|
PR MICRONEEDLING SCARS - UP TO 4 INCHES
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 00109
|
|
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 MICRONEEDLING TAT RMVL 4-6 SQ INCHES
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 00122
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$180.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: BCBS Complete |
$180.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.00
|
|
|
PR MICRONEEDLING TAT RMVL 6-9 SQ INCHES
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 00123
|
|
Hospital Revenue Code
|
990
|
| 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 MICRONEEDLING TAT RMVL 9-12 SQ INCHES
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 00124
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
|
|
PR MICRONEEDLING TAT RMVL UP TO 2 SQ INCH
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 00110
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
|
|
PR MICROSURG TQS REQ USE OPERATING MICROSCOPE
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
HCPCS 69990
|
| Min. Negotiated Rate |
$138.88 |
| Max. Negotiated Rate |
$11,952.59 |
| Rate for Payer: Aetna Commercial |
$292.64
|
| Rate for Payer: Aetna Medicare |
$218.39
|
| Rate for Payer: BCBS Complete |
$145.82
|
| Rate for Payer: BCBS MAPPO |
$218.39
|
| Rate for Payer: BCBS Trust/PPO |
$11,952.59
|
| Rate for Payer: BCN Commercial |
$349.21
|
| Rate for Payer: BCN Medicare Advantage |
$218.39
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cash Price |
$392.80
|
| Rate for Payer: Cofinity Commercial |
$292.64
|
| Rate for Payer: Cofinity Commercial |
$314.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$218.39
|
| Rate for Payer: Healthscope Commercial |
$262.07
|
| Rate for Payer: Healthscope Whirlpool |
$262.07
|
| Rate for Payer: Meridian Medicaid |
$145.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$229.31
|
| Rate for Payer: PACE SWMI |
$218.39
|
| Rate for Payer: PHP Medicare Advantage |
$218.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$138.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$343.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.98
|
| Rate for Payer: Priority Health Medicare |
$218.39
|
| Rate for Payer: Priority Health Narrow Network |
$305.98
|
| Rate for Payer: UHC Medicare Advantage |
$224.94
|
|
|
PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC
|
Professional
|
Both
|
$1,671.00
|
|
|
Service Code
|
HCPCS 69440
|
| Min. Negotiated Rate |
$446.02 |
| Max. Negotiated Rate |
$1,668.90 |
| Rate for Payer: Aetna Commercial |
$906.54
|
| Rate for Payer: Aetna Medicare |
$676.52
|
| Rate for Payer: BCBS Complete |
$468.32
|
| Rate for Payer: BCBS MAPPO |
$676.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,668.90
|
| Rate for Payer: BCN Commercial |
$1,024.27
|
| Rate for Payer: BCN Medicare Advantage |
$676.52
|
| Rate for Payer: Cash Price |
$1,336.80
|
| Rate for Payer: Cash Price |
$1,336.80
|
| Rate for Payer: Cofinity Commercial |
$974.19
|
| Rate for Payer: Cofinity Commercial |
$906.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$676.52
|
| Rate for Payer: Healthscope Commercial |
$811.82
|
| Rate for Payer: Healthscope Whirlpool |
$811.82
|
| Rate for Payer: Meridian Medicaid |
$468.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$710.35
|
| Rate for Payer: PACE SWMI |
$676.52
|
| Rate for Payer: PHP Medicare Advantage |
$676.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,169.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$988.18
|
| Rate for Payer: Priority Health Medicare |
$676.52
|
| Rate for Payer: Priority Health Narrow Network |
$988.18
|
| Rate for Payer: UHC Medicare Advantage |
$696.82
|
|
|
PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES
|
Professional
|
Both
|
$2,914.00
|
|
|
Service Code
|
HCPCS 15730
|
| Min. Negotiated Rate |
$583.41 |
| Max. Negotiated Rate |
$2,089.09 |
| Rate for Payer: Aetna Commercial |
$1,191.07
|
| Rate for Payer: Aetna Medicare |
$888.86
|
| Rate for Payer: BCBS Complete |
$612.58
|
| Rate for Payer: BCBS MAPPO |
$888.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,930.99
|
| Rate for Payer: BCN Commercial |
$2,089.09
|
| Rate for Payer: BCN Medicare Advantage |
$888.86
|
| Rate for Payer: Cash Price |
$2,331.20
|
| Rate for Payer: Cash Price |
$2,331.20
|
| Rate for Payer: Cofinity Commercial |
$1,279.96
|
| Rate for Payer: Cofinity Commercial |
$1,191.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$888.86
|
| Rate for Payer: Healthscope Commercial |
$1,066.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,066.63
|
