|
PR DESTRUCTION NEUROLYTIC AGT GENICULAR NERVE W/IMG
|
Professional
|
Both
|
$818.00
|
|
|
Service Code
|
HCPCS 64624
|
| Min. Negotiated Rate |
$84.99 |
| Max. Negotiated Rate |
$613.50 |
| Rate for Payer: Aetna Commercial |
$174.67
|
| Rate for Payer: Aetna Medicare |
$130.35
|
| Rate for Payer: BCBS Complete |
$89.24
|
| Rate for Payer: BCBS MAPPO |
$130.35
|
| Rate for Payer: BCN Commercial |
$219.61
|
| Rate for Payer: BCN Medicare Advantage |
$130.35
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cash Price |
$654.40
|
| Rate for Payer: Cofinity Commercial |
$187.70
|
| Rate for Payer: Cofinity Commercial |
$174.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.35
|
| Rate for Payer: Healthscope Commercial |
$156.42
|
| Rate for Payer: Healthscope Whirlpool |
$156.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$136.87
|
| Rate for Payer: Meridian Medicaid |
$89.24
|
| Rate for Payer: Molina Medicare/Medicaid |
$143.38
|
| Rate for Payer: Nomi Health Commercial |
$156.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$613.50
|
| Rate for Payer: PACE SWMI |
$130.35
|
| Rate for Payer: PHP Medicare Advantage |
$130.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$255.08
|
| Rate for Payer: Priority Health Medicare |
$130.35
|
| Rate for Payer: Priority Health Narrow Network |
$255.08
|
| Rate for Payer: Railroad Medicare Medicare |
$130.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$257.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$130.35
|
| Rate for Payer: UHC Exchange |
$257.66
|
| Rate for Payer: UHC Medicaid |
$84.99
|
| Rate for Payer: UHCCP DNSP |
$130.35
|
| Rate for Payer: UHCCP Medicaid |
$84.99
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 15/>
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 17004
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$107.82
|
| Rate for Payer: Aetna Medicare |
$80.46
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS MAPPO |
$80.46
|
| Rate for Payer: BCN Commercial |
$117.02
|
| Rate for Payer: BCN Medicare Advantage |
$80.46
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$115.86
|
| Rate for Payer: Cofinity Commercial |
$107.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.46
|
| Rate for Payer: Healthscope Commercial |
$96.55
|
| Rate for Payer: Healthscope Whirlpool |
$96.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.48
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.51
|
| Rate for Payer: Nomi Health Commercial |
$96.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$240.00
|
| Rate for Payer: PACE SWMI |
$80.46
|
| Rate for Payer: PHP Medicare Advantage |
$80.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$135.82
|
| Rate for Payer: Priority Health Medicare |
$80.46
|
| Rate for Payer: Priority Health Narrow Network |
$135.82
|
| Rate for Payer: Railroad Medicare Medicare |
$80.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.46
|
| Rate for Payer: UHC Exchange |
$168.26
|
| Rate for Payer: UHC Medicaid |
$52.82
|
| Rate for Payer: UHCCP DNSP |
$80.46
|
| Rate for Payer: UHCCP Medicaid |
$52.82
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 1ST
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 17000
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$104.25 |
| Rate for Payer: Aetna Commercial |
$61.32
|
| Rate for Payer: Aetna Medicare |
$45.76
|
| Rate for Payer: BCBS Complete |
$31.98
|
| Rate for Payer: BCBS MAPPO |
$45.76
|
| Rate for Payer: BCN Commercial |
$65.19
|
| Rate for Payer: BCN Medicare Advantage |
$45.76
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$65.89
|
| Rate for Payer: Cofinity Commercial |
$61.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.76
|
| Rate for Payer: Healthscope Commercial |
$54.91
|
| Rate for Payer: Healthscope Whirlpool |
$54.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.05
|
| Rate for Payer: Meridian Medicaid |
$31.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.34
|
| Rate for Payer: Nomi Health Commercial |
$54.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.25
|
| Rate for Payer: PACE SWMI |
$45.76
|
| Rate for Payer: PHP Medicare Advantage |
$45.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$75.67
|
| Rate for Payer: Priority Health Medicare |
$45.76
|
| Rate for Payer: Priority Health Narrow Network |
$75.67
|
| Rate for Payer: Railroad Medicare Medicare |
$45.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$45.76
|
