|
PR IP/OBS CONSLTJ NEW/EST PT SF MDM 35 MINUTES
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 99252
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$176.98 |
| Rate for Payer: Aetna Commercial |
$77.71
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$176.98
|
| Rate for Payer: BCN Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.80
|
| Rate for Payer: Priority Health Narrow Network |
$90.80
|
|
|
PR IPRATROPIUM BROMIDE NON-COMP
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS J7644
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$0.35
|
| Rate for Payer: Aetna Medicare |
$0.26
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS MAPPO |
$0.26
|
| Rate for Payer: BCN Commercial |
$0.04
|
| Rate for Payer: BCN Medicare Advantage |
$0.26
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cofinity Commercial |
$0.35
|
| Rate for Payer: Cofinity Commercial |
$0.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.26
|
| Rate for Payer: Healthscope Commercial |
$0.31
|
| Rate for Payer: Healthscope Whirlpool |
$0.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.27
|
| Rate for Payer: PACE SWMI |
$0.26
|
| Rate for Payer: PHP Medicare Advantage |
$0.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
| Rate for Payer: Priority Health Medicare |
$0.26
|
| Rate for Payer: UHC Medicare Advantage |
$0.27
|
|
|
PR IR DEEP HEAT PAIN RELIEF 15MIN
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00099
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
|
|
PR IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 96523
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$1,469.20 |
| Rate for Payer: Aetna Commercial |
$31.68
|
| Rate for Payer: Aetna Medicare |
$23.64
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS MAPPO |
$23.64
|
| Rate for Payer: BCBS Trust/PPO |
$1,469.20
|
| Rate for Payer: BCN Commercial |
$37.14
|
| Rate for Payer: BCN Medicare Advantage |
$23.64
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$31.68
|
| Rate for Payer: Cofinity Commercial |
$34.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.64
|
| Rate for Payer: Healthscope Commercial |
$28.37
|
| Rate for Payer: Healthscope Whirlpool |
$28.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.82
|
| Rate for Payer: PACE SWMI |
$23.64
|
| Rate for Payer: PHP Medicare Advantage |
$23.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.13
|
| Rate for Payer: Priority Health Medicare |
$23.64
|
| Rate for Payer: Priority Health Narrow Network |
$34.13
|
| Rate for Payer: UHC Medicare Advantage |
$24.35
|
|
|
PR IRRIGATION CORPORA CAVERNOSA PRIAPISM
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 54220
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$460.68 |
| Rate for Payer: Aetna Commercial |
$175.54
|
| Rate for Payer: Aetna Medicare |
$131.00
|
| Rate for Payer: BCBS Complete |
$89.91
|
| Rate for Payer: BCBS MAPPO |
$131.00
|
| Rate for Payer: BCBS Trust/PPO |
$460.68
|
| Rate for Payer: BCN Commercial |
$321.55
|
| Rate for Payer: BCN Medicare Advantage |
$131.00
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$188.64
|
| Rate for Payer: Cofinity Commercial |
$175.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.00
|
| Rate for Payer: Healthscope Commercial |
$157.20
|
| Rate for Payer: Healthscope Whirlpool |
$157.20
|
| Rate for Payer: Meridian Medicaid |
$89.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$137.55
|
| Rate for Payer: PACE SWMI |
$131.00
|
| Rate for Payer: PHP Medicare Advantage |
$131.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$85.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.91
|
| Rate for Payer: Priority Health Medicare |
$131.00
|
| Rate for Payer: Priority Health Narrow Network |
$212.91
|
| Rate for Payer: UHC Medicare Advantage |
$134.93
|
|
|
PR IRRIGATION TRAY
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS A4320
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$4.58
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$5.42
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
|
|
PR IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
HCPCS 57150
|
| Min. Negotiated Rate |
$25.73 |
| Max. Negotiated Rate |
$2,018.63 |
| Rate for Payer: Aetna Commercial |
$34.48
|
| Rate for Payer: Aetna Medicare |
$25.73
|
| Rate for Payer: BCBS Complete |
$47.20
|
| Rate for Payer: BCBS MAPPO |
$25.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,018.63
|
| Rate for Payer: BCN Commercial |
$85.52
|
| Rate for Payer: BCN Medicare Advantage |
$25.73
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cofinity Commercial |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$37.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.73
|
| Rate for Payer: Healthscope Commercial |