| Rate for Payer: Meridian Medicaid |
$612.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$933.30
|
| Rate for Payer: PACE SWMI |
$888.86
|
| Rate for Payer: PHP Medicare Advantage |
$888.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$583.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,039.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,118.02
|
| Rate for Payer: Priority Health Medicare |
$888.86
|
| Rate for Payer: Priority Health Narrow Network |
$1,118.02
|
| Rate for Payer: UHC Medicare Advantage |
$915.53
|
|
|
PR MIRENA, 52 MG
|
Professional
|
Both
|
$1,443.00
|
|
|
Service Code
|
HCPCS J7298
|
| 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 |
$1,103.90
|
| Rate for Payer: BCN Commercial |
$1,107.20
|
| 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 MISCELLANEOUS VISION SERVICE
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS V2799
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: BCBS Complete |
$2.00
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.50
|
|
|
PR MISOPROSTOL, ORAL, 200 MCG
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS S0191
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$0.96
|
| Rate for Payer: BCBS Complete |
$1.60
|
| Rate for Payer: BCBS Trust/PPO |
$0.64
|
| Rate for Payer: BCN Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.80
|
|
|
PR MITOMYCIN INJECTION
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS J9280
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$113.79 |
| Rate for Payer: Aetna Commercial |
$105.89
|
| Rate for Payer: Aetna Medicare |
$79.02
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$79.02
|
| Rate for Payer: BCBS Trust/PPO |
$10.36
|
| Rate for Payer: BCN Commercial |
$3.72
|
| Rate for Payer: BCN Medicare Advantage |
$79.02
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$113.79
|
| Rate for Payer: Cofinity Commercial |
$105.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.02
|
| Rate for Payer: Healthscope Commercial |
$94.83
|
| Rate for Payer: Healthscope Whirlpool |
$94.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$82.98
|
| Rate for Payer: PACE SWMI |
$79.02
|
| Rate for Payer: PHP Medicare Advantage |
$79.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health Medicare |
$79.02
|
| Rate for Payer: UHC Medicare Advantage |
$81.39
|
|
|
PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 95805
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$682.50 |
| Rate for Payer: Aetna Commercial |
$522.65
|
| Rate for Payer: Aetna Commercial |
$522.65
|
| Rate for Payer: Aetna Medicare |
$390.04
|
| Rate for Payer: Aetna Medicare |
$390.04
|
| Rate for Payer: BCBS Complete |
$390.00
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$390.04
|
| Rate for Payer: BCBS MAPPO |
$390.04
|
| Rate for Payer: BCBS Trust/PPO |
$639.77
|
| Rate for Payer: BCBS Trust/PPO |
$639.77
|
| Rate for Payer: BCN Commercial |
$610.36
|
| Rate for Payer: BCN Commercial |
$610.36
|
| Rate for Payer: BCN Medicare Advantage |
$390.04
|
| Rate for Payer: BCN Medicare Advantage |
$390.04
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$780.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$522.65
|
| Rate for Payer: Cofinity Commercial |
$522.65
|
| Rate for Payer: Cofinity Commercial |
$561.66
|
| Rate for Payer: Cofinity Commercial |
$561.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.04
|
| Rate for Payer: Healthscope Commercial |
$468.05
|
| Rate for Payer: Healthscope Commercial |
$468.05
|
| Rate for Payer: Healthscope Whirlpool |
$468.05
|
| Rate for Payer: Healthscope Whirlpool |
$468.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$409.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$409.54
|
| Rate for Payer: PACE SWMI |
$390.04
|
| Rate for Payer: PACE SWMI |
$390.04
|
| Rate for Payer: PHP Medicare Advantage |
$390.04
|
| Rate for Payer: PHP Medicare Advantage |
$390.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$682.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$560.98
|
| Rate for Payer: Priority Health Medicare |
$390.04
|
| Rate for Payer: Priority Health Medicare |
$390.04
|
| Rate for Payer: Priority Health Narrow Network |
$560.98
|
| Rate for Payer: Priority Health Narrow Network |
$560.98
|
| Rate for Payer: UHC Medicare Advantage |
$401.74
|
| Rate for Payer: UHC Medicare Advantage |
$401.74
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
IP
|
$903.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$632.10 |
| Max. Negotiated Rate |
$903.00 |
| Rate for Payer: Aetna Commercial |
$812.70
|
| Rate for Payer: ASR ASR |
$875.91
|
| Rate for Payer: BCBS Trust/PPO |