| Rate for Payer: UHC Exchange |
$91.49
|
| Rate for Payer: UHC Medicaid |
$30.46
|
| Rate for Payer: UHCCP DNSP |
$45.76
|
| Rate for Payer: UHCCP Medicaid |
$30.46
|
|
|
PR DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 17003
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Aetna Commercial |
$2.20
|
| Rate for Payer: Aetna Medicare |
$1.64
|
| Rate for Payer: BCBS Complete |
$1.12
|
| Rate for Payer: BCBS MAPPO |
$1.64
|
| Rate for Payer: BCN Commercial |
$2.36
|
| Rate for Payer: BCN Medicare Advantage |
$1.64
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$2.36
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$1.97
|
| Rate for Payer: Healthscope Whirlpool |
$1.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.72
|
| Rate for Payer: Meridian Medicaid |
$1.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.80
|
| Rate for Payer: Nomi Health Commercial |
$1.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$22.50
|
| Rate for Payer: PACE SWMI |
$1.64
|
| Rate for Payer: PHP Medicare Advantage |
$1.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.73
|
| Rate for Payer: Priority Health Medicare |
$1.64
|
| Rate for Payer: Priority Health Narrow Network |
$2.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.64
|
| Rate for Payer: UHC Exchange |
$3.65
|
| Rate for Payer: UHC Medicaid |
$1.07
|
| Rate for Payer: UHCCP DNSP |
$1.64
|
| Rate for Payer: UHCCP Medicaid |
$1.07
|
|
|
PR DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH
|
Professional
|
Both
|
$1,612.00
|
|
|
Service Code
|
HCPCS 45190
|
| Min. Negotiated Rate |
$428.77 |
| Max. Negotiated Rate |
$1,278.44 |
| Rate for Payer: Aetna Commercial |
$876.16
|
| Rate for Payer: Aetna Medicare |
$653.85
|
| Rate for Payer: BCBS Complete |
$450.21
|
| Rate for Payer: BCBS MAPPO |
$653.85
|
| Rate for Payer: BCN Commercial |
$1,049.25
|
| Rate for Payer: BCN Medicare Advantage |
$653.85
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cash Price |
$1,289.60
|
| Rate for Payer: Cofinity Commercial |
$941.54
|
| Rate for Payer: Cofinity Commercial |
$876.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.85
|
| Rate for Payer: Healthscope Commercial |
$784.62
|
| Rate for Payer: Healthscope Whirlpool |
$784.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.54
|
| Rate for Payer: Meridian Medicaid |
$450.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$719.24
|
| Rate for Payer: Nomi Health Commercial |
$784.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,209.00
|
| Rate for Payer: PACE SWMI |
$653.85
|
| Rate for Payer: PHP Medicare Advantage |
$653.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$428.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,278.44
|
| Rate for Payer: Priority Health Medicare |
$653.85
|
| Rate for Payer: Priority Health Narrow Network |
$1,278.44
|
| Rate for Payer: Railroad Medicare Medicare |
$653.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,225.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$653.85
|
| Rate for Payer: UHC Exchange |
$1,225.76
|
| Rate for Payer: UHC Medicaid |
$428.77
|
| Rate for Payer: UHCCP DNSP |
$653.85
|
| Rate for Payer: UHCCP Medicaid |
$428.77
|
|
|
PR DESTRUCTION VAGINAL LESIONS EXTENSIVE
|
Professional
|
Both
|
$750.00
|
|
|
Service Code
|
HCPCS 57065
|
| Min. Negotiated Rate |
$105.86 |
| Max. Negotiated Rate |
$562.50 |
| Rate for Payer: Aetna Commercial |
$217.52
|
| Rate for Payer: Aetna Medicare |
$162.33
|
| Rate for Payer: BCBS Complete |
$111.15
|
| Rate for Payer: BCBS MAPPO |
$162.33
|
| Rate for Payer: BCN Commercial |
$279.37
|
| Rate for Payer: BCN Medicare Advantage |
$162.33
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cash Price |
$600.00
|
| Rate for Payer: Cofinity Commercial |
$233.76
|
| Rate for Payer: Cofinity Commercial |
$217.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.33
|
| Rate for Payer: Healthscope Commercial |
$194.80
|
| Rate for Payer: Healthscope Whirlpool |
$194.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.45
|
| Rate for Payer: Meridian Medicaid |
$111.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$178.56
|
| Rate for Payer: Nomi Health Commercial |
$194.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$562.50
|
| Rate for Payer: PACE SWMI |
$162.33
|
| Rate for Payer: PHP Medicare Advantage |
$162.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$105.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$282.93
