Payer: Priority Health Narrow Network |
$177.86
|
| Rate for Payer: UHC Medicare Advantage |
$133.22
|
|
|
PR EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 92522
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$1,580.15 |
| Rate for Payer: Aetna Commercial |
$145.22
|
| Rate for Payer: Aetna Medicare |
$108.37
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$108.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,580.15
|
| Rate for Payer: BCN Commercial |
$161.75
|
| Rate for Payer: BCN Medicare Advantage |
$108.37
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$156.05
|
| Rate for Payer: Cofinity Commercial |
$145.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.37
|
| Rate for Payer: Healthscope Commercial |
$130.04
|
| Rate for Payer: Healthscope Whirlpool |
$130.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$113.79
|
| Rate for Payer: PACE SWMI |
$108.37
|
| Rate for Payer: PHP Medicare Advantage |
$108.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$148.67
|
| Rate for Payer: Priority Health Medicare |
$108.37
|
| Rate for Payer: Priority Health Narrow Network |
$148.67
|
| Rate for Payer: UHC Medicare Advantage |
$111.62
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART 1ST
|
Professional
|
Both
|
$1,083.00
|
|
|
Service Code
|
HCPCS 61650
|
| Min. Negotiated Rate |
$318.04 |
| Max. Negotiated Rate |
$964.28 |
| Rate for Payer: Aetna Commercial |
$766.86
|
| Rate for Payer: Aetna Medicare |
$572.28
|
| Rate for Payer: BCBS Complete |
$389.60
|
| Rate for Payer: BCBS MAPPO |
$572.28
|
| Rate for Payer: BCBS Trust/PPO |
$318.04
|
| Rate for Payer: BCN Commercial |
$832.21
|
| Rate for Payer: BCN Medicare Advantage |
$572.28
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cash Price |
$866.40
|
| Rate for Payer: Cofinity Commercial |
$766.86
|
| Rate for Payer: Cofinity Commercial |
$824.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$572.28
|
| Rate for Payer: Healthscope Commercial |
$686.74
|
| Rate for Payer: Healthscope Whirlpool |
$686.74
|
| Rate for Payer: Meridian Medicaid |
$389.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$600.89
|
| Rate for Payer: PACE SWMI |
$572.28
|
| Rate for Payer: PHP Medicare Advantage |
$572.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$371.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$758.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$964.28
|
| Rate for Payer: Priority Health Medicare |
$572.28
|
| Rate for Payer: Priority Health Narrow Network |
$964.28
|
| Rate for Payer: UHC Medicare Advantage |
$589.45
|
|
|
PR EVASC INTRACRANIAL PROLNG ADMN RX AGENT ART ADDL
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS 61651
|
| Min. Negotiated Rate |
$158.47 |
| Max. Negotiated Rate |
$415.04 |
| Rate for Payer: Aetna Commercial |
$330.28
|
| Rate for Payer: Aetna Medicare |
$246.48
|
| Rate for Payer: BCBS Complete |
$166.39
|
| Rate for Payer: BCBS MAPPO |
$246.48
|
| Rate for Payer: BCBS Trust/PPO |
$301.13
|
| Rate for Payer: BCN Commercial |
$358.20
|
| Rate for Payer: BCN Medicare Advantage |
$246.48
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cash Price |
$368.80
|
| Rate for Payer: Cofinity Commercial |
$330.28
|
| Rate for Payer: Cofinity Commercial |
$354.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$246.48
|
| Rate for Payer: Healthscope Commercial |
$295.78
|
| Rate for Payer: Healthscope Whirlpool |
$295.78
|
| Rate for Payer: Meridian Medicaid |
$166.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$258.80
|
| Rate for Payer: PACE SWMI |
$246.48
|
| Rate for Payer: PHP Medicare Advantage |
$246.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$158.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$415.04
|
| Rate for Payer: Priority Health Medicare |
$246.48
|
| Rate for Payer: Priority Health Narrow Network |
$415.04
|
| Rate for Payer: UHC Medicare Advantage |
$253.87
|
|
|
PR EVASC PLACEMENT ILIAC ARTERY OCCLUSION DEVICE