$30.88
|
| Rate for Payer: Healthscope Whirlpool |
$30.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.02
|
| Rate for Payer: PACE SWMI |
$25.73
|
| Rate for Payer: PHP Medicare Advantage |
$25.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.45
|
| Rate for Payer: Priority Health Medicare |
$25.73
|
| Rate for Payer: Priority Health Narrow Network |
$36.45
|
| Rate for Payer: UHC Medicare Advantage |
$26.50
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS 1ST VSL
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 93571
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: Aetna Commercial |
$267.31
|
| Rate for Payer: BCBS Complete |
$140.00
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCBS Trust/PPO |
$640.30
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: BCN Commercial |
$295.16
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$285.14
|
| Rate for Payer: Priority Health Narrow Network |
$285.14
|
| Rate for Payer: Priority Health Narrow Network |
$285.14
|
|
|
PR IV DOP VEL&/OR PRESS C/FLO RSRV MEAS ADDL VSL
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 93572
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Aetna Commercial |
$145.84
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$78.72
|
| Rate for Payer: BCN Commercial |
$165.66
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.15
|
| Rate for Payer: Priority Health Narrow Network |
$154.15
|
|
|
PR IV INFUSION HYDRATION EACH ADDITIONAL HOUR
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 96361
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Aetna Medicare |
$12.06
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$12.06
|
| Rate for Payer: BCBS Trust/PPO |
$22.72
|
| Rate for Payer: BCN Commercial |
$18.57
|
| Rate for Payer: BCN Medicare Advantage |
$12.06
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$17.37
|
| Rate for Payer: Cofinity Commercial |
$16.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.06
|
| Rate for Payer: Healthscope Commercial |
$14.47
|
| Rate for Payer: Healthscope Whirlpool |
$14.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.66
|
| Rate for Payer: PACE SWMI |
$12.06
|
| Rate for Payer: PHP Medicare Advantage |
$12.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.07
|
| Rate for Payer: Priority Health Medicare |
$12.06
|
| Rate for Payer: Priority Health Narrow Network |
$17.07
|
| Rate for Payer: UHC Medicare Advantage |
$12.42
|
|
|
PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 96360
|
| Min. Negotiated Rate |
$30.51 |
| Max. Negotiated Rate |
$190.72 |
| Rate for Payer: Aetna Commercial |
$40.88
|
| Rate for Payer: Aetna Medicare |
$30.51
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: BCBS MAPPO |
$30.51
|
| Rate for Payer: BCBS Trust/PPO |
$190.72
|
| Rate for Payer: BCN Commercial |
$47.41
|
| Rate for Payer: BCN Medicare Advantage |
$30.51
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cofinity Commercial |
$40.88
|
| Rate for Payer: Cofinity Commercial |
$43.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.51
|
| Rate for Payer: Healthscope Commercial |
$36.61
|
| Rate for Payer: Healthscope Whirlpool |
$36.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$32.04
|
| Rate for Payer: PACE SWMI |
$30.51
|
| Rate for Payer: PHP Medicare Advantage |
$30.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.57
|
| Rate for Payer: Priority Health Medicare |
$30.51
|
| Rate for Payer: Priority Health Narrow Network |
$43.57
|
| Rate for Payer: UHC Medicare Advantage |
$31.43
|
|
|
PR IV INFUSION THERAPY/PROPHYLAXIS /DX 1ST TO 1 HR
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 96365
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$80.16
|
| Rate for Payer: Aetna Medicare |
$59.82
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$59.82
|
| Rate for Payer: BCBS Trust/PPO |
$168.00
|
| Rate for Payer: BCN Commercial |
$93.34
|
| Rate for Payer: BCN Medicare Advantage |
$59.82
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$86.14
|
| Rate for Payer: Cofinity Commercial |
$80.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.82
|
| Rate for Payer: Healthscope Commercial |
$71.78
|
| Rate for Payer: Healthscope Whirlpool |
$71.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.81
|
| Rate for Payer: PACE SWMI |
$59.82
|
| Rate for Payer: PHP Medicare Advantage |
$59.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.78
|
| Rate for Payer: Priority Health Medicare |
$59.82
|
| Rate for Payer: Priority Health Narrow Network |
$85.78
|
| Rate for Payer: UHC Medicare Advantage |
$61.61
|
|
|
PR IV INFUSION THERAPY PROPHYLAXIS/DX EA HOUR
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 96366
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$1,006.94 |