|
| Rate for Payer: Priority Health Medicare |
$162.33
|
| Rate for Payer: Priority Health Narrow Network |
$282.93
|
| Rate for Payer: Railroad Medicare Medicare |
$162.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$315.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$162.33
|
| Rate for Payer: UHC Exchange |
$315.20
|
| Rate for Payer: UHC Medicaid |
$105.86
|
| Rate for Payer: UHCCP DNSP |
$162.33
|
| Rate for Payer: UHCCP Medicaid |
$105.86
|
|
|
PR DESTRUCTION VAGINAL LESIONS SIMPLE
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
HCPCS 57061
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$279.75 |
| Rate for Payer: Aetna Commercial |
$136.20
|
| Rate for Payer: Aetna Medicare |
$101.64
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS MAPPO |
$101.64
|
| Rate for Payer: BCN Commercial |
$137.05
|
| Rate for Payer: BCN Medicare Advantage |
$101.64
|
| Rate for Payer: Cash Price |
$298.40
|
| Rate for Payer: Cash Price |
$298.40
|
| Rate for Payer: Cofinity Commercial |
$146.36
|
| Rate for Payer: Cofinity Commercial |
$136.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.64
|
| Rate for Payer: Healthscope Commercial |
$121.97
|
| Rate for Payer: Healthscope Whirlpool |
$121.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.72
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.80
|
| Rate for Payer: Nomi Health Commercial |
$121.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.75
|
| Rate for Payer: PACE SWMI |
$101.64
|
| Rate for Payer: PHP Medicare Advantage |
$101.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$176.02
|
| Rate for Payer: Priority Health Medicare |
$101.64
|
| Rate for Payer: Priority Health Narrow Network |
$176.02
|
| Rate for Payer: Railroad Medicare Medicare |
$101.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$185.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.64
|
| Rate for Payer: UHC Exchange |
$185.59
|
| Rate for Payer: UHC Medicaid |
$67.31
|
| Rate for Payer: UHCCP DNSP |
$101.64
|
| Rate for Payer: UHCCP Medicaid |
$67.31
|
|
|
PR DETERMINATION REFRACTIVE STATE
|
Professional
|
Both
|
$99.00
|
|
|
Service Code
|
HCPCS 92015
|
| Min. Negotiated Rate |
$10.01 |
| Max. Negotiated Rate |
$74.25 |
| Rate for Payer: Aetna Commercial |
$21.33
|
| Rate for Payer: BCBS Complete |
$10.51
|
| Rate for Payer: BCN Commercial |
$19.98
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Meridian Medicaid |
$10.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.43
|
| Rate for Payer: Priority Health Narrow Network |
$23.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$25.00
|
| Rate for Payer: UHC Exchange |
$25.00
|
| Rate for Payer: UHC Medicaid |
$10.01
|
| Rate for Payer: UHCCP Medicaid |
$10.01
|
|
|
PR DEVELOPMENTAL SCREEN W/SCORING & DOC STD INSTRM
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 96110
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: Aetna Commercial |
$10.35
|
| Rate for Payer: BCN Commercial |
$17.43
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16.07
|
| Rate for Payer: Priority Health Narrow Network |
$16.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.94
|
| Rate for Payer: UHC Exchange |
$14.94
|
|
|
PR DEVELOPMENTAL TESTING W/INTERP & REPORT
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 96111
|
| Min. Negotiated Rate |
$99.60 |
| Max. Negotiated Rate |
$186.75 |
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.75
|
|
|
PR DEVELOPMENTAL TST ADMIN PHYS/QHP 1ST HOUR
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 96112
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Aetna Commercial |
$142.08
|
| Rate for Payer: Aetna Medicare |
$106.03
|
| Rate for Payer: BCBS Complete |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$106.03
|
| Rate for Payer: BCN Commercial |
$180.27
|
| Rate for Payer: BCN Medicare Advantage |
$106.03
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$142.08
|
| Rate for Payer: Cofinity Commercial |
$152.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.03
|
| Rate for Payer: Healthscope Commercial |
$127.24
|
| Rate for Payer: Healthscope Whirlpool |
$127.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.33
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.63
|
| Rate for Payer: Nomi Health Commercial |
$127.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$199.50
|
| Rate for Payer: PACE SWMI |
$106.03
|
| Rate for Payer: PHP Medicare Advantage |