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 34808
|
| Min. Negotiated Rate |
$125.88 |
| Max. Negotiated Rate |
$313.33 |
| Rate for Payer: Aetna Commercial |
$267.65
|
| Rate for Payer: Aetna Medicare |
$199.74
|
| Rate for Payer: BCBS Complete |
$132.17
|
| Rate for Payer: BCBS MAPPO |
$199.74
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$287.83
|
| Rate for Payer: BCN Medicare Advantage |
$199.74
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$287.63
|
| Rate for Payer: Cofinity Commercial |
$267.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.74
|
| Rate for Payer: Healthscope Commercial |
$239.69
|
| Rate for Payer: Healthscope Whirlpool |
$239.69
|
| Rate for Payer: Meridian Medicaid |
$132.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$209.73
|
| Rate for Payer: PACE SWMI |
$199.74
|
| Rate for Payer: PHP Medicare Advantage |
$199.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.33
|
| Rate for Payer: Priority Health Medicare |
$199.74
|
| Rate for Payer: Priority Health Narrow Network |
$313.33
|
| Rate for Payer: UHC Medicare Advantage |
$205.73
|
|
|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT
|
Professional
|
Both
|
$2,537.00
|
|
|
Service Code
|
HCPCS 34701
|
| Min. Negotiated Rate |
$769.14 |
| Max. Negotiated Rate |
$1,919.30 |
| Rate for Payer: Aetna Commercial |
$1,629.72
|
| Rate for Payer: Aetna Medicare |
$1,216.21
|
| Rate for Payer: BCBS Complete |
$807.60
|
| Rate for Payer: BCBS MAPPO |
$1,216.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,422.71
|
| Rate for Payer: BCN Commercial |
$1,763.15
|
| Rate for Payer: BCN Medicare Advantage |
$1,216.21
|
| Rate for Payer: Cash Price |
$2,029.60
|
| Rate for Payer: Cash Price |
$2,029.60
|
| Rate for Payer: Cofinity Commercial |
$1,751.34
|
| Rate for Payer: Cofinity Commercial |
$1,629.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,216.21
|
| Rate for Payer: Healthscope Commercial |
$1,459.45
|
| Rate for Payer: Healthscope Whirlpool |
$1,459.45
|
| Rate for Payer: Meridian Medicaid |
$807.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,277.02
|
| Rate for Payer: PACE SWMI |
$1,216.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,216.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$769.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,775.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,919.30
|
| Rate for Payer: Priority Health Medicare |
$1,216.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,919.30
|
| Rate for Payer: UHC Medicare Advantage |
$1,252.70
|
|
|
PR EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT
|
Professional
|
Both
|
$3,836.00
|
|
|
Service Code
|
HCPCS 34702
|
| Min. Negotiated Rate |
$1,148.71 |
| Max. Negotiated Rate |
$2,863.53 |
| Rate for Payer: Aetna Commercial |
$2,436.07
|
| Rate for Payer: Aetna Medicare |
$1,817.96
|
| Rate for Payer: BCBS Complete |
$1,206.15
|
| Rate for Payer: BCBS MAPPO |
$1,817.96
|
| Rate for Payer: BCBS Trust/PPO |
$2,005.96
|
| Rate for Payer: BCN Commercial |
$2,630.55
|
| Rate for Payer: BCN Medicare Advantage |
$1,817.96
|
| Rate for Payer: Cash Price |
$3,068.80
|
| Rate for Payer: Cash Price |
$3,068.80
|
| Rate for Payer: Cofinity Commercial |
$2,436.07
|
| Rate for Payer: Cofinity Commercial |
$2,617.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,817.96
|
| Rate for Payer: Healthscope Commercial |
$2,181.55
|
| Rate for Payer: Healthscope Whirlpool |
$2,181.55
|
| Rate for Payer: Meridian Medicaid |
$1,206.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,908.86
|
| Rate for Payer: PACE SWMI |
$1,817.96
|
| Rate for Payer: PHP Medicare Advantage |
$1,817.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,148.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,685.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,863.53
|
| Rate for Payer: Priority Health Medicare |
$1,817.96
|
| Rate for Payer: Priority Health Narrow Network |
$2,863.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,872.50
|
|