$700.10
|
| Rate for Payer: BCN Commercial |
$700.10
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cofinity Commercial |
$848.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.40
|
| Rate for Payer: Healthscope Commercial |
$903.00
|
| Rate for Payer: Healthscope Whirlpool |
$875.91
|
| Rate for Payer: Mclaren Commercial |
$812.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$767.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$794.64
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$903.00
|
|
|
Service Code
|
HCPCS 23700
|
| Min. Negotiated Rate |
$126.95 |
| Max. Negotiated Rate |
$632.10 |
| Rate for Payer: Aetna Commercial |
$258.62
|
| Rate for Payer: Aetna Medicare |
$193.00
|
| Rate for Payer: BCBS Complete |
$133.30
|
| Rate for Payer: BCBS MAPPO |
$193.00
|
| Rate for Payer: BCBS Trust/PPO |
$286.11
|
| Rate for Payer: BCN Commercial |
$288.81
|
| Rate for Payer: BCN Medicare Advantage |
$193.00
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cofinity Commercial |
$277.92
|
| Rate for Payer: Cofinity Commercial |
$258.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.00
|
| Rate for Payer: Healthscope Commercial |
$231.60
|
| Rate for Payer: Healthscope Whirlpool |
$231.60
|
| Rate for Payer: Meridian Medicaid |
$133.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$202.65
|
| Rate for Payer: PACE SWMI |
$193.00
|
| Rate for Payer: PHP Medicare Advantage |
$193.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.79
|
| Rate for Payer: Priority Health Medicare |
$193.00
|
| Rate for Payer: Priority Health Narrow Network |
$301.79
|
| Rate for Payer: UHC Medicare Advantage |
$198.79
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Professional
|
Both
|
$903.00
|
|
|
Service Code
|
HCPCS 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$126.95 |
| Max. Negotiated Rate |
$632.10 |
| Rate for Payer: Aetna Commercial |
$258.62
|
| Rate for Payer: Aetna Medicare |
$193.00
|
| Rate for Payer: BCBS Complete |
$133.30
|
| Rate for Payer: BCBS MAPPO |
$193.00
|
| Rate for Payer: BCBS Trust/PPO |
$286.11
|
| Rate for Payer: BCN Commercial |
$288.81
|
| Rate for Payer: BCN Medicare Advantage |
$193.00
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cofinity Commercial |
$258.62
|
| Rate for Payer: Cofinity Commercial |
$277.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.00
|
| Rate for Payer: Healthscope Commercial |
$231.60
|
| Rate for Payer: Healthscope Whirlpool |
$231.60
|
| Rate for Payer: Meridian Medicaid |
$133.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$202.65
|
| Rate for Payer: PACE SWMI |
$193.00
|
| Rate for Payer: PHP Medicare Advantage |
$193.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$126.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.79
|
| Rate for Payer: Priority Health Medicare |
$193.00
|
| Rate for Payer: Priority Health Narrow Network |
$301.79
|
| Rate for Payer: UHC Medicare Advantage |
$198.79
|
|
|
PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS
|
Facility
|
OP
|
$903.00
|
|
|
Service Code
|
CPT 23700
|
| Hospital Charge Code |
23700
|
| Min. Negotiated Rate |
$632.10 |
| Max. Negotiated Rate |
$1,785.76 |
| Rate for Payer: Aetna Commercial |
$812.70
|
| Rate for Payer: Aetna Medicare |
$1,428.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,785.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,785.76
|
| Rate for Payer: ASR ASR |
$875.91
|
| Rate for Payer: BCBS Complete |
$820.59
|
| Rate for Payer: BCBS MAPPO |
$1,428.61
|
| Rate for Payer: BCBS Trust/PPO |
$700.10
|
| Rate for Payer: BCN Commercial |
$700.10
|
| Rate for Payer: BCN Medicare Advantage |
$1,428.61
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cash Price |
$722.40
|
| Rate for Payer: Cofinity Commercial |
$848.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$722.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,428.61
|
| Rate for Payer: Healthscope Commercial |
$903.00
|
| Rate for Payer: Healthscope Whirlpool |
$875.91
|
| Rate for Payer: Humana Choice PPO Medicare |
$1,428.61
|
| Rate for Payer: Mclaren Commercial |
$812.70
|
| Rate for Payer: Mclaren Medicaid |
$781.45
|
| Rate for Payer: Mclaren Medicare |
$1,428.61
|
| Rate for Payer: Meridian Medicaid |
$820.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,500.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,642.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$767.55
|
| Rate for Payer: PACE Medicare |
$1,357.18
|
| Rate for Payer: PACE SWMI |
$1,428.61
|
| Rate for Payer: PHP Commercial |
$1,571.47
|
| Rate for Payer: PHP Medicaid |