$106.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$166.24
|
| Rate for Payer: Priority Health Medicare |
$106.03
|
| Rate for Payer: Priority Health Narrow Network |
$166.24
|
| Rate for Payer: Railroad Medicare Medicare |
$106.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$106.03
|
| Rate for Payer: UHC Exchange |
$206.80
|
| Rate for Payer: UHC Medicaid |
$68.16
|
| Rate for Payer: UHCCP DNSP |
$106.03
|
| Rate for Payer: UHCCP Medicaid |
$68.16
|
|
|
PR DEVELOPMENTAL TST ADMIN PHYS/QHP EA ADDL 30 MIN
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 96113
|
| Min. Negotiated Rate |
$28.76 |
| Max. Negotiated Rate |
$96.75 |
| Rate for Payer: Aetna Commercial |
$59.98
|
| Rate for Payer: Aetna Medicare |
$44.76
|
| Rate for Payer: BCBS Complete |
$30.20
|
| Rate for Payer: BCBS MAPPO |
$44.76
|
| Rate for Payer: BCN Commercial |
$74.20
|
| Rate for Payer: BCN Medicare Advantage |
$44.76
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$64.45
|
| Rate for Payer: Cofinity Commercial |
$59.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.76
|
| Rate for Payer: Healthscope Commercial |
$53.71
|
| Rate for Payer: Healthscope Whirlpool |
$53.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.00
|
| Rate for Payer: Meridian Medicaid |
$30.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.24
|
| Rate for Payer: Nomi Health Commercial |
$53.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$96.75
|
| Rate for Payer: PACE SWMI |
$44.76
|
| Rate for Payer: PHP Medicare Advantage |
$44.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$68.43
|
| Rate for Payer: Priority Health Medicare |
$44.76
|
| Rate for Payer: Priority Health Narrow Network |
$68.43
|
| Rate for Payer: Railroad Medicare Medicare |
$44.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$44.76
|
| Rate for Payer: UHC Exchange |
$93.75
|
| Rate for Payer: UHC Medicaid |
$28.76
|
| Rate for Payer: UHCCP DNSP |
$44.76
|
| Rate for Payer: UHCCP Medicaid |
$28.76
|
|
|
PR DEXAMETHASONE SODIUM PHOS
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J1100
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: Aetna Commercial |
$0.15
|
| Rate for Payer: Aetna Medicare |
$0.11
|
| Rate for Payer: BCBS MAPPO |
$0.11
|
| Rate for Payer: BCBS Trust/PPO |
$0.01
|
| Rate for Payer: BCN Commercial |
$0.01
|
| Rate for Payer: BCN Medicare Advantage |
$0.11
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$0.16
|
| Rate for Payer: Cofinity Commercial |
$0.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.11
|
| Rate for Payer: Healthscope Commercial |
$0.13
|
| Rate for Payer: Healthscope Whirlpool |
$0.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.12
|
| Rate for Payer: Nomi Health Commercial |
$0.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
| Rate for Payer: PACE SWMI |
$0.11
|
| Rate for Payer: PHP Medicare Advantage |
$0.11
|
| Rate for Payer: Priority Health Medicare |
$0.11
|
| Rate for Payer: Railroad Medicare Medicare |
$0.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$0.11
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.11
|
| Rate for Payer: UHC Exchange |
$0.11
|
| Rate for Payer: UHCCP DNSP |
$0.11
|
|
|
PR DIABETES PREVENTION PROGRAM
|
Professional
|
Both
|
$137.00
|
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.75
|
|
|
PR DIABETES PREVENTION PROG STANDARDIZED CURRICULUM
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 0403T
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$112.94 |
| Rate for Payer: Aetna Commercial |
$32.06
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCN Commercial |
$59.32
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$25.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.94
|
| Rate for Payer: UHC Exchange |
$112.94
|
|
|
PR DIAGNOSTIC ARTHROSCOPY SHOULDER +- SYNOVIAL BX
|
Professional
|
Both
|
$1,333.00
|
|
|
Service Code
|
HCPCS 29805
|
| Min. Negotiated Rate |
$286.27 |
| Max. Negotiated Rate |
$999.75 |
| Rate for Payer: Aetna Commercial |
$583.80
|
| Rate for Payer: Aetna Medicare |
$435.67
|
| Rate for Payer: BCBS Complete |
$300.58
|
| Rate for Payer: BCBS MAPPO |
$435.67
|
| Rate for Payer: BCN Commercial |
$721.58
|
| Rate for Payer: BCN Medicare Advantage |
$435.67
|
| Rate for Payer: Cash Price |
$1,066.40
|
| Rate for Payer: Cash Price |
$1,066.40
|
| Rate for Payer: Cofinity Commercial |
$627.36
|
| Rate for Payer: Cofinity Commercial |
$583.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$435.67