| Rate for Payer: Aetna Commercial |
$26.04
|
| Rate for Payer: Aetna Medicare |
$19.43
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$19.43
|
| Rate for Payer: BCBS Trust/PPO |
$1,006.94
|
| Rate for Payer: BCN Commercial |
$29.81
|
| Rate for Payer: BCN Medicare Advantage |
$19.43
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$27.98
|
| Rate for Payer: Cofinity Commercial |
$26.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.43
|
| Rate for Payer: Healthscope Commercial |
$23.32
|
| Rate for Payer: Healthscope Whirlpool |
$23.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$20.40
|
| Rate for Payer: PACE SWMI |
$19.43
|
| Rate for Payer: PHP Medicare Advantage |
$19.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.40
|
| Rate for Payer: Priority Health Medicare |
$19.43
|
| Rate for Payer: Priority Health Narrow Network |
$27.40
|
| Rate for Payer: UHC Medicare Advantage |
$20.01
|
|
|
PR IV INFUSION THER PROPH ADDL SEQUENTIAL TO 1 HR
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 96367
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$1,165.43 |
| Rate for Payer: Aetna Commercial |
$36.42
|
| Rate for Payer: Aetna Medicare |
$27.18
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS MAPPO |
$27.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,165.43
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Medicare Advantage |
$27.18
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$39.14
|
| Rate for Payer: Cofinity Commercial |
$36.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.18
|
| Rate for Payer: Healthscope Commercial |
$32.62
|
| Rate for Payer: Healthscope Whirlpool |
$32.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.54
|
| Rate for Payer: PACE SWMI |
$27.18
|
| Rate for Payer: PHP Medicare Advantage |
$27.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.62
|
| Rate for Payer: Priority Health Medicare |
$27.18
|
| Rate for Payer: Priority Health Narrow Network |
$38.62
|
| Rate for Payer: UHC Medicare Advantage |
$28.00
|
|
|
PR IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 15860
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$10,615.31 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Medicare |
$105.45
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS MAPPO |
$105.45
|
| Rate for Payer: BCBS Trust/PPO |
$10,615.31
|
| Rate for Payer: BCN Commercial |
$154.42
|
| Rate for Payer: BCN Medicare Advantage |
$105.45
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$151.85
|
| Rate for Payer: Cofinity Commercial |
$141.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.45
|
| Rate for Payer: Healthscope Commercial |
$126.54
|
| Rate for Payer: Healthscope Whirlpool |
$126.54
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$110.72
|
| Rate for Payer: PACE SWMI |
$105.45
|
| Rate for Payer: PHP Medicare Advantage |
$105.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.88
|
| Rate for Payer: Priority Health Medicare |
$105.45
|
| Rate for Payer: Priority Health Narrow Network |
$129.88
|
| Rate for Payer: UHC Medicare Advantage |
$108.61
|
|
|
PR IV NFS THERAPY PROPHYLAXIS/DX CONCURRENT NFS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 96368
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$1,117.88 |
| Rate for Payer: Aetna Commercial |
$25.17
|
| Rate for Payer: Aetna Medicare |
$18.78
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$18.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,117.88
|
| Rate for Payer: BCN Commercial |
$28.83
|
| Rate for Payer: BCN Medicare Advantage |
$18.78
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$25.17
|
| Rate for Payer: Cofinity Commercial |
$27.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.78
|
| Rate for Payer: Healthscope Commercial |
$22.54
|
| Rate for Payer: Healthscope Whirlpool |
$22.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$19.72
|
| Rate for Payer: PACE SWMI |
$18.78
|
| Rate for Payer: PHP Medicare Advantage |
$18.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26.49
|
| Rate for Payer: Priority Health Medicare |
$18.78
|
| Rate for Payer: Priority Health Narrow Network |
$26.49
|
| Rate for Payer: UHC Medicare Advantage |
$19.34
|
|
|
PR IV ULTRASOUND,FIRST VESSEL
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 37250
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$210.00 |
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.00
|
|
|
PR KETOROLAC TROMETHAMINE INJ
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1885
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: Aetna Commercial |
$0.73
|
| Rate for Payer: Aetna Medicare |
$0.55
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCBS MAPPO |
$0.55
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.11
|