$781.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,428.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$781.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$632.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$821.73
|
| Rate for Payer: Priority Health Medicare |
$1,428.61
|
| Rate for Payer: Priority Health Narrow Network |
$641.13
|
| Rate for Payer: Railroad Medicare Medicare |
$1,428.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$794.64
|
| Rate for Payer: UHC Medicare Advantage |
$1,471.47
|
| Rate for Payer: VA VA |
$1,428.61
|
|
|
PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 20950
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$29,358.48 |
| Rate for Payer: Aetna Commercial |
$114.70
|
| Rate for Payer: Aetna Medicare |
$85.60
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: BCBS MAPPO |
$85.60
|
| Rate for Payer: BCBS Trust/PPO |
$29,358.48
|
| Rate for Payer: BCN Commercial |
$387.52
|
| Rate for Payer: BCN Medicare Advantage |
$85.60
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cofinity Commercial |
$114.70
|
| Rate for Payer: Cofinity Commercial |
$123.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.60
|
| Rate for Payer: Healthscope Commercial |
$102.72
|
| Rate for Payer: Healthscope Whirlpool |
$102.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.88
|
| Rate for Payer: PACE SWMI |
$85.60
|
| Rate for Payer: PHP Medicare Advantage |
$85.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$133.29
|
| Rate for Payer: Priority Health Medicare |
$85.60
|
| Rate for Payer: Priority Health Narrow Network |
$133.29
|
| Rate for Payer: UHC Medicare Advantage |
$88.17
|
|
|
PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT
|
Professional
|
Both
|
$404.00
|
|
|
Service Code
|
HCPCS 44139
|
| Min. Negotiated Rate |
$75.83 |
| Max. Negotiated Rate |
$1,085.13 |
| Rate for Payer: Aetna Commercial |
$159.96
|
| Rate for Payer: Aetna Medicare |
$119.37
|
| Rate for Payer: BCBS Complete |
$79.62
|
| Rate for Payer: BCBS MAPPO |
$119.37
|
| Rate for Payer: BCBS Trust/PPO |
$1,085.13
|
| Rate for Payer: BCN Commercial |
$173.96
|
| Rate for Payer: BCN Medicare Advantage |
$119.37
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cash Price |
$323.20
|
| Rate for Payer: Cofinity Commercial |
$159.96
|
| Rate for Payer: Cofinity Commercial |
$171.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.37
|
| Rate for Payer: Healthscope Commercial |
$143.24
|
| Rate for Payer: Healthscope Whirlpool |
$143.24
|
| Rate for Payer: Meridian Medicaid |
$79.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.34
|
| Rate for Payer: PACE SWMI |
$119.37
|
| Rate for Payer: PHP Medicare Advantage |
$119.37
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.32
|
| Rate for Payer: Priority Health Medicare |
$119.37
|
| Rate for Payer: Priority Health Narrow Network |
$209.32
|
| Rate for Payer: UHC Medicare Advantage |
$122.95
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 99149
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$91.70 |
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.70
|
|
|
PR MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 99150
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 99143
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$127.40 |
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 99144
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.50
|
|
|
PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 99145
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
|
|
PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 99157
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$660.90 |
| Rate for Payer: Aetna Commercial |
$81.58
|
| Rate for Payer: Aetna Medicare |
$60.88
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$60.88
|
| Rate for Payer: BCBS Trust/PPO |
$660.90
|
| Rate for Payer: BCN Commercial |
$98.47
|
| Rate for Payer: BCN Medicare Advantage |
$60.88
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cofinity Commercial |
$87.67
|
| Rate for Payer: Cofinity Commercial |
$81.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.88
|
| Rate for Payer: Healthscope Commercial |
$73.06
|
| Rate for Payer: Healthscope Whirlpool |
$73.06
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.92
|
| Rate for Payer: PACE SWMI |
$60.88
|
| Rate for Payer: PHP Medicare Advantage |
$60.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.14
|
| Rate for Payer: Priority Health Medicare |
$60.88
|
| Rate for Payer: Priority Health Narrow Network |
$138.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.71
|
|