|
| Rate for Payer: Healthscope Commercial |
$522.80
|
| Rate for Payer: Healthscope Whirlpool |
$522.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$457.45
|
| Rate for Payer: Meridian Medicaid |
$300.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$479.24
|
| Rate for Payer: Nomi Health Commercial |
$522.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$999.75
|
| Rate for Payer: PACE SWMI |
$435.67
|
| Rate for Payer: PHP Medicare Advantage |
$435.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$286.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$771.34
|
| Rate for Payer: Priority Health Medicare |
$435.67
|
| Rate for Payer: Priority Health Narrow Network |
$771.34
|
| Rate for Payer: Railroad Medicare Medicare |
$435.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$816.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$435.67
|
| Rate for Payer: UHC Exchange |
$816.86
|
| Rate for Payer: UHC Medicaid |
$286.27
|
| Rate for Payer: UHCCP DNSP |
$435.67
|
| Rate for Payer: UHCCP Medicaid |
$286.27
|
|
|
PR DIAGNOSTIC BONE MARROW ASPIRATIONS
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS 38220
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$73.26
|
| Rate for Payer: Aetna Medicare |
$54.67
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS MAPPO |
$54.67
|
| Rate for Payer: BCN Commercial |
$100.09
|
| Rate for Payer: BCN Medicare Advantage |
$54.67
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$78.72
|
| Rate for Payer: Cofinity Commercial |
$73.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.67
|
| Rate for Payer: Healthscope Commercial |
$65.60
|
| Rate for Payer: Healthscope Whirlpool |
$65.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.40
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.14
|
| Rate for Payer: Nomi Health Commercial |
$65.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.00
|
| Rate for Payer: PACE SWMI |
$54.67
|
| Rate for Payer: PHP Medicare Advantage |
$54.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$133.19
|
| Rate for Payer: Priority Health Medicare |
$54.67
|
| Rate for Payer: Priority Health Narrow Network |
$133.19
|
| Rate for Payer: Railroad Medicare Medicare |
$54.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$54.67
|
| Rate for Payer: UHC Exchange |
$122.84
|
| Rate for Payer: UHC Medicaid |
$35.36
|
| Rate for Payer: UHCCP DNSP |
$54.67
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 38221
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna Commercial |
$76.62
|
| Rate for Payer: Aetna Medicare |
$57.18
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$57.18
|
| Rate for Payer: BCN Commercial |
$103.08
|
| Rate for Payer: BCN Medicare Advantage |
$57.18
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$82.34
|
| Rate for Payer: Cofinity Commercial |
$76.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.18
|
| Rate for Payer: Healthscope Commercial |
$68.62
|
| Rate for Payer: Healthscope Whirlpool |
$68.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.04
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.90
|
| Rate for Payer: Nomi Health Commercial |
$68.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$283.50
|
| Rate for Payer: PACE SWMI |
$57.18
|
| Rate for Payer: PHP Medicare Advantage |
$57.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$137.16
|
| Rate for Payer: Priority Health Medicare |
$57.18
|
| Rate for Payer: Priority Health Narrow Network |
$137.16
|
| Rate for Payer: Railroad Medicare Medicare |
$57.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$122.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.18
|
| Rate for Payer: UHC Exchange |
$122.22
|
| Rate for Payer: UHC Medicaid |
$36.85
|
| Rate for Payer: UHCCP DNSP |
$57.18
|
| Rate for Payer: UHCCP Medicaid |
$36.85
|
|
|
PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 38222
|
| Min. Negotiated Rate |
$39.83 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$83.12
|
| Rate for Payer: Aetna Medicare |
$62.03
|
| Rate for Payer: BCBS Complete |
$41.82
|
| Rate for Payer: BCBS MAPPO |
$62.03
|
| Rate for Payer: BCN Commercial |
$110.55
|
| Rate for Payer: BCN Medicare Advantage |
$62.03
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Cofinity Commercial |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$83.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.03
|