| Rate for Payer: BCN Medicare Advantage |
$0.55
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$0.79
|
| Rate for Payer: Cofinity Commercial |
$0.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.55
|
| Rate for Payer: Healthscope Commercial |
$0.66
|
| Rate for Payer: Healthscope Whirlpool |
$0.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: PACE SWMI |
$0.55
|
| Rate for Payer: PHP Medicare Advantage |
$0.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: UHC Medicare Advantage |
$0.56
|
|
|
PR KO IMMOB CANVAS LONG PRE OTS
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS L1830
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$64.89 |
| Rate for Payer: Aetna Commercial |
$42.62
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCN Commercial |
$64.89
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
|
|
PR KYBELLA
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 00086
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$240.00 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
|
|
PR Kyleena, 19.5 mg
|
Professional
|
Both
|
$1,443.00
|
|
|
Service Code
|
HCPCS J7296
|
| Min. Negotiated Rate |
$1,010.10 |
| Max. Negotiated Rate |
$1,156.78 |
| Rate for Payer: Aetna Commercial |
$1,101.70
|
| Rate for Payer: BCBS Complete |
$1,156.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,118.44
|
| Rate for Payer: BCN Commercial |
$1,121.75
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Cash Price |
$1,154.40
|
| Rate for Payer: Meridian Medicaid |
$1,156.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,101.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,010.10
|
|
|
PR KYLEENA, 19.5 MG
|
Professional
|
Both
|
$860.00
|
|
|
Service Code
|
HCPCS Q9984
|
| Min. Negotiated Rate |
$344.00 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: BCBS Complete |
$344.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$602.00
|
|
|
PR KYPHECTOMY SINGLE OR TWO SEGMENTS
|
Professional
|
Both
|
$12,673.00
|
|
|
Service Code
|
HCPCS 22818
|
| Min. Negotiated Rate |
$145.43 |
| Max. Negotiated Rate |
$8,871.10 |
| Rate for Payer: Aetna Commercial |
$2,840.36
|
| Rate for Payer: Aetna Medicare |
$2,119.67
|
| Rate for Payer: BCBS Complete |
$1,440.53
|
| Rate for Payer: BCBS MAPPO |
$2,119.67
|
| Rate for Payer: BCBS Trust/PPO |
$145.43
|
| Rate for Payer: BCN Commercial |
$3,130.47
|
| Rate for Payer: BCN Medicare Advantage |
$2,119.67
|
| Rate for Payer: Cash Price |
$10,138.40
|
| Rate for Payer: Cash Price |
$10,138.40
|
| Rate for Payer: Cofinity Commercial |
$3,052.32
|
| Rate for Payer: Cofinity Commercial |
$2,840.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,119.67
|
| Rate for Payer: Healthscope Commercial |
$2,543.60
|
| Rate for Payer: Healthscope Whirlpool |
$2,543.60
|
| Rate for Payer: Meridian Medicaid |
$1,440.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,225.65
|
| Rate for Payer: PACE SWMI |
$2,119.67
|
| Rate for Payer: PHP Medicare Advantage |
$2,119.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,371.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8,871.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,271.22
|
| Rate for Payer: Priority Health Medicare |
$2,119.67
|
| Rate for Payer: Priority Health Narrow Network |
$3,271.22
|
| Rate for Payer: UHC Medicare Advantage |
$2,183.26
|
|
|
PR LABYRINTHOTOMY TRANSCANAL
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 69801
|
| Min. Negotiated Rate |
$79.45 |
| Max. Negotiated Rate |
$2,908.82 |
| Rate for Payer: Aetna Commercial |
$163.98
|
| Rate for Payer: Aetna Medicare |
$122.37
|
| Rate for Payer: BCBS Complete |
$83.42
|
| Rate for Payer: BCBS MAPPO |
$122.37
|
| Rate for Payer: BCBS Trust/PPO |
$2,908.82
|
| Rate for Payer: BCN Commercial |
$336.70
|
| Rate for Payer: BCN Medicare Advantage |
$122.37
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$163.98
|
| Rate for Payer: Cofinity Commercial |
$176.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.37
|
| Rate for Payer: Healthscope Commercial |
$146.84
|
| Rate for Payer: Healthscope Whirlpool |
$146.84
|
| Rate for Payer: Meridian Medicaid |
$83.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.49
|
| Rate for Payer: PACE SWMI |
$122.37
|
| Rate for Payer: PHP Medicare Advantage |
$122.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.91
|
| Rate for Payer: Priority Health Medicare |
$122.37
|
| Rate for Payer: Priority Health Narrow Network |
$174.91
|
| Rate for Payer: UHC Medicare Advantage |
$126.04
|
|
|
PR LAIV3 VACCINE LIVE FOR INTRANASAL USE
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 90660
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$21.70 |
| Rate for Payer: Aetna Commercial |
$0.01
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
|