| Rate for Payer: Healthscope Commercial |
$74.44
|
| Rate for Payer: Healthscope Whirlpool |
$74.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.13
|
| Rate for Payer: Meridian Medicaid |
$41.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$68.23
|
| Rate for Payer: Nomi Health Commercial |
$74.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$300.00
|
| Rate for Payer: PACE SWMI |
$62.03
|
| Rate for Payer: PHP Medicare Advantage |
$62.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.10
|
| Rate for Payer: Priority Health Medicare |
$62.03
|
| Rate for Payer: Priority Health Narrow Network |
$147.10
|
| Rate for Payer: Railroad Medicare Medicare |
$62.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$62.03
|
| Rate for Payer: UHC Exchange |
$136.97
|
| Rate for Payer: UHC Medicaid |
$39.83
|
| Rate for Payer: UHCCP DNSP |
$62.03
|
| Rate for Payer: UHCCP Medicaid |
$39.83
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE
|
Professional
|
Both
|
$583.00
|
|
|
Service Code
|
HCPCS 62270
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$437.25 |
| Rate for Payer: Aetna Commercial |
$79.35
|
| Rate for Payer: Aetna Medicare |
$59.22
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$59.22
|
| Rate for Payer: BCN Commercial |
$96.11
|
| Rate for Payer: BCN Medicare Advantage |
$59.22
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cash Price |
$466.40
|
| Rate for Payer: Cofinity Commercial |
$85.28
|
| Rate for Payer: Cofinity Commercial |
$79.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.22
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Healthscope Whirlpool |
$71.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.18
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$65.14
|
| Rate for Payer: Nomi Health Commercial |
$71.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$437.25
|
| Rate for Payer: PACE SWMI |
$59.22
|
| Rate for Payer: PHP Medicare Advantage |
$59.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$111.63
|
| Rate for Payer: Priority Health Medicare |
$59.22
|
| Rate for Payer: Priority Health Narrow Network |
$111.63
|
| Rate for Payer: Railroad Medicare Medicare |
$59.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$59.22
|
| Rate for Payer: UHC Exchange |
$110.21
|
| Rate for Payer: UHC Medicaid |
$37.49
|
| Rate for Payer: UHCCP DNSP |
$59.22
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
|
|
PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
HCPCS 62328
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$159.31 |
| Rate for Payer: Aetna Commercial |
$98.22
|
| Rate for Payer: Aetna Medicare |
$73.30
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$73.30
|
| Rate for Payer: BCN Commercial |
$125.99
|
| Rate for Payer: BCN Medicare Advantage |
$73.30
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$105.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.30
|
| Rate for Payer: Healthscope Commercial |
$87.96
|
| Rate for Payer: Healthscope Whirlpool |
$87.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.97
|
| Rate for Payer: Meridian Medicaid |
$49.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$80.63
|
| Rate for Payer: Nomi Health Commercial |
$87.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.50
|
| Rate for Payer: PACE SWMI |
$73.30
|
| Rate for Payer: PHP Medicare Advantage |
$73.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$146.34
|
| Rate for Payer: Priority Health Medicare |
$73.30
|
| Rate for Payer: Priority Health Narrow Network |
$146.34
|
| Rate for Payer: Railroad Medicare Medicare |
$73.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$159.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$73.30
|
| Rate for Payer: UHC Exchange |
$159.31
|
| Rate for Payer: UHC Medicaid |
$46.86
|
| Rate for Payer: UHCCP DNSP |
$73.30
|
| Rate for Payer: UHCCP Medicaid |
$46.86
|
|
|
PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I
|
Professional
|
Both
|
$1,588.00
|
|
|
Service Code
|
HCPCS 36909
|
| Min. Negotiated Rate |
$112.04 |
| Max. Negotiated Rate |
$1,191.00 |
| Rate for Payer: Aetna Commercial |
$237.07
|
| Rate for Payer: Aetna Medicare |
$176.92
|
| Rate for Payer: BCBS Complete |
$117.64
|
| Rate for Payer: BCBS MAPPO |
$176.92
|
| Rate for Payer: BCN Commercial |
$291.81
|
| Rate for Payer: BCN Medicare Advantage |
$176.92
|
| Rate for Payer: Cash Price |
$1,270.40
|
| Rate for Payer: Cash Price |
$1,270.40
|
| Rate for Payer: Cofinity Commercial |
$254.76
|
| Rate for Payer: Cofinity Commercial |
$237.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.92
|
| Rate for Payer: Healthscope Commercial |
$212.30
|
| Rate for Payer: Healthscope Whirlpool |
$212.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.77
|
| Rate for Payer: Meridian Medicaid |
$117.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$194.61
|
| Rate for Payer: Nomi Health Commercial |
$212.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,191.00
|
| Rate for Payer: PACE SWMI |
$176.92
|
| Rate for Payer: PHP Medicare Advantage |
$176.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$112.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$313.81
|
| Rate for Payer: Priority Health Medicare |
$176.92
|
| Rate for Payer: Priority Health Narrow Network |
$313.81
|
| Rate for Payer: Railroad Medicare Medicare |
$176.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$176.92
|
| Rate for Payer: UHC Exchange |
$360.15
|
| Rate for Payer: UHC Medicaid |
$112.04
|
| Rate for Payer: UHCCP DNSP |
$176.92
|
| Rate for Payer: UHCCP Medicaid |
$112.04
|
|
|
PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 90945
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$161.25 |
| Rate for Payer: Aetna Commercial |
$101.18
|
| Rate for Payer: Aetna Medicare |
$75.51
|
| Rate for Payer: BCBS Complete |
$51.66
|
| Rate for Payer: BCBS MAPPO |
$75.51
|
| Rate for Payer: BCN Commercial |
$127.98
|
| Rate for Payer: BCN Medicare Advantage |
$75.51
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$108.73
|
| Rate for Payer: Cofinity Commercial |
$101.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.51
|
| Rate for Payer: Healthscope Commercial |
$90.61
|
| Rate for Payer: Healthscope Whirlpool |
$90.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$79.29
|
| Rate for Payer: Meridian Medicaid |
$51.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$83.06
|
| Rate for Payer: Nomi Health Commercial |
$90.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.25
|
| Rate for Payer: PACE SWMI |
$75.51
|
| Rate for Payer: PHP Medicare Advantage |
$75.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$118.03
|
| Rate for Payer: Priority Health Medicare |
$75.51
|
| Rate for Payer: Priority Health Narrow Network |
$118.03
|
| Rate for Payer: Railroad Medicare Medicare |
$75.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$75.51
|
| Rate for Payer: UHC Exchange |
$137.86
|
| Rate for Payer: UHC Medicaid |
$49.20
|
| Rate for Payer: UHCCP DNSP |
$75.51
|
| Rate for Payer: UHCCP Medicaid |
$49.20
|
|
|
PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 90947
|
| Min. Negotiated Rate |
$67.73 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$141.17
|
| Rate for Payer: Aetna Medicare |
$105.35
|
| Rate for Payer: BCBS Complete |
$71.12
|
| Rate for Payer: BCBS MAPPO |
$105.35
|
| Rate for Payer: BCN Commercial |
$180.76
|
| Rate for Payer: BCN Medicare Advantage |
$105.35
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$151.70
|
| Rate for Payer: Cofinity Commercial |
$141.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.35
|
| Rate for Payer: Healthscope Commercial |
$126.42
|
| Rate for Payer: Healthscope Whirlpool |
$126.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.62
|
| Rate for Payer: Meridian Medicaid |
$71.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.89
|
| Rate for Payer: Nomi Health Commercial |
$126.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.50
|
| Rate for Payer: PACE SWMI |
$105.35
|
| Rate for Payer: PHP Medicare Advantage |
$105.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$166.71
|
| Rate for Payer: Priority Health Medicare |
$105.35
|
| Rate for Payer: Priority Health Narrow Network |
$166.71
|
| Rate for Payer: Railroad Medicare Medicare |
$105.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$201.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$105.35
|
| Rate for Payer: UHC Exchange |
$201.38
|
| Rate for Payer: UHC Medicaid |
$67.73
|
| Rate for Payer: UHCCP DNSP |
$105.35
|
| Rate for Payer: UHCCP Medicaid |
$67.73
|
|
|
PR DIAPHRAGM
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS A4266
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$80.00 |
| Rate for Payer: Aetna Commercial |
$32.28
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: BCN Commercial |
$80.00
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.75
|
|
